Ultrasonic myocardial tissue characterization in patients with dilated cardiomyopathy: Value in noninvasive assessment of myocardial fibrosis

Naito, Junko; Masuyama, Tohru; Mano, Toshiaki; Kondo, Hiroya; Yamamoto, Keiji; Nagano, Reiko; Doi, Yasuji; Hori, Masatsugu; Kamada, Takenobu

doi:10.1016/s0002-8703(96)90059-9

Cited by 65 publications

(46 citation statements)

References 27 publications

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“…In experimental studies, IBS absolute values have been shown to be reliable indices of LV fibrosis. In addition, they have been shown to reflect myocardial collagen content as assessed by endomyocardial biopsy in humans (15,16,18). It has been demonstrated that even mild reductions in renal function are associated with a greater prevalence of LVH (27,28); the increase in IBS reflectivity that was observed in our study also indicates an early increase in LV collagen deposition, beginning well before the development of ESRD.…”

Section: Discussionsupporting

confidence: 62%

“…Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). In humans, ultrasonic backscatter indices have been shown to be related to myocardial collagen content as assessed by endomyocardial biopsy (15)(16)(17)(18). Therefore, we considered it worthwhile to analyze myocardial ultrasonic backscatter (IBS) in patients who had CRF and were undergoing hemodialysis, in patients with mild to moderate CRF, and in patients with essential hypertension with comparable age, BP values and LVM to evaluate whether interstitial collagen deposition as evaluated by acoustic densitometry may appear early in the course of chronic kidney disease (CKD).…”

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confidence: 99%

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Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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The objective of this study was to detect ultrastructural changes in myocardium related to collagen content by ultrasound tissue characterization in patients with chronic kidney disease (CKD) and in uncomplicated hypertensive control subjects. In 25 hemodialysis (HD) patients, in 25 patients with moderate to severe chronic renal failure (CRF), and in 10 patients with essential hypertension (EH) and normal renal function matched for age, BP, and left ventricular mass index, left ventricular anatomy and function were evaluated by conventional echocardiography, and integrated backscatter signal (IBS) was analyzed by acoustic densitometry. IBS mean reflectivity increased from 48% in patients with EH to 56% in patients with CRF to 62% in HD patients (ANOVA P < 0.01). IBS mean cyclic variation was progressively increased from 4.35 ؎ 1.2 dB in HD patients to 5.27 ؎ 0.90 in patients with CRF to 6.50 ؎ 1.6 dB in patients with EH (ANOVA P < 0.01). At multivariate analysis, IBS mean reflectivity was positively related to age and serum creatinine (␤ 0.351, P ‫؍‬ 0.036; and ␤ ‫؍‬ 0.408, P ‫؍‬ 0.016, respectively). IBS mean cyclic variation was inversely related to age and serum creatinine (␤ ‫؍‬ ؊0.274, P ‫؍‬ 0.025; and ␤ ‫؍‬ ؊0.262, P ‫؍‬ 0.025, respectively) and positively related to left ventricular midwall fractional shortening and transmitral E/A ratio (␤ ‫؍‬ 0.269, P < 0.05; and ␤ ‫؍‬ 0.314, P < 0.001, respectively). The data support the hypothesis that interstitial collagen deposition may appear early in the course of CKD and suggest that acoustic densitometry may represent a useful tool for the assessment of myocardial tissue changes in patients with CKD. 18: 195318: -195818: , 200718: . doi: 10.1681 L eft ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity and mortality in patients with ESRD as well as in hypertensive patients, in patients with coronary artery disease, and in the general population (1). It has been demonstrated that changes in LV mass index (LVMI) over time are associated with cardiovascular prognosis (2-4), and LVH is currently considered an important intermediate end point in the treatment of hypertensive patients (5,6). A greater prevalence of LVH has been reported in patients with chronic renal failure (CRF) (7), possibly contributing to the greater risk for cardiovascular events in these patients (8,9). Experimental studies have demonstrated that the typical changes in uremic cardiomyopathy are increased cardiac size, interstitial and perivascular fibrosis, reduced capillary density, and thickening of intramural myocardial arterioles (10). J Am Soc NephrolAcoustic densitometry is a noninvasive tool for the evaluation of myocardial tissue characteristics and provides an integrated on-line capability to measure, display, and analyze the average acoustic image intensity within a user-specified region of interest (ROI). Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). I...

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Section: Discussionsupporting

confidence: 62%

mentioning

confidence: 99%

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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“…Recently, the analysis of IB and strain rate imaging have been used to detect myocardial structural and functional abnormalities in various cardiac conditions, and it has been shown that IB analysis has a higher ability to assess myocardial fibrosis in comparison with strain rate imaging [13]. Previous studies have demonstrated that the analysis of IB has the potential to assess myocardial interstitial fibrosis and intrinsic myocardial contractility in DCM [9,10]. These clinical observations have revealed an increased calibrated IB and a reduced CV-IB in patients with DCM, and it has been reported that both parameters correlate with a histologic estimate of myocardial fibrosis in the biopsy specimen of DCM patients [14].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have investigated ultrasonic tissue characterization in patients with DCM, and have shown that the analysis of IB has the potential to assess the myocardial interstitial fibrosis and intrinsic myocardial contractility in DCM [9,10]. We have thus hypothesized that a close relationship should exist between the activity of angiogenic factors and alterations in myocardial texture in DCM.…”

