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Wahlberg KJ, Kluge MA, Hopkins WE. Leveraging Color M-Mode to Diagnose Aorto-Atrial Fistula as a Complication of Infective Endocarditis. Case Rep Cardiol 2024; 2024:7550403. [PMID: 38881677 PMCID: PMC11178404 DOI: 10.1155/2024/7550403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/28/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Aorto-atrial fistula is a rare and life-threatening complication of infective endocarditis, classically diagnosed by visualizing a connection between the aorta and atrium with associated continuous flow. A patient presented with bioprosthetic and native valve enterococcal endocarditis with multiple complications, including an aorto-atrial fistula that was diagnosed by color M-mode on transesophageal echocardiography. We review the features of aorto-atrial fistula and utilize this case to demonstrate how M-mode can be leveraged to provide improved temporal resolution in the setting of diagnostic uncertainty.
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Affiliation(s)
- Kramer J Wahlberg
- Department of Medicine Division of Cardiology at the Robert Larner MD College of Medicine University of Vermont, Burlington, VT, USA
| | - Matthew A Kluge
- Department of Medicine The Lifespan Cardiovascular Institute at Rhode Island The Warren Alpert Medical School Brown University, Providence, RI, USA
| | - William E Hopkins
- Department of Medicine Division of Cardiology at the Robert Larner MD College of Medicine University of Vermont, Burlington, VT, USA
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2
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Petoello E, Kerkow E, Phad N, Ficial B, de Waal K. Which left atrial volume measurement should we use in the neonatal intensive care? Early Hum Dev 2024; 191:105985. [PMID: 38513546 DOI: 10.1016/j.earlhumdev.2024.105985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Increased left atrial volume (LAV) is a marker of cardiovascular risk. Echocardiography standards to assess LAV in adults and children are the biplane area-length method (AL) and method of disks (MOD). LAV in neonatology is usually derived as M-mode ratio between the LA and the Aorta (LAAo). The aim of this study is to determine feasibility and reliability of these methods in neonatal clinical practice. METHODS Clinically indicated echocardiograms in neonatal intensive care patients were retrospectively analyzed. Feasibility was determined with an image quality score describing insonation angle, foreshortening and wall clarity. Reliability was determined with Bland-Altman and correlation coefficient analysis of intra- and inter-observer measurements. RESULTS 104 infants ranging from 23 to 39 weeks gestation were included. The feasibility of LAAo, AL and MOD was comparable (median image score 4 out of 6 points). Linear regression between AL and MOD was excellent (R2 0.99). LAAo best-fit with MOD was reached with curve-linear regression (R2 0.28) whereby a LAAo of 1.60 correlated with 1.24 ml/kg, but with a wide 95 % CI. The correlation coefficient within and between observers for LAAo, biplane AL, biplane MOD and monoplane MOD was 0.93 (0.87-0.96), 0.98 (0.96-0.99), 0.98 (0.96-0.99), 0.99 (0.97-0.99) and 0.58 (0.11-0.81), 0.75 (0.44-0.89), 0.92 (0.88-0.98), 0.96 (0.88-0.98) respectively. CONCLUSION All methods were equally feasible and reliable when repeated by the same observer, but LAAo reliability was poor when repeated by a different observer. Biplane MOD was the most reliable and thus recommended in neonatal practice. Monoplane MOD performed well and could be considered as alternative but might be less accurate.
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Affiliation(s)
- Enrico Petoello
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Emma Kerkow
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia
| | - Nilkant Phad
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Koert de Waal
- John Hunter Children's Hospital, Department of Neonatology, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
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3
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Lin M, Zhang Z, Gao X, Bian Y, Wu RS, Park G, Lou Z, Zhang Z, Xu X, Chen X, Kang A, Yang X, Yue W, Yin L, Wang C, Qi B, Zhou S, Hu H, Huang H, Li M, Gu Y, Mu J, Yang A, Yaghi A, Chen Y, Lei Y, Lu C, Wang R, Wang J, Xiang S, Kistler EB, Vasconcelos N, Xu S. A fully integrated wearable ultrasound system to monitor deep tissues in moving subjects. Nat Biotechnol 2024; 42:448-457. [PMID: 37217752 DOI: 10.1038/s41587-023-01800-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Recent advances in wearable ultrasound technologies have demonstrated the potential for hands-free data acquisition, but technical barriers remain as these probes require wire connections, can lose track of moving targets and create data-interpretation challenges. Here we report a fully integrated autonomous wearable ultrasonic-system-on-patch (USoP). A miniaturized flexible control circuit is designed to interface with an ultrasound transducer array for signal pre-conditioning and wireless data communication. Machine learning is used to track moving tissue targets and assist the data interpretation. We demonstrate that the USoP allows continuous tracking of physiological signals from tissues as deep as 164 mm. On mobile subjects, the USoP can continuously monitor physiological signals, including central blood pressure, heart rate and cardiac output, for as long as 12 h. This result enables continuous autonomous surveillance of deep tissue signals toward the internet-of-medical-things.
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Affiliation(s)
- Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ziyang Zhang
- Department of Computer Science Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Zhuorui Zhang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Xiangchen Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Andrea Kang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Chonghe Wang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Baiyan Qi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohan Li
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Albert Yang
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Amer Yaghi
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | | | - Erik B Kistler
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Anesthesiology and Critical Care, University of California San Diego, La Jolla, CA, USA
| | - Nuno Vasconcelos
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Sheng Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
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4
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Lopez L, Saurers DL, Barker PCA, Cohen MS, Colan SD, Dwyer J, Forsha D, Friedberg MK, Lai WW, Printz BF, Sachdeva R, Soni-Patel NR, Truong DT, Young LT, Altman CA. Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:119-170. [PMID: 38309834 DOI: 10.1016/j.echo.2023.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Echocardiography is a fundamental component of pediatric cardiology, and appropriate indications have been established for its use in the setting of suspected, congenital, or acquired heart disease in children. Since the publication of guidelines for pediatric transthoracic echocardiography in 2006 and 2010, advances in knowledge and technology have expanded the scope of practice beyond the use of traditional modalities such as two-dimensional, M-mode, and Doppler echocardiography to evaluate the cardiac segmental structures and their function. Adjunct modalities such as contrast, three-dimensional, and speckle-tracking echocardiography are now used routinely at many pediatric centers. Guidelines and recommendations for the use of traditional and newer adjunct modalities in children are described in detail in this document. In addition, suggested protocols related to standard operations, infection control, sedation, and quality assurance and improvement are included to provide an organizational structure for centers performing pediatric transthoracic echocardiograms.
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Affiliation(s)
- Leo Lopez
- Department of Pediatrics Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, California.
| | - Daniel L Saurers
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Piers C A Barker
- Duke Children's Hospital & Health Center, Duke University, Durham, North Carolina
| | - Meryl S Cohen
- Cardiac Center and Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeanine Dwyer
- Pediatric Heart Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Daniel Forsha
- Ward Family Heart Center, Children's Mercy Kansas City Hospital, Kansas City, Missouri
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wyman W Lai
- Division of Pediatric Cardiology, University of California School of Medicine, Irvine, California; Department of Pediatrics, Children's Hospital of Orange County, Orange, California
| | - Beth F Printz
- Rady Children's Hospital San Diego and University of California, San Diego, San Diego, California
| | - Ritu Sachdeva
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Neha R Soni-Patel
- Pediatric & Adult Congenital Heart Center, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dongngan T Truong
- University of Utah and Division of Pediatric Cardiology, Primary Children's Hospital, Salt Lake City, Utah
| | - Luciana T Young
- Seattle Children's Hospital and Pediatric Cardiology, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A Altman
- Baylor College of Medicine and Texas Children's Heart Center, Texas Children's Hospital, Houston, Texas
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5
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Alkassar M, Engelhardt S, Abu-Tair T, Ojeda E, Treffer PC, Weyand M, Rompel O. Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry. Diagnostics (Basel) 2023; 13:3162. [PMID: 37891983 PMCID: PMC10605840 DOI: 10.3390/diagnostics13203162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
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Affiliation(s)
- Muhnnad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
- Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, 90419 Nuremberg, Germany
| | - Sophia Engelhardt
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany;
| | - Efren Ojeda
- Siemens Healtineers, 91052 Erlangen, Germany; (E.O.); (P.C.T.)
| | | | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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6
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Park CH, Yoon H, Jo IJ, Woo S, Heo S, Chang H, Lee G, Park JE, Kim T, Lee SU, Hwang SY, Cha WC, Shin TG. A Pilot Study Evaluating LV Diastolic Function with M-Mode Measurement of Mitral Valve Movement in the Parasternal Long Axis View. Diagnostics (Basel) 2023; 13:2412. [PMID: 37510155 PMCID: PMC10378499 DOI: 10.3390/diagnostics13142412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This pilot study aimed to develop a new, reliable, and easy-to-use method for the evaluation of diastolic function through the M-mode measurement of mitral valve (MV) movement in the parasternal long axis (PSLA), similar to E-point septal separation (EPSS) used for systolic function estimation. Thirty healthy volunteers from a tertiary emergency department (ED) underwent M-mode measurements of the MV anterior leaflet in the PSLA view. EPSS, A-point septal separation (APSS), A-point opening length (APOL), and E-point opening length (EPOL) were measured in the PSLA view, along with the E and A velocities and e' velocity in the apical four-chamber view. Correlation analyses were performed to assess the relationship between M-mode and Doppler measurements, and the measurement time was evaluated. No significant correlations were found between M-mode and Doppler measurements in the study. However, M-mode measurements exhibited high reproducibility and faster acquisition, and the EPOL value consistently exceeded the APOL value, resembling the E and A pattern. These findings suggest that visually assessing the M-mode pattern on the MV anterior leaflet in the PSLA view may be a practical approach to estimating diastolic function in the ED. Further investigations with a larger and more diverse patient population are needed to validate these findings.
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Affiliation(s)
- Chan-Ho Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Ik-Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sookyoung Woo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center; Seoul 06351, Republic of Korea
| | - Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Jong-Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Se-Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Sung-Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Won-Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Tae-Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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7
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Aoki T, Wong V, Endo Y, Hayashida K, Takegawa R, Okuma Y, Shoaib M, Miyara SJ, Yin T, Becker LB, Shinozaki K. Bio-physiological susceptibility of the brain, heart, and lungs to systemic ischemia reperfusion and hyperoxia-induced injury in post-cardiac arrest rats. Sci Rep 2023; 13:3419. [PMID: 36854715 PMCID: PMC9974929 DOI: 10.1038/s41598-023-30120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Cardiac arrest (CA) patients suffer from systemic ischemia-reperfusion (IR) injury leading to multiple organ failure; however, few studies have focused on tissue-specific pathophysiological responses to IR-induced oxidative stress. Herein, we investigated biological and physiological parameters of the brain and heart, and we particularly focused on the lung dysfunction that has not been well studied to date. We aimed to understand tissue-specific susceptibility to oxidative stress and tested how oxygen concentrations in the post-resuscitation setting would affect outcomes. Rats were resuscitated from 10 min of asphyxia CA. Mechanical ventilation was initiated at the beginning of cardiopulmonary resuscitation. We examined animals with or without CA, and those were further divided into the animals exposed to 100% oxygen (CA_Hypero) or those with 30% oxygen (CA_Normo) for 2 h after resuscitation. Biological and physiological parameters of the brain, heart, and lungs were assessed. The brain and lung functions were decreased after CA and resuscitation indicated by worse modified neurological score as compared to baseline (222 ± 33 vs. 500 ± 0, P < 0.05), and decreased PaO2 (20 min after resuscitation: 113 ± 9 vs. baseline: 128 ± 9 mmHg, P < 0.05) and increased airway pressure (2 h: 10.3 ± 0.3 vs. baseline: 8.1 ± 0.2 mmHg, P < 0.001), whereas the heart function measured by echocardiography did not show significant differences compared before and after CA (ejection fraction, 24 h: 77.9 ± 3.3% vs. baseline: 82.2 ± 1.9%, P = 0.2886; fractional shortening, 24 h: 42.9 ± 3.1% vs. baseline: 45.7 ± 1.9%, P = 0.4658). Likewise, increases of superoxide production in the brain and lungs were remarkable, while those in the heart were moderate. mRNA gene expression analysis revealed that CA_Hypero group had increases in Il1b as compared to CA_Normo group significantly in the brain (P < 0.01) and lungs (P < 0.001) but not the heart (P = 0.4848). Similarly, hyperoxia-induced increases in other inflammatory and apoptotic mRNA gene expression were observed in the brain, whereas no differences were found in the heart. Upon systemic IR injury initiated by asphyxia CA, hyperoxia-induced injury exacerbated inflammation/apoptosis signals in the brain and lungs but might not affect the heart. Hyperoxia following asphyxia CA is more damaging to the brain and lungs but not the heart.
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Affiliation(s)
- Tomoaki Aoki
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Vanessa Wong
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Yusuke Endo
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Yu Okuma
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Neurosurgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Santiago J Miyara
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Tai Yin
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Lance B Becker
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA.
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8
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Hu H, Huang H, Li M, Gao X, Yin L, Qi R, Wu RS, Chen X, Ma Y, Shi K, Li C, Maus TM, Huang B, Lu C, Lin M, Zhou S, Lou Z, Gu Y, Chen Y, Lei Y, Wang X, Wang R, Yue W, Yang X, Bian Y, Mu J, Park G, Xiang S, Cai S, Corey PW, Wang J, Xu S. A wearable cardiac ultrasound imager. Nature 2023; 613:667-675. [PMID: 36697864 PMCID: PMC9876798 DOI: 10.1038/s41586-022-05498-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/31/2022] [Indexed: 01/26/2023]
Abstract
Continuous imaging of cardiac functions is highly desirable for the assessment of long-term cardiovascular health, detection of acute cardiac dysfunction and clinical management of critically ill or surgical patients1-4. However, conventional non-invasive approaches to image the cardiac function cannot provide continuous measurements owing to device bulkiness5-11, and existing wearable cardiac devices can only capture signals on the skin12-16. Here we report a wearable ultrasonic device for continuous, real-time and direct cardiac function assessment. We introduce innovations in device design and material fabrication that improve the mechanical coupling between the device and human skin, allowing the left ventricle to be examined from different views during motion. We also develop a deep learning model that automatically extracts the left ventricular volume from the continuous image recording, yielding waveforms of key cardiac performance indices such as stroke volume, cardiac output and ejection fraction. This technology enables dynamic wearable monitoring of cardiac performance with substantially improved accuracy in various environments.
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Affiliation(s)
- Hongjie Hu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Hao Huang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Mohan Li
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Xiaoxiang Gao
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Lu Yin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ruixiang Qi
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Ray S Wu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xiangjun Chen
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Yuxiang Ma
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Keren Shi
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Materials Science and Engineering Program, University of California, Riverside, CA, USA
| | - Chenghai Li
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Timothy M Maus
- Department of Anesthesiology, University of California, San Diego Health Sulpizio Cardiovascular Center, La Jolla, CA, USA
| | - Brady Huang
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chengchangfeng Lu
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA
| | - Muyang Lin
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Sai Zhou
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Zhiyuan Lou
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yue Gu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Neurosurgery, Yale University, New Haven, CT, USA
| | - Yimu Chen
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Yusheng Lei
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
| | - Xinyu Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Ruotao Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Wentong Yue
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Yang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Yizhou Bian
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Jing Mu
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Geonho Park
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
| | - Shu Xiang
- Softsonics, Inc., San Diego, CA, USA
| | - Shengqiang Cai
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Paul W Corey
- Department of Anesthesiology, Sharp Memorial Hospital, San Diego, CA, USA
| | - Joseph Wang
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA
| | - Sheng Xu
- Department of Nanoengineering, University of California San Diego, La Jolla, CA, USA.
