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Gao X, Abdi M, Auger DA, Sun C, Hanson CA, Robinson AA, Schumann C, Oomen PJ, Ratcliffe S, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Holmes JW, Kramer CM, Epstein FH, Salerno M, Bilchick KC. Cardiac Magnetic Resonance Assessment of Response to Cardiac Resynchronization Therapy and Programming Strategies. JACC Cardiovasc Imaging 2021; 14:2369-2383. [PMID: 34419391 DOI: 10.1016/j.jcmg.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy. BACKGROUND CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain. METHODS CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets. RESULTS 100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50 years-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals <240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P < 0.001), LV end-systolic volume (r = -0.58; P < 0.001), and LVEF (r = -0.52; P < 0.001). CONCLUSIONS CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.
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Affiliation(s)
- Xu Gao
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher A Hanson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Austin A Robinson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher Schumann
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pim J Oomen
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah Ratcliffe
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Oliver J Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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Guta AC, Badano LP, Ochoa-Jimenez RC, Genovese D, Previtero M, Civera S, Ruocco A, Bettella N, Parati G, Muraru D. Three-dimensional echocardiography to assess left ventricular geometry and function. Expert Rev Cardiovasc Ther 2020; 17:801-815. [PMID: 31770493 DOI: 10.1080/14779072.2019.1697234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Quantification of left ventricular (LV) size and function represents the most frequent indication for an echocardiographic study. New echocardiographic techniques have been developed over the last decades in an attempt to provide a more comprehensive, accurate, and reproducible assessment of LV function.Areas covered: Although two-dimensional echocardiography (2DE) is the recommended imaging modality to evaluate the LV, three-dimensional echocardiography (3DE) has proven to be more accurate, by avoiding geometric assumptions about LV geometry, and to have incremental value for outcome prediction in comparison to conventional 2DE. LV shape (sphericity) and mass are actually measured with 3DE. Myocardial deformation analysis using 3DE can early detect subclinical LV dysfunction, before any detectable change in LV ejection fraction.Expert opinion: 3DE eliminates the errors associated with foreshortening and geometric assumptions inherent to 2DE and 3DE measurements approach very closely those obtained by CMR (the current reference modality), while maintaining the unique clinical advantage of a safe, highly cost/effective, portable imaging technique, available to the cardiologist at bedside to translate immediately the echocardiography findings into the clinical decision-making process.
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Affiliation(s)
- Andrada C Guta
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Luigi P Badano
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Roberto C Ochoa-Jimenez
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Internal Medicine Department, Mount Sinai St Luke's and Mount Sinai West, New York, NY, USA
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Marco Previtero
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Stefania Civera
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Alessandro Ruocco
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Natascia Bettella
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy
| | - Gianfranco Parati
- Facoltà di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua School of Medicine, Padua, Italy.,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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Cardiac resynchronisation therapy optimisation of interventricular delay by the systolic dyssynchrony index: A comparative, randomised, 12-month follow-up study. Hellenic J Cardiol 2019; 60:16-25. [DOI: 10.1016/j.hjc.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
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Vondrák J, Marek D, Večeřa J, Benešová K, Vojtíšek P. Cardiac resynchronization therapy - A comparison of VV delay optimization by 3D echocardiography using systolic dyssynchrony index and QRS width assessment at 6 months after CRT implantation. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Badran HA, Kamel JZ, Mohamed TR, Abdelhamid MA. Using three-dimensional echocardiography to guide left ventricle lead position in cardiac resynchronization therapy: does it make any difference. J Interv Card Electrophysiol 2017; 48:299-306. [PMID: 28194611 DOI: 10.1007/s10840-017-0229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an effective treatment for patients with advanced heart failure. Nearly 30% of candidates are inadequate responders. Proper patient selection, left ventricle (LV) lead placement optimization, and optimization of the programming of the CRT device are important approaches to improve outcome of CRT. We examined the role of three-dimensional (3D) echocardiography in determining the optimal LV lead position as a method of optimizing CRT response. METHODS Forty-seven patients with a mean age of 60.2 ± 11.1 years including five (10.6%) females, all having advanced CHF (EF <35%, LBBB >120 mesc, or non-LBBB >150 msec, with NYHA II-III or ambulatory class IV) were enrolled. Detailed history (NYHA class, Minnesota living with heart failure questionnaire), clinical examination, 6-min walk test, and standard 2D echocardiography were done in all cases. 3D echo detailed analysis of the LV 16 segments was done to determine the latest wall to reach the minimal systolic volume. Multisite pacing was done blind to the 3D echo data achieving a stable LV lead position in mid LV segment. This exact fluoroscopic site was determined (in two orthogonal views) and correlated with 3D most delayed area using a resized 16-segment schema. Patients were classified retrospectively into group A with concordance between the delayed LV area and LV lead position and group B with discordance between both. Patients were followed up after 3-6 (5.1 ± 1.8) months. Patients with reduction of 2D LV end-systolic volume of ≥10% at follow-up were termed volumetric responders. Poorly echogenic patients and those with decompensated NYHA class IV, sustained atrial arrhythmias, and rheumatic or congenital heart diseases were excluded. RESULTS LV lead placement was concordant in 22 (46.8%) cases. After the follow-up period, 31 (65.9%) of the study population were considered volumetric responders with no significant difference among both groups (14 (63.3%) in group A vs 17 (68%) in group B, p > 0.05). CRT insertion resulted in significant improvement of NYHA class in 36 (76.5%) cases, 6-min walk test (447.2 ± 127.0 vs 369.6 ± 87.5 m, p < 0.01), MLHFQ (58.1 ± 19.7 vs 69.6 ± 13.5, p < 0.01), QRS duration (131.2 ± 13.8 vs 149.4 ± 16 msec, p < 0.01), 2D LV EF 33.0 ± 9.5 vs 25.3 ± 6.5, p < 0.001), LVESV (156.0 ± 82.9 vs177.6 ± 92.7 ml, p < 0.05), and 3D LVEF (29.1 ± 9.0 vs 23.6 ± 5.9, p < 0.001) irrespective of the etiology of heart failure. However, there were no significant differences between both groups regarding the same parameters (6-min walk test 470.8 ± 128.7 vs 428.3 ± 126.8 m, MLHFQ 56.8 ± 20.0 vs 58.11 ± 19.0, QRS duration 129.9 ± 12.4 vs 132.1 ± 15.1 msec, 2D LVEF 30.9 ± 8.3 vs 34.58 ± 10.9, LVESV 173.0 ± 110.0 vs 143.0 ± 67.9, 3D LVEF 26 ± 8 vs 31 ± 9, for groups A and B, respectively, p < 0.05). CONCLUSIONS Standard anatomical LV lead placement remains a simple, practical, and effective method in patients undergoing CRT. 3D echocardiography-guided LV lead placement added no clinical benefit compared to standard techniques.
