Assessment Of Myocardial Function Research Articles

Comprehensive assessment of left ventricular myocardial function by two-dimensional speckle-tracking echocardiography

BackgroundLeft ventricular ejection fraction (LVEF) results from the combined action of longitudinal and circumferential contraction, radial thickening, and basal and apical rotation. The study of these parameters together may lead to an accurate assessment of the cardiac function.MethodsNinety healthy volunteers, categorized by gender and age (≤ 55 and > 55 years), were evaluated using two-dimensional speckle tracking echocardiography. Transversal views of the left ventricle (LV) were obtained to calculate circumferential strain and left ventricular twist, while three apical views were obtained to determine longitudinal strain (LS) and mitral annular plane systolic excursion (MAPSE). We established the integral myocardial function of the LV according to: 1. The Combined Deformation Parameter (CDP), which includes Deformation Product (DP) - Twist x LS (° x %) - and Deformation Index (DefI) -Twist / LS (° / %)-; and 2. the Torsion Index (TorI): Twist / MAPSE (° / cm).ResultsThe mean age of our patients was 50.3 ± 11.1 years. CDP did not vary with gender or age. The average DP was − 432 ± 172 ° x %, and the average DefI was − 0.96 ± 0.36 ° / %. DP provides information about myocardial function (normal, pseudonormal, depressed), and the DefI quotient indicates which component (s) is/are affected in cases of abnormality. TorI was higher in volunteers over 55 years (16.5 ± 15.2 vs 13.1 ± 5.0 °/cm, p = 0.003), but did not vary with gender.ConclusionsThe proposed parameters integrate values of twisting and longitudinal shortening. They allow a complete physiological assessment of cardiac systolic function, and could be used for the early detection and characterization of its alteration.

Rate of left ventricular pressure change by Doppler echocardiography in dogs with chronic mitral valve disease at different stages of congestive heart failure.

Although the major pathological feature of chronic mitral valve disease is mitral regurgitation, myocardial dysfunction has been suggested to be present in dogs with chronic mitral valve disease. However, accurate assessment of myocardial function remains challenging. Doppler-derived rate of left ventricular pressure change is a simple, less load-dependent method for evaluating myocardial function. We aimed to evaluate Doppler-derived rate of left ventricular pressure change for assessing myocardial function in different stages of dogs with chronic mitral valve disease. This analytical cross-sectional study recruited 55 client-owned dogs with chronic mitral valve disease prospectively. Based on physical examination, indirectly measured blood pressure, routine hematologic and biochemistry examinations, thoracic radiography, electrocardiography, and echocardiography, dogs were diagnosed as mitral valve disease and excluded for systemic diseases and other cardiac diseases. They were classified according to the International Small Animal Cardiac Health Council scales. Doppler-derived rates of left ventricular pressure rise and fall (dP/dt and -dP/dt) were analyzed by two investigators using continuous-wave Doppler imaging. Doppler-derived dP/dt was higher in dogs of class IIIa than in those of the other classes, whereas values of -dP/dt decreased significantly with the severity of congestive heart failure. The peak velocity of the early diastolic wave and -dP/dt were identified as independent predictors of congestive heart failure. Our findings suggested that Doppler-derived dP/dt and -dP/dt, used in combination with conventional echocardiographic variables, could allow a better understanding of myocardial dysfunction and a possibility for prediction of the risk of heart failure in dogs with chronic mitral valve disease.

Role of galectin-3 in subclinical myocardial impairment in psoriasis.

