1
|
Eldemire R, Mestroni L, Taylor MRG. Genetics of Dilated Cardiomyopathy. Annu Rev Med 2024; 75:417-426. [PMID: 37788487 PMCID: PMC10842880 DOI: 10.1146/annurev-med-052422-020535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Dilated cardiomyopathy (DCM) is defined as dilation and/or reduced function of one or both ventricles and remains a common disease worldwide. An estimated 40% of cases of familial DCM have an identifiable genetic cause. Accordingly, there is a fast-growing interest in the field of molecular genetics as it pertains to DCM. Many gene mutations have been identified that contribute to phenotypically significant cardiomyopathy. DCM genes can affect a variety of cardiomyocyte functions, and particular genes whose function affects the cell-cell junction and cytoskeleton are associated with increased risk of arrhythmias and sudden cardiac death. Through advancements in next-generation sequencing and cardiac imaging, identification of genetic DCM has improved over the past couple decades, and precision medicine is now at the forefront of treatment for these patients and their families. In addition to standard treatment of heart failure and prevention of arrhythmias and sudden cardiac death, patients with genetic cardiomyopathy stand to benefit from gene mechanism-specific therapies.
Collapse
Affiliation(s)
- Ramone Eldemire
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
- Cardiovascular Institute, University of Colorado, Aurora, Colorado, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, University of Colorado, Aurora, Colorado, USA
- Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
2
|
Atici A, Asoglu R, Demirkiran A, Demir AA, Barman HA, Cevik E, Dursun M, Bugra MZ. Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients after Anterior Myocardial Infarction. Am J Med Sci 2021; 363:130-139. [PMID: 34848187 DOI: 10.1016/j.amjms.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction (MI). Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. We aimed to compare the two-dimensional echocardiography (2DE), contrast-2DE and real-time three-dimensional echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior. METHODS The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (<40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and magnetic resonance imaging (MRI) were performed on all patients within one month after anterior MI. RESULTS Transthoracic 2DE detected thrombi in 29 patients, contrast-2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast-2DE and RT-3DE, respectively. CONCLUSIONS We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT.
Collapse
Affiliation(s)
- Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Ramazan Asoglu
- Adiyaman Health Education and Research Hospital, Department of Cardiology, Adiyaman, Turkey
| | - Ahmet Demirkiran
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Aslan Demir
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Hasan Ali Barman
- Istanbul University - Cerrahpasa, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Erdem Cevik
- Cardiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Memduh Dursun
- Radiology Department, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | |
Collapse
|
3
|
Vieira MLC, Branco CEDB, Gazola ASL, Vieira PPAC, Benvenuti LA, Demarchi LMMF, Gutierrez PS, Aiello VD, Tarasoutchi F, Sampaio RO. 3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time. Front Cardiovasc Med 2021; 8:676938. [PMID: 34355026 PMCID: PMC8329529 DOI: 10.3389/fcvm.2021.676938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
Collapse
Affiliation(s)
- Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Kwon A, Ahn HS, Kim GH, Cho JS, Park CS, Youn HJ. Right Ventricular Analysis Using Real-time Three-dimensional Echocardiography for Preload Dependency. J Cardiovasc Imaging 2020; 28:36-47. [PMID: 31805622 PMCID: PMC6992920 DOI: 10.4250/jcvi.2019.0079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The importance of the right ventricle (RV) has been increasingly recognized, and accurate RV measurement has become necessary. However, assessment of the RV with two-dimensional (2D) echocardiography has several limitations. As the development of novel methods for RV measurement continues, we can expect more accordant values related to RV geometry. METHODS Fifty-eight subjects who were examined by transthoracic echocardiography (TTE) immediately before and after hemodialysis (HD) were enrolled. Real-time, full-volume, three-dimensional (3D) echocardiographic images were acquired and analyzed using dedicated software. Conventional RV parameters for RV size and function were measured for comparison with pre-HD and post-HD values by both 2D-TTE and 3D-TTE. RESULTS 3D RV volumes and ejection fractions were significantly decreased after HD. The values of the 3D image-derived RV dimensions, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and longitudinal strain were also affected by acute preload changes (TAPSE pre-HD: 22.4 ± 4.0 mm, post-HD: 19.0 ± 4.2 mm, p < 0.001; FAC pre-HD: 49.6% ± 5.9%, post-HD: 46.4% ± 5.5%, p < 0.001; septal longitudinal strain pre-HD: -20.1% ± 3.7%, post-HD: -16.8% ± 3.8%, p < 0.001). With the exception of FAC, most 2D RV parameters were well correlated with the 3D values. CONCLUSIONS Various parameters representing RV anatomy and function were acquired easily and more accurately from 3D echocardiographic images than from 2D images but were affected by acute preload changes. 3D TTE could be a new modality for assessing RV function and size, but each value from 3D TTE should be interpreted with caution while considering the loading condition of the patients.
Collapse
Affiliation(s)
- Ami Kwon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Suk Ahn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gee Hee Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Sun Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Seok Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Ho Joong Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
6
|
Ahn HS, Kim YK, Song HC, Choi EJ, Kim GH, Cho JS, Ihm SH, Kim HY, Park CS, Youn HJ. The impact of preload on 3-dimensional deformation parameters: principal strain, twist and torsion. Cardiovasc Ultrasound 2017; 15:22. [PMID: 28899401 PMCID: PMC5596939 DOI: 10.1186/s12947-017-0111-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022] Open
Abstract
Background Strain analysis is feasible using three-dimensional (3D) echocardiography. This approach provides various parameters based on speckle tracking analysis from one full-volume image of the left ventricle; however, evidence for its volume independence is still lacking. Methods Fifty-eight subjects who were examined by transthoracic echocardiography immediately before and after hemodialysis (HD) were enrolled. Real-time full-volume 3D echocardiographic images were acquired and analyzed using dedicated software. Two-dimensional (2D) longitudinal strain (LS) was also measured for comparison with 3D strain values. Results Longitudinal (pre-HD: −24.57 ± 2.51, post-HD: −21.42 ± 2.15, P < 0.001); circumferential (pre-HD: −33.35 ± 3.50, post-HD: −30.90 ± 3.22, P < 0.001); and radial strain (pre-HD: 46.47 ± 4.27, post-HD: 42.90 ± 3.61, P < 0.001) values were significantly decreased after HD. The values of 3D principal strain (PS), a unique parameter of 3D images, were affected by acute preload changes (pre-HD: −38.10 ± 3.71, post-HD: −35.33 ± 3.22, P < 0.001). Twist and torsion values were decreased after HD (pre-HD: 17.69 ± 7.80, post-HD: 13.34 ± 6.92, P < 0.001; and pre-HD: 2.04 ± 0.86, post-HD:1.59 ± 0.80, respectively, P < 0.001). The 2D LS values correlated with the 3D LS and PS values. Conclusion Various parameters representing left ventricular mechanics were easily acquired from 3D echocardiographic images; however, like conventional parameters, they were affected by acute preload changes. Therefore, strain values from 3D echocardiography should be interpreted with caution while considering the preload conditions of the patients.
