Simpson's Method Of Discs Research Articles

Correlation of Speckle-Tracking Echocardiography with Traditional Biomarkers in Predicting Cardiotoxicity among Pediatric Hemato-Oncology Patients: A Comprehensive Evaluation of Anthracycline Dosages and Treatment Protocols.

Speckle tracking-echocardiography (STE) is a novel non-invasive imaging tool capable of quantifying myocardial deformation, and thus holds promise in detecting early subclinical myocardial injury. This study aimed to evaluate the correlation of STE with traditional biomarkers in predicting anthracycline-induced cardiotoxicity in the context of varying dosages and treatment protocols in pediatric hemato-oncology patients. We conducted a retrospective study involving pediatric hemato-oncology patients undergoing anthracycline-based chemotherapy. A total of 99 patients were included in the final analysis, with 82 receiving Doxorubicin, of which 58.5% were males, and 17 receiving Epirubicin, of which 70.6% were males, with a median of 10 years old. Traditional biomarkers, such as Troponin I (cTnI) and B-type natriuretic peptide (BNP), were compared with STE parameters, including the global longitudinal strain (GLS), Simpson method of discs (SMOD), and myocardial performance index (MPI). A comprehensive evaluation was conducted based on different dosages of anthracyclines and different treatment protocols, with a follow-up period of one year post-chemotherapy. It was observed that the cTnI levels in the Doxorubicin group were significantly higher (3.2 ng/mL, p = 0.002) than in the Epirubicin group (2.7 ng/mL). However, BNP and NT-proBNP levels were not significantly different between the two groups (p = 0.096 and p = 0.172, respectively). Regarding STE parameters, a significant negative correlation was observed between the anthracycline dose and GLS (Rho = -0.411, p = 0.001), indicating increased cardiotoxicity with dose elevation. The SMOD and MPI gave significantly better values in the Epirubicin group (59.2 and 0.41 vs. 54.4 and 0.36, respectively). However, the ROC analysis did not find GLS, SMOD, or MPI to be significant independent predictors of cardiotoxicity (p > 0.05). There was also considerable variation in cardiotoxicity between the Doxorubicin and Epirubicin study groups, suggesting that the risk of cardiotoxicity is not solely determined by dose. Our study underlines the potential of STE as a sensitive tool for the early detection and prediction of anthracycline-induced cardiotoxicity in pediatric hemato-oncology patients, but only in association with the clinical findings and cardiac biomarkers. While traditional biomarkers still play a role, STE can offer a more accurate prediction of cardiac risk, potentially leading to better management and outcomes for these patients.

Relation of Myocardial Perfusion Reserve and Left Ventricular Ejection Fraction in Ischemic and Nonischemic Cardiomyopathy

Quantification of myocardial perfusion reserve (MPR) using vasodilator stress cardiac magnetic resonance is increasingly used to detect coronary artery disease. However, MPR can also be altered because of changes in microvascular function. We aimed to determine whether MPR can distinguish between ischemic cardiomyopathy (IC) secondary to coronary artery disease and non-IC (NIC) with microvascular dysfunction and no underlying epicardial coronary disease. A total of 60 patients (mean age 65 ± 14 years, 30% women), including 31 with IC and 29 with NIC, were identified from a pre-existing vasodilator stress cardiac magnetic resonance registry. Short-axis cine slices were used to measure left ventricular ejection fraction (LVEF) using the Simpson method of disks. MPR index (MPRi) was determined from first-pass myocardial perfusion images during stress and rest using the upslope ratio, normalized for the arterial input and corrected for rate pressure product. Patients in both groups were divided into subgroups of LVEF ≤35% and LVEF >35%. Differences in MPRi between the subgroups were examined. MPRi was moderately correlated with LVEF in patients with NIC (r=0.53, p=0.03), whereas the correlation in patients with IC was lower (r=0.32, p=0.22). Average LVEF in NIC and IC was 34% ± 8% and 35% ± 8%, respectively (p=0.63). MPRi was not significantly different in IC compared with NIC (1.17 [0.88 to 1.61] vs 1.23 [1.07 to 1.66], p=0.41), including the subgroups of LVEF (IC: 1.20 ± 0.56 vs NIC: 1.15 ± 0.24, p=0.75 for LVEF ≤35% and IC: 1.35 ± 0.44 vs NIC: 1.58 ± 0.50, p=0.19 for LVEF >35%). However, MPRi was significantly lower in patients with LVEF ≤35% compared with those with LVEF>35% (1.17 ± 0.40 vs 1.47 ± 0.47, p=0.01). Similar difference between LVEF groups was noted in the patients with NIC (1.15 ± 0.24 vs 1.58 ± 0.50, p=0.006) but not in the patients with IC (1.20 ± 0.56 vs 1.35 ± 0.44, p=0.42). MPRi can be abnormal in the presence of left ventricular dysfunction with nonischemic etiology. This is a potential pitfall to consider when using this approach to detect ischemia because of epicardial coronary disease using myocardial perfusion imaging.

