P1506Pulmonary decongestion pattern during stress lung ultrasound

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R O Arbucci ◽  
M C Scali ◽  
A Zagatina ◽  
L Cortigiani ◽  
A D'Andrea ◽  
...  
Keyword(s):  
Wall Motion ◽  
Lung Ultrasound ◽  
Regional Wall Motion ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Stress Score ◽  
Group 2 ◽  
Artery Disease ◽  
B Lines ◽  
Group 1

Abstract Background B-profile detected by lung ultrasound (LUS) during stress echocardiography (SE) consists in B-lines with lung sliding and mirrors extra-vascular lung water accumulation (“wet lung”), more often found with ischemic regional wall motion abnormalities (RWMA) and/or diastolic dysfunction. B-lines present at rest may also decrease during stress. Aim To assess the frequency and functional correlates of decreasing B-profile (“drying lung” pattern) during SE. Methods We prospectively performed transthoracic echocardiography (TTE) and LUS evaluation at rest and peak stress in 780 patients with B-lines at rest referred for exercise (n=387), vasodilator (n=324) or dobutamine (n=69) SE for known/suspected coronary artery disease (CAD) and/or heart failure (HF). Recruitment occurred in 17 certified labs of 8 countries with the ABCD protocol, including regional wall motion abnormalities with wall motion score index (WMSI), B-lines, left ventricular contractile reserve (LVCR based on force, systolic blood pressure/end-systolic volume) and Doppler-based coronary flow velocity reserve (CFVR, available in 473 patients). By LUS, we adopted the 4-site simplified scan, each site scored from 0=normal A-lines, to 10=coalescing B-lines. By selection, all patients had resting B-lines score ≥2. Invasive or noninvasive coronary angiography was available in 208 patients. Results Two B-lines stress patterns were identified: Group 1, increase or unchanged pattern (B-line stress score ≥ rest, n=698, 89%); Group 2, decrease-disappearance pattern (B-line stress score < rest for ≤2 points, n=82, 11%). Group 1 showed higher prevalence of inducible ischemia (Group 1 = 74/698 vs. Group 2 = 5/82, 11% vs. 6%, p<0.001), abnormal LVCR (Group 1 = 403/698 vs. Group 2 = 36/82, 58% vs. 42%, p=0.012) and impaired CFVR (Group 1 = 173/433 vs. Group 2 = 5/40, 40 vs. 12%, p<0.001): see figure. Two- or three-vessel coronary artery disease was also more frequent in fixed-worsening pattern (Group 1 = 88/191 vs. Group 2 = 3/17, 46 vs. 17%, p=0.024). Multivariate logistic regression analysis identified peak Force (Odds Ratio, OR, 1.039, 95% Confidence Intervals, CI: 1.006–1.074, P=0.022), stress-rest Δ-WMSI (OR 0.190, 95% CI 0.086–0.419, P<0.001) and normal CFVR (OR=1.754, 95% CI: 1.147–2.682, P=0.010) as significant predictors of drying lung pattern. Disappearing BLines Conclusion About one out of 10 patients with resting B-lines exhibit a decrease-disappearance pattern during stress. They show a more benign coronary anatomic, myocardial functional and coronary physiological profile compared to patients with the fixed-worsening pattern. The drying lung pattern is more often accompanied by a strong (higher peak force), non-ischemic and warm heart (with normal CFVR).

scholarly journals 1675 ABCDE vasodilator stress echocardiography in non-ischemic heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Kuznetsova ◽  
C Borguezan Daros ◽  
H Zanella ◽  
Q Ciampi ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Group 3 ◽  
Group 2 ◽  
Positivity Criterion ◽  
Group 1

