The S-wave angle identifies arrhythmogenic right ventricular cardiomyopathy in patients with electrocardiographically concealed disease phenotype

Background

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) carries risk of sudden death. We hypothesize that the S-wave angle differentiates ARVD/C with otherwise normal electrocardiograms from controls.

Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values

Background: Three‐dimensional echocardiography (3DE) allows accurate estimation of left ventricular (LV) volumes and function in children. Because of the peculiar morphology of the right ventricle (RV), RV volumes and function assessment remain challenging. 3D software adapted for RV morphology is a promising noninvasive method. Aims: The aims of this study were to evaluate the feasibility of 3D RV analysis in a normal pediatric population and to compare 3D RV to 3D LV measurements. Patients and methods: 3D transthoracic echocardiography was performed in 50 patients (mean age 9.5 years ± 5.1) with normal cardiac anatomy and function. Measurements were performed with the X3‐1 or the X7‐2 matrix probe (iE33, Philips Medical Systems, Andover, MA, USA). Ventricular volumes were analyzed with dedicated analysis software (TomTec Imaging Systems, Munich, Germany). Results: Measurements were possible in 100% of LVs and 94% of RVs. The stroke volumes of the two ventricles correlated well (r = 0.81 [95% CI, 0.68–0.89], P < 0.0001) with a mean difference of 3.6 mL (±9.2). Compared to the LV, the RV had higher mean end‐diastolic volume (53 mL [±29] versus 46 mL [±46], P = 0.020) and end‐systolic volume (29 mL [±17] versus 17 mL [±12], P < 0.0001) but lower mean ejection fraction (49%[±8] versus 67%[±10], P < 0.0001). Conclusion: 3DE using dedicated software is a feasible and reproducible method for RV volume quantification in children with normal hearts. Further studies are needed to validate the accuracy of the measurements. (Echocardiography 2012;29:492‐501)     

Evaluation of two,commercial, multi‐dye,nucleic acid amplification technology tests,for HBV/HCV/HIV‐1/HIV‐2 and B19V/HAV,for screening blood and plasma for further manufacture

Background The cobas^® TaqScreen MPX Test, version 2.0, a multiplex, multi‐dye nucleic acid amplification technology (NAT) test from Roche was evaluated by two European Blood Banks, the German Red Cross Blood Donor Service, Frankfurt, Germany and Centro de Hemoterapia y Hemodonación de Castilla y León, Valladolid, Spain. In addition, the cobas^® TaqScreen DPX Test was evaluated for the simultaneous detection and quantitation of parvovirus B19 and the detection of hepatitis A virus (HAV). Study Design and Methods The performances of the two tests were evaluated regarding the analytical sensitivity, the reproducibility of the tests using samples containing low concentrations of each virus and cross‐contamination using samples containing high titres of virus. Results The analytical sensitivity of the MPX Test, version 2.0, obtained by the German Red Cross Blood Donor Service was 1·1, 3·9 and 43·3 IU/ml for HBV, HCV and HIV‐1, respectively. The comparable analytical sensitivity at Centro de Hemoterapia y Hemodonación de Castilla y León was 3·5, 17·6 and 50·6 IU/ml for HBV, HCV and HIV‐1, respectively. The analytical sensitivity of the DPX test determined by the German Red Cross Blood Donor Service was 0·6 and 3·8 IU/ml for HAV and B19. Conclusion These multiplex and multi‐dye blood screening assays represent a flexible NAT screening system for mini‐pools between 6 and 96 samples per pool and fulfil all requirements of the European Pharmacopoeia for HCV and B19V testing of plasma for fractionation. The inclusion of a new multi‐dye technology means discriminatory assays are no longer required for either test thus improving workflow, turn‐around time and minimize the risk of obtaining a reactive result for which the virus cannot be identified.     

Saline Contrast Echocardiography in the Era of Multimodality Imaging—Importance of “Bubbling It Right”

Saline contrast echocardiography is an established imaging modality. Logical interpretation of a carefully performed study is vital to realize its diagnostic potential. In this review, we discuss utility of saline contrast echocardiography in evaluation of various pathologies within and outside the heart other than a patent foramen ovale.     

