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Routkevitch D, Soulé Z, Kats N, Baca E, Hersh AM, Kempski-Leadingham KM, Menta AK, Bhimreddy M, Jiang K, Davidar AD, Smit C, Theodore N, Thakor NV, Manbachi A. Non-contrast ultrasound image analysis for spatial and temporal distribution of blood flow after spinal cord injury. Sci Rep 2024; 14:714. [PMID: 38184676 PMCID: PMC10771432 DOI: 10.1038/s41598-024-51281-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
Ultrasound technology can provide high-resolution imaging of blood flow following spinal cord injury (SCI). Blood flow imaging may improve critical care management of SCI, yet its duration is limited clinically by the amount of contrast agent injection required for high-resolution, continuous monitoring. In this study, we aim to establish non-contrast ultrasound as a clinically translatable imaging technique for spinal cord blood flow via comparison to contrast-based methods and by measuring the spatial distribution of blood flow after SCI. A rodent model of contusion SCI at the T12 spinal level was carried out using three different impact forces. We compared images of spinal cord blood flow taken using both non-contrast and contrast-enhanced ultrasound. Subsequently, we processed the images as a function of distance from injury, yielding the distribution of blood flow through space after SCI, and found the following. (1) Both non-contrast and contrast-enhanced imaging methods resulted in similar blood flow distributions (Spearman's ρ = 0.55, p < 0.0001). (2) We found an area of decreased flow at the injury epicenter, or umbra (p < 0.0001). Unexpectedly, we found increased flow at the periphery, or penumbra (rostral, p < 0.05; caudal, p < 0.01), following SCI. However, distal flow remained unchanged, in what is presumably unaffected tissue. (3) Finally, tracking blood flow in the injury zones over time revealed interesting dynamic changes. After an initial decrease, blood flow in the penumbra increased during the first 10 min after injury, while blood flow in the umbra and distal tissue remained constant over time. These results demonstrate the viability of non-contrast ultrasound as a clinical monitoring tool. Furthermore, our surprising observations of increased flow in the injury periphery pose interesting new questions about how the spinal cord vasculature reacts to SCI, with potentially increased significance of the penumbra.
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Affiliation(s)
- Denis Routkevitch
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Zoe Soulé
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Kats
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Emily Baca
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew M Hersh
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelley M Kempski-Leadingham
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Arjun K Menta
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly Jiang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A Daniel Davidar
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Constantin Smit
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nitish V Thakor
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- HEPIUS Innovation Laboratory, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Hagendorff A, Kandels J, Metze M, Tayal B, Stöbe S. Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking? Diagnostics (Basel) 2023; 13:1359. [PMID: 37046577 PMCID: PMC10093440 DOI: 10.3390/diagnostics13071359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Bhupendar Tayal
- Harrington Heart and Vascular Center, Department of Cardiology, University Hospitals, Cleveland, OH 44106, USA;
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
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Zhou L, Wei HY, Ge YL, Ding ZN, Shi HW. Comparison of the effective orifice area of prosthetic mitral valves using two-dimensional versus three-dimensional transesophageal echocardiography. J Int Med Res 2021; 49:300060521997621. [PMID: 33729857 PMCID: PMC7975571 DOI: 10.1177/0300060521997621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study compared the continuity equation-based effective orifice area
(EOA) of prosthetic mitral valves between two-dimensional (2D) and 3D
transesophageal echocardiography (TEE). Methods Thirty-four patients without major aortic valve abnormalities underwent
mitral valve replacement surgery. The EOAs of prosthetic mitral valves were
calculated using the continuity equation with 2D and 3D TEE. For 18/34
patients using a biological valve prosthesis, the EOA of the prosthesis was
obtained from commercial records. Results The EOA of prosthetic mitral valves significantly varied between the 2D and
3D methods (2.22 ± 0.71 vs 2.35 ± 0.70 cm2, n = 34). The area of
the diameter of the left ventricular outflow tract as determined by the 3D
method was significantly higher than that by the 2D method (mean difference:
−0.14 ± 0.20 cm2), with 95% coherence boundaries of −0.53 and
0.25 cm2. The regression equation for the EOA by 3D and 2D
TEE was y = 0.27 + 0.94x, with a good correlation. Conclusions The EOA of prosthetic mitral valves is underestimated using the 2D TEE method
compared with the 3D TEE method. The 3D-TEE method has the advantage of
higher precision over the 2D TEE method, and it may be helpful for better
assessment of prosthetic mitral valves intraoperatively.
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Affiliation(s)
- Lei Zhou
- Department of Anesthesiology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hai-Yan Wei
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ya-Li Ge
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zheng-Nian Ding
- Department of Anesthesiology, Jiangsu People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong-Wei Shi
- Department of Anesthesiology, Nanjing First Hospital & Nanjing Cardiovascular Disease Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Wegner B, Meel R, Nell T, Nqwata L, Wong M. Hydatid disease of the interventricular septum: Echocardiographic and computed tomography findings. SA J Radiol 2020; 24:1986. [PMID: 33391841 PMCID: PMC7756595 DOI: 10.4102/sajr.v24i1.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Abstract
Hydatid disease (HD) is prevalent in South Africa, with cardiac HD being a rare but important manifestation to recognise and diagnose. An incidental finding on computed tomography (CT) of the chest in a patient with pulmonary HD prompted further multimodality imaging, which confirmed the presence of cardiac HD involving the interventricular septum. This case report focuses on imaging findings related to cardiac HD, as demonstrated by the CT of the chest and two- and three-dimensional transoesophageal echocardiography. Multimodality imaging is essential to assist in making a diagnosis and providing a detailed assessment of patients with cardiac HD.