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, USA.
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
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Rad EM, Ilali HM, Majnoon MT, Zeinaloo A. Mechanical QT and JT intervals by M-mode echocardiography: An extrapolation from the concurrent electrocardiographic tracings. Ann Pediatr Cardiol 2022; 15:364-373. [PMID: 36935820 PMCID: PMC10015387 DOI: 10.4103/apc.apc_169_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/03/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background Congenital long QT syndrome (CLQTS) is a life-threatening ion channelopathy leading to syncope and sudden death. Early diagnosis during the prenatal period and timely intervention can prevent sudden cardiac death and catastrophic consequences of this genetic ion channelopathy. Fetal magnetocardiography and fetal electrocardiography (ECG) enable the measurement of fetal QT and JT intervals, but their inherently technically challenging and/or resource-intensiveness nature preclude their routine clinical application. On the other hand, the high-temporal resolution of M-mode echocardiography makes it a well-suited and widely available modality for the measurement of cardiac events. Aims and Objectives We aimed to investigate the mechanical counterparts of the electrical QT and JT intervals on M-mode echocardiographic images of the tricuspid, mitral and aortic valves, and aortic wall. Methods We performed a prospective study on consecutive children referred to the outpatient pediatric cardiology clinic at a tertiary children's hospital. We defined M-mode echocardiographic landmark points on tracings of tricuspid annular planar systolic excursion, mitral and aortic valves, and aortic wall with simultaneous electrocardiographic recording. We measured the mean±SD of the absolute time difference and RR-adjusted time difference in cases with non-coincident ECG events and echocardiographic landmarks. Results Fifty healthy children were enrolled in the study. In 47 (94%) out of the 50 children, Q was coincident with the starting point of the tricuspid annular plane systolic excursion. In all children, the Q was coincident with the mid-point of the A-C line of the mitral valve. In 38 (76%) cases, there was a bump on the anterior wall of the aortic root immediately before the change in the slope of the aortic wall. This was coincident with the Q wave in 100% of cases. In all cases, the J point coincided with the point of acceleration of velocity on TAPSE. In all children, the J point coincided with the initial maximal opening of the aortic cusps. The end of the T wave occurred coincident with the peak of the tricuspid annular planar systolic excursion in 47 children (94%). In 48 children (96%), the end of the T wave coincided with the aortic cusps' closure point. Conclusions Based on our findings, we propose to measure the averaged mechanical QT and JT intervals by using an angled M-mode tracing of the aortic and mitral valve in five consecutive beats in the parasternal long-axis view. This is the first study on mechanical QT and JT intervals in healthy children. The study opens the horizons into the in-utero diagnosis of congenital long QT syndrome by measuring fetal QT and JT intervals using the widely available M-mode echocardiography.
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Affiliation(s)
- Elaheh Malakan Rad
- Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, Iran
| | - Hamidreza Mirzaei Ilali
- Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, Iran
| | - Mohammad-Taghi Majnoon
- Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, Iran
| | - Aliakbar Zeinaloo
- Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, Iran
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10
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Güllüpınar B, Sağlam C, Koran S, Turhan A, Ünlüer EE. The role of mitral annular plane systolic excursion in prediction of acute blood loss in healthy voluntary blood donors. J Ultrason 2022; 22:e33-e38. [PMID: 35449700 PMCID: PMC9009345 DOI: 10.15557/jou.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
Aim The aim of this study is to compare the diameter of the inferior vena cava with mitral annular plane systolic excursion measurement in order to determine the volume loss before and after blood donation in healthy volunteers. Material and methods The study was a single-center, prospective, cross-sectional study which included 46 healthy blood donors donating in a tertiary care hospital's blood bank. The inclusion criteria for the study were: volunteers aged 18-65 years, over 50 kg in weight, who met blood donation criteria, with hemoglobin values of >13.5 g/dL for males and >12.5 g/dL for females. After obtaining written consent, the systolic, diastolic, and mean arterial blood pressure along with the pulse rate of the donors were measured in standing and lying positions by the attending physician. Next, inferior vena cava and mitral annular plane systolic excursion measurements were made both pre and post blood donation. Results The decrease in both inferior vena cava diameter and mitral annular plane systolic excursion values measured pre and post blood donation was found to be statistically significant (p <0.05). There was no difference between the other variables pre and post blood donation. Conclusions Our study revealed that decreased inferior vena cava and mitral annular plane systolic excursion values correlated in determining blood loss post blood donation. Mitral annular plane systolic excursion may be useful to predict blood loss in the early stages of hemorrhagic shock.
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Affiliation(s)
- Birdal Güllüpınar
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
| | - Caner Sağlam
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
| | - Serhat Koran
- Department of Family Medicine, Bagcılar Medipol University Hospital, Turkey
| | | | - Erden Erol Ünlüer
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Turkey
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11
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Manohar A, Pack JD, Schluchter AJ, McVeigh ER. Four-dimensional computed tomography of the left ventricle, Part II: Estimation of mechanical activation times. Med Phys 2022; 49:2309-2323. [PMID: 35192200 PMCID: PMC9007845 DOI: 10.1002/mp.15550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 01/27/2022] [Accepted: 02/13/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE We demonstrate the viability of a four-dimensional X-ray computed tomography (4DCT) imaging system to accurately and precisely estimate mechanical activation times of left ventricular (LV) wall motion. Accurate and reproducible timing estimates of LV wall motion may be beneficial in the successful planning and management of cardiac resynchronization therapy (CRT). METHODS We developed an anthropomorphically accurate in silico LV phantom based on human CT images with programmed septal-lateral wall dyssynchrony. Twenty-six temporal phases of the in silico phantom were used to sample the cardiac cycle of 1 s. For each of the 26 phases, 1 cm thick axial slabs emulating axial CT image volumes were extracted, 3D printed, and imaged using a commercially available CT scanner. A continuous dynamic sinogram was synthesized by blending sinograms from these static phases; the synthesized sinogram emulated the sinogram that would be acquired under true continuous phantom motion. Using the synthesized dynamic sinogram, images were reconstructed at 70 ms intervals spanning the full cardiac cycle; these images exhibited expected motion artifact characteristics seen in images reconstructed from real dynamic data. The motion corrupted images were then processed with a novel motion correction algorithm (ResyncCT) to yield motion corrected images. Five pairs of motion uncorrected and motion corrected images were generated, each corresponding to a different starting gantry angle (0 to 180 degrees in 45 degree increments). Two line profiles perpendicular to the endocardial surface were used to sample local myocardial motion trajectories at the septum and the lateral wall. The mechanical activation time of wall motion was defined as the time at which the endocardial boundary crossed a fixed position defined on either of the two line profiles while moving toward the center of the LV during systolic contraction. The mechanical activation times of these myocardial trajectories estimated from the motion uncorrected and the motion corrected images were then compared with those derived from the static images of the 3D printed phantoms (ground truth). The precision of the timing estimates was obtained from the five different starting gantry angle simulations. RESULTS The range of estimated mechanical activation times observed across all starting gantry angles was significantly larger for the motion uncorrected images than for the motion corrected images (lateral wall: 58 ± 15 ms vs 12 ± 4 ms, p < 0.005; septal wall: 61 ± 13 ms vs 13 ± 9 ms, p < 0.005). CONCLUSIONS 4DCT images processed with the ResyncCT motion correction algorithm yield estimates of mechanical activation times of LV wall motion with significantly improved accuracy and precision. The promising results reported in this study highlight the potential utility of 4DCT in estimating the timing of mechanical events of interest for CRT guidance.
