Eight control and 12 Streptozotocin (STZ)-induced diabetic rats underwent transthoracic echocardiography with high-resolution technology at baseline and 2, 4, 8, 12, and 16 weeks after STZ injection. Radial function was analysed using conventional M-mode, and velocity, strain and strain rate imaging. Longitudinal function was analysed using pulsed Doppler imaging of the mitral annulus.

In the diabetic rats, a significant increase in LV end diastolic and end systolic diameter was measured when compared with controls (P < 0.001). Fractional shortening and LV ejection fraction remained unchanged in both groups. Using DMI, diabetic rats demonstrated a decrease in radial systolic velocity (rate of change: +0.01 vs. –0.003 week^–1; P < 0.01) and radial systolic strain rate (+0.003 vs. –0.205 week^–1; P = 0.08) of the anteroseptal wall. Histologic examination revealed dilated cardiomyopathy with no signs of fibrosis.

Although LV ejection fraction remained preserved, velocity and strain rate imaging was able to detect radial systolic dysfunction in diabetic rats. The absence of histological signs of fibrosis suggests that other mechanisms play a role in the development of diabetic cardiomyopathy.

Forty consecutive patients referred for transplant assessment underwent transthoracic RT-3DE. Full volume 3DE data sets were acquired from apical views with the iE33 ultrasound system (Philips Ultrasound, Bothell, USA). Four patients were excluded due to poor image quality. The remaining 36 patients had end-diastolic (LVEDV) and end-systolic (LVESV) left ventricular volumes manually traced, using endocardial detection software. Cardiac output was subsequently calculated: [(LVEDV – LVESV) x heart rate]. Thermodilution derived cardiac outputs, under the same haemodynamic conditions, were used as reference for comparison. There was close correlation between RT-3DE and catheter derived cardiac outputs (r = 0.91, y = 0.86x + 0.45, SEE 0.39 L/min, mean difference from reference –0.06 L/min, SD 0.40 L/min). RT-3DE data analysis took 3 min per case.

This study shows RT-3DE is an accurate method for calculating cardiac output. In patients requiring serial evaluation of cardiac function, this non-invasive test may be preferable to invasive right heart catheterisation.

One hundred and twenty-eight patients with AS underwent quantitative Doppler echocardiographic measurements at rest and during exercise test. Of these patients, 60 had an abnormal response to exercise. Two independent determinants of an abnormal exercise response were selected in multivariate analysis: a larger increase in mean transaortic pressure gradient (P = 0.00014) and a limited contractile reserve—latent left ventricular dysfunction—as indicated by smaller changes in ejection fraction (P = 0.0002). Limiting symptoms were associated with greater increase in mean transaortic pressure gradient, smaller changes in systolic blood pressure and a lower ejection fraction at peak exercise. The increase in pressure gradient was associated with smaller exercise-induced changes in aortic valve area and in ejection fraction and new or worsening mitral regurgitation during exercise.

Abnormal responses to exercise in asymptomatic AS patients are mediated by a larger increase in mean transaortic pressure gradient and/or a limited contractile reserve characterized by an inadequate increase in ejection fraction at exercise.

Pulsed tissue Doppler imaging (TDI) was used to record myocardial velocities along these axes in 25 patients with IVNC (10 asymptomatic–LV ejection fraction [LVEF] ≥ 50%; 15 symptomatic–LVEF < 50%) and 15 healthy controls. In all cases, the systolic velocity pattern featured 2 distinct peaks (SW1, SW2). These peak velocities and the intervals from the electrocardiographic Q wave to each peak (Q-SW1, Q-SW2) were recorded for each axis, and group means were calculated. The asymptomatic group displayed significantly higher long axis SW2 and significantly longer long axis Q-SW1 than the controls. The symptomatic group had significantly lower SW1 and SW2 on both axes and significantly longer short axis Q-SW1 than the asymptomatic group and the controls. Long axis Q-SW1 and short axis Q-SW1 in the symptomatic group were significantly longer than the corresponding control findings, but were not significantly different from the corresponding asymptomatic group findings.

In conclusion, patients with IVNC exhibit distinct systolic myocardial shortening velocities along the long and short axes of the LV. Further, these pulsed TDI findings suggest that asymptomatic patients (those with normal LVEF) have subclinical myocardial dysfunction.

A review of consecutive patients who presented to our outpatient echocardiography laboratory for a resting transthoracic study between April 2006 and May 2006 was performed. Echocardiograms were reexamined and LA volume measured using the AL, SIMP, and PE methods. Of 102 consecutive patients evaluated, 97 had a measure of LA volume using all 3 methods. A significant difference in the measurement of mean ± SD LA volume was noted among the 3 different methods: 37 ± 16 mL/m² for AL, 34 ± 14 mL/m² for SIMP, and 27 ± 12 mL/m² for PE. The PE method yielded routinely smaller values compared with either the AL or SIMP method (P < 0.001). Differences increased with increased LA volume. The SIMP method derived consistently smaller (<5 mL/m²) values than those of the AL method, consistent across the full range of LA volumes.

