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Saloux E, Garrec ML, Menet N, Dillon L, Simard C, Fraschini C, Manrique A. Cardiac 2-D Shear Wave Imaging Using a New Dedicated Clinical Ultrasound System: A Phantom Study. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:843-851. [PMID: 38471998 DOI: 10.1016/j.ultrasmedbio.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The purpose of this study was to assess cardiac shear wave imaging implemented in a new MACH 30 ultrasound machine (SuperSonic Imaging, Aix-en-Provence, France) and interfaced with a linear probe and a phased array probe, in comparison with a previously validated Aixplorer system connected to a linear probe (SuperSonic Imaging) using Elasticity QA phantoms (Models 039 and 049, CIRS Inc., Norfolk, VA, USA). METHODS Quantile-quantile plots were used for distribution agreement. The accuracy of stiffness measurement was assessed by the percentage error and the mean percentage error (MPE), and its homogeneity, by the standard deviation of the MPE. A p value <0.01 was considered to indicate statistical significance. RESULTS The accuracy of dedicated cardiac sequences for linear probes was similar for the two systems with an MPE of 8 ± 14% versus 20 ± 21% (p = not significant) with the SuperSonic MACH 30 and Aixplorer, respectively, and was influenced by target stiffness and location of the measurement in the field of view, but without drift over time. The optimal transthoracic cardiac probe workspace was located between 4 and 10 cm, with an MPE of 29.5 ± 25% compared with 93.3 ± 130% outside this area (p < 0.0001). In this area, stiffness below 20 kPa was significantly different from the reference (p < 0.0001). The sectorial probe revealed no MPE difference in any of the measurement areas, with no significant lateral or axial gradient. CONCLUSION The new Supersonic MACH 30 system upgraded with a sectorial probe and specific cardiac settings provided homogenous stiffness measurements, especially when operating at depths between 4 and 10 cm. These phantom results may be useful in designing future in vivo studies.
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Affiliation(s)
- Eric Saloux
- Centre Hospitalier, Universitaire de Caen Normandie, Caen, France; UR 4650 PSIR, Université de Caen Normandie, Caen, France.
| | | | - Nina Menet
- UR 4650 PSIR, Université de Caen Normandie, Caen, France
| | - Ludovic Dillon
- Centre Hospitalier, Universitaire de Caen Normandie, Caen, France
| | | | | | - Alain Manrique
- Centre Hospitalier, Universitaire de Caen Normandie, Caen, France; UR 4650 PSIR, Université de Caen Normandie, Caen, France
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2
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Arani A, Murphy MC, Bhopalwala H, Arunachalam SP, Rossman PJ, Trzasko JD, Glaser K, Sui Y, Gunderson T, Arruda-Olson AM, Manduca A, Kantarci K, Ehman RL, Araoz PA. Sex Differences in Aging-related Myocardial Stiffening Quantitatively Measured with MR Elastography. Radiol Cardiothorac Imaging 2024; 6:e230140. [PMID: 38780427 DOI: 10.1148/ryct.230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Purpose To investigate the feasibility of using quantitative MR elastography (MRE) to characterize the influence of aging and sex on left ventricular (LV) shear stiffness. Materials and Methods In this prospective study, LV myocardial shear stiffness was measured in 109 healthy volunteers (age range: 18-84 years; mean age, 40 years ± 18 [SD]; 57 women, 52 men) enrolled between November 2018 and September 2019, using a 5-minute MRE acquisition added to a clinical MRI protocol. Linear regression models were used to estimate the association of cardiac MRI and MRE characteristics with age and sex; models were also fit to assess potential age-sex interaction. Results Myocardial shear stiffness significantly increased with age in female (age slope = 0.03 kPa/year ± 0.01, P = .009) but not male (age slope = 0.008 kPa/year ± 0.009, P = .38) volunteers. LV ejection fraction (LVEF) increased significantly with age in female volunteers (0.23% ± 0.08 per year, P = .005). LV end-systolic volume (LVESV) decreased with age in female volunteers (-0.20 mL/m2 ± 0.07, P = .003). MRI parameters, including T1, strain, and LV mass, did not demonstrate this interaction (P > .05). Myocardial shear stiffness was not significantly correlated with LVEF, LV stroke volume, body mass index, or any MRI strain metrics (P > .05) but showed significant correlations with LV end-diastolic volume/body surface area (BSA) (slope = -3 kPa/mL/m2 ± 1, P = .004, r2 = 0.08) and LVESV/BSA (-1.6 kPa/mL/m2 ± 0.5, P = .003, r2 = 0.08). Conclusion This study demonstrates that female, but not male, individuals experience disproportionate LV stiffening with natural aging, and these changes can be noninvasively measured with MRE. Keywords: Cardiac, Elastography, Biological Effects, Experimental Investigations, Sexual Dimorphisms, MR Elastography, Myocardial Shear Stiffness, Quantitative Stiffness Imaging, Aging Heart, Myocardial Biomechanics, Cardiac MRE Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Arvin Arani
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Matthew C Murphy
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Huzefa Bhopalwala
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Shivaram P Arunachalam
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Phillip J Rossman
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Joshua D Trzasko
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kevin Glaser
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Yi Sui
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Tina Gunderson
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Adelaide M Arruda-Olson
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Armando Manduca
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kejal Kantarci
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Richard L Ehman
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Philip A Araoz
- From the Departments of Radiology (A.A., M.C.M., H.B., S.P.A., P.J.R., J.D.T., K.G., Y.S., A.M., K.K., R.L.E., P.A.A.), Quantitative Health Science (T.G.), and Cardiology (A.M.A.O.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Caenen A, Bézy S, Pernot M, Nightingale KR, Vos HJ, Voigt JU, Segers P, D'hooge J. Ultrasound Shear Wave Elastography in Cardiology. JACC Cardiovasc Imaging 2024; 17:314-329. [PMID: 38448131 DOI: 10.1016/j.jcmg.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 11/14/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024]
Abstract
The advent of high-frame rate imaging in ultrasound allowed the development of shear wave elastography as a noninvasive alternative for myocardial stiffness assessment. It measures mechanical waves propagating along the cardiac wall with speeds that are related to stiffness. The use of cardiac shear wave elastography in clinical studies is increasing, but a proper understanding of the different factors that affect wave propagation is required to correctly interpret results because of the heart's thin-walled geometry and intricate material properties. The aims of this review are to give an overview of the general concepts in cardiac shear wave elastography and to discuss in depth the effects of age, hemodynamic loading, cardiac morphology, fiber architecture, contractility, viscoelasticity, and system-dependent factors on the measurements, with a focus on clinical application. It also describes how these factors should be considered during acquisition, analysis, and reporting to ensure an accurate, robust, and reproducible measurement of the shear wave.
