Noninvasive Cardiology Unit

San Raffaele Cimena, Italy

Noninvasive Cardiology Unit

San Raffaele Cimena, Italy

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Blondheim D.S.,Noninvasive Cardiology Unit | Blondheim D.S.,Technion - Israel Institute of Technology | Vassilenko L.,Hillel Yaffe Medical Center | Vassilenko L.,Technion - Israel Institute of Technology | And 14 more authors.
Journal of Cardiology | Year: 2016

Objective: Clinical follow-up of aortic dimensions is performed interchangeably by multi-detector computed tomography (MDCT) and by cardiac echocardiography (ECHO). This study assesses the relationship between measurements of the aortic diameter by MDCT and ECHO at various predetermined locations using several methods. Methods: The aortic diameter was measured at 6 locations between the aortic annulus and the aortic arch in 49 patients who underwent both MDCT and ECHO. Measurements were performed by three methods: internal-to-internal edge (INT), external-to-internal edge (MIX), and external-to-external edge (EXT). Measurements by MDCT and ECHO were made by an experienced radiologist and cardiologist, respectively, both blinded to results and images from the other modality. Results: The average aortic diameter at all locations was significantly different between the MDCT and ECHO by all three methods (INT: 30.0 ± 5.8 mm vs. 27.8 ± 5.9 mm; MIX: 31.5 ± 5.8 mm vs. 30.8 ± 5.8 mm; EXT: 32.9 ± 6.6 mm vs. 33.8 ± 6.5 mm, p < 0.002 for all). While mean absolute differences between INT and EXT methods were similar (3.5 ± 3.1 mm and 3.4 ± 2.7 mm, respectively), the absolute difference using the MIX method was significantly smaller (3.1 ± 2.8 mm; p < 0.001 for INT vs. MIX; p < 0.05 for EXT vs. MIX). Conclusions: There is considerable variability between MDCT and ECHO measurements of the ascending aorta. Measuring the aortic diameter by the MIX provides the closest measurements and is advised for long-term follow-up. © 2015 Japanese College of Cardiology.


PubMed | Noninvasive Cardiology Unit and Hillel Yaffe Medical Center
Type: Comparative Study | Journal: Journal of cardiology | Year: 2016

Clinical follow-up of aortic dimensions is performed interchangeably by multi-detector computed tomography (MDCT) and by cardiac echocardiography (ECHO). This study assesses the relationship between measurements of the aortic diameter by MDCT and ECHO at various predetermined locations using several methods.The aortic diameter was measured at 6 locations between the aortic annulus and the aortic arch in 49 patients who underwent both MDCT and ECHO. Measurements were performed by three methods: internal-to-internal edge (INT), external-to-internal edge (MIX), and external-to-external edge (EXT). Measurements by MDCT and ECHO were made by an experienced radiologist and cardiologist, respectively, both blinded to results and images from the other modality.The average aortic diameter at all locations was significantly different between the MDCT and ECHO by all three methods (INT: 30.05.8mm vs. 27.85.9mm; MIX: 31.55.8mm vs. 30.85.8mm; EXT: 32.96.6mm vs. 33.86.5mm, p<0.002 for all). While mean absolute differences between INT and EXT methods were similar (3.53.1mm and 3.42.7mm, respectively), the absolute difference using the MIX method was significantly smaller (3.12.8mm; p<0.001 for INT vs. MIX; p<0.05 for EXT vs. MIX).There is considerable variability between MDCT and ECHO measurements of the ascending aorta. Measuring the aortic diameter by the MIX provides the closest measurements and is advised for long-term follow-up.


Losi M.-A.,University of Naples Federico II | Nistri S.,CMSR Veneto Medica Altavilla Vicentina | Galderisi M.,University of Naples Federico II | Betocchi S.,University of Naples Federico II | And 11 more authors.
Cardiovascular Ultrasound | Year: 2010

Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiomyopathy. The identification of patients with HCM is sometimes still a challenge. Moreover, the pathophysiology of the disease is complex because of left ventricular hyper-contractile state, diastolic dysfunction, ischemia and obstruction which can be coexistent in the same patient. In this review, we discuss the current and emerging echocardiographic methodology that can help physicians in the correct diagnostic and pathophysiological assessment of patients with HCM. © 2010 Losi et al; licensee BioMed Central Ltd.


