Assessment Of Regional Wall Motion Research Articles

Assessment of Agreement between Gated SPECT Myocardial Perfusion Imaging and Echocardiography for Measurement of Left Ventricular Parameters in Dilated Cardiomyopathy Patients

Background: Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to assess the agreement between the 2D-echocardiography and gated single-photon emission tomography (SPECT) for evaluation of these parameters in patients with DCM. Patients and methods: Gated SPECT and 2D-echocardiography were performed in 60 patients having DCM. Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Standard technique was used for 2D-echocardiography. Regional wall motion was evaluated using both modalities and was scored by two independent observers using a 4-point scoring system for 5 specific walls. Results: The overall agreement between the two imaging modalities for the assessment of regional wall motion was 95% (286/300 walls). With gated SPECT left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) were 27.38±6.71%, 214.73±75.35 ml, and 158.33±63.22 ml, respectively, and 31.25±5.09%, 185.05±55.63 ml, and 123.47±46.00 ml, respectively, with echocardiography. The correlation between gated SPECT and 2D-echocardiography was moderate (r = 0.59, P<0.001) for the assessment of LVEF. The correlation for EDV and ESV were also moderate, but with wider limits of agreement (r = 0.62, P<0.001 and r = 0.65, P<0.001, respectively) and significantly higher values were obtained with gated SPECT (P<0.001). For EDV, Bland-Altman measurements agreement analysis between the two methods demonstrated good agreement with finding of bias 29.68 and showed large limits of agreement, 95% upper and lower limit of agreement in 148.82 to -89.45 ml interval. For ESV, Bland-Altman measurements agreement analysis between them demonstrated good agreement with finding of bias 33.3 and showed large limits of agreement, 95% upper and lower limit of agreement in 130.12 to -63.52 interval. For LVEF, Bland-Altman measurements agreement analysis between them demonstrated good agreement with finding of bias 3.9 and 95% upper and lower limit of agreement in +14.8% to -7.0% interval. Conclusion: Gated SPECT and 2D-echocardiography correlate well and by Bland- Altman agreement analysis they exhibit good agreement with large limits for the assessment of LV function and LV volumes. Like 2D-echocardiography, gated SPECT provides reliable information about LV function and dimension with the additional advantage of perfusion data. Bangladesh J. Nuclear Med. 24(1&2): 28-35, 2021

Assessment of Left Ventricular Function and Regional Wall Motion by 256-Slice Dual-Source Coronary CT Angiography: A Comparison With 2D Transthoracic Echocardiography

Assessment of Left Ventricular Function and Regional Wall Motion by 256-Slice Dual-Source Coronary CT Angiography: A Comparison With 2D Transthoracic Echocardiography

Global longitudinal strain could detect coronary artery disease with more severe diameter stenosis in patients with normal left ventricular ejection fraction.

Two-dimensional speckle tracking Doppler echocardiography detects left ventricular myocardial deformation not otherwise detectable by visual regional wall motion assessment. This deformation can be expressed numerically as global longitudinal shortening (GLS).

Effect of Intermittent High–Mechanical Index Impulses on Left Ventricular Strain

Intermittent high-mechanical index (MI) impulses from a transthoracic ultrasound transducer are recommended for regional wall motion analysis and assessment of myocardial perfusion following intravenous administration of ultrasound enhancing agents (UEAs). High-MI impulses (>1.0) applied in this setting have also been shown to increase microvascular blood flow through a purinergic signaling pathway, but their effects on left ventricular (LV) myocardial function are unknown. Therefore, the aim of this study was to investigate the effect of transthoracic intermittent high-MI impulses during intravenous UEA infusion in patients with normal and abnormal resting systolic function. Fifty patients referred for echocardiography to evaluate LV systolic function during continuous infusion of UEAs (Definity 3% infusion) were prospectively assigned to low-MI (<0.2) imaging alone (group 1) or low-MI (<0.2) imaging with intermittent high-MI impulses (five frames, 1.8MHz, MI=1.0-1.2) applied at least two times in each apical window to clear myocardial contrast (group 2). Global longitudinal strain (GLS) measurements were obtained at baseline before UEA administration and at 5-min intervals up to 10-min after infusion completion. There were no differences between groups with respect to age, gender, resting GLS, biplane LV ejection fraction, or cardiac risk factors. Resting GLS in group 1 was -15.5±5.2% before UEA infusion and -15.5±5.4% at 10min after UEA infusion. In comparison, GLS increased in group 2 (-15.3±5.0 before infusion and -16.8±4.8% at 10min, P<.00001). Improvements in GLS were seen in patients with normal and abnormal systolic function. Regional analysis demonstrated that the increase in strain in patients with abnormal LV ejection fractions was primarily in the apical segments (-12.0±2.7% before infusion and -13.4±3.4% at 10min, P=.001). High-MI impulses during infusion of a commercially available contrast agent can improve LV systolic function and may have therapeutic effect in patients with LV dysfunction.

