Recommendations for a standardized report for adult transthoracic echocardiography: A report from the American Society of Echocardiography's Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report

BackgroundHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that presents clinicians with a diagnostic challenge. The use of natriuretic peptides to exclude a diagnosis of HFpEF has been proposed. We sought to compare HFpEF patients with N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) level above and below the proposed cut‐off.MethodsStable patients (n = 30) with left ventricular (LV) ejection fraction ≥ 50% were eligible if they had a diagnosis of HF according to the European Society of Cardiology diagnostic criteria. Characteristics of patients with NT‐proBNP below (≤125 pg/mL) and above (>125 pg/mL) the diagnostic criterion were compared.ResultsThere were 19 (66%) women with median age 54 years. Half were African American (16, 53%), and most were obese. There were no significant differences in clinical characteristics or medication use between groups. LV end‐diastolic volume index was greater in high NT‐proBNP patients (P = 0.03). Left atrial volume index, E/e′ ratio, and E/e′ ratio at peak exercise were not significantly different between NT‐proBNP groups. Peak oxygen consumption (VO2), VO2 at ventilatory threshold, and ventilatory efficiency measures were impaired in all patients and were not significantly different between high and low NT‐proBNP patients.ConclusionsNT‐proBNP was below the proposed diagnostic cut‐off point of 125 pg/mL in half of this obese study cohort. Cardiac diastolic dysfunction and cardiorespiratory fitness were not significantly different between high and low NT‐proBNP patients. These data indicate that excluding the diagnosis of HFpEF based solely on NT‐proBNP levels should be discouraged.

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“…Transthoracic Doppler echocardiography was performed by a cardiologist according to current recommendations 20, 21, 22…”

Section: Methodsmentioning

confidence: 99%

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

et al. 2018

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“…Echocardio-graphic studies were obtained using an HP Phillips Sonos 5500 (Andover, Massachusetts) or IE33 apparatus with dual harmonic imaging and short-and long-axis views, as recommended by the American Society of Echocardiography. 10 The LV endsystolic volume, LV end-diastolic volume, and LV ejection fraction were computed in the apical 4-and 2-chambers views over multiple cycles, using the modified Simpson formula. 10 The wall motion score index was calculated as the ratio of the sum of the score from each of 16 segments using standard scoring recommendations divided by the total number of segments.…”

Section: Methodsmentioning

confidence: 99%

“…10 The LV endsystolic volume, LV end-diastolic volume, and LV ejection fraction were computed in the apical 4-and 2-chambers views over multiple cycles, using the modified Simpson formula. 10 The wall motion score index was calculated as the ratio of the sum of the score from each of 16 segments using standard scoring recommendations divided by the total number of segments. 10 Transmitral flow and LV outflow tract flow Doppler spectra and the annular tissue Doppler spectra were obtained from the apical window, and the cardiac index was calculated.…”

Section: Methodsmentioning

confidence: 99%

Interleukin-1 Blockade With Anakinra to Prevent Adverse Cardiac Remodeling After Acute Myocardial Infarction (Virginia Commonwealth University Anakinra Remodeling Trial [VCU-ART] Pilot Study)

Abbate

Kontos

Grizzard

et al. 2010

The American Journal of Cardiology

363

222

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Acute myocardial infarction (AMI) initiates an intense inflammatory response in which interleukin-1 (IL-1) plays a central role. The IL-1 receptor antagonist is a naturally occurring antagonist, and anakinra is the recombinant form used to treat inflammatory diseases. The aim of the present pilot study was to test the safety and effects of IL-1 blockade with anakinra on left ventricular (LV) remodeling after AMI. Ten patients with ST-segment elevation AMI were randomized to either anakinra 100 mg/day subcutaneously for 14 days or placebo in a doubleblind fashion. Two cardiac magnetic resonance (CMR) imaging and echocardiographic studies were performed during a 10-to 14-week period. The primary end point was the difference in the interval change in the LV end-systolic volume index (LVESVi) between the 2 groups on CMR imaging. The secondary end points included differences in the interval changes in the LV enddiastolic volume index, and C-reactive protein levels. A +2.0 ml/m 2 median increase (interquartile range +1.0, +11.5) in the LVESVi on CMR imaging was seen in the placebo group and a -3.2 ml/ m 2 median decrease (interquartile range -4.5, -1.6) was seen in the anakinra group (p = 0.033). The median difference was 5.2 ml/m 2 . On echocardiography, the median difference in the LVESVi change was 13.4 ml/m 2 (p = 0.006). Similar differences were observed in the LV enddiastolic volume index on CMR imaging (7.6 ml/m 2 , p = 0.033) and echocardiography (9.4 ml/m 2 , p = 0.008). The change in C-reactive protein levels between admission and 72 hours after admission correlated with the change in the LVESVi (R =+0.71, p = 0.022). In conclusion, in the present pilot study of patients with ST-segment elevation AMI, IL-1 blockade with anakinra was safe and favorably affected by LV remodeling. If confirmed in larger trials, IL-1 blockade might represent a novel therapeutic strategy to prevent heart failure after AMI.Acute myocardial infarction (AMI) initiates an intense inflammatory response characterized by an accumulation of leukocytes in the injured myocardium and the production of cytokines and chemokines, which further promotes adverse cardiac remodeling and heart failure. [1][2][3] Interleukin-1 (IL-1) is the prototypic inflammatory cytokine, inducing adhesion NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript molecules and chemokines. 4 IL-1 is also a known myocardial suppressant. [4][5] In AMI, IL-1 is initially released by the ischemic endothelial cells and cardiomyocytes and, later, by the leukocytes infiltrating the myocardium. 6 Although IL-1 leads to leukocyte recruitment, which contributes to infarct healing, IL-1 also promotes cell death in cardiomyocytes. 6,7 The naturally occurring IL-1 receptor antagonist binds to the IL-1 receptor and prevents IL-1 activity. 4 We have reported that a recombinant human IL-1 receptor antagonist, anakinra, ameliorated cardiac remodeling after a large anterior wall AMI in the experimental mouse model and improved survival. 7 Moreover, mice with...

