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Liang S, Liu M, Liu Z, Zhong X, Qin Y, Liang T, Wang X, Tang Z, Li Q, Huang H. Global longitudinal strain assessment in contrast-enhanced echocardiography in breast cancer patients: a feasibility study. Cardiovasc Ultrasound 2023; 21:7. [PMID: 37081550 PMCID: PMC10116775 DOI: 10.1186/s12947-023-00304-w] [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: 12/04/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Left ventricular global longitudinal strain (GLS) obtained from two-dimensional speckle-tracking echocardiography (2D-STE) can reflect cancer therapy-related cardiac dysfunction in breast cancer (BC) patients, however, the accuracy and reproducibility of 2D-STE are restricted due to poor image quality. METHODS Between January 2019 and October 2021, 160 consecutive BC patients aged ≥ 18 years were recruited. The 160 BC patients (mean age: 48.41 ± 9.93 years, 100% women) underwent both 2D-STE and Contrast-enhanced echocardiography (CEcho), 125 of whom were included in the measurement of GLS. The intraclass correlation coefficient (ICC) was used to determine the intra- and inter-observer reproducibility of 2D-STE and CEcho-STE. Correlation (r) was calculated using Pearson correlation. Statistical significance was set at P < 0.05. RESULTS Among 160 BC patients, more segments were recognized by CEcho-STE than by 2D-STE (2,771, 99.53% vs. 2,440, 84.72%). The left ventricular ejection fraction (LVEF) obtained by 2D was lower than CEcho (61.75 ± 6.59% vs. 64.14 ± 5.97%, P < 0.0001). The GLS obtained by 2D-STE was lower than CEcho-STE (-21.74 ± 2.77% vs. -26.79 ± 4.30%, P = 0.001). The ICC of the intraobserver and interobserver agreements in the CEcho-STE group was lower than that in the 2D-STE group. GLS measurements were in good agreement between the 2D-STE and CEcho-STE groups (r = 0.773). CONCLUSIONS CEcho can overcome some imaging limitations and recognize more segments than 2D, which may provide an LVEF and GLS closer to the true value. Based on AutoStrain, CEcho-STE may serve as a complementary method for those with poor image quality.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Mei Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Xiaorong Zhong
- Department of Head and Neck Oncology Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yupei Qin
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Ting Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Zhuoqin Tang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Qian Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China.
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Platts DG, Shiino K, Chan J, Burstow DJ, Scalia GM, Fraser JF. Echocardiographic assessment of myocardial function and mechanics during veno-venous extracorporeal membrane oxygenation. Echo Res Pract 2019; 6:25-35. [PMID: 30959479 PMCID: PMC6499935 DOI: 10.1530/erp-18-0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) plays a fundamental role in the management of patients supported with extra-corporeal membrane oxygenation (ECMO). In light of fluctuating clinical states, serial monitoring of cardiac function is required. Formal quantification of ventricular parameters and myocardial mechanics offer benefit over qualitative assessment. The aim of this research was to compare unenhanced (UE) versus contrast-enhanced (CE) quantification of myocardial function and mechanics during ECMO in a validated ovine model. METHODS Twenty-four sheep were commenced on peripheral veno-venous ECMO. Acute smoke-induced lung injury was induced in 21 sheep (3 controls). CE-TTE with Definity using Cadence Pulse Sequencing was performed. Two readers performed image analysis with TomTec Arena. End diastolic area (EDA, cm2), end systolic area (ESA, cm2), fractional area change (FAC, %), endocardial global circumferential strain (EGCS, %), myocardial global circumferential strain (MGCS, %), endocardial rotation (ER, degrees) and global radial strain (GRD, %) were evaluated for UE-TTE and CE-TTE. RESULTS Full data sets are available in 22 sheep (92%). Mean CE EDA and ESA were significantly larger than in unenhanced images. Mean FAC was almost identical between the two techniques. There was no significant difference between UE and CE EGCS, MGCS and ER. There was significant difference in GRS between imaging techniques. Unenhanced inter-observer variability was from 0.48-0.70 but significantly improved to 0.71-0.89 for contrast imaging in all echocardiographic parameters. CONCLUSION Semi-automated methods of myocardial function and mechanics using CE-TTE during ECMO was feasible and similar to UE-TTE for all parameters except ventricular areas and global radial strain. Addition of contrast significantly decreased inter-observer variability of all measurements.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Kenji Shiino
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Fujita Health University, Toyoake, Japan
