Showing papers by "Jens-Uwe Voigt published in 2011"

Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications: Endorsed by the Japanese Society of Echocardiography

Abstract: Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment.Several such technique shave emerged over the past decades to address the issue of reader's experience and inter measurement variability in interpretation.Some were widely embraced by echocardiographers around the world and became part of the clinical routine,whereas others remained limited to research and exploration of new clinical applications.Two such techniques have dominated the research arena of echocardiography: (1) Doppler based tissue velocity measurements,frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements.Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated backscatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses,briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.

Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese society of echocardiography

Abstract: Echocardiographic imaging is ideally suited for the evaluation of cardiac mechanics because of its intrinsically dynamic nature. Because for decades, echocardiography has been the only imaging modality that allows dynamic imaging of the heart, it is only natural that new, increasingly automated techniques for sophisticated analysis of cardiac mechanics have been driven by researchers and manufacturers of ultrasound imaging equipment. Several such techniques have emerged over the past decades to address the issue of reader's experience and inter-measurement variability in interpretation. Some were widely embraced by echocardiographers around the world and became part of the clinical routine, whereas others remained limited to research and exploration of new clinical applications. Two such techniques have dominated the research arena of echocardiography: (1) Doppler-based tissue velocity measurements, frequently referred to as tissue Doppler or myocardial Doppler, and (2) speckle tracking on the basis of displacement measurements. Both types of measurements lend themselves to the derivation of multiple parameters of myocardial function. The goal of this document is to focus on the currently available techniques that allow quantitative assessment of myocardial function via image-based analysis of local myocardial dynamics, including Doppler tissue imaging and speckle-tracking echocardiography, as well as integrated back- scatter analysis. This document describes the current and potential clinical applications of these techniques and their strengths and weaknesses, briefly surveys a selection of the relevant published literature while highlighting normal and abnormal findings in the context of different cardiovascular pathologies, and summarizes the unresolved issues, future research priorities, and recommended indications for clinical use.

The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography.

Abstract: Pocket-size imaging devices are a completely new type of echo machines which have recently reached the market. They are very cheap, smartphone-size hand-held echo machines with limited technical capabilities. The aim of this European Association of Echocardiography (EAE) position paper is to provide recommendations on the use of pocket-size imaging devices in the clinical arena by profiling the educational needs of potential users other than cardiologists experts in echo. EAE recommendations about pocket-size imaging devices can be summarized in: (1) pocket-size imaging devices do not provide a complete diagnostic echocardiographic examination. The range of indications for their use is therefore limited. (2) Imaging assessment with pocket-size imaging devices should be reported as part of the physical examination of the patient. Image data should be stored according to the applicable national rules for technical examinations. (3) With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended for all users. The certification should be limited to the clinical questions that can potentially be answered by pocket-size devices. (4) The patient has to be informed that an examination with the current generation of pocket-size imaging devices does not replace a complete echocardiogram.

Diagnostic Accuracy of a Hand-Held Ultrasound Scanner in Routine Patients Referred for Echocardiography

Abstract: Background The aim of this study was to investigate the imaging capabilities of recent hand-held ultrasound scanners. Methods Three hundred forty-nine patients were scanned with hand-held ultrasound (HAND) and high-end echocardiography (HIGH). Segmental endocardial border delineation was scored (2 = good, 1=poor, 0=invisible) to describe image quality. Assessments of left ventricular (LV) dimensions, regional and global LV function, and grades of valve disease were compared. Results The mean endocardial visibility grades were 1.6 ± 0.5 with HAND and 1.7 ± 0.4 with HIGH ( P P r = 0.99, P P Conclusions Handheld echocardiography was feasible and missed no relevant findings. Given the future implementation of spectral Doppler capabilities, this handheld scanner can safely be used in clinical routine.

Acute radiation effects on cardiac function detected by strain rate imaging in breast cancer patients.

Abstract: Purpose To investigate the occurrence of early radiation-induced changes in regional cardiac function using strain rate imaging (SRI) by tissue Doppler echocardiography. Methods and Materials We included 20 left-sided and 10 right-sided breast cancer patients receiving radiotherapy (RT) to the breast or chest wall. Standard echocardiography and SRI were performed before RT (baseline), immediately after RT (post-RT), and at 2 months follow-up (FUP) after RT. Regional strain (S) and strain rate (SR) values were obtained from all 18 left ventricular (LV) segments. Data were compared to the regional radiation dose. Results A reduction in S was observed post-RT and at FUP in left-sided patients (S post-RT : −17.6 ± 1.5%, and S FUP : −17.4 ± 2.3%, vs. S baseline : −19.5 ± 2.1%, p post-RT : −15.3 ± 2.5%, and S FUP : −14.3 ± 3.7%, vs. S baseline : −19.3 ± 3.0%, p post-RT : −1.06 ± 0.15 s −1 , and SR FUP : −1.16 ± 0.28 s −1 , vs. SR baseline : −1.29 ± 0.27s −1 , p = 0.01), but not in mid- or basal segments. Furthermore, we observed that segments exposed to more than 3 Gy showed a significant decrease in S after RT (S post-RT : −16.1 ± 1.6%, and S FUP : −15.8 ± 3.4%, vs. S baseline : −18.9 ± 2.6%, p Conclusions SRI shows a dose-related regional decrease in myocardial function after RT. It might be a useful tool in the evaluation of modern RT techniques, with respect to cardiac toxicity.

