DOCSLIB.ORG

Hypertrophic Cardiomyopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hypertrophic Cardiomyopathy GUIDELINES AND STANDARDS American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy Endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography Sherif F. Nagueh, MD, FASE, Chair,* S. Michelle Bierig, RDCS, FASE,* Matthew J. Budoff, MD,§ Milind Desai, MD,* Vasken Dilsizian, MD,† Benjamin Eidem, MD, FASE,* Steven A. Goldstein, MD,* Judy Hung, MD, FASE,* Martin S. Maron, MD,‡ Steve R. Ommen, MD,* and Anna Woo, MD,* Houston, Texas; St. Louis, Missouri; Los Angeles, California; Cleveland, Ohio; Baltimore, Maryland; Rochester, Minnesota; Washington, District of Columbia; Boston, Massachusetts; Toronto, Ontario, Canada (J Am Soc Echocardiogr 2011;24:473-98.) Keywords: Hypertrophic cardiomyopathy, Echocardiography, Nuclear imaging, Cardiovascular magnetic res- onance, Cardiac computed tomography TABLE OF CONTENTS From the Methodist DeBakey Heart and Vascular Center, Houston, Texas (S.F.N.); St. Anthony’s Medical Center, St. Louis, Missouri (S.M.B.); Los Angeles Biomedical Research Institute, Torrance, California (M.J.B.); Cleveland Clinic, Abbreviations 474 Cleveland, Ohio (M.D.); the University of Maryland School of Medicine, Organization of the Writing Group and Evidence Review 474 Baltimore, Maryland (V.D.); Mayo Clinic, Rochester, Minnesota (B.E., S.R.O.); 1. Introduction 474 Washington Hospital Center, Washington, District of Columbia (S.A.G.); 2. Echocardiography 474 Massachusetts General Hospital, Boston, Massachusetts (J.H.); Tufts Medical A. Cardiac Structure 474 Center, Boston, Massachusetts (M.S.M.); and Toronto General Hospital, B. Assessment of LV Systolic Function 475 University of Toronto, Toronto, Ontario, Canada (A.W.). C. Assessment of LV Diastolic Function 477 D. Dynamic Obstruction and Mitral Valve Abnormalities 477 The following authors reported no actual or potential conflicts of interest in relation E. Mitral Regurgitation in HCM 480 to this document: Sherif F. Nagueh, MD, FASE, S. Michelle Bierig, RDCS, FASE, F. Myocardial Ischemia, Fibrosis, and Metabolism 481 Matthew J. Budoff, MD, Milind Desai, MD, Vasken Dilsizian, MD, Benjamin Eidem, G. Guidance of Septal Reduction Procedures 481 MD, FASE, Steven A. Goldstein, MD, Judy Hung, MD, FASE, Steve R. Ommen, i. Surgical Myectomy 481 MD, and Anna Woo, MD. The following author reported a relationship with one ii. Alcohol Septal Ablation 481 or more commercial interests: Martin S. Maron, MD, serves as a consultant for iii. Permanent Pacing 483 PGx Health. H. Screening and Preclinical Diagnosis 483 Attention ASE Members: 3. Nuclear Imaging 484 The ASE has gone green! Visit www.aseuniversity.org to earn free continuing A. Cardiac Structure 484 medical education credit through an online activity related to this article. Cer- B. Radionuclide Angiography for LV Systolic Function 484 tificates are available for immediate access upon successful completion of C. Radionuclide Angiography for LV Diastolic Function 484 the activity. Nonmembers will need to join the ASE to access this great mem- D. Dynamic Obstruction and Mitral Valve Abnormalities 484 ber benefit! E. Mitral Regurgitation in HCM 484 F. Myocardial Ischemia, Fibrosis, and Metabolism 484 i. SPECT 484 Reprint requests: American Society of Echocardiography, 2100 Gateway Centre ii. Positron Emission Tomography (PET) 485 Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: [email protected]). iii. Imaging Metabolism 486 Writing Group of the *American Society of Echocardiography (ASE) †American G. Guidance of Septal Reduction Procedures 486 Society of Nuclear Cardiology, ‡ Society for Cardiovascular Magnetic H. Screening and Preclinical Diagnosis 486 Resonance, and §Society of Cardiovascular Computed Tomography. 