1
|
Obara Y, Mori S, Arakawa M, Kanai H. Appropriate Window Function and Window Length in Multifrequency Velocity Estimator for Rapid Motion and Locality of Layered Myocardium. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1353-1369. [PMID: 35188890 DOI: 10.1109/tuffc.2022.3153048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The heart wall has a multilayered structure and moves rapidly during ejection and rapid filling periods. Local strain rate (SR) measurements of each myocardial layer can contribute to accurate and sensitive evaluations of myocardial function. However, ultrasound-based velocity estimators using a single-frequency phase difference cannot realize these measurements owing to insufficient maximum detectable velocity, which is limited by a quadrature frequency. We previously proposed a velocity estimator using multifrequency phase differences to improve the maximum detectable velocity. However, the improvement is affected by a spatial discrete Fourier transform (DFT) window length that represents the locality of the velocity estimation. In this article, we theoretically describe that shortening the window increases the interference between different frequency components and decreases the maximum detectable velocity. The tradeoff between the maximum detectable velocity and the window length was confirmed through simulations and a water-tank experiment. Under the tradeoff, the Hanning window, which was used in previous studies, is not always appropriate for the local measurement of the velocity, which sometimes exceeds 100 mm [Formula: see text] depending on the subject, direction of the ultrasound beam to the heart wall, and cardiac periods. In the in vivo measurement with the short window, the Tukey window with a large flat part that has a high-frequency resolution and ameliorates the discontinuity at both edges of the windowed signal was appropriate to measure the maximum velocity. This study offers the potential for local measurements of each myocardial layer using the multifrequency velocity estimator with the appropriate window function and window length.
Collapse
|
2
|
Brainin P. Myocardial Postsystolic Shortening and Early Systolic Lengthening: Current Status and Future Directions. Diagnostics (Basel) 2021; 11:diagnostics11081428. [PMID: 34441362 PMCID: PMC8393947 DOI: 10.3390/diagnostics11081428] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
The concept of paradoxical myocardial deformation, commonly referred to as postsystolic shortening and early systolic lengthening, was originally described in the 1970s when assessed by invasive cardiac methods, such as ventriculograms, in patients with ischemia and animal experimental models. Today, novel tissue-based imaging technology has revealed that these phenomena occur far more frequently than first described. This article defines these deformational patterns, summarizes current knowledge about their existence and highlights the clinical potential associated with their understanding.
Collapse
Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, DK-2900 Gentofte, Denmark
| |
Collapse
|
3
|
Malik D, Mittal B, Sood A, Parmar M, Kaur G, Bahl A. Left ventricular mechanical dyssynchrony assessment in long-standing type II diabetes mellitus patients with normal gated SPECT-MPI. J Nucl Cardiol 2019; 26:1650-1658. [PMID: 29392627 DOI: 10.1007/s12350-018-1208-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessment of left ventricular mechanical dyssynchrony (LVMD) using phase analysis of gated SPECT-MPI is well established. However, there is little information about the influence of diabetes mellitus on phase analysis. The present work was to evaluate the LVMD in longstanding type II diabetes mellitus (DM) patients with normal gated SPECT-MPI. METHODS Retrospective analysis of 146 (86 type II diabetics for > 5 years' duration and 60 nondiabetics) consecutive patients with normal gated SPECT-MPI and adequate LVEF was done. Sixty age- and sex-matched nondiabetic served as control. LVMD was determined from the cutoff values (> mean + 2 SD) observed for phase standard deviation (PSD) and phase bandwidth (PBW) from the control subjects. Multivariate logistic regression analysis was applied to assess the correlation between various confounding factors. RESULTS LVMD was detected in 24 (28%) diabetic patients with the pre-defined cut-off values for PSD (> 10.8) and PBW (> 35.6) derived from the controls. Hyperlipidemia, overweight/obesity, duration of DM and its long-term complications were independently associated with LVMD, with long-term complications being the highest risk factor (OR 28.00; P < .001). CONCLUSION The evolution time of the patients with type II diabetes mellitus affects the left ventricular mechanical synchrony.
