Left ventricular volume from paired biplane two-dimensional echocardiography.
TL;DR: The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography, and the volumes determined with a modified Simpson's rule formula determined systolic and diastolic left ventricular volumes from the bi plane echogram and the biplane angiogram.
Abstract: To evaluate the applicability of two-dimensional echocardiography to left ventricular volume determination, 30 consecutive patients undergoing biplane left ventricular cineangiography were studied with a wide-angle (84 degrees), phased-array, two-dimensional echocardiographic system. Two echographic projections were used to obtain paired, biplane, tomographic images of the left ventricle. We used the short-axis view (from the precordial window) as an anolog of the left anterior oblique angiogram, and the long-axis, two-chamber view (from the apex impulse window) as a right anterior oblique angiographic equivalent. A modified Simpson's rule formula was used to calculate systolic and diastolic left ventricular volumes from the biplane echogram and the biplane angiogram. These methods correlated well for ejection fraction (r = 0.87) and systolic volume (r = 0.90), but only modestly for diastolic volume (r = 0.80). These correlations are noteworthy because 65% of the patients had significant segmental wall motion abnormalities. The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography.
Citations
More filters
TL;DR: The combination of tissue Doppler imaging of the mitral annulus and mitral inflow velocity curves provides better estimates of LV filling pressures than other methods (pulmonary vein, preload reduction), however, accurate prediction of filling pressures for an individual patient requires a stepwise approach incorporating all available data.
Abstract: Background—Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether mitral annular velocities as assessed by tissue Doppler imaging are associated with invasive measures of diastolic LV performance and whether additional information is gained over traditional Doppler variables. Methods and Results—One hundred consecutive patients referred for cardiac catheterization underwent simultaneous Doppler interrogation. Invasive measurements of LV pressures were obtained with micromanometer-tipped catheters, and the mean LV diastolic pressure (M-LVDP) was used as a surrogate for mean left atrial pressure. Doppler signals from the mitral inflow, pulmonary venous inflow, and TDI of the mitral annulus were obtained. Isolated parameters of transmitral flow correlated with M-LVDP only when ejection fraction <50%. The ratio of mitral velocity to early diastolic veloc...
2,779 citations
TL;DR: Measurement of BNP could be a cost-effective method of screening for left-ventricular systolic dysfunction in the general population, especially if its use were targeted to individuals at high risk.
1,001 citations
TL;DR: The results suggest that cardiovascular magnetic resonance is the preferred technique for volume and ejection fraction estimation in heart failure patients, because of its 3D approach for non-symmetric ventricles and superior image quality.
Abstract: Aims To prospectively compare the agreement of left ventricular volumes and ejection fraction by M-mode echocardiography (echo), 2D echo, radionuclide ventriculography and cardiovascular magnetic resonance performed in patients with chronic stable heart failure. It is important to know whether the results of each technique are interchangable, and thereby how the results of large studies in heart failure utilizing one technique can be applied using another. Some studies have compared cardiovascular magnetic resonance with echo or radionuclude ventriculography but few contain patients with heart failure and none have compared these techniques with the current fast breath-hold acquisition cardiovascular magnetic resonance.
Methods and Results Fifty two patients with chronic stable heart failure taking part in the CHRISTMAS Study, underwent M-mode echo, 2D echo, radionuclude ventriculography and cardiovascular magnetic resonance within 4 weeks. The scans were analysed independently in blinded fashion by a single investigator at three core laboratories. Of the echocardiograms, 86% had sufficient image quality to obtain left ventricular ejection fraction by M-mode method, but only 69% by 2D Simpson's biplane analysis. All 52 patients tolerated the radionuclude ventriculography and cardiovascular magnetic resonance, and all these scans were analysable. The mean left ventricular ejection fraction by M-mode cube method was 39±16% and 29±15% by Teichholz M-mode method. The mean left ventricular ejection fraction by 2D echo Simpson's biplane was 31±10%, by radionuclude ventriculography was 24±9% and by cardiovascular magnetic resonance was 30±11. All the mean left ventricular ejection fractions by each technique were significantly different from all other techniques ( P <0·001), except for cardiovascular magnetic resonance ejection fraction and 2D echo ejection fraction by Simpson's rule ( P =0·23). The Bland–Altman limits of agreement encompassing four standard deviations was widest for both cardiovascular magnetic resonance vs cube M-mode echo and cardiovascular magnetic resonance vs Teichholz M-mode echo at 66% each, and was 58% for radionuclude ventriculography vs cube M-mode echo, 44% for cardiovascular magnetic resonance vs Simpson's 2D echo, 39% for radionuclide ventriculography vs Simpson's 2D echo, and smallest at 31% for cardiovascular magnetic resonance–radionuclide ventriculography. Similarly, the end-diastolic volume and end-systolic volume by 2D echo and cardiovascular magnetic resonance revealed wide limits of agreement (52ml to 216ml and 11ml to 188ml, respectively).
