Determination Of Left Ventricular Volumes Research Articles

Stretch-induced compliance mechanism in pregnancy-induced cardiac hypertrophy and the impact of cardiovascular risk factors.

Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1stT) and a separate group of 31 (3rd trimester, 3rdT) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1stT and 3rdT, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1stT and 3rdT. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1stT. NT-pro-BNP increased slightly after AVO but only in the 1stT. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1stT and 3rdT, which was influenced by CVR factors. The LV of 3rdT pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance.NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank-Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors.

Deep learning-based left ventricular segmentation demonstrates improved performance on respiratory motion-resolved whole-heart reconstructions.

Deep learning (DL)-based segmentation has gained popularity for routine cardiac magnetic resonance (CMR) image analysis and in particular, delineation of left ventricular (LV) borders for LV volume determination. Free-breathing, self-navigated, whole-heart CMR exams provide high-resolution, isotropic coverage of the heart for assessment of cardiac anatomy including LV volume. The combination of whole-heart free-breathing CMR and DL-based LV segmentation has the potential to streamline the acquisition and analysis of clinical CMR exams. The purpose of this study was to compare the performance of a DL-based automatic LV segmentation network trained primarily on computed tomography (CT) images in two whole-heart CMR reconstruction methods: (1) an in-line respiratory motion-corrected (Mcorr) reconstruction and (2) an off-line, compressed sensing-based, multi-volume respiratory motion-resolved (Mres) reconstruction. Given that Mres images were shown to have greater image quality in previous studies than Mcorr images, we hypothesized that the LV volumes segmented from Mres images are closer to the manual expert-traced left ventricular endocardial border than the Mcorr images. This retrospective study used 15 patients who underwent clinically indicated 1.5 T CMR exams with a prototype ECG-gated 3D radial phyllotaxis balanced steady state free precession (bSSFP) sequence. For each reconstruction method, the absolute volume difference (AVD) of the automatically and manually segmented LV volumes was used as the primary quantity to investigate whether 3D DL-based LV segmentation generalized better on Mcorr or Mres 3D whole-heart images. Additionally, we assessed the 3D Dice similarity coefficient between the manual and automatic LV masks of each reconstructed 3D whole-heart image and the sharpness of the LV myocardium-blood pool interface. A two-tail paired Student's t-test (alpha = 0.05) was used to test the significance in this study. The AVD in the respiratory Mres reconstruction was lower than the AVD in the respiratory Mcorr reconstruction: 7.73 ± 6.54 ml vs. 20.0 ± 22.4 ml, respectively (n = 15, p-value = 0.03). The 3D Dice coefficient between the DL-segmented masks and the manually segmented masks was higher for Mres images than for Mcorr images: 0.90 ± 0.02 vs. 0.87 ± 0.03 respectively, with a p-value = 0.02. Sharpness on Mres images was higher than on Mcorr images: 0.15 ± 0.05 vs. 0.12 ± 0.04, respectively, with a p-value of 0.014 (n = 15). We conclude that the DL-based 3D automatic LV segmentation network trained on CT images and fine-tuned on MR images generalized better on Mres images than on Mcorr images for quantifying LV volumes.

Left ventricular volumes on positron emission tomography: validation against cardiovascular magnetic resonance

