GWI is a potential new technique that allows better understanding of the relationship between LV remodelling and increased wall stress under different loading conditions.

Background: Noninvasive detection of functionally significant coronary artery disease (CAD) by echocardiography remains challenging, with the need to perform stress imaging to detect ischemia. The aim of this study was to determine whether global myocardial work (MW), derived from noninvasive left ventricular (LV) pressure-strain loops at rest, can predict significant CAD in patients without regional wall motion abnormalities and preserved LV ejection fraction (EF). Methods: One hundred and fifteen patients referred for coronary angiography who had EF $ 55%, no resting regional wall motion abnormalities, and no chest pain were assessed using echocardiography. Global MW was derived from noninvasive LV pressure-strain loops constructed from speckle-tracking echocardiography indexed to brachial systolic blood pressure. Global constructive work represented the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation. Global wasted work represented energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation. Global MW efficiency was derived from the percentage ratio of constructive work to the sum of constructive work and wasted work. Results: Patients with significant CAD demonstrated a significantly reduced global MW (P < .001) compared with those without CAD. Global longitudinal strain was significantly reduced (P < .001) in patients with multivessel CAD but not those with single-vessel CAD (P = .47). Receiver operating characteristic curve analysis demonstrated that global MW was the most powerful predictor of significant CAD (area under the curve = 0.786) and was superior to global longitudinal strain (area under the curve = 0.693). The optimal cutoff global MW value to predict significant CAD was 1,810 mm Hg% (sensitivity, 92%; specificity, 51%). Conclusions: Noninvasive global MW derived using LV pressure-strain loops at rest is a more sensitive index than global longitudinal strain to detect significant CAD in patients with no regional wall motion abnormalities and normal EF. This is a potential valuable clinical tool to assist in the early diagnosis of CAD.

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BackgroundMany echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR).Methods and results92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland–Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes.ConclusionAs compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.

This study revealed that both trainee sonographers and TOE proceduralists found the simulation process was realistic, helped in image acquisition and improved assessment of spatial relationships. Echocardiographic simulators may play an important role in the future training of echocardiographic skills.

In light of the rapidly evolving COVID-19 pandemic, it was considered important for the CSANZ Imaging Council to provide a position statement to guide clinical practice and facilitate resource and service planning appropriately.This statement represents expert consensus opinion, available evidence and international guidelines. Given the changing nature of our understanding of COVID-19, institutional protocols should increasingly be guided by evidence-based practices and recommendations.It is important to emphasise that this is a general statement and that individual laboratories should consider their unique circumstances in adapting this statement to their situation. We are mindful that we cannot totally stop providing outpatient services until we reach a critical stage (as advised by state and local health networks). However, rationalising resources and services to prepare for the pandemic and demand is crucial.

The prevalence of Pompe disease in western Sweden (3 in 1.27 million or 0.24 per 100.000 inhabitants) is lower than in the Netherlands and New York. Re-evaluation of patients with myopathies but without definite diagnosis is rewarding since 12 of 82 patients in our study had a definite molecular diagnosis after workup.