1
|
Wifstad SV, Lovstakken L, Avdal J, Berg EAR, Torp H, Grenne B, Fiorentini S. Quantifying Valve Regurgitation Using 3-D Doppler Ultrasound Images and Deep Learning. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:3317-3326. [PMID: 36315529 DOI: 10.1109/tuffc.2022.3218281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Accurate quantification of cardiac valve regurgitation jets is fundamental for guiding treatment. Cardiac ultrasound is the preferred diagnostic tool, but current methods for measuring the regurgitant volume (RVol) are limited by low accuracy and high interobserver variability. Following recent research, quantitative estimators of orifice size and RVol based on high frame rate 3-D ultrasound have been proposed, but measurement accuracy is limited by the wide point spread function (PSF) relative to the orifice size. The aim of this article was to investigate the use of deep learning to estimate both the orifice size and the RVol. A simulation model was developed to simulate the power-Doppler images of blood flow through orifices with different geometries. A convolutional neural network (CNN) was trained on 30 000 image pairs. The network was used to reconstruct orifices from power-Doppler data, which facilitated estimators for regurgitant orifice areas and flow volumes. We demonstrate that the network improves orifice shape reconstruction, as well as the accuracy of orifice area and flow volume estimation, compared with a previous approach based on thresholding of the power-Doppler signal (THD), and compared with spatially invariant deconvolution (DC). Our approach reduces the area estimation error on simulations: (THD: 13.2 ± 9.9 mm2, DC: 12.8 ± 15.8 mm2, and ours: 3.5 ± 3.2 mm2). In a phantom experiment, our approach reduces both area estimation error (THD: 10.4 ± 8.4 mm2, DC: 10.98 ± 8.17, and ours: 9.9 ± 6.0 mm2) and flow rate estimation error (THD: 20.3 ± 9.9 ml/s, DC: 18.14 ± 13.01 ml/s, and ours: 7.1 ± 10.6 ml/s). We also demonstrate in vivo feasibility for six patients with aortic insufficiency, compared with standard echocardiography and magnetic resonance references.
Collapse
|
2
|
Singh A, Su J, This A, Allaire S, Rouet JM, Laghi A, Kebed K, Addetia K, Schreckenberg M, Lang RM, Bonnefous O. A Novel Approach for Semi Automated 3D Quantification of Mitral Regurgitant Volume Reflects a More Physiologic Approach to MR. J Am Soc Echocardiogr 2022; 35:940-946. [PMID: 35605896 DOI: 10.1016/j.echo.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/12/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Quantification of mitral regurgitation (MR) by echocardiography is an integral to assessing lesion severity, and entails integration of multiple Doppler-based parameters. These methods are primarily founded upon the principle of PISA (proximal isovelocity surface area), a 2D method known to employ several assumptions regarding MR jet characteristics. We analyzed the results of a semi-automated method of 3D-based RV estimation which accounts for jet behavior throughout the cardiac cycle, and compared it to conventional 2D PISA methods for MR. METHODS A total of 50 patients referred for transesophageal echocardiogram (TEE) for evaluation of primary (n= 25) and secondary MR (n=25) were included for analysis. 3D full volume color data sets were acquired, along with standard 2D methods for PISA calculation. 3D semi-automated MR flow quantification algorithm was applied offline to calculate 3D regurgitant volume (RVol), with simultaneous temporal curves generated from the 3D dataset. 3DRvol was compared to 2DRVol. 3D vena contracta area was also performed in all cases. RESULTS There was a modest correlation between 2DRVol and 3DRVol (r = 0.60). The semi-automated 3D approach resulted in significantly lower RV values compared to 2D PISA. Real-time and dynamic flow curve patterns were used for integral estimates of 3DRVol over the cardiac cycle, with a distinct bimodal pattern in functional MR, and brief and solitary peak in primary. CONCLUSIONS Using a semi-automated 3D software for quantification of mitral regurgitation allows for simultaneous calculation of 3D RVol with an automated generation of dynamic flow curves characteristic of the underlying MR mechanism. Our flow curve pattern results highlight well-known differences between MR flow dynamics in degenerative MR compared to functional MR.
Collapse
Affiliation(s)
- Amita Singh
- University of Chicago Medical Center (Chicago, IL).