Psoriasis has been shown to increase cardiovascular risk, and a contributor to this might be enhanced myocardial fibrosis promoted by the disease-associated pro-inflammatory milieu. We sought to investigate the relationship of galectin-3 (Gal-3) - a recognized mediator of fibrosis with inflammatory activation and left ventricular (LV) systolic and diastolic function in patients with psoriasis. We enrolled 102 psoriatic patients (mean age: 52.5 ± 12.6 years). Sixty-five age- and sex-matched healthy subjects served as controls. Echocardiographic assessment of myocardial function included estimation of LV longitudinal systolic deformation (GLS) and diastolic indices: tissue e' velocity and E/e' ratio. Laboratory measurements encompassed blood Gal-3, creatinine, glucose, insulin, CRP and erythrocyte sedimentation rate (ESR). Patients with psoriasis were characterized by elevated Gal-3 (12.3 [9.3-13.4] vs. 6.3 [5.5-9.4] ng/mL in healthy controls, P < 0.001), ESR (17.0 [11.0-29.0] vs. 8.5 [6.0-13.0] mm, respectively, P < 0.001) and CRP (3.1 [1.7-10.6] vs. 1.9 [1.5-4.0] mg/L, respectively, P < 0.001), and reduced GLS (19.9 ± 3.7 vs. 22.0 ± 3.0%, respectively, P < 0.001). Progressive deterioration of GLS was demonstrated across Gal-3 tertiles. Significant associations between GLS and age (beta = -0.21, P < 0.04), Gal-3 (beta = -0.27, P < 0.01), CRP (beta = -0.22, P < 0.03), ESR (beta = -0.25, P < 0.01), waist circumference (beta = -0.22, P < 0.03) and waist-to-hip ratio (beta = -0.20, P < 0.05) were found. Stepwise multiple regression analysis revealed that the independent determinants of GLS in psoriatic patients were Gal-3 (beta = -0.24, P < 0.01) and ESR (beta = -0.21, P < 0.03). Regression-based mediation analysis demonstrated that the relationship between ESR and GLS was partially mediated by Gal-3. Subclinical left ventricular systolic dysfunction in psoriasis, as evidenced by reduced GLS, is linked with the inflammatory upregulation, and enhanced profibrotic activity (as reflected by elevated serum Gal-3) may be involved in this process. These putative mechanisms may be responsible for the observed higher incidence of heart failure in this disease condition and should be considered as a potential target for preventive and therapeutic measures.

The transverse four-chamber view for the assessment of atrial tissue deformation in the fetus.

AimsTo determine if atrial tissue deformation (peak strain, PS) and time to peak strain (TTPS) can be assessed in the fetus, with identification of best echocardiographic plane.Materials and methodsPulsed-wave tissue Doppler study of a longitudinal and a transverse four-chamber view (FCV) in each of 20 healthy fetuses. Determination of PS and TTPS in regions of interest (ROI), viz., lateral walls of the right and left atria (RA, LA); comparison of values depending on section plane, with results-based discussion of the physiology of fetal atrial deformation and of possible clinical uses.ResultsPS and TTPS could be determined on transverse FCV in 91% of subjects and in 61% on longitudinal FCV. Transverse PS and TTPS were significantly higher than longitudinal (p = 0.0001). Transverse PS was significantly higher in RA than in LA (26.9% vs. 17.3%, p = 0.034), and transverse TTPS was significantly shorter in RA than in LA (p = 0.034).ConclusionAtrial radial PS and TTPS determinations are possible in the fetus. The transverse FCV is best suited for these. The highest PS values and shortest TTPS values are found in ROI representing the RA. Our findings may contribute to detailed intrauterine assessment of atrial and ventricular myocardial function.

Effects of Spinal Anaesthesia on Left Ventricular Function: An Observational Study using Two-Dimensional Strain Echocardiography.

Hypotension frequently occurs during spinal anaesthesia (SA), especially in the elderly. This side effect could have a cardiac component per se (myocardial contractility impairment). Two-dimensional (2D) strain and strain rate imaging are new echocardiographic methods allowing an accurate assessment of myocardial function by quantifying myocardial deformation. Allowing quantification of minor myocardial dysfunction not detectable by standard echocardiography, strain imaging could bring new perspective on the cardiac effect of SA. Our objective was to evaluate the effects of SA on left ventricular function assessed by 2D strain echocardiography. In this prospective observational study, we enrolled 20 patients older than 60 years, who underwent elective lower-limb surgery under SA. Myocardial strain imaging were collected before and 20 minutes after SA (injection of 10 mg of isobaric bupivacaine with 5 μg of sufentanil). We observed an increase in global longitudinal reconnoitering (Δ-0.2±0.3% s-1; p<0.005), whereas left ventricular ejection fraction was not modified by SA. This slight increase in myocardial contractility could be an adaptive mechanism to compensate the preload decrease and limit the blood pressure drop.

