SPECIAL ARTICLES
Meeting highlights of the 15th annual Scientific Sessions of the American Society of Echocardiography: June 26 to 30, 2004
John Gorcsan, III, MD, FACC*,*,
Roberto M. Lang, MD, FACC ,
Michael H. Picard, MD, FACC ,
William A. Zoghbi, MD, FACC ,
Peter C. Frommelt, MD, FACC|| and
Linda D. Gillam, MD, FACC¶
* University of Pittsburgh, Pittsburgh, Pennsylvania
University of Chicago, Chicago, Illinois
Massachusetts General Hospital, Boston, Massachusetts
Baylor College of Medicine, Houston, Texas
|| Medical College of Wisconsin, Milwaukee, Wisconsin
¶ Hartford Hospital, Hartford, Connecticut
Manuscript received August 17, 2004;
revised manuscript received August 24, 2004,
accepted August 26, 2004.
* Reprint requests and correspondence: Dr. John Gorcsan III, University of Pittsburgh, Scaife 564, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213-2582
(Email: gorcsanj{at}msx.upmc.edu).
 |
Abstract
|
|---|
"Echocardiography is the heart of clinical cardiology" was an appropriate theme for the 15th Scientific Sessions of the American Society of Echocardiography. Care of the cardiovascular patient is constantly changing, and this meeting showcased how echocardiographic and Doppler methods continue to be critically important to detect and quantify disease, determine response to therapy, and guide clinical decision making in contemporary medicine. This highly successful five-day educational event attracted a record number of attendees and focused on disease-based clinical applications of the latest technological advances in cardiac ultrasound, including advances in diagnosis and treatment of heart failure, valvular disease, coronary disease, and congenital disease.
|
Abbreviations and Acronyms
| | ASE = American Society of Echocardiography | | BNP = B-type natriuretic peptide | | CRT = cardiac resynchronization therapy | | EF = ejection fraction | | HF = heart failure | | LV = left ventricular | | MPI = myocardial performance index | | MRI = magnetic resonance imaging | | RV = right ventricular |
|
"Echocardiography is the heart of clinical cardiology" was an appropriate theme for the 15th Scientific Sessions of the American Society of Echocardiography (ASE) in San Diego, California. Echocardiography is truly essential to contemporary care of the patient with cardiovascular disease. This highly successful five-day educational event that attracted a record number of attendees was chaired by Dr. John Gorcsan III and focused on disease-based clinical applications of the latest technological advances in cardiac ultrasound. One outstanding highlight was the ASE's President, Dr. Randy Martin, who presented the Inge Edler lecture, named for the father of echocardiography. Dr. Martin's lecture, "Making a Difference in Individual Lives," dramatically demonstrated how echocardiography improves human health by impacting the individual patient. Another highlight was Dr. Mario Garcia's presentation of "Echocardiography Is the Keystone to the Evaluation of Cardiac Function" as the Harvey Feigenbaum lecture, which recognizes young faculty who have made significant contributions to the field.
|
Young investigator competition
|
|---|
An important priority for the Society is to showcase the Young Investigators who represent the future of the field of echocardiography. Among four finalists who competed, Dr. Partho Sengupta was the winner for his work on cardiac myofiber array (1). His group used an elegant pig model with sonomicrometry and tissue Doppler to demonstrate the changing transmural myocardial direction along with non-homogenous temporal deformation within different myocardial layers. This accounts for the changing polarity of waveforms seen in tissue Doppler during the isovolumic phases of the cardiac cycle. The other three investigations focused on newer applications of contrast echocardiography. Johan Verjans, MS, presented a novel means of identifying apoptosis noninvasively with ultrasound in a murine model of acute myocardial infarction (2). Contrast microspheres were conjugated with annexin-V, an endogenous protein that binds to phosphatidylserine expressed in myocytes in early apoptosis. Real-time contrast ultrasound showed enhancement in the infarct area. Peroxidase staining showed annexin-V within the infarct area, confirming the binding of the microspheres. Dr. Eran Toledo presented the feasibility of quantitative assessment of myocardial perfusion using real-time three-dimensional echocardiography in an isolated rabbit heart as well as in patients with coronary artery disease (3). This has the potential for more accurate assessment of perfusion defects compared with two-dimensional myocardial contrast echocardiography. Lastly, Dr. Khim Tong presented the incremental value of regional perfusion with contrast over regional function in patients presenting to the emergency department with suspected cardiac chest pain (4). Of 999 patients recruited, 16.7% had early cardiac events. Regional function alone increased the prognostic information of clinical and electrocardiographic variables by 215%, whereas myocardial perfusion alone increased it by only 157%. However, when both regional function and perfusion data were combined, prognostic information increased by 248%. This incremental information of perfusion by contrast was also observed to predict late cardiac events.
|
Echocardiography in heart failure
|
|---|
Resynchronization therapy.
