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Li L, Homer P, Craft M, Kutty S, Putschoegl A, Marshall A, Danford D, Yetman A. Machine Learning-Enabled Fully Automated Assessment of Left Ventricular Volume, Ejection Fraction and Strain: Experience in Pediatric and Young Adult Echocardiography. Pediatr Cardiol 2024; 45:1183-1191. [PMID: 36208311 DOI: 10.1007/s00246-022-03015-7] [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: 07/08/2022] [Accepted: 09/18/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Left ventricular (LV) volumes, ejection fraction (EF), and myocardial strain have been shown to be predictive of clinical and subclinical heart disease. Automation of LV functional assessment overcomes difficult technical challenges and complexities. We sought to assess whether a fully automated assessment of LV function could be reliably used in children and young adults. METHODS Fifty normal volunteers (22/28, female/male) were prospectively recruited for research echocardiography. LV volumes, EF, and strain were measured both manually and automatically. An experienced sonographer performed all the manual analysis and recorded the analysis timing. The fully automated analyses were accomplished by 5 groups of observers with different knowledge and medical background. AutoLV and AutoSTRAIN (TomTec) were employed for the fully automated LV analysis. The LV volumes, EF, strain, and analysis time were compared between manual and automated methods, and among the 5 groups of observers. RESULTS Software-determined endocardial border detection was achievable in all subjects. The analysis times of the experienced sonographer were significantly shorter for AutoLV and AutoSTRAIN than manual analyses (both p < 0.001). Strong correlations were seen between conventional EF and AutoLV (r = 0.8373), and between conventional three view global longitudinal strain (GLS) and AutoSTRAIN (r = 0.9766). The volumes from AutoLV and three view GLS from AutoSTRAIN had strong correlations among different observers regardless of level of expertise. EF from AutoLV analysis had moderately strong correlations among different observers. CONCLUSION Automated pediatric LV analysis is feasible in normal hearts. Machine learning-enabled image analysis saves time and produces results that are comparable to traditional methods.
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Affiliation(s)
- Ling Li
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA.
- Pediatric Cardiology, Child Health Research Institute, Department of Pediatrics, University of Nebraska College of Medicine, 42nd and Emile, Omaha, NE, 68198, USA.
| | - Paul Homer
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Mary Craft
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Shelby Kutty
- Helen B. Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Putschoegl
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Amanda Marshall
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - David Danford
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Anji Yetman
- Department of Pediatric Cardiology, University of Nebraska College of Medicine and Children's Hospital and Medical Center Omaha, Omaha, NE, USA
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van Dijck P, Hannemann C, Dreger H, Stangl V, Stangl K, Ludwig A, Hewing B. Increased Expression of Inactive Rhomboid Protein 2 in Circulating Monocytes after Acute Myocardial Infarction. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10519-5. [PMID: 38743187 DOI: 10.1007/s12265-024-10519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
Increased TNF-α levels following acute myocardial infarction (AMI) contribute to impaired recovery of myocardial function. Interaction of inactive rhomboid protein 2 (iRhom2) with TNF-α converting enzyme (TACE) is required for TNF-α shedding from immune cells. We hypothesized that iRhom2 expression increases in circulating monocytes following AMI. Transcript levels of iRhom2, TACE and TNF-α were evaluated by quantitative real-time PCR in isolated monocytes of 50 AMI patients at admission (d1) and 3 days (d3) after. We observed a significant increase in levels of iRhom2 mRNA expression in monocytes between d1-3, while TNF-α and TACE mRNA expression remained unchanged. At d3, iRhom2 mRNA expression positively correlated with levels of intermediate monocytes or serum TNF-α, and negatively with LV systolic function. iRhom2 may contribute to regulation of post-infarction inflammation and is associated with LV dysfunction following AMI. iRhom2 modulation should be evaluated as a potential therapeutic strategy to attenuate cardiac remodeling following AMI.
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Affiliation(s)
- Phillip van Dijck
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
| | - Carmen Hannemann
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Henryk Dreger
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Deutsches Herzzentrum der Charité, Berlin, Germany
- Structural Heart Interventions Program (SHIP), Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Verena Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Karl Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Antje Ludwig
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Berlin Institute of Health (BIH), 10178, Berlin, Germany
| | - Bernd Hewing
- Department of Cardiology, Angiology and Intensive Care Medicine, Campus Mitte, Deutsches Herzzentrum der Charité, Charitéplatz 1, 10117, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany.