Section: Introductionmentioning

confidence: 99%

Serum markers of angiogenesis and myocardial ultrasonic tissue characterization in patients with dilated cardiomyopathy

Ohtsuka

Inoue

Hara

et al. 2005

European J of Heart Fail

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Background and aims: It has been proven that a disturbance in angiogenesis contributes to the progression of myocardial interstitial fibrosis in idiopathic dilated cardiomyopathy (DCM). This study was designed to evaluate the relationship between serum activity of angiogenic factors and myocardial ultrasonic tissue characterization in patients with DCM. Methods and results:We studied 30 patients with DCM and 15 healthy control subjects. Serum levels of vascular endothelial growth factor (VEGF), interleukin (IL)-4 and IL-13 were measured using enzyme-linked immunosorbent assay. We determined calibrated myocardial integrated backscatter (IB) as the value of myocardial interstitial fibrosis using ultrasonic tissue characterization and also quantified the magnitude of cyclic variations in IB (CV-IB). Serum levels of VEGF and IL-13 were significantly higher in patients with DCM than in control subjects (both Pb0.05). Calibrated IB was significantly higher and CV-IB was markedly lower in patients with DCM than in control subjects (both Pb0.01). In patients with DCM, the levels of IL-13 significantly correlated with calibrated IB (r=0.520, P=0.018). In addition, there was a significant negative correlation between levels of VEGF and CV-IB (r=À0.611, P=0.007). Conclusion: The increase in serum VEGF and IL-13 may be closely related to alterations in myocardial texture in DCM.

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“…Do mesmo modo, o aumento do conteúdo de colágeno presente no processo de fibrose comum a vários processos patológicos cardiovasculares poderia implicar em maior intensidade do integrated backscatter 19,20 . Isto têm sido observado em vários estudos 18,21,22 . No que concerne à contribuição do conteúdo protéico e lipídico na determinação do coeficiente de backscatter, os estudos são menos claros 21 .…”

Section: O Integrated Backscatterunclassified

Caracterização ultra-sônica tecidual miocárdica

Pazin‐Filho¹,

Schmidt

Almeida-Filho

et al. 2003

Arq. Bras. Cardiol.

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Atualização cardite, isquemia e trauma, como causa de mobilidade parietal segmentar anormal); 3) quantificar a extensão da mudança ou envolvimento; e 4) diferenciar tecido normal, embora não funcionante de tecido lesado ou necrótico 4 .A perspectiva concreta de utilização da ecocardiografia na análise das características anatômicas ultra-estruturais do músculo cardíaco abriu-se durante a última década, com a técnica da caracterização tecidual, que avalia, quantitativamente, as alterações nas ondas de ultra-som durante sua interação física com o tecido miocárdico, permitindo estabelecer correlações com as propriedades físicas das estruturas do tecido miocárdico 4 .Quando o feixe de ultra-som, emitido pelo transdutor, incide sobre os tecidos, basicamente dois tipos de sinais refletidos retornam ao transdutor. Eles são diretamente dependentes da relação entre a dimensão da superfície atingida pelo feixe de ultra-som e o comprimento de onda desse feixe 5 ( fig. 1). Assim, existe um primeiro conjunto de sinais decorrentes do fenômeno de reflexão especular do ultrasom, incidindo sobre superfícies que apresentam dimensão muito maior que o comprimento de onda do ultra-som; mas também existe um outro, decorrente do fenômeno de dispersão (em inglês, scatter), ocorrido quando a dimensão da superfície sobre a qual incide o feixe de ultra-som é muito menor que o seu comprimento de onda. Ao contrário do fenômeno de reflexão, que se dá preferencialmente em uma direção, o fenômeno de dispersão é multidirecional e apenas uma parte pequena do ultra-som dispersado pode ser captada pelo transdutor (conhecido como backscatter). O fenô-meno de dispersão é o responsável pela produção dos sinais que são processados para análise de velocidade e direção de fluxo sanguíneo (técnica de Doppler), ao mesmo tempo que depende da heterogeneidade regional das propriedades físicas do tecido, especialmente de densidade e compressibilidade, quando interage com o ultra-som, além da extensão e distribuição dessa heterogeneidade 5 .Para a obtenção das imagens ecocardiográficas bidimensionais convencionais, são utilizados os sinais oriundos da reflexão especular, que permitem imagens de melhor resolução espacial, enquanto os sinais provenientes do Ao longo das últimas décadas, os métodos ultrasonográficos de investigação cardiovascular receberam avanços tecnológicos, contribuindo decisivamente para o aprimoramento diagnóstico e prognóstico de doenças, que apresentam envolvimento cardíaco. Não obstante ter a ecocardiografia se consolidado como método de ampla utilização clínica, em face do amplo conjunto de informações morfológicas e funcionais que essa técnica pode proporcionar, os avanços relativos à sua capacidade de permitir inferên-cias relativas à constituição anatômica de estruturas cardía-cas eram, até recentemente, bastante limitados.Desde o início do desenvolvimento da ecocardiografia, era possível documentar que algumas estruturas eram mais refringentes do que outras, o que, em muitas ocasiões, podia ser correlacionado com a constituição da e...

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Ultrasonic myocardial tissue characterization in patients with dilated cardiomyopathy: Value in noninvasive assessment of myocardial fibrosis

Cited by 65 publications

References 27 publications

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Serum markers of angiogenesis and myocardial ultrasonic tissue characterization in patients with dilated cardiomyopathy

Caracterização ultra-sônica tecidual miocárdica

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