Cardiac resynchronization therapy (CRT) has been recently proposed as an alternative treatment modality for patients with severe heart failure (HF) refractory to drug therapy. The results of clinical trials have shown improvements in symptoms, exercise capacity, and left ventricular (LV) performance with an associated reduction in hospitalization and improved survival compared with optimized medical therapy alone. An important evolving application of echocardiography is its role in CRT. Drs. Jerome Bax and John Gorcsan III were among the faculty who gave state-of-the-art overviews on the role of echocardiographic modalities used to predict both the response to CRT and mechanisms of reduced mitral regurgitation as well as guide optimal lead placement (5–7). They concluded that echocardiography, and in particular tissue Doppler methods, are promising to quantify mechanical dyssynchrony and potentially predict patient responders to CRT. Featured new data included presentations by Burgess et al. (8) who emphasized that prolonged electrocardiographic QRS duration did not accurately identify patients who responded to CRT, and supported the concept that mechanical echocardiographic markers of dyssynchrony play a role in identifying patient responders. They applied color-tissue Doppler M-mode to assess the anteroseptal to posterior wall delay as a means to quantify LV dyssynchrony (9). Dohi et al. (10) introduced sudendocardial radial strain as a new method to quantify mechanical dyssynchrony in an animal model of right ventricular (RV) pacing induced dyssynchrony. They demonstrated that radial strain dynamics assessed by short-axis echocardiographic images can quantify the degree of septal to free wall dyssynchrony induced by RV pacing, which mimics the native left bundle-branch block. They also showed the degree of dyssynchrony to be worsened by LV dysfunction, and significantly improved with biventricular pacing. In another novel approach, Notomi et al. (11) used tissue Doppler to measure myocardial torsion in degrees of apical twist before and after CRT, and demonstrated that patients who responded to CRT have improved myocardial torsion. Interestingly, Belcik et al. (12) demonstrated that myocardial viability in ischemic HF as assessed with myocardial contrast echocardiography correlated linearly with the improvement in symptoms and ejection fraction (EF) after CRT.
Zhang et al. (13) extended the concept of cardiac dyssynchrony beyond CRT and assessed 46 patients to predict the extent of LV remodeling after acute myocardial infarction. They used magnetic resonance imaging (MRI) measures of myocardial volume and EF to show that tissue Doppler dyssynchrony was an independent predictor of early remodeling after infarction. Myers et al. (14) also extended dyssynchrony analysis to study a series of HF patients (mean EF of 26%) and observed that mechanical dyssynchrony occurred in a significant percentage of patients with QRS duration <120 ms. These emerging data suggest that echocardiographic markers of dyssynchrony in patients without electrocardiographic bundle-branch block potentially extend CRT to these patients, although this needs to be prospectively evaluated (14).
Prognostic value in HF.
B-type natriuretic peptide (BNP) is playing a role in the diagnosis and treatment of HF patients. Dokainish et al. (15) evaluated the prognostic value of BNP added to echocardiography in a series of 81 patients with HF. Using the combined end point of cardiac death and hospitalization for HF, echocardiography alone predicted 20 of 28 events, whereas echo-Doppler plus BNP predicted all adverse events. The addition of BNP to echocardiography with Doppler was cost-effective and of powerful prognostic value (15).
|
Valvular disease
|
|---|
Mitral valve disease.
