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Pinter SZ, Rubin JM, Hall AL, Fowlkes JB, Kripfgans OD. Color Flow Ultrasound Spatial Sampling Beam Density for Partial Volume-Corrected Three-Dimensional Volume Flow (3DVF): Theory, Simulation, and Experiment. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1122-1133. [PMID: 38729810 DOI: 10.1016/j.ultrasmedbio.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 02/03/2024] [Accepted: 03/26/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The purpose of this study was to quantify the accuracy of partial volume-corrected three-dimensional volume flow (3DVF) measurements as a function of spatial sampling beam density using carefully-designed parametric analyses in order to inform the target applications of 3DVF. METHODS Experimental investigations employed a mechanically-swept curvilinear ultrasound array to acquire 3D color flow (6.3 MHz) images in flow phantoms consisting of four lumen diameters (6.35, 4.88, 3.18 and 1.65 mm) with volume flow rates of 440, 260, 110 and 30 mL/min, respectively. Partial volume-corrected three-dimensional volume flow (3DVF) measurements, based on the Gaussian surface integration principle, were computed at five regions of interest positioned between depths of 2 and 6 cm in 1 cm increments. At each depth, the color flow beam point spread function (PSF) was also determined, using in-phase/quadrature data, such that 3DVF bias could then be related to spatial sampling beam density. Corresponding simulations were performed for a laminar parabolic flow profile that was sampled using the experimentally-measured PSFs. Volume flow was computed for all combinations of lumen diameters and the PSFs at each depth. RESULTS Accurate 3DVF measurements, i.e., bias less than ±20%, were achieved for spatial sampling beam densities where at least 6 elevational color flow beams could be positioned across the lumen. In these cases, greater than 8 lateral color flow beams were present. PSF measurements showed an average lateral-to-elevational beam width asymmetry of 1:2. Volume flow measurement bias increased as the color flow beam spatial sampling density within the lumen decreased. CONCLUSION Applications of 3DVF, particularly those in the clinical domain, should focus on areas where a spatial sampling density of 6 × 6 (lateral x elevational) beams can be realized in order to minimize measurement bias. Matrix-based ultrasound arrays that possess symmetric PSFs may be advantageous to achieve adequate beam densities in smaller vessels.
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Affiliation(s)
- Stephen Z Pinter
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - J Brian Fowlkes
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Gomes FKA, Fagundes AADP, Amorim FF. Cardiac Output and Stroke Volume Assessments by Transthoracic Echocardiography and Pulse index Continuous Cardiac Output Monitor in Critically ill Adult Patients: A Comparative Study. J Intensive Care Med 2024; 39:341-348. [PMID: 37769347 DOI: 10.1177/08850666231204787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE Bedside transthoracic echocardiography (TTEcho) is a noninvasive cardiac output (CO) monitoring method that has grown recently. However, there are questions regarding its accuracy compared to invasive methods. We aimed to evaluate the agreement and correlation of TTEcho and pulse index continuous CO (PiCCO) monitor measurements for CO and systolic volume (SV) in critically ill patients. METHODS This prospective experimental study included consecutive adult patients who required invasive hemodynamic monitoring admitted at an intensive care unit in the Federal District, Brazil, from January/2019 to January/2021. Correlation and agreement between SV and CO measurements by PiCCO and TTEcho were performed using the Spearman correlation and the Bland-Altman analysis. RESULTS The study enrolled 29 patients, with adequate TTEcho evaluations in all patients. There were very strong correlations between CO-TTEcho and CO-PiCCO (r = 0.845, P < .001) and SV-TTEcho and SV-PiCCO (r = 0.800, P < .001). TTEcho estimations for CO and SV were feasible within the limits of agreement in 96.6% (28/29) compared to PiCCO. The mean difference between CO-PiCCO and CO-TTEcho was 0.250 L/min (limits of agreement: -1.083 to 1.583 L/min, percentage error: 21.0%), and between SV-PiCCO and SV-TTEcho was 2.000 mL (limits of agreement: -16.960 to 20.960, percentage error: 24.3%). The reduced cardiac index (CI) measurements by TTEcho showed an accuracy of 89.7% (95% IC: 72.6%-97.8%) and an F1 score of 92.7% (95% IC: 75.0%-98.0%), considering the CI-PiCCO as the gold standard. CONCLUSION Echocardiographic measurements of CO and SV are comparable to measurements by PiCCO. These results reinforce echocardiography as a reliable tool to evaluate hemodynamics in critically ill patients.
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Affiliation(s)
- Flávia K A Gomes
- Graduate Program in Health Sciences, Higher Education School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Adult Intensive Care Unit, Hospital DF Star, Brasília, Federal District, Brazil
- Adult Intensive Care Unit, Hospital Home, Brasília, Federal District, Brazil
| | | | - Fábio F Amorim
- Graduate Program in Health Sciences, Higher Education School of Health Sciences (ESCS), Brasília, Federal District, Brazil
- Graduate Program in Health Sciences, University of Brasilia (UnB), Brasília, Federal District, Brazil
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Yeung AWK, Kulnik ST, Parvanov ED, Fassl A, Eibensteiner F, Völkl-Kernstock S, Kletecka-Pulker M, Crutzen R, Gutenberg J, Höppchen I, Niebauer J, Smeddinck JD, Willschke H, Atanasov AG. Research on Digital Technology Use in Cardiology: Bibliometric Analysis. J Med Internet Res 2022; 24:e36086. [PMID: 35544307 PMCID: PMC9133979 DOI: 10.2196/36086] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022] Open
Abstract
Background Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth.
