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Tah S, Valderrama M, Afzal M, Iqbal J, Farooq A, Lak MA, Gostomczyk K, Jami E, Kumar M, Sundaram A, Sharifa M, Arain M. Heart Failure With Preserved Ejection Fraction: An Evolving Understanding. Cureus 2023; 15:e46152. [PMID: 37900404 PMCID: PMC10613100 DOI: 10.7759/cureus.46152] [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: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.
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Affiliation(s)
- Sunanda Tah
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Maham Afzal
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | | | - Aisha Farooq
- Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
| | | | - Karol Gostomczyk
- Medicine, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, POL
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | | | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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Burrage MK, Lewis AJ, Miller JJJ. Functional and Metabolic Imaging in Heart Failure with Preserved Ejection Fraction: Promises, Challenges, and Clinical Utility. Cardiovasc Drugs Ther 2023; 37:379-399. [PMID: 35881280 PMCID: PMC10014679 DOI: 10.1007/s10557-022-07355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is recognised as an increasingly prevalent, morbid and burdensome condition with a poor outlook. Recent advances in both the understanding of HFpEF and the technological ability to image cardiac function and metabolism in humans have simultaneously shone a light on the molecular basis of this complex condition of diastolic dysfunction, and the inflammatory and metabolic changes that are associated with it, typically in the context of a complex patient. This review both makes the case for an integrated assessment of the condition, and highlights that metabolic alteration may be a measurable outcome for novel targeted forms of medical therapy. It furthermore highlights how recent technological advancements and advanced medical imaging techniques have enabled the characterisation of the metabolism and function of HFpEF within patients, at rest and during exercise.
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Affiliation(s)
- Matthew K Burrage
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Andrew J Lewis
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
| | - Jack J J. Miller
- Oxford Centre for Clinical Cardiovascular Magnetic Resonance Research (OCMR); Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, UK
- The PET Research Centre and The MR Research Centre, Aarhus University, Aarhus, Denmark
- Department of Physics, Clarendon Laboratory, University of Oxford, Parks Road, Oxford, UK
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Pan CK, Zhao BW, Zhang XX, Pan M, Mao YK, Yang Y. Three-dimensional echocardiographic assessment of left ventricular volume in different heart diseases using a fully automated quantification software. World J Clin Cases 2022; 10:4050-4063. [PMID: 35665130 PMCID: PMC9131239 DOI: 10.12998/wjcc.v10.i13.4050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/10/2021] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HeartModel (HM) is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function. This study used HM to quantify the left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) of patients with dilated cardiomyopathy (DCM), coronary artery heart disease with segmental wall motion abnormality, and hypertrophic cardiomyopathy (HCM) to determine whether there were differences in the feasibility, accuracy, and repeatability of measuring the LVEDV, LVESV, LV ejection fraction (LVEF) and left atrial end-systolic volume (LAESV) and to compare these measurements with those obtained with traditional two-dimensional (2D) and three-dimensional (3D) methods.
AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.
METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups: (1) 42 patients with normal heart shape and function (control group, Group A); (2) 35 patients with DCM (Group B); (3) 41 patients with LV remodeling after acute myocardial infarction (Group C); and (4) 32 patients with HCM (Group D). The LVEDV, LVESV, LVEF and LAESV obtained by HM with (HM-RE) and without regional endocardial border editing (HM-NE) were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation, consistency, and repeatability of all methods.
RESULTS (1) The parameters measured by HM were significantly different among the groups (P < 0.05 for all). Compared with Groups A, C, and D, Group B had higher LVEDV and LVESV (P < 0.05 for all) and lower LVEF (P < 0.05 for all); (2) HM-NE overestimated LVEDV, LVESV, and LAESV with wide biases and underestimated LVEF with a small bias; contour adjustment reduced the biases and limits of agreement (bias: LVEDV, 28.17 mL, LVESV, 14.92 mL, LAESV, 8.18 mL, LVEF, -0.04%). The correlations between HM-RE and advanced cardiac 3D quantification (3DQA) (rs = 0.91-0.95, P < 0.05 for all) were higher than those between HM-NE (rs = 0.85-0.93, P < 0.05 for all) and the traditional 2D methods. The correlations between HM-RE and 3DQA were good for Groups A, B, and C but remained weak for Group D (LVEDV and LVESV, rs = 0.48-0.54, P < 0.05 for all); and (3) The intraobserver and interobserver variability for the HM-RE measurements were low.
CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality. HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.
