Assessment Of Left Ventricular Wall Motion Research Articles

Clinical value of quantitative measurements derived from GATED SPECT: motion and thickening, volumes and related LVEF.

Radionuclide myocardial perfusion imaging using ECG-gated acquisition with single photon emission computed tomography (gated SPECT) is the current state of the art imaging modality for symptomatic patients with known or at least indeterminate likelihood of coronary artery disease. Gated SPECT provides a wide variety of additional information about left ventricular (LV) function measurements, for example LV volumes, ejection fraction (LVEF) and regional wall motion abnormalities. This contributes to a higher diagnostic accuracy, additional prognostic information and predicting benefit from revascularization in these patients. Gated SPECT is an easily reproducible and accurate tool, which provides additional information to myocardial perfusion, regarding functional LV data. Assessment of LV wall motion, volumes and LVEF increases diagnostic accuracy and has prognostic and predictive value for the individual patient.

Clinical Application of Strain Imaging

Left ventricular (LV) dysfunction increases the risk for serious post-operative complications. Accurate assessment of LV wall motion is necessary to guide anesthetic management; however, traditional measures have a high degree of inter- and intra-observer variability. Myocardial deformation as measured by strain and strain rates is improving the diagnostic and prognostic utility of echocardiography to determine LV function in patients with cardiovascular disease. Strain can be measured using tissue Doppler and speckle tracking imaging from two-dimensional or three-dimensional echocardiography using various online and offline software packages. Tissue Doppler strain analysis provides excellent temporal resolution but is limited by the imaging angle of insonation. Speckle tracking strain imaging is angle independent and now the more commonly used modality. Strain has been demonstrated to guide therapy, monitor disease progression in various pathologic states, and is emerging as a strong predictor of clinical outcomes.

Evaluation of graft patency after coronary artery bypass grafting by using stress echocardiography combined with strain imaging

Background: Vasodilator stress echocardiography is a non-invasive tool which allows a detailed evaluation of coronary flow reserve integrated with myocardial wall motion analysis. In the present study we aimed to evaluate the value of velocity vector imaging (VVI) –based strain imaging, combined with dipyridamole stress echocardiography for assessment of left internal mammarian artery (LIMA) graft patency in patients who underwent robotic-assisted coronary artery bypass graft (CABG) surgery. Methods: We studied 40 patients (age 59.25±9.61 years, 58% male) who had robotic-assisted CABG surgery for LIMA-left anterior descending (LAD) artery and scheduled for coronary angiography. VVI-based strain echocardiography combined with dipyridamole stress echocardiography was performed. Left ventricular (LV) myocardial motion was evaluated using global strain and strain rate measurements. Additionally, Doppler evaluation of flow reserve of each LIMA graft were assessed. Results: Echocardiographic findings were compared with angiographic data. Among 40 patients only 7 had graft stenosis, based on angiography. We observed fair agreement between VVI combined stress echocardiography results and identification of 50%-100% LIMA stenosis. Impairment in LV global strain and strain rate values at peak dose dipyridamole predicted LIMA graft patency (p=0.02 for strain and p=0.0001 for strain rate). The average coronary flow reserve (CFR) value of all the LIMA grafts was 1.28±0.55. The agreement between CFR value and graft patency did not reach statistical significance (p=0.307). Conclusions: An integrated assessment of LV wall motion and flow reserve of LIMA graft in patients who underwent robotic-assisted CABG surgery is an accurate approach for identifying graft stenosis. This combined technique provides a useful tool for the non-invasive determination of LIMA graft patency, after CABG operation.

Cardiovascular magnetic resonance myocardial feature tracking predicts severity of wall motion abnormalities following acute coronary syndromes

Background Left ventricular wall motion assessment following acute myocardial infarction (AMI) allows prediction of functional recovery. Current methods are based upon visual assessment, with inherent operator variability. CMR myocardial feature tracking (CMR-FT) is a recently introduced technique for tissue voxel motion tracking on standard steady-state free precession (SSFP) images to derive circumferential and radial myocardial mechanics. We sought to determine whether CMR-FT could be used as a quantitative measure of wall motion assessment and predict recovery in function following AMI. Methods Patients presenting with non-ST elevation myocardial infarction (NSTEMI) were studied using a 3 Tesla Phillips Achieva system with Multi-transmit ® technology and a 32-channel receiver coil, immediately prior to, and 3-months following, percutaneous coronary revascularization (PCI). Cine images were acquired using a SSFP cine technique, with analysis performed on the left-ventricular (LV) short-axis stack, covering the LV from apex to base. The acquisition pulse sequence provided a typical spatial resolution of 1.8 x 1.8 x 8 mm with a 2mm inter-slice gap and a temporal resolution of 50 frames per second. A 5-point wall motion scoring system was used to determine regional wall motion abnormalities (RWMA), with derivation of an indexed wall motion score (WMSI) specific to the region of infarction, according to the AHA 16-segment model. Myocardial strain parameters were derived following automated endo- and epi-cardial wall motion tracking of the SSFP cine short axis stack using dedicated software (Tomtec™, Germany). Pre-PCI LV short axis circumferential (Ecc) and radial (Err) peak strains were related to WMSI using a Pearson correlation analysis. Visual and quantitative analyses were performed by two blinded reviewers.