Establishment of Myocardial Strain Measurement Data in Pediatric Patients Without Structural Heart Disease: A Single Center Study.

Accurate assessment of LV systolic function remains a challenge, especially in the pediatric population. Myocardial strain measurement by 2D speckle tracking echocardiography (2DSTE) is a relatively new modality for assessment of regional and global myocardial wall motion. This study aims to establish the normative value among various pediatric age groups at a large pediatric tertiary care institution and to describe the challenges encountered in establishing such strain data. Transthoracic echocardiograms were acquired in 121 healthy children (age 0-21years) and were retrospectively analyzed. The global longitudinal strain (GLS) was obtained by 2D speckle tracking using Philips Epiq7® and QLAB post processing software. The normative value for left ventricular GLS (%) obtained in our study was - 20.8 ± 2.3 (< 1year); - 21.4 ± 2.2 (1-4years); - 19.6 ± 2.4 (5-9years); - 19.4 ± 2.6 (10-14years); - 18.9 ± 3.0 (15-21years). There was a statistically significant difference in GLS between the different age groups. The BMI (kg/m2) of assessed subjects were 14.6 ± 2.3 (< 1year); 16.3 ± 1.5 (1-4years); 16.7 ± 2.3 (5-9years); 21.3 ± 4.6 (10-14years); 23.9 ± 5.9 (15-21years). There was no significant difference in GLS by gender or by BMI found in our study. We present our experience with establishment of normative values of 2DSTE in our pediatric echocardiography lab. This study shows that age is the major determinant of variation in peak GLS in healthy subjects, emphasizing the importance of establishment of normative data among various age groups in pediatrics.

P1553 Regional peak systolic longitudinal strain during dipyridamole stress echocardiography in patients with normokinetic response determined by visual assessment

