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Seraphim A, Knott KD, Menacho K, Augusto JB, Davies R, Pierce I, Joy G, Bhuva AN, Xue H, Treibel TA, Cooper JA, Petersen SE, Fontana M, Hughes AD, Moon JC, Manisty C, Kellman P. Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR. JACC Cardiovasc Imaging 2021; 14:2107-2119. [PMID: 34023269 PMCID: PMC8560640 DOI: 10.1016/j.jcmg.2021.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. BACKGROUND Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. METHODS In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. RESULTS A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r2 = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m2) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p = 0.002). CONCLUSIONS Pulmonary transit time (and its derived parameter pulmonary blood volume index), measured automatically without user interaction as part of CMR perfusion mapping, independently predicted adverse cardiovascular outcomes. These biomarkers may offer additional insights into cardiopulmonary function beyond conventional predictors including ejection fraction.
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Affiliation(s)
- Andreas Seraphim
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Joao B Augusto
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Rhodri Davies
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Jackie A Cooper
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Royal Free Hospital, Pond Street, London, United Kingdom
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom.
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, Maryland, USA.
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2
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Read DJ, Doleman B, Heinink T, Selby NM, Lund JN, Phillips BE, Williams JP. Contrast-enhanced ultrasound assessed renal microvascular perfusion may predict postoperative renal complications following colorectal surgery. Clin Exp Pharmacol Physiol 2021; 48:971-977. [PMID: 33783024 DOI: 10.1111/1440-1681.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
Colorectal surgery is associated with an above-average mortality rate of approximately 15%. During surgery, maintenance of vital organ perfusion is essential in order to reduce postoperative mortality and morbidity, with renal perfusion of particular importance. Oesophageal Doppler monitors (ODM) are commonly used to try and provide accurate measures of fluid depletion during surgery; however, it is unclear to what extent they reflect organ perfusion. In addition, it is not known whether macro- and/ or microvascular perfusion indices are associated with renal complications following colorectal surgery. Thirty-two participants scheduled for colorectal surgery had three measures of macro- and microvascular renal blood flow via contrast enhanced ultrasound (CEUS), and simultaneous measures of cardiac output indices via ODM: (i) pre-operatively; (ii) intra-operatively at the mid-point of operation, and (iii) after the conclusion of surgery. The Postoperative Morbidity Survey (POMS) was used to assess postoperative complications. Intra-operatively, there was a significant correlation between renal microvascular flow (RT) and renal macrovascular flow (TTI) (ρ = 0.52; p = 0.003). Intra-operative TTI, but not RT, was associated with cardiac index (ρ = -0.50; p=0.0003). Intra-operative RT predicted increases in renal complications (OR 1.46; 95% CI 1.03-2.09) with good discrimination (C-statistic, 0.85). Complications were not predicted by TTI or ODM-derived indices. There was no relationship between RT and TTI before or after surgery. ODM measures of haemodynamic status do not correlate with renal microvascular blood flow, and as such are likely not suitable to determine vital organ perfusion. Only CEUS-derived measures of microvascular perfusion were predictive of postoperative renal complications.
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Affiliation(s)
| | | | | | - Nicholas M Selby
- Royal Derby Hospital, Derby, UK
- Centre for Kidney Research and Innovation, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
| | - Jonathan N Lund
- Royal Derby Hospital, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
| | - Bethan E Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
- Nottingham NIHR Biomedical Research Centre, Queens Medical Centre, Nottingham, UK
| | - John P Williams
- Royal Derby Hospital, Derby, UK
- Centre for Kidney Research and Innovation, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby, UK
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3
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Turco S, Frinking P, Wildeboer R, Arditi M, Wijkstra H, Lindner JR, Mischi M. Contrast-Enhanced Ultrasound Quantification: From Kinetic Modeling to Machine Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:518-543. [PMID: 31924424 DOI: 10.1016/j.ultrasmedbio.2019.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 05/14/2023]
Abstract
Ultrasound contrast agents (UCAs) have opened up immense diagnostic possibilities by combined use of indicator dilution principles and dynamic contrast-enhanced ultrasound (DCE-US) imaging. UCAs are microbubbles encapsulated in a biocompatible shell. With a rheology comparable to that of red blood cells, UCAs provide an intravascular indicator for functional imaging of the (micro)vasculature by quantitative DCE-US. Several models of the UCA intravascular kinetics have been proposed to provide functional quantitative maps, aiding diagnosis of different pathological conditions. This article is a comprehensive review of the available methods for quantitative DCE-US imaging based on temporal, spatial and spatiotemporal analysis of the UCA kinetics. The recent introduction of novel UCAs that are targeted to specific vascular receptors has advanced DCE-US to a molecular imaging modality. In parallel, new kinetic models of increased complexity have been developed. The extraction of multiple quantitative maps, reflecting complementary variables of the underlying physiological processes, requires an integrative approach to their interpretation. A probabilistic framework based on emerging machine-learning methods represents nowadays the ultimate approach, improving the diagnostic accuracy of DCE-US imaging by optimal combination of the extracted complementary information. The current value and future perspective of all these advances are critically discussed.