Collapse
Affiliation(s)
- Hyo-Suk Ahn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong-Kyun Kim
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Ho Chul Song
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Euy Jin Choi
- Nephrology, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Gee-Hee Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jung Sun Cho
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Hyun Ihm
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hee-Yeol Kim
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Seok Park
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Ho-Joong Youn
- Divisions of Cardiology, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| |
Collapse
|
7
|
|
8
|
Badano LP. The clinical benefits of adding a third dimension to assess the left ventricle with echocardiography. SCIENTIFICA 2014; 2014:897431. [PMID: 24959374 PMCID: PMC4052480 DOI: 10.1155/2014/897431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/23/2014] [Indexed: 05/09/2023]
Abstract
Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management.
Collapse
Affiliation(s)
- Luigi P. Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padua, Via Giustiniani 2, 35123 Padua, Italy
- *Luigi P. Badano:
| |
Collapse
|
9
|
Tsuburaya RS, Uchizumi H, Ueda M, Demura Y, Mukaida S, Sudou S, Irahara K, Sakai N, Shiraishi K. Utility of real-time three-dimensional echocardiography for Duchenne muscular dystrophy with echocardiographic limitations. Neuromuscul Disord 2013; 24:402-8. [PMID: 24444550 DOI: 10.1016/j.nmd.2013.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is strongly associated with a unique form of dilated cardiomyopathy. Cardiac complications are the leading cause of death in DMD; thus, longitudinal assessments and early intervention for cardiac dysfunction are necessary to improve prognosis. Two-dimensional echocardiography, which is routinely used for cardiac assessment, has some limitations for quantitative analyses in DMD patients with thoracic deformities and regional wall motion abnormalities in the left ventricle. Recently, real-time three-dimensional echocardiography has emerged as a feasible tool for cardiac assessment in various cardiac diseases. The aim of this study was to examine the utility of this technology in DMD. We evaluated left ventricular ejection fraction (LVEF), a major parameter of left ventricular function, in 17 male DMD patients. LVEF values measured by real-time three-dimensional echocardiography were compared with those determined by two established nuclear cardiology methods: "the first-pass method of radionuclide angiocardiography" and "quantitative electrocardiogram-gated single-photon emission computed tomography". A good correlation was observed for LVEF values, particularly between real-time three-dimensional echocardiography and "the first-pass method of radionuclide angiocardiography" (r=0.90, p<0.05). Thus, real-time three-dimensional echocardiography can provide an accurate measurement of LVEF in DMD patients with echocardiographic limitations.
Collapse
Affiliation(s)
- Rie S Tsuburaya
- Department of Pediatric Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan.
| | - Hiroshi Uchizumi
- Department of Cardiology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Michio Ueda
- Department of Radiology and Clinical Physiology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Yutaka Demura
- Department of Radiology and Clinical Physiology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Souichi Mukaida
- Department of Pediatric Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Shinji Sudou
- Department of Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Kaori Irahara
- Department of Pediatric Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Naoko Sakai
- Department of Pediatric Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
| | - Kazuhiro Shiraishi
- Department of Pediatric Neurology, National Hospital Organization Utano Hospital, Kyoto, Japan
| |
Collapse
|
10
|
Evaluation of left ventricular structure and function by three-dimensional echocardiography. Curr Opin Crit Care 2013; 19:387-96. [DOI: 10.1097/mcc.0b013e328364d75e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
11
|
Quantitation of cardiac chamber geometry and function using transthoracic three-dimensional echocardiography. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:1-46. [PMID: 22275509 DOI: 10.1093/ehjci/jer316] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Greupner J, Zimmermann E, Grohmann A, Dübel HP, Althoff TF, Althoff T, Borges AC, Rutsch W, Schlattmann P, Hamm B, Dewey M. Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol 2012; 59:1897-907. [PMID: 22595410 DOI: 10.1016/j.jacc.2012.01.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 12/27/2011] [Accepted: 01/17/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). BACKGROUND Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients. METHODS A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed. RESULTS For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58). CONCLUSIONS 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
Collapse
|
14
|
Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:3-46. [PMID: 22183020 DOI: 10.1016/j.echo.2011.11.010] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
15
|
Badano LP, Boccalini F, Muraru D, Bianco LD, Peluso D, Bellu R, Zoppellaro G, Iliceto S. Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound 2012; 20:1-22. [PMID: 22509433 PMCID: PMC3324722 DOI: 10.4250/jcu.2012.20.1.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 02/04/2023] Open
Abstract
The advent of three-dimensional echocardiography (3DE) has significantly improved the impact of non-invasive imaging on our understanding and management of cardiac diseases in clinical practice. Transthoracic 3DE enables an easier, more accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of the third dimension is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner. The purpose of this review is to provide readers with an update on the current clinical applications of transthoracic 3DE, emphasizing the incremental benefits of 3DE over conventional two-dimensional echocardiography.
Collapse
Affiliation(s)
- Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | | | | | | | | | | |
Collapse
|
16
|
[Evaluation of the left ventricle with three-dimensional echocardiography: comparison with cardiac magnetic resonance]. RADIOLOGIA 2010; 52:534-40. [PMID: 20846703 DOI: 10.1016/j.rx.2010.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 05/28/2010] [Accepted: 06/04/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Three-dimensional echocardiography (3DE) is becoming increasingly common in clinical environments. However, the quality of the images depends on the acoustic window, and it can be difficult to identify the endocardial borders. The objective of this study was to evaluate the performance of 3DE in determining the volumes and left ventricular ejection fraction in unselected patients against the gold standard, cardiac magnetic resonance (CMR). MATERIAL AND METHODS In 47 unselected patients who underwent CMR, we performed 3DE using a real-time acquisition technique and semiautomatic border detection. RESULTS We excluded 4 patients (8.5%) because they had an extremely deficient acoustic window. In the remaining 43 patients, including those with a suboptimal acoustic window, we obtained the following correlations between 3DE and CMR: end-diastolic volume, 0.71; end-systolic volume, 0.77; ejection fraction, 0.74. Although the end-diastolic volume was systematically underestimated, no significant differences were observed in the ejection fraction. When the 11 patients with suboptimal acoustic windows were excluded, we observed a systematic underestimation of the end-diastolic and end-systolic volumes, which paradoxically gave rise to improved correlation coefficients (0.79, 0.92, and 0.84, respectively) and a more accurate ejection fraction. CONCLUSIONS Compared to CMR, 3DE systematically underestimates the ventricular volumes but enables adequate determination of the left ventricular ejection fraction regardless of the quality of the acoustic window.
