Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

http://www.botonimarco.it/files/chamberquantification.pdf

Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

We have presented recommendations for the optimum acquisition of quantitative two-dimensional data in the current echocardiographic environment. It is likely that advances in imaging may enhance or supplement these approaches. For example, three-dimensional reconstruction methods may greatly augment the accuracy of volume determination if they become more efficient. The development of three-dimensional methods will depend in turn on vastly improved transthoracic resolution similar to that now obtainable by transesophageal echocardiography. Better resolution will also make the use of more direct methods of measuring myocardial mass practical. For example, if the epicardium were well resolved in the long-axis apical views, the myocardial shell volume could be measured directly by the biplane method of discs rather than extrapolating myocardial thickness from a single short-axis view. At present, it is our opinion that current technology justifies the clinical use of the quantitative two-dimensional methods described in this article. When technically feasible, and if resources permit, we recommend the routine reporting of left ventricular ejection fraction, diastolic volume, mass, and wall motion score.

Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.

Nuclear cardiology, echocardiography, cardiovascular magnetic resonance (CMR), cardiac computed tomography (CT), positron emission computed tomography (PET), and coronary angiography are imaging modalities that have been used to measure myocardial perfusion, left ventricular function, and coronary anatomy for clinical management and research. Although there are technical differences between these modalities, all of them image the myocardium and the adjacent cavity. However, the orientation of the heart, angle selection for cardiac planes, number of segments, slice display and thickness, nomenclature for segments, and assignment of segments to coronary arterial territories have evolved independently within each field. This evolution has been based on the inherent strengths and weaknesses of the technique and the practical clinical application of these modalities as they are used for patient management. This independent evolution has resulted in a lack of standardization and has made accurate intra- and cross-modality comparisons for clinical patient management and research very difficult, if not, at times, impossible.

Attempts to standardize these options for all cardiac imaging modalities should be based on the sound principles that have evolved from cardiac anatomy and clinical needs.1–3⇓⇓ Selection of standardized methods must be based on the following criteria:





An earlier special report from the American Heart Association, American College of Cardiology, and Society of Nuclear Medicine4 defined standards for plane selection and display orientation for serial …

/pdf/standardized-myocardial-segmentation-and-nomenclature-for-3acd7sia50.pdf

Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart A Statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association

http://cardiologia.publicacionmedica.com/contenido/images/stemi_aha_2013.pdf

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

https://www.medpagetoday.com/upload/2014/3/3/02536-1.pdf

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease

Conventional M-mode echocardiography has become established as a diagnostic tool for noninvasive evaluation of cardiovascular diseases. Now the advent of two-dimensional real-time echocardiography has opened a new era of investigation. This paper describes in detail the technique of a complete two-dimensional ultrasonic examination of the heart and great vessels. Four transducer locations were commonly utilized--namely, parasternal, apical, subxiphoid, and suprasternal notch positions. The tomographic sections of the heart obtained along the long and short axes of the heart and great vessels by utilizing the above positions were validated by detailed anatomic and contrast echocardiographic techniques.

Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation

Studies of the correlation of aortic valve gradient determined by continuous-wave Doppler echocardiography and that determined at catheterization have, to date, involved young patients and nonsimultaneous measurements. We therefore obtained simultaneous Doppler echocardiographic and catheter measurements of pressure gradient in 100 consecutive adults (mean age 69, range 50 to 89 years). In 63 patients pressure measurements were obtained with dual-catheter techniques and in 37 they were obtained by withdrawal of the catheter from the left ventricle to the ascending aorta. Forty-six of these patients also underwent an outpatient Doppler study 7 days or less before catheterization. The simultaneous pressure waveforms and Doppler spectral velocity profiles were digitized at 10 msec intervals and maximum, mean, and instantaneous gradients (mm Hg) were derived for each. The correlation between the Doppler-determined gradient and the simultaneously measured maximum catheter gradient was r = .92 (SEE = 15 mm Hg), that between the Doppler-determined and mean catheter gradient was r = .93 (SEE = 10 mm Hg), and that between the Doppler and peak-to-peak catheter gradient was r = .91 (SEE = 14). The correlation between the nonsimultaneously Doppler-determined gradient and the maximum gradient measured by catheter was not as strong (r = .79, SEE = 24). The continuous-wave Doppler echocardiographic velocity profile represents the instantaneous transaortic pressure gradient throughout the cardiac cycle. The best correlation with continuous-wave Doppler-determined gradient was obtained with maximum and mean gradients measured by catheter. Continuous-wave Doppler echocardiography can be used to reliably predict the pressure gradient in adults with calcific aortic stenosis.

Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients.

An underfluid ultrasound imaging catheter system includes a catheter having a distal end inserted into an underfluid structure, an ultrasonic transducer array mounted proximate the distal end of the catheter wherein the array has a row of individual transducer crystals, a lens mounted on the array for defocusing ultrasound beams in a direction perpendicular to an axis of the array so as to provide a volumetric field of view within which the underfluid features are imaged. Alternatively, the single row of transducer crystals is replaced by multiple rows of transducer crystals so as to provide a volumetric field of view. This imaging catheter system helps an operator see 3-dimensional images of an underfluid environment, such as the 3-dimensional images of fluid-filled cavities of heart, blood vessel, urinary bladder, etc. Features in such wide volumetric field of view can be imaged, measured, or intervened by an underfluid therapeutic device with an aid of the real-time image.

Volumetric image ultrasound transducer underfluid catheter system

Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

A self contained ultrasound device for the delivery of therapeutic and other types of tools to be visualized in an ultrasound-type environment within the blood before, during, and after an intervention includes a catheter having a catheter body with a proximal and distal ends. The catheter contains an ultrasonic transducer proximate its distal end. An access port is provided in the catheter for delivery of a therapeutic device or the like to proximate the distal end of the catheter body. A guide wire port is further provided for insertion therethrough of a guide wire.

Abdul J. Tajik

Papers

Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation

Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients.

Volumetric image ultrasound transducer underfluid catheter system

M-mode and two-dimensional echocardiographic features in cardiac amyloidosis.

Transvascular ultrasound hemodynamic and interventional catheter and method