Mele D.,Azienda Ospedaliera Universitaria | Agricola E.,Noninvasive Cardiology Unit | Monte A.D.,Azienda Ospedaliera Universitaria | Galderisi M.,University of Naples Federico II | And 8 more authors.
International Journal of Cardiology | Year: 2013

Background: In patients with ischemic heart failure undergoing cardiac resynchronization therapy (CRT) the underlying myocardial substrate at the left ventricle (LV) pacing site may affect CRT response. However, the effect of delivering the pacing stimulus remote, adjacent to or over LV transmural scar tissue (TST) identified by echocardiography is still unknown. Methods: First, 35 patients with healed myocardial infarction (57 ± 11 years) were prospectically studied to demonstrate the capability of echocardiographic end-diastolic wall thickness (EDWT) to identify LV-TST as defined by delayed enhancement magnetic resonance imaging (DE-MRI). Subsequently, in 136 patients (65 ± 10 years) who underwent CRT, EDWT was retrospectively evaluated at baseline. The LV catheter placement was defined over, adjacent to and remote from TST if pacing was delivered at a scarred segment, at a site 1 segment adjacent to or remote from scarred segments. CRT response was defined as LV end-systolic volume (ESV) decrease by at least 10% after 6 months. Results: A EDWT ≤ 5 mm identified TST at DE-MRI with 92% sensitivity and 96% specificity. In the 76 CRT responders, less overall and posterolateral TST segments and more segments paced remote from TST areas were found. At the multivariate regression analysis, the number of TST segments and scar/pacing relationship showed a significant association with CRT response. Conclusions: In addition to LV global scar burden, CRT response relates also to the myocardial substrate underlying pacing site as evaluated by standard echocardiography. This information may expand the role of echocardiography to guide pacing site avoiding pacing at TST areas. © 2011 Elsevier Ireland Ltd.


Grupper A.,Noninvasive Cardiology Unit | Grupper A.,Tel Aviv University | Beigel R.,Noninvasive Cardiology Unit | Beigel R.,Tel Aviv University | And 14 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objective The outcome of aortic valve replacement for patients with low gradient severe aortic stenosis and preserved ejection fraction has been debated. The aim of the present study was to evaluate the effect of aortic valve intervention on survival in that group.© 2014 The American Association for Thoracic Surgery Methods A cohort of 416 consecutive patients with low gradient severe aortic stenosis (aortic valve area, ≤1 cm2 mean pressure gradient, <40 mm Hg) and preserved ejection fraction (≥50%) were identified from the Sheba Medical Center echocardiography database. Clinical data, aortic valve intervention, and death were recorded.Results During an average follow-up of 28 months, of 416 study patients (mean age, 76 ± 14 years, 42% men), 97 (23%) underwent aortic valve intervention and 140 (32%) died. Mantel-Byar analysis showed that the cumulative probability of survival was significantly greater after aortic valve intervention. Multivariate analysis revealed a 49% reduction in the risk of death after surgery (P <.05). The survival benefit of aortic valve intervention was comparable with adjustment to older age, aortic valve area ≤ 0.8 cm2, and a low (≤35cm2/m2) or normal (>35 cm2/m2) stroke volume index.Conclusions Our findings suggest that aortic valve intervention is associated with improved survival among patients with low gradient severe aortic stenosis and preserved left ventricular function. The presence of either a low or normal stroke volume index did not affect the mortality benefit.