3. Cardiovascular Magnetic Resonance 486 0894-7317/$36.00 A. Cardiac Structure 486 B. Assessment of LV Systolic Function 487 Copyright 2011 by the American Society of Echocardiography. C. Assessment of LV Diastolic Function 487 doi:10.1016/j.echo.2011.03.006 473 474 Nagueh et al Journal of the American Society of Echocardiography May 2011 D. Dynamic Obstruction and The purpose of this document is to review the strengths and Abbreviations Mitral Valve Abnormali- applications of the current imaging modalities and provide ASE = American Society of ties 487 recommendation guidelines for using these techniques to optimize Echocardiography E. Mitral Regurgitation in the management of patients with HCM. The recommendations are HCM 488 CAD based on observational studies, sometimes obtained in a small = Coronary artery F. Myocardial Ischemia, Fibrosis, number of patients, and from the clinical experience of the writing disease and Metabolism 488 group members, given the scarcity of multimodality imaging compar- CMR i. Ischemia 488 = Cardiovascular ative effectiveness studies. Notwithstanding these recommendations, magnetic resonance ii. Fibrosis 488 iii. Imaging Metabolism 489 the writing group believes that the selection of a given imaging CT = Computed tomography G. Guidance of Septal Reduc- modality must be individualized. tion Procedures 489 EF = Ejection fraction H. Screening and Preclinical HCM = Hypertrophic Diagnosis 489 1. INTRODUCTION cardiomyopathy 4. Cardiac Computed Tomogra- phy 489 ICD HCM is the most common genetic cardiomyopathy. Across multiple = Implantable A. Cardiac Structure 489 geographies and ethnicities, the prevalence is approximately 0.2%.1 cardioverter-defibrillator B. Assessment of LV Systolic HCM is transmitted in an autosomal dominant inheritance pattern. LA = Left atrial Function 490 C. Assessment of LV Diastolic The natural history is benign in the majority of patients, with a near LGE = Late gadolinium Function 490 normal life span. However, adverse outcomes, including sudden car- enhancement D. Dynamic Obstruction and diac death, lifestyle-limiting symptoms secondary to dynamic left ven- Mitral Valve Abnormali- tricular (LV) outflow tract (LVOT) obstruction and/or diastolic filling LV = Left ventricular ties 490 abnormalities, atrial fibrillation, and LV systolic dysfunction, occur in LVOT = Left ventricular E. Mitral Regurgitation in some patients.1 outflow tract HCM 490 The clinical diagnosis of HCM is based on the demonstration of LV F. Myocardial Ischemia, Fibrosis, MCE hypertrophy in the absence of another disease process that can rea- = Myocardial contrast and Metabolism 490 sonably account for the magnitude of hypertrophy present.1 Many echocardiography G. Guidance of Septal Reduc- patients are diagnosed serendipitously when a cardiac murmur or RV = Right ventricular tion Procedures 490 H. Screening and Preclinical electrocardiographic abnormality prompts echocardiographic evalua- SAM = Systolic anterior Diagnosis 491 tion. Others present with dyspnea, chest pain, and/or presyncope. motion 5. Hypertrophic Cardiomyopathy Sudden cardiac death occurs in approximately 1% of patients with Imaging in the Pediatric Popula- HCM each year, and detecting patients at risk for sudden cardiac STE = Speckle-tracking tion 491 echocardiography death is one of the most challenging clinical dilemmas. At the current 6. Role of Imaging in the Differential time, a set of clinical risk factors1 and imaging results are considered in SPECT = Single photon- Diagnosis of Hypertrophic Car- the context of each patient’s specific circumstances to help each pa- emission computed diomyopathy 491 tient decide whether an implantable cardioverter-defibrillator (ICD) 7. Recommendations for Clinical tomography represents an appropriate choice for that patient.1 Applications 492 TEE = Transesophageal A. Cardiac Structure 492 The management of HCM is based on a thorough understanding echocardiography B. Assessment of LV Systolic and of the underlying anatomy and pathophysiology. In addition, careful assessment for concomitant structural heart disease is crucial to allow 3D = Three-dimensional Diastolic Function 493 C. Assessment of LVOT Ob- appropriate patient selection for advanced therapies. TTE = Transthoracic struction 493 Various imaging modalities can be used to assess cardiac structure echocardiography D. Evaluation of Patients Under- and function, the presence and severity of dynamic obstruction, the going Invasive Therapy 493 2D = Two-dimensional presence of mitral valve abnormalities, and the severity of mitral re- E. Diagnosis of CAD in Patients gurgitation, as well as myocardial ischemia, fibrosis, and metabolism. With HCM 494 In addition, imaging can be used to guide treatment, screening and F. Screening 494 preclinical diagnosis and to detect phenocopies. G. Role of Imaging in Identifying Patients at High Risk for Sudden Cardiac Death 494 ORGANIZATION OF THE WRITING GROUP AND EVIDENCE 2. ECHOCARDIOGRAPHY