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Affiliation(s)
- Andy Wai Kan Yeung
- Division of Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Emil D Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | - Anna Fassl
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Rik Crutzen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Johanna Gutenberg
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Center for Human Computer Interaction, Paris Lodron University Salzburg, Salzburg, Austria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria.,REHA Zentrum Salzburg, Salzburg, Austria
| | - Jan David Smeddinck
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
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Tracy E, Zhu M, Streiff C, Sahn DJ, Ashraf M. Quantification of the area and shunt volume of multiple, circular, and noncircular ventricular septal defects: A 2D/3D echocardiography comparison and real time 3D color Doppler feasibility determination study. Echocardiography 2017; 35:90-99. [PMID: 29082558 DOI: 10.1111/echo.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Quantification of defect size and shunt flow is an important aspect of ventricular septal defect (VSD) evaluation. This study compared three-dimensional echocardiography (3DE) with the current clinical standard two-dimensional echocardiography (2DE) for quantifying defect area and tested the feasibility of real time 3D color Doppler echocardiography (RT3D-CDE) for quantifying shunt volume of irregular shaped and multiple VSDs. METHODS Latex balloons were sutured into the ventricles of 32 freshly harvested porcine hearts and were connected with tubing placed in septal perforations. Tubing was varied in area (0.13-5.22 cm²), number (1-3), and shape (circle, oval, crescent, triangle). A pulsatile pump was used to pump "blood" through the VSD (LV to RV) at stroke volumes of 30-70 mL with a stroke rate of 60 bpm. Two-dimensional echocardiography (2DE), 3DE, and RT3D-CDE images were acquired from the right side of the phantom. RESULTS For circular VSDs, both 2DE and 3DE area measurements were consistent with the actual areas (R² = 0.98 vs 0.99). For noncircular/multiple VSDs, 3DE correlated with the actual area more closely than 2DE (R² = 0.99 vs 0.44). Shunt volumes obtained using RT3D-CDE positively correlated with pumped stroke volumes (R² = 0.96). CONCLUSIONS Three-dimensional echocardiography (3DE) is a feasible method for determining VSD area and is more accurate than 2DE for evaluating the area of multiple or noncircular VSDs. Real-time 3D color Doppler echocardiography (RT3D-CDE) is a feasible method for quantifying the shunt volume of multiple or noncircular VSDs.
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Affiliation(s)
- Evan Tracy
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Meihua Zhu
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Cole Streiff
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - David J Sahn
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
| | - Muhammad Ashraf
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
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Hudson JM, Williams R, Milot L, Wei Q, Jago J, Burns PN. In Vivo Validation of Volume Flow Measurements of Pulsatile Flow Using a Clinical Ultrasound System and Matrix Array Transducer. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:579-585. [PMID: 27979667 DOI: 10.1016/j.ultrasmedbio.2016.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 10/18/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
The goal of this study was to evaluate the accuracy of a non-invasive C-plane Doppler estimation of pulsatile blood flow in the lower abdominal vessels of a porcine model. Doppler ultrasound measurements from a matrix array transducer system were compared with invasive volume flow measurements made on the same vessels with a surgically implanted ultrasonic transit-time flow probe. For volume flow rates ranging from 60 to 750 mL/min, agreement was very good, with a Pearson correlation coefficient of 0.97 (p < 0.0001) and a mean bias of -4.2%. The combination of 2-D matrix array technology and fast processing gives this Doppler method clinical potential, as many of the user- and system-dependent parameters of previous methods, including explicit vessel angle and diameter measurements, are eliminated.
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Affiliation(s)
- John M Hudson
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Ross Williams
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Laurent Milot
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Qifeng Wei
- Philips Ultrasound, Bothell, Washington, USA
| | - James Jago
- Philips Ultrasound, Bothell, Washington, USA
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
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Zhu M, Ashraf M, Tam L, Streiff C, Kimura S, Shimada E, Sahn DJ. Quantification of Shunt Volume Through Ventricular Septal Defect by Real-Time 3-D Color Doppler Echocardiography: An in Vitro Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1193-1200. [PMID: 26850842 DOI: 10.1016/j.ultrasmedbio.2015.12.017] [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: 04/28/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
Quantification of shunt volume is important for ventricular septal defects (VSDs). The aim of the in vitro study described here was to test the feasibility of using real-time 3-D color Doppler echocardiography (RT3-D-CDE) to quantify shunt volume through a modeled VSD. Eight porcine heart phantoms with VSDs ranging in diameter from 3 to 25 mm were studied. Each phantom was passively driven at five different stroke volumes from 30 to 70 mL and two stroke rates, 60 and 120 strokes/min. RT3-D-CDE full volumes were obtained at color Doppler volume rates of 15, 20 and 27 volumes/s. Shunt flow derived from RT3-D-CDE was linearly correlated with pump-driven stroke volume (R = 0.982). RT3-D-CDE-derived shunt volumes from three color Doppler flow rate settings and two stroke rate acquisitions did not differ (p > 0.05). The use of RT3-D-CDE to determine shunt volume though VSDs is feasible. Different color volume rates/heart rates under clinically/physiologically relevant range have no effect on VSD 3-D shunt volume determination.
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Affiliation(s)
- Meihua Zhu
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammad Ashraf
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lydia Tam
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cole Streiff
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sumito Kimura
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Eriko Shimada
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Sahn
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, USA.
