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- Author: Jamal Nasir Khan x
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Muhammad Khan, Ruben De Sousa, Kam Rai, and Jamal Nasir Khan
Handi Salim, Martin Been, David Hildick-Smith, and Jamal Nasir Khan
Viren Ahluwalia, Faizel Osman, Jitendra Parmar, and Jamal Nasir Khan
Summary
Despite 3D echocardiography (3DE) acquiring significantly greater data than standard 2D echocardiography (2DE), it is underutilised in assessing cardiac anatomy and physiology. A key advantage is the ability of a single 3DE acquisition to be post-processed to generate volume-rendered 3D models and an unlimited number of multiplanar reconstruction (MPR) images. We describe the case of a highly anxious patient with life-threatening complex aortic valve endocarditis and aortic root abscess, refusing transesophageal echocardiography (TOE) under general anaesthesia with tachycardia, breathlessness and acute kidney injury precluding accurate or safe gated (computed tomography) CT, who was comprehensively assessed with a rapid 3D-TOE under sedation. This led to timely surgery and an excellent outcome for the patient.
Learning points:
- 3DE is of greater clinical value than 2DE as it is able to post-process a single 3DE image acquisition into volume rendered 3D models, and provide an unlimited number of multiplanar reconstruction (MPR) images.
- 3DE is highly effective in difficult cases where speed is important.
- 3DE is superior in the planning of complex surgical cases.
Sadie Bennett, Chun Wai Wong, Timothy Griffiths, Martin Stout, Jamal Nasir Khan, Simon Duckett, Grant Heatlie, and Chun Shing Kwok
Background
Echocardiographic evaluation of left ventricular ejection fraction (LVEF) is used in the risk stratification of patients with an acute myocardial infarction (AMI). However, the prognostic value of the Tei index, an alternative measure of global cardiac function, in AMI patients is not well established.
Methods
We conducted a systematic review, using MEDLINE and EMBASE, to evaluate the prognostic value of the Tei index in predicting adverse outcomes in patients presenting with AMI. The data was collected and narratively synthesised.
Results
A total of 16 studies were including in this review with 2886 participants (mean age was 60 years from 14 studies, the proportion of male patients 69.8% from 14 studies). Patient follow-up duration ranged from during the AMI hospitalisation stay to 57.8 months. Tei index showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus formation in 14 out of the 16 studies. However, in one of these studies, Tei index was only significantly predictive of cardiac events in patients where LVEF was <40%. In two further studies, Tei index was not associated with predicting adverse outcomes once LVEF, left ventricular end-systolic volume index and left ventricular early filling time was taken into consideration. In the two remaining studies, there was no prognostic value of Tei index in relation to patient outcomes.
Conclusions
Tei index may be an important prognostic marker in AMI patients, however, more studies are needed to better understand when it should be used routinely within clinical practice.
