Assessment Of Segmental Wall Motion Research Articles

E0233 Late gadolinium-enhanced MRI in restrictive cardiomyopathy

ObjectiveTo evaluate the diagnostic value of MRI in combination of late gadolinium-enhanced imaging in the identification of restrictive cardiomyopathy (RCM).Methods116 patients with RCM underwent ECG, x-ray, Echocardiography and MRI. The...

E0699 Late gadolinium-enhanced cardiac MRI in restrictive cardiomyopathy

ObjectiveTo evaluate the diagnostic value of MRI in combination of late gadolinium-enhanced imaging in the identification of restrictive cardiomyopathy (RCM).Methods116 patients with RCM underwent ECG, X-ray, Echocardiography and MRI. The...

Automated Versus Visual Segmental Scoring

Echocardiography is the most widely used noninvasive test for assessing the structure and function of the heart, accounting for 14% of overall Medicare expenditures for imaging in 2007.1 Despite the availability of a variety of validated quantitative methods for assessing chamber size and cardiac function, many elements of echocardiographic interpretation remain qualitative rather than quantitative. This is particularly true of the assessment of regional wall motion. Notwithstanding progress in the field of myocardial perfusion echocardiography2 and earlier efforts to quantitate regional function with acoustic quantitation3 and Doppler tissue imaging-based methods,4 echocardiographic assessment of regional wall motion remains the principal method by which echocardiographers make the diagnosis of coronary disease. Moreover, the ability to visually identify stress-induced regional wall motion abnormalities is the foundation for stress echocardiography. Article see p 47 The ability to reproducibly and reliably detect regional wall motion abnormalities is an essential skill for any physician interpreting echocardiograms and conceded to be one of the most difficult skills to acquire.5 Consequently, an automated quantitative approach to assessing regional function would be invaluable as a tool for the interpretation of echocardiograms for teaching and research and could prove useful in training echocardiographers. The study of Liel Cohen6 in this issue of Circulation: Cardiovascular Imaging proposes just such a tool. In their article, the authors report their evaluation of a semiautomated method of measuring regional longitudinal strain to develop segmental scores, classifying segments as normal, hypokinetic, or akinetic/dyskinetic/aneurysmal. As the authors note, strain analysis based on speckle tracking as opposed to angle-dependent Doppler tissue imaging methods is appealing because it avoids translation artifact and angle dependence. Twelve expert echocardiographers of the Israeli Echocardiography Research Group at 9 major Israeli cardiology centers used this approach as well as qualitative visual segmental scoring in 15 patients …

A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain

Background— Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain. Methods and Results— Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was r =0.63 ( P <0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery. Conclusions— Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.

Use of pharmaceuticals in noninvasive cardiovascular diagnosis.

A number of pharmaceuticals are employed as diagnostic agents for cardiovascular diseases. Four groups of agents are reviewed here: 1) vasoactive substances employed as adjuncts to physical maneuvers in diagnosis of structural heart disease; 2) vasodilators used to produce heterogeneity of coronary flow; 3) sympathomimetic agents simulating the effects of exercise on the heart for the purpose of detection of coronary artery stenosis; and 4) ultrasonic contrast agents used to enhance myocardial imaging for the assessment of segmental wall motion. In the first group are amyl nitrate, a vasodilator, and methoxamine and phenylephrine, both vasopressors. The vasodilators of the second group are dipyridamole and adenosine. When combined with scintigraphic perfusion imaging or with echocardiographic assessment of segmental wall motion, these agents can detect single- or multiple-vessel coronary artery disease with sensitivity and specificity comparable to submaximal exercise. They are especially useful for preoperative risk assessment before noncardiac surgery. The sympathomimetic agents of the third group, dobutamine and arbutamine, increase myocardial contractility and heart rate, and dilate the peripheral vasculature. As with the vasodilators, when combined with nuclear or echocardiographic techniques they are equivalent to exercise in detection of coronary disease. They are especially useful in patients with bronchospastic disease and for assessment of myocardial viability. Agents from groups 2 and 3 have acceptable side-effect and safety profiles. The last group reviewed includes echocardiographic contrast agents that, in this investigative setting, are employed to enhance detection of segmental wall motion when used with agents from groups 2 and 3.

Assessment of segmental wall motion abnormalities using contrast two-dimensional echocardiography in awake mice.

