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Venet M, Malik A, Gold S, Zhang N, Gopaul J, Dauz J, Yazaki K, Ponzoni M, Coles JG, Maynes JT, Sun M, Howell A, Chaturvedi R, Mertens L, Mroczek D, Uike K, Baranger J, Friedberg MK, Villemain O. Impact of Right Ventricular Pressure Overload on Myocardial Stiffness Assessed by Natural Wave Imaging. JACC Cardiovasc Imaging 2024:S1936-878X(24)00284-5. [PMID: 39177563 DOI: 10.1016/j.jcmg.2024.06.020] [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: 12/22/2023] [Revised: 05/29/2024] [Accepted: 06/28/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Right ventricular (RV) hemodynamic performance determines the prognosis of patients with RV pressure overload. Using ultrafast ultrasound, natural wave velocity (NWV) induced by cardiac valve closure was proposed as a new surrogate to quantify myocardial stiffness. OBJECTIVES This study aimed to assess RV NWV in rodent models and children with RV pressure overload vs control subjects and to correlate NWV with RV hemodynamic parameters. METHODS Six-week-old rats were randomized to pulmonary artery banding (n = 6), Sugen hypoxia-induced pulmonary arterial hypertension (n = 7), or sham (n = 6) groups. They underwent natural wave imaging, echocardiography, and hemodynamic assessment at baseline and 6 weeks postoperatively. The authors analyzed NWV after tricuspid and after pulmonary valve closure (TVC and PVC, respectively). Conductance catheters were used to generate pressure-volume loops. In parallel, the authors prospectively recruited 14 children (7 RV pressure overload; 7 age-matched control subjects) and compared RV NWV with echocardiographic and invasive hemodynamic parameters. RESULTS NWV significantly increased in RV pressure overload rat models (4.99 ± 0.27 m/s after TVC and 5.03 ± 0.32 m/s after PVC in pulmonary artery banding at 6 weeks; 4.89 ± 0.26 m/s after TVC and 4.84 ± 0.30 m/s after PVC in Sugen hypoxia at 6 weeks) compared with control subjects (2.83 ± 0.15 m/s after TVC and 2.72 ± 0.34 m/s after PVC). NWV after TVC correlated with both systolic and diastolic parameters including RV dP/dtmax (r = 0.75; P < 0.005) and RV Ees (r = 0.81; P < 0.005). NWV after PVC correlated with both diastolic and systolic parameters and notably with RV end-diastolic pressure (r = 0.65; P < 0.01). In children, NWV after both right valves closure in RV pressure overload were higher than in healthy volunteers (P < 0.01). NWV after PVC correlated with RV E/E' (r = 0.81; P = 0.008) and with RV chamber stiffness (r = 0.97; P = 0.03). CONCLUSIONS Both RV early-systolic and early-diastolic myocardial stiffness show significant increase in response to pressure overload. Based on physiology and our observations, early-systolic myocardial stiffness may reflect contractility, whereas early-diastolic myocardial stiffness might be indicative of diastolic function.
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Affiliation(s)
- Maelys Venet
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Bordeaux University Hospital, Department of Pediatric and Adult Congenital Cardiology, Pessac, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France.