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Shimada E, Zhu M, Kimura S, Streiff C, Houle H, Datta S, Sahn DJ, Ashraf M. Quantitative assessment of mitral inflow and aortic outflow stroke volumes by 3-dimensional real-time full-volume color flow doppler transthoracic echocardiography: an in vivo study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:95-103. [PMID: 25542944 DOI: 10.7863/ultra.34.1.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Noninvasive quantification of left ventricular (LV) stroke volumes has an important clinical role in assessing circulation and monitoring therapeutic interventions for cardiac disease. This study validated the accuracy of a real-time 3-dimensional (3D) color flow Doppler method performed during transthoracic echocardiography (TTE) for quantifying volume flows through the mitral and aortic valves using a dedicated offline 3D flow computation program compared to LV sonomicrometry in an open-chest animal model. METHODS Forty-six different hemodynamic states in 5 open-chest pigs were studied. Three-dimensional color flow Doppler TTE and 2-dimensional (2D) TTE were performed by epicardial scanning. The dedicated software was used to compute flow volumes at the mitral annulus and the left ventricular outflow tract (LVOT) with the 3D color flow Doppler method. Stroke volumes by 2D TTE were computed in the conventional manner. Stroke volumes derived from sonomicrometry were used as reference values. RESULTS Mitral inflow and LVOT outflow derived from the 3D color flow Doppler method correlated well with stroke volumes by sonomicrometry (R = 0.96 and 0.96, respectively), whereas correlation coefficients for mitral inflow and LVOT outflow computed by 2D TTE and stroke volumes by sonomicrometry were R = 0.84 and 0.86. Compared to 2D TTE, the 3D method showed a smaller bias and narrower limits of agreement in both mitral inflow (mean ± SD: 3D, 2.36 ± 2.86 mL; 2D, 10.22 ± 8.46 mL) and LVOT outflow (3D, 1.99 ± 2.95 mL; 2D, 4.12 ± 6.32 mL). CONCLUSIONS Real-time 3D color flow Doppler quantification is feasible and accurate for measurement of mitral inflow and LVOT outflow stroke volumes over a range of hemodynamic conditions.
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Affiliation(s)
- Eriko Shimada
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - Meihua Zhu
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - Sumito Kimura
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - Cole Streiff
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - Helene Houle
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - Saurabh Datta
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
| | - David J Sahn
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.).
| | - Muhammad Ashraf
- Oregon Health and Science University, Portland, Oregon USA (E.S., M.Z., S.K., C.S., D.J.S., M.A.); and Siemens Medical Solutions USA, Inc, Mountain View, California USA (H.H., S.D.)
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Real-Time Three-Dimensional Echocardiographic Flow Quantification in Valvular Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9298-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Kimura S, Streiff C, Zhu M, Shimada E, Datta S, Ashraf M, Sahn DJ. Evaluation of a new 3-dimensional color Doppler flow method to quantify flow across the mitral valve and in the left ventricular outflow tract: an in vitro study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:265-271. [PMID: 24449729 DOI: 10.7863/ultra.33.2.265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this study was to assess the accuracy, feasibility, and reproducibility of determining stroke volume from a novel 3-dimensional (3D) color Doppler flow quantification method for mitral valve (MV) inflow and left ventricular outflow tract (LVOT) outflow at different stroke volumes when compared with the actual flow rate in a pumped porcine cardiac model. METHODS Thirteen freshly harvested pig hearts were studied in a water tank. We inserted a latex balloon into each left ventricle from the MV annulus to the LVOT, which were passively pumped at different stroke volumes (30-80 mL) using a calibrated piston pump at increments of 10 mL. Four-dimensional flow volumes were obtained without electrocardiographic gating. The digital imaging data were analyzed offline using prototype software. Two hemispheric flow-sampling planes for color Doppler velocity measurements were placed at the MV annulus and LVOT. The software computed the flow volumes at the MV annulus and LVOT within the user-defined volume and cardiac cycle. RESULTS This novel 3D Doppler flow quantification method detected incremental increases in MV inflow and LVOT outflow in close agreement with pumped stroke volumes (MV inflow, r = 0.96; LVOT outflow, r = 0.96; P < .01). Bland-Altman analysis demonstrated overestimation of both (MV inflow, 5.42 mL; LVOT outflow, 4.46 mL) with 95% of points within 95% limits of agreement. Interobserver variability values showed good agreement for all stroke volumes at both the MV annulus and LVOT. CONCLUSIONS This study has shown that the 3D color Doppler flow quantification method we used is able to compute stroke volumes accurately at the MV annulus and LVOT in the same cardiac cycle without electrocardiographic gating. This method may be valuable for assessment of cardiac output in clinical studies.
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Affiliation(s)
- Sumito Kimura
- Department of Pediatric Cardiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Dr, L608, Portland, OR 97239-3098 USA.
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Perry R, Joseph M. Advanced echocardiographic techniques. Australas J Ultrasound Med 2012; 15:126-142. [PMID: 28191159 PMCID: PMC5024913 DOI: 10.1002/j.2205-0140.2012.tb00196.x] [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] [Indexed: 11/12/2022] Open
Abstract
Echocardiography has advanced significantly since its first clinical use. The move towards more accurate imaging and quantification has driven this advancement. In this review, we will briefly focus on three distinct but important recent advances, three‐dimensional (3D) echocardiography, contrast echocardiography and myocardial tissue imaging. The basic principles of these techniques will be discussed as well as current and future clinical applications.