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Affiliation(s)
- Haitham A Badran
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - John Z Kamel
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek R Mohamed
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
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Rosa I, Marini C, Stella S, Ancona F, Spartera M, Margonato A, Agricola E. Mechanical dyssynchrony and deformation imaging in patients with functional mitral regurgitation. World J Cardiol 2016; 8:146-162. [PMID: 26981211 PMCID: PMC4766266 DOI: 10.4330/wjc.v8.i2.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/06/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic functional mitral regurgitation (FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy (DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle (LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy (CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.
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Badano LP. The clinical benefits of adding a third dimension to assess the left ventricle with echocardiography. SCIENTIFICA 2014; 2014:897431. [PMID: 24959374 PMCID: PMC4052480 DOI: 10.1155/2014/897431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/23/2014] [Indexed: 05/09/2023]
Abstract
Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management.
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Affiliation(s)
- Luigi P. Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padua, Via Giustiniani 2, 35123 Padua, Italy
- *Luigi P. Badano:
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Dai M, Lu J, Qian DAJ, Cai JF, Liu XY, Wu XQ, Yang ZY, Li XR, Wang RX. Assessment of left ventricular dyssynchrony and cardiac function in patients with different pacing modes using real-time three-dimensional echocardiography: Comparison with tissue Doppler imaging. Exp Ther Med 2013; 6:1213-1219. [PMID: 24223646 PMCID: PMC3820759 DOI: 10.3892/etm.2013.1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/05/2013] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the left ventricular mechanical dyssynchrony (LVMD) and left ventricular dysfunction of patients in AAI, DDD and VVI pacing modes using real-time three-dimensional echocardiography (RT3DE) and tissue Doppler imaging (TDI). The results from the RT3DE and TDI were subsequently compared. Twenty patients with sick sinus syndrome (SSS) who had undergone the implantation of a dual-chamber pacemaker were enrolled in this study and the pacemakers were programmed to AAI, DDD and VVI modes, sequentially. The RT3DE and TDI parameters were obtained following pacing for 24 h in each mode. With RT3DE, we measured the systolic dyssynchrony indices, including Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif% and Tmsv6-Dif%, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF), respectively. With TDI, we measured the standard deviation and the maximal difference in time from the QRS onset to the peak systolic velocity for 12 left ventricular myocardial segments, i.e. Ts-SD and Ts-Dif, respectively. The results showed that the Tmsv16-SD% and Ts-SD in the AAI mode were significantly lower than those in the DDD and VVI modes (P<0.05); however, there were no significant differences between the DDD and VVI modes (P>0.05). The LVEF in the AAI, DDD and VVI modes was 63.1±8.9, 58.6±11.2 and 57.9±7.6%, respectively (P>0.05). There were negative correlations between the LVEF and Tmsv16-SD% (r, −0.651; P<0.001) and Ts-SD (r, −0.649; P<0.0001). A moderate correlation (r, 0.698; P<0.0001) was observed between Tmsv16-SD% and Ts-SD. The concordance rate between Tmsv16-SD% and Ts-SD for detecting LVMD was 76%. This study showed that DDD and VVI pacing modes induced significant LVMD and a reduction in LVEF, unlike the AAI pacing mode. RT3DE and TDI were capable of objectively evaluating LVMD; however, each method had certain faults. At present, there is a lack of a uniform standard for assessing LVMD; therefore, the use of a variety of techniques and indices is necessary in order to comprehensively evaluate LVMD in patients with different cardiac pacing modes.