| | - Aimen Malik
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Gold
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Naiyuan Zhang
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Josh Gopaul
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Dauz
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kana Yazaki
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matteo Ponzoni
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John G Coles
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mei Sun
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison Howell
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rajiv Chaturvedi
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dariusz Mroczek
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kiyoshi Uike
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jerome Baranger
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Olivier Villemain
- Department of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Bordeaux University Hospital, Department of Pediatric and Adult Congenital Cardiology, Pessac, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France. https://twitter.com/Villemain_Team
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Youssef AS, Petrescu A, Salaets T, Bézy S, Wouters L, Orlowska M, Caenen A, Duchenne J, Puvrez A, Cools B, Heying R, D'hooge J, Gewillig M, Voigt JU. Evolution of Natural Myocardial Shear Wave Behavior in Young Hearts: Determinant Factors and Reproducibility Analysis. J Am Soc Echocardiogr 2024:S0894-7317(24)00352-3. [PMID: 39002706 DOI: 10.1016/j.echo.2024.07.004] [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: 11/24/2023] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Myocardial diastolic function assessment in children by conventional echocardiography is challenging. High-frame rate echocardiography facilitates the assessment of myocardial stiffness, a key factor in diastolic function, by measuring the propagation velocities of myocardial shear waves (SWs). However, normal values of natural SWs in children are currently lacking. The aim of this study was to explore the behavior of natural SWs among children and adolescents, their reproducibility, and the factors affecting SW velocities from childhood into adulthood. METHODS One hundred six healthy children (2-18 years of age) and 62 adults (19-80 years of age) were recruited. High-frame rate images were acquired using a modified commercial scanner. An anatomic M-mode line was drawn along the ventricular septum, and propagation velocities of natural SWs after mitral valve closure were measured in the tissue acceleration-coded M-mode display. RESULTS Throughout life, SW velocities after mitral valve closure exhibited pronounced age dependency (r = 0.73; P < .001). Among the pediatric population, SW velocities correlated significantly with measures of cardiac geometry (septal thickness and left ventricular end-diastolic dimension), local hemodynamics (systolic blood pressure), and echocardiographic parameters of systolic and diastolic function (global longitudinal strain, mitral E/e' ratio, isovolumic relaxation time, and mitral deceleration time) (P < .001). In a multivariate analysis including all these factors, the predictors of SW velocities were age, mitral E/e', and global longitudinal strain (r = 0.81). CONCLUSIONS Natural myocardial SW velocities in children can be detected and measured. SW velocities showed significant dependence on age and diastolic function. Natural SWs could be a promising additive tool for the assessment of diastolic function among children.
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Affiliation(s)
- Ahmed S Youssef
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Medicine, Suez Canal University, Ismailia, Egypt
| | - Aniela Petrescu
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, University Medical Center of the Johannes Gutenber-Universitat Mainz, Mainz, Germany
| | - Thomas Salaets
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Laurine Wouters
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Annette Caenen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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Nakano M, Kuromatsu R, Kawaguchi T. Ultrasonographic Assessment of Tissue Stiffness: Recent Progress in Transient Elastography and Shear Wave Elastography in the Liver and Various Organs. Kurume Med J 2024; 70:1-10. [PMID: 38763738 DOI: 10.2739/kurumemedj.ms7012010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Ultrasonography is a noninvasive and widely accessible modality in clinical practice. Recently, ultrasonography has been used to evaluate tissue stiffness; the two representative techniques are transient elastography (FibroScan®) and shear wave elastography. These modalities are now generally used for the assessment of liver fibrosis, the prediction of hepatocarcinogenesis, and determining prognosis. In addition, shear wave elastography is available, not only for the liver but also for various other organs, including the breast and brain. In the breast and brain, shear wave elastography distinguishes malignant lesions from benign ones. Moreover, shear wave elastography can be useful for differentiating between ischemic and hemorrhagic strokes. This review summarizes the recent progress in transient elastography and shear wave elastography of the liver and introduces the advantages of ultrasonographic assessment of tissue stiffness in various organs, including the breast, brain, kidney, heart, thyroid, pancreas, muscle, and bone.
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Affiliation(s)
- Masahito Nakano
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
| | - Ryoko Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
- Ultrasound Diagnostic Center, Kurume University Hospital
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine
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Caenen A, Bézy S, Pernot M, Nightingale KR, Vos HJ, Voigt JU, Segers P, D'hooge J. Ultrasound Shear Wave Elastography in Cardiology. JACC Cardiovasc Imaging 2024; 17:314-329. [PMID: 38448131 DOI: 10.1016/j.jcmg.2023.12.007] [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: 12/23/2022] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024]
Abstract
The advent of high-frame rate imaging in ultrasound allowed the development of shear wave elastography as a noninvasive alternative for myocardial stiffness assessment. It measures mechanical waves propagating along the cardiac wall with speeds that are related to stiffness. The use of cardiac shear wave elastography in clinical studies is increasing, but a proper understanding of the different factors that affect wave propagation is required to correctly interpret results because of the heart's thin-walled geometry and intricate material properties. The aims of this review are to give an overview of the general concepts in cardiac shear wave elastography and to discuss in depth the effects of age, hemodynamic loading, cardiac morphology, fiber architecture, contractility, viscoelasticity, and system-dependent factors on the measurements, with a focus on clinical application. It also describes how these factors should be considered during acquisition, analysis, and reporting to ensure an accurate, robust, and reproducible measurement of the shear wave.