Conclusion These results suggest that ejection fraction measurements by various techniques are not interchangeable. The conclusions and recommendations of research studies in heart failure should therefore be interpreted in the context of locally available techniques. In addition, there are very wide variances in volumes and ejection fraction between techniques, which are most marked in comparisons using echocardiography. This suggests that cardiovascular magnetic resonance is the preferred technique for volume and ejection fraction estimation in heart failure patients, because of its 3D approach for non-symmetric ventricles and superior image quality.
950 citations
TL;DR: A rapid assay for BNP can reliably detect the presence of diastolic abnormalities on echocardiography, and in patients with normal systolic function, elevated BNP levels and diastsolic filling abnormalities might help to reinforce the diagnosis diastolics dysfunction.
Abstract: Background— Although Doppler echocardiography has been used to identify abnormal left ventricular (LV) diastolic filling dynamics, inherent limitations suggest the need for additional measures of diastolic dysfunction. Because data suggest that B-natriuretic peptide (BNP) partially reflects ventricular pressure, we hypothesized that BNP levels could predict diastolic abnormalities in patients with normal systolic function. Methods and Results— We studied 294 patients referred for echocardiography to evaluate ventricular function. Patients with abnormal systolic function were excluded. Cardiologists making the assessment of LV function were blinded to BNP levels. Patients were classified as normal, impaired relaxation, pseudonormal, and restrictivelike filling patterns. Patients diagnosed with evidence of abnormal LV diastolic function (n=119) had a mean BNP concentration of 286±31 pg/mL; those in the normal LV group (n=175) had a mean BNP concentration of 33±3 pg/mL. Patients with restrictivelike filling ...
811 citations
TL;DR: This study documents that a simple, easily recordable, noninvasive Doppler index of myocardial performance correlates with invasive measurement of left ventricular systolic and diastolic function and appears to be a promisingnoninvasive measurement of overall cardiac function.
Abstract: A simple, reproducible, noninvasive Doppler index for the assessment of overall cardiac function has been described previously. The purpose of this study was to correlate the Doppler index with accepted indexes of cardiac catheterization of left ventricular performance. Thirty-four patients with ischemic heart disease or idiopathic dilated cardiomyopathy prospectively underwent a simultaneous cardiac catheterization and Doppler echocardiographic study. Invasive measurements of peak +dP/dt, peak -dP/dt, and tau were obtained from the high-fidelity left ventricular pressures. A Doppler index of myocardial performance was defined as the summation of isovolumetric contraction and relaxation time divided by ejection time. There was a correlation between Doppler measurement of isovolumetric contraction time and peak +dP/dt (r = 0.842; p < 0.0001) and Doppler measurement of isovolumetric relaxation time and peak -dP/dt (r = 0.638; p < 0.001). Left ventricular ejection time correlated with both peak +dP/dt (r = 0.539; p < 0.001) and peak -dP/dt (r = 0.582; p < 0.001). The Doppler index correlated with simultaneously recorded systolic peak +dP/dt (r = 0.821; p < 0.0001) and diastolic peak -dP/dt (r = 0.833; p < 0.001) and tau (r = 0.680; p < 0.0001). This study documents that a simple, easily recordable, noninvasive Doppler index of myocardial performance correlates with invasive measurement of left ventricular systolic and diastolic function and appears to be a promising noninvasive measurement of overall cardiac function.
789 citations
References
More filters
TL;DR: The use of a cube function of the echographic minor axis was an accurate predictor of volumes only in smaller ventricular chambers, but overestimated volumes in larger hearts.
Abstract: We compared dimensions of the left ventricular minor axis (S) measured at enddiastole (SD) and end-systole (SS) by echocardiography with dimensions and left ventricular volumes measured by biplane angiocardiography in 27 patients with diverse cardiac abnormalities. There were high correlations between echographic and angiographic ventricular minor-axis dimensions (r = 0.85 for SD and 0.87 for SS), between echographic dimensions and ventricular volumes (r = 0.84 for end-systolic volume [ESV] and SS, 0.83 for end-diastolic volume [EDV] and SD), and between the relative change in the echographic minor axis with systole (% Δ S) and ejection fraction (r = 0.79). Regression formulae were derived from these relationships which allowed calculation of ventricular volumes from echo dimensions alone: ESV = 47 SD—120, EDV = 59 SD—153. These equations allowed relatively accurate prediction of volumes over a wide range of ventricular sizes. The use of a cube function of the echographic minor axis was an accurate predic...
