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Ali Al-Allak HM, Noaman Al-Aboodi AH. A Four-Dimensional Volumetric Quantification of the Left Ventricle in Healthy Pregnant Women in the Third Trimester. Cureus 2023; 15:e46342. [PMID: 37920612 PMCID: PMC10618626 DOI: 10.7759/cureus.46342] [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: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Hemodynamic load and heart structural remodeling rise during pregnancy because these changes are physiologically necessary. Adaptations in the mother's circulatory system may either initiate or aggravate the development of cardiovascular disease in the offspring. If the body is unable to adjust to these changes, it may develop heart conditions like cardiomyopathy. There is a lack of third-trimester echocardiographic data on left ventricular (LV) volume and function in healthy Iraqi women. To understand the cardiac alterations that occur during normal pregnancy, a precise tool that evaluates cardiac function is needed. In that regard, the four-dimensional echocardiography (4DE) technique has markedly improved the quality and accuracy of assessing the size and function of the left ventricle. AIM The present study aimed to assess LV volume and function in the third trimester of a healthy pregnancy using 4DE and to compare the results of LV assessment using 4DE with those of LV assessment using conventional two-dimensional (2D) echocardiography. METHODS The study was conducted on 75 healthy pregnant women (the case group) and 75 non-pregnant women (the control group). The participants attended Al-Fortat Teaching Hospital from April 1, 2022, to May 30, 2023, and had 2D and 4D echocardiographic studies performed on them. RESULTS The LV end-diastolic volume (EDV), end-systolic volume (ESV), and cardiac output (CO) were significantly increased in the case group compared to the control group (90.87 ± 18.03 ml vs. 62.64 ± 14.11 ml, P<0.001; 35.59 ± 6.52 ml vs. 22.42 ± 5.82 ml, P<0.001; and 4.87 ± 1.27 vs. 3.35 ± 0.87 L/m, P<0.001, respectively). In contrast, the LV ejection fraction (LVEF) was significantly decreased in the pregnant group compared to the control group (60.37 ± 5.42 % vs. 64.04 ± 4.99 %, P<0.01). Additionally, the study showed significant differences in EDV, ESV, ejection fraction (EF%), and CO (P<0.001) between 2D and 4D echocardiography, according to the Bland Altman test. CONCLUSION In healthy pregnant women in their third trimester, there is an increase in the indicators of preload (ventricular volume and CO) and a decrease in EF%. The 4DE provides detailed images and information about cardiac volumes and function, allowing for the early detection of any potential problems that may arise during pregnancy and thus improving the health outcomes of both the mother and the developing fetus.
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Bunting KV, O'Connor K, Steeds RP, Kotecha D. Cardiac Imaging to Assess Left Ventricular Systolic Function in Atrial Fibrillation. Am J Cardiol 2021; 139:40-49. [PMID: 33065079 DOI: 10.1016/j.amjcard.2020.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
Abstract
The validity and reproducibility of systolic function assessment in patients with atrial fibrillation (AF) using cardiac magnetic resonance, echocardiography, nuclear imaging and computed tomography is unknown. A prospectively-registered systematic review was performed, including 24 published studies with patients in AF at the time of imaging and reporting validity or reproducibility data on left ventricular systolic parameters (PROSPERO: CRD42018091674). Data extraction and risk of bias were performed by 2 investigators independently and synthesized qualitatively. In 3 cardiac magnetic resonance studies (40 AF patients), left ventricular ejection fraction and stroke volume measurements correlated highly with catheter angiography (r ≥0.85), and intra- and/or interobserver variability were low. From 3 nuclear studies (171 AF patients), there were no external validation assessments but intra and/or interobserver and intersession variability were low. In 18 echocardiography studies (2,566 AF patients), 2 studies showed high external validity of global longitudinal strain and tissue Doppler s' with angiography-derived dP/dt (r ≥0.88). Global longitudinal strain and myocardial performance index were both associated with adverse cardiovascular events. Reproducibility of echocardiography was better when selecting an index-beat (where 2 preceding R-to-R intervals are similar) compared to averaging of consecutive beats. There were no studies relating to computed tomography. Most studies were small and biased by selection of patients with good quality images, limiting clinical extrapolation of results. The validity of systolic function measurements in patients with AF remains unclear due to the paucity of good-quality data.
