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Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA). Nucl Med Commun 2015; 35:818-23. [PMID: 24781009 PMCID: PMC4076031 DOI: 10.1097/mnm.0000000000000143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, 123I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease.
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2
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Zafrir N, Nevzorov R, Bental T, Strasberg B, Gutstein A, Mats I, Kornowski R, Solodky A. Prognostic value of left ventricular dyssynchrony by myocardial perfusion-gated SPECT in patients with normal and abnormal left ventricular functions. J Nucl Cardiol 2014; 21:532-40. [PMID: 24623397 DOI: 10.1007/s12350-014-9852-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular (LV) dyssynchrony by phase analysis has been studied by myocardial perfusion imaging (MPI)-gated SPECT in patients with LV dysfunction in various clinical settings. We aimed to investigate the routine use of phase analysis with gated SPECT for predicting cardiac outcome. METHODS Patients referred to a tertiary medical center in 2010-2011 prospectively underwent a gated SPECT and phase analysis, and follow-up for cardiac events. The values of clinical variables, MPI, LV function, and LV dyssynchrony in predicting cardiac events were tested by univariate and multivariate analyses. RESULTS The study group included 787 patients (66.5 ± 11 years, 81% men) followed for a mean duration of 18.3 ± 6.2 months. There were 45 (6%) cardiac events defined as composite endpoint; cardiac death occurred in 26 patients, and the rest had new-onset or worsening heart failure and life-threatening arrhythmias. In multivariate analysis, it was shown that NYHA class, diabetes mellitus, and LVEF <50% were the independent predictors for composite endpoint. However, the independent predictors for cardiac mortality were NYHA class (for each increment in class) and phase standard deviation (SD) (for each 10° increment). CONCLUSION Gated SPECT with phase analysis for the assessment of LV dyssynchrony can successfully predict cardiac death together with NYHA class, in patients with LV dysfunction.
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Affiliation(s)
- Nili Zafrir
- Nuclear Cardiology Unit, Rabin Medical Center, Beilinson Campus, 49100, Petah Tikva, Israel,
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3
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Prognostic significance of left ventricular dyssynchrony by phase analysis of gated SPECT in medically treated patients with dilated cardiomyopathy. Clin Nucl Med 2014; 38:510-5. [PMID: 23698460 DOI: 10.1097/rlu.0b013e318292eedf] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE The study aimed to investigate the value of clinical variables and rest gated single-photon emission computed tomography (SPECT) in predicting cardiac deaths in medically treated dilated cardiomyopathy (DCM) patients. METHODS This is a retrospective study. Fifty-six consecutive hospitalized DCM patients who underwent rest gated SPECT myocardial perfusion imaging were initially recruited. Patients were further excluded for receiving heart transplantation, cardiac resynchronization treatment, and noncardiac death during follow-up. The remaining 48 medically treated DCM patients were selected into the final analysis. Phase analysis of gated SPECT was conducted to identify left ventricular (LV) dyssynchrony. Cardiac death during follow-up was considered as the only endpoint. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent predictors of cardiac death. Kaplan-Meier cumulative survival analysis with stratification was performed, and survival curves were compared by log-rank test. RESULTS The mean age was 47.5 ± 15.8 years (range, 15-76 yrs) and 85.4% were men. The mean LV ejection fraction was 22.2 ± 7.7%. During the follow-up period (22.7 ± 5.1 mos), 12 (25.0%) cardiac deaths occurred. Compared to survivors, patients with cardiac death had lower body mass index (BMI, P = 0.010), higher percent of prolonged QRS duration (QRSD, P = 0.043), and severe LV dyssynchrony (P = 0.002). Multivariate Cox analysis demonstrated that severe LV dyssynchrony [hazard ratio = 9.607, 95% confidential interval (95% CI) 2.064-44.713, P = 0.004] and BMI (hazard ratio = 0.851, 95% CI 0.732-0.989, P = 0.036) were predictive of cardiac death. CONCLUSION Left ventricular dyssynchrony assessed by phase analysis of gated SPECT and BMI are predictive of cardiac death in medically treated DCM patients.
