Dissociation between wall thickening of normal myocardium and cyclic variation of backscatter during inotropic stimulation

Feinberg, Micha S.; Gussak, Hiie M.; Dávila‐Román, Víctor G.; Baumann, Chris M.; Miller, James G.; Pérez, Julio E.

doi:10.1016/s0002-9149(97)89347-2

Cited by 19 publications

(4 citation statements)

References 30 publications

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“…The mechanisms that contribute to CVIBS include sarcomere length, change in fiber orientation during the cardiac cycle, and the deposition of cross- linked myocardial collagen (18−23). Several previous studies have demonstrated that CVIBS reflects the intrinsic contractile function of the heart (18,24,25), although other groups have been unable to relate systolic thickening to the amplitude of CVIBS (26,27). Factors associated with CVIBS may be different for each pathologic condition.…”

Section: Discussionmentioning

confidence: 96%

Impact of the Angiotensin II Receptor Antagonist, Losartan, on Myocardial Fibrosis in Patients with End-Stage Renal Disease: Assessment by Ultrasonic Integrated Backscatter and Biochemical Markers

et al. 2005

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Section: Discussionmentioning

confidence: 96%

Impact of the Angiotensin II Receptor Antagonist, Losartan, on Myocardial Fibrosis in Patients with End-Stage Renal Disease: Assessment by Ultrasonic Integrated Backscatter and Biochemical Markers

et al. 2005

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“…20 However, it has also been shown that CVIB does not depend entirely on segmental contractility in either ischaemic or non-ischaemic myocardial dysfunction 924-27 29 31 32 In ischaemic heart disease, regions of severe hypokinetic or akinetic segments in acute myocardial infarction may show recovery of CVIB after coronary recanalisation 912 16 24-26 28 32 In non-ischaemic heart disease, a transient reduction in CVIB accompanies rejection of cardiac allografts and recovers following intensive antirejection treatment 18.…”

Section: Discussionmentioning

confidence: 99%

“…The real time two dimensional integrated backscatter device enables us to analyse multiple segments simultaneously. Although this technique has been validated29 and many studies using it have been reported, there are few reports in which multiple segmental integrated backscatter analysis was attempted 35. Real time, two dimensional integrated backscatter images also have an advantage over M mode images because the M mode technique does not permit perfect geometric localisation of structures, and the two dimensional approach provides for spatial averaging during examination.…”

Section: Discussionmentioning

confidence: 99%

Prediction of contractile reserve by cyclic variation of integrated backscatter of the myocardium in patients with chronic left ventricular dysfunction

Muro

Ota

Watanabe

et al. 2001

Heart

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Objective-To clarify whether assessment of the acoustic properties of the myocardium at rest can predict contractile reserve in patients with chronic left ventricular dysfunction. Methods-23 patients (mean (SD) age 63 (12) years) with chronic left ventricular dysfunction were studied. The magnitude of cardiac cycle dependent variation of integrated backscatter (CVIB) of the myocardium was measured at rest in the basal and mid segment of the septum and posterior wall of the left ventricle, using a real time two dimensional integrated backscatter imaging system. The results were compared with the percentage wall thickening and the wall motion at rest and during low dose dobutamine infusion. The wall motion was graded as normal, hypokinetic, or akinetic and contractile reserve was considered present when an akinetic or hypokinetic segment improved during dobutamine infusion. Results-The CVIB at rest correlated with per cent wall thickening at rest and during dobutamine infusion (at rest, r = 0.61, p < 0.0001, during dobutamine, r = 0.76, p < 0.0001). Of the 76 segments examined, 27 showed contractile reserve. The mean CVIB at rest was significantly greater in segments with contractile reserve than in those without (p < 0.0001). CVIB above 3 dB at rest predicted segments with contractile reserve with a sensitivity and specificity of 81% and 60%, respectively (p < 0.0001). Conclusions-CVIB reflected not only myocardial contractility but also the functional capacity of the myocardium. It predicted segmental contractile reserve in patients with chronic left ventricular dysfunction. (Heart 2001;85:165-170) Keywords: contractile reserve; acoustic properties of myocardium; cyclic variation of integrated backscatter; left ventricular dysfunction Contractile reserve is the potential of ventricular segments that contract abnormally in the basal state to show augmented contractility with pharmacological or mechanical interventions. The prediction of contractile reserve in dysfunctional myocardium has therapeutic and prognostic implications. 1-5Although dobutamine induced systolic wall thickening assessed by echocardiography has proved reliable for evaluating regional contractile reserve, 6-8 it is time consuming and relatively invasive. Ultrasonic tissue characterisation by integrated backscatter is a time saving and non-invasive approach for determining the static and dynamic properties of the myocardium. Normal myocardium shows cardiac cycle dependent variation of integrated backscatter (CVIB). CVIB reflects regional and intramural contractile performance, and its magnitude is decreased in both ischaemic [9][10][11][12][13][14][15] and nonischaemic 16-20 myocardial disease. Studies have shown that the magnitude of CVIB is preserved in segments with functional recovery after myocardial ischaemia, 11 21-24 and that it predicts contractile reserve in ischaemic myocardial damage.10 11 We hypothesised that myocardial segments with preserved CVIB in patients with chronic left ventricular dysfunction might show contrac...

