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Hohri Y, Chung MM, Kandula V, Kim I, Leb J, Hayashi H, Elmously A, O’Donnell TFX, Patel V, Vedula V, Takayama H. Blood flow assessment technology in aortic surgery: a narrative review. J Thorac Dis 2024; 16:2623-2636. [PMID: 38738252 PMCID: PMC11087597 DOI: 10.21037/jtd-23-1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/23/2024] [Indexed: 05/14/2024]
Abstract
Background and Objective Blood flow assessment is an emerging technique that allows for assessment of hemodynamics in the heart and blood vessels. Recent advances in cardiovascular imaging technologies have made it possible for this technique to be more accessible to clinicians and researchers. Blood flow assessment typically refers to two techniques: measurement-based flow visualization using echocardiography or four-dimensional flow magnetic resonance imaging (4D flow MRI), and computer-based flow simulation based on computational fluid dynamics modeling. Using these methods, blood flow patterns can be visualized and quantitative measurements of mechanical stress on the walls of the ventricles and blood vessels, most notably the aorta, can be made. Thus, blood flow assessment has been enhancing the understanding of cardiac and aortic diseases; however, its introduction to clinical practice has been negligible yet. In this article, we aim to discuss the clinical applications and future directions of blood flow assessment in aortic surgery. We then provide our unique perspective on the technique's translational impact on the surgical management of aortic disease. Methods Articles from the PubMed database and Google Scholar regarding blood flow assessment in aortic surgery were reviewed. For the initial search, articles published between 2013 and 2023 were prioritized, including original articles, clinical trials, case reports, and reviews. Following the initial search, additional articles were considered based on manual searches of the references from the retrieved literature. Key Content and Findings In aortic root pathology and ascending aortic aneurysms, blood flow assessment can elucidate postoperative hemodynamic changes after surgical reconfiguration of the aortic valve complex or ascending aorta. In cases of aortic dissection, analysis of blood flow can predict future aortic dilatation. For complicated congenital aortic anomalies, surgeons may use preoperative imaging to perform "virtual surgery", in which blood flow assessment can predict postoperative hemodynamics for different surgical reconstructions and assist in procedural planning even before entering the operating room. Conclusions Blood flow assessment and computational modeling can evaluate hemodynamics and flow patterns by visualizing blood flow and calculating biomechanical forces in patients with aortic disease. We anticipate that blood flow assessment will become an essential tool in the treatment planning and understanding of the progression of aortic disease.
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Affiliation(s)
- Yu Hohri
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Megan M. Chung
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Viswajit Kandula
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Ilya Kim
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Jay Leb
- Department of Radiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Hideyuki Hayashi
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Adham Elmously
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Thomas FX O’Donnell
- Division of Vascular Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Virendra Patel
- Division of Vascular Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Columbia University in the City of New York, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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Maidu B, Martinez-Legazpi P, Guerrero-Hurtado M, Nguyen CM, Gonzalo A, Kahn AM, Bermejo J, Flores O, Del Alamo JC. Super-resolution Left Ventricular Flow and Pressure Mapping by Navier-Stokes-Informed Neural Networks. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.12.589319. [PMID: 38659851 PMCID: PMC11042210 DOI: 10.1101/2024.04.12.589319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Intraventricular vector flow mapping (VFM) is a growingly adopted echocardiographic modality that derives time-resolved two-dimensional flow maps in the left ventricle (LV) from color-Doppler sequences. Current VFM models rely on kinematic constraints arising from planar flow incompressibility. However, these models are not informed by crucial information about flow physics; most notably the pressure and shear forces within the fluid and the resulting accelerations. This limitation has rendered VFM unable to combine information from different time frames in an acquisition sequence or derive fluctuating pressure maps. In this study, we leveraged recent advances in artificial intelligence (AI) to develop AI-VFM, a vector flow mapping modality that uses physics-informed neural networks (PINNs) encoding mass conservation and momentum balance inside the LV, and no-slip boundary conditions at the LV endocardium. AI-VFM recovers the flow and pressure fields in the LV from standard echocardiographic scans. It performs phase unwrapping and recovers flow data in areas without input color-Doppler data. AI-VFM also recovers complete flow maps at time points without color-Doppler input data, producing super-resolution flow maps. We show that informing the PINNs with momentum balance is essential to achieving temporal super-resolution and significantly increases the accuracy of AI-VFM compared to informing the PINNs only with mass conservation. AI-VFM is solely informed by each patient's flow physics; it does not utilize explicit smoothness constraints or incorporate data from other patients or flow models. AI-VFM takes 15 minutes to run in off-the-shelf graphics processing units and its underlying PINN framework could be extended to map other flow-associated metrics like blood residence time or the concentration of coagulation species.