Abstract Introduction Cardiovascular magnetic resonance (CMR) is the gold standard for determination of left ventricular volumes (LVV), including end diastolic volume (LVEDV) and end systolic volume (LVESV). With incorporation of ECG gating, the quantitative analysis of ventricular function can be achieved in Positron Emission Tomography (PET) studies. However, the accuracy of LVV quantification using PET has not been shown in previous studies. Purpose We aimed to assess the inter-study variability of LVEDV and LVESV between CMR and PET. Methods Consecutive patients who underwent both PET and CMR within 1 year were identified from prospective institutional registries. LVV on PET was compared against CMR as a reference standard using several statistical measures of agreement. Results The study population consisted of 233 patients (mean age 60.8±13.6 years, 64.8% male). The median (IQR) duration between CMR and PET was 41 (11–96) days. The median (IQR) LVEDV values were 144 (107–196) on PET and 178 (138–236) on CMR (mean difference 36.09±2.36, p<0.001). As shown in Figure 1, there was a good correlation (Spearman rho=0.88, p<0.001; Intraclass Correlation Coefficient 0.88, 95% CI 0.84–0.90, P<0.001) with moderate limits of agreement (95% limits of agreement −108.17–35.99). A total of 0% and 3.9% of the cohort had LVEDV >150 ml/m2 by CMR and PET respectively. Overall results were similar with LVESV values and similar in subgroup analysis of patients with a low EF (<40%), a coronary artery disease scar, LV hypertrophy and of patients with defibrillators. Conclusion Our analysis has shown a good correlation of LVV between PET and CMR, indicating PET derived LVV can accurately be used in the diagnosis and management of patients. Funding Acknowledgement Type of funding sources: None.

TCT-67 Modification of the Impella Device for Instantaneous Determination of Native Left Ventricular Cardiac Output and Volume

TCT-67 Modification of the Impella Device for Instantaneous Determination of Native Left Ventricular Cardiac Output and Volume

Automated three-dimensional echocardiographic quantification for left ventricular volume and function in patients with hypertrophic cardiomyopathy.

Accurate, reproducible, noninvasive determination of left ventricular (LV) volumes and ejection fraction (EF) is important for clinical assessment, selection of therapy, and serial monitoring of patients with hypertrophic cardiomyopathy (HCM). Current clinical Two-dimensional echocardiography (2DE) may cause inaccurate measurements in patients with HCM because of their asymmetric ventricles and limitations of 2DE technology. Three-dimensional echocardiography (3DE) have demonstrated significantly greater accuracy. However, the time-consuming workflow limits the clinical utility of 3DE. We aim to compare the performance of a novel automated 3DE system (HeartModel, Philips Healthcare) with 2DE in a group of patients with HCM. Cardiac magnetic resonance (CMR) was reference standard. Fifty-three patients with HCM were examined by automated 3DE (3DEA), two-dimensional biplane Simpson's method (2DBP), manual 3DE method, and CMR, respectively. For patients with poor automated quantification, manual correction was performed. The Pearson correlation coefficient and Bland-Altman analysis and paired Student t tests were used to assess inter-technique agreement. 3DEA measurements with contour editing correlate well with CMR and manual 2DE and 3DE measurements (r = .80-.96). The analysis time of 3DEA was shorter than that of 2DBP (3DEA, 141 ± 15s; 2DBP, 174 ± 17 s). Inter-observer variability was reduced significantly with use of 3DEA. Compared with current clinical 2DBP method, the analysis time of automated 3DE was much shorter with the added benefit of enhanced accuracy and reproducibility. Patients with asymmetric chamber may rely more on the timesaving automated 3DE quantification in the future.

A comparison of 8 and 16 frames gated SPECT imaging for determination of left ventricular volumes and ejection fraction: effects of gender and myocardial counts.

In myocardial gated SPECT imaging each cardiac cycle is divided into 8 or 16 temporal frames and the cause of the difference between 8 and 16 frames is not specified exactly. The aim of this study was to investigate the effect of myocardial detector counts and gender on the difference between 8 and 16 frames and also to compare the LVEF obtained by 8 and 16 frames with echocardiography. The study population included 84 patients who underwent gated SPECT imaging. Left ventricular parameters were assessed on 8 and 16 frames gated SPECT. LVEF was also measured with two-dimensional echocardiography within 5-10days after gated SPECT imaging. There was agood correlation between 8 and 16 frames for calculation of LVEF (p = 0.00, r = 0.860), EDV (p = 0.00, r = 0.965) and ESV (p = 0.00, r = 0.956) in all patients. But the difference between 8 and 16 frames for calculation of LVEF (p = 0.00), EDV (p = 0.014) and ESV (p = 0.00) was statistically significant. This difference was assessed separately in females, males, patients with high photon counts and patients with low photon counts and in all subgroups was statistically significant difference in the estimation of LVEF and ESV (p < 0.05) but no significant difference in the estimation of EDV (p > 0.05). Echocardiography resulted in smaller LVEF as compared to 8 and 16 frames gated SPECT studies and there was asignificant difference between thetwo methods (p = 0.00). The myocardial detector counts and gender have no effect on the difference between 8 and 16 frames methods and the LVEF on echocardiography is smaller than the gated SPECT, but the 8-frame is closer to echocardiography.