Different Patterns of Adaptation of the Right Ventricle to Pressure Overload: A Comparison between Pulmonary Hypertension and Pulmonary Stenosis

Abstract: Background The study was designed to compare RV morphological and functional parameters derived from conventional and myocardial deformation echocardiography in two instances of right heart pressure overload: pulmonary arterial hypertension (PAH) and pulmonary stenosis (PS). Methods Sixty-two individuals were included: 22 patients with pulmonary arterial hypertension (PAH), 19 patients with PS and 21 healthy individuals who served as a control group. All patients had clinical evaluation with 6-minute walking test, standard and two-dimensional strain echocardiography and B-type natriuretic peptide evaluation. Results At similar levels of pressure overload (RV systolic pressure, 88.2 ± 31.5 vs 73.4 ± 34.9 mm Hg; P = NS) the right ventricles of patients with PS were less dilated (RV end-diastolic diameter, 31.7 ± 3.7 vs 43.7 ± 10.5 mm; P P r = 0.64, P = .03), not in those with PS ( r = 0.22, P = .50). Conclusions At similar levels of pressure overload, the right ventricle is less dilated and performs better in patients with PS compared with those with PAH.

Regional right ventricular deformation in patients with open and closed atrial septal defect.

Abstract: Aims This study aimed at (i) evaluating regional right ventricular (RV) deformation in patients with an atrial septal defect (ASD)-type secundum using strain and strain rate imaging and (ii) investigating the relation of regional deformation with functional capacity using cardiopulmonary exercise testing (CPET) in order to identify subclinical changes in RV function. Methods and results Forty-five patients with ASD-type secundum (18 open, 27 closed) and 20 age-matched controls were included. All underwent standard echocardiography and colour-Doppler myocardial velocity imaging. Longitudinal deformation was measured in the RV free wall divided in two segments. ASD patients underwent symptom-limited CPET. When compared with controls, apical strain was higher (−38.2 ± 9.9 vs. −29.9 ± 6.6%; P = 0.004) and lower (−25.2 ± 6.1 vs. −29.9 ± 6.6%; P = 0.006) in patients with an open and a closed ASD, respectively. Apical strain was higher (−38.2 ± 9.9 vs. −27.9 ± 6.6%; P = 0.001) and lower (−25.2 ± 6.1 vs. −28.7 ± 7.4%; P = 0.022) than basal strain in patients with an open and a closed ASD, respectively. In patients with an open ASD, apical strain correlated with shunt-ratio ( R = −0.78; P < 0.0001), RV end-diastolic area ( R = −0.68; P = 0.002), and RV stroke volume ( R = −0.67; P = 0.002). Peak oxygen consumption (peak vO2) was below average in patients with an open (79 ± 19% predicted; P < 0.0001) and a closed ASD (89 ± 18% predicted; P = 0.002). After ASD repair, apical strain correlated with peak vO2 ( R = −0.49; P = 0.01) and with ventilatory efficiency ( R = 0.62; P = 0.001). Conclusion Volume overload of the right ventricle in patients with ASD-type secundum causes a regional deformation pattern with higher apical strain, related to parameters of volume load severity. After ASD repair, lower apical strain values correlated with functional capacity. Measurement of apical strain seems sensitive for detecting mild RV dysfunction.

Clinical validation of a novel speckle-tracking-based ejection fraction assessment method.

Abstract: Background The aim of this study was to determine the feasibility, accuracy, and reproducibility of a novel tracking-based echocardiographic ejection fraction (EF) assessment method in comparison with traditional methods based on magnetic resonance imaging and echocardiography. Methods In a prospective assessment, apical echocardiographic grayscale image loops from 81 patients were read in random order by four experienced readers, blinded to any data of the cases. In three separate sessions, EFs were estimated using biplane tracking-based assessment and according to the modified Simpson's rule, as well as by visual interpretation in three apical views. Data were compared with a reference EF derived from echocardiography and magnetic resonance imaging. Results On average, no significant difference was found between EF estimates of the different methods. Tracking-based EF assessments were possible in 90% of the patients. Tracking-based EF assessments showed slightly higher deviations from the reference EF than the modified Simpson's rule, while interobserver and intraobserver variability of tracking-based assessment were significantly better. Visual interpretation allowed the fastest EF assessment. Tracking-based EF assessment was approximately twice as fast as the modified Simpson's rule. Conclusions Tracking-based EF assessment is feasible, has lower interobserver and intraobserver variability, and is faster than traditional echocardiographic EF quantification. Its minimal demand on user interaction makes it a favorable alternative to traditional echocardiographic approaches, with a particular clinical advantage when reliable follow-up measurements are needed.