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Affiliation(s)
- Bahetihazi Maidu
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Pablo Martinez-Legazpi
- Dept. of Mathematical Physics and Fluids. Universidad Nacional de Educación a Distancia & CIBERCV, Madrid, Spain
| | - Manuel Guerrero-Hurtado
- Dept. of Aerospace Engineering and Bioengineering, Universidad Carlos III De Madrid, Leganes, Spain
| | - Cathleen M Nguyen
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Alejandro Gonzalo
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine., University of California San Diego, La Jolla, CA, USA
| | - Javier Bermejo
- Dept. of Cardiology, Hospital General Universitario Gregorio Marañon & CIBERCV, Madrid, Spain
| | - Oscar Flores
- Dept. of Aerospace Engineering and Bioengineering, Universidad Carlos III De Madrid, Leganes, Spain
| | - Juan C Del Alamo
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington School of Medicine, Seattle, WA, USA
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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3
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Petrescu A, Voigt JU. [Echocardiography with high frame rates in the clinical practice : Principles, applications and perspectives]. Herz 2023; 48:339-351. [PMID: 37530782 DOI: 10.1007/s00059-023-05199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Continuous developments in cardiovascular imaging, software and hardware have led to technological advancements that open new ways for assessing myocardial mechanics, hemodynamics, and function. Through new scan modalities, echocardiographic scanners can nowadays achieve very high frame rates up to 5000 frames s-1 which enables a wide variety of new applications, including shear wave elastography, ultrafast speckle tracking, the visualization of intracardiac blood flow and myocardial perfusion imaging. This review provides an overview of these advances and demonstrates possible applications and their potential added value in the clinical practice.
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Affiliation(s)
- Aniela Petrescu
- Abteilung für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgien.
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4
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Wilson SI, Ingram KE, Oh A, Moreno MR, Kassi M. The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD. Front Cardiovasc Med 2023; 10:1248300. [PMID: 37692033 PMCID: PMC10484111 DOI: 10.3389/fcvm.2023.1248300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop-such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry-that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.
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Affiliation(s)
- Shannon I. Wilson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - Katelyn E. Ingram
- DeBakey Heart and Vascular- Heart Center Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Albert Oh
- School of Engineering Medicine, Texas A&M University, Houston, TX, United States
| | - Michael R. Moreno
- J. Mike Walker ‘66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, United States
| | - Mahwash Kassi
- Cardiology, DeBakey Heart and Vascular, Houston Methodist Hospital, Houston, TX, United States
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Mele D, Beccari R, Pedrizzetti G. Effect of Aging on Intraventricular Kinetic Energy and Energy Dissipation. J Cardiovasc Dev Dis 2023; 10:308. [PMID: 37504564 PMCID: PMC10380306 DOI: 10.3390/jcdd10070308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
In recent years, analysis of kinetic energy (KE) and the rate of kinetic energy dissipation (KED) or energy loss (EL) within the cardiac chambers, obtained by cardiac imaging techniques, has gained increasing attention. Thus, there is a need to clarify the effect of physiological variables, specifically aging, on these energetic measures. To elucidate this aspect, we reviewed the literature on this topic. Overall, cardiac magnetic resonance and echocardiographic studies published so far indicate that aging affects the energetics of left and right intraventricular blood flow, although not all energy measures during the cardiac cycle seem to be affected by age in the same way. Current studies, however, have limitations. Additional large, multicenter investigations are needed to test the effect of physiological variables on intraventricular KE and KED/EL measures.