Collapse
|
17
|
Claver E, Leta R, Pujadas S, Hidalgo A, Carreras F, Pons-Lladó G. Evaluation of the left ventricle with three-dimensional echocardiography: Comparison with cardiac magnetic resonance. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
18
|
Maruyama Y, Toyama K, Sato S, Masaki N, Kirimura M, Yoshimoto N. Accuracy of three-dimensional echocardiography in patients with prior anteroseptal myocardial infarction. J Echocardiogr 2009; 7:9-15. [PMID: 27278074 DOI: 10.1007/s12574-008-0002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/19/2008] [Accepted: 12/11/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Echocardiography is the most feasible modality for monitoring cardiac volume and function. However, conventional two-dimensional echocardiography (2DE) is frequently not accurate in measuring cardiac performance in cases of abnormal left ventricular wall motion, because of the geometric assumptions. Quantitative gated scintigraphy and magnetic resonance imaging are reliable modalities, but are expensive and not feasible for repetitive use. Real-time three-dimensional echocardiography (RT3DE) has been proved to be applicable in daily practice. The purpose of this study was to confirm the superiority of RT3DE to 2DE in assessing cardiac volume and function in patients with abnormal wall motion. METHODS The subjects were 41 patients with old anteroseptal myocardial infarction who underwent left ventricular volume and functional measurement by RT3DE, 2DE, and left ventriculography (LVG). End-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) from RT3DE and 2DE were measured and compared with results from LVG. RESULTS RT3DE correlated well with LVG in measurements of EDV, ESV, and EF (r = 0.815, 0.940, and 0.812, respectively; P < 0.001 each). Likewise, 2DE correlated with LVG, but underestimated left ventricular volume, particularly EDV (r = 0.652, 0.909, and 0.761, respectively; P < 0.001 each). CONCLUSION Values derived from RT3DE were closer to those from LVG than were values derived from 2DE. RT3DE provides important information on cardiac function in patients with prior anteroseptal myocardial infarction.
Collapse
Affiliation(s)
- Yoshiaki Maruyama
- Department of Health Promotion, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan.
| | - Kentaro Toyama
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan
| | - Shunichi Sato
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan
| | - Nobuyuki Masaki
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan
| | - Masato Kirimura
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan
| | - Nobuo Yoshimoto
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda-Tsujidomachi, Kawagoe, 350-8550, Japan
| |
Collapse
|
19
|
Real-time three-dimensional echocardiographic assessment of left ventricular remodeling index in patients with hypertensive heart disease and coronary artery disease. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2009; 29:122-6. [PMID: 19224178 DOI: 10.1007/s11596-009-0126-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Indexed: 01/19/2023]
Abstract
Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controls (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocardiography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.
Collapse
|
20
|
Three-Dimensional Echocardiography. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
21
|
Nucifora G, Badano LP, Dall'Armellina E, Gianfagna P, Allocca G, Fioretti PM. Fast Data Acquisition and Analysis with Real Time Triplane Echocardiography for the Assessment of Left Ventricular Size and Function: A Validation Study. Echocardiography 2009; 26:66-75. [DOI: 10.1111/j.1540-8175.2008.00762.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
22
|
Shiota T. 3D echocardiography: The present and the future. J Cardiol 2008; 52:169-85. [DOI: 10.1016/j.jjcc.2008.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 12/14/2022]
|
23
|
Kirkpatrick JN, Lang RM. Insights into myocardial mechanics in normal and pathologic states using newer echocardiographic techniques. Curr Heart Fail Rep 2008; 5:143-50. [DOI: 10.1007/s11897-008-0023-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
van der Heide J, Mannaerts H, Yang L, Sieswerda G, Visser† C, Kamp O. Contrast-enhanced versus non-enhanced three-dimensional echocardiography of left ventricular volumes. Neth Heart J 2008; 16:47-52. [PMID: 18335021 PMCID: PMC2245811 DOI: 10.1007/bf03086117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In three-dimensional echocardiography (3DE), individual endocardial trabeculae are not clearly visible necessitating left ventricular (LV) volumes to be measured by tracing the innermost endocardial contour. Ultrasound contrast agents aim to improve endocardial definition, but may delineate the outermost endocardial contour by filling up intertrabecular space. Although measurement reproducibility may benefit, there may be a significant influence on absolute LV volume measurements. METHODS Twenty patients with a recent myocardial infarction and good ultrasound image quality underwent 3DE using the TomTec Freehand method before and during continuous intravenous contrast infusion. LV volumes were measured offline using TomTec Echo-Scan software. RESULTS The use of contrast enhancement increased end-diastolic (110+/-35 vs. 144+/-53 ml; p<0.01) and end-systolic volume measurements (68+/-31 vs. 87+/-45 ml; p<0.01) significantly compared with non-contrast; the ejection fraction remained unchanged (40+/-13 vs. 41+/-14%, p=NS). Measurement reproducibility did not improve significantly, however. CONCLUSION Volumes measured by 3DE are significantly larger when ultrasound contrast is used. Possibly, intertrabecular space comprises a substantial part of the LV cavity. In the presence of an adequate apical acoustic window, ultrasound contrast does not improve LV volume measurement reproducibility. (Neth Heart J 2008;16:47-52.).
Collapse
Affiliation(s)
- J.A. van der Heide
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - H.F.J. Mannaerts
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - L. Yang
- Department of Cardiology, the Second Affiliated Hospital, Sun Yat-Sen University, Ghangzou, People’s Republic of China
| | - G.T. Sieswerda
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C.A. Visser†
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - O. Kamp
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
25
|
Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation. Eur Heart J 2007; 29:1296-306. [PMID: 17989075 DOI: 10.1093/eurheartj/ehm467] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of the study was to validate a novel formula for aortic area, based on the principle of continuity equation (CE), that substitutes Doppler-derived stroke volume (SV) by SV directly measured with real-time three-dimensional (RT3D) echo and semi-automated border detection. RT3D has proved outstanding accuracy for left ventricular volume calculation. So far, however, neither this potential has been applied to haemodynamic assessment, nor RT3D has succeeded in the evaluation of aortic valve disease. METHODS AND RESULTS Aortic area was measured in 41 patients with aortic stenosis using Gorlin's equation, Hakki's formula, Doppler CE, two-dimensional Simpson's volumetric method, and by the novel RT3D method. RT3D has the best linear association and absolute agreement with Gorlin of all non-invasive methods r = 0.902, intraclass correlation coefficient (ICC) = 0.846, better than CE (r = 0.646, ICC = 0.626) and two-dimensional volumetric method (r = 0.627, ICC = 0.378). Linear and Passing-Bablok regression show that RT3D fits better to Gorlin (r(2) = 0.814) than CE (r(2) = 0.417) and two-dimensional method (r(2) = 0.393). Its accuracy is comparable to Hakki's formula, routinely employed in catheter laboratories. Inter- and intraobserver agreements (ICC) were, respectively, 0.732 and 0.985, better than CE (0.662, 0.857). RT3D also grades most efficiently the severity of aortic stenosis as mild, moderate, or severe (weighted kappa = 0.932). RT3D underestimates aortic area (95% CI 0.084-0.193). ROC curves, however, show that the optimal cutoff point to consider aortic stenosis severity remains close to 1 cm(2) (1.06 cm(2)). CONCLUSIONS RT3D is more accurate than CE and than two-dimensional volumetric methods to calculate area and to grade the severity of aortic stenosis. Area obtained by three-dimensional echo is slightly underestimated, but its range is clinically negligible.