A Novel Artificial Intelligence Echocardiography Software Achieves Equivalence to Physician-Read Images with Ultrasound Enhancing Agents in Left Ventricular Volume Determination

A Novel Artificial Intelligence Echocardiography Software Achieves Equivalence to Physician-Read Images with Ultrasound Enhancing Agents in Left Ventricular Volume Determination

ARTIFICIAL INTELLIGENCE ASSESSMENT OF LEFT VENTRICULAR VOLUMES AND FUNCTION ON POCUS IMAGING

A main clinical application of cardiac point-of-care ultrasound (POCUS) is Left Ventricular (LV) function. Artificial Intelligence (AI) with the use of Machine Learning may improve diagnostic accuracy and reliability, particularly for non-expert users. AI software that provides real-time determination of LV volumes and systolic function through a U-net based model to detect landmark locations and provide LV segmentation, was assessed for reliability and accuracy on POCUS compared to cart-based machine images, analyzed by both AI and human expert (ASE Level III Echocardiographer). This is a prospective study in which POCUS (Lumify, Philips) and Cart-based (iE33, Philips; Vivid E9, General Electric) images were collected by an experienced sonographer. Apical 2-chamber (AP2) and apical 4-chamber (AP4) views used for analysis. LV length and volume were calculated, at end-systole and end-diastole. LV ejection fraction (LVEF) was calculated for monoplane (AP2, AP4) and biplane Simpson’s method. Saturated linear mixed modelling was used for assessment of differences between mean values, with a Wald-test for combination of view, machine-type and cardiac cycle (SAS 9.4 with PROC MIXED procedure). Linear regression models and Wilcoxon paired rank tests conducted to assess for accuracy, with regression lines, and adjusted Rˆ2 reported. Images from 51 consecutive patients analyzed. Data from between 46 to 50 patients used for LV length, volume, and EF calculations, with specific views removed by AI software’s exclusion criteria for poor quality. Mean biplane LV volumes were higher in AI compared to expert derived values for Cart-based and POCUS devices (Table 1). Mean biplane LVEF was higher in expert derived cart-based measurements compared to AI [6.5% (95% CI: 2.1, 10.9, p-value = 0.004)]. No difference in mean biplane LVEF existed between expert-derived and AI values for POCUS devices (Table 1). Correlation between AI and expert derived LVEF was comparable for Cart-based vs. POCUS for biplane assessment (R2 = 0.42 Cart; 0.45 POCUS, Figure 1). Median difference between AI and expert derived biplane LVEF was 7.5% higher on Cart-based compared to POCUS (95% CI: 4,11, Wilcoxon p-value < 0.001). AI derived LV volumes were higher for Cart-based and POCUS images. Expert derived LVEF was found to be higher (6.5%) compared to AI on Cart-based images, with no difference on POCUS. Correlation between AI and expert derived values for both modalities was satisfactory, suggesting AI derived LV volume and EF assessment is comparable across Cart-based and POCUS images and to human expert assessment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Contrast Enhancement and Image Quality Influence Two- and Three-dimensional Echocardiographic Determination of Left Ventricular Volumes: Comparison With Magnetic Resonance Imaging.