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Affiliation(s)
- Chen-Ke Pan
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Bo-Wen Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Xuan-Xuan Zhang
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Mei Pan
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Yan-Kai Mao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Yuan Yang
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou 310016, Zhejiang Province, China
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Zhang Y, Wu C, Sun W, Zhu S, Zhang Y, Xie Y, Zhu Y, Zhang Z, Zhao Y, Li Y, Xie M, Zhang L. Left Heart Chamber Volumetric Assessment by Automated Three-Dimensional Echocardiography in Heart Transplant Recipients. Front Cardiovasc Med 2022; 9:877051. [PMID: 35571203 PMCID: PMC9091562 DOI: 10.3389/fcvm.2022.877051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Recently, a new automated software (Heart Model) was developed to obtain three-dimensional (3D) left heart chamber volumes. The aim of this study was to verify the feasibility and accuracy of the automated 3D echocardiographic algorithm in heart transplant (HTx) patients. Conventional manual 3D transthoracic echocardiographic (TTE) tracings and cardiac magnetic resonance (CMR) images were used as a reference for comparison. Methods This study enrolled 103 healthy HTx patients prospectively. In protocol 1, left ventricular end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), left atrial max volume (LAVmax), LA minimum volume (LAVmin) and LV ejection fraction (LVEF) were obtained using the automated 3D echocardiography (3DE) and compared with corresponding values obtained through the manual 3DE. In protocol 2, 28 patients’ automated 3DE measurements were compared with CMR reference values. The impacts of contour edit and surgical technique were also tested. Results Heart Model was feasible in 97.1% of the data sets. In protocol 1, there was strong correlation between 3DE and manual 3DE for all the parameters (r = 0.77 to 0.96, p<0.01). Compared to values obtained through manual measurements, LV volumes and LVEF were overestimated by the automated algorithm and LA volumes were underestimated. All the biases were small except for that of LAVmin. After contour adjustment, the biases reduced and all the limits of agreement were clinically acceptable. In protocol 2, the correlations for LV and LA volumes were strong between automated 3DE with contour edit and CMR (r = 0.74 to 0.93, p<0.01) but correlation for LVEF remained moderate (r = 0.65, p < 0.01). Automated 3DE overestimated LV volumes but underestimated LVEF and LA volumes compared with CMR. The limits of agreement were clinically acceptable only for LVEDV and LAVmax. Conclusion Simultaneous quantification of left heart volumes and LVEF with the automated Heart Model program is rapid, feasible and to a great degree it is accurate in HTx recipients. Nevertheless, only LVEDV and LAVmax measured by automated 3DE with contour edit seem applicable for clinical practice when compared with CMR. Automated 3DE for HTx recipients is a worthy attempt, though further verification and optimization are needed.
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Affiliation(s)
- Yiwei Zhang
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Sun
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shuangshuang Zhu
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanting Zhang
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ye Zhu
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Zisang Zhang
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yang Zhao
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Mingxing Xie,
| | - Li Zhang
- Department of Ultrasound Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Li Zhang,
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Wang Y, Zhang L, Liu J, Yue X, Shi H, Li Y, Xie M, Lv Q. Automated three-dimensional echocardiographic quantification for left ventricular volume and function in patients with hypertrophic cardiomyopathy. Echocardiography 2022; 39:658-666. [PMID: 35347747 DOI: 10.1111/echo.15322] [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: 08/31/2021] [Revised: 12/24/2021] [Accepted: 02/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Accurate, reproducible, noninvasive determination of left ventricular (LV) volumes and ejection fraction (EF) is important for clinical assessment, selection of therapy, and serial monitoring of patients with hypertrophic cardiomyopathy (HCM). Current clinical Two-dimensional echocardiography (2DE) may cause inaccurate measurements in patients with HCM because of their asymmetric ventricles and limitations of 2DE technology. Three-dimensional echocardiography (3DE) have demonstrated significantly greater accuracy. However, the time-consuming workflow limits the clinical utility of 3DE. AIM We aim to compare the performance of a novel automated 3DE system (HeartModel, Philips Healthcare) with 2DE in a group of patients with HCM. Cardiac magnetic resonance (CMR) was reference standard. METHODS Fifty-three patients with HCM were examined by automated 3DE (3DEA), two-dimensional biplane Simpson's method (2DBP), manual 3DE method, and CMR, respectively. For patients with poor automated quantification, manual correction was performed. The Pearson correlation coefficient and Bland-Altman analysis and paired Student t tests were used to assess inter-technique agreement. RESULTS 3DEA measurements with contour editing correlate well with CMR and manual 2DE and 3DE measurements (r = .80-.96). The analysis time of 3DEA was shorter than that of 2DBP (3DEA, 141 ± 15s; 2DBP, 174 ± 17 s). Inter-observer variability was reduced significantly with use of 3DEA. CONCLUSION Compared with current clinical 2DBP method, the analysis time of automated 3DE was much shorter with the added benefit of enhanced accuracy and reproducibility. Patients with asymmetric chamber may rely more on the timesaving automated 3DE quantification in the future.