Collapse
|
26
|
Sai-Sudhakar CB, Vandse R, Armen TA, Bickle KM, Nathan NS. Efficacy of chordal cutting in alleviating ischemic mitral regurgitation: insights from 3-dimensional echocardiography. J Cardiothorac Surg 2007; 2:39. [PMID: 17894872 PMCID: PMC2042986 DOI: 10.1186/1749-8090-2-39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 09/25/2007] [Indexed: 11/15/2022] Open
Abstract
Background Ischemic mitral regurgitation often complicates severe ischemic heart disease and adversely affects the prognosis in these patients. There is wide variation in the clinical spectrum of ischemic mitral regurgitation due to varying location and chronicity of ischemia and anomalies in annular and ventricular remodeling. As a result, there is lack of consensus in treating these patients. Treatment has to be individualized for each patient. Most of the available surgical options do not consistently correct this condition in all the patients. Chordal cutting is one of the newer surgical approaches in which cutting a limited number of critically positioned basal chordae have found success by relieving the leaflet tethering and thereby improving the coaptation of leaflets. Three-dimensional echocardiography is a potentially valuable tool in identifying the specific pattern of tethering and thus the suitability of this procedure in a given clinical scenario. Case Presentation A 66-year-old man with cardiomyopathy and ischemic mitral regurgitation presented to us with the features of congestive heart failure. The three-dimensional echocardiography revealed severe mitral regurgitation associated with the tethering of the lateral (P1) and medial (P3) scallops of the posterior leaflet of the mitral valve due to secondary chordal attachments. The ejection fraction was only 15% with severe global systolic and diastolic dysfunction. Mitral regurgitation was successfully corrected with mitral annuloplasty and resection of the secondary chordae tethering the medial and lateral scallops of the posterior leaflet of the mitral valve. Conclusion Cutting the second order chordae along with mitral annuloplasty could be a novel method to remedy Ischemic mitral regurgitation by relieving the tethering of the valve leaflets. The preoperative three-dimensional echocardiography should be considered in all patients with Ischemic mitral regurgitation to assess the complex three-dimensional interactions between the mitral valve apparatus and the left ventricle. This aids in timely surgical planning.
Collapse
Affiliation(s)
- Chittoor B Sai-Sudhakar
- Department of Cardiothoracic Surgery, Ohio State University Medical Center, N-816 Doan Hall, 410 W 10Avenue, Columbus, OH 43210, USA
| | - Rashmi Vandse
- Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall,410 W 10Avenue, Columbus, OH 43210, USA
| | - Todd A Armen
- Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall,410 W 10Avenue, Columbus, OH 43210, USA
| | - Katherine M Bickle
- Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall,410 W 10Avenue, Columbus, OH 43210, USA
| | - Nadia S Nathan
- Department of Anesthesiology, Ohio State University Medical Center, N-416 Doan Hall,410 W 10Avenue, Columbus, OH 43210, USA
| |
Collapse
|
27
|
Kito G. [Evaluation of cardiac function in cynomolgus monkeys using real-time three dimensional echocardiography: applications to pharmacological and safety assessment]. Nihon Yakurigaku Zasshi 2007; 129:437-43. [PMID: 17575421 DOI: 10.1254/fpj.129.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
28
|
Mor-Avi V, Lang RM. Three-Dimensional Echocardiographic Evaluation of the Heart Chambers: Size, Function, and Mass. Cardiol Clin 2007; 25:241-51. [PMID: 17765103 DOI: 10.1016/j.ccl.2007.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The major advantage of three-dimensional (3D) ultrasound imaging of the heart is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened 2D views. In this article, we review the literature that has provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart in the assessment of cardiac chamber size, function, and mass, and discuss its potential future applications.
Collapse
Affiliation(s)
- Victor Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago, MC5084, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
| | | |
Collapse
|
29
|
Badano LP, Dall'Armellina E, Monaghan MJ, Pepi M, Baldassi M, Cinello M, Fioretti PM. Real-time three-dimensional echocardiography: technological gadget or clinical tool? J Cardiovasc Med (Hagerstown) 2007; 8:144-62. [PMID: 17312431 DOI: 10.2459/jcm.0b013e3280116b50] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The complex anatomy of cardiac structures requires three-dimensional spatial orientation of images for a better understanding of structure and function, thereby improving image interpretation. Real-time three-dimensional echocardiography is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume. The simultaneous display of multiple tomographic images allows three-dimensional perspective and the anatomically correct examination of any structure within the volumetric image. As a consequence, it is less operator-dependent and hence more reproducible. Dedicated software systems and technologies are based on high-performance computers designed for graphic handling of three-dimensional images by providing possibilities beyond those obtainable with echocardiography. This methodology allows simultaneous display of multiple superimposed planes in an interactive manner as well as a quantitative assessment of cardiac volumes and ventricular mass in a three-dimensional format without a pre-established assumption of cardiac chamber geometry. In addition, myocardial contraction and/or perfusion abnormalities are clearly identified. Finally, real-time three-dimensional colour Doppler flow mapping enables complete visualisation of the regurgitant jet and new ways of assessing regurgitant lesion severity. Thus, this technique expands the abilities of non-invasive cardiology and may open new doors for the evaluation of cardiac diseases. In this article, current and future clinical applications of real-time three-dimensional echocardiography are reviewed.
Collapse
Affiliation(s)
- Luigi P Badano
- Department of Cardiopulmonary Sciences, University Hospital of Udine, Udine, Italy.
| | | | | | | | | | | | | |
Collapse
|
30
|
Tsusaki H, Yonamine H, Tamai A, Shimomoto M, Kuwano K, Iwao H, Nagata R, Kito G. Left ventricular volume and function in cynomolgus monkeys using real-time three-dimensional echocardiography. J Med Primatol 2007; 36:39-46. [PMID: 17359465 DOI: 10.1111/j.1600-0684.2006.00192.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the feasibility of evaluating cardiac function by real time three-dimensional (RT3D) echocardiography in isoflurane-anesthetized male cynomolgus monkeys. Additionally differences between inhibitory effects of beta-blockers and a Ca channel blocker on left ventricular (LV) function were examined. METHODS AND RESULTS End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) in the control (without any drug effect) were not significantly changed by repetitive measurement at a 30-day interval. Propranolol and metoprolol (0.1 and 0.3 mg/kg/10 minutes, i.v.) caused a dose-dependent increase in ESV, but little effect on EDV, resulting in a decrease in EF. Verapamil (0.1 and 0.3 mg/kg/10 minutes, i.v.) increased both EDV and ESV, but decreased EF was noted at 0.3 mg/kg. CONCLUSIONS These results demonstrate the feasibility of RT3D echocardiography in providing reproducible estimations of LV volume and EF in monkeys when evaluating drugs that may affect cardiac function.
Collapse
Affiliation(s)
- Hideshi Tsusaki
- Shin Nippon Biomedical Laboratories (SNBL) Ltd, Miyanoura, Kagoshima, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-Dimensional Echocardiography. J Am Coll Cardiol 2006; 48:2053-69. [PMID: 17112995 DOI: 10.1016/j.jacc.2006.07.047] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 07/06/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
Over the past 3 decades, echocardiography has become a major diagnostic tool in the arsenal of clinical cardiology for real-time imaging of cardiac dynamics. More and more, cardiologists' decisions are based on images created from ultrasound wave reflections. From the time ultrasound imaging technology provided the first insight into the human heart, our diagnostic capabilities have increased exponentially as a result of our growing knowledge and developing technology. One of the most significant developments of the last decades was the introduction of 3-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging. While continuing its meteoric rise instigated by constant technological refinements and continuing increase in computing power, this tool is guaranteed to be integrated in routine clinical practice. The major proven advantage of this technique is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic and unique comprehensive views of cardiac valves and congenital abnormalities. In addition, 3D imaging is extremely useful in the intraoperative and postoperative settings because it allows immediate feedback on the effectiveness of surgical interventions. In this article, we review the published reports that have provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart and discuss its potential future applications.
