Early Diagnosis of Cardiovascular Diseases in Workers: Role of Standard and Advanced Echocardiography

Figure 1. A 43-year-old male patient with anteroapical myocardial infarction. Subsequent stent implantation in the left anterior descending (LAD) coronary artery and medical therapy. (a) Dilated left ventricle (LV) in long axis view. (b) Akinetic scarred septum (IVS) in M-mode representation. (c) Dilated LV in apical 4-chamber view with mitral valve (MV) regurgitation. (d) White scarred segments compared to red normokinetic segments in the “bull's-eye” plot by speckle-tracking echocardiography. Strain curves show reduction of anteroapical longitudinal strain. Ao = aorta; LA = left atrium; PW = LV posterior wall.

Figure 2. Provocative testing in ischemic heart disease. (a) Exercise stress echocardiography in a patient with normal coronary arteries. Persistent normal wall motion after exercise (125 W). (b) Dobutamine stress echocardiography in a patient with ischemic heart disease. Anteroseptal hypokinesia at peak dose (40 mcg) is shown both by wall motion abnormalities (top panels) and strain analysis (bottom right panel, lighter segments in the “bull's-eye” representation of peak systolic strain). LV = left ventricle.

Figure 3. A 48-year-old male patient with systemic arterial hypertension, left ventricular hypertrophy, and diastolic dysfunction. Patient was on medical therapy. (a) Concentric left ventricular hypertrophy. (b) Mitral inflow velocity with inverted E/A ratio. (c) Mitral annulus velocity with inverted Ea/Aa ratio. Ea reduction with increased E/Ea ratio suggests diastolic dysfunction. A = inflow late diastolic (atrial) velocity; E = inflow early diastolic velocity; Ea = annular early diastolic velocity; IVS = interventricular septum; LV = left ventricle; PW = LV posterior wall; RV = right ventricle; Sa = annular systolic velocity.

Figure 4. Left atrial (LA) size and function in systemic arterial hypertension. Novel technologies for LA analysis. (a) LA wall deformation curve by speckle tracking echocardiography. (b) LA volume by three-dimensional echocardiography. ACS = atrial contraction strain; PS = peak strain (peak global longitudinal strain at ventricular end-systole).

Figure 5. A 48-year-old male patient with dilated cardiomyopathy from previous myocarditis and systolic dysfunction. Patient was on medical therapy. (a) LV dilatation and septal (IVS) and posterior wall (PW) hypokinesia by M-mode echocardiography. (b) Two-dimensional four-chamber apical view showing LV end-systolic dilatation and mitral valve (MV) regurgitation. (c) Three-dimensional four-chamber apical view showing LV dilatation and severe systolic dysfunction (left ventricular ejection fraction = 32%). (d) Calculation of three-dimensional right ventricular volumes showing right ventricular ejection fraction at lower normal limits (45%). GLS = global longitudinal strain; IVS = interventricular septum; LV = left ventricle; LVEF = left ventricular ejection fraction; PW = LV posterior wall; RA = right atrium; RV = right ventricle; RVEF = right ventricular ejection fraction.

Figure 6. A 27-year-old male patient with patent foramen ovale (PFO) and a history of transient ischaemic attack (TIA). Patient had atrial device implantation. (a) Atrial septal aneurysm (ASA) with PFO and left-to-right shunt by transesophageal echocardiography. (b) TEE right-to-left shunt after intravenous injection of ultrasound contrast agent. (c) Postdevice transesophageal longitudinal bicaval view showing absence of shunt flow. LA = left atrium; RA = right atrium.

Figure 7. A 32-year-old female patient with ostium secundum atrial septal defect (ASD) and a history of ischaemic stroke. Patient had atrial device implantation. (a) Three-dimensional apical 4-chamber view, ASD. (b) Transesophageal three-dimensional longitudinal view, ASD shape. (c) Transesophageal 4-chamber view, left-to-right shunt by color Doppler. (d) Postdevice three-dimensional apical 4-chamber view showing absence of shunt flow. IVC = inferior vena cava; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; SVC = superior vena cava.

Figure 8. A 38-year-old male patient with congenital mitral valve prolapse (MVP), mitral regurgitation (MR), and progressive dyspnea. Patient had mitral valve surgery. (a) MVP by M-mode echocardiography. (b) Color Doppler in apical 4-chamber view showing severe MR. (c) Doppler-estimated systolic pulmonary artery pressure (58 mmHg). (d) MR reduction after mitral valve surgery (MV mechanical prosthesis). LA = left atrium; LV = left ventricle; MV = mitral valve; RA = right atrium; RV = right ventricle.

Figure 9. A 35-year-old female patient with systemic lupus erythematosus and progressive dyspnea from severe mitral regurgitation (MR). Patient had percutaneous mitral valve (MV) clip implantation. (a) Thickened MV leaflets. (b) Severe MR by TEE. (c) MR reduction after percutaneous MV clip implantation. Ao = aorta; LA = left atrium; LV = left ventricle.

Figure 10. A 46-year-old male patient with valvar aortic stenosis (AS) and angina pectoris. Patient had aortic valve surgery. (a) Left ventricular hypertrophy from pressure afterload. (b) High transvalvular pressure gradient (81 mmHg peak, 44 mmHg mean) by color Doppler. (c) Reduced aortic valvar area (0.7 cm2) by TEE. (d) Aortic pressure gradient reduction (12 mmHg peak, 7 mmHg mean) after aortic valve surgery. Ao = aorta; IVS = interventricular septum; LA = left atrium; LV = left ventricle; PW = LV posterior wall; RA = right atrium.