The Council on Intraoperative Echocardiography led by Drs. Sol Aronson and Joseph Mathew presented a symposium on mitral valve disease. A systematic approach to evaluate each mitral component—the annulus, leaflets, chordae, and the LV myocardium—was emphasized. Dr. Judy Hung discussed ischemic mitral regurgitation as an imbalance in tethering and closing forces acting on the leaflets. Geometric remodeling of the ventricle with displacement of the papillary muscles and annular dilation also increases tethering forces, and closing forces are reduced from impaired LV systolic performance. Because ischemic mitral regurgitation is a disease of the entire mitral complex, reducing annular size alone may be ineffective, and new strategies that directly address tethering by infarct plication, papillary muscle repositioning, or basal chordal cutting to increase coaptational surface area are being explored. Dr. Jack Shanewise reviewed the pathophysiology of myxomatous mitral regurgitation, discussing both segmental prolapse as well as leaflet flail caused by chordal rupture. He emphasized the importance of being able to define the extent of myxomatous leaflet and chordal disease as well as the location of culprit prolapsing and/or flail segments. Dr. Joseph Sabik discussed surgical approaches to the myxomatous valve and emphasized that successful repair is no longer limited to isolated flail of the middle scallop of the posterior leaflet.
Dr. Gerald Buckberg discussed surgical approaches to LV remodeling including revascularization of viable myocardium, reduction of volume, realignment of papillary muscles, and reduction of annular size. Dr. Steven Bolling advocated mitral rings to reduce the size of dilated annuli in patients with functional mitral valve disease. Dr. William Stewart encouraged the use of vena contracta, regurgitant volume, and effective regurgitant orifice to quantify mitral regurgitation, rather than color jet area alone. Percutaneous approaches to patients with mitral valve disease were presented where the echocardiographer plays important roles by determining pre-procedure pathophysiology, intra-procedure monitoring, and assessing post-procedure outcome. An innovative program is planned for 2005 in Boston that will focus on the aortic valve and include live transmission of cases from the operating rooms of Boston area hospitals.
Three-dimensional echocardiography.
Drs. Roberto Lang and Navin Nanda reviewed current and evolving approaches in which three-dimensional imaging and color flow Doppler are important for ischemic, myxomatous, and endocarditic valve disease where disease may be focally located. Recent data included a presentation by Yosefy et al. (16) that real-time three-dimensional data can delineate the complexity of the isovelocity contour of valve regurgitation. Song et al. (17) showed that three-dimensional mitral valve geometry is a more significant factor in ischemic mitral regurgitation than LV geometry or EF. Gill et al. (18) used three-dimensional echocardiography to improve the evaluation of mitral stenosis before valvuloplasty and improved the ability to predict successful outcomes in comparison to routine echo. Daimon et al. (19) reported dynamic changes in mitral annular geometry that occur during the cardiac cycle, and Qin et al. (20) described the changes that occur in the mitral valve apparatus after angioplasty repair for ischemic mitral regurgitation.
Prosthetic valves.
Dr. Linda Gillam presented a systematic approach for following patients with valve prosthesis, making the point that all prosthetic valves are intrinsically mildly stenotic and regurgitant. She stressed the importance of the baseline post-implantation evaluation and the role of intraoperative transesophageal echocardiography and the generally benign course of small paravalvular regurgitant jets identified at the time of implantation. Drs. Alfred Parisi and Mario Garcia debated the approach to patients with a prosthetic valve thrombosis, noting that prosthetic valve obstruction occurs as a result of thrombosis in 60% of cases, pannus in 6% of cases, and on a mixed basis in the remainder. Although the choice of thrombolysis versus surgery is patient dependent, the best candidates for thrombolysis appear to be those with right-sided valve obstruction, and/or the thrombus is small and soft and the patient has not had a stroke.
|
Coronary artery disease
|
|---|
The most common form of cardiac disease encountered by the practicing clinician is coronary artery disease, and this meeting highlighted the important role that echo Doppler methods continue to play in its diagnosis and management. Dr. Murat Tuzcu emphasized the role that intracardiac ultrasound plays for the quantification of coronary disease and to determine effects of novel therapies, such as ApoA-1 Milano recently referred to as "super" high-density lipoprotein. Dr. Sanjiv Kaul provided an update on myocardial contrast perfusion imaging with a view to the myocardial capillaries. Drs. James Thomas and Thomas Marwick discussed the evolving roles of tissue Doppler and strain imaging for coronary disease. Because routine visual assessment of wall motion is subjective, tissue Doppler and strain appear to have the most promise in stress echo and viability determinations. Advances in signal processing and software analysis have made clinical applications a closer reality. Dr. Harvey Feigenbaum presented a state-of-the-art approach combining the aforementioned echocardiographic techniques. Featured new presentations included experimental studies that use echo as a tool to understanding myocardial physiology, the introduction of new technologies and applications for the assessment of ischemic heart disease, the evolving role of contrast echo, and clinical studies with direct patient applications.
