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Kelley RE, Kelley BP. Heart-Brain Relationship in Stroke. Biomedicines 2021; 9:biomedicines9121835. [PMID: 34944651 PMCID: PMC8698726 DOI: 10.3390/biomedicines9121835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
The patient presenting with stroke often has cardiac-related risk factors which may be involved in the mechanism of the stroke. The diagnostic assessment is predicated on recognition of this potential relationship. Naturally, an accurate history is of utmost importance in discerning a possible cause and effect relationship. The EKG is obviously an important clue as well as it allows immediate assessment for possible cardiac arrhythmia, such as atrial fibrillation, for possible acute ischemic changes reflective of myocardial ischemia, or there may be indirect factors such as the presence of left ventricular hypertrophy, typically seen with longstanding hypertension, which could be indicative of a hypertensive mechanism for a patient presenting with intracerebral hemorrhage. For all presentations in the emergency room, the vital signs are important. An elevated body temperature in a patient presenting with acute stroke raises concern about possible infective endocarditis. An irregular-irregular pulse is an indicator of atrial fibrillation. A markedly elevated blood pressure is not uncommon in both the acute ischemic and acute hemorrhagic stroke setting. One tends to focus on possible cardioembolic stroke if there is the sudden onset of maximum neurological deficit versus the stepwise progression more characteristic of thrombotic stroke. Because of the more sudden loss of vascular supply with embolic occlusion, seizure or syncope at onset tends to be supportive of this mechanism. Different vascular territory involvement on neuroimaging is also a potential indicator of cardioembolic stroke. Identification of a cardiogenic source of embolus in such a setting certainly elevates this mechanism in the differential. There have been major advances in management of acute cerebrovascular disease in recent decades, such as thrombolytic therapy and endovascular thrombectomy, which have somewhat paralleled the advances made in cardiovascular disease. Unfortunately, the successful limitation of myocardial damage in acute coronary syndrome, with intervention, does not necessarily mirror a similar salutary effect on functional outcome with cerebral infarction. The heart can also affect the brain from a cerebral perfusion standpoint. Transient arrhythmias can result in syncope, while cardiac arrest can result in hypoxic-ischemic encephalopathy. Cardiogenic dementia has been identified as a mechanism of cognitive impairment associated with severe cardiac failure. Structural cardiac abnormalities can also play a role in brain insult, and this can include tumors, such as atrial myxoma, patent foramen ovale, with the potential for paradoxical cerebral embolism, and cardiomyopathies, such as Takotsubo, can be associated with precipitous cardioembolic events.
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Affiliation(s)
- Roger E. Kelley
- Ochsner/LSU Health Sciences Center, Department of Neurology, Shreveport, LA 71130, USA
- Correspondence:
| | - Brian P. Kelley
- Division of Cardiology, Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA;
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Yaghi S, Song C, Gray WA, Furie KL, Elkind MSV, Kamel H. Left Atrial Appendage Function and Stroke Risk. Stroke 2015; 46:3554-9. [PMID: 26508750 DOI: 10.1161/strokeaha.115.011273] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/24/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Shadi Yaghi
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.).
| | - Christopher Song
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.)
| | - William A Gray
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.)
| | - Karen L Furie
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.)
| | - Mitchell S V Elkind
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.)
| | - Hooman Kamel
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology (S.Y., K.L.F.), and Division of Cardiology, Department of Internal Medicine (C.S.), The Warren Alpert Medical School of Brown University, Providence, RI; Cardiology Division, Department of Internal Medicine (W.A.G.) and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health (W.A.G.), Columbia University, New York, NY; and Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY (H.K.)
