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Abstract: Purpose: To evaluate the efficiency of automated function imaging (AFI) on transthoracic echocardiogram (TTE) for detecting left ventricular (LV) wall motion (LVWM) abnormalities, we compared longitudinal peak systolic strain (LPSS) measurements using AFI with naked eye TTE evaluations by experienced cardiologists and non-experienced residents. Materials and methods: A total of 352 segments of LV myocardium from 22 consecutive subjects with LVWM abnormalities based on American Heart Association classifications (11 male, mean age 58±14years) on previous TTE (Vivid-7, GE) were evaluated. LPSS was measured using stored AFI data. Naked eye evaluation of LVWM was performed by 2 experienced cardiologists and 2 non-experienced residents. Results: AFI successfully tracked 342 (97%) of all segments (mean LPSS −14.8±8.1%). A significant strong negative correlation was observed between LV ejection fraction using method of disks and global LPSS (R=−0.8974). Temporary AFI criteria of LPSS were normal <−12; hypokinesis −12-2; and akinesis >2. Of 342 segments, 239, 87, and 16 segments were diagnosed as normal, hypokinesis, and akinesis, respectively. Level of agreement and kappa coefficients between qualitative evaluation of LVWM by AFI temporary criteria and qualitative evaluation of LVWM by experienced cardiologist 2 (0.784 and 0.479, respectively) were inferior to those comparing experienced cardiologists (0.845 and 0.595) but superior comparing experienced cardiologist with non-experienced resident (0.696 and 0.323), and between the 2 non-experienced-residents (0.682 and 0.347). Conclusion: Qualitative evaluation of LVWM using temporary AFI criteria had a 97% success rate and agreed well with findings of an experienced cardiologist. AFI can be a useful tool for training residents. [Copyright &y& Elsevier]

Abstract: Purpose: To distinguish focal fibrotic and non-fibrotic lesions in left-ventricular myocardium (LVM) in hypertrophic-cardiomyopathy (HCM)-subjects, we compared myocardial regional peak-strain values using two-dimensional speckle-tracking transthoracic-echocardiography (TTE) in multislice computed-tomography (CT)-detected fibrotic, non-fibrotic and normal control lesions. Methods: Twenty subjects (10 consecutive HCM-subjects (8-males, mean 63.4-years), 10 healthy controls (5-males, mean 51.5-years)) underwent speckle-tracking TTE (iE-33), and analysis of regional peak-longitudinal (LS) and radial-strain (RS), and corresponding strain rates in each of 17 LVM segments (American-Heart-Association classification). In HCM-subjects, fibrotic lesions were identified by early-phase defective enhancement and late-phase abnormal enhancement by CT (Light-Speed-Ultra-16). Regional peak LS and RS at basal, mid and apical levels were measured in MSCT-detected fibrotic and non-fibrotic LVM lesions. Results: In 10 HCM subjects, 143 lesions (84.1%) yielded good tracking on TTE. Twenty lesions showed fibrotic changes in 5 subjects by CT. Regional peak-LS and RS absolute values were significantly lower in both fibrotic and non-fibrotic lesions in HCM subjects than in controls at basal, mid, apical levels (all P<0.05). While peak-LS (%) absolute values were significantly lower in fibrotic than non-fibrotic lesions at basal, mid and apical levels (all P<0.05), regional peak-RS absolute values were significantly lower only at mid levels. LS was a more sensitive indicator than the corresponding rate, with better reproducibility. Conclusions: In HCM, regional peak-LS was significantly lower in fibrotic than non-fibrotic lesions in LVM by CT. Regional peak-LS by speckle-tracking provides useful information noninvasively to distinguish fibrotic from non-fibrotic lesions in LVM in HCM and normal LVM in healthy controls. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate efficacy and reproducibility of 320-slice computed tomography (CT) for measuring left atrial (LA) maximum (LAVmax) and minimum volume (LAVmin) during the cardiac cycle, we compared CT with three- and two-dimensional (3D and 2D) transthoracic echocardiogram (TTE). Materials and methods: LAVmax and LAVmin (ml), and LA ejection fraction (LAEF) (%) were assessed in 22 consecutive subjects (15 males, 59.5±15.1years) using retrospective electrocardiogram gated 320-slice CT (Aquilion One, Toshiba Medical) and 3D-TTE (IE-33, Phillips). LAVmax and LAVmin were selected from the time volume curve. LAEF was calculated as (LAVmax−LAVmin)/LAVmax×100(%). Results: Mean±standard deviation (SD) of LAVmax and LAV min were significantly larger by CT than 3D-TTE or 2D-TTE (both P<0.01). LAEF was 25.3±13.1% by CT, 30.2±6.8% by 3D-TTE (P=NS) and 33.9±8.9% by 2D-TTE (P<0.05). The correlation coefficients (CCs) between CT and 3D-TTE in LAVmax, LAmin, and LAEF were 0.64, 0.68 and 0.57, respectively. Mean difference±1.96SD of LAVmax, LAVmin and LAEF by Bland and Altman analysis calculated from CT minus 3D-TTE were 48.8±59.1ml, 41.1±63.2ml, and −4.9±21.1%, respectively. The CCs and mean difference±1.96SD between CT and 2D-TTE had similar tendencies. The CCs of interobserver variation were (for CT, 3D-TTE, 2D-TTE, respectively): 0.90, 0.95 and 0.94 (LAVmax), 0.97 and 0.97 and 0.93 (LAVmin), and 0.64, 0.77 and 0.34 (LAEF). Conclusions: 320-slice CT enables direct LAV measurements and has high reproducibility and positive correlation with 3D and 2D TTE. Absolute value of LAV by CT was larger than that by 3D and 2D TTE. [Copyright &y& Elsevier]

