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- Consultor in Cardiology Cardiac imaging and clinical cardiologyMD PhD University of La Plata Director Master US in ca... moreConsultor in Cardiology Cardiac imaging and clinical cardiologyMD PhD University of La Plata Director Master US in cardiologyHead Cardiac Imaging ICBA Postgraduate Professor of cardiology Director INstituto de cardiologia LaPlataFellow ACC and ASEMiembro Emérito FACDirector Fellowship Cardiac Imaging ICBA Argentina(Consultor in Cardiology Cardiac imaging and clinical cardiologyMD PhD University of La Plata Director Master US in cardiologyHead Cardiac Imaging ICBA Postgraduate Professor of cardiology Director INstituto de cardiologia LaPlataFellow ACC and ASEMiembro Emérito FACDirector Fellowship Cardiac Imaging ICBA Argentina)edit
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Tienda online donde Comprar Eco cardiografia Tridimensional. Como Entenderla, Como Utilizarla, Como Realizarla + Contenido Online al precio 142,64 € de Ricardo Ronderos, tienda de Libros de Medicina, Libros de Cardiologia - Ecocardiografia
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Aims Aortic valve area (AVA) used for echocardiographic assessment of aortic stenosis (AS) has been traditionally interpreted independently of sex, age and race. As differences in normal values might impact clinical decision-making, we... more
Aims Aortic valve area (AVA) used for echocardiographic assessment of aortic stenosis (AS) has been traditionally interpreted independently of sex, age and race. As differences in normal values might impact clinical decision-making, we aimed to establish sex-, age- and race-specific normative values for AVA and Doppler parameters using data from the World Alliance Societies of Echocardiography (WASE) Study. Methods and results Two-dimensional transthoracic echocardiographic studies were obtained from 1903 healthy adult subjects (48% women). Measurements of the left ventricular outflow tract (LVOT) diameter and Doppler parameters, including AV and LVOT velocity time integrals (VTIs), AV mean pressure gradient, peak velocity, were obtained according to ASE/EACVI guidelines. AVA was calculated using the continuity equation. Compared with men, women had smaller LVOT diameters and AVA values, and higher AV peak velocities and mean gradients (all P < 0.05). LVOT and AV VTI were signifi...
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Background Lead-induced tricuspid regurgitation (LITR) is caused by several mechanisms that can be assessed by 3D-Echocardiography (3DE). Its prevalence was not studied to date in the Latin-American series. Purpose To determine prevalence... more
Background Lead-induced tricuspid regurgitation (LITR) is caused by several mechanisms that can be assessed by 3D-Echocardiography (3DE). Its prevalence was not studied to date in the Latin-American series. Purpose To determine prevalence and mechanisms of LITR in a series of patients with permanent cardiac devices by 3DE. Methods We perform a cross-sectional analysis of 101 patients with permanent cardiac devices as pacemakers or defibrillators. Transthoracic 3DE was obtained on all patients in RV-focused apical views to perform a complete tricuspid valve leaflets, subvalvular apparatus, lead placement and functional assessment to evaluate possible mechanisms of tricuspid regurgitation. Results Of a total of 101 patients, lead visualization was possible in 88%. In 59% lead was in commissural position and did not interfere with tricuspid leaflet mobility. Nevertheless, in 41% LITR was observed by several mechanisms. Leaflet impingement was the most prevalent cause in 30,7% causing v...
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BACKGROUND Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved by 3D echocardiography. Understanding normal... more
BACKGROUND Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved by 3D echocardiography. Understanding normal valve size, structure and function is essential for differentiation of healthy from disease states. We aimed to establish normative values for the MV apparatus size and morphology and determine how they vary across age, sex and race groups, using data from the World Alliance of Societies of Echocardiography (WASE) normal values study. METHODS 3D volumetric datasets obtained with transthoracic echocardiography in 748 normal subjects (51% male) were analyzed using commercial MV analysis software (TOMTEC) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age: 18-40 years (N=266), 41-65 years (N=249) and >65 years (N=233) to identify sex- and age-related differences. In addition, differences between black, white and Asian populations were studied. Inter- and intra-observer variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements. RESULTS Compared to women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared to the black and white populations, Asian population showed significantly smaller mitral annular size. While many of the age-, sex, and race differences in MV parameters were statistically significant, they were comparable to or smaller than the corresponding measurement variability. Indexing by body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality. CONCLUSION This analysis of the WASE data provides normative values of the mitral apparatus size and morphology. While sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.