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Affiliation(s)
- Ashish Manohar
- Department of Mechanical and Aerospace Engineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Jed D Pack
- Radiation Systems Lab, GE Global Research, Niskayuna, New York, USA
| | - Andrew J Schluchter
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
| | - Elliot R McVeigh
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, California, USA
- Department of Radiology, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Cardiovascular Division, UC San Diego School of Medicine, La Jolla, California, USA
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12
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Wang S, Zhao P, Zhang Y, Zhu L, Zhu J, Luo Y, Li Q. The Therapeutic Effects of Curcumin in Early Septic Acute Kidney Injury: An Experimental Study. Drug Des Devel Ther 2021; 15:4243-4255. [PMID: 34675487 PMCID: PMC8504871 DOI: 10.2147/dddt.s332623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/25/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Sepsis is the leading condition associated with acute kidney injury (AKI) in the hospital and intensive care unit (ICU), sepsis-induced AKI (S-AKI) is strongly associated with poor clinical outcomes. Curcumin possesses an ability to ameliorate renal injury from ischemia-reperfusion, but it is still unknown whether they have the ability to reduce S-AKI. The aim of this study was to investigate the protective effects of curcumin on S-AKI and to assess its therapeutic potential on renal function, inflammatory response, and microcirculatory perfusion. METHODS Male Sprague-Dawley (SD) rats underwent cecal ligation and puncture (CLP) to induce S-AKI and immediately received vehicle (CLP group) or curcumin (CLP+Cur group) after surgery. At 12 and 24h after surgery, serum indexes, inflammatory factors, cardiac output (CO), renal blood flow and microcirculatory flow were measured. RESULTS Serum levels of creatinine (Scr), cystatin C (CysC), IL-6 and TNF-α were significantly lower in the CLP+Cur group than those in the CLP group (P < 0.05). Treatment with curcumin improved renal microcirculation at 24h by measurement of contrast enhanced ultrasound (CEUS) quantitative parameters [peak intensity (PI); half of descending time (DT/2); area under curve (AUC); P < 0.05]. In histopathological analysis, treatment with curcumin reduced damage caused by CLP. CONCLUSION Curcumin can alleviate S-AKI in rats by improving renal microcirculatory perfusion and reducing inflammatory response. Curcumin may be a potential novel therapeutic agent for the prevention or reduction of S-AKI.
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Affiliation(s)
- Shuo Wang
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ping Zhao
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jianing Zhu
- Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qiuyang Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China
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Bonagura JD, Visser LC. Echocardiographic assessment of dilated cardiomyopathy in dogs. J Vet Cardiol 2021; 40:15-50. [PMID: 34750089 DOI: 10.1016/j.jvc.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Dilated cardiomyopathy (DCM) is a frequent cause of cardiac disability, congestive heart failure (CHF), and arrhythmic death in dogs. The etiology of DCM is usually idiopathic/genetic, but some causes of a DCM phenotype are reversible. The disease is classified into preclinical (occult) and clinical (overt) stages; the latter stems from heart failure with reduced ejection fraction. DCM is further characterized by clinical, electrocardiographic, circulating biomarker, and imaging abnormalities. The diagnosis of clinical DCM with CHF is straightforward; however, identification of the preclinical stage can be challenging. Echocardiography is central to the diagnosis of both stages and characterized by left ventricular (LV) systolic dysfunction with progressive chamber dilation and variable enlargements of the left atrium and right-sided chambers. Left ventricular dilation is defined by increased LV end-diastolic volumes, areas, and internal dimensions normalized to body size or indexed to the aorta. Systolic dysfunction is characterized by decreased LV ejection fraction, increased end-systolic volume, and reduced shortening across minor and longitudinal LV axes. Dyssynchrony can confound the interpretation of linear indices of systolic function. A comprehensive echocardiogram in DCM includes two-dimensional and M-mode studies, spectral and tissue Doppler imaging, and potentially three-dimensional echocardiography and myocardial strain imaging. Echocardiographic findings should be interpreted within the context of identifiable risks and comorbidities, physical diagnosis, complementary diagnostic testing, and limitations of current reference intervals. Ambiguous examinations should be repeated. Specific echocardiographic criteria for the diagnosis of DCM are proposed to encourage discussion and additional outcome and breed-specific echocardiographic studies of canine DCM.
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Affiliation(s)
- John D Bonagura
- Departments of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC, 27606, USA; Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA.
| | - Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA
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Kruckman L, Fries RC, Kadotani S, Stack JP, Wallace LG. Comparison of three two-dimensional echocardiographic methods of assessing left ventricular size in Doberman Pinschers. J Vet Cardiol 2021; 40:110-118. [PMID: 34238699 DOI: 10.1016/j.jvc.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Compare three methods of obtaining linear left ventricular dimensions within the same Doberman Pinscher (DP). ANIMALS One hundred and thirty-nine client-owned DP. MATERIALS AND METHODS Linear left ventricular dimensions were measured using two-dimensional short-axis (Sx-2D), motion-mode short-axis (Sx-MM), and motion-mode long-axis (Lx-MM) methods, then left ventricular volumes were obtained using monoplane Simpson's method of discs (SMOD). A Friedman test with Dunn's multiple comparisons was used to compare differences between methods. Bias and correlation were evaluated via Bland-Altman and Spearman's correlation. Sensitivity and specificity for diagnosing occult dilated cardiomyopathy (DCM) compared to SMOD were determined. Coefficients of variation (CVs) were calculated for intra- and inter-observer measurement variability. RESULTS There were significant differences between all linear dimensions in diastole and systole. Short-axis 2D measurements had significant bias compared with Sx-MM (diastole +1.19 mm, systole +1.65 mm) and Lx-MM (diastole +4.36 mm, systole +3.87 mm) as did Sx-MM compared with Lx-MM (diastole +3.17 mm, systole +2.22 mm). All linear dimensions had a moderate positive correlation with SMOD. The sensitivity and specificity of linear measurements to detect DCM were: Sx-2D (sensitivity 72.0%, specificity 88.5%), Sx-MM (sensitivity 52.0%, specificity 92.0%), and Lx-MM (sensitivity 37.5%, specificity 99.1%). All methods had acceptably low CV for intra- and inter-observer measurement variability. CONCLUSIONS Results of this study suggest that linear measurements are repeatable and correlate with reference standard; however, there is a significant bias between measurements, and they should not be used interchangeably.
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Affiliation(s)
- L Kruckman
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - R C Fries
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States.
| | - S Kadotani
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - J P Stack
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
| | - L G Wallace
- Department of Veterinary Clinical Medicine, University of Illinois, 1008 W. Hazelwood Dr, Urbana, IL, 61801, United States
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16
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Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Tracheal, Lung, and Diaphragmatic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2019; 35:310-322. [PMID: 31883769 DOI: 10.1053/j.jvca.2019.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 11/11/2022]
Abstract
Today, proficiency in cardiopulmonary ultrasound is considered essential for anesthesiologists and critical care physicians. Conventional 2-dimensional images, however, do not permit optimal characterization of specific conditions (eg, diaphragmatic paralysis, major atelectasis, and pneumothorax) that may have relevant clinical implications in critical care and perioperative settings. By contrast, M-mode (motion-based) ultrasonographic imaging modality offers the highest temporal resolution in ultrasonography; this modality, therefore, can provide important information in ultrasound-driven approaches performed by anesthesiologists and intensivists for diagnosis, monitoring, and procedural guidance. Despite its practicability, M-mode has been progressively abandoned in echocardiography and is often underused in lung and diaphragmatic ultrasound. This review describes contemporary applications of M-mode ultrasonography in the practice of critical care and perioperative medicine. Information presented for each clinical application includes image acquisition and interpretation, evidence-based clinical implications in critically ill and surgical patients, and main limitations. The article focuses on tracheal, lung, and diaphragmatic ultrasound. It reviews tracheal ultrasound for procedural guidance during endotracheal intubation, confirmation of correct tube placement, and detection of esophageal intubation; lung ultrasound for the confirmation of endotracheal and endobronchial (selective) intubation and for the diagnosis of pneumothorax, alveolar-interstitial syndrome (cardiogenic v noncardiogenic pulmonary edema), pulmonary consolidation (pneumonia v major atelectasis) and pleural effusion; and diaphragmatic ultrasound for the diagnosis of diaphragmatic dysfunction and prediction of extubation success.