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4
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Jenkins C, Haluska B, Marwick TH. Assessment of Temporal Heterogeneity and Regional Motion to Identify Wall Motion Abnormalities Using Treadmill Exercise Stress Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2009; 22:268-75. [DOI: 10.1016/j.echo.2008.11.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Indexed: 10/21/2022]
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5
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Takeda Y, Sakata Y, Mano T, Nishio M, Ohtani T, Hori M, Masuyama T, Yamamoto K. Noninvasive Assessment of Diastolic Function in Subjects With Preserved Left Ventricular Ejection Fraction: Usefulness of Color Kinetic Imaging. J Card Fail 2008; 14:569-76. [DOI: 10.1016/j.cardfail.2008.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/19/2008] [Accepted: 03/28/2008] [Indexed: 11/29/2022]
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6
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Chen J, Faber TL, Cooke CD, Garcia EV. Temporal resolution of multiharmonic phase analysis of ECG-gated myocardial perfusion SPECT studies. J Nucl Cardiol 2008; 15:383-91. [PMID: 18513645 DOI: 10.1016/j.nuclcard.2008.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 01/15/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiharmonic phase analysis (MHPA) was developed to assess left-ventricular dyssynchrony from gated myocardial perfusion single-photon emission computed tomography (GSPECT) studies. This study was intended to determine the temporal resolution of MHPA. METHODS A reference normal GSPECT study with 128 frames/cycle was simulated using NCAT, a nonuniform rational B-splines-based cardiac torso phantom. It was shifted in the time domain to insert phase delays. Realistic GSPECT studies (8 or 16 frames/cycle) were then obtained by down-sampling the reference and shifted studies. All GSPECT projections were generated with attenuation, scatter, collimator blurring, and Poisson noise. Seventeen regional phases were calculated from the GSPECT reconstructions (filtered back-projection without compensation for physical factors), using linear interpolation for the reference study, and MHPA for the realistic studies. Comparing the regional phases between the realistic studies without and with shifts determined whether MHPA could identify certain phase delays. RESULTS When there were enough counts/pixel (>10 counts/pixel), MHPA with either 1, 2, or 3 harmonics could resolve a phase difference of 5.6 degrees , corresponding to 1/64 of the cardiac cycle. CONCLUSIONS With clinically equivalent counts, the temporal resolution of MHPA is 1/64 of a cardiac cycle. Achieving this high temporal resolution from data with low temporal resolution demonstrates the benefit of replacing discrete points with continuous harmonic functions.
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Affiliation(s)
- Ji Chen
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA.
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7
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Chen J, Henneman MM, Trimble MA, Bax JJ, Borges-Neto S, Iskandrian AE, Nichols KJ, Garcia EV. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2008; 15:127-36. [PMID: 18242490 DOI: 10.1016/j.nuclcard.2007.11.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiac resynchronization therapy (CRT) has shown benefits in patients with severe heart failure. However, at least 30% of patients selected for CRT by use of traditional criteria (New York Heart Association class III or IV, depressed left ventricular [LV] ejection fraction, and prolonged QRS duration) do not respond to CRT. Recent studies with tissue Doppler imaging have shown that the presence of LV dyssynchrony is an important predictor of response to CRT. Phase analysis has been developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography myocardial perfusion imaging. This technique uses Fourier harmonic functions to approximate regional wall thickness changes over the cardiac cycle and to calculate the regional onset-of-mechanical contraction phase. Once the onset-of-mechanical contraction phases are obtained 3-dimensionally over the left ventricle, a phase distribution map is formed that represents the degree of LV dyssynchrony. This technique has been compared with other methods of measuring LV dyssynchrony and shown promising results in clinical evaluations. In this review the phase analysis methodology is described, and its up-to-date validations are summarized.
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Affiliation(s)
- Ji Chen
- Department of Radiology, Emory University, Atlanta, GA 30322, USA.
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8
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Harada M, Hayashi K, Takarada Y, Hirai H. Evaluation of left ventricular diastolic function using color kinesis. J Med Ultrason (2001) 2007; 34:29-35. [DOI: 10.1007/s10396-006-0127-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
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9
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Corsi C, Lang RM, Veronesi F, Weinert L, Caiani EG, MacEneaney P, Lamberti C, Mor-Avi V. Volumetric Quantification of Global and Regional Left Ventricular Function From Real-Time Three-Dimensional Echocardiographic Images. Circulation 2005; 112:1161-70. [PMID: 16103242 DOI: 10.1161/circulationaha.104.513689] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Real-time 3D echocardiographic (RT3DE) data sets contain dynamic volumetric information on cardiac function. However, quantification of left ventricular (LV) function from 3D echocardiographic data is performed on cut-planes extracted from the 3D data sets and thus does not fully exploit the volumetric information. Accordingly, we developed a volumetric analysis technique aimed at quantification of global and regional LV function.