Purpose:To evaluate the effect of image quality and contrast enhancement (CE) on left ventricular (LV) volume determination by two- (2D) and three-dimensional (3D) echocardiography (2DE/3DE).Methods:We studied 32 post-myocardial infarction (MI) patients without (2DE/3DE) and with CE (CE2DE/CE3DE), in comparison with cardiac magnetic resonance imaging (CMR).Results:Two-dimensional echocardiography showed the largest negative bias versus CMR for diastolic and systolic volumes (−59, −28 mL, respectively) with lower biases for CE2DE (−37, −22 mL), 3DE (−31, −17 mL), and CE3DE (−17, −11 mL). Bias for ejection fraction (EF) ranged from −2.1% for 2DE to +1.4% for CE3DE. Agreement (intraclass correlation coefficient, ICC) for EF between CMR and 3DE (0.86 without and 0.85 with contrast) was better than for 2DE (0.73 without and 0.69 with contrast). The inter-/intra-observer coefficients of variation for EF varied from 16%/10% (2DE) to 6.9%/6.6% (CE2DE), and 8.3%/4.8% (3DE) to 6.7%/6.8% (CE3DE), respectively. The agreement (ICC) with CMR for EF measured by 2DE/3DE changed from 0.64/0.84 with poor image quality to 0.81/0.87 with moderate to good image quality.Conclusions:Three-dimensional echocardiography was more accurate than 2DE for estimating LV volumes, with less inter-/intra-observer variability in EF values. Contrast enhancement improved accuracy for both 2DE and 3DE and improved the inter-observer variability of EF estimates for 2DE and 3DE. Image quality had more impact on the agreement of EF values with CMR for 2DE than for 3DE. Our results emphasize the importance of using the same technique for longitudinal studies of LV EF and specially LV volumes.

Determination of Fetal Left Ventricular Volume Based on Two-Dimensional Echocardiography.

Determination of fetal left ventricular (LV) volume in two-dimensional echocardiography (2DE) is significantly important for quantitative analysis of fetal cardiac function. A backpropagation (BP) neural network method is proposed to predict LV volume more accurately and effectively. The 2DE LV border and volume are considered as the input and output of BP neural network correspondingly. To unify and simplify the input of the BP neural network, 16 distances calculated from the border to its center with equal angle are used instead of the border. Fifty cases (forty frames for each) were used for this study. Half of them selected randomly are used for training, and the others are used for testing. To illustrate the performance of BP neural network, area-length method, Simpson's method, and multivariate nonlinear regression equation method were compared by comparisons with the volume references in concordance correlation coefficient (CCC), intraclass correlation coefficient (ICC), and Bland-Altman plots. The ICC and CCC for BP neural network with the volume references were the highest. For Bland-Altman plots, the BP neural network also shows the highest agreement and reliability with volume references. With the accurate LV volume, LV function parameters (stroke volume (SV) and ejection fraction (EF)) are calculated accurately.

Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity.

Purpose The primary toxicity of trastuzumab therapy for human epidermal growth factor receptor 2-overexpressing (HER2-positive) breast cancer is dose-independent cardiac dysfunction. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. We hypothesized that angiotensin-converting enzyme inhibitors and β-blockers could prevent trastuzumab-related cardiotoxicity. Patients and Methods In this double-blinded, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF. Results Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. Baseline demographic, cancer, and cardiovascular profiles were similar between groups. Study drugs were well tolerated with no serious adverse events. After 17 cycles of trastuzumab, indexed left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups ( P = .001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis. Conclusion Perindopril and bisoprolol were well tolerated in patients with HER2-positive early breast cancer who received trastuzumab and protected against cancer therapy-related declines in LVEF; however, trastuzumab-mediated left ventricular remodeling-the primary outcome-was not prevented by these pharmacotherapies.

Cardiac steatosis and left ventricular remodeling in heart failure with reduced and preserved ejection fraction

Background Heart failure (HF) is characterised by alterations in fatty acid and glucose metabolism. We aimed to determine if myocardial lipid is increased in HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction (EF), and assess whether it is related to cardiac structure and function. Methods 25 HFrEF due to dilated cardiomyopathy (DCM), 18 HFpEF (defined by EF >50%, abnormal diastolic function, maximum oxygen consumption <80% predicted for age, height and gender, with a cardiac limitation in exercise) and 28 normal volunteers were prospectively recruited. All subjects underwent cardiovascular magnetic (MR) resonance at 3T for the determination of left ventricular (LV) volumes and function, and cardiac 1 H MR spectroscopy to quantify myocardial lipid/water (%). Results

