Abstract
BackgroundExercise stress echocardiography is clinically used to assess cardiovascular diseases. For accurate cardiac evaluation, a stable field-of-view is required. However, transducer orientation and position are difficult to preserve. Hands-free acquisitions might provide more consistent and reproducible results. In this study, the field-of-view stability and variability of hands-free acquisitions are objectively quantified in a comparison with manually obtained images, based on image structural and feature similarities. In addition, the feasibility and consistency of hands-free strain imaging is assessed.MethodsIn twelve healthy males, apical and parasternal images were acquired hands-free, using a fixation device, and manually, during semi-supine exercise sessions. In the final ten seconds of every exercise period, the image structural similarity and cardiac feature consistency were computed using a steerable pyramid employing complex, oriented wavelets. An algorithm discarding images displaying lung artifacts was created. Hands-free strain consistency was analyzed.ResultsHands-free acquisitions were possible in 9 of the 12 subjects, whereas manually 10 out of 12 could be imaged. The image structural similarity was significantly improved in the hands-free apical window acquisitions (0.91 versus 0.82), and at least equally good in the parasternal window (0.90 versus 0.82). The change in curvature and orientation of the interventricular septum also appeared to be lower in the hands-free acquisitions. The variability in field-of-view was similar in both acquisitions. Longitudinal, septal strain was shown to be at least as consistent when obtained hands-free compared to manual acquisitions.ConclusionsThe field-of-view was shown to be more or equally stable and consistent in the hands-free data in comparison to manually obtained images. The variability was similar, thus respiration- and exercise-induced motions were comparable for manual and hands-free acquisitions. Additionally, the feasibility of hands-free strain has been demonstrated. Furthermore, the results suggest the hands-free measurements to be more reproducible, though further analysis is required.
Highlights
Exercise stress echocardiography is clinically used to assess cardiovascular diseases
Exercise stress echocardiography is preferred over pharmacological stress, since exercise capacity is an important risk indicator and the target heart rate is less commonly achieved with pharmacological stress, which compromises its sensitivity [8, 9]
The aim of this paper is to give an objectively quantified demonstration of the field of view (FOV) stability of hands-free acquisitions, which are acquired with a fixated transducer, and compare the FOV stability and variability to acquisitions obtained manually by a clinically trained cardiac sonographer
Summary
Exercise stress echocardiography is clinically used to assess cardiovascular diseases. Stress echocardiography is employed in the clinic as a risk classifier on cardiovascular events in patients with suspected cardiac impairment This diagnostic method provides insight in diastolic and systolic dysfunction during daily life activities, whereas unstressed measurements might underestimate the severity of anomalies. Exercise stress echocardiography is preferred over pharmacological stress, since exercise capacity is an important risk indicator and the target heart rate is less commonly achieved with pharmacological stress, which compromises its sensitivity [8, 9] These tests are performed in an upright or supine position with an increasing exercise intensity until the target heart rate (85% of age-predicted maximum) is reached [10]. Upright exercise better resembles daily activities, is a better reflection of real-life exercise hemodynamics, and preload is decreased to a greater extend
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