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BACKGROUND Though the assessment of right ventricular (RV) diastolic function is feasible, it has garnered far less momentum for use compared to its left ventricular counterpart. The scarcity of data defining normative RV diastolic... more
BACKGROUND Though the assessment of right ventricular (RV) diastolic function is feasible, it has garnered far less momentum for use compared to its left ventricular counterpart. The scarcity of data defining normative RV diastolic function and the fact that implications of RV diastolic dysfunction in different disease states on outcomes are less well known, both hinder integration into routine clinical assessment. We sought to establish normal values of RV diastolic parameters stratified by sex, age and race using data from the World Alliance of Societies of Echocardiography (WASE) Study. METHODS We analyzed a subset of 888 normal subjects from the WASE database, including measurements of tricuspid valve (TV) inflow E- and A-wave velocities, E-wave deceleration time, TV annular tissue Doppler e' and a' velocities. Additionally, right atrial (RA) maximal volume and RA peak reservoir strain were measured. Patients were grouped by age (<40, 41-65, >65 years), and stratified by sex and race. Differences were analyzed using unpaired t-tests. RESULTS When compared to men, women had significantly higher TV e', E-wave and A-wave velocities, though differences were modest. Increasing age was associated with stepwise lower TV E-wave, e' velocities and TV E/A, higher a' velocities and E/e' ratios. RA peak reservoir strain was also lower and RA ESV trended towards being smaller for older age groups. Asian subjects demonstrated significantly higher a' velocities, lower E-wave, smallest RA ESV and lowest RA peak strain values, compared to whites of both sexes. CONCLUSIONS This study provides normal values for parameters used in the assessment of RV diastolic function stratified by race, sex and age. Our results demonstrate significant differences in RV diastolic parameters between age groups, which manifest in both the individual parameters and composite ratios of TV inflow and annular velocities. While limited sex- and race-related differences were also noted, age appears to have the most significant impact on RV diastolic parameters. These findings may aid in refining the current normative values.
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Resumen es: El infarto de miocardio con coronarias angiograficamente normales tiene una prevalencia de aproximadamente el 7-10%. Muchas veces, el diagnostico etiolog...
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Page 1. Stress-Induced Cardiomyopathy Ricardo E. Ronderos, MD, PhD, Gustavo Avegliano, MD, and Gonzalo Dallasta, MD ... 14. Hurst RT, Askew JW, Reuss CS, et al.: Transient midven-tricular ballooning: a new variant. J Am Coll Cardiol 2006,... more
Page 1. Stress-Induced Cardiomyopathy Ricardo E. Ronderos, MD, PhD, Gustavo Avegliano, MD, and Gonzalo Dallasta, MD ... 14. Hurst RT, Askew JW, Reuss CS, et al.: Transient midven-tricular ballooning: a new variant. J Am Coll Cardiol 2006, 48:579583. ...
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BackgroundBetween 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is... more
BackgroundBetween 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment.ObjectiveTo evaluate if inferior vena cava (IVC) and lung ultrasound (CAVAL US)-guided therapy for AHF patients reduces subclinical congestion at discharge.MethodsCAVAL US-AHF is a single-centre, single-blind randomised controlled trial designed to evaluate if an IVC and lung ultrasound-guided healthcare strategy is superior to standard care to reduce subclinical congestion at discharge. Fifty-eight patients with AHF will be randomised using a block randomisation programme that will assign to either lung and IVC ultrasound-guided decongestion therapy (‘intervention group’) or clinical-guided decongestion therapy (‘control group’), using a ...
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Aims Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation... more
Aims Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socioeconomic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multicentre registry. Methods and results The EurObservational Programme (EORP) of the European Society of Cardiology EURO-ENDO (European Infective Endocarditis) registry comprises a prospective cohort of 3113 adult patients admitted for IE in 156 hospitals in 40 countries between January 2016 and March 2018. Patients were separated in three groups, according to World Bank economic stratification [group 1: high income (75.6%); group 2: upper-middle income (15.4%); group 3: lower-middle income (9.1%)]. Group 3 patients were younger [median age (interquartile range, IQR): group 1, 66 (53–75) years; group 2, 57 (41–68) years; group 3, 33 (26–43) years; P < 0.001] with a higher frequency of smoke...