Abstract OnBehalf on behalf of the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Background Regional wall motion (RWMA) remains the cornerstone of stress echocardiography (SE) and its evaluation is still based on visual assessment by 2D. Regional longitudinal peak systolic strain (LPSS) provides a quantitative, operator-independent assessment of RWMA. Aim To compare 2D (qualitative) versus strain (quantitative) assessment of RWMA during dipyridamole SE. Methods In a prospective study we recruited 17 patients (mean age 69 ± 7 years, 11 women) with known or suspected CAD referred for accelerated high dose (0.84 mg/kg in 6") dipyridamole SE. We included patients with normokinesis at rest and with normal SE response. A 17-segment model was used to assess RWMA and strain (LPSS and global longitudinal strain, GLS). Ejection fraction (EF) was measured with Simpson"s biplane method. LPPS and GLS were measured using Automated Function Analysis (AFI). Results 289 segments could be assessed head-to-head with the 2 methods (2D and Strain). Heart rate was 61 ± 8 bpm at rest and rose to 86 ± 19 at peak stress (p = 0.0001) EF increased from 66 ± 7% (rest) to 73 ± 5% (peak stress, p = 0.0006 vs rest). GLS increased from -17.9 ± 3.4% at rest to -19.8 ± 2.4% at peak stress (p = 0.0074). Stress-rest (Δ) changes in EF did not correlate with Δ-GLS (r = 0.2, p = ns). LPSS was -18.2 ± 5.2% at rest and on average increased to -19.7 ± 5.8 % (p &amp;lt; 0.0001 vs rest), with heterogeneity of regional contractile reserve, highest in apical segments 13-17 (n = 85, LPSS rest= -20.3 ± 4.9 vs stress = - 22.5 ± 4.3, p = 0.0002), intermediate in mid-segments 7-12 (n = 102, LPSS rest= -18.5 ± 5.0 vs stress = -19.8 ± 5.6, p= 0.0166) and lowest in basal segments 1-6 (n = 102, LPSS rest= -16.1 ± 5.0 vs stress = - 17.3 ± 6.1, p= =0.0518= ns), see figure. At individual segment analysis, 50 segments (17.3%) showed an unmatched response, with normal visual response and LPSS reduction (stress ≤ rest at least 15%), observed especially in basal segments, see Table, unmatched 2D strain segments. Conclusions DSE allows a simultaneous qualitative and quantitative assessment of regional wall motion and global function by 2D and advanced strain-based indices. Strain-SE is feasible and may corroborate the results of trained naked eye interpretation with quantitative support, but degree of changes in regional strain is related to specific position of segment in basal, mid or apical part of left ventricle, with unmatched results between visual and strain not infrequent, especially in basal segments. Unmached 2D strain segments Basal (1-6), n = 102 Mid (7-12), n = 102 Apical (13-17), n = 85 P value Basal vs Mid P value Mid vs Apical P value Basal vs Apical 24 (23.5%) 18 (17.6%) 8 (9.4%) ns ns =0.0185 Number and proportion of segments with LPSS worsening ≥15% in basal, mid and apical portion of left ventricle. Abstract P1553 Figure. Changes of regional LPSS during DSE

P1404 Additional power of automated longitudinal strain during dobutamine stress echo for detecting inducible ischemia in left anterior descending artery stenosis

Abstract Background Dobutamine stress echo (DSE) is a sensitive but subjective test of inducible ischemia. Speckle tracking allows now a quantitative assessment of regional wall motion, even during DSE. Purpose To investigate the feasibility and accuracy of global and regional longitudinal strain during DSE to detect significant CAD. Methods This is a prospective, observational study, including 88 patients undergoing DSE for suspected CAD. Thirthy-three patients with negative DSE were excluded from analysis. The remaining 50 patients (82% males, mean age 66.3 ± 8.2 years) with positive DSE underwent subsequent invasive coronary angiography (CA). Besides visual regional wall motion score index (WMSI), global longitudinal strain (GLS) and regional longitudinal strain (RLS) were determined at rest, at peak stress and at early recovery by a dedicated software (Automated Function Imaging) incorporated in a quoad-screen of the echo machine and activated by automatic quantification. Obstructive CAD was defined as &amp;gt;70% stenosis or intermediate stenosis combined with fractional flow reserve &amp;lt;0.80. Results The feasibility of DES regional longitudinal strain was 100% (n = 50/50) in the pooled population. Fifteen patients did not show coronary stenosis whereas obstructive CAD was detected in 35 patients (12 with multi-vessel disease). Among these patients, 18 patients had left anterior descending artery (LAD) stenosis, 18 left circumflex coronary artery (LCX) stenosis and 15 right coronary artery (RCA) stenosis. GLS reduction at peak stress (k = 0.253, p = 0.037) and WMSI increase at peak stress (k = 0.217, p = 0.04) showed mild but significant agreement with CA for detecting significant coronary stenosis, whereas the agreement of GLS at recovery (k=-0.087, p = 0.518) was poor. When single lesion territory was considered, GLS at peak stress (17.4 ± 5.5 vs 20.5 ± 4.4%, p = 0.034) and LAD longitudinal strain (= average of 8 myocardial segments: middle and apical posterior septum, basal, middle and apical anterior septum, basal, middle and apical anterior wall) at peak stress showed significantly lower values in the obstructed LAD regions than the territories perfused by non-obstructed coronary arteries (17.1 ± 7.6 vs 21.6 ± 5.5% p = 0.021). Conversely, in presence of significant LCX or RCA stenosis, visual regional wall motion of LCX and RCA territories were higher at peak stress (WMSI LCX = 1.80 ± 0.65 in presence of LCX stenosis vs. 1.38 ± 0.44 in absence of stenosis, p &amp;lt; 0.01; WMSI RCA = 1.89 ± 0.52 in presence of RCA stenosis vs. 1.42 ± 0.42 in absence of stenosis, p = 0.002), but RLS at peak stress showed a trend to increase, without achieving the statistical significance (RLS RCA: p = 0.128, RLS LCX: p = 0.103). Conclusion AFI-based strain quantitative analysis appears to be highly feasible during DSE. It appears also to be more accurate than the visual wall motion for the detection of myocardial ischemia in presence of LAD while the accuracy is suboptimal in patients with LCX and RCA stenosis.

