Abstract
Assessment of intraventricular pressure gradients (IVPG) using color Doppler M-mode echocardiography has gained increasing interest in the evaluation of cardiac function. However, standardized analysis tools for IVPG quantification are missing. We aimed to evaluate the feasibility, the test-retest observer reproducibility, and the inter-system variability of a semi-automated IVPG quantification algorithm. The study included forty healthy volunteers (50% were men). All volunteers were examined using two ultrasound systems, the Philips Epiq 7 and the General Electric Vivid 6. Left ventricular diastolic (DIVPG) and systolic (SIVPG) intraventricular pressure gradients were measured from the spatiotemporal distribution of intraventricular propagation flow velocities using color Doppler M-mode in standard apical views. There was good feasibility for both systolic and diastolic IVPG measurements (82.5% and 85%, respectively). Intra and inter-observer test-retest variability measured with the intraclass correlation coefficient were 0.98 and 0.93 for DIVPG respectively, and 0.95 and 0.89 for SIVPG respectively. The inter-system concordance was weak to moderate with Lin’s concordance correlation coefficient of 0.59 for DIVPG and 0.25 for SIVPG. In conclusion, it is feasible and reproducible to assess systolic and diastolic IVPG using color Doppler M-mode in healthy volunteers. However, the inter-system variability in IVPG analysis needs to be taken into account, especially when using displayed data.
Highlights
Assessment of intraventricular pressure gradients (IVPG) using color Doppler M-mode echocardiography has gained increasing interest in the evaluation of cardiac function
In the absence of recommendations for systolic and diastolic IVPG quantifications based on displayed Joint Photographic Experts Group (JPEG) data obtained from color Doppler velocity profiles, we showed that to prevent a significant underestimation of IVPGs (Figs. 3 and 6) the acquisitions should be made with a grayscale gain of 60% and a temporal displayed resolution of at least 285 Hz
Our findings showed similar concordance between raw and displayed velocity data for both systems, suggesting that the use of displayed velocity data might not be responsible for major inaccuracies in IVPG measurements
Summary
Assessment of intraventricular pressure gradients (IVPG) using color Doppler M-mode echocardiography has gained increasing interest in the evaluation of cardiac function. The same authors have demonstrated that the inability to augment DIVPGs in heart failure was strongly correlated with peak VO218 These echocardiographic studies have used the same approach based on the Bernoulli equation to estimate non-invasively the instantaneous local pressure gradient from the spatiotemporal distribution of blood velocities along the LV long axis. The present study aimed to assess the feasibility, the test-retest observer reproducibility, and the inter ultrasound system variability of systolic and diastolic IVPG measurements, using a semi-automated algorithm based on velocities extracted from color Doppler M-mode image file
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