Collapse
Affiliation(s)
- Roberto M Lang
- Cardiac Imaging Center, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
| | | | | | | | | |
Collapse
|
32
|
Houck RC, Cooke JE, Gill EA. Live 3D Echocardiography: A Replacement for Traditional 2D Echocardiography? AJR Am J Roentgenol 2006; 187:1092-106. [PMID: 16985162 DOI: 10.2214/ajr.04.0857] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We describe the development of real-time 3D imaging and review the previously used versions of 3D echocardiography so that the reader will appreciate why current developments truly do represent a quantum leap in the technology. CONCLUSION Three-dimensional echocardiography has now been shown to have several advantages over 2D echocardiography, particularly for volume measurements, visualization of septal defects, and whole-valve evaluation. Given these data, it is clear that 3D echocardiography is here to stay and soon will become part of routine echocardiographic examinations.
Collapse
Affiliation(s)
- Robin C Houck
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, Box 359748, 329 Ninth Ave., Seattle, WA 98104-2599, USA
| | | | | |
Collapse
|
33
|
Krenning BJ, Voormolen MM, van Geuns RJ, Vletter WB, Lancée CT, de Jong N, Ten Cate FJ, van der Steen AFW, Roelandt JRTC. Rapid and Accurate Measurement of Left Ventricular Function with a New Second-Harmonic Fast-Rotating Transducer and Semi-Automated Border Detection. Echocardiography 2006; 23:447-54. [PMID: 16839381 DOI: 10.1111/j.1540-8175.2006.00241.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Measurement of left ventricular (LV) volume and function are the most common clinical referral questions to the echocardiography laboratory. A fast, practical, and accurate method would offer important advantages to obtain this important information. To validate a new practical method for rapid measurement of LV volume and function. We developed a continuous fast-rotating transducer, with second-harmonic capabilities, for three-dimensional echocardiography (3DE). Fifteen cardiac patients underwent both 3DE and magnetic resonance imaging (reference method) on the same day. 3DE image acquisition was performed during a 10-second breath-hold with a frame rate of 100 frames/sec and a rotational speed of 6 rotations/sec. The individual images were postprocessed with Matlab software using multibeat data fusion. Subsequently, with these images, 12 datasets per cardiac cycle were reconstructed, each comprising seven equidistant cross-sectional images for analysis in the new TomTec 4DLV analysis software, which uses a semi-automated border detection (ABD) algorithm. The ABD requires an average analysis time of 15 minutes per patient. A strong correlation was found between LV end-diastolic volume (r = 0.99; y = 0.95x - 1.14 ml; SEE = 6.5 ml), LV end-systolic volume (r = 0.96; y = 0.89x + 7.91 ml; SEE = 7.0 ml), and LV ejection fraction (r = 0.93; y = 0.69x + 13.36; SEE = 2.4%). Inter- and intraobserver agreement for all measurements was good. The fast-rotating transducer with new ABD software is a dedicated tool for rapid and accurate analysis of LV volume and function.
Collapse
Affiliation(s)
- Boudewijn J Krenning
- Department of Cardiology, Thoraxcenter and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
van den Bosch AE, Robbers-Visser D, Krenning BJ, Voormolen MM, McGhie JS, Helbing WA, Roos-Hesselink JW, Simoons ML, Meijboom FJ. Real-Time Transthoracic Three-Dimensional Echocardiographic Assessment of Left Ventricular Volume and Ejection Fraction in Congenital Heart Disease. J Am Soc Echocardiogr 2006; 19:1-6. [PMID: 16423662 DOI: 10.1016/j.echo.2005.06.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the (1) feasibility of real-time three-dimensional echocardiography (RT-3DE) data acquisition and (2) volumes and function of the abnormal left ventricle (LV) in adult patients with congenital heart disease (CHD), compared with magnetic resonance imaging (MRI) data. METHODS Thirty-two patients (59% were male) with CHD were evaluated on the same day by MRI and RT-3DE. Acquisition of RT-3DE data sets was feasible in 29 of the 32 patients (91%). The time of 3D data acquisition was 4 +/- 2 minutes, and LV analysis was 17 +/- 5 minutes per patient for manual border tracing. RESULTS A good correlation was observed between RT-3DE with manual border detection and MRI for LV end-diastolic volume (r = 0.97), LV end-systolic volume (r = 0.98), and LV ejection fraction (r = 0.94). CONCLUSION RT-3DE is feasible for volumetric analysis of the abnormal LV allowing accurate determination of LV volume and ejection fraction compared with MRI in adult patients with CHD.
Collapse
|
35
|
Abstract
Conventional 2D echocardiography is an excellent qualitative imaging method, but its use for quantitation is limited by test-retest reproducibility of image planes. The increasing sophistication of medical treatments for left ventricular dysfunction, hypertension and valvular heart disease has created the need for accurate and reproducible measurements of chamber dimensions. Similarly, improvements in valve repair and catheter-based interventions for valve lesions and septal defects have created the need for better visualisation of cardiac structures. The use of 31) echocardiography may decrease variability both in the quality and interpretation of complex pathology among investigators. Three-dimensional echocardiography is achieved by using a 3D spatial registration device with a conventional 21) scanner, or by using a high-speed, phased-array real-time scanner. The latter are still developmental, so that the technique currently requires use of a 21) scanner, combined with a 31) spatial coordinate system, which may be external or internal to the scanning transducer. An external system permits data acquired from several cardiac windows to be integrated and reconstructed. Image reconstruction is performed using a wire-frame model or surface rendering. Wire-frame models are formed by manual or automatic connection of boundary data points; this approach uses fewer data points than rendering, can be rapidly processed and is sufficient for quantitative analysis. Surface-rendering uses lighting and shading applied to a wire-frame model to produce a realistic 31) display, which may be useful for surgical planning and increasing understanding of anatomic relations. Three-dimensional echocardiography yields more accurate measurements of ventricular volume and function, as well as new measurements such as infarct area. With increased reproducibility and reliability, 3D echocardiography may well prove to be the essential tool required for the serial follow up of left ventricular mass and volume.