Intraoperative Evaluation of Left Ventricular Volume and Function

Intraoperative Evaluation of Left Ventricular Volume and Function

Usefulness of nasal continuous positive airway pressure in acute congestive heart failure infants with pulmonary artery hypertension and congenital heart disease

Objective To describe the early use of nasal continuous positive airway pressure (nCPAP) ventilation for infants presenting acute congestive heart failure (CHF) complicated by congenital heart disease (CHD) and pulmonary artery hypertension (PH). Methods Sixty infants with CHD treated for acute CHF were randomly divided into the nCPAP group (n=32) and the non-nCPAP group (n=28). Data were analyzed, which included lactic acid value (Lac) by arterial blood gas analysis, calculation of oxygenation index [pa(O2)/FiO2], detection of serum N-terminal pro-brain natriuretic peptide of type B (NT-proBNP) level, determination of left ventricular end diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) by noninvasive bedside ultrasonic cardiogram (UCG). Results 1.Comparison of arterial blood gas between the 2 groups: 1 d after treatment, there were significant differences in pa(O2)/FiO2 and Lac between the 2 groups(t=4.743, 5.402, all P 0.05).2.Comparison of index of heart function between the 2 groups: after 3-7 d treatment, LVEDVI, LVEF, and PASP were statistically different between the 2 groups(t=2.052, 2.704, 2.019, all P<0.05).3.Comparison of serum indexes between the 2 groups: 3-7 d after treatment, serum NT-proBNP level was improved dramatically compared with the non-nCPAP group(t=9.869, P<0.05).4.Comparison of clinical prognosis between the 2 groups: the differences in needing endobronchial intubation rate, mechanical ventilation time, time in PICU and mortality rate were all statistically significant between the 2 groups(χ2=5.505, P=0.019; t=4.788, P=0.000; t=5.068, P=0.000; χ2=4.284; P=0.038). Conclusions The early use of noninvasive nCPAP for eligible patients with acute CHF complicated by CHD and PH seems to improve their prognosis by improving pa(O2)/FiO2, reducing left ventricular and right ventricular afterload and improving the left ventricular function. Key words: Congenital heart disease; Pulmonary artery hypertension; Congestive heart failure; Continuous positive airway pressure ventilation

Analysis of Left Ventricular Volumes and Function: A Multicenter Comparison of Cardiac Magnetic Resonance Imaging, Cine Ventriculography, and Unenhanced and Contrast-Enhanced Two-Dimensional and Three-Dimensional Echocardiography

Contrast echocardiography improves accuracy and reduces interreader variability on left ventricular (LV) functional analyses in the setting of two-dimensional (2D) echocardiography. The need for contrast imaging using three-dimensional (3D) echocardiography is less defined. The aim of this multicenter study was to define the accuracy and interreader agreement of unenhanced and contrast-enhanced 2D and 3D echocardiography for the assessment of LV volumes and ejection fraction (EF). A multicenter, open-label study was conducted including 63 patients, using intrasubject comparisons to assess the agreement of unenhanced and contrast-enhanced 2D and 3D echocardiography as well as calibrated biplane cine ventriculography with cardiac magnetic resonance for the determination of LV volumes and EF. Each of the imaging techniques used to define LV function was assessed by two independent, off-site readers unaware of the results of the other imaging techniques. LV end-systolic and end-diastolic volumes were underestimated by 2D and 3D unenhanced echocardiography compared with cardiac magnetic resonance. Contrast enhancement resulted in similar significant increases in LV volumes on 2D and 3D echocardiography. The mean percentage of interreader variability for LV EF was reduced from 14.3% (95% confidence interval [CI], 11.7%-16.8%) for unenhanced 2D echocardiography and 14.3% (95% CI, 9.7%-18.9%) for unenhanced 3D echocardiography to 8.0% (95% CI, 6.3%-9.7%; P < .001) for contrast-enhanced 2D echocardiography and 7.4% (95% CI, 5.7%-9.1%; P < .01) for contrast-enhanced 3D echocardiography and thus to a similar level as for cardiac magnetic resonance (7.9%; 95% CI, 5.4%-10.5%). A similar effect was observed for interreader variability for LV volumes. Contrast administration on 3D echocardiography results in improved determination of LV volumes and reduced interreader variability. The use of 3D echocardiography requires contrast application as much as 2D echocardiography to reduce interreader variability for volumes and EF.

