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Harnish P, Nesheiwat Z, Mahmood S, Soni R, Eltahawy E. Echocardiography in Detecting Mechanical Complications in Acute Coronary Syndrome. CASE 2020; 4:393-398. [PMID: 33117936 PMCID: PMC7581651 DOI: 10.1016/j.case.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
ACS encompasses a wide variety of complex symptoms and presentations. The use of echocardiography in ACS assists in early clinical decision-making. Echocardiography can aid in detecting early and late mechanical complications of ACS. Early detection of complications of ACS on echocardiography can improve outcomes.
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Suri JS, Puvvula A, Biswas M, Majhail M, Saba L, Faa G, Singh IM, Oberleitner R, Turk M, Chadha PS, Johri AM, Sanches JM, Khanna NN, Viskovic K, Mavrogeni S, Laird JR, Pareek G, Miner M, Sobel DW, Balestrieri A, Sfikakis PP, Tsoulfas G, Protogerou A, Misra DP, Agarwal V, Kitas GD, Ahluwalia P, Kolluri R, Teji J, Maini MA, Agbakoba A, Dhanjil SK, Sockalingam M, Saxena A, Nicolaides A, Sharma A, Rathore V, Ajuluchukwu JN, Fatemi M, Alizad A, Viswanathan V, Krishnan PR, Naidu S. COVID-19 pathways for brain and heart injury in comorbidity patients: A role of medical imaging and artificial intelligence-based COVID severity classification: A review. Comput Biol Med 2020; 124:103960. [PMID: 32919186 PMCID: PMC7426723 DOI: 10.1016/j.compbiomed.2020.103960] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/05/2023]
Abstract
Artificial intelligence (AI) has penetrated the field of medicine, particularly the field of radiology. Since its emergence, the highly virulent coronavirus disease 2019 (COVID-19) has infected over 10 million people, leading to over 500,000 deaths as of July 1st, 2020. Since the outbreak began, almost 28,000 articles about COVID-19 have been published (https://pubmed.ncbi.nlm.nih.gov); however, few have explored the role of imaging and artificial intelligence in COVID-19 patients-specifically, those with comorbidities. This paper begins by presenting the four pathways that can lead to heart and brain injuries following a COVID-19 infection. Our survey also offers insights into the role that imaging can play in the treatment of comorbid patients, based on probabilities derived from COVID-19 symptom statistics. Such symptoms include myocardial injury, hypoxia, plaque rupture, arrhythmias, venous thromboembolism, coronary thrombosis, encephalitis, ischemia, inflammation, and lung injury. At its core, this study considers the role of image-based AI, which can be used to characterize the tissues of a COVID-19 patient and classify the severity of their infection. Image-based AI is more important than ever as the pandemic surges and countries worldwide grapple with limited medical resources for detection and diagnosis.
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Affiliation(s)
- Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA,Corresponding author. American Institute of Medical and Biological Engineering Fellow, American Institute of Ultrasound in Medicine Fellow, Asia Pacific Vascular Society Stroke Monitoring and Diagnosis Division AtheroPoint™, Roseville, CA, 95661, USA
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA,Annu's Hospitals for Skin and Diabetes, Nellore, AP, India
| | | | - Misha Majhail
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA,Oakmont High School and AtheroPoint™, Roseville, CA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy
| | - Gavino Faa
- Department of Pathology - AOU of Cagliari, Italy
| | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | | | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | - Paramjit S. Chadha
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology,Queen's University, Kingston, Ontario, Canada
| | - J. Miguel Sanches
- Institute of Systems and Robotics, Instituto Superior Tecnico, Lisboa, Portugal
| | - Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | | | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - David W. Sobel
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | | | | | - George Tsoulfas
- Aristoteleion University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Vikas Agarwal
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK,Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Superspeciality Hospital, New Delhi, India
| | | | - Jagjit Teji
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Mustafa Al Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, Canada
| | | | | | | | - Ajit Saxena
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | | | - Mostafa Fatemi
- Dept. of Physiology & Biomedical Engg., Mayo Clinic College of Medicine and Science, MN, USA
| | - Azra Alizad
- Dept. of Radiology, Mayo Clinic College of Medicine and Science, MN, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | | | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN, USA
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Abstract
Noninvasive cardiac imaging has an important role in the assessment of patients with acute-onset chest pain. In patients with suspected acute coronary syndrome (ACS), cardiac imaging offers incremental value over routine clinical assessment, the electrocardiogram, and blood biomarkers of myocardial injury, to confirm or refute the diagnosis of coronary artery disease and to assess future cardiovascular risk. This Review covers the current guidelines and clinical use of the common noninvasive imaging techniques, including echocardiography and stress echocardiography, computed tomography coronary angiography, myocardial perfusion scintigraphy, positron emission tomography, and cardiovascular magnetic resonance imaging, in patients with suspected ACS, and provides an update on the developments in noninvasive imaging techniques in the past 5 years.