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Affiliation(s)
- Annette Caenen
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Mathieu Pernot
- Physics for Medicine, INSERM, CNRS, ESPCI, PSL University, Paris, France
| | | | - Hendrik J Vos
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Youssef AS, Salaets T, Bézy S, Wouters L, Orlowska M, Caenen A, Duchenne J, Puvrez A, De Somer L, Cools B, D'hooge J, Gewillig M, Voigt JU. Shear-Wave Elastography Reflects Myocardial Stiffness Changes in Pediatric Inflammatory Syndrome Post COVID-19. JACC Cardiovasc Imaging 2024; 17:214-216. [PMID: 37737791 DOI: 10.1016/j.jcmg.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
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Espeland T, Wigen MS, Dalen H, Berg EAR, Hammer TA, Salles S, Lovstakken L, Amundsen BH, Aakhus S. Mechanical Wave Velocities in Left Ventricular Walls in Healthy Subjects and Patients With Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:111-124. [PMID: 37676209 DOI: 10.1016/j.jcmg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Mechanical wave velocity (MWV) measurement is a promising method for evaluating myocardial stiffness, because these velocities are higher in patients with myocardial disease. OBJECTIVES Using high frame rate echocardiography and a novel method for detection of myocardial mechanical waves, this study aimed to estimate the MWVs for different left ventricular walls and events in healthy subjects and patients with aortic stenosis (AS). Feasibility and reproducibility were evaluated. METHODS This study included 63 healthy subjects and 13 patients with severe AS. All participants underwent echocardiographic examination including 2-dimensional high frame rate recordings using a clinical scanner. Cardiac magnetic resonance was performed in 42 subjects. The authors estimated the MWVs at atrial kick and aortic valve closure in different left ventricular walls using the clutter filter wave imaging method. RESULTS Mechanical wave imaging in healthy subjects demonstrated the highest feasibility for the atrial kick wave reaching >93% for all 4 examined left ventricular walls. The MWVs were higher for the inferolateral and anterolateral walls (2.2 and 2.6 m/s) compared with inferoseptal and anteroseptal walls (1.3 and 1.6 m/s) (P < 0.05) among healthy subjects. The septal MWVs at aortic valve closure were significantly higher for patients with severe AS than for healthy subjects. CONCLUSIONS MWV estimation during atrial kick is feasible and demonstrates higher velocities in the lateral walls, compared with septal walls. The authors propose indicators for quality assessment of the mechanical wave slope as an aid for achieving consistent measurements. The discrimination between healthy subjects and patients with AS was best for the aortic valve closure mechanical waves. (Ultrasonic Markers for Myocardial Fibrosis and Prognosis in Aortic Stenosis; NCT03422770).
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Affiliation(s)
- Torvald Espeland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten S Wigen
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Erik A R Berg
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tommy A Hammer
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Radiology, Clinic of Radiology and Nuclear Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sebastien Salles
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Lovstakken
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Brage H Amundsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Zhang N, Tang L, Zhang L, Wang Q, Zhao L, Liu X, Hua Y, Duan H, Shao S, Zhou K, Wang C. Evaluation of left ventricular stiffness with echocardiography. Echocardiography 2024; 41:e15737. [PMID: 38284673 DOI: 10.1111/echo.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/25/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Half of patients with heart failure are presented with preserved ejection fraction (HFpEF). The pathophysiology of these patients is complex, but increased left ventricular (LV) stiffness has been proven to play a key role. However, the application of this parameter is limited due to the requirement for invasive catheterization for its measurement. With advances in ultrasound technology, significant progress has been made in the noninvasive assessment of LV chamber or myocardial stiffness using echocardiography. Therefore, this review aims to summarize the pathophysiological mechanisms, correlations with invasive LV stiffness constants, applications in different populations, as well as the limitations of echocardiography-derived indices for the assessment of both LV chamber and myocardial stiffness. Indices of LV chamber stiffness, such as the ratio of E/e' divided by left ventricular end-diastolic volume (E/e'/LVEDV), the ratio of E/SRe (early diastolic strain rates)/LVEDV, and diastolic pressure-volume quotient (DPVQ), are derived from the relationship between echocardiographic parameters of LV filling pressure (LVFP) and LV size. However, these methods are surrogate and lumped measurements, relying on E/e' or E/SRe for evaluating LVFP. The limitations of E/e' or E/SRe in the assessment of LVFP may contribute to the moderate correlation between E/e'/LVEDV or E/SRe/LVEDV and LV stiffness constants. Even the most validated measurement (DPVQ) is considered unreliable in individual patients. In comparison to E/e'/LVEDV and E/SRe/LVEDV, indices like time-velocity integral (TVI) measurements of pulmonary venous and transmitral flows may demonstrate better performance in assessing LV chamber stiffness, as evidenced by their higher correlation with LV stiffness constants. However, only one study has been conducted on the exploration and application of TVI in the literature, and the accuracy of assessing LV chamber stiffness remains to be confirmed. Regarding echocardiographic indices for LV myocardial stiffness evaluation, parameters such as epicardial movement index (EMI)/ diastolic wall strain (DWS), intrinsic velocity propagation of myocardial stretch (iVP), and shear wave imaging (SWI) have been proposed. While the alteration of DWS and its predictive value for adverse outcomes in various populations have been widely validated, it has been found that DWS may be better considered as an overall marker of cardiac function performance rather than pure myocardial stiffness. Although the effectiveness of iVP and SWI in assessing left ventricular myocardial stiffness has been demonstrated in animal models and clinical studies, both indices have their limitations. Overall, it seems that currently no echocardiography-derived indices can reliably and accurately assess LV stiffness, despite the development of several parameters. Therefore, a comprehensive evaluation of LV stiffness using all available parameters may be more accurate and enable earlier detection of alterations in LV stiffness.