| | - Jonathan Chan
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Darryl J Burstow
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Gregory M Scalia
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
- Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Mao S, Xu DP, Dang XJ, Li W, Wu HL. Shenzhu Guanxin Recipe Granules () for Improving Exercise Tolerance in Patients with Stable Angina (SERIES Trial): A Protocol of Multicenter, Randomized, Double-Blind, Placebo Parallel Controlled Clinical Trial. Chin J Integr Med 2018; 25:96-102. [PMID: 30328569 DOI: 10.1007/s11655-018-3017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many patients with chronic angina experience anginal episodes despite successful recanalization, antianginal and antiischemic medications. Empirical observations suggested that Shenzhu Guanxin Recipe Granules (, SGR), a Chinese herbal compound, exerted potential impacts on increased treadmill exercise performance and angina relieve. However, there has been no systematic study to clarify the impact of SGR on exercise tolerance in patients with stable angina. The SERIES (ShEnzhu guanxin Recipe for Improving Exercise tolerance in patients with Stable angina) trial is designed to determine the effects of SGR on exercise duration, electrocardiographic (ECG) evidence of myocardial ischemia, and incidence of major adverse cardiac events (MACE) in stable anginal patients. METHODS A total of 184 eligible patients with stable angina will be randomly assigned to receive placebo or SGR (10 g/day for 12 weeks) in a 1:1 ratio. The primary outcome will be the change from baseline in total exercise tolerance duration, time to onset of angina and ECG ischemia during exercise treadmill testing performed over a 12-week study period. The secondary outcome will include ECG measures, the occurrence and composite of MACE and the Seattle Angina Questionnaire score. Moreover, the coronary microcirculation will be evaluated to explore the possible effects in response to treatment of SGR. After the procedure, all participants will be followed up by interview at 3 and 6 months, enquiring about any cardiac events, hospitalizations, cardiac functional level and medication usage. Additionally, the occurrence of adverse events will be evaluated at each follow-up. DISCUSSION This study may provide novel evidence on the efficacy of SGR in improving exercise tolerance and potentially reducing clinical adverse events. (Trial registration No. ChiCTR-TRC-14004504).
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Affiliation(s)
- Shuai Mao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Dan-Ping Xu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Xiao-Jing Dang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Winny Li
- Faculty of Medicine, University of Toronto, Toronto, M5G 0A4, Canada
| | - Huan-Lin Wu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,Heart Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China. .,Beijing University of Chinese Medicine, Beijing, 100029, China.
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Medvedofsky D, Lang RM, Kruse E, Guile B, Weinert L, Ciszek B, Jacobson Z, Negron J, Volpato V, Prado A, Patel AR, Mor-Avi V. Feasibility of Left Ventricular Global Longitudinal Strain Measurements from Contrast-Enhanced Echocardiographic Images. J Am Soc Echocardiogr 2018; 31:297-303. [DOI: 10.1016/j.echo.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 11/28/2022]
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Zoppellaro G, Venneri L, Khattar RS, Li W, Senior R. Simultaneous Assessment of Myocardial Perfusion, Wall Motion, and Deformation during Myocardial Contrast Echocardiography: A Feasibility Study. Echocardiography 2016; 33:889-95. [PMID: 26833555 DOI: 10.1111/echo.13190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology. METHODS AND RESULTS We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences. CONCLUSIONS Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.
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Affiliation(s)
- Giacomo Zoppellaro
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Lucia Venneri
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
| | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
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Nagy AI, Sahlen A, Manouras A, Henareh L, da Silva C, Gunyeli E, Apor AA, Merkely B, Winter R. Combination of contrast-enhanced wall motion analysis and myocardial deformation imaging during dobutamine stress echocardiography. Eur Heart J Cardiovasc Imaging 2014; 16:88-95. [DOI: 10.1093/ehjci/jeu171] [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] [Indexed: 11/14/2022] Open
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Becher H, Gibson PH. Contrast Echocardiography: Current Applications and Future Perspectives. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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