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Affiliation(s)
- Yushan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofei Yue
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Lab of Molecular Imaging, Wuhan, China
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Xing YY, Xue HY, Ye YQ. Heart Model A.I. Three-Dimensional Echocardiographic Evaluation of Left Ventricular Function and Parameter Setting. Int J Gen Med 2021; 14:7971-7981. [PMID: 34795512 PMCID: PMC8593599 DOI: 10.2147/ijgm.s332855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective This study aims to explore the feasibility of HeartModel A.I. (HM) three-dimensional echocardiography (3DE) to assess left ventricular function and discover suitable border parameter settings. Methods A total of 113 patients that underwent echocardiography in our hospital were eligible for inclusion. The HM 3DE (HM method) and conventional 3DE (3D method) were used to analyze echocardiography images. The HM was set to different border settings (end-diastolic [ED] and end-systolic [ES] settings) to assess different left ventricular systolic function parameters including left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), and left ventricular ejection fraction (LVEF), and left ventricular diastolic function parameters including maximal left atrium volume (LAVMAX). All of these parameters were evaluated using the HM method and then compared with the 3D method. Results The differences in LVEDV, LVESV, and LVEF measured with different HM border settings were statistically significant (P<0.05) and were strongly correlated with the 3D method. For LVEF, the reading using the HM method with ED and ES = 70 and 30 showed the best agreement with the 3D method, and the difference in the readings was not statistically significant (P > 0.05). For LVEDV and LVESV, the reading using the HM method with ED and ES = 40 and 20 showed the best agreement with the 3D method, but the difference in the readings was statistically significant (P < 0.05). The measurements taken using the HM method were more reproducible than those taken using the 3D method (P<0.05). The measurement time when using the HM method was significantly less than the 3D method (P<0.05). In terms of LAVMAX, the correlation between the HM and 3D methods was strong, but the requirements for agreement were not satisfied. Conclusion Evaluation of the left ventricular function using HM 3DE is feasible, saves time, and is reproducible. To assess the left ventricular function, the border parameter setting of ED and ES = 70 and 30 provided the best fit for the Chinese population.
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Affiliation(s)
- Yuan-Yuan Xing
- Hebei Medical University, Shijiazhuang, Hebei, 050017, People's Republic of China.,Department of Ultrasound, Hebei General Hospital, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hong-Yuan Xue
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yu-Quan Ye
- Hebei Medical University, Shijiazhuang, Hebei, 050017, People's Republic of China.,Department of Ultrasound, Hebei General Hospital, Shijiazhuang, 050051, Hebei, People's Republic of China
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Baldea SM, Velcea AE, Rimbas RC, Andronic A, Matei L, Calin SI, Muraru D, Badano LP, Vinereanu D. 3-D Echocardiography Is Feasible and More Reproducible than 2-D Echocardiography for In-Training Echocardiographers in Follow-up of Patients with Heart Failure with Reduced Ejection Fraction. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:499-510. [PMID: 33267962 DOI: 10.1016/j.ultrasmedbio.2020.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Left ventricular volumes (LVVs) and ejection fraction (LVEF) are key elements in the evaluation and follow-up of patients with heart failure with reduced ejection fraction (HFrEF). Therefore, a feasible and reproducible imaging method to be used by both experienced and in-training echocardiographers is mandatory. Our aim was to establish if, in a large echo lab, echocardiographers in-training provide feasible and more reproducible results for the evaluation of patients with HFrEF when using 3-dimensional echocardiography (3-DE) versus 2-dimensional echocardiography (2-DE). Sixty patients with HFrEF (46 males, age: 58 ± 17 y) underwent standard transthoracic 2-D acquisitions and 3-D multibeat full volumes of the left ventricle. One expert user in echocardiography (expert) and three echocardiographers with different levels of training in 2-DE (beginner, medium and advanced) measured the 2-D LVVs and LVEFs on the same consecutive images of patients with HFrEF. Afterward, the expert performed a 1-mo training in 3-DE analysis of the users, and both the expert and trainees measured the 3-D LVVs and LVEF of the same patients. Measurements provided by the expert and all trainees in echo were compared. Six patients were excluded from the study because of poor image quality. The mean end-diastolic LVV of the remaining 54 patients was 214 ± 75 mL with 2-DE and 233 ± 77 mL with 3-DE. Mean LVEF was 35 ± 10% with 2-DE and 33 ± 10% with 3-DE. Our analysis revealed that, compared with the expert user, the trainees had acceptable reproducibility for the 2-DE measurements, according to their level of expertise in 2-DE (intra-class coefficients [ICCs] ranging from 0.75 to 0.94). However, after the short training in 3-DE, they provided feasible and more reproducible measurements of the 3-D LVVs and LVEF (ICCs ranging from 0.89-0.97) than they had with 2-DE. 3-DE is a feasible, rapidly learned and more reproducible method for the assessment of LVVs and LVEF than 2-DE, regardless of the basic level of expertise in 2-DE of the trainees in echocardiography. In echo labs with a wide range of staff experience, 3-DE might be a more accurate method for the follow-up of patients with HFrEF.