Methods and Results—
RT3DE images obtained in 30 patients (Philips 7500) were analyzed by use of custom software based on the level-set approach for semiautomated detection of LV endocardial surface throughout the cardiac cycle, from which global and regional LV volume (LVV)–time and wall motion (WM)–time curves were obtained. The study design included 3 protocols. In protocol 1, time curves obtained in 16 patients were compared point-by-point with MRI data (linear regression and Bland-Altman analyses). Global LVV correlated highly with MRI (
r
=0.98;
y
=0.99
x
+2.3) with minimal bias (1.4 mL) and narrow limits of agreement (±20 mL). WM correlated highly only in basal and midventricular segments (
r
=0.88;
y
=0.85
x
+0.7). In protocol 2, we tested the ability of this technique to differentiate populations with known differences in LV function by studying 9 patients with dilated cardiomyopathy and 9 normal subjects. All calculated indices of global and regional systolic and diastolic LV function were significantly different between the groups. In protocol 3, we tested the feasibility of automated detection of regional WM abnormalities in 11 patients. In each segment, abnormality was detected when regional shortening fraction was below a threshold obtained in normal subjects. The automated detection agreed with expert interpretation of 2D WM in 86% of segments.
Conclusions—
Volumetric analysis of RT3DE data is clinically feasible and allows fast, semiautomated, dynamic measurement of LVV and automated detection of regional WM abnormalities.
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Affiliation(s)
- Cristiana Corsi
- University of Chicago Medical Center, Chicago, IL 60637, USA
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10
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Hamlin SK, Villars PS, Kanusky JT, Shaw AD. Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment. Am J Crit Care 2004. [DOI: 10.4037/ajcc2004.13.6.453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.
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Affiliation(s)
- Shannan K. Hamlin
- University of Texas Health Science Center at Houston (SKH, PSV, JTK) and Department of Critical Care Medicine, University of Texas M.D. Anderson Cancer Center (SKH, ADS), Houston, Tex
| | - Penelope S. Villars
- University of Texas Health Science Center at Houston (SKH, PSV, JTK) and Department of Critical Care Medicine, University of Texas M.D. Anderson Cancer Center (SKH, ADS), Houston, Tex
| | - Joseph T. Kanusky
- University of Texas Health Science Center at Houston (SKH, PSV, JTK) and Department of Critical Care Medicine, University of Texas M.D. Anderson Cancer Center (SKH, ADS), Houston, Tex
| | - Andrew D. Shaw
- University of Texas Health Science Center at Houston (SKH, PSV, JTK) and Department of Critical Care Medicine, University of Texas M.D. Anderson Cancer Center (SKH, ADS), Houston, Tex
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11
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Decara JM, Mor-Avi V, Weinert L, Korcarz CE, Collins KA, Spencer KT, Bednarz JE, Lang RM. Automated quantitative assessment of wall motion in patients with poor acoustic windows. J Am Soc Echocardiogr 2004; 17:723-31. [PMID: 15220896 DOI: 10.1016/j.echo.2004.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND No technique exists for objective evaluation of left ventricular wall motion in contrast-enhanced images. We tested a new technique for quantification of regional fractional area change using contrast-enhanced power modulation imaging with color kinesis. METHODS The feasibility of this technique for detecting acute ischemia was first tested in 11 pigs. Next, the accuracy for detecting resting wall-motion abnormalities was determined in 52 patients requiring contrast and compared with conventional interpretation of 2-dimensional images by inexperienced readers. Expert interpretation of 2-dimensional images served as the gold standard. RESULTS In pigs, coronary occlusion resulted in reversible hypokinesis and reduced regional fractional area change. In patients with poor acoustic windows, this technique's accuracy for quantitative detection of resting wall-motion abnormalities was 86% compared with 81% for conventional interpretation by inexperienced readers (P <.01). CONCLUSIONS Regional wall motion can be accurately assessed using color-encoded power modulation imaging for patients requiring contrast. This technique may prove a useful diagnostic aid to echocardiographers of varying levels of experience.
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Affiliation(s)
- Jeanne M Decara
- Noninvasive Cardiac Imaging Laboratory, University of Chicago, IL 60637, USA.
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12
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Ito T, Suwa M, Imai M, Nakamura T, Kitaura Y. Assessment of regional left ventricular filling dynamics using color kinesis in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2004; 17:146-51. [PMID: 14752489 DOI: 10.1016/j.echo.2003.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Using color kinesis, we evaluated regional left ventricular filling dynamics in patients with hypertrophic cardiomyopathy (HCM). METHODS In all, 20 patients (14 men and 6 women) and 20 age-matched healthy control subjects (10 men and 10 women) were studied. From color kinesis diastolic images in a left ventricular short-axis view, we generated regional time curves (6 segments) of left ventricular filling. The percent filling fraction at 25%, 50%, and 75% of filling time was averaged for all segments in each patient, and the SD of its mean was used as an asynchrony index at each particular filling time. The mean filling time for each segment was also measured. RESULTS The asynchrony index was increased significantly in mid (50%) to late (75%) diastole in patients with HCM as compared with control subjects. Patients with HCM had regional mean filling times prolonged even in the nonhypertrophic segments. Moreover, there was significant correlation between the asynchrony index at mid and late diastole, and the global mean filling time. CONCLUSIONS Color kinesis is useful in evaluating regional filling dynamics in patients with HCM. Our data reinforce the notion that HCM is a functionally heterogeneous disorder.