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Affiliation(s)
- Min Dai
- Department of Cardiology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214023
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Tsang W, Kenny C, Adhya S, Kapetanakis S, Weinert L, Lang RM, Monaghan M. Interinstitutional Measurements of Left Ventricular Volumes, Speckle-Tracking Strain, and Dyssynchrony Using Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2013; 26:1253-7. [DOI: 10.1016/j.echo.2013.07.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Indexed: 10/26/2022]
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Evaluation of left ventricular structure and function by three-dimensional echocardiography. Curr Opin Crit Care 2013; 19:387-96. [DOI: 10.1097/mcc.0b013e328364d75e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Quantitative assessment of left ventricular systolic function using 3-dimensional echocardiography. Indian Heart J 2013; 65:620-8. [PMID: 24206890 DOI: 10.1016/j.ihj.2013.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Assessment of left ventricular systolic function is the commonest and one of the most important indications for performance of echocardiography. It is important for prognostication, determination of treatment plan, for decisions related to expensive device therapies and for assessing response to treatment. The current methods based on two-dimensional echocardiography are not reliable, have high degree of inter-observer and intra-observer variability and are based on presumptions about the geometry of left ventricle (LV). Real-time three-dimensional echocardiography (RT3DE) on the other hand is fast, easy, accurate, relatively operator independent and is not based on any assumptions related to the shape of LV. Owing to these advantages, it is the Echocardiographic modality of choice for assessment of systolic function of the LV. We describe here a step by step approach to evaluation of LV volumes, ejection fraction, regional systolic function and Dyssynchrony analysis based on RT3DE. It has been well validated in clinical studies and is rapidly being incorporated in routine clinical practice.
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Minamiguchi H, Sakata Y, Ohtani T, Mizote I, Takeda Y, Mizuno H, Okuyama Y, Nakatani S, Fujita M, Watanabe T, Uematsu M, Komuro I. Usefulness of overlapping of the E and A waves of the transmitral flow as a predictor of responders to cardiac resynchronization therapy. Am J Cardiol 2013; 111:1613-8. [PMID: 23497774 DOI: 10.1016/j.amjcard.2013.01.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/31/2013] [Accepted: 01/31/2013] [Indexed: 11/29/2022]
Abstract
Atrioventricular (AV) dyssynchrony as well as ventricular-ventricular dyssynchrony plays an important role in the selection of candidates for cardiac resynchronization therapy (CRT), but no method for assessing the AV dyssynchrony has been established. The aim of this study was to investigate whether the degree of overlap of the E and A waves can predict response to CRT. The study subjects were 48 consecutive patients maintaining sinus rhythm and intrinsic AV conduction who underwent de novo dual-chamber CRT device implantation. CRT responders were defined as those with reductions in left ventricular end-systolic volume >15% at 6 months after CRT device implantations. Twenty-three patients (48%) were CRT responders. In a multivariate analysis, the overlap ratio of the E and A waves was the only independent predictor of response to CRT (odds ratio 1.03, 95% confidence interval 1.01 to 1.06, p = 0.01). Using a cut-off value of 33%, patients with overlap ratios of the E and A waves ≥33% had a significantly higher rate of response to CRT than those with ratios <33% (73% vs 27%, p = 0.002). In conclusion, the overlap ratio of the E and A waves before CRT device implantation may predict CRT response. This simple method may be helpful in evaluating dyssynchrony in patients, particularly with severe reduced left ventricular wall motion, because this method does not require any wall motion analysis.
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Affiliation(s)
- Hitoshi Minamiguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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van der Heide JA, Aly MFA, Kleijn SA, van Dijk J, Kamp O. A new quantification method for mechanical dyssynchrony with three-dimensional echocardiography; segmental time and volume loss for prediction of response to cardiac resynchronisation therapy. Int J Cardiovasc Imaging 2013; 28:1895-904. [PMID: 22302648 PMCID: PMC3485531 DOI: 10.1007/s10554-012-0019-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 01/17/2012] [Indexed: 01/22/2023]
Abstract
A novel method to assess left ventricular (LV) mechanical dyssynchrony using three-dimensional echocardiography (3DE) and semi-automated border detection was investigated, which might be superior in prediction of response to cardiac resynchronisation therapy (CRT) compared to traditional measures that rely solely on segmental time-to-contraction. Twenty-eight heart failure patients underwent real-time 3DE before CRT and at 6–12 months follow-up. Analysis of 3DE was performed using TomTec Research-Arena software featuring semi-automated endocardial border detection. The following echocardiographic parameters were calculated in a 16-segment model: areas under segmental time-volume-curves (STV); delay between contraction of the earliest and latest segment (L-E); and standard deviation of segmental time-to-contraction (SDI). Response to CRT was defined as ≥10% decrease in LV end-systolic volume at follow-up. Baseline Pre-STV had a higher sensitivity than SDI for prediction of response (94 vs 67%, respectively), with equal specificity (78%) and a higher area under receiver operator characteristic curve. In contrast, L-E had a sensitivity of 83% and a specificity of 56%. Using 3DE, methods that combine segmental time-to-contraction with segmental contractility might improve LV dyssynchrony assessment compared to traditional methods based on segmental time-to-contraction alone. Pre-STV might be a better predictor of response to CRT than SDI.