Abstract P4-01-21: Head to head comparison of standard echo doppler versus 3D speckle tracking echocardiography for early subclinical cardiotoxicity detection in breast cancer patients treated with anthracycline adjuvant chemotherapy

Abstract Background. Anthracycline (ANT)-containing regimens represent the prevalent choice for adjuvant therapy in early breast cancer (EBC) patients. However, cardio toxicity is a major limitation, strongly affecting the quality of life and the overall survival of cancer patients, regardless of the oncologic prognosis. Aims: To assess the diagnostic power of real-time 3D Speckle Tracking Echocardiography (STE) in comparison with standard echo Doppler (SED) in detection of early subclinical ANT related cardio toxicity in breast cancer patients. Methods: Fifty-five consecutive patients (F/M = 54/1, mean age = 48 years) with EBC were prospectively enrolled in the study. All patients received three cycles of epirubicin (EPI) based chemo regimen followed by taxanes. Overall, average EPI cumulative dose per patient was 505 ± 68 mg/m2 (range = 360-720 mg/m2). Complete SED exam including determination of 2D ejection fraction (EF) and pulsed Tissue Doppler of the mitral annulus were measured at baseline and at the end of the three cycles of EPI. Three-D determination of left ventricular volumes and EF as well as 3D STE-derived global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) were assessed, whenever feasible, at the same time points. Results: All the patients completed the three cycles of EPI as per protocol. No overt clinical manifestation of heart failure was observed. Standard echo doppler was performed in all the patients. Two-D EF did not significantly change with EPI treatment. However, the E/e’ ratio measured by SED, was significantly increased after EPI administration (6.7±1.7 vs. 7.25±1.8 before and after treatment, respectively; p&amp;lt;0.05). Overall, 3D ventricular volumetric assessment was feasible in the 63.6% (35/55) of patients and 3D STE in the 60% (33/55) of patients due to anatomical or technical problems. Among parameters measured by 3D STE, a reduction of EF (58.8±8% vs. 61.7±7.1%, before and after treatment, respectively; p&amp;lt;0.02) and a significant increase of the left ventricular end-systolic volume (p&amp;lt;0.01) was observed. Importantly, a significant decrease of the following 3D STE parameters: GLS (p&amp;lt;0.01), GRS (p&amp;lt;0.001), GCS (p&amp;lt;0.0001) and GAS (p&amp;lt;0.0001) were observed after EPI therapy. Conclusions: Results from the present study confirm the increased sensitivity of real time 3D STE technique in detecting early subclinical signs of cardio toxicity in patients with EBC treated with EPI adjuvant chemotherapy. However, due to technical problems, STE was not feasible in the entire patient population included in the study. Among parameters measured by SED, the E/e’ ratio identifies early signs of cardiac dysfunction more accurately compared to the standard 2D EF determination. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-21.

Minimally invasive intraoperative estimation of left-ventricular end-systolic elastance with phenylephrine as loading intervention