1680 Left ventricular filling pressure assessment with exercise stress echocardiography in patients with non-valvular atrial fibrillation

Abstract Background Noninvasive parameters of LV filling pressure (E/e’) and pulmonary pressures (RVSP) by Doppler echocardiography correlate with functional capacity and outcome in sinus rhythm (SR). Their role in AF is less clear. Elevated left ventricular filling pressures (E/e’) and pulmonary artery systolic pressures (PASP) by Doppler stress echocardiography correlate with impaired functional capacity in patients in sinus rhythm (SR). However, there is limited data in atrial fibrillation (AF). Purpose The aim of this study was to delineate the characteristics of patients with AF referred for exercise stress echocardiography and determine the prevalence and significance of E/e’ and PASP elevations in AF. Methods Subjects were patients referred for exercise treadmill stress echocardiography (n= 14,937) and underwent regional wall motion assessment, Doppler assessment of mitral inflow (E) and early tissue relaxation (e’) velocities and PASP at rest and immediately following maximum symptom limited exercise. Exclusion criteria included significant valvular heart disease (moderate or greater stenosis and/or regurgitation of any cardiac valve or previous valve repair or replacement) (1%), congenital heart disease (&amp;lt;1%) or refusal to participate in research (&amp;lt;1%). Results Patients with AF (n = 310, 2%) were older (71 ± 10 vs 59 ± 13 years, p &amp;lt; 0.001). While resting blood pressure was similar, resting heart rates were higher in AF (80 ± 17 bpm vs 73 ± 13 bpm, p &amp;lt; 0.0001). AF patients achieved lower workloads (6.4 ± 2.4 METS vs 9 ± 2.4 METS, p &amp;lt; 0.001) with lower peak double products (22336 ± 6677 vs 25148 ± 5438, p &amp;lt; 0.001). Rates of resting (27% vs 10%, p &amp;lt; 0.0001) and exercise-induced (37% vs 20%, p &amp;lt; 0.0001) regional wall motion abnormalities were higher in AF. Mean E/e’ was higher in AF at rest (12 ± 5 vs 9 ± 3, p &amp;lt; 0.001) and with exercise (12 ± 5 vs 10 ± 4, p &amp;lt; 0.001), with a higher percentage of patients in AF having E/e’ ≥15 at rest (20% vs 6% in SR, p= &amp;lt;0.001) and with exercise in (23% vs 8%, p &amp;lt; 0.001). PASP was higher in AF at rest (33 ± 8 mm Hg vs 28 ± 6 mm Hg, p &amp;lt; 0.001) and with exercise (48 ± 12 vs 42 ± 11, p &amp;lt; 0.001) compared to SR. E/e’ correlated with exercise capacity in AF and in SR, with an E/e’ cutoff of 11.7 that was best predictive of impaired functional capacity (&amp;lt; 5 METS in women and &amp;lt; 7 METS in men). Conclusions Abnormalities of E/e’ and PASP are more prevalent in patients with AF and correlate with impaired functional capacity. In patients with AF, a medial E/e’ ratio of ≥ 12 immediately following exercise is best associated with impaired functional capacity.

