Three-dimensional Wall Motion Research Articles

Cyclic three-dimensional wall motion of the human ascending and abdominal aorta characterized by time-resolved three-dimensional ultrasound speckle tracking.

The aim of this study was to measure, characterize, and compare the time-resolved three-dimensional wall kinematics of the ascending and the abdominal aorta. Comprehensive description of aortic wall kinematics is an important issue for understanding its physiological functioning and early detection of adverse changes. Data on the three-dimensional, dynamic cyclic deformation of the aorta in vivo are scarce. Either most imaging techniques available are too slow to capture aortic wall motion (CT, MRI) or they do not provide three-dimensional geometry data. Three-dimensional volume data sets of ascending and abdominal aortae of male healthy subjects (25.5 [24.5, 27.5]years) were acquired by use of a commercial echocardiography system with a temporal resolution of 11-25Hz. Longitudinal and circumferential strain, twist, and relative volume change were determined by use of a commercial speckle tracking algorithm and in-house software. The kinematics of the abdominal aorta is characterized by diameter change, almost constant length and unidirectional, either clockwise or counter clockwise twist. In contrast, the ascending aorta undergoes a complex deformation with alternating clockwise and counterclockwise twist. Length and diameter changes were in the same order of magnitude with a phase shift between both. Longitudinal strain and its phase shift to circumferential strain contribute to the proximal aorta's Windkessel function. Complex cyclic deformations are known to be highly fatiguing. This may account for increased degradation of components of the aortic wall and therefore promote aortic dissection or aneurysm formation.

M-mode apical systolic excursion: A new and simple method to evaluate global left ventricular longitudinal strain

IntroductionSince M-mode measurements can assess deformation of specific regions of the left ventricle, we hypothesized that M-mode measurements like M-mode apical systolic excursion (MMASE) and mitral annular plane systolic excursion (MAPSE) may be correlated with left ventricular longitudinal strain (LVLS). MethodsAll subjects of the study underwent a full echocardiographic evaluation and MMASE and MAPSE measurement. Three-dimensional wall motion tracking (3D-WMT) was performed. ResultsThirty-one patients were evaluated. Significant correlations between MAPSE and LVLS (−0.372; p=0.04) and between MMASE and LVLS (−0.398; p=0.027) were found. LVLS was linearly related to MAPSE and MMASE (in mm) as follows: ST=−10.6 −0.4 * MAPSE (r2=0.14) and ST=−13.1 −0.5 * MMASE (r2=0.16). ConclusionsOur results demonstrate that simpler and faster methods than strain based on complex speckle analysis can also have a role in predicting subclinical left ventricular systolic dysfunction.

M-mode apical systolic excursion: A new and simple method to evaluate global left ventricular longitudinal strain

IntroductionSince M-mode measurements can assess deformation of specific regions of the left ventricle, we hypothesized that M-mode measurements like M-mode apical systolic excursion (MMASE) and mitral annular plane systolic excursion (MAPSE) may be correlated with left ventricular longitudinal strain (LVLS). MethodsAll subjects of the study underwent a full echocardiographic evaluation and MMASE and MAPSE measurement. Three-dimensional wall motion tracking (3D-WMT) was performed. ResultsThirty-one patients were evaluated. Significant correlations between MAPSE and LVLS (−0.372; p=0.04) and between MMASE and LVLS (−0.398; p=0.027) were found. LVLS was linearly related to MAPSE and MMASE (in mm) as follows: ST=−10.6 −0.4 * MAPSE (r2=0.14) and ST=−13.1 −0.5 * MMASE (r2=0.16). ConclusionsOur results demonstrate that simpler and faster methods than strain based on complex speckle analysis can also have a role in predicting subclinical left ventricular systolic dysfunction.

Quantification of left atrial volumes using three-dimensional wall motion tracking echocardiographic technology: comparison with cardiac magnetic resonance

Left atrium (LA) size assessment is clinically relevant, but the accuracy of two-dimensional echocardiographic (2D-echo) methods is limited. Three-dimensional (3D) echocardiography is an excellent alternative but is far from being used in daily clinical practice. Three-dimensional-wall motion tracking (3D-WMT) allows us to obtain volumes in a very simple and rapid manner. The aims of this study were to evaluate the accuracy of 3D-WMT technology to assess LA volume using cardiac magnetic resonance (CMR) as a reference method, to evaluate its reproducibility, and to determine its added clinical value to classify the LA enlargement severity. Seventy consecutive patients referred for a CMR study were prospectively enrolled. They underwent LA volume assessment by means of 2D-echo, 3D-WMT, and CMR. Inter-methods agreement was assessed. The mean age was 56 ± 18 years and 42 patients (60%) were males. Average maximal LA volume obtained by 2D-echo, 3D-WMT, and CMR were 63.33 ± 26.82, 79.80 ± 29.0, and 79.80 ± 28.99 mL, respectively. Univariate linear regression analysis showed a good correlation between 3D-WMT and CMR (r = 0.83; P < 0.001). The agreement analysis showed a similar result (ICC = 0.83; 95% CI = 0.74-0.89; P < 0.001). Furthermore, the LA enlargement degree was better evaluated with 3D-WMT than with 2D-echo. This study validates LA volume measurements obtained using the new and fast 3D-WMT technology, compared with CMR. This method is fast, accurate, and reproducible, and it allows a better classification of left LA enlargement severity compared with 2D-echo.

