Tomographic 3DE is an accurate noninvasive technique for calculating LV volumes and systolic function in patients with LV aneurysm. Unlike current 2D methods, tomographic 3DE requires no geometric assumptions that limit accuracy.

Three-dimensional echocardiography (3DE) provides volumetric measurements without geometric assumptions. Volume-rendered 3DE has been shown to be accurate for the measurement of right ventricular (RV) volumes in vitro and in animal studies; however, few data are available regarding its accuracy in patients. This study examined the accuracy of 3DE for quantitation of RV volumes and ejection fraction (EF) in patients, compared to magnetic resonance imaging (MRI) and radionuclide ventriculography (RNV). Twenty patients underwent MRI, gated equilibrium RNV, and 3DE using rotational acquisition from both the transesophageal and transthoracic approaches. RV volumes and EF were calculated from the 3DE data using multislice analysis (true Simpson's rule). RV volumes calculated by MRI (end-diastolic volume (EDV) 109.4 +/- 34.3 mls, end-systolic volume (ESV) 59.6 +/- 31.0 mls, and EF 47.7 +/- 17.1%) agreed closely with 3DE. For transesophageal echocardiography, EDV was 108.1 +/- 29.7 mls (r = 0.86, mean difference 1.3 +/- 17.8 mls); ESV was 62.5 +/- 23.8 mls (r = 0.85, mean difference 2.8 +/- 15.1 mls); and EF was 43.2 +/- 11.7% (r = 0.84, mean difference 4.5 +/- 9.7%). For transthoracic echocardiography, EDV was 107.7 +/- 27.5 mls (r = 0.85, mean difference 1.6 +/- 18.2 mls); ESV was 59.7 +/- 22.1 mls (r = 0.93, mean difference 3.2 +/- 19.6 mls); and EF was 45.2 +/- 11.5% (r = 0.86, mean difference 2.0 +/- 9.4%). There were close correlations, small mean differences and narrow limits of agreement between RNV-derived EF (43.4 +/- 12.1%) and both transesophageal (r = 0.95 mean difference 0.2 +/- 3.7%) and transthoracic 3DE (r = 0.95, mean difference 1.8 +/- 5.4%). Three-dimensional echocardiography is a promising new method of calculating RV volumes and EF, comparing well with MRI and RNV. The accuracy of transthoracic 3DE was comparable to that of the transesophageal approach. Three-dimensional echocardiography has the potential to be useful in the clinical assessment of RV disorders.

Background: Complete real-world data on the indications and outcomes of left atrial appendage closure (LAAC) outside of clinical trials are rare. In this study, we stratified patients undergoing LAAC by indication groups. Methods: This analysis of the national multicentre Austrian LAAC Registry comprised all patients that underwent LAAC up until 2018 at the currently active centres in Austria. The baseline characteristics, procedural details and outcomes between the following indication groups were compared: bleeding as an indication for LAAC (“bleeding” group) vs. thromboembolism despite oral anticoagulation (OAC; “thromboembolism” group) vs. an intolerance to OAC for reasons other than the above (“other” group). Results: The analysis included 186 patients, with 59.7% in the “bleeding” group, 8.1% in the “thromboembolism” group and 32.2% in the “other” group. The CHADS2 score was the highest in the “thromboembolism” group and the HAS-BLED score was the highest in the “bleeding” group. The procedural outcomes were similar between groups (implantation success, 97.3%), with major complications occurring in 7.0% of patients. One-year survival free from stroke, bleeding or LAAC-associated hospitalisation was 83.9%, 90.0% and 81.4% in the “bleeding”, “thromboembolism” and “other” groups, respectively (p = 0.891). Conclusions: In routine clinical practice, LAAC was used in a heterogeneous patient population with atrial fibrillation (AF) and contraindication, inefficacy or intolerance to OAC. The long-term outcome was favourable in all groups.

Ultrasound can be exploited to derive therapeutic results by using its bioeffects such as creation of mechanical vibrations, localized cavitations, microstream formation, physicochemical changes and thermal energy. Extensive in vitro and animal investigations during the last 2 decades have laid a foundation for ultrasound energy to be used for treatment purposes in various medical specialties. In the area of cardiovascular diseases, ultrasound could be used for thrombolysis, adjunct to coronary interventions, drug delivery, local gene transfer, and creating therapeutic lesions. The dispensation approaches to therapeutic ultrasound are varied, from the use of low- to medium-range frequency, low to focused high intensity, and catheter-based to external devices. Catheter-based ultrasound could be useful for intracoronary thrombolysis, and external ultrasound instrument with transcutaneous delivery could be of use in applications such as creation of myocardial lesions, peripheral vessel thrombolysis, and drug and gene delivery. Adjunct administration of microbubbles has been found to enhance thrombolysis, and drug and gene therapy. Ongoing studies strongly suggest that therapeutic ultrasound could have an important role in cardiovascular disorders associated with thrombosis, inflammation, atherosclerotic disease, and arrhythmias.

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