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Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with... more
Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with devices. Echocardiography and microbiological findings are essential for diagnosis but may be insufficient in this group of patients. Our objective was to evaluate the usefulness of positron emission tomography and fusion with computed tomography (PET / CT) in patients with suspected IE, carriers of prosthetic valves or intracardiac devices; 32 patients were studied, who underwent PET / CT with 18F-Fluorine deoxyglucose (18F-FDG). Those with intense focal and/or heterogeneous uptake with a Standard Uptake Value SUV) cut-off point greater than or equal to 3.7 were considered suggestive of infection. The initial diagnoses according to the modified Duke criteria were compared with the final diagnosis established by the Institutional Endocarditis Unit. The a...
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Background: The development of paravalvular leaks after surgical valve replacement is a rare complication but with high morbidity and mortality. Percutaneous closure is an alternative to surgery in high-risk surgical patients. However, as... more
Background: The development of paravalvular leaks after surgical valve replacement is a rare complication but with high morbidity and mortality. Percutaneous closure is an alternative to surgery in high-risk surgical patients. However, as it is sporadically performed due to its complexity, there is limited information on its effectiveness and safety. Objectives: The aim of this study was to assess the mid-term effectiveness and safety of the procedure and to report the techniques employed. Methods: Both in-hospital and mid-term clinical and echocardiographic evolution and procedural complications of all patients undergoing percutaneous leak closure were analyzed. Results: Percutaneous closure of 13 leaks (6 aortic and 7 mitral) was performed in 9 patients. Technical success was achieved in 100% of cases, with a marked improvement in functional class and laboratory parameters. Paravalvular regurgitation assessed by Doppler echocardiography was minimal or mild after the procedure as w...
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The advent of three-dimensional (3D) acquisition has been an important development in transesophageal echocardiography (TEE). This imaging technique entered the clinical arena during the first decade of the new century, when the expansion... more
The advent of three-dimensional (3D) acquisition has been an important development in transesophageal echocardiography (TEE). This imaging technique entered the clinical arena during the first decade of the new century, when the expansion of the computing power of computers and the development of nanotechnology have made possible to insert a full matrix array into the tip of a transesophageal probe, providing TEE real-time volumetric imaging and prompting the use of 3D TEE in different cardiological, clinical, and research settings. Currently, major clinical applications of 3D TEE are left ventricular volume and ejection fraction measurement, assessment of heart valve anatomy and function, preoperative planning and monitoring different interventional procedures in the catheterization laboratory and hybrid surgical theatres.
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BACKGROUND Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). OBJECTIVES This study sought to investigate whether there are significant differences in complications, cardiac... more
BACKGROUND Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). OBJECTIVES This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. METHODS Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. RESULTS A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001). CONCLUSIONS HD-IE is a health care-associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non-HD-IE patients, whereas cardiac surgery is less frequently performed.
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Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical... more
Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-centre registry. Methods The ESC-EORPEURO-ENDO registry comprises a prospective cohort of 3116 adult patients admitted to 156 hospitals in 40 countries with IE between January 2016 and March 2018. We analysed the complete dataset to assess potentially important determinants of variation according to World Bank economic stratification (high income (Group 1) [73.8%]; upper-middle income (Group 2) [17.1%]; lower-middle income (Group 3)[9.1%]). Results Patients in Group 3 were younger (median age [IQR]: Group 1 - 66 [54–75] years; Group 2 - 57 [40–68] years; Group 3 - 33 [26–43] years; p<0.001) with a higher prevalence of smoking, intravenous ...
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Background: Standard gray-scale imaging (GSI), three-dimensional (3D) echocardiography has been shown to be superior to two-dimensional echocardiography in measuring left ventricular volume. However, the often relatively poor quality of... more
Background: Standard gray-scale imaging (GSI), three-dimensional (3D) echocardiography has been shown to be superior to two-dimensional echocardiography in measuring left ventricular volume. However, the often relatively poor quality of transthoracic gray-scale data can limit the potential application of this technique. Doppler myocardial imaging (DMI) is a new ultrasound technique that potentially offers higher-quality 3D images with a transthoracic approach than
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Introducción: Actualmente no hay consenso sobre el manejo anestésico más adecuado en el implante valvular aórtico percutáneo por vía transfemoral. Aunque se ha demostrado la factibilidad de concretar el procedimiento bajo anestesia local... more
Introducción: Actualmente no hay consenso sobre el manejo anestésico más adecuado en el implante valvular aórtico percutáneo por vía transfemoral. Aunque se ha demostrado la factibilidad de concretar el procedimiento bajo anestesia local con sedación consciente o sin esta, los resultados clínicos reportados son controvertidos. Objetivos: Evaluar la seguridad y eficacia del implante valvular aórtico percutáneo por vía transfemoral realizado bajo anestesia general versus anestesia local con sedación consciente. Material y métodos: Análisis unicéntrico y retrospectivo de los pacientes con estenosis aórtica grave sintomática con alto riesgo quirúrgico sometidos a un implante valvular aórtico percutáneo por vía transfemoral desde marzo de 2009 a diciembre de 2016, según el manejo anestésico. Los desenlaces de seguridad y eficacia fueron evaluados a 30 días según las definiciones del Valve Academic Research Consortium-2. Además, se evaluaron los principales tiempos durante la internación....