Quantitative detection of changes in regional wall motion using real time strain-encoded cardiovascular magnetic resonance

A comprehensive cardiovascular magnetic resonance (CMR) exam includes assessment of regional wall motion, which typically involves qualitative interpretation by an experienced reader, although time-consuming quantitative measurements of myocardial wall thickening can be performed. Myocardial strain imaging offers the potential to more accurately quantify the extent and severity of regional wall motion abnormalities and has even been proposed as a mechanism to identify changes in regional contractility before they are visually evident1. Strain imaging may be particularly valuable to assess the impact of coronary artery disease on the myocardium because ischemia is known to first alter the longitudinal deformation of the subendocardial myocardial fibers prior to impacting the regional thickening in the radial direction that is required to create a visually appreciable wall motion abnormality1. In patients with chest pain, alterations in strain following the infusion of an inotrope such as dobutamine can be used to improve the detection of underlying coronary artery disease2. Myocardial strain can be measured using several different CMR-based tagging techniques, such as complementary spatial modulation of magnetization (C-SPAMM) 3 with harmonic phase encoding (HARP) post-processing 4,5, displacement encoding with stimulating echoes (DENSE) 6, cine phase contrast imaging, and strain-encoded CMR (SENC) 7–9. Additionally, it is also possible to use feature tracking algorithms to derive strain measurements from standard cine-CMR images 10,11. Each of these approaches has its advantages and limitations. Recent improvements in SENC-CMR allow for image acquisition to occur during a single heart beat in real time without sacrificing temporal resolution. Unlike the other strain imaging approaches, with SENC imaging being performed during a single heart beat, image quality is not significantly impacted by respiratory motion and arrhythmia. Previous single center studies have suggested that SENC-CMR can be used to improve the detection of coronary artery disease when compared to cine-image wall motion interpretation 12. In this multi-center study, we hypothesized that in the presence of coronary artery disease, changes in regional longitudinal and circumferential strain detected using SENC under intermediate-dose dobutamine stress CMR would precede changes in wall thickening visible on cine-CMR images.

The Clinical use of Stress Echocardiography in Ischemic Heart Disease Cardiovascular Ultrasound (2017)15:7. Translation authors: Arystan A.Zh., Fettser D.V.

Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combinationof echocardiography with a physical, pharmacological or electrical stress allows detecting myocardial ischemia with an excellentaccuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiographyprovides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, butat a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. The evidenceon its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinicalfoundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anteriordescending artery, into a single test. The improvement of technology and in imaging quality will make this approach more andmore feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the currentqualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome itsmain weaknesses: dependence on operator expertise, the lack of outcome data (a widespread problem in clinical imaging) to documentthe improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stressechocardiography to ischemic heart disease.

Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation

BackgroundCardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality. ObjectiveThe aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation. MethodsThe proposed method uses a recent image processing tool called “monogenic signal” to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy). ResultsThe results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively. ConclusionAccuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.

Clinical impact of cardiovascular magnetic resonance in evaluation for possible arrhythmogenic right ventricular dysplasia/cardiomyopathy

Methods Patients referred for assessment of ARVD/C were evaluated. Using 2010 ARVD/C Task Force criteria, clinical history, family history, ECG and other test results were evaluated with and without CMR findings to determine definite, borderline or possible ARVD/C. CMR included assessment of right ventricular(RV) size, function, and regional wall motion(RWM). For alternative diagnoses, tissue characterization and late gadolinium enhancement were routinely performed. Qp:Qs was performed when intracardiac shunt was suspected by the supervising physician.

Detection of LV function abnormality using temporal patterns of normalized wall thickness

Background Global measures of cardiac function may not reflect subtle wall motion abnormalities. In such cases, assessment of regional cardiac wall motion is required, which is usually evaluated visually with highly subjective results. Automatic analysis techniques can be classified into intensity-based and contour-based methods with the latter category avoiding the image quality-related limitations in the first one. In this study, we present a contour-based technique for detecting wall motion abnormality based on studying the temporal pattern of normalized wall thickness.