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Affiliation(s)
- Annette Caenen
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Mathieu Pernot
- Physics for Medicine, INSERM, CNRS, ESPCI, PSL University, Paris, France
| | | | - Hendrik J Vos
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Sengupta PP, Chandrashekhar Y. Advancing Myocardial Tissue Analysis Using Echocardiography. JACC Cardiovasc Imaging 2024; 17:228-231. [PMID: 38325962 DOI: 10.1016/j.jcmg.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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6
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Espeland T, Wigen MS, Dalen H, Berg EAR, Hammer TA, Salles S, Lovstakken L, Amundsen BH, Aakhus S. Mechanical Wave Velocities in Left Ventricular Walls in Healthy Subjects and Patients With Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:111-124. [PMID: 37676209 DOI: 10.1016/j.jcmg.2023.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Mechanical wave velocity (MWV) measurement is a promising method for evaluating myocardial stiffness, because these velocities are higher in patients with myocardial disease. OBJECTIVES Using high frame rate echocardiography and a novel method for detection of myocardial mechanical waves, this study aimed to estimate the MWVs for different left ventricular walls and events in healthy subjects and patients with aortic stenosis (AS). Feasibility and reproducibility were evaluated. METHODS This study included 63 healthy subjects and 13 patients with severe AS. All participants underwent echocardiographic examination including 2-dimensional high frame rate recordings using a clinical scanner. Cardiac magnetic resonance was performed in 42 subjects. The authors estimated the MWVs at atrial kick and aortic valve closure in different left ventricular walls using the clutter filter wave imaging method. RESULTS Mechanical wave imaging in healthy subjects demonstrated the highest feasibility for the atrial kick wave reaching >93% for all 4 examined left ventricular walls. The MWVs were higher for the inferolateral and anterolateral walls (2.2 and 2.6 m/s) compared with inferoseptal and anteroseptal walls (1.3 and 1.6 m/s) (P < 0.05) among healthy subjects. The septal MWVs at aortic valve closure were significantly higher for patients with severe AS than for healthy subjects. CONCLUSIONS MWV estimation during atrial kick is feasible and demonstrates higher velocities in the lateral walls, compared with septal walls. The authors propose indicators for quality assessment of the mechanical wave slope as an aid for achieving consistent measurements. The discrimination between healthy subjects and patients with AS was best for the aortic valve closure mechanical waves. (Ultrasonic Markers for Myocardial Fibrosis and Prognosis in Aortic Stenosis; NCT03422770).
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Affiliation(s)
- Torvald Espeland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten S Wigen
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Erik A R Berg
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tommy A Hammer
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Radiology, Clinic of Radiology and Nuclear Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sebastien Salles
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Lovstakken
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Brage H Amundsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Petrescu A, Voigt JU. [Echocardiography with high frame rates in the clinical practice : Principles, applications and perspectives]. Herz 2023; 48:339-351. [PMID: 37530782 DOI: 10.1007/s00059-023-05199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Continuous developments in cardiovascular imaging, software and hardware have led to technological advancements that open new ways for assessing myocardial mechanics, hemodynamics, and function. Through new scan modalities, echocardiographic scanners can nowadays achieve very high frame rates up to 5000 frames s-1 which enables a wide variety of new applications, including shear wave elastography, ultrafast speckle tracking, the visualization of intracardiac blood flow and myocardial perfusion imaging. This review provides an overview of these advances and demonstrates possible applications and their potential added value in the clinical practice.
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Affiliation(s)
- Aniela Petrescu
- Abteilung für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgien.