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Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne Billancourt, France; Faculty of Medicine Paris Ile de France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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17
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Satılmış Siliv N, Yamanoglu A, Pınar P, Celebi Yamanoglu NG, Torlak F, Parlak I. Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1027-1038. [PMID: 30265408 DOI: 10.1002/jum.14791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/07/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF. CONCLUSIONS Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.
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Affiliation(s)
| | - Adnan Yamanoglu
- Department of Emergency Medicine, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Pelin Pınar
- Department of Emergency Medicine, Bozyaka Training and Research Hospital, Izmir, Turkey
| | | | - Fatih Torlak
- Eskisehir Odunpazarı Public Health Center, Eskisehir, Turkey
| | - Ismet Parlak
- Department of Emergency Medicine, Bozyaka Training and Research Hospital, Izmir, Turkey
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Aurich M, Niemers M, Fuchs P, Greiner S, Müller-Hennessen M, Uhlmann L, Giannitsis E, Ehlermann P, Meder B, Katus HA, Mereles D. Pathophysiological background and prognostic implication of systolic aortic root motion in non-ischemic dilated cardiomyopathy. Sci Rep 2019; 9:3866. [PMID: 30846742 PMCID: PMC6405754 DOI: 10.1038/s41598-019-40386-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023] Open
Abstract
Recordings of aortic root movement represent one of the first accomplishments of ultrasound in medicine and mark the beginning of functional cardiac imaging. However, the underlying mechanism is not completely understood. Since the aortic root is directly connected to the cardiac skeleton we hypothesize, that the amplitude of systolic aortic root motion (SARM) may be mainly caused by displacement of the cardiac base towards the apex and might therefore be used as measure of left ventricular longitudinal function (LV-LF). One hundred and eighty patients with dilated cardiomyopathy and 180 healthy controls were prospectively included into this study. SARM was lower in patients compared to controls (9 ± 3 mm vs. 12 ± 2 mm, p < 0.001) and lowest in patients with cardiovascular events (9 ± 3 mm vs. 7 ± 3 mm, p < 0.001). During a median follow-up time of 38 months, the combined end-point of cardiovascular death or hospitalization for heart failure was reached by 25 patients (13.9%). Reduced SARM had significant prognostic impact on outcome (hazard ratio 0.74, 95% confidence interval 0.63–0.88, p < 0.001) and remained an independent predictor in the multivariate analysis. Compared to parameters with potential influence on its mechanism, SARM correlated best (r = 0.75, p < 0.001) with global longitudinal strain (GLS). SARM may therefore represent an alternative echocardiographic parameter for the assessment of LV-LF, particularly when GLS is not feasible or apical views are not available.
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Affiliation(s)
- Matthias Aurich
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
| | - Matthias Niemers
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Patrick Fuchs
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Greiner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Müller-Hennessen
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Meder
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
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Virtual M-Mode for Echocardiography: A New Approach for the Segmentation of the Anterior Mitral Leaflet. IEEE J Biomed Health Inform 2019; 23:305-313. [DOI: 10.1109/jbhi.2018.2799738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
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Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
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Maron BJ. Harvey Feigenbaum, MD, and the Creation of Clinical Echocardiography: A Conversation With Barry J. Maron, MD. Am J Cardiol 2017; 120:2085-2099. [PMID: 29156174 DOI: 10.1016/j.amjcard.2017.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
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Huang SJ, Ting I, Huang AM, Slama M, McLean AS. Longitudinal wall fractional shortening: an M-mode index based on mitral annular plane systolic excursion (MAPSE) that correlates and predicts left ventricular longitudinal strain (LVLS) in intensive care patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:292. [PMID: 29178915 PMCID: PMC5702151 DOI: 10.1186/s13054-017-1876-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022]
Abstract
Background Left ventricular longitudinal strain (LVLS) is a modern measurement for LV function. However, strain measurement is often difficult in critically ill patients. We sought to show LVLS can be estimated using M-mode-derived longitudinal wall fractional shortening (LWFS), which is less dependent on image quality and is easier to perform in critically ill patients. Methods Transthoracic echocardiographic records were retrospectively screened and 80 studies suitable for strain and M-mode measurements in the apical 4-chamber view were selected. Longitudinal wall fractional shortening was derived from conventional M-mode (LWFS) and curved anatomical M-mode (CAMMFS). The relationships between LVLS and mitral annular plane systolic excusion (MAPSE) and M-mode-derived fractional shortening were examined using univariate generalized linear model in a training set (n = 50) and was validated in a separate validation set (n = 30). Results MAPSE, CAMMFS, and LWFS demonstrated very good correlations with LVLS (r = 0.852, 0.875 and 0.909, respectively). LWFS was the best unbiased predictor for LVLS (LVLS = 1.180 x LWFS - 0.737, P < 0.001). Intra- and inter-rater agreement and reliability for LWFS measurement were good. Conclusions LVLS can be estimated by LWFS in the critically ill patients. It provides a fast and accurate prediction of LVLS. LWFS is a reproducible and reliable measurement which can be used as a potential index in place of LVLS in the critically ill population. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1876-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen J Huang
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, NSW, 2747, Australia.
| | - Iris Ting
- Cardiovascular Ultrasound Laboratory, Nepean Hospital, Sydney, NSW, Australia
| | - Andrea M Huang
- Sydney Medical Program, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Michel Slama
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, NSW, 2747, Australia.,Unité de réanimation médicale CHU Sud Amiens, and unité INSERM 1088, UPJV, Amiens, France
| | - Anthony S McLean
- Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Sydney, NSW, 2747, Australia
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Hurtado-Aguilar LG, Mulderrig S, Moreira R, Hatam N, Spillner J, Schmitz-Rode T, Jockenhoevel S, Mela P. Ultrasound for In Vitro, Noninvasive Real-Time Monitoring and Evaluation of Tissue-Engineered Heart Valves. Tissue Eng Part C Methods 2017; 22:974-981. [PMID: 27673356 DOI: 10.1089/ten.tec.2016.0300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineered heart valves are developed in bioreactors where biochemical and mechanical stimuli are provided for extracellular matrix formation. During this phase, the monitoring possibilities are limited by the need to maintain the sterility and integrity of the valve. Therefore, noninvasive and nondestructive techniques are required. As such, optical imaging is commonly used to verify valve's functionality in vitro. It provides important information (i.e., leaflet symmetry, geometric orifice area, and closing and opening times), which is, however, usually limited to a singular view along the central axis from the outflow side. In this study, we propose ultrasound as a monitoring method that, in contrast to established optical imaging, can assess the valve from different planes, scanning the whole three-dimensional geometry. We show the potential benefits associated with the application of ultrasound to bioreactors, in advancing heart valve tissue engineering from design to fabrication and in vitro maturation. Specifically, we demonstrate that additional information, otherwise unavailable, can be gained to evaluate the valve's functionality (e.g., coaptation length, and effective cusp height and shape). Furthermore, we show that Doppler techniques provide qualitative visualization and quantitative evaluation of the flow through the valve, in real time and throughout the whole in vitro fabrication phase.