Collapse
Affiliation(s)
- Dharmender Malik
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Madan Parmar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurvinder Kaur
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
4
|
Bois JP, Scott C, Chareonthaitawee P, Gibbons RJ, Rodriguez-Porcel M. Phase analysis single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) detects dyssynchrony in myocardial scar and increases specificity of MPI. EJNMMI Res 2019; 9:11. [PMID: 30706258 PMCID: PMC6355889 DOI: 10.1186/s13550-019-0476-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is commonly used to assess patients with cardiovascular disease. However, in certain scenarios, it may have limited specificity in the identification of hemodynamically significant coronary artery disease (e.g., false positive), potentially resulting in additional unnecessary testing and treatment. Phase analysis (PA) is an emerging, highly reproducible quantitative technology that can differentiate normal myocardial activation (synchrony) from myocardial scar (dyssynchrony). The objective of this study is to determine if PA can improve the specificity SPECT MPI. METHODS An initial cohort of 340 patients (derivation cohort), referred for SPECT-MPI, was prospectively enrolled. Resting MPI studies were assessed for resting perfusion defects (scar). These were utilized as the reference standard for scar. Subsequently, we collected a second independent validation cohort of 138 patients and tested the potential of PA to reclassify patients for the diagnosis of "scar" or "no scar." Patients were assigned to three categories depending upon their pre-test probability of scar based on multiple clinical and imaging parameters: ≤ 10% (no scar), 11-74% (indeterminate), and ≥ 75% (scar). The ability of PA variables to reclassify patients with scar to a higher group and those without scar to a lower group was then determined using the net reclassification index (NRI). RESULTS Entropy (≥ 59%) was independently associated with scar in both patient cohorts with an odds ratio greater than five. Furthermore, when added to multiple clinical/imaging variables, the use of entropy significantly improved the area under the curve for assessment of scar (0.67 vs. 0.59, p = 0.04). The use of entropy correctly reclassified 24% of patients without scar, by clinical model, to a lower risk category (as determined by pre-test probability) with an overall NRI of 18% in this validation cohort. DISCUSSION The use of PA entropy can improve the specificity of SPECT MPI and may serve as a useful adjunctive tool to the interpreting physician. The current study determined the optimal PA parameters to detect scar (derivation cohort) and applied these parameters to a second, independent, patient group and noted that entropy (≥ 59%) was independently associated with scar in both patient cohorts. Therefore, PA, which requires no additional imaging time or radiation, enhances the diagnostic capabilities of SPECT MPI. CONCLUSION The use of PA entropy significantly improved the specificity of SPECT MPI and could influence the labeling of a patient as having or not having myocardial scar and thereby may influence not only diagnostic reporting but also potentially prognostic determination and therapeutic decision-making.