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Affiliation(s)
- Takahide Ito
- Third Division, Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki City, Osaka 569-8686, Japan.
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13
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Ito T, Suwa M, Imai M, Hozumi T, Tonari S, Kitaura Y. Acute Effects of Diltiazem on Regional Left Ventricular Diastolic Filling Dynamics in Patients With Hypertrophic Cardiomyopathy as Assessed by Color Kinesis. Circ J 2004; 68:1035-40. [PMID: 15502385 DOI: 10.1253/circj.68.1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of calcium antagonists on regional left ventricular (LV) filling dynamics in patients with hypertrophic cardiomyopathy (HCM) is not well known, so the present study evaluated the results of echocardiography with color kinesis (CK) analysis during diltiazem infusion. METHODS AND RESULTS Nineteen patients (16 men, 3 women; mean age 55+/-15 years) underwent echocardiography with CK analysis during intravenous diltiazem (10 mg/2 min). Using the quantitative CK software the LV short-axis image was divided into 6 segments and the percent endocardial expansion at the early, mid- and late-diastolic filling time was averaged for all segments, with the standard deviation of the mean used as an index of diastolic asynchrony (asynchrony index). The regional mean filling time was also measured for the corresponding segments. As global diastolic parameters, the global filling time, peak filling rate, and the time-to-peak filling were calculated. After the administration of diltiazem, the asynchrony index was decreased for all three diastolic filling times. Diltiazem shortened the mean filling time overall, especially in the posterior and lateral wall segments. These findings were associated with significant improvement in the CK-derived global diastolic parameters. CONCLUSIONS Diltiazam has a favorable effect on LV diastolic asynchrony, which may account for the acute changes in global LV relaxation.
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Affiliation(s)
- Takahide Ito
- The Third Division, Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki 569-8686, Japan.
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Yamaura K, Hoka S, Okamoto H, Takahashi S. Quantitative analysis of left ventricular regional wall motion with color kinesis during abdominal aortic cross-clamping. J Cardiothorac Vasc Anesth 2003; 17:703-8. [PMID: 14689409 DOI: 10.1053/j.jvca.2003.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST). DESIGN An observational study. SETTING University hospital. PARTICIPANTS Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass. MEASUREMENTS AND MAIN RESULTS CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and interobserver variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs. CONCLUSIONS A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery.
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Affiliation(s)
- Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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15
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Liu J, Murata K, Fujino T, Ueda K, Kimura K, Wada Y, Oyama R, Tanaka N, Matsuzaki M. Effect of dobutamine on regional diastolic left ventricular asynchrony in patients with left ventricular hypertrophy. Circ J 2003; 67:119-24. [PMID: 12547992 DOI: 10.1253/circj.67.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dobutamine improves systolic as well as diastolic function, but its effect on left ventricular (LV) asynchrony is unknown. An on-line automated segmental motion analysis (A-SMA) system was developed, based on an automatic border detection technique, to evaluate the effect of dobutamine on LV asynchrony in patients with LV hypertrophy (LVH). Low dose (5 microg x kg (-1) x min(-1)) dobutamine stress echocardiography was performed in 15 patients with LVH and in 15 healthy subjects. Short-axis LV views were obtained and divided into 4 wedge-shaped segments using A-SMA. The time - area curve and its first derivative curve in each segment were displayed. Total normalized peak filling rates (nPFR) were obtained. Systolic and diastolic asynchronies were assessed from the coefficient of variation (CV) of the regional time intervals from end diastole to the peak ejection rate (T-PER), and from end systole to the peak filling rate (T-PFR), respectively. At baseline, the CV of T-PER and T-PFR in patients with LVH were greater than those in healthy subjects (CV-T-PER: 18.8+/-9.2 vs 9.6+/-4.3%, CV-T-PFR: 19.5+/-7 vs 8.1+/-4.1%, both p<0.01). During dobutamine infusion, differences among groups at baseline disappeared and systolic and diastolic asynchronies improved (CV-T-PER: 7.3+/-4.8 vs 5.7+/-2.1%, CV-T-PFR: 6.8+/-3.5 vs 5.1+/-1.3%, both p>0.05). Total nPFR increased (from 3.2+/-1.0 /s to 5.6+/-1.3 /s, p<0.01) with dobutamine infusion in patients with LVH. Dobutamine improved LV diastolic asynchrony, as evaluated by A-SMA, in patients with LVH demonstrating that the lusitropic effect of dobutamine improved LV regional diastolic asynchrony, playing an important role in the improvement of global LV diastolic filling.