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Affiliation(s)
- J. A. van der Heide
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M. F. A. Aly
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - S. A. Kleijn
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. van Dijk
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - O. Kamp
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Institute for Cardiovascular Research (IcaR-VU), VU Medical Center, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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Cai W, Dong Y, Zhou X, Chen SB, Zhao JH, Jiang TM, Li YM. Left ventricular systolic dyssynchrony in patients with isolated symptomatic myocardial bridge. SCAND CARDIOVASC J 2012; 47:11-9. [PMID: 23036109 DOI: 10.3109/14017431.2012.736635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The impact of myocardial bridge (MB) on left ventricular (LV) systolic synchrony is insufficiently understood. DESIGN Thirty-five subjects with isolated mid-left, anterior, descending artery (LAD) MB, preserved LV ejection fraction (LVEF > 50%), and otherwise, normal coronary angiogram were identified from 3607 patients who underwent diagnostic coronary angiography and were evaluated by tissue Doppler imaging and real-time three-dimensional echocardiography (RT3DE). Control subjects consisted of 26 age and sex-matched coronary angiographically "normal" subjects. RESULTS MB patients were characterized by reduced, early, diastolic strain rate in LAD-supplied apical segments (lateral and anterior), with prevalence of LV systolic dyssynchrony of 25.7% (9/35). MB patients were further classified by the medians of MB stenosis and length. For MB stenosis < 52.5%, Class I: length < 17 mm (n = 7), Class II: length ≥ 17 mm (n = 10); for stenosis ≥ 52.5%, Class III: length < 17 mm (n = 10), Class IV: length ≥ 17 mm (n = 8). Binary Logistic regression model revealed that higher MB lesion classification (odds ratio: 4.944, 95%CI 1.174-20.82, P < 0.05) and hypertension (odds ratio: 15.32, 95%CI: 1.252-187.6, P < 0.05) are statistically associated with LV systolic dyssynchrony, which was independent of LV mass. CONCLUSIONS MB in the mid LAD is associated with myocardial dyssynchrony. Hypertensive individuals and those with more severe bridging (determined by length and stenosis) tend to have an increased incidence of dyssynchrony.
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Affiliation(s)
- Wei Cai
- Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces, Tianjin, PR China
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Li DY, Liang L, Cao GK, Xia Y, Xu TD, Chen J, Wang XP, Chen JH. Real-time three-dimensional echocardiographic evaluation of left ventricular systolic synchronicity in patients with chronic heart failure: comparison with tissue Doppler imaging. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:410-418. [PMID: 22535638 DOI: 10.1002/jcu.21935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 03/19/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND To investigate the clinical value of real-time three-dimensional echocardiography (RT-3DE) for assessing of left ventricular systolic synchronicity. METHODS Thirty healthy volunteers and 62 patients with congestive heart failure (CHF) were enrolled. The SD of time to peak systolic motion (TDI-Ts12-SD) was measured with tissue Doppler imaging in 12 myocardial segments. The SD and maximal difference of the time to minimal systolic volume (Tmsv) between 16, 12, or 6 myocardial segments, expressed as a percentage of cardiac cycle duration, were measured with RT-3DE and labeled Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-D%, Tmsv12-D%, and Tmsv6-D%, respectively. The Spearman coefficient and Kappa value were calculated, and Bland-Altman analysis was performed to investigate the correlation and agreement between the two methods. Tmsv values were compared with ejection fraction (EF). RESULTS There was a moderately positive (p< 0.01) correlation between TDI-Ts12-SD and Tmsv16-SD%, Tmsv12-SD%, Tmsv16-D%, and Tmsv12-D% (r = 0.65, 0.64, and 0.65, respectively, with Kappa values of 0.66, 0.65, 0.72, and 0.74, respectively, p< 0.01). Tmsv16-SD%, Tmsv12-SD%, and Tmsv12-D% were significantly different between CHF patients with EF ≤ 35% and those with EF > 35%. CONCLUSIONS RT-3DE can be used in patients with CHF to quantify left ventricular mechanical dyssynchrony. Tmsv12-SD% and Tmsv12-D% were the best indices of left ventricular systolic synchronicity in relation to the severity of CHF as evaluated from EF.
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Affiliation(s)
- Dong-ye Li
- Cardiovascular Disease Institute of Xuzhou Medical College, People's Republic of China
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Kleijn SA, Aly MF, Knol DL, Terwee CB, Jansma EP, Abd El-Hady YA, Kandil HI, Sorour KA, van Rossum AC, Kamp O. A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:763-775. [DOI: 10.1093/ehjci/jes041] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:1-46. [PMID: 22275509 DOI: 10.1093/ehjci/jer316] [Citation(s) in RCA: 385] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:3-46. [PMID: 22183020 DOI: 10.1016/j.echo.2011.11.010] [Citation(s) in RCA: 490] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Russo C, Jaubert MP, Jin Z, Homma S, Di Tullio MR. Intra- and Interobserver Reproducibility of Left Ventricular Mechanical Dyssynchrony Assessment by Real Time Three-Dimensional Echocardiography. Echocardiography 2012; 29:598-607. [DOI: 10.1111/j.1540-8175.2011.01655.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hotta VT, Martinelli Filho M, Mathias W, Vieira MLC. New equation for prediction of reverse remodeling after cardiac resynchronization therapy. Echocardiography 2012; 29:678-87. [PMID: 22348339 DOI: 10.1111/j.1540-8175.2011.01658.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To integrate data from two-dimensional echocardiography (2D ECHO), three-dimensional echocardiography (3D ECHO), and tissue Doppler imaging (TDI) for prediction of left ventricular (LV) reverse remodeling (LVRR) after cardiac resynchronization therapy (CRT). It was also compared the evaluation of cardiac dyssynchrony by TDI and 3D ECHO. METHODS Twenty-four consecutive patients with heart failure, sinus rhythm, QRS ≥ 120 msec, functional class III or IV and LV ejection fraction (LVEF) ≤ 0.35 underwent CRT. 2D ECHO, 3D ECHO with systolic dyssynchrony index (SDI) analysis, and TDI were performed before, 3 and 6 months after CRT. Cardiac dyssynchrony analyses by TDI and SDI were compared with the Pearson's correlation test. Before CRT, a univariate analysis of baseline characteristics was performed for the construction of a logistic regression model to identify the best predictors of LVRR. RESULTS After 3 months of CRT, there was a moderate correlation between TDI and SDI (r = 0.52). At other time points, there was no strong correlation. Nine of twenty-four (38%) patients presented with LVRR 6 months after CRT. After logistic regression analysis, SDI (SDI > 11%) was the only independent factor in the prediction of LVRR 6 months of CRT (sensitivity = 0.89 and specificity = 0.73). After construction of receiver operator characteristic (ROC) curves, an equation was established to predict LVRR: LVRR =-0.4LVDD (mm) + 0.5LVEF (%) + 1.1SDI (%), with responders presenting values >0 (sensitivity = 0.67 and specificity = 0.87). CONCLUSIONS In this study, there was no strong correlation between TDI and SDI. An equation is proposed for the prediction of LVRR after CRT. Although larger trials are needed to validate these findings, this equation may be useful to candidates for CRT.
