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Thompson AJ, O'Leary PW, Miller A, Martineau S, Reece C, Breuer A, Eidem BW, Qureshi MY. Inter-observer and Inter-vendor Variability in Strain Measurements in Patients with Single Right Ventricular Anatomy. Pediatr Cardiol 2021; 42:1341-1349. [PMID: 33891133 DOI: 10.1007/s00246-021-02617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/15/2021] [Indexed: 11/24/2022]
Abstract
Myocardial strain offers new insights into ventricular performance, There are software packages from several different companies used to ascertain this, and little data is available in patients with single right ventricle (sRV) physiology. We aimed to compare the analysis of two strain software applications using a cohort of patients with sRV for both inter-vendor and inter-observer variability. Echocardiograms from 85 patients with sRV (122 separate studies) were prospectively evaluated. All had Glenn and/or Fontan palliation. Longitudinal 4-chamber (4LS), inflow/outflow (IO), circumferential, and radial strain were assessed using Velocity Vector Imaging (VVI, Seimens, Munich) and Automated Functional Imaging (AFI, General Electric, Boston) software. In a subset of 45 patients (61 separate studies), strain measurements were obtained by two sonographers so a paired "inter-observer" analysis could be performed. A moderate correlation between measurements made by the two systems was observed. Circumferential strain assessment had the highest R value (0.77) with all others having R values < 0.6. Both software packages showed modest inter-observer reproducibility for longitudinal and circumferential strain. VVI intraclass correlation coefficients (ICC) for 4LS and average circumferential strain (ACS) were 0.6 and 0.58, compared to 0.68 and 0.59 for AFI. Other than radial strain and VVI IO inferior strain, mean strain differences between AFI and VVI were ≤ 1%. Inter-observer variability is modest, however, mean differences are minimal suggesting reasonable clinical reliability. Inter-vendor variability is greater and not as clinically reliable. In patients with sRV, serial assessments with strain should be performed using the same software.
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Affiliation(s)
- Alex J Thompson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Patrick W O'Leary
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Miller
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara Martineau
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chelsea Reece
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amanda Breuer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin W Eidem
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Yasir Qureshi
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Zhong SW, Zhang YQ, Chen LJ, Zhang ZF, Wu LP, Hong WJ. Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three-dimensional echocardiography after fontan operation. Echocardiography 2021; 38:1218-1227. [PMID: 34156720 DOI: 10.1111/echo.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure. METHODS Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%). RESULTS RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = -.570, p = 0.003). CONCLUSIONS RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation.
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Affiliation(s)
- Shu-Wen Zhong
- International Department, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Fang Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Jing Hong
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Chen LJ, Zhang YQ, Bao SF, Zhong SW, Sun AM, Zhang ZF. Velocity vector imaging for the assessment of segmental ventricular function in children with a single right ventricle after cavopulmonary anastomosis. Curr Med Res Opin 2019; 35:203-210. [PMID: 29611724 DOI: 10.1080/03007995.2018.1460337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Ventricular function assessment is very important for the treatment and prognostic classification of children with a single right ventricle (SRV) after cavopulmonary anastomosis (CPA). However, unusual ventricular shapes can result in inaccurate measurements. The aim of this study was to evaluate velocity vector imaging (VVI) for assessing segmental ventricular function in children with SRV after CPA. METHODS Twenty-one children with SRV after CPA and 21 age- and sex-matched children with normal biventricular anatomy and function were included. The longitudinal velocity, displacement, strain and strain rate were measured in the two groups in six segments by VVI. The velocity, displacement, strain and strain rate of the SRVs were compared with max(dp/dt) measured during simultaneous cardiac catheterization in the SRV subjects. RESULTS The control group consisted of 13 males and 8 females (69% males) with a mean age of 6.7 ± 3.5 years and mean weight of 20.5 ± 6.5 kg, and the study group consisted of 13 males and 8 females with a mean age 6.7 ± 3.7 years and mean weight of 20.6 ± 6.8 kg. Age, weight and sex distribution were similar between the groups (all, p > .05). Strain and strain rate values in all six segments were significantly lower in the study group than in the control group (all, p < .05). The max(dp/dt) of the SRV was 522.84 ± 158.32 mmHg/s, and the strain rate of the basal segment at the rudimentary chamber correlated best with max(dp/dt) (r = 0.74, p < .01). CONCLUSIONS Segmental ventricular dysfunction was present in children with SRV after CPA, and it could be assessed using VVI.
