Background. This study attempted to assess the value of analyzing the intensity of continuous-wave Doppler signals of aortic regurgitation (AR) by comparing the findings of conventional color flow mapping (CFM) and the decay of continuous-wave Doppler aortic regurgitant flow velocity pattern. Methods. Study population consisted of 50 consecutive patients with AR referred to the echocardiography laboratory of Hyogo College of Medicine Hospital in whom analyzable continuous-wave Doppler aortic regurgitant flow velocity pattern was obtained. In all of the patients, AR was graded by conventional CFM using a three-point scale, and the continuous-wave Doppler aortic regurgitant flow velocity pattern was provided for the determination of the decay and the intensity of AR signals. Intensity of the AR signal was standardized with the intensity of the signals of systolic ejection flow on the same recording. Results. There was a modest but statistically significant correlation between the CFM grading of AR and the standardized intensity of AR signals (r=0.42, n=50, p<0.01) and between the decay of continuous-wave Doppler aortic regurgitant flow velocity pattern and the standardized intensity of AR signals (r=0.55, n=50, p<0.01). Conclusions. Analysis of the intensity of continuous-wave Doppler signals of AR may be useful in noninvasive assessment of AR. Intense Doppler signals of AR are likely indicative of severe regurgitation.
Background. The apical approach (ApA) has been usually employed for the continuous-wave Doppler (CWD) measurement of pressure gradient in the left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to assess the usefulness of a left parasternal approach (LPA) using the most cranial part of the echo-window for the measurement of the LVOT pressure gradient. Methods. CWD using LPA and ApA was performed in 19 patients with HOCM to measure LVOT peak pressure gradients (PGLPA and PGApA, respectively) and record a signal of mitral regurgitation (MR). The beam incident angles to LVOT flow in LPA (θLPA) and in ApA (θApA) were measured using color Doppler flow imaging. Results. PGLPA was distinctly greater (>= 10mmHg) than PGApA in 7 patients (37%); they were similar in 6 (32%); and PGLPA was distinctly smaller (<= -10mmHg) than PGApA in 6 (32%). All patients had MR. While all the MR jets in ApA shifted away from the probe, i.e. to the same side of the LVOT flow, 18 of the 19 MR jets shifted to the opposite side of the LVOT flow, when using LPA. Cos θLPA was significantly smaller and Cos θApA was significantly greater in the HOCM patients than 10 control subjects (p<0.001 for both). Both PGLPA and PGApA correlated with the invasive pressure gradient (r=0.99 and r=0.97) in 7 patients who underwent invasive study. PGLPA was closer to the invasive pressure gradient than PGApA in 6 patients. Conclusions. LPA provided a more accurate measurement of pressure gradient than ApA in about one third of HOCM patients, probably due to the altered direction of LVOT flow in HOCM. LPA is also useful in distinguishing LVOT flow from MR jet commonly seen in these patients.
Background. Previously, there was no standard technique for accurately measuring papillary muscle (PM) function. The aim of the present study was to investigate PM contractility using myocardial strain imaging in patients with myocardial infarction. Methods. We recorded motion velocities using tissue velocity imaging and strains using myocardial strain imaging at the mid-portion of the posteromedial PM and at the mid-portion of the left ventricular (LV) inferior/posterior wall on the apical 2-chamber view in 29 patients. The patients were divided into 2 groups: a normal control (C) group (n=21; mean LV ejection fraction, 77±11%) and an inferior/posterior myocardial infarction (MI) group (n=8; mean LV ejection fraction, 59±17%). Results. There was no difference in mean age between the 2 groups (C; 55±16 years, MI; 65±11 years). The peak systolic velocities of the LV inferior/posterior wall were significantly lower in the MI group than in the C group (C; 9.1±3.0 cm/s, MI; 6.1±2.2 cm/s, p<0.05), whereas there was no difference in the peak velocities of the posteromedial PM between the 2 groups (C; 6.3±1.3 cm/s, MI; 5.3±1.0 cm/s). In contrast, the peak systolic strains in the MI group were significantly lower in both the LV inferior/posterior wall (C; -27±5%, MI; -16±5%, p<0.01) and the posteromedial PM (C; -26±5%, MI; -16±4%, p<0.01). Conclusions. These results suggest that myocardial strain imaging is more sensitive and accurate for determining PM contractility compared to tissue velocity imaging.
A 36-year-old female was referred to our hospital because of high fever for 5 days and abnormal behavior. She had a grade II pan-systolic murmur at the right sternal border and blood culture grew methicillin-sensitive Staphylococcus aureus. A transthorasic echocardiogram showed vegetation of the tricuspid valve and severe tricuspid regurgitation. A transesophageal echocardiogram also revealed atrial septal aneurysm and patent foramen ovale. One month after admission, elective valve replacement was performed due to refractory heart failure and uncontrolled infection. At the time of surgery, there was an anterior mitral leaflet perforation with vegetation and a destroyed tricuspid valve with huge vegetation; dual-sided infective endocarditis was disclosed.