Reference Systems in Echocardiographic Quantitative Wall Motion Analysis With Registration of Respiration

Dobutamine-Atropine Stress Echocardiography

“…Several methods for the assessment of segmental FAC exist but they have different performance characteristics; methods with a fi xed reference system can appreciate and locate regional abnormalities in endocardial excursions but are sensitive to heart motion relative to the transducer while methods with fl oating reference can compensate for the latter at the expense of the ability to localise abnormalities in excursions [90,91] . By defi nition, FAC is a function of the end-diastolic cavity area and the segmental FACs are therefore affected by LV dilatation.…”

“…By defi nition, FAC is a function of the end-diastolic cavity area and the segmental FACs are therefore affected by LV dilatation. In addition, the principle used for segmentation of the left ventricle may affect the relative weight assigned to the regional FACs and their sensitivity to confounders such as heart motion relative to the transducer [91] .…”

“…We found that segmental FACs, those of cross sections and FACs of entire cavity areas were equally sensitive to mild LV dysfunction but no segmental FAC method could accurately predict the infarct related coronary artery in patients with single vessel disease [92] . Previous studies employing manual endocardial tracings and these methods to detect and localise larger myocardial infarctions have arrived at confl icting conclusions [58,60,90,91] , but after the development of a clinically applicable computerised tracing principle, Lang et al [93] found that the centroid method with fi xed reference accurately detected and located regional LV dysfunction. We found that FAC methods with fl oating reference and FACs of cross sections were the least affected by surgery-induced adverse heart motion relative to the transducer but appeared to overestimate the extent of LV dysfunction signifi cantly in patients with moderately reduced LV function [92] , also in accordance with previous observations [91] .…”

“…Previous studies employing manual endocardial tracings and these methods to detect and localise larger myocardial infarctions have arrived at confl icting conclusions [58,60,90,91] , but after the development of a clinically applicable computerised tracing principle, Lang et al [93] found that the centroid method with fi xed reference accurately detected and located regional LV dysfunction. We found that FAC methods with fl oating reference and FACs of cross sections were the least affected by surgery-induced adverse heart motion relative to the transducer but appeared to overestimate the extent of LV dysfunction signifi cantly in patients with moderately reduced LV function [92] , also in accordance with previous observations [91] . Furthermore, our identifi cation of reference points seemed reasonably reproducible whereas tracing of endocardial borders varied substantially between, and to a lesser degree within, observers underscoring the limitations of the method [92] .…”

Quantitative Analysis of Dobutamine–Atropine Stress Echocardiography by Fractional Area Change

“…Several studies have documented the usefulness of segmental fractional area change analysis to locate larger myocardial infarctions in echocardiographic recordings obtained at rest [10,11,27] , some of which have emphasized the need to control for motion of the heart relative to the transducer during respiration or following coronary surgery [11,27] . We believe that the ability of segmental fractional area change to correctly locate stress induced left ventricular dysfunction, subtle as it often is, may be offset by the confounding effects of intra-thoracic motion of the heart, heavy breathing, changes in shape and dimensions of the left ventricle, remote left ventricular dysfunction and variation in recording all of which may occur frequently at peak stress during dobutamine-atropine stress echocardiography.…”