Noninvasive LV Pressure Estimation Using Subharmonic Emissions From Microbubbles

Dave, Jaydev K.; Halldorsdottir, Valgerdur G.; Eisenbrey, John R.; Raichlen, Joel S.; Liu, Ji‐Bin; McDonald, Maureen E.; Dickie, Kris; Wang, Shumin; Leung, Corina; Forsberg, Flemming

doi:10.1016/j.jcmg.2011.08.017

Cited by 63 publications

(64 citation statements)

References 5 publications

(17 reference statements)

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“…Since its implementation on two modified commercial US scanners, SHAPE has been used to track dynamic pressures in vitro (12), to monitor interstitial fluid pressures in a swine melanoma model (13), and to separately measure left ventricular pressures and changes in portal pressures in canine models (14,15).…”

Section: Methodsmentioning

confidence: 99%

Chronic Liver Disease: Noninvasive Subharmonic Aided Pressure Estimation of Hepatic Venous Pressure Gradient

Eisenbrey

Dave²,

Halldorsdottir³

et al. 2013

Radiology

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Purpose:To compare subharmonic aided pressure estimation (SHAPE) with pressure catheter-based measurements in human patients with chronic liver disease undergoing transjugular liver biopsy. Materials and Methods:This HIPAA-compliant study had U.S. Food and Drug Administration and institutional review board approval, and written informed consent was obtained from all participants. Forty-five patients completed this study between December 2010 and December 2011. A clinical ultrasonography (US) scanner was modified to obtain SHAPE data. After transjugular liver biopsy with pressure measurements as part of the standard of care, 45 patients received an infusion of a microbubble US contrast agent and saline. During infusion, SHAPE data were collected from a portal and hepatic vein and were compared with invasive measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. Results:-The 45 study patients included 27 men and 18 women (age range, 19-71 years; average age, 55.8 years). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the hepatic venous pressure gradient (HVPG) (R = 0.82). Patients at increased risk for variceal hemorrhage (HVPG > 12 mm Hg) had a significantly higher mean subharmonic gradient than patients with lower HVPGs (1.93 dB 6 0.61 [standard deviation] vs 21.47 dB 6 0.29, P , .001), with a sensitivity of 100% and a specificity of 81%, indicating that SHAPE may be a useful tool for the diagnosis of clinically important portal hypertension. Conclusion:Preliminary results show SHAPE to be an accurate noninvasive technique for estimating portal hypertension.q RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Section: Methodsmentioning

confidence: 99%

Chronic Liver Disease: Noninvasive Subharmonic Aided Pressure Estimation of Hepatic Venous Pressure Gradient

Eisenbrey

Dave²,

Halldorsdottir³

et al. 2013

Radiology

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“…The cardiac applications of the SHAPE technique have been limited to pre-clinical studies to date. Encouragingly low errors were observed in the left and right ventricles of canines between the SHAPE technique and the pressure catheter measurements (within 3.5 mmHg) (Dave et al 2012b, 2012c). To the best of our knowledge, this is the most accurate noninvasive in vivo cardiac pressure estimation reported to date.…”

Section: Introductionmentioning

confidence: 88%

“…In this mode, two transmit pulses with a phase difference of 180° were transmitted and the received signal was summed. A PA4-2 transducer was used for data acquisition with a transmit frequency of 2.5 MHz (based on our previous work; Dave et al 2012b, 2012c). The incident acoustic output on the Sonix RP scanner is coded in 2 dB decrements from 0 dB (0 dB is the maximum incident acoustic output and the corresponding mechanical index was less than 0.38 as measured in a water tank set up using a calibrated hydrophone).…”

Section: Methodsmentioning

confidence: 99%

“…Several approaches to utilizing ultrasound contrast agents for ambient pressure estimation have been proposed, but high errors (as much as 50 mmHg or 30% relative to the reference standard) associated with these techniques have prevented pre-clinical or clinical applications (Bouakaz et al 1999, Fairbank and Scully 1977, Hök 1981, Miwa 1982, Shankar et al 1986); clinical applications would require errors on the order of 5 mmHg with the reference standard (Pickering et al 2005). One of the other approaches to utilize microbubble based ultrasound contrast agents for ambient pressure estimation is based on the subharmonic signal amplitude and this approach has been tested and used extensively by our group and others (Adam et al 2005, Andersen and Jensen 2009, 2010, Dave et al 2011, 2012a, 2012b, 2012c, Eisenbrey et al 2013, Forsberg et al 2005, Frinking et al 2012, Halldorsdottir et al 2011, 2014, Shi et al 1999). Briefly, this approach relies on eliciting ambient pressure sensitive subharmonic signals, extracting the subharmonic signal amplitude (which is at half the transmit frequency) and then, estimating ambient pressure based on a linear relationship between the subharmonic signal amplitude and the ambient pressure.…”