Experimental studies.
Effects of exercise on LV hypertrophy and remodeling as a function of age were studied in an animal model by Morgan et al. (21). Young and middle-aged mice developed concentric hypertrophy during vigorous exercise, whereas the oldest mice developed LV dilation and eccentric hypertrophy. This observation may enable further studies into the role of arterial stiffness, resistance, and coupling, and this model may also be useful in studying the effects of therapies for ventricular remodeling. Huang et al. (22) examined the effects of mobilization of autologous bone marrow stem cells in rats after myocardial infarction. Bone marrow stem cells were mobilized with injections of granulocyte-colony stimulating factor. Whereas ultimate infarct size was not different in treatment or control groups, the degree of adverse remodeling was attenuated in the treated group, demonstrating its potential benefit and the valuable role of echocardiography in assessing this novel treatment.
New technologies and applications.
Many studies utilized tissue Doppler and derived measures of strain in the setting of ischemia and infarction. An important study by Korinek et al. (23) found an association between alterations in regional strain during ischemia with decreases in regional concentrations of high-energy nucleotides and their metabolites. These observations give credence to the role of strain rate imaging as a tool to identify early aspects of the regional ischemia cascade. Another application of tissue Doppler was to assess the "untwisting" of the ventricle that occurs during diastole. Notomi et al. (24) demonstrated that tissue Doppler rotational velocities from short-axis views before and after bicycle exercise were highest during the isovolumic phase of diastole representing enhanced rotation or LV "untwisting." Nagashima et al. (25) studied a new biomarker for acute myocardial infarction that has a faster release than established blood markers. This biomarker, a fatty acid binding protein, when combined with echocardiography in the early phases of infarction had an improved accuracy for the early (<3 h) diagnosis of infarction compared with more established biomarkers alone. Wall motion assessment by echo was necessary to enhance the specificity of this biomarker, and echocardiography clearly plays a complementary role.
Exercise and pharmacologic stress echo.
Stress echo is now not only important for diagnosis but is clearly a strong tool to assess patient prognosis and outcome. Bangalore et al. (26) studied 1,560 patients and found that stress echo was the most cost-effective diagnostic strategy in patients with intermediate to high probability of coronary artery disease compared with a non-imaging exercise treadmill testing followed by coronary angiography. However, a nuclear stress-testing arm was not included. Nash et al. (27) focused on patients older than 70 years of age who had normal cardiac size and function and examined clinical parameters, exercise capacity, resting echo indices, and stress echo indices. An impaired relaxation pattern on transmitral valve Doppler (ratio of early transmitral flow velocity to atrial flow velocity [E/A ratio] <1) identified those with a subsequent lower exercise capacity and an inability to augment stroke volume with exercise. This impaired relaxation pattern may be associated with a reduced functional capacity in the elderly (27). Alam et al. (28) demonstrated that viable myocardium detected by low-dose dobutamine test was a predictor of improved EF and long-term survival after revascularization. Finally, a new, very small ultrasound transducer applied to the chest wall with full two-dimensional imaging and rotation capabilities was reported. This has promise for continuous wall motion assessment from apical views during treadmill exercise (29).
Contrast echo: Assessment of ventricular function.
Contrast echocardiographic enhancement of the LV endocardial border is routinely used clinically to assess LV function and delineate intracardiac masses, particularly in patients with poor acoustic windows. Hoffmann et al. (30) supported this concept with the results of a large multicenter European study demonstrating that contrast-enhanced echocardiography improves the interobserver agreement of biplane calculations of EF to a level that is comparable to that obtained by MRI, believed to be the gold standard for LV volume determination. Caiani et al. (31) hypothesized that contrast enhancement would improve the accuracy of LV volume and EF by real-time three-dimensional echocardiography as compared with cardiac MRI. However, contrast enhancement did not improve the accuracy of three-dimensional images because it significantly underestimated LV volumes, probably owing to increased bubble destruction in the lateral fields. In another study, McCulloch et al. (32) compared the diagnostic certainty of two- and three-dimensional echocardiography with and without contrast in the evaluation of suspected LV thrombus in 31 patients. The authors concluded that both echocardiographic modalities have similar diagnostic capabilities in detecting LV thrombus; however, three-dimensional imaging improved diagnostic confidence.