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Affiliation(s)
- Jinyao Liu
- Department of Cardiovascular Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
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16
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Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: a prognostic study with fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 2002; 40:2022-30. [PMID: 12475464 DOI: 10.1016/s0735-1097(02)02569-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The study evaluated the prognostic value of interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy (IDC). BACKGROUND Biventricular pacing is an emerging treatment for patients with dilated cardiomyopathy and ventricular dyssynchrony. The prognostic values of interventricular and intraventricular dyssynchrony have not been previously compared. METHODS A total of 103 patients with IDC were studied. Left bundle branch block was present in 25% of patients. Equilibrium radionuclide angiography was performed and Fourier phase analyses were examined in both ventricles. Difference between the mean phase of left ventricle (LV) and right ventricle (RV) assessed interventricular dyssynchrony, and standard deviations (SDs) of the mean phase in each ventricle assessed intraventricular dyssynchrony. RESULTS The QRS duration was related to both interventricular and intraventricular dyssynchrony. A degradation of the hemodynamic status was associated with an increase in intraventricular dyssynchrony but not in interventricular dyssynchrony. With a follow-up of 27 +/- 23 months, 18 patients had a major cardiac event (7 cardiac deaths; 11 worsening, leading to heart transplantation). The SDs of the LV and RV mean phase and QRS duration were predictors of cardiac event (all p < 0.0001), but interventricular dyssynchrony was not. Among 13 univariate predictors of cardiac event, the only independent predictors were an increased SD of LV mean phase (p = 0.0004) and an increased pulmonary capillary wedge pressure (p = 0.009). CONCLUSIONS Intraventricular dyssynchrony evaluated with phase analysis of radionuclide angiography is an independent predictor of cardiac event in IDC. The prognosis is related to intraventricular rather than to interventricular dyssynchrony in IDC.
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Affiliation(s)
- Laurent Fauchier
- Service de Cardiologie B, Centre Hospitalier Universitaire Trousseau, Tours, France.
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17
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Mehta SK, Super DM, Salvator A, Singer L, Connuck D, Fradley LG, Harcar-Sevcik RA, Thomas JD, Sun JP. Diastolic filling abnormalities by color kinesis in newborns exposed to intrauterine cocaine. J Am Soc Echocardiogr 2002; 15:447-53. [PMID: 12019428 DOI: 10.1067/mje.2002.117296] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Because cocaine crosses the placenta, we prospectively evaluated global and segmental systolic and diastolic cardiac function by color kinesis in clinically asymptomatic newborns who were exposed to cocaine in utero (group 1, n = 82). Their data were compared with normal controls (group 3, n = 87) and newborns exposed to drugs other than cocaine (group 2, n = 108). During left ventricular filling, newborns exposed to cocaine, compared with groups 2 and 3, had significantly (P <.05) higher global fractional area change (%) (76 +/- 10.3 vs 72 +/- 9.4 and 72 +/- 9.1, respectively), regional fractional area changes (%) for the anterior, septal, inferior, and lateral wall, and in the index of asynchrony (at 50% filling 13.2 +/- 5.8 vs 11.3 +/- 4.1 and 11.6 +/- 4.2, respectively). There were no significant differences in systolic function among the 3 groups. Prenatal cocaine exposure in asymptomatic infants leads to higher global and segmental fractional area changes and asynchrony during diastole. The significance and course of these alterations require further investigation.
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Affiliation(s)
- Sudhir Ken Mehta
- Department of Pediatrics, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
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Sun JP, Super DM, Salvator A, Singer L, Connuck D, Goetz Fradley L, Harcar-Sevcik RA, Kirchner HL, Thomas JD, Mehta SK. Quantification of regional left ventricular wall motion in newborns by color kinesis. J Am Soc Echocardiogr 2002; 15:356-63. [PMID: 11944014 DOI: 10.1067/mje.2002.117295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Normal values for regional left ventricular wall motion, although documented in adults, have not been reported in healthy newborns. METHODS This study prospectively evaluated global and segmental systolic and diastolic cardiac function by color kinesis in clinically asymptomatic healthy newborns. RESULTS Eighty-eight asymptomatic infants who were less than 48 hours old were studied. Systolic and diastolic parameters of global and regional left ventricular function are reported as means +/- SD, medians, 5th and 95th percentiles to establish the normative values for newborns. The reported fractional area changes during systole and diastole are similar to the reported normal values for older subjects. Higher body surface area significantly correlated with an increased peak velocity during systole, and fractional area changes during filling of the lateral wall. CONCLUSIONS Our report of left ventricular regional wall-motion characteristics of healthy newborns, as evaluated by color kinesis, may help in the objective evaluation and management of newborns suspected to have global or segmental ventricular dysfunction.