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Diagnostic application of the universal definition of myocardial infarction in the intensive care unit. Curr Opin Crit Care 2008; 14:543-8. [DOI: 10.1097/mcc.0b013e32830d34b9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xiaoqing W, Zhengyu Y, Dajung Q, Qiang W, Xiaoping B, Jianqiu Z. Very early stage detection of acute myocardial infarction by harmonic ultrasonic integrated backscatter. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:567-572. [PMID: 18222030 DOI: 10.1016/j.ultrasmedbio.2007.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 08/13/2007] [Accepted: 09/27/2007] [Indexed: 05/25/2023]
Abstract
To study the very early diagnosis of acute myocardial infarction (AMI) by harmonic imaging ultrasonic integrated backscatter (IBS). Thirty normal persons, 68 cases with AMI, of whom 28 cases were at the very early stage of acute myocardial infarction (in 2 h), and 40 cases with acute myocardial infarction (in 2 to 12 h) were examined by IBS and the cyclic variation of integrated backscatter (CVIB) with HP-5500 ultrasonic system in different segment (the segment of myocardial infarction and no myocardial infarction). In the segment of AMI of the very early stage (in 2 h) the IBS (dB) is much higher than that of the segment of no AMI (18.7 versus 8.3), p < 0.001, the CVIB (dB) are lower (6.1 versus 7.6), p < 0.001. But at that time there are no obvious changes in ECG. In the other 40 cases with AMI in 2 to 12 h, IBS in the segment of AMI is obviously higher than the normal person and no infarction segment in the same heart (21.3:8.3, 20.2:8.5) p < 0.05, but CVIB (dB) is obviously lower than the normal person and no infarction segment in the same heart (5.8:7.6, 5.9:9.4) p < 0.05 the changes of the ultrasonic is coincidence with ECG. IBS (dB) are very obvious just as in ECG. The result demonstrates that ultrasonic tissue characterization with harmonic imaging integrated backscatter can be used for diagnosis in the very early stage of AMI, and can judge the segment range of AMI and function of the whole heart.
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Affiliation(s)
- Wu Xiaoqing
- The Cardiovascular Department of the No 1 Hospital of Wuxi of the Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, PR China.
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Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernández-Avilés F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N. Universal definition of myocardial infarction. Circulation 2007; 116:2634-53. [PMID: 17951284 DOI: 10.1161/circulationaha.107.187397] [Citation(s) in RCA: 1818] [Impact Index Per Article: 106.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Using percutaneous angioplasty to induce the ischemic cascade in the cardiac catheterization laboratory, echocardiographic wall motion abnormalities have been documented to precede electrocardiographic abnormalities and angina. Therefore, detection of cardiac wall motion abnormalities is potentially more sensitive than the history, physical examination, and ECG for identification of myocardial ischemia. Echocardiography is highly reliable for assessing cardiac wall motion and, thus, it has been used for diagnosis and risk assessment in patients presenting to the emergency department (ED) with symptoms suggestive of myocardial ischemia. In patients who have acute ST-elevation myocardial infarction (MI), echocardiography is comparable to invasive left ventriculography for detecting wall motion abnormalities. However, the usefulness of echocardiography in the low-risk population that has chest pain of uncertain origin and a nondiagnostic initial presentation is less well established.
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Abstract
CPCs have been developed to meet the clinical challenge posed by the diverse group of patients presenting to the ED with findings suggestive of a coronary event. Using a protocol-driven approach, high- and low-risk patients can be identified on presentation, facilitating urgent therapy in the former and triage of the latter to more deliberate management. Most CPCs focus on low-risk patients who are being increasingly managed by accelerated diagnostic protocols. These methods comprise systematic strategies that include innovative diagnostic approaches during a 6 to 12 hour period of observation with serial ECGs, continuous monitoring and cardiac biomarker measurements. A negative evaluation is usually followed by predischarge stress testing, and positive findings mandate admission. An essential aspect of the CPC strategy is continuity of care for patients with negative cardiac evaluations. Current data indicate that management of low-risk patients with chest pain in a CPC is safe accurate, and appears to be cost-effective.