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Affiliation(s)
| | | | | | - Anca Andronic
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | | | - Denisa Muraru
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Luigi Paolo Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiac, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Guta AC, Badano LP, Ochoa-Jimenez RC, Genovese D, Previtero M, Civera S, Ruocco A, Bettella N, Parati G, Muraru D. Three-dimensional echocardiography to assess left ventricular geometry and function. Expert Rev Cardiovasc Ther 2020; 17:801-815. [PMID: 31770493 DOI: 10.1080/14779072.2019.1697234] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Quantification of left ventricular (LV) size and function represents the most frequent indication for an echocardiographic study. New echocardiographic techniques have been developed over the last decades in an attempt to provide a more comprehensive, accurate, and reproducible assessment of LV function.Areas covered: Although two-dimensional echocardiography (2DE) is the recommended imaging modality to evaluate the LV, three-dimensional echocardiography (3DE) has proven to be more accurate, by avoiding geometric assumptions about LV geometry, and to have incremental value for outcome prediction in comparison to conventional 2DE. LV shape (sphericity) and mass are actually measured with 3DE. Myocardial deformation analysis using 3DE can early detect subclinical LV dysfunction, before any detectable change in LV ejection fraction.Expert opinion: 3DE eliminates the errors associated with foreshortening and geometric assumptions inherent to 2DE and 3DE measurements approach very closely those obtained by CMR (the current reference modality), while maintaining the unique clinical advantage of a safe, highly cost/effective, portable imaging technique, available to the cardiologist at bedside to translate immediately the echocardiography findings into the clinical decision-making process.
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Affiliation(s)
- Andrada C Guta
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Luigi P Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto C Ochoa-Jimenez
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Internal Medicine Department, Mount Sinai St Luke's and Mount Sinai West, New York, NY, USA
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Marco Previtero
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Stefania Civera
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Alessandro Ruocco
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Natascia Bettella
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Gianfranco Parati
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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9
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Added Value of 3- Versus 2-Dimensional Echocardiography Left Ventricular Ejection Fraction to Predict Arrhythmic Risk in Patients With Left Ventricular Dysfunction. JACC Cardiovasc Imaging 2019; 12:1917-1926. [DOI: 10.1016/j.jcmg.2018.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 11/20/2022]
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10
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Weigand S, Karl M, Brkić A, Lennerz C, Grebmer C, Blažek P, Kornmayer M, Schaarschmidt C, Wesemann L, Reents T, Hessling G, Deisenhofer I, Kolb C. The impact of multipole pacing on left ventricular function in patients with cardiac resynchronization therapy - A real-time three-dimensional echocardiography approach. Int J Cardiol 2018; 272:238-243. [PMID: 30121181 DOI: 10.1016/j.ijcard.2018.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/22/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is standard of care in heart failure (HF), however this technique is associated with a non-responder rate of 30%. Multipole pacing (MPP) with a quadripolar lead may optimize CRT and responder rate by creating two electrical wave fronts in the left ventricular (LV) myocardium simultaneously in order to reduce mechanical dyssynchrony. The objective of this study was to investigate the acute impact of MPP on LV function by assessing systolic dyssynchrony index (SDI) and left ventricular ejection fraction (LVEF) via real-time three-dimensional echocardiography (RT3DE). METHODS In 41 consecutive patients (87.8% male; mean age 66.0 ± 12.7 years) who received CRT defibrillators with a quadripolar LV lead, RT3DE datasets were acquired the day after implantation under the following pacing configurations: Baseline AAI, conventional biventricular pacing using distal or proximal LV poles and MPP. Datasets were analyzed in paired samples evaluating SDI and LVEF depending on programmed pacing modality. RESULTS MPP resulted in statistically significant reduction of SDI compared to baseline (6.3%; IQR 4.4-7.8 and 9.9%; IQR 8.0-12.7; p < 0.001) and to conventional biventricular pacing using distal (7.6%; IQR 6.5-9.1; p < 0.001) or proximal (7.4%; IQR 6.2-8.8; p < 0.001) LV poles respectively. MPP yielded significant increase in LVEF compared to baseline (30.6%; IQR 25.8-37.5 and 27.2%; IQR 21.1-33.6; p < 0.001) and to conventional biventricular pacing configuration with distal (28.1%; IQR 22.1-34.5; p < 0.001) or proximal (28.6%; IQR 23.2-34.9; p < 0.001) LV poles respectively. CONCLUSIONS Multipole pacing improves mechanical dyssynchrony of the left ventricular myocardium as assessed by SDI and LVEF.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