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Affiliation(s)
- Simona Turco
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Rogier Wildeboer
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel Arditi
- École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Hessel Wijkstra
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jonathan R Lindner
- Knight Cardiovascular Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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4
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Monahan K, Lenihan D, Brittain EL, Saliba L, Piana RN, Robison LL, Hudson MM, Armstrong GT. The relationship between pulmonary artery wedge pressure and pulmonary blood volume derived from contrast echocardiography: A proof-of-concept study. Echocardiography 2018; 35:1266-1270. [PMID: 29756230 DOI: 10.1111/echo.14023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pulmonary transit time (PTT) obtained from contrast echocardiography is a marker of global cardiopulmonary function. Pulmonary blood volume (PBV), derived from PTT, may be a noninvasive surrogate for left-sided filling pressures, such as pulmonary artery wedge pressure (PAWP). We sought to assess the relationship between PBV obtained from contrast echocardiography and PAWP. METHODS Participants were adult survivors of childhood cancer that had contrast echocardiography performed nearly simultaneously with right-heart catheterization. PTT was derived from time-intensity curves of contrast passage through the right ventricle (RV) and left atrium (LA). PBV relative to overall stroke volume (rPBV) was estimated from the product of PTT and heart rate during RV-LA transit. PAWP was obtained during standard right-heart catheterization. The Spearman correlation coefficient was used to assess the relationship between rPBV and PAWP. RESULTS The study population consisted of 7 individuals who had contrast echocardiography and right-heart catheterization within 3 hours of each other. There was a wide range of right atrial (1-17 mm Hg), mean pulmonary artery (18-42 mm Hg), and PAW pressures (4-26 mm Hg) as well as pulmonary vascular resistance (<1-6 Wood Units). We observed a statistically significant correlation between rPBV and PAWP (r = .85; P = .02). CONCLUSION Relative PBV derived from contrast echocardiography correlates with PAWP. If validated in larger studies, rPBV could potentially be used as an alternative to invasively determine left-sided filling pressure.
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Affiliation(s)
- Ken Monahan
- Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, TN, USA
| | - Daniel Lenihan
- Division of Cardiovascular Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, TN, USA
| | - Linda Saliba
- Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, TN, USA
| | - Robert N Piana
- Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's, Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's, Research Hospital, Memphis, TN, USA.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's, Research Hospital, Memphis, TN, USA.,Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
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5
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de Lepper AG, Herold IH, Saporito S, Bouwman RA, Mischi M, Korsten HH, Reesink KD, Houthuizen P. Noninvasive pulmonary transit time: A new parameter for general cardiac performance. Echocardiography 2017; 34:1138-1145. [DOI: 10.1111/echo.13590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anouk G.W. de Lepper
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Ingeborg H.F. Herold
- Department of Anesthesiology and Intensive-Care; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Salvatore Saporito
- Department of Electrical Engineering; Signal Processing Systems; Eindhoven University of Technology; Eindhoven The Netherlands
| | - R. Arthur Bouwman
- Department of Anesthesiology and Intensive-Care; Catharina Hospital Eindhoven; Eindhoven The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering; Signal Processing Systems; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Hendrikus H.M. Korsten
- Department of Anesthesiology and Intensive-Care; Catharina Hospital Eindhoven; Eindhoven The Netherlands
- Department of Electrical Engineering; Signal Processing Systems; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Koen D. Reesink
- Department of Biomedical Engineering; CARIM School for Cardiovascular Diseases; Maastricht University; Maastricht The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology; Catharina Hospital Eindhoven; Eindhoven The Netherlands
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6