- Berlin Institute of Health (BIH), 10178, Berlin, Germany.
- Zentrum Für Kardiologie, Kardiologische Gemeinschaftspraxis, Muenster, Germany.
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany.
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Komanek T, Rabis M, Omer S, Peters J, Frey UH. Quantification of left ventricular ejection fraction and cardiac output using a novel semi-automated echocardiographic method: a prospective observational study in coronary artery bypass patients. BMC Anesthesiol 2023; 23:65. [PMID: 36855077 PMCID: PMC9972694 DOI: 10.1186/s12871-023-02025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Echocardiographic quantification of ejection fraction (EF) by manual endocardial tracing requires training, is time-consuming and potentially user-dependent, whereas determination of cardiac output by pulmonary artery catheterization (PAC) is invasive and carries a risk of complications. Recently, a novel software for semi-automated EF and CO assessment (AutoEF) using transthoracic echocardiography (TTE) has been introduced. We hypothesized that AutoEF would provide EF values different from those obtained by the modified Simpson's method in transoesophageal echocardiography (TOE) and that AutoEF CO measurements would not agree with those obtained via VTILVOT in TOE and by thermodilution using PAC. METHODS In 167 patients undergoing coronary artery bypass graft surgery (CABG), TTE cine loops of apical 4- and 2-chamber views were recorded after anaesthesia induction under steady-state conditions. Subsequently, TOE was performed following a standardized protocol, and CO was determined by thermodilution. EF and CO were assessed by TTE AutoEF as well as TOE, using the modified Simpson's method, and Doppler measurements via velocity time integral in the LV outflow tract (VTILVOT). We determined Pearson's correlation coefficients r and carried out Bland-Altman analyses. The primary endpoints were differences in EF and CO. The secondary endpoints were differences in left ventricular volumes at end diastole (LVEDV) and end systole (LVESV). RESULTS AutoEF and the modified Simpson's method in TOE showed moderate EF correlation (r = 0.38, p < 0.01) with a bias of -12.6% (95% limits of agreement (95%LOA): -36.6 - 11.3%). AutoEF CO correlated poorly both with VTILVOT in TOE (r = 0.19, p < 0.01) and thermodilution (r = 0.28, p < 0.01). The CO bias between AutoEF and VTILVOT was 1.33 l min-1 (95%LOA: -1.72 - 4.38 l min-1) and 1.39 l min-1 (95%LOA -1.34 - 4.12 l min-1) between AutoEF and thermodilution, respectively. AutoEF yielded both significantly lower EF (EFAutoEF: 42.0% (IQR 29.0 - 55.0%) vs. EFTOE Simpson: 55.2% (IQR 40.1 - 70.3%), p < 0.01) and CO values than the reference methods (COAutoEF biplane: 2.30 l min-1 (IQR 1.30 - 3.30 l min-1) vs. COVTI LVOT: 3.64 l min-1 (IQR 2.05 - 5.23 l min-1) and COPAC: 3.90 l min-1 (IQR 2.30 - 5.50 l min-1), p < 0.01)). CONCLUSIONS AutoEF correlated moderately with TOE EF determined by the modified Simpson's method but poorly both with VTILVOT and thermodilution CO. A systematic bias was detected overestimating LV volumes and underestimating both EF and CO compared to the reference methods. TRIAL REGISTRATION German Register for Clinical Trials (DRKS-ID DRKS00010666, date of registration: 08/07/2016).
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Affiliation(s)
- Thomas Komanek
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Marco Rabis
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Saed Omer
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Jürgen Peters
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany
| | - Ulrich H Frey
- Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany. .,Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen und Universitätsklinikum Essen, Essen, Germany.