Cardiac Positron Emission Tomography-Magnetic Resonance Imaging: Current Status and Future Directions.

Simultaneous acquisition positron emission tomography-magnetic resonance imaging (PET-MRI) has the ability to combine anatomic information derived from cardiac MRI with quantitative capabilities of cardiac PET and MRI and the promise of molecular imaging by specific PET tracers. This combination of cardiac PET and MRI delivers a robust and comprehensive clinical examination. It has the potential to assess various cardiovascular conditions, including assessment of myocardial ischemia, infarction, and function, as well as specific characterization of inflammatory and infiltrative heart diseases such as cardiac sarcoid and amyloid. It also offers fascinating possibilities in imaging other cardiovascular-related disease states, such as tumor imaging and vascular imaging. In this review, we begin with a general overview of the potentials of PET-MRI in cardiovascular imaging, followed by a discussion of the technical challenges unique to cardiovascular PET-MRI. We then discuss PET-MRI in various cardiovascular disease imaging applications. Potential limitations of PET-MRI and future directions are also considered.

Phenotypic Clustering of Left Ventricular Diastolic Function Parameters: Patterns and Prognostic Relevance

ObjectivesThis study sought to explore the natural clustering of echocardiographic variables used for assessing left ventricular (LV) diastolic dysfunction (DD) in order to isolate high-risk phenotypic patterns and assess their prognostic significance. BackgroundAssessment of LV DD is important in the management and prognosis of cardiovascular diseases. Data-driven approaches such as cluster analysis may be useful in segregating similar cases without the constraint of an a priori algorithm for risk stratification. MethodsThe study included a convenience sample of 866 consecutive patients referred for myocardial function assessment (age 65 ± 17 years; 55.3% women; ejection fraction 60 ± 9%) for whom echocardiographic parameters of DD assessment were obtained per conventional guideline recommendations. Unsupervised, hierarchical cluster analysis of these parameters was conducted using the Ward linkage method. Major adverse cardiovascular events, hospitalization, and mortality were compared between conventional and cluster-based classifications. ResultsClustering algorithms for screening the presence of DD in 559 of 866 patients identified 2 distinct groups and revealed modest agreement with conventional classification (kappa = 0.41, p < 0.001). Further cluster analysis in 387 patients with DD helped to classify the severity of DD into 2 groups, with good agreement with conventional classification (kappa = 0.619, p < 0.001). Survival analyses of patients assessed by both clustering algorithms for screening and grading DD showed improved prediction of event-free survival by clusters over conventional classification for all-cause mortality and cardiac mortality, even after accounting for a multivariable, balanced propensity score. ConclusionsAn unsupervised assessment of echocardiographic variables for assessing LV DD revealed unique patterns of grouping. These natural patterns of clustering may better identify patient groups who have similar risk, and their incorporation into clinical practice may help eliminate indeterminate results and improve clinical outcome prediction.

2D myocardial deformation imaging based on RF-based non-rigid image registration.

Myocardial deformation imaging is a well-established echocardiographic technique for the assessment of myocardial function. Although some solutions make use of speckle tracking of the reconstructed B-mode images, others apply block matching on the underlying radio-frequency (RF) data in order to increase sensitivity to small inter-frame motion and deformation. However, for both approaches, lateral motion estimation remains a challenge due to the relatively poor lateral resolution of the ultrasound image in combination with the lack of phase information in this direction. Hereto, non-rigid image registration (NRIR) of B-mode images has previously been proposed as an attractive solution. However, hereby, the advantages of RF-based tracking were lost. The aim of this study was therefore to develop an NRIR motion estimator adopted to RF data sets. The accuracy of this estimator was quantified using synthetic data and was contrasted against a state of the art block matching solution. The results show that RF-based NRIR outperforms BM in terms of tracking accuracy particularly, as hypothesized, in the lateral direction. Finally, this RF-based NRIR algorithm was applied clinically, illustrating its ability to estimate both in-plane velocity components in-vivo.