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Affiliation(s)
- Nanjun Zhang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Liting Tang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Linling Zhang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Qinhui Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Li Zhao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Medical School of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoliang Liu
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Duan
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuran Shao
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
- Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Petrescu A, Voigt JU. [Echocardiography with high frame rates in the clinical practice : Principles, applications and perspectives]. Herz 2023; 48:339-351. [PMID: 37530782 DOI: 10.1007/s00059-023-05199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Continuous developments in cardiovascular imaging, software and hardware have led to technological advancements that open new ways for assessing myocardial mechanics, hemodynamics, and function. Through new scan modalities, echocardiographic scanners can nowadays achieve very high frame rates up to 5000 frames s-1 which enables a wide variety of new applications, including shear wave elastography, ultrafast speckle tracking, the visualization of intracardiac blood flow and myocardial perfusion imaging. This review provides an overview of these advances and demonstrates possible applications and their potential added value in the clinical practice.
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Affiliation(s)
- Aniela Petrescu
- Abteilung für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgien.
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Jin FQ, Kakkad V, Bradway DP, LeFevre M, Kisslo J, Khouri MG, Trahey GE. Evaluation of Myocardial Stiffness in Cardiac Amyloidosis Using Acoustic Radiation Force Impulse and Natural Shear Wave Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1719-1727. [PMID: 37149428 PMCID: PMC10330400 DOI: 10.1016/j.ultrasmedbio.2023.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Increased myocardial stiffness (MS) is an important hallmark of cardiac amyloidosis (CA) caused by myocardial amyloid deposition. Standard echocardiography metrics assess MS indirectly via downstream effects of cardiac stiffening. The ultrasound elastography methods acoustic radiation force impulse (ARFI) and natural shear wave (NSW) imaging assess MS more directly. METHODS This study compared MS in 12 healthy volunteers and 13 patients with confirmed CA using ARFI and NSW imaging. Parasternal long-axis acquisitions of the interventricular septum were obtained using a modified Acuson Sequoia scanner and a 5V1 transducer. ARFI-induced displacements were measured through the cardiac cycle, and ratios of diastolic-over-systolic displacement were calculated. NSW speeds from aortic valve closure were extracted from echocardiography-tracked displacement data. RESULTS ARFI stiffness ratios were significantly lower in CA patients than controls (mean ± standard deviation: 1.47 ± 0.27 vs. 2.10 ± 0.47, p < 0.001), and NSW speeds were significantly higher in CA patients than controls (5.58 ± 1.10 m/s vs. 3.79 ± 1.10 m/s, p < 0.001). A linear combination of the two metrics exhibited greater diagnostic potential than either metric alone (area under the curve = 0.97 vs. 0.89 and 0.88). CONCLUSION MS was measured to be significantly higher in CA patients using both ARFI and NSW imaging. Together, these methods have potential utility to aid in clinical diagnosis of diastolic dysfunction and infiltrative cardiomyopathies.
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Affiliation(s)
- Felix Q Jin
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Vaibhav Kakkad
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.
| | - David P Bradway
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Melissa LeFevre
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Kisslo
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michel G Khouri
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Gregg E Trahey
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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9
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Cheng Q, Huang X, Fan X, Sun J, Zhang J, Tang Q, Deng Y, Bi X. Exploring the prospect of intrinsic wave propagation in evaluating myocardial stiffness among patients with type 2 diabetes. Front Cardiovasc Med 2023; 10:1162500. [PMID: 37378401 PMCID: PMC10291123 DOI: 10.3389/fcvm.2023.1162500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Background Diabetes predisposes affected individuals to impaired myocardial perfusion and ischemia, leading to cardiac dysfunction. Increased myocardial stiffness is an independent and significant risk factor in diastolic dysfunction. This study sought to estimate myocardial stiffness in Type 2 diabetes (T2DM) patients using the intrinsic wave velocity propagation (IVP) along the longitudinal wall motion during late diastole and evaluate the value of IVP in assessing cardiac function and structure. Methods 87 and 53 participants with and without T2DM (control group) were enrolled. Of the 87 T2DM patients (DM group), 43 were complicated with hypertension (DM + H group), and 44 were not (DM-H group). Ultrasound parameters were measured and analyzed, including color M-mode flow propagation velocity, global longitudinal systolic strain (GLS), and IVP. Results IVP was higher in the DM group than in the control group (1.62 ± 0.25 m/s and 1.40 ± 0.19 m/s, P < 0.001). After stratification for hypertension, IVP in both DM + H (1.71 ± 0.25 m/s) and DM-H (1.53 ± 0.20 m/s) groups were found to be significantly higher than that in the control group (1.40 ± 0.19 m/s); also, the difference of IVP between DM + H and DM-H group reached statistical significance. Moreover, IVP was significantly correlated with flow propagation velocity during early diastole (Pve) (r = -0.580, P < 0.001), flow propagation velocity during late diastole (Pva) (r = 0.271, P < 0.001), GLS (r = 0.330, P < 0.001), interventricular septal thickness at end-diastole (IVSd) (r = 0.321, P < 0.001), blood glucose (r = 0.246, P < 0.003), systolic blood pressure (r = 0.370, P < 0.001) and diastolic blood pressure (r = 0.389, P < 0.001). Conclusions The results indicated the application potential of IVP in assessing the early detection of cardiac function changes noninvasively and sensitively. The correlation with myocardial stiffness warrants further studies to substantiate its potential clinical utility.