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Affiliation(s)
- Luis G Hurtado-Aguilar
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Shane Mulderrig
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Ricardo Moreira
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Nima Hatam
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Jan Spillner
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Thomas Schmitz-Rode
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Stefan Jockenhoevel
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany .,3 Institute for Textile Engineering, RWTH Aachen University , Aachen, Germany
| | - Petra Mela
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
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Malhotra S, Jain D. Detection of interventricular dyssynchrony: An evolution of the phase analysis technique. J Nucl Cardiol 2017; 24:1687-1689. [PMID: 27282162 DOI: 10.1007/s12350-016-0550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Clinical and Translation Research Center, Suite 7030, Buffalo, NY, 14221, USA.
| | - Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College, Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY, USA
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Kerut EK, McIlwain E, Nishimura RA. Grade I diastolic dysfunction and elevated left ventricular end-diastolic pressure: Mitral Doppler inflow, pulmonary vein atrial reversal, and the M-mode mitral B-bump. Echocardiography 2017; 34:1371-1373. [DOI: 10.1111/echo.13631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Affiliation(s)
- Tiffany Chen
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tara L Jones
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eric V Krieger
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Pantazopoulos JS, David A, Kostis WJ, Cosgrove NM, Kostis JB. Cardiovascular outcomes in patients with intraventricular conduction blocks: A sixteen-year follow-up in a state-wide database. Hellenic J Cardiol 2016; 58:194-201. [PMID: 27965025 DOI: 10.1016/j.hjc.2016.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To assess the adverse clinical effects of left anterior hemiblock alone or in combination with right bundle branch block and of complete left bundle branch block in comparison with isolated right bundle branch block and the relationship of these effects with altered mechanoelectric factors resulting in left ventricular dysfunction. METHODS In a 16-year follow-up study using a statewide database, we studied the occurrence of mortal and morbid cardiovascular (CV) events among patients without apparent ischemic heart disease who had left anterior hemiblock (LAHB, n=4273, right bundle branch block (RBBB) with LAHB (BFBB, n=1857) and left bundle branch block (LBBB, n=9484 compared to isolated RBBB (n=25288). RESULTS After adjustment for demographics, co-morbidities and insurance, LAHB was associated with a significant excess risk of all-cause death (HR 1.134, 95% CI 1.061-1.213, p=0.0002) and CV death (HR 1.329, 95% CI 1.174-1.501, p<0.0001). BFBB was associated with excess HF (HR 1.190, 95% CI 1.048-1.351, p<0.0071), all-cause death (HR 1.440, 95% CI 1.045-1.252, p=0.0036) and CV death (HR 1.210, 95% CI 1.020-1.436, p<0.0001). LBBB was associated with an excess risk of MR (HR 1.307, 95% CI 1.116-1.530, p<0.0009), HF 1.177, 95% CI1.097-1.263, p<0.0001) and CV death (HR 1.220, 95% CI 1.106-1.345, p<0.0001). CONCLUSIONS In patients without apparent ischemic heart disease, the presence of LAHB alone or in combination with RBBB imparts increased risk of CV and all-cause death compared to isolated RBBB. BFBB is also associated with an increased risk of HF.
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Affiliation(s)
- John S Pantazopoulos
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Alice David
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nora M Cosgrove
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis. Int Urol Nephrol 2016; 49:525-532. [PMID: 27943170 DOI: 10.1007/s11255-016-1473-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Control of hydration status is an important constituent of adequate and efficient hemodialysis (HD) treatment. Nevertheless, there are no precise clinical indices for early recognition of small changes in fluid status of patients undergoing chronic hemodialysis therapy. This study aimed to evaluate and compare the widely used and reliable method of indexed inferior vena cava diameter (IVCDi) with established and more recently available techniques (bioelectrical impedance analysis [BIA], continuous blood volume monitoring [Crit-line], and the B-line score [BLS] with lung ultrasonography) for estimating the hydration status of patients on HD. METHODS Fifty-three patients undergoing chronic HD thrice weekly were included in the study. Evaluation of hydration status methods (IVCDi, BLS, BIA, and Crit-line) was performed thrice weekly before and after HD. Receiver operating characteristic curve analysis was performed to evaluate the discriminative power of (methods) the BLS, BIA, and Crit-line for predicting over- and underhydration of patients, as determined by the reference method, IVCDi. RESULTS BLS showed the most promising results in predicting overhydration, as determined by IVCDi, compared with BIA and Crit-line and presented a sensitivity of 77% and specificity of 74%. The accuracy of the BLS was higher than that of BIA (0.81 vs. 0.71, p = 0.032) and Crit-line (0.61, p = 0.001). BLS also showed more promising results in predicting underhydration, as determined by IVCDi, than BIA and Crit-line and presented a sensitivity of 78% and a specificity of 73%. The accuracy of the BLS was higher than that of BIA (0.83 vs. 0.76, p = 0.035) and Crit-line (0.50, p < 0.001). CONCLUSIONS The BLS is a useful and easily performed technique that has recently become available for accurate evaluation of dry weight and fluid status in patients with end-stage renal disease undergoing chronic HD. This method might help recognize asymptomatic lung congestion in these patients.
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Shillcutt SK, Tavazzi G, Shapiro BP, Diaz-Gomez J. Pulmonic Regurgitation in the Adult Cardiac Surgery Patient. J Cardiothorac Vasc Anesth 2016; 31:215-228. [PMID: 27712967 DOI: 10.1053/j.jvca.2016.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Sasha K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
| | - Guido Tavazzi
- Department of Anesthesia and Intensive Care, Emergency Medicine, University of Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Anesthesiology, and Neurosurgery, Mayo Clinic, Jacksonville, FL
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Marek J, Gandalovičová J, Kejřová E, Pšenička M, Linhart A, Paleček T. Echocardiography and cardiac resynchronization therapy. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zurauskas M, Bradu A, Ferguson DR, Hammer DX, Podoleanu A. Closed loop tracked Doppler optical coherence tomography based heart monitor for the Drosophila melanogaster larvae. JOURNAL OF BIOPHOTONICS 2016; 9:246-52. [PMID: 25924107 DOI: 10.1002/jbio.201500007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/22/2015] [Accepted: 04/01/2015] [Indexed: 05/19/2023]
Abstract
This paper presents a novel instrument for biosciences, useful for studies of moving embryos. A dual sequential imaging/measurement channel is assembled via a closed-loop tracking architecture. The dual channel system can operate in two regimes: (i) single-point Doppler signal monitoring or (ii) fast 3-D swept source OCT imaging. The system is demonstrated for characterizing cardiac dynamics in Drosophila melanogaster larva. Closed loop tracking enables long term in vivo monitoring of the larvae heart without anesthetic or physical restraint. Such an instrument can be used to measure subtle variations in the cardiac behavior otherwise obscured by the larvae movements. A fruit fly larva (top) was continuously tracked for continuous remote monitoring. A heartbeat trace of freely moving larva (bottom) was obtained by a low coherence interferometry based doppler sensing technique.
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Affiliation(s)
- Mantas Zurauskas
- Applied Optics Group, School of Physical Sciences, University of Kent, CT2 7NH, Canterbury, UK.
| | - Adrian Bradu
- Applied Optics Group, School of Physical Sciences, University of Kent, CT2 7NH, Canterbury, UK
| | - Daniel R Ferguson
- Physical Sciences Inc., 20 New England Business Center, Andover MA, 01810, USA
| | - Daniel X Hammer
- Physical Sciences Inc., 20 New England Business Center, Andover MA, 01810, USA
| | - Adrian Podoleanu
- Applied Optics Group, School of Physical Sciences, University of Kent, CT2 7NH, Canterbury, UK
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Abstract
BACKGROUND Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. METHODS The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. RESULTS During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. CONCLUSIONS This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.
