Myocardial rapid velocity distribution

4D cardiac electromechanical activation imaging

Cardiac abnormalities, a major cause of morbidity and mortality, affect millions of people worldwide. Despite the urgent clinical need for early diagnosis, there is currently no noninvasive technique that can infer to the electrical function of the whole heart in 3D and thereby localize abnormalities at the point of care. Here we present a new method for noninvasive 4D mapping of the cardiac electromechanical activity in a single heartbeat for heart disease characterization such as arrhythmia and infarction. Our novel technique captures the 3D activation wave of the heart in vivo using high volume-rate (500 volumes per second) ultrasound with a 32 × 32 matrix array. Electromechanical activation maps are first presented in a normal and infarcted cardiac model in silico and in canine heart during pacing and re-entrant ventricular tachycardia in vivo. Noninvasive 4D electromechanical activation mapping in a healthy volunteer and a heart failure patient are also determined. The technique described herein allows for direct, simultaneous and noninvasive visualization of electromechanical activation in 3D, which provides complementary information on myocardial viability and/or abnormality to clinical imaging.

Natural Shear Wave Imaging in the Human Heart: Normal Values, Feasibility, and Reproducibility

Left ventricular myocardial stiffness could offer superior quantification of cardiac systolic and diastolic function when compared to the current diagnostic tools. Shear wave elastography in combination with acoustic radiation force has been widely proposed to noninvasively assess tissue stiffness. Interestingly, shear waves can also result from intrinsic cardiac mechanical events (e.g., closure of valves) without the need for external excitation. However, it remains unknown whether these natural shear waves always occur, how reproducible they can be detected and what the normal range of shear wave propagation speed is. The present study, therefore, aimed at establishing the feasibility of detecting shear waves created after mitral valve closure (MVC) and aortic valve closure (AVC), the variability of the measurements, and at reporting the normal values of propagation velocity. Hereto, a group of 30 healthy volunteers was scanned with high-frame rate imaging (>1000 Hz) using an experimental ultrasound system transmitting a diverging wave sequence. Tissue Doppler velocity and acceleration were used to create septal color M-modes, on which the shear waves were tracked and their velocities measured. Overall, the methodology was capable of detecting the transient vibrations that spread throughout the intraventricular septum in response to the closure of the cardiac valves in 92% of the recordings. Reference velocities of 3.2±0.6 m/s at MVC and 3.5±0.6 m/s at AVC were obtained. Moreover, in order to show the diagnostic potential of this approach, two patients (one with cardiac amyloidosis and one undergoing a dobutamine stress echocardiography) were scanned with the same protocol and showed markedly higher propagation speeds: the former presented velocities of 6.6 and 5.6 m/s; the latter revealed normal propagation velocities at baseline, and largely increased during the dobutamine infusion (>15 m/s). Both cases showed values consistent with the expected changes in stiffness and cardiac loading conditions.

Effect of Transmit Beamforming on Clutter Levels in Transthoracic Echocardiography

Transmit beamforming has a strong impact on several factors that govern image quality, field-of-view, and frame-rate in ultrasound imaging. For cardiac applications, the visualization of fine structures and the ability to track their motion is equally important. Consequently, beamforming choices for echocardiography aim to optimize these trade-offs. Acoustic clutter can dramatically impact image quality and degrade the diagnostic value of cardiac ultrasound imaging. Clutter levels, however, are closely tied to the choice of beamforming configuration. This study aims to quantify the impact of transmit beamforming on clutter levels under in vivo conditions. The performance of focused as well as plane wave transmit configurations in fundamental and harmonic modes is evaluated under matched conditions. Contrast between the cardiac chambers and the interventricular septum is used as a surrogate for the level of clutter in a given imaging scenario. Under in vivo conditions, contrast was found to improve incrementally across the four beamforming configurations in the following order: fundamental-plane, fundamental-focused, harmonic-plane, and harmonic-focused. Using the fundamental-focused configuration as a reference, the harmonic-plane and harmonic-focused cases showed improvements in median contrast of 2.97 dB and 6.1 dB, respectively, while the fundamental-plane case showed a contrast deterioration of 1.23 dB. Contrast was also found to vary systematically as a function of imaging depth. Median contrast for the right ventricle (shallow chamber) was measured to be 2.96 dB lower than that in the left ventricle (deep chamber).