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Moore C, McCrary AW, LeFevre M, Sturgeon GM, Barker PAC, von Ramm OT. Ultrasound Visualization and Recording of Transient Myocardial Vibrations. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1431-1440. [PMID: 36990961 DOI: 10.1016/j.ultrasmedbio.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/19/2023] [Accepted: 02/12/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE A new visualization and recording method used to assess and quantitate autogenic high-velocity motions in myocardial walls to provide a new description of cardiac function is described. METHODS The regional motion display (RMD) is based on high-speed difference ultrasound B-mode images and spatiotemporal processing to record propagating events (PEs). Sixteen normal participants and one patient with cardiac amyloidosis were imaged at rates of 500-1000/s using the Duke Phased Array Scanner, T5. RMDs were generated using difference images and spatially integrating these to display velocity as function of time along a cardiac wall. RESULTS In normal participants, RMDs revealed four discrete PEs with average onset timing with respect to the QRS complex of -31.7, +46, +365 and +536 ms. The late diastolic PE propagated apex to base in all participants at an average velocity of 3.4 m/s by the RMD. The RMD of the amyloidosis patient revealed significant changes in the appearance of PEs compared with normal participants. The late diastolic PE propagated at 5.3 m/s from apex to base. All four PEs lagged the average timing of normal participants. CONCLUSION The RMD method reliably reveals PEs as discrete events and successfully allows reproducible measurement of PE timing and the velocity of at least one PE. The RMD method is applicable to live, clinical high-speed studies and may offer a new approach to characterization of cardiac function.
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Affiliation(s)
- Cooper Moore
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Andrew W McCrary
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Melissa LeFevre
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gregory M Sturgeon
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Piers A C Barker
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Olaf T von Ramm
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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11
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Khedraki R, Robinson AA, Jordan T, Grodin JL, Mohan RC. A Review of Current and Evolving Imaging Techniques in Cardiac Amyloidosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023; 25:43-63. [PMID: 38239280 PMCID: PMC10795761 DOI: 10.1007/s11936-023-00976-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 03/07/2023]
Abstract
Purpose of review Establishing an early, efficient diagnosis for cardiac amyloid (CA) is critical to avoiding adverse outcomes. We review current imaging tools that can aid early diagnosis, offer prognostic information, and possibly track treatment response in CA. Recent findings There are several current conventional imaging modalities that aid in the diagnosis of CA including electrocardiography, echocardiography, bone scintigraphy, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) imaging. Advanced imaging techniques including left atrial and right ventricular strain, and CMR T1 and T2 mapping as well as ECV quantification may provide alternative non-invasive means for diagnosis, more granular prognostication, and the ability to track treatment response. Summary Leveraging a multimodal imaging toolbox is integral to the early diagnosis of CA; however, it is important to understand the unique role and limitations posed by each modality. Ongoing studies are needed to help identify imaging markers that will lead to an enhanced ability to diagnose, subtype and manage this condition.
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Affiliation(s)
- Rola Khedraki
- Section of Advanced Heart Failure, Division of Cardiovascular Medicine, Scripps Clinic, Prebys Cardiovascular Institute, 9898 Genesee Ave., AMP-300, La Jolla, San Diego, CA 92037, USA
| | - Austin A. Robinson
- Section of Advanced Heart Failure, Division of Cardiovascular Medicine, Scripps Clinic, Prebys Cardiovascular Institute, 9898 Genesee Ave., AMP-300, La Jolla, San Diego, CA 92037, USA
| | - Timothy Jordan
- Section of Advanced Heart Failure, Division of Cardiovascular Medicine, Scripps Clinic, Prebys Cardiovascular Institute, 9898 Genesee Ave., AMP-300, La Jolla, San Diego, CA 92037, USA
| | - Justin L. Grodin
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Rajeev C. Mohan
- Section of Advanced Heart Failure, Division of Cardiovascular Medicine, Scripps Clinic, Prebys Cardiovascular Institute, 9898 Genesee Ave., AMP-300, La Jolla, San Diego, CA 92037, USA
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12
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Bézy S, Duchenne J, Orlowska M, Caenen A, Amoni M, Ingelaere S, Wouters L, McCutcheon K, Minten L, Puvrez A, D'hooge J, Voigt JU. Impact of Loading and Myocardial Mechanical Properties on Natural Shear Waves: Comparison to Pressure-Volume Loops. JACC Cardiovasc Imaging 2022; 15:2023-2034. [PMID: 36163339 DOI: 10.1016/j.jcmg.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Shear wave elastography (SWE) has been proposed as a novel noninvasive method for the assessment of myocardial stiffness, a relevant determinant of diastolic function. It is based on tracking the propagation of shear waves, induced, for instance, by mitral valve closure (MVC), in the myocardium. The speed of propagation is directly related to myocardial stiffness, which is defined by the local slope of the nonlinear stress-strain relation. Therefore, the operating myocardial stiffness can be altered by both changes in loading and myocardial mechanical properties. OBJECTIVES This study sought to evaluate the capability of SWE to quantify myocardial stiffness changes in vivo by varying loading and myocardial tissue properties and to compare SWE against pressure-volume loop analysis, a gold standard reference method. METHODS In 15 pigs, conventional and high-frame rate echocardiographic data sets were acquired simultaneously with pressure-volume loop data after acutely changing preload and afterload and after inducting an ischemia/reperfusion (I/R) injury. RESULTS Shear wave speed after MVC significantly increased by augmenting preload and afterload (3.2 ± 0.8 m/s vs 4.6 ± 1.2 m/s and 4.6 ± 1.0 m/s, respectively; P = 0.001). Preload reduction had no significant effect on shear wave speed compared to baseline (P = 0.118). I/R injury resulted in significantly higher shear wave speed after MVC (6.1 ± 1.2 m/s; P < 0.001). Shear wave speed after MVC had a strong correlation with the chamber stiffness constant β (r = 0.63; P < 0.001) and operating chamber stiffness dP/dV before induction of an I/R injury (r = 0.78; P < 0.001) and after (r = 0.83; P < 0.001). CONCLUSIONS Shear wave speed after MVC was influenced by both acute changes in loading and myocardial mechanical properties, reflecting changes in operating myocardial stiffness, and was strongly related to chamber stiffness, invasively derived by pressure-volume loop analysis. SWE provides a novel noninvasive method for the assessment of left ventricular myocardial properties.