Abstract: Purpose: To differentiate pseudodyskinesis (PD) of the inferior left ventricular (LV) wall from inferior myocardial infarction (IMI) noninvasively, we performed focal site evaluation using two-dimensional speckle tracking transthoracic echocardiography (TTE). Materials and methods: Speckle tracking TTE was carried out in 57 patients, with 19 subjects in each of three groups (Group A, suspected PD; Group B, LV IMI; and Group C, controls). Inferior wall PD was defined as follows: compression of the inferior LV wall by the diaphragm in the LV short axis view with a normal electrocardiogram and no evidence of previous ischemic events. Results: Respective values in Groups A–C for LV ejection fraction (EF) were 63.6±4.2%, 52.3±7.6%, and 61.5±3.8%, for inferior wall speckle tracking focal site evaluation peak radial strain of 30.0±14.3%, 7.5±7.1%, and 42.1±22.9%, for peak circumferential strain of 23.1±6.0%, 16.8±8.4%, and 22.7±7.1%, and for longitudinal strain in the mid-inferior wall of 18.4±3.4%, 11.4±4.0% and 15.8±5.9%. LVEF values were significantly lower in Group B than Groups A and C (P<0.001), as were those of radial, circumferential, and longitudinal strains (P<0.05). In receiver-operating characteristic analysis the optimal cut-off values with corresponding sensitivities and specificities for differentiation of PD from IMI were >19% with 84.2% and 94.7% for radial, >15% with 89.4% and 52.6% for circumferential, and >15% with 73.6% and 100% for longitudinal strain, respectively. Conclusions: Determination of regional strain from speckle tracking TTE, especially radial and longitudinal strains, can provide focal and quantitative noninvasive evaluation for distinguishing PD of the inferior wall from IMI. [Copyright &y& Elsevier]

Abstract: Purpose: To examine the usefulness of plasma atrial (ANP) and brain natriuretic peptide (BNP) levels and transthoracic echocardiogram (TTE) findings in predicting left ventricular (LV) dysfunction in muscular dystrophies (MD). Materials and methods: 135 MD subjects (83 Duchenne MD (DMD), all males, mean age 22±7years, 20 Becker MD (BMD), all males, 45±16years, 21 limb-girdle MD (LGMD), 14 males, 52±13years, and 11 facioscapulohumeral MD (FSHD), all males, 58±13years) underwent TTE and measurement of BNP and ANP. Results: In DMD, TTE revealed asynergy of the LV posterior-wall (72%), interventricular septum (IVS) (29%) and LV apex-wall (24%); in BMD subjects: TTE revealed asynergy of LV posterior-wall (50%) and IVS (25%); in LGMD and FSHD subjects: TTE revealed asynergy of LV posterior-wall (33 and 27%, respectively). LV end-diastolic (LVDdI) and end-systolic diameter index (LVDsI) were significantly larger in DMD than FSHD, and LV ejection fraction (LVEF) was significantly lower in DMD than LGMD and FSHD. In DMD, when LVEF was >=35%, BNP and ANP levels remained low, but when LVEF<35%, BNP and ANP levels showed steep increase. Relationship between LVEF and BNP or ANP levels was curvilinear (R 2 =0.69 and 0.55, respectively, p <0.001) using following equation: BNP=673491×EF−2.897, ANP=5716.6×EF−1.422, respectively. When LVDdI>=40mm/m2 or LVDsI>=35mm/m2, LVEF<=35%, plasma BNP and ANP levels increased steeply and the relationship between LVDdI, LVDsI, or LVEF and plasma BNP or ANP levels was curvilinear. Conclusion: In DMD, LVEF was significantly lower, asynergy of LV posterior-wall was more frequent and BNP and ANP levels were dramatically higher when LVDdI>=40mm/m2, LVDsI>=35mm/m2 or LVEF<35%. [ABSTRACT FROM AUTHOR]

Abstract: Cardiac amyloidosis is generally a progressive disease with a poor prognosis, so early diagnosis and appropriate treatments are important. Although cardiac amyloidosis can be diagnosed definitively by endomyocardial biopsy, non-invasive methods of diagnosis are desired because of a great risk in biopsy. In ECG-gated enhanced multislice computed tomography, not only clear images of the cardiac morphology but also the character of myocardium indicating fibrosis can be identified. We demonstrate two patients with cardiac amyloidosis who showed marked thickening of left ventricular wall with partial fibrotic changes by enhanced multislice computed tomography. [Copyright &y& Elsevier]