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Affiliation(s)
- Rebecca Perry
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
| | - Majo Joseph
- Flinders Clinical Research; South Australian Health and Medical Research Institute; Adelaide South Australia Australia
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park South Australia Australia
- Discipline of Medicine Flinders University; Bedford Park South Australia Australia
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Thavendiranathan P, Phelan D, Collier P, Thomas JD, Flamm SD, Marwick TH. Quantitative Assessment of Mitral Regurgitation. JACC Cardiovasc Imaging 2012; 5:1161-75. [DOI: 10.1016/j.jcmg.2012.07.013] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/12/2012] [Accepted: 07/23/2012] [Indexed: 11/28/2022]
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Thavendiranathan P, Phelan D, Thomas JD, Flamm SD, Marwick TH. Quantitative Assessment of Mitral Regurgitation. J Am Coll Cardiol 2012; 60:1470-83. [DOI: 10.1016/j.jacc.2012.05.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/28/2022]
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Sudhakar S, Khairnar P, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography. Echocardiography 2012. [DOI: 10.1111/j.1540-8175.2011.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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14
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Ge S. Automated Measurement of Stroke Volumes by Real-Time Three-Dimensional Doppler Echocardiography: Coming of Age? J Am Soc Echocardiogr 2012; 25:66-7. [DOI: 10.1016/j.echo.2011.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Thavendiranathan P, Liu S, Datta S, Walls M, Nitinunu A, Van Houten T, Tomson NA, Vidmar L, Georgescu B, Wang Y, Srinivasan S, De Michelis N, Raman SV, Ryan T, Vannan MA. Automated Quantification of Mitral Inflow and Aortic Outflow Stroke Volumes by Three-Dimensional Real-Time Volume Color-Flow Doppler Transthoracic Echocardiography: Comparison with Pulsed-Wave Doppler and Cardiac Magnetic Resonance Imaging. J Am Soc Echocardiogr 2012; 25:56-65. [DOI: 10.1016/j.echo.2011.10.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 10/15/2022]
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Alunni G, Garrone P, Giorgi M, Calcagnile C, Sbarra P, Marocco C, Costanza G, Meynet I, Casolati D, Marra S. Real time triplane echocardiography in the assessment of the functional area of prosthetic aortic valves: reliability and feasibility. Echocardiography 2011; 29:34-41. [PMID: 22044699 DOI: 10.1111/j.1540-8175.2011.01551.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
PURPOSE Our study is aimed at evaluating the feasibility and reliability of a simple method for the measurement of the functional area of prosthetic aortic valves (EOA). Three-dimensional echocardiography has proven accurate for left ventricular volume, stroke volume, and aortic valve area measurement. We studied the feasibility and reliability of real time simultaneous triplane echocardiography (RT3P) for assessing the EOA with a fast formula based on the principle of continuity equation, in which we replaced Doppler-derived stroke volume (SV) with SV directly measured with RT3P. METHODS AND RESULTS EOA of prosthetic aortic valves were measured in 23 consecutive patients requiring periodical follow up. EOA was calculated using Doppler continuity equation (DCE) and the RT3P method by replacing Doppler-derived SV with SV measured with real time triplane echocardiography. We compared functional areas obtained with the two methods with the prosthetic area indicated in the manufacturer's specifications and with the mean transprosthetic gradient. Both methods had a good correlation with the area indicated by the manufacturer. RT3P revealed an inverse correlation between functional area and mean gradient that was better than DCE (P = 0.0359). Inter- and intraobserver variability was not different between the two methods. Execution time was significantly shorter for RT3P. CONCLUSIONS RT3P is a simple method that can be performed quite rapidly, and can complement the overall assessment of prosthetic valve function. Further studies can confirm our technique.
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Affiliation(s)
- Gianluca Alunni
- Department of Cardiology 2, S. Giovanni Battista University Hospital, Turin, Italy.
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17
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Paltiel HJ, Padua HM, Gargollo PC, Cannon GM, Alomari AI, Yu R, Clement GT. Contrast-enhanced, real-time volumetric ultrasound imaging of tissue perfusion: preliminary results in a rabbit model of testicular torsion. Phys Med Biol 2011; 56:2183-97. [PMID: 21403185 DOI: 10.1088/0031-9155/56/7/018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (US) imaging is potentially applicable to the clinical investigation of a wide variety of perfusion disorders. Quantitative analysis of perfusion is not widely performed, and is limited by the fact that data are acquired from a single tissue plane, a situation that is unlikely to accurately reflect global perfusion. Real-time perfusion information from a tissue volume in an experimental rabbit model of testicular torsion was obtained with a two-dimensional matrix phased array US transducer. Contrast-enhanced imaging was performed in 20 rabbits during intravenous infusion of the microbubble contrast agent Definity® before and after unilateral testicular torsion and contralateral orchiopexy. The degree of torsion was 0° in 4 (sham surgery), 180° in 4, 360° in 4, 540° in 4, and 720° in 4. An automated technique was developed to analyze the time history of US image intensity in experimental and control testes. Comparison of mean US intensity rate of change and of ratios between mean US intensity rate of change in experimental and control testes demonstrated good correlation with testicular perfusion and mean perfusion ratios obtained with radiolabeled microspheres, an accepted 'gold standard'. This method is of potential utility in the clinical evaluation of testicular and other organ perfusion.
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Affiliation(s)
- H J Paltiel
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
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18
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Alunni G, Giorgi M, Sartori C, Garrone P, Conrotto F, D’Amico M, Scacciatella P, Andriani M, Levis M, Marra S. Real Time Triplane Echocardiography in Aortic Valve Stenosis: Validation, Reliability, and Feasibility of a New Method for Valve Area Quantification. Echocardiography 2010; 27:644-50. [DOI: 10.1111/j.1540-8175.2009.01099.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Shahgaldi K, Manouras A, Brodin LÅ, Winter R. Direct Measurement of Left Ventricular Outflow Tract Area Using Three-Dimensional Echocardiography in Biplane Mode Improves Accuracy of Stroke Volume Assessment. Echocardiography 2010; 27:1078-85. [DOI: 10.1111/j.1540-8175.2010.01197.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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20
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3D transesophageal echocardiography: a review of recent literature 2007–2009. Curr Opin Anaesthesiol 2010; 23:80-8. [DOI: 10.1097/aco.0b013e328334a6b3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Weitzel N, Salcedo E, Puskas F, Nasrallah F, Fullerton D, Seres T. Using Real Time Three-Dimensional Transesophageal Echocardiography during Ross Procedure in the Operating Room. Echocardiography 2009; 26:1278-83. [DOI: 10.1111/j.1540-8175.2009.01030.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Harkel AT, Van Osch-Gevers M, Helbing W. Real-Time Transthoracic Three Dimensional Echocardiography: Normal Reference Data for Left Ventricular Dyssynchrony in Adolescents. J Am Soc Echocardiogr 2009; 22:933-8. [DOI: 10.1016/j.echo.2009.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Indexed: 10/20/2022]
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23
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Abstract
Visualization of, and measurements related to, haemodynamic phenomena in arteries may be made using ultrasound systems. Most ultrasound technology relies on simple measurements of blood velocity taken from a single site, such as the peak systolic velocity for assessment of the degree of lumen reduction caused by an arterial stenosis. Real-time two-dimensional (2D) flow field visualization is possible using several methods, such as colour flow, blood flow imaging, and echo particle image velocimetry; these have applications in the examination of the flow field in diseased arteries and in heart chambers. Three-dimensional (3D) and four-dimensional ultrasound systems have been described. These have been used to provide 2D velocity profile data for the estimation of volumetric flow. However, they are limited for haemodynamic evaluation in that they provide only one component of the velocity. The provision of all seven components (three space, three velocity, and one time) is possible using image-guided modelling, in which 3D ultrasound is combined with computational fluid dynamics. This method also allows estimation of turbulence data and of relevant quantities such as the wall shear stress.