Contrast Echocardiography: Current Applications and Future Perspectives

Contrast echocardiography is an established imaging method and an essential tool in every state of the art echocardiographic laboratory. It has also been the subject of several major clinical and research studies during the last year. This article addresses the impact of these studies on the clinical use of contrast echocardiography. Most recent studies have been performed with commercially available ultrasound contrast agents, which cross the pulmonary vasculature and are used for assessment of the left heart. The principle licensed indication for these contrast media is the delineation of left ventricular (LV) borders, masses, and aneurysms. The superiority of 2-dimensional contrast echocardiography over nonenhanced 2-dimensional imaging has been confirmed for assessment of LV volumes and ejection fraction, and there is growing evidence for the use of contrast 3-dimensional echocardiography. Two studies have demonstrated the usefulness of contrast-enhanced TEE for detection of thrombi in the left atrial appendage. The improved endocardial definition seen with ultrasound contrast media can also be used for strain analysis on selected systems. In stress echocardiography, contrast has been used for myocardial perfusion imaging in addition to assessment of regional LV wall motion. A large European multicenter study has demonstrated Sonovue-enhanced myocardial contrast echocardiography to be more sensitive than nuclear single photon emission computed tomography (SPECT) for the detection of significant coronary artery disease. Two further studies are discussed, which have demonstrated the impact of isolated perfusion defects on patients’ outcome. In addition, several publications have supplemented existing evidence regarding the safety of commercially available contrast agents. Recent studies continue to establish the usefulness and safety of contrast echocardiography for the currently licensed indications. There is also now good evidence for the use of myocardial contrast echocardiography as an alternative to nuclear imaging.

Automatic assessment of regional and global wall motion abnormalities in echocardiography images by nonlinear dimensionality reduction

Identification and assessment of left ventricular (LV) global and regional wall motion (RWM) abnormalities are essential for clinical evaluation of various cardiovascular diseases. Currently, this evaluation is performed visually which is highly dependent on the training and experience of echocardiographers and thus is prone to considerable interobserver and intraobserver variability. This paper presents a new automatic method, based on nonlinear dimensionality reduction (NLDR) for global wall motion evaluation and also detection and classification of RWM abnormalities of LV wall in a three-point scale as follows: (1) normokinesia, (2) hypokinesia, and (3) akinesia. Isometric feature mapping (Isomap) is one of the most popular NLDR algorithms. In this paper, a modified version of Isomap algorithm, where image to image distance metric is computed using nonrigid registration, is applied on two-dimensional (2D) echocardiography images of one cycle of heart. By this approach, nonlinear information in these images is embedded in a 2D manifold and each image is characterized by a point on the constructed manifold. This new representation visualizes the relationship between these images based on LV volume changes. Then, a new global and regional quantitative index from the resultant manifold is proposed for global wall motion estimation and also classification of RWM of LV wall in a three-point scale. Obtained results by our method are quantitatively evaluated to those obtained visually by two experienced echocardiographers as the reference (gold standard) on 10 healthy volunteers and 14 patients. Linear regression analysis between the proposed global quantitative index and the global wall motion score index and also with LV ejection fraction obtained by reference experienced echocardiographers resulted in the correlation coefficients of 0.85 and 0.90, respectively. Comparison between the proposed automatic RWM scoring and the reference visual scoring resulted in an absolute agreement of 82% and a relative agreement of 97%. The proposed diagnostic method can be used as a useful tool as well as a reference visual assessment by experienced echocardiographers for global wall motion estimation and also classification of RWM abnormalities of LV wall in a three-point scale in clinical evaluations.

133 Coronary wave intensity: a novel invasive tool for predicting myocardial viability following acute coronary syndromes

IntroductionWave intensity analysis (WIA) uses simultaneous changes in intracoronary pressure and flow to characterise energy transfer within the coronary circulation. In normal hearts, flow is predominantly driven by a microcirculatory-derived,...