Imaging the Propagation of the Electromechanical Wave in Heart Failure Patients with Cardiac Resynchronization Therapy

BACKGROUND

Current electrocardiographic and echocardiographic measurements in heart failure (HF) do not take into account the complex interplay between electrical activation and local wall motion. The utilization of novel technologies to better characterize cardiac electromechanical behavior may lead to improved response rates with cardiac resynchronization therapy (CRT). Electromechanical wave imaging (EWI) is a noninvasive ultrasound-based technique that uses the transient deformations of the myocardium to track the intrinsic EW that precedes myocardial contraction. In this paper, we investigate the performance and reproducibility of EWI in the assessment of HF patients and CRT.

METHODS

EWI acquisitions were obtained in five healthy controls and 16 HF patients with and without CRT pacing. Responders (n = 8) and nonresponders (n = 8) to CRT were identified retrospectively on the basis of left ventricular (LV) reverse remodeling. Electromechanical activation maps were obtained in all patients and used to compute a quantitative parameter describing the mean LV lateral wall activation time (LWAT).

RESULTS

Mean LWAT was increased by 52.1 ms in HF patients in native rhythm compared to controls (P < 0.01). For all HF patients, CRT pacing initiated a different electromechanical activation sequence. Responders exhibited a 56.4-ms ± 28.9-ms reduction in LWAT with CRT pacing (P < 0.01), while nonresponders showed no significant change.

CONCLUSION

In this initial feasibility study, EWI was capable of characterizing local cardiac electromechanical behavior as it pertains to HF and CRT response. Activation sequences obtained with EWI allow for quantification of LV lateral wall electromechanical activation, thus providing a novel method for CRT assessment.

A Comparison of the Performance of Different Multiline Transmit Setups for Fast Volumetric Cardiac Ultrasound

It was previously demonstrated in 2-D echocardiography that a proper multiline transmit (MLT) implementation can be used to increase frame rate while preserving image quality. Initial findings for extending MLT to 3-D showed that it might address the low spatiotemporal resolution of current volumetric ultrasound systems. However, to date, it remains unclear how much transmit/receive parallelization would be possible using a 3-D MLT system. Therefore, the aim of this paper was to contrast different MLT setups for 3-D imaging by computer simulation in order to determine an optimal tradeoff between the amount of parallelization of an MLT system and the corresponding signal-to-noise ratio of the resulting images. Hereto, the image quality of several MLT setups was estimated by quantifying their crosstalk energy level. The results showed that for the tested setups, 4MLT broad beams and 9MLT narrow beams with Tukey ( α = 0.5 ) apodization in transmit and receive give the highest frame rate gain while maintaining an acceptable interbeam interference level. Moreover, although 16MLT narrow beams with Tukey/Tukey ( α = 0.5 ) apodization did show more pronounced interbeam interference, its gain in frame rate might outweigh its predicted loss in image quality. As such both 9MLT and 16MLT narrow beams were tested experimentally. For both systems, four receive lines were reconstructed from each transmit beam. The contrast-to-noise ratio of these imaging strategies was quantified and compared with the image quality obtained with line-by-line scanning. Despite some expected loss in image quality, the resulting images of the parallelized systems were very competitive to the benchmark, while speeding up the acquisition process by a factor of 36 and 64, respectively.