Pulmonary vascular resistance as assessed by bicycle stress echocardiography in patients with atrial septal defect type secundum.

Abstract: Background— Volume overload of the pulmonary circulation in patients with atrial septal defect (ASD)-type secundum causes pulmonary vascular disease over a long period of time. This study aimed at (1) evaluating pulmonary vascular resistance (PVR) and (2) investigating the relation between PVR and exercise capacity in patients with open and closed ASD. Methods and Results— Forty-six patients with ASD-type secundum (18 open, 28 closed) and 20 age-matched controls were enrolled. All underwent standard and symptom-limited bicycle stress echocardiography and cardiopulmonary exercise testing. PVR was calculated as the slope of a pulmonary artery systolic pressure (PAP)-flow plot or as the ratio of PAP to cardiac output (total PVR). The slope of PAP-flow was higher in patients with open (5.1±2.2 versus 3.0±0.8 mm Hg/L per min; P =0.002) and closed ASD (4.0±1.7 versus 3.0±0.8 mm Hg/L per min) compared with controls. In patients with an open ASD, total PVR did not change from rest to peak exercise. In patients with a closed ASD and controls, total PVR decreased from rest to peak exercise. However, in patients with an ASD closed later in life (≥34 years, median age at repair), the slope of PAP-flow was higher (5.1±1.4 versus 3.0±0.8 mm Hg/L per min; P <0.0001), but total PVR did not change from rest to peak exercise. Peak oxygen consumption correlated inversely with the slope of the PAP-flow plots in patients with open ( P =0.013) and closed ASD ( P =0.005). Conclusions— In patients with an open ASD, the slope of PAP-flow was higher and total PVR did not change from rest to peak exercise. In patients with an ASD closed later in life, the slope of PAP-flow was higher and total PVR did not change from rest to peak exercise, indicating altered pulmonary hemodynamics in these patients.

Extra-cardiac compression and left ventricular inflow obstruction as a complication of a Sengstaken–Blakemore tube

Abstract: A 78-year-old man was admitted for a proximal humerus fracture after an accidental fall. On Day 4 after admission, he developed haematemesis. Oesophagogastroscopy revealed oesophageal varices. Bleeding could be initially controlled by an endoscopic ligature of the varices, but 1h later, recurrent haematemesis was seen. A Sengstaken–Blakemore tube was passed down the oesophagus and the gastric balloon was inflated inside the stomach. A traction of 1 …

Left ventricular 2D flow pattern estimation by combining speckle tracking with Navier-Stokes-based regularization in an iterative way

Abstract: Ultrasound imaging with low dose contrast injection would be of interest to better characterize the cardiac flow dynamics inside the left ventricle (LV). The aim of this study was to combine speckle tracking (ST) with regularization based on Navier-Stokes (NS) equations in an iterative manner in order to improve the pure ST results when the inflow velocities were high. It was tested in a Computational Fluid Dynamics (CFD) based Ultrasound simulation environment. On two subsequent images in diastasis, block-matching was applied using normalized cross-correlation as a similarity measure and spline-interpolation for subsample motion estimation. During regularization, the difference between the measured and the regularized velocity field was added as an external force to a finite difference implementation of the NS equations. This regularized velocity field was used as prior to the ST procedure between the following pair of images by guiding and reshaping the search region appropriately. This iterative approach was performed in the forward and the backward temporal direction to obtain the flow fields of the whole filling phase. The RMSE of all velocity estimates (amplitude & angle) within each frame was calculated using the CFD velocity vector fields as the ground truth and these findings were contrasted to pure ST. In this study, we could thus show that LV flow tracking by combining ST with NS based regularization in an iterative manner improves the accuracy of the pure ST results even at high inflow velocity.

Left atrial myxoma. Evaluation with transoesophageal echocardiographic and real time three-dimensional imaging.

Abstract: Myxoma is the most common benign cardiac neoplasm. A 66-year-old woman presented with a large left atrial myxoma, which was detected by a real-time three-dimensional echocardiography (RT3DE) and a real-time three-dimensional transoesophageal echocardiography (RT3D-TEE) approach. RT3DE and RT3D-TEE proved to be techniques that can provide additional contributions to the diagnostic investigation of structural heart diseases.