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Affiliation(s)
- Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Annette Caenen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Matthew Amoni
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Laurine Wouters
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lennert Minten
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alexis Puvrez
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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Seliverstova E, Caenen A, Bézy S, Nooijens S, Voigt JU, D'hooge J. Comparing Myocardial Shear Wave Propagation Velocity Estimation Methods Based on Tissue Displacement, Velocity and Acceleration Data. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2207-2216. [PMID: 35963827 DOI: 10.1016/j.ultrasmedbio.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Shear wave elastography (SWE) is a promising technique used to assess cardiac function through the evaluation of cardiac stiffness non-invasively. However, in the literature, SWE varies in terms of tissue motion data (displacement, velocity or acceleration); method used to characterize mechanical wave propagation (time domain [TD] vs. frequency domain [FD]); and the metric reported (wave speed [WS], shear or Young's modulus). This variety of reported methodologies complicates comparison of reported findings and sheds doubt on which methodology better approximates the true myocardial properties. We therefore conducted a simulation study to investigate the accuracy of various SWE data analysis approaches while varying cardiac geometry and stiffness. Lower WS values were obtained by the TD method compared with the FD method. Acceleration-based WS estimates in the TD were systematically larger than those based on velocity (∼10% difference). These observations were confirmed by TD analysis of 32 in vivo SWE mechanical wave measurements. In vivo data quality is typically too low for accurate FD analysis. Therefore, our study suggests using acceleration-based TD analysis for in vivo SWE to minimize underestimation of the true WS and, thus, to maximize the sensitivity of SWE to detect stiffness changes resulting from pathology.
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Affiliation(s)
| | - Annette Caenen
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium; Ghent University, Ghent, Belgium
| | - Stephanie Bézy
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Sjoerd Nooijens
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Jens-Uwe Voigt
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
| | - Jan D'hooge
- Katholieke Universiteit Leuven, UZ Herestraat 49-Box 7003, Leuven 3000, Belgium
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Quantitative stiffness assessment of cardiac grafts using ultrasound in a porcine model: A tissue biomarker for heart transplantation. EBioMedicine 2022; 83:104201. [PMID: 35932640 PMCID: PMC9358428 DOI: 10.1016/j.ebiom.2022.104201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Heart transplantation is the definitive treatment for many cardiovascular diseases. However, no ideal approach is established to evaluate heart grafts and it mostly relies on qualitative interpretation of surgeon based on the organ aspect including anatomy, color and manual palpation. In this study we propose to assess quantitatively the Shear Wave Velocity (SWV) using ultrasound as a biomarker of cardiac viability on a porcine model. Methods The SWV was assessed quantitatively using a clinical ultrasound elastography device (Aixplorer, Supersonics Imagine, France) linked to a robotic motorized arm (UR3, Universal Robots, Denmark) and the elastic anisotropy was obtained using a custom ultrasound research system. SWV was evaluated as function of time in two porcine heart model during 20h at controlled temperature (4°C). One control group (N = 8) with the heart removed and arrested by cold cardioplegia and immerged in a preservation solution. One ischemic group (N = 6) with the organ harvested after 30 min of in situ warm ischemia, to mimic a donation after cardiac death. Hearts graft were revived at two preservation times, at 4 h (N = 11) and 20 h (N = 10) and the parameters of the cardiac function evaluated. Findings On control hearts, SWV remained unchanged during the 4h of preservation. SWV increased significantly between 4 and 20h. For the ischemic group, SWV was found higher after 4h (3.04 +/- 0.69 vs 1.69+/-0.19 m/s, p = 0.007) and 20h (4.77+/-1.22 m/s vs 3.40+/-0.75 m/s, p = 0.034) of preservation with significant differences. A good correlation between SWV and cardiac function index was found (r2=0.88) and manual palpation score (r2=0.81). Interpretation Myocardial stiffness increase was quantified as a function of preservation time and harvesting conditions. The correlation between SWV and cardiac function index suggests that SWV could be used as a marker of graft viability. This technique may be transposed to clinical transplantation for assessing the graft viability during transplantation process. Funding FRM PME20170637799, Agence Biomédecine AOR Greffe 2017, ANR-18-CE18-0015.