Collapse
Affiliation(s)
- John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA. .,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Chris Scott
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond J Gibbons
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
5
|
Huang X, Yue Y, Wang Y, Deng Y, Liu L, Di Y, Sun S, Chen D, Fan L, Cao J. Assessment of left ventricular systolic and diastolic abnormalities in patients with hypertrophic cardiomyopathy using real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging. Cardiovasc Ultrasound 2018; 16:23. [PMID: 30285887 PMCID: PMC6167824 DOI: 10.1186/s12947-018-0142-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022] Open
Abstract
Background Conventional echocardiography is not sensitive enough to assess left ventricular (LV) dysfunction in hypertrophic cardiomyopathy (HCM) patients. This research attempts to find a new ultrasonic technology to better assess LV diastolic function, systolic function, and myocardial longitudinal and circumferential systolic strain of segments with different thicknesses in HCM patients. Methods This study included 50 patients with HCM and 40 healthy subjects as controls. The peak early and late mitral annulus diastolic velocities at six loci (Ea′ and Aa′, respectively) and the Ea′/Aa′ ratio were measured using real-time tri-plane echocardiography and quantitative tissue velocity imaging (RT-3PE-QTVI). The mean value of Ea′ at six loci (Em′) was obtained for the calculation of E/Em′ ratio. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV stroke volume (LVSV), and LV ejection fraction (LVEF) were measured using real-time three-dimensional echocardiography (RT-3DE). LV myocardial longitudinal peak systolic strain (LPSS) and circumferential peak systolic strain (CPSS) in the apical-middle-basal segments (LPSS-api, LPSS-mid, LPSS-bas; CPSS-api, CPSS-mid, and CPSS-bas, respectively) were obtained using a software for two-dimensional speckle tracking imaging (2D-STI). According to the different segmental thicknesses (STs) in each HCM patient, the values (LPSS and CPSS) of all the myocardial segments were categorized into three groups and the respective averages were computed. Results The Ea′, Aa′, and, Ea′/Aa’ ratio in HCM patients were lower than those in the controls (all p < 0.001), while the E/Em′ ratio in HCM patients was higher than that in the controls (p < 0.001). The LVEDV, LVSV, and LVEF were significantly lower in HCM patients than in controls (all p < 0.001). In HCM patients, the LPSS-api, LPSS-mid, LPSS-bas, CPSS-api, CPSS-mid, and CPSS-bas and the LPSS and CPSS of LV segments with different thicknesses were all significantly reduced (all p < 0.001). Conclusions In HCM patients, myocardial dysfunction was widespread not only in the obviously hypertrophic segments but also in the non-hypertrophic segments; the LV systolic and diastolic functions were damaged, even with a normal LVEF. LV diastolic dysfunction, systolic dysfunction, and myocardial deformation impairment in HCM patients can be sensitively revealed by RT-3PE-QTVI, RT-3DE, and 2D-STI.
Collapse
Affiliation(s)
- Xin Huang
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Yan Yue
- Department of medical administration, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yinmeng Wang
- Department of Respiration, Clifford Hospital, Guangzhou, 511495, China
| | - Yujiao Deng
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lu Liu
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Yanqi Di
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Shasha Sun
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Deyou Chen
- Department of Outpatient, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Fan
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Jian Cao
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China.
| |
Collapse
|
6
|
Abstract
Deformation imaging by echocardiography is a well-established research tool which has been gaining interest from clinical cardiologists since the introduction of speckle tracking. Post-processing of echo images to analyze deformation has become readily available at the fingertips of the user. New parameters such as global longitudinal strain have been shown to provide added diagnostic value, and ongoing efforts of the imaging societies and industry aimed at harmonizing methods will improve the technique further. This review focuses on recent advances in the field of echocardiographic strain and strain rate imaging, and provides an overview on its current and potential future clinical applications.
Collapse
Affiliation(s)
- Oana Mirea
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium
| | - Jurgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium; Department of Cardiovascular Diseases, UZ Leuven - University Hospitals Leuven, Herestraat, Leuven, Belgium
| |
Collapse
|
7
|
Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Tanaka H, Chikamori T, Hida S, Igarashi Y, Shiba C, Usui Y, Hatano T, Yamashina A. Diagnostic Value of Vasodilator-Induced Left Ventricular Dyssynchrony as Assessed by Phase Analysis to Detect Multivessel Coronary Artery Disease. ACTA ACUST UNITED AC 2015. [DOI: 10.17996/anc.15001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hirokazu Tanaka