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Affiliation(s)
- P R Hoskins
- Department of Medical Physics, Edinburgh University, Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK,
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24
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Effects of surgical ventricular restoration on left ventricular contractility assessed by a novel contractility index in patients with ischemic cardiomyopathy. Am J Cardiol 2009; 103:674-9. [PMID: 19231332 DOI: 10.1016/j.amjcard.2008.10.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 10/31/2008] [Accepted: 10/31/2008] [Indexed: 11/22/2022]
Abstract
A pressure-normalized left ventricular (LV) wall stress (dsigma*/dt(max)) was recently reported as a load-independent index of LV contractility. We hypothesized that this novel contractility index might demonstrate improvement in LV contractile function after surgical ventricular restoration (SVR) using magnetic resonance imaging. A retrospective analysis of magnetic resonance imaging data of 40 patients with ischemic cardiomyopathy who had undergone coronary artery bypass grafting with SVR was performed. LV volumes, ejection fraction, global systolic and diastolic sphericity, and dsigma*/dt(max) were calculated. After SVR, a decrease was found in end-diastolic and end-systolic volume indexes, whereas LV ejection fraction increased from 26% +/- 7% to 31% +/- 10% (p <0.001). LV mass index and peak normalized wall stress were decreased, whereas the sphericity index (SI) at end-diastole increased, indicating that the left ventricle became more spherical after SVR. LV contractility index dsigma*/dt(max) improvement (from 2.69 +/- 0.74 to 3.23 +/- 0.73 s(-1), p <0.001) was associated with shape change as evaluated by the difference in SI between diastole and systole (r = 0.32, p <0.001, preoperative; r = 0.23, p <0.001, postoperative), but not with baseline LV SI. In conclusion, SVR excludes akinetic LV segments and decreases LV wall stress. Despite an increase in sphericity, LV contractility, as determined by dsigma*/dt(max), actually improves. A complex interaction of LV maximal flow rate and LV mass may explain the improvement in LV contractility after SVR. Because dsigma*/dt(max) can be estimated from simple noninvasive measurements, this underscores its clinical utility for assessment of contractile function with therapeutic intervention.
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25
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Brown J, Jenkins C, Marwick TH. Use of myocardial strain to assess global left ventricular function: a comparison with cardiac magnetic resonance and 3-dimensional echocardiography. Am Heart J 2009; 157:102.e1-5. [PMID: 19081404 DOI: 10.1016/j.ahj.2008.08.032] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ejection fraction (EF) plays a prominent role in clinical decision making but remains dependent on image quality and left ventricular geometry. Using magnetic resonance imaging (MRI-EF) as the reference standard, we sought whether global longitudinal strain (GLS) could be an alternative to the measurement of EF. METHODS Manual and semi-automated tracing was used to measure Simpson's biplane ejection-fraction (2D-EF) and 3D ejection fraction (3D-EF) and MRI in 62 patients with previous infarction. Global longitudinal strain was measured by 2-dimensional strain (2DS) in the apical views. Automated EF was calculated using speckle tracking to detect the end-diastolic and end-systolic endocardial border. RESULTS Strain curves were derived in all segments, with artifactual curves being excluded. The correlation of GLS with MRI-EF (r = -0.69, P < .0001) was comparable to that between 3D-EF and MRI (r = 0.80, P < .0001), and better than that between 2D-EF (r = 0.58, P < .0001) or automated EF and MRI (r = 0.62, P < .0001). To convert GLS into an equivalent MRI-EF, linear regression was used to develop the formula EF = -4.35 (strain + 3.9). Of the 32 patients with a normal MRI-EF (> or =50%), 75% had normal systolic function by GLS, whereas 85% of patients were recognized as having a normal 3D-EF. Fewer patients were recognized as normal by 2D-EF (70%, P = .14) and automated-EF (61%, P = .04). In those with >6 abnormal segments, the correlation of GLS with MRI-EF improved significantly (r = -0.77, P < .0001) and was similar to 3D-EF (r = 0.76, P < .0001). CONCLUSION Global longitudinal strain is an effective method for quantifying global left ventricular function, particularly in patients with extensive wall motion abnormalities.