REVIEW A. Cardiac Structure The writing group was composed of acknowledged experts in hyper- LV volumes and the pattern of hypertrophy can be well defined by trophic cardiomyopathy (HCM) and its imaging representing the echocardiography (Figure 1, Video 1 [ view video clip online], ASE, the American Society of Nuclear Cardiology, the Society for Table 1). Ventricular volumes in HCM are usually normal or slightly Cardiovascular Magnetic Resonance, and the Society of reduced. Traditionally, the biplane Simpson’s method has been ap- Cardiovascular Computed Tomography. The document was re- plied to the measurement of LV volumes and ejection fraction viewed by the ASE Guidelines and Standards Committee and four of- (EF).2 Recently, real-time
Load more

Recommended publications
  • Cardiac CT - Quantitative Evaluation of Coronary Calcification
    Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Imaging of the Heart Effective Date: January 1, 2018 Proprietary Date of Origin: 03/30/2005 Last revised: 11/14/2017 Last reviewed: 11/14/2017 8600 W Bryn Mawr Avenue South Tower - Suite 800 Chicago, IL 60631 P. 773.864.4600 Copyright © 2018. AIM Specialty Health. All Rights Reserved www.aimspecialtyhealth.com Table of Contents Description and Application of the Guidelines ........................................................................3 Administrative Guidelines ........................................................................................................4 Ordering of Multiple Studies ...................................................................................................................................4 Pre-test Requirements ...........................................................................................................................................5 Cardiac Imaging ........................................................................................................................6 Myocardial Perfusion Imaging ................................................................................................................................6 Cardiac Blood Pool Imaging .................................................................................................................................12 Infarct Imaging .....................................................................................................................................................15
    [Show full text]
  • Resting Coronary Flow Velocity in The
    European Heart Journal – Cardiovascular Imaging (2012) 13,79–85 CLINICAL/ORIGINAL PAPERS doi:10.1093/ehjci/jer153 Resting coronary flow velocity in the functional evaluation of coronary artery stenosis: study on sequential use of computed tomography angiography and transthoracic Doppler Downloaded from https://academic.oup.com/ehjcimaging/article/13/1/79/2397059 by guest on 30 September 2021 echocardiography Esa Joutsiniemi 1, Antti Saraste 1,2*, Mikko Pietila¨ 1, Heikki Ukkonen 1,2, Sami Kajander 2, Maija Ma¨ki 2,3, Juha Koskenvuo 3, Juhani Airaksinen 1, Jaakko Hartiala 3, Markku Saraste 3, and Juhani Knuuti 2 1Department of Cardiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland; 2Turku PET Centre, Kiinamyllynkatu 4-8, 20520 Turku, Finland; and 3Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland Received 10 March 2011; accepted after revision 2 August 2011; online publish-ahead-of-print 30 August 2011 Aims Accelerated flow at the site of flow-limiting stenosis can be detected by transthoracic Doppler echocardiography (TTDE). We studied feasibility and accuracy of sequential coronary computed tomography angiography (CTA) and TTDE in detection of haemodynamically significant coronary artery disease (CAD). ..................................................................................................................................................................................... Methods We prospectively enrolled 107 patients with intermediate (30–70%) pre-test likelihood of CAD. All patients under- and results went CTA using a 64-slice scanner. Using TTDE, the ratio of maximal diastolic flow velocity to pre-stenotic flow velocity (M/P ratio) was measured in the coronary segments with stenosis in CTA. In all patients, the results were compared with invasive coronary angiography, including measurement of fractional flow reserve when appropriate.