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center
| | | | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University
| | | | - Chie Shiba
- Department of Cardiology, Tokyo Medical University
| | | | | | | |
Collapse
|
9
|
Assessment of Ventricular-Vascular Function by Echocardiography. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Temporal analysis of regional strain rate during adenosine triphosphate stress before and after percutaneous coronary interventions. Heart Vessels 2014; 30:309-17. [PMID: 24633495 DOI: 10.1007/s00380-014-0491-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
Regional myocardial ischemia is thought to be characterized by diastolic dysfunction. We aimed to clarify whether temporal analysis of strain rate (SR) index derived from two-dimensional speckle-tracking echocardiography (2DTE) can assess the regional myocardial ischemia or not. Forty-two patients with significant coronary stenoses were referred for percutaneous coronary intervention (PCI). 2DTE was performed before and a day after PCI. Time from aortic valve closure to peak early diastolic longitudinal SR ∆(TAVC-E SR) was measured both at baseline and during adenosine triphosphate (ATP) infusion. TAVC-E SR was calculated as TAVC-E SR during ATP infusion subtracted by TAVC-E SR at baseline. In forty-five target ischemic regions, TAVC-E SR at baseline was significantly longer than that of control regions (166 ± 28 vs. 136 ± 32 ms, P < 0.0001). TAVC-E SR in target ischemic regions significantly prolonged during ATP stress to 221 ± 37 ms (P < 0.0001), while it did not change in control regions. Immediately after PCI, TAVC-E SR in target regions significantly decreased to 135 ± 27 ms, P < 0.0001 without prolongation during ATP stress. Receiver operating characteristic curves demonstrated that ∆TAVC-E SR could assess regional myocardial ischemia by a cutoff criterion of 14 ms with sensitivity of 93% and specificity of 95%. 2DTE-derived TAVC-E SR significantly increased during ATP stress only in ischemic myocardium. This phenomenon disappeared immediately after PCI. Temporal analysis of TAVC-E SR appeared to be useful to assess the regional myocardial ischemia.
Collapse
|
11
|
Park SC, Kang KW, Yoon HS, Myung JC, Choi YJ, Park SH, Jung KT, Chin JY. The Feasibility of the Initial Postsystolic to Systolic Strain Rate Ratio as a Predictor of the Viability of Ischemic Myocardium with Acute Myocardial Infarction. Echocardiography 2013; 31:825-32. [DOI: 10.1111/echo.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Soon Chang Park
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Ki-Woon Kang
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Hyeon Soo Yoon
- Division of Cardiology; Worker's Compensation Hospital; Daejeon Korea
| | - Jin Cheol Myung
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Yu Jeong Choi
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Sang Hyun Park
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Kyung Tae Jung
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| | - Jung Yeon Chin
- Division of Cardiology; Eulji University Hospital; Eulji University School of Medicine; Daejeon Korea
| |
Collapse
|
12
|
Igarashi Y, Chikamori T, Hida S, Tanaka H, Shiba C, Usui Y, Hatano T, Yamashina A. Usefulness of phase analysis to differentiate ischemic and non-ischemic etiologies of left ventricular systolic dysfunction in patients with heart failure. Circ J 2013; 78:141-50. [PMID: 24172076 DOI: 10.1253/circj.cj-13-0137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The detection of significant coronary artery disease (CAD) in patients with heart failure (HF) from left ventricular (LV) systolic dysfunction is crucial. We evaluated the usefulness of LV mechanical dyssynchrony as assessed by phase analysis compared with conventional gated single-photon emission computed tomography to identify ischemic etiology in patients with HF. METHODS AND RESULTS Forty-one consecutive patients who were initially admitted to hospital due to HF resulting from systolic dysfunction were evaluated. All patients underwent cardiac catheterization. LV mechanical dyssynchrony was evaluated using SyncTool™ to obtain the phase SD and histogram bandwidth. The changes in phase SD and histogram bandwidth with stress were calculated. The summed stress score, summed difference score, and changes in phase SD and histogram bandwidth with stress were greater in 26 patients with CAD than in 15 patients without CAD (P=0.001 and P=0.01). On multivariate analysis a phase SD of >14° (odds ratio [OR], 16.7) and a summed stress score of >17 (OR, 8.0) best differentiated LV dysfunction of ischemic and non-ischemic etiologies, with a sensitivity of 89% and a specificity of 87% (χ(2)=20), compared with summed stress score only (sensitivity, 46%; specificity, 87%; χ(2)=4.5). CONCLUSIONS The addition of phase analysis to conventional perfusion analysis enables better differentiation of the etiology of HF in patients with systolic dysfunction.
