scholarly journals 94 Combined use of voltage mapping and speckle tracking echocardiography for the early diagnosis of ARVC/D: a case report

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Nicolò Sisti ◽  
Amato Santoro ◽  
Claudia Baiocchi ◽  
Antonio Biancofiore ◽  
Simone Pistoresi ◽  
...  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Low Voltage ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Right Ventricular Strain ◽  
The Right

Abstract A 38 years-old man was admitted to our hospital after ventricular tachycardia with left-bundle-branch block and inferior axis morphology. After undergoing different examinations the criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) were met. An electrophysiological study was then performed together with endocardial bipolar and unipolar voltage map. Unipolar and bipolar voltage mapping of the right ventricle showed low voltage areas and corresponding fragmented potentials from the tricuspid annulus to the inferior apex. On the right ventricular outer tract (RVOT), the bipolar voltage mapping was normal while the unipolar mapping showed low-voltage areas in the antero-septal outer tract. An off-line map was used to perform speckle tracking analysis on intracardiac echocardiography (ICE) clips of right ventricle and standard echocardiography. A reduction of the strain analysis was stored in correspondence of the fragmented electrograms area, in particular, speckle tracking analysis on ICE views showed a reduction of the RV LS in the segments below tricuspid valve, in the three different myocardial layers. The endocardial longitudinal strain was reduced from sub-tricuspidalic segments to the RV apex in accordance with the fragmentated potentials stored during voltage mapping. On the contrary, at anterior RVOT wall, the unipolar voltage mapping showed fragmented potentials and the STE analysis revealed a reduced epicardial LS. This case report lays emphasis on the importance of the integration of ICE-derived right ventricular strain and voltage mapping in the improvement of the sensibility of an early diagnosis of the ARVC.

scholarly journals AB0611 STRAIN ANALYSIS OF THE RIGHT VENTRICLE USING 2D-SPECKLE TRACKING ECHOCARDIOGRAPHY IN A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1601.1-1602
Author(s):  
A. Spinella ◽  
P. Macripo’ ◽  
E. Cocchiara ◽  
E. Galli ◽  
F. Lumetti ◽  
...  
Keyword(s):  
Uric Acid ◽  
Systemic Sclerosis ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Right Ventricular Strain ◽  
2D Speckle Tracking ◽  
The Right

Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease with multiple organ impairment. Cardio-pulmonary involvement is common: pulmonary fibrosis, pulmonary hypertension (PH), and electrical disorders are the most serious complications and causes of increased mortality.Objectives:We evaluated features related with the onset and development of PH in a cohort of SSc patients. We further studied ecocardiographic abnormalities, by means of 2D-speckle tracking echocardiography (STE) with specific reference to the right ventricular strain measure (RV-strain).Methods:We analyzed data from 50 SSc patients (pts) referred to our University-based Rheumatology Centre and SSc Unit from January 2007 to June 2019 (F/M 45/5; lc/dcSSc 45/5; mean age 59.20±14.357 years; mean disease duration 12.08±8.75 years). All pts underwent general and cardio-pulmonary assessment in our Cardio-Rheumatology Clinic. The following parameters were considered: blood exams, in particular inflammation indexes, uric acid test and serum autoantibodies; pulmonary function tests; high resolution scan of the lungs (HRCT); standard electrocardiogram (ECG) and RV-strain measured by 2D-STE. These examinations were performed according to clinical picture and current methodologies. We compared SSc subjects with (10/50) and without (40/50) PH diagnosis during follow-up regardless of treatments.Results:SSc pts with PH didn’t show significant alterations concerning RV-strain if compared with pts without PH (p=0.707). Nevertheless, RV-strain value was modified in relation to TAPSE alterations in all pts but this data correlated with right ventricular dilatation only in PH subjects. Furthermore, interesting significant values about dilatation of right and left atria (p=0.007, p=0.048), dilatation of inferior vena cava (p=0.037) and right ventricle (p=0.023) were observed. Left ventricular hypertrophy (p=0.012) as well as valvular insufficiencies (mitral and aortic) were more frequent in PH group too (p=0.016). These pts showed higher incidence of skin ulcers (p=0.0001), higher values of blood pressure (p=0.004), elevated uric acid levels (p=0,027) and anti-centromere antibodies positivity (p=0.0001).Conclusion:Our research provides further evidence of the prognostic value of echocardiographic findings in SSc subjects, with focus on PH. Population enlargement is ongoing in order to identify more accurate results about RV-strain, considering the efficacy of PH treatments on cardiac contractility. Speckle tracking echocardiography proves to be a sensitive, low-cost, non-invasive and reliable tool to detect early cardiac impairment in Ssc, full of potential future prospects.Disclosure of Interests:None declared

scholarly journals Metastatic adenocarcinoma involving the right ventricle and pulmonary artery leading to right heart failure: case report

2017 ◽  
Vol 136 (3) ◽  
pp. 262-265 ◽  
Author(s):  
Turgut Karabag ◽  
Caner Arslan ◽  
Turab Yakisan ◽  
Aziz Vatan ◽  
Duygu Sak
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Right Heart Failure ◽  
Ventricular Outflow Tract ◽  
Right Heart ◽  
The Right

ABSTRACT CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, cost-effective and useful technique in making the differential diagnosis.

scholarly journals 478 A rare case of right ventricular ischaemia and ventricular tachycardia in neonate caused by intermittent occlusion of origin of the right coronary artery by an echogenic mass

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Padmanabhan
Keyword(s):  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Early Diagnosis ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Coronary Artery ◽  
Perinatal Asphyxia ◽  
Poor Condition ◽  
Post Surgery ◽  
The Right