300 citations
TL;DR: B-scan ultrasonography appears to be a safe, noninvasive, easily repeated technic for the study of left ventricular geometry, ejection and segmental motion in patients with various cardiac disorders.
Abstract: To assess the usefulness of B-scan ultrasonography in determining left ventricular geometry and function, 25 patients with various cardiac disorders were studied with B-scan imaging within 24 hours of performance of biplane cine angiography of the left ventricle. In 14 patients asynergy present on the left anterior oblique ventriculogram was also detected on the B-scan image. A good correlation was found between the area ejection fractions as determined from the B-scan and the ventriculographic silhouettes (r = 0.92). A good correlation was also found between the B-scan area ejection fraction and the biplane volume ejection fraction (r = 0.87), even in patients with left ventricular asynergy, in whom the quantification of left ventricular geometry and function by standard time-motion echocardiography may be inaccurate. Thus, B-scan ultrasonography appears to be a safe, noninvasive, easily repeated technic for the study of left ventricular geometry, ejection and segmental motion in patients with v...
179 citations
TL;DR: This technique is found to be valuable in patients with congenital heart disease who are undergoing cross sectional echocardiography, using an 800 phased array sector scanner.
Abstract: We have evaluated apex echocardiography, using an 80 degrees phased array sector scanner, in 368 patients with congenital heart disease. With the patient lying with the left side dependent, the transducer is placed over the apex of the heart and cross sectional images are obtained in the plane perpendicular to the cardiac septa and through the orifices of the mitral and tricuspid valves. In this view, the chambers are side by side and both atria and ventricles are separated by their respective septa and atrioventricular valves. Defects in the region of the septa can be detected. Congenital defects involving the atrioventricular valves, such as endocardial cushion defects, tricuspid atresia, and Ebstein's anomaly, can be defined. The location of the baffle after Mustard's operation for aortopulmonary transposition and intra-atrial structures, such as the membrance in cor triatriatum, can be seen. The position of the apex of the heart can be located in dextro, levo, or mesocardia by definition of the apex image. The relative size of the ventricular septum can be identified with the apex image. We have found this technique to be valuable in patients with congenital heart disease who are undergoing cross sectional echocardiography.
168 citations
TL;DR: The clinical profile of the 50 patients with coronary artery disease demonstrated that optimal candidates for biplane ventriculography are patients with prior myocardial infarction, left ventricular enlargement and clinical evidence of abnormal hemodynamic status.
Abstract: Fifty patients with coronary artery disease were studied with biplane left cineventriculography (right and left anterior oblique views). Volumetric analyses were compared with those of 10 normal patients also studied with simultaneous biplane ventriculography. In normal subjects there was good agreement between minor diameters in the right and left anterior oblique views, and between ventricular volumes and ejection fractions determined by single plane and biplane techniques. In patients with coronary artery disease there was more scatter in these values, especially when asynergy was present. Loss of ventricular symmetry probably explains this disparity. By providing visualization of all five zones of the left ventricular wall, the biplane technique allowed a comprehensive evaluation of ventricular asynergy and overall function. The clinical profile of the 50 patients with coronary artery disease demonstrated that optimal candidates for biplane ventriculography are patients with prior myocardial infarction, left ventricular enlargement and clinical evidence of abnormal hemodynamic status.
150 citations
TL;DR: An echocardiographic measurement of the minimal separation between the anterior mitral valve leaflet at its E point and the Interventricular septum was evaluated as an index of left ventricular function.
Abstract: An echocardiographic measurement of the minimal separation between the anterior mitral valve leaflet at its E point and the Interventricular septum was evaluated as an index of left ventricular function. Mitral-septal separation was found to be easily measured, reproducible and independent of patient position or heart rate changes of up to 32 beats/min. In a group of 30 normal subjects, E point-septal separation was absent in 25 and minimal (less than 4 mm) in the remaining 5. The relation of this variable to biplane angiographic ejection fraction was examined in 125 patients with a variety of cardiac diseases. After the 15 patients with mitral stenosis and aortic insufficiency (conditions that affect anterior leaflet motion) were excluded, a strong negative correlation ( r = −0.87, P r = −0.86, P
119 citations