Collapse
Affiliation(s)
- D Spicer
- Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | | |
Collapse
|
36
|
Houck RC, Cooke J, Gill EA. Three-dimensional echo: transition from theory to real-time, a technology now ready for prime time. Curr Probl Diagn Radiol 2005; 34:85-105. [PMID: 15886612 DOI: 10.1016/j.cpradiol.2005.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Robin C Houck
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA 98104-2599, USA
| | | | | |
Collapse
|
37
|
Tsusaki H, Yonamine H, Tamai A, Shimomoto M, Iwao H, Nagata R, Kito G. Evaluation of cardiac function in primates using real-time three-dimensional echocardiography as applications to safety assessment. J Pharmacol Toxicol Methods 2005; 52:182-7. [PMID: 15935708 DOI: 10.1016/j.vascn.2005.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A timed non-invasive determination of cardiac function is potentially important for safety pharmacology and toxicity studies. The objectives of this study were to evaluate the accuracy of real-time three-dimensional (RT3D) echocardiography measurements of the left ventricular (LV) volume and LV function and to investigate the effects of some drugs on LV function in cynomolgus monkeys. METHODS RT3D echocardiography was performed (SONOS 7500, Philips Med Sys) under isoflurane inhalation. RT3D echocardiography measurements and reconstructions were obtained using Tom-Tec (4DLV analysis). We determined end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), stroke volume (SV), cardiac output (CO) and heart rate as assessments of LV function. EDV, calculated from two-dimensional (2D) echocardiography and RT3D echocardiography, and the actual LV volume were evaluated and compared. Furthermore, each parameter was determined before and after intravenous infusion (5 or 10 min) of propranolol, verapamil and dobutamine. RESULTS A strong correlation was found between the actual LV volume and that calculated from RT3D echocardiography (r=0.96, p<0.001). Propranolol (0.1 mg/kg/10 min, n=5) caused an increase in ESV, but not EDV, resulting in a decrease in EF and SV, while verapamil produced increases in both EDV and ESV. Dobutamine (0.01 mg/kg/5 min, n=5) produced decreases in both EDV and ESV and thereby the increased CO resulted from the increased SV. DISCUSSION These results demonstrate that RT3D echocardiography provides a feasible and accurate estimation of LV volume and EF for safety pharmacology and toxicity studies.
Collapse
Affiliation(s)
- Hideshi Tsusaki
- Shin Nippon Biomedical Laboratories, Ltd., 2438 Miyanoura, Kagoshima 891-1394, Japan
| | | | | | | | | | | | | |
Collapse
|
38
|
Matsumura Y, Hozumi T, Arai K, Sugioka K, Ujino K, Takemoto Y, Yamagishi H, Yoshiyama M, Yoshikawa J. Non-invasive assessment of myocardial ischaemia using new real-time three-dimensional dobutamine stress echocardiography: comparison with conventional two-dimensional methods. Eur Heart J 2005; 26:1625-32. [PMID: 15817607 DOI: 10.1093/eurheartj/ehi194] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Although two-dimensional-dobutamine stress echocardiography (2D-DSE) is useful for the diagnosis of myocardial ischaemia, it requires the acquisition of multiple cross-sections at each stage. The introduction of new real-time three-dimensional echocardiography (RT3DE) offers rapid acquisition and 3D display of the entire left ventricle (LV). The purpose was to evaluate real-time three-dimensional-dobutamine stress echocardiography (RT3D-DSE) for the diagnosis of ischaemia using exercise (201)Tl single-photon emission computed tomography (SPECT) as the reference standard, in comparison with 2D-DSE. METHODS AND RESULTS We performed DSE in 56 consecutive patients who had undergone SPECT because of suspected ischaemia. 3D images by RT3DE were acquired from the apical window after the acquisition of cross-sectional images at every stage of 2D-DSE. Wall motion analysis in RT3DE was performed from anatomical images by cropping the acquired full volume data sets. Mean scanning time for adequate image acquisition at peak stress by RT3D-DSE was shorter than that by 2D-DSE (29+/-4 vs. 68+/-6 s, P<0.0001). RT3DE provided adequate images at success rate of 92% at rest and 89% at peak stress, whereas two-dimensional echocardiography did at 94 and 90%, respectively. The sensitivity, specificity, and accuracy of RT3D-DSE for the detection of coronary artery disease are 86, 80, and 82%, respectively. Those of 2D-DSE are 86, 83, and 84%, respectively. There were no significant differences in the sensitivity, specificity, and accuracy between these two methods (P=1.000). CONCLUSION RT3D-DSE offers rapid and simple acquisition of the entire LV wall motion and provides feasible and accurate assessment of myocardial ischaemia.
Collapse
Affiliation(s)
- Yoshiki Matsumura
- The Department of Internal Medicine and Cardiology, Osaka City University Medical School, Abeno-ku, Osaka 545 8585, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Gutiérrez-Chico JL, Zamorano JL, Pérez de Isla L, Orejas M, Almería C, Rodrigo JL, Ferreirós J, Serra V, Macaya C. Comparison of left ventricular volumes and ejection fractions measured by three-dimensional echocardiography versus by two-dimensional echocardiography and cardiac magnetic resonance in patients with various cardiomyopathies. Am J Cardiol 2005; 95:809-13. [PMID: 15757621 DOI: 10.1016/j.amjcard.2004.11.046] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 12/20/2022]
Abstract
End-diastolic volume and end-systolic volume were measured in 35 consecutive patients with cardiomyopathy using 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography (2, 4, and 8 planes) and cardiac magnetic resonance imaging. Three-dimensional echocardiography correlates better with magnetic resonance imaging than does 2-D echocardiography. Its accuracy improves with the increase in the number of planes used. Two-dimensional echocardiography underestimates volumes, mainly in the subgroup with an ejection fraction of <50%, whereas 3-D echocardiography does not, if enough planes are used. However, in patients with an end-diastolic volume > or =150 ml, the underestimation of 3-D echocardiography is statistically significant. Increasing the number of planes to 8 reduces this bias. Conversely, patients with an end-diastolic volume <150 ml are accurately studied with just 4 planes.
Collapse
|
40
|
Mischi M, Jansen AHM, Kalker AACM, Korsten HHM. Identification of ultrasound contrast agent dilution systems for ejection fraction measurements. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2005; 52:410-420. [PMID: 15857049 DOI: 10.1109/tuffc.2005.1417263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Left ventricular ejection fraction is an important cardiac-efficiency measure. Standard estimations are based on geometric analysis and modeling; they require time and experienced cardiologists. Alternative methods make use of indicator dilutions, but they are invasive due to the need for catheterization. This study presents a new minimally invasive indicator dilution technique for ejection fraction quantification. It is based on a peripheral injection of an ultrasound contrast agent bolus. Left atrium and left ventricle acoustic intensities are recorded versus time by transthoracic echocardiography. The measured curves are corrected for attenuation distortion and processed by an adaptive Wiener deconvolution algorithm for the estimation of the left ventricle impulse response, which is interpolated by a monocompartment exponential model for the ejection fraction assessment. This technique measures forward ejection fraction, which excludes regurgitant volumes. The feasibility of the method was tested on a group of 20 patients with left ventricular ejection fractions going from 10% to 70%. The results are promising and show a 0.93 correlation coefficient with echographic bi-plane ejection fraction measurements. A more extensive validation as well as an investigation on the method applicability for valve insufficiency and right ventricular ejection fraction quantification will be an object of future study.