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Affiliation(s)
- Jing Ping Sun
- Cleveland Clinic Foundation, Fairview Hospital, Case Western Reserve University, Cleveland, Ohio 44111, USA
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19
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Fujino T, Ono S, Murata K, Tanaka N, Tone T, Yamamura T, Tomochika Y, Kimura K, Ueda K, Liu J, Wada Y, Murashita M, Kondo Y, Matsuzaki M. New method of on-line quantification of regional wall motion with automated segmental motion analysis. J Am Soc Echocardiogr 2001; 14:892-901. [PMID: 11547275 DOI: 10.1067/mje.2001.113631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have recently developed an automated segmental motion analysis (A-SMA) system, based on an automatic "blood-tissue interface" detection technique, to provide real-time and on-line objective echocardiographic segmental wall motion analysis. To assess the feasibility of A-SMA in detecting regional left ventricular (LV) wall motion abnormalities, we performed 2-dimensional echocardiography with A-SMA in 13 healthy subjects, 22 patients with prior myocardial infarction (MI), and 9 with dilated cardiomyopathy (DCM). Midpapillary parasternal short-axis and apical 2- and 4-chamber views were obtained to clearly trace the blood-tissue interface. The LV cavity was then divided into 6 wedge-shaped segments by A-SMA. The area of each segment was calculated automatically throughout a cardiac cycle, and the area changes of each segment were displayed as bar graphs or time-area curves. The systolic fractional area change (FAC), peak ejection rate (PER), and filling rate (PFR) were also calculated with the use of A-SMA. In the control group, a uniform FAC was observed in real time among 6 segments in the short-axis view (60% +/- 10% to 78% +/- 9%), or among 5 segments in either the 2-chamber (59% +/- 12% to 75% +/- 16%) or 4-chamber view (58% +/- 13% to 72% +/- 12%). The variations of FAC, PER, and PFR were obviously decreased in infarct-related regions in the MI group and were globally decreased in the DCM group. We conclude that A-SMA is an objective and time-saving method for assessing regional wall motion abnormalities in real time. This method is a reliable new tool that provides on-line quantification of regional wall motion.
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Affiliation(s)
- T Fujino
- Second Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Japan
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20
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Mor-Avi V, Lang RM. Recent advances in echocardiographic evaluation of left ventricular anatomy, perfusion, and function. Cardiol Rev 2001; 9:146-59. [PMID: 11304400 DOI: 10.1097/00045415-200105000-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2001] [Indexed: 11/25/2022]
Abstract
This article provides a brief overview of several recently developed, emerging technologies and discusses their potential uses on clinical grounds. These new technologies include three-dimensional imaging, objective automated evaluation of ventricular function with acoustic quantification, assessment of regional ventricular performance using color kinesis and tissue Doppler imaging, harmonic imaging, and power Doppler imaging. Our hope is that readers will gain a better understanding of the principles underlying these technological advances, which will help them to integrate these new techniques efficiently into their clinical practices.
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Affiliation(s)
- V Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago, MC 5084, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
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21
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Mor-Avi V, Collins KA, Korcarz CE, Shah M, Spencer KT, Lang RM. Detection of regional temporal abnormalities in left ventricular function during acute myocardial ischemia. Am J Physiol Heart Circ Physiol 2001; 280:H1770-81. [PMID: 11247791 DOI: 10.1152/ajpheart.2001.280.4.h1770] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Echocardiographic diagnosis of myocardial ischemia is based on visualizing hypokinesis, which occurs late in the ischemic cascade. We hypothesized that temporal changes in endocardial motion may constitute sensitive early markers of ischemia. Two protocols were performed in 19 anesthetized pigs. Protocol 1 included 54 intracoronary balloon occlusions. Transthoracic images were acquired at baseline and every 15 s during 5 min of occlusion and reperfusion. In protocol 2, ischemia was induced in 12 animals by use of graded dobutamine infusion, after creating significant partial occlusions without a resting wall motion abnormality. Systolic and diastolic endocardial motion was color encoded using color kinesis and analyzed using custom software. All ischemic episodes caused detectable and reversible changes. The earliest sign of ischemia was tardokinesis in 31/54 occlusions, whereas hypokinesis appeared first in 23/54 cases. Dobutamine-induced ischemia caused tardokinesis first in 9/12 and hypokinesis in 3/12 animals. Reversible ischemic changes in regional left ventricular performance can be objectively detected using analysis of echocardiographic images and will likely improve the early noninvasive diagnosis of acute ischemia.
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Affiliation(s)
- V Mor-Avi
- The Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, Illinois 60637, USA.