Section: Introductionmentioning

confidence: 99%

“…The SHAPE technique has been tested in vitro (Dave et al 2011, 2012a, Halldorsdottir et al 2011, Shi et al 1999), in pre-clinical studies (Dave et al 2012b, 2012c, Forsberg et al 2005, Halldorsdottir et al 2014) and also, in humans for portal hypertension assessment (Eisenbrey et al 2013). The cardiac applications of the SHAPE technique have been limited to pre-clinical studies to date.…”

Section: Introductionmentioning

confidence: 99%

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Non-Invasive Intra-cardiac Pressure Measurements Using Subharmonic-Aided Pressure Estimation: Proof of Concept in Humans

Dave

Kulkarni

Pangaonkar

et al. 2017

Ultrasound in Medicine & Biology

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This study evaluated the feasibility of noninvasive intracardiac pressure estimation using subharmonic signals from ultrasound contrast agents in humans. This IRB approved proof-of-concept study included 15 consenting patients scheduled for left and right heart catheterization. During the catheterization procedure, Definity (Lantheus Medical Imaging, N Billerica, MA) was infused intravenously at 4–10 ml/min. Ultrasound scanning was performed with a Sonix RP (BK Ultrasound, Richmond, Canada) using pulse inversion, three incident acoustic output levels, and 2.5 MHz transmit frequency. Radiofrequency data were processed and subharmonic amplitudes were compared with the pressure catheter data. Correlation coefficient between subharmonic signals and pressure catheter data ranged from −0.3 to −0.9. For acquisitions with optimum acoustic output, pressure errors between the subharmonic technique and catheter were as low as 2.6 mmHg. However, automatically determining optimum acoustic output during scanning for each patient remains to be addressed before clinical applicability can be decided.

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Three‐Dimensional Subharmonic Aided Pressure Estimation for Assessing Arterial Plaques in a Rabbit Model

Nam

Liu

Eisenbrey

et al. 2018

J of Ultrasound Medicine

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Objectives-To investigate 3-dimensional subharmonic aided pressure estimation (SHAPE) for measuring intraplaque pressure and the pressure gradient across the plaque cap as novel biomarkers for potentially predicting plaque vulnerability.Methods-Twenty-seven rabbits received a high-cholesterol diet for 2 weeks before a balloon catheter injury to denude the endothelium of the aorta, followed by 8 to 10 weeks of the high-cholesterol diet to create arteriosclerotic plaques. SHAPE imagings of the resulting plaques were performed 12, 16, and 20 weeks after injury using a LOGIQ 9 scanner with a 4D10L probe (GE Healthcare, Milwaukee, WI) before and during an infusion of Definity (Lantheus Medical Imaging, North Billerica, MA) and Sonazoid (GE Healthcare, Oslo, Norway). The ratios of the maximum subharmonic magnitudes at baseline and during the infusion were correlated with the intraplaque pressure and pressure gradient across the plaque cap obtained from direct measurements.Results-Ten rabbits died prematurely after the balloon injury procedure or due to toxicity from the high-cholesterol diet, whereas 2 rabbits were excluded for other conditions. Five rabbits were scanned in the 12-, 16-, and 20-week groups, respectively. Even after 20 weeks, the plaques that developed were very small (mean AE SD, 0.9 AE 0.4 × 0.14 AE 0.05 cm). Definity performed better than Sonazoid in this application but still only achieved a moderate correlation with pressure across the plaque cap (Definity, r = -0.40; Sonazoid, r = 0.22) and intraplaque pressure (Definity, r = -0.19; Sonazoid, r = -0.11).Conclusions-Initial findings from plaque pressure estimation using 3-dimensional SHAPE technique showed only moderate correlations with reference standards, but that may be have been due to weaknesses in the animal model studied.

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Noninvasive LV Pressure Estimation Using Subharmonic Emissions From Microbubbles

Cited by 63 publications

References 5 publications

Chronic Liver Disease: Noninvasive Subharmonic Aided Pressure Estimation of Hepatic Venous Pressure Gradient

Chronic Liver Disease: Noninvasive Subharmonic Aided Pressure Estimation of Hepatic Venous Pressure Gradient

Non-Invasive Intra-cardiac Pressure Measurements Using Subharmonic-Aided Pressure Estimation: Proof of Concept in Humans

Three‐Dimensional Subharmonic Aided Pressure Estimation for Assessing Arterial Plaques in a Rabbit Model

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