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Comprehensive left atrial appendage optimization of thrombus using surface echocardiography: the CLOTS multicenter pilot trial. J Am Soc Echocardiogr 2009; 22:1165-72. [PMID: 19647401 DOI: 10.1016/j.echo.2009.05.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to determine the ability to identify thrombus within the left atrial appendage (LAA) in the setting of atrial fibrillation (AF) using transthoracic echocardiography (TTE). In AF, the structure and function of the LAA has historically been evaluated using transesophageal echocardiography (TEE). The role of TTE remains undefined. METHODS The Comprehensive Left Atrial Appendage Optimization of Thrombus (CLOTS) multicenter study enrolled 118 patients (85 men; mean age, 67 +/- 13 years) with AF of >2 days in duration undergoing clinically indicated TEE. On TEE, the LAA was evaluated for mild spontaneous echo contrast (SEC), severe SEC, sludge, or thrombus. Doppler Tissue imaging (DTI) peak S-wave and E-wave velocities of the LAA walls (anterior, posterior, and apical) were acquired on TTE. Transthoracic echocardiographic harmonic imaging (with and without intravenous contrast) was examined to determine its ability to identify LAA SEC, sludge, or thrombus. RESULTS Among the 118 patients, TEE identified 6 (5%) with LAA sludge and 2 (2%) with LAA thrombi. Both LAA thrombi were identified on TTE using harmonic imaging with contrast. Anterior, posterior, and apical LAA wall DTI velocities on TTE varied significantly among the 3 groups examined (no SEC, mild SEC, severe SEC, sludge or thrombus). An apical E velocity < or = 9.7 cm/s on TTE best identified the group of patients with severe SEC, sludge, or thrombus. An anterior S velocity < or = 5.2 cm/s on TTE best identified the group of patients with sludge or thrombus. CONCLUSIONS The CLOTS multicenter pilot trial determined that TTE is useful in the detection of thrombus using harmonic imaging combined with intravenous contrast (Optison; GE Healthcare, Milwaukee, WI). Additionally, LAA wall DTI velocities on TTE are useful in determining the severity of LAA SEC and detecting sludge or thrombus.
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Casella F, Rana B, Casazza G, Bhan A, Kapetanakis S, Omigie J, Reiken J, Monaghan MJ. The potential impact of contemporary transthoracic echocardiography on the management of patients with native valve endocarditis: a comparison with transesophageal echocardiography. Echocardiography 2009; 26:900-6. [PMID: 19486112 DOI: 10.1111/j.1540-8175.2009.00906.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Between 1987 and 1994, several studies demostrated transthoracic echocardiography (TTE) to be less sensitive than transesophageal echocardiography (TEE) in detecting native valve endocarditis. Recent technologic advances, especially the introduction of harmonic imaging and digital processing and storage, have improved TTE image quality. The aim of this study was to determine the diagnostic accuracy of contemporary TTE. METHODS Between 2003 and 2007, 75 patients underwent both TTE and TEE for clinically suspected infective endocarditis. The diagnostic accuracy of TTE was assessed using transesophageal echocardiography as the gold standard for diagnosis of endocarditis. RESULTS Of the 75 patients in this study, 33 were found to be positive by TEE. The sensitivity for detection of infective endocarditis by TTE was 81.8%. It provided good image quality in 81.5% of cases; in these patients sensitivity was even greater (89.3%). CONCLUSION Contemporary TTE has improved the diagnostic accuracy of infective endocarditis by ameliorating image quality; it provides an accurate assessment of endocarditis and may reduce the need for TEE.
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Affiliation(s)
- Francesco Casella
- Department of Cardiology, King's College Hospital, Denmark Hill, London, UK
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Kim MK, Park DG. Correlation between Stroke and Spontaneous Echo Contrast by Tissue Harmonic Imaging in Patients with Dilated Cardiomyopathy. J Cardiovasc Ultrasound 2009. [DOI: 10.4250/jcu.2009.17.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Min-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Coletta C, Infusino T, Sciarretta S, Sestili A, Trambaiolo P, Cianfrocca C, De Marchis E, Auriti A, Salustri A. Transthoracic Doppler echocardiography for the assessment of left atrial appendage size and blood flow velocity. A multicentre study. J Cardiovasc Med (Hagerstown) 2008; 9:147-52. [DOI: 10.2459/jcm.0b013e3281053abd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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de Luca I, Colonna P, Sorino M, Del Salvatore B, De Luca L. New Monodimensional Transthoracic Echocardiographic Sign of Left Atrial Appendage Function. J Am Soc Echocardiogr 2007; 20:324-32. [PMID: 17336761 DOI: 10.1016/j.echo.2006.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Italo de Luca
- Department of Cardiology-Azienda Policlinico, Bari, Italy.