Yosefy C.,Ben - Gurion University of the Negev | Yosefy C.,Noninvasive Cardiology Unit | Azhibekov Y.,Ben - Gurion University of the Negev | Brodkin B.,Ben - Gurion University of the Negev | And 3 more authors.
Cardiovascular Ultrasound | Year: 2016

Background: Not all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones "online" for bedside measurements. Thus, we hypothesized that a simple and rapid rotation of the sagittal view (green box, x-plane) that shows all needed left atrial appendage (LAA) number of lobes, orifice area, maximal and minimal diameters and depth parameters on the 3D transesophageal echocardiography (3DTEE) image and LAA measurements after turning the images into 2D (Rotational 3DTEE/"Yosefy Rotation") is as accurate as the direct measurement on real-time-3D image (RT3DTEE). Methods: We prospectively studied 41 consecutive patients who underwent a routine TEE exam, using QLAB 10 Application on EPIQ7 and IE33 3D-Echo machine (BORTHEL Phillips) between 01/2013 and 12/2015. All patients underwent 64-slice CT before pulmonary vein isolation or for workup of pulmonary embolism. LAA measurements were compared between RT3DTEE and Rotational 3DTEE versus CT. Results: Rotational 3DTEE measurements of LAA were not statistically different from RT3DTEE and from CT regarding: number of lobes (1.6 ± 0.7, 1.6 ± 0.6, and 1.4 ± 0.6, respectively, p = NS for all); internal area of orifice (3.1 ± 0.6, 3.0 ± 0.7, and 3.3 ± 1.5 cm2, respectively, p = NS for all); maximal LAA diameter (24.8 ± 4.5, 24.6 ± 5.0, and 24.9 ± 5.8 mm, respectively, p = NS for all); minimal LAA diameter (16.4 ± 3.4, 16.7 ± 3.3, and 17.0 ± 4.4 mm, respectively, p = NS for all), and LAA depth (20.0 ± 2.1, 19.8 ± 2.2, and 21.7 ± 6.9 mm, respectively, p = NS for all). Conclusion: Rotational 3DTEE method for assessing LAA is a simple, rapid and feasible method that has accuracy similar to that of RT3DTEE and CT. Thus, rotational 3DTEE ("Yosefy rotation") may facilitate LAA closure procedure by choosing the appropriate device size. © 2016 The Author(s).


Carasso S.,Noninvasive Cardiology Unit | Carasso S.,Technion - Israel Institute of Technology | Mutlak D.,Noninvasive Cardiology Unit | Lessick J.,Noninvasive Cardiology Unit | And 6 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background: Symptomatic patients with severe aortic stenosis (AS) demonstrate abnormal left ventricular (LV) mechanics. The aim of this study was to compare mechanics in asymptomatic and symptomatic patients with severe AS using two-dimensional myocardial strain imaging. Methods: One hundred fifty-four patients with severe AS (aortic valve area ≤ 1.0 cm2) referred to a heart valve clinic from 2004 to 2011 were studied. Thirty patients were asymptomatic, with normal LV ejection fractions (≥55%), without other significant valvular disease or wall motion abnormalities. Thirty-two symptomatic patients who underwent early aortic valve replacement, with similar age, gender, LV ejection fraction, and aortic valve area, were selected for comparison. Both groups were also compared with 32 healthy subjects with similar age and gender distributions and normal echocardiographic results who served as controls. LV longitudinal and circumferential strain and rotation were measured using speckle-tracking software applied to archived echocardiographic studies. Conventional echocardiographic and myocardial mechanical parameters were compared among the study subgroups. Results: Patients with asymptomatic severe AS demonstrated smaller reductions in longitudinal strain, higher (supernormal) apical circumferential strain (-38 ± 6% vs -35 ± 4%, P <.05), and extreme (supernormal) apical rotation (12.2 ± 4.9° vs 2.9 ± 1.7°, P <.0005) compared with symptomatic patients. Apical rotation < 6° was the single significant predictor of symptoms in logistic regression analysis of clinical, echocardiographic, and mechanical parameters. Twelve asymptomatic patients underwent eventual aortic valve replacement and showed decreases in strain and apical rotation compared with baseline values. Conclusions: Longitudinal strain was uniformly low in patients with severe AS and lower in those with symptoms. Compensatory circumferential myocardial mechanics (increased apical circumferential strain and rotation) were absent in symptomatic patients. Thus, myocardial mechanics may help in the follow-up of patients with severe AS and timing of valve surgery. © 2015 American Society of Echocardiography.

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