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Papadopoulou SL, Sachpekidis V, Kantartzi V, Styliadis I, Nihoyannopoulos P. Clinical validation of an artificial intelligence-assisted algorithm for automated quantification of left ventricular ejection fraction in real time by a novel handheld ultrasound device. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:29-37. [PMID: 36713988 PMCID: PMC9707920 DOI: 10.1093/ehjdh/ztac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 02/01/2023]
Abstract
Aims We sought to evaluate the reliability and diagnostic accuracy of a novel handheld ultrasound device (HUD) with artificial intelligence (AI) assisted algorithm to automatically calculate ejection fraction (autoEF) in a real-world patient population. Methods and results We studied 100 consecutive patients (57 ± 15 years old, 61% male), including 38 with abnormal left ventricular (LV) function [LV ejection fraction (LVEF) < 50%]. The autoEF results acquired using the HUD were independently compared with manually traced biplane Simpson's rule measurements on cart-based systems to assess method agreement using intra-class correlation coefficient (ICC), linear regression analysis, and Bland-Altman analysis. The diagnostic accuracy for the detection of LVEF <50% was also calculated. Test-retest reliability of measured EF by the HUD was assessed by calculating the ICC and the minimal detectable change (MDC). The ICC, linear regression analysis, and Bland-Altman analysis revealed good agreement between autoEF and reference manual EF (ICC = 0.85; r = 0.87, P < 0.001; mean bias -1.42% with limits of agreement 14.5%, respectively). Detection of abnormal LV function (EF < 50%) by autoEF algorithm was feasible with sensitivity 90% (95% CI 75-97%), specificity 87% (95% CI 76-94%), PPV 81% (95% CI 66-91%), NPV 93% (95% CI 83-98%), and a total diagnostic accuracy of 88%. Test-retest reliability was excellent (ICC = 0.91, P < 0.001; r = 0.91, P < 0.001; mean difference ± SD: 0.54% ± 5.27%, P = 0.308) and MDC for LVEF measurement by autoEF was calculated at 4.38%. Conclusion Use of a novel HUD with AI-enabled capabilities provided similar LVEF results with those derived by manual biplane Simpson's method on cart-based systems and shows clinical potential.
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Affiliation(s)
| | | | - Vasiliki Kantartzi
- Department of Cardiology, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, Thessaloniki 56403, Greece
| | - Ioannis Styliadis
- Department of Cardiology, Papageorgiou General Hospital, Ring Road, Nea Efkarpia, Thessaloniki 56403, Greece
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart & Lung Institute, The Hammersmith Hospital, Du Cane Road, London W120NN, UK,First Cardiology Department, Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
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Kouris NT, Kostopoulos VS, Psarrou GA, Kostakou PM, Tzavara C, Olympios CD. Left ventricular ejection fraction and Global Longitudinal Strain variability between methodology and experience. Echocardiography 2021; 38:582-589. [PMID: 33704841 DOI: 10.1111/echo.15025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Although ejection fraction (EF) is the cornerstone of the assessment of left ventricular (LV) systolic function, its measurement faces a number of challenges related to image quality, assumptions of LV geometry, and expertise. The aim of this study was to test the inter-observer variability of EF and GLS measurement in patients with a broad spectrum of LV function, between physicians and investigators (Inv) with different levels of expertise. METHODS In 122 patients, EF and GLS were measured by 4 Inv blinded to each other with different level of experience in echocardiography; EF was measured using 3 methods: visual assessment, biplane Simpson's method, and auto-EF method. GLS was measured from the 3 apical views. A significant difference for LVEF and for LVGLS was considered to be >10 and >2 absolute values, respectively. RESULTS Intra-observer agreement was excellent for visually assessed EF (ICC = 0.87, P < .001) and GLS (ICC = 0.82, P < .001) and good for EF measured by Simpson's method (ICC = 0.70, P < .001) and auto-EF (ICC = 0.72, P < .001). Intra-observer and inter-observer agreements were excellent for GLS with ICCs above 0.8. GLS discordance between the 4 Inv was not significant. Discordance in EF and GLS measurements among the Inv was not related to image quality or wall motion abnormalities. CONCLUSION Although EF has proved its prognostic value in various cardiovascular entities, GLS seems to be more reliable for serial assessment of LV function, demonstrating lower intra- and inter-observer variability, even by different physicians with variant level of expertise.