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Affiliation(s)
- Karina V Bunting
- University of Birmingham, Institute of Cardiovascular Sciences, Medical School, Birmingham, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - Kieran O'Connor
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Richard P Steeds
- University of Birmingham, Institute of Cardiovascular Sciences, Medical School, Birmingham, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Dipak Kotecha
- University of Birmingham, Institute of Cardiovascular Sciences, Medical School, Birmingham, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Kotecha D, Mohamed M, Shantsila E, Popescu BA, Steeds RP. Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review. Europace 2018; 19:1427-1438. [PMID: 28387802 PMCID: PMC5834126 DOI: 10.1093/europace/eux027] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/10/2017] [Indexed: 02/06/2023] Open
Abstract
Aims Echocardiography is vital in the routine assessment and management of atrial fibrillation (AF). We performed a systematic review of the validity and reproducibility of echocardiographic left ventricular systolic and diastolic function in AF, and optimal acquisition methods. Methods and results Online databases were searched for studies in patients with AF at the time of echocardiography (1960 to August 2015), prospectively registered with PROSPERO (CRD42015025297). The systematic review included 32 studies from 3 066 search results (1 968 patients with AF). Average age was 67 years, 33% were women, mean LVEF 53% (±10%), and average E/e’ 11.7 (±2.7). Data on the validity and reproducibility of systolic indices were extremely limited. In contrast, diastolic parameters demonstrated correlation with invasive filling pressure and adequate reproducibility: E/e’ (n = 444) r = 0.47 to 0.79; IVRT (n = 177) r = –0.70 to –0.95; E/Vp` (n = 55) r = 0.63 and 0.65; pulmonary vein diastolic flow (n = 67) r = –0.80 and –0.91. Elevated E/e’ (>15) was associated with functional capacity, quality of life, and impaired prognosis. For optimal acquisition in AF patients, cardiac cycles with controlled heart rate (<100 beats/min) and similar preceding and pre-preceding RR intervals are required. Cardiac cycle length and equivalence were more important than the number of beats averaged. Conclusion With careful selection of appropriate cardiac cycles, echocardiography is a valid tool to identify diastolic dysfunction in AF, and E/e’ is an independent marker of clinical status and adverse prognosis. However, data on systolic function was extremely limited and requires further prospective study and assessment of variability in clinical practice.
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Affiliation(s)
- Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.,Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.,Department of Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Mohamed Mohamed
- Department of Cardiology, East Kent Hospitals University NHS Trust, Ashford, UK
| | - Eduard Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, and Institute of Cardiovascular Diseases 'Prof. C. C. Iliescu' Bucharest, Romania
| | - Richard P Steeds
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Ferrara F, Gargani L, Ostenfeld E, D'Alto M, Kasprzak J, Voilliot D, Selton-Suty C, Vriz O, Marra AM, Argiento P, Stanziola AA, Cittadini A, D'Andrea A, Bossone E. Imaging the right heart pulmonary circulation unit: Insights from advanced ultrasound techniques. Echocardiography 2017; 34:1216-1231. [DOI: 10.1111/echo.13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Francesco Ferrara
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R.; Pisa Italy
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund; Clinical Physiology and Skane University Hospital; Lund University; Lund Sweden
| | - Michele D'Alto
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Jaroslaw Kasprzak
- Department of Cardiology; Bieganski Hospital; Medical University of Lodz; Lodz Poland
| | - Damien Voilliot
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Christine Selton-Suty
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Olga Vriz
- Cardiology and Emergency Department; Hospital of San Daniele del Friuli; Udine Italy
| | | | - Paola Argiento
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Anna A. Stanziola
- Department of Respiratory Diseases; Monaldi Hospital; University “Federico II,”; Naples Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences; University Federico II of Naples; Naples Italy
| | | | - Eduardo Bossone
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
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Quantification of Right Ventricular Volume and Function Using Single-Beat Three-Dimensional Echocardiography: A Validation Study with Cardiac Magnetic Resonance. J Am Soc Echocardiogr 2016; 29:392-401. [DOI: 10.1016/j.echo.2016.01.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Indexed: 11/22/2022]