    [Show full text]
  • And Its Obstructive Form, Idiopathic Hypertrophic Subaortic Stenosis (IHSS), in Pediatrics
    Asymmetric septal hypertrophy (ASH) and its obstructive form, idiopathic hypertrophic subaortic stenosis (IHSS), in pediatrics ALBERT K. HARVEY, DD. Oklahoma City, Oklahoma IHSS. The father had no siblings, but two uncles had Although idiopathic hypertrophic died suddenly of heart disease at early ages. subaortic stenosis usually occurs in Case 1 adults, the possibility of its presence in children must not be overlooked. It An 18-year-old white girl said she had not experienced dyspnea, exercise intolerance, syncope, or chest pain. She has been reported even as early as was a senior in high school and had participated in dra- infancy and in stillborn fetuses. The matic and athletic activities. Physical examination condition appears to be genetically showed the pulse rate to be 74 and the blood pressure transmitted, with the natural history 110/64 mm. Hg. Pulses on the upper and lower ex- one of progressive disease. The tremities were strong and symmetric. The point of atypical location of an aortic stenosis maximum intensity (PMI) was not enlarged, and no type murmur is a clue to early thrill or precordial heave was perceptible. There was a diagnosis. Echocardiography is Grade 2/6 harsh systolic ejection murmur along the lower confirmative of a diagnosis. Four case left sternal border, which was transmitted well to the reports are presented. apex. No diastolic component was present. The phono- cardiogram showed an intermittent fourth heart sound. An x-ray film of the chest showed the heart size and vascularity of the lung field to be normal. An elec- trocardiogram (EKG) revealed left ventricular hyper- trophy with marked ST and T wave changes in the left precordial leads.
    [Show full text]
  • Acr–Nasci–Sir–Spr Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (Cta)
    The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2021 (Resolution 47)* ACR–NASCI–SIR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE AND INTERPRETATION OF BODY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.
    [Show full text]
  • Idiopathic Isolated Right Ventricular Apical Hypertrophy
    Acta Cardiol Sin 2018;34:288-290 Letter to the Editor doi: 10.6515/ACS.201805_34(3).20180122A Idiopathic Isolated Right Ventricular Apical Hypertrophy Debika Chatterjee1 and Pradeep Narayan2 INTRODUCTION creased RV compliance or RV dysfunction. Isolated right ventricular hypertrophy is extremely rare and reports in the literature are very sparse. We re- DISCUSSION port a case of focal apical right ventricular hypertrophy without involvement of the left ventricular cavity or the RV hypertrophy is usually reported in association inter-ventricular septum. with left ventricular hypertrophy which in turn could be secondary to hypertrophic cardiomyopathy (HCM), hy- pertensive left ventricular hypertrophy (LVH) or other CASE infiltrative conditions.1 However, isolated involvement of right ventricle is extremely rare in these conditions. The A 50 year old male, asymptomatic, normotensive only situation where isolated RV hypertrophy is seen is in patient on routine medical evaluation was found to have presence of idiopathic pulmonary artery hypertension. inverted T-waves on the electrocardiogram (Figure 1). However, the hypertrophy in these cases is rarely focal. He had no history of angina or any other symptoms. Isolated apical hypertrophic cardiomyopathy is an However, despite complete lack of symptoms, because extremely unusual nonobstructive hypertrophy that is of the abnormality on the electrocardiography (ECG) an localized to the cardiac apex.2 Even in these cases spar- echocardiography was carried out for further evaluation. ing of the left ventricular apex with involvement of only Echocardiography revealed focal hypertrophy of the the right ventricular apex is even more uncommon. The right ventricular (RV) apex almost obliterating the apex most common presenting symptom in patients with api- (Figure 2A) but sparing the inter-ventricular septum.
    [Show full text]
  • Equilibrium Radionuclide Angiography/ Multigated Acquisition
    EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION Equilibrium Radionuclide Angiography/ Multigated Acquisition S van Eeckhoudt, Bravis ziekenhuis, Roosendaal VJR Schelfhout, Rijnstate, Arnhem 1. Introduction Equilibrium radionuclide angiography (ERNA), also known as radionuclide ventriculography (ERNV), gated synchronized angiography (GSA), blood pool scintigraphy or multi gated acquisition (MUGA), is a well-validated technique to accurately determine cardiac function. In oncology its high reproducibility and low inter observer variability allow for surveillance of cardiac function in patients receiving potentially cardiotoxic anti-cancer treatment. In cardiology it is mostly used for diagnosis and prognosis of patients with heart failure and other heart diseases. 2. Methodology This guideline is based on available scientifi c literature on the subject, the previous guideline (Aanbevelingen Nucleaire Geneeskunde 2007), international guidelines from EANM and/or SNMMI if available and applicable to the Dutch situation. 3. Indications Several Class I (conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective) indications exist: • Evaluation of left ventricular function in cardiac disease: - Coronary artery disease - Valvular heart disease - Congenital heart disease - Congestive heart failure • Evaluation of left ventricular function in non-cardiac disease: - Monitoring potential cardiotoxic side effects of (chemo)therapy - Pre-operative risk stratifi cation in high risk surgery • Evaluation of right ventricular function: - Congenital heart disease - Mitral valve insuffi ciency - Heart-lung transplantation 4. Contraindications None 5. Medical information necessary for planning • Clear description of the indication (left and/or right ventricle) • Previous history of cardiac disease • Previous or current use of cardiotoxic medication PART I - 211 Deel I_C.indd 211 27-12-16 14:15 EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY/ MULTIGATED ACQUISITION 6.
