Regurgitation Quantification Using 3D PISA in Volume Echocardiography

Grady, Leo; Datta, Saurabh; Kutter, Oliver; Duong, Christophe; Wein, Wolfgang; Little, Stephen H.; Igo, Stephen R.; Liu, Shizhen; Vannan, Mani A.

doi:10.1007/978-3-642-23626-6_63

Cited by 24 publications

(31 citation statements)

References 12 publications

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“…123,124 3D echocardiography is far superior to 2D echocardiography for assessment of mitral valve geometry 125 and seems to be more accurate for estimation of MR severity. 126,127 Although the severity of functional MR generally correlates with the degree of LV dilatation and dysfunction, significant functional MR can also occur with relatively milder LV systolic dysfunction when it is secondary to an inferior or posterior wall myocardial infarction. 128 Nonetheless, the presence of any degree of functional MR is an adverse prognostic marker, with a graded relationship between the severity of MR and the risk of adverse clinical outcomes.…”

Section: Functional Mitral Regurgitationmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. evidence supporting the diagnosis of HF. Echocardiography is the most commonly used modality for this purpose because of its ease of application, noninvasive nature, safety, and ability to provide a vast amount of information about cardiac structure and function. Additionally, echocardiography also plays an important role in guiding therapeutic decision-making and in monitoring response to therapy. Over the past 3 decades, numerous advancements have occurred in the field of echocardiography that have helped improve our understanding of the morpho-functional aberrations occurring in HF. This review summarizes the recent advances in echocardiography as applicable to the evaluation and management of HF. Classification of Heart FailureTo facilitate clinical management, several attempts have been made to divide HF patients into categories that unify them according to their dominant clinical presentations. Thus, HF has often been described as low output failure or high output failure; forward failure or backward failure; systolic HF or diastolic HF; HFrEF or HF with preserved ejection fraction (HFpEF); and so on. More recently, HF has also been classified according to alterations in the mechanical function of the left ventricle (LV; Table 1). 6The classification of HF into systolic or diastolic HF appeared to be intuitive, categorizing patients based on the primary pathogenic abnormality, that is, impairment of cardiac contractility or impairment of filling. However, this description has now been abandoned with the recognition that these 2 entities are not mutually exclusive and have considerable overlap. Significant LV diastolic dysfunction is a ubiquitous occurrence in patients with systolic HF, whereas systolic dysfunction...

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Section: Functional Mitral Regurgitationmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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“…The algorithm generates an isovelocity segmentation in the voxel-based 3D space representing the 3D geometry (free of specific geometric assumptions) of the PISA ( Figure 2C-2G) using an optimized random walker method with a directed graph approach. 17 The segmentation results were automatically smoothened by 3D Gaussian kernel, and an isovelocity surface mesh was computed using a marching cube algorithm. No modifications were made to the automatically …”

Section: Automated Measurement Of 3d Pisamentioning

confidence: 99%

“…12,17 The essential steps are summarized in Figure 2 and Movie I in online-only Data Supplement. The user first selects the aliasing velocity and identifies the PISA on the appropriate systolic frames ( Figure 2B).…”

Section: Automated Measurement Of 3d Pisamentioning

confidence: 99%

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Quantification of Chronic Functional Mitral Regurgitation by Automated 3-Dimensional Peak and Integrated Proximal Isovelocity Surface Area and Stroke Volume Techniques Using Real-Time 3-Dimensional Volume Color Doppler Echocardiography

Thavendiranathan

Liu

Datta

et al. 2013

Circ: Cardiovascular Imaging

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125

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Background-The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography. Methods and Results-Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm 2 ) was underestimated to a greater degree by the 2D (0.12±0.05 cm 2 ) than the 3D method (0.25±0.10 cm 2 ; P<0.001 for both). Compared with the flowmeter (40±14 mL), the RVol by 2D PISA (20±19 mL) was underestimated (P<0.001), but the 3D peak (43±16 mL) and integrated PISA-based (38±14 mL) RVol were comparable (P>0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol r=0.84 and regurgitant fraction r=0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL; P=0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL; P<0.001). In addition, RVol calculated as the difference in automated mitral and aortic stroke volumes by real-time 3D volume color flow Doppler echocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL; P=0.33). Conclusions-Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity. (Circ Cardiovasc Imaging. 2013;6:125-133.)Key Words: 3D integrated PISA ◼ 3D peak PISA ◼ automated 3D stroke volume ◼ cardiac MR imaging ◼ mitral regurgitation ◼ real-time 3D volume color flow Doppler echocardiography

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“…64 Extensive in vitro experiments established the accuracy of this method in measuring surface area, EROA, and RgV. 64 Studies regarding in vivo validation of this automated technique for MR quantification are currently in progress.…”

Section: Direct Measurement Of Vca By 3d Echocardiographymentioning

confidence: 97%