A total of 150 patients with presumed aneurysmatic peripheral atherosclerotic disease were included in the study. Patients were first scanned with conventional ultrasound (US), serving as reference technique. An infra-renal abdominal aorta diameter of ≥30 mm was defined as an AAA. Hereafter, the aorta was scanned using the Aortascan BVI 9600. Statistical analyses were performed using SPSS version 15.0 statistical software. Abdominal aortic aneurysms were detected with conventional US in 78 (52%) patients, compared with 74 (49%) AAA's detected with Aortascan BVI 9600. The Aortascan BVI 9600 demonstrated a sensitivity, specificity, positive and negative predictive value of 90, 94, 95, and 89%, respectively, in the detection of AAA's.

The Aortascan BVI 9600 automatically detects the aortic diameter with a 90% sensitivity without the need for a trained operator. Because of these unique capabilities, it can be used for AAA screening outside the hospital.

Twenty-nine patients (56 ± 12 years) with a history of recent acute coronary events (ACE) underwent STE-DSE. Left ventricular images, sampled at frame rates 70–100 Hz, were analysed off-line (Echopac BT 6.0.0). Velocity, strain, and rotational imaging were performed. Twenty patients had LV ejection fraction (EF) >40% (Group 1) whereas nine patients had LVEF <40% (Group 2). Average heart and frame rates were identical during DSE in the two groups (P = ns). Global circumferential strain (%) was significantly lower in Group 2 compared with Group 1 (10.65 ± 5.30 vs. 16.82 ± 6.61; P < 0.05) at rest and during peak stress (14.72 ± 6.51 vs. 21.13 ± 7.2; P < 0.05). The global peak rotation rate (degree/s) was, however, higher at rest in Group 2 (70 ± 97 vs. 19 ± 67; P < 0.05) and 20 µg stress. Peak systolic velocity increased in three of the four LV walls at 20 µg (in Groups 1 and 2). A global rotational rate increased significantly at 20 µg during systole in both the groups, but was unchanged in Group 2 during diastole.

Speckle tracking echocardiography dobutamine stress appears to provide comprehensive information on LV mechanical status in the aftermath of ACE. The modality may help risk stratify such patients.

Transthoracic and transoesophageal data from patients with a variety of cardiac conditions were used for analysis of LV regional function. The focus was on the effects of mechanical asynchrony. Ejection fraction was calculated on the basis of LV end-diastolic volume and end-systolic volume obtained by two different ways: (i) end-systolic volume as a whole; and (ii) the sum of all regional end-systolic volumes (which may occur at different times). The relative difference, D-EF, between EFs obtained by (i) and (ii) was taken as the ‘merit’ of EF. A value of zero is the highest merit. Irrespective of the examination method, we found that D-EF was always higher than zero, and that its value depended on the extent of mechanical asynchrony.

Ejection fraction is not the arithmetic average of regional EFs. An increase of asynchrony increases D-EF, i.e. it reduces the merit of EF as a measure of cardiac function.

Twenty-five patients underwent 2DE and RT3DE. Views of 2DE (RV inflow, RV short axis, and apical four-chamber) were compared with RT3DE views by four readers. RT3DE data sets were sliced from anterior–posterior (apical view) and from base to apex (short axis) to obtain six standardized planes. Readers recorded the RV ejection fraction (RVEF) from 2DE and RT3DE images. RVEF recorded by RT3DE (RVEF_3D) and 2D (RVEF_2D) were compared with RVEF by disc summation (RVEF_DS), which was used as a reference. Interobserver variability among readers of RVEF_3D and RVEF_2D was then compared. Overall, mean RVEF_DS, RVEF_3D, and RVEF_2D were 37 ± 11%, 38 ± 10%, 41 ± 10%, respectively. The mean difference of RVEF_3D – RVEF_DS was significantly less than RVEF_2D–RVEF_DS (3.7 ± 4% vs. 7.1 ± 5%, P = 0.0066, F-test). RVEF_3D correlated better with RVEF_DS (r = 0.875 vs. r = 0.69, P = 0.028, t-test). RVEF_3D was associated with a 39% decrease in interobserver variability when compared with RVEF_2D [standard deviation of mean difference: 3.7 vs. 5.1, (RT3DE vs. 2DE), P = 0.018, t-test].

RT3DE provides improved accuracy of RV function assessment and decreases interobserver variability when compared with 2D views.

