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Konijnenberg LSF, Beijnink CWH, van Lieshout M, Vos JL, Rodwell L, Bodi V, Ortiz-Pérez JT, van Royen N, Rodriguez Palomares J, Nijveldt R. Cardiovascular magnetic resonance imaging-derived intraventricular pressure gradients in ST-segment elevation myocardial infarction: a long-term follow-up study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae009. [PMID: 39045208 PMCID: PMC11195698 DOI: 10.1093/ehjimp/qyae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/07/2024] [Indexed: 07/25/2024]
Abstract
Aims Recently, novel post-processing tools have become available that measure intraventricular pressure gradients (IVPGs) on routinely obtained long-axis cine cardiac magnetic resonance (CMR) images. IVPGs provide a comprehensive overview of both systolic and diastolic left ventricular (LV) functions. Whether IVPGs are associated with clinical outcome after ST-elevation myocardial infarction (STEMI) is currently unknown. Here, we investigated the association between CMR-derived LV-IVPGs and major adverse cardiovascular events (MACE) in a large reperfused STEMI cohort with long-term outcome. Methods and results In this prospectively enrolled multi-centre cohort study, 307 patients underwent CMR within 14 days after the first STEMI. LV-IVPGs (from apex-to-base) were estimated on the long-axis cine images. During a median follow-up of 9.7 (5.9-12.5) years, MACE (i.e. composite of cardiovascular death and de novo heart failure hospitalisation) occurred in 49 patients (16.0%). These patients had larger infarcts, more often microvascular injury, and impaired LV-IVPGs. In univariable Cox regression, overall LV-IVPG was significantly associated with MACE and remained significantly associated after adjustment for common clinical risk factors (hazard ratio (HR) 0.873, 95% confidence interval (CI) 0.794-0.961, P = 0.005) and myocardial injury parameters (HR 0.906, 95% CI 0.825-0.995, P = 0.038). However, adjusted for LV ejection fraction and LV global longitudinal strain (GLS), overall LV-IVPG does not provide additional prognostic information (HR 0.959, 95% CI 0.866-1.063, P = 0.426). Conclusion Early after STEMI, CMR-derived LV-IVPGs are univariably associated with MACE and this association remains significant after adjustment for common clinical risk factors and measures of infarct severity. However, LV-IVPGs do not add prognostic value to LV ejection fraction and LV GLS.
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Affiliation(s)
- Lara S F Konijnenberg
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Casper W H Beijnink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Maarten van Lieshout
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jacqueline L Vos
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Epidemiology and Biostatistics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Instituto de Investigación Sanitaria (INCLIVA), 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28022 Madrid, Spain
| | - José T Ortiz-Pérez
- Department of Cardiology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Clínic Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - José Rodriguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28022 Madrid, Spain
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Prognostic implications of systolic function in patients with cirrhosis. GASTROENTEROLOGÍA Y HEPATOLOGÍA 2022; 46:446-454. [DOI: 10.1016/j.gastrohep.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
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Postigo A, Viola F, Chazo C, Martínez-Legazpi P, González-Mansilla A, Rodríguez-González E, Fernández-Avilés F, Del Álamo JC, Ebbers T, Bermejo J. Assessment of Blood Flow Transport in the Left Ventricle Using Ultrasound. Validation Against 4-D Flow Cardiac Magnetic Resonance. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1822-1832. [PMID: 35764455 PMCID: PMC10408642 DOI: 10.1016/j.ultrasmedbio.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Four-dimensional flow cardiac magnetic resonance (CMR) is the reference technique for analyzing blood transport in the left ventricle (LV), but similar information can be obtained from ultrasound. We aimed to validate ultrasound-derived transport in a head-to-head comparison against 4D flow CMR. In five patients and two healthy volunteers, we obtained 2D + t and 3D + t (4D) flow fields in the LV using transthoracic echocardiography and CMR, respectively. We compartmentalized intraventricular blood flow into four fractions of end-diastolic volume: direct flow (DF), retained inflow (RI), delayed ejection flow (DEF) and residual volume (RV). Using ultrasound we also computed the properties of LV filling waves (percentage of LV penetration and percentage of LV volume carried by E/A waves) to determine their relationships with CMR transport. Agreement between both techniques for quantifying transport fractions was good for DF and RV (Ric [95% confidence interval]: 0.82 [0.33, 0.97] and 0.85 [0.41, 0.97], respectively) and moderate for RI and DEF (Ric= 0.47 [-0.29, 0.88] and 0.55 [-0.20, 0.90], respectively). Agreement between techniques to measure kinetic energy was variable. The amount of blood carried by the E-wave correlated with DF and RV (R = 0.75 and R = 0.63, respectively). Therefore, ultrasound is a suitable method for expanding the analysis of intraventricular flow transport in the clinical setting.
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Affiliation(s)
- Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Federica Viola
- Department of Health, Medicine and Caring Sciences and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED and CIBERCV, Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Elena Rodríguez-González
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical Engineering Department, Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain.
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Matsuura K, Bach MB, Takahashi K, Willesen JL, Koch J, Tanaka R. Non-invasive assessment of left ventricular relaxation property using color M-mode-derived intraventricular pressure gradients in cats. J Vet Cardiol 2022; 41:236-248. [DOI: 10.1016/j.jvc.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
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Ma D, Mandour AS, Yoshida T, Matsuura K, Shimada K, Kitpipatkun P, Uemura A, Ifuku M, Takahashi K, Tanaka R. Intraventricular pressure gradients change during the development of left ventricular hypertrophy: Effect of salvianolic acid B and beta-blocker. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:229-240. [PMID: 34777543 DOI: 10.1177/1742271x20987584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022]
Abstract
Introduction Intraventricular pressure gradient is regarded as a non-invasive indicator of diastolic function. Salvianolic acid B (Sal-B), a traditional Asian medicine, revealed its usefulness in myocardial infarction models; however, the hemodynamic effect of salvianolic acid B is still unknown. The present study aimed to investigate the intraventricular pressure gradient changes during the development of left ventricular hypertrophy with or without salvianolic acid B and a beta-blocker. Methods In total, 48 rats were divided into four groups; Sham, Non-treatment, salvianolic acid B, and Carvedilol. Aortic coarctation-induced left ventricular hypertrophy was done in three groups and the treatment was started from the third to the sixth week. Blood pressure, conventional echocardiography, and color M-mode echocardiography for measurement of intraventricular pressure gradient were carried out for six consecutive weeks. Results At 4.5 weeks, the LV mass was elevated in the coarctation groups but the blood pressure was significantly lower in salvianolic acid B and Carvedilol groups (P < 0.05). In the Non-treatment group, the total intraventricular pressure gradient was increased at 4.5 and 6 weeks (2.60 and 2.65, respectively). Meanwhile, the basal intraventricular pressure gradient was elevated at 3 and 6 weeks (1.67 and 1.75) compared with the Sham group. Salvianolic acid B and Carvedilol significantly reduced the basal intraventricular pressure gradient at six weeks compared with the Non-treatment group (1.52 and 1.51 vs 1.75, respectively). Conclusions Salvianolic acid B and Carvedilol promote cardiac function by decreasing the elevated basal intraventricular pressure gradient. The current preclinical results revealed the efficacy of salvianolic acid B as a potential therapy for left ventricular hypertrophy because of the non-blood pressure lowering effect.