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Wang H, Shuraih M, Ahmad M. Real Time Three-Dimensional Echocardiography in Assessment of Left Ventricular Dyssynchrony and Cardiac Resynchronization Therapy. Echocardiography 2012; 29:192-9. [DOI: 10.1111/j.1540-8175.2011.01622.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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23
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Tani T, Sumida T, Tanabe K, Ehara N, Yamaguchi K, Kawai J, Yagi T, Morioka S, Fujiwara H, Okada Y, Kita T, Furukawa Y. Left Ventricular Systolic Dyssynchrony Index by Three-Dimensional Echocardiography in Patients with Decreased Left Ventricular Function: Comparison with Tissue Doppler Echocardiography. Echocardiography 2011; 29:346-52. [DOI: 10.1111/j.1540-8175.2011.01577.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Samir R, Tawfik M, El Missiri AM, El Shahid G, Maaty MA, El Sayed M. Assessment of Left Ventricular Mechanical Dyssynchrony Using Real Time Three-Dimensional Echocardiography: A Comparative Study to Doppler Tissue Imaging. Echocardiography 2011; 29:173-81. [DOI: 10.1111/j.1540-8175.2011.01548.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Hung CL, Tien SL, Lo CI, Hung TC, Yeh HI, Wang YS. The incremental value of regional dyssynchrony in determining functional mitral regurgitation beyond left ventricular geometry after narrow QRS anterior myocardial infarction: a real time three-dimensional echocardiography study. Echocardiography 2011; 28:665-75. [PMID: 21718355 DOI: 10.1111/j.1540-8175.2011.01403.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Determinants of functional mitral regurgitation (FMR) severity after acute anterior myocardial infarction (MI) remained unclear. Our aim was to: (1) test whether LV dyssynchrony upon real time three-dimensional echocardiography (RT-3DE) is independently associated with FMR severity; and (2) to investigate the role of regional systolic dyssynchrony index (SDI) in identifying FMR severity. METHODS RT-3DE was successfully performed on 64 consecutive patients following acute anterior MI with a narrow QRS complex (<130 ms) and another 30 healthy volunteers. MR severity was assessed using vena contracta method. SDI was derived from the dispersion of the time to minimum regional volume for all 16 LV segments. Multiple linear regression analysis was used to identify the independent relationship between FMR and SDI with and without multivariate adjustment. RESULTS The mean LV ejection fraction was 49.6%± 11.9% in the MI group. All regional (except apical) and global SDIs were associated with regional LV remodeling and were significantly correlated with FMR even after multivariate adjustment, with midwall SDI being most strongly associated with MR severity (R(2) = 0.55, P < 0.001). Regional midwall SDI superimposed on LV global geometry and mitral leaflet deformation substantially expanded the area under curve in identifying FMR (AUC increased from 0.69 to 0.93, c-statistics: P = 0.041). CONCLUSIONS While both global and regional dyssynchrony following anterior MI were independently related to FMR severity, regional midwall dyssynchrony further added incremental value in predicting FMR severity beyond traditional parameters. This finding provides a new insight into the understanding of FMR after anterior MI and may further potentiate specific therapeutic approaches.
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Affiliation(s)
- Chung-Lieh Hung
- Division of Cardiovascular Medicine and Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
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van der Heide JA, Kleijn SA, Aly MFA, Slikkerveer J, Kamp O. Three-dimensional echocardiography for left ventricular quantification: fundamental validation and clinical applications. Neth Heart J 2011; 19:423-31. [PMID: 21584798 PMCID: PMC3189315 DOI: 10.1007/s12471-011-0160-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
One of the earliest applications of clinical echocardiography is evaluation of left ventricular (LV) function and size. Accurate, reproducible and quantitative evaluation of LV function and size is vital for diagnosis, treatment and prediction of prognosis of heart disease. Early three-dimensional (3D) echocardiographic techniques showed better reproducibility than two-dimensional (2D) echocardiography and narrower limits of agreement for assessment of LV function and size in comparison to reference methods, mostly cardiac magnetic resonance (CMR) imaging, but acquisition methods were cumbersome and a lack of user-friendly analysis software initially precluded widespread use. Through the advent of matrix transducers enabling real-time three-dimensional echocardiography (3DE) and improvements in analysis software featuring semi-automated volumetric analysis, 3D echocardiography evolved into a simple and fast imaging modality for everyday clinical use. 3DE provides the possibility to evaluate the entire LV in three spatial dimensions during the complete cardiac cycle, offering a more accurate and complete quantitative evaluation the LV. Improved efficiency in acquisition and analysis may provide clinicians with important diagnostic information within minutes. The current article reviews the methodology and application of 3DE for quantitative evaluation of the LV, provides the scientific evidence for its current clinical use, and discusses its current limitations and potential future directions.