Comparison of three two-dimensional echocardiographic methods of assessing left ventricular size in Doberman Pinschers

IntroductionCompare three methods of obtaining linear left ventricular dimensions within the same Doberman Pinscher (DP). AnimalsOne hundred and thirty-nine client-owned DP. Materials and MethodsLinear left ventricular dimensions were measured using two-dimensional short-axis (Sx-2D), motion-mode short-axis (Sx-MM), and motion-mode long-axis (Lx-MM) methods, then left ventricular volumes were obtained using monoplane Simpson's method of discs (SMOD). A Friedman test with Dunn's multiple comparisons was used to compare differences between methods. Bias and correlation were evaluated via Bland-Altman and Spearman's correlation. Sensitivity and specificity for diagnosing occult dilated cardiomyopathy (DCM) compared to SMOD were determined. Coefficients of variation (CVs) were calculated for intra- and inter-observer measurement variability. ResultsThere were significant differences between all linear dimensions in diastole and systole. Short-axis 2D measurements had significant bias compared with Sx-MM (diastole +1.19 mm, systole +1.65 mm) and Lx-MM (diastole +4.36 mm, systole +3.87 mm) as did Sx-MM compared with Lx-MM (diastole +3.17 mm, systole +2.22 mm). All linear dimensions had a moderate positive correlation with SMOD. The sensitivity and specificity of linear measurements to detect DCM were: Sx-2D (sensitivity 72.0%, specificity 88.5%), Sx-MM (sensitivity 52.0%, specificity 92.0%), and Lx-MM (sensitivity 37.5%, specificity 99.1%). All methods had acceptably low CV for intra- and inter-observer measurement variability. ConclusionsResults of this study suggest that linear measurements are repeatable and correlate with reference standard; however, there is a significant bias between measurements, and they should not be used interchangeably.

Comparative assessment of left atrial volume in healthy cats by two-dimensional and three-dimensional echocardiography

BackgroundThe left atrium (LA) is an important prognostic parameter in cardiac pathologies of cats. Its size is currently measured in one-dimensional methods, while human medicine considers two- and three-dimensional echocardiography as standard. The objectives of this study were to compare monoplane, biplane, triplane and real-time three dimensional echocardiography for volumetric measurement of the left atrium in healthy cats and establish a reference interval for further studies on cats with heart disease. Additionally, the influence of age, sex and weight on left atrial volume (LAV) was tested.ResultsOne dimensional monoplane Simpson method of discs (SMOD) in the right parasternal four chamber view (r4) and the left apical 2 chamber view (l2) as well as biplane SMOD had no significant difference for left atrial maximum volume (LAMax). They can be used as equivalent in future studies and one common reference range was set up (1.96 ± 0.54 ml). Those three methods produced significantly higher volumes than triplane echocardiography (RTTPE) and real time three dimensional echocardiography (RT3DE) using TomTec® software. LA volumetry with RTTPE and RT3DE-TomTec™ was more feasible than expected, but low RT3DE image quality was the main reason for excluding patients. Neither age nor weight had an influence on LA volume in healthy cats. Male LAV results were only slightly, but in 2D and RTTPE significantly higher than those of female cats with a range of + 10.46% to + 19.58%.ConclusionsMonoplane, biplane, triplane and real-time three dimensional echocardiography were feasible for LA volumetry in healthy cats and showed acceptable intra- and interobserver variability. One common LAMax reference range for monoplane r4, l2 and biplane SMOD was set up. Raw data can be used for LA volumes and does not need to be correlated with the cat’s weight or age. Male cats have only slightly but significantly larger atria than females in 2D and RTTPE. Therefore, under reservation, also sex related limit values were defined.