We performed aortic arch analysis on all 2000 adult patients (mean age 52, range 18–89) referred to our echocardiography lab for transthoracic echocardiograms between January and December 2007. Adequate study was obtained in 1826 patients (91% of cases). Suprasternal notch views and aortic arch analysis were normal in 1787 patients (98%) and abnormal in 39 patients (2%). Among patients with abnormal findings, 32 patients (82%) had aortic arch plaques, 24 of them (75%) had plaques <4 mm, and 8 patients (25%) had plaques ≥4 mm. Four patients (10%) had aortic arch aneurysms (diameter ≥4.5 cm). Other abnormal findings included one case of coarctation of the aorta, one case of a floating thrombus in a right pulmonary artery branch, one case of severe stenosis of the inominate artery, and one case of type A aortic dissection. Subsequently, 7 patients (18%) underwent surgery, 4 patients (10%) were started on oral anticoagulation therapy, and 28 patients (72%) treated with an antiplatelet and risk factors modification.

Aortic arch analysis showed significant pathology in 2% of the adult population undergoing routine TTE. This led to therapeutic interventions in all patients with abnormal findings, and to curative therapy in more than quarter of them. Aortic arch analysis should be mandatory during a routine exam and part of any standard digital acquisition protocol for TTE in adults.

Forty patients were studied by transthoracic 2D and 3D echocardiography pre- and 3, 6, and 12 months post-surgery. TAPSE (15.5 ± 3, 16.5 ± 3, and 18.5 ± 4 mm at 3, 6, and 12 months, respectively) and PSV (11.9 ± 2, 12 ± 2, and 12.8 ± 3 cm/s at 3, 6, and 12 months, respectively) were significantly (P < 0.001) lower after surgery in comparison with pre-surgical values (TAPSE: 25.3 ± 4 mm; PSV: 17.8 ± 4 cm/s). On the contrary, pre-operative RVEF (58.4 ± 4%) did not change after surgery (56.9 ± 5, 59.5 ± 5, and 58.5 ± 5% at each step).

Despite the post-operative reduction of RV performance along the long axis suggested by TAPSE and PSV, the absence of a decrease in 3D RVEF leads to caution in the interpretation of these 2D and Doppler parameters after cardiac surgery, supporting the hypothesis of geometrical rather than functional changes in the right ventricle.

Seventy healthy volunteers, with a good continuous wave Doppler tricuspid regurgitation signal at rest, underwent quantitative Doppler echocardiographic measurements at rest and during semi-supine exercise test. Pulmonary artery systolic pressure was estimated at rest, at low level (25 W), and at peak exercise using four times tricuspid valve regurgitation velocity squared adding a right atrial pressure of 5 mmHg. During exercise, PASP increased from rest (27 ± 4 mmHg) to peak (51 ± 9 mmHg). None of the individuals reached a PASP ≥ 60 mmHg at 25 W. Pulmonary artery systolic pressure at peak was higher in individuals ≥60 years old compared with those from 20 to 59 years old (56 ± 9 vs. 49 ± 7 mmHg, P = 0.02). Pulmonary artery systolic pressure at peak exercise ≥60 mmHg was found in 36% of the individuals aged from 60 to 70 and in 50% after 70. Age, LV mass, and PASP at rest were independent predictors of PASP at peak exercise.

Pulmonary artery systolic pressure at peak exercise can reach values ≥60 mmHg in many healthy individuals older than 60 with good exercise capacity. However, high levels of PASP > 60 mmHg for low level of exercise should be considered abnormal.

Retrospective longitudinal cohort of children (n = 88) after repair of TOF followed by serial echocardiography over 9 years. LV and RV diameters were expressed by z-scores based on normal paediatric reference values. Time courses of LV and RV diameter z-scores, degree of PR, and influence of co-variables were analysed using mixed regression models. LV diameter z-scores were significantly lowered before repair, increased after surgery, but fell again over time; thus, mean LV diameters were significantly lower than normal population means at all times. LV diameter z-scores correlated negatively with RV dilation and degree of PR. Notably, they were significantly higher in patients with previous shunts. After pulmonary valve replacement, LV diameter z-scores recovered to normal, whereas RV diameter z-scores remained abnormal.

Our results confirm progressive adverse RV–LV interaction in the long-term post-operative follow-up of TOF. The use of z-scores facilitated the analysis of time courses of LV and RV diameters.