Abstract OnBehalf Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging Background ABCDE-stress echocardiography (SE) may explore different aspects in the heterogeneous entity of known or suspected heart failure (HF). Aim To assess ABCDE-vasodilator SE in non-ischemic HF Methods In a prospective, observational, multicenter study, we recruited 428 patients with angiographically normal coronary arteries: 148 patients with HF and preserved (&gt;50%) ejection fraction (HFpEF, Group 1); 100 with HF and mid-range (40-50%) ejection fraction (HFmrEF, Group 2); 180 with HF and reduced (&lt;40%) ejection fraction (HFrEF, Group 3). A group of 75 healthy asymptomatic patients (30 male, 40%, age 57 ± 14 years) referred to testing for screening was also selected (Controls). All patients underwent vasodilator SE with dipyridamole (0.84 mg/kg) in 14 accredited laboratories of 5 countries (Argentina, Brasil, Russian Federation, Serbia and Italy). The ABCDE-SE protocol was adopted: A for regional wall motion abnormalities; B for B-lines (positivity criterion: stress ≥ rest for ≥ 2 points in a 4-site simplified scan available in 181 pts and 10 controls); C for left ventricular contractile reserve (LVCR) based on force (systolic blood pressure/end-systolic volume, positivity criterion: peak/ rest ≤1.1); D for pulsed wave Doppler-based assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (positivity criterion: peak/rest ≤2.0); E for EKG-based assessment of heart rate reserve (positivity criterion: peak/rest ≤1.22). Results All positivity criteria, except A, were more prevalent (p&lt;.01) in Group 3 compared to Group 2, in Group 2 compared to Group 1, and Group 1 compared to controls: see figure. In particular, a blunted heart rate reserve was found in 4/75 controls (5%), 27/148 pts of Group 1 (18%), 28/100 of Group 2 (28%) and 98/180 of Group 3 (54%). Conclusions ABCDE-vasodilator SE can help to identify the profound pathophysiological heterogeneity underlying a similar clinical presentation in patients with known or suspected HF with angiographically normal coronary arteries. These patients rarely show stress-induced regional wall motion abnormalities (A), but may exhibit pulmonary congestion (B), reduced myocardial functional reserve (C), altered coronary microcirculation (D) and cardiac autonomic dysfunction (E). Abstract 1675 Figure. The positivity rate of ABCDE criteria

scholarly journals P1403 Prognostic value of B-lines during stress lung ultrasound

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Coviello ◽  
M C Scali ◽  
A Zagatina ◽  
N Zhuravskaya ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Wall Motion ◽  
Lung Ultrasound ◽  
Peak Stress ◽  
Regional Wall Motion ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
B Lines

Abstract OnBehalf Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging Background B-lines (also known as comets) by lung ultrasound (LUS) are a marker of pulmonary congestion and interstitial pulmonary edema during stress echocardiography (SE). Aim To assess the prognostic value of B-lines during SE. Methods We prospectively performed transthoracic echocardiography (TTE) and LUS (4-site simplified scan) evaluation at rest and peak stress in 1437 patients (age 63 ± 11 years; 874 males, 61%) referred for exercise (n = 581), vasodilator (n = 819: dipyridamole, n= 809 and adenosine, n= 10) or dobutamine (n = 37) SE for known or suspected coronary artery disease or heart failure. B-lines were assessed by LUS with a 4-site simplified scan (total score from 0-1, dry lung, to 40, alveolar pulmonary edema). Follow-up (median 16 months) was completed in all. Results B-lines were 1.14 [0-35] at rest and increased during stress (2.10 [0-40], p&lt;.001). At individual patient analysis, B-lines appeared de novo/increased (≥2 points) during stress in 306 (21.3%), remained absent or fixed in 1097 (76.3%) and decreased/disappeared in 34 (2.4%). At follow-up, there were 174 events: 17 deaths, 14 non-fatal myocardial infarctions, 51 hospital admissions for acute heart failures, and 92 late (&gt; 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced regional wall motion abnormalities (Hazard Ratio, HR, 2.842, 95% Confidence Intervals, CI: 2.016-4.005, p&lt;.0.001) and B-lines change during stress (HR 1.471, 95% CI: 1.054-2.052, p=.022) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival for 943 pts with absent (score 0-1), 333 with mild (2-5), 90 with moderate (6-10) and 71 with severe (&gt;10) B-lines at peak stress: see figure. Conclusion B-lines by LUS are a useful adjunct to regional wall motion abnormalities for risk stratification during SE. The presence and number of B-lines during stress allow a titration of risk. The outcome is darker with more comets in the SE sky. Abstract P1403 Figure. Survival curves and peak stress B-lines