Diverging Wave Volumetric Imaging Using Subaperture Beamforming

Several clinical settings could benefit from 3-D high frame rate (HFR) imaging and, in particular, HFR 3-D tissue Doppler imaging (TDI). To date, the proposed methodologies are based mostly on experimental ultrasound platforms, making their translation to clinical systems nontrivial as these have additional hardware constraints. In particular, clinically used 2-D matrix array transducers rely on subaperture (SAP) beamforming to limit cabling between the ultrasound probe and the back-end console. Therefore, this paper is aimed at assessing the feasibility of HFR 3-D TDI using diverging waves (DWs) on a clinical transducer with SAP beamforming limitations. Simulation studies showed that the combination of a single DW transmission with SAP beamforming results in severe imaging artifacts due to grating lobes and reduced penetration. Interestingly, a promising tradeoff between image quality and frame rate was achieved for scan sequences with a moderate number of transmit beams. In particular, a sparse sequence with nine transmissions showed good imaging performance for an imaging sector of 70 ^°×70 ^° at volume rates of approximately 600 Hz. Subsequently, this sequence was implemented in a clinical system and TDI was recorded in vivo on healthy subjects. Velocity curves were extracted and compared against conventional TDI (i.e., with focused transmit beams). The results showed similar velocities between both beamforming approaches, with a cross-correlation of 0.90 ± 0.11 between the traces of each mode. Overall, this paper indicates that HFR 3-D TDI is feasible in systems with clinical 2-D matrix arrays, despite the limitations of SAP beamforming.

Acoustic output of multi-line transmit beamforming for fast cardiac imaging: a simulation study

Achieving higher frame rates in cardiac ultrasound could unveil short-lived myocardial events and lead to new insights on cardiac function. Multi-line transmit (MLT) beamforming (i.e., simultaneously transmitting multiple focused beams) is a potential approach to achieve this. However, two challenges come with it: first, it leads to cross-talk between the MLT beams, appearing as imaging artifacts, and second, it presents acoustic summation in the near field, where multiple MLT beams overlap. Although several studies have focused on the former, no studies have looked into the implications of the latter on acoustic safety. In this paper, the acoustic field of 4-MLT was simulated and compared with single-line transmit (SLT). The findings suggest that standard MLT does present potential concerns. Compared with SLT, it shows a 2-fold increase in mechanical index (MI) (from 1.0 to 2.3), a 6-fold increase in spatial-peak pulse-average intensity (I(sppa)) (from 99 to 576 W∙cm(-2)) and a 12-fold increase in spatial-peak temporalaverage intensity (I(spta)) (from 119 to 1407 mW∙cm(-2)). Subsequently, modifications of the transmit pulse and delay line of MLT were studied. These modifications allowed for a change in the spatio-temporal distribution of the acoustic output, thereby significantly decreasing the safety indices (MI = 1.2, I(sppa) = 92 W∙cm(-2) and I(spta) = 366 mW∙cm(-2)). Accordingly, they help mitigate the concerns around MLT, reducing potential tradeoffs between acoustic safety and image quality.

Ultrafast cardiac ultrasound imaging: technical principles, applications, and clinical benefits

Several recent technical advances in cardiac ultrasound allow data to be acquired at a very high frame rate. Retrospective gating, plane/diverging wave imaging, and multiline transmit imaging all improve the temporal resolution of the conventional ultrasound system. The main drawback of such high frame rate data acquisition is that it typically has reduced image quality. However, for given clinical applications, the acquisition of temporally-resolved data might outweigh the reduction in image quality. It is the aim of this paper to provide an overview of the technical principles behind these new ultrasound imaging modalities, to review the current evidence of their potential clinical added value, and to forecast how they might influence daily clinical practice.

Stochastic precision analysis of 2D cardiac strain estimation in vivo

Ultrasonic strain imaging has been applied to echocardiography and carries great potential to be used as a tool in the clinical setting. Two-dimensional (2D) strain estimation may be useful when studying the heart due to the complex, 3D deformation of the cardiac tissue. Increasing the framerate used for motion estimation, i.e. motion estimation rate (MER), has been shown to improve the precision of the strain estimation, although maintaining the spatial resolution necessary to view the entire heart structure in a single heartbeat remains challenging at high MERs. Two previously developed methods, the temporally unequispaced acquisition sequence (TUAS) and the diverging beam sequence (DBS), have been used in the past to successfully estimate in vivo axial strain at high MERs without compromising spatial resolution. In this study, a stochastic assessment of 2D strain estimation precision is performed in vivo for both sequences at varying MERs (65, 272, 544, 815 Hz for TUAS; 250, 500, 1000, 2000 Hz for DBS). 2D incremental strains were estimated during left ventricular contraction in five healthy volunteers using a normalized cross-correlation function and a least-squares strain estimator. Both sequences were shown capable of estimating 2D incremental strains in vivo. The conditional expected value of the elastographic signal-to-noise ratio (E(SNRe|ε)) was used to compare strain estimation precision of both sequences at multiple MERs over a wide range of clinical strain values. The results here indicate that axial strain estimation precision is much more dependent on MER than lateral strain estimation, while lateral estimation is more affected by strain magnitude. MER should be increased at least above 544 Hz to avoid suboptimal axial strain estimation. Radial and circumferential strain estimations were influenced by the axial and lateral strain in different ways. Furthermore, the TUAS and DBS were found to be of comparable precision at similar MERs.