Use of 2-dimensional speckle-tracking echocardiography to assess left ventricular systolic function in dogs with systemic inflammatory response syndrome.

BackgroundEarly identification of systolic dysfunction in dogs with systemic inflammatory response syndrome (SIRS) potentially could improve the outcome and decrease mortality.ObjectiveTo compare 2‐dimensional speckle tracking (2D‐STE) with 2‐dimensional (2D) and M‐mode echocardiography in the evaluation of systolic function in SIRS dogs.AnimalsSeventeen SIRS and 17 healthy dogs.MethodsProspective observational case‐control study. Each dog underwent physical examination, conventional echocardiography, 2D‐STE, and C‐reactive protein measurement.ResultsDogs with SIRS had lower 2D‐STE ejection fraction (X4D‐EF; 44 ± 8 versus 53 ± 8; P = .003), endocardial global longitudinal strain (ENDO‐G‐Long‐St; −14.6 ± 3.2 versus −18.5 ± 4.1; P = .003), and normalized left ventricular diameter in diastole (1.38 ± 0.25 versus 1.54 ± 0.17; P = .04) and systole (0.85 ± 0.18 versus 0.97 ± 0.11; P = .03) as compared to healthy dogs. Simpson method of disks (SMOD) right parasternal EF (55 ± 9 versus 60 ± 6; P = .07) and end systolic volume index (ESVI; 23 ± 10 versus 21 ± 6; P = .61), SMOD left apical EF (59 ± 9 versus 59 ± 6; P = .87) and ESVI (20 ± 8 versus 22 ± 6; P = .25), fractional shortening (FS; 34 ± 5 versus 33 ± 4; P = .39), M‐mode EF (64 ± 7 versus 62 ± 5; P = .35), and ESVI (23 ± 11 versus 30 ± 9; P = .06) were not significantly different between SIRS and control group, respectively.Conclusion and Clinical ImportanceSpeckle tracking X4D‐EF and ENDO‐G‐Long‐St are more sensitive than 2D and M‐Mode FS, EF, and ESVI in detecting systolic impairment in dogs with SIRS.

Simpson's method of discs in Salukis and Whippets: Echocardiographic reference intervals for end-diastolic and end-systolic left ventricular volumes

BackgroundSighthound breeds are known to have different cardiac sizes and dimensions from other breeds; therefore, breed-specific references are required to avoid misinterpretation of echocardiographic findings. End-diastolic volume (EDV) and end-systolic volume (ESV) reference intervals derived from Simpson's method of discs (SMOD) do not exist for Salukis or Whippets. ObjectivesTo establish EDV and ESV reference intervals for SMOD in Salukis and Whippets. Animals110 Salukis and 119 Whippets. MethodsReference intervals for SMOD with and without normalization to body surface area (BSA) were established using the right parasternal and left apical views in 93 healthy Salukis and 82 healthy Whippets. Volumes were compared between both echocardiographic views, genders, and racing and show pedigree dogs. The 90% reference intervals were calculated using the robust method. ResultsAgreement between right-sided and left-sided echocardiographic views was good. Reference intervals indexed to body surface area (BSA) for Whippets were 59–109 mL/m² for end-diastolic volume index and 18–53 mL/m² for end-systolic volume index. Corresponding values for Salukis were 68–126 mL/m² for end-diastolic volume index and 27–64 mL/m² for end-systolic volume index. There were no indexed volume differences between male and female or racing and show pedigree dogs in both breeds. The non-normalized volumes significantly differed between genders. Conclusions and clinical importanceWhippets and Salukis had larger systolic and diastolic left ventricular volumes compared with other breeds. This study provided echocardiographic reference intervals for SMOD-derived left ventricular volumes for these athletic breeds.