Collapse
|
13
|
Hida S, Chikamori T, Tanaka H, Igarashi Y, Shiba C, Usui Y, Hatano T, Yamashina A. Diagnostic Value of Left Ventricular Dyssynchrony After Exercise and at Rest in the Detection of Multivessel Coronary Artery Disease on Single-Photon Emission Computed Tomography. Circ J 2012; 76:1942-52. [DOI: 10.1253/circj.cj-11-1392] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Hida
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Taishiro Chikamori
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Hirokazu Tanaka
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Yuko Igarashi
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Chie Shiba
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Yasuhiro Usui
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Tsuguhisa Hatano
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University
- Department of Cardiology, Tokyo Medical University
| |
Collapse
|
14
|
Hosaka M, Takagi A, Takagi T, Ashihara K, Hagiwara N. Strain measurements during adenosine triphosphate infusion before and after percutaneous coronary intervention. Circ J 2010; 74:1600-8. [PMID: 20606329 DOI: 10.1253/circj.cj-09-0972] [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: 11/09/2022]
Abstract
BACKGROUND In regional myocardial ischemia, contractile delay develops, which can be assessed by measuring time to peak strain (TPS) on tissue Doppler imaging. The aims of the present study were to clarify the usefulness of TPS measurements during adenosine triphosphate (ATP) stress in assessing myocardial ischemia and to evaluate whether prolongation of TPS disappears immediately after percutaneous coronary intervention (PCI) or not. METHODS AND RESULTS A total of 26 patients underwent strain measurements before and after PCI. Corrected TPS for heart rate (TPSc) in target regions and in control regions were measured both at baseline and during ATP infusion. TPSc ratio was calculated as a ratio of TPSc during ATP stress to TPSc at baseline. TPSc in the target region significantly increased during ATP infusion before PCI, which was significantly longer than hyperemic TPSc in control regions. Accordingly, TPSc ratio in the target regions before PCI was significantly greater than that in control regions (1.22+/-0.17 vs 0.96+/-0.09, respectively, P<0.0001). Following PCI, the TPSc ratio in the target regions significantly decreased to 0.98+/-0.05 (P<0.0001). Receiver operating characteristic curve analysis provided a cut-off of 1.04 in TPSc ratio for detecting myocardial ischemia with a sensitivity of 93% and specificity of 93%. CONCLUSIONS TPS measurements during ATP stress differentiated target from control myocardium before PCI. The prolongation of TPSc disappeared immediately after PCI.
Collapse
Affiliation(s)
- Motoko Hosaka
- Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | | | | | | | | |
Collapse
|
15
|
Lyseggen E, Vartdal T, Remme EW, Helle-Valle T, Pettersen E, Opdahl A, Edvardsen T, Smiseth OA. A novel echocardiographic marker of end systole in the ischemic left ventricle: “tug of war” sign. Am J Physiol Heart Circ Physiol 2009; 296:H645-54. [DOI: 10.1152/ajpheart.00313.2008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study introduces a new clinical method to define left ventricular (LV) end systole (ES) during tissue Doppler imaging (TDI). Preliminary experiments showed a sharp inflection point in strain traces (SIP) from ischemic borderzones, which coincided with onset of a postsystolic shortening wave ( VPS) in the velocity trace. In a single-vessel disease model, we investigated whether SIP and VPS may serve as markers of global ES and their mechanism. In six anesthetized dogs we measured LV pressure and myocardial long-axis function by using TDI and sonomicrometry. Ischemia was induced by left anterior descending coronary artery occlusion. ES was defined by the minimum first derivative of LV pressure. TDI and sonomicrometry demonstrated a sharp SIP and VPS at ES in the ischemic borderzone (defined as moderately ischemic myocardium by pressure-dimension loop analysis). Time differences relative to ES ( ± SD) were −0.1 ± 2.3 (intraclass correlation coefficient RIC = 0.996) and 6.8 ± 10.7 ms ( RIC = 0.89) for SIP as shown by sonomicrometry and TDI, respectively. There was a strong inverse relationship between postsystolic shortening in the borderzone and simultaneous lengthening of nonischemic myocardium. In 30 patients with acute myocardial infarction, SIP and VPS evaluated by TDI were compared with ES defined by aortic valve closure. Time differences were −4 ± 14 ( RIC = 0.94) and −2 ± 11 ms ( RIC = 0.96), respectively. In the ischemic borderzone, SIP and VPS identified global ES with high accuracy. The force balance or “tug of war” between borderzone and nonischemic myocardium is a likely underlying mechanism for these markers. The method may be used as an “all in one heart beat” approach for TDI analysis in acute myocardial ischemia.
