The EACVI/ASE/Industry Task Force to standardize deformation imaging prepared this consensus document to standardize definitions and techniques for using two-dimensional (2D) speckle tracking echocardiography (STE) to assess left atrial, right ventricular, and right atrial myocardial deformation. This document is intended for both the technical engineering community and the clinical community at large to provide guidance on selecting the functional parameters to measure and how to measure them using 2D STE.This document aims to represent a significant step forward in the collaboration between the scientific societies and the industry since technical specifications of the software packages designed to post-process echocardiographic datasets have been agreed and shared before their actual development. Hopefully, this will lead to more clinically oriented software packages which will be better tailored to clinical needs and will allow industry to save time and resources in their development.
OBJECTIVES
The aims of this study were to: 1) assess the feasibility of left ventricular (LV) vortex flow analysis using contrast echocardiography (CE); and 2) characterize and quantify LV vortex flow in normal subjects and patients with LV systolic dysfunction.
BACKGROUND
Vortices that form during LV filling have specific geometry and anatomical locations that are critical determinants of directed blood flow during ejection. Therefore, it is clinically relevant to assess the vortex flow patterns to better understand the LV function.
METHODS
Twenty-five patients (10 normal and 15 patients with abnormal LV systolic function) underwent CE with intravenous contrast agent, Definity (Bristol-Myers Squibb Medical Imaging, Inc., North Billerica, Massachusetts). The velocity vector and vorticity were estimated by particle image velocimetry. Average vortex parameters including vortex depth, transverse position, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also estimated.
RESULTS
Vortex depth and vortex length were significantly lower in the abnormal LV function group (0.443 ± 0.04 vs. 0.482 ± 0.06, p < 0.05; 0.366 ± 0.06 vs. 0.467 ± 0.05, p < 0.01, respectively). Vortex width was greater (0.209 ± 0.05 vs. 0.128 ± 0.06, p < 0.01) and sphericity index was lower (1.86 ± 0.5 vs. 3.66 ± 0.6, p < 0.001) in the abnormal LV function group. Relative strength (1.13 ± 0.4 vs. 2.10 ± 0.8, p < 0.001), vortex relative strength (0.57 ± 0.2 vs. 1.19 ± 0.5, p < 0.001), and vortex pulsation correlation (0.63 ± 0.2 vs. 1.31 ± 0.5, p < 0.001) were significantly lower in the abnormal LV function group.
CONCLUSIONS
It was feasible to quantify LV vorticity arrangement by CE using particle image velocimetry in normal subjects and those with LV systolic dysfunction, and the vorticity imaging by CE may serve as a novel approach to depict vortex, the principal quantity to assess the flow structure.
Two-dimensional speckle tracking echocardiography (2D STE) is a novel technique of cardiac imaging for quantifying complex cardiac motion based on frame-to-frame tracking of ultrasonic speckles in gray scale 2D images. Two-dimensional STE is a relatively angle independent technology that can measure global and regional strain, strain rate, displacement, and velocity in longitudinal, radial, and circumferential directions. It can also quantify rotational movements such as rotation, twist, and torsion of the myocardium. Two-dimensional STE has been validated against hemodynamics, tissue Doppler, tagged magnetic resonance imaging, and sonomicrometry studies. Two-dimensional STE has been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. A large number of studies have evaluated the role of 2D STE in predicting response to cardiac resynchronization therapy in patients with severe heart failure. However, the clinical utility of 2D STE in the above mentioned conditions remains controversial because of conflicting reports from different studies. Emerging areas of application include prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and effect of intracoronary injection of bone marrow stem cells on left ventricular function in patients with acute myocardial infarction. The emerging technique of three-dimensional STE may further extend its clinical usefulness.