The tissue Doppler imaging derived post-systolic velocity notch originates at the aortic annulus

Background

A distinct velocity pattern represented by a "notch" is observed during the time interval between the end of the systolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolic velocity notch (PSN) has not been resolved.

Methods

The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthy subjects.

Results

The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and the posterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 ± 2.2, 6.0 ± 2.3, 6.8 ± 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and the MA (4.77 ± 1.28 vs. 2.88 ± 1.11, 2.15 ± 0.73, 2.44 ± 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32 (31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and no one at the MA.

Conclusion

The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocity curve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apically directed acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly at the level of the AA. Its mechanism remains to be elucidated.

Ultrafast imaging in biomedical ultrasound

Although the use of ultrasonic plane-wave transmissions rather than line-per-line focused beam transmissions has been long studied in research, clinical application of this technology was only recently made possible through developments in graphical processing unit (GPU)-based platforms. Far beyond a technological breakthrough, the use of plane or diverging wave transmissions enables attainment of ultrafast frame rates (typically faster than 1000 frames per second) over a large field of view. This concept has also inspired the emergence of completely novel imaging modes which are valuable for ultrasound-based screening, diagnosis, and therapeutic monitoring. In this review article, we present the basic principles and implementation of ultrafast imaging. In particular, present and future applications of ultrafast imaging in biomedical ultrasound are illustrated and discussed.

High-frame-rate echocardiography using diverging transmit beams and parallel receive beamforming

PURPOSE

Echocardiography is a widely used modality for diagnosis of the heart. It enables observation of the shape of the heart and estimation of global heart function based on B-mode and M-mode imaging. Subsequently, methods for estimating myocardial strain and strain rate have been developed to evaluate regional heart function. Furthermore, it has recently been shown that measurements of transmural transition of myocardial contraction/relaxation and propagation of vibration caused by closure of a heart valve would be useful for evaluation of myocardial function and viscoelasticity. However, such measurements require a frame rate much higher than that achieved by conventional ultrasonic diagnostic equipment. In the present study, a method based on parallel receive beamforming was developed to achieve high-frame-rate (over 300 Hz) echocardiography.

METHODS

To increase the frame rate, the number of transmits was reduced to 15 with angular intervals of 6°, and 16 receiving beams were created for each transmission to obtain the same number and density of scan lines as realized by conventional sector scanning. In addition, several transmits were compounded to obtain each scan line to reduce the differences in transmit-receive sensitivities among scan lines. The number of transmits for compounding was determined by considering the width of the transmit beam. For transmission, plane waves and diverging waves were investigated. Diverging waves showed better performance than plane waves because the widths of plane waves did not increase with the range distance from the ultrasonic probe, whereas lateral intervals of scan lines increased with range distance.

RESULTS

The spatial resolution of the proposed method was validated using fine nylon wires. Although the widths at half-maxima of the point spread functions obtained by diverging waves were slightly larger than those obtained by conventional beamforming and parallel beamforming with plane waves, point spread functions very similar to those obtained by conventional beamforming could be realized by parallel beamforming with diverging beams and compounding. However, there was an increase in the lateral sidelobe level in the case of parallel beamforming with plane and diverging waves. Furthermore, the heart of a 23-year-old healthy male was measured.

CONCLUSION

Although the contrast of the B-mode image obtained by the proposed method was degraded due to the increased sidelobe level, a frame rate of 316 Hz, much higher than that realized by conventional sector scanning of several tens of Hertz, was realized with a full lateral field of view of 90°.