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Improved detection of left ventricular thrombi and spontaneous echocontrast by tissue harmonic imaging in patients with myocardial infarction. J Am Soc Echocardiogr 2006; 19:1373-81. [PMID: 17098141 DOI: 10.1016/j.echo.2006.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tissue harmonic imaging (THI) reduces near-field and side-lobe artifacts. This could improve recognition of cardiac masses, including thrombi and spontaneous echocontrast (SEC), a known thromboembolic risk factor. OBJECTIVES We tested the hypothesis that THI improves detection of left ventricular (LV) thrombi and SEC compared with transthoracic fundamental imaging in patients with recent myocardial infarction. METHODS In all, 118 consecutive patients with recent myocardial infarction were studied at predischarge. The echocardiographic examination was performed in both fundamental imaging and THI modality and evaluated by 3 skilled and 3 nonexperienced observers for recognition of LV thrombosis and SEC. RESULTS THI increased LV thrombi diagnosis by 25% by skilled observers and by 50% by nonexperienced readers, reducing the number of false-positive diagnoses by 67%. Also, compared with fundamental imaging, THI improved recognition of LV SEC by both experienced and nonexperienced observers by 56% and 62%, respectively. CONCLUSIONS The improved recognition of LV thrombosis and SEC by THI in patients with myocardial infarction is clinically relevant allowing appropriate treatment and prognostic stratification. Therefore, routine use of THI should be recommended when studying such patients in clinical practice.
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Chirillo F, Pedrocco A, De Leo A, Bruni A, Totis O, Meneghetti P, Stritoni P. Impact of harmonic imaging on transthoracic echocardiographic identification of infective endocarditis and its complications. Heart 2005; 91:329-33. [PMID: 15710712 PMCID: PMC1768775 DOI: 10.1136/hrt.2003.031583] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the comparative diagnostic value of harmonic imaging (HI) in the assessment of patients with suspected infective endocarditis (IE). SETTING Tertiary referral centre. DESIGN 139 consecutive patients were evaluated with three imaging modalities: transthoracic echocardiography with fundamental imaging (FI); HI; and transoesophageal echocardiography (TOE). Image quality was assessed for each modality by semiquantitative scoring (0, poor, to 3, excellent). Presence, dimension, and characteristics of vegetations were assessed separately for each imaging modality, as well as presence of abscesses. RESULTS 35 patients had definite IE. TOE was positive in 33 patients, HI in 28, and FI in 12 (p < 0.001 for FI v HI and v TOE). Mean image quality was 1.4 (0.7) for FI, 2.1 (0.6) for HI (p < 0.01 v FI), and 2.6 (0.4) for TOE (p < 0.001 v HI). The association between FI and TOE findings was Phi = 0.35 (chi2 = 17.57, p = 0.0014) and between HI and TOE it was Phi = 0.95 (chi2 = 125.72, p < 0.0001; p < 0.0001 v FI). The global echo score of vegetations was 7.1 (3.3) with FI, 8.5 (3.4) with HI, and 11.3 (3.9) with TOE (p < 0.001 v HI). Compared with TOE, FI identified only one of seven abscesses (sensitivity 14%) and HI identified two of seven abscesses (sensitivity 28%). CONCLUSIONS HI provides an accurate assessment of suspected IE. TOE achieves superior definition of IE related abnormalities.
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Affiliation(s)
- F Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Piazzale Ospedale 1, 31100 Treviso, Italy.
