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Biatrial and right ventricular deformation imaging: Implications of the recent EACVI consensus document in the clinics and beyond

Saha, Samir K; Kiotsekoglou, Anatoli; Gopal, Aasha S; Lindqvist, Per
In this review, right ventricular (RV), right atrial (RA), and left atrial (LA) strain in some selected clinical situations has been discussed in light of the current literature. To exemplify the significance of the use of multichamber strain, we have provided some illustrations of common cardiac problems. The recently published European Association of Cardiovascular Imaging (EACVI) consensus document for standardization of RV, RA, and LA strain, using the currently available software, has fulfilled the aspirations of investigators world over who have been studying atrial strain using a bailed-out algorithm designed principally to quantify left ventricular deformation. The purpose of this review was to reiterate the value of the application of RV and biatrial strain imaging in research and day-to-day clinical practice, using the 2-dimensional speckle tracking echocardiography (2D-STE). Also, we present a short report on how RA strain may remain coupled to pulmonary hemodynamics. Besides, we have highlighted the technical challenges of atrial strain quantification. We have not used the nomenclature of chamber deformation proposed by the EACVI document as the publications cited in this review have used different sets of nomenclature.
PMID: 31609029
ISSN: 1540-8175
CID: 4590922

Deformation imaging of the atria using 2D strain: A noninvasive modality to characterize operating compliance? [Case Report]

Saha, Samir K; Kiotsekoglou, Anatoli; Gopal, Aasha S
This viewpoint with two illustrated case summaries of biventricular and biatrial mechanical function/dysfunction emphasizes the importance of continued research in deformation imaging beyond the left ventricle, as there are no Cinderellas in the heart and we just cannot afford to be nonchalant toward the atria, particularly the right atrium.
PMID: 30099765
ISSN: 1540-8175
CID: 4590912

Haptics and the heart: Force and tactile feedback system for cardiovascular interventions

Schecter, Stuart; Lin, Wei; Gopal, Aasha; Fan, Roger; Rashba, Eric
BACKGROUND/PURPOSE:Interventional cardiovascular procedures are performed while operators view multiple visual displays including fluoroscopic and ultrasonic images, intracardiac electrical signals, electroanatomic mapping data, and hemodynamic indices. Operators are unable to palpate physiologic and biophysical signals or feel intracardiac anatomy due to the attenuation and dampening properties of cardiac catheters. This poses a significant limitation when performing higher risk procedures such as complex coronary interventions, transeptal or epicardial puncture to gain access to the left atrium or pericardium for ablation of heart rhythm disorders, cardiac device delivery, and when attempting to maintain stable tissue contact force ("CF") during ablation of cardiac arrhythmia. METHODS/MATERIALS:We utilized signals acquired from a prototype sensorized cardiac guiding catheter, conventional transeptal puncture kit with end hole manometry, commercially available contact force sensing ablation catheter, and epicardial puncture needle, input these signals into a novel signal processing system and generated palpable sensations to blinded subjects using a proprietary tactile/force (haptic) feedback system. Qualitative and quantitative analysis of the system was performed. RESULTS/CONCLUSION:The proprietary haptic (tactile and force) feedback system provides sense of touch during cardiovascular interventions recreating palpable, real-time biophysical events and physiologic information and enables operators to react to critical cardiovascular signals with minimal delay relative to visual motor reaction time to simple display data. SUMMARY:We describe a proprietary haptic (tactile and force) feedback system that provides sense of touch during cardiovascular interventions recreating palpable, real-time biophysical events and physiologic information.
PMID: 30017728
ISSN: 1878-0938
CID: 4590902

Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction

Saha, Samir K; Luo, Xia-Xia; Gopal, Aasha S; Govind, Satish C; Fang, Fang; Liu, Ming; Zhang, Qing; Ma, Chunyan; Dong, Ming; Kiotsekoglou, Anatoli; Yu, Cheuk-Man
AIMS:Deformation imaging, particularly of left-sided heart, is fast becoming an essential tool in clinical cardiology. However, data are scant regarding the value of biventricular and bi-atrial deformation in association with comorbidities in heart failure with reduced left ventricular ejection fraction (HFREF). METHODS AND RESULTS: = .68, all P < .05). In the multivariate model, however, only PASP predicted adverse outcome. PASP also had the largest AUC (0.8) in the ROC analysis. A creatinine level of >88 μmol/L (SCREAT) and a cutoff value of LA reservoir strain (LARS %) at <16.7% provided the best sensitivity (86%) and specificity (40%) with an odds ratio of 3.8. In the Kaplan-Meier survival estimate, LARS%-SCREAT predicted all-cause mortality and HF hospitalization. CONCLUSION:Multichamber deformation imaging along with renal function and PASP could best predict adverse outcome in HFREF.
PMID: 29399878
ISSN: 1540-8175
CID: 4590892

3D and 4D Ultrasound: Current Progress and Future Perspectives

Kwon, Susan H; Gopal, Aasha S
Purpose of Review/UNASSIGNED:Three-dimensional (3D) echocardiography (3DE) and 4-dimensional echocardiography (4DE), also known as real-time (RT) 3DE (RT3DE), are rapidly emerging technologies which have made significant impact in the clinical arena over the years. This review will discuss the recent applications of 3DE in diagnosing and treating different types of cardiovascular disease. Recent Findings/UNASSIGNED:Recent studies using 3DE expanded on prior findings and introduced additional applications to different cardiac conditions. Some studies have used 3D parameters to prognosticate long-term outcomes. Numerous innovative software designs including fully automated algorithms have been introduced to better evaluate valvular heart disease and cardiac function. Summary/UNASSIGNED:With further evolution of 3DE technologies, this imaging modality will emerge as a powerful tool and likely become the imaging modality of choice in the diagnosis and management of various cardiac disorders.
PMID: 29201268
ISSN: 1941-9066
CID: 4590882