Propagation of vibration caused by electrical excitation in the normal human heart

The ability to noninvasively detect regional dynamic myocardial damage related to action potentials and mechanical properties affected by heart disease is of great clinical importance. Though there are invaluable clinical tools for diagnosis of a broad range of cardiac conditions, such myocardial properties cannot be evaluated. We have previously shown that pulsive vibration occurs on the myocardium after electrical stimulation of an isolated heart. In this study, using a novel technique for ultrasonic measurement of the myocardial motion, we detected pulsive vibrations spontaneously caused by electrical excitation and by valve closure. Using a sparse sector scan, the vibrations were measured almost simultaneously at about 10,000 points set in the heart wall at a high temporal resolution. The consecutive spatial distributions of the phase of the vibrations revealed wave propagation along the wall in healthy subjects for the first time in vivo. At around the time of the Q-wave of the electrocardiogram, the propagation started from the interventricular septum and extended to both the base and apical sides of the heart with a speed of 1 m/s, which corresponds to the propagation of electrical excitation from the Purkinje fiber-myocyte junction in the interventricular septum. Other vibrations then propagated from the base at several m/s, although some of them had dispersion properties. These are shear waves caused by the mitral-valve closure, corresponding to the first heart sound. These phenomena have potential for detection of regional myocardial tissue damage related to propagation of the action potentials and regional myocardial viscoelasticity.

A composite high-frame-rate system for clinical cardiovascular imaging

High frame-rate ultrasound RF data acquisition has been proved to be critical for novel cardiovascular imaging techniques, such as high-precision myocardial elastography, pulse wave imaging (PWI), and electromechanical wave imaging (EWI). To overcome the frame-rate limitations on standard clinical ultrasound systems, we developed an automated method for multi-sector ultrasound imaging through retrospective electrocardiogram (ECG) gating on a clinically used open architecture system. The method achieved both high spatial (64 beam density) and high temporal resolution (frame rate of 481 Hz) at an imaging depth up to 11 cm and a 100% field of view in a single breath-hold duration. Full-view imaging of the left ventricle and the abdominal aorta of healthy human subjects was performed using the proposed technique in vivo. ECG and ultrasound RF signals were simultaneously acquired on a personal computer (PC). Composite, full-view frames both in RF- and B-mode were reconstructed through retrospective combination of seven small (20%) juxtaposed sectors using an ECG-gating technique. The axial displacement of the left ventricle, in both long-axis and short-axis views, and that of the abdominal aorta, in a long-axis view, were estimated using a RF-based speckle tracking technique. The electromechanical wave and the pulse wave propagation were imaged in a ciné-loop using the proposed imaging technique. Abnormal patterns of such wave propagation can serve as indicators of early cardiovascular disease. This clinical system could thus expand the range of applications in cardiovascular elasticity imaging for quantitative, noninvasive diagnosis of myocardial ischemia or infarction, arrhythmia, abdominal aortic aneurysms, and early-stage atherosclerosis.

Visualization of propagation of pulse vibration along the heart wall and imaging of its propagation speed

Though myocardial viscoelasticity is essential in the evaluation of heart diastolic properties, it has never been noninvasively measured in vivo. By the ultrasonic measurement of the myocardial motion, we have already found that some pulsive waves are spontaneously excited by aortic-valve closure (AVC) at end-systole (T0) (IEEE UFFC-43(1996)791-810). Using a sparse sector scan, in which the beam directions are restricted to about 16, the pulsive waves were measured almost simultaneously at about 160 points set along the heart wall at a sufficiently high frame rate (UMB 27(2001)752-768). The consecutive spatial phase distributions clearly revealed wave propagation along the heart wall for the first time (IEEE UFFC 51(2005)1931-1942). The propagation time of the wave along the heart wall is very small and cannot be measured by conventional equipment. Based on this phenomenon, we developed a means to measure the myocardial viscoelasticity in vivo. The phase velocity of the wave is determined for each frequency component. By comparing the dispersion of the phase velocity with the theoretical one of the Lamb wave, which propagates along the viscoelastic plate (heart wall) immersed in blood, the instantaneous viscoelasticity is determined noninvasively (IEEE UFFC-51(2005)1931-1942). In this study, the phase distribution obtained by the sparse scan is interpolated and extrapolated, and then the spatial distribution of the instantaneous phase velocity of the wave components propagating from the base side to the apical side of the heart wall is obtained for the longitudinal cross-sectional image.