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Lewandowski D, Yang EY, Nguyen DT, Khan MA, Malahfji M, El Tallawi C, Chamsi Pasha MA, Graviss EA, Shah DJ, Nagueh SF. Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification. JACC Cardiovasc Imaging 2023:S1936-878X(23)00032-3. [PMID: 37038874 DOI: 10.1016/j.jcmg.2022.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
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Affiliation(s)
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mohammad A Khan
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Maan Malahfji
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Sengupta PP, Chandrashekhar Y. Understanding Myocardial Biomechanics Through the Lens of Cardiac Imaging: A Shear Privilege. JACC Cardiovasc Imaging 2022; 15:2158-2160. [PMID: 36481089 DOI: 10.1016/j.jcmg.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Seliverstova E, Caenen A, Bézy S, Nooijens S, Voigt JU, D'hooge J. Comparing Myocardial Shear Wave Propagation Velocity Estimation Methods Based on Tissue Displacement, Velocity and Acceleration Data. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2207-2216. [PMID: 35963827 DOI: 10.1016/j.ultrasmedbio.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Shear wave elastography (SWE) is a promising technique used to assess cardiac function through the evaluation of cardiac stiffness non-invasively. However, in the literature, SWE varies in terms of tissue motion data (displacement, velocity or acceleration); method used to characterize mechanical wave propagation (time domain [TD] vs. frequency domain [FD]); and the metric reported (wave speed [WS], shear or Young's modulus). This variety of reported methodologies complicates comparison of reported findings and sheds doubt on which methodology better approximates the true myocardial properties. We therefore conducted a simulation study to investigate the accuracy of various SWE data analysis approaches while varying cardiac geometry and stiffness. Lower WS values were obtained by the TD method compared with the FD method. Acceleration-based WS estimates in the TD were systematically larger than those based on velocity (∼10% difference). These observations were confirmed by TD analysis of 32 in vivo SWE mechanical wave measurements. In vivo data quality is typically too low for accurate FD analysis. Therefore, our study suggests using acceleration-based TD analysis for in vivo SWE to minimize underestimation of the true WS and, thus, to maximize the sensitivity of SWE to detect stiffness changes resulting from pathology.
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Affiliation(s)
| | - Annette Caenen
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium; Ghent University, Ghent, Belgium
| | - Stephanie Bézy
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Sjoerd Nooijens
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Jens-Uwe Voigt
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Jan D'hooge
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
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Quantitative stiffness assessment of cardiac grafts using ultrasound in a porcine model: A tissue biomarker for heart transplantation. EBioMedicine 2022; 83:104201. [PMID: 35932640 PMCID: PMC9358428 DOI: 10.1016/j.ebiom.2022.104201] [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: 04/19/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Heart transplantation is the definitive treatment for many cardiovascular diseases. However, no ideal approach is established to evaluate heart grafts and it mostly relies on qualitative interpretation of surgeon based on the organ aspect including anatomy, color and manual palpation. In this study we propose to assess quantitatively the Shear Wave Velocity (SWV) using ultrasound as a biomarker of cardiac viability on a porcine model. Methods The SWV was assessed quantitatively using a clinical ultrasound elastography device (Aixplorer, Supersonics Imagine, France) linked to a robotic motorized arm (UR3, Universal Robots, Denmark) and the elastic anisotropy was obtained using a custom ultrasound research system. SWV was evaluated as function of time in two porcine heart model during 20h at controlled temperature (4°C). One control group (N = 8) with the heart removed and arrested by cold cardioplegia and immerged in a preservation solution. One ischemic group (N = 6) with the organ harvested after 30 min of in situ warm ischemia, to mimic a donation after cardiac death. Hearts graft were revived at two preservation times, at 4 h (N = 11) and 20 h (N = 10) and the parameters of the cardiac function evaluated. Findings On control hearts, SWV remained unchanged during the 4h of preservation. SWV increased significantly between 4 and 20h. For the ischemic group, SWV was found higher after 4h (3.04 +/- 0.69 vs 1.69+/-0.19 m/s, p = 0.007) and 20h (4.77+/-1.22 m/s vs 3.40+/-0.75 m/s, p = 0.034) of preservation with significant differences. A good correlation between SWV and cardiac function index was found (r2=0.88) and manual palpation score (r2=0.81). Interpretation Myocardial stiffness increase was quantified as a function of preservation time and harvesting conditions. The correlation between SWV and cardiac function index suggests that SWV could be used as a marker of graft viability. This technique may be transposed to clinical transplantation for assessing the graft viability during transplantation process. Funding FRM PME20170637799, Agence Biomédecine AOR Greffe 2017, ANR-18-CE18-0015.