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Affiliation(s)
- Danfu Ma
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Ahmed S Mandour
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan.,Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Tomohiko Yoshida
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Katsuhiro Matsuura
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kazumi Shimada
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Pitipat Kitpipatkun
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Akiko Uemura
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Mayumi Ifuku
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryou Tanaka
- Departments of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
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Analysis of inter-system variability of systolic and diastolic intraventricular pressure gradients derived from color Doppler M-mode echocardiography. Sci Rep 2020; 10:7180. [PMID: 32346030 PMCID: PMC7188811 DOI: 10.1038/s41598-020-64059-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/09/2020] [Indexed: 11/11/2022] Open
Abstract
Assessment of intraventricular pressure gradients (IVPG) using color Doppler M-mode echocardiography has gained increasing interest in the evaluation of cardiac function. However, standardized analysis tools for IVPG quantification are missing. We aimed to evaluate the feasibility, the test-retest observer reproducibility, and the inter-system variability of a semi-automated IVPG quantification algorithm. The study included forty healthy volunteers (50% were men). All volunteers were examined using two ultrasound systems, the Philips Epiq 7 and the General Electric Vivid 6. Left ventricular diastolic (DIVPG) and systolic (SIVPG) intraventricular pressure gradients were measured from the spatiotemporal distribution of intraventricular propagation flow velocities using color Doppler M-mode in standard apical views. There was good feasibility for both systolic and diastolic IVPG measurements (82.5% and 85%, respectively). Intra and inter-observer test-retest variability measured with the intraclass correlation coefficient were 0.98 and 0.93 for DIVPG respectively, and 0.95 and 0.89 for SIVPG respectively. The inter-system concordance was weak to moderate with Lin’s concordance correlation coefficient of 0.59 for DIVPG and 0.25 for SIVPG. In conclusion, it is feasible and reproducible to assess systolic and diastolic IVPG using color Doppler M-mode in healthy volunteers. However, the inter-system variability in IVPG analysis needs to be taken into account, especially when using displayed data.
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Hodzic A, Garcia D, Saloux E, Ribeiro PAB, Ethier A, Thomas JD, Milliez P, Normand H, Tournoux F. Echocardiographic evidence of left ventricular untwisting-filling interplay. Cardiovasc Ultrasound 2020; 18:8. [PMID: 32075637 PMCID: PMC7029574 DOI: 10.1186/s12947-020-00190-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 11/11/2022] Open
Abstract
Background Left ventricular untwisting generates an early diastolic intraventricular pressure gradient (DIVPG) than can be quantified by echocardiography. We sought to confirm the quantitative relationship between peak untwisting rate and peak DIVPG in a large adult population. Methods From our echocardiographic database, we retrieved all the echocardiograms with a normal left ventricular ejection fraction, for whom color Doppler M-Mode interrogation of mitral inflow was available, and left ventricular untwisting rate was measurable using speckle tracking. Standard indices of left ventricular early diastolic function were assessed by Doppler (peaks E, e’ and Vp) and speckle tracking (peak strain rate Esr). Load dependency of DIVPG and untwisting rate was evaluated using a passive leg raising maneuver. Results We included 154 subjects, aged between 18 to 77 years old, 63% were male. Test-retest reliability for color Doppler-derived DIVPG measurements was good, the intraclass correlation coefficients were 0.97 [0.91–0.99] and 0.97 [0.67–0.99] for intra- and inter-observer reproducibility, respectively. Peak DIVPG was positively correlated with peak untwisting rate (r = 0.73, P < 0.001). On multivariate analysis, peak DIVPG was the only diastolic parameter that was independently associated with untwisting rate. Age and gender were the clinical predictive factors for peak untwisting rate, whereas only age was independently associated with peak DIVPG. Untwisting rate and DIVPG were both load-dependent, without affecting their relationship. Conclusions Color Doppler-derived peak DIVPG was quantitatively and independently associated with peak untwisting rate. It thus provides a reliable flow-based index of early left ventricular diastolic function.
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Affiliation(s)
- Amir Hodzic
- Department of Clinical Physiology, INSERM COMETE, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. .,Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. .,Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada.
| | - Damien Garcia
- CREATIS, CNRS UMR 5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Paula A B Ribeiro
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - Amélie Ethier
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
| | - James D Thomas
- Department of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, USA
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Hervé Normand
- Department of Clinical Physiology, INSERM COMETE, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Francois Tournoux
- Research Center of the Hospital of the University of Montreal (Centre de Recherche du Centre Hospitalier de l'Université de Montréal), Montreal, Canada
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Abstract
Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.
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Londono-Hoyos FJ, Swillens A, Van Cauwenberge J, Meyers B, Koppula MR, Vlachos P, Chirinos JA, Segers P. Assessment of methodologies to calculate intraventricular pressure differences in computational models and patients. Med Biol Eng Comput 2017; 56:469-481. [PMID: 28812203 DOI: 10.1007/s11517-017-1704-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/03/2017] [Indexed: 12/29/2022]
Abstract
Intraventricular pressure differences (IVPDs) govern left ventricular (LV) efficient filling and are a significant determinant of LV diastolic function. Our primary aim is to assess the performance of available methods (color M-mode (CMM) and 1D/2D MRI-based methods) to determine IVPDs from intracardiac flow measurements. Performance of three methods to calculate IVPDs was first investigated via an LV computational fluid dynamics (CFD) model. CFD velocity data were derived along a modifiable scan line, mimicking ultrasound/MRI acquisition of 1D (IVPDCMM/IVPD1D MRI) and 2D (IVPD2D MRI) velocity-based IVPD information. CFD pressure data (IVPDCFD) was used as a ground truth. Methods were also compared in a small cohort (n = 13) of patients with heart failure with preserved ejection fraction (HFpEF). In silico data showed a better performance of the IVPD2D MRI approach: RMSE values for a well-aligned scan line were 0.2550 mmHg (IVPD1D MRI), 0.0798 mmHg (IVPD2D MRI), and 0.2633 mmHg (IVPDCMM). In vivo data exhibited moderate correlation between techniques. Considerable differences found may be attributable to different timing of measurements and/or integration path. CFD modeling demonstrated an advantage using 2D velocity information to compute IVPDs, and therefore, a 2D MRI-based method should be favored. However, further studies are needed to support the clinical significance of MRI-based computation of IVPDs over CMM.