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26
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Three-dimensional echocardiography: What is next? CURRENT CARDIOVASCULAR IMAGING REPORTS 2008. [DOI: 10.1007/s12410-008-0008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Measuring cardiac output in critically ill infants and children: Are we still "talking the talk" or can we now "walk the walk"? Pediatr Crit Care Med 2008; 9:449-50. [PMID: 18496401 DOI: 10.1097/pcc.0b013e318172ec3b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Soriano BD, Hoch M, Ithuralde A, Geva T, Powell AJ, Kussman BD, Graham DA, Tworetzky W, Marx GR. Matrix-Array 3-Dimensional Echocardiographic Assessment of Volumes, Mass, and Ejection Fraction in Young Pediatric Patients With a Functional Single Ventricle. Circulation 2008; 117:1842-8. [PMID: 18362236 DOI: 10.1161/circulationaha.107.715854] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Quantitative assessment of ventricular volumes and mass in pediatric patients with single-ventricle physiology would aid clinical management, but it is difficult to obtain with 2-dimensional echocardiography. The purpose of the present study was to compare matrix-array 3-dimensional echocardiography (3DE) measurements of single-ventricle volumes, mass, and ejection fraction with those measured by cardiac magnetic resonance (CMR) in young patients.
Methods and Results—
Twenty-nine patients (median age, 7 months) with a functional single ventricle undergoing CMR under general anesthesia were prospectively enrolled. The 3DE images were acquired at the conclusion of the CMR. Twenty-seven of 29 3DE data sets (93%) were optimal for 3DE assessment. Two blinded and independent observers performed 3DE measurements of volume, mass, and ejection fraction. The 3DE end-diastolic volume correlated well (
r
=0.96) but was smaller than CMR by 9% (
P
<0.01), and 3DE ejection fraction was smaller than CMR by 11% (
P
<0.01). There was no significant difference in measurements of end-systolic volume and mass. The 3DE interobserver differences for mass and volumes were not significant except for ejection fraction (8% difference;
P
<0.05). Intraobserver differences were not significant.
Conclusions—
In young pediatric patients with a functional single ventricle, matrix-array 3DE measurements of mass and volumes compare well with those obtained by CMR. 3DE will provide an important modality for the serial analysis of ventricular size and performance in young patients with functional single ventricles.
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Affiliation(s)
- Brian D. Soriano
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Martin Hoch
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Alejandro Ithuralde
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Tal Geva
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Andrew J. Powell
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Barry D. Kussman
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Dionne A. Graham
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Wayne Tworetzky
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
| | - Gerald R. Marx
- From the Departments of Cardiology (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anesthesiology (B.D.K.), Children’s Hospital Boston, Boston, Mass, and the Departments of Pediatrics (B.D.S., M.H., A.I., T.G., A.J.P., D.A.G., W.T., G.R.M.) and Anaesthesia (B.D.K.), Harvard Medical School, Boston, Mass
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Poh KK, Levine RA, Solis J, Shen L, Flaherty M, Kang YJ, Guerrero JL, Hung J. Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography. Eur Heart J 2008; 29:2526-35. [PMID: 18263866 DOI: 10.1093/eurheartj/ehn022] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Two-dimensional echocardiographic (2DE) continuity-equation derived aortic valve area (AVA) in aortic stenosis (AS) relies on non-simultaneous measurement of left ventricular outflow tract (LVOT) velocity and geometric assumptions of LVOT area, which can amplify error, especially in upper septal hypertrophy (USH). We hypothesized that real-time three-dimensional echocardiography (RT3DE) can improve accuracy of AVA by directly measuring LVOT stroke volume (SV) in one window. METHODS AND RESULTS RT3DE colour Doppler and 2DE were acquired in 68 AS patients (74 +/- 12 yrs) prospectively. SV was derived from flow obtained from a sampling curve placed orthogonal to LVOT (Tomtec Imaging). Agreement between continuity-equation derived AVA by RT3DE (AVA(3D-SV)) and 2DE (AVA(2D)) and predictors of discrepancies were analysed. Validation of LVOT SV was performed by aortic flow probe in a sheep model with balloon inflation of septum to mimic USH. There was only modest correlation between AVA(2D) and AVA(3D-SV) (r = 0.71, difference 0.11 +/- 0.23 cm(2)). The degree of USH was significantly associated with difference in AVA calculation (r = 0.4, P = 0.005). In experimentally distorted LVOT geometry in sheep, RT3DE correlated better with flow probe assessment (r = 0.96, P < 0.001) than 2DE (r = 0.71, P = 0.006). CONCLUSION RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry.
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Affiliation(s)
- Kian Keong Poh
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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30
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Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation. Eur Heart J 2007; 29:1296-306. [PMID: 17989075 DOI: 10.1093/eurheartj/ehm467] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of the study was to validate a novel formula for aortic area, based on the principle of continuity equation (CE), that substitutes Doppler-derived stroke volume (SV) by SV directly measured with real-time three-dimensional (RT3D) echo and semi-automated border detection. RT3D has proved outstanding accuracy for left ventricular volume calculation. So far, however, neither this potential has been applied to haemodynamic assessment, nor RT3D has succeeded in the evaluation of aortic valve disease. METHODS AND RESULTS Aortic area was measured in 41 patients with aortic stenosis using Gorlin's equation, Hakki's formula, Doppler CE, two-dimensional Simpson's volumetric method, and by the novel RT3D method. RT3D has the best linear association and absolute agreement with Gorlin of all non-invasive methods r = 0.902, intraclass correlation coefficient (ICC) = 0.846, better than CE (r = 0.646, ICC = 0.626) and two-dimensional volumetric method (r = 0.627, ICC = 0.378). Linear and Passing-Bablok regression show that RT3D fits better to Gorlin (r(2) = 0.814) than CE (r(2) = 0.417) and two-dimensional method (r(2) = 0.393). Its accuracy is comparable to Hakki's formula, routinely employed in catheter laboratories. Inter- and intraobserver agreements (ICC) were, respectively, 0.732 and 0.985, better than CE (0.662, 0.857). RT3D also grades most efficiently the severity of aortic stenosis as mild, moderate, or severe (weighted kappa = 0.932). RT3D underestimates aortic area (95% CI 0.084-0.193). ROC curves, however, show that the optimal cutoff point to consider aortic stenosis severity remains close to 1 cm(2) (1.06 cm(2)). CONCLUSIONS RT3D is more accurate than CE and than two-dimensional volumetric methods to calculate area and to grade the severity of aortic stenosis. Area obtained by three-dimensional echo is slightly underestimated, but its range is clinically negligible.
