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Radwan H, Shawky A, Selem AE. Does the Post-Systolic Shortening of the Left Ventricle by Tissue Doppler Imaging Predict Coronary Artery Disease? ARCHIVES OF CARDIOVASCULAR IMAGING 2016; 4. [DOI: 10.5812/acvi.41788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Kaseno H, Toyama T, Okaniwa H, Toide H, Yamashita E, Kawaguchi R, Adachi H, Hoshizaki H, Oshima S. Diastolic Stunning as a Marker of Severe Coronary Artery Stenosis: Analysis by Speckle Tracking Radial Strain in the Resting Echocardiogram. Echocardiography 2015; 33:30-7. [PMID: 26120955 DOI: 10.1111/echo.12999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hiroyo Kaseno
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Takuji Toyama
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroki Okaniwa
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroyuki Toide
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Eiji Yamashita
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Ren Kawaguchi
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hitoshi Adachi
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroshi Hoshizaki
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Shigeru Oshima
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
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Stress echocardiography: a useful tool for children with aortic stenosis. Pediatr Cardiol 2013; 34:1237-43. [PMID: 23377382 DOI: 10.1007/s00246-013-0635-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
The development of echocardiographic ventricular wall motion abnormalities and ST segment changes with exercise may enhance the detection of myocardial ischemia in children with aortic valve stenosis (AS). This study aimed to assess the relationship between the exercise wall motion index (WMIe), ST segment depression (STd), and overall functionality in asymptomatic children with isolated AS. A prospective interpretation of collected stress echocardiographic images was performed. The 98 children who met the inclusion criteria had a mean age of 12.8 years and a male/female ratio of 4/1. Group 1 (mild AS) was composed of 70 children, and group 2 (moderate or severe AS) was composed of 28 children. Abnormal WMIe was seen in 8 patients (5 in group 1 and 3 in group 2), and significant STd was observed in 13 children (3 in group 1 and 10 in group 2). Four (50 %) of the eight patients with abnormal WMIe also had significant STd. Severity of stenosis was associated with STd (odds ratio [OR], 12.0; 95 % CI 3.0-49.0), logistic regression). A significant association also existed between abnormal WMIe and STd (OR, 9.0; 95 % CI 1.9-42.0, logistic regression). Exercise duration was significantly shorter in group 2 (12 ± 4.52 min) than in group 1 (13 ± 5.28 min) (p = 0.02, analysis of covariance). The appearance of wall motion abnormalities and STd during exercise may be helpful in detecting inducible, functionally important myocardial ischemia in asymptomatic children with AS. Stress echocardiography may be a useful adjunct to more traditional exercise testing in risk stratifying asymptomatic children with AS.
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Chen D, Liao Y, Xu Q, Li Y, Wu W, Wu J, Liao W, Xu D, Liu Y, Wu P, Bin J. Persistence of systolic and diastolic regional dysfunction after brief episodes of myocardial ischemia evaluated with velocity vector imaging. Int J Cardiol 2012; 167:987-94. [PMID: 22445875 DOI: 10.1016/j.ijcard.2012.03.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 02/01/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The time course and characteristics of persistent regional dysfunction after ischemia remain unclear. Velocity vector imaging (VVI) allows accurate quantification of regional myocardial function. The aim of this study was to characterize the time course of regional diastolic and systolic abnormality after recovery from different durations of ischemia by VVI. METHODS 72 rats underwent brief left coronary occlusion (3, 5, 10 and 15 min, respectively) followed by reperfusion for 4-8h. Hemodynamic measurements and VVI were performed at various time points. Regional systolic and diastolic functions were estimated from peak diastolic and systolic circumferential strain rate (SR-d and SR-s) of the left ventricle, respectively. RESULTS Both SR-d and SR-s were significantly decreased in the ischemic segment during occlusion compared to non-ischemic segment. With the increase in occlusive time, the duration of reduced SR-d and SR-s after reperfusion was prolonged. Both SR-d and SR-s returned to pre-occlusion values in less than 30 min after reperfusion in the 3 min and 5 min ischemia groups. However, in the 10- and 15-min ischemia groups, SR-d did not fully recovered even at 240 min after reperfusion despite complete recovery of SR-s. The left ventricular hemodynamics during occlusion were significantly changed in all groups and returned to baseline immediately after reperfusion. CONCLUSION The persistence of diastolic regional dysfunction is longer than systolic regional dysfunction after a relative longer ischemic event, suggesting that recent myocardial ischemic insult mimicking variant angina may be recognized with the evaluation of regional diastolic function.
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Affiliation(s)
- Dongdong Chen
- Organ Failure Key Laboratory of Ministry of Education, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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HORI Y, KUNIHIRO SI, KANAI K, HOSHI F, ITOH N, HIGUCHI SI. The relationship between invasive hemodynamic measurements and tissue Doppler-derived myocardial velocity and acceleration during isovolumic relaxation in healthy dogs. J Vet Med Sci 2010; 71:1419-25. [PMID: 19959890 DOI: 10.1292/jvms.001419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the feasibility of using the values of tissue Doppler imaging (TDI)-derived myocardial velocity during isovolumic relaxation (V(IR)) and myocardial acceleration during isovolumic relaxation (ACC) obtained from the left ventricular (LV) free wall to evaluate LV relaxation in normal dogs. Seven dogs were anesthetized, and dobutamine or esmolol was infused at a rate of 5.0 and 10.0 mug/kg/min or 100 and 500 mug/kg/min, respectively, via a cephalic vein. The order of drug administration (dobutamine or esmolol) was assigned to each dog. Simultaneous pulsed-Doppler (PD) echocardiography, TDI and hemodynamic measurements were performed. Compared with the baseline values, dobutamine significantly increased dP/dt min, but significantly shortened tau (tau). Similarly, esmolol significantly decreased dP/dt min, but significantly prolonged tau. Compared with the baseline values, dobutamine significantly increased V(IR) and ACC, and esmolol significantly decreased V(IR) and ACC. Both dP/dt min and tau were significantly correlated with TDI-derived IVRT (r=-0.43 and 0.74), V(IR) (r=0.85 and -0.49) and ACC (r=0.84 and -0.52). These results indicate that the TDI-derived V(IR) and ACC values obtained from the LV free wall can potentially be used to assess LV relaxation in dogs.
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Affiliation(s)
- Yasutomo HORI
- Department of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Towada, Aomori, Japan.