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Affiliation(s)
- Francisco J Londono-Hoyos
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium. .,Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Abigail Swillens
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
| | - Joris Van Cauwenberge
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
| | - Brett Meyers
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Maheswara Reddy Koppula
- Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Pavlos Vlachos
- Department of Mechanical Engineering, Purdue University, West Lafayette, IN, USA
| | - Julio A Chirinos
- Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Patrick Segers
- bioMMeda Research Group, Institute of Biomedical Technology (IBiTech), iMinds Ghent University, Ghent, Belgium
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Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, Heiberg E. On estimating intraventricular hemodynamic forces from endocardial dynamics: A comparative study with 4D flow MRI. J Biomech 2017; 60:203-210. [PMID: 28711164 DOI: 10.1016/j.jbiomech.2017.06.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/26/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
Intraventricular pressure gradients or hemodynamic forces, which are their global measure integrated over the left ventricular volume, have a fundamental importance in ventricular function. They may help revealing a sub-optimal cardiac function that is not evident in terms of tissue motion, which is naturally heterogeneous and variable, and can influence cardiac adaptation. However, hemodynamic forces are not utilized in clinical cardiology due to the unavailability of simple non-invasive measurement tools. Hemodynamic forces depend on the intraventricular flow; nevertheless, most of them are imputable to the dynamics of the endocardial flow boundary and to the exchange of momentum across the mitral and aortic orifices. In this study, we introduce a simplified model based on first principles of fluid dynamics that allows estimating hemodynamic forces without knowing the velocity field inside the LV. The model is validated with 3D phase-contrast MRI (known as 4D flow MRI) in 15 subjects, (5 healthy and 10 patients) using the endocardial surface reconstructed from the three standard long-axis projections. Results demonstrate that the model provides consistent estimates for the base-apex component (mean correlation coefficient r=0.77 for instantaneous values and r=0.88 for root mean square) and good estimates of the inferolateral-anteroseptal component (r=0.50 and 0.84, respectively). The present method represents a potential integration to the existing ones quantifying endocardial deformation in MRI and echocardiography to add a physics-based estimation of the corresponding hemodynamic forces. These could help the clinician to early detect sub-clinical diseases and differentiate between different cardiac dysfunctional states.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - Per M Arvidsson
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Johannes Töger
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden
| | - Federico Domenichini
- Department of Civil and Environmental Engineering, University of Firenze, Firenze, Italy
| | - Håkan Arheden
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Einar Heiberg
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden; Department of Biomedical Engineering, Lund University, Lund, Sweden
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Jain S, Londono FJ, Segers P, Gillebert TC, De Buyzere M, Chirinos JA. MRI Assessment of Diastolic and Systolic Intraventricular Pressure Gradients in Heart Failure. Curr Heart Fail Rep 2016; 13:37-46. [DOI: 10.1007/s11897-016-0281-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Donati F, Figueroa CA, Smith NP, Lamata P, Nordsletten DA. Non-invasive pressure difference estimation from PC-MRI using the work-energy equation. Med Image Anal 2015; 26:159-72. [PMID: 26409245 PMCID: PMC4686008 DOI: 10.1016/j.media.2015.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/21/2015] [Accepted: 08/31/2015] [Indexed: 01/15/2023]
Abstract
Pressure difference is an accepted clinical biomarker for cardiovascular disease conditions such as aortic coarctation. Currently, measurements of pressure differences in the clinic rely on invasive techniques (catheterization), prompting development of non-invasive estimates based on blood flow. In this work, we propose a non-invasive estimation procedure deriving pressure difference from the work-energy equation for a Newtonian fluid. Spatial and temporal convergence is demonstrated on in silico Phase Contrast Magnetic Resonance Image (PC-MRI) phantoms with steady and transient flow fields. The method is also tested on an image dataset generated in silico from a 3D patient-specific Computational Fluid Dynamics (CFD) simulation and finally evaluated on a cohort of 9 subjects. The performance is compared to existing approaches based on steady and unsteady Bernoulli formulations as well as the pressure Poisson equation. The new technique shows good accuracy, robustness to noise, and robustness to the image segmentation process, illustrating the potential of this approach for non-invasive pressure difference estimation.
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Affiliation(s)
- Fabrizio Donati
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
| | - C Alberto Figueroa
- University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48105, United States.
| | - Nicolas P Smith
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Auckland, Engineering School Block 1, Level 5, 20 Symonds St, Auckland 101, New Zealand.
| | - Pablo Lamata
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Oxford, Department of Computer Science, Wolfson Building, Parks Road, Oxford OX1 3QD, United Kingdom.
| | - David A Nordsletten
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
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14
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Pérez del Villar C, Yotti R, Bermejo J. Imaging Techniques in Acute Heart Failure. ACTA ACUST UNITED AC 2015; 68:612-23. [PMID: 26002273 DOI: 10.1016/j.rec.2015.02.021] [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: 01/30/2015] [Accepted: 02/16/2015] [Indexed: 12/01/2022]
Abstract
In recent years, imaging techniques have revolutionized the diagnosis of heart failure. In patients with a clinical picture of acute decompensation, prognosis is largely determined by early implementation of general measures and treatment of the underlying cause. Given its diagnostic yield and portability, ultrasound has become an essential tool in the setting of acute heart failure, and is currently found in all medical departments involved in the care of the critically ill patient. Cardiac magnetic resonance and computed tomography allow detailed characterization of multiple aspects of cardiac structure and function that were previously unavailable. This helps guide and monitor many of the treatment decisions in the acute heart failure population in an entirely noninvasive way. This article aims to review the usefulness of the imaging techniques that are clinically relevant in the context of an episode of acute heart failure. We discuss the indications and limitations of these techniques in detail and describe the general principles for the appropriate interpretation of results.
