Background: Quantitative echo cardiographic assessment of right ventricular (RV) function is becoming of increasing interest in cardiac diseases that affect the right ventricle, such as congenital heart disease and acute or chronic pulmonary hypertension (PH),but is still challenging due to RV complex anatomy and structure. Aim of the Work: To study the effect of PH on the RV volumes and function using 2DE, 3DE and RV quantification by angiography in patients with PH secondary to congenital heart disease and to compare between 3D RV quantification by echocardiogram and invasive by angiography in patients with PH secondary to congenital heart disease. Patients and Methods: This cross sectional study included all patients with congenital heart diseases complicated by pulmonary hypertension referred to cardiology department in Ain shams university hospital for elective hemodynamic assessment.Results: The diagnostic accuracy of 3D RV and angiography (Ang.) RV parameters for detecting hemodynamic signs of pulmonary hypertension (a composite of PVR > 7) was shown by receiver-operating characteristic curves. The parameters with the largest areas under the curve (AUC) were: 3D tenting volume (1.
Background Three-dimensional speckle tracking echocardiography (STE) is an ideal modality for accurate assessment of myocardial deformation, the Novel 4D-Global Area strain (GAS) is a very sensitive parameter in detection of subtle changes involving the myocardium as it encompasses both global longitudinal and global circumferential strains . Objectives To investigate the predictive value of four dimensional (4D) strain echocardiography for major adverse cardio-vascular events (MACE) in ST-elevation acute myocardial infarction (STEMI) after successful reperfusion by primary PCI. Methods 171 patients who underwent successful primary PCI were enrolled and properly examined by 2D and 4D echocardiography with 4D strain parameters evaluation then followed up all-over a year for the occurrence of Major adverse Cardiovascular Events (MACE) . Results Thirty two MACE were recorded in 170 patients who completed the follow-up period for one year, compared with those without MACE, patients with MACE had PTCA done during the index Primary PCI intervention, had multi-vessel CAD affection, higher LVEDD, higher LVESD, lower 2D- LVEF, higher WMSI, higher baseline HR, higher EDV and ESV, lower 3D- LVEF, higher 3D-GLS, 3D-GCS and 3D-GAS with lower 3D-GRS, all with p-values < 0.005. Multi-variant logistic regression analysis showed that GAS was the most powerful predictor for MACE among our study population with the best cut-off value of 3D-GAS> -17, with p-value of (0.008) OR (20.668), CI (2.227-191.827) with relative risk of adverse events of 18.205 (95% CI 6.976- 47.506 – P value < 0.001). Conclusion Our data supports the superiority of 4D strain echocardiography parameters specially GAS for prediction of adverse clinical events among patients managed by successful primary PCI .
Background Functional single ventricle (FSV) is a spectrum of severe congenital heart disease, with multiple anatomic variations but similar surgical treatment strategies. FSV patients are living longer into adulthood compared to two or three decades ago, and they are more frequently undergoing imaging to assist in clinical and surgical management. Objective To determine impact of ventricular morphology on myocardial deformation in patients with single ventricle. Material and Methods From November 2017 to July 2018, 41 patients with single ventricle morphology or Physiology who were referred to Ain-Shams University hospitals for follow up Echocardiography or diagnostic cardiac catheterization were enrolled in the study.All patients subjected to history, clinical examination Echocardiography (conventional 2D and speckle tracking “global longitudinal strain and strain rate”.Dominant ventricular strain was analyzed using conventional two-dimensional echocardiographic. The region of interest was obtained by tracing the dominant ventricle endocardial borders at end-systole. An automated software program was used to calculate the frame-to-frame displacements of speckle pattern within the region of interest throughout the cardiac cycle. Results There is statiscially significance between the basic anatomy of the single ventricle and the ejection fraction (p value 0.001) and global longitudinal strain pattern by speckle tracking echocardiography with (p value 0.031) with no statistically effect of the side of dominance. Conclusion: Regarding the side of dominant ventricle there is no significant relation between the side of dominant ventricle on myocardial deformation (by ejection fraction, global strain and strain rate by speckle tracking echocardiography) but there is significant relation between the ventricular morphology and the myocardial deformation that was assessed by by the ejection fraction and global longitudinal strain (by speckle tracking echocardiography) but with no significant effect on the strain rate (by speckle tracking echocardiography)
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