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Moreira FC, Miglioransa MH, Hartmann IB, Rohde LE. Left atrial appendage assessment by second harmonic transthoracic echocardiography after an acute ischemic neurologic event. J Am Soc Echocardiogr 2005; 18:206-12. [PMID: 15746707 DOI: 10.1016/j.echo.2004.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although second harmonic (sh) imaging is widely available in most contemporary ultrasound systems, its accuracy to evaluate left atrial appendage (LAA) morphology and function remains poorly characterized. We conducted a cross-sectional survey of patients with acute ischemic neurologic conditions (n = 51) who underwent both transesophageal and transthoracic echocardiography (TTE) to explore the performance of sh in LAA assessment. Doppler and LAA area evaluation by sh TTE were feasible in most patients (98%). We observed positive and significant associations between sh TTE and transesophageal echocardiography assessment of LAA peak emptying velocities (r = 0.63, P < .001) and LAA maximum area (r = 0.73, P < .001). In addition, all patients (n = 7) with LAA thrombus or spontaneous contrast had peak emptying velocities less than 50 cm/s on sh TTE (negative predictive value of 100%). In multivariate analysis, LAA peak emptying velocity remained independently associated with LAA thrombus or contrast. In conclusion, sh TTE can provide valuable and clinically relevant information of LAA morphology and dynamics.
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Affiliation(s)
- Fábio Cañellas Moreira
- Cardiovascular Divisions of Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2061, Porto Alegrem RS, Brazil 90035-003
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Abstract
Harmonic ultrasound is a technique based on the principle of transmitting at frequency f and receiving at frequency 2f (or 1/2f). This technology has become available through the development of wide-bandwidth transducers. Microbubble contrast media produce a large amount of harmonic signal. Contrast harmonic ultrasound provides the opportunity to image patterns of high flow vasculature and overall perfusion. Regions of poor perfusion, including necrosis or infarction, can be identified with contrast harmonic ultrasound. While proportionately lower, tissues also produce harmonic signals. Tissue harmonic ultrasound sequences often improve subjective image quality compared to fundamental ultrasound in echocardiographic and abdominal examinations. This review will discuss the physical principles of harmonic ultrasound signal generation, medical and animal research applications, and an overview of current veterinary experiences.
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Affiliation(s)
- Laura Ziegler
- Department of Surgical Sciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
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Carerj S, Trifiró MP, Granata A, Luzza F, Arrigo F, Oreto G. Comparison between transesophageal echocardiography and transthoracic echocardiography with harmonic tissue imaging for left atrial appendage assessment. Clin Cardiol 2002; 25:268-70. [PMID: 12058789 PMCID: PMC6653987 DOI: 10.1002/clc.4960250605] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2001] [Accepted: 11/02/2001] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA. HYPOTHESIS The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function. METHODS The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20-82). The TTE as sessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two-chamber view, the longitudinal two-chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality. RESULTS Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted in adequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 +/-1.17 and 3.59 +/- 1.16 cm2, respectively; LAA minimum area was 1.81 +/- 0.98 and 1.77 +/- 0.97 cm2, respectively. Percent LAA area change was 51 +/- 16.5 and 50.9 +/- 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods. CONCLUSIONS The results suggest that HFI TNE may be a useful tool for the exploration of LAA.
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Trambaiolo P, Salustri A, Tanga M, Tonti G, Fedele F, Palamara A. Assessment of left atrial appendage wall velocities by transesophageal tissue Doppler echocardiography: a clinical study in patients with sinus rhythm. J Am Soc Echocardiogr 2002; 15:425-32. [PMID: 12019425 DOI: 10.1067/mje.2002.115886] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To assess left atrial appendage (LAA) wall velocities, 42 patients in sinus rhythm underwent tissue Doppler interrogation during a clinically indicated transesophageal echocardiography. Color Doppler (B-mode and M-mode) and pulsed Doppler of LAA walls were obtained and analyzed in all patients. Color-coded tissue Doppler rendered a qualitative assessment of LAA wall, depicting both the timing and the sequence of LAA contraction. With pulsed Doppler interrogation, a triphasic signal was recorded in all patients, consisting of a positive wave (D1), followed by a biphasic wave (positive D2 and negative D3). Peak velocities of D1, D2, and D3 were 6.1 +/- 2, 20.1 +/- 7, and 16.1 +/- 5 cm/s, respectively. Mean coefficient of variation of LAA wall velocities was 6%, significantly lower than that of LAA percentage area change (29%). Compared with patients with abnormal relaxation, patients with normal mitral inflow had higher D1 peak velocities (7.3 +/- 1.2 vs 4.3 +/- 1 cm/s, respectively; P <.0001). Time sequence of ECG, LAA flow, and mitral inflow indicates that D1 component of LAA wall occurs in early diastole and is likely due to the upward movement of the mitral ring toward the base of the LAA wall. In conclusion, evaluation of LAA wall using tissue Doppler is feasible and reproducible. Although color tissue Doppler analysis allows a qualitative assessment, pulsed Doppler gives new quantitative insights for the comprehensive assessment of LAA wall dynamics, which complements the information obtained with flow interrogation.