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Ren M, Tian JW, Leng XP, Wang HM, Wang Y, Wang ZZ. Assessment of global and regional left ventricular function after surgical revascularization in patients with coronary artery disease by real-time triplane echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1175-1184. [PMID: 19710215 DOI: 10.7863/jum.2009.28.9.1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the capability of real-time triplane echocardiography (RT3PE) for monitoring global and regional systolic function of the left ventricle (LV) after surgical revascularization and for evaluating the effect of surgery and predicting restenosis. METHODS Forty-nine patients underwent RT3PE before and at 10 days and 1, 3, and 6 months after coronary artery bypass grafting (CABG). The global systolic function of the LV was assessed with the parameters of end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and stroke volume (SV). The regional myocardial deformation was detected by triplane strain rate imaging. Recovery of myocardial function after surgery and the correlation between global and regional function were investigated. RESULTS In 41 of the 49 patients, the EDV and ESV decreased, and the EF and SV increased gradually and showed statistical significance at 3 and 6 months after surgery (P < .05; P < .01). The systolic strain rate (SR(sys)) and systolic strain (S(sys)) increased, and the postsystolic strain index (PSI) decreased progressively after CABG, with significant changes in almost all studied segments at 6 months (P < .05; P < .01). In addition, recovery of the SR(sys), S(sys), and PSI at each follow-up stage after surgery correlated well with EF improvement, with a positive correlation between the SR(sys), S(sys), and EF and a negative correlation between the PSI and EF. Restenosis was suspected in the other 8 patients. The sensitivity, specificity, and accuracy of RT3PE to predict restenosis were 75.00%, 89.47%, and 85.19%, respectively. CONCLUSIONS Real-time triplane echocardiography can be used to quantitatively assess global and regional myocardial function. It may represent a new, powerful method to monitor improvement of myocardial function after CABG and to predict restenosis.
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Affiliation(s)
- Min Ren
- Department of Ultrasound, Second Affiliated Hospital of Harbin Medical University, China
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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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Vitarelli A, Sciomer S, Schina M, Luzzi MF, Dagianti A. Detection of left ventricular systolic and diastolic abnormalities in patients with coronary artery disease by color kinesis. Clin Cardiol 2009; 20:927-33. [PMID: 9383586 PMCID: PMC6655956 DOI: 10.1002/clc.4960201106] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Color kinesis (CK) is a recently developed echocardiographic technique based on acoustic quantification that automatically tracks and displays endocardial motion in real time and has been used in initial studies to improve the evaluation of global and regional wall motion. HYPOTHESIS For further validation of the use of CK for analysis of segmental ventricular dysfunction, we assessed its sensitivity and specificity for detection of regional systolic and diastolic wall motion abnormalities in patients with coronary artery disease (CAD). METHODS Two-dimensional (2-D) echocardiography and CK were used to study 15 normal subjects and 63 patients with technically good quality echocardiographic tracings, who underwent coronary arteriography within 1 month of echocardiography. Significant (> 70% luminal diameter stenosis) CAD was present in 50 patients (79%). RESULTS Color kinesis tracked endocardial motion accurately in 93% of left ventricular segments. Wall motion score, systolic segmental endocardial motion (SEM), and the time of systolic SEM (tSEM) and diastolic (tDEM) segmental endocardial motion were calculated. Intra- and interobserver variability were within narrow limits. SEM and tSEM were significantly lower and tDEM was significantly higher in the patient population than in the control group (p < 0.001). Comparison between CK and 2-D echocardiography showed a correlation coefficient of 0.81 between the two techniques. The score was identically graded in 74% of segments, with concordance of 82% in diagnosing segments as abnormal. Interobserver concordance was 86% for CK (r = 0.85) and 81% for 2-D echocardiography (r = 0.80). The sensitivity and specificity of systolic and diastolic CK parameters for the detection of CAD were 88 and 92% and 77 and 85%, respectively. The positive predictive values were 93 and 96%, respectively, the negative predictive values were 63 and 73%, respectively, and the overall accuracy was 86 and 91%, respectively. CONCLUSIONS Our data suggest that CK is a feasible and sensitive technique for identifying regional systolic as well as diastolic wall motion abnormalities in patients with CAD.
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Affiliation(s)
- A Vitarelli
- Cardiac Department, La Sapienza University, Rome, Italy
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Ishii K, Imai M, Suyama T, Maenaka M, Nagai T, Kawanami M, Seino Y. Exercise-Induced Post-Ischemic Left Ventricular Delayed Relaxation or Diastolic Stunning. J Am Coll Cardiol 2009; 53:698-705. [PMID: 19232903 DOI: 10.1016/j.jacc.2008.09.057] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/25/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
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Onishi T, Uematsu M, Nanto S, Morozumi T, Watanabe T, Awata M, Iida O, Sera F, Nagata S. Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion. Circ J 2009; 73:125-31. [DOI: 10.1253/circj.cj-08-0728] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | - Osamu Iida
- Cardiovascular Division, Kansai Rosai Hospital
| | - Fusako Sera
- Cardiovascular Division, Kansai Rosai Hospital
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Detection of Postischemic Regional Left Ventricular Delayed Outward Wall Motion or Diastolic Stunning After Exercise-induced Ischemia in Patients with Stable Effort Angina by Using Color Kinesis. J Am Soc Echocardiogr 2008; 21:309-14. [DOI: 10.1016/j.echo.2007.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Indexed: 11/19/2022]
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Thambyrajah J, Vijayalakshmi K, Graham RJ, Turley AJ, de Belder MA, Stewart MJ. Strain rate imaging pre- and post-percutaneous coronary intervention: a potential role in the objective detection of ischaemia in exercise stress echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:646-54. [PMID: 18296398 DOI: 10.1093/ejechocard/jen035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS To determine the feasibility of strain rate imaging (SRI) in the objective detection of exercise-induced ischaemia. METHODS AND RESULTS Sixteen patients undergoing elective percutaneous coronary intervention (PCI) underwent treadmill exercise stress echocardiography (ESE) pre- and post-PCI. Measurement of systolic SRI parameters was attempted in all myocardial segments at baseline, peak stress, and in recovery. Segments were divided into those supplied by target (Group 1) and non-target vessels (Group 2). Percutaneous coronary intervention was successful in all patients. In Group 1, there was no significant difference in post-systolic strain rate (SRps) at baseline or at peak stress but there was significantly greater SRps pre-PCI compared with post-PCI at 30 min into recovery (-0.37 +/- 0.53 vs. -0.07 +/- 0.44 s(-1), P = 0.004). There were similar findings with the SRps index [ratio of SRps:peak systolic strain rate (SRsys)]. Group 2 segments did not demonstrate any significant differences in SRI parameters pre- and post-PCI. At peak exercise pre-PCI, Group 1 segments had significantly delayed time to SRsys compared with Group 2 (0.12 +/- 0.05 vs. 0.09 +/- 0.05 s, P = 0.013), a difference that was abolished post-PCI. CONCLUSION This suggests a potential role for SRI in the objective detection of exercise-induced ischaemia by echocardiography at peak stress and during recovery at the time of improved image quality.
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Affiliation(s)
- J Thambyrajah
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough TS4 3BW, UK.