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Affiliation(s)
- Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
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Noninvasive Evaluation of Intraventricular Flow Dynamics by the HyperDoppler Technique: First Application to Normal Subjects, Athletes, and Patients with Heart Failure. J Clin Med 2022; 11:jcm11082216. [PMID: 35456305 PMCID: PMC9026209 DOI: 10.3390/jcm11082216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022] Open
Abstract
Background: HyperDoppler is a new echocardiographic color Doppler-based technique that can assess intracardiac flow dynamics. The aim of this study was to verify the feasibility and reproducibility of this technique in unselected patients and its capability to differentiate measures of vortex flow within the left ventricle (LV) in normal sedentary subjects, athletes, and patients with heart failure. Methods: Two hundred unselected, consecutive patients presenting at the echocardiographic laboratory, 50 normal subjects, 30 athletes, and 50 patients with chronic heart failure and LV ejection fraction <50% were enrolled. Images were acquired using a MyLab X8 echo-scanner. Area, intensity, depth, length, and kinetic energy dissipation (KED) of vortex flow were measured. Results: The HyperDoppler technique feasibility was 94.5%. According to the intraclass correlation coefficient evaluations, repeatability and reproducibility of vortex flow measures were good for vortex area (0.82, 0.85), length (0.83, 0.82), and depth (0.87, 0.84) and excellent for intensity (0.92, 0.90) and KED (0.98, 0.98). Combining different vortex flow measures, the LV flow profile of healthy sedentary individuals, athletes, and heart failure patients could be differentiated. Conclusions: HyperDoppler is a feasible, reliable, and practical technique for the assessment of LV flow dynamics and may distinguish normal subjects and patients with heart failure.
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Voorneveld J, Keijzer LBH, Strachinaru M, Bowen DJ, Mutluer FO, van der Steen AFW, Cate FJT, de Jong N, Vos HJ, van den Bosch AE, Bosch JG. Optimization of Microbubble Concentration and Acoustic Pressure for Left Ventricular High-Frame-Rate EchoPIV in Patients. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2432-2443. [PMID: 33720832 DOI: 10.1109/tuffc.2021.3066082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
High-frame-rate (HFR) echo-particle image velocimetry (echoPIV) is a promising tool for measuring intracardiac blood flow dynamics. In this study, we investigate the optimal ultrasound contrast agent (UCA: SonoVue) infusion rate and acoustic output to use for HFR echoPIV (PRF = 4900 Hz) in the left ventricle (LV) of patients. Three infusion rates (0.3, 0.6, and 1.2 ml/min) and five acoustic output amplitudes (by varying transmit voltage: 5, 10, 15, 20, and 30 V-corresponding to mechanical indices of 0.01, 0.02, 0.03, 0.04, and 0.06 at 60-mm depth) were tested in 20 patients admitted for symptoms of heart failure. We assess the accuracy of HFR echoPIV against pulsed-wave Doppler acquisitions obtained for mitral inflow and aortic outflow. In terms of image quality, the 1.2-ml/min infusion rate provided the highest contrast-to-background ratio (CBR) (3-dB improvement over 0.3 ml/min). The highest acoustic output tested resulted in the lowest CBR. Increased acoustic output also resulted in increased microbubble disruption. For the echoPIV results, the 1.2-ml/min infusion rate provided the best vector quality and accuracy; mid-range acoustic outputs (corresponding to 15-20-V transmit voltages) provided the best agreement with the pulsed-wave Doppler. Overall, the highest infusion rate (1.2 ml/min) and mid-range acoustic output amplitudes provided the best image quality and echoPIV results.