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Affiliation(s)
- J. A. van der Heide
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - S. A. Kleijn
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
| | - M. F. A. Aly
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - J. Slikkerveer
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
| | - O. Kamp
- Department of Cardiology 5F 003, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands
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Fornwalt BK. The Dyssynchrony in Predicting Response to Cardiac Resynchronization Therapy: A Call for Change. J Am Soc Echocardiogr 2011; 24:180-4. [DOI: 10.1016/j.echo.2010.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shizukuda Y, Bhatti S, Munjal J, Hu YL, Harrelson A. Personalized echocardiography: clinical applications of advanced echocardiography and future directions. Future Cardiol 2010; 6:833-44. [PMID: 21142639 DOI: 10.2217/fca.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Future cardiology practice will be increasingly individualized, and thus to maintain its central role, echocardiography must keep pushing to expand the boundaries of real-time data acquisition from tissue and fluid motion, and yet still provide efficient and timely data analysis that leads to succinct, clear clinical recommendations tailored to each person in our care. In this article, recent efforts to expand echocardiography techniques into an era of increasingly personalized cardiology, including advances in color-coded tissue Doppler, 3D echocardiography and complex exercise stress echocardiography are described. The common metric for success in each of these efforts is the development of robust and institutionally supportable echocardiography protocols for specific cardiology disease populations that currently may be underdiagnosed and/or undertreated. The common result in each case should be the creation of new guidelines that can supplement the current standard protocols advocated by professional echocardiography organizations.
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Affiliation(s)
- Yukitaka Shizukuda
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA.
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29
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Ho JK, Mahajan A. Cardiac Resynchronization Therapy for Treatment of Heart Failure. Anesth Analg 2010; 111:1353-61. [DOI: 10.1213/ane.0b013e3181fa3408] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Cui W, Gambetta K, Zimmerman F, Freter A, Sugeng L, Lang R, Roberson DA. Real-Time Three-Dimensional Echocardiographic Assessment of Left Ventricular Systolic Dyssynchrony in Healthy Children. J Am Soc Echocardiogr 2010; 23:1153-9. [DOI: 10.1016/j.echo.2010.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 11/26/2022]
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31
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Zheng M, Li X, Zhang P, Shentu W, Ashraf M, Imanbayev G, Streiff C, Ge S, Sahn DJ. Assessment of Interventricular Dyssynchrony by Real Time Three-Dimensional Echocardiography: An In Vitro Study in a Porcine Model. Echocardiography 2010; 27:709-15. [DOI: 10.1111/j.1540-8175.2009.01094.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Three-Dimensional Transesophageal Echocardiography Is a Major Advance for Intraoperative Clinical Management of Patients Undergoing Cardiac Surgery. Anesth Analg 2010; 110:1548-73. [DOI: 10.1213/ane.0b013e3181d41be7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Leung KYE, Bosch JG. Automated border detection in three-dimensional echocardiography: principles and promises. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:97-108. [PMID: 20139440 DOI: 10.1093/ejechocard/jeq005] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Several automated border detection approaches for three-dimensional echocardiography have been developed in recent years, allowing quantification of a range of clinically important parameters. In this review, the background and principles of these approaches and the different classes of methods are described from a practical perspective, as well as the research trends to achieve a robust method.
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Affiliation(s)
- K Y Esther Leung
- Thoraxcenter Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands
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Tanaka H, Hara H, Saba S, Gorcsan J. Usefulness of three-dimensional speckle tracking strain to quantify dyssynchrony and the site of latest mechanical activation. Am J Cardiol 2010; 105:235-42. [PMID: 20102925 DOI: 10.1016/j.amjcard.2009.09.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 12/01/2022]
Abstract
Previous methods to quantify dyssynchrony could not determine regional 3-dimensional (3-D) strain. We hypothesized that a novel 3-D speckle tracking strain imaging system can quantify left ventricular (LV) dyssynchrony and site of latest mechanical activation. We studied 64 subjects; 54 patients with heart failure were referred for cardiac resynchronization therapy (CRT) with an ejection fraction 25 +/- 6% and QRS interval 165 +/- 29 ms and 10 healthy volunteer controls. The 3-D speckle tracking system determined radial strain using a 16-segment model from a pyramidal 3-D dataset. Dyssynchrony was quantified as maximal opposing wall delay and SD in time to peak strain. The 3-D analysis was compared to standard 2-dimensional (2-D) strain datasets and site of 3-D latest mechanical activation, not possible by 2D was quantified. As expected, dyssynchrony in patients on CRT was significantly greater than in controls (maximal opposing wall delay 316 +/- 112 vs 59 +/- 12 ms and SD 124 +/- 48 vs 28 +/- 11 ms, p <0.001 vs normal). The 3-D opposing wall delay was closely correlated with 3-D 16-segment SD (r = 0.95) and 2-D mid-LV strain (r = 0.83) and SD (r = 0.85, all p values <0.001). The 3-D site of the latest mechanical activation was most commonly midposterior (26%), basal posterior (22%), midlateral (20%), and basal lateral (17%). Eleven patients studied after CRT demonstrated improvements in 3-D synchrony (300 +/- 124 to 94 +/- 37 ms) and ejection fraction (24 +/- 6% to 31 +/- 7%, p <0.05). In conclusion, 3-D speckle tracking can successfully quantify 3-D dyssynchrony and site the latest mechanical activation. This approach may play a clinical role in management of patients on CRT.