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Onishi T, Uematsu M, Nanto S, Iida O, Morozumi T, Kotani JI, Awata M, Nagata S. Positive Isovolumic Relaxation Velocity Detected by a Spectral Tissue Doppler Mapping Technique as an Indicator of Coronary Artery Disease: A Prospective Study. J Am Soc Echocardiogr 2007; 20:158-64. [PMID: 17275701 DOI: 10.1016/j.echo.2006.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND A positive myocardial velocity during isovolumic relaxation phase (V(IR)) detected by spectral tissue Doppler imaging has been shown to indicate ischemic myocardium. We sought to examine the diagnostic value of positive V(IR) for detecting coronary artery disease (CAD) in patients with chest pain and apparently normal left ventricular contraction. METHODS A total of 138 patients (74 men, age 69 +/- 8 years) underwent spectral Doppler tissue imaging measurements at the annular and mid left ventricular levels in the apical 4- and 2-chamber views (8 points/patient) at rest in addition to standard echocardiography. Subsequently, patients underwent thallium-201 myocardial perfusion single photon emission computed tomography (n = 98) and/or coronary angiography (n = 60). The duration of positive V(IR) was also assessed. CAD was diagnosed by having more than 75% diameter stenosis in coronary angiography. RESULTS CAD was present in 41 patients (30%). The duration of positive V(IR) was distributed from 0 to 280 milliseconds with the median value of 100 milliseconds. Presence of positive V(IR) predicted CAD with sensitivity of 80% and specificity of 61%. CONCLUSIONS Positive V(IR) detected by spectral tissue Doppler imaging is a useful indicator of CAD in patients with apparently normal left ventricular contraction and chest pain.
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Affiliation(s)
- Toshinari Onishi
- Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
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Miwa K, Ishii K, Makita T, Okuda N. Effects of Postischemic Regional Left Ventricular Diastolic Wall Motion Abnormalities or Delayed Relaxation Following Coronary Vasospasm on Global Diastolic Function. Circ J 2005; 69:439-45. [PMID: 15791039 DOI: 10.1253/circj.69.439] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Regional left ventricular (LV) diastolic wall motion abnormalities detected by color kinesis (CK), an echocardiographic technique, may be a more sensitive measure to postischemic damage following coronary spasm than parameters of global diastolic function. METHODS AND RESULTS Regional LV diastolic wall motion was evaluated by using CK in 18 patients with variant angina on the day following coronary spasm, which was induced by intracoronary acetylcholine. Fractional regional LV cavity area expansion in the short-axis view during the first 30% of the LV filling time, was used to identify postischemic asynchronous diastolic wall motion. Regional delayed relaxation was observed in any of the LV regions in all the patients, who were divided into 2 groups (Group S: 7 patients with single-vessel spasm with regional delayed relaxation in one area. Group M: 11 patients with multivessel spasm or spasm of the proximal left anterior descending branch with regional delayed relaxation in multiple areas). In Group S, no abnormality (0%) was noted in any of the indexes of global diastolic function including the isovolumic relaxation time, the ratio of peak rapid filling to peak atrial filling velocities and the deceleration time. In contrast, in 5 (45%) of the Group M patients, abnormalities were noted in all of those indexes. CONCLUSIONS Postischemic regional LV-delayed relaxation following coronary vasospasm was detected sensitively by analysis of CK images. The indexes of global LV diastolic function are insensitive to postischemic damage following single vessel spasm, although they are somewhat sensitive following multivessel spasm.
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Affiliation(s)
- Kunihisa Miwa
- The Second Department of Internal Medicine, Kansai Electric Power Hospital, Osaka, Japan.
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Miwa K, Ishii K, Makita T, Okuda N. Diagnosis of multivessel coronary vasospasm by detecting postischemic regional left ventricular delayed relaxation on echocardiography using color kinesis. Circ J 2004; 68:483-7. [PMID: 15118293 DOI: 10.1253/circj.68.483] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is not known whether multivessel coronary spasm occurs spontaneously in patients who have variant angina (VA) with demonstrated multivessel spasm induced by intracoronary injection of acetylcholine (ACh). Regional left ventricular (LV) diastolic dysfunction or wall motion abnormality may persist after an episode of coronary vasospasm. Color kinesis (CK) is a recent development that facilitates the echocardiographic evaluation of regional diastolic wall motion. METHODS AND RESULTS Regional diastolic wall motion was evaluated using CK in 26 patients with VA within 1 week of the last episode of angina. The LV segmental filling fraction in the short-axis view during the first 30% of the diastolic filling time, expressed as a percentage, was used to objectively identify postischemic diastolic endocardial motion asynchrony. Diastolic asynchrony or regional LV delayed relaxation was noted in all 26 (100%) patients and in 14 (54%) it was detected in multiple vascular territories, suggesting multivessel spasm. Multivessel spasm was induced by ACh in 11 (79%) of the patients with suspected multivessel spasm by CK. In 11 (92%) of the 12 patients with multivessel spasm induced by ACh multiple regions of delayed relaxation had been noted by CK. The regions of delayed relaxation were largely consistent with the territories perfused by the arteries reacting to ACh (sensitivity: 96%, specificity: 91%). CONCLUSION ACh induced spasm in the same coronary arteries as those perfusing the regions with delayed diastolic wall motion detected by CK in most of the patients with VA, suggesting that multivessel spasm does occur spontaneously in patients with susceptible arteries.
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Affiliation(s)
- Kunihisa Miwa
- Second Department of Internal Medicine, Kansai Electric Power Hospital, Osaka, Japan.
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Donal E, Coisne D, Pham B, Ragot S, Herpin D, Thomas JD. Anatomic m-mode, a pertinent tool for the daily practice of transthoracic echocardiography. J Am Soc Echocardiogr 2004; 17:962-7. [PMID: 15337961 DOI: 10.1016/j.echo.2004.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to compare anatomic M-mode (AMM), a new echocardiographic postprocessing option, and conventional M-mode (CMM) using fundamental imaging and tissue harmonic imaging. METHODS Transthoracic echocardiography was performed in 15 selected patients to analyze the reproducibility of AMM and in 47 patients to assess its clinical value versus CMM. Acquisitions were performed successively: CMM fundamental imaging; CMM tissue harmonic imaging; tissue harmonic imaging cineloops for AMM; and fundamental imaging cineloops for AMM. Quantitative analysis was performed offline. The angle alpha between the CMM line and the septal endocardial interface was calculated and the expected percentage of error in measuring left ventricular diameter was derived. RESULTS AMM analysis was reproducible. Optimal AMM full echocardiographic definition was obtainable in 77% of the population, whereas CMM was optimal for 49% because of scan line misalignment, causing a measurement overestimation exceeding 5%. CONCLUSION The ability with AMM to reduce the alpha angle to 0 degrees and, thus, avoid overestimation of left ventricular dimensions might improve follow-up in several pathologic conditions.
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Affiliation(s)
- Erwan Donal
- Department de Cardiologie, Centre Hospitaler Universitaire La Miletrie, Poitiers, France.