One hundred and sixty type 2 diabetic patients and 110 non-diabetic controls, all with no evidence of heart disease, were studied. The participants were stratified into four distinct age-groups (A: <46, B: 46–60, C: 61–75, and D: >75 years) and underwent full echocardiographic examination. Conventional systolic and diastolic parameters were similar between the study groups. However, tissue Doppler imaging examination revealed an impaired systolic and diastolic longitudinal myocardial function in diabetic patients vs. controls, although these differences were not noticed within the youngest age-group. Diastolic dysfunction was established concomitantly in both diabetic and control subjects in age-group B. In contrast, diabetic patients showed an earlier induction of myocardial systolic dysfunction, evidenced by significantly lower average systolic longitudinal myocardial velocity in age-group B. Independent predictors of systolic myocardial dysfunction were age, glycated haemoglobin, and systemic blood pressure.

Type 2 diabetic patients demonstrate an early and concomitant induction of systolic and diastolic myocardial dysfunction as a preclinical manifestation of diabetic cardiomyopathy.

We evaluated 70 individuals, consisting of 35 hypertensives and 35 middle-aged volunteers as a control. None had DD based on global indices (deceleration time, isovolumic relaxation time, and E/A). Segmental early and late diastolic Doppler-derived strain rates (SRs) were recorded from 18 segments in the longitudinal axis. The number of segments with SR_E/SR_A<1.1 was represented as segmental DD. Mean relaxation of the basal, mid, and apical regions was also calculated. Septal and mean mitral annular Ea velocities were also recorded. Non-hypertensive, middle-aged individuals had evidence of segmental DD that was mostly distributed at the basal parts of the heart, and in particular at the septal wall. Hypertensive patients had a lower mean relaxation based on SR_E and SR_E/A at the basal, mid, and apical regions, with the basal parts appearing more compromised and with higher segmental DD compared with controls. Segmental DD in that group was more extensive towards the mid and even apical regions, with the septal and basal inferior walls being the most heavily affected areas. The lateral wall appeared to be the region that was most resistant to diastolic abnormalities in both groups. Even individuals with ‘normal’ septal and mean Ea had evidence of segmental DD. However, contrary to global indices of DD, septal Ea could predict the presence of segmental DD.

Abnormal relaxation appears to have a particular distribution over the myocardial walls. Basal parts are generally more heavily affected, particularly the septal and inferior walls. The lateral wall and apical regions are more resistant to diastolic abnormalities. In subjects with normal global DD, strain echocardiography has an incremental value over mitral annular diastolic velocities and global indices of DD for early detection of diastolic abnormalities.

Fifty-one consecutive patients with heart failure underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve and local contractile reserve (assessed by two-dimensional speckle tracking) in the region of the LV pacing lead. Responders (30 patients) showed a greater exercise-induced increase in left ventricular ejection fraction (LVEF) compared with non-responders (P < 0.001). Contractile reserve was directly related to the improvement in LVEF and to LV reverse remodelling after 6 months of CRT (P < 0.001). A 6.5% exercise-induced increase in LVEF yielded a sensitivity of 90% and a specificity of 85.7% to predict the response after 6 months of CRT. Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders than in non-responders (P < 0.0001).

Myocardial contractile reserve (global and regional) is a strong predictive factor of LV reverse remodelling after CRT.

The study population consisted of 40 non-selected patients (mean age 48 ± 18 year, 20 men) and 50 non-selected healthy volunteers (mean age 34 ± 12 year, 21 men). Feasibility and intra-observer reproducibility of the measurement of LV rotation parameters by STE were assessed for two different methods (Method A: six tracking points placed mid-myocardial and Method B: six tracking points placed endocardial and epicardial forming six myocardial segments). Subsequently, inter-observer and temporal reproducibility of the most robust method were assessed. Complete LV rotation assessment was more feasible with Method A (60 out of 90 subjects, 67% vs. 50 out of 90 subjects, 56%). In the 49 subjects in whom both Methods A and B were feasible, intra-observer reproducibility of LV rotation parameters was better with Method A (variabilities 2 ± 3 to 10 ± 9% vs. 2 ± 4 to 21 ± 18%). With this method, inter-observer variability varied from 4 ± 4 to 13 ± 9% and temporal variability from 4 ± 6 to 19 ± 15%.

The most robust method to assess LV rotation with QLAB software is from the mid-myocardium. This method is feasible in approximately two-thirds of subjects and has good intra-observer, inter-observer, and temporal reproducibility, allowing to study changes over time in LV rotation in an individual patient.