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8
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Petrescu A, D'hooge J, Voigt JU. Concepts and applications of ultrafast cardiac ultrasound imaging. Echocardiography 2021; 38:7-15. [PMID: 33471395 DOI: 10.1111/echo.14971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
The concept of ultrafast echocardiographic imaging has been around for decades. However, only recent progress in ultrasound machine hardware and computer technology allowed to apply this concept to echocardiography. High frame rate echocardiography can visualize phenomena that have never been captured before. It enables a wide variety of potential new applications, including shear wave imaging, speckle tracking, ultrafast Doppler imaging, and myocardial perfusion imaging. The principles of these applications and their potential clinical use will be presented in this manuscript.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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9
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Hoving AM, Voorneveld J, Mikhal J, Bosch JG, Groot Jebbink E, Slump CH. In vitro performance of echoPIV for assessment of laminar flow profiles in a carotid artery stent. J Med Imaging (Bellingham) 2021; 8:017001. [PMID: 33457445 PMCID: PMC7804295 DOI: 10.1117/1.jmi.8.1.017001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Detailed blood flow studies may contribute to improvements in carotid artery stenting. High-frame-rate contrast-enhanced ultrasound followed by particle image velocimetry (PIV), also called echoPIV, is a technique to study blood flow patterns in detail. The performance of echoPIV in presence of a stent has not yet been studied extensively. We compared the performance of echoPIV in stented and nonstented regions in an in vitro flow setup. Approach: A carotid artery stent was deployed in a vessel-mimicking phantom. High-frame-rate contrast-enhanced ultrasound images were acquired with various settings. Signal intensities of the contrast agent, velocity values, and flow profiles were calculated. Results: The results showed decreased signal intensities and correlation coefficients inside the stent, however, PIV analysis in the stent still resulted in plausible flow vectors. Conclusions: Velocity values and laminar flow profiles can be measured in vitro in stented arteries using echoPIV.
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Affiliation(s)
- Astrid M Hoving
- University of Twente, TechMed Centre, Robotics and Mechatronics Group, Enschede, The Netherlands
| | - Jason Voorneveld
- Erasmus MC, Thorax Center, Department of Biomedical Engineering, Rotterdam, The Netherlands
| | - Julia Mikhal
- University of Twente, TechMed Centre, BIOS Lab-on-a-Chip Group, Enschede, The Netherlands
| | - Johan G Bosch
- Erasmus MC, Thorax Center, Department of Biomedical Engineering, Rotterdam, The Netherlands
| | - Erik Groot Jebbink
- University of Twente, TechMed Centre, Multi-Modality Medical Imaging Group, Enschede, The Netherlands
| | - Cornelis H Slump
- University of Twente, TechMed Centre, Robotics and Mechatronics Group, Enschede, The Netherlands
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10
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Vos HJ, Voorneveld JD, Groot Jebbink E, Leow CH, Nie L, van den Bosch AE, Tang MX, Freear S, Bosch JG. Contrast-Enhanced High-Frame-Rate Ultrasound Imaging of Flow Patterns in Cardiac Chambers and Deep Vessels. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2875-2890. [PMID: 32843233 DOI: 10.1016/j.ultrasmedbio.2020.07.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Cardiac function and vascular function are closely related to the flow of blood within. The flow velocities in these larger cavities easily reach 1 m/s, and generally complex spatiotemporal flow patterns are involved, especially in a non-physiologic state. Visualization of such flow patterns using ultrasound can be greatly enhanced by administration of contrast agents. Tracking the high-velocity complex flows is challenging with current clinical echographic tools, mostly because of limitations in signal-to-noise ratio; estimation of lateral velocities; and/or frame rate of the contrast-enhanced imaging mode. This review addresses the state of the art in 2-D high-frame-rate contrast-enhanced echography of ventricular and deep-vessel flow, from both technological and clinical perspectives. It concludes that current advanced ultrasound equipment is technologically ready for use in human contrast-enhanced studies, thus potentially leading to identification of the most clinically relevant flow parameters for quantifying cardiac and vascular function.
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Affiliation(s)
- Hendrik J Vos
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Medical Imaging, Department of Imaging Physics, Applied Sciences, Delft University of Technology, Delft, The Netherlands.