BACKGROUND Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using 2D echocardiography (2DE). Yet, 3D echocardiography... more
BACKGROUND Echocardiography remains the most widely used modality to assess left ventricular (LV) chamber size and function. Currently this assessment is most frequently performed using 2D echocardiography (2DE). Yet, 3D echocardiography (3DE) has been shown to be more accurate and reproducible than 2DE. Current normative reference values for 3D LV analysis are predominantly based on data from North America and Europe. The World Alliance of Societies of Echocardiography (WASE) study was a designed to sample normal subjects from around the world to provide more universal global reference ranges. In this study we sought to assess the world-wide feasibility of LV 3DE and report on size and function measurements. METHODS 2262 healthy subjects were prospectively enrolled from 19 centers in 15 countries. 3D LV full-volume datasets were obtained and analyzed offline with vendor-neutral software. Measurements included end-diastolic and end-systolic volumes (EDV, ESV), ejection fraction (EF), global longitudinal and circumferential strain (GLS and GCS). Results were categorized by age (18-40, 41-65 and >65 years), sex and race. RESULTS 1589 subjects (feasibility 70%) had adequate LV datasets for analysis. Mean normal values for indexed EDV, ESV and EF in men and women were 70 ± 15 and 65 ± 12 mL, 28 ± 7 and 25 ± 6 mL and 60 ± 5, 62 ± 5% respectively. Men had larger LV volumes and lower EF than women. GLS and GCS were higher in magnitude in women. In both sexes, LV volumes were lower and EF tended to be higher with increasing age, especially considering the differences between the youngest and oldest age groups. While GLS was similar across age groups in men, in women, the youngest and middle-age cohorts revealed higher magnitudes of GLS when compared to the oldest age group. GCS was higher in magnitude at older age in both men and women. Finally, Asians had smaller chamber sizes and higher EF and absolute strain values than both blacks and whites. CONCLUSIONS Age, sex, and race should be considered when defining normal reference values for LV dimension and function parameters obtained by 3DE.
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BACKGROUND Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are... more
BACKGROUND Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography (WASE) Study, we sought to establish normal ranges of aortic dimensions across sexes, races and a wide range of ages. METHODS Adult individuals free from heart, lung and kidney disease were prospectively enrolled from 15 countries with even distribution among sexes and age groups: young (18-40), middle (41-65) and old (>65 years). Transthoracic 2D echocardiograms of 1,585 subjects (age 47±17 years, 50.4% male, body surface area (BSA) 1.77±0.22 m2) were analyzed in a core laboratory following ASE guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva (SoV), and sinotubular junction (STJ). Differences among age, sex and racial groups were evaluated using unpaired two-tailed student's t-tests. RESULTS All aortic root dimensions were larger in males compared to females. After indexing to BSA, all measured dimensions were significantly larger in females, whereas males continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared to the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA- or height adjustment. Lastly, differences in aortic dimensions were also observed according to race: Asians had the smallest non-indexed aortic dimensions at all levels. CONCLUSIONS There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
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BACKGROUND Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual... more
BACKGROUND Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous reports have yielded mixed conclusions regarding the effects of age, sex and/or race. The current report from the World Alliance Societies of Echocardiography (WASE) study focuses on 2D and 3D measures of LA structure and function, with subgroup analysis by age-, sex- and race. METHODS Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 males, 864 females) evenly distributed among age subgroups: 18-40 years (n=745), 41-65 years (n=618) and >65 years (n=402); 38.4% white, 39.9% Asian, 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS 3D maximal and minimum LA volumes adjusted for BSA were nearly identical for men and women, but women demonstrated higher 3D total and passive EF. 2D reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF, reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EF decreased with age. Inter-racial differences were noted in LA volumes without substantial differences in functional indices. CONCLUSIONS While similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EF. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathological processes.