| | - Michael Karl
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Amir Brkić
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Grebmer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Marielouise Kornmayer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Lorraine Wesemann
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany
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Cai Q, Wang J, Li H, Li C, Wu X, Lu X. Measurement of Left Ventricular Volumes and Ejection Fraction in Patients with Regional Wall Motion Abnormalities Using an Automated 3D Quantification Algorithm. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2274-2282. [PMID: 30122311 DOI: 10.1016/j.ultrasmedbio.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/30/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
Accurate and rapid left ventricular (LV) ejection fraction (EF) measurement is crucial for patients with wall motion abnormalities (WMAs). Conventional 2D echocardiographic imaging has limitations. The recently developed software HeartModel (HM, Philips Healthcare, Andover, MA, USA) has shown promise in automated 3D quantification. However, the accuracy and detailed features of HM in measurements of LV volume and EF in patients with regional WMAs have not been carefully investigated. In the present study, echocardiographic imaging (EPIQ, X5-1, Philips Healthcare) was performed in 72 patients with WMAs. The LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF were measured by HM in three modes: without editing and with global and regional endocardial border editing (Auto 3D-NE, Auto 3D-GE and Auto 3D-RE, respectively). The conventional 2D Simpson's biplane method and manual 3D quantification (QLAB-3DQA software, Philips Healthcare), as the standard method, were used for comparison. Among the three HM modalities, Auto 3D-RE exhibited the best correlation with manual 3D in assessing EDV, ESV and EF (r = 0.88, 0.93 and 0.91, respectively), although it took slightly longer (67.3 ± 13.0 s). Auto 3D-RE also exhibited a small degree of bias for the measurements (EDV: 11.7mL, ESV: 8.45mL, EF: -1.57%) and narrow limits of agreement. Heterogeneity of LV wall motion was defined to indicate the dispersion degree of WMAs. It associated with the difference in EF measurement between Auto 3D-RE and manual 3D (p = 0.014, hazard ratio = 5.19). In patients with WMAs, HM with regional contour editing enables accurate and efficient evaluation of LV volume and EF.
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Affiliation(s)
- Qizhe Cai
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Jiangtao Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Hong Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Cheng Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaopeng Wu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China.
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12
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Siciliano M, Migliore F, Badano L, Bertaglia E, Pedrizzetti G, Cavedon S, Zorzi A, Corrado D, Iliceto S, Muraru D. Cardiac resynchronization therapy by multipoint pacing improves response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo study. Europace 2018; 19:1833-1840. [PMID: 28025231 DOI: 10.1093/europace/euw331] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/26/2016] [Indexed: 01/09/2023] Open
Abstract
Aims To characterize the effect of multipoint pacing (MPP) compared to biventricular pacing (BiV) on left ventricle (LV) mechanics and intraventricular fluid dynamics by three-dimensional echocardiography (3DE) and echocardiographic particle imaging velocimetry (Echo-PIV). Methods and results In 11 consecutive patients [8 men; median age 65 years (57-75)] receiving cardiac resynchronization therapy (CRT) with a quadripolar LV lead (Quartet,St.Jude Medical,Inc.), 3DE and Echo-PIV data were collected for each pacing configuration (CRT-OFF, BiV, and MPP) at follow-up after 6 months. 3DE data included LV volumes, LV ejection fraction (LVEF), strain, and systolic dyssynchrony index (SDI). Echo-PIV was used to evaluate the directional distribution of global blood flow momentum, ranging from zero, when flow force is predominantly along the base-apex direction, up to 90° when it becomes transversal. MPP resulted in significant reduction in end-diastolic and end-systolic volumes compared with both CRT-OFF (P = 0.02; P = 0.008, respectively) and BiV (P = 0.04; P = 0.03, respectively). LVEF and cardiac output were significant superior in MPP compared with CRT-OFF, but similar between MPP and BiV. Statistical significant differences when comparing global longitudinal and circumferential strain and SDI with MPP vs. CRT-OFF were observed (P = 0.008; P = 0.008; P = 0.01, respectively). There was also a trend towards improvement in strain between BiV and MPP that did not reach statistical significance. MPP reflected into a significant reduction of the deviation of global blood flow momentum compared with both CRT-OFF and BiV (P = 0.002) indicating a systematic increase of longitudinal alignment from the base-apex orientation of the haemodynamic forces. Conclusion These preliminary results suggest that MPP resulted in significant improvement of LV mechanics and fluid dynamics compared with BiV. However, larger studies are needed to confirm this hypothesis.