    [Show full text]
  • Comparison of Echocardiography and Angiography in Determining the Cause of Severe Aortic Regurgitation
    Br Heart J: first published as 10.1136/hrt.51.1.36 on 1 January 1984. Downloaded from Br Heart J 1984; 51: 36-45 Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation NICHOLAS L DEPACE, PASQUALE F NESTICO, MORRIS N KOTLER, GARY S MINTZ, DEMETRIOS KIMBIRIS, INDER P GOEL, E ELAINE GLAZIER-LASKEY, JOHN ROSS From the LikoffCardiovascular Institute, Hahnemann University, Philadelphia, Pennsylvania, USA SUMMARY To assess the accuracy of echocardiography in determining the cause of aortic regurgita- tion M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a biscuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgi- tation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation. Aortic regurgitation may be caused by valvular dis- ment for predominant aortic regurgitation were http://heart.bmj.com/ ease, aortic root disease, or a combination of both. reviewed.
    [Show full text]
  • The Challenge of Assessing Heart Valve Prostheses by Doppler Echocardiography
    Editorial Comment The Challenge of Assessing Heart Valve Prostheses by Doppler Echocardiography Helmut Baumgartner, MD, Muenster, Germany The assessment of prosthetic valve function remains challenging. by continuous-wave Doppler measurement. Using these velocities Echocardiography has become the key diagnostic tool not only be- for the calculation of transvalvular gradients results in marked overes- cause of its noninvasive nature and wide availability but also because timation of the actual pressure drop across the prostheses.6 The fact of limitations inherent in alternative diagnostic techniques. Invasive that this phenomenon more or less disappears in malfunctioning bi- evaluation is limited particularly in mechanical valves that cannot leaflet prostheses when the funnel-shaped central flow channel ceases be crossed with a catheter, and in patients with both aortic and mitral to exist because of restricted leaflet motion makes the interpretation valve replacements, full hemodynamic assessment would even of Doppler data and their use for accurate detection of prosthesis mal- require left ventricular puncture. Although fluoroscopy and more function even more complicated.7 Furthermore, the lack of a flat ve- recently computed tomography allow the visualization of mechanical locity profile and the central high velocities described above cause valves and the motion of their occluders, the evaluation of prosthetic erroneous calculations of valve areas when the continuity equation valves typically relies on Doppler echocardiography. incorporates such measurements.8 For these reasons, the analysis of Although Doppler echocardiography has become an ideal nonin- occluder motion using fluoroscopy (in mitral prostheses, this may vasive technique for the evaluation of native heart valves and their also be obtained on transesophageal echocardiography) remains es- function, the assessment of prosthetic valves has remained more dif- sential to avoid the misinterpretation of high Doppler velocities across ficult.
    [Show full text]
  • Thoracic Aorta
    GUIDELINES AND STANDARDS Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cuellar-Calabria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herve Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium (J Am Soc Echocardiogr 2015;28:119-82.) TABLE OF CONTENTS Preamble 121 B. How to Measure the Aorta 124 I. Anatomy and Physiology of the Aorta 121 1. Interface, Definitions, and Timing of Aortic Measure- A. The Normal Aorta and Reference Values 121 ments 124 1.