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Guron CW, Hartford M, Persson A, Herlitz J, Thelle D, Caidahl K. Timing of regional left ventricular lengthening by pulsed tissue Doppler. J Am Soc Echocardiogr 2004; 17:307-12. [PMID: 15044862 DOI: 10.1016/j.echo.2003.12.017] [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: 11/20/2022]
Abstract
Pulsed tissue Doppler can measure myocardial velocities with high temporal resolution. Our aim was to determine the onset timing of the regional left ventricular longitudinal early lengthening (e) in relation to the mitral inflow (E) in acute coronary syndromes. We applied pulsed tissue Doppler to the septal, lateral, inferior, and anterior left ventricular basal walls of 160 patients with acute coronary syndromes and 60 control subjects. Maximum systolic and early diastolic velocities were lower for patient than for control walls (6.1 +/- 1.7 vs 7.9 +/- 1.4 cm/s, P <.0001, and 6.9 +/- 2.3 vs 10.0 +/- 2.3 cm/s, P <.0001, respectively) and e started later than E (12 +/- 30 vs 2 +/- 19 milliseconds later, P <.0001). All 3 variables related to the degree of visual left ventricular wall pathology. The intraindividual time range for all 4 e starts was wider for patients (43 +/- 27 vs 30 +/- 18 milliseconds, P <.0001). Our results show that pulsed tissue Doppler can identify a delayed and asynchronous initial wall lengthening in acute coronary syndromes.
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Affiliation(s)
- Cecilia Wallentin Guron
- Department of Clinical Physiology, Göteborg University, Sahlgrenska University Hospital, Sweden.
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Ishii K, Miwa K, Makita T, Okuda N, Aoyama T. Diagnosis of coronary vasospasm by detection of postischemic regional left ventricular delayed relaxation using echocardiographic evaluation with color kinesis. Clin Cardiol 2004; 26:477-82. [PMID: 14579919 PMCID: PMC6653843 DOI: 10.1002/clc.4960261009] [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: 11/08/2022] Open
Abstract
BACKGROUND Coronary vasospasm has been diagnosed by invasive provocative procedures during coronary arteriography. It would be useful to have a reliable, noninvasive, and safe diagnostic method for coronary vasospasm. Regional left ventricular (LV) diastolic dysfunction may persist without systolic dysfunction after an episode of coronary vasospasm. Color kinesis (CK) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion. HYPOTHESIS Color kinesis may be useful for diagnosis of coronary vasospasm by detection of postischemic regional LV diastolic wall motion abnormality. METHODS Fifty-one consecutive patients with the last chest symptom within 2 weeks (4 +/- 3 days) were studied echocardiographically. Regional fractional area change during the first 30% of LV filling time in percentage of the segmental end-diastolic area change (CK diastolic index) was used to identify diastolic endocardial motion asynchrony. RESULTS After diagnostic coronary arteriography with spasm provocation, 26 patients were diagnosed with coronary spastic angina (CSA) and the other 25 with chest pain syndrome (CPS). Regional delayed relaxation (CK-diastolic index < or = 50%) or diastolic asynchrony had been observed in at least one region in 25 (96%) patients with CSA, whereas it had been noted in 2 (8%) patients with CPS. In 17 (65%) patients with CSA, it had been detected in multiple vascular territories, suggesting multivessel spasm. The diastolic asynchrony disappeared in CSA after a month of angina-free period. CONCLUSION Analysis of CK images allows identification of regional LV delayed relaxation or diastolic asynchrony in patients with coronary vasospasm, differentiating them from patients with chest pain syndrome (sensitivity 96%, specificity 92%).
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Affiliation(s)
- Katsuhisa Ishii
- The Second Department of Internal Medicine, Kansai Electric Power Hospital, Osaka, Japan.
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Umekawa S, Yamamoto K, Koezuka A, Nakao S, Yuba M, Sakata Y, Ozaki T, Masuyama T. Hand-Carried Echocardiography in Assessing Ventricular Function and Valvular Regurgitation. J Echocardiogr 2004. [DOI: 10.2303/jecho.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Higher myocardial strain rates duringisovolumic relaxation phase than duringejection characterize acutely ischemic myocardium. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)02171-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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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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22
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Desco M, Ledesma-Carbayo MJ, Pérez E, Santos A, Antoranz JC, Malpica N, Marcos-Alberca P, García-Fernández MA. Assessment of normal and ischaemic myocardium by quantitative M-mode tissue Doppler imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2002; 28:561-569. [PMID: 12079693 DOI: 10.1016/s0301-5629(02)00496-9] [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
This paper presents a methodology and a software package developed to quantify M-mode tissue Doppler imaging (TDI), defining a number of quantitative parameters drawn from velocity and gradient curves obtained after segmenting the myocardial wall into anatomical layers. The independent clinical predictive value of these parameters to detect motion abnormalities in the presence of ischaemia was evaluated in a comparative study between a group of 17 healthy volunteers and 18 ischaemic patients. Factor analysis and stepwise logistic regression were used to assess the independent predictive value of these parameters in detecting abnormal contractility of the basal posterior segment. The statistical analysis performed has proved that any single parameter related to the gradient intensity, particularly the maximum gradient at the moment of the "e" wave, provides meaningful clinical information, achieving a rate of correct classification of 79.1% on the same data set used for the analysis. Adding additional parameters does not improve the diagnostic performance. Further testing with different settings (stress studies, other pathologies or segments) is warranted.
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Affiliation(s)
- Manuel Desco
- Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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23
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Reese TG, Feinberg DA, Dou J, Wedeen VJ. Phase contrast MRI of myocardial 3D strain by encoding contiguous slices in a single shot. Magn Reson Med 2002; 47:665-76. [PMID: 11948727 DOI: 10.1002/mrm.10111] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantitative measurements of inherently three-dimensional (3D) cardiac strain and strain rate require 3D data; MRI provides uniquely high sensitivity to material strain by combining phase contrast with single-shot acquisition methods, such as echo-planar imaging (EPI). Previous MRI methods applied to 3D strain used multiple two-dimensional (2D) acquisitions and suffered loss of sensitivity due to magnification within the strain calculation of physiologic noise related to cardiac beat-to-beat variability. In the present work, each single-shot acquisition generates 3D image data by acquiring two contiguous 2D Fourier transform (FT) images in a single echo train of an EPI readout. Although strain encoding divides across multiple EPI shots, each strain component is computed only within single-shot data, avoiding noise magnification. Strain tensor maps are displayed using iconic 3D graphics or a simple color code of tensor shape. In a deforming gel phantom, gradient-recalled echo (GRE) MRI movies of 3D strain rates match expected strain fields. In normal human subjects, 3D strain rate tensor movies of heart and brain comprising seven slices in each of seven cardiac phases were completed in 56 heartbeats. Stimulated echo (STE) MRI of net systolic 3D strain was also demonstrated. Two-slices-in-one-shot spatial encoding permits a complete quantitative survey of ventricular 3D strain in under a minute, with routine patient supervision and turnkey image processing.