Collapse
|
16
|
Bijnens B, Claus P, Weidemann F, Strotmann J, Sutherland GR. Investigating Cardiac Function Using Motion and Deformation Analysis in the Setting of Coronary Artery Disease. Circulation 2007; 116:2453-64. [DOI: 10.1161/circulationaha.106.684357] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bart Bijnens
- From the Medical School and Faculty of Electronic Engineering (B.B.), University of Zagreb, Croatia; the Department of Cardiology (B.B., P.C.), University of Leuven, Belgium; the Department of Medicine (F.W., J.S.), University Hospital Wuerzburg, Germany; and the Department of Cardiology (G.R.S.), St. George’s Hospital, London, United Kingdom
| | - Piet Claus
- From the Medical School and Faculty of Electronic Engineering (B.B.), University of Zagreb, Croatia; the Department of Cardiology (B.B., P.C.), University of Leuven, Belgium; the Department of Medicine (F.W., J.S.), University Hospital Wuerzburg, Germany; and the Department of Cardiology (G.R.S.), St. George’s Hospital, London, United Kingdom
| | - Frank Weidemann
- From the Medical School and Faculty of Electronic Engineering (B.B.), University of Zagreb, Croatia; the Department of Cardiology (B.B., P.C.), University of Leuven, Belgium; the Department of Medicine (F.W., J.S.), University Hospital Wuerzburg, Germany; and the Department of Cardiology (G.R.S.), St. George’s Hospital, London, United Kingdom
| | - Jörg Strotmann
- From the Medical School and Faculty of Electronic Engineering (B.B.), University of Zagreb, Croatia; the Department of Cardiology (B.B., P.C.), University of Leuven, Belgium; the Department of Medicine (F.W., J.S.), University Hospital Wuerzburg, Germany; and the Department of Cardiology (G.R.S.), St. George’s Hospital, London, United Kingdom
| | - George R. Sutherland
- From the Medical School and Faculty of Electronic Engineering (B.B.), University of Zagreb, Croatia; the Department of Cardiology (B.B., P.C.), University of Leuven, Belgium; the Department of Medicine (F.W., J.S.), University Hospital Wuerzburg, Germany; and the Department of Cardiology (G.R.S.), St. George’s Hospital, London, United Kingdom
| |
Collapse
|
17
|
Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography--from technical considerations to clinical applications. J Am Soc Echocardiogr 2007; 20:234-43. [PMID: 17336748 DOI: 10.1016/j.echo.2006.08.023] [Citation(s) in RCA: 355] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Indexed: 12/19/2022]
Abstract
During the past several years, strain and strain rate imaging have emerged as a quantitative technique to accurately estimate myocardial function and contractility. Non-Doppler, 2-dimensional (2D) strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements. It analyzes motion by tracking speckles in the ultrasonic image in two dimensions. Current available software allows spatial and temporal image processing with recognition and selection of such elements on ultrasound image. The geometric shift of each speckle represents local tissue movement. By tracking theses speckles, 2D tissue velocity, strain, and strain rate can be calculated. Non-Doppler 2D strain imaging is simple to perform. It requires only one cardiac cycle to be acquired; further processing and interpretation can be done after image data acquisition. Because it is not based on tissue Doppler measurements, it is angle independent. Data regarding accuracy, validity, and clinical application of non-Doppler 2D strain imaging are rapidly accumulating. This technique may prove to be of significant clinical value, enabling rapid and accurate assessment of global and segmental myocardial function.