Area strain: umbrales de normalidad de un nuevo parámetro en sujetos sanos

The echocardiographic technology known as three-dimensional wall motion tracking offers three-dimensional images of the myocardium and provides multiple measures of deformation, one of which is known as “area strain” (AS), which combines left ventricular longitudinal and circumferential deformations. Our aim was to describe the normal maximum systolic reference AS value in a sample of healthy subjects. Sixty consecutive subjects without known cardiovascular risk factors or diseases were enrolled, and left ventricular AS was measured. Overall mean AS was –38.87 ± 5.89%. Mean values at the level of the basal, middle, and apical segments were −38.42 ± 7.58%, −38.74 ± 6.34%, and −43.18 ± 12.81%, respectively. Thus, our results show for the first time the reference values for AS in healthy subjects. Full English text available from: www.revespcardiol.org

Area Strain: Normal Values for a New Parameter in Healthy People

The echocardiographic technology known as three-dimensional wall motion tracking offers three-dimensional images of the myocardium and provides multiple measures of deformation, one of which is known as “area strain” (AS), which combines left ventricular longitudinal and circumferential deformations. Our aim was to describe the normal maximum systolic reference AS value in a sample of healthy subjects. Sixty consecutive subjects without known cardiovascular risk factors or diseases were enrolled, and left ventricular AS was measured. Overall mean AS was –38.87 ± 5.89%. Mean values at the level of the basal, middle, and apical segments were –38.42% ± 7.58%, –38.74% ± 6.34%, and −43.18% ± 12.81%, respectively. Thus, our results show for the first time the reference values for AS in healthy subjects.

Novel Area Strain Based on Three-Dimensional Wall Motion Analysis for Assessment of Global Left Ventricular Performance after Repair of Tetralogy of Fallot

This study aimed to determine the usefulness of novel parameters of left ventricular (LV) endocardial area strain (AS) in assessing global LV performance in patients with repaired tetralogy of Fallot (TOF). Thirty patients, aged 21.7 ± 5.8 years, with repaired TOF and 25 healthy subjects aged 19.9 ± 5.5 years were studied. Three-dimensional LV wall motion tracking was performed to determine global and regional peak AS, an AS-systolic dyssynchrony index (SDI), and LV volumes and ejection fraction. The AS-SDI was derived from the dispersion of time-to-minimum segmental endocardial areas, expressed as a percentage of RR interval, using a 16-segment model. The LV global performance plot was generated by plotting peak global AS against AS-SDI. The coefficients of variations for intra- and interobserver measurement of LV global AS were 6.3% and 10.6%, respectively. Compared with controls, patients had significantly lower global AS (30.5% ± 4.5% vs. 40.9% ± 2.8%, P < .001) and greater AS-SDI (10.0% ± 2.9% vs. 4.1% ± 1.4%, P < .001). Global AS (r= 0.94, P < .001) and AS-SDI (r= -0.76, P < .001) correlated strongly with LV ejection fraction. The global performance plot identified 87% of patients (26/30) with both reduced LV global AS and LV systolic mechanical dyssynchrony. AS measurement of LV endocardium based on three-dimensional wall motion tracking is reproducible and enables convenient assessment of global LV performance using a composite representation of parameters, including global AS and an AS-derived index of mechanical dyssynchrony.

3D-wall motion tracking: a new tool for myocardial contractility analysis.

BACKGROUND: Left-ventricular ejection fraction (LVEF), the most frequently used parameter to evaluate left ventricular (LV) systolic function, depends not only on LV contractility, but also on different variables such as pre-load and after-load. Three-dimensional wall motion tracking echocardiography (3D-WMT) is a new technique that provides information regarding different new parameters of LV systolic function. Our aim was to evaluate whether the new 3D-WMT-derived LV systolic function parameters are less dependent on load conditions than LVEF. METHODS: In order to modify the load conditions to study the dependence of the different LV systolic function parameters on them, a group of renal failure patients under chronic hemodialysis treatment was selected. The echocardiographic studies, including the 3D-WMT analysis, were performed immediately before and immediately after the hemodialysis session. RESULTS: Thirty-one consecutive patients were enrolled (mean age 65.5 ± 17.0 years; 74.2% men). There was a statistically significant change in predialysis and postdialysis, pre-load and after-load conditions (E/È ratio and systolic blood pressure) and in the LV end-diastolic volume and LVEF. Nevertheless, the findings did not show any significant change before and after dialysis in the 3D-WMT-derived parameters. CONCLUSIONS: LV 3D-wall motion tracking-derived systolic function parameters are less dependent on load conditions than LVEF. They might measure myocardial contractility in a more direct way than LVEF. Thus, hypothetically, they might be useful to detect early and subtle contractility impairments in a wide number of cardiac patients and they could help to optimize the clinical management of such patients.

Quantitative Three-Dimensional Wall Motion Analysis Predicts Ischemic Region Size and Location

Stress echocardiography is an important screening test for coronary artery disease. Currently, cardiologists rely on visual analysis of left ventricular (LV) wall motion abnormalities, which is subjective and qualitative. We previously used finite-element models of the regionally ischemic left ventricle to develop a wall motion measure, 3DFS, for predicting ischemic region size and location from real-time 3D echocardiography (RT3DE). The purpose of this study was to validate these methods against regional blood flow measurements during regional ischemia and to compare the accuracy of our methods to the current state of the art, visual scoring by trained cardiologists. We acquired RT3DE images during 20 brief (<2 min) coronary occlusions in dogs and determined ischemic region size and location by microsphere-based measurement of regional perfusion. We identified regions of abnormal wall motion using 3DFS and by blinded visual scoring. 3DFS predicted ischemic region size well (correlation r (2) = 0.64 against microspheres, p < 0.0001), reducing error by more than half compared to visual scoring (8 +/- 9% vs. 19 +/- 14%, p < 0.05), while localizing the ischemic region with equal accuracy. We conclude that 3DFS is an objective, quantitative measure of wall motion that localizes acutely ischemic regions as accurately as wall motion scoring while providing superior quantification of ischemic region size.