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Affiliation(s)
- Candelas Pérez del Villar
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Yotti
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Bermejo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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15
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Palmiero P, Zito A, Maiello M, Cameli M, Modesti PA, Muiesan ML, Novo S, Saba PS, Scicchitano P, Pedrinelli R, Ciccone MM. Left ventricular diastolic function in hypertension: methodological considerations and clinical implications. J Clin Med Res 2014; 7:137-44. [PMID: 25584097 PMCID: PMC4285058 DOI: 10.14740/jocmr2050w] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/30/2022] Open
Abstract
The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination of hypertensive patient; indeed when LV diastolic function is impaired, it is possible to have heart failure even with preserved LV ejection fraction. Left ventricular diastolic dysfunction (LVDD) occurs frequently and is associated to heart disease. Doppler echocardiography is the best tool for early LVDD diagnosis. Hypertension affects LV relaxation and when left ventricular hypertrophy (LVH) occurs, it decreases compliance too, so it is important to calculate Doppler echocardiography parameters, for diastolic function evaluation, in all hypertensive patients. The purpose of our review was to discuss about the strong relationship between LVDD and hypertension, and their relationship with LV systolic function. Furthermore, we aimed to assess the relationship between the arterial stiffness and LV structure and function in hypertensive patients.
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Affiliation(s)
| | - Annapaola Zito
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Maria Maiello
- ASL Department of Cardiology, Brindisi District, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Novo
- Department of Internal Medicine and Cardiovascular Diseases, Palermo, Italy
| | - Pier Sergio Saba
- Cardiologia, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Pietro Scicchitano
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Universita di Pisa, Pisa, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
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16
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Contribution of the Diastolic Vortex Ring to Left Ventricular Filling. J Am Coll Cardiol 2014; 64:1711-21. [DOI: 10.1016/j.jacc.2014.06.1205] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022]
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17
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Bermejo J, Benito Y, Alhama M, Yotti R, Martínez-Legazpi P, Del Villar CP, Pérez-David E, González-Mansilla A, Santa-Marta C, Barrio A, Fernández-Avilés F, Del Álamo JC. Intraventricular vortex properties in nonischemic dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2014; 306:H718-29. [PMID: 24414062 DOI: 10.1152/ajpheart.00697.2013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vortices may have a role in optimizing the mechanical efficiency and blood mixing of the left ventricle (LV). We aimed to characterize the size, position, circulation, and kinetic energy (KE) of LV main vortex cores in patients with nonischemic dilated cardiomyopathy (NIDCM) and analyze their physiological correlates. We used digital processing of color-Doppler images to study flow evolution in 61 patients with NIDCM and 61 age-matched control subjects. Vortex features showed a characteristic biphasic temporal course during diastole. Because late filling contributed significantly to flow entrainment, vortex KE reached its maximum at the time of the peak A wave, storing 26 ± 20% of total KE delivered by inflow (range: 1-74%). Patients with NIDCM showed larger and stronger vortices than control subjects (circulation: 0.008 ± 0.007 vs. 0.006 ± 0.005 m(2)/s, respectively, P = 0.02; KE: 7 ± 8 vs. 5 ± 5 mJ/m, P = 0.04), even when corrected for LV size. This helped confining the filling jet in the dilated ventricle. The vortex Reynolds number was also higher in the NIDCM group. By multivariate analysis, vortex KE was related to the KE generated by inflow and to chamber short-axis diameter. In 21 patients studied head to head, Doppler measurements of circulation and KE closely correlated with phase-contract magnetic resonance values (intraclass correlation coefficient = 0.82 and 0.76, respectively). Thus, the biphasic nature of filling determines normal vortex physiology. Vortex formation is exaggerated in patients with NIDCM due to chamber remodeling, and enlarged vortices are helpful for ameliorating convective pressure losses and facilitating transport. These findings can be accurately studied using ultrasound.
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Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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18
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Yotti R, Bermejo J, Benito Y, Sanz-Ruiz R, Ripoll C, Martínez-Legazpi P, del Villar CP, Elízaga J, González-Mansilla A, Barrio A, Bañares R, Fernández-Avilés F. Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study. Circ Cardiovasc Imaging 2013; 7:164-72. [PMID: 24173273 DOI: 10.1161/circimaging.113.000722] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Noninvasive indices based on Doppler echocardiography are increasingly used in clinical cardiovascular research to evaluate left ventricular global systolic chamber function. Our objectives were to clinically validate ultrasound-based methods of global systolic chamber function to account for differences between patients in conditions of abnormal load, and to assess their sensitivity to load confounders. METHODS AND RESULTS Twenty-seven patients (8 dilated cardiomyopathy, 10 normal ejection fraction, and 9 end-stage liver disease) underwent simultaneous echocardiography and left heart catheterization with pressure-conductance instrumentation. The reference index, maximal elastance (Emax), was calculated from pressure-volume loop data obtained during acute inferior vena cava occlusion. A wide range of values were observed for left ventricular systolic chamber function (Emax: 2.8±1.0 mm Hg/mL), preload, and afterload. Among the noninvasive indices tested, the peak ejection intraventricular pressure difference showed the best correlation with Emax (R=0.75). A significant but weaker correlation with Emax was observed for ejection fraction (R=0.41), midwall fractional shortening (R=0.51), global circumferential strain (R=-0.53), and strain rate (R=-0.46). Longitudinal strain and strain rate failed to correlate with Emax, as did noninvasive single-beat estimations of this index. Principal component and multiple regression analyses demonstrated that peak ejection intraventricular pressure difference was less sensitive to load, whereas ejection fraction and longitudinal strain and strain rate were heavily influenced by afterload. CONCLUSIONS Current ultrasound methods have limited accuracy to characterize global left ventricular systolic chamber function in a given patient. The Doppler-derived peak ejection intraventricular pressure difference should be preferred for this purpose because it best correlates with the reference index and is more robust in conditions of abnormal load.
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19
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Pasipoularides A. Flujo diastólico ventricular derecho e izquierdo: ¿por qué son bajos los gradientes de presión intraventricular medidos? Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Pasipoularides A. Right and left ventricular diastolic flow field: why are measured intraventricular pressure gradients small? ACTA ACUST UNITED AC 2012; 66:337-41. [PMID: 24775813 DOI: 10.1016/j.rec.2012.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Ares Pasipoularides
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States.