scholarly journals Impact of Persistent Left Ventricular Regional Wall Motion Abnormalities in Childhood Cancer Survivors after Anthracycline Therapy: Assessment of Global Left Ventricular Myocardial Performance By 3D Speckle-Tracking Echocardiography

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1274-1274
Author(s):  
Hirotsugu Okuma ◽  
Hiroshi Yagasaki ◽  
Katsuyoshi Shimozawa ◽  
Hideo Mugishima ◽  
Nobutaka Noto
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Regional Wall Motion ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Myocardial Performance ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Group 2 ◽  
Group 1

Abstract Background: Previous studies of childhood cancer survivors demonstrated the existence of transient or persistent left ventricular (LV) regional wall motion abnormalities (WMA) after treatment with anthracyclines, but the differential impact on deformation of persistent regional WMA against global LV myocardial performance is unknown. Methods: To investigate whether childhood cancer survivors after treatment with anthracyclines with persistent LV regional WMA have a poorer LV myocardial performance compared to those without WMA, 34 long-term childhood cancer survivors (mean age 14.6±4.0 years) with a median cumulative anthracycline dose 234.7mg/m2 (range 80-625mg/m2) who had been off treatment for ≥ 5 years and a preserved LV ejection fraction (EF) (>55%), and 12 healthy control subjects, were studied by using 3D speckle-tracking echocardiography (3D STE). The 34 patients were divided into two groups according to the existence of regional WMA: group 1 (with WMA, n=14), group 2 (without WMA, n=20). 3D STE was performed to assess LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), LV torsion, LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LVEF, and LV systolic dyssynchrony index (SDI: % of SD of time to peak of the 16-segment/R-R interval). Results: Of the 14 patients with WMA, regional WMA was seen at mid-anterior septum in 13 patients (92.8%) and apical septum in 1 patient (7.2%). There was no statistical difference in LVEDV, LVESV, LVEF, GLS, LV torsion or SDI derived from GLS, GCS, GAS among the 3 groups. In contrast, there were significant differences in GRS (p<0.001), GAS (p<0.018), GCS (p<0.025), and SDI derived from GRS (p<0.01) among the 3 groups. Compared with group 2, group 1 had significantly reduced GRS (14.3±6.1% vs. 33.1±10.1%, p=0.003), GCS (-23.5±3.7% vs. -33.9±6.5%, p=0.026), GAS (-34.3±5.1% vs. -45.41±6.6%, p=0.034, respectively), and greater SDI derived from GRS (16.5±5.1% vs. 6.9±2.9%, p<0.01, respectively). Moreover, existence of WMA was correlated with GRS (p<0.0001), SDI derived from GRS (p<0.0001), LVEF (p=0.036), and cumulative dose (p=0.049). Multiple linear regression analysis identified GRS as a significant determinant of the existence of WMA (β=0.751, p=0.001). Conclusion: Childhood cancer survivors after anthracycline therapy with persistent regional WMA show a poorer LV myocardial performance with mechanical dyssynchrony compared to those without regional WMA, despite a preserved LVEF. Disclosures No relevant conflicts of interest to declare.

Does Nitrous Oxide Cause Regional Wall Motion Abnormalities in Patients with Coronary Artery Disease?

