Evaluation Of Regional Wall Motion Research Articles

Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging.

The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.

The Prognostic Value of Coronary Flow Velocity Reserve in Two Coronary Arteries During Vasodilator Stress Echocardiography

Vasodilator stress echocardiography (SE) allows combined evaluation of regional wall motion and Doppler coronary flow velocity reserve (CFVR) of both the left anterior descending coronary artery (LAD) and the right coronary artery (RCA). The aim of this study was to prospectively assess the prognostic correlates of LAD and RCA CFVR on SE. A total of 1,365 patients with known or suspected coronary artery disease underwent dipyridamole SE with combined evaluation of CFVR in both the LAD and the RCA. Ischemia was present on SE in 263 patients (19%). CFVR was abnormal (≤2.0) in 545 patients (40%): 172 in the LAD only, 149 in the RCA only, and 224 in both the LAD and the RCA. During a median follow-up period of 20months, 44 deaths and 98 myocardial infarctions occurred. In the overall population, LAD CFVR ≤ 2.0 (hazard ratio [HR], 3.93) and inducible ischemia (HR, 2.74) were multivariate prognostic predictors. In the subset with ischemia on SE, CFVR did not add to peak wall motion score index (HR, 2.23). In patients without ischemia on SE, age (HR, 1.04), anti-ischemic therapy at the time of testing (HR, 1.6) and LAD CFVR≤2.0 (HR, 10.8) were independent prognostic indicators. In patients without ischemia on SE and LAD CFVR >2.0, the 4-year event rate was 4% in those with RCA CFVR > 2.0 and 18% in those with RCA CFVR ≤ 2.0 (P<.0001). Ischemia on SE with high peak wall motion score index identifies a high-risk subset regardless of the underlying CFVR response. Absence of ischemia on SE is associated with intermediate risk, and LAD CFVR is essential to identify a truly low-risk subset. RCA CFVR is less useful than LAD CFVR but may have a role for further risk stratification in patients without ischemia and normal LAD CFVR.

Prognostic value of dual imaging stress echocardiography following coronary bypass surgery

AimsTo assess the prognostic value of dual imaging stress echocardiography after coronary artery bypass grafting (CABG). Dual imaging stress echocardiography, combining the evaluation of regional wall motion and Doppler echocardiographic derived coronary flow velocity reserve (CFVR) of the left anterior descending artery (LAD), is the state-of-the-art methodology during vasodilatory stress. Methods and resultsIn a prospective, multicenter, observational study, 349 patients (270 men; 69 ± 9 years; 262 symptomatic) with history of CABG underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echocardiography with CFVR evaluation of LAD by Doppler. The composite endpoint of death and myocardial infarction was considered in the survival analysis. Positivity rate with either criteria was 13% in the 262 symptomatic patients with appropriate and 6% in the 87 asymptomatic patients with maybe/rarely appropriate indications on the basis of 2014 American College of Cardiology Foundation guidelines. During a median follow-up of 22 months (1st quartile 8, 3rd quartile 44), there were 56 (16%) events: 21 deaths, and 35 nonfatal myocardial infarctions. At Cox analysis, ischemia at stress echo (HR 4.80, 95% CI 2.69–8.55; p < 0.0001), and CFVR of LAD ≤2 (HR 2.28, 95% CI 1.32–3.95; p = 0.003) were multivariable prognostic predictors. Considering the group with no ischemia, patients with CFVR ≤2 showed 2.5 fold higher yearly hard events as compared to those with CFVR >2 (7.5 vs 2.9%; p = 0.002). ConclusionsDual imaging stress echocardiography provides useful prognostic information following CABG. Inducible ischemia and abnormal CFVR are strong and independent prognostic indicators in patients with appropriate and rarely/maybe appropriate indications.

The Value of Using Pulsed Tissue Doppler Mitral Annulus Velocity during Dobutamine Stress Echocardiography for Assessment of Myocardial Viability in Patients with Coronary Artery Disease before Revasularization

Background: Assessment of viability could be of significance in ischemic and heart failure patients before deciding for revascularization. The use of Dobutamine stress echocardiography has the disadvantage of subjective visual evaluation of regional wall motion, so, new technologies have been modified; one of these is to assess mitral annular velocity using tissue Doppler imaging. Aim: The aim of this study was to evaluate the value of Pulsed wave tissue Doppler mitral annulus velocity with dobutamine echocardiography in assessment of myocardial viability and prediction of functional recovery of wall motion abnormalities after revasularization in patients with coronary artery disease. Patients and methods: The study group included 40 patients, selected consecutively from patients presented to Ain Shams university Hospitals with coronary artery disease as proved by diagnostic coronary angiography and recommended for potential coronary revascularization. Each patient underwent baseline transthoracic echocardiography, in addition to low dose dobutamine echocardiography using TDI at mitral annulus in 6 different walls. All patients were subjected to revascularization (30 by PCI and 10 by CABG) then followed up after 6 months by transthoracic echocardiography to assess improvement in EF and SWMA. Results: Using the 16 segment method, a total of 640 segments were studied: 250 Segments were considered nondysfunctional (39%), 390 Segments were dysfunctional: of which, severely hypokinetc (216, 55.4 % of abnormal), 158 segments akinetic (40.5% of abnormal), and 16 Segments were dyskinetic (4.1% of abnormal). The mean SWM index at rest was 1.9 (0.39).Using low dose dobutamine echocardiography, 220 segments were detected to be viable (56.4%), while 170 were non-viable (43.6%). In order to relate the results of TDI, The 16 segments were reevaluated into 6 walls per patient. Using this method, 240 walls were studied. 19 walls were excluded due to technical difficulties in assessment of TDI. Pulsed wave TDI demonstrated that dysfunctional areas had lower systolic velocities compared to areas considered as normal. Similarly, the increase from baseline to DSE (ΔTDI) was higher in nondysfunctional areas vs. dysfunctional areas. However, there was no significant difference in the mean TDI at rest for viable and non-viable walls as detected by dobutamine stress echocardiography. But the increase in TDI velocity with peak dobutamine was significantly more in viable (1.97±0.44) vs. nonviable (1.14±0.54) walls, with p<0.0001.The ejection fraction improved from 39.87±8.22 (mean + STD) at baseline to 46.13±8.58 (mean + STD) at follow-up. The score index of the segmental wall motion during follow up after revascularization was 1.45±0.29 (mean+STD). Among the total dysfunctional segments detected at baseline echocardiography, follow-up echo postoperatively showed improvement by ≥1 score in 239 segments (61.3 %).In the 220 dobutamine positive segments, 182 segments improved postrevacsularization (82.7%) while 38 did not show improvement (17.3%), whereas in the segments designated as dobutamine non-viable, 122 segments were not improved (71.8%) and 48 segments (28.2%) improved post revascularization. Taking improvement as the gold standard for viability, sensitivity of dobutamine is: 82.7%, specificity 71.8%, PPV 79.1%, NPV 76.3%. Using TDI method, 115 (79.3%) walls were diagnosed as viable by this method, while 30 walls were nonviable (20.7%). 80 walls (55.2% of total studied walls) were detected to be viable by both dobutamine conventional 2D echocardiography and dobutamine TDI echocardiography (systolic wave), On the other hand, 27 walls (18.6% of total studied walls) were detected to be non-viable by both methods. However, 38 walls (26.2% of total abnormal walls) showed discordance between the two methods. The improvement of 74 walls of 80 combined TDI& DSE positive walls, making a sensitivity of 90.2%, similarly 24 of 27 concordant TDI & DSE negative walls did not improve, making a specificity of 92.3%. Conclusion: The current study confirmed the importance of using TDI in different mitral annular sites, as an objective tool in detecting myocardial viability, and to improve the sensitivity and specificity of DSE.

Correlation between plasma B-type natriuretic peptide levels and left ventricular diastolic function using color kinetic imaging

B-type natriuretic peptide (BNP) has been used widely as an objective marker for severity and prognostic predictor of heart failure. Recently it has been reported that plasma BNP level is associated with left ventricular (LV) diastolic dysfunction. Color kinesis (CK), a technique based on acoustic quantification, has been developed to facilitate the evaluation of regional wall motion and LV function. The aim of this study is to investigate the relationship between plasma BNP levels and LV diastolic function using diastolic CK imaging. The study included 65 subjects in sinus rhythm who were referred for echocardiography to evaluate cardiac function with simultaneous measurements of plasma BNP. Thirty-five patients were in New York Heart Association class I or II, and 15 were in class III or IV. We performed echocardiography with assessment of LV function, including LV ejection fraction (EF), transmitral flow (E/A), early diastolic mitral annular velocity (e'), and diastolic CK. Diastolic CK images, obtained from LV mid-papillary short-axis view, were analyzed using ICK software. The CK-diastolic index (CK-DI) was defined as the calculated LV segmental filling fraction during the first 30% of diastole, expressed as a percentage. The mean CK-DI was determined from the average CK-DI of six segments (anterior, anteroseptal, septal, inferior, posterior, lateral wall). Blood for BNP was collected on the same day as the echocardiographic study. We found significant correlations between mean CK-DI and log BNP (r=-0.66, p<0.0001), whereas log BNP correlated weakly with EF (r=-0.26), E/A (r=0.22), DT (r=-0.15) and E/e' (r=0.41). Our results suggest that the plasma BNP level may be related to LV relaxation. The analysis of diastolic CK may be useful for quantitative assessment of LV diastolic function in patients with heart failure.

Contrast echocardiography: Putting things into perspective – a Canadian Cardiovascular Society/Canadian Society of Echocardiography joint commentary

In a recently published Canadian Cardiovascular Society/Canadian Society of Echocardiography Position Paper on Contrast Echocardiography in Canada, we reviewed the clinical diagnostic utility of ultrasound contrast agents (UCAs) in echocardiography (1). These agents are approved in Canada for left ventricular (LV) opacifi-cation in suboptimal echocardiograms to enhance endocardial borders and ventricular chambers, and assess regional wall motion. Despite improvements in the quality of echocardiographic imaging, an estimated 5% to 10% of rest echocardiograms and 20% to 30% of stress echocardiograms remain suboptimal (2–4). The use of UCAs improves diagnostic accuracy and contributes to a cost-effective pattern of care (3). In previous clinical studies, UCAs have been shown to be safe and effective in numerous circumstances such as improving the accuracy of qualitative assessment of global LV systolic function as well as quantitative assessment of LV volumes and ejection fraction, improving the accuracy and interobserver agreement of LV regional wall motion evaluation, increasing the reproducibility and interobserver agreement in stress echocardiography interpretation, and helping to define specific anomalies (myocardial rupture, pseudoaneurysms, intracardiac thrombi, aortic dissection, LV noncompaction, apical hypertrophic cardiomyopathy, etc) (1). UCAs enhance Doppler signals and have been used during transesophageal echocardiography for left atrial appendage thrombus detection and assessment of aortic dissection (1).

Dual-Source CT with Improved Temporal Resolution in Assessment of Left Ventricular Function: A Pilot Study

Functional analysis using MDCT has been limited by insufficient temporal resolution. The aim of this study was to assess the performance of a dual-source CT system with improved temporal resolution in the determination of both volume- or time-dependent functional parameters and regional wall motion in comparison with cine MRI. Twenty patients (15 of whom had previous myocardial infarction) were prospectively examined using dual-source CT. MRI was used as the standard of reference. Using the Simpson's method, ventricular volumes were determined for the whole of the cardiac cycle and results compared using Parson's correlation and Bland-Altman analysis. Regional wall motion was assessed on cine images and compared using weighted kappa statistics. Dual-source CT revealed a strong correlation with cine MRI regarding the quantification of end-diastolic volume (r = 0.98), end-systolic volume (r = 0.99), stroke volume (r = 0.96), and ejection fraction (r = 0.95). Good correlation was obtained for peak ejection rate (r = 0.79) and peak filling rate (r = 0.84), whereas agreement proved only moderate for time-to-peak ejection rate (r = 0.68) or time-to-peak filling rate from end-systole (r = 0.64). The mean difference for ejection fraction was negligible (bias, 0.72%). Good agreement between both techniques was likewise found for regional wall motion (kappa = 0.88). With the improvement of temporal resolution between 42 and 83 milliseconds, dual-source CT not only enables accurate assessment of global functional parameters, but it also allows for quantification of time-dependent variables and reliable evaluation of regional wall motion.

Dual breath-hold magnetic resonance cine evaluation of global and regional cardiac function

The purpose of our study was to evaluate the accuracy of a multislice cine magnetic resonance imaging (MRI) technique with parallel imaging in regard to global and regional left ventricular function. Forty-two individuals underwent cine MRI on a 1.5-tesla scanner. Cine MRI used a steady-state free precession technique and was performed as a single-slice technique (nonTSENSE cine) and an accelerated multislice technique (TSENSE cine) with five slices per breath-hold. End diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) were evaluated for all data sets and in regard to regional wall motion and regional wall motion analysis, and quantitative regional wall thickness and systolic thickening were also assessed. EDV, ESV, and EF based on TSENSE cine showed excellent correlation to the nonTSENSE cine approach (all r(2)=0.99, P<0.001). While EDV evaluations showed a small underestimation for TSENSE cine, ESV and EF showed accurate results compared with nonTSENSE cine. Both readers showed good agreement (kappa=0.72) in regional wall motion assessment comparing both techniques. Data acquisition for the multislice approach was significantly shorter ( approximately 75%) that in single-slice cine. We conclude that accurate evaluation of regional wall motion and left ventricular EF is possible using accelerated multislice cine MR with high spatial and temporal resolution.

Accelerating cardiac cine 3D imaging using k-t BLAST.

By exploiting spatiotemporal correlations in cardiac acquisitions using k-t BLAST, gated cine 3D acquisitions of the heart were accelerated by a net factor of 4.3, making single breathhold acquisitions possible. Sparse sampling of k-t space along a sheared grid pattern was implemented into a cine 3D SSFP sequence. The acquisition of low-resolution training data, which was required to resolve aliasing in the k-t BLAST method, was either interleaved into the sampling process or obtained in a separate prescan to allow for shorter breathhold durations in patients with heart disease. Volumetric datasets covering the heart with 20 slices at a spatial resolution of 2 x 2 x 5 mm3 were recorded with 20 cardiac phases in a total breathhold duration of 25-27 sec, or 18 sec if partial Fourier sampling was additionally employed. The feasibility of the method was demonstrated on healthy volunteers and on patients. The comparison of endocardial area derived from single slices of the 3D dataset with values extracted from separate single-slice acquisitions showed no significant differences. By shortening the acquisition substantially, k-t BLAST may greatly facilitate volumetric imaging of the heart for evaluation of regional wall motion and the assessment of ventricular volume and ejection fraction.

Improved recognition of dysfunctioning myocardial segments by longitudinal strain rate versus velocity in patients with myocardial infarction

Doppler tissue imaging (DTI) can measure myocardial velocities but velocities alone cannot distinguish active from passive wall motion, whereas this is possible by strain rate (SR) imaging (SRI). We evaluated the accuracy of SRI for recognition of abnormal regional systolic function compared with DTI, B-mode echocardiography, and anatomic M-mode in 24 patients with myocardial infarction who underwent gated stress Tc 99m sestamibi scan. Sensitivity and specificity for recognition of infarct segments were 91% and 84% for visual SRI, 63% and 73% for visual DTI, 78% and 71% for B-mode echocardiography, and 87% and 77% for anatomic M-mode, respectively. Peak SRs correlated with wall-motion assessment by B-mode echocardiography better than peak velocities ( P = .66 vs .10), with less overlap between groups. Therefore, SRI improves evaluation of regional wall motion compared with DTI and conventional ultrasound techniques in patients with myocardial infarction, mainly because it identifies segments that are moving passively but not shortening normally.

Diagnosis of coronary vasospasm by detection of postischemic regional left ventricular delayed relaxation using echocardiographic evaluation with color kinesis.

Coronary vasospasm has been diagnosed by invasive provocative procedures during coronary arteriography. It would be useful to have a reliable, noninvasive, and safe diagnostic method for coronary vasospasm. Regional left ventricular (LV) diastolic dysfunction may persist without systolic dysfunction after an episode of coronary vasospasm. Color kinesis (CK) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion. Color kinesis may be useful for diagnosis of coronary vasospasm by detection of postischemic regional LV diastolic wall motion abnormality. Fifty-one consecutive patients with the last chest symptom within 2 weeks (4 +/- 3 days) were studied echocardiographically. Regional fractional area change during the first 30% of LV filling time in percentage of the segmental end-diastolic area change (CK diastolic index) was used to identify diastolic endocardial motion asynchrony. After diagnostic coronary arteriography with spasm provocation, 26 patients were diagnosed with coronary spastic angina (CSA) and the other 25 with chest pain syndrome (CPS). Regional delayed relaxation (CK-diastolic index < or = 50%) or diastolic asynchrony had been observed in at least one region in 25 (96%) patients with CSA, whereas it had been noted in 2 (8%) patients with CPS. In 17 (65%) patients with CSA, it had been detected in multiple vascular territories, suggesting multivessel spasm. The diastolic asynchrony disappeared in CSA after a month of angina-free period. Analysis of CK images allows identification of regional LV delayed relaxation or diastolic asynchrony in patients with coronary vasospasm, differentiating them from patients with chest pain syndrome (sensitivity 96%, specificity 92%).