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21
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Ghosh E, Kovács SJ. Spatio-temporal attributes of left ventricular pressure decay rate during isovolumic relaxation. Am J Physiol Heart Circ Physiol 2012; 302:H1094-101. [DOI: 10.1152/ajpheart.00990.2011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Global left ventricular (LV) isovolumic relaxation rate has been characterized: 1) via the time constant of isovolumic relaxation τ or 2) via the logistic time constant τ L. An alternate kinematic method, characterizes isovolumic relaxation (IVR) in accordance with Newton's Second Law. The model's parameters, stiffness Ek, and damping/relaxation μ result from best fit of model-predicted pressure to in vivo data. All three models (exponential, logistic, and kinematic) characterize global relaxation in terms of pressure decay rates. However, IVR is inhomogeneous and anisotropic. Apical and basal LV wall segments untwist at different times and rates, and transmural strain and strain rates differ due to the helically variable pitch of myocytes and sheets. Accordingly, we hypothesized that the exponential model (τ) or kinematic model (μ and Ek) parameters will elucidate the spatiotemporal variation of IVR rate. Left ventricular pressures in 20 subjects were recorded using a high-fidelity, multipressure transducer (3 cm apart) catheter. Simultaneous, dual-channel pressure data was plotted in the pressure phase-plane (dP/d t vs. P) and τ, μ, and Ek were computed in 1631 beats (average: 82 beats per subject). Tau differed significantly between the two channels ( P < 0.05) in 16 of 20 subjects, whereas μ and Ek differed significantly ( P < 0.05) in all 20 subjects. These results show that quantifying the relaxation rate from data recorded at a single location has limitations. Moreover, kinematic model based analysis allows characterization of restoring (recoil) forces and resistive (crossbridge uncoupling) forces during IVR and their spatio-temporal dependence, thereby elucidating the relative roles of stiffness vs. relaxation as IVR rate determinants.
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Affiliation(s)
- Erina Ghosh
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University, St. Louis, Missouri
| | - Sándor J. Kovács
- Cardiovascular Biophysics Laboratory, Cardiovascular Division, Department of Internal Medicine, School of Medicine; and
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University, St. Louis, Missouri
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22
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Unsupervised dealiasing and denoising of color-Doppler data. Med Image Anal 2011; 15:577-88. [DOI: 10.1016/j.media.2011.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/24/2011] [Accepted: 03/12/2011] [Indexed: 11/19/2022]
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23
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Yotti R, Bermejo J, Benito Y, Antoranz JC, Desco MM, Rodríguez-Pérez D, Cortina C, Mombiela T, Barrio A, Elízaga J, Fernández-Avilés F. Noninvasive Estimation of the Rate of Relaxation by the Analysis of Intraventricular Pressure Gradients. Circ Cardiovasc Imaging 2011; 4:94-104. [PMID: 21245360 DOI: 10.1161/circimaging.110.960369] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background—
During late ejection, myocardial relaxation causes systolic flow to decelerate and stop, and this phenomenon is coupled with the generation of a pressure gradient inside the left ventricle (LV). We hypothesized that the peak reverse ejection intraventricular pressure difference (REIVPD) between the LV apex and the outflow tract could be a useful method to improve the assessment of LV relaxation using Doppler echocardiography.
Methods and Results—
Three sets of animal experiments and 1 clinical study were designed. In 6 pigs, a close relationship between REIVPD and the intensity of the relaxation wave (
R
rm
=0.89) was demonstrated using wave intensity analysis of high-fidelity pressure-volume-velocity data. In 19 animals, REIVPD sensitively detected modifications of the lusotropic state and closely correlated with the time constant of LV relaxation (τ) within animals (
R
rm
=−0.93). Load-dependence analysis in 5 pigs showed that REIVPD remained stable up to values of 35% to 40% acute preload reduction. Clinical validation was tested in 50 patients (23 with normal systolic function) undergoing simultaneous Doppler echocardiography and high-fidelity LV pressure measurements on the same beat. REIVPD and tissue Doppler mitral annulus velocity (e′) were independently related to τ, but the REIVPD · e′ product correlated better with τ than either variable separately (bootstrap-corrected correlation coefficients:
R
=−0.84 versus −0.71, and −0.70, respectively,
P
<0.05). Area under the receiver operating characteristic curve to predict impaired relaxation (τ>50 ms) for e′ · REIVPD was 0.96 (95% confidence interval, 0.85 to 0.99).
Conclusions—
The Doppler-derived REIVPD provides a sensitive, reliable, reproducible, and relatively load-independent index of the rate of LV relaxation. Combined with tissue Doppler measurements of longitudinal function, this method improves noninvasive assessment of LV relaxation in the clinical setting.
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Affiliation(s)
- Raquel Yotti
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Javier Bermejo
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Yolanda Benito
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - J. Carlos Antoranz
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - M. Mar Desco
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Daniel Rodríguez-Pérez
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Cristina Cortina
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Teresa Mombiela
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Alicia Barrio
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Jaime Elízaga
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Francisco Fernández-Avilés
- From the Department of Cardiology (R.Y., J.B., Y.B., C.C., T.M., A.B., J.E., F.F.-A.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; and the Department of Mathematical Physics and Fluids (C.A., M.M.D., D.R.-P.), Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
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24
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Bazilevs Y, del Alamo JC, Humphrey JD. From imaging to prediction: Emerging non-invasive methods in pediatric cardiology. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Garcia D, Del Alamo JC, Tanne D, Yotti R, Cortina C, Bertrand E, Antoranz JC, Perez-David E, Rieu R, Fernandez-Aviles F, Bermejo J. Two-dimensional intraventricular flow mapping by digital processing conventional color-Doppler echocardiography images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:1701-13. [PMID: 20562044 DOI: 10.1109/tmi.2010.2049656] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam blood velocities were calculated using the continuity equation under a planar flow assumption. To validate the algorithm, 2D Doppler flow mapping and laser particle image velocimetry (PIV) measurements were carried out in an atrio-ventricular duplicator. Phase-contrast magnetic resonance (MR) acquisitions were used to measure in vivo the error due to the 2D flow assumption and to potential scan-plane misalignment. Finally, the applicability of the Doppler technique was tested in the clinical setting. In vitro experiments demonstrated that the new method yields an accurate quantitative description of the main vortex that forms during the cardiac cycle (mean error for vortex radius, position and circulation). MR image analysis evidenced that the error due to the planar flow assumption is close to 15% and does not preclude the characterization of major vortex properties neither in the normal nor in the dilated LV. These results are yet to be confirmed by a head-to-head clinical validation study. Clinical Doppler studies showed that the method is readily applicable and that a single large anterograde vortex develops in the healthy ventricle while supplementary retrograde swirling structures may appear in the diseased heart. The proposed echocardiographic method based on the continuity equation is fast, clinically-compliant and does not require complex training. This technique will potentially enable investigators to study of additional quantitative aspects of intraventricular flow dynamics in the clinical setting by high-throughput processing conventional color-Doppler images.