First Magnetic Resonance Managed by a Cardiology Department in the Spanish Public Healthcare System. Experience and Difficulties of an Innovative Model

Magnetic resonance (MR) is considered the gold standard in the assessment of myocardial morphology, function, perfusion, and viability. However, its main limitation is its scarce availability. In 2014, we installed the first MR scanner exclusively managed by a cardiology department within the publicly-funded Spanish healthcare system with the aim of improving patient-care, training and research in the department. In the time interval analyzed, July 2014 to May 2017, 3422 cardiac MR scans were performed (32minutes used per study; 96% with good quality; 75% with contrast media administration). The most prevalent clinical indications were cardiomyopathy (29%) and ischemic heart disease (12%). Twenty-five percent of studies were conducted in the context of research protocols. Follow-up studies predominated among outpatients, while pretherapeutic assessment was more common in hospitalized patients. The presumptive diagnosis was changed by cardiac MR scanning in up to 20% of patients investigated for ischemic heart disease. The installation and operative management of an MR scanner in our cardiology department has allowed us to integrate this technique into daily clinical practice, modify our clinical protocols, optimize access to this technology among cardiac patients, improve training, and conduct clinical research.

Normative Data for Left and Right Ventricular Systolic Strain in Healthy Caucasian Italian Children by Two-Dimensional Speckle-Tracking Echocardiography

There is an increasing interest in echocardiographic strain (ε) measurements for the assessment of ventricular myocardial function in children; however, pediatric nomograms remain limited. Our aim was to establish pediatric nomograms for the left ventricular (LV) and the right ventricular (RV) ε measured by two-dimensional speckle-tracking echocardiography (2D-STE) in a large cohort of healthy children prospectively enrolled. Echocardiographic measurements included STE LV longitudinal and circumferential and RV longitudinal global end-systolic ε. Age, weight, height, heart rate (HR), and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. Echocardiograms were performed by Philips-iE33 systems (Philips, Bothell, WA) and offline measurements on Philips-Q-Lab-9. In all, 721 subjects (age 31days to 17years; 48% female) were studied. Low coefficients of determination (R2) were noted among all of the ε parameters evaluated and adjusted for age, weight, height, BSA, and HR (i.e., R2 all≤0.10; range, 0.01-0.088). This hampered the possibility of performing z-scores with a sufficient reliability. Thus, we are limited to presenting data as mean values (±SD) stratified for age groups and divided by gender. LV longitudinal ε values decreased with age (P<.001), while no significant age-related variations were noted for RV longitudinal ε. A significant base-to-apex (lowest to highest) gradient in circumferential LV ε values was noted at all ages (P<.001). We report pediatric echocardiographic normative data for 2D-STE for the LV and RV ε by using vendor-specific software. Our results confirm previous observations, showing only little variations of strain parameters with age and gender.

Assessment of Myocardial Function and Injury by Echocardiography and Cardiac Biomarkers in African Children With Severe Plasmodium falciparum Malaria.

Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria. A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1. Mbale Regional Referral Hospital. Children 3 months to 12 years old with severe falciparum malaria. Usual care. We enrolled 104 children, median age 23.3 months, including 61 children with severe malarial anemia. Cardiac troponin I levels were elevated (> 0.1 ng/mL) in n equals to 50, (48%), and median brain natriuretic peptide was within normal range (69.1 pg/mL; interquartile range, 48.4-90.8). At T0, median Cardiac index was significantly higher in the severe malarial anemia versus nonsevere malarial anemia group (6.89 vs 5.28 L/min/m) (p = 0.001), which normalized in both groups at T1 (5.60 vs 5.13 L/min/m) (p = 0.452). Cardiac index negatively correlated with hemoglobin, r equals to -0.380 (p < 0.001). Four patients (3.8%) had evidence of depressed cardiac systolic function (ejection fraction < 45%). Overall, six children died, none developed pulmonary edema, biventricular failure, or required diuretic treatment. Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction.

Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability in Patients with Coronary Artery Disease

AbstractBackground: The principal goal of the assessment of myocardial viability is to identify patients whose symptoms, exercise capacity, and long-term prognosis may improve after revascularization. Contrast enhanced cardiac MRI has devel-oped as a promising imaging modality for the assessment of myocardial viability which provides direct imaging of necrotic tissue with high contrast and high spatial resolution. Aim of the work was to assess role of cardiac MRI as a non-invasive tool in the evaluation of myocardial viability in patients with coronary artery disease.Aim of Study: To assess the role of cardiac MRI as a non-invasive tool in the evaluation of myocardial viability in patients with coronary artery disease.Material and Methods: The study included 25 patients diagnosed as having Coronary Artery Disease (CAD), (age range, 28-68 years ±11.29). All selected patients were subjected to cardiac MRI examination using 1.5-T MR system for studying myocardial function and viability. Comparison was made between echocardiography and cardiac MRI regarding segmental wall motion using the 17-segment model of the American Heart Association for assessment of myocardial function. Delayed-enhancement MRI was performed to deter-mine myocardial viability and scarring while black blood T2W sequence with fat suppression was done to detect cases with acute infarction. Microvascular occlusion was diagnosed using early Gadolinium enhancement sequence.Results: Good agreement between cardiac MRI and echocardiography regarding segmental wall motion with p-value of 0.065. Sensitivity and specificity of cardiac MRI for detecting SWMA were 93.6%, and 44.4% respectively. Myo-cardial viability was evaluated by cardiac MRI with the use of end-diastolic wall thickness, imaging of early and late enhancement after contrast administration. Late gadolinium enhancement allowed assessing state of myocardium and visualizing myocardial scar with its quantification. Two segments showed 1-25% transmural extent of myocardial wall infarction, while 120 segments showed 71-100% extent and 261 segments showed no enhancing scar.Conclusion: Cardiac MR imaging is an effective and reliable method for the evaluation of myocardial function as compared to echocardiography. Also it is effective and reliable method for the evaluation of myocardial viability being able to assess both the infarct size and trans-murality and accord-ingly helps to predict functional recovery after revasculariza-tion.

Primera resonancia magnética gestionada por cardiología en la red sanitaria pública española: experiencia y dificultades de un modelo innovador

Magnetic resonance (MR) is considered the gold standard in the assessment of myocardial morphology, function, perfusion, and viability. However, its main limitation is its scarce availability. In 2014, we installed the first MR scanner exclusively managed by a cardiology department within the publicly-funded Spanish healthcare system with the aim of improving patient-care, training and research in the department. In the time interval analyzed, July 2014 to May 2017, 3422 cardiac MR scans were performed (32minutes used per study; 96% with good quality; 75% with contrast media administration). The most prevalent clinical indications were cardiomyopathy (29%) and ischemic heart disease (12%). Twenty-five percent of studies were conducted in the context of research protocols. Follow-up studies predominated among outpatients, while pretherapeutic assessment was more common in hospitalized patients. The presumptive diagnosis was changed by cardiac MR scanning in up to 20% of patients investigated for ischemic heart disease. The installation and operative management of an MR scanner in our cardiology department has allowed us to integrate this technique into daily clinical practice, modify our clinical protocols, optimize access to this technology among cardiac patients, improve training, and conduct clinical research.Full English text available from: www.revespcardiol.org/en

Assessment of left ventricular regional wall motion abnormalities using regional time-volume curves obtained by real time three-dimensional echocardiography.

BackgroundThree-dimensional echocardiography provides a volumetric measurement of global and regional left ventricular (LV) function. It avoids the subjectivity of 2D echocardiography in the assessment of regional wall motion abnormalities (RWMA).PurposeEvaluate the feasibility and practicality of 3D echocardiography in the evaluation of ischemic patients with abnormal regional LV contractility.MethodsThe study included 40 patients with ischemic heart disease and RWMA as well as 30 control subjects. They underwent routine clinical examination and conventional 2D echocardiographic assessment. Segments were categorized as; normal, hypokinetic; akinetic or dyskinetic. Three-dimensional echocardiographic images were acquired and later on analyzed offline. Global LV function was semi-automatically calculated by the machine using volumetric measurements. Regional LV function was calculated manually for the 17 LV segments by detecting the end-diastolic (EDD) and end-systolic (ESD) points on the specific segment volume curve and the regional ejection fraction (EF) was calculated by the following formula {(EDDx-ESDx)/EDDx}, where x represents the specific segment. Regional EF was compared between patients and control subjects.ResultsThe mean age was 55.0 ± 8.0 and 32.6 ± 8.5 years (P < 0.001) in patients and control groups, respectively. No statistically significant difference in EF between 2D and 3D images (47.3 ± 10.5 vs 48.0 ± 8.0, p = 0.6). There was a good correlation between the 2D-RWMA and 3D-regional EF, and this correlation was consistent in the whole 17 segments.ConclusionThree-dimensional echocardiography is an easy, non-invasive and objective tool to detect regional wall motion abnormalities in ischemic patients. It shows comparable results with conventional 2D images with the advantage of quantitative assessment of regional myocardial function.