Collapse
|
41
|
Fleming SM, Cumberledge B, Kiesewetter C, Parry G, Kenny A. Usefulness of real-time three-dimensional echocardiography for reliable measurement of cardiac output in patients with ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 2005; 95:308-10. [PMID: 15642580 DOI: 10.1016/j.amjcard.2004.08.101] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Revised: 08/31/2004] [Accepted: 08/31/2004] [Indexed: 11/29/2022]
Abstract
The determination of stroke volume (SV) is a potentially important application of real-time 3-dimensional echocardiography (RT3DE). SV measurements by thermodilution were compared with values obtained using transthoracic RT3DE in a sequential cohort of patients who underwent assessment for potential cardiac transplantation. There was a strong correlation between echocardiographically derived SV and catheterization data (r = 0.95, n = 14). On average, RT3DE appeared to underestimate SV by 7.5 ml (SD = 5.8) or 17% (SD = 12%). A role for RT3DE in the measurement of SV in severe heart failure is suggested.
Collapse
|
42
|
|
43
|
Arai K, Hozumi T, Matsumura Y, Sugioka K, Takemoto Y, Yamagishi H, Yoshiyama M, Kasanuki H, Yoshikawa J. Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction. Am J Cardiol 2004; 94:552-8. [PMID: 15342282 DOI: 10.1016/j.amjcard.2004.05.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 05/17/2004] [Accepted: 05/17/2004] [Indexed: 11/17/2022]
Abstract
Three-dimensional echocardiography is an ideal tool for the measurement of left ventricular (LV) volume because no geometric assumptions about LV shape are needed. The introduction of new real-time 3-dimensional echocardiography (RT3DE) has allowed rapid acquisition of a 3-dimensional dataset with good image quality. The purpose of this study was to examine the accuracy of RT3DE for the measurement of LV volume and ejection fraction in patients with wall motion abnormalities by using quantitative gated single-photon emission computed tomography (QGSPECT) as a reference standard. The study population consisted of 25 consecutive patients with wall motion abnormalities who underwent LV volume measurement by 2-dimensional echocardiography and by QGSPECT. LV volume and ejection fraction by RT3DE were measured offline by using the average rotation method. In 23 of 25 patients (92%), it was possible to measure 3-dimensional volume with RT3DE. RT3DE correlated well with QGSPECT in the measurement of end-diastolic volume and end-systolic volume (r = 0.97, mean difference 3.4 ml; r = 0.98, mean difference 2.0 ml, respectively), 2-dimensional echocardiography also correlated with QGSPECT but underestimated LV volume (r = 0.98, mean difference 21.1 ml; r = 0.98, mean difference 15.6 ml, respectively). Ejection fraction obtained by RT3DE had better agreement with that obtained by QGSPECT than that obtained by 2-dimensional echocardiography (r = 0.92, mean difference -0.2%; r = 0.89, mean difference -2.7%, respectively). RT3DE allows convenient and accurate estimation of LV volume and ejection fraction in patients with wall motion abnormalities.
Collapse
Affiliation(s)
- Kotaro Arai
- Department of Internal Medicine and Cardiology, Osaka City University Medical School, Osaka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Garcia MJ. Echocardiographic assessment in cell transplantation. Int J Cardiol 2004; 95 Suppl 1:S50-2. [PMID: 15336848 DOI: 10.1016/s0167-5273(04)90015-0] [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: 10/26/2022]
Affiliation(s)
- Mario J Garcia
- Cardiology Division -- The Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|
45
|
Schenk S, McCarthy PM, Starling RC, Hoercher KJ, Hail MD, Ootaki Y, Francis GS, Doi K, Young JB, Fukamachi K. Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2004; 128:38-43. [PMID: 15224019 DOI: 10.1016/j.jtcvs.2003.11.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Activation of the neuroendocrine axis in congestive heart failure is of prognostic significance, and neurohumoral blocking therapy prolongs survival. The hypothesis that surgical reduction of left ventricular size and function decreases neuroendocrine activation is less established. We evaluated the neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. METHODS Norepinephrine, plasma renin activity, and angiotensin II were measured in 10 patients before and 12 months after left ventricular reconstruction. In an additional 5 patients, brain natriuretric peptide was measured before and 3 months postoperatively. Three-dimensional cardiovascular imaging was used to assess ejection fraction and left ventricular end-diastolic volume index. RESULTS Concurrent with improvements of New York Heart Association functional class (2.9 +/- 0.5 preoperatively vs 2.0 +/- 0.4 postoperatively, P <.001), ejection fraction (23.9% +/- 6.6% vs 36.2% +/- 6.2%, P <.01), and left ventricular end-diastolic volume index (140.8 +/- 33.8 mL/m(2) vs 90.6 +/- 18.3 mL/m(2), P <.01), considerable reductions were observed for median plasma profiles of norepinephrine (562.0 pg/mL vs 319.0 pg/mL, P <.05), plasma renin activity (5.75 microg/L/h vs 3.45 microg/L/h, P <.05), angiotensin II (41.0 ng/mL vs 23.0 ng/mL, P =.051), and brain natriuretric peptide (771.0 pg/mL vs 266.0 pg/mL, P <.05). The more plasma renin activity or angiotensin II decreased after left ventricular reconstruction, the higher was the increase in ejection fraction (R = -.745, P <.05 [plasma renin activity]; R = -.808, P <.05 [angiotensin II]). CONCLUSIONS Surgical improvements of ejection fraction and left ventricular end-diastolic volume index by left ventricular reconstruction were accompanied by improvement of both the neuroendocrine activity and the functional status in patients with congestive heart failure. Whether this favorable neurohormonal response is predictive of an improved survival requires further evaluation.
Collapse
Affiliation(s)
- Soren Schenk
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kühl HP, Schreckenberg M, Rulands D, Katoh M, Schäfer W, Schummers G, Bücker A, Hanrath P, Franke A. High-resolution transthoracic real-time three-dimensional echocardiography: quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging. J Am Coll Cardiol 2004; 43:2083-90. [PMID: 15172417 DOI: 10.1016/j.jacc.2004.01.037] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2003] [Revised: 12/05/2003] [Accepted: 01/12/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to validate high-resolution transthoracic real-time (RT) three-dimensional echocardiography (3DE), in combination with a novel semi-automatic contour detection algorithm, for the assessment of left ventricular (LV) volumes and function in patients. BACKGROUND Quantitative RT-3DE has been limited by impaired image quality and time-consuming manual data analysis. METHODS Twenty-four subjects with abnormal (n = 14) or normal (n = 10) LVs were investigated. The results for end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) obtained by manual tracing were compared with the results determined by the semi-automatic border detection algorithm. Moreover, the results of the semi-automatic method were compared with volumes and EF obtained by cardiac magnetic resonance imaging (CMRI). RESULTS Excellent correlation coefficients (r = 0.98 to 0.99) and low variability (EDV -1.3 +/- 8.6 ml; ESV -0.2 +/- 5.4 ml; EF -0.1 +/- 2.7%; p = NS) were observed between the semi-automatically and manually assessed data. The RT-3DE data correlated highly with CMRI (r = 0.98). However, LV volumes were underestimated by RT-3DE compared with CMRI (EDV -13.6 +/- 18.9 ml, p = 0.002; ESV -12.8 +/- 20.5 ml, p = 0.005). The difference for EF was not significant between the two methods (EF 0.9 +/- 4.4%, p = NS). Observer variability was acceptable, and repeatability of the method was excellent. CONCLUSIONS The RT-3DE, in combination with a semi-automatic contour tracing algorithm, allows accurate determination of cardiac volumes and function compared with both manual tracing and CMRI. High repeatability suggests applicability of the method for the serial follow-up of patients with cardiac disease.