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Affiliation(s)
- Damien Garcia
- CRCHUM-Research Centre, University of Montreal Hospital, Montreal, QC H2L2W5, Canada
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26
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Del Alamo JC, Marsden AL, Lasheras JC. Recent advances in the application of computational mechanics to the diagnosis and treatment of cardiovascular disease. Rev Esp Cardiol 2009; 62:781-805. [PMID: 19709514 PMCID: PMC6089365 DOI: 10.1016/s1885-5857(09)72359-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
During the last 30 years, research into the pathogenesis and progression of cardiovascular disease has had to employ a multidisciplinary approach involving a wide range of subject areas, from molecular and cell biology to computational mechanics and experimental solid and fluid mechanics. In general, research was driven by the need to provide answers to questions of critical importance for disease management. Ongoing improvements in the spatial resolution of medical imaging equipment coupled to an exponential growth in the capacity, flexibility and speed of computational techniques have provided a valuable opportunity for numerical simulations and complex experimental techniques to make a contribution to improving the diagnosis and clinical management of many forms of cardiovascular disease. This paper contains a review of recent progress in the numerical simulation of cardiovascular mechanics, focusing on three particular areas: patient-specific modeling and the optimization of surgery in pediatric cardiology, evaluating the risk of rupture in aortic aneurysms, and noninvasive characterization of intraventricular flow in the management of heart failure.
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Affiliation(s)
- Juan C Del Alamo
- Department of Mechanical and Aerospace Engineering, University of California, San Diego, California, USA
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27
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del Álamo JC, Marsden AL, Lasheras JC. Avances en mecánica computacional para el diagnóstico y tratamiento de la enfermedad cardiovascular. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71692-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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NAGAO T, YOSHIDA K, OKADA K, MIYAZAKI S, UEGUCHI T, MURASE K. Development of a Noninvasive Method to Measure Intravascular and Intracardiac Pressure Differences Using Magnetic Resonance Imaging. Magn Reson Med Sci 2008; 7:113-22. [DOI: 10.2463/mrms.7.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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29
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Rojo-Alvarez JL, Bermejo J, Rodríguez-González AB, Martínez-Fernández A, Yotti R, García-Fernández MA, Carlos Antoranz J. Impact of image spatial, temporal, and velocity resolutions on cardiovascular indices derived from color-Doppler echocardiography. Med Image Anal 2007; 11:513-25. [PMID: 17573232 DOI: 10.1016/j.media.2007.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 01/23/2007] [Accepted: 04/15/2007] [Indexed: 11/28/2022]
Abstract
Quantitative processing of color-Doppler echocardiographic images has substantially improved noninvasive assessment of cardiac physiology. Many indices are computed from the velocity fields derived either from color-Doppler tissue imaging (DTI), such as acceleration, strain and strain-rate, or from blood-flow color-Doppler, such as intracardiac pressure gradients (ICPG). All of these indices are dependent on the finite resolution of the ultrasound scanner. Therefore, we developed an image-dependent method for assessing the influence of temporal, spatial, and velocity resolutions, on cardiovascular parameters derived from velocity images. In order to focus our study on the spatial, temporal, and velocity resolutions of the digital image, we did not consider the effect of other sources of noise such as the interaction between ultrasound and tissue. A simple first-order Taylor's expansion was used to establish the functional relationship between the acquired image velocity and the calculated cardiac index. Resolutions were studied on: (a) myocardial acceleration, strain, and strain-rate from DTI, and (b) ICPG from blood-flow color-Doppler. The performance of Taylor's-based error bounds (TBEB) was demonstrated on simulated models and illustrated on clinical images. Velocity and temporal resolution were highly relevant for the accuracy of DTI-derived parameters and ICPGs. TBEB allow to assess the effects of ideal digital image resolution on quantitative cardiovascular indices derived from velocity measurements obtained by cardiac imaging techniques.
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Affiliation(s)
- José Luis Rojo-Alvarez
- Department of Signal Theory and Communications, Universidad Rey Juan Carlos, Madrid, Spain
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30
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Cortina C, Bermejo J, Yotti R, Desco MM, Rodríguez-Pérez D, Antoranz JC, Rojo-Alvarez JL, Garcia D, García-Fernández MA, Fernández-Avilés F. Noninvasive Assessment of the Right Ventricular Filling Pressure Gradient. Circulation 2007; 116:1015-23. [PMID: 17684149 DOI: 10.1161/circulationaha.107.691154] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The physiological basis of right ventricular (RV) diastolic function remains incompletely studied in humans. The driving force responsible for RV filling, the pressure gradient along the RV inlet from the right atrium to the RV apex, has never been measured in the clinical setting.
Methods and Results—
We validated a method for measuring the RV filling pressure difference (RVFPD) from color Doppler M-mode recordings in 12 pigs undergoing interventions on RV preload, afterload, and lusitropic states (error, −0.1±0.4 mm Hg compared with micromanometers; intraclass correlation coefficient, 0.88). Peak early RVFPD correlated directly with mean right atrial pressure and inversely with the time constant of RV relaxation. In 21 patients with dilated cardiomyopathy, the peak RVFPD was 1.0 mm Hg (95% CI, 0.8 to 1.2), significantly lower than in age-matched control subjects (1.4 mm Hg; 95% CI, 1.2 to 1.6). In another population of 19 young healthy volunteers, the peak RVFPD was 2.3 mm Hg (95% CI, 2.0 to 2.6), which was reduced by nitroglycerine and esmolol and was augmented by volume overload and atropine infusions. RVFPD was generated almost exclusively by inertial forces.
Conclusions—
For the first time, the RV driving filling force can be accurately measured noninvasively in the clinical setting, and the method is sensitive to detect the effects of preload, chronotropic, and lusitropic states. In patients with dilated cardiomyopathy, the RV filling force is markedly reduced, indicating severely impaired RV relaxation. These findings suggest that this is a useful tool for improving the clinical assessment of RV diastolic function.
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Affiliation(s)
- Cristina Cortina
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain
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Rovner A, Waggoner AD, Mathews SJ, Dávila-Román VG, de las Fuentes L. Role of Tissue Doppler and Color M-Mode Imaging for Evaluation of Diastolic Function in Ambulatory Patients with LV Systolic Dysfunction. Echocardiography 2007; 24:478-84. [PMID: 17456066 DOI: 10.1111/j.1540-8175.2007.00435.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Tissue Doppler imaging (TDI) and color M-mode (CMM) indices provide assessment of left ventricular (LV) relaxation when combined with pulse-wave Doppler (PWD)-derived transmitral inflow, allows for estimation of LV filling pressures. However, use of these indices in patients with LV systolic dysfunction (LVSD) has not been well characterized. METHODS AND RESULTS The study included 115 patients (age 58 +/- 11 years, 67% male) with LVSD (LV ejection fraction [LVEF] < 55%). Patients were grouped according to the diastolic LV filling pressure assessed by E/Em(septal) ratio as follows: 1) Normal (NFP), E/Em(septal) < 8; 2) Intermediate (IFP), E/Em(septal): 8-15; and 3) High (HFP), E/Em(septal) >15. Age-, gender-, and LVEF-adjusted analyses were performed. LV volumes and LVEF were significantly different between the groups (P < 0.01). PWD-derived E-wave velocity showed a significant stepwise increase across the three groups and the Em(septal) velocity demonstrated a stepwise decrease (P < 0.01 for both). CMM-derived diastolic intra-ventricular pressure gradient (IVPG) was significantly lower in the HFP compared to the other 2 groups (P < 0.01 for both); Vp was increased in the HFP compared to the other 2 groups (P < 0.01 for both), and Vp exhibited a U-shape relationship to LVEF. CONCLUSION In patients with LVSD, abnormal LV relaxation is uniformly observed regardless of LV filling pressure. PWD-derived E-wave velocity and the TDI-derived Em velocity are important measurements to identify elevated LV filling pressures. CMM-derived Vp and IVPG were of limited incremental value for the evaluation of diastolic function in patients with LVSD.