Murine models of cardiac disease are becoming an important tool for studying pathophysiological processes. Development of methods to accurately assess ventricular function are therefore important. The purpose of this study was to evaluate the feasibility of echocardiographic assessment of segmental wall motion abnormalities in a murine model of myocardial infarction. Two-dimensional contrast (C+) and noncontrast (C-) echocardiography were performed in 76 awake mice 2 days before and 2 days after left coronary ligation. The short-axis images obtained with two-dimensional echocardiography and corresponding postmortem cross-sectional histological samples stained with Evans blue dye were each divided into 16 segments, and all matched segments were examined for correlation between wall motion abnormalities and myocardial hypoperfusion. With the use of contrast enhancement, the number of visualized segments was significantly increased (base: C- 86%, C+ 98%; midpapillary: C- 57%, C+ 89%; apex: C- 30%, C+ 74%). Agreement between echocardiographically assessed regional wall motion abnormalities and pathologically determined hypoperfusion in basal, midpapillary, and apical levels were 90%, 93%, and 93%, respectively. Agreement between echocardiographically normal wall motion and pathologically normal findings in basal, midpapillary, and apical levels were 99%, 88%, and 71%, respectively. Thus echocardiographic assessment of segmental wall motion in awake mice was feasible and the accuracy was improved with the use of a contrast agent.

Con: TEE is not a routine monitor in anesthesia for cardiac surgery

Con: TEE is not a routine monitor in anesthesia for cardiac surgery

Echocardiographic analysis of dysfunctional and normal myocardial segments before and immediately after coronary artery bypass graft surgery.

Echocardiography has revealed evidence of "subnormal" regional contraction patterns that result from myocardial ischemia and are often accompanied by nonadjacent "hyperkinetic" regions. Whether these regions of hyperkinetic wall motion persist unchanged or revert to normal after coronary artery bypass graft (CABG) surgery has not been studied in humans. Using echocardiography, we evaluated both dysfunctional and normal myocardial regions for changes in segmental wall motion and percent of systolic wall thickening that occurred immediately after CABG surgery in 32 patients. Segmental wall motion analysis before CABG surgery in these patients revealed that 170 (66%) of 256 myocardial segments were subnormal, of which 115 (67%) improved and 102 (60%) returned to normal immediately after CABG surgery. Eleven myocardial segments that were hyperkinetic before CABG surgery returned to normal after CABG surgery. Preoperatively, 162 (63%) of 256 myocardial segments had systolic wall thickening less than 30%, which increased from 11.8% +/- 8.9% to 24.3% +/- 14.3% (mean +/- SD) (P less than 0.01) postoperatively. Conversely, a reverse trend was found when systolic wall thickening was greater than 30% before CABG surgery: thickening decreased from 46.2% +/- 13.8% to 33.4% +/- 14.8% after CABG surgery (P less than 0.01). Thus, we conclude that immediately after CABG surgery, there is a recovery of function in some myocardial segments and a reduction in function in others. Furthermore, we conclude that the semiquantitative assessment of percent of systolic wall thickening is a more reliable (consistent) echocardiographic index of myocardial function compared with the qualitative assessment of segmental wall motion immediately after CABG surgery.

Advances in noninvasive cardiovascular imaging: implications for the anesthesiologist.

We have presented a review of recent advances in medical imaging which are relevant to the practice of anesthesia and associated research. The appropriate interpretation and use of the information derived from these noninvasive technologies can prevent unnecessary morbidity and mortality. Echocardiography remains the most advanced tool for noninvasive cardiac imaging because of its applicability for most cardiac disorders and its exquisite spatial resolution. Two-dimensional systems produce real time, dynamic, qualitative assessments of cardiac chamber morphology, size, thickness, and performance. The development of transesophageal echocardiography has brought this imaging power into the operating room for use by anesthesiologists. Recently developed quantitative and color-coded Doppler techniques will reveal intracardiac flow patterns and their alterations by anesthetics and surgery. These advantages are partially offset by inherent difficulties in quantifying echocardiographic data, and the need for highly trained operators for image reproduction. Nuclear cardiology and echocardiology are highly complementary. The scintigraphic methods identify myocardium at risk for infarction, confirm infarction when present, and produce quantitative, highly reproducible estimates of ventricular filling and performance. Time required to obtain data can be very brief for first-pass techniques, and these data are ideally suited for computer processing. Equilibrium studies require a larger dose of radioactive material, but provide excellent assessment of segmental wall motion. Preoperative studies with dipyridamole and Tl can indicate the patients truly at high risk for perioperative myocardial infarction. Monitoring and intensive care efforts may be better allocated with this information. No new technology in the past decade has stirred as much interest among clinicians as magnetic resonance imaging. Like echocardiography, it uses no ionizing radiation and is entirely noninvasive. But, unlike other imaging techniques, it utilizes multiple tissue characteristics to provide quick, highly resolved, tomographic images. Since bone is invisible to the magnetic resonance scanner, tissues inside bony structures are often best revealed with MRI. Nonimaging studies, i.e., spectroscopic data not spatially encoded, may prove to be the most important research currently underway in this field. In vivo estimates of intracellular functions, enzyme kinetics, and drug kinetics and metabolism are already in progress. The effects of anesthetic in the central nervous system and other organs may be explored in ways previously not possible.(ABSTRACT TRUNCATED AT 400 WORDS)