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Weitzel N, Salcedo E, Puskas F, Nasrallah F, Fullerton D, Seres T. Using Real Time Three-Dimensional Transesophageal Echocardiography during Ross Procedure in the Operating Room. Echocardiography 2009; 26:1278-83. [DOI: 10.1111/j.1540-8175.2009.01030.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Monaghan M, Bax J, Franke A, Kamp O, Kuehl H, Nihoyannopoulos P, TenCate F. 3-Dimensional Echocardiographic Assessment of Left Ventricular Dyssynchrony. JACC Cardiovasc Imaging 2009; 2:1334-5; author reply 1335-6. [DOI: 10.1016/j.jcmg.2009.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/03/2009] [Accepted: 09/11/2009] [Indexed: 11/24/2022]
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Izumo M, Lancellotti P, Suzuki K, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Nobuoka S, Ohtaki E, Miyake F. Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:961-7. [DOI: 10.1093/ejechocard/jep114] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kleijn SA, van Dijk J, de Cock CC, Allaart CP, van Rossum AC, Kamp O. Assessment of Intraventricular Mechanical Dyssynchrony and Prediction of Response to Cardiac Resynchronization Therapy: Comparison between Tissue Doppler Imaging and Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2009; 22:1047-54. [PMID: 19647409 DOI: 10.1016/j.echo.2009.06.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Sebastiaan A Kleijn
- VU University Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
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39
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The use of real-time three-dimensional echocardiography for the quantification of left ventricular volumes and function. Curr Opin Cardiol 2009; 24:402-9. [DOI: 10.1097/hco.0b013e32832cbb8a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nemes A, Geleijnse ML, Soliman OII, Vletter WB, Forster T, ten Cate FJ. New method for evaluation of left ventricular dyssynchrony and success of cardiac resynchronization therapy: real-time 3-dimensional echocardiography. Orv Hetil 2009; 150:1834-8. [DOI: 10.1556/oh.2009.28713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A klinikai tapasztalat azt mutatja, hogy a jelenleg elérhető kritériumok alapján kiválasztott szívelégtelen betegek közel egyharmada a kardiális reszinkronizációs terápia (CRT) ellenére nonreszpondernek bizonyul, vagyis az optimális kezelés ellenére klinikai állapotukban javulás nem észlelhető. Ez a tény vezetett ahhoz a kutatási irányhoz, hogy találjunk olyan, noninvazív képalkotó diagnosztika (például echokardiográfia) során mérhető és/vagy számítható értéket, amely alkalmas a diszszinkrónia megítélésére és jobban segíti kiválasztani a CRT-re alkalmas betegeket. Ennek az áttekintő közleménynek a célja a legújabb noninvazív echokardiográfiás módszer, a real-time háromdimenziós echokardiográfia lehetséges szerepének bemutatása lenne az elérhető irodalom alapján.
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Affiliation(s)
| | | | | | - Wim B. Vletter
- 1 Erasmus MC Thoraxcentrum, Kardiológiai Klinika Rotterdam
| | - Tamás Forster
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ Szeged Korányi fasor 6. 6720
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Agarwal R, Lang RM, Beshai JF. Role of echocardiography in selection of patients for biventricular pacing therapy. Curr Cardiol Rep 2009; 11:352-9. [PMID: 19709495 DOI: 10.1007/s11886-009-0049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cardiac resynchronization therapy (CRT) has demonstrated improved quality of life, New York Heart Association class, left ventricular ejection fraction, and survival in patients with moderate to severe heart failure, left ventricular ejection fraction less than or equal to 35%, and a prolonged QRS duration. QRS duration remains the primary surrogate for mechanical dyssynchrony, defining the pathophysiology of abnormal regional mechanical activation. Studies have demonstrated that 30% to 40% of patients who meet current criteria for CRT are nonresponders. Therefore, there is great interest in the relationship between electrical and mechanical dyssynchrony, and the ability of each alone or together to predict response remains unknown. Echocardiographic approaches have emerged to quantify mechanical dyssynchrony with greater specificity than QRS duration alone. Although these methods are complex, exciting, and highly accurate for predicting response to CRT in single-center studies, they lack widespread applicability and validation to replace current criteria for device implantation. Use of echocardiography to define dyssynchrony and the impact of promising imaging methods for future patient selection for CRT are discussed.