| | - Jason D Voorneveld
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erik Groot Jebbink
- M3i: Multi-modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Chee Hau Leow
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Luzhen Nie
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Steven Freear
- School of Electronic and Electrical Engineering, University of Leeds, Leeds, United Kingdom
| | - Johan G Bosch
- Biomedical Engineering, Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Voorneveld J, Keijzer LBH, Strachinaru M, Bowen DJ, Goei JSL, Ten Cate F, van der Steen AFW, de Jong N, Vos HJ, van den Bosch AE, Bosch JG. High-Frame-Rate Echo-Particle Image Velocimetry Can Measure the High-Velocity Diastolic Flow Patterns. Circ Cardiovasc Imaging 2020; 12:e008856. [PMID: 30939921 DOI: 10.1161/circimaging.119.008856] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason Voorneveld
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lana B H Keijzer
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mihai Strachinaru
- Department of Cardiology (M.S., D.J.B., J.S.L.G., F.T.C., A.E.v.d.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Daniel J Bowen
- Department of Cardiology (M.S., D.J.B., J.S.L.G., F.T.C., A.E.v.d.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeffrey S L Goei
- Department of Cardiology (M.S., D.J.B., J.S.L.G., F.T.C., A.E.v.d.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Folkert Ten Cate
- Department of Cardiology (M.S., D.J.B., J.S.L.G., F.T.C., A.E.v.d.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonius F W van der Steen
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N de Jong
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hendrik J Vos
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology (M.S., D.J.B., J.S.L.G., F.T.C., A.E.v.d.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering (J.V., L.B.H.K., A.F.W.v.d.S., N.d.J., H.J.V., J.G.B.), Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
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12
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Nyrnes SA, Fadnes S, Wigen MS, Mertens L, Lovstakken L. Blood Speckle-Tracking Based on High-Frame Rate Ultrasound Imaging in Pediatric Cardiology. J Am Soc Echocardiogr 2020; 33:493-503.e5. [PMID: 31987749 DOI: 10.1016/j.echo.2019.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Flow properties play an important role in cardiac function, remodeling, and morphogenesis but cannot be displayed in detail with today's echocardiographic techniques. The authors hypothesized that blood speckle-tracking (BST) could visualize and quantify flow patterns. The aim of this study was to determine the feasibility, accuracy, and potential clinical applications of BST in pediatric cardiology. METHODS BST is based on high-frame rate ultrasound, using a combination of plane-wave imaging and parallel receive beamforming. Pattern-matching techniques are used to quantify blood speckle motion. Accuracy of BST velocity measurements was validated using a rotating phantom and by comparing BST-derived inflow velocities with pulsed-wave Doppler obtained in the left ventricles of healthy control subjects. To test clinical feasibility, 102 subjects (21 weeks to 11.5 years of age) were prospectively enrolled, including healthy fetuses (n = 4), healthy control subjects (n = 51), and patients with different cardiac diseases (n = 47). RESULTS The phantom data showed a good correlation (r = 0.95, with a tracking quality threshold of 0.4) between estimated BST velocities and reference velocities down to a depth of 8 cm. There was a good correlation (r = 0.76) between left ventricular inflow velocity measured using BST and pulsed-wave Doppler. BST displayed lower velocities (mean ± SD, 0.59 ± 0.14 vs 0.82 ± 0.21 m/sec for pulsed-wave Doppler). However, the velocity amplitude in BST increases with reduced smoothing. The clinical feasibility of BST was high, as flow patterns in the area of interest could be visualized in all but one case (>99%). CONCLUSIONS BST is highly feasible in fetal and pediatric echocardiography and provides a novel approach for visualizing blood flow patterns. BST provides accurate velocity measurements down to 8 cm, but compared with pulsed-wave Doppler, BST displays lower velocities. Studying blood flow properties may provide novel insights into the pathophysiology of pediatric heart disease and could become an important diagnostic tool.
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Affiliation(s)
- Siri A Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Smedsrud Wigen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lasse Lovstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Waal K, Crendal E, Boyle A. Left ventricular vortex formation in preterm infants assessed by blood speckle imaging. Echocardiography 2019; 36:1364-1371. [DOI: 10.1111/echo.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Affiliation(s)
- Koert Waal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle Newcastle New South Wales Australia
| | - Edward Crendal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle Newcastle New South Wales Australia
- John Hunter Hospital Department of Cardiology and University of Newcastle Newcastle New South Wales Australia
| | - Andrew Boyle
- John Hunter Hospital Department of Cardiology and University of Newcastle Newcastle New South Wales Australia
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14
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Walker AR, Uejima T, Prinz C, Voigt JU, Fraser AG. Inaccuracies in Measuring Velocities and Timing of Flow and Tissue Motion Using High-End Ultrasound Systems. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1446-1454. [PMID: 30975534 DOI: 10.1016/j.ultrasmedbio.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 06/09/2023]
Abstract
To evaluate the accuracy of measurements of the velocities and timing of blood flow and of tissue motion, we tested four commercially available ultrasound systems. Pulsed wave, continuous wave and tissue Doppler recordings acquired across a range of angles of insonation were compared against a calibrated Doppler string phantom. Temporal delays were measured from the onset of the simulated electrocardiogram to the start of each Doppler signal. Across all modalities and angles, the mean errors of measurements of velocity using the four systems were 0.2%, 1.7%, 6.0% and 3.1%. The largest errors occurred using tissue Doppler at 5 cm/s (mean overestimation: 5.8%, range: +1.1%-12.5%). Mean delays in displaying the onset of flow were -3, 6, 11 and -16 ms. All differences between machines were statistically significant. The accuracy of high-end ultrasound systems for measuring velocities is better than in earlier reports, but the reporting of routine testing against standard phantoms should be mandatory.