Contrast echo perfusion imaging.
Myocardial contrast echocardiography is an emerging method to study myocardial perfusion in patients with known or suspected coronary artery disease. The prognostic value of myocardial contrast echocardiography was reported for the five-year prediction of cardiac events in a large group of patients with confirmed coronary artery disease (33). When all cardiac events were analyzed, the cumulative event for survival was 90% for negative and 23% for positive adenosine contrast echocardiographic studies, respectively (log-rank = 74, p < 0.0001). However, a lack of current methodological uniformity in the performance of myocardial perfusion stress testing was evidenced by a myriad of abstracts proposing a variety of different methods. For example, McGrain et al. (34) proposed small bolus injections of Definity, instead of the traditional continued infusions, during dipyridamole stress. The mode of stress during perfusion imaging is also variable, as exemplified by Miszalski et al. (35), who described the use of myocardial contrast echocardiography during supine bicycle stress, and by the report of Kunichika et al. (36) on delayed imaging using high-energy ultrasound. The majority of investigators continue to perform a subjective, experience-dependent, qualitative evaluation of contrast images, whereas Lodato et al. (37) proposed parametric imaging as a means of objective detection of perfusion defects as compared with angiographic findings.
New applications of contrast and ultrasound.
This meeting extended ultrasound and contrast echocardiography to be employed for diagnostic and therapeutic purposes. Craig et al. (38) demonstrated in an in vitro study that it is possible to create atrial septal perforations using high-density focused ultrasound and demonstrated its potential to palliate or treat congenital cardiac defects. Porter et al. (39) described the use of contrast with real-time low mechanical index pulse sequence schemes to assess endothelial dysfunction and to facilitate rapid arterial thrombolysis. Finally, Leong-Poi et al. (40) suggested that aVß3-targeted contrast-enhanced ultrasound can be used to noninvasively assess angiogenic responses to chronic ischemia, even before maximal changes in tissue perfusion.
|
Pediatric echocardiography
|
|---|
The pediatric scientific sessions program committee, led by Dr. Peter Frommelt honored Dr. Stephen P. Sanders with its Founder's Award for his major influence in the field of pediatric echocardiography.
Three-dimensional echocardiography.
The application of three-dimensional echocardiography in the assessment of the fetus and child with congenital heart disease was featured. Sklansky et al. (41) described the application of single volume, real-time three-dimensional echocardiography as a tool for prenatal screening of congenital heart disease. Single volume data sets could be rapidly acquired to enable visualization of all major fetal cardiac structures and views, improving fetal echocardiographic screening. The Medical University of South Carolina described three-dimensional echocardiographic and color Doppler reconstruction of the aortic arch (42). They found this was particularly useful in imaging aortic arch abnormalities and aortopulmonary shunts.
The right ventricle.
Echocardiographic assessment of the right ventricle remains a challenging aspect of congenital cardiac imaging, and innovative approaches to evaluation of RV performance were presented. The application of color Doppler tissue imaging for the evaluation of RV systolic function in patients with congenital heart disease was described in a heterogeneous group of children and adults with congenital heart disease that resulted in either RV pressure overload or RV dilation (43). Peak systolic velocity and isovolumic acceleration at the lateral tricuspid annulus were found to be significant predictors of RVEF obtained from cine-MRI imaging when adjusted for age, RV dilation, and pressure overload. Dr. Judith Therrien et al. used the myocardial performance index (MPI) to assess systemic RV function in patients with transposition of the great arteries after atrial switch palliation (44). They found that MPI correlated well with MRI-derived RVEF. An MPI value of >0.7 accurately predicted an EF <30%, and an MPI <0.4 accurately predicted an EF of >50%. It appears that both of these techniques hold real promise in the assessment of RV function in congenital heart disease.
Small animal models.