Image Quality Influences the Assessment of Left Ventricular Function

Transesophageal echocardiography has become a standard tool for evaluating left ventricular function during cardiac surgery. However, the image quality varies widely between patients and examinations. The aim of this study was to investigate the influence of the image quality on 5 commonly used 2-dimensional methods. Transesophageal real-time 3-dimensional echocardiography (3DE) served as a reference. Left ventricular function was evaluated in 63 patients with sufficient real-time 3DE image quality. The image quality was rated using the ratio of the visualized border divided by the total endocardial border. These ratings were used to generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%) image quality. The ejection fraction (EF), end-diastolic volume, and end-systolic volume were analyzed by the Simpson method of disks (biplane and monoplane), eyeball method, Teichholz method, and speckle-tracking method. Furthermore, the fractional area change was determined. Each correlation with real-time 3DE was evaluated. Correlations of the EF and volumes, respectively, as determined by long-axis view methods increased with improving image quality: the Simpson biplane method was found to be the most accurate method, with good image quality for the EF (r = 0.946) and volumes (end-diastolic volume, r = 0.962; end-systolic volume, r = 0.989). Correlations of the EF and fractional area change by short-axis view methods decreased with improving image quality, with the Teichholz EF found to be most accurate with poor (r = 0.928) in contrast to good (r = 0.699) image quality. With good image quality, the Simpson biplane method is the most accurate 2-dimensional method for assessing the left ventricular EF. Short-axis view methods, especially the Teichholz method yield better correlations with poor image quality. The eyeball method was unaffected by image quality.

Simpson's Method of Discs for Measurement of Echocardiographic End‐Diastolic and End‐Systolic Left Ventricular Volumes: Breed‐Specific Reference Ranges in Boxer Dogs

BackgroundBoxer dogs are predisposed to congenital and adult onset cardiac diseases. Breed‐specific reference values for M‐mode and Doppler echocardiographic measurements previously have been established. Left ventricular (LV) end‐systolic (ESV) and end‐diastolic volumes (EDV) can be measured by M‐mode or two‐dimensional methods, such as Simpson's method of discs (SMOD). Reference ranges for SMOD‐derived LV volumes are lacking.ObjectivesTo determine reference intervals for EDV and ESV in Boxer dogs.AnimalsPreviously collected data from 85 healthy Boxers (37 males and 48 females) were used for analysis.MethodsSimpson's method of discs‐derived EDV and ESV were measured using offline analysis by 1 observer, in both the right parasternal and the left apical views. Measurements were compared between both views and between male and female dogs using a t‐test. Reference intervals were established using the mean + 2 × SD.ResultsMeasurements obtained from both views showed good agreement, and mean EDVI and ESVI, indexed to body surface area (BSA), were calculated. Reference intervals were 49–93 mL/m² for EDVI, and 22–50 mL/m² for ESVI. EDV and ESV were significantly higher in males compared with females, when indexing to BSA, but not when indexing to body weight.Conclusion and Clinical ImportanceThe upper limit for ESVI exceeds the previously suggested cut‐off of 30 mL/m² for detection of systolic dysfunction. The reference intervals generated in this study should be useful clinically in the assessment of LV size and function in Boxer dogs.

Use of Simpson's Method of Disc to Detect Early Echocardiographic Changes in Doberman Pinschers with Dilated Cardiomyopathy

M-mode is the echocardiographic gold standard to diagnose dilated cardiomyopathy (DCM) in dogs, whereas Simpson's method of discs (SMOD) is the preferred method to detect echocardiographic evidence of disease in humans. To establish reference values for SMOD and to compare those with M-mode measurements. Nine hundred and sixty-nine examinations of 471 Doberman Pinschers. Using a prospective longitudinal study design. Reference values for SMOD were established using 75 healthy Doberman Pinschers >8 years old with <50 ventricular premature contractions (VPCs) in 24 hours. The ability of the new SMOD cut-off values, normalized to body surface area (BSA), for left ventricular end-diastolic volume (LVEDV/BSA >95mL/m(2) ) and end-systolic volume (LVESV/BSA > 55mL/m(2) ) to detect echocardiographic changes in Doberman Pinschers with DCM was compared with currently recommended M-mode values. Dogs with elevated SMOD values but normal M-mode measurements were followed-up using a prospective longitudinal study design. At the final examination 175 dogs were diagnosed with DCM according to both methods (M-mode and SMOD). At previous examinations, M-mode values were abnormal in 142 examinations only, whereas all 175 SMOD already had detected changes. Additionally, 19 of 154 dogs with >100 VPCs/24 hours and normal M-mode values had abnormal SMOD measurement. Six dogs with increased SMOD measurements remained healthy at several follow-up examinations (classified as false positive); in 24 dogs with increased SMOD measurements, no follow-up examinations were available (classified as unclear). SMOD measurements are superior to M-mode to detect early echocardiographic changes in Dobermans with occult DCM.