Left Ventricle Functional Assessment by Three-Dimensional Echocardiography in Patients with Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus frequently presents subclinical myocardial involvement; this has an early onset and predicts mortality. The analysis of myocardial deformation (strain) by three-dimensional speckle tracking echocardiography could be useful in the assessment of myocardial function. Objective: The aim of this study was to assess left ventricular structure and systolic function through the analysis of threedimensional deformation. Methods: Thirty seven women with systemic lupus erythematosus (age 35±10 years) and no history of structural heart disease and 20 controls (34±8 years) were included in the study. Two-dimensional and three-dimensional echocardiography was performed according to the recommendations of the American Society of Echocardiography to acquire global longitudinal strain, radial strain, circumferential strain and strain area. Systemic lupus erythematosus activity was estimated with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI), considering a score ≥4 as active disease. Results: There were no differences in age, risk factors, blood pressure, and heart rate between both groups. From a structural point of view, both atria presented larger size in the systemic lupus erythematosus group. This group of patients presented lower global longitudinal strain (-19.7±2.7 vs. -21.1±2.5, p=0.009), global radial strain (50.7±8.7 vs. 56.5±5.6; p=0.02) and global strain area (-32.1±3.9 vs. -34.7±2.1, p=0.004). This decrease was even more marked in women with active systemic lupus erythematosus. Conclusions: All deformation parameters were reduced in patients with systemic lupus erythematosus, which could be due to incipient alterations of left ventricular systolic function.

Comparison of Unenhanced and Contrast-Enhanced Echocardiographic Assessment of Myocardial Function and Mechanics During Veno-Venous Extracorporeal Membrane Oxygenation

Background: Transthoracic echocardiography (TTE) plays a fundamental role in management of patients supported with extracorporeal membrane oxygenation (ECMO). Formal quantification of ventricular parameters and myocardial mechanics offer benefit over qualitative assessment. The aim of this research was to compare unenhanced (UE) with contrast-enhanced (CE) quantification of myocardial function and mechanics during ECMO in a validated ovine model.

Role of Tissue Doppler Tei Index in Evaluating Myocardial Performance after Coronary Revascularization

Background: Tei index expresses the overall systolic and diastolic myocardial function in a single number. The use of tissue Doppler instead of conventional pulsed wave Doppler enables us to measure Tei index in a single scan. It also has many advantages for the assessment of myocardial function with coronary revascularization in IHD patients. Methods: We included 47 chronic ischemic heart disease patients with LV dysfunction (EF<50%) who were subjected to coronary revascularization with either CABG or PCI. They were divided into 2 groups according to the improvement of EF after revascularization. Group I: Included 35 patients who had an increase ≥ 5% in LV EF at follow up. Group II: Included 12 patients who had an increase <5% increase in LV EF at follow up. Echocardiography including tissue Doppler Tei index (tdTei) was done twice; just before and at least 4 months after coronary revascularization. Results: Following revascularization; improvement of ejection fraction correlated well with tdTei improvement (r=0.67, p<0.001) and was associated with improvement of wall motion score index (p<0.001) and diastolic function parameters including E`/A` (p<0.05) and E/E` (p<0.001). Using ROC curve, we found that the tdTei index at cut-off point 72.9; can predict patients who are expected to have ejection fraction improvement from coronary revascularization with high sensitivity (83.3%) and specifity (80%). It also correlated well to TIMI score (p<0.05). Conclusion: Tissue Doppler Tei index is a promising technique allowing accurate quantitative description of the effect of ischemia on myocardium including both diastolic and systolic dysfunction in a single number. Baseline tdTei index can predict patients who are expected to have improvement of myocardial function (both diastolic and systolic) after coronary revascularization.