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Affiliation(s)
- Paolo Trambaiolo
- Laboratory of Echocardiography, Division of Cardiology, Sandro Pertini Hospital Roma, Italy
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Hosono T, Chiba Y, Kanai H, Kanagawa T. Initial experiences of tissue harmonic imaging in the diagnosis of fetal cardiac tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:400-402. [PMID: 11952972 DOI: 10.1046/j.1469-0705.2002.00664.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The usefulness of tissue harmonic imaging in prenatal diagnosis is illustrated in two fetuses with a cardiac tumor. Tissue harmonic imaging provided more informative images than conventional B-mode imaging, enabling the detection of the site of attachment of the cardiac tumor and estimation of intracardiac blood flow. The advantages of tissue harmonic imaging over conventional B-mode imaging in prenatal diagnosis are discussed.
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Affiliation(s)
- T Hosono
- Department of Perinatology, National Cardiovascular Center, Suita, Osaka, Japan.
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Abstract
Noncontrast harmonic imaging (HI) has been shown to improve image quality in adults with poor acoustic windows. The utility of fetal echocardiography may be limited by suboptimal acoustic windows, and the use of HI in fetal echocardiography has not previously been defined. The purpose of this study was to compare the quality of fundamental imaging (FI) and HI in fetal echocardiography. Sixty-two fetal echocardiograms, including 44 (71%) with limited acoustic windows, were performed with the use of FI and HI. Image quality and visualization of the ventricles, valves, and the aortic and ductal arches were evaluated and compared between FI and HI. Mean HI scores were higher than mean FI scores for all the structures evaluated. Compared with FI, HI improved the image quality and visualization of cardiac structures in this group of fetuses with predominantly suboptimal acoustic windows. Harmonic imaging is a useful adjunct to FI in echocardiography, and the benefits of HI extend to cardiac imaging in the fetus.
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Affiliation(s)
- J P Kovalchin
- Texas Children's Hospital and the Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA. johnk2bcm.tmc.edu
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Schlachetzki F, Hoelscher T, Dorenbeck U, Greiffenberg B, Marienhagen J, Ullrich OW, Bogdahn U. Sonographic parenchymal and brain perfusion imaging: preliminary results in four patients following decompressive surgery for malignant middle cerebral artery infarct. ULTRASOUND IN MEDICINE & BIOLOGY 2001; 27:21-31. [PMID: 11295267 DOI: 10.1016/s0301-5629(00)00309-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
To investigate new methods of diagnostic transcranial sonography for brain parenchymal, vascular and perfusion imaging, we performed 3-D native tissue harmonic transcranial sonography (3D-nthTCS), 3-D transcranial color-coded duplex sonography (3D-TCCS), and "loss-of-correlation" imaging (LOC-TCCS) in four patients following early hemicraniectomy due to space-occupying "malignant" middle cerebral artery infarction (MMCAI). Three-dimensional datasets, utilizing 3D-nthTCS and 3D-TCCS, were created and up to 10 axial 2-D B-mode image planes, similar to CCT, reconstructed in each patient. Three-dimensional reconstructions of the circle of Willis documented one persistent carotid-T occlusion and three recanalizations of the MCA. LOC-TCCS, based on stimulated acoustic emission from an ultrasound (US) contrast agent, demonstrated a perfusion deficit in 2 of 3 patients, with regard to their infarcts. Concluding, 3D-nthTCS, 3D-TCCS and LOC-TCCS are promising tools for bedside monitoring, early prognosis and treatment evaluation for MMCAI in the postoperative period. Further studies should be performed to standardize these new methods and evaluate their applications through the intact calvarina.
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Affiliation(s)
- F Schlachetzki
- Department of Neurology, University of Regensburg, Regensburg, Germany.