Abstract OnBehalf Cornwall A term neonate with poor condition at birth was noted to be markedly bradycardic when crying. ECG showed first degree heart block. Echocardiogram demonstrated poor bi-ventricular function. He was treated for Hypoxic ischemic encephalopathy (HIE). In the next few hours he developed short episodes of ventricular tachycardia with left bundle branch block and non-conducted P waves suggesting an origin of tachycardia from the right ventricle. His repeat ECHO suggested that he had right ventricular infarction due to a very rare finding of intermittent occlusion of the origin of the right coronary artery by an echogenic mass. He was transferred for emergency cardiac surgery to remove a clot of 1.6cm, occluding the right coronary artery. Histology findings were in keeping with a thrombus. Thrombophilia screen for both parents and infant were negative. MRI Brain did not show evidence of HIE suggesting his poor condition at birth was secondary to intermittent coronary ischemia. Discussion: Myocardial infarction (MI) in neonates is a rarely encountered and potentially life-threatening condition, with mortality rate as high as 90%. We present one of the first reported cases of successful surgical management of an acute right coronary artery thrombosis after an early diagnosis. The cause of thrombosis remains unclear in our patient. They were born in poor condition with initial pH 6.9 and lactate of 10, but with a structurally normal heart and negative thrombophilia screen. Perinatal asphyxia is a potential cause; however there is doubt that this may be a symptom rather than cause of the right coronary artery occlusion. Early diagnosis was key in management after a high level of clinical suspicion. He made significant recovery with near normal RV function, and is currently on captopril and carvedilol post-surgery. This is one of the first cases to document near full return of cardiac function following ischaemia to the right ventricle Abstract 478 Figure. 5

scholarly journals Evaluation of fetal cardiac function in maternal gestational diabetes mellitus by speckle tracking echocardiography

2021 ◽  
Author(s):  
Peina Huang ◽  
Youbin Deng ◽  
Ling Feng ◽  
Yiping Gao ◽  
Xueqing Cheng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Right Ventricle ◽  
Cardiac Function ◽  
Gestational Diabetes Mellitus ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Fetal Cardiac Function ◽  
The Right

Abstract The aim of this study was to assess the cardiac function in fetuses of mothers with gestational diabetes mellitus (GDM) by using fetalHQ, a quantitative analysis software for the assessment of fetal cardiac function based on speckle tracking echocardiography. In this prospective cross-sectional study, 49 fetuses exposed to GDM and 50 normal fetuses were enrolled and fetal echocardiography were performed and analyzed. In the GDM group, left ventricular (24 ± 4 vs. 28 ± 4, p < 0.001) and right ventricular global longitudinal strain (23 ± 4 vs. 26 ± 4, p = 0.002) and right ventricular free wall strain (26 ± 6 vs. 29 ± 5, p = 0.006) were significantly lower compared with the control group, whereas there was no significant difference in global spherical index (1.2 ± 0.1 vs. 1.2 ± 0.1, p = 0.425). Additionally, 24-segment transverse fraction shortening of the right ventricle was more impaired than the left and the segments with reduced fraction shortening were mainly located in the mid and apical sections of the right ventricle, and mid section of the left ventricle. In conclusion, fetuses exposed to GDM may have cardiac dysfunction before the onset of cardiac morphologic abnormalities, and the right ventricle is more vulnerable than the left during fetal development.

scholarly journals Target Characteristics and Voltage Mapping of the Matrix in Idiopathic Premature Ventricular Contractions Originating from the Right Ventricular Outflow Tract

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zhiyong Zhang ◽  
Xiaofeng Hou ◽  
Zhiyong Qian ◽  
Jianghong Guo ◽  
Jiangang Zou
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Premature Ventricular Contractions ◽  
Bipolar Voltage ◽  
Successful Ablation ◽  
Voltage Mapping ◽  
Significant Difference ◽  
The Right

Background. The study was aimed at exploring the electrophysiological characteristics (EPS) of the optimal ablation site and its relationship with electroanatomic voltage mapping (EVM) in idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). Methods. A total of 28 patients with idiopathic RVOT PVCs underwent successful ablation and EVM using a 3D electroanatomical mapping (CARTO) system. Results. Both bipolar and unipolar EVM showed a similar band-like lower-voltage area (LVA) under the pulmonary valve in all the patients; 21.4% of the targets were located in the band-like LVA. 42.9% of the targets were at the border of the band-like LVA on the bipolar voltage map, but unipolar mapping showed that 53.6% of the targets were located in the band-like LVA, and 35.7% of the targets at the border of the band-like LVA. A significant difference was found in both unipolar and bipolar voltage values between the regions within 0-5 mm above the optimal ablation site and the other regions. A similar difference was observed only in unipolar voltage values below the optimal ablation site. At the ablation site, there were frequent occurrences of a fragmented wave and voltage reversion in the bipolar electrograms, frustrated falling limbs, W bottom, and a QS configuration width > 150  ms in the unipolar electrograms. Conclusions. EVM showed that the band-like LVA was an interesting area for the search of the optimal ablation sites of idiopathic RVOT-PVCs, especially the border area. There was focal microscarring around the ablation targets; some characteristics of EPS proved significant for successful ablation.

scholarly journals Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the “Right Way” to Explore the Forgotten Chamber

2015 ◽  
Vol 9 ◽  
pp. CMC.S27462 ◽  
Author(s):  
Antoine Kossaify
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Right Ventricular Ejection Fraction ◽  
Timely Initiation ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Assessment ◽  
The Right

Background The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber. Objective We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography. Methods A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed. Results A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S′) <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography. Conclusion Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.

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