Left-ventricular end-systolic elastance (Ees) is an index of cardiac contractility, but the invasive nature of its assessment has limited perioperative application. We explored the feasibility of a minimally invasive method of Ees estimation for perioperative assessment of cardiac function and evaluated the suitability of phenylephrine as a loading intervention. In 17 surgical patients, Ees was determined as the slope of the end-systolic pressure-volume relation, which was obtained from non-invasive or invasive continuous arterial pressure measurements and left-ventricular volume determinations using transoesophageal echocardiography (TOE). Ees was determined using as loading interventions preload reduction by inferior vena cava compression (IVCC) and afterload increase by phenylephrine administration. Median invasive Ees determined with phenylephrine estimated 1.05 (0.59-1.21) mm Hg ml(-1) and with IVCC 0.58 (0.31-1.13) mm Hg ml(-1). Bland-Altman analysis to evaluate the level of agreement between minimally invasive and invasive Ees estimation revealed a bias of -0.03 (0.12) mm Hg ml(-1) with limits of agreement from -0.27 to 0.21 mm Hg ml(-1) and the percentage error was 33%. Agreement between Ees obtained with phenylephrine and IVCC revealed a bias of 0.15 (0.69) mm Hg ml(-1) with limits of agreement from -1.21 to 1.51 mm Hg ml(-1) and a percentage error of 149%. It is feasible to determine Ees combining continuous non-invasive arterial pressure measurements and left-ventricular volume determinations with TOE. However, administration of phenylephrine cannot substitute IVCC as a loading intervention, indicating that estimation of Ees in the intraoperative setting remains a challenge.

Three-Dimensional Mechanical Dyssynchrony and Myocardial Deformation of the Left Ventricle in Patients with Tricuspid Atresia after Fontan Procedure

The aim of this study was to test the hypothesis that dyssynchronous contraction of functional single ventricles occurs in Fontan patients and is related to indices of myocardial deformation and global ventricular function. Twenty patients with tricuspid atresia (mean age, 23.5 ± 7.1 years) were studied 17.8 ± 3.8 years after undergoing the Fontan procedure. Three-dimensional echocardiographic data were acquired for determination of left ventricular (LV) volumes and systolic dyssynchrony indices. LV myocardial deformation was determined using speckle-tracking echocardiography. Calibrated integrated backscatter intensity was measured as an index of myocardial fibrosis. The results were compared with those in 20 controls. Compared with controls, patients had significantly greater systolic dyssynchrony indices (6.13 ± 1.32% vs 4.06 ± 0.84%, P < .001). The prevalence of LV mechanical dyssynchrony (systolic dyssynchrony index > 5.74%) in patients was 55% (95% confidence interval, 32%-77%). LV global systolic longitudinal, radial, and circumferential strain (P < .001 for all), longitudinal systolic (P < .001) and early diastolic (P < .001) strain rate, and circumferential systolic (P < .001) and early diastolic (P= .009) strain rate were significantly lower in patients than in controls, while the average calibrated integrated backscatter was higher (P < .001). Patients with LV dyssynchrony (n= 11) had lower global LV longitudinal strain (P= .02), reduced LV ejection fractions (P= .002), and higher average calibrated integrated backscatter (P= .03) compared with those without LV dyssynchrony (n= 9). A high proportion of patients with tricuspid atresia after the Fontan operation exhibit LV mechanical dyssynchrony, which may in part be related to myocardial fibrosis and has implications for myocardial deformation and global ventricular function.

Three‐Dimensional Echocardiography in Evaluation of Left Ventricular Indices

Accurate determination of left ventricular mass, volume, ejection fraction, and wall motion is important for clinical decision making. Currently, M-mode and two-dimensional echocardiography (2DE) have been routinely used for this purpose. Although these 1D or 2D modalities provide excellent diagnostic and prognostic information, they have a number of technical limitations including the time required to perform the procedure and operator-dependent image acquisitions. In addition, they are inherently limited by geometric assumption of three-dimensional (3D) left ventricular structures based on 2D slices. With the improvement in transducer technology and software development, 3D echocardiography (3DE) has become widely available. Left ventricular quantitation by 3DE has been demonstrated to be accurate by multiple studies that compared 3DE with reference techniques. In addition, 3DE measurements were found to be more reproducible and less variable than 2DE. Real time 3DE imaging has potential advantages in stress echocardiography including rapid acquisition, unlimited number of planes, avoidance of foreshortening, and precise segment matching. This is a major step forward in our diagnostic armamentarium for the evaluation of ischemia. In this review, we summarized the current evidence of 3DE for left ventricular evaluation.

Systematic Evaluation of Current Possibilities to Determine Left Ventricular Volumes by Echocardiography in Patients after Myocardial Infarction

Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.