Collapse
|
47
|
Sugeng L, Weinert L, Lang RM. Left ventricular assessment using real time three dimensional echocardiography. BRITISH HEART JOURNAL 2003; 89 Suppl 3:iii29-36. [PMID: 14594873 PMCID: PMC1876303 DOI: 10.1136/heart.89.suppl_3.iii29] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- L Sugeng
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | | | | |
Collapse
|
48
|
Chamoun AJ, McCulloch M, Xie T, Shah S, Ahmad M. Real-time three-dimensional echocardiography versus two-dimensional echocardiography in the diagnosis of left ventricular apical thrombi: preliminary findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:412-418. [PMID: 14528439 DOI: 10.1002/jcu.10199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Real-time 3-dimensional transthoracic echocardiography (RT-3D-TE) with real-time volume rendering (RTVR) offers multiple simultaneous views and spatial definition of intracardiac structures superior to that attainable by 2-dimensional transthoracic echocardiography (2D-TE). We hypothesized that RT-3D-TE would therefore improve identification of left ventricular apical thrombi (LVT). METHODS Patients were referred to our echocardiography laboratory over an 8-month period. Those diagnosed with a "suspicious" or "definite" LVT on the basis of 2D-TE images underwent RT-3D-TE on the same day. All 2D-TE, RT-3D-TE, and RTVR images were reviewed by 2 independent observers. RT-3D-TE findings were considered positive for LVT if LVT was visualized in both B-scan (apical orthogonal) and C-scan (short axis, with and without tilting angle) planes and on RTVR images, nondiagnostic (or suspicious) for LVT if it was not visualized in all planes, and negative for LVT if it was not visualized in any plane. RESULTS Thirty patients (19 men and 11 women) with a mean age (+/- standard deviation) of 52 +/- 13 years were enrolled. The interobserver agreement coefficient was 63% for 2D-TE interpretations of LVT and 93% for RT-3D-TE interpretations of LVT (p<0.05). The final interpretations by RT-3D-TE with RTVR were positive for LVT in 16 patients (53%), suspicious for LVT in 4 patients (13%), and negative for LVT in 10 patients (30%). CONCLUSIONS RT-3D-TE with RTVR offers dramatically clearer echocardiographic findings than does 2D-TE. In particular, RT-3D-TE is able to provide a clear diagnosis of LVT/non-LVT when 2D-TE images are merely suggestive of the disorder. Therefore, RT-3D-TE with RTVR, which is a clinically feasible alternative to 2-dimensional echocardiography, has great potential to positively affect the diagnosis, follow-up, and care of patients with suspected LVT.
Collapse
Affiliation(s)
- Antonio J Chamoun
- Division of Cardiology, The University of Texas Medical Branch at Galveston, 301 University Boulevard, 4.148 McCullough Building, Galveston, Texas 77555-0766, USA
| | | | | | | | | |
Collapse
|
49
|
Krenning BJ, Voormolen MM, Roelandt JRTC. Assessment of left ventricular function by three-dimensional echocardiography. Cardiovasc Ultrasound 2003; 1:12. [PMID: 14514356 PMCID: PMC201029 DOI: 10.1186/1476-7120-1-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 09/08/2003] [Indexed: 11/10/2022] Open
Abstract
Accurate determination of LV volume, ejection fraction and segmental wall motion abnormalities is important for clinical decision-making and follow-up assessment. Currently, echocardiography is the most common used method to obtain this information. Three-dimensional echocardiography has shown to be an accurate and reproducible method for LV quantitation, mainly by avoiding the use of geometric assumptions. In this review, we describe various methods to acquire a 3D-dataset for LV volume and wall motion analysis, including their advantages and limitations. We provide an overview of studies comparing LV volume and function measurement by various gated and real-time methods of acquisition compared to magnetic resonance imaging. New technical improvements, such as automated endocardial border detection and contrast enhancement, will make accurate on-line assessment with little operator interaction possible in the near future.
Collapse
Affiliation(s)
| | - Marco M Voormolen
- Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
| | - Jos RTC Roelandt
- Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
50
|
Mannaerts HFJ, Van Der Heide JA, Kamp O, Papavassiliu T, Marcus JT, Beek A, Van Rossum AC, Twisk J, Visser CA. Quantification of left ventricular volumes and ejection fraction using freehand transthoracic three-dimensional echocardiography: comparison with magnetic resonance imaging. J Am Soc Echocardiogr 2003; 16:101-9. [PMID: 12574735 DOI: 10.1067/mje.2003.7] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Our aim was to validate 3-dimensional echocardiography (3DE) for assessment of left ventricular (LV) end-diastolic volume, end-systolic volume (ESV), stroke volume, and ejection fraction (EF) using the freehand-acquisition method. Furthermore, LV volumes by breath hold-versus free breathing-3DE acquisition were assessed and compared with magnetic resonance imaging (MRI). METHODS From the apical position, a fan-like 3DE image was acquired during free breathing and another, thereafter, during breath hold. In 27 patients, 28 breath hold- and 24 free breathing-3DE images were acquired. A total of 17 patients underwent both MRI and 3DE. MRI contours were traced along the outer endocardial contour, including trabeculae, and along the inner endocardial contour, excluding trabeculae, from the LV volume. RESULTS All 28 (100%) breath hold- and 86% of free breathing-3DE acquisitions could be analyzed. Intraobserver variation (percentual bias +/- 2 SD) of end-diastolic volume, ESV, stroke volume, and EF for breath-hold 3DE was, respectively, 0.3 +/- 10.2%, 0.3 +/- 14.6%, 0.1 +/- 18.4%, and -0.1 +/- 5.8%. For free-breathing 3DE, findings were similar. A significantly better interobserver variability, however, was observed for breath-hold 3DE for ESV and EF. Comparison of breath-hold 3DE with MRI inner contour showed for end-diastolic volume, ESV, stroke volume, and EF, a percentual bias (+/- 2 SD) of, respectively, -13.5 +/- 26.9%, -17.7 +/- 47.8%, -10.6 +/- 43.6%, and -1.8 +/- 11.6%. Compared with the MRI outer contour, a significantly greater difference was observed, except for EF. CONCLUSIONS 3DE using the freehand method is fast and highly reproducible for (serial) LV volume and EF measurement, and, hence, ideally suited for clinical decision making and trials. Breath-hold 3DE is superior to free-breathing 3DE regarding image quality and reproducibility. Compared with MRI, 3DE underestimates LV volumes, but not EF, which is mainly explained by differences in endocardial contour tracing by MRI (outer contour) and 3DE (inner contour) of the trabecularized endocardium. Underestimation is reduced when breath-hold 3DE is compared with inner contour analysis of the MRI dataset.
Collapse
Affiliation(s)
- Herman F J Mannaerts
- Department of Cardiology and Institute for Cardiovascular Research, VU University Medical Center., Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|