1988 ◽  
Vol 67 (7) ◽  
pp. 695???700 ◽  
Author(s):  
John R. Slavik ◽  
Kenneth R. LaMantia ◽  
Charles J. Kopriva ◽  
Edward Prokop ◽  
Michael D. Ezekowitz ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Nitrous Oxide ◽  
Coronary Artery ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Artery Disease

scholarly journals Short-term Prognostic Value of Admission Cardiac Troponin T, C-Reactive Protein and Echocardiographic Regional Wall Motion Abnormalities in Patients with Acute ST Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Pooja Dhaon ◽  
Dharmendra Uraiya ◽  
Neeraj Tripathi
Keyword(s):  
Cardiac Troponin ◽  
Troponin T ◽  
Regional Wall Motion ◽  
Cardiac Troponin T ◽  
Reactive Protein ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: With increasing burden of Coronary Artery Disease (CAD) and ST-Elevation Myocardial Infarction (STEMI) in India, early risk stratification of patients is as important as making a correct diagnosis. Cardiac Troponin T (cTnT), C-Reactive Protein (CRP) and echocardiographic Regional Wall Motion Abnormalities (RWMA) are used to assess the patients of STEMI at presentation. The short term prognostic importance of these parameters also need to be known. Aim: To study the prognostic values of admission Cardiac Troponin T (cTnT), CRP and echocardiographic RWMA in patients with acute STEMI. Materials and Methods: Fifty patients of STEMI were evaluated from January 2017 to July 2017 by Troponin-T (positive >0.18 ng/mL), CRP (positive >3 mg/l) and echocardiography (positive with presence of RWMA) on day one. The patients were divided into three groups: Group 1: patients with all the three parameters positive, Group 2: patients with all three parameters negative, Group 3: patients with one or two parameters positive. The end points observed were heart failure Left Ventricular Ejection Fraction (LV EF) <40%) assessed by echocardiography at day 28, significant ventricular ectopics (>class II by Lown’s classification) and mortality at day 30 in the groups. Chi-square test for equality of proportions was used to analyse the difference in outcome in the groups. Results: The mean age of patients was 54 years. There were 25 (50%) patients in group 1, 14 (28%) patients in group 2 and 11 (22%) patients in group 3. Twelve (24%) patients had heart failure with 9 (18%) in group 1 and 3 (6%) in group 3 (p<0.05). 9 (18%) patients had significant ventricular ectopics with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Mortality was found in 9 (18%) patients with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Conclusion: Acute STEMI with high cTnT, CRP and presence of RWMA on echocardiography at admission need more aggressive management and close follow-up.

Coronary artery imaging

2016 ◽  
Author(s):  
Andreas Hagendorff ◽  
Ivan Stankovic ◽  
Masaaki Takeuchi
Keyword(s):  
Coronary Artery ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Contrast Imaging ◽  
Non Invasive ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Artery Disease ◽  
Artery Flow ◽  
Myocardial Hypoperfusion

Assessment of coronary artery disease using echocardiography is normally performed by the detection of regional wall motion abnormalities at rest or stress-induced myocardial hypoperfusion and ischaemia. Direct visualization of native coronary arteries by echocardiography is uncommon, but possible. In contrast, imaging of coronary artery flow by transthoracic color-coded Doppler echocardiography is increasingly popular, especially in combination with the administration of adenosine for the non-invasive assessment of coronary flow velocity reserve.

scholarly journals Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Thu-Thao Le ◽  
Briana W. Y. Ang ◽  
Jennifer A. Bryant ◽  
Chee Yang Chin ◽  
Khung Keong Yeo ◽  
...  
Keyword(s):  
Wall Motion ◽  
Regional Wall Motion ◽  
Diagnostic Value ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Regional Wall ◽  
Percentile Rank ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Background Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. Methods In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. Results In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94–1.00)] in discriminating between FFR-normal and FFR-positive patients. Conclusion The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. Trial registration: ClinicalTrials.gov, NCT03217227, Registered 11 July 2017–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart

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