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Zhu M, Ashraf M, Zhang Z, Streiff C, Shimada E, Kimura S, Schaller T, Song X, Sahn DJ. Real Time Three-Dimensional Echocardiographic Evaluations of Fetal Left Ventricular Stroke Volume, Mass, and Myocardial Strain: In Vitro and In Vivo Experimental Study. Echocardiography 2015; 32:1697-706. [PMID: 25865121 DOI: 10.1111/echo.12939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Left ventricular stroke volume, mass, and myocardial strain are valuable indicators of fetal heart function. This study investigated the feasibility of nongated real time three-dimensional echocardiography (RT3DE) to determine fetal stroke volume (SV), left ventricular mass (LVM), and myocardial strain under different conditions. METHODS To evaluate fetal hearts, fetal-sized rabbit hearts were used in this study. The in vitro portion of this study was carried out using a balloon inserted into the LV of eight fresh rabbit hearts and driven by a calibrated pulsatile pump. RT3DE volumes were obtained at various pump-set SVs. The in vivo experiments in this study were performed on open-chest rabbits. RT3DE volumes were acquired at the following conditions: baseline, simulated hypervolemia, inferior vena cava (IVC) ligation, and ascending aorta (AAO) ligation. Displacement values and sonomicrometry data were used as references for RT3DE-derived SV, LVM, longitudinal strain (LS), and circumferential strain (CS). RESULTS Excellent correlations between RT3DE-derived values and reference values were demonstrated and accompanied by high coefficients of determination (R(2) ) for both in vitro and in vivo studies for SV, LVM, LS, and CS (in vitro: SV: R(2) = 0.98; LVM: R(2) = 0.97; LS: R(2) = 0.87, CS: R(2) = 0.80; in vivo: SV: R(2) = 0.92; LVM: R(2) = 0.98; LS: in vivo: R(2) = 0.84; CS: in vivo: R(2) = 0.76; all P < 0.05). CONCLUSIONS RT3DE is capable of quantifying the SV, LVM, and myocardial strain of fetal-sized hearts under different conditions. This nongated RT3DE may aid the evaluation of fetal cardiac function, providing a superior understanding of the progress of fetal heart disorders.
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Affiliation(s)
- Meihua Zhu
- Oregon Health & Science University, Portland, Oregon
| | | | - Zhijun Zhang
- Oregon Health & Science University, Portland, Oregon
| | - Cole Streiff
- Oregon Health & Science University, Portland, Oregon
| | - Eriko Shimada
- Oregon Health & Science University, Portland, Oregon
| | - Sumito Kimura
- Oregon Health & Science University, Portland, Oregon
| | | | - Xubo Song
- Oregon Health & Science University, Portland, Oregon
| | - David J Sahn
- Oregon Health & Science University, Portland, Oregon
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Ostenfeld E, Flachskampf FA. Assessment of right ventricular volumes and ejection fraction by echocardiography: from geometric approximations to realistic shapes. Echo Res Pract 2015; 2:R1-R11. [PMID: 26693327 PMCID: PMC4676454 DOI: 10.1530/erp-14-0077] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/07/2015] [Indexed: 11/08/2022] Open
Abstract
Right ventricular volumes and ejection fraction are challenging to assess by echocardiography, but are well established as functional and prognostic parameters. Three-dimensional (3D) echocardiography has become widespread and relatively easy to use, making calculation of these parameters feasible in the large majority of patients. We review past attempts to estimate right ventricular volumes, current strengths and weaknesses of 3D echocardiography for this task, and compare with corresponding data from magnetic resonance imaging.
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Affiliation(s)
- Ellen Ostenfeld
- Department of Clinical Physiology, Skånes Universitetssjukhus, Lund University , 22185, Lund , Sweden
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Bax JJ, Marsan NA, Delgado V. Non-invasive imaging in atrial fibrillation: focus on prognosis and catheter ablation. Heart 2014; 101:94-100. [DOI: 10.1136/heartjnl-2013-305150] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Zheng XZ, Yang B, Wu J. Feasibility of a new image processing (4D Auto LVQ) to assessing right ventricular function in patients with chronic obstructive pulmonary disease. COPD 2013; 11:333-8. [PMID: 24102493 DOI: 10.3109/15412555.2013.836172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new single-beat three-dimensional (3D) real time echocardiographic semi-automatic images processing (4D Auto LVQ) allows accurate assessment of left ventricular function, but whether it is suitable for the evaluation of right ventricular function remains unknown. To evaluate the feasibility of this procedure for assessing right ventricular volumes and function, right ventricular end-diastolic volumes (RVEDV), end-systolic volumes (RVESV) and ejection fraction (RVEF), stroke volumes (SV) and cardiac output (CO) were computed in 49 patients with chronic obstructive pulmonary disease (COPD) using 4D Auto LVQ. The myocardial performance index (MPI) was obtained by Doppler tissue imaging. The RV function parameters were compared with MPI by linear correlation analysis. A comparison of the performance of these RV function parameters in discrimination between MPI at a value of >0.45 or not was done. Compared with normal subjects, patients with COPD had significantly greater RVEDV, RVESV, MPI and significantly lower RVEF. Significant correlations were found between RVEF and MPI (r = -0.67, p < 0.001). The areas under the receiver operating characteristic curve for RVEF in discrimination between MPI at a value of >0.45 or not were 0.72, while they were 0.55 for SV and 0.57 for CO, respectively. The overall sensitivity, specificity and accuracy for RVEF analysis in predicting a >0.45 MPI in patients with COPD was 78.57%, 66.67% and 73.46%, respectively. These data suggest that 4D Auto LVQ is a feasible method for right ventricular volumes and function quantification in patients with COPD. Further studies are needed to improve the accuracy of the measurements.