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Affiliation(s)
- Timothy G Reese
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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24
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Wilkenshoff UM, Hatle L, Sovany A, Wranne B, Sutherland GR. Age-dependent changes in regional diastolic function evaluated by color Doppler myocardial imaging: a comparison with pulsed Doppler indexes of global function. J Am Soc Echocardiogr 2001; 14:959-69. [PMID: 11593200 DOI: 10.1067/mje.2001.116321] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The goals of this study were to evaluate possible normal age-related changes in regional myocardial relaxation as detected by color Doppler myocardial imaging (CDMI) velocities and to compare the extent of any such changes with age-induced changes in global diastolic function. In 80 healthy subjects (aged 21 to 72 years, equally subdivided by decades) the mitral flow velocities in early diastole (E) and atrial contraction (A) were recorded as were the velocities of left ventricular (LV) motion of early (EDV) and late diastole (LDV) in the 16 standard LV segments, and their ratios were calculated. In healthy persons younger than 40 years, all segments showed an EDV/LDV ratio > 1, whereas in healthy persons aged 40 years or older the mean EDV of all segments decreased, and the mean LDV increased, resulting in a significant decrease of the mean EDV/LDV ratio with age. Values of EDV/LDV ratios were higher than E/A ratios (P <.0001), but their changes with age correlated well with each other (r = 0.805). With increasing age, an EDV/LDV ratio <1 was observed more often in basal segments (P <.001, compared with mid and apical segments) and less often in segments of anteroseptal and posterior walls viewed from the parasternal window. The presence of >50% segments with an EDV/LDV ratio <1 was associated with an E/A ratio <1. Regional diastolic function indexes as evaluated by CDMI changed with increasing age in a heterogeneous way and influenced global diastolic function parameters.
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Affiliation(s)
- U M Wilkenshoff
- Linköping Heart Center, University Hospital, Linköping, Sweden
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25
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Belohlavek M, Pislaru C, Bae RY, Greenleaf JF, Seward JB. Real-time strain rate echocardiographic imaging: temporal and spatial analysis of postsystolic compression in acutely ischemic myocardium. J Am Soc Echocardiogr 2001; 14:360-9. [PMID: 11337681 DOI: 10.1067/mje.2001.110786] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Postsystolic compression (PSC) is a sensitive indicator of regional left ventricular ischemic diastolic dysfunction. Quantitative assessment of compression patterns by strain rate imaging could determine the presence and spatial extent of PSC for the detection and analysis of acute ischemic diastolic dysfunction. With the use of a segmental left ventricular model, we evaluated time to compression/expansion crossover (T-CEC) in standard apical views. Data at baseline and after acute left anterior descending coronary artery occlusion were collected from 18 open-chest pigs. We found significant mean prolongation of T-CEC, ranging from 43.9 +/- 48.6 ms to 110.8 +/- 73.8 ms, in all apical segments and in 2 midventricular (anterior and anteroseptal) segments. Analysis of variance demonstrated that the prolonged T-CEC is spatially consistent with perfusion defect. The temporal and spatial analysis of T-CEC with the use of strain rate imaging is a new noninvasive technique for identification and topographic quantitation of ischemic diastolic dysfunction expressed by PSC.
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Affiliation(s)
- M Belohlavek
- Division of Cardiovascular Diseases Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn. 55905, USA.
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26
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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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27
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Pislaru C, Belohlavek M, Bae RY, Abraham TP, Greenleaf JF, Seward JB. Regional asynchrony during acute myocardial ischemia quantified by ultrasound strain rate imaging. J Am Coll Cardiol 2001; 37:1141-8. [PMID: 11263621 DOI: 10.1016/s0735-1097(01)01113-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We propose a new method to easily quantify asynchronous wall motion due to postsystolic shortening (PSS). We also studied the relationship of the spatial and temporal extent of PSS to the extent of myocardium at ischemic risk after variable duration of ischemia. BACKGROUND Postsystolic shortening is a sensitive marker of asynchrony during ischemia. Current techniques for detection of asynchrony are either subjective, or invasive and time-consuming. Strain rate imaging (SRI) can noninvasively depict PSS as prolonged compression/expansion crossover. METHODS Nineteen open-chest pigs were scanned from apical views, before and after left anterior descending coronary artery occlusion. Strain rates were derived offline from tissue Doppler velocity cineloops. The time from electrocardiographic R-wave to the occurrence of compression/expansion crossover (TCEC) was calculated. Prolonged TCEC during ischemia was identified using a standardized analysis and both spatial (% of left ventricle) and temporal extent were quantified. The extent of myocardium at risk was measured in seven animals from dye-stained specimens. RESULTS Prolonged TCEC was found in all ischemic segments. There was a good correlation (r = 0.91; p < 0.001) and good agreement between the spatial distributions of prolonged TCEC and myocardium at risk. The extent of myocardium at risk was better approximated by TCEC measurement (36 +/- 7% vs. 39 +/- 8%, respectively; p = NS) than by wall motion analysis (47 +/- 17%, p < 0.05). The duration of occlusion did not prolong TCEC. CONCLUSIONS Prolonged TCEC consistently occurs in ischemic myocardium and is apparently not affected by the duration of ischemia. Standardized analysis of TCEC in SRI closely quantifies the extent of ischemic myocardium. This new method may be a useful tool in other cardiac conditions associated with regional diastolic asynchrony.
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Affiliation(s)
- C Pislaru
- Department of Physiology and Biophysics, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
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28
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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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29
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von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schömig A, Schwaiger M. Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy. J Am Coll Cardiol 2000; 36:444-52. [PMID: 10933356 DOI: 10.1016/s0735-1097(00)00735-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We evaluated regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing. BACKGROUND Evaluation and quantification of diastolic myocardial function remain a challenge for imaging techniques in stress tests. METHODS A prospective study compared the detection of coronary artery stenosis: 1) by pulsed Doppler myocardial mapping, 2) by two-dimensional echocardiographic dobutamine stress test, and 3) by perfusion scintigraphy in 64 patients using coronary angiography for reference. An age matched subgroup of 10 patients with normal angiograms and two-dimensional echocardiographic stress test served as control group. Peak myocardial contraction velocity (Vc) and lengthening rate during early diastolic left ventricular (LV) filling (VE) were measured in 12 LV segments from three apical views. RESULTS In controls, myocardial velocities increased during stress by > or =3.6 cm/s (p < 0.001). In LV segments depending on a stenosed artery (n = 70), VE decreased by > or =1 cm/s and, thus, was different from control segments (n = 112, p < 0.001) and from scar segments (n = 13, p < 0.01), whereas the change of Vc was similar to that in scar segments. A stress induced 2 cm/s reduction of VE discerned the best diagnostic accuracy (sensitivity 84%, specificity 93%) in comparison with two-dimensional echocardiography (78% and 71%) and perfusion scintigraphy (61% and 86%). Using receiver operating curves at incremental levels of luminal narrowing, these relations persisted. CONCLUSIONS Quantification of diastolic myocardial function by pulsed Doppler myocardial mapping during dobutamine stress test was shown to be a feasible, accurate, reproducible, noninvasive technique that should be considered to be a sensitive alternative to the present echocardiographic and scintigraphic imaging techniques for stress tests.