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Affiliation(s)
- Nikos T Kouris
- General Hospital of Elefsina "Thriassio", Athens, Greece
| | | | | | | | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Left Ventricular End Diastolic Volume and Ejection Fraction Calculation: Correlation between Three Echocardiographic Methods. Cardiol Res Pract 2020; 2020:8076582. [PMID: 32190384 PMCID: PMC7064836 DOI: 10.1155/2020/8076582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) and end diastolic volume (EDV) are measured using Simpson's biplane (SB), 3-dimensional method (3DE), and speckle tracking (STE). Comparisons between methods in routine practice are limited. Our purpose was to compare and to determine the correlations between these three methods in clinical setting. Methods LVEF and EDV were measured by three methods in 474 consecutive patients and compared using multiple Bland–Altman (BA) plots. The correlations (R) between methods were calculated. Results Median (IQR) LVEF_SB, LVEF_STE, and LVEF_3DE were 63.0% (60–69)%, 61% (57–65)%, and 62% (57–68)%. Median (IQR) EDV_SB, EDV_STE, and EDV_3DE were 85 ml (71–106) ml, 82 ml (69–100) ml, and 73 ml (59–89) ml. R between LVEF_SB and LVEF_3DE was 0.65 when echogenicity was good and 0.43 when poor. R for EDV_SB and EDV_3DE was 0.75 when echogenicity was good and 0.45 when poor. On BA analysis, biases were acceptable (<3.5% for LVEF) but limits of agreement (LOA) were large: 95% of the differences were between −15.4% and +18.8% for LVEF as evaluated by SB in comparison with 3DE, with a bias of 1.7%. In the comparison EDV_SB and EDV_3DE, the bias was 14 ml and the LOA were between −24 ml and +53 ml. On linear regressions, LVEF_3DE = 17.92 + 0.69 LVEF_SB and EDV_3DE = 18.94 + 0.63 EDV_SB. Conclusions The three methods were feasible and led to acceptable bias but large LOA. Although these methods are not interchangeable, our results allow 3DE value prediction from SB, the most commonly used method.
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Reproducibility of Combined Acquisition and Measurement of Left Ventricular Longitudinal Peak Segmental Strain in Relation to the Severity of Left Ventricular Dysfunction. J Am Soc Echocardiogr 2019; 32:1451-1461.e3. [DOI: 10.1016/j.echo.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022]
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Nolan MT, Thavendiranathan P. Automated Quantification in Echocardiography. JACC Cardiovasc Imaging 2019; 12:1073-1092. [DOI: 10.1016/j.jcmg.2018.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
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Accurate assessment of LV function using the first automated 2D-border detection algorithm for small animals - evaluation and application to models of LV dysfunction. Cardiovasc Ultrasound 2019; 17:7. [PMID: 31010431 PMCID: PMC6477743 DOI: 10.1186/s12947-019-0156-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023] Open
Abstract
Echocardiography is the most commonly applied technique for non-invasive assessment of cardiac function in small animals. Manual tracing of endocardial borders is time consuming and varies with operator experience. Therefore, we aimed to evaluate a novel automated two-dimensional software algorithm (Auto2DE) for small animals and compare it to the standard use of manual 2D-echocardiographic assessment (2DE). We hypothesized that novel Auto2DE will provide rapid and robust data sets, which are in agreement with manually assessed data of animals.2DE and Auto2DE were carried out using a high-resolution imaging-system for small animals. First, validation cohorts of mouse and rat cine loops were used to compare Auto2DE against 2DE. These data were stratified for image quality by a blinded expert in small animal imaging. Second, we evaluated 2DE and Auto2DE in four mouse models and four rat models with different cardiac pathologies.Automated assessment of LV function by 2DE was faster than conventional 2DE analysis and independent of operator experience levels. The accuracy of Auto2DE-assessed data in healthy mice was dependent on cine loop quality, with excellent agreement between Auto2DE and 2DE in cine loops with adequate quality. Auto2DE allowed for valid detection of impaired cardiac function in animal models with pronounced cardiac phenotypes, but yielded poor performance in diabetic animal models independent of image quality.Auto2DE represents a novel automated analysis tool for rapid assessment of LV function, which is suitable for data acquisition in studies with good and very good echocardiographic image quality, but presents systematic problems in specific pathologies.