2D speckle tracking and TDI echocardiograms were performed in 79 healthy adult male volunteers (age range: 22–76 years). 2D speckle tracking allowed the determination of myocardial and peak systolic and early diastolic SR in radial, circumferential, and longitudinal planes, whereas TDI provided longitudinal only. Mean circumferential and radial and SR were calculated from data collected at six basal myocardial regions, whereas mean longitudinal and SR derived from both 2D speckle tracking and TDI were calculated from the basal septum and basal lateral walls. Standard 2D echocardiography allowed the assessment of LV morphology including LV length, LV end-diastolic volume, LV end-diastolic diameter, mean wall thickness, and LV mass. The association of myocardial and SR data with relevant LV morphology indices was determined by adoption of the general, non-linear allometric model (y= ax^b). The b exponent ± 95% confidence intervals were reported. The relationships between the measures of LV morphology and myocardial and SR were highly variable and generally weak. Only two relationships displayed at least a moderate effect size (r ≥ 0.30): (i) 2D circumferential peak systolic SR and LV end-diastolic dimension (b = –0.92; –1.35 to 0.5, r = 0.44) and (ii) TDI longitudinal peak systolic SR and LV length (b = –1.39; –2.11 to –0.66, r = 0.41).

The empirical relationships derived in this cohort do not support the need to scale myocardial and SR derived from 2D speckle or TDI for any index of LV morphology.

Echo imaging and invasive LV pressure measurements were performed during right atrial (RA) pacing and dobutamine challenge in eight pigs. LV torsion and torsional rate profiles were analysed from grey scale and tissue Doppler data (apical and basal short axis) at frame rates of 82 ± 17 and 183 ± 14 Hz, respectively. Temporal subsampling of TDI data sets was performed at 82 ± 6 Hz in order to mimic the mean temporal resolution of STI and the LV torsional curves were again extracted. At rest, LV UR values were comparable for both imaging techniques. However, during dobutamine stimulation, TDI estimated peak UR was predominantly higher than UR measured by STI (–112.1 ± 64.5°/s vs. –75.5 ± 31.4°/s, P < 0.05). The similarity of LV UR measurements with respect to the STI/TDI data was examined by a Bland–Altman analysis.

Although both methods regarding LV UR correlated well, these methods cannot be interchanged. STI showed a bias to underestimate UR at high values.

Sixteen patients aged 25.6 ± 3.7 years (eight each after Senning or Mustard repair of complete transposition) were studied. Transoesophageal imaging was performed in the catheterization laboratory under general anaesthesia before and at the end of a 10 min infusion of 5 µg/kg/min of Dobutamine. The BNP levels were measured at rest. Myocardial Doppler data were acquired before and at peak stress in a four-chamber view. The BNP (pg/mL) values of 67.3 ± 47.5 (14–189) were elevated. There was no correlation between BNP and IVA, strain, or systolic and diastolic velocities at rest. Dobutamine stress led to a significant increase in IVA, s-velocity, and strain but no significant change in e-velocity. A correlation was found between increase in IVA under Dobutamine and BNP levels (r = 0.57, P < 0.02).

Elevated BNP levels correlate with response of systolic right ventricular function assessed by IVA to Dobutamine stress.

We evaluated whether peak systolic longitudinal strain (PSLS) of left ventricle using 2D speckle tracking method might be useful for screening of severe CAD. One hundred and eight patients who underwent echocardiography and coronary angiography were evaluated. Patients were grouped according to the coronary angiographic findings as follows; high-risk group with left main or three-vessel CAD (n = 38), low-risk group with one- or two-vessel CAD (n = 28), and control group without CAD (n = 30).

PSLSs of all left ventricular segments were obtained successfully in 96 (89%) patients. None had RWMA at resting echocardiogram. PSLS was significantly reduced, especially in mid- and basal segments, in the high-risk group. Receiver operating characteristic (ROC) curve analysis demonstrated that mid- and basal PSLSs could effectively detect patients with severe CAD (area under ROC curve = 0.83, 95% CI 0.75–0.91). According to ROC curve analysis, –17.9% appears to be a helpful cutoff value for discriminating those with severe CAD (specificity 79% and sensitivity 79%).

PSLS at rest was significantly lower in patients with left main or three-vessel CAD without RWMA, and might be useful for identifying patients with a severe CAD.