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Affiliation(s)
- H von Bibra
- Department of Clinical Physiology, Karolinska Hospital, Stockholm, Sweden.
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30
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Palmes PP, Masuyama T, Yamamoto K, Kondo H, Sakata Y, Takiuchi S, Kuzuya T, Hori M. High-frame-rate tissue harmonic imaging enhances anatomic M-mode sections of the left ventricle in short-axis view. J Am Soc Echocardiogr 2000; 13:738-47. [PMID: 10936817 DOI: 10.1067/mje.2000.104649] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND High-frame-rate echocardiography (HFRE) and tissue harmonic imaging (THI) may improve image quality, thereby enabling anatomic M-mode sections of left ventricular (LV) wall segments to be visualized in various planes in the short-axis view. OBJECTIVES The goals of this study were to compare image quality between HFRE and conventional-frame-rate echocardiography (CFRE) and between fundamental imaging (FI) and THI, and to obtain anatomic M-mode values of basal short-axis LV segments from healthy subjects for use in the evaluation of abnormal segments in patients with myocardial infarction (MI). METHODS AND RESULTS The study included 28 healthy subjects and 15 patients with MI who underwent 2-dimensional echocardiography with an ultrasonographic system equipped with THI and anatomic M-mode. Left ventricular image cineloops at the basal short-axis view that were obtained with 3 combinations of imaging techniques (FI + CFRE, FI + HFRE, and THI + HFRE) were digitized and displayed side-by-side in random order for comparison by blinded readers. M-mode sections were done in 3 planes: anteroseptal-posterior, inferoseptal-lateral, and anterior-inferior basal segments. The THI + HFRE combination showed the best image quality with significant reduction in noise artifacts, resulting in a good signal-to-noise ratio and good tractability of all LV segments by anatomic M-mode. In healthy subjects, significant intersegmental differences existed in the diastolic and systolic thicknesses and in the percent systolic thickening of LV segments. In patients with MI, LV systolic thickening was significantly decreased in abnormal segments. No significant differences were noted in ejection fraction and fractional shortening among the 3 anatomic M-mode planes. CONCLUSION High-frame-rate tissue harmonic imaging improved image quality, thereby allowing reproducible anatomic M-mode measurements in various planes in the short-axis view and providing a convenient objective evaluation of global and regional LV function.
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Affiliation(s)
- P P Palmes
- Department of Internal Medicine and Therapeutics, and the Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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31
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Bruch C, Schmermund A, Bartel T, Schaar J, Erbel R. Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1999; 15:379-90. [PMID: 10595404 DOI: 10.1023/a:1006255329288] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 +/- 13 years) and 17 CAD patients with normal systolic function and > or = 70% luminal narrowing of the LAD (age 56 +/- 11 years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 +/- 1.64 cm/s) in CAD patients and negative velocities (-1.39 +/- 0.81 cm/s) in normal subjects. Thus, TDI allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.
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Affiliation(s)
- C Bruch
- Department of Cardiology, University Essen, Germany.
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Segar DS, Skolnick D, Sawada SG, Fitch G, Wagner D, Adams D, Feigenbaum H. A comparison of the interpretation of digitized and videotape recorded echocardiograms. J Am Soc Echocardiogr 1999; 12:714-9. [PMID: 10477415 DOI: 10.1016/s0894-7317(99)70021-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Conventional echocardiograms are typically recorded on videotape and later reviewed and interpreted by a physician. Although videotape recording is an excellent medium for this purpose, it does have several disadvantages, which may be overcome by digital storage. This study compared the diagnostic accuracy of digitized and videotape recorded echocardiograms. Echocardiographic examinations (n = 110) were recorded simulta-neously on videotape and were digitized with a commercially available frame grabber system. Images were transmitted by an Ethernet link to the network-based computer system and compressed with a nondestructive compression algorithm. Images were reviewed on a personal computer. Images were interpreted by 3 observers, and differences in interpretation were documented. There were 274 findings in 110 patients. Exact agreement in interpretation was found in 83%. A major discrepancy occurred in 2%, and a minor discrepancy occurred in 15%. Most discrepancies occurred in the setting of valvular heart disease. When compared with a consensus interpretation, no significant difference was seen in the number of errors between the digital and videotape interpretation. We conclude that the interpretation of a properly recorded digitized echocardiographic examination yields interpretations equivalent to those of videotape recordings.
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Affiliation(s)
- D S Segar
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202-4800, USA.
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33
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Garcia-Fernandez MA, Azevedo J, Moreno M, Bermejo J, Moreno R. Regional Left Ventricular Diastolic Dysfunction Evaluated by Pulsed-Tissue Doppler Echocardiography. Echocardiography 1999; 16:491-500. [PMID: 11175181 DOI: 10.1111/j.1540-8175.1999.tb00096.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Pulsed-wave Doppler tissue imaging (DTI) allows the examination of regional wall motion at a very high temporal resolution and therefore constitutes an excellent technique for assessing diastolic motion of left ventricular walls. Regional relaxation has been well characterized in normal subjects using this technique, and physiological time intervals and motion wave profiles are described. In an experimental model of acute ischemia, local relaxation impairment was observed showing highly characteristic local diastolic abnormalities. Interestingly, these findings took place before any decrease in systolic motion was recordable. In a prospective clinical study, noninvasive regional DTI parameters were compared with coronary angiography to assess the feasibility and clinical value of the technique; the diagnostic accuracy is discussed in detail. Also, the association between regional diastolic parameters and global regional function as assessed by Doppler analysis of transmitral left ventricular filling flow was studied, stressing the impact of regional diastolic function on overall ventricular performance. Finally, the diagnostic role of pulsed-wave DTI on stress testing, identification of myocardial viability, and microvascular angina is reviewed.