Myocardial Deformation Imaging

Myocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function. As this technology has evolved, it has been applied to an increasing number of research questions, and the number of publications incorporating deformation imaging has grown in parallel. Although not yet sufficiently vetted for routine clinical use, these methods offer the long-term potential for more complete, accurate, and reproducible assessment of myocardial function. Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function. During systole, the ventricular myocardium simultaneously shortens in the longitudinal and circumferential planes and thickens in the radial plane, with reciprocal changes in diastole (Figure). Deformation imaging, in the broadest sense, allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate. Strain is defined as the change in length of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the rate of this deformation. Longitudinal and circumferential shortening results in negative strain values, whereas radial thickening results in a positive strain value. Previously, assessment of myocardial strain could be performed with the use of sonomicrometry crystals, which can only be performed experimentally1 or with magnetic resonance imaging–based myocardial tagging,2,3 which is limited by relatively low temporal resolution and the limited availability and expense of cardiac magnetic resonance imaging. Extension of these techniques to echocardiography has allowed …

Comparison of dual-source 64-slice adenosine stress CT perfusion with stress-gated SPECT-MPI for evaluation of left ventricular function and volumes

Evaluation of left ventricular (LV) volumes and ejection fraction (LVEF) represent important components of pharmacologic stress imaging with either myocardial CT perfusion (CTP) or gated single-photon emission CT (SPECT) myocardial perfusion imaging (SPECT-MPI). We compared measurements of left ventricular function and volumes obtained with CTP and SPECT-MPI. Forty-seven patients (mean age, 62 ± 11 years; male, n = 39) underwent stress CTP and SPECT-MPI. LVEF (in %), end-systolic volume (ESV; in mL), and end-diastolic volume (EDV; in mL) derived from stress CTP images were compared with SPECT-MPI. Stress CTP was in good agreement with SPECT-MPI for quantification of LVEF (r = 0.91), EDV (r = 0.75), and ESV (r = 0.83; all P < 0.001). The mean LVEF measured by stress CTP (66% ± 17%) was similar to SPECT-MPI (64% ± 15%). Similar values were also derived for mean EDV (123 ± 30 mL vs 120 ± 34 mL) and ESV (44 ± 28 mL vs 51 ± 34 mL) for CTP and SPECT-MPI, respectively. Good agreement was also shown between both techniques for the assessment of regional wall motion with identical wall motion scores in 95.3% of the segments (κ = 0.79). LVEF and LV volume parameters as determined by dual-source 64-slice adenosine stress CTP show a high correlation with values obtained with stress-gated SPECT-MPI.

Assessment of left ventricular volumes, ejection fraction and regional wall motion with retrospective electrocardiogram triggered 320-detector computed tomography: a comparison with 2D-echocardiography

Left ventricular (LV) volumes, ejection fraction (LVEF) and regional wall motion (LVRWM) have important treatment and prognostic implications in patients with coronary artery disease. We sought to determine the accuracy of 320-row multidetector computed tomography (MDCT) for the assessment of LV volumes, LVEF and LVRWM, using 2D-echocardiography as the reference standard. We evaluated 50 consecutive patients (mean age 60 ± 14 years, 66% male) who underwent 320-detector MDCT (dose-modulated retrospective electrocardiogram-triggering) and 2D-echocardiography within 14 days for investigation of known or suspected coronary artery disease. Two blinded readers measured LV volumes on MDCT and visually assessed LVRWM with a 3-point scale using a 17-segment model. A separate experienced echocardiologist, blinded to MDCT findings, assessed LVRWM on 2D-echocardiograms and determined LV volumes and LVEF using Simpson's biplane method. 2D-echocardiography served as the reference standard. Mean LVEF was 59 ± 9% (range 26-75%) on 2D-echocardiography and 60 ± 9% (range 27-76%) on MDCT. Using linear regression analysis, MDCT agreed very well with 2D-echocardiography for assessment of LVEDV (r(2) = 0.88; P < 0.001), LVESV (r(2) = 0.95; P < 0.001) and LVEF (r(2) = 0.90; P < 0.001). Mean differences (±standard deviation) of 14 ± 13 ml, 5 ± 7 ml and 1 ± 3% were observed between MDCT and 2D-echocardiography for LVEDV, LVESV and LVEF, respectively. On 2D-echocardiography, 81/850 (9.5%) segments had abnormal LVRWM. Agreement for assessment of LVRWM between 2D-echocardiography and MDCT was excellent (96%, k = 0.76). Accurate assessment of LV volumes, LVEF and LVRWM is feasible with 320-detector MDCT, with MDCT demonstrating slightly larger LV volumes than 2D-echocardiography.

How should we measure global and regional left ventricular systolic function?

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.