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Harbo MB, Stokke MK, Sjaastad I, Espe EKS. One step closer to myocardial physiology: From PV loop analysis to state-of-the-art myocardial imaging. Acta Physiol (Oxf) 2022; 234:e13759. [PMID: 34978759 DOI: 10.1111/apha.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
Recent advances in cardiac imaging have revitalized the assessment of fundamental physiological concepts. In the field of cardiac physiology, invasive measurements with pressure-volume (PV) loops have served as the gold standard methodology for the characterization of left ventricular (LV) function. From PV loop data, fundamental aspects of LV chamber function are derived such as work, efficiency, stiffness and contractility. However, the parametrization of these aspects is limited because of the need for invasive procedures. Through the utilization of recent advances in echocardiography, magnetic resonance imaging and positron emission tomography, it has become increasingly feasible to quantify these fundamental aspects of LV function non-invasively. Importantly, state-of-the-art imaging technology enables direct assessment of myocardial performance, thereby extending functional assessment from the net function of the LV chamber, as is done with PV loops, to the myocardium itself. With a strong coupling to underlying myocardial physiology, imaging measurements of myocardial work, efficiency, stiffness and contractility could represent the next generation of functional parameters. The purpose of this review is to discuss how the new imaging parameters of myocardial work, efficiency, stiffness and contractility can bring cardiac physiologists, researchers and clinicians alike one step closer to underlying myocardial physiology.
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Affiliation(s)
- Markus Borge Harbo
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
- Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Emil Knut Stenersen Espe
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
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13
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Villalobos Lizardi JC, Baranger J, Nguyen MB, Asnacios A, Malik A, Lumens J, Mertens L, Friedberg MK, Simmons CA, Pernot M, Villemain O. A guide for assessment of myocardial stiffness in health and disease. NATURE CARDIOVASCULAR RESEARCH 2022; 1:8-22. [PMID: 39196108 DOI: 10.1038/s44161-021-00007-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/10/2021] [Indexed: 08/29/2024]
Abstract
Myocardial stiffness is an intrinsic property of the myocardium that influences both diastolic and systolic cardiac function. Myocardial stiffness represents the resistance of this tissue to being deformed and depends on intracellular components of the cardiomyocyte, particularly the cytoskeleton, and on extracellular components, such as collagen fibers. Myocardial disease is associated with changes in myocardial stiffness, and its assessment is a key diagnostic marker of acute or chronic pathological myocardial disease with the potential to guide therapeutic decision-making. In this Review, we appraise the different techniques that can be used to estimate myocardial stiffness, evaluate their advantages and disadvantages, and discuss potential clinical applications.
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Affiliation(s)
- José Carlos Villalobos Lizardi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jerome Baranger
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Minh B Nguyen
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Atef Asnacios
- Laboratoire Matière et Systèmes Complexes, CNRS UMR 7057, Université de Paris, Paris, France
| | - Aimen Malik
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Craig A Simmons
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS UMR 8063, PSL Research University, Paris, France
| | - Olivier Villemain
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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14
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Caenen A, Pernot M, Nightingale KR, Voigt JU, Vos HJ, Segers P, D'hooge J. Assessing cardiac stiffness using ultrasound shear wave elastography. Phys Med Biol 2021; 67. [PMID: 34874312 DOI: 10.1088/1361-6560/ac404d] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Shear wave elastography offers a new dimension to echocardiography: it measures myocardial stiffness. Therefore, it could provide additional insights into the pathophysiology of cardiac diseases affecting myocardial stiffness and potentially improve diagnosis or guide patient treatment. The technique detects fast mechanical waves on the heart wall with high frame rate echography, and converts their propagation velocity into a stiffness value. A proper interpretation of shear wave data is required as the shear wave interacts with the intrinsic, yet dynamically changing geometrical and material characteristics of the heart under pressure. This dramatically alters the wave physics of the propagating wave, demanding adapted processing methods compared to other shear wave elastography applications as breast tumor and liver stiffness staging. Furthermore, several advanced analysis methods have been proposed to extract supplementary material features such as viscosity and anisotropy, potentially offering additional diagnostic value. This review explains the general mechanical concepts underlying cardiac shear wave elastography and provides an overview of the preclinical and clinical studies within the field. We also identify the mechanical and technical challenges ahead to make shear wave elastography a valuable tool for clinical practice.