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Ha JW, Chung N, Kang SM, Jang KJ, Kim IJ, Rim SJ, Jang Y, Shim WH, Cho SY, Kim SS. Enhanced detection of left atrial spontaneous echo contrast by transthoracic harmonic imaging in mitral stenosis. J Am Soc Echocardiogr 2000; 13:849-54. [PMID: 10980088 DOI: 10.1067/mje.2000.106791] [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: 11/22/2022]
Abstract
BACKGROUND Spontaneous echo contrast (SEC) of the left atrium is associated with increased risk of thromboembolism in patients with mitral stenosis (MS). The determination of the presence and severity of left atrial (LA) SEC is of prognostic importance in these patients. Harmonic imaging (HI), a novel echocardiographic technique that differs from conventional fundamental imaging (FI) in that it involves transmitting ultrasound at one frequency and receiving at twice the transmitted frequency, produces better endocardial border definition and myocardial opacification. However, there are no data about its value for the detection of LA SEC. The purpose of this study was to investigate the utility of transthoracic noncontrast tissue HI in the detection of LA SEC in patients with MS. METHODS Seventy-four consecutive patients with MS (49 women, mean age 51 years) underwent standard transthoracic echocardiography (TTE) in both HI and FI modes and transesophageal echocardiography (TEE) to determine the presence and severity of LA SEC. Left atrial SEC was graded by TEE as either mild (only seen at high gain) or severe (visible in the entire left atrium at normal gain control of the equipment). The control group comprised 30 patients randomly selected from patients who did not have LA SEC at the TEE examination. RESULTS Atrial fibrillation was found in 46 patients (62.2%). The mean mitral valve area and mean mitral gradient were 1.0+/-0.3 cm(2) and 8.2+/-4.1 mm Hg, respectively. Nine patients (12.2%) had episodes of systemic embolism; 8 had stroke, and 1 had peripheral embolism. Left atrial thrombus was found in 11 patients (14.9%) by TEE. Left atrial SEC was present in all but one patient by TEE (mild in 35 patients, severe in 38). Fundamental imaging with TTE, however, revealed LA SEC in only 5 (6.8%) of the 73 patients. In contrast, with HI, LA SEC could be detected in 63 (86.3%) patients. In the detection of severe LA SEC, the sensitivities of FI and HI were 13.2% (5/38) and 100% (38/38), respectively. Left atrial SEC was not observed in control subjects by either FI or HI. CONCLUSIONS Transthoracic HI significantly enhances the detection of LA SEC in patients with MS.
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Affiliation(s)
- J W Ha
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Affiliation(s)
- H Feigenbaum
- Indiana University School of Medicine, Indiana University, and the Krannert Institute of Cardiology, Indianapolis, USA
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Tanabe K, Belohlavek M, Greenleaf JF, Seward JB. Tissue harmonic imaging: experimental analysis of the mechanism of image improvement. JAPANESE CIRCULATION JOURNAL 2000; 64:202-6. [PMID: 10732852 DOI: 10.1253/jcj.64.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tissue harmonic scanning visually improves echocardiographic image quality. The aim of the present study was to objectively assess the improvement in harmonic image quality under controlled laboratory conditions. A tissue-mimicking phantom that contained 8-mm-diameter cystic lesions at depths ranging from 2 to 12 cm was used. Harmonic scans (1.7 MHz transmit, 3.4 MHz receive) of the phantom were obtained and lesion detectability was compared to that in scans acquired with 2 fundamental frequencies (2.0 and 3.3 MHz). A 2 cm-thick ethanol layer was also used to simulate the nonlinear effect of human fat. Cyst detectability was quantified by measurement of the contrast-to-speckle ratio (CSR). The results indicated no significant difference in the CSR between harmonic and fundamental images obtained without the ethanol layer. With images obtained with the ethanol layer, a relative increase of the CSR during harmonic imaging was observed with respect to fundamental imaging (p<0.05). In conclusion, a fat layer, here simulated by ethanol, plays a significant role in determining the resulting image quality. Without this layer, the contribution of the second harmonic mode was not significant. Thus, in a slim patient, the harmonic mode may not be as beneficial to image improvement as in an obese patient.
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Affiliation(s)
- K Tanabe
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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