A Hybrid Active Contour Segmentation Method for Myocardial D-SPECT Images

The ischaemic heart disease has become one of the leading causes of mortality worldwide. Dynamic single-photon emission computed tomography (D-SPECT) is an advanced routine diagnostic tool commonly used to validate the myocardial function in patients suffering from various heart diseases. Accurate automatic localization and segmentation of myocardial regions is helpful in creating a 3-D myocardial model and assisting clinicians to perform assessments of myocardial function. Thus, image segmentation is a key technology in preclinical cardiac studies. Intensity inhomogeneity is one of the common challenges in image segmentation and is caused by image artifacts and instrument inaccuracy. In this paper, a novel region-based active contour model that can segment the myocardial D-SPECT image accurately is presented. First, a local region-based fitting image is defined based on the information related to the intensity. Second, a likelihood fitting image energy function is built in a local region around each point in a given vector-valued image. Next, the level set method is used to present a global energy function with respect to the neighborhood center. The proposed approach guarantees precision and computational efficiency by combining the region-scalable fitting energy model and local image fitting energy model, and it can solve the issue of high sensitivity to initialization for myocardial D-SPECT segmentation.

Segmental Myocardial Displacement and Tissue Velocity Analysis of the Right Ventricle in Hypoplastic Left Heart Syndrome Fetuses and Controls Using Color Tissue Doppler Imaging (C-TDI)

Abstract Introduction: The long-term outcome of patients with HLHS (hypoplastic left heart syndrome) is mainly determined by right ventricular function. Our study examines, whether there are differences in segmental right ventricular myocardial displacement and tissue velocities of fetuses with HLHS compared to healthy fetuses during gestation. Materials and methods: A prospective study was conducted including 20 fetuses with HLHS and 20 gestational age matched controls. c-TDI (colour tissue Doppler imaging) derived systolic and diastolic velocities as well as myocardial displacement were assessed in three different locations of the right ventricle (RV). A ROI (region of interest) was placed in the basal, middle and apical part of the myocardium. Possible changes of c-TDI indices in the course of pregnancy and between the three different segments were investigated in both groups. Results: HLHS fetuses showed significantly lower e' velocities measured in the basal and middle part of the RV compared to healthy controls (p &lt; 0.05). Basal displacement showed significantly lower values in HLHS fetuses compared to controls. In control fetuses but not in HLHS fetuses there was a significant increase of basal diastolic velocities and displacement in the course of pregnancy. According to myocardial velocities and displacement values there was a significant decrease from the base of the fetal heart to the apex pointed in both groups. Conclusions: An altered right ventricular myocardial function in HLHS fetuses within different myocardial segments could be demonstrated. An apicobasal gradient with higher velocity and displacement values in the basal part of RV myocardium could be found in both groups. The technique may be of value in the prenatal assessment of myocardial function, however its role as a monitoring tool and outcome predictor needs to be defined.

The role of echocardiography in Kawasaki disease.

Kawasaki disease (KD) is an acute, self-limited vasculitis affecting young children. It can result in coronary artery abnormalities in a significant proportion of patients, especially if the diagnosis is missed or treatment gets delayed. Echocardiography is the imaging modality of choice for detection of coronary artery abnormalities and assessment of myocardial function. It is also useful for characterization and risk stratification of patients with KD. Echocardiography should be performed at the time of diagnosis and then again at 1-2 weeks and 4-6 weeks after treatment, for uncomplicated cases who do not have significant coronary artery involvement. Use of a standardized imaging protocol is necessary to detect and characterize coronary artery abnormalities, including standardization of measurements (Z scores). For patients with evolving abnormalities, more frequent assessment is necessary in order to detect thromboses in aneurysms. Long-term prognosis and management is dependent on both the maximal and current Z scores of aneurysms. Patients with large or giant aneurysms (i.e., Z score ≥ 10) are at the highest risk of both thrombosis and stenosis. Such patients need careful follow-up for subsequent cardiovascular events. Many of them would be candidates for advanced cardiovascular imaging and may require revascularization therapy. Serial echocardiography plays a key role in surveillance. In addition, stress echocardiography has proven useful as a modality to assess for inducible myocardial ischemia. Intravascular ultrasound has been recommended for functional and structural assessment of coronary arteries in children with KD.