Automated Interpretation of Regional Left Ventricular Wall Motion from Cardiac Magnetic Resonance Images

Magnetic resonance (MR) diagnosis of regional left ventricular (LV) dysfunction relies on visual interpretation of cine images that suffers from wide inter-observer variability, especially when performed by readers not specifically trained in the assessment of LV wall motion. Quantitative analysis tools, though widely available, are rarely used because they provide large amounts of detailed information, the interpretation of which requires additional time-consuming processing. We tested the feasibility of fast automated interpretation of regional LV function using computer analysis of this wall motion information. Dynamic, ECG-gated, steady-state free precession short-axis images were obtained in 6-10 slices in 28 subjects (10 normal volunteers; 18 patients). Images were reviewed by an expert cardiologist who provided "gold standard" grades (normal, abnormal) for regional wall motion and, independently, by four radiologists. Same images were then analyzed using custom software. Regional fractional area changes computed in normal volunteers were used to obtain the optimal segment- and slice-specific threshold values for automated classification of regional wall motion for each patient. The levels of agreement with the "gold standard" grades were compared between the radiologists and the automated interpretation. While the visual interpretation required 2-5 minute per patient, the automated interpretation required < 1 sec, after endocardial border detection was complete. The automated interpretation resulted in higher sensitivity, specificity, and accuracy (84%, 77%, 79%, respectively) than the radiologists' grades (80%, 76%, 77%, respectively) and eliminated the high interobserver variability. Once the endocardial boundaries are defined, computer analysis of the regional wall motion information allows accurate, fully automated, immediate, objective and experience-independent interpretation of regional LV function.

Left ventricular wall motion during diastolic filling in endurance-trained athletes.

The purpose of this study was to assess left ventricular (LV) wall motion in highly endurance-trained athletes to evaluate LV diastolic function in physiologically hypertrophied hearts. Diastolic filling dynamics have previously been examined in endurance-trained athletes by measuring pulsed-wave mitral inflow velocities during the early and atrial filling phase, indicating an unimpaired LV function. Assessment of LV wall motion may give additional information about the LV diastolic function in endurance-trained athletes. Left ventricular mass (LVM) and volume (LVV) were determined by M-mode echocardiography. Peak LV wall motion in the region of the basal septum close to the mitral anulus were measured during the early rapid and atrial filling phase by tissue Doppler in 30 endurance-trained athletes (T) and 16 sedentary control subjects (C) presumed to be healthy. Myocardial LVM and LVV in T (LVM 159.4 +/- 18.0 g.m(-2), LVV 100.4 +/- 13.0 mL.m(-2)) were significantly higher than in C (LVM 105.7 +/- 12.0.m(-2), LVV 70.1 +/- 11.9 mL.m(-2)), and heart rate (HR) was significantly lower (HR C: 69.6 +/- 11.0 bpm, T 50.9 +/- 8.7 bpm),which is consistent with endurance training (P < 0.01 for both). Peak LV wall motion during the early rapid filling phase did not differ significantly between the groups (T: 10.69 +/- 1.46 cm.(s-)1; C: 10.61 +/- 1.52 cm.(s-)1). Peak atrial wall motion was significantly lower in T (4.53 +/- 0.84 cm.s-1) versus C (5.74 +/- 0.75 cm.s(-1)), and the ratio of peak early diastolic to atrial wall motion was consequently higher in athletes (P < 0.01 for both). Regional wall motion at the basal septum near the mitral anulus during the early rapid filling phase is not altered by an increase in LVM or LVV when associated with endurance training.

Correlation of gated SPECT imaging with two-dimensional echocardiography in regional and global left ventricular wall motion assessment

Correlation of gated SPECT imaging with two-dimensional echocardiography in regional and global left ventricular wall motion assessment

Left ventricular wall motion assessment: Comparison between gated spect ventriculography and echocardiography

Left ventricular wall motion assessment: Comparison between gated spect ventriculography and echocardiography

Quantitation of left ventricular volumes and ejection fraction by biplane transesonhageal echocardiography

Transthoracic echocardiography has been reported to be a useful noninvasive method for quantitative assessment of left ventricular (LV) volumes and ejection fraction. 1–6 Transesophageal echocardiography (TEE) has been used to provide an assessment of LV wall motion and thickness. 7–10 TEE would be expected to be useful for quantitative assessment of volumes and ejection fraction, especially with use of the biplane probe, with nearly orthogonal cross sections. 11, 12 The accuracy of TEE may be limited by the inability to image the true apex with foreshortened cross sections. This study assesses the accuracy of biplane TEE for estimation of LV volumes and ejection fraction in comparison with that of transthomcic echocardiography.