Prevalence of Congenital Heart Disease and Pulmonary Hypertension in Down's Syndrome: An Echocardiographic Study

Espinola-Zavaleta, Nilda; Soto, María Elena; Romero-Gonzalez, Angel; Gómez-Puente, Lidia Del Carmen; Muñoz-Castellanos, Luis; Gopal, Aasha S; Keirns, Candace; Lupi-Herrera, Eulo
BACKGROUND:Down's syndrome (DS) is a genetic anomaly, which undergoes increased morbidity and mortality when associated with congenital heart disease (CHD). The aims of the study were to determine the prevalence of CHD and pulmonary hypertension (PH) in DS. METHODS:One hundred twenty-seven patients with DS living in Mexico City were evaluated by physical exam, electrocardiogram and echocardiogram. RESULTS:CHD was found in 40%. In 80% (n = 102) PH was present [systolic pulmonary artery pressure (SPAP) of 47 ± 19 mm Hg and mean pulmonary artery pressure (MPAP) of 32 ± 11 mm Hg]. Patients with CHD and PH were classified as having 1) no shunt (n = 18) with SPAP of 37 ± 9 mm Hg and MPAP of 25 ± 6 mm Hg and 2) with shunt (n = 26) with PASP of 57 ± 29 mm Hg and MPAP of 38 ± 19 mm Hg (p ≤ 0.001). In those without CHD or with CHD without shunt (n = 76), SPAP was 37 ± 19 mm Hg and the MPAP 25 ± 6 mm Hg. The prevalence of PH in DS was 5.9% at one year and 15% at 10 years. The odds ratio of PH in DS with CHD was 7.3 vs. 3 without CHD. CONCLUSION/CONCLUSIONS:DS has a high prevalence of CHD and PH. PH prevalence increases when it is associated with CHD. The pathophysiology of PH in DS without CHD should be studied in the near future. Echocardiography is an indispensible tool for evaluation of DS.
PMID: 26140148
ISSN: 1975-4612
CID: 4590872

Utility of Remote Monitoring Using a Mobile Phone in Patients with Heart Failure: the REMOTE-HF-1 Study [Meeting Abstract]

Stahlberg, Marcus; Govind, Satish C.; Orr, Nicole M.; Gopal, Aasha S.; Lachmann, Justine S.; Bhagirath, R.; Ramesh, S. S.; Lund, Lars H.; Braunschweig, Frieder
ISSN: 0009-7322
CID: 3519512

Relative Merits of Ejection Fraction and Strain by 2D Echo, 3D Echo and Cardiac Magnetic Resonance Imaging for Image-Based Recognition of Heart Failure [Meeting Abstract]

Saha, Samir K.; Toole, Rena S.; Kiotsekoglou, Anatoli; Cao, Jie J.; Reichek, Nathaniel; Gopal, Aasha
ISSN: 0009-7322
CID: 4590962

Value of two-dimensional speckle tracking and real time three-dimensional echocardiography for the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography

Saha, Samir K; Kiotsekoglou, Anatoli; Toole, Rena S; Moggridge, James C; Nichols, Kenneth J; Govind, Satish; Gopal, Aasha S
BACKGROUND:While speckle tracking echocardiography (2DSTE) can be used to study longitudinal, circumferential, and radial function, real time 3D echocardiography (3DE) generates dynamic time-volume curves, offering a wide array of new parameters for characterizing mechanical and volumetric properties of the left ventricle (LV). Our aim was to investigate the merit of these new techniques to separate normal from abnormal echocardiograms as well as to identify subclinical disease in reportedly normal subjects. METHODS:Eighty-one patients (mean age 61 ± 16 years) underwent standard 2D echocardiography (2DE) enhanced by 2DSTE and 3DE. The data included LV volumes and ejection fraction (EF), velocities, strain/strain rate, and peak ejection/filling rates. The patients were divided into Group 1: normal (n = 42) and Group 2: abnormal (n = 39) on the basis of an expert interpretation of the resting 2DE. RESULTS:Global longitudinal strain (%) was 17 ± 4 in Group1 and 14 ± 4 in Group2 (P < 0.002). Strain rates (SR, 1/sec) at peak systole (1.1 ± 0.2 vs 0.9 ± 0.3, P < 0.001) and early diastole (1.3 ± 0.3 vs 0.9 ± 0.3, P < 0.001) were also higher in Group1. Three-dimensional peak ejection and filling rates (EDV/sec) were significantly higher in Group1 (-2.5 ± 0.4 vs -2.1 ± 0.7, and 1.8 ± 0.2 vs 1.5 ± 0.5, P < 0.002, P < 0.001, respectively). The best discriminatory power for predicting a normal 2DE was systolic SR with a sensitivity of 82% and a specificity of 54% using a cutoff value of 1.09. Interestingly, 19/41 (46%) of Group1 patients had systolic SR < 1.09, suggesting subclinical disease. CONCLUSIONS:2DSTE and 3DE can discriminate between normal and abnormal echocardiograms and have the potential to detect subclinical LV dysfunction.
PMID: 22329775
ISSN: 1540-8175
CID: 4590852

Effect of Spatial and Temporal Resolution on the Calculation of Global Longitudinal Strain by Three-Dimensional Echocardiography [Meeting Abstract]

Gopal, Aasha S.; Toole, Rena S.; Cao, Jie J.
ISSN: 0009-7322
CID: 4590942