Yu et al. (45) described the application of the myocardial performance index in hamsters genetically altered for early cardiac dysfunction. The MPI was useful in predicting survival in this animal model of HF and was better at assessing prognosis than percent fractional shortening of the left ventricle. In a separate study, a collaborative team led by Dr. Colin Phoon used a 40-MHz biomicroscopy Doppler probe to study embryonic mice with a known fatal genetic mutation that results in lack of development of the aortic and pulmonary valves (46). They found reduced cardiac output, altered placental flow, and diastolic dysfunction to contribute to HF and death in mice with the mutation. This probe elegantly described the complex physiology that can result in embryonic HF and provides an additional tool in the assessment of small animal genetic modeling of heart disease.
|
Conclusions
|
|---|
Care of the cardiovascular patient is ever changing at a fast pace. This meeting showcased how echocardiographic and Doppler methods continue to be critically important to detect and quantify disease, determine response to therapy, and guide clinical decision making in contemporary medicine. Dr. Sanjiv Kaul as next year's program chair and current ASE President Dr. Linda Gillam are organizing an innovative and exciting educational program for June 15 to 18, 2005 in Boston, Massachusetts, as the 16th Annual Scientific Sessions, which should not be missed.
|
References
|
|---|
- Sengupta PP, Wang J, Korinek J, Khandheria BK, Belohavek M. Myocardial fiber direction and the transmural sequence of deformation influences genesis of spectral waveforms in Doppler myocardial imaging(abstr) J Am Soc Echocardiogr 2004;17:494A.
- Verjans JW, Brittin R, Narula N, et al. Noninvasive in vivo ultrasound imaging of apoptosis in acute myocardial infarction with annexin-V conjugated microspheres(abstr) J Am Soc Echocardiogr 2004;17:494A.
- Toledo E, Lang RM, Collins KA, et al. Feasibility of quantitative assessment of myocardial perfusion using real-time three-dimensional echocardiographic imaging(abstr) J Am Soc Echocardiogr 2004;17:494A.
- Tong KL, Rinkevich D, Wei K, et al. Incremental value of regional perfusion over regional function in patients presenting to the emergency department with suspected cardiac chest pain(abstr) J Am Soc Echocardiogr 2004;17:494A.
- Bax JL, Ansalone G, Breithardt OA, et al. Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use? J Am Coll Cardiol 2004;44:1-9.[Abstract/Free Full Text]
- Gorcsan J, Kanzaki H, Bazaz R, Dohi K, Schwartzman D. Usefulness of echocardiographic tissue synchronization imaging to predict acute response to cardiac resynchronization therapy Am J Cardiol 2004;93:1178-1181.[CrossRef][Medline]
- Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorcsan J. A mechanism for immediate reduction in mitral regurgitation following cardiac resynchronization therapy: insights from mechanical activation strain mapping J Am Coll Cardiol 2004;44:1616-1625.
- Burgess BC, Peng L, Chugh A, Armstrong WF. Electrical versus mechanical dyssynchrony in patients receiving resynchronization therapy(abstr) J Am Soc Echocardiogr 2004;17:529A.
- Burgess BC, Peng L, Chugh A, Armstrong WF. Tissue Doppler echocardiography and optimization of mechanical resynchronization with biventricular pacing therapy(abstr) J Am Soc Echocardiogr 2004;17:532A.
- Dohi K, Pinsky M, Severyn D, Gorcsan J. Subendocardial radial strain using angle-corrected imaging is related to mechanical dyssynchrony: assessment in a left bundle branch block and biventricular pacing model(abstr) J Am Soc Echocardiogr 2004;17:543A.
- Notomi Y, Grimm RA, Shiota T, Alger DA, Greenbery NI, Thomas JD. Measurements in ventricular torsion before and after biventricular pacer implantation(abstr) J Am Soc Echocardiogr 2004;17:528A.
- Belcik T, Hummel JP, Mounsey P, Dimarco JP, Kaul S, Lindner JR. Myocardial viability determined by MCE influences the response to cardiac resynchronization therapy in patients with ischemic cardiomyopathy(abstr) J Am Soc Echocardiogr 2004;17:542A.
- Zhang Y, Chan A, Yu CM, et al. Cardiac asynchrony predicts left ventricular remodeling after acute myocardial infarction: an echocardiographic and cardiac magnetic resonance imaging study(abstr) J Am Soc Echocardiogr 2004;17:543A.