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Affiliation(s)
- Annette Caenen
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, BELGIUM
| | - Mathieu Pernot
- INSERM U979 "Physics for medicine", ESPCI Paris, PSL Research University, CNRS UMR 7587, Institut Langevin, Paris, FRANCE
| | - Kathryn R Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, UNITED STATES
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, BELGIUM
| | - Hendrik J Vos
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Zuid-Holland, NETHERLANDS
| | - Patrick Segers
- Institute of Biomedical Engineering and Technology, Universiteit Gent, Gent, BELGIUM
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, BELGIUM
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15
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Takaya Y, Nakamura K, Nakayama R, Ohtsuka H, Amioka N, Kondo M, Akazawa K, Ohno Y, Ichikawa K, Saito Y, Akagi S, Yoshida M, Miyoshi T, Ito H. Efficacy of shear wave elasticity for evaluating myocardial hypertrophy in hypertensive rats. Sci Rep 2021; 11:22812. [PMID: 34819579 PMCID: PMC8613270 DOI: 10.1038/s41598-021-02271-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
Shear wave (SW) imaging is a novel ultrasound-based technique for assessing tissue characteristics. SW elasticity may be useful to assess the severity of hypertensive left ventricular (LV) hypertrophy. This study aimed to evaluate the efficacy of SW elasticity for assessing the degree of myocardial hypertrophy using hypertensive rats. Rats were divided into hypertension group and control group. SW elasticity was measured on the excised heart. Myocardial hypertrophy was assessed histologically. LV weight was greater in hypertension group. An increase in interventricular septum and LV free wall thicknesses was observed in hypertension group. SW elasticity was significantly higher in hypertension group than in control group (14.6 ± 4.3 kPa vs. 6.5 ± 1.1 kPa, P < 0.01). The cross-sectional area of cardiomyocytes was larger in hypertension group than in control group (397 ± 50 μm2 vs. 243 ± 14 μm2, P < 0.01), and SW elasticity was positively correlated with the cross-sectional area of cardiomyocytes (R = 0.96, P < 0.01). This study showed that SW elasticity was higher in hypertensive rats and was closely correlated with the degree of myocardial hypertrophy, suggesting the efficacy of SW elasticity for estimating the severity of hypertensive LV hypertrophy.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroaki Ohtsuka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naofumi Amioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Kondo
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kaoru Akazawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuko Ohno
- Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yukihiro Saito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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16
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Argulian E, Narula J. Advanced Cardiovascular Imaging in Clinical Heart Failure. JACC-HEART FAILURE 2021; 9:699-709. [PMID: 34391742 DOI: 10.1016/j.jchf.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
Cardiovascular imaging is the cornerstone of the assessment of patients with heart failure. Although noninvasive volumetric estimation of the cardiac function is an essential and indisputably useful clinical tool, cardiac imaging has evolved and matured to offer detailed functional, hemodynamic, and tissue characterization. The adoption of a new framework to diagnose and phenotype heart failure that incorporates comprehensive imaging assessment has been lacking in clinical trials. The present review offers a general overview of available imaging strategies for patients with heart failure.
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Affiliation(s)
- Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Donal E, Taconne M, Hubert A, Le Rolle V. The future of the diastolic function assessment will take advantage of the past and of the automatization. Eur Heart J Cardiovasc Imaging 2021; 22:599-600. [PMID: 33495779 DOI: 10.1093/ehjci/jeab014] [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: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35033 Rennes, France
| | - Marion Taconne
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35033 Rennes, France
| | - Arnaud Hubert
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35033 Rennes, France
| | - Virginie Le Rolle
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35033 Rennes, France
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18
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Echocardiographic Stiffness Measurements: How to Rule the Waves? JACC Cardiovasc Imaging 2021; 14:1506-1507. [PMID: 34353545 DOI: 10.1016/j.jcmg.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
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19
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Petrescu A, D'hooge J, Voigt JU. Concepts and applications of ultrafast cardiac ultrasound imaging. Echocardiography 2021; 38:7-15. [PMID: 33471395 DOI: 10.1111/echo.14971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
The concept of ultrafast echocardiographic imaging has been around for decades. However, only recent progress in ultrasound machine hardware and computer technology allowed to apply this concept to echocardiography. High frame rate echocardiography can visualize phenomena that have never been captured before. It enables a wide variety of potential new applications, including shear wave imaging, speckle tracking, ultrafast Doppler imaging, and myocardial perfusion imaging. The principles of these applications and their potential clinical use will be presented in this manuscript.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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20
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Pernot M, Villemain O. Myocardial Stiffness Assessment by Ultrasound: Are We Ready for the Clinical "Lift Off"? JACC Cardiovasc Imaging 2020; 13:2314-2315. [PMID: 33008759 DOI: 10.1016/j.jcmg.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mathieu Pernot
- Physics for Medicine, INSERM U1273, ESPCI, CNRS, PSL Research University, Paris, France.
| | - Olivier Villemain
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Department, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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