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Mărgulescu AD, Şuran MCB, Vinereanu D. Do 2-Dimensional Speckle Tracking Indexes Have Sufficient Reproducibility to Be Used in Clinical Practice When Image Acquisition and Severity of LV Dysfunction Are Taken Into Account? JACC Cardiovasc Imaging 2019; 12:756-759. [DOI: 10.1016/j.jcmg.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
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Aurich M, Fuchs P, Müller-Hennessen M, Uhlmann L, Niemers M, Greiner S, Täger T, Hirschberg K, Ehlermann P, Meder B, Frankenstein L, Giannitsis E, Katus HA, Mereles D. Unidimensional Longitudinal Strain: A Simple Approach for the Assessment of Longitudinal Myocardial Deformation by Echocardiography. J Am Soc Echocardiogr 2018; 31:733-742. [DOI: 10.1016/j.echo.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 12/20/2022]
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12
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Franchi F, Cameli M, Taccone FS, Mazzetti L, Bigio E, Contorni M, Mondillo S, Scolletta S. Assessment of left ventricular ejection fraction in critically ill patients at the time of speckle tracking echocardiography: intensivists in training for echocardiography versus experienced operators. Minerva Anestesiol 2018; 84:1270-1278. [PMID: 29648414 DOI: 10.23736/s0375-9393.18.12249-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The biplane Simpson's method is considered the gold standard to assess and monitor left ventricular (LV) ejection fraction (EF) in critically ill patients. Recently, a new semi-automatic technique based on speckle tracking echocardiography called "Auto-EF" has been introduced. We compared LVEF values obtained with biplane Simpson's method and Auto-EF by two groups of operators: trainee echocardiography intensivists and experienced echocardiographers. METHODS A standard transthoracic echocardiography was performed on 37 patients. According to image quality 29 patients were selected. Each inexperienced and experienced operator executed an off-line analysis using both Simpson's method and Auto-EF. LVEF obtained by the two groups of operators were then compared. RESULTS EF values assessed with Simpson's method showed a moderate correlation (r=0.70, P<0.01) between inexperienced and experienced operators. The Bland-Altman analysis showed a mean bias of 0.3% with limits of agreement (LoA) from -24.4 to +25.1%. Values obtained with Auto-EF showed a good correlation (r=0.94, P<0.01) with a mean bias of 0.2% and LoA from -10.1 to +10.4%. CONCLUSIONS Due to its semiautomatic nature, for inexpert operators Auto-EF seems more reproducible than the traditional Simpson's method for monitoring left ventricular function in critically ill patients.
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Affiliation(s)
- Federico Franchi
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy -
| | - Matteo Cameli
- Unit of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Loredana Mazzetti
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Bigio
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Martina Contorni
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Unit of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sabino Scolletta
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment). Curr Cardiol Rep 2017; 19:9. [PMID: 28176279 DOI: 10.1007/s11886-017-0815-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
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Hewing B, Theres L, Spethmann S, Stangl K, Dreger H, Knebel F. Left atrial strain predicts hemodynamic parameters in cardiovascular patients. Echocardiography 2017; 34:1170-1178. [DOI: 10.1111/echo.13595] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bernd Hewing
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- Berlin Institute of Health (BIH); Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Lena Theres
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Sebastian Spethmann
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- Department of Internal Medicine (Cardiology and Angiology); Bundeswehrkrankenhaus Berlin; Berlin Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Campus Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- Berlin Institute of Health (BIH); Berlin Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin; Berlin Germany
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15
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Benyounes N, Lang S, Gout O, Ancédy Y, Etienney A, Cohen A. Could quantitative longitudinal peak systolic strain help in the detection of left ventricular wall motion abnormalities in our daily echocardiographic practice? Arch Cardiovasc Dis 2016; 109:533-541. [DOI: 10.1016/j.acvd.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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16
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Stankovic I, Prinz C, Ciarka A, Daraban AM, Kotrc M, Aarones M, Szulik M, Winter S, Belmans A, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. Relationship of visually assessed apical rocking and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT). Eur Heart J Cardiovasc Imaging 2015; 17:262-9. [DOI: 10.1093/ehjci/jev288] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/04/2015] [Indexed: 11/14/2022] Open
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17
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Knackstedt C, Bekkers SC, Schummers G, Schreckenberg M, Muraru D, Badano LP, Franke A, Bavishi C, Omar AMS, Sengupta PP. Fully Automated Versus Standard Tracking of Left Ventricular Ejection Fraction and Longitudinal Strain. J Am Coll Cardiol 2015; 66:1456-66. [DOI: 10.1016/j.jacc.2015.07.052] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/30/2015] [Accepted: 07/27/2015] [Indexed: 12/22/2022]
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18