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22
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Mor-Avi V, Spencer K, Gorcsan J, Demaria A, Kimball T, Monaghan M, Perez J, Sun JP, Weinert L, Bednarz J, Collins K, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Thomas J, Lang R. Normal values of regional left ventricular endocardial motion: multicenter color kinesis study. Am J Physiol Heart Circ Physiol 2000; 279:H2464-76. [PMID: 11045984 DOI: 10.1152/ajpheart.2000.279.5.h2464] [Citation(s) in RCA: 24] [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: 11/22/2022]
Abstract
Our goal was to establish normal values for quantitative color kinesis indexes of left ventricular (LV) wall motion over a wide range of ages, which are required for objective diagnosis of regional systolic and diastolic dysfunction. Color-encoded images were obtained in 194 normal subjects (95 males, 99 females, age 2 mo to 79 yr) in four standard views. Quantitative indexes of magnitude and timing of systolic and diastolic function were studied for age- and gender-related differences. Normal limits of all ejection and filling indexes were in a narrow range (< or =25% of the mean), with no major gender-related differences. Despite invariable ejection fractions, both peak filling and ejection rates decreased with age (30 and 20%, correspondingly) with a concomitant increase in mean filling and ejection times, resulting in five- and twofold increases in the late to early filling and ejection ratios, correspondingly. Diastolic asynchrony increased with age (from 4.7 +/- 2.0 to 6.4 +/- 3.2 from the 2nd to 7th decade). The normal values of color kinesis indexes should allow objective detection of regional LV systolic and diastolic dysfunction.
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Affiliation(s)
- V Mor-Avi
- The University of Chicago, Chicago, Illinois 60637, USA.
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23
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Carey CF, Mor-Avi V, Koch R, Lang R, Pérez JE. Effects of inotropic stimulation on segmental left ventricular relaxation quantified by color kinesis. Am J Cardiol 2000; 85:1476-80. [PMID: 10856396 DOI: 10.1016/s0002-9149(00)00798-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although myocardial ischemia impairs left ventricular (LV) relaxation before contractile function, regional LV diastolic dysfunction is difficult to evaluate by conventional echocardiography. Because beta-adrenergic stimulation enhances myocardial relaxation, we sought to characterize segmental LV diastolic function (by color kinesis) during dobutamine stress echocardiography and compare it with independently assessed segmental systolic function. We studied 22 patients with suspected coronary artery disease with color kinesis by acquiring digital images with endocardial motion display throughout diastole. Quantification of LV segmental diastolic peak filling rate (SPFR, normalized to segmental end-diastolic area/s) was obtained at rest, low-dose, and peak dobutamine infusion in myocardial segments visualized from the short-axis and/or apical 4-chamber views. In patients with resting normal LV systolic function and a dobutamine-induced hypercontractile response (group I, n = 13 patients; 102 segments), progressive increases in SPFR (p <0.001) were seen in all segments. However, in LV segments with resting systolic wall motion abnormalities (group II, n = 9 patients; 74 segments) SPFR measured at rest was significantly lower than that in group I (p <0.005) and did not increase significantly in response to dobutamine. In both groups of patients, LV myocardial segments (n = 528; rest and after dobutamine)-systolic and quantitative diastolic function-were concordant in 84% and 77% as viewed from short-axis and apical views, respectively. Thus, segmental LV diastolic function can be measured with color kinesis at rest and after inotropic stimulation, allowing comparison with segmental systolic function during pharmacologic stress testing.
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Affiliation(s)
- C F Carey
- Washington University School of Medicine, St. Louis, MO 63110, USA
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24
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Koch R, Lang RM, Garcia MJ, Weinert L, Bednarz J, Korcarz C, Coughlan B, Spiegel A, Kaji E, Spencer KT, Mor-Avi V. Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images. J Am Coll Cardiol 1999; 34:409-19. [PMID: 10440153 DOI: 10.1016/s0735-1097(99)00233-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analysis of color kinesis (CK) images to detect dobutamine-induced wall motion abnormalities and compared this technique with inexperienced reviewers of conventional gray-scale images. BACKGROUND Conventional interpretation of stress echocardiographic studies is subjective and experience dependent. METHODS CK images were obtained in 89 of 104 consecutive patients undergoing clinical dobutamine stress studies and were analyzed using custom software to calculate regional fractional area change in 22 segments in four standard views. Each patient's data obtained at rest was used as a control for automated detection of dobutamine-induced wall motion abnormalities. Independently, studies were reviewed without CK overlays by two inexperienced readers who classified each segment's response to dobutamine. A consensus reading of two experienced reviewers was used as the gold standard for comparisons. In a subgroup of 16 patients, these consensus readings and CK detection of wall motion abnormalities were compared with coronary angiography. RESULTS The consensus reading detected ischemic response to dobutamine in 43 of 1958 segments in 23 of 89 patients. Automated detection of stress-induced wall motion abnormalities correlated more closely with the standard technique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specificity 0.98 vs. 0.94 and accuracy 0.97 vs. 0.92). When compared with coronary angiography in a subgroup of patients, analysis of CK images differentiated between normal and abnormal wall motion more accurately than expert readers of gray-scale images (accuracy of 0.93 vs. 0.82). CONCLUSIONS Analysis of CK images allows fast, objective and automated evaluation of regional wall motion, sensitive enough for clinical dobutamine stress data and more accurate than inexperienced readers. This method may result in a valuable adjunct to conventional visual interpretation of dobutamine stress echocardiography.