Reproducibility of Right Ventricular Volumes and Ejection Fraction Using Real-time Three-Dimensional Echocardiography: Comparison With Cardiac MRI

Objectives The nongeometric nature of the right ventricle (RV) makes it difficult to measure. We sought to determine whether real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography (2DE) for the follow-up of RV function by validation vs cardiac MRI. Methods RV volumes and ejection fraction (EF) were studied with 2DE (including area-length [A-L], the modified two-dimensional subtraction [2DS] method, and the Simpson method of discs), RT3DE, and MRI in 50 patients with left ventricular wall motion abnormalities, the results of which suggested possible RV infarction. Test-retest variation was performed by a complete restudy using a separate sonographer within 24 h without the alteration of hemodynamics or therapy. Interobserver and intraobserver variations were noted in a subgroup of 20 patients. Results EF estimations were similar using each technique. The mean (± SD) MRI end-diastolic volume (87 ± 22 mL) was only slightly underestimated by RT3DE (mean difference, −3 ± 10; p < 0.05), with a greater mean difference for 2DE A-L (−29 ± 10; p < 0.05), and the Simpson method of discs (−29 ± 23; p < 0.05), and was greatly overestimated by 2DS (mean difference, 26 ± 23; p < 0.05). Similarly, the mean MRI end-systolic volume (46 ± 17 mL) was only slightly underestimated by RT3DE (−4 ± 7; p < 0.05), compared with 2DE A-L (−16 ± 8; p < 0.05) and the Simpson method of discs (−16 ± 8; p < 0.05), and was overestimated by 2DS (14 ± 13; p < 0.05). RT3DE findings had a higher correlation with each parameter than any 2DE technique. There was also good intraobserver and interobserver correlation between RT3DE by two sonographers. RT3DE had less test-retest variation of RV volumes and EF than any 2DE measure. Conclusions RT3DE is more accurate than two-dimensional approaches and reduces the test-retest variation of RV volumes and EF measurements in follow-up RV assessment. The nongeometric nature of the right ventricle (RV) makes it difficult to measure. We sought to determine whether real-time three-dimensional echocardiography (RT3DE) is superior to two-dimensional echocardiography (2DE) for the follow-up of RV function by validation vs cardiac MRI. RV volumes and ejection fraction (EF) were studied with 2DE (including area-length [A-L], the modified two-dimensional subtraction [2DS] method, and the Simpson method of discs), RT3DE, and MRI in 50 patients with left ventricular wall motion abnormalities, the results of which suggested possible RV infarction. Test-retest variation was performed by a complete restudy using a separate sonographer within 24 h without the alteration of hemodynamics or therapy. Interobserver and intraobserver variations were noted in a subgroup of 20 patients. EF estimations were similar using each technique. The mean (± SD) MRI end-diastolic volume (87 ± 22 mL) was only slightly underestimated by RT3DE (mean difference, −3 ± 10; p < 0.05), with a greater mean difference for 2DE A-L (−29 ± 10; p < 0.05), and the Simpson method of discs (−29 ± 23; p < 0.05), and was greatly overestimated by 2DS (mean difference, 26 ± 23; p < 0.05). Similarly, the mean MRI end-systolic volume (46 ± 17 mL) was only slightly underestimated by RT3DE (−4 ± 7; p < 0.05), compared with 2DE A-L (−16 ± 8; p < 0.05) and the Simpson method of discs (−16 ± 8; p < 0.05), and was overestimated by 2DS (14 ± 13; p < 0.05). RT3DE findings had a higher correlation with each parameter than any 2DE technique. There was also good intraobserver and interobserver correlation between RT3DE by two sonographers. RT3DE had less test-retest variation of RV volumes and EF than any 2DE measure. RT3DE is more accurate than two-dimensional approaches and reduces the test-retest variation of RV volumes and EF measurements in follow-up RV assessment.