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Westphal RJ, Bueno RRL, Galvão PBDA, Zanis Neto J, Souza JM, Guérios ÊE, Senegaglia AC, Brofman PR, Pasquini R, Cunha CLPD. Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy. Arq Bras Cardiol 2015; 103:521-9. [PMID: 25590932 PMCID: PMC4290743 DOI: 10.5935/abc.20140164] [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: 04/05/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even
under optimal medical treatment. Autologous infusion of bone marrow adult stem
cells has shown promising preliminary results in these patients. Objective Determine the effectiveness of autologous transplantation of bone marrow adult
stem cells on systolic and diastolic left ventricular function, and on the degree
of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in
functional classes NYHA II and III. Methods We administered 4,54 x 108 ± 0,89 x 108 bone marrow
adult stem cells into the coronary arteries of 24 patients with dilated idiopathic
cardiomyopathy in functional classes NYHA II and III. Changes in functional class,
systolic and diastolic left ventricular function and degree of mitral
regurgitation were assessed after 3 months, 6 months and 1 year. Results During follow-up, six patients (25%) improved functional class and eight (33.3%)
kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after
3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no
significant changes neither in diastolic left ventricular function nor in mitral
regurgitation degree. A combined cardiac resynchronization and implantable
cardioversion defibrillation was implanted in two patients (8.3%). Four patients
(16.6%) had sudden death and four patients died due to terminal cardiac failure.
Average survival of these eight patients was 2.6 years. Conclusion Intracoronary infusion of bone marrow adult stem cells was associated with an
improvement or stabilization of functional class and an improvement in left
ventricular ejection fraction, suggesting the efficacy of this intervention. There
were no significant changes neither in left ventricular diastolic function nor in
the degree of mitral regurgitation.
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Affiliation(s)
| | | | | | - José Zanis Neto
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | | | - Paulo Roberto Brofman
- Centro de Pesquisa, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Menegatti E, Tessari M, Gianesini S, Vannini ME, Sisini F, Zamboni P. Human internal jugular valve M-mode ultrasound characterization. Curr Neurovasc Res 2014; 11:149-55. [PMID: 24712644 PMCID: PMC4031920 DOI: 10.2174/1567202611666140408094014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 12/02/2022]
Abstract
In humans the mechanism governing the internal jugular vein (IJV) valve opening and closure is still unclear. M-mode is used in echo-cardiology for the heart valves assessment. Sometimes it was performed also in deep peripheral veins and in vena cava assessment, but never in the IJV valve. Aim of the present study is to investigate the IJV valves physiology in healthy volunteers, by means of both B and M-mode ultrasound.
Eighty-three (83) healthy volunteers (35 Male, 48 Female, 25.7±6.7 y.o.), for a total of 166 IJVs, were enrolled. The entire cohort underwent IJVs high-resolution B and M-mode evaluation, in standardized postural and respiratory conditions. Presence, motility, and number of cusps, as well as their opening and closure mechanism have been assessed.
Bilateral valve absence occurred in 13/83 (16%), whereas at least a one side absence was recorded in 38/83 (46‰ of the cohort) (p<0.0356). Valve leaflets were always mobile and respectively bi-cusps in 34%, or mono-cusp in 27%. The latter was significantly more frequent on the left side (35%) than on the right side (19%) (p<0.0013).
In supine, M-mode valve opening was synchronous with the cardiac cycle.
To the contrary, in an upright position, the valve remained always open and saddled to the wall, independently from the cardiac cycle.
In healthy subjects, the IJV valve leaflets are always mobile, but the significant rate of mono and bilateral absence could suggest a progressive phylogenetic importance loss of such apparatus. M-mode ultrasound enhances the characterization of IJV valve, for this reason it should be taken into consideration to routinely add it to the cerebral venous return investigation.
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Affiliation(s)
| | | | | | | | | | - Paolo Zamboni
- Vascular Diseases Center - University of Ferrara, Via Aldo Moro 8, 44124 Cona (FE), Italy.
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Gibson PH, Becher H, Choy JB. Classification of left ventricular size: diameter or volume with contrast echocardiography? Open Heart 2014; 1:e000147. [PMID: 25525505 PMCID: PMC4267109 DOI: 10.1136/openhrt-2014-000147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 11/11/2014] [Accepted: 11/26/2014] [Indexed: 11/06/2022] Open
Abstract
Background Left ventricular (LV) size is an important clinical variable, commonly assessed at echocardiography by measurement of the internal diameter in diastole (IDD). However, this has recognised limitations and volumetric measurement from apical views is considered superior, particularly with the use of echocardiographic contrast. We sought to determine the agreement in classification of LV size by different measures in a large population of patients undergoing echocardiography. Methods and results Data were analysed retrospectively from consecutive patients (n=2008, 61% male, median 62 years) who received echocardiographic contrast for LV opacification over 3 years in a single institution. Repeat studies were not included. LVIDD was measured, and LV end-diastolic volume (LVEDV) calculated using Simpson's biplane method. Both measures were indexed (i) to body surface area and categorised according to the American Society of Echocardiography (ASE) guidelines as normal, mild, moderate or severely dilated. Of 320 patients with a severely dilated LVEDVi, only 95 (30%) were similarly classified by LVIDD, with 86 patients (27%) measuring in the normal range. LVIDDi agreement was poorer, with only 43 patients (13%) classified as being severely dilated, and 173 (54%) measuring in the normal range. Conclusions Currently recommended echocardiographic measures of LV size show limited agreement when classified according to currently recommended cut-offs. LV diameter should have a limited role in the assessment of LV size, particularly where a finding of LV dilation has important diagnostic or therapeutic implications.
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Affiliation(s)
- Patrick H Gibson
- Division of Cardiology; Department of Medicine , Mazankowski Alberta Heart Institute, University of Alberta , Edmonton, Alberta , Canada
| | - Harald Becher
- Division of Cardiology; Department of Medicine , Mazankowski Alberta Heart Institute, University of Alberta , Edmonton, Alberta , Canada
| | - Jonathan B Choy
- Division of Cardiology; Department of Medicine , Mazankowski Alberta Heart Institute, University of Alberta , Edmonton, Alberta , Canada
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Martinez SC, Bradley EA, Novak EL, Rasalingam R, Cedars AM, Ewald GA, Silvestry SC, Joseph SM. Slope of the anterior mitral valve leaflet: a new measurement of left ventricular unloading for left ventricular assist devices and systolic dysfunction. Tex Heart Inst J 2014; 41:262-72. [PMID: 24955040 DOI: 10.14503/thij-13-3604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e' and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (<0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF <0.35 was 11.6 cm/s (95% confidence interval, 10.4-12.8); SLAM had a moderately strong correlation with E/e' in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P <0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF <0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.