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Affiliation(s)
- Andrew R Walker
- Department of Biomedical Engineering, Västmanland Hospital, Västerås, Sweden.
| | - Tokuhisa Uejima
- Wales Heart Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom
| | - Christian Prinz
- Department of Cardiovascular Diseases, University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium
| | - Alan G Fraser
- Wales Heart Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff, United Kingdom; Department of Cardiovascular Diseases, University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium
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15
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Mele D, Smarrazzo V, Pedrizzetti G, Capasso F, Pepe M, Severino S, Luisi GA, Maglione M, Ferrari R. Intracardiac Flow Analysis: Techniques and Potential Clinical Applications. J Am Soc Echocardiogr 2019; 32:319-332. [DOI: 10.1016/j.echo.2018.10.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 01/20/2023]
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16
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Voorneveld J, Muralidharan A, Hope T, Vos HJ, Kruizinga P, van der Steen AFW, Gijsen FJH, Kenjeres S, de Jong N, Bosch JG. High Frame Rate Ultrasound Particle Image Velocimetry for Estimating High Velocity Flow Patterns in the Left Ventricle. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:2222-2232. [PMID: 29990263 DOI: 10.1109/tuffc.2017.2786340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Echocardiographic determination of multicomponent blood flow dynamics in the left ventricle remains a challenge. In this paper, we compare contrast enhanced, high frame rate (HFR) (1000 frames/s) echo-particle image velocimetry (ePIV) against optical particle image velocimetry (oPIV, gold standard), in a realistic left ventricular (LV) phantom. We find that ePIV compares well to oPIV, even for the high velocity inflow jet (normalized RMSE = 9% ± 1%). In addition, we perform the method of proper orthogonal decomposition, to better qualify and quantify the differences between the two modalities. We show that ePIV and oPIV resolve very similar flow structures, especially for the lowest order mode with a cosine similarity index of 86%. The coarser resolution of ePIV does result in increased variance and blurring of smaller flow structures when compared to oPIV. However, both modalities are in good agreement with each other for the modes that constitute the bulk of the kinetic energy. We conclude that HFR ePIV can accurately estimate the high velocity diastolic inflow jet and the high energy flow structures in an LV setting.
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17
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Sampath K, Harfi TT, George RT, Katz J. Optimized Time-Resolved Echo Particle Image Velocimetry– Particle Tracking Velocimetry Measurements Elucidate Blood Flow in Patients With Left Ventricular Thrombus. J Biomech Eng 2018; 140:2668583. [DOI: 10.1115/1.4038886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 02/04/2023]
Abstract
Contrast ultrasound is a widely used clinical tool to obtain real-time qualitative blood flow assessments in the heart, liver, etc. Echocardiographic particle image velocimetry (echo-PIV) is a technique for obtaining quantitative velocity maps from contrast ultrasound images. However, unlike optical particle image velocimetry (PIV), routine echo images are prone to nonuniform spatiotemporal variations in tracer distribution, making analysis difficult for standard PIV algorithms. This study introduces optimized procedures that integrate image enhancement, PIV, and particle tracking velocimetry (PTV) to obtain reliable time-resolved two-dimensional (2D) velocity distributions. During initial PIV analysis, multiple results are obtained by varying processing parameters. Optimization involving outlier removal and smoothing is used to select the correct vector. These results are used in a multiparameter PTV procedure. To demonstrate their clinical value, the procedures are implemented to obtain velocity and vorticity distributions over multiple cardiac cycles using images acquired from four left ventricular thrombus (LVT) patients. Phase-averaged data elucidate flow structure evolution over the cycle and are used to calculate penetration depth and strength of left ventricular (LV) vortices, as well as apical velocity induced by them. The present data are consistent with previous time-averaged results for the minimum vortex penetration depth associated with LVT occurrence. However, due to decay and fragmentation of LV vortices, as they migrate away from the mitral annulus, in two cases with high penetration, there is still poor washing near the resolved clot throughout the cycle. Hence, direct examination of entire flow evolution may be useful for assessing risk of LVT relapse before prescribing anticoagulants.