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“…Regional wall motion of the left ventricle was analyzed on the basis of the division of the left ventricle into 17 segments, according to the recommendations of the American Society of Echocardiography. 10) Regional mobility has been denoted as: normal (scored as 1 point), hypokinesia -significantly reduced mobility (2 points), akinesia -the absence of systolic wall thickening (3 points), and dyskinesia -paradoxical movement of segments of the left ventricle in systole (4 points). The sum of the points obtained by scoring an individual segment is divided by number of scored segments and marked as the wall motion score index (WMSI).…”

Section: Methodsmentioning

confidence: 99%

“…All M-mode and 2 D measurements were made according to the recommendations given by the American Society of Echocardiography. 10) Left ventricular volumes and the ejection fraction of the left ventricle (LVEF) were calculated based on a biplanar disc summation method (modified Simpson's rule). Regional wall motion of the left ventricle was analyzed on the basis of the division of the left ventricle into 17 segments, according to the recommendations of the American Society of Echocardiography.…”

Section: Methodsmentioning

confidence: 99%

Temporal Changes in Plasma Brain Natriuretic Peptide Levels During Exercise Stress-Echocardiography in Patients With Dilated Cardiomyopathy

et al. 2014

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SummaryThe aim of this study was to evaluate temporal changes in brain natriuretic petide (BNP) levels during exercise stress-echocardiography in patients with dilated cardiomyopathy with respect to the left ventricular contractile reserve. We studied 55 consecutive patients with dilated cardiomyopathy (mean age, 55 ± 10 years, 49 (89.1%) male). All patients underwent exercise stress-echocardiography on a treadmill using the modified Bruce protocol. Contractile reserve was assessed by measuring changes in the wall motion score index (ΔWMSI) at rest and and at peak exercise. Levels of BNP were measured at rest, in the first minute, and after 20 minutes following termination of the stress test. Thirty-six patients had preserved left ventricular contractile reserve and 19 patients did not. Patients with preserved left ventricular contractile reserve showed a continuous rise in BNP levels from baseline to peak exercise and to 20 minutes following exertion (83.95 ± 108.51 versus 105.89 ± 116.00 versus 110.95 ± 119.70 ng/L, P < 0.001, respectively). On the other hand, patients without preserved left ventricular contractile reserve showed a decline in BNP levels at peak exercise as compared to baseline (335.49 ± 693.11 versus 320.08 ± 562.60, P = 0.031). ΔBNP was positively correlated with preserved contractile reserve (r = 0.46, P = 0.03) and lower NYHA class (r = -0.65, P = 0.001) in patients in whom baseline LVEF was lower than 20%. Multivariate analysis identified only WMSI at rest (beta -3.365, P = 0.008, 95% CI 0.03 to 0.411) as an independent predictor of left ventricular contractile reserve.The increase in BNP levels during exercise stress-echocardiography is associated with preserved left ventricular contractile reserve in patients with dilated cardiomyopathy. ( 1) Left ventricular contractile reserve has been identified as one of the major prognostic indicators. Contractile reserve was most frequently assessed using pharmacological agents, such as dobutamine and dipyridamole, 2,3) but rarely using physical exertion.4) It has been clearly demonstrated that preserved left ventricular contractile reserve was associated with milder forms of heart failure and identified patients with better prognosis. 2-4)The most important clinical use of BNP is to separate left ventricular dysfunction from other causes of dyspnea.5-7) The diagnostic and prognostic value of BNP measurements at rest in patients with heart failure is very well documented, but the potential clinical implications of changes in BNP during physical exertion in these patients are much less clear.There are initial reports indicating that the NT-pro BNP changes in response to dobutamine reflect improvement in left ventricular contractility and constitute an independent predictor of left ventricular inotropic reserve in patients with dilated cardiomyopathy, 8) and although resting NT-pro BNP levels can be used as a surrogate risk predictor, their changes during betaadrenergic stimulation showed no additive predictive value in assessing the clinical outcome...

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Recommendations for a standardized report for adult transthoracic echocardiography: A report from the American Society of Echocardiography's Nomenclature and Standards Committee and Task Force for a Standardized Echocardiography Report

Cited by 315 publications

References 12 publications

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

Low NT‐proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction

Interleukin-1 Blockade With Anakinra to Prevent Adverse Cardiac Remodeling After Acute Myocardial Infarction (Virginia Commonwealth University Anakinra Remodeling Trial [VCU-ART] Pilot Study)

Temporal Changes in Plasma Brain Natriuretic Peptide Levels During Exercise Stress-Echocardiography in Patients With Dilated Cardiomyopathy

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