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Affiliation(s)
- Aleksandr Rovner
- Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, Cardiovascular Division, St. Louis, Missouri 63110, USA
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Rojo-Alvarez JL, Bermejo J, Juárez-Caballero VM, Yotti R, Cortina C, García-Fernández MA, Antoranz JC. Support vector analysis of color-Doppler images: a new approach for estimating indices of left ventricular function. IEEE TRANSACTIONS ON MEDICAL IMAGING 2006; 25:1037-43. [PMID: 16894996 DOI: 10.1109/tmi.2006.875437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Reliable noninvasive estimators of global left ventricular (LV) chamber function remain unavailable. We have previously demonstrated a potential relationship between color-Doppler M-mode (CDMM) images and two basic indices of LV function: peak-systolic elastance (Emax) and the time-constant of LV relaxation (tau). Thus, we hypothesized that these two indices could be estimated noninvasively by adequate postprocessing of CDMM recordings. A semiparametric regression (SR) version of support vector machine (SVM) is here proposed for building a blind model, capable of analyzing CDMM images automatically, as well as complementary clinical information. Simultaneous invasive and Doppler tracings were obtained in nine mini-pigs in a high-fidelity experimental setup. The model was developed using a test and validation leave-one-out design. Reasonably acceptable prediction accuracy was obtained for both Emax (intraclass correlation coefficient Ric, = 0.81) and tau (Ric, = 0.61). For the first time, a quantitative, noninvasive estimation of cardiovascular indices is addressed by processing Doppler-echocardiography recordings using a learning-from-samples method.
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Affiliation(s)
- J L Rojo-Alvarez
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Spain
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Yotti R, Bermejo J, Antoranz JC, Desco MM, Cortina C, Rojo-Alvarez JL, Allué C, Martín L, Moreno M, Serrano JA, Muñoz R, García-Fernández MA. A Noninvasive Method for Assessing Impaired Diastolic Suction in Patients With Dilated Cardiomyopathy. Circulation 2005; 112:2921-9. [PMID: 16275881 DOI: 10.1161/circulationaha.105.561340] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diastolic suction is a major determinant of early left ventricular filling in animal experiments. However, suction remains incompletely characterized in the clinical setting. METHODS AND RESULTS First, we validated a method for measuring the spatio-temporal distributions of diastolic intraventricular pressure gradients and differences (DIVPDs) by digital processing color Doppler M-mode recordings. In 4 pigs, the error of peak DIVPD was 0.0+/-0.2 mm Hg (intraclass correlation coefficient, 0.95) compared with micromanometry. Forty patients with dilated cardiomyopathy (DCM) and 20 healthy volunteers were studied at baseline and during dobutamine infusion. A positive DIVPD (toward the apex) originated during isovolumic relaxation, reaching its peak shortly after mitral valve opening. Peak DIVPD was less than half in patients with DCM than in control subjects (1.2+/-0.6 versus 2.5+/-0.8 mm Hg, P<0.001). Dobutamine increased DIVPD in control subjects by 44% (P<0.001) but only by 23% in patients with DCM (P=NS). DIVPDs were the consequence of 2 opposite forces: a driving force caused by local acceleration, and a reversed (opposed to filling) convective force that lowered the total DIVPD by more than one third. In turn, local acceleration correlated with E-wave velocity and ejection fraction, whereas convective deceleration correlated with E-wave velocity and ventriculo:annular disproportion. Convective deceleration was highest among patients showing a restrictive filling pattern. CONCLUSIONS Patients with DCM show an abnormally low diastolic suction and a blunted capacity to recruit suction with stress. By raising the ventriculo:annular disproportion, chamber remodeling proportionally increases convective deceleration and adversely affects left ventricular filling. These previously unreported mechanisms of diastolic dysfunction can be studied by using Doppler echocardiography.
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Affiliation(s)
- Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Yotti R, Bermejo J, Desco MM, Antoranz JC, Rojo-Alvarez JL, Cortina C, Allué C, Rodríguez-Abella H, Moreno M, García-Fernández MA. Doppler-Derived Ejection Intraventricular Pressure Gradients Provide a Reliable Assessment of Left Ventricular Systolic Chamber Function. Circulation 2005; 112:1771-9. [PMID: 16172285 DOI: 10.1161/circulationaha.104.485128] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ejection intraventricular pressure gradients are caused by the systolic force developed by the left ventricle (LV). By postprocessing color Doppler M-mode (CDMM) images, we can measure noninvasively the ejection intraventricular pressure difference (EIVPD) between the LV apex and the outflow tract. This study was designed to assess the value of Doppler-derived EIVPDs as noninvasive indices of systolic chamber function. METHODS AND RESULTS CDMM images and pressure-volume (conductance) signals were simultaneously acquired in 9 minipigs undergoing pharmacological interventions and acute ischemia. Inertial, convective, and total EIVPD curves were calculated from CDMM recordings. Peak EIVPD closely correlated with indices of systolic function based on the pressure-volume relationship: peak elastance (within-animal R=0.98; between-animals R=0.99), preload recruitable stroke work (within-animal R=0.81; between-animals R=0.86), and peak of the first derivative of pressure corrected for end-diastolic volume (within-animal R=0.88; between-animals R=0.91). The correlation of peak inertial EIVPD with these indices was also high (all R>0.75). Load dependence of EIVPDs was studied in another 5 animals in which consecutive beats obtained during load manipulation were analyzed. During caval occlusion (40% EDV reduction), dP/dtmax, ejection fraction, and stroke volume significantly changed, whereas peak EIVPD remained constant. Aortic occlusion (40% peak LV pressure increase) significantly modified dP/dtmax, ejection fraction, and stroke volume; a nearly significant trend toward decreasing peak EIVPD was observed (P=0.06), whereas inertial EIVPD was unchanged (P=0.6). EIVPD beat-to-beat and interobserver variabilities were 2+/-12% and 5+/-11%, respectively. CONCLUSIONS Doppler-derived EIVPDs provide quantitative, reproducible, and relatively load-independent indices of global systolic chamber function that correlate closely with currently available reference methods.