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Heinink TP, Read DJ, Mitchell WK, Bhalla A, Lund JN, Phillips BE, Williams JP. Oesophageal Doppler guided optimization of cardiac output does not increase visceral microvascular blood flow in healthy volunteers. Clin Physiol Funct Imaging 2017; 38:213-219. [PMID: 28168868 DOI: 10.1111/cpf.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Oesophageal Doppler monitoring (ODM) is used clinically to optimize cardiac output (CO) and guide fluid therapy. Despite limited experimental evidence, it is assumed that increasing CO increases visceral microvascular blood flow (MBF). We used contrast-enhanced ultrasound (CEUS) to assess whether ODM-guided optimization of CO altered MBF. METHODS Sixteen healthy male volunteers (62 ± 3·4 years) were studied. Baseline measurements of CO were recorded via ODM. Hepatic and renal MBF was assessed via CEUS. Saline 0·9% was administered to optimize CO according to a standard protocol and repeat CEUS performed. Time-intensity curves were constructed, allowing organ perfusion calculation via time to 5% perfusion (TT5). MBF was assessed via organ perfusion rise time (RT) (5-95%). RESULTS CO increased (4535 ± 241 ml/min versus 5442 ± 329 ml/min, P<0·0001) following fluid administration, whilst time to renal (22·48 ± 1·19 s versus 20·79 ± 1·31 s; P = 0·03), but not hepatic (28·13 ± 4·48 s versus 26·83 ± 1·53 s; P = 0·15) perfusion decreased. Time to renal perfusion was related to CO (renal: r = -0·43, P = 0·01). Hepatic nor renal RT altered following fluid administration (renal: 9·03 ± 0·86 versus 8·93 ± 0·85 s P = 0·86; hepatic: 27·86 ± 1·60 s versus 30·71 ± 2·19 s, P = 0·13). No relationship was observed between changes in CO and MBF in either organ (renal: r = -0·17, P = 0·54; hepatic: r = -0·07, P = 0·80). CONCLUSIONS ODM-optimized CO reduces time to renal perfusion but does not alter renal or hepatic MBF. A lack of relationship between microvascular visceral perfusion and CO following ODM-guided optimization may explain the absence of improved clinical outcome with ODM monitoring.
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Affiliation(s)
- Thomas P Heinink
- Department of Anaesthesia and Critical Care, Royal Derby Hospital, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - David J Read
- Department of Anaesthesia and Critical Care, Royal Derby Hospital, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - William K Mitchell
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Ashish Bhalla
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK
| | - Jonathan N Lund
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK.,University of Nottingham, Derby, UK
| | - Bethan E Phillips
- MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK.,University of Nottingham, Derby, UK
| | - John P Williams
- Department of Anaesthesia and Critical Care, Royal Derby Hospital, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Derby, UK.,University of Nottingham, Derby, UK
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7
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Furuta S, Inouye DS, Hayashi MS, Takanishi DM, Yu M. Blood volume measured by ultrasound and radioisotope dilution in critically ill subjects. J Surg Res 2017; 207:77-84. [DOI: 10.1016/j.jss.2016.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 02/08/2023]
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8
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Hackett HK, Boulet LM, Dominelli PB, Foster GE. A methodological approach for quantifying and characterizing the stability of agitated saline contrast: implications for quantifying intrapulmonary shunt. J Appl Physiol (1985) 2016; 121:568-76. [PMID: 27365283 DOI: 10.1152/japplphysiol.00422.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/27/2016] [Indexed: 12/26/2022] Open
Abstract
Agitated saline contrast echocardiography is often used to determine blood flow through intrapulmonary arteriovenous anastomoses (Q̇IPAVA). We applied indicator dilution theory to time-acoustic intensity curves obtained from a bolus injection of hand-agitated saline contrast to acquire a quantitative index of contrast mass. Using this methodology and an in vitro model of the pulmonary circulation, the purpose of this study was to determine the effect of transit time and gas composition [air vs. sulphur hexafluoride (SF6)] on contrast conservation between two detection sites separated by a convoluted network of vessels. We hypothesized that the contrast lost between the detection sites would increase with transit times and be reduced by using contrast bubbles composed of SF6 Changing the flow and/or reducing the volume of the circulatory network manipulated transit time. Contrast conservation was measured as the ratio of outflow and inflow contrast masses. For air, 53.2 ± 3.4% (SE) of contrast was conserved at a transit time of 9.25 ± 0.02 s but dropped to 16.0 ± 1.0% at a transit time of 10.17 ± 0.06 s. Compared with air, SF6 contrast conservation was significantly greater (P < 0.05) with 114.3 ± 2.9% and 73.7 ± 3.3% of contrast conserved at a transit time of 10.39 ± 0.02 s and 13.46 ± 0.04 s, respectively. In summary, time-acoustic intensity curves can quantify agitated saline contrast, but loss of contrast due to bubble dissolution makes measuring Q̇IPAVA across varying transit time difficult. Agitated saline composed of SF6 is stabilized and may be a suitable alternative for Q̇IPAVA measurement.