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Affiliation(s)
- Xiao-Zhi Zheng
- 1Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine , Nanjing City, Jiangsu Province , P.R.China
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10
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Index-Beat Assessment of Left Ventricular Systolic and Diastolic Function during Atrial Fibrillation Using Myocardial Strain and Strain Rate. J Am Soc Echocardiogr 2012; 25:953-9. [DOI: 10.1016/j.echo.2012.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Indexed: 11/21/2022]
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11
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Greupner J, Zimmermann E, Grohmann A, Dübel HP, Althoff TF, Althoff T, Borges AC, Rutsch W, Schlattmann P, Hamm B, Dewey M. Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol 2012; 59:1897-907. [PMID: 22595410 DOI: 10.1016/j.jacc.2012.01.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 12/27/2011] [Accepted: 01/17/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI). BACKGROUND Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients. METHODS A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed. RESULTS For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: ±14.2%) than for CVG (±20.2%) and 3D Echo (±21.2%). Only CVG (59.5 ± 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 ± 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58). CONCLUSIONS 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function.
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Ostenfeld E, Carlsson M, Shahgaldi K, Roijer A, Holm J. Manual correction of semi-automatic three-dimensional echocardiography is needed for right ventricular assessment in adults; validation with cardiac magnetic resonance. Cardiovasc Ultrasound 2012; 10:1. [PMID: 22226082 PMCID: PMC3398276 DOI: 10.1186/1476-7120-10-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional echocardiography (3DE) and semi-automatic right ventricular delineation has been proposed as an appropriate method for right ventricle (RV) evaluation. We aimed to examine how manual correction of semi-automatic delineation influences the accuracy of 3DE for RV volumes and function in a clinical adult setting using cardiac magnetic resonance (CMR) as the reference method. We also examined the feasibility of RV visualization with 3DE. METHODS 62 non-selected patients were examined with 3DE (Sonos 7500 and iE33) and with CMR (1.5T). Endocardial RV contours of 3DE-images were semi-automatically assessed and manually corrected in all patients. End-diastolic (EDV), end-systolic (ESV) volumes, stroke volume (SV) and ejection fraction (EF) were computed. RESULTS 53 patients (85%) had 3DE-images feasible for examination. Correlation coefficients and Bland Altman biases between 3DE with manual correction and CMR were r = 0.78, -22 ± 27 mL for EDV, r = 0.83, -7 ± 16 mL for ESV, r = 0.60, -12 ± 18 mL for SV and r = 0.60, -2 ± 8% for EF (p < 0.001 for all r-values). Without manual correction r-values were 0.77, 0.77, 0.70 and 0.49 for EDV, ESV, SV and EF, respectively (p < 0.001 for all r-values) and biases were larger for EDV, SV and EF (-32 ± 26 mL, -21 ± 15 mL and - 6 ± 9%, p ≤ 0.01 for all) compared to manual correction. CONCLUSION Manual correction of the 3DE semi-automatic RV delineation decreases the bias and is needed for acceptable clinical accuracy. 3DE is highly feasible for visualizing the RV in an adult clinical setting.
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Affiliation(s)
- Ellen Ostenfeld
- Department of Cardiology, Malmö, Skåne University Hospital, Sweden.
