The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

https://biblio.ugent.be/publication/5953422/file/5953443.pdf

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging.

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.

https://www.asefoundation.org/wp-content/uploads/2013/05/Current-and-Evolving-Echo-Tech-for-the-Quantitative-Eval-of-Cardiac-Mechanics-Part-1.pdf

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

The authors summarize the recent developments in speckle-tracking echocardiography (STE), a relatively new technique that can be used in conjunction with two-dimensional or three-dimensional echocardiography for resolving the multidirectional components of left ventricular (LV) deformation. The tracking system is based on grayscale B-mode images and is obtained by automatic measurement of the distance between 2 pixels of an LV segment during the cardiac cycle, independent of the angle of insonation. The integration of STE with real-time cardiac ultrasound imaging overcomes some of the limitations of previous work in the field and has the potential to provide a unified framework to more accurately quantify the regional and global function of the left ventricle. STE holds promise to reduce interobserver and intraobserver variability in assessing regional LV function and to improve patient care while reducing health care costs through the early identification of subclinical disease. Following a brief overview of the approach, the authors pool the initial observations from clinical studies on the development, validation, merits, and limitations of STE.

Assessment of Myocardial Mechanics Using Speckle Tracking Echocardiography: Fundamentals and Clinical Applications

Background— Mechanical dyssynchrony is a potential means to predict response to cardiac resynchronization therapy (CRT). We hypothesized that novel echocardiographic image speckle tracking can quantify dyssynchrony and predict response to CRT. Methods and Results— Seventy-four subjects were studied: 64 heart failure patients undergoing CRT (aged 64±12 years, ejection fraction 26±6%, QRS duration 157±28 ms) and 10 normal controls. Speckle tracking applied to routine midventricular short-axis images calculated radial strain from multiple circumferential points averaged to 6 standard segments. Dyssynchrony from timing of speckle-tracking peak radial strain was correlated with tissue Doppler measures in 47 subjects (r=0.94, P<0.001; 95% CI 0.90 to 0.96). The ability of baseline speckle-tracking radial dyssynchrony (time difference in peak septal wall–to–posterior wall strain ≥130 ms) to predict response to CRT was then tested. It predicted an immediate increase in stroke volume in 48 patients studied the day ...

Novel Speckle-Tracking Radial Strain From Routine Black-and-White Echocardiographic Images to Quantify Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy

Objectives We sought to assess the feasibility of 2-dimensional strain, a novel software for real-time quantitative echocardiographic assessment of myocardial function Methods Conventional and a novel non-Doppler–based echocardiography technique for advanced wall-motion analysis were performed in 20 patients with myocardial infarction and 10 healthy volunteers from the apical views Two-dimensional strain is on the basis of the estimation that a discrete set of tissue velocities are present per each of many small elements on the ultrasound image This software permits real-time assessment of myocardial velocities, strain, and strain rate These parameters were also compared with Doppler tissue imaging measurements in 10 additional patients Results In all, 803% of infarct and 978% of normal segments could be adequately tracked by the software Peak systolic strain, strain rate, and peak systolic myocardial velocities, calculated from the software, were significantly higher in the normal than in the infarct segments In the 10 additional patients, velocities, strain, and strain rate obtained with the novel software were not significantly different from those obtained with Doppler tissue imaging Conclusion Two-dimensional strain can accomplish real-time wall-motion analysis, and has the potential to become a standard for real-time automatic echocardiographic assessment of cardiac function

Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function.

Improving motion estimation by accounting for local image distortion

Asynchronous cardiac activation leads to decreased pumping efficiency. Quantifying the activation sequence may optimize both the selection of patients for cardiac resynchronization therapy (CRT) and its efficacy. The feasibility of assessing the directivity and the degree of synchronous activation with ultrasound was examined. A tissue tracking method (CEB, GE-Ultrasound, AFI, GE Healthcare Inc., Wauwatosa, WI, USA) provided the regional strain profiles. The first maxima in systole of the regional circumferential strains were considered as the activation times. An integrative vector (SDV) describes the activation synchrony and directivity. In six open-chest sheep, activation maps and SDV were calculated in short-axis planes of the left ventricle for normal activation and induced pacings from the anterior and lateral free walls. Both magnitude and angle of the SDV were statistically different (p < 0.05) for the different pacings. Localization of the pacing site was 3° ± 18° from true position. Conclusions were that motion analysis in echocardiograms provides insightful information regarding the activation process and may enhance procedures such as CRT. (E-mail: Dan@bm.technion.ac.il)

Detection of the cardiac activation sequence by novel echocardiographic tissue tracking method.

Quantification of cardiac local contraction across the entire ventricle wall is essential for better diagnosis and therapeutic planning. A new ultrasound B-mode image analysis technique was developed that identifies and tracks real reflectors in successive frames. This study tests the ability the technique to identify the mechanical propagation sequmce. Cardiac function was monitored (sheep open chest studies, n=7) by pressure transducers, sonocrystals, and aortic flow' meter, concurrent with ultrasound image acquisition. Epicardial electrodes mapped electrical propagation, and allowed diflerent LV pacings. Normal SA node derived activity was compared with abnormal LV contractions. Mechanical indices derived from US images correlated well with the sonocrystals measurements, and the sequence of mechanical conrraction with the measured electrical activation. Image analysis allows precise reconstruction of myocardial activation with 16msec time resolution.

/pdf/ultrasonographic-quantification-of-local-cardiac-dynamics-by-2ut3gya8o9.pdf

P. Lysyansky

Papers

Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function.

Improving motion estimation by accounting for local image distortion

Detection of the cardiac activation sequence by novel echocardiographic tissue tracking method.

Ultrasonographic quantification of local cardiac dynamics by tracking real reflectors: algorithm development and experimental validation

371 A novel method for real-time quantitative echocardiographic assessment of myocardial function