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Affiliation(s)
- Brett Wegner
- Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruchika Meel
- Division of Cardiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Cardiology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Tamarin Nell
- Department of Diagnostic Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Diagnostic Radiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Lamla Nqwata
- Division of Pulmonology, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Wong
- Division of Pulmonology, Department of Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock. Crit Care Med 2019; 46:e1040-e1046. [PMID: 30134304 DOI: 10.1097/ccm.0000000000003356] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used. DESIGN Prospective, noninterventional study. SETTING ICU at a large academic center. PATIENTS Patients with new, undifferentiated shock, and vasopressor requirements despite fluid resuscitation were included. Patients with significant cardiac disease and conditions that precluded adequate passive leg raising were excluded. INTERVENTIONS Carotid corrected flow time was measured via ultrasound before and after a passive leg raise maneuver. Predicted fluid responsiveness was defined as greater than 10% increase in stroke volume on noninvasive cardiac output monitoring following passive leg raise. Images and measurements were reanalyzed by a second, blinded physician. The accuracy of change in carotid corrected flow time to predict fluid responsiveness was evaluated using receiver operating characteristic analysis. MEASUREMENTS AND MAIN RESULTS Seventy-seven subjects were enrolled with 54 (70.1%) classified as fluid responders by noninvasive cardiac output monitoring. The average change in carotid corrected flow time after passive leg raise for fluid responders was 14.1 ± 18.7 ms versus -4.0 ± 8 ms for nonresponders (p < 0.001). Receiver operating characteristic analysis demonstrated that change in carotid corrected flow time is an accurate predictor of fluid responsiveness status (area under the curve, 0.88; 95% CI, 0.80-0.96) and a 7 ms increase in carotid corrected flow time post passive leg raise was shown to have a 97% positive predictive value and 82% accuracy in detecting fluid responsiveness using noninvasive cardiac output monitoring as a reference standard. Mechanical ventilation, respiratory rate, and high positive end-expiratory pressure had no significant impact on test performance. Post hoc blinded evaluation of bedside acquired measurements demonstrated agreement between evaluators. CONCLUSIONS Change in carotid corrected flow time can predict fluid responsiveness status after a passive leg raise maneuver. Using point-of-care ultrasound to assess change in carotid corrected flow time is an acceptable and reproducible method for noninvasive identification of fluid responsiveness in critically ill patients with undifferentiated shock.
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Murray CSG, Salama AY, Akdogan RE, Harb S, Nahar T, Nanda NC. Assessment of tricuspid valve by two- and three-dimensional echocardiography with special reference to percutaneous repair and prosthetic valve implantation procedures. Echocardiography 2018; 35:1419-1438. [PMID: 30209853 DOI: 10.1111/echo.14130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/28/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022] Open
Abstract
Moderate-to-severe tricuspid regurgitation affects approximately 1.6 million people in the United States. An estimated 8000 patients will undergo tricuspid surgery annually, leaving a large number of patients with this condition untreated. Many of these individuals who are not referred for surgery engender a large unmet clinical need; this may be primarily due to the surgical risk involved. In persons who are categorized as high-risk surgical candidates, percutaneous procedures present a viable alternative. The majority of developmental attention as regards percutaneous approaches has been focused on the aortic and mitral valves recently, but few data are available about the feasibility and efficacy of minimally invasive tricuspid valve treatment. We review the usefulness of two- and three-dimensional echocardiography in the assessment of the tricuspid valve with special reference to recent interest in percutaneous repair and prosthetic valve implantation procedures for severe functional tricuspid regurgitation.
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Affiliation(s)
- Christopher S G Murray
- Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Ahmed Y Salama
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raziye E Akdogan
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Serge Harb
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tamanna Nahar
- Section of Cardiology, Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, New York
| | - Navin C Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Stegmann H, Bäuerle T, Kienle K, Dittrich S, Alkassar M. 4D cardiac magnetic resonance imaging, 4D and 2D transthoracic echocardiography: a comparison of in-vivo assessment of ventricular function in rats. Lab Anim 2018; 53:169-179. [PMID: 30081741 DOI: 10.1177/0023677218789971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Preclinical cardiovascular research is the foundation of our understanding and broad knowledge of heart function and cardiovascular disease. Reliable cardiac imaging modalities are the basis for applicable results. Four-dimensional cardiac magnetic resonance (4D CMR) has been set as the gold standard for in-vivo assessment of ventricular function in rodents. However, technical improvements in echocardiography now allow us to image the whole heart, which makes four-dimensional echocardiography (4DE) a possible alternative to 4D CMR. To date, no study has systematically assessed 4DE in comparison with 4D CMR in rats. In total we studied 26 juvenile Sprague-Dawley rats (Crl: CD (SD) IGS). Twenty rats underwent echocardiographic imaging (2D and 4D) and 4D CMR. Five of those rats underwent a ligation of the superior and inferior vena cava to reduce the cardiac inflow as a disease model. Six additional rats were used to assess reproducibility of echocardiography and underwent three echocardiographic examinations. 4D CMR was performed on a 7T scanner; 2D and 4D echocardiography was conducted using a 40 MHz transducer. Correlation between 4D CMR, 4DE and 2DE for left-ventricular ejection fraction (LVEF) was assessed. An excellent correlation was observed between 4DE and 4D CMR ( r = 0.95, p < 0.001). Correlation of 2DE and 4D CMR was weak ( r = 0.57, p < 0.01). 4DE provides results that are equally precise as 4D CMR and highly reproducible with less technical effort than 4D CMR.
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Affiliation(s)
- Hedwig Stegmann
- 1 Department of Paediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Bäuerle
- 2 Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Kienle
- 1 Department of Paediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Dittrich
- 1 Department of Paediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Muhannad Alkassar
- 1 Department of Paediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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