ECG-gated, mechanical and electromechanical wave imaging of cardiovascular tissues in vivo

In simplistic terms, the motion of the heart can be summarized as an active contraction and passive relaxation of the myocardium. However, the local motion of cardiovascular tissues over the course of an entire cardiac cycle results from various transient events such as the valves closing/opening, sudden changes in blood pressure and electrical conduction of the myocardium. The transient motion generated by most of these events occurs within a very short time (on the order of 1 ms) and cannot be imaged correctly with conventional imaging systems, due to their limited temporal resolution. In this paper, we propose a method for imaging this rapid transient motion of tissues in cardiovascular applications. Our method is based on imaging tissues with ultrasound at high frame rates (up to 8000 fps) by synchronizing the two-dimensional (2D) image acquisition on the electrocardiogram (ECG) signals. In vivo feasibility is demonstrated in anesthetized mice. The propagation of several transient mechanical waves was imaged in different regions of the myocardium and the wave phase velocities were found to be between 0.44 m/s and 5 m/s. These waves may be generated by either a purely mechanical effects or through electromechanical coupling in the myocardium depending on the phase of the cardiac cycle, in which they occur. The abdominal aorta was also imaged using the same technique and the propagation of a mechanical pulse wave was imaged. The pulse wave velocity was measured and the Young's modulus of the vessel wall was derived based on the Moens-Korteweg equation. This method could potentially be used for mapping the stiffness of the myocardium and the artery walls and may lead to the early diagnosis of cardiovascular diseases.

Automatic timing of aortic valve closure in apical tissue Doppler images

Ultrasound color tissue Doppler imaging (TDI) can be used to estimate velocities of moving left ventricular cardiac tissue. Aortic valve closure (AVC) can be observed as a notch in apical TDI velocity/time curves occurring after ejection, but before early relaxation. This work sought to evaluate automatic and automated algorithms using TDI for timing AVC. Mitral valve position and the time point of early relaxation were extracted and used to accomplish the task. To test the algorithms, phonocardiogram of the second heart sound was recorded simultaneously with TDI and used as a reference method. The algorithms were tested on apical views of 16 healthy subjects. In 98% of the cardiac cycles, the automatic algorithm estimated the time point of AVC within 25 ms of the reference. Automatic detection of AVC might save manual effort and provide a marker separating ejection and diastole for further automated analysis.

Propagation of spontaneously actuated pulsive vibration in human heart wall and in vivo viscoelasticity estimation

Though myocardial viscoelasticity is essential in the evaluation of heart diastolic properties, it has never been noninvasively measured in vivo. By the ultrasonic measurement of the myocardial motion, we have already found that some pulsive waves are spontaneously excited by aortic-valve closure (AVC) at end-systole (T0). These waves may serve as an ideal source of the intrinsic heart sound caused by AVC. In this study, using a sparse sector scan, in which the beam directions are restricted to about 16, the pulsive waves were measured almost simultaneously at about 160 points set along the heart wall at a sufficiently high frame rate. The consecutive spatial phase distributions, obtained by the Fourier transform of the measured waves, clearly revealed wave propagation along the heart wall for the first time. The propagation time of the wave along the heart wall is very small (namely, several milliseconds) and cannot be measured by conventional equipment. Based on this phenomenon, we developed a means to measure the myocardial viscoelasticity in vivo. In this measurement, the phase velocity of the wave is determined for each frequency component. By comparing the dispersion of the phase velocity with the theoretical one of the Lamb wave (the plate flexural wave), which propagates along the viscoelastic plate (heart wall) immersed in blood, the instantaneous viscoelasticity is determined noninvasively. This is the first report of such noninvasive determination. In in vivo experiments applied to five healthy subjects, propagation of the pulsive wave was clearly visible in all subjects. For the 60-Hz component, the typical propagation speed rapidly decreased from 5 m/s just before the time of AVC (t = T0 - 8 ms) to 3 m/s at t = T0 + 10 ms. In the experiments, it was possible to determine the viscosity more precisely than the elasticity. The typical value of elasticity was about 24-30 kPa and did not change around the time of AVC. The typical transient values of viscosity decreased rapidly from 400 Pa x s at t = T0 - 8 ms to 70 Pa x s at t = T0 + 10 ms. The measured shear elasticity and viscosity in this study are comparable to those obtained for the human tissues using audio frequency in in vitro experiments reported in the literature.