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Affiliation(s)
- Heather K Hackett
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - Lindsey M Boulet
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada; and
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9
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Herold IHF, Saporito S, Mischi M, van Assen HC, Bouwman RA, de Lepper AGW, van den Bosch HCM, Korsten HHM, Houthuizen P. Pulmonary transit time measurement by contrast-enhanced ultrasound in left ventricular dyssynchrony. Echo Res Pract 2016; 3:35-43. [PMID: 27249553 PMCID: PMC4989099 DOI: 10.1530/erp-16-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/16/2016] [Indexed: 11/08/2022] Open
Abstract
Background Pulmonary transit time (PTT) is an indirect measure of preload and left ventricular function, which can be estimated using the indicator dilution theory by contrast-enhanced ultrasound (CEUS). In this study, we first assessed the accuracy of PTT-CEUS by comparing it with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Secondly, we tested the hypothesis that PTT-CEUS correlates with the severity of heart failure, assessed by MRI and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods and results Twenty patients referred to our hospital for cardiac resynchronization therapy (CRT) were enrolled. DCE-MRI, CEUS, and NT-proBNP measurements were performed within an hour. Mean transit time (MTT) was obtained by estimating the time evolution of indicator concentration within regions of interest drawn in the right and left ventricles in video loops of DCE-MRI and CEUS. PTT was estimated as the difference of the left and right ventricular MTT. Normalized PTT (nPTT) was obtained by multiplication of PTT with the heart rate. Mean PTT-CEUS was 10.5±2.4s and PTT-DCE-MRI was 10.4±2.0s (P=0.88). The correlations of PTT and nPTT by CEUS and DCE-MRI were strong; r=0.75 (P=0.0001) and r=0.76 (P=0.0001), respectively. Bland–Altman analysis revealed a bias of 0.1s for PTT. nPTT-CEUS correlated moderately with left ventricle volumes. The correlations for PTT-CEUS and nPTT-CEUS were moderate to strong with NT-proBNP; r=0.54 (P=0.022) and r=0.68 (P=0.002), respectively. Conclusions (n)PTT-CEUS showed strong agreement with that by DCE-MRI. Given the good correlation with NT-proBNP level, (n)PTT-CEUS may provide a novel, clinically feasible measure to quantify the severity of heart failure. Clinical Trial Registry: NCT01735838
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Affiliation(s)
- Ingeborg H F Herold
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Salvatore Saporito
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hans C van Assen
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Anouk G W de Lepper
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Hendrikus H M Korsten
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, the Netherlands Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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10
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Herold IHF, Saporito S, Bouwman RA, Houthuizen P, van Assen HC, Mischi M, Korsten HHM. Reliability, repeatability, and reproducibility of pulmonary transit time assessment by contrast enhanced echocardiography. Cardiovasc Ultrasound 2016; 14:1. [PMID: 26729228 PMCID: PMC4700640 DOI: 10.1186/s12947-015-0044-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/22/2015] [Indexed: 01/08/2023] Open
Abstract
Background The aim of this study is to investigate the inter and intra-rater reliability, repeatability, and reproducibility of pulmonary transit time (PTT) measurement in patients using contrast enhanced ultrasound (CEUS), as an indirect measure of preload and left ventricular function. Methods Mean transit times (MTT) were measured by drawing a region of interest (ROI) in right and left cardiac ventricle in the CEUS loops. Acoustic intensity dilution curves were obtained from the ROIs. MTTs were calculated by applying model-based fitting on the dilution curves. PTT was calculated as the difference of the MTTs. Eight raters with different levels of experience measured the PTT (time moment 1) and repeated the measurement within a week (time moment 2). Reliability and agreement were assessed using intra-class correlations (ICC) and Bland-Altman