| | - Jimmy Su
- Philips Healthcare (Cambridge, MA)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Zhou L, Wei HY, Ge YL, Ding ZN, Shi HW. Comparison of the effective orifice area of prosthetic mitral valves using two-dimensional versus three-dimensional transesophageal echocardiography. J Int Med Res 2021; 49:300060521997621. [PMID: 33729857 PMCID: PMC7975571 DOI: 10.1177/0300060521997621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study compared the continuity equation-based effective orifice area
(EOA) of prosthetic mitral valves between two-dimensional (2D) and 3D
transesophageal echocardiography (TEE). Methods Thirty-four patients without major aortic valve abnormalities underwent
mitral valve replacement surgery. The EOAs of prosthetic mitral valves were
calculated using the continuity equation with 2D and 3D TEE. For 18/34
patients using a biological valve prosthesis, the EOA of the prosthesis was
obtained from commercial records. Results The EOA of prosthetic mitral valves significantly varied between the 2D and
3D methods (2.22 ± 0.71 vs 2.35 ± 0.70 cm2, n = 34). The area of
the diameter of the left ventricular outflow tract as determined by the 3D
method was significantly higher than that by the 2D method (mean difference:
−0.14 ± 0.20 cm2), with 95% coherence boundaries of −0.53 and
0.25 cm2. The regression equation for the EOA by 3D and 2D
TEE was y = 0.27 + 0.94x, with a good correlation. Conclusions The EOA of prosthetic mitral valves is underestimated using the 2D TEE method
compared with the 3D TEE method. The 3D-TEE method has the advantage of
higher precision over the 2D TEE method, and it may be helpful for better
assessment of prosthetic mitral valves intraoperatively.
Collapse
Affiliation(s)
- Lei Zhou
- Department of Anesthesiology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, Jiangsu, China
| | - Hai-Yan Wei
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ya-Li Ge
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zheng-Nian Ding
- Department of Anesthesiology, Jiangsu People's Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong-Wei Shi
- Department of Anesthesiology, Nanjing First Hospital & Nanjing Cardiovascular Disease Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
4
|
Zhou L, Wei H, Ge Y, Ding Z, Shi H. [Consistency of effective orifice area of prosthetic mitral valve estimated using 2-dimensional and 3-dimensional transesophageal echocardiography]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:238-242. [PMID: 33624597 DOI: 10.12122/j.issn.1673-4254.2021.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the consistency of effective orifice area (EOA) of prosthetic mitral valve estimated using 2- dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE). OBJECTIVE This study was conducted among 34 patients undergoing mitral valve replacement surgery in Nanjing First Hospital between March and June in 2019. The diameter of the left ventricular outflow tract (LVOT) measured by 2D-TEE was used to calculate the cross sectional area of LVOT (CSALVOT). In 3D-TEE method, LVOT area was measured directly by planimetry on an enface view. The EOAs of the prosthetic mitral valve were calculated for both methods using the continuity equation. Bland-Altman plot consistency test was used to analyze the consistency between the two sets of EOA results, and linear regression analysis was used to analyze their correlation. OBJECTIVE The EOA of the prosthetic mitral valve differed significantly between 2D method and 3D method (2.22±0.71 cm2 vs 2.35±0.70 cm2, P < 0.001) with a mean difference of -0.14±0.20 cm2 and 95% coherence boundaries of (-0.53, 0.25 cm2). The regression equation for EOA-3D and EOA-2D is y=0.27 + 0.94x, showing a good correlation between the two methods. OBJECTIVE EOA estimation of the prosthetic mitral valve using 2D and 3D TEE has a good consistency, and the results estimated by the 2D method are slightly lower by about 6% than those by the 3D method.
Collapse
Affiliation(s)
- L Zhou
- Department of Anesthesiology, Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - H Wei
- Department of Anesthesiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
| | - Y Ge
- Department of Anesthesiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
| | - Z Ding
- Department of Anesthesiology, First Affiliated Hospital to Nanjing Medical University, Nanjing 210029, China
| | - H Shi
- Department of Anesthesiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China
| |
Collapse
|
5
|
Wang W, Jiang Y, Li J, Gong K, Zhao L, Tang G, Meng Y, Wang Z. Diagnostic value of mitral regurgitant jet volume in the assessment of mitral regurgitation severity by general imaging three-dimensional quantification. Int J Cardiovasc Imaging 2020; 36:1963-1972. [DOI: 10.1007/s10554-020-01916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
|
6
|
Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography. J Am Soc Echocardiogr 2020; 33:342-354. [DOI: 10.1016/j.echo.2019.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/27/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022]
|
7
|
Evaluation of the Integrative Algorithm for Grading Chronic Aortic and Mitral Regurgitation Severity Using the Current American Society of Echocardiography Recommendations: To Discriminate Severe from Moderate Regurgitation. J Am Soc Echocardiogr 2018; 31:1002-1012.e2. [DOI: 10.1016/j.echo.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/21/2022]
|
8
|
Abstract
PURPOSE OF REVIEW Three-dimensional (3D) echocardiography (3DE) and 4-dimensional echocardiography (4DE), also known as real-time (RT) 3DE (RT3DE), are rapidly emerging technologies which have made significant impact in the clinical arena over the years. This review will discuss the recent applications of 3DE in diagnosing and treating different types of cardiovascular disease. RECENT FINDINGS Recent studies using 3DE expanded on prior findings and introduced additional applications to different cardiac conditions. Some studies have used 3D parameters to prognosticate long-term outcomes. Numerous innovative software designs including fully automated algorithms have been introduced to better evaluate valvular heart disease and cardiac function. SUMMARY With further evolution of 3DE technologies, this imaging modality will emerge as a powerful tool and likely become the imaging modality of choice in the diagnosis and management of various cardiac disorders.