As decisions in cardiology increasingly rely on noninvasive methods, fast and precise image processing tools have become a crucial component of the analysis workflow. To the best of our knowledge, we propose the first automatic system for patient-specific modeling and quantification of the left heart valves, which operates on cardiac computed tomography (CT) and transesophageal echocardiogram (TEE) data. Robust algorithms, based on recent advances in discriminative learning, are used to estimate patient-specific parameters from sequences of volumes covering an entire cardiac cycle. A novel physiological model of the aortic and mitral valves is introduced, which captures complex morphologic, dynamic, and pathologic variations. This holistic representation is hierarchically defined on three abstraction levels: global location and rigid motion model, nonrigid landmark motion model, and comprehensive aortic-mitral model. First we compute the rough location and cardiac motion applying marginal space learning. The rapid and complex motion of the valves, represented by anatomical landmarks, is estimated using a novel trajectory spectrum learning algorithm. The obtained landmark model guides the fitting of the full physiological valve model, which is locally refined through learned boundary detectors. Measurements efficiently computed from the aortic-mitral representation support an effective morphological and functional clinical evaluation. Extensive experiments on a heterogeneous data set, cumulated to 1516 TEE volumes from 65 4-D TEE sequences and 690 cardiac CT volumes from 69 4-D CT sequences, demonstrated a speed of 4.8 seconds per volume and average accuracy of 1.45 mm with respect to expert defined ground-truth. Additional clinical validations prove the quantification precision to be in the range of inter-user variability. To the best of our knowledge this is the first time a patient-specific model of the aortic and mitral valves is automatically estimated from volumetric sequences.
Cardiac resynchronization therapy (CRT) has emerged as an important method to treat patient with symptomatic heart failure with evidence of intraventricular dyssynchrony. Tissue Doppler imaging by echocardiography has been shown to be an excellent tool for the assessment of mechanical left ventricular dyssynchrony and the selection of patients for CRT. However, there are some patients who do not show symptomatic improvement following CRT. One possible explanation for this is the need to optimize not only longitudinal synchrony, but also improve the circumferential and radial dynamics of the left ventricle. Doppler imaging does not allow reliable assessment of the latter because of the angle-dependency of the technique. Velocity Vector Imaging (VVI) is a newer technique which is angle-independent and thus provides an avenue to evaluate short-axis mechanics of the left ventricle. We describe a case in which VVI was used to assess the left ventricular dynamics in a patient with heart failure who did not respond to CRT.
A novel framework to efficiently deal with three-dimensional (3-D) segmentation of challenging inhomogeneous data in real-time has been recently introduced by the authors. However, the existing framework still relied on manual initialization, which prevented taking full advantage of the computational speed of the method. In the present article, an automatic initialization scheme adapted to 3-D, echocardiographic data is proposed. Moreover, a novel segmentation functional, which explicitly takes the darker appearance of the blood into account, is also introduced. The resulting automatic segmentation framework provides an efficient, fast and accurate solution for quantification of the main left ventricular volumetric indices used in clinical routine. In practice, the observed computation times are in the order of 1 s.
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp eft ventricular (LV) apical thrombus formation is a major complication in patients with LV dysfunction following an anterior myocardial infarction (MI). 1-10 Although the mechanisms of potential thrombus formation are diverse, abnormalities in apical contraction and the resulting change in the dynamics of flow leading to stagnant flow of the LV apex is one of the most important factors for thrombus formation in these patients. 3-7 Because the LV apical thrombus can be the major source of systemic embolization, 4,8 the characterization and elucidation of the mechanistic dynamics of flow during LV apical thrombus formation is crucial for risk stratification and decisions regarding treatment strategies. However, conventional echo-Doppler parameters are not sufficient to explain flow dynamics and the hemostatic mechanism of LV apical thrombus formation.In the past several years, several published reports have described the study of LV vortex flow and the evaluation of the LV flow dynamics. 11-13 Recently, we have demonstrated that characterization and quantification of the LV vortex flow using contrast echocardiography (CE) is feasible and useful for evaluating LV flow dynamics. 14 However, the characteristics of LV vortex flow using CE in patients with apical LV thrombus have not been demonstrated. The objective of this study was to investigate the correlation between the LV vortex flow pattern and the LV apical thrombus formation in patients with acute anterior wall MI. Background: The current study was designed to investigate the correlation between the left ventricular (LV) vortex flow pattern and LV apical thrombus formation in patients with acute anterior wall myocardial infarction (MI).
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