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Affiliation(s)
- Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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Yotti R, Bermejo J, Antoranz JC, Rojo-Alvarez JL, Allue C, Silva J, Desco MM, Moreno M, García-Fernández MA. Noninvasive assessment of ejection intraventricular pressure gradients. J Am Coll Cardiol 2004; 43:1654-62. [PMID: 15120827 DOI: 10.1016/j.jacc.2003.09.066] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Revised: 08/14/2003] [Accepted: 09/29/2003] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study was designed to validate in vivo a new method to measure ejection intraventricular pressure gradients (IVPGs) by processing color M-mode Doppler data and to assess the effects of inotropic interventions on IVPGs in the clinical setting. BACKGROUND In the absence of obstruction, ejection IVPGs cannot be estimated by Doppler using the simplified Bernoulli equation. METHODS High-fidelity micromanometers were placed in the left ventricle of eight minipigs, and synchronic Doppler images and pressure signals were obtained during different hemodynamic conditions. Twenty healthy volunteers and 20 dilated cardiomyopathy patients were studied at baseline and during esmolol, dobutamine, and atropine infusion (only dobutamine in patients). RESULTS Excellent agreement was observed between micromanometer and Doppler methods for measuring instantaneous pressure differences among the apex, the mid-cavity, and the outflow tract (R(intraclass) = 0.98, 0.81, 0.76, and 0.98 for the peak, time-to-peak, peak reverse, and time-to-peak reverse values, respectively; n = 810 beats). Error of the noninvasive method was -0.05 +/- 0.25 mm Hg for the peak pressure difference. Parametrical images demonstrated that IVPGs originate mainly in the mid-ventricle and then propagate to the outflow tract. Both the magnitude and the temporal course of IVPGs were different among volunteers and patients. Inotropic interventions induced significant changes in the apex-outflow tract pressure differences in both populations, whereas atropine had no effect on IVPGs. CONCLUSIONS For the first time, ejection IVPGs can be accurately visualized and measured by Doppler-echocardiography. Important aspects of the dynamic interaction among myocardial performance, load mechanics, and ejection dynamics can be assessed in the clinical setting using this method.
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Affiliation(s)
- Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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Yotti R. ¿Qué significado tiene un gradiente de presión intraventricular sistólico durante el ejercicio? Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77255-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quiles J, García-Fernández MA, Almeida PB, Pérez-David E, Bermejo J, Moreno M, Avanzas P. Portable spectral Doppler echocardiographic device: overcoming limitations. Heart 2003; 89:1014-8. [PMID: 12923013 PMCID: PMC1767834 DOI: 10.1136/heart.89.9.1014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is evidence that new portable echocardiographic devices are useful in evaluating heart anatomy and function, but a lack of Doppler modes has up to now been an important limitation in obtaining haemodynamic data. OBJECTIVES To report the Doppler capabilities of a new hand held echocardiographic device. DESIGN Blinded comparison of two types of echocardiography machine. SETTING Tertiary care centre. PATIENTS 98 consecutive patients were randomly imaged with the hand held device, with a standard platform as reference. OUTCOME MEASURES Pulsed wave transmitral Doppler inflow tract velocities, deceleration time, and continuous wave Doppler measurements of aortic ejection and tricuspid regurgitation peak velocities were recorded. RESULTS There was excellent agreement between the hand held device and standard echocardiography for the evaluation of diastolic E and A waves, E/A ratio, and deceleration time with pulsed wave Doppler (intraclass correlation coefficients of 0.97, 0.93, 0.90, and 0.78, respectively). In addition, good agreement was found between continuous wave Doppler measurements of aortic ejection and tricuspid regurgitation velocities (intraclass correlation coefficients of 0.96 and 0.80). However, there was a significant difference between patients with tricuspid regurgitation measured with the hand held device (25.5%) and by standard echocardiography (65.3%), resulting in misdiagnosis of eight patients with pronounced pulmonary hypertension. CONCLUSIONS New hand held devices with Doppler capabilities overcome previous limitations in evaluating haemodynamic variables. With colour Doppler they are now suitable for the complete evaluation of valvar disease and diastolic function. However, important limitations remain in the evaluation of pulmonary pressures.
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Affiliation(s)
- J Quiles
- Non-invasive Cardiology Laboratory, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Thompson RB, McVeigh ER. Fast measurement of intracardiac pressure differences with 2D breath-hold phase-contrast MRI. Magn Reson Med 2003; 49:1056-66. [PMID: 12768584 PMCID: PMC2396313 DOI: 10.1002/mrm.10486] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intracardiovascular blood pressure differences can be derived from velocity images acquired with phase-contrast (PC) MRI by evaluating the Navier-Stokes equations. Pressure differences within a slice of interest can be calculated using only the in-plane velocity components from that slice. This rapid exam is proposed as an alternative to the lengthy 3D velocity imaging exams. Despite their good spatial coverage, the 3D exams are prone to artifacts and errors from respiratory motion and insufficient temporal resolution, and are unattractive in the clinical setting due to their excessive scan times (>10 min of free breathing). The proposed single-slice approach requires only one or two breath-holds of acquisition time, and the velocity data can be processed for the calculation of pressure differences online with immediate feedback. The impact of reducing the pressure difference calculation to two dimensions is quantified by comparison with 3D data sets for the case of blood flow within the cardiac chambers. The calculated pressure differences are validated using high-fidelity pressure transducers both in a pulsatile flow phantom and in vivo in a dog model. There was excellent agreement between the transducer and PC-MRI results in all of the studies.
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Affiliation(s)
- Richard B Thompson
- Laboratory of Cardiac Energetics, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Abstract
Despite diastolic dysfunction is recognized to play a major role in the pathophysiology of heart failure, the importance of an accurate diagnosis and treatment of this syndrome in clinical practice is poorly established. Recent publications suggest that diastolic dysfunction is the primary cause of heart failure in 30-50% of patients. Several studies also show that, in a significant number of patients with systolic dysfunction, diastolic function is the major determinant of their symptomatic status, their response to treatment and their outcome. Other preliminary data suggest that diastolic dysfunction is an important cause of exercise intolerance in patients with chronic hypertension. This paper discusses the most recent concepts related to the mechanisms, the diagnosis and the treatment of diastolic dysfunction based on diagnostic imaging techniques.
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Affiliation(s)
- Mario Jorge García
- Laboratorio de Ecografía. Departamento de Cardiología. Fundación Cleveland Clinic. Cleveland. OH 44195, USA.
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