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Affiliation(s)
- Mariachiara Siciliano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Luigi Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy
| | - Stefano Cavedon
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
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Luo XX, Fang F, So HK, Liu C, Yam MC, Lee APW. Automated left heart chamber volumetric assessment using three-dimensional echocardiography in Chinese adolescents. Echo Res Pract 2017; 4:53-61. [PMID: 28986349 PMCID: PMC5633056 DOI: 10.1530/erp-17-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/29/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several studies have reported the accuracy and reproducibility of HeartModel for automated determination of three-dimensional echocardiography (3DE)-derived left heart volumes and left ventricular (LV) ejection fraction (LVEF) in adult patients. However, it remains unclear whether this automated adaptive analytics algorithm, derived from a 'training' population, can encompass adequate echo images in Chinese adolescents. OBJECTIVES The aim of our study was to explore the accuracy of HeartModel in adolescents compared with expert manual three-dimensional (3D) echocardiography. METHODS Fifty-three Chinese adolescent subjects with or without heart disease underwent 3D echocardiographic imaging with an EPIQ system (Philips). 3D cardiac volumes and LVEF obtained with the automated HeartModel program were compared with manual 3D echocardiographic measurements by an experienced echocardiographer. RESULTS There was strong correlation between HeartModel and expert manual 3DE measurements (r = 0.875-0.965, all P < 0.001). Automated LV and left atrial (LA) volumes were slightly overestimated when compared to expert manual measurements, while LVEF showed no significant differences from the manual method. Importantly, the intra- and inter-observer variability of automated 3D echocardiographic model was relatively low (<1%), surpassing the manual approach (3.5-17.4%), yet requiring significantly less analyzing time (20 ± 7 vs 177 ± 30 s, P < 0.001). CONCLUSION Simultaneous quantification of left heart volumes and LVEF with the automated HeartModel program is rapid, accurate and reproducible in Chinese adolescent cohort. Therefore, it has a potential to bring 3D echocardiographic assessment of left heart chamber volumes and function into busy pediatric practice.
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Affiliation(s)
- Xiu-Xia Luo
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, People's Republic of China.,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Fang Fang
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hung-Kwan So
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Chao Liu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Man-Ching Yam
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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14
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Tsang W, Lang RM. Reporting of three-dimensional echocardiography-derived left ventricular volumes comes of age. Arch Cardiovasc Dis 2017; 110:577-579. [PMID: 28882433 DOI: 10.1016/j.acvd.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Wendy Tsang
- Toronto General Hospital, University Health Network, Toronto, M5G 2C4 Canada
| | - Roberto M Lang
- University of Chicago Medical Center, 60637 Chicago, IL, USA.
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15
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Medvedofsky D, Mor-Avi V, Byku I, Singh A, Weinert L, Yamat M, Kruse E, Ciszek B, Nelson A, Otani K, Takeuchi M, Lang RM. Three-Dimensional Echocardiographic Automated Quantification of Left Heart Chamber Volumes Using an Adaptive Analytics Algorithm: Feasibility and Impact of Image Quality in Nonselected Patients. J Am Soc Echocardiogr 2017; 30:879-885. [PMID: 28688857 DOI: 10.1016/j.echo.2017.05.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although 3D echocardiography (3DE) allows accurate and reproducible quantification of cardiac chambers, it has not been integrated into clinical practice because it relies on manual input, which interferes with workflow. A recently developed automated adaptive analytics algorithm for simultaneous quantification of left ventricular and atrial (LV, LA) volumes was found to be accurate and reproducible in patients with good images. We sought to prospectively test its feasibility and accuracy in consecutive patients in relationship with image quality and reader experience. METHODS Three hundred consecutive patients underwent 3DE. Image quality was graded as poor, adequate, or good. Images were analyzed by an expert echocardiographer to obtain LV volumes and ejection fraction (EF) and LA volume using the automated analysis (HeartModel, Philips, Andover, MA) with and without editing the endocardial boundaries and using conventional manual tracing (QLAB, Philips, Andover, MA) blinded to the automated measurements as a reference. In a subgroup of 100 patients, automated analysis was repeated by two readers without 3DE experience. RESULTS Automated analysis failed in 31/300 patients (10%). Patients with poor image quality (n = 72, 24%) showed suboptimal agreement with the reference technique, especially for LVEF. Importantly, patients with adequate (n = 89, 30%) and good (n = 108, 36%) images showed small biases and excellent correlations without border corrections, which were further improved with editing. In contrast, border corrections by inexperienced readers did not improve the agreement with reference values. CONCLUSIONS Automated 3DE analysis allows accurate quantification of left-heart size and function in 66% of consecutive patients, while in the remaining patients, its performance is limited/unreliable due to image quality. Border corrections require 3DE experience to improve the accuracy of the automated measurements. In patients with sufficient image quality, this automated approach has the potential to overcome the workflow limitations of the 3D analysis in clinical practice.
