R ight ventricular (RV) volumes and ejection fraction (EF)are important determinants of survival in patients with myocardial infarction, 1 systolic heart failure, 2-4 congenital heart disease, 5 and pulmonary arterial hypertension.6 Clinical Perspective on p 710Cardiac magnetic resonance (CMR) is the current gold standard for quantitation of RV geometry and function, but its widespread use is limited by costs, time consumption, and contraindications, making it unsuitable for patient screening or monitoring on large scale.One of the major breakthroughs of transthoracic threedimensional echocardiography (3DE) is the ability to measure RV volumes and EF, otherwise not feasible by standard two-dimensional (2D) echocardiography. 7 However, recent recommendations for RV quantitation 8 indicated that limited normative data are currently available for 3DE and, despite significant differences by age and sex for RV geometry and function were identified by CMR, 9 no reliable age-or sexspecific reference values can be recommended at present for 3DE. Paralleling the findings obtained with CMR, 9 we hypothesized that RV volumes and EF measured by 3DEBackground-Right ventricular (RV) volumes and ejection fraction (EF) vary significantly with demographic and anthropometric factors and are associated with poor prognosis in several cardiovascular diseases. This multicenter study was designed to (1) establish the reference values for RV volumes and EF using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on RV anatomy; (3) develop normative equations. Methods and Results-RV volumes (end-diastolic volume and end-systolic volume), stroke volume, and EF were measured by 3D echocardiography in 540 healthy adult volunteers, prospectively enrolled, evenly distributed across age and sex. The relation of age, sex, and body size parameters was investigated using bivariate and multiple linear regression. Analysis was feasible in 507 (94%) subjects (260 women; age, 45±16 years; range, 18-90). Age, sex, height, and weight significantly influenced RV volumes and EF. Sex effect was significant (P<0.01), with RV volumes larger and EF smaller in men than in women. Older age was associated with lower volumes (end-diastolic volume, −5 mLdecade; endsystolic volume, −3 mL/decade; EF, −2 mL/decade) and higher EF (+1% per decade). Inclusion of body size parameters in the statistical models resulted in improved overall explained variance for volumes (end-diastolic volume, R 2 =0.43; end-systolic volume, R 2 =0.35; stroke volume, R 2 =0.30), while EF was unaffected. Ratiometric and allometric indexing for age, sex, and body size resulted in no significant residual correlation between RV measures and height or weight. Conclusions-The MethodsHealthy volunteers were prospectively enrolled in 3 Italian tertiary centers (C1, C2, C3) having a large expertise in 3DE for RV quantification (>400 studies/y per center for both clinical and research purposes). Participating centers were asked to provi...

In patients with LVNC evaluated by using CMR, the degree of LV trabeculation seems to have no prognostic impact over and above LV dilation, LV systolic dysfunction, and presence of LGE.

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PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status.

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The applied method was feasible and accurate in normal and regurgitant valves, and may potentially have an impact on diagnosis, improvement of surgical techniques and design of annular prostheses.

ObjectiveMitral annular disjunction (MAD) is an abnormality linked to mitral valve prolapse (MVP), possibly associated with malignant ventricular arrhythmias. We assessed the agreement among different imaging techniques for MAD identification and measurement.Methods131 patients with MVP and significant mitral regurgitation undergoing transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) were retrospectively enrolled. Transoesophageal echocardiography (TOE) was available in 106 patients. MAD was evaluated in standard long-axis views (four-chamber, two-chamber, three-chamber) by each technique.ResultsConsidering any-length MAD, MAD prevalence was 17.3%, 25.5%, 42.0% by TTE, TOE and CMR, respectively (p<0.05). The agreement on MAD identification was moderate between TTE and CMR (κ=0.54, 95% CI 0.49 to 0.59) and good between TOE and CMR (κ=0.79, 95% CI 0.74 to 0.84). Assuming CMR as reference and according to different cut-off values for MAD (≥2 mm, ≥4 mm, ≥6 mm), specificity (95% CI) of TTE and TOE was 99.6 (99.0 to 100.0)% and 98.7 (97.4 to 100.0)%; 99.3 (98.4 to 100.0)% and 97.6 (95.8 to 99.4)%; 97.8 (96.2 to 99.3)% and 93.2 (90.3 to 96.1)%, respectively; sensitivity (95% CI) was 43.1 (37.8 to 48.4)% and 74.5 (69.4 to 79.5)%; 54.0 (48.7 to 59.3)% and 88.9 (85.2 to 92.5)%; 88.0 (84.5 to 91.5)% and 100.0 (100.0 to 100.0)%, respectively. MAD length was 8.0 (7.0-10.0), 7.0 (5.0-8.0], 5.0 (4.0-7.0) mm, respectively by TTE, TOE and CMR. Agreement on MAD measurement was moderate between TTE and CMR (ρ=0.73) and strong between TOE and CMR (ρ=0.86).ConclusionsAn integrated imaging approach could be necessary for a comprehensive assessment of patients with MVP and symptoms suggestive for arrhythmias. If echocardiography is fundamental for the anatomic and haemodynamic characterisation of the MV disease, CMR may better identify small length MAD as well as myocardial fibrosis.

Background Post-procedural aortic regurgitation (AR) has been described in a large number of patients receiving transcatheter aortic valve implantation (TAVI). Objective The aim of this study was to examine the intraoperative 2-dimensional (2D) and 3-dimensional (3D) echocardiographic features of the aortic valve associated with significant post-procedural paravalvular AR. Methods A total of 135 patients (8167 years) with severe symptomatic aortic stenosis, who underwent TAVI, were imaged with comprehensive 2D and 3D transoesophageal echocardiography before the procedure and peri-procedure. Various baseline and peri-procedural echocardiographic characteristics were tested to predict paravalvular AR post-TAVI: calcifications at the aortic valve commissures and leaflets, 'aortic annulus eccentricity index', 'area cover index', overlap between aortic prosthesis and anterior mitral leaflet. Post-procedural paravalvular AR$2 was considered significant. Results Successful TAVI was achieved in all patients. The incidence of paravalvular AR$2 immediately after the procedure was 21% (28 patients). Commissural calcifications and, particularly, the calcification of the commissure between the right coronary and noncoronary cusps was significantly more frequent in presence of paravalvular AR; the area cover index pre-TAVI was significantly lower among patients with AR (11.1611.8% vs 20.8612.5%, p¼0.0004). Multivariate analysis revealed that calcification of the commissure between the right coronary and non-coronary cusps (OR¼2.66, 95% CI 1.39 to 5.12, p¼0.001), and the area cover index pre-TAVI (OR¼0.95, 95% CI 0.91 to 0.99, p¼0.006) were the only independent predictors of significant paravalvular AR after TAVI. Conclusions Intraoperative 2D and 3D transoesophageal echocardiography identified calcification of the commissure between the right coronary and non-coronary cusps and the area cover index as independent predictors of significant paravalvular AR following TAVI.