Collapse
Affiliation(s)
- Gila Perk
- Noninvasive Cardiology Laboratory, The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York, USA.
| | | | | |
Collapse
|
18
|
Runqing X, Xie M, Wang X, Lü Q. Assessment of regional myocardial function in patients with hypertrophic cardiomyopathy by tissue strain imaging. ACTA ACUST UNITED AC 2006; 26:334-7. [PMID: 16961286 DOI: 10.1007/bf02829568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The value of tissue strain imaging (SI) in regional myocardial systolic and diastolic function assessment was studied. In 18 patients with nonobstructive hypertrophic cardiomyopathy (HCM) and 20 age-matched healthy subjects, regional myocardial longitudinal peak systolic strain in eject time (represented by epsilon(et)) was measured at basal, mid and apical segments of septal, lateral and posterior walls of the left ventricle (LV) and compared between groups. Epsilon(et) had no significant difference between segments in control group (P > 0.05), which displayed a decreasing trend from basal segments to apical ones. Epsilon(et) in the HCM group was significantly decreased (P < 0.05) as compared with that in the healthy group. In the HCM group, epsilon(et) in the midseptum was significantly less than at the basal and apical septum, and was also less than at the rest LV walls in the same group (P < 0.01). The systolic reversed epsilon(et) was noticed in 35% of the hypertrophic segments in HCM group. Significantly negative correlation existed between the absolute value of epsilon(et) and wall thickness in the midseptum (r = -0.83). The post-systolic strain (PSS) segment number the and amplitudes in healthy group were significantly less than those in HCM group (P < 0.05). Both regional myocardial systolic and diastolic functions were impaired in hypertrophic or non-hypertrophic segments in patients with the HCM, especially in hypertrophic segments. Strain imaging technique is a sensitive and accura tool in myocardial dysfunction assessment.
Collapse
Affiliation(s)
- Xiong Runqing
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | | | | | | |
Collapse
|
19
|
Sengupta PP, Khandheria BK, Korinek J, Wang J, Belohlavek M. Biphasic tissue Doppler waveforms during isovolumic phases are associated with asynchronous deformation of subendocardial and subepicardial layers. J Appl Physiol (1985) 2005; 99:1104-11. [PMID: 15905326 DOI: 10.1152/japplphysiol.00191.2005] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Subendocardial and subepicardial layers of the left ventricle (LV) are characterized with right- and left-handed helical orientations of myocardial fibers. We investigated the origin of biphasic deformations of the LV wall during isovolumic contraction (IVC) and relaxation (IVR). In eight open-chest adult pigs, strain rates were measured along the right- and left-handed helical directions in the LV anterior wall by implanting 16 sonomicrometry crystals. Sonomicrometry strain rates were compared with the longitudinal subendocardial strain rates obtained by tissue Doppler imaging. During ejection and diastolic filling, shortening and lengthening occurred synchronously along the right- and left-handed helical directions. However, during IVC and IVR, the deformations were dissimilar in the two directions. Transmural shortening during IVC occurred along the right-handed helical direction and was accompanied with transient lengthening in the left-handed helical direction. Conversely, during IVR, the LV lengthened along the left-handed helical direction and shortened in the right-handed helical direction. Peak subendocardial strain rates obtained by tissue Doppler imaging during IVC and IVR correlated with corresponding sonomicrometry strain rate values obtained along the right- and left-handed helical directions ( r = 0.81, P < 0.001 and r = 0.70, P = 0.001, respectively). Our data suggest that brief counterdirectional movements occur within the LV wall during IVC and IVR. Shortening along the right-handed helical direction is accompanied with reciprocal lengthening in the left-handed helical direction during IVC and vice versa during IVR. The results support an association between asynchronous deformation of subendocardial and subepicardial muscle fibers and the biphasic isovolumic movements observed with high-resolution tissue Doppler imaging.