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Affiliation(s)
- Sara C Martinez
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Elisa A Bradley
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Eric L Novak
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Ravi Rasalingam
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Ari M Cedars
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Gregory A Ewald
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Scott C Silvestry
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
| | - Susan M Joseph
- Department of Internal Medicine, Cardiovascular Division (Drs. Bradley, Cedars, Ewald, Joseph, Martinez, and Rasalingam; and Mr. Novak), and Department of Surgery, Division of Cardiothoracic Surgery (Dr. Silvestry), Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110
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Stout D, Berr SS, LeBlanc A, Kalen JD, Osborne D, Price J, Schiffer W, Kuntner C, Wall J. Guidance for Methods Descriptions Used in Preclinical Imaging Papers. Mol Imaging 2013. [DOI: 10.2310/7290.2013.00055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- David Stout
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Stuart S. Berr
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Amy LeBlanc
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Joseph D. Kalen
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Dustin Osborne
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Julie Price
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Wynne Schiffer
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Claudia Kuntner
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
| | - Jonathan Wall
- From the Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA; Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN; Small Animal Imaging Program/Laboratory Animal Sciences Program/SAIC-Frederick, Frederick National Laboratory for Cancer Research, Frederick, MD; Departments of Medicine
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Ghersin E, Castellon I, Runco Therrien JE, Tanawuttiwat T, Lessick J, Checkver A, Soto V. ECG-gated cardiac MDCT for detection of systolic anterior motion of mitral valve. ACUTE CARDIAC CARE 2013; 15:69-75. [PMID: 23957448 DOI: 10.3109/17482941.2013.822085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Evaluating ECG-gated cardiac MDCT detection of systolic anterior motion of the mitral valve, in comparison to trans-thoracic echocardiography as a gold standard. MATERIALS AND METHODS Study group included 83 consecutive patients (57 men; average age 56.1 years) evaluated with both retrospective ECG-gated cardiac MDCT and trans-thoracic echocardiography within an interval of 30 days. ECG-gated cardiac MDCT imaging was performed with retrospective ECG- gating using 64-slice and 128-slice CT scanners with an inherent temporal resolution range of 75-165 ms. MDCT's and trans- thoracic echocardiograms were retrospectively and independently evaluated by experienced radiologist and cardiologist respectively, for presence of systolic anterior motion of the mitral valve. RESULTS 7 patients (8.4%) were found to have systolic anterior motion by trans-thoracic echocardiography, from which 6 were found to have systolic anterior motion by ECG-gated cardiac MDCT. Of the 76 patients without systolic anterior motion on trans-thoracic echocardiography, all were correctly identified using ECG-gated cardiac MDCT. The sensitivity, specificity, positive and negative predictive values and accuracy of ECG-gated cardiac MDCT in identifying systolic anterior motion of the mitral valve were 85.7% (6/7), 100% (76/76), 100% (6/6), 98.7% (76/77) and 98.8% (82/83), respectively. CONCLUSION ECG-gated cardiac MDCT is comparable to trans-thoracic echocardiography in detecting systolic anterior motion of the mitral valve.
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Affiliation(s)
- Eduard Ghersin
- Department of Radiology, Leonard M. Miller School of Medicine, University of Miami, Florida, USA.
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McConnell MV, Wu HH. Respiratory-mode display of echocardiographic images highlights effects of pericardial disease. JACC Cardiovasc Imaging 2013; 6:917-9. [PMID: 23769491 DOI: 10.1016/j.jcmg.2012.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/12/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Michael V McConnell
- Department of Medicine (Cardiovascular), Stanford University, Stanford, California 94305, USA.
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Evaluating the Regional Myocardial Function by Left Ventricular Radial Myocardial Motion Velocity Gradient: An Omni-directional M-mode Echocardiography Study. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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NOVIANA DENI, KURNIAWAN LYNNKAATLAURA. Heart Size Evaluation of Indonesian Domestic House Cat by Motion Mode Echocardiography Imaging. HAYATI JOURNAL OF BIOSCIENCES 2013. [DOI: 10.4308/hjb.20.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Stöhr EJ, González-Alonso J, Shave R. Reply to “Letter to the editor: ‘Left ventricular mechanical limitations to stroke volume in healthy humans during incremental exercise'”. Am J Physiol Heart Circ Physiol 2012. [DOI: 10.1152/ajpheart.00997.2011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Rob Shave
- University of Wales Institute, Cardiff, and
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Lopez L, Lai WW. Chamber and Vessel Quantification in Pediatric Echocardiography: What Do the Guidelines Teach Us? CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stöhr EJ, González-Alonso J, Shave R. Left ventricular mechanical limitations to stroke volume in healthy humans during incremental exercise. Am J Physiol Heart Circ Physiol 2011; 301:H478-87. [DOI: 10.1152/ajpheart.00314.2011] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During incremental exercise, stroke volume (SV) plateaus at 40–50% of maximal exercise capacity. In healthy individuals, left ventricular (LV) twist and untwisting (“LV twist mechanics”) contribute to the generation of SV at rest, but whether the plateau in SV during incremental exercise is related to a blunting in LV twist mechanics remains unknown. To test this hypothesis, nine healthy young males performed continuous and discontinuous incremental supine cycling exercise up to 90% peak power in a randomized order. During both exercise protocols, end-diastolic volume (EDV), end-systolic volume (ESV), and SV reached a plateau at submaximal exercise intensities while heart rate increased continuously. Similar to LV volumes, two-dimensional speckle tracking-derived LV twist and untwisting velocity increased gradually from rest (all P < 0.001) and then leveled off at submaximal intensities. During continuous exercise, LV twist mechanics were linearly related to ESV, SV, heart rate, and cardiac output (all P < 0.01) while the relationship with EDV was exponential. In diastole, the increase in apical untwisting was significantly larger than that of basal untwisting ( P < 0.01), emphasizing the importance of dynamic apical function. In conclusion, during incremental exercise, the plateau in LV twist mechanics and their close relationship with SV and cardiac output indicate a mechanical limitation in maximizing LV output during high exercise intensities. However, LV twist mechanics do not appear to be the sole factor limiting LV output, since EDV reaches its maximum before the plateau in LV twist mechanics, suggesting additional limitations in diastolic filling to the heart.
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Affiliation(s)
- Eric J. Stöhr
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge; and
| | - José González-Alonso
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge; and
| | - Rob Shave
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge; and
- Cardiff School of Sport, University of Wales Institute Cardiff, Cardiff, United Kingdom
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Re: “American Society of Echocardiography Recommendations for Quality Echocardiography Laboratory Operations”. J Am Soc Echocardiogr 2011; 24:930; author reply 930. [DOI: 10.1016/j.echo.2011.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Indexed: 11/23/2022]
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Seo Y, Ito H, Nakatani S, Takami M, Naito S, Shiga T, Ando K, Wakayama Y, Aonuma K. The role of echocardiography in predicting responders to cardiac resynchronization therapy. Circ J 2011; 75:1156-63. [PMID: 21383516 DOI: 10.1253/circj.cj-10-0861] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This multicenter prospective cohort study aimed to identify both ability of echocardiographic parameters to detect cardiac resynchronization therapy (CRT) volume responders and relation of these parameters with clinical outcomes. METHODS AND RESULTS CRT responder was defined as ≥ 15% reduction of left ventricular (LV) end-systolic volume at 6 months. Seven echocardiographic dyssynchrony parameters were evaluated. The clinical endpoint comprised time to death from any cause or unplanned hospitalization for a major cardiovascular event. Of the 217 patients enrolled, 63 percent were classified as volume responders, in whom significantly fewer events occurred than in non-responders (log rank, P < 0.001). No single echocardiographic criterion had significant power to detect volume responders, but a combining measurement of dyssynchrony between septum and LV free wall with M-mode and tissue Doppler imaging was independently associated with volume responders. In addition, this combined parameter was associated with the endpoint (hazard ratio, 0.66, 95% confidence interval 0.30-0.98, P = 0.04). In contrast, left bundle branch block was identified as an independent predictor of volume responders and more strongly associated with the endpoint (hazard ratio, 0.38, 95% confidence interval 0.20-0.72, P = 0.003). CONCLUSIONS Echocardiographic parameters did not show significant power to detect CRT responders independently.
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Affiliation(s)
- Yoshihiro Seo
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
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How can we best image congenital heart defects? Are two-dimensional and three-dimensional echocardiography competitive or complementary? J Am Soc Echocardiogr 2010; 23:722-5. [PMID: 20620860 DOI: 10.1016/j.echo.2010.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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