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Affiliation(s)
- Miguel Angel Garcia-Fernandez
- Servicio de Cardiologia No Invasiva, Laboratorio de Ecocardiografia, Hospital General Universitario "Gregorio Marañon," Calle Doctor Esquerdo 46, Madrid 28007, Spain
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Moreno R, García-Fernández MA, Moreno M, Puerta P, Bermejo J, Ortega A, Sarnago F, Delcń JL. Regional Diastolic Function in Microvascular Angina Studied by Pulsed-Wave Doppler Tissue Imaging. Echocardiography 1999; 16:239-244. [PMID: 11175144 DOI: 10.1111/j.1540-8175.1999.tb00808.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES: Diastolic dysfunction is an early finding during myocardial ischemia. However, regional diastolic function has not been studied in patients with microvascular angina (MA). The purpose of this study was to assess the regional diastolic function in patients with MA through use of the new echocardiographic technique, pulsed-wave Doppler tissue imaging (DTI). METHODS: Regional diastolic function was studied by DTI in 81 myocardial segments of seven patients with MA and in 54 segments of six healthy control subjects. RESULTS: Myocardial segments in patients with MA had, in comparison with controls, an increased regional isovolumetric relaxation time (126 +/- 34 vs 99 +/- 34 msec, P < 0.0001), a higher e/a ratio (1.1 +/- 0.7 vs 0.8 +/- 0.3, P = 0.0048), and a lower peak velocity of the late diastolic wave a (6.9 +/- 2.9 vs 8.4 +/- 1.7 cm/msec, P = 0.0009). Moreover, peak velocity of systolic wave s was higher in patients with MA (5.8 +/- 1.4 vs 5.3 +/- 1.2 cm/msec, P = 0.0424). CONCLUSIONS: Patients with MA have an impaired regional diastolic function (an increased regional isovolumetric relaxation time and a lower a wave) and a higher velocity of the regional systolic wave s. These findings may have physiopathological implications.
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Affiliation(s)
- Raúl Moreno
- Laboratory of Echocardiography, Department of Cardiology, Hospital Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid, Spain
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35
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Vitarelli A, Sciomer S, Penco M, Dagianti A, Pugliese M. Assessment of left ventricular dyssynergy by color kinesis. Am J Cardiol 1998; 81:86G-90G. [PMID: 9662235 DOI: 10.1016/s0002-9149(98)00061-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Color kinesis is a new echocardiographic technique based on acoustic quantification. It has been developed to facilitate the ability to identify contraction abnormalities and has been incorporated into a commercially available ultrasound imaging system. The potential of this technique to improve the qualitative and quantitative assessment of wall motion abnormalities is described. Evaluation of color-encoded images allows detection of decreased amplitude of endocardial motion in abnormally contracting segments as well as a shorter time of endocardial excursion in segments with severely decreased motion. Compared with off-line quantitative studies, color kinesis has the advantage to be used on-line, without time-consuming manual tracing of endocardial boundaries. In addition, a single end-systolic color image contains the entire picture of spatial and temporal contraction and can be digitally stored and retrieved. In patients with proven coronary artery disease, color kinesis had a sensitivity of 88%, a specificity of 77%, and an overall accuracy of 86% in identifying the presence of segmental dysfunction. The practical application of color kinesis might be to improve our ability to distinguish normal from hypokinesis, something that has always been difficult in clinical echocardiography. Segmental analysis of color kinesis images allows objective detection of dobutamine-induced regional wall motion abnormalities in agreement with conventional visual interpretation of the corresponding 2-dimensional views. A method for objective assessment of wall dynamics during dobutamine stress echocardiography would be of particular clinical value, because these images are even more difficult to interpret than conventional echocardiograms. Quantitative assessment of diastolic function may allow objective evaluation of segmental relaxation abnormalities, especially under conditions of pharmacologic stress testing. Acquisition of color kinesis images during dobutamine stress echocardiography, both transthoracic and transesophageal, may facilitate the assessment of hybernating but viable myocardium and enhance the sensitivity in the detection of coronary artery disease.
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Affiliation(s)
- A Vitarelli
- Cardiac Department, La Sapienza University, Rome, Italy
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Godoy IE, Mor-Avi V, Weinert L, Vignon P, Korcarz C, Spencer KT, Lang RM. Use of color kinesis for evaluation of left ventricular filling in patients with dilated cardiomyopathy and mitral regurgitation. J Am Coll Cardiol 1998; 31:1598-606. [PMID: 9626840 DOI: 10.1016/s0735-1097(98)00144-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We tested the feasibility of using analysis of color kinesis images to objectively assess global and regional left ventricular (LV) diastolic function in patients with dilated cardiomyopathy (DCM). In addition, the ability of this technique to track drug-induced changes on LV diastolic properties was studied. BACKGROUND Diastolic dysfunction contributes to symptomatology in patients with DCM. The assessment of LV diastolic function using conventional Doppler echocardiography is indirect and is confounded by multiple variables. Moreover, the noninvasive evaluation of regional diastolic properties is difficult. In contrast, color kinesis directly tracks and color-encodes regional diastolic endocardial motion. METHODS We studied 24 patients with DCM and mitral regurgitation (MR) and 24 age-matched normal subjects. Transmitral and pulmonary vein flow velocities were measured using pulsed Doppler echocardiography. Diastolic color kinesis images were used to calculate indexes of magnitude and timing of global and regional diastolic function. Diastolic asynchrony was evaluated in different subgroups of patients with DCM. The effects of drug infusions (nitroprusside and dobutamine) were also studied. RESULTS Color kinesis indexes of global diastolic function showed significant differences between patients with DCM and normal subjects. Compared with Doppler indexes, color kinesis was less confounded by MR and was capable of differentiating between drug-induced lusitropic and vasodilator effects. Diastolic asynchrony was increased in patients with DCM and severe MR. CONCLUSIONS Quantitative analysis of global and regional LV diastolic function in patients with DCM using color kinesis is feasible.
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Affiliation(s)
- I E Godoy
- Department of Medicine, University of Chicago, Illinois, USA.
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Luotolahti M, Saraste M, Voipio-Pulkki LM, Hartiala J. The Sensitivity of Exercise Echocardiography Can Be Improved by Taking the Delayed Myocardial Contraction into Account. Echocardiography 1998; 15:345-352. [PMID: 11175047 DOI: 10.1111/j.1540-8175.1998.tb00615.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to test whether the systolic myocardial wall motion abnormalities at the early stages of ischemia are applicable to the diagnosis of coronary artery disease. Forty-four patients with suspected coronary artery disease were studied with the use of low-level exercise echocardiography. Exercise was stopped at the onset of first cardiac symptoms, and no patient exceeded 70% of the age-predicted maximal heart rate level. Forty patients had significant stenosis in at least one coronary artery on coronary angiography. Ten control subjects with a low probability of ischemic heart disease also were studied with exercise echocardiography. The first ischemic wall motion abnormality in systole, defined as delayed onset of the contraction (a regional delay of at least 100 milliseconds in a frame-by-frame analysis of echocardiograms) without any reduction in systolic movement, was regarded separately from hypokinesis (systolic wall motion excursion of less than 5 mm). When the delayed onset of the contraction also was taken into account, 37 of the 40 patients with coronary artery disease had an ischemic response after exercise. The sensitivity of the test thus was 93%. The reduction in systolic wall movement was detected in only 18 of these patients at the exercise level attained (70% or less of age-predicted maximal heart rate). There were two false-positive echocardiograms, but when the control group also was considered, the specificity of the test remained high at 86%. The sensitivity of exercise echocardiography can be increased by paying attention to the delayed onset of the systolic contraction, which occurs at the early stages of ischemia.