- Myers TM, Leon AR, Notobartolo D, Mertino J, Smith AL. The prevalence of asynchrony in patients with heart failure and normal QRS duration compared to normal controls (abstr) J Am Soc Echocardiogr 2004;17554A–1.
- Dokainish D, Zoghbi W, Ambriz E, Quinones MA, Nagueh SF. Cost-effectiveness of echocardiography and B-type natriuretic peptide in the prognosis of patients with congestive heart failure(abstr) J Am Soc Echocardiogr 2004;17:530A.
- Yosefy C, Vaturi M, Levine RA, Hung J. Proximal flow convergence region as assessed by matrix-array real-time 3D echo: the complexity of the isovelocity contour(abstr) J Am Soc Echocardiogr 2004;17:497A.
- Song JM, Shiota T, Qin J, et al. Determinants of ischemic mitral regurgitation in patients with anterior myocardial infarction: a real-time three-dimensional echocardiography study(abstr) J Am Soc Echocardiogr 2004;17:497A.
- Gill E, Sisk EJ, Tognazzi-Evans TA, et al. Live 3-D echo and biplane evaluation of mitral stenosis for prediction of mitral valvuloplasty success(abstr) J Am Soc Echocardiogr 2004;17:499A.
- Daimon M, Shiota T, Saracino G, Greenberg NL, Thomas JD. Dynamic change in mitral annular geometry during a cardiac cycle: novel computerized 3D echo method(abstr) J Am Soc Echocardiogr 2004;17:519A.
- Qin JX, Shiota T, Shin JH, et al. Immediate changes of mitral apparatus and hemodynamic after annuloplasty repair in patients with ischemic mitral regurgitation: 2D and 3D echo studies(abstr) J Am Soc Echocardiogr 2004;17:520A.
- Morgan JG, Cuesta M, Ichinose F, et al. Interaction of age and exercise on left ventricular remodeling in mice(abstr) J Am Soc Echocardiogr 2004;17:529A.
- Huang G, Liu H, Shu X, Pan C, Cai N. Echocardiographic evaluation of the effect of autologous bone marrow stem cells mobilization with granulocyte-colony stimulation factor on the left ventricular remodeling and function in post-infarction rats(abstr) J Am Soc Echocardiogr 2004;17:561A.
- Korinek J, Wang J, Urheim S, et al. A decrease in regional myocardial work measured by novel strain rate echocardiography correlates with ischemic inhibition of myocardial energetics characterized by ATP and GTP levels(abstr) J Am Soc Echocardiogr 2004;17:513A.
- Notomi Y, Shiota T, Desserrano D, Greenberg NL, Thomas JD. Left ventricular torsional deformation in hypertrophic obstructive cardiomyopathy(abstr) J Am Soc Echocardiogr 2004;17:555A.
- Nagashima E, Ota T, Michihiko H, et al. Novel diagnostic triage of early stage of acute myocardial infarction: combination of rapid heart-type fatty acid binding protein and wall motion analysis using echocardiography at the emergency room(abstr) J Am Soc Echocardiogr 2004;17:559A.
- Bangalore S, Yao SS, Chaudhry FA. Cost effectiveness of various testing strategies in patients with known or suspected coronary artery disease: a stress echo study(abstr) J Am Soc Echocardiogr 2004;17:514A.
- Nash PJ, Cinar C, Garcia MJ. Impaired relaxation pattern is associated with decreased exercise tolerance in the elderly(abstr) J Am Soc Echocardiogr 2004;17:544A.
- Alam I, Mahenthiran J, Gradus-Pizlo I, et al. Impact of improvement in global systolic function on long-term outcome in patients with ischemic ventricular dysfunction(abstr) J Am Soc Echocardiogr 2004;17:512A.
- Nakashiki K, Kisanuki A, Otsuji Y, et al. Usefulness of a novel ultrasound transducer for continuous monitoring treadmill exercise stress echocardiography in detection of coronary artery stenosis(abstr) J Am Soc Echocardiogr 2004;17:544A.
- Hoffmann R, Von Bardeleben S, Borges A, et al. Contrast enhanced echocardiography improves interobserver agreement on assessment of ejection fraction—a multicenter study(abstr) J Am Soc Echocardiogr 2004;17;:503A.