Elasticity imaging of atheroma with transcutaneous ultrasound: preliminary study

BACKGROUND

Knowledge of the physical properties of atherosclerotic plaque is essential when evaluating its vulnerability in a clinical setting. Such knowledge, however, is still difficult to obtain with the various approaches developed to date.

METHODS AND RESULTS

This article describes a noninvasive method for evaluating the regional elasticity (the elastic modulus in the circumferential direction) of tissue surrounding atherosclerotic plaque in which a novel phased tracking method is applied to measure minute changes in thickness of each of the multiple layers of the arterial wall during one heartbeat. By comparing the pathological findings with the distribution of elasticity, average elasticity of lipid and that of a mixture of smooth muscle and collagen fiber can be determined. On the basis of these reference parameters, each point is statistically categorized as lipid, mixture, or other. Thus, the plaque is electronically stained using transcutaneous ultrasound. By applying the method to the common carotid arteries, the presence of thin collagen fiber was clarified along the arterial axis for normal subjects, whereas soft inclusion of lipid was found for every plaque in subjects with hyperlipidemia.

CONCLUSIONS

This novel method offers potential as a diagnostic technique for detection of plaque vulnerability with high spatial resolution.

Left ventricular transmural systolic function by high-sensitivity velocity measurement "phased-tracking method" across the septum in doxorubicin cardiomyopathy

The clinical usefulness of doxorubicin is limited by doxorubicin-induced cardiomyopathy (DoxCM). The prognosis of this disorder is poor, and a sensitive noninvasive method for detection of DoxCM is strongly required. In this study, we examined if the transmural systolic function (TSF) obtained by the novel phased-tracking method is capable of supplying new information on DoxCM. A total of 18 healthy subjects and 30 patients with acute lymphoblastic leukemia were examined for TSF, as defined by the transmural profile of % thickening obtained by measuring the velocity at each preset point of 0.75-mm intervals. The total number of measurements was 94. In the patients, a decrease in both the peak velocity and the systolic layer thickening was observed, even in the subclinical phase of the normal ejection fraction. For healthy subjects, systolic thickening occurred in the left ventricular (LV) side of the interventricular septum (IVS), and was characterized by a sharp single-peak configuration of the profile. For the patients, however, the peak became dull and/or unclear, which indicates that a change in transmural functional distribution occurred. We concluded that the TSF is a useful measure for diagnosis of the early phase of DoxCM.

Systolic heterogeneity of transmural myocardial function in normal subjects: physiological functional heterogeneity

Because of the lack of a clinical method for assessing the transmural myocardial function, few studies on the heterogeneity during the myocardial contraction/relaxation sequence inside the human ventricular wall have been reported, despite the fact that the importance of the pathophysiology in the transmural heterogeneity has been stressed in previous experimental studies. We studied the transmyocardial functional heterogeneity of the basal anteroseptal segment in normal subjects (n = 8, 40.0 +/- 12.8 year, male), adopting the novel high resolution Doppler measurement "Phased Tracking Method". Each transmural layer of 0.75 mm thickness showed functional heterogeneity (physiological transmural functional heterogeneity), namely larger thickening occurred in the left ventricular endocardial side (right side 1/3: 26.1 +/- 5.2% of the total wall thickness, middle 1/3: 31.9 +/- 2.7%, left side 1/3: 42.1 +/- 6.4%) and the peak thickening shifted smoothly in time from the middle layers to the left subendocardial side during the contraction period. We concluded that transmural functional heterogeneity does exist in normal subjects as well as in the experimental animals of previous reports. Smooth and coordinate myocardial layer contraction across the ventricular wall (physiological transmural functional heterogeneity) is fundamental to maintain the normal ventricular function.