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Affiliation(s)
- Matti Luotolahti
- Department of Clinical Physiology, Turku University Hospital, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland
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Mikić I, Krucinski S, Thomas JD. Segmentation and tracking in echocardiographic sequences: active contours guided by optical flow estimates. IEEE TRANSACTIONS ON MEDICAL IMAGING 1998; 17:274-84. [PMID: 9688159 DOI: 10.1109/42.700739] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This paper presents a method for segmentation and tracking of cardiac structures in ultrasound image sequences. The developed algorithm is based on the active contour framework. This approach requires initial placement of the contour close to the desired position in the image, usually an object outline. Best contour shape and position are then calculated, assuming that at this configuration a global energy function, associated with a contour, attains its minimum. Active contours can be used for tracking by selecting a solution from a previous frame as an initial position in a present frame. Such an approach, however, fails for large displacements of the object of interest. This paper presents a technique that incorporates the information on pixel velocities (optical flow) into the estimate of initial contour to enable tracking of fast-moving objects. The algorithm was tested on several ultrasound image sequences, each covering one complete cardiac cycle. The contour successfully tracked boundaries of mitral valve leaflets, aortic root and endocardial borders of the left ventricle. The algorithm-generated outlines were compared against manual tracings by expert physicians. The automated method resulted in contours that were within the boundaries of intraobserver variability.
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Affiliation(s)
- I Mikić
- Department of Electrical Engineering, University of California, San Diego 92122, USA.
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Affiliation(s)
- D L Brutsaert
- Department of Physiology and Medicine, University of Antwerp, Belgium
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Bjørnstad K, Aakhus S, Torp HG. How does computer-assisted digital wall motion analysis influence observer agreement and diagnostic accuracy during stress echocardiography? INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1997; 13:105-14. [PMID: 9110190 DOI: 10.1023/a:1005752331136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study assessed interobserver and intraobserver variation and diagnostic accuracy during 25 dipyridamole stress echocardiography tests interpreted with different analysis systems: a) computer display of high frame rate digital cineloops (47 frames/s); b) computer display of lower frame rate digital cineloops (24 frames/s); and c) videotape recordings. The majority of the patients (84%) had documented coronary artery disease with baseline wall motion abnormalities due to previous myocardial infarctions and/or coronary bypass surgery, thus comprising a population with difficult interpretation of stress echocardiography. Diagnostic accuracy was assessed using coronary angiography as reference method. Interobserver and intraobserver agreement was highest when analysis was performed from computer-displayed cineloops, 96 and 92%, respectively, compared to 84 and 80% respectively, using videotape recordings. Sensitivity for identification of coronary artery stenosis was similar using digital cineloops with high frame rate or videotape recordings (67% to 80% for both systems), and tended to be lower using cineloops with lower frame rate for analysis (53%). Inter- and intraobserver differences for wall motion score index were not significantly influenced by the analysis system. We conclude that computer assisted analysis with high frame rate of the displayed cineloops provides optimal observer agreement and diagnostic accuracy in the same range as videotape analysis in patients undergoing stress echocardiography.
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Affiliation(s)
- K Bjørnstad
- Department of Medicine, University Hospital of Trondheim, Norway
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Vitarelli A, Luzzi MF, Penco M, Fedele F, Dagianti A. On-line quantitative assessment of left ventricular filling during dobutamine stress echocardiography: a useful addition to conventional wall motion scoring. Int J Cardiol 1997; 59:57-69. [PMID: 9080026 DOI: 10.1016/s0167-5273(96)02895-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In order to determine whether the diastolic rate of ventricular volume change obtained on-line with an automatic border detection (ABD) system during dobutamine stress echocardiography (DSE) would provide an interpretation of the diastolic ventricular response to the drug in quantitative terms in the assessment of coronary artery disease, we studied, with ABD and DSE, 59 patients who underwent coronary arteriography within 2 months of the stress test. Eleven patients had normal coronary findings or non-significant coronary lesions. Significant (> or =70% diameter stenosis) coronary artery disease (CAD) was present in 48 patients (81%). Dobutamine stress echocardiography (DSE) to a maximal dose of 50 microg/kg per min was performed in all patients. ABD images were acquired at rest and at the peak of infusion along with conventional two-dimensional images. The following measurements were evaluated: left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), slope of rapid filling segment (RFS), peak filling rate (PFR), rapid filling phase fractional change (RFFC). Patients with non-significant coronary artery lesions exhibited a hyperdynamic response with an LVEF increment of at least 20% from baseline to peak drug infusion. In these patients the effect of dobutamine produced an increase of RFS from 35.5+/-5.6 to 86.5+/-10.5 ml/s, an increase of PFR from 4.4+/-0.6 to 6.8+/-0.6 EDV/s, and an increase of RFFC from 74+/-8 to 92+/-5% (P<0.001). Of the 48 patients with coronary artery disease, 27 had <20% LVEF increase at peak dobutamine infusion. Four of 22 patients with single vessel disease and 23 of 26 patients with multivessel disease had an abnormal systolic response. After dobutamine infusion single vessel CAD patients showed a decrease of RFS from 33.4+/-5.3 to 26.7+/-5.9 ml/s, a decrease of PFR from 3.8+/-0.7 to 3.0+/-0.7 EDV/s, and a decrease of RFFC from 73+/-6 to 59+/-4% (P<0.001). Multivessel CAD patients showed a decrease of RFS from 32.0+/-5.9 to 23.1+/-4.1 ml/s, a decrease of PFR form 3.8+/-0.6 to 2.8+/-0.6 EDV/s, and a decrease of RFFC from 71+/-5 to 54+/-8% (P<0.001). The overall sensitivity of detecting CAD was 85% for conventional DSE and 90% for ABD-DSE (P=NS). The sensitivities of detecting patients with single vessel and multivessel CAD with conventional DSE were 68 and 92%, respectively, and with ABD-DSE were 91% (P<0.01) and 96% (P=NS), respectively. Our results show that an abnormal diastolic as well as systolic response during on-line quantitative assessment of dobutamine stress echocardiography is a sensitive marker of coronary artery disease and is predictive for the detection of extensive lesions. The described measurements can be utilized to improve the DSE sensitivity in identifying coronary artery disease. On-line quantitation of diastolic indexes with ABD can represent another step toward obtaining uniform results after stress echocardiography.
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Affiliation(s)
- A Vitarelli
- Cardiac Department, La Sapienza University, Rome, Italy.
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Louie EK, Louie DS. New Echocardiographic Technology: Does it Add to Clinical Decision-Making? Semin Cardiothorac Vasc Anesth 1997. [DOI: 10.1177/108925329700100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric K. Louie
- Division of Cardiology, Loyola University Medical Center, Maywood, IL
| | - David S. Louie
- Division of Cardiology, Loyola University Medical Center, Maywood, IL
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