analysis. Repeatability was tested by estimating the variance of means (ANOVA) of three injections in each patient at different doses. Reproducibility was tested by the ICC of the two time moments. Results Fifteen patients with heart failure were included. The mean PTT was 11.8 ± 3.1 s at time moment 1 and 11.7 ± 2.9 s at time moment 2. The inter-rater reliability for PTT was excellent (ICC = 0.94). The intra-rater reliability per rater was between 0.81–0.99. Bland-Altman analysis revealed a bias of 0.10 s within the rater groups. Reproducibility for PTT showed an ICC = 0.94 between the two time moments. ANOVA showed no significant difference between the means of the three different doses F = 0.048 (P = 0.95). The mean and standard deviation for PTT estimates at three different doses was 11.6 ± 3.3 s. Conclusions PTT estimation using CEUS shows a high inter- and intra-rater reliability, repeatability at three different doses, and reproducibility by ROI drawing. This makes the minimally invasive PTT measurement using contrast echocardiography ready for clinical evaluation in patients with heart failure and for preload estimation. Electronic supplementary material The online version of this article (doi:10.1186/s12947-015-0044-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingeborg H F Herold
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Salvatore Saporito
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, De Zaale, 5612 AZ, Eindhoven, The Netherlands.
| | - R Arthur Bouwman
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Hans C van Assen
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, De Zaale, 5612 AZ, Eindhoven, The Netherlands.
| | - Massimo Mischi
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, De Zaale, 5612 AZ, Eindhoven, The Netherlands.
| | - Hendrikus H M Korsten
- Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. .,Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, De Zaale, 5612 AZ, Eindhoven, The Netherlands.
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Herold I, Soliman Hamad M, van Assen H, Bouwman R, Korsten H, Mischi M. Pulmonary blood volume measured by contrast enhanced ultrasound: a comparison with transpulmonary thermodilution. Br J Anaesth 2015; 115:53-60. [DOI: 10.1093/bja/aeu554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2014] [Indexed: 11/14/2022] Open
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Boronyak SM, Monahan K, Brittain EL, Merryman WD. An Inflection Point Method for the Determination of Pulmonary Transit Time From Contrast Echocardiography. IEEE Trans Biomed Eng 2015; 62:1853-61. [PMID: 25706506 DOI: 10.1109/tbme.2015.2405764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Indicator-dilution curves (IDCs) for the estimation of pulmonary transit times (PTTs) can be generated noninvasively using contrast echocardiography. Currently, these IDCs are analyzed by manual inspection, which is not feasible in a clinical setting, or fit to a statistical model to derive parameters of interest. However, IDCs generated from patients are frequently subject to significant low-frequency noise and recirculation artifacts that obscure the first-pass signal and render model fitting impractical or inaccurate. Thus, the objective of this paper was to develop alternative computational methods to determine PTT using noisy clinical data in which the signal decay is not adequately visible. METHODS We report on a method that uses a model fit to the rise portion of the IDCs to determine the signal inflection point. Additionally, a signal truncation algorithm was developed that enables automated analysis of the IDCs. RESULTS We compare PTTs derived from our inflection point method to those obtained by manual inspection in 25 patients (R(2) = 0.86) and to those obtained by mean transit time calculation following fitting to a local density random walk model (R(2) = 0.80) in a subset of this cohort. CONCLUSION Combined with a signal truncation algorithm, the inflection point method provides robust, automated determination of PTT from noisy IDCs containing recirculation artifacts. SIGNIFICANCE The inflection point method addresses the need for computational analysis of IDCs obtained from contrast echocardiograms that are not amenable to first-pass model fitting.
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