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15
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Burnhope E, Polcaro A, Runge JH, Granlund I, Bosio F, Troelstra MA, Villa ADM, Chiribiri A, Carr-White G, Webb J, Razavi R, Martorell J, Sinkus R, Ismail TF. Assessment of Myocardial Stiffness in Patients With Left Ventricular Hypertrophy: CMR Elastography Using Intrinsic Actuation. JACC. CARDIOVASCULAR IMAGING 2022; 15:1163-1165. [PMID: 35680224 DOI: 10.1016/j.jcmg.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/01/2022] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
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16
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Harbo MB, Stokke MK, Sjaastad I, Espe EKS. One step closer to myocardial physiology: From PV loop analysis to state-of-the-art myocardial imaging. Acta Physiol (Oxf) 2022; 234:e13759. [PMID: 34978759 DOI: 10.1111/apha.13759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 11/29/2022]
Abstract
Recent advances in cardiac imaging have revitalized the assessment of fundamental physiological concepts. In the field of cardiac physiology, invasive measurements with pressure-volume (PV) loops have served as the gold standard methodology for the characterization of left ventricular (LV) function. From PV loop data, fundamental aspects of LV chamber function are derived such as work, efficiency, stiffness and contractility. However, the parametrization of these aspects is limited because of the need for invasive procedures. Through the utilization of recent advances in echocardiography, magnetic resonance imaging and positron emission tomography, it has become increasingly feasible to quantify these fundamental aspects of LV function non-invasively. Importantly, state-of-the-art imaging technology enables direct assessment of myocardial performance, thereby extending functional assessment from the net function of the LV chamber, as is done with PV loops, to the myocardium itself. With a strong coupling to underlying myocardial physiology, imaging measurements of myocardial work, efficiency, stiffness and contractility could represent the next generation of functional parameters. The purpose of this review is to discuss how the new imaging parameters of myocardial work, efficiency, stiffness and contractility can bring cardiac physiologists, researchers and clinicians alike one step closer to underlying myocardial physiology.
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Affiliation(s)
- Markus Borge Harbo
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
- Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Emil Knut Stenersen Espe
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- K.G. Jebsen Center for Cardiac Research University of Oslo Oslo Norway
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17
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:465-475. [DOI: 10.1093/ehjci/jeab287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
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18
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Singh A, Sun D, Mor-Avi V, Addetia K, Patel AR, DeCara JM, Ward RP, Lang RM. Can echocardiographic assessment of diastolic function be automated? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2021; 38:10.1007/s10554-021-02488-6. [PMID: 34882301 DOI: 10.1007/s10554-021-02488-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Echocardiographic evaluation of left ventricular diastolic function relies on a multi-pronged algorithm, which incorporates Doppler-based and volumetric parameters. Integration of clinical data in diastolic assessment is recommended, though not clearly outlined. We sought to develop an automated tool for diastolic function, compare its performance to human-generated diagnoses and identify the common sources of error. Our software tool is based on the 2016 diastolic guidelines algorithm, which uses 8 parameters as input, with 10 conditions as the logic and 5 possible outputs as final diagnoses. Initially, we prospectively studied 563 patients whose diastolic function was independently evaluated by an expert echocardiographer and by the automated tool. Incongruent cases were further analyzed, after which features of myocardial disease were integrated into a refined version of the software that was tested in an independent cohort of 1106 patients. In the initial analysis, 202/563 grades (36%) were incongruent between the automated and human reads, with the highest rate of discordance for mild and indeterminate categories. In 17% of cases, human diagnoses differed from that dictated by the algorithm due to integration of clinical factors. Follow-up analysis using the refined automated tool did not improve the discordance rate (440/1106; 40%). There was more discordance in cases of: age > 40 years, impaired mitral inflow patterns (E/A < 0.8) and reduced mitral e' values. Further analysis revealed differences in how readers interpreted the interaction between these factors and diastolic function, which could not be incorporated into the automated tool. In conclusion, although assessment of diastolic function relies on an algorithm that can be automated, this algorithm does not include clear guidance on how to incorporate age, or age-related changes in Doppler-based parameters, often resulting in discordant diagnoses. Standardized interpretation of these factors is needed to improve the reproducibility of diastolic function grading by human readers and the accuracy of the automated classification.
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Affiliation(s)
- Amita Singh
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA.
| | - Deyu Sun
- Philips Healthcare, Cambridge, MA, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Jeanne M DeCara
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - R Parker Ward
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
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Caenen A, Pernot M, Nightingale KR, Voigt JU, Vos HJ, Segers P, D'hooge J. Assessing cardiac stiffness using ultrasound shear wave elastography. Phys Med Biol 2021; 67. [PMID: 34874312 DOI: 10.1088/1361-6560/ac404d] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Shear wave elastography offers a new dimension to echocardiography: it measures myocardial stiffness. Therefore, it could provide additional insights into the pathophysiology of cardiac diseases affecting myocardial stiffness and potentially improve diagnosis or guide patient treatment. The technique detects fast mechanical waves on the heart wall with high frame rate echography, and converts their propagation velocity into a stiffness value. A proper interpretation of shear wave data is required as the shear wave interacts with the intrinsic, yet dynamically changing geometrical and material characteristics of the heart under pressure. This dramatically alters the wave physics of the propagating wave, demanding adapted processing methods compared to other shear wave elastography applications as breast tumor and liver stiffness staging. Furthermore, several advanced analysis methods have been proposed to extract supplementary material features such as viscosity and anisotropy, potentially offering additional diagnostic value. This review explains the general mechanical concepts underlying cardiac shear wave elastography and provides an overview of the preclinical and clinical studies within the field. We also identify the mechanical and technical challenges ahead to make shear wave elastography a valuable tool for clinical practice.