Right atrial size relates to right ventricular end-diastolic pressure in an adult population with congenital heart disease

Aim: Noninvasive markers of right ventricular (RV) diastolic dysfunction are limited by their lack of reproducibility and accuracy. We tested the hypothesis that right atrial (RA) size measured by echocardiography was correlated to invasive parameters of RV diastolic filling. Methods and Results: We studied 31 consecutive adult patients with congenital heart disease. From 2D echocardiography images, we measured maximal RA long‐axis and short‐axis lengths, area and volume. We compared each of these measures to right ventricular end‐diastolic pressure (RVEDP) and mean right atrial pressure (mRAP) measured by right heart catheterization. RA long‐axis, short‐axis, area, and volume correlated significantly with RVEDP (r = 0.78, P < 0.001; r = 0.61, P < 0.001; r = 0.79, P < 0.001; and r = 0.75, P < 0.001, respectively) and mRAP (r = 0.66, P < 0.001; r = 0.56, P = 0.002; r = 0.70, P < 0.001; r = 0.68, P < 0.001, respectively). Single cut points for each echocardiographic parameter demonstrated reasonable accuracy to rule‐in and rule‐out RVEDP ≥7 mm Hg (sensitivity = 74%, specificity = 82%, positive LR = 4.1, negative LR = 0.32 for RA long‐axis of 49 mm; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.12 for RA area of 14 cm²; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.13 for RA volume of 37 mL). Conclusion: RA size measured by echocardiography is strongly correlated to invasive parameters of RV diastolic filling and predicts high RV end‐diastolic pressure. (Echocardiography 2011;28:109‐116)     

Exploring Self‐Neglect in Older Adults: Preliminary Findings of the Self‐Neglect Severity Scale and Next Steps

Despite the public health implications of self‐neglect, no tool exists for characterizing this condition. Self‐neglecters often have no caregivers or surrogates to interview regarding the neglect and are often too cognitively impaired to provide valid self‐reports. In response to this need, researchers from the Consortium for Research in Elder Self‐neglect of Texas (CREST) collaborated with other experts in the field of elder self‐neglect to design the Self‐neglect Severity Scale (SSS). The SSS assesses three domains of self‐neglect (hygiene, functioning, and environment) and relies on observational ratings assigned by trained observers. After pilot testing and revision, the SSS was field tested in the homes of subjects who had been reported to and substantiated by Texas Adult Protective Services (APS) as self‐neglecting and compared with results of subjects recruited from a local geriatric clinic who were reported to APS but had no history of self‐neglect. The first field test demonstrated that the SSS could distinguish elderly self‐neglecters from community dwellers who do not self‐neglect. The SSS exhibited adequate scale reliability (Cronbach alpha) and correlation with case status. Interrater reliability also appeared adequate, although sensitivity and specificity fell below the conventional acceptable range. Future methods are proposed for refining the SSS to improve its use as the benchmark for identifying elder self‐neglect.     

Incremental value of three‐dimensional transthoracic echocardiography over the two‐dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum

The usefulness of two‐dimensional transthoracic echocardiography (2DTTE) in the assessment of right heart compression and dysfunction produced by pectus excavatum chest wall deformity has been well described in the literature by several investigators. However, there is a paucity of reports describing incremental value of live/real time three‐dimensional transthoracic echocardiography (3DTTE) over the two‐dimensional technique in the evaluation of right heart function in these patients. We present a severe case of pectus excavatum chest wall deformity in a young male, in whom 3DTTE provided incremental value over standard 2DTTE in assessing compression of the right heart before surgery and marked improvement in right heart function parameters following surgical repair. In addition, an updated summary of salient features of this deformity, including 2D and 3DTTE findings as well as right heart echocardiographic parameters by both 2D and 3DTTE in normal/healthy subjects summarized from the literature have been provided in a tabular form for comparison.     

Right bundle-branch block unmasking a myocardial infarction

A patient with an acute anteroseptal myocardial infarction and intermittent right bundle-branch block is presented. Abnormal Q waves in right precordial leads were only observed during right bundle-branch block. In the absence of right bundle-branch block, depolarization of the right ventricular free wall concealed the abnormal Q waves typical of an anteroseptal infarct. Right bundle-branch block, by preventing early activation of the right ventricular free wall, facilitated the correct diagnosis and localization of the infarction.     

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

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.     

Progressive dyspnea and signs of right heart dysfunction

A 40‐year‐old woman was admitted due to dyspnea and fever. Transthoracic echocardiography revealed signs of right heart volume overload and vegetations on the tricuspid valve with insufficiency. Transesophageal echocardiography showed a sinus venosus defect (SVD) with significant left‐to‐right shunt. Computed tomography scanning was primarily performed to rule out pulmonary embolism; however, it showed interatrial communication. Due to the concomitant tricuspid insufficiency with additional volume overload, the diagnosis of SVD was more challenging. Usually, transthoracic echocardiography remains the initial diagnostic imaging modality; however, detection rates are very low. Therefore, further imaging is mandatory in unexplained substantial right heart dilatation.     

Incremental Value of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Right Ventricular Masses

This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients.