Regional End-diastolic Volume Research Articles

Three-Dimensional Echocardiography and Coagulation Function Detection in the Prognosis Evaluation of Patients with Acute Myocardial Infarction.

This research was aimed at discussing the application value of coagulation function detection and three-dimensional echocardiography in the prognosis evaluation of acute myocardial infarction (AMI) patients. 72 patients with AMI were divided into the recovered group (good recovery) and unrecovered group (poor recovery) according to the results of postoperative ultrasonography. The left ventricular parameters of the patients were detected by three-dimensional ultrasound, and the coagulation function was also detected. The results showed that 3 months after surgery, the regional end-systolic volume (rESV) and regional end-diastolic volume (rEDV) of the left ventricle in the patients were smaller than the measured values 1 week after surgery. The left ventricular regional ejection fraction (rEF) was greater than the value measured 1 week after surgery, and all the differences were statistically significant (P < 0.05). For the end-systolic volume (ESV), end-diastolic volume (EDV), and ejection fraction (EF) (%), the two-dimensional ultrasound results were significantly lower than the three-dimensional ultrasound results, and there were significant differences (P < 0.05). Tmsvle6-Dif% of the recovered patients was 14.99 ± 9.88 and 14.37 ± 9.78 3 months and 6 months after surgery, respectively. These were smaller than 30.91 ± 18.63 and 33.51 ± 17.96 of the unrecovered patients; the differences were of statistical significance (P < 0.05). Tmsvl6-SD% of recovered patients was 3.69 ± 2.47 and 3.61 ± 1.83 3 months and 6 months after surgery, respectively, which were also smaller than 7.38 ± 4.06 and 7.96 ± 2.82 of unrecovered patients, showing statistically significant difference (P < 0.05). The postoperative Tmsvle6-Dif% and Tmsvl6-SD% of the recovered group were lower than those of the unrecovered patients, with the statistically significant differences (P < 0.05). The level of coagulation factors in the recovered group was also significantly lower than that in the unrecovered group with the difference statistically significant (P < 0.05). The results suggested that three-dimensional echocardiography played an important role in the evaluation of cardiac conditions in AMI patients. The level of coagulation factors varied with the AMI condition of patients, and there was an obvious relationship between them, which could provide a reference value for the prognosis evaluation of patients.

Restoration of optimal ellipsoid left ventricular geometry: lessons learnt fromin silicosurgical modelling

Several issues that are inherent in the surgical techniques of surgical ventricular restoration (SVR) need specialized devices or techniques to overcome them, which may not always result in optimal outcomes. We used a non-invasive novel in silico modelling technique to study left ventricular (LV) morphology and function before and after SVR. The cardiac magnetic resonance imaging derived actual pre- and postoperative endocardial morphology and function was compared with the in silico analysis of the same. Cardiac magnetic resonance steady state free precession (SSFP) cine images were employed to segment endocardial surface contours over the cardiac cycle. Using the principle of Hausdorff distance to examine phase-to-phase regional endocardial displacement, dyskinetic/akinetic areas were identified at the instant of peak basal contraction velocity. Using a three-dimensional (3D) surface clipping tool, the maximally scarred, dyskinetic or akinetic LV antero-apical areas were virtually resected and a new apex was created. A virtual rectangular patch was created upon the clipped surface LV model by 3D Delaunay triangulation. Presurgical endocardial mechanical function quantified from cine cardiac magnetic resonance, using a technique of spherical harmonics (SPHARM) surface parameterization, was applied onto the virtually clipped and patched LV surface model. Finally, the in silico model of post-SVR LV shape was analysed for quantification of regional left ventricular volumes (RLVVs) and function. This was tested in 2 patients with post-myocardial infarction antero-apical LV aneuryms. Left ventricular mechanical dysynchrony was evaluated by RLVV analysis of pre-SVR, in silico post-SVR and actual post-SVR LV endocardial surface data. Following exclusion of the scarred areas, the virtual resected LV model demonstrated significantly lesser areas of akinesia. The decreases in regional LV volumes in the in silico modelling were significant and comparable with the actual decreases following SVR. Both the regional end diastolic volume (EDV) and end systolic volume (ESV) at the apex decreased significantly corresponding to greater reductions in apical volumes by the technique of rectangular patch plasty (apical EDV 2.1607 ± 0.20577 to 0.4774 ± 0.1775 ml, P = 0.007; apical ESV 1.9708 ± 0.36451 to 0.442 ± 0.047 ml, P = 0.013). This pilot study was done using novel in silico techniques for virtual surgical modelling, which helped in accurate estimation and planning of optimal LV restoration by SVR.

Assessment of regional left ventricular systolic function in patients with hypertrophic cardiomyopathy by real-time three-dimensional echocardiography

Objective To assess regional left ventricular systolic function in patients with hypertrophic cardiomyopathy (HCM) using real-time three-dimensional echocardiography (RT-3DE).Methods Twenty-five patients with HCM which was asymmetric septal hypertrophy,and twenty healthy subjects were enrolled in the study.The apical four-chamber view of left ventricular was acquired by RT-3DE.The left ventricular volume-time curves were analyzed quantitatively with Tomtec 4D LV-Analysis 3.0,and regional end-diastolic volume and end-systolic volume of left ventricular (rEDV,rESV),the time to minimum systolic volume (rESVT),regional stroke volume (rSV),regional ejection fraction (rEF),regional-global ejection fraction (rgEF) and the parameters of left ventricular dyssynchrony were measured.Results In the HCM group,the values of Tmsv16-Dif,Tmsv16-SD,Tmsv16-Dif％,Tmsv16-SD％ were significantly lower compared with the control group (P ＜ 0.01),and rEDV,rSV,rEF and rgEF in hypertrophic segments were lower than those in non-thickening and mild-thickening segments (P ＜0.05).In the control group,there were no significant difference of those parameters among all segments (P ＞0.05).The values of rEDV,rSV and rgEF in hypertrophic segments decreased in the HCM group (P ＜0.05),at the basal level,rEF in hypertrophic segments decreased,at the apical level,it increased,but the differences at the mid-ventricular level between the two groups were not significant;the values of rEF and rgEF in non-thickening and mild-thickening segments increased (P ＜0.05).Conclusions RT-3DE could sensitively detect left ventricular dyssynchrony and accurately assess regional left ventricular volume and function of different segments in patients with HCM. Key words: Echocardiography, real-time three-dimensional; Cardiomyopathy, hypertrophic; Ventricular function, left

Evaluation of right ventricular global and regional volume and systolic function in patients with atrial septal defect using real-time three-dimensional echocardiography

Objective To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE),and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods RT3DE images were acquired from 22 patients with secundum ASD and 22 normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV),end systolic volume (ESV),systolic volume (SV) and ejection fraction (EF) in three compartments (inflow,body and outflow).RV dyssynehrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv％) in three RV compartments.Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP),pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.Results RV global and regional EDV,ESV and SV were larger (all P ＜0.001) and EF was lower (all P ＜0.05) in the ASD group than in the controls.RV regional volume and systolic function were changed to various degrees in different compartment in the patients group.There were no significant differences in Tmsv,Tmsv％ and RV dyssynchrony parameters between the two groups.In patients with ASD,RV global and regional EDV,ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r =0.463-0.704,all P ＜ 0.05) ; RV global EF was negatively correlated with PVRe (r =-0.477,P ＜ 0.05).Conclusions In patients with ASD,RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global volume and regional volume in the inflow compartment were positively correlated with RV pre-load while RV global EF was negatively correlated with RV afterload. Key words: Echocardiography, three-dimensional; Ventricular function, right; Heart septal defect,atrial

Evaluation of Right Ventricular Regional Volume and Systolic Function in Patients with Pulmonary Arterial Hypertension Using Three‐Dimensional Echocardiography

To evaluate right ventricular (RV) regional volume and systolic function in patients with pulmonary arterial hypertension (PAH) using real time three-dimensional echocardiography (RT3DE), and to explore the relationship between parameters measured by RT3DE and right heart catheterization (RHC). RT3DE images were acquired from 24 patients with PAH and 27 normal controls for evaluation and analysis to obtain RV regional end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) in three compartments (inflow, body, and outflow). Conventional echocardiographic parameters were calculated and recorded. RHC was performed in 17 patients to obtain pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). RV regional EDV and ESV were significantly higher while regional EF was significantly lower in the PAH patients when compared with controls (P < 0.001). In the PAH group, EDV was similar in the inflow and body compartment, both higher than that in the outflow compartment (P < 0.05); EF was the highest in the inflow compartment and the lowest in the body compartment (P < 0.05). RV regional EF in the inflow compartment and global EF were negatively correlated with PASP (r =-0.766, -0.816, P < 0.001) and PVR (r =-0.529, -0.656, P < 0.05). In patients with PAH, RV regional volume was enlarged and systolic function was impaired with distinct characteristics; regional EF in the inflow compartment and global EF were inversely correlated with PASP and PVR. Evaluation of RV regional systolic function using RT3DE may play a potential role in the noninvasive assessment of the severity of PAH.

Evaluation of right ventricular global and regional volume and systolic function in normal children by real-time three-dimensional echocardiography

Objective To evaluate right ventricular(RV) global and regional volume and systolic function by real-time three-dimensional echocardiography (RT-3DE) in normal children with different age.Methods One hundred and ninty-two normal children were divided into five groups by age:group Ⅰ,＜1 years old,32 cases;group Ⅱ,≥1 years old-＜3 years old,46 cases;group Ⅲ,≥3 years old-＜6 years old,36 cases;group Ⅳ,≥6 years old-＜9 years old,41 cases;group Ⅴ,≥9 years old-＜14 years old,37 cases.Full volume imaging of RV was obtained at the parasternal four-chamber view near the apex by RT-3DE.RT-3DE data set were analyzed off-line by TomTec RV-Function.RV were divided into three parts:inflow,body,outflow.The measurements were including RV global and regional end-diastolic volume (EDV),end-systolic volume (ESV),ejection fraction (EF) and the ratio of regional parts EDV to RVEDV. The volume and systolic function were compared in three regional parts.RV global and regional parts EF and the ratio of regional parts EDV to RVEDV were also compared in five age groups.Correlation analysis and curve estimation were studied on RV global and regional EDV with age and physical development indexes.Results In the comparison of three regional parts:inflow EDV and EF were higher than outflow and body parts (P＜0.05).No significant different was found between outflow EDV and body EDV (P＞0.05),however,outflow EF was significant higher than body EF(P＜0.05).The comparison of RV global and regional EF in five age groups were no statistical different (P＞0.12). The ratio of regional parts EDV to RVEDV remained constant in five age groups(P＞0.58).Correlation analysis showed the global and regional RV volume were strongly correlated with age,height,weight and BSA (r＞0.77,P=0.000).The best correlation was found with BSA (r＞0.83,P=0.000).Curve estimation demonstrated that the relationship of RV global and regional EDV with age and physical development indexes could be best expressed by power model,the best matched model were found with BSA.Conclusions Among three regional parts of RV,inflow and outflow parts volume contraction were the two main contribution factors for RV function.In childhood RV volume didn't increase linearly with age and physical development indexes,but in an exponential model. Key words: Echocardiography,real-time three-dimensional; Children; Ventricular function,right

Real Time Three‐Dimensional Echocardiographic Assessment of Left Ventricular Regional Systolic Function and Dyssynchrony in Patients with Dilated Cardiomyopathy

To evaluate left ventricular (LV) regional systolic function and dyssynchrony in patients with dilated cardiomyopathy (DCM) by real time three-dimensional echocardiography (RT-3DE). The study population comprised 30 normal controls (NOR) and 44 patients with DCM. We divided the left ventricle into apical, middle, and basal regions. We calculated the LV regional end-diastolic volume ((R)EDV), regional end-systolic volume ((R)ESV), regional ejection fraction ((R)EF), and standard deviation in the time to minimal systolic volume in each level segment (Tmsv-SD) of the three regions by RT-3DE. Compared with NOR, the (R)EDV, (R)ESV, and Tmsv-SD of DCM were significantly higher, whereas the (R)EF was lower (P < 0.01). In DCM, the Tmsv-SD increased smoothly from base to apex, and the (R)EF gradually decreased from base to apex (P < 0. 05). Linear correlation was observed between the Tmsv-SD of the middle region and 3D-EF in DCM (r =-0. 6829, P < 0.01). RT-3DE provides a simple and feasible approach to quantify LV regional systolic function and dyssynchrony.

Quantification of Regional Volume and Systolic Function of the Left Ventricle by Real-Time Three-Dimensional Echocardiography

Real-time three-dimensional (3D) echocardiography (RT-3DE) provides a unique technique to evaluate left ventricular regional function in a 3D format. We aimed to explore whether the left ventricular segmental volume and systolic function is uniform and to establish normal values of volume and systolic function parameters of 16 regions in healthy subjects. RT-3DE was performed in 41 normal subjects and four-dimensional (4D)-left ventricle (LV) analysis software and a TomTec workstation were used to analyze data for regional end-diastolic volume (EDV R), regional end-systolic volume (ESV R), regional stroke volume (SV R), regional ejection fraction (EF R), ratio of SV R to global SV (SV R/G) and ratio of SV R to global EDV (EF R/G). All regional volume and systolic function parameters were not uniform among the left ventricular walls. They all increased in the order of inferior, posterior, lateral, septal, anterior and antero-septal walls with an increasing trend from the apical, middle to basal segments. The systolic function (EF R, SV R/G and EF R/G) of the anterior and antero-septal walls was significantly higher than that of the lateral, inferior and posterior walls. And the intra- and interobserver variability for EDV R, ESV R, SV R/G and EF R/G ranged from 2.9% to 5.8%. In conclusion, the regional volume and systolic function of the left ventricle is not uniform and, therefore, a normal left ventricle cannot be regarded as a symmetric model for assessing the regional systolic function. This information may improve the accuracy of RT-3DE techniques in the assessment of the left ventricular regional function. (E-mail: zhangyun@sdu.edu.cn and yaogh@yahoo.com)

611 Surface detection and color-encoding applied to real-time three-dimensional echocardiographic images as a basis for automated assessment of left ventricular wall motion

Purpose: Color encoding of left ventricular (LV) endocardial motion in 2D echo (2DE) has been shown to improve visual detection of regional wall motion abnormalities (RWMA). Our goals were: 1) to extend this technique to color encode detected LV endocardial surfaces from real-time 3D echo (RT3DE) images; 2) to automatically detect systolic RWMA and test its accuracy against visual interpretation of 2DE images. Methods: 19 normal subjects (N), and 14 patients with RWMA (including 7 with global LV dysfunction) underwent RT3DE and 2DE (Philips). 2DE images (apical 2-, 3and 4-chamber) were reviewed by an expert cardiologist, who graded wall motion (18 segments model) as normal or abnormal (AB). RT3DE datasets were analyzed using custom software: frame-by-frame semiautomated LV surface detection was followed by logical operations applied to each pair of consecutive frames, to track and color encode endocardial motion in 3D. Then, regional fractional volume change (RFVC) in % of regional end-diastolic volume was calculated automatically by colored voxels count, and displayed as stacked color-histograms. In RWMA, RFVCs were compared with regional thresholds, derived from RFVC computed in N and optimized using ROC analysis, for automated classification of wall motion. Results: The generation of 3D color-encoded wall-motion and RFVC quantification took <10 sec. In RWMA, 182/252 segments were graded as AB (Figure 1, arrows). The automated technique agreed with the expert reader in 225/252 (89%) segments, with only 8/252 (3%) false positive and 19/252 (8%) false negative detections (sensitivity: 0.91; specificity: 0.80; accuracy: 0.84). Conclusions: The proposed technique could improve the visual assessment of wall motion from RT3DE images, and represent the basis for automated detection of RWMA.

Patterns of regional diastolic function in the normal human left ventricle: An ultrafast computed tomographic study

The detailed evaluation of regional diastolic filling at multiple ventricular levels in the normal human left ventricle has not previously been reported. Ultrafast computed tomography was used to characterize global and regional early diastolic filling in the left ventricle of 11 normal male volunteers. Regional early diastolic filling data from six distinct ventricular levels (apex to base) were fit to a third-order polynomial curve, and the peak rate of diastolic filling and time of peak filling were determined. Peak filling rate was 259 ± 17 ml/s (±SEM) as a global average, where peak filling rate referenced to end-diastolic volume and stroke volume across the levels examined was 3.78 ± 0.17 s−and 4.83 ± 0.20 s−respectively. Average filling fraction was 39 ± I%, and time to peak filling from end-systole was 145 ± 5 ms.Regional (tomographic) peak filling rates, except for the most apical level examined, were not statistically different across the ventricle. Filling fraction and time to peak filling were remarkably constant from one level to another. However, reference of regional peak filling rate to regional end-diastolic volume demonstrated significant nonuniformity from apex (120% of average for all levels) to base (87% of average for all levels). Peak filling rate referenced to tomographic stroke volume was less variable and not statistically different across the ventricle as a whole.In conclusion, values of regional absolute early peak diastolic ventricular filling rate or values normalized for regional end-diastolic volume are characteristically nonuniform across the left ventricle, whereas other variables such as filling fraction, time to peak filling and regional peak filling rate referenced to regional stroke volume are highly uniform. This confirms an intimate relation between rates of regional diastolic filling and regional ventricular size and stroke volume in the normal human heart.