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Echocardiographic Deformation Imaging for the Assessment of Left Ventricular Function: Clinical Implications and Perspectives— Update 2014. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Aurich M, André F, Keller M, Greiner S, Hess A, Buss SJ, Katus HA, Mereles D. Assessment of Left Ventricular Volumes with Echocardiography and Cardiac Magnetic Resonance Imaging: Real-Life Evaluation of Standard versus New Semiautomatic Methods. J Am Soc Echocardiogr 2014; 27:1017-24. [DOI: 10.1016/j.echo.2014.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Indexed: 10/24/2022]
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20
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Greiner S, Heimisch M, Aurich M, Heß JA, Katus HA, Mereles D. Multiplane two-dimensional strain echocardiography for segmental analysis of right ventricular mechanics. Clin Res Cardiol 2014; 103:817-24. [DOI: 10.1007/s00392-014-0723-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
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21
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2014; 14:721-40. [PMID: 23847385 DOI: 10.1093/ehjci/jet123] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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22
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Spethmann S, Stüer K, Diaz I, Althoff T, Hewing B, Baumann G, Dreger H, Knebel F. Left atrial mechanics predict the success of pulmonary vein isolation in patients with atrial fibrillation. J Interv Card Electrophysiol 2014; 40:53-62. [DOI: 10.1007/s10840-014-9876-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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23
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Muller L, Brière M, Bastide S, Roger C, Zoric L, Seni G, de La Coussaye JE, Ripart J, Lefrant JY. Preoperative fasting does not affect haemodynamic status: a prospective, non-inferiority, echocardiography study. Br J Anaesth 2014; 112:835-41. [PMID: 24496782 DOI: 10.1093/bja/aet478] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The link between preoperative fasting and hypovolaemia remains unclear. We tested the hypothesis that preoperative fasting does not significantly increase the proportion of patients with hypovolaemia according to transthoracic echocardiography (TTE) criteria. METHODS Patients of ASA status I-III and without bowel preparation were included in a non-inferiority, prospective, single-centre trial. Patients underwent passive leg raising (PLR) test and TTE at admission (Day 0) and after 8 h fasting (Day 1). The primary hypothesis was that an 8 h preoperative fasting does not increase the proportion (margin=5%) of patients with a positive PLR test ('functional approach'). The secondary hypothesis was that echocardiographic filling pressures or stroke volume (margin 10%) are not affected by preoperative fasting ('static approach'). RESULTS One hundred patients were included and 98 analysed. After an 8 h fasting, the change in the proportion of responders to PLR was -6.1% [95% confidence interval (CI)=-16.0 to 3.8] of responders to PLR test on Day 0 when compared with Day 1. Because 95% CI was strictly inferior to 5%, there was no significant increase in the proportion of PLR responders on Day 1 when compared with Day 0. The 95% CI changes of static variables were always fewer than 10%, meaning that preoperative fasting induced significantly no relevant changes in static variables. CONCLUSION Preoperative fasting did not alter TTE dynamic and static preload indices in ASA I-III adult patients. These results suggest that preoperative fasting does not induce significant hypovolaemia. Clinical trial registration NCT 01258361.
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Affiliation(s)
- L Muller
- Department of Anesthesiology, Critical Care, Emergency, and Pain, Division Anesthésie Réanimation Douleur Urgences, Centre hospitalier universitaire Caremeau, Place du Pr Debré. 30029 Nîmes, France
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24
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bergler J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:1013-32. [PMID: 23998694 DOI: 10.1016/j.echo.2013.07.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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26
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Monte I, Buccheri S, Bottari V, Blundo A, Licciardi S, Romeo MA. Left Ventricular Rotational Dynamics in Beta Thalassemia Major: A Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr 2012; 25:1083-90. [DOI: 10.1016/j.echo.2012.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Indexed: 11/15/2022]
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27
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Amzulescu MS, Slavich M, Florian A, Goetschalckx K, Voigt JU. Does Two-Dimensional Image Reconstruction from Three-Dimensional Full Volume Echocardiography Improve the Assessment of Left Ventricular Morphology and Function? Echocardiography 2012; 30:55-63. [DOI: 10.1111/j.1540-8175.2012.01800.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mihaela Silvia Amzulescu
- Department of Cardiology; “C.C. Iliescu” Emergency Institute of Cardiovascular Diseases; Bucharest; Romania
| | - Massimo Slavich
- Division of Noninvasive Cardiology; San Raffaele Hospital, Scientific Institute; Milano; Italy
| | - Anca Florian
- Department of Cardiology; “C.C. Iliescu” Emergency Institute of Cardiovascular Diseases; Bucharest; Romania
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases; University Hospital Gasthuisberg, Catholic University Leuven; Leuven; Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases; University Hospital Gasthuisberg, Catholic University Leuven; Leuven; Belgium
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28
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Echocardiographic Evaluation of Left Ventricular Structure and Function: New Modalities and Potential Applications in Clinical Trials. J Card Fail 2012; 18:159-72. [DOI: 10.1016/j.cardfail.2011.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/10/2011] [Accepted: 10/28/2011] [Indexed: 12/17/2022]
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