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Affiliation(s)
- Kaushik Sampath
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe 223, Baltimore, MD 21218 e-mail:
| | - Thura T. Harfi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287 e-mail:
| | - Richard T. George
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287 e-mail:
| | - Joseph Katz
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe 122, Baltimore, MD 21218 e-mail:
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18
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Tang C, Zhu Y, Zhang J, Niu C, Liu D, Liao Y, Zhu L, Peng Q. Analysis of left ventricular fluid dynamics in dilated cardiomyopathy by echocardiographic particle image velocimetry. Echocardiography 2017; 35:56-63. [PMID: 29082600 DOI: 10.1111/echo.13732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Chouchou Tang
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
- Imaging and Nuclear Medicine, Ultrasound Room; Infection Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Yizhong Zhu
- Internal Medicine; First Affiliated Hospital of Sun Yat-sen University; Guangzhou Guangdong Province China
| | - Jing Zhang
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Chengcheng Niu
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Dan Liu
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Yacong Liao
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Lijun Zhu
- Imaging and Nuclear Medicine; the First Affiliated Hospital of Southern Medical University; Guangzhou Guangdong Province China
| | - Qinghai Peng
- Imaging and Nuclear Medicine; Ultrasound Department; the Second Xiangya Hospital of Central South University; Changsha Hunan Province China
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19
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Itatani K, Miyazaki S, Furusawa T, Numata S, Yamazaki S, Morimoto K, Makino R, Morichi H, Nishino T, Yaku H. New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI. Gen Thorac Cardiovasc Surg 2017; 65:611-621. [PMID: 28929446 DOI: 10.1007/s11748-017-0834-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 11/28/2022]
Abstract
Blood flow imaging is a novel technology in cardiovascular medicine and surgery. Today, two types of blood flow imaging tools are available: measurement-based flow visualization including 4D flow MRI (or 3D cine phase-contrast magnetic resonance imaging), or echocardiography flow visualization software, and computer flow simulation modeling based on computational fluid dynamics (CFD). MRI and echocardiography flow visualization provide measured blood flow but have limitations in temporal and spatial resolution, whereas CFD flow calculates the flow according to assumptions instead of flow measurement, and it has sufficiently fine resolution up to the computer memory limit, and it enables even virtual surgery when combined with computer graphics. Blood flow imaging provides profound insight into the pathophysiology of cardiovascular diseases, because it quantifies and visualizes mechanical stress on the vessel walls or heart ventricle. Wall shear stress (WSS) is a stress on the endothelial wall caused by the near wall blood flow, and it is thought to be a predictor of atherosclerosis progression in coronary or aortic diseases. Flow energy loss (EL) is the loss of blood flow energy caused by viscous friction of turbulent diseased flow, and it is expected to be a predictor of ventricular workload on various heart diseases including heart valve disease, cardiomyopathy, and congenital heart diseases. Blood flow imaging can provide useful information for developing predictive medicine in cardiovascular diseases, and may lead to breakthroughs in cardiovascular surgery, especially in the decision-making process.
