Faculty Bibliography

BACKGROUND:Left ventricular hypertrophy (LVH) is a common condition that carries an increased risk of cardiovascular events. Use of ECG in detection of LVH is limited because of the reported low sensitivity. Conventional echocardiographic techniques used as the standard for estimating left ventricular (LV) mass have limitations related to the position of the image plane and shape of the ventricle. Three-dimensional echocardiography is free of these limitations and therefore is more accurate. We hypothesized that accuracy of ECG criteria for LVH would improve when LV mass was assessed by three-dimensional echocardiography. RESULTS:For most of the criteria, sensitivity, specificity and accuracy improved when LV mass was assessed by three-dimensional echocardiography. Two-dimensional echocardiography significantly overestimated LV mass as compared with the three-dimensional method. CONCLUSIONS:Sensitivity, specificity, and accuracy of the ECG criteria improved when LV mass was estimated by three-dimensional echocardiography. This improvement may be attributed at least in part to superior accuracy of three-dimensional measurements.

OBJECTIVES/OBJECTIVE:We defined the effects of the operative (OP) state and phenylephrine challenge on the assessment of mitral regurgitation (MR) severity. METHODS:In all, 57 patients underwent transesophageal echocardiographic assessment of MR severity pre-OP (PREOP) and intra-OP. MR severity was assessed PREOP under conscious sedation and intra-OP with general anesthesia, before and after hemodynamic manipulation with vasoactive agents, to match intra-OP and PREOP transesophageal echocardiographic mean arterial blood pressures. RESULTS:Intra-OP MR and mean arterial pressure were less than PREOP in 27 patients (both P < .001). When PREOP and OP blood pressures were matched using phenylephrine, there was no significant difference in MR severity between the two states (P = 1.0). Nonetheless, MR severity was still underestimated in 6 patients and overestimated in 7 patients intra-OP. CONCLUSIONS:Intra-OP transesophageal echocardiography underestimates MR severity. Phenylephrine reduces, yet does not eliminate, intra-OP underestimation of MR severity.

HYPOTHESES/OBJECTIVE:(1) Mitral regurgitation (MR) severity is directly associated with mitral annular remodeling as evidenced by mitral annular enlargement. (2) Increasing severity of chronic MR will result in symmetric enlargement of the mitral annulus as measured by annular shape indices. BACKGROUND:Limited data exist on mitral annular remodeling for patients with MR. Identification of annular changes may be important in aiding surgical repair. METHODS:The mitral annulus was measured in several planes using transthoracic echocardiography in 173 patients: trace to no MR (34), mild MR (48), moderate MR (45), and severe MR (46). Patients were subgrouped by mechanism of MR and annular shape indices were determined. RESULTS:With increasing MR severity, there was a corresponding symmetric increase in all systolic and diastolic measurements, but no significant differences in annular shape indices between subgroups by MR severity or by MR mechanism. CONCLUSIONS:Mitral annular remodeling is symmetric, regardless of degree or mechanism of MR.

Primary cardiac lymphomas are rare. They can be detected incidentally during echocardiography or cardiac operation. They can have various clinical manifestations. We report a case of primary cardiac large B-cell lymphoma in a 66-year-old man with symptoms of chest pain and light-headedness who was found to have a right atrial mass with echocardiography and without right ventricular outflow tract obstruction or pericardial involvement.

PURPOSE/OBJECTIVE:The purpose of this investigation was to determine whether left ventricular mass (LVM) assessed from myocardial perfusion gated SPECT (GSPECT) data corresponds with echocardiographic estimates, and whether mass accuracy decreases as relative myocardial wall thickness increases. MATERIALS AND METHODS/METHODS:Myocardial perfusion tomograms were selected retrospectively for 37 patients, of whom 18 had Tl-201 and 19 had Tc-99m sestamibi GSPECT poststress data collections, which were subsequently processed using quantitative gated SPECT software (Cedars Sinai Medical Center, Los Angeles, CA). These patients also had clinically indicated echocardiograms for assessment of wall thickness and possible valvular involvement. In addition, LV internal diameter and posterior wall thickness were measured at end-diastole by two-dimensional guided M-mode echocardiography to assess relative myocardial wall thickness, and LVM was measured by three-dimensional echocardiography using an acoustic spatial locator device. RESULTS:LVM values were not significantly different between GSPECT and three-dimensional echocardiography (153 +/- 39 g versus 146 +/- 35 g, respectively; P = NS). GSPECT correlated significantly (r = 0.63, P < 0.0001) with three-dimensional echocardiography, with a mean difference of 7 +/- 32 g but a substantial root mean squared error of 31 g. Results were similar for similar mass ranges when subgrouped by isotope and by the presence of significant myocardial perfusion defects. Results were independent of relative myocardial wall thickness determined by two-dimensional echocardiography. The two methods yielded similar results in the highest mass range of 400 to 500 g. CONCLUSIONS:GSPECT and three-dimensional echo LVM correlated significantly, but given the large spread of statistical errors, these two techniques should not be considered interchangeable. Because gamma camera resolution is limited, GSPECT LVM should be viewed as an approximation.