    [Show full text]
  • Understanding Cardiomyopathy: Practical Guidelines
    Chapter 30 Understanding Cardiomyopathy: Practical Guidelines Asha Moorthy, Jain T Kallarakkal HYPERTROPHIC CARDIOMYOPATHY genes predominate in frequency. Beta-myosin heavy chain (the first identified), myosin-binding protein C and cardiac troponin T Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder probably comprise more than one half of the genotyped patients to caused by mutations in 1 of the 12 sarcomeric or nonsarcomeric date. Seven other genes each account for fewer cases: regulatory and genes and is recognized as the most common cause of sudden cardiac essential myosin light chains, titin, alpha-tropomyosin, alpha-actin, death (SCD) in the young and an important substrate for disability cardiac troponin I and alpha-myosin heavy chain. at any age. It affects men and women equally and occurs in many races and countries. The clinical diagnosis of HCM is established most easily and reliably with two-dimensional echocardiography by Clinical Course demonstrating left ventricular hypertrophy (LVH) which is typically asymmetric in distribution, and showing virtually any diffuse or Adverse clinical course proceeds along one or more of the following segmental pattern of left ventricular (LV) wall thickening. LV wall pathways, which ultimately dictate treatment strategies: (1) high thickening is associated with a nondilated and hyperdynamic risk for premature, sudden and unexpected death; (2) progressive chamber, in the absence of any other cardiac or systemic disease symptoms like exertional dyspnea, chest pain and impaired
    [Show full text]
  • Cardiac Surgery
    NON-PROFIT ORG. U.S. POSTAGE UAB Insight on Heart and Vascular Disease PAID PERMIT NO. 1256 410 • 500 22nd Street South BIRMINGHAM, AL Insight 1530 3rd ave S ON HEART AND VASCULAR DISEASE birmingham al 35294-0104 UAB Division of Cardiovascular Disease medicine.uab.edu/cardiovasculardisease UAB Division of Cardiothoracic Surgery medicine.uab.edu/cardiothoracicsurgery UAB Section of Vascular Surgery and Endovascular Therapy medicine.uab.edu/vascularsurgery Combined Therapy UAB Ambassador Program for Peripheral Vascular Disease The Ambassador Program gives referring physicians complete access to patient notes, letters, reports, and other data through a Catheter Ablation of secure Web portal. To join this program, please contact Physician Tachycardia Services at 1.800.822.6478. Minimally Invasive Pulmonary Thromboendarterectomy Clinic Cardiac Surgery welcOme 3 cOnTents Uab inSighT Welcome to the first issue of UAB Insight on Heart and Vascular On hearT and Disease, designed to keep you informed about UAB’s leading role in Cardiothoracic Surgery VaScUlar diSeaSe evaluation and treatment of cardiac and vascular diseases. UAB con- FALL 2009 sistently ranks among the top 30 cardiac programs rated in U.S. News Minimally Invasive Cardiac Surgery ... 2 & World Reports, and is a regional, national, and international referral VOlUme 1, nUmber 1 center for cardiac and vascular disease diagnosis and treatment. Adult Congenital Heart Disease ........ 3 With expertise in every major area of heart and vascular diseases, and James Kirklin, MD E D I T O R I N C H I E F as home to the Southeast’s largest and most technologically advanced Pulmonary Thromboendarterectomy Julius Linn, MD Heart and Vascular Center, we offer innovative, scientifically based Clinic .................................................
    [Show full text]
  • A Common Occurrence After Coronary Bypass Surgery
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector lACC Vol. 15, No.6 1261 May 1990:1261-9 Acute Myocardial Dysfunction and Recovery: A Common Occurrence After Coronary Bypass Surgery WARREN M. BREISBLATT, MD, FACC, KEITH L. STEIN, MD, CYNTHIA J. WOLFE, RN, WILLIAM P. FOLLANSBEE, MD, FACC, JOHN CAPOZZI, CNMT, JOHN M. ARMITAGE, MD, ROBERT L. HARDESTY, MD, FACC Pittsburgh, Pennsylvania To evaluate whether acute myocardial dysfunction was min after coronary bypass and showed complete recovery common in the early postoperative period, serial hemody• within 48 h. Left ventricular end-systolic and end-diastolic namic measurements and radionuclide evaluation of ven• volume index increased significantly postoperatively, but tricular function were performed before and after opera• recovery in left ventricular ejection fraction was mostly due tion in 24 patients undergoing elective coronary bypass to decreases in end-systolic volume index (50 ± 22 ml at surgery. All patients had uncomplicated surgery, and no trough and 32 ± 16 ml at recovery). Depressed myocardial patient sustained an intraoperative infarction. In 96% of function was independent of bypass time, number of grafts patients, significant depression in right and left ventricular placed, preoperative medications or core temperatures ejection fraction was seen postoperatively, reaching a nadir postoperatively. Postoperative therapy with pressors or at 262 ± 116 min after coronary bypass. Left ventricular inotropic agents delayed but did
    [Show full text]