Noninvasive Evaluation of Intraventricular Flow Dynamics by the HyperDoppler Technique: First Application to Normal Subjects, Athletes, and Patients with Heart Failure

Abstract

Background: HyperDoppler is a new echocardiographic color Doppler-based technique that can assess intracardiac flow dynamics. The aim of this study was to verify the feasibility and reproducibility of this technique in unselected patients and its capability to differentiate measures of vortex flow within the left ventricle (LV) in normal sedentary subjects, athletes, and patients with heart failure. Methods: Two hundred unselected, consecutive patients presenting at the echocardiographic laboratory, 50 normal subjects, 30 athletes, and 50 patients with chronic heart failure and LV ejection fraction <50% were enrolled. Images were acquired using a MyLab X8 echo-scanner. Area, intensity, depth, length, and kinetic energy dissipation (KED) of vortex flow were measured. Results: The HyperDoppler technique feasibility was 94.5%. According to the intraclass correlation coefficient evaluations, repeatability and reproducibility of vortex flow measures were good for vortex area (0.82, 0.85), length (0.83, 0.82), and depth (0.87, 0.84) and excellent for intensity (0.92, 0.90) and KED (0.98, 0.98). Combining different vortex flow measures, the LV flow profile of healthy sedentary individuals, athletes, and heart failure patients could be differentiated. Conclusions: HyperDoppler is a feasible, reliable, and practical technique for the assessment of LV flow dynamics and may distinguish normal subjects and patients with heart failure.

From Strain toward Hyperdoppler Echocardiographic Evaluation in Sports Medicine

“…Some research proposed the hyperdoppler in the investigation of the dissincronicity of the myocardial function. As recently shown a large clinical application of this method is possible both in healthy people, athletes and pathological clinical situations [9,13]. Considering the wide population investigated in sports medicine, especially subjects with comorbidities, the role of hyperdoppler can find many fields of application, mainly in the follow-up of sports eligibility or exercise prescription.…”

Effect of Aging on Intraventricular Kinetic Energy and Energy Dissipation

“…The HyperDoppler technique is also based on color Doppler information but with different assumptions, with respect to VFM [2]. Both the HyperDoppler and the echoPIV HyperFlow techniques [41] may evaluate LV KE (Figure 1) and KED.…”

“…Energy measures can also be performed during systole (peak systolic and mean systolic KE and KED/EL) and throughout the cardiac cycle (systo-diastolic or global KE and KED/EL). Having in mind that the separation between systole and diastole is not sharp when seen in terms of fluid dynamics, the HyperFlow and HyperDoppler software analyze flow velocities during an entire heartbeat by using a steady-streaming approach [2,41]; thus, the KED estimated in this way is the global one (gKED).…”

“…These measures are of potential interest in cardiology since they potentially represent a new way to observe cardiac function and workload [1]. Analysis of KE and KED/EL has been applied to characterize athletes' heart [2][3][4] and to patients with renal disease [5,6], prediabetes and type 2 diabetes mellitus [7], systemic lupus erythematosus [8], aortic regurgitation [9], aortic stenosis [10], cardiac amyloidosis [11], hypertrophic cardiomyopathy [12], myocardial infarction [13,14], and heart failure [15][16][17]. Although these applications are only preliminary, they clearly show the attention of clinical investigators toward the information coming from intracardiac flow dynamics analysis.…”

Flow Dynamic Pattern in Liver and Renal Transplantation under Exercise Prescription Program

“…The echocardiographic parameters are well known to establish the degree of systolic and diastolic dysfunction [ 10 ]. In addition to the strain analysis primarily studied in terms of several chronic conditions, and also in terms of transplantation regarding systolic time [ 11 ], more recently, the new parameters relating to the intracardiac fluxes [ 12 , 13 ] are emerging tools designed to better identify the myocardial function in healthy individuals and in patients [ 14 ]. During the cardiac cycle, the vortex flow changes and during the isovolumic contraction phase, blood is redirected toward the LV outflow tract [ 15 ].…”