Significant differences exist among these 3 commonly used methods for measuring LA volume. Standardization of the measurement of LA volume is recommended.

Quantitation of LA function is challenging and often established parameters including peak A are limited to sinus rhythm (SR). We hypothesized that atrial function could be characterized independent of rhythm by combining analogues of LA volume, reservoir function and LV stroke volume.

Seventy-two patients with chronic atrial fibrillation (CAF) were followed for six months post cardioversion (CV). Thirty-seven age matched healthy subjects were controls. The LAFI = LAEF x LVOT-VTI/LAESVI (LAEF = LA emptying fraction, LAESVI = maximal LA volume indexed to BSA, LVOT-VTI = outflow tract velocity time integral).

The LAFI pre-CV in the CAF group was depressed vs controls (0.10 ± 0.05 vs 0.54 ± 0.17; P = 0.0001). Post-CV, LAFI was lower in persistent AF than in those restored to SR (AF vs SR: 0.08 ± 0.03 vs 0.15 ± 0.08; P = 0.0001), improved progressively in SR and was unchanged when AF persisted.

The LAFI, a simple, rhythm independent expression of atrial function, appears sensitive to differences between individuals in AF and those restored to SR and justifies clinical and investigative applications.

We studied 49 patients divided into: group A: 15 patients with previous anterior MI and evidence of myocardial scar; group B: 10 patients with previous anterior MI and no evidence of myocardial scar and group C: 24 patients without anterior MI. All patients underwent coronary angiography at least 6 months after an index event and any reperfusion procedure. Group A patients had lower PHT (199 ± 62 ms) than group C (377 ± 103 ms, p = 0.0001) and group B (316 ± 154 ms, p = 0.029) patients. No other LAD flow velocity parameter differed among the 3 groups. A PHT value of 265 ms discriminated patients with scarred anteriorwallwith a sensitivity of 79% and a specificity of 94% (0.88, p < 0.001).

Shortening of the LAD flow diastolic PHT in patients with remote, reperfused anterior MI reflects scarred myocardial tissue in the anteroapical wall while patients who maintain diastolic wall thickness after an acute coronary syndrome have PHT similar to patients without anterior MI.

Thirty-one pediatric patients with transfusion-dependent β thalassemia with normal LVFS were evaluated. Seven patients with serum ferritin <2500 ng/ mL, 13 patients with serum ferritin 2500–5000 ng/mL, and 11 patients with serum ferritin >5000 ng/mL were studied. Diastolic dysfunction was absent in all patients with serum ferritin <2500 ng/mL, and was present in all patients with serum ferritin >5000 ng/mL. Deceleration time (DT) has a significant correlation with serum ferritin (r = –0.59, p < 0.0001). Difference of pulmonary vein atrial reversal flow and mitral valve A wave duration (PVAR – MVA) and early ventricular filling velocity to early diastolic myocardial velocity ratio (E/Em) significantly correlated with serum ferritin (r = 0.49, p = 0.006; r = 0.56, p = 0.001, respectively).

Decreased DT, increased PVAR-MVA duration, and increased E/Em ratio reliably reflected severe iron overload in pediatric patients with β thalassemia. Systolic and diastolic LV function is preserved in patients who have serum ferritin <2500 ng/mL.

Attendees (n = 35, 23 cardiologists, 12 sonographers) were shown how to use 3DE review software and asked to identify the pathology of five patients (wall motion abnormality, peri-prosthetic mitral regurgitation, subaortic membrane, small ventricular septal defect, submitral stenosis) on 2D and 3D images. In the following one and a half-day interactive teaching course, brief presentations on application of 3DE for assessment of wall motion, valve and congenital abnormalities were followed by review of 3D datasets, during which the attendees made their own interpretations before being shown the optimal viewing strategy. Test cases were not discussed and the test was repeated at the end of the course.

Most attendees (57%) had access but with little or no use of a 3DE system. Three-dimensional echocardiography had no incremental value before training. After training, overall correct responses significantly improved compared with baseline interpretation, although improvement was not the same for all diagnoses. All groups (cardiologists vs. sonographers, inexperienced vs. moderately experienced reviewers) improved similarly.

Incorporation of 3DE into standard practice may be limited by inexperience. An interactive teaching course with rehearsal and direct mentoring appears to overcome this limitation and may improve the uptake of this technique.

Forty-nine subjects were recruited from a pulmonary function lab to undergo a brief echocardiographic examination by an internist using a HCU device. All subjects also received an examination with a full-featured echocardiogram machine as a gold standard.

All subjects with normal PFT had normal LV systolic function. Among subjects with abnormal PFT, 6 (15%) had LV systolic dysfunction and the remainder had normal LV systolic function. No subjects with LV systolic dysfunction by full-featured echocardiograms were missed by the HCU (sensitivity 100%, specificity 95%, negative predictive value 100%, positive predictive value 75%).

LV systolic dysfunction is prevalent among patients with pulmonary disease and can be accurately screened for by a physician using a hand carried ultrasound device with subsequent confirmation with complete echocardiography.