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31
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Lu X, Nadvoretskiy V, Klas B, Bu L, Stolpen A, Ayres NA, Sahn DJ, Ge S. Measurement of Volumetric Flow by Real-time 3-Dimensional Doppler Echocardiography in Children. J Am Soc Echocardiogr 2007; 20:915-20. [PMID: 17555931 DOI: 10.1016/j.echo.2007.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND We sought to assess the accuracy and reproducibility of an automated real-time (RT) 3-dimensional (3D) Doppler echocardiography (RT3DDE) technique for measuring volumetric flow (VF) in children. METHODS A total of 19 healthy children (age = 11.5 +/- 3.5 years) were studied to measure VF through mitral valve (MV), aortic valve (AV), pulmonary valve (PV), and tricuspid valve (TV) by RT3DDE. RT 3D echocardiography was also performed to measure left ventricular (LV) end-systolic volume, LV end-diastolic volume, and stroke volume (stroke volume = LV end-diastolic volume--LV end-systolic volume), which served as a reference standard for comparison with VF by RT3DDE. RESULTS Compared with stroke volume by RT 3D echocardiography, the correlation with VF was excellent for MV (r = 0.91), good for AV (r = 0.89) and PV (r = 0.89), but poor for TV (r = 0.20) by RT3DDE. There were good agreements for AV (bias = 0.9 +/- 5.0 mL), PV (bias = -0.4 +/- 5.7 mL), and MV (bias = 4.1 +/- 4.7 mL), and marked underestimation for TV (bias = -24.4 +/- 14.6 mL). CONCLUSIONS Our data demonstrated that VF measurement by RT3DDE is feasible and reasonably accurate for MV, AV, and PV but problematic for TV.
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Affiliation(s)
- Xiuzhang Lu
- Baylor College of Medicine, Houston, Texas 77030, USA
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32
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Zhong L, Tan RS, Ghista DN, Ng EYK, Chua LP, Kassab GS. Validation of a novel noninvasive cardiac index of left ventricular contractility in patients. Am J Physiol Heart Circ Physiol 2007; 292:H2764-72. [PMID: 17237251 DOI: 10.1152/ajpheart.00540.2006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although there are several excellent indexes of myocardial contractility, they require accurate measurement of pressure via left ventricular (LV) catheterization. Here we validate a novel noninvasive contractility index that is dependent only on lumen and wall volume of the LV chamber in patients with normal and compromised LV ejection fraction (LVEF). By analysis of the myocardial chamber as a thick-walled sphere, LV contractility index can be expressed as maximum rate of change of pressure-normalized stress (dσ*/d tmax, where σ* = σ/P and σ and P are circumferential stress and pressure, respectively). To validate this parameter, dσ*/d tmax was determined from contrast cine-ventriculography-assessed LV cavity and myocardial volumes and compared with LVEF, dP/d tmax, maximum active elastance ( Ea,max), and single-beat end-systolic elastance [ Ees(SB)] in 30 patients undergoing clinically indicated LV catheterization. Patients with different tertiles of LVEF exhibit statistically significant differences in dσ*/d tmax. There was a significant correlation between dσ*/d tmax and dP/d tmax (dσ*/d tmax = 0.0075dP/d tmax − 4.70, r = 0.88, P < 0.01), Ea,max (dσ*/d tmax = 1.20 Ea,max + 1.40, r = 0.89, P < 0.01), and Ees(SB) [dσ*/d tmax = 1.60 Ees(SB) + 1.20, r = 0.88, P < 0.01]. In 30 additional individuals, we determined sensitivity of the parameter to changes in preload (intravenous saline infusion, n = 10 subjects), afterload (sublingual glyceryl trinitrate, n = 10 subjects), and increased contractility (intravenous dobutamine, n = 10 patients). We confirmed that the index is not dependent on load but is sensitive to changes in contractility. In conclusion, dσ*/d tmax is equivalent to dP/d tmax, Ea,max, and Ees(SB) as an index of myocardial contractility and appears to be load independent. In contrast to other measures of contractility, dσ*/d tmax can be assessed with noninvasive cardiac imaging and, thereby, should have more routine clinical applicability.
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Affiliation(s)
- Liang Zhong
- Department of Cardiology, National Heart Centre, University of New South Wales-Asia, Singapore
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33
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Qi X, Cogar B, Hsiung MC, Nanda NC, Miller AP, Yelamanchili P, Baysan O, Wu YS, Lan GY, Ko JS, Cheng CH, Lin CC, Huang CM, Yin WH, Young MS. Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging. Echocardiography 2007; 24:166-73. [PMID: 17313549 DOI: 10.1111/j.1540-8175.2006.00428.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Due to reliance upon geometric assumptions and foreshortening issues, the traditionally utilized transthoracic two-dimensional echocardiography (2DTTE) has shown limitations in assessing left ventricular (LV) volume, mass, and function. Cardiac magnetic resonance imaging (MRI) has shown potential in accurately defining these LV characteristics. Recently, the emergence of live/real time three-dimensional (3D) TTE has demonstrated incremental value over 2DTTE and comparable value with MRI in assessing LV parameters. Here we report 58 consecutive patients with diverse cardiac disorders and clinical characteristics, referred for clinical MRI studies, who were evaluated by cardiac MRI and 3DTTE. Our results show good correlation between the two modalities.