- Caiani EG, Sugeng L, Corsi C, et al. Does contrast enhancement improve left ventricular volume measurements from real-time three-dimensional echocardiography(abstr)? J Am Soc Echocardiogr 2004;17:553A.
- McCulloch ML, Tran T, Quinones MA, Zoghbi WA. Real-time three-dimensional echocardiography with and without contrast in the differential diagnosis of left ventricular apical thrombi: comparison with two-dimensional echocardiography(abstr) J Am Soc Echocardiogr 2004;17:519A.
- Moraes A, Palheiro FC, Carrinho M, et al. Myocardial contrast echocardiography is a powerful long-term (up to 66 months) predictor for hard cardiac events in patients at low, intermediate and high risk for coronary artery disease(abstr) J Am Soc Echocardiogr 2004;17:515A.
- McGrain AC, Tsutsui JM, Xie F, Mahrous H, Rosenberg M, Porter TR. Detection and quantification of coronary artery disease following intravenous bolus injections of lipid encapsulated microbubbles during dipyridamole stress(abstr) J Am Soc Echocardiogr 2004;17:515A.
- Miszalski T, Schmidt H, Bernhardt P, Omran H, Luederitz B, Kuntz-Hehner S. Myocardial contrast echocardiography in detection of single and multivessel coronary artery disease during supine bicycle stress and continuous infusion of contrast agent(abstr) J Am Soc Echocardiogr 2004;17:542A.
- Kunichika H, Cotter B, Kunichika N, DeMaria AN. Identification of risk area and infarct zone myocardium from the hyperenhancement visualized after occlusion/reperfusion using delayed imaging and exposure to high energy ultrasound(abstr) J Am Soc Echocardiogr 2004;17:501A.
- Lodato JA, Spencer KT, Collins KA, et al. Use of parametric imaging in myocardial contrast echocardiography during vasodilator stress(abstr) J Am Soc Echocardiogr 2004;17:563A.
- Craig R, Bu L, Bailey E, et al. Creating an atrial communication using high intensity focused ultrasound (HIFU): an in vitro dosimetry study(abstr) J Am Soc Echocardiogr 2004;17:503A.
- Porter TR, Tsutsui JM, Lof J, et al. Guided visualization of therapeutic ultrasound assisted thrombolysis of acute arterial thrombus with simultaneous imaging using a high frequency non-linear pulse sequence scheme(abstr) J Am Soc Echocardiogr 2004;17:541A.
- Leong-Poi H, Christiansen JP, Klibanov AL, et al. A comparison of the angiogenic response to chronic ischemia to that induced by growth-factor therapy using aVß3-targeted contrast-enhanced ultrasound(abstr) J Am Soc Echocardiogr 2004;17:540A.
- Sklansky M, Miller D, Pretorius D, DeVore G, Wong P. Prenatal screening for congenital heart disease using real-time three-dimensional echocardiography(abstr) J Am Soc Echocardiogr 2004;17:506A.
- Lucas JF, Shirali GS, Chessa K. Transthoracic three-dimensional echocardiography enhances evaluation of native and postoperative aortic arch abnormalities(abstr) J Am Soc Echocardiogr 2004;17:506A.
- Lytrivi ID, Lai WW, Ko H, Nielsen JC, Parness IA, Srivastava S. Color Doppler tissue imaging for evaluation of right ventricular systolic function in patients with congenital heart disease(abstr) J Am Soc Echocardiogr 2004;17:495A.
- Salehian O, Schwerzmann M, Webb G, Therrien J. Echocardiographic myocardial performance index correlates well with cardiac magnetic resonance derived ejection fraction of systemic right ventricle in patients with transposition of great arteries(abstr) J Am Soc Echocardiogr 2004;17:495A.
- Yu B, Otsuji Y, Ikeda Y, et al. Prediction of the prognosis in small animal model of congestive heart failure (hamster UMX 7) using Tei index(abstr) J Am Soc Echocardiogr 2004;17:505A.
- Phoon CK, Ji RP, Aristizabal O, et al. 40 MHz ultrasound reveals multiple mechanisms of embryonic heart failure in NFATc1 knockout (-/-) mice(abstr) J Am Soc Echocardiogr 2004;17:505A.
|
Top
Abstract
Young investigator competition