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Affiliation(s)
- Diego Medvedofsky
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - Isida Byku
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Amita Singh
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Lynn Weinert
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Megan Yamat
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Eric Kruse
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Boguslawa Ciszek
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Alma Nelson
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Kyoko Otani
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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16
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Medvedofsky D, Mor-Avi V, Amzulescu M, Fernández-Golfín C, Hinojar R, Monaghan MJ, Otani K, Reiken J, Takeuchi M, Tsang W, Vanoverschelde JL, Indrajith M, Weinert L, Zamorano JL, Lang RM. Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study. Eur Heart J Cardiovasc Imaging 2017; 19:47-58. [PMID: 28159984 DOI: 10.1093/ehjci/jew328] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/20/2016] [Indexed: 12/31/2022] Open
Affiliation(s)
| | - Victor Mor-Avi
- University of Chicago, Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Kyoko Otani
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Lynn Weinert
- University of Chicago, Medical Center, Chicago, Illinois, USA
| | | | - Roberto M Lang
- University of Chicago, Medical Center, Chicago, Illinois, USA
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17
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Wong KKL, Fong S, Wang D. Impact of advanced parallel or cloud computing technologies for image guided diagnosis and therapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:187-192. [PMID: 28234271 DOI: 10.3233/xst-17252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Kelvin K L Wong
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Simon Fong
- Department of Computer and Information Science, University of Macau, Taipa, Macau SAR, Macau, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, Research Center for Medical Image Computing, The Chinese University of Hong Kong, Hong Kong
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18
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Feng C, Chen L, Li J, Wang J, Dong F, Xu J. Three-dimensional echocardiographic measurements using automated quantification software for big data processing. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:313-321. [PMID: 28269820 DOI: 10.3233/xst-17262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare a full-automated software to quantify 3D transthoracic echocardiography namely, 3DE-HM (three-dimensional echocardiography HeartModel, Philips Healthcare) with the traditional manual quantitative method (3DE-manual) for assessing volumes of left atrial and ventricular volumes, and left ventricular ejection fraction (LVEF). METHODS 3D full volume images acquired from 156 subjects were collected and divided into 3 groups, which include 70 normal control cases (Group A), 17 patients with left ventricular remodeling after acute myocardial infarction (AMI) (Group B), and 69 patients with left atrial remodeling secondary to hypertension (Group C). The 3DE-HM method was used to quantify left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial end-systolic volume (LAESV), and left ventricular ejection fraction (LVEF), respectively. The results were compared with those obtained with the 3DE-manual method for correlation and consistency analyses. The reproducibility of the 3DE-HM method was also evaluated. RESULTS There was a high correlation between LVEDV, LVESV, LAESV and LVEF values obtained with the 3DE-HM method and those obtained using the 3DE-manual method (r = 0.72 to 0.97). The correlation was strongest for Group B, patients with left ventricular remodeling post-AMI also demonstrated the greatest degree of morphologic changes. There was a significant difference in all parameters measured with the 3DE-HM method in different groups (P < 0.05). The difference in the measurements of LVEDV and LVESV between the two methods was greatest in patients in Group B compared with patients with hypertension-induced left ventricular remodeling (Group C) and in normal controls (Group A) (P < 0.05). Lastly, the difference in the measurement of LAESV between the two methods was greater in patients with hypertension-induced left ventricular remodeling (Group C) than that in the control group (Group A) (P < 0.05). The post-processing time of the 3DE-HM data was significantly shorter than that using the 3DE-manual method (P < 0.05). There was no significant variability in repeated measurements at different time points using the 3DE-HM method either between subjects in different groups or within the same subject. CONCLUSION 3DE-HM is a quick and feasible method for left ventricular quantification and is clinically applicable for evaluating patients with left atrial and left ventricular remodeling.
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Affiliation(s)
- Cheng Feng
- Department of Ultrasound, Shenzhen People's Hospital, The Second Affiliated Hospital of Medical College of Jinan University, Shenzhen, China
| | - Lixin Chen
- Department of Ultrasound, Shenzhen People's Hospital, The Second Affiliated Hospital of Medical College of Jinan University, Shenzhen, China
| | - Jian Li
- Department of Ultrasound, Shenzhen People's Hospital, The Second Affiliated Hospital of Medical College of Jinan University, Shenzhen, China
| | - Jiangtao Wang
- Ultrasonic Marketing Department of Philips (China) Investment Co., Ltd., China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, The Second Affiliated Hospital of Medical College of Jinan University, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Affiliated Hospital of Medical College of Jinan University, Shenzhen, China
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Tsang W, Salgo IS, Medvedofsky D, Takeuchi M, Prater D, Weinert L, Yamat M, Mor-Avi V, Patel AR, Lang RM. Transthoracic 3D Echocardiographic Left Heart Chamber Quantification Using an Automated Adaptive Analytics Algorithm. JACC Cardiovasc Imaging 2016; 9:769-782. [DOI: 10.1016/j.jcmg.2015.12.020] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 12/17/2022]
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20
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Hatipoğlu S, Babur Güler G, Kaya Ö, Kahveci G, Güler E, Eroğlu E, Özdemir N. Real-time three-dimensional left ventricular contraction in patients with diastolic dysfunction. J Med Ultrason (2001) 2016; 43:373-80. [PMID: 27052553 DOI: 10.1007/s10396-016-0711-3] [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: 12/16/2015] [Accepted: 03/14/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Systolic alterations in left ventricular (LV) myocardial function have been reported previously in patients with diastolic dysfunction (DD). Recent advances in real-time three-dimensional echocardiography (3DE) enable the measurement of a set of parameters previously difficult to obtain with standard two-dimensional echocardiography (2DE). The aim of this study was to evaluate global 3DE LV contraction in patients with and without DD who had normal ejection fraction (EF). METHODS Sixty-five patients (average age 56 ± 6 years; 31 females and 34 males) with normal EF (>50 %) referred to echocardiographic examination for the evaluation of DD were included. In addition to measuring conventional echocardiographic parameters, they were also evaluated with 3DE. End diastolic volume, end systolic volume, EF, corrected standard deviation (SD) of time to minimal systolic volume for 16 segments its dispersion, average excursion of the segments and the SD of segmental motion (excursion-SD) were recorded. RESULTS When we tested the differences among three groups of diastolic function (normal, Grade 1, and Grade 2), the results showed that coronary artery disease, left atrial volume, septum, posterior wall, E, A, E/A, deceleration time, E' septum, E' lateral, and excursion-SD were significantly different. An ordered logistic regression analysis revealed that excursion-SD (p < 0.001) and septum (p < 0.001) measurements were statistically significant for predicting DD grade. CONCLUSION In our patient population, a decline in excursion-SD values was observed with increasing DD grade. In other words, the amount of segmental difference in terms of excursion was reduced.
