Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

http://www.botonimarco.it/files/chamberquantification.pdf

Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques have improved and expanded dramatically, due to the introduction of higher frequency transducers, harmonic imaging, fully digital machines, left-sided contrast agents, and other technological advancements. Furthermore, echocardiography due to its portability and versatility is now used in emergency rooms, operating rooms, and intensive care units. Standardization of measurements in echocardiography has been inconsistent and less successful, compared to other imaging techniques and consequently, echocardiographic measurements are sometimes perceived as less reliable. Therefore, the American Society of Echocardiography, working together with the European Association of Echocardiography, a branch of the European Society of Cardiology, has critically reviewed the literature and updated the recommendations for quantifying cardiac chambers using echocardiography. This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.

/pdf/recommendations-for-chamber-quantification-p3fv2qysao.pdf

Recommendations for chamber quantification

The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002





The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence Minor changes in verbiage and references are discouraged

The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated The full-text guideline incorporating the updated material is available on the Internet (wwwaccorg or wwwamericanheartorg) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …

https://cdr.lib.unc.edu/downloads/bz60cz34d

ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)

Methodology These Guidelines are based on the Diagnostic and Therapeutic Guidelines published in 1995 and 1997, respectively, and have now been combined into one paper. Where new information is available an update has been performed while other parts are unchanged or adjusted to a limited extent. The aim of this report is to provide practical guidelines for the diagnosis, assessment and treatment of heart failure for use in clinical practice and in addition for epidemiological surveys and clinical trials. They are intended as a support for practising physicians and other health care professionals concerned with the management of heart failure patients and provide advice on how to manage these patients including recommendations for referral. The recommendations in these guidelines should always be considered in the light of local regulatory requirements for the administration of any chosen drug or device. This report was drafted by a Task Force (see Appendix 1) appointed by the Committee for Practice Guidelines and Policy Conferences of the European Society of Cardiology (ESC). It was circulat d among the Nucleus of the Working Group on Heart Failure, other Working Groups, and several experts in the field of heart failure. It was updated based on comments received. It was then sent to the Committee and after their input the document was approved for publication.    Recommendations regarding treatments have been based on the degree of available evidence.

Guidelines for the diagnosis and treatment of chronic heart failure

Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function.

Assessment of myocardial velocities by Doppler tissue imaging is gaining in importance. However, generally accepted reference values are still missing. In this study we examined 62 consecutive healthy subjects (mean age 46, range 22-82 years) by pulsed wave Doppler tissue imaging to characterize the systolic and diastolic velocity profiles of the left and right ventricles. The subjects were divided into 3 different age-groups: group I, younger than 40 years; group II, 40 to 59 years; and group III, 60 years and older. Recordings were made along the long axis in the apical 4- and 2-chamber views by using 4 sites (septal, anterior, lateral, and inferior) at the mitral annulus and 1 site at the tricuspid annulus. Systolic mitral annular velocity (10.3 +/- 1.4 cm/s) correlated strongly with global left ventricular function determined by M-mode echocardiographic mitral annular displacement (r = 0.70, P <.001). The systolic velocity was significantly lower in group III than in group I (9.6 vs 10.8 cm/s, P <.01). A relatively weak, but significant, correlation was found between systolic velocity and the age of the subjects (r = -0.43, P <.001). Mitral annular early diastolic velocity was also lower in group III compared with group I (11.3 vs 17.7 cm/s, P <.001), with a strong correlation with age (r = -0.81, P <.001) and other conventional Doppler diastolic parameters. Both the systolic and early diastolic mitral annular velocities at the septum were lower than at other left ventricular sites. Tricuspid annular systolic velocity (15.2 +/- 1.9 cm/s) was higher than mitral annular systolic velocity (P <.001). Unlike mitral annular velocity, systolic tricuspid annular velocity was not correlated with age. However, the diastolic tricuspid annular velocities correlated well with transtricuspid Doppler diastolic parameters. The method of recording the annular velocities was feasible in all subjects, simple and highly reproducible.

Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects.

Echocardiographic recording of the atrioventricular (AV) plane displacement during the cardiac cycle was used to assess left ventricular (LV) global function in patients with congestive heart failure (CHF) The study population consisted of 70 patients with chronic CHF (NYHA functional groups III and IV) following dilated cardiomyopathy (DCM) or myocardial infarction (MI), and 35 age-matched healthy subjects The AV plane displacement was recorded from the apical 4- and 2-chamber views at four LV sites located about 90 degrees apart and representing the septal, anterior, lateral and posterior parts of the LV wall A mean value was calculated from the above sites (AV-mean) Patients with CHF showed a significant generalized reduction of AV plane displacement compared to healthy subjects (56 mm vs 145 mm, P less than 0001) Thirty CHF patients also underwent radionuclide angiography in order to determine the ejection fraction (EF) The correlation between AV-mean and EF was good (r = 082, P less than 0001) The selection of an AV-mean of less than 7 mm to define a severely depressed LV function (EF less than 30%) gave a sensitivity of 92% and a specificity of 67% It is concluded that the AV plane displacement can be used to estimate LV systolic function in patients with CHF

Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction.

Echocardiographic quantitative assessment of the atrioventricular plane displacement (AVPD) in systole towards the apex has been used to estimate global left ventricular (L V) function. The study population consisted of 106 patients with coronary artery disease (CAD) with or without previous myocardial infarction and 40 age-matched healthy subjects. The AVPD was recorded from the apical four-and two-chamber views at four sites corresponding to the septal, lateral, anterior and posterior walls of the left ventricle. A mean displacement (A Vmean) was calculated from the above sites. A Vmean was significantly decreased in patients with CAD compared to healthy subjects (P<0.001). In patients in whom the left ventricular ejection fraction (L VEF) was calculated from cineangiograms a good correlation between A Vmean and LVEF was found (r = 0.89, P < 0.001, SEE= 6.4). Selecting an A Vmean of 10 min or more to define a normal L VEF ( 2.55%) resulted in a sensitivity of 92% and a specificity of 87% in predicting a normal versus abnormal left ventricular systolic function. It is concluded that the ease of recording the A VPD by echocardiography provides a simple and valuable non-invasive method to assess global left ventricular function in patients with CAD.

Haemodynamic significance of the atrioventricular plane displacement in patients with coronary artery disease

Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarction

Recent echocardiographic studies have shown that the atrioventricular (AV) valve plane displacement toward the apex in systole plays an important role in the pump function of the left ventricle. 1–6 The method of recording the AV plane displacement is simple and the magnitude of the AV plane displacement can be used to assess left ventricular systolic function in patients with acute myocardial infarction, coronary artery disease and severe chronic congestive heart failure. 5–7 At the start of diastole, the AV plane begins to ascend rapidly toward the atrium away from the apex. Atrial systole also contributes to ventricular filling by further displacing the AV plane in the same direction, and this is noticed in the last part of the diastolic phase of AV plane displacement and is associated with the P wave of the electrocardiogram. 8 The purpose of this study was to evaluate the diastolic function in healthy control subjects of different age groups by relating the motion of the AV plane due to atrial systole to the total diastolic ascent of the AV plane.

Assessment by echocardiogram of left ventricular diastolic function in healthy subjects using the atrioventricular plane displacement.

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