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Affiliation(s)
- R Koch
- Department of Medicine, The University of Chicago Medical Center, Illinois 60637, USA
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25
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Kotoh K, Watanabe G, Ueyama K, Uozaki M, Suzuki M, Misaki T, Wakasugi M, Ito Y. On-line assessment of regional ventricular wall motion by transesophageal echocardiography with color kinesis during minimally invasive coronary artery bypass grafting. J Thorac Cardiovasc Surg 1999; 117:912-7. [PMID: 10220684 DOI: 10.1016/s0022-5223(99)70371-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our objective was to determine the changes in regional ventricular wall motion during minimally invasive direct coronary artery bypass grafting by color kinesis using transesophageal echocardiography. METHODS Minimally invasive coronary artery bypass grafting was performed in 34 patients, during which transesophageal echocardiography was used. Thirteen patients had isolated disease of the left anterior descending artery. Regional ventricular wall motion was analyzed by color kinesis with the SONOS 2500 transesophageal echocardiograph (Hewlett-Packard Co, Andover, Mass). On-line assessment of regional wall motion was continued during the operation. RESULTS Wall motion abnormalities during ischemia were present in 4 cases, left ventricular mid-anterior hypokinesis in 3 cases, and left ventricular apical-lateral hypokinesis in 1 case. In all cases, wall motion was maintained after bypass. In patients with total coronary occlusion, changes in wall motion did not occur during anastomosis. CONCLUSIONS Color kinesis allowed us to evaluate the change in regional ventricular wall motion induced by myocardial ischemia during minimally invasive coronary artery bypass grafting both objectively and quantitatively.
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Affiliation(s)
- K Kotoh
- Departments of Surgery and Anesthesiology, Toyama Medical and Pharmaceutical University, Toyama, Japan
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26
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Mor-Avi V, Godoy IE, Lang RM. Color Kinesis: New Technique or Just Another Display of Acoustic Quantification? Echocardiography 1999; 16:95-103. [PMID: 11175127 DOI: 10.1111/j.1540-8175.1999.tb00790.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Color kinesis is a relatively new echocardiographic technique that allows color encoding of endocardial motion in real time. We briefly review the literature on the current clinical uses and limitations of this technique, as well as its potential future applications based on some of our results. The major advantage of this modality is that it provides the basis for objective and automated evaluation of regional systolic and diastolic function, which may have a direct impact on the diagnosis of various myocardial disease states and, in particular, coronary artery disease.
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Affiliation(s)
- Victor Mor-Avi
- The University of Chicago Medical Center, 5841 S. Maryland Ave., Chicago, IL 60637
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27
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Vignon P, Spencer KT, Mor-Avi V, Weinert L, Lang RM. Evaluation of Global and Regional Right Ventricular Function Using Automated Border Detection Techniques. Echocardiography 1999; 16:105-116. [PMID: 11175128 DOI: 10.1111/j.1540-8175.1999.tb00791.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Quantitative evaluation of right ventricular (RV) function remains challenging due to the complex geometry of this chamber, which precludes the use of simple geometric assumptions. Automated border detection (ABD) techniques, which provide online changes in cardiac chamber dimensions, have been predominantly used for quantitative assessment of global as well as regional left ventricular function. Recently, acoustic quantification has been validated for quantitative evaluation of global RV function, and color kinesis has been used to objectively assess systolic and diastolic regional RV function. In this article, the main studies validating ABD for the objective assessment of global RV function and the current clinical uses of this technique are reviewed. In addition, technical guidelines and limitations of ABD techniques are described, and potential applications of color kinesis for quantitative assessment of regional systolic and diastolic RV performance are detailed. ABD techniques provide new insights into right atrial and RV systolic and diastolic properties. The clinical value of these techniques in the diagnosis, prognosis, and potential guidance of therapeutic management of RV dysfunction remains to be determined.
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Affiliation(s)
- Philip Vignon
- The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
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