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Affiliation(s)
- Annette Caenen
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, BELGIUM
| | - Mathieu Pernot
- INSERM U979 "Physics for medicine", ESPCI Paris, PSL Research University, CNRS UMR 7587, Institut Langevin, Paris, FRANCE
| | - Kathryn R Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, UNITED STATES
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, BELGIUM
| | - Hendrik J Vos
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Zuid-Holland, NETHERLANDS
| | - Patrick Segers
- Institute of Biomedical Engineering and Technology, Universiteit Gent, Gent, BELGIUM
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, BELGIUM
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20
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Takaya Y, Nakamura K, Nakayama R, Ohtsuka H, Amioka N, Kondo M, Akazawa K, Ohno Y, Ichikawa K, Saito Y, Akagi S, Yoshida M, Miyoshi T, Ito H. Efficacy of shear wave elasticity for evaluating myocardial hypertrophy in hypertensive rats. Sci Rep 2021; 11:22812. [PMID: 34819579 PMCID: PMC8613270 DOI: 10.1038/s41598-021-02271-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
Shear wave (SW) imaging is a novel ultrasound-based technique for assessing tissue characteristics. SW elasticity may be useful to assess the severity of hypertensive left ventricular (LV) hypertrophy. This study aimed to evaluate the efficacy of SW elasticity for assessing the degree of myocardial hypertrophy using hypertensive rats. Rats were divided into hypertension group and control group. SW elasticity was measured on the excised heart. Myocardial hypertrophy was assessed histologically. LV weight was greater in hypertension group. An increase in interventricular septum and LV free wall thicknesses was observed in hypertension group. SW elasticity was significantly higher in hypertension group than in control group (14.6 ± 4.3 kPa vs. 6.5 ± 1.1 kPa, P < 0.01). The cross-sectional area of cardiomyocytes was larger in hypertension group than in control group (397 ± 50 μm2 vs. 243 ± 14 μm2, P < 0.01), and SW elasticity was positively correlated with the cross-sectional area of cardiomyocytes (R = 0.96, P < 0.01). This study showed that SW elasticity was higher in hypertensive rats and was closely correlated with the degree of myocardial hypertrophy, suggesting the efficacy of SW elasticity for estimating the severity of hypertensive LV hypertrophy.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroaki Ohtsuka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naofumi Amioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Kondo
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kaoru Akazawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuko Ohno
- Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yukihiro Saito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Echocardiographic Stiffness Measurements: How to Rule the Waves? JACC Cardiovasc Imaging 2021; 14:1506-1507. [PMID: 34353545 DOI: 10.1016/j.jcmg.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
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22
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Salles S, Espeland T, Molares A, Aase SA, Hammer TA, Støylen A, Aakhus S, Lovstakken L, Torp H. 3D Myocardial Mechanical Wave Measurements: Toward In Vivo 3D Myocardial Elasticity Mapping. JACC Cardiovasc Imaging 2021; 14:1495-1505. [PMID: 32861651 DOI: 10.1016/j.jcmg.2020.05.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/20/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to investigate the potential of a novel 3-dimensional (3D) mechanical wave velocity mapping technique, based on the natural mechanical waves produced by the heart itself, to approach a noninvasive 3D stiffness mapping of the left ventricle. BACKGROUND Myocardial fibrosis is recognized as a pathophysiological substrate of major cardiovascular disorders such as cardiomyopathies and valvular heart disease. As fibrosis leads to increased myocardial stiffness, ultrasound elastography measurements could provide important clinical information. METHODS A 3D high frame rate imaging sequence was implemented on a high-end clinical ultrasound scanner to achieve 820 volumes/s when gating over 4 consecutive cardiac cycles. Five healthy volunteers and 10 patients with various degrees of aortic stenosis were included to evaluate feasibility and reproducibility. Mechanical waves were detected using the novel Clutter Filter Wave Imaging approach, shown to be highly sensitive to the weak tissue displacements caused by natural mechanical waves. RESULTS 3D spatiotemporal maps of mechanical wave velocities were produced for all subjects. Only the specific mechanical wave at atrial contraction provided a full 3D coverage of the left ventricle (LV). The average atrial kick propagation velocity was 1.6 ± 0.2 m/s in healthy volunteers and 2.8 ± 0.8 m/s in patients (p = 0.0016). A high correlation was found between mechanical wave velocity and age (R2 = 0.88, healthy group), septal wall thickness (R2 = 0.73, entire group), and peak jet velocity across the aortic valve (R2 = 0.70). For 3 of the patients, the higher mechanical wave velocity coexisted with the presence of late gadolinium enhancement on cardiac magnetic resonance. CONCLUSIONS In this study, 3D LV mechanical wave velocities were visualized and measured in healthy volunteers and patients with aortic stenosis. The proposed imaging sequence and measurement technique allowed, for the first time, the measurement of full spatiotemporal 3D elasticity maps of the LV using ultrasound. (Ultrasonic markers for myocardial fibrosis and prognosis in aortic stenosis; NCT03422770).
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Affiliation(s)
- Sebastien Salles
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Torvald Espeland
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Alfonso Molares
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Tommy Arild Hammer
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Asbjørn Støylen
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svend Aakhus
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Lasse Lovstakken
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans Torp
- Centre for Innovative Ultrasound Solutions, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Naser JA, Anupraiwan O, Adigun RO, Maleszewski JJ, Pislaru SV, Pellikka PA, Pislaru C. Myocardial Stiffness by Cardiac Elastography in Hypertrophic Cardiomyopathy: Relationship With Myocardial Fibrosis and Clinical Outcomes. JACC Cardiovasc Imaging 2021; 14:2051-2053. [PMID: 34274273 DOI: 10.1016/j.jcmg.2021.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
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24
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Jurcuţ R, Onciul S, Adam R, Stan C, Coriu D, Rapezzi C, Popescu BA. Multimodality imaging in cardiac amyloidosis: a primer for cardiologists. Eur Heart J Cardiovasc Imaging 2021; 21:833-844. [PMID: 32393965 DOI: 10.1093/ehjci/jeaa063] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022] Open
Abstract
Amyloidosis is a systemic infiltrative disease, in which unstable proteins misfold, form aggregates and amyloid fibrils which can deposit in various organs: heart, kidneys, liver, gastrointestinal tract, nervous system structures, lungs, or soft tissue. Cardiac amyloidosis (CA) diagnosis requires awareness, high level of clinical suspicion and expertise in integrating clinical, electrocardiographic, and multimodality imaging data. The overall scenario is complex and no single test emerges over the others, but different techniques are useful at various stages of the diagnostic workup. After a clinical suspicion of CA is raised by various non-imaging red-flags, eligible patients should undergo complete echocardiography and multiparametric cardiovascular magnetic resonance imaging. Even though the clinical suspicion of CA is confirmed by cardiac imaging, the accurate differentiation between the two most frequent and treatable amyloid types, i.e. light chain (AL) and transthyretin (ATTR) requires further work-up including phosphate scintigraphy. This article reviews the latest and essential data on multimodality imaging of patients with suspected or confirmed CA in a useful and practical manner for the general and imaging cardiologists.