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Affiliation(s)
- Li-Jun Chen
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yu-Qi Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Sheng-Fang Bao
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shu-Wen Zhong
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ai-Min Sun
- b Department of Medical Imaging , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhi-Fang Zhang
- a Department of Pediatric Cardiology , Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Chen LJ, Tong ZR, Wang Q, Zhang YQ, Liu JL. Feasibility of Computational Fluid Dynamics for Evaluating the Intraventricular Hemodynamics in Single Right Ventricle Based on Echocardiographic Images. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1042038. [PMID: 29568740 PMCID: PMC5820678 DOI: 10.1155/2018/1042038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 12/04/2022]
Abstract
This study introduced a combined computational fluid dynamics (CFD) and echocardiography methodology to simulate blood flow in the single right ventricle (SRV) and normal ventricles to study the intraventricular flow. Derived from echocardiographic image loops, CFD-based three-dimensional (3D) flow models of normal subject's left ventricle (LV) and right ventricle (RV) and SRV with and without heart failure at three characteristic diastolic statuses were reconstructed. The CFD derived morphological and functional measurements in normal ventricles and the SRV were validated with echocardiography. The vortex in the normal ventricles and the SRV were studied. The morphological and functional measurements derived from CFD modeling and echocardiography were comparable, and both methods demonstrated the larger volume and higher spherical index in the SRV, in particular the SRV with heart failure. All the vortices in the SRV were smaller than those in the normal control subject's LV and RV, notably with heart failure. Unlike normal LV and RV, no vortex ring was observed in the SRV. Echocardiography-based CFD demonstrated the feasibility of quantifying ventricular morphology and function; in addition, CFD can detect the abnormal flow pattern (smaller or obliterated vortices) in the SRV when compared with normal ventricles.
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Affiliation(s)
- Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Zhi-Rong Tong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Qian Wang
- Department of Medical Imaging, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Jin-Long Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Koopman LP, Geerdink LM, Bossers SSM, Duppen N, Kuipers IM, ten Harkel AD, van Iperen G, Weijers G, de Korte C, Helbing WA, Kapusta L. Longitudinal Myocardial Deformation Does Not Predict Single Ventricle Ejection Fraction Assessed by Cardiac Magnetic Resonance Imaging in Children with a Total Cavopulmonary Connection. Pediatr Cardiol 2018; 39:283-293. [PMID: 29071373 PMCID: PMC5797755 DOI: 10.1007/s00246-017-1753-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Survival of children with single ventricle heart defects after the total cavopulmonary connection (TCPC) has improved, but impaired cardiac function remains a major cause of morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) is the gold standard in assessing single ventricle volume and function, but high costs and limited availability hamper its routine use. A cheaper and more available alternative is echocardiography. Myocardial function can be studied in more detail using speckle tracking echocardiography (STE). The purpose of the study was to describe the association between myocardial deformation assessed by speckle tracking echocardiography (STE) and single ventricle function assessed by cMRI and to evaluate differences in myocardial deformation in children with single left and single right ventricular morphology. Cross-sectional, multicenter study in 77 children after TCPC was conducted. STE segmental and global longitudinal peak strain and systolic strain rate (SR) of the dominant ventricle were measured. Impaired SV function by cMRI was defined as ejection fraction (EF) < 45%. Mean age was 11.8 (range 9.7-14.3) years. Pearson R for cMRI EF versus global longitudinal strain and SR was - 0.25 (p = 0.06) and - 0.03 (p = 0.82), respectively. Global single ventricle longitudinal strain and SR was similar in patients after TCPC with single left and single right ventricular morphology (- 19.0 ± 3.1% vs 19.2 ± 3.2%, p = 0.94). STE myocardial deformation parameters do not correlate with single ventricle ejection fraction assessed by cMRI.
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Affiliation(s)
- L. P. Koopman
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - L. M. Geerdink
- Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children’s Hospital, Nijmegen, The Netherlands ,Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - S. S. M. Bossers
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - N. Duppen
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - I. M. Kuipers
- Department of Pediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A. D. ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G. van Iperen
- Department of Pediatric Cardiology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - G. Weijers
- Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - C. de Korte
- Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - W. A. Helbing
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands ,Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - L. Kapusta
- Department of Pediatric Cardiology, Radboud University Medical Centre, Amalia Children’s Hospital, Nijmegen, The Netherlands ,Pediatric Cardiology Unit, Dana Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Wang X, Lian Y, Wang X, Tian M. Study of Regional Left Ventricular Longitudinal Function in Fetuses with Gestational Diabetes Mellitus by Velocity Vector Imaging. Echocardiography 2016; 33:1228-33. [PMID: 27460645 DOI: 10.1111/echo.13238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Xiaoyan Wang
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Yajun Lian
- Internal Medicine-Cardiovascular Department; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Xiaofang Wang
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
| | - Min Tian
- Department of Ultrasound; Heping Hospital Affiliated to Changzhi Medical College; Changzhi Shanxi China
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