Prolonged postischemic regional left ventricular delayed relaxation or diastolic asynchrony detected by color kinesis following coronary vasospasm

Coronary vasospasm is characterized by transient myocardial ischemia resulting from temporary coronary flow obstruction followed by reperfusion.1,2 Several studies have suggested that left ventricular (LV) diastolic function may be a more sensitive marker of coronary ischemia than systolic function.3–6 It is conceivable that impaired or stunned regional diastolic function follows transient severe myocardial ischemia associated with coronary vasospasm. To date, the postischemic process of normalization of regional diastolic function in patients with coronary vasospasm has not been investigated. We hypothesized that the adverse effect of spasm-induced ischemia on regional diastolic function would persist well beyond the ischemic event. Color kinesis (CK) (Philips Medical Systems, Andover, Massachusetts), a new technique based on acoustic quantification, has recently been developed to facilitate the evaluation of regional wall motion.7,8 The present study was designed to investigate whether impaired regional LV wall motion or diastolic asynchrony could actually be diagnosed using this method, and, if so, how long the regional diastolic dysfunction persists after coronary vasospasm.

Echocardiographic assessment of left atrioventricular plane displacement as a complement to left ventricular regional wall motion evaluation in the detection of myocardial dysfunction.

We aimed to find out if abnormal left atrioventricular plane displacement (AVPD) is a sign of myocardial dysfunction, even in patients with normal left ventricular (LV) regional wall motion (RWM). We prospectively performed echocardiography in 1350 consecutive patients referred to our echocardiography laboratory. Left AVPD and LV RWM were evaluated in all patients. We prospectively selected all patients with normal LV RWM but impaired left AVPD for further analysis of clinical parameters. Eighty-eight of the 1350 patients had completely normal LV RWM but impaired left AVPD (< or = 10 mm) in at least one region (septal, lateral, posterior, anterior). Of these, 60.2% had prior and/ or acute myocardial infarction, predominantly non-Q-wave, whereas 33.0% had angina without infarction and 2.3% had hypertension. In 49 (55.7%) patients coronary angiography was performed. All were abnormal. In 4.5% (n = 4) of the patients no obvious reason for the AVPD decrease was found, but was not precluded. Almost all patients with abnormal left AVPD and completely normal LV RWM had clinical cardiac disease. Thus, decreased AVPD despite normal LV RWM seems to be a true sign of myocardial dysfunction, predominantly indicating subendocardial dysfunction. In screening for patients with myocardial dysfunction assessment of left AVPD may be useful as a complement to LV RWM evaluation. The prognosis in such patients is currently being evaluated.

Evaluation of regional wall motion and quantitative measures of ventricular function during dobutamine stress echocardiography in pediatric cardiac transplantation patients

Background: Graft coronary disease is a leading cause of death in patients who have undergone cardiac transplantation. The purpose of this study was to evaluate regional wall motion response and quantitative measures of ventricular function during dobutamine stress echocardiography (DSE) in pediatric transplantation patients. Methods: Eleven patients were evaluated the first year after transplantation (10/11 no rejection). Ten of the 11 were reevaluated 1.2 ± 0.3 years later (9/10 no rejection). Results: Dobutamine stress echocardiography revealed the following: (1) baseline regional wall motion abnormalities in 80% that resolved in all, (2) increased heart rate and blood pressure, (3) no change in left ventricular end-diastolic diameter, (4) decreased end-systolic diameter, (5) decreased wall stress and increased velocity of circumferential fiber shortening, (6) increased VCFcZ score (representing systolic left ventricular function), and (7) a decreased mitral passive-to-active filling ratio. Patients with rejection had abnormal VCFcZ scores at rest. Conclusions: Pediatric transplantation patients without rejection have baseline regional wall motion abnormalities. With DSE, the following are present: (1) resolution of wall motion abnormalities, (2) increased contractility independent of load, and (3) changes in diastolic parameters that reflect increased heart rate. Patients with rejection may have abnormal contractility at rest. (J Am Soc Echocardiogr 2000;13:932-40.)

Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images

OBJECTIVESTo test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analysis of color kinesis (CK) images to detect dobutamine-induced wall motion abnormalities and compared this technique with inexperienced reviewers of conventional gray-scale images.BACKGROUNDConventional interpretation of stress echocardiographic studies is subjective and experience dependent.METHODSCK images were obtained in 89 of 104 consecutive patients undergoing clinical dobutamine stress studies and were analyzed using custom software to calculate regional fractional area change in 22 segments in four standard views. Each patient’s data obtained at rest was used as a control for automated detection of dobutamine-induced wall motion abnormalities. Independently, studies were reviewed without CK overlays by two inexperienced readers who classified each segment’s response to dobutamine. A consensus reading of two experienced reviewers was used as the gold standard for comparisons. In a subgroup of 16 patients, these consensus readings and CK detection of wall motion abnormalities were compared with coronary angiography.RESULTSThe consensus reading detected ischemic response to dobutamine in 43 of 1958 segments in 23 of 89 patients. Automated detection of stress-induced wall motion abnormalities correlated more closely with the standard technique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specificity 0.98 vs. 0.94 and accuracy 0.97 vs. 0.92). When compared with coronary angiography in a subgroup of patients, analysis of CK images differentiated between normal and abnormal wall motion more accurately than expert readers of gray-scale images (accuracy of 0.93 vs. 0.82).CONCLUSIONSAnalysis of CK images allows fast, objective and automated evaluation of regional wall motion, sensitive enough for clinical dobutamine stress data and more accurate than inexperienced readers. This method may result in a valuable adjunct to conventional visual interpretation of dobutamine stress echocardiography.

Computer evaluation of left ventricular wall motion by means of shape-based tracking and symbolic description

Relevant cardiac pathologies manifest themselves as abnormal movements of left ventricular (LV) myocardial wall. An objective quantification is usually accomplished by computer analysis of temporal sequences of LV contours, as obtained by angiography or echography. However the choice of the reference system for measuring motion is still open to discussion. Simple geometric models cannot deal with the non-uniform myocardial fibre structure, which gives rise to non-rigid movements, asynchronous even in normal subjects. Therefore, a new method, Curvature–Motion (CM), was developed for improving motion assessment. Since LV contour shape and position change smoothly throughout the cardiac cycle, the points of curvature extremes are tracked frame-to-frame and selected by exploiting physiologically-based assumptions; then, the points lying among these landmarks are mapped onto sequential contours, according to local displacements and curvature changes. In this way point-trajectories are allowed to be curvilinear and different in systole and diastole. CM gave no significant differences in estimating the known motion of computer-generated contours ( R=0.88), unlike other methods commonly adopted ( R<0.80). Moreover, for the evaluation of regional wall motion of a pre-classified set of angiographic contours, CM showed a greater specificity (88%) and accuracy (90%) with respect to the centre-line method (respectively 83% and 87%). Finally, a fuzzy logic inference system is proposed for translating significant motion patterns from the quantitative form, as provided by the analysis method, into the linguistic terms used by cardiologists in their clinical examinations. This makes the interpretation of quantitative analysis easier and allows medical users to interact with the system for searching particular properties in a single clinical report as well as in a large database.

New modalities of regional and global left ventricular function analysis: state of the art

Study of left ventricular (LV) regional and global function represents a main point of the cardiologic evaluation. This article presents an overview of the state of the art in quantitative analysis of ventricular wall motion and describes the different techniques available in clinical settings; we also present the personal experience of the authors in comparing conventional 2-dimensional (2D) echocardiography with other recently developed, more sophisticated techniques. Conventional 2D echocardiography mainly depends on the operator’s ability. Moreover, the physiologic regional pattern of myocardial wall motion in different segments of left ventricle is still not completely known as well as the heart’s rotational and translational movements. Qualitative and quantitative transesophageal echocardiography allows a better and more accurate evaluation of regional wall motion, and improves the on-line border detection feasibility even in patients with poor transthoracic echocardiographic window. The automated system for on-line endocardial border detection, color kinesis, and the power Doppler are, at the moment, promising techniques. Using magnetic resonance imaging as a “gold standard” for the study of global and regional left ventricular function, the investigators describe personal experiences with tissue Doppler imaging and a new computerized system for tissue Doppler images postprocessing analysis.

Segmental analysis of color kinesis images: new method for quantification of the magnitude and timing of endocardial motion during left ventricular systole and diastole.

We describe a method for objective assessment of left ventricular (LV) endocardial wall motion based on Color Kinesis, a new echocardiographic technique that color-encodes pixel transitions between blood and myocardial tissue. We developed a software that analyzes Color Kinesis images and provides quantitative indices of magnitude and timing of regional endocardial motion. Images obtained in 12 normal subjects were used to evaluate the variability in each index. Esmolol, dobutamine, and atropine were used to track variations in LV function in 14 subjects. Objective evaluation of wall motion was tested in 20 patients undergoing dobutamine stress testing. Regional fractional area change, displacement, and radial shortening were displayed as histograms and time curves. Global function was assessed by calculating magnitude and timing of peak ejection or filling rates and mean time of ejection or filling. Patterns of endocardial motion were consistent between normal subjects. Fractional area change and peak ejection rate decreased with esmolol and increased with dobutamine. Time to peak ejection and mean time of contraction were prolonged with esmolol and shortened with dobutamine. Using atropine, we proved that our findings with dobutamine were not secondary to its chronotropic effects. Dobutamine induced regional wall motion abnormalities in 10 patients in 38 segments diagnosed conventionally. Segmental analysis detected abnormalities in 36 of these 38 segments and in an additional 5 of 322 segments. Analysis of Color Kinesis images allows fast, objective, and automated evaluation of regional wall motion sensitively enough to evaluate clinical dobutamine stress data. This method has significant potential in the diagnosis of myocardial ischemia.

80. 局所壁運動評価におけるColor Kinesis法の有用性 : 視覚的評価との比較

80. 局所壁運動評価におけるColor Kinesis法の有用性 : 視覚的評価との比較

Contrast cine left ventriculography: Comparison of two pigtail catheter shapes and analysis of factors determining the final quality

Ventricular arrhythmias or inadequate opacification of the ventricular cavity during contrast-cine left ventriculography frequently interfere with evaluation of regional wall motion, ejection fraction or mitral regurgitation. In this prospective, randomized study traditional (straight) pigtail catheter was compared with a new, large loop pigtail catheter (both 6 French, large lumen) in terms of the quality of the cine left ventriculograms. Straight (Group I) and curved pigtail (Group II) groups were further subdivided randomly into a preset (13 cc per second for 3 seconds with a pressure rise time of 0.5 seconds) injection rate (Group IA, n = 46, and Group IIA, n = 48) or operator definded injection rate (Group IB, n = 49, and Group IIB, n = 45) subgroups. The ventricular tachycardia and couplets occurred at similar frequency among the groups. The curved pigtail subgroups showed significantly more frequent catheter induced mitral regurgitation. However, the opacification and overall quality of the left ventriculograms were distributed similarly between the groups. Because the catheter type and injection protocol did not affect the left ventriculogram quality in our study, variables determining opacification and overall quality rating are analyzed in the overall group of 190 patients. Left ventricular opacification was excellent in 72, acceptable in 108 and marginal in 10 patients. The patients with marginal opacification were significantly heavier (P = .004) with larger left ventricular enddiastolic volumes (P = .019), and smaller amount of contrast volume per enddiastolic volume (P = .005) and kilogram body weight (P = .003). The overall quality of left ventriculograms were excellent in 38, acceptable in 133, and marginal in 19 patients. The patients with excellent left ventriculograms were significantly younger (P = .019) and slightly less heavy (P = 0.09). Significantly more female patients were also in this group (P = .036). Ventricular tachycardia was the most common cause of unsatisfactory left ventriculograms. In the RAO view, deeper (more apical) placement of the catheter was associated with higher incidence of ventricular tachycardia (53%). The most "silent" area was the posterobasal area. In conclusion, the perfect left ventriculogram remains to be an elusive goal in routine clinical practice. When using 6F highflow pigtail catheters and nonionic contrast agents, more basal catheter position and higher contrast volume increase the quality of the left ventriculograms.