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Affiliation(s)
- Suzan Hatipoğlu
- Maltepe Ersoy Hospital, Altay Çesme Mah. Varna Sok. No. 16, Maltepe, Istanbul, Turkey.
| | | | - Özgür Kaya
- Department of Economics, American University of Sharjah, Ash Shariqah, United Arab Emirates
| | - Gökhan Kahveci
- Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Güler
- Medipol University Hospital, Istanbul, Turkey
| | - Elif Eroğlu
- Acıbadem University Hospital, Istanbul, Turkey
| | - Nihal Özdemir
- Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Zhong SW, Zhang YQ, Chen LJ, Wang SS, Li WH. Evaluation of Left Ventricular Volumes and Function by Real Time Three-Dimensional Echocardiography in Children with Functional Single Left Ventricle: A Comparison between QLAB and TomTec. Echocardiography 2015; 32:1554-63. [DOI: 10.1111/echo.12990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shu-Wen Zhong
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Li-Jun Chen
- Department of Pediatric Cardiology; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Shan-Shan Wang
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Wei-Hua Li
- Department of Pediatrics; Shanghai Children's Medical Center; Shanghai Jiaotong University School of Medicine; Shanghai China
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Ojala T, Mathur S, Vatanen A, Sinha MD, Jahnukainen K, Simpson J. Repeatability and Agreement of Real Time Three-dimensional Echocardiography Measurements of Left Ventricular Mass and Synchrony in Young Patients. Echocardiography 2014; 32:522-7. [DOI: 10.1111/echo.12672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Tiina Ojala
- Department of Pediatric Cardiology; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Sujeev Mathur
- Department of Congenital Heart Disease; Evelina London Children′s Hospital; Guy's and St. Thomas NHS Trust; London United Kingdom
| | - Anu Vatanen
- Division of Pediatric Hematology-Oncology; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Manish D. Sinha
- Department of Paediatric Nephrology; Evelina London Children′s Hospital; Guy's and St. Thomas NHS Trust; London United Kingdom
| | - Kirsi Jahnukainen
- Division of Pediatric Hematology-Oncology; Children's Hospital; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - John Simpson
- Department of Congenital Heart Disease; Evelina London Children′s Hospital; Guy's and St. Thomas NHS Trust; London United Kingdom
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Badano LP. The clinical benefits of adding a third dimension to assess the left ventricle with echocardiography. SCIENTIFICA 2014; 2014:897431. [PMID: 24959374 PMCID: PMC4052480 DOI: 10.1155/2014/897431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/23/2014] [Indexed: 05/09/2023]
Abstract
Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management.
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Affiliation(s)
- Luigi P. Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padua, Via Giustiniani 2, 35123 Padua, Italy
- *Luigi P. Badano:
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Evaluation of left ventricular structure and function by three-dimensional echocardiography. Curr Opin Crit Care 2013; 19:387-96. [DOI: 10.1097/mcc.0b013e328364d75e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Echocardiography and Vascular Ultrasound: New Developments and Future Directions. Can J Cardiol 2013; 29:304-16. [DOI: 10.1016/j.cjca.2012.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/22/2012] [Accepted: 11/02/2012] [Indexed: 12/15/2022] Open
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Badano LP, Boccalini F, Muraru D, Bianco LD, Peluso D, Bellu R, Zoppellaro G, Iliceto S. Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound 2012; 20:1-22. [PMID: 22509433 PMCID: PMC3324722 DOI: 10.4250/jcu.2012.20.1.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 02/04/2023] Open
Abstract
The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography.
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Affiliation(s)
- Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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