Collapse
Affiliation(s)
- Susan H. Kwon
- Research Department, 100 Port Washington Blvd, Roslyn, NY 11576 USA
| | - Aasha S. Gopal
- Research Department, 100 Port Washington Blvd, Roslyn, NY 11576 USA
| |
Collapse
|
9
|
Cobey FC, Patel V, Gosling A, Ursprung E. The Emperor Has No Clothes: Recognizing the Limits of Current Echocardiographic Technology in Perioperative Quantification of Mitral Regurgitation. J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
10
|
Varelmann DJ, Muehlschlegel JD. Noteworthy Literature Published in 2016 for the Cardiothoracic Anesthesiologist. Semin Cardiothorac Vasc Anesth 2017; 21:8-16. [DOI: 10.1177/1089253216687858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical research and outcome studies dominated the publication spectrum for the cardiothoracic anesthesiologist in 2016. Echocardiography is an important tool in the armamentarium of the cardiothoracic anesthesiologist. Technology is advancing at a fast pace: A new method to quantify the regurgitant volume in mitral regurgitation has been described in an experimental model and been validated in humans. Interesting studies on key elements of our daily practice have been published: Does tranexamic acid decrease the transfusion requirements after cardiac surgery? Are patients with a postoperative cognitive deficit at risk for dementia 7.5 years after surgery? What is the best strategy for post–cardiac surgery atrial fibrillation? What is the mechanism of preconditioning with remifentanil? Large multicenter looked at the treatment strategies for moderate and severe ischemic mitral regurgitation and benefits of transcatheter aortic valve replacement versus the surgical approach. These studies may give us ideas on how to tailor treatment to optimize the patients’ outcome and to minimize the associated risks.
Collapse
Affiliation(s)
- Dirk J. Varelmann
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
11
|
Zhou X, Vannan MA, Lancellotti P. Quantitative Three-Dimensional Color Flow Echocardiography of Chronic Mitral Regurgitation: New Methods, New Perspectives, New Challenges. J Am Soc Echocardiogr 2016; 29:935-937. [DOI: 10.1016/j.echo.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
Pierce EL, Rabbah JPM, Thiele K, Wei Q, Vidakovic B, Jensen MO, Hung J, Yoganathan AP. Three-Dimensional Field Optimization Method: Gold-Standard Validation of a Novel Color Doppler Method for Quantifying Mitral Regurgitation. J Am Soc Echocardiogr 2016; 29:917-925. [PMID: 27354250 DOI: 10.1016/j.echo.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate diagnosis of mitral regurgitation (MR) severity is central to proper treatment. Although numerous approaches exist, an accurate, gold-standard clinical technique remains elusive. The authors previously reported on the initial development and demonstration of the automated three-dimensional (3D) field optimization method (FOM) algorithm, which exploits 3D color Doppler ultrasound imaging and builds on existing MR quantification techniques. The aim of the present study was to extensively validate 3D FOM in terms of accuracy, ease of use, and repeatability. METHODS Three-dimensional FOM was applied to five explanted ovine mitral valves in a left heart simulator, which were systematically perturbed to yield a total of 29 unique regurgitant geometries. Three-dimensional FOM was compared with a gold-standard flow probe, as well as the most clinically prevalent MR volume quantification technique, the two-dimensional (2D) proximal isovelocity surface area (PISA) method. RESULTS Overall, 3D FOM overestimated and 2D PISA underestimated MR volume, but 3D FOM error had smaller magnitude (5.2 ± 9.9 mL) than 2D PISA error (-6.9 ± 7.7 mL). Two-dimensional PISA remained superior in diagnosis for round orifices and especially mild MR, as predicted by ultrasound physics theory. For slit-type orifices and severe MR, 3D FOM showed significant improvement over 2D PISA. Three-dimensional FOM processing was technically simpler and significantly faster than 2D PISA and required fewer ultrasound acquisitions. Three-dimensional FOM did not show significant interuser variability, whereas 2D PISA did. CONCLUSIONS Three-dimensional FOM may provide increased clinical value compared with 2D PISA because of increased accuracy in the case of complex or severe regurgitant orifices as well as its greater repeatability and simpler work flow.
Collapse
Affiliation(s)
- Eric L Pierce
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Jean Pierre M Rabbah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | | | - Qifeng Wei
- Philips Health Tech, Andover, Massachusetts
| | - Brani Vidakovic
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Morten O Jensen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Judy Hung
- Echocardiography Laboratory of the Massachusetts General Hospital, Boston, Massachusetts
| | - Ajit P Yoganathan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
| |
Collapse
|