Collapse
Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, 200 First St. SW, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
20
|
Ingul CB, Stoylen A, Slordahl SA. Recovery of Stunned Myocardium in Acute Myocardial Infarction Quantified by Strain Rate Imaging: A Clinical Study. J Am Soc Echocardiogr 2005; 18:401-10. [PMID: 15891749 DOI: 10.1016/j.echo.2004.09.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Strain rate (SR) imaging (SRI) is a tissue Doppler-based method of regional myocardial deformation imaging. The aim of this study was to see whether SRI could quantify changes in myocardial mechanical function after an acute myocardial infarction, and to follow the time course of these changes. METHODS In all, 26 consecutive patients with first-time acute myocardial infarctions were examined on days 1, 7, and 90. Segments were analyzed with SRI and wall-motion score. RESULTS Peak systolic SR in infarcted segments increased significantly in magnitude from day 1 to 7 (-0.45 to -0.68 s -1 , P < .001), but not after day 7. The deformation rate in border zone segments also increased significantly from day 1 to 7 (-0.8 to -0.95 s -1 , P < .05), with no further significant changes at 3 months. In normal segments, peak systolic SR decreased in magnitude during the first week. Systolic strain showed similar results as peak systolic SR. CONCLUSION SRI can demonstrate small changes in deformation rate from midinfarct through the infarct and border zone to normal myocardium. It can also show changes over time, probably as a result of recovery of stunned myocardium.
Collapse
Affiliation(s)
- Charlotte Bjork Ingul
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | |
Collapse
|
21
|
Barra JG, Crottogini AJ, Willshaw P, Lascano EC, Pichel RH. Contribution of myocardium hydraulic skeleton to left ventricular wall interaction and synergy in dogs. Am J Physiol Heart Circ Physiol 2004; 287:H896-904. [PMID: 15031122 DOI: 10.1152/ajpheart.00041.2004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The most premature motion change after coronary occlusion is early diastolic thinning of the ischemic left ventricular (LV) wall, with concomitant thickening of the normoperfused wall. We aimed 1). to demonstrate that these early changes are the result of the absence of fluid within the ischemic myocardium (hydraulic skeleton) rather than to cell anoxia and 2). to quantitate the contribution of the lack of hydraulic skeleton to left ventricular asynergy of contraction in seven anesthetized dogs submitted to acute, short-lasting circumflex artery (Cx) occlusion (ischemia) and to perfusion of the Cx with an oxygen-free solution (anoxia). We analyzed the time course of regional work index (WI, area of the LV pressure-wall thickness loop) and regional efficiency (defined as the ratio of WI to the maximum possible work). Interwall asynergy was defined as the difference between the regional efficiency of the anterior and posterior walls. After 9-10 s, posterior wall efficiency decreased 37 +/- 6% with anoxia and 72 +/- 3% with ischemia (P < 0.025), and interwall asynergy was 0 +/- 6% with anoxia and 32 +/- 5% with ischemia (P < 0.05). The contribution of absent hydraulic skeleton to interwall asynergy (calculated as the difference between %asynergy in anoxia and %asynergy in ischemia) was 30 +/- 8% (P < 0.05). In conclusion, the earliest wall motion change observed after acute coronary occlusion, namely ischemic wall thinning concomitant with normoperfused wall thickening during isovolumic relaxation, is the result of the absence of intracoronary fluid. The lack of hydraulic skeleton within the myocardium contributes approximately 30% to interwall asynergy.
Collapse
Affiliation(s)
- Juan Gabriel Barra
- Department of Physiological, Favaloro University, C1078AAI Buenos Aires, Argentina.
| | | | | | | | | |
Collapse
|