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Affiliation(s)
- Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | | | | | - Satoshi Numata
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rina Makino
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroko Morichi
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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20
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Nakashima K, Itatani K, Kitamura T, Oka N, Horai T, Miyazaki S, Nie M, Miyaji K. Energy dynamics of the intraventricular vortex after mitral valve surgery. Heart Vessels 2017; 32:1123-1129. [DOI: 10.1007/s00380-017-0967-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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21
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Temporal averaging of two-dimensional correlation functions for velocity vector imaging of cardiac blood flow. J Med Ultrason (2001) 2015; 42:323-30. [DOI: 10.1007/s10396-015-0620-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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22
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Effects of Right Ventricular Hemodynamic Burden on Intraventricular Flow in Tetralogy of Fallot: An Echocardiographic Contrast Particle Imaging Velocimetry Study. J Am Soc Echocardiogr 2014; 27:1311-8. [DOI: 10.1016/j.echo.2014.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/17/2022]
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23
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Mehregan F, Tournoux F, Muth S, Pibarot P, Rieu R, Cloutier G, Garcia D. Doppler vortography: a color Doppler approach to quantification of intraventricular blood flow vortices. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:210-21. [PMID: 24210865 PMCID: PMC3864856 DOI: 10.1016/j.ultrasmedbio.2013.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 05/11/2023]
Abstract
We propose a new approach to quantification of intracardiac vorticity based on conventional color Doppler images -Doppler vortography. Doppler vortography relies on the centrosymmetric properties of the vortices. Such properties induce particular symmetries in the Doppler flow data that can be exploited to describe the vortices quantitatively. For this purpose, a kernel filter was developed to derive a parameter, the blood vortex signature (BVS), that allows detection of the main intracardiac vortices and estimation of their core vorticities. The reliability of Doppler vortography was assessed in mock Doppler fields issued from simulations and in vitro data. Doppler vortography was also tested in patients and compared with vector flow mapping by echocardiography. Strong correlations were obtained between Doppler vortography-derived and ground-truth vorticities (in silico: r2 = 0.98, in vitro: r2 = 0.86, in vivo: r2 = 0.89). Our results indicate that Doppler vortography is a potentially promising echocardiographic tool for quantification of vortex flow in the left ventricle.
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Affiliation(s)
- Forough Mehregan
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
| | - François Tournoux
- Department of Echocardiography, CHUM, University of Montreal Hospital, Canada
| | - Stéphan Muth
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
| | - Philippe Pibarot
- Department of Medicine, Laval University, and Québec Heart & Lung Institute
| | - Régis Rieu
- Aix-Marseille University, CNRS, UMR 7287, ISM GIBoc, Marseille, France
| | - Guy Cloutier
- CRCHUM, Research Center, University of Montreal Hospital, Canada
- LBUM, Laboratory of Biorheology and Medical Ultrasonics
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Canada
| | - Damien Garcia
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Canada
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24
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Prinz C, Lehmann R, Brandao da Silva D, Jurczak B, Bitter T, Faber L, Horstkotte D. Echocardiographic particle image velocimetry for the evaluation of diastolic function in hypertrophic nonobstructive cardiomyopathy. Echocardiography 2013; 31:886-94. [PMID: 24355083 DOI: 10.1111/echo.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS To use particle image velocimetry (PIV) echocardiography for the evaluation of diastolic dysfunction (DD) in patients with hypertrophic nonobstructive cardiomyopathy (HNCM). METHODS This study included 50 individuals, thereof 30 patients with DD due to HNCM and 20 healthy individuals who served as controls. HNCM patients were divided into 3 groups according to DD severity. All subjects underwent clinical assessment, exercise testing, and standard as well as PIV echocardiography. RESULTS Energy dissipation was higher in DD patients than in the control group. The severity of flow pattern disturbance corresponded to the degree of DD. In a subgroup of 20 HNCM patients we found significant correlations between invasive measured left ventricular end-diastolic pressure and noninvasive PIV parameters for intraventricular pressure differences and filling. Inter-observer variability (mean difference ± 1.96 SD) for all tested PIV measurements was good. CONCLUSION According to DD severity, patients with HNCM have disturbed intraventricular flow and reduced intraventricular pressure differences, consistent with a reduced intraventricular suction. PIV echocardiography appears to be feasible for detailed analysis of ventricular vortex flow in DD conditions. Further research using PIV echocardiography in different cardiac pathologies seems warranted.
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Affiliation(s)
- Christian Prinz
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University, Bochum, Bad Oeynhausen, Germany
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