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Affiliation(s)
- Ezra A Amsterdam
- Divisions of Cardiovascular Medicine, University of California, Davis, Medical Center, Sacramento, California, USA.
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Hancock JE, Cooke JC, Chin DT, Monaghan MJ. Determination of successful reperfusion after thrombolysis for acute myocardial infarction: a noninvasive method using ultrasonic tissue characterization that can be applied clinically. Circulation 2002; 105:157-61. [PMID: 11790694 DOI: 10.1161/hc0202.102116] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the present study was to determine the use of cyclic variation in ultrasonic integrated backscatter (IBS), which is reduced in ischemic myocardium, to predict an occluded infarct-related artery (IRA) after thrombolysis for acute myocardial infarction (AMI). This is important, because patency of the IRA 90 minutes after thrombolysis has been shown to predict outcome. METHODS AND RESULTS One hundred thirteen patients with AMI had peak-to-peak cyclic IBS measured in the myocardial territory supplied by their IRA as well as a remote territory with normal function from the parasternal long- or short-axis view. This analysis took 5 to 10 minutes. Wall motion score index was assessed, and coronary angiography, to determine patency of the IRA, was performed in all patients. Cyclic IBS in the IRA territory was much lower in segments supplied by an occluded IRA (3.3 versus 4.6 dB, P<0.00001). Using a difference in cyclic IBS between infarcted and normal segments of 15% (or 1.5 dB) as a cutoff, the sensitivity, specificity, positive and negative predictive values to determine an occluded IRA were 92%, 75%, 81%, and 89%, respectively. CONCLUSIONS The difference in cyclic IBS between IRA and remote normal segments, which can be analyzed rapidly, can be used to predict patency of the IRA in patients with AMI. This provides a noninvasive method to determine those patients who may require urgent invasive investigation.
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Affiliation(s)
- J E Hancock
- Cardiology Department, King's College Hospital, London, UK.
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Bi X, Deng Y, Pan M, Yang H, Xiang H, Chang Q, Li C. Influence of contractility on myocardial ultrasonic integrated backscatter and cyclic variation in integrated backscatter. Curr Med Sci 2002; 22:233-4, 259. [PMID: 12658813 DOI: 10.1007/bf02828189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2001] [Indexed: 10/19/2022]
Abstract
To evaluate the effects of left ventricular contractility on the changes of average image intensity (AII) of the myocardial integrated backscatter (IB) and cyclic variation in IB (CVIB), 7 adult mongrel dogs were studied. The magnitude of AII and CVIB were measured from myocardial IB carves before and after dobatamine or propranolol infusion. Dobutamine or propranolol did not affect the magnitude of AII (13.8 +/- 0.7 vs 14.7 +/- 0.5, P > 0.05 or 14.3 +/- 0.5 vs 14.2 +/- 0.4, P > 0.05). However, dobutamine produced a significant increase in the magnitude of CVIB (6.8 +/- 0.3 vs 9.5 +/- 0.6, P < 0.001) and propranolol induced significant decrease in the magnitude of CVIB (7.1 +/- 0.2 vs 5.2 +/- 0.3, P < 0.001). The changes of the magnitude of AII and CVIB in the myocardium have been demonstrated to reflect different myocardial physiological and pathological changes respectively. The alteration of contractility did not affect the magnitude of AII but induced significant change in CVIB. The increase of left ventricular contractility resulted in a significant rise of the magnitude of CVIB and the decrease of left ventricular contractility resulted in a significant fall of the magnitude of CVIB.