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Affiliation(s)
- Richa Agarwal
- University of Chicago Medical Center, Chicago, IL 60637, USA
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Harkel AT, Van Osch-Gevers M, Helbing W. Real-Time Transthoracic Three Dimensional Echocardiography: Normal Reference Data for Left Ventricular Dyssynchrony in Adolescents. J Am Soc Echocardiogr 2009; 22:933-8. [DOI: 10.1016/j.echo.2009.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Indexed: 10/20/2022]
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Fornwalt BK, Delfino JG, Sprague WW, Oshinski JN. It's time for a paradigm shift in the quantitative evaluation of left ventricular dyssynchrony. J Am Soc Echocardiogr 2009; 22:672-6. [PMID: 19501325 PMCID: PMC2694138 DOI: 10.1016/j.echo.2009.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Brandon K. Fornwalt
- Emory University School of Medicine, Atlanta, GA
- Emory/Georgia Institute of Technology, Department of Biomedical Engineering, Atlanta, GA
| | | | - William W. Sprague
- Emory/Georgia Institute of Technology, Department of Biomedical Engineering, Atlanta, GA
| | - John N. Oshinski
- Emory University School of Medicine, Atlanta, GA
- Emory/Georgia Institute of Technology, Department of Biomedical Engineering, Atlanta, GA
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Agarwal R, Beshai JF, Lang RM. Can real-time three-dimensional echocardiography be used reliably for the assessment of left ventricular dyssynchrony? Arch Cardiovasc Dis 2009; 102:469-72. [DOI: 10.1016/j.acvd.2009.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 05/15/2009] [Indexed: 11/16/2022]
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Quantification of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2009; 22:232-9. [DOI: 10.1016/j.echo.2008.11.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Indexed: 11/18/2022]
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Shiota T. 3D echocardiography: The present and the future. J Cardiol 2008; 52:169-85. [DOI: 10.1016/j.jjcc.2008.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 12/14/2022]
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Gimenes VML, Vieira MLC, Andrade MM, Pinheiro J, Hotta VT, Mathias W. Standard values for real-time transthoracic three-dimensional echocardiographic dyssynchrony indexes in a normal population. J Am Soc Echocardiogr 2008; 21:1229-35. [PMID: 18848431 DOI: 10.1016/j.echo.2008.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a paucity of information describing the real-time 3-dimensional echocardiography (RT3DE) and dyssynchrony indexes (DIs) of a normal population. We evaluate the RT3DE DIs in a population with normal electrocardiograms and 2- and 3-dimensional echocardiographic analyses. This information is relevant for cardiac resynchronization therapy. METHODS We evaluated 131 healthy volunteers (73 were male, aged 46 +/- 14 years) who were referred for routine echocardiography; who presented normal cardiac structure on electrocardiography, 2-dimensional echocardiography, and RT3DE; and who had no history of cardiac diseases. We analyzed 3-dimensional left ventricular ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricular systolic DI% (6-, 12-, and 16-segment models). RT3DE data were analyzed by quantifying the statistical distribution (mean, median, standard deviation [SD], relative SD, coefficient of skewness, coefficient of kurtosis, Kolmogorov-Smirnov test, D'Agostino-Pearson test, percentiles, and 95% confidence interval). RESULTS Left ventricular ejection fraction ranged from 50% to 80% (66.1% +/- 7.1%); left ventricle end-diastolic volume ranged from 39.8 to 145 mL (79.1 +/- 24.9 mL); left ventricle end-systolic volume ranged from 12.9 to 66 mL (27 +/- 12.1 mL); 6-segment DI% ranged from 0.20% to 3.80% (1.21% +/- 0.66%), median: 1.06, relative SD: 0.5482, coefficient of skewness: 1.2620 (P < .0001), coefficient of Kurtosis: 1.9956 (P = .0039); percentile 2.5%: 0.2900, percentile 97.5%: 2.8300; 12-segment DI% ranged from 0.22% to 4.01% (1.29% +/- 0.71%), median: 1.14, relative SD: 0.95, coefficient of skewness: 1.1089 (P < .0001), coefficient of Kurtosis: 1.6372 (P = .0100), percentile 2.5%: 0.2850, percentile 97.5%: 3.0700; and 16-segment DI% ranged from 0.29% to 4.88% (1.59 +/- 0.99), median: 1.39, relative SD: 0.56, coefficient of skewness: 1.0792 (P < .0001), coefficient of Kurtosis: 0.9248 (P = .07), percentile 2.5%: 0.3750, percentile 97.5%: 3.750. CONCLUSION This study allows for the quantification of RT3DE DIs in normal subjects, providing a comparison for patients with heart failure who may be candidates for cardiac resynchronization therapy.
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Affiliation(s)
- Vera M L Gimenes
- Hospital do Coração, Echocardiography Laboratory, São Paulo, Brazil
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Three-dimensional echocardiography: What is next? CURRENT CARDIOVASCULAR IMAGING REPORTS 2008. [DOI: 10.1007/s12410-008-0008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bibliography. Current world literature. Imaging and echocardiography. Curr Opin Cardiol 2008; 23:512-5. [PMID: 18670264 DOI: 10.1097/hco.0b013e32830d843f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The introduction of three-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging is one of the most significant developments in ultrasound imaging of the heart of the past decade. This imaging modality currently provides valuable clinical information that empowers echocardiography with new levels of confidence in diagnosing heart disease. One major advantage of seeing the additional dimension is the improvement in the accuracy of the evaluation of cardiac chamber volumes by eliminating geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic views of cardiac valves capable of demonstrating numerous pathologies in a unique, noninvasive manner. This article reviews the major technological developments in 3D echocardiography and some of the recent literature that has provided the scientific basis for its clinical use.
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