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“…24 ,25 Consistent with previous studies, 27 ,28 the lack of a change in CVIB during low dose dobutamine stimulation was observed in both segments with and without viability. Feinberg et al 27 reported the dissociation between wall thickening of normal segments and cyclic vari- ation of integrated backscatter during dobutamine stimulation. Naito et al 28 also reported similar ndings in patients with dilated cardiomyopathy.…”

Section: Cyclic Variation For Prediction Of Functional Recoverymentioning

confidence: 99%

Use of Cyclic Variation of Integrated Backscatter to Assess Contractile Reserve and Myocardial Viability in Chronic Ischemic Left Ventricular Dysfunction

et al. 2002

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The detection of viable myocardium has important implications for management, but use of stress echocardiography to detect this is subjective and requires exposure to dobutamine. We investigated whether cyclic variation (CV) of integrated backscatter (IB) from the apical views could provide a resting study for detection of contractile reserve (CR) and prediction of myocardial viability in 27 patients with chronic ischemic left ventricular (LV) dysfunction. Repeat echocardiography was performed after 6.7 +/- 3.8 months of follow-up; 14 patients underwent revascularization and 13 were treated medically. Using a standardized dobutamine echocardiography (DbE) protocol, images from three apical views were acquired at 80-120 frames/sec at rest and during stress. CR was identified if improvement of wall motion was observed at low dose (5 or 10 microg/kg/min) DbE. Myocardial viability was characterized by improvement at follow-up echocardiography in patients with revascularization. CVIB at rest and low dose dobutamine were assessed in 194 segments with resting asynergy (severe hypokinesis or akinesis), of which 88 (45%) were in patients who underwent revascularization. Of these, CVIB could be measured in 190 (98%) segments at rest and 185 (95%) at low dose dobutamine. Sixty-two (33%) segments had CR during low dose DbE and 50 (57%) segments showed wall-motion recovery (myocardial viability) at follow-up echocardiography. Segments with CR had significantly higher CVIB at rest (P < 0.001) and low dose dobutamine (P = 0.005) than segments without CR. Using optimal thresholds of CVIB (> 8.2 dB) at rest, the accuracy of CVIB for detecting CR was 70%. Compared with nonviable segments, viable segments had significantly higher CVIB at rest (P < 0.001) and low dose dobutamine (P < 0.001). Using optimal thresholds of CVIB (> 5.3 dB) at rest, the accuracy of CVIB for detecting myocardial viability was 85%, which was higher than that in conventional DbE (62%, P < 0.01). Thus, assessment of CVIB from the apical views is a feasible and accurate tool for detecting CR and predicting myocardial viability in chronic LV dysfunction.

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Dissociation between wall thickening of normal myocardium and cyclic variation of backscatter during inotropic stimulation

Cited by 19 publications

References 30 publications

Impact of the Angiotensin II Receptor Antagonist, Losartan, on Myocardial Fibrosis in Patients with End-Stage Renal Disease: Assessment by Ultrasonic Integrated Backscatter and Biochemical Markers

Impact of the Angiotensin II Receptor Antagonist, Losartan, on Myocardial Fibrosis in Patients with End-Stage Renal Disease: Assessment by Ultrasonic Integrated Backscatter and Biochemical Markers

Prediction of contractile reserve by cyclic variation of integrated backscatter of the myocardium in patients with chronic left ventricular dysfunction

Use of Cyclic Variation of Integrated Backscatter to Assess Contractile Reserve and Myocardial Viability in Chronic Ischemic Left Ventricular Dysfunction

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