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Affiliation(s)
- Xin Qi
- University of Alabama at Birmingham, Division of Cardiovascular Disease, Birmingham, Alabama 35249, USA
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Abstract
Three-dimensional (3D) color Doppler echocardiography is a relatively new noninvasive tool that displays and quantitates regurgitant flow and also enables estimation of cardiac output, stroke volume, pulmonary outflow, and shunt calculations. This article provides an overview of the current methodology of 3D color flow, and its advantages and limitations.
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Affiliation(s)
- Lissa Sugeng
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, MC 5084, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Lodato JA, Weinert L, Baumann R, Coon P, Anderson A, Kim A, Fedson S, Sugeng L, Lang RM. Use of 3-Dimensional Color Doppler Echocardiography to Measure Stroke Volume in Human Beings: Comparison with Thermodilution. J Am Soc Echocardiogr 2007; 20:103-12. [PMID: 17275694 DOI: 10.1016/j.echo.2006.07.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND The availability of accurate noninvasive measurements of cardiac output (CO) would be useful in assessing disease severity and the effects of therapeutic interventions in many different clinical settings. Current noninvasive methods are limited by their dependence on geometric assumptions. We tested the feasibility of a new technique for CO measurements based on 3-dimensional color Doppler echocardiographic (3D-CD) imaging. OBJECTIVE We sought to compare the accuracy of CO determination in human beings as measured by 3D-CD and conventional 2-dimensional echocardiography (2DE) using thermodilution as the gold standard for comparison. METHODS Simultaneous 3D-CD, 2DE, and thermodilution data were acquired in 47 patients postcardiac transplantation with good acoustic windows who required routine hemodynamic evaluation with a pulmonary artery catheter. Data were stored on compact disc and analyzed offline using custom software. Echocardiographic data were compared against thermodilution using linear regression and Bland-Altman analysis. RESULTS Correlation coefficients for 3D-CD and 2DE of the left ventricular outflow tract were r = 0.94 and r = 0.78, respectively. Correlation coefficients for 3D-CD and 2DE of the mitral valve were r = 0.93 and r = 0.75, respectively. Compared with 2DE, 3D-CD demonstrated a smaller bias and narrower limits of agreement in the left ventricular outflow tract (-1.84 +/- 16.8 vs -8.6 +/- 36.2 mL) and mitral valve inflow (-0.2 +/- 15.6 vs 10.0 +/- 26 mL). CONCLUSION The 3D-CD determination of CO is feasible and accurate. Compared with previous noninvasive modalities, 3D-CD has the advantages of independence of geometric assumptions and ease of image acquisition and analysis.
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Affiliation(s)
- Joseph A Lodato
- Noninvasive Cardiac Imaging Laboratory, Section of Cardiology, Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA
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Paré-Bardera JC, Aguilar-Torres R, Gallego García de Vinuesa P, Velasco del Castillo S. Actualización en técnicas de imagen cardiaca. Ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores. Rev Esp Cardiol 2007; 60 Suppl 1:41-57. [PMID: 17352855 DOI: 10.1157/13099712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article contains a review of the most significant publications on non-invasive recent cardiac imaging techniques in 2005. The increasing importance of technological innovation in echocardiography is reflected in the sections on three dimensional echocardiography, contrast echocardiography, and myocardial deformation measurement techniques (i.e., strain echocardiography). The most important developments affecting cardiology in the techniques of magnetic resonance imaging and multidetector computed tomography are also summarized. This review ends with a detailed description of the contributions made by imaging techniques to the diagnosis of aortic disease.
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Pemberton J, Ge S, Thiele K, Jerosch-Herold M, Sahn DJ. Real-time Three-dimensional Color Doppler Echocardiography Overcomes the Inaccuracies of Spectral Doppler for Stroke Volume Calculation. J Am Soc Echocardiogr 2006; 19:1403-10. [PMID: 17098150 DOI: 10.1016/j.echo.2006.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Indexed: 11/22/2022]
Abstract
Real-time 3-dimensional echocardiography is increasingly used in clinical cardiology. Studies have been shown that this technique can be accurately used to assess both cardiac mass and chamber volumes. We review the work showing that real-time 3-dimensional Doppler echocardiography can be used to accurately calculate intracardiac flow volumes that can potentially be used to assess cardiac function, intracardiac shunt, and valve regurgitation.
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Affiliation(s)
- James Pemberton
- James Cook University Hospital, Middlesbrough, United Kingdom
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Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-Dimensional Echocardiography. J Am Coll Cardiol 2006; 48:2053-69. [PMID: 17112995 DOI: 10.1016/j.jacc.2006.07.047] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 07/06/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
Over the past 3 decades, echocardiography has become a major diagnostic tool in the arsenal of clinical cardiology for real-time imaging of cardiac dynamics. More and more, cardiologists' decisions are based on images created from ultrasound wave reflections. From the time ultrasound imaging technology provided the first insight into the human heart, our diagnostic capabilities have increased exponentially as a result of our growing knowledge and developing technology. One of the most significant developments of the last decades was the introduction of 3-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging. While continuing its meteoric rise instigated by constant technological refinements and continuing increase in computing power, this tool is guaranteed to be integrated in routine clinical practice. The major proven advantage of this technique is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic and unique comprehensive views of cardiac valves and congenital abnormalities. In addition, 3D imaging is extremely useful in the intraoperative and postoperative settings because it allows immediate feedback on the effectiveness of surgical interventions. In this article, we review the published reports that have provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart and discuss its potential future applications.
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Affiliation(s)
- Roberto M Lang
- Cardiac Imaging Center, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Pearlman AS. Echocardiography: prospects for the next 5 years. THE AMERICAN HEART HOSPITAL JOURNAL 2006; 4:232-8. [PMID: 16894264 DOI: 10.1111/j.1541-9215.2006.05536.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Alan S Pearlman
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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