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Affiliation(s)
- Ruxandra Jurcuţ
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
| | - Sebastian Onciul
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,Department of Cardiology, Floreasca Emergency Hospital, Calea Floreasca 8, Bucharest 014461, Romania
| | - Robert Adam
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
| | - Claudiu Stan
- Department of Nuclear Medicine and Ultrasonography, Fundeni Clinical Institute, Sos. Fundeni 258, Bucharest 022322, Romania
| | - Daniel Coriu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,Department of Haematology, Fundeni Clinical Hospital, Sos. Fundeni 258, Bucharest 022322, Romania
| | - Claudio Rapezzi
- University Cardiological Center, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Bogdan A Popescu
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
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25
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Donnellan E, Wazni O, Kanj M, Elshazly MB, Hussein A, Baranowski B, Hanna M, Patel D, Trulock K, Martyn M, Menon V, Saliba W, Jaber WA. Atrial fibrillation ablation in patients with transthyretin cardiac amyloidosis. Europace 2021; 22:259-264. [PMID: 32031230 DOI: 10.1093/europace/euz314] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) occurs in as many as 70% of patients with transthyretin cardiac amyloidosis (ATTR CA). The aim of our study was to investigate the impact of AF ablation on freedom from recurrent arrhythmia, hospitalization for AF or heart failure (HF), and mortality. METHODS AND RESULTS This was a retrospective observational cohort study of 72 patients with ATTR CA and AF, of whom 24 underwent AF ablation and were matched in a 2:1 manner based on age, gender, ATTR CA stage, New York Heart Association functional class, ejection fraction, and date of AF diagnosis with 48 patients with ATTR CA and AF undergoing medical management. During a mean follow-up of 39 ± 26 months, 10 (42%) patients remained free of recurrent arrhythmia following ablation. Ablation was significantly more effective in those with Stage I or II ATTR CA, with 9/14 (64%) patients with Stage I or II ATTR CA remaining free of recurrent arrhythmia compared to only 1/10 (10%) patients with Stage III disease (P = 0.005). Death occurred in 7 (29%) patients in the ablation group compared to 36 (75%) in the non-ablation arm (P = 0.01). Rates of ischaemic stroke were similar in both groups. Ablation was associated with a significant reduction in the frequency of hospitalization for HF/arrhythmia (1.7 ± 2.4 hospitalizations vs. 4 ± 3.5, P = 0.005). On Cox proportional hazards analyses, ablation was associated with improved survival (hazard ratio 0.38, 95% confidence intervals 0.17-0.86; P = 0.02). CONCLUSION Atrial fibrillation ablation is associated with reduced mortality in ATTR CA and is most effective when performed earlier during the disease process.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Michael Martyn
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Pedreira O, Correia M, Chatelin S, Villemain O, Goudot G, Thiebaut S, Bassan G, Messas E, Tanter M, Papadacci C, Pernot M. Smart ultrasound device for non-invasive real-time myocardial stiffness quantification of the human heart. IEEE Trans Biomed Eng 2021; 69:42-52. [PMID: 34097602 DOI: 10.1109/tbme.2021.3087039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantitative assessment of myocardial stiffness is crucial to understand and evaluate cardiac biomechanics and function. Despite the recent progresses of ultrasonic shear wave elastography, quantitative evaluation of myocardial stiffness still remains a challenge because of strong elastic anisotropy. In this paper we introduce a smart ultrasound approach for non-invasive real-time quantification of shear wave velocity (SWV) and elastic fractional anisotropy (FA) in locally transverse isotropic elastic medium such as the myocardium. The approach relies on a simultaneous multidirectional evaluation of the SWV without a prior knowledge of the fiber orientation. We demonstrated that it can quantify accurately SWV in the range of 1.5 to 6 m/s in transverse isotropic medium (FA<0.7) using numerical simulations. Experimental validation was performed on calibrated phantoms and anisotropic ex vivo tissues. A mean absolute error of 0.22 m/s was found when compared to gold standard measurements. Finally, in vivo feasibility of myocardial anisotropic stiffness assessment was evaluated in four healthy volunteers on the antero-septo basal segment and on anterior free wall of the right ventricle (RV) in end-diastole. A mean longitudinal SWV of 1.08 0.20 m/s was measured on the RV wall and 1.74 0.51 m/s on the Septal wall with a good intra-volunteer reproducibility (0.18 m/s). This approach has the potential to become a clinical tool for the quantitative evaluation of myocardial stiffness and diastolic function.
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27
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Fibrosis in hypertrophic cardiomyopathy: role of novel echo techniques and multi-modality imaging assessment. Heart Fail Rev 2021; 26:1297-1310. [PMID: 33990907 DOI: 10.1007/s10741-020-10058-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) represents one of the primary cardiomyopathies and may lead to heart failure and sudden cardiac death. Among various histologic features of the disease examined, assessment of myocardial fibrosis may offer valuable