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Lilli A, Baratto MT, Del Meglio J, Chioccioli M, Magnacca M, Svetlich C, Ghidini Ottonelli A, Poddighe R, Comella A, Casolo G. Three-dimensional simultaneous strain-volume analysis describes left ventricular remodelling and its progression: a pilot study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:520-7. [PMID: 21676962 PMCID: PMC3135213 DOI: 10.1093/ejechocard/jer073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Three-dimensional (3D)-echocardiography speckle imaging allows the evaluation of frame-by-frame strain and volume changes simultaneously. The aim of the present investigation was to describe the strain-volume combined assessment in different patterns of cardiac remodelling. METHODS AND RESULTS Fifty patients received a 3D acquisition. Patients were classified as follows: healthy subjects (CNT), previous AMI, and normal ejection fraction (EF; group A); ischaemic cardiomyopathy with reduced EF (group B); hypertrophic/infiltrative cardiomyopathy (group C). Values of 3D strain were plotted vs. volume for each frame to build a strain-volume curve for each case. Peak of radial, longitudinal, and circumferential systolic strain (Rεp, Lεp, and Cεp, respectively), slopes of the curves (RεSl, LεSl, CεSl), and strain to end-diastolic volume (EDV) ratio (Rε/V, Lε/V, Cε/V) were computed for the analysis. Strain-volume curves of the CNT group were steep and clustered, whereas, due to progressive dilatation and reduction of strains, progressive flattening could be demonstrated in groups A and B. Quantitative data supported visual assessment with progressive lower slopes (P< 0.05 for RεSl, CεSl, P= 0.06 for LεSl) and significantly lower ratios (P< 0.01 for Rε/V, Lε/V, and Cε/V). Group C showed an opposite behaviour with slopes and ratios close to those of normal subjects. Correlation coefficients between EDV and slopes of the curves were significant for all the directions of strain (CεSl: r = 0.891; RєSl: r = 0.704; LєSl: r = 0.833; P< 0.0001 for all). CONCLUSION We measured left ventricular volumes and strain by 3D-echo and obtained strain-volume curve to evaluate their behaviour in remodelling. A distinctive and progressive pattern consistent with pathophysiology was observed. The analysis here shown could represent a new non-invasive method to assess myocardial mechanics and its relationship with volumes.
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Affiliation(s)
- Alessio Lilli
- UO Cardiology, Versilia Hospital, Via Aurelia 335, Lido Di Camaiore, Italy.
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van der Heide JA, Kleijn SA, Aly MFA, Slikkerveer J, Kamp O. Three-dimensional echocardiography for left ventricular quantification: fundamental validation and clinical applications. Neth Heart J 2011; 19:423-31. [PMID: 21584798 PMCID: PMC3189315 DOI: 10.1007/s12471-011-0160-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
One of the earliest applications of clinical echocardiography is evaluation of left ventricular (LV) function and size. Accurate, reproducible and quantitative evaluation of LV function and size is vital for diagnosis, treatment and prediction of prognosis of heart disease. Early three-dimensional (3D) echocardiographic techniques showed better reproducibility than two-dimensional (2D) echocardiography and narrower limits of agreement for assessment of LV function and size in comparison to reference methods, mostly cardiac magnetic resonance (CMR) imaging, but acquisition methods were cumbersome and a lack of user-friendly analysis software initially precluded widespread use. Through the advent of matrix transducers enabling real-time three-dimensional echocardiography (3DE) and improvements in analysis software featuring semi-automated volumetric analysis, 3D echocardiography evolved into a simple and fast imaging modality for everyday clinical use. 3DE provides the possibility to evaluate the entire LV in three spatial dimensions during the complete cardiac cycle, offering a more accurate and complete quantitative evaluation the LV. Improved efficiency in acquisition and analysis may provide clinicians with important diagnostic information within minutes. The current article reviews the methodology and application of 3DE for quantitative evaluation of the LV, provides the scientific evidence for its current clinical use, and discusses its current limitations and potential future directions.
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Affiliation(s)
- J. A. van der Heide
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - S. A. Kleijn
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
| | - M. F. A. Aly
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - J. Slikkerveer
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
| | - O. Kamp
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
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15
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How should we measure global and regional left ventricular systolic function? J Echocardiogr 2011; 9:41-50. [PMID: 27276879 DOI: 10.1007/s12574-011-0085-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
The assessment of left ventricular (LV) systolic function is frequently the most important task during the echocardiography examination. LV ejection fraction (EF) is the most commonly used measure to assess LV systolic function. EF is well established, with strong prognostic and therapeutic implications, but, nevertheless, it may not always be satisfactory in all patients. Other measures of myocardial contractility can provide valuable additive information in some patients. This is particularly true in patients with suspected heart failure but normal EF. The measurement of longitudinal function using M-mode and/or deformation analysis from tissue Doppler data or speckle tracking algorithms can be useful in this respect. Regional LV dysfunction can be difficult to detect using visual semi-quantitative assessment of regional wall motion. Contrast echocardiography can be most helpful in delineating the LV endocardial border and, thus, increasing sensitivity for detecting wall motion abnormalities. Deformation analysis can also be helpful for detecting subtle wall motion abnormalities, but these methods should be used with caution due to measurement variability and image quality dependence.
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