In the present multicentre study analysing a large cohort of healthy subjects and patients with LVDD, the normal range and the clinical relevance of the myocardial function of the LA using 2DSTE have been determined.

Intrahepatic cholangiocarcinomas were classified into two types based on their microscopic appearance. Tumors with histologic similarities to hilar cholangiocarcinomas (predominantly ductal adenocarcinomas with minor tubular components, if present, restricted to the invasive front) were defined as the perihilar type, whereas the others were classified as peripheral cholangiocarcinomas. Among the 47 cases examined in the present study, 26 (55%) were classified as the perihilar type, whereas 21 (45%) were the peripheral type. The perihilar type had higher pT stages and more frequently showed a periductal-infiltrating gross appearance and microscopic perineural infiltration than peripheral cholangiocarcinomas. The presence of low-grade biliary intraepithelial neoplasia in the adjacent bile ducts was only found in perihilar cholangiocarcinomas (6/21, 29%). The immunophenotype also differed between the two types with MUC5AC and MUC6 being more commonly expressed in the perihilar type. One-third of perihilar cholangiocarcinomas lacked the expression of SMAD4, suggesting SMAD4 mutations, whereas the loss of BAP1 expression and IDH1 mutations were almost restricted to the peripheral type (35 and 15%, respectively). Patients with perihilar cholangiocarcinoma had worse overall survival than those with peripheral cancer (P=0.027). A multivariate analysis identified the histologic classification as an independent prognostic factor (P=0.005, HR=3.638). Comparisons between intrahepatic and hilar cholangiocarcinomas also revealed that the molecular features and prognosis of perihilar cholangiocarcinomas were very similar to those of hilar cholangiocarcinomas. In conclusion, this histology-based classification scheme of intrahepatic cholangiocarcinomas will be useful and clinically relevant because it represents different underlying molecular features and has an independent prognostic value.

R ight ventricular (RV) function is closely coupled with subsequent morbidity and mortality in patients with diseases affecting the right heart chambers. [1][2][3][4][5][6][7] The most common cause of RV dysfunction is chronic left-sided heart failure. Complex factors such as pulmonary hypertension, intrinsic myocardial involvement, ventricular interdependence, and myocardial ischemia lead to RV dysfunction. 1 Therefore, assessment of RV function is clinically important in almost all patients with heart disease. However, the complex geometry of the RV poses a significant limitation to the reliable quantitation of RV volumes and ejection fraction (RVEF) using 2-dimensional transthoracic echocardiography. Although cardiac magnetic resonance (CMR) imaging is the gold standard for the evaluation of RV volumes and RVEF, 8,9 factors such as cost, portability, time consumption, and contraindications hinder its routine use in every patient. Three-dimensional transthoracic echocardiography (3DTTE) has the advantage of full-volume acquisition of the entire right ventricle, which may overcome the technical and clinical limitations of 2-dimensional transthoracic echocardiography. [10][11][12] Recent studies have validated the accuracy of 3DTTE-determined RV volumes and RVEF against CMR 13,14 and determined the reference values of RV volumes and RVEF in healthy subjects. 15,16 However, the prognostic value of RVEF is largely unknown. We hypothesized that RVEF assessed by 3DTTE (3DRVEF) would offer incremental value over left ventricular (LV) functional parameters for predicting future cardiac events. See Editorial by Fernández-Golfín and Zamorano See Clinical PerspectiveAccordingly, the aims of this study were (1) to validate the accuracy of 3DTTE-determined RV volumes and RVEF against CMR reference and (2) to evaluate the prognostic value of 3DRVEF to predict future cardiac death and major adverse cardiac events (MACEs) in a large number of patients.Background-Cardiac magnetic resonance is the gold standard for the evaluation of right ventricular (RV) volumes, but it is impractical to perform in every patient. Although reference values of RV volumes and RV ejection fraction by 3D transthoracic echocardiography (3DTTE) have been established, their prognostic values have not been elucidated yet. We hypothesized that RV ejection fraction measured by 3DTTE (3DRVEF) predicts future cardiovascular events. Methods and Results-In protocol 1, we determined the accuracy of RV volumes and RV ejection fraction measurements by 3DTTE against cardiac magnetic resonance in 60 subjects. In protocol 2, 3DRVEF was measured in 446 patients with various cardiovascular diseases. Study subjects were followed up to record cardiac death and major adverse cardiovascular events. In protocol 1, 3DTTE-determined RV end-diastolic volume, end-systolic volume, and RV ejection fraction had good correlations to those by cardiac magnetic resonance (r=0.74-0.90). In protocol 2, 38 cardiac deaths and 88 major adverse cardiovascular events occurred during a med...

No abstract

Automated 3DE analysis of left-heart chambers is an accurate alternative to conventional manual methodology, which yields almost the same values across laboratories and is more reproducible. This technique may contribute towards full integration of 3DE quantification into clinical routine.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ecause of the rapid increase in cases of calcific aortic stenosis (AS) in industrialized countries, there are increasing numbers of symptomatic elderly patients who do not undergo aortic valve surgery because the surgical intervention poses significant risks related to coexisting comorbidities. 1,2 As a result, there are growing concerns regarding the poor prognosis of these patients and the increased associated medical costs. 3 Transcatheter aortic valve implantation (TAVI) has recently emerged as an alternative to surgery in high-risk patients with AS. 4-7 Detailed anatomical information regarding the aortic root geometry is important for selecting candidates for successful TAVI while avoiding associated complications. Recent studies have reported that multidetector computed tomography (MDCT) provides 3-dimensional (D) morphological information on the geometry of the aortic root, as well as the spatial relationship between the aortic annulus and the ostia of the left and right coronary arteries (LCA and RCA, respectively). 8-11 However, because of its known limitations, MDCT cannot be performed in all patients.Real-time 3D transesophageal echocardiography (3DTEE) has the potential to provide 3D information regarding aortic root morphology. We hypothesized that real-time 3DTEE could be a useful alternative for assessing aortic root geometry. Accordingly, the aims of this study were: (1) to validate 3DTEE measurements of aortic root using MDCT measurements as a reference, and (2) to examine whether the aortic root geometry differs between patients with and without AS. Methods Study PopulationProtocol 1 We retrospectively enrolled 35 patients referred for MDCT coronary angiography who underwent Background: Precise evaluation of the aortic root geometry prior to transcatheter aortic valve implantation is important for procedural success in patients with aortic stenosis (AS). To determine the potential for 3-dimensional transesophageal echocardiography (3DTEE), the aims of the present study were: (1) to assess the accuracy of 3DTEE measurements of the aortic root using multidetector computed tomography (MDCT) as a reference, and (2) to examine whether aortic root geometry differs between patients with and without AS.

No abstract

LAVIs by both 2DE and 3DE are powerful predictors of future cardiac events. 3D LAVImin tended to have a stronger and additive prognostic value than 3D LAVImax.