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Affiliation(s)
- Xiaojun Bi
- Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
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How to monitor myocardial ischemia. Curr Opin Crit Care 2000. [DOI: 10.1097/00075198-200010000-00010] [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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Stress Echocardiography. Echocardiography 2000. [DOI: 10.1111/j.1540-8175.2000.tb01169.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Finch-Johnston AE, Gussak HM, Mobley J, Holland MR, Petrovic O, Pérez JE, Miller JG. Cyclic Variation of Integrated Backscatter: Dependence of Time Delay on the Echocardiographic View Used and the Myocardial Segment Analyzed. J Am Soc Echocardiogr 2000. [DOI: 10.1016/s0894-7317(00)90037-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liu YB, Wu CC, Lin LC, Ho YL, Kao HL, Lee YT. Alterations in ultrasonic backscatter during intra-aortic balloon counterpulsation support in patients with acute myocardial infarction. ULTRASOUND IN MEDICINE & BIOLOGY 1999; 25:1185-1193. [PMID: 10576261 DOI: 10.1016/s0301-5629(99)00072-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Alterations of ultrasonic backscatter parameters have been evident in humans with myocardial infarction or ischemia. The backscatter variability could be restored in ischemic or stunned myocardium after reperfusion. The aims of this study were to determinate changes in regional myocardial ultrasonic backscatter during intra-aortic balloon counterpulsation (IABP) support in patients with acute myocardial infarction (AMI), and to evaluate whether backscatter imaging could be a functional guide of IABP support. A total of 9 patients with AMI were investigated during IABP support with a two-dimensional (2-D) ultrasonic backscatter imaging approach for parasternal short-axis view. Coronary angiography was performed in 6 of the 9 patients. A total of 21 vessel territories were studied in different modes of IABP support: 1:1, 1:2 and standby. Restoration of cyclic variation of backscatter after IABP support was demonstrated in 10 vessel territories. Failure of restoration of cyclic variation of backscatter after IABP support was noted in 6 vessel territories with severe coronary lesions (total or nearly total occlusion) or scar tissue. No changes of the ultrasonic backscatter were found in nonischemic vessel territories with patent coronary arteries or TIMI III coronary flow. In addition, the wall motion score did not change significantly with different IABP support. These results suggest that IABP could restore the cyclic variation of backscatter in ischemic myocardium. Myocardial anisotropy may play an influential role in the alterations of ultrasonic backscatter. We propose that ultrasonic backscatter could be a noninvasively functional guide of IABP use in patients with AMI.
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Affiliation(s)
- Y B Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC
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16
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Abstract
Each year in the United States, more than 2 million patients are hospitalized with chest pain suggestive of myocardial ischemia, with fewer than 20% of these patients having an acute coronary event. Chest pain emergency units have been created to facilitate urgent therapy for patients with a serious cardiovascular event and to triage lower risk patients to less intensive, more cost-effective inpatient care or discharge to home. The clinical history, physical examination, and initial electrocardiogram are key to initial stratification of patients for further management, but additional methods are necessary to clearly distinguish patients with inconclusive findings at presentation as high- and low-risk. Innovative electrocardiographic methods have increased sensitivity for detecting myocardial ischemia. Accelerated diagnostic protocols with new cardiac serum markers can detect myocardial ischemia or infarction with increasing accuracy. Early echocardiographic, scintigraphic, and treadmill stress protocols can further evaluate patients who have nondiagnostic electrocardiograms and negative serum markers. This review presents the current status of chest pain emergency units and the evolving management strategies they encompass.
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Affiliation(s)
- W R Lewis
- Department of Internal Medicine, University of California (Davis) Medical Center, Sacramento, USA
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Kontos MC. Role of Echocardiography in the Emergency Department for Identifying Patients with Myocardial Infarction and Ischemia. Echocardiography 1999; 16:193-205. [PMID: 11175141 DOI: 10.1111/j.1540-8175.1999.tb00804.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Echocardiography is a valuable, noninvasive diagnostic tool that can provide information on systolic function and valvular abnormalities and can provide alternative explanations for causes of chest pain. Experimental as well as clinical studies have shown that wall motion abnormalities have a high sensitivity for predicting myocardial infarction. More recent studies, performed in the emergency department on patients evaluated for myocardial ischemia, have reported similar results. An important aspect is that necrosis is not necessary to cause wall motion abnormalities; therefore, echocardiography can also be used to identify patients with ischemia without infarction. Importantly, sensitivity is significantly higher than that for electrocardiography and is comparable to that for myocardial perfusion imaging. Newer developments, such as digital transmission over telephone lines, may lead to more widespread routine use in the emergency department. Acute emergency department echocardiography appears to be a promising tool when used in the evaluation of patients with chest pain.
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Lin LC, Wu CC, Ho YL, Chen MF, Liau CS, Lee YT. Ultrasonic tissue characterization in predicting residual ischemia and myocardial viability for patients with acute myocardial infarction. ULTRASOUND IN MEDICINE & BIOLOGY 1998; 24:1107-1120. [PMID: 9833578 DOI: 10.1016/s0301-5629(98)00104-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The identification of viable myocardium and residual ischemia in patients with acute myocardial infarction has important prognostic implications. The ultrasonic tissue characterization with integrated backscatter and dobutamine-atropine stress echocardiography were performed 8.3+/-3 days after AMI in 30 patients. After coronary angioplasty for the residual stenosis of infarct-related artery, both modalities were repeated. The parameter obtained from ultrasonic tissue characterization, phase-weighted variation, could differentiate the myocardium with residual coronary stenosis or nonviable myocardium from the viable myocardium without residual coronary stenosis (p < 0.001). Using the cutoff value of 5.8 dB, the sensitivity, specificity and accuracy for detecting viable myocardium without residual coronary stenosis were 75%, 100% and 90.2%, respectively. The phase-weighted variation of the viable infarction zone restored after the coronary stenosis was relieved. In contrast, the nonviable myocardium had a small phase-weighted variation that was irrelevant to the patency of the infarct-related artery. The ultrasonic tissue characterization may be used in identifying patients with acute myocardial infarction whose infarction zones are viable without residual ischemia.
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Affiliation(s)
- L C Lin
- Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei
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Nesković AN, Mojsilović A, Jovanović T, Vasiljević J, Popović M, Marinković J, Bojić M, Popović AD. Myocardial tissue characterization after acute myocardial infarction with wavelet image decomposition: a novel approach for the detection of myocardial viability in the early postinfarction period. Circulation 1998; 98:634-41. [PMID: 9715855 DOI: 10.1161/01.cir.98.7.634] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only a few texture measures can be used for texture characterization of infarcted myocardium and detection of reperfused myocardium early after infarction. This study was conducted to establish the relationship between texture properties of infarcted myocardium and infarct-related artery patency by quantitative computer analysis of 2-dimensional echocardiographic images with the wavelet-based method for texture characterization, evaluate the relationship between texture properties and myocardial viability, and correlate histopathologic changes after experimental infarction with the texture measures. METHODS AND RESULTS We analyzed 2-dimensional transthoracic echocardiographic images in 18 patients at different time points after infarction using the wavelet transform method. Regional wall motion of infarcted segments was analyzed on a follow-up echocardiographic study obtained 6 months after infarction. To verify the accuracy of the proposed texture measure and energy difference cutoff value, we prospectively evaluated another group of 19 patients. In addition, histopathologic changes in 9 dogs with experimental infarction were correlated with the texture measures. Sensitivity, specificity, and accuracy of the wavelet method for detection of reperfusion in the study group were 73%, 86%, and 78%, respectively, on day 2; 91%, 86%, and 89%, at 1 week; and 100%, 100%, and 100% at 3 weeks. Among 9 patients with improvement in regional wall motion on a follow-up study, 7 on day 2, 8 at 1 week, and 9 at 3 weeks were classified into the reperfused group by the wavelet method. Histopathologic features associated with the classification of reperfusion by the wavelet method were infarct transmurality (P=0.024) and degree of necrosis (P=0.028). CONCLUSIONS Our clinical and experimental data suggest that the wavelet method can be used to differentiate between viable myocardium with recovery potential and definite myocardial necrosis in the early postinfarction period.
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Affiliation(s)
- A N Nesković
- Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade University Medical School, Yugoslavia
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Lin LC, Wu CC, Ho YL, Lin CW, Chen WJ, Chen MF, Liau CS, Lee YT. Ultrasonic tissue characterization for coronary care unit patients with acute myocardial infarction. ULTRASOUND IN MEDICINE & BIOLOGY 1998; 24:187-196. [PMID: 9550177 DOI: 10.1016/s0301-5629(97)00265-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The ultrasonic integrated backscatter of myocardium changes in infarction and ischemia. On the third day after acute myocardial infarction, 30 patients underwent ultrasonic tissue characterization from the parasternal short-axis view. With a composite parameter, the phase-weighted variation, sensitivity, specificity, and accuracy for diagnosing multivessel coronary artery disease were 84.6%, 52.9% and 66.6%, respectively. Using 67 degrees as the cutoff value for the phase deviation of the backscatter power curve, the recanalization of the infarct-related artery could be detected with a positive predictive value of 77.7% and a negative predictive value of 66.6%. Ultrasonic tissue characterization is a feasible technique for detecting the multivessel coronary artery diseases and the recanalization of infarct-related artery for patients with acute myocardial infarction. The diminished cardiac cycle-dependent variation in integrated backscatter and increased phase deviation can differentiate patent coronary arteries from those coronary arteries with anatomically significant stenoses.
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Affiliation(s)
- L C Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC
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Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davidson TW, Davis JL, Douglas PS, Gillam LD. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 1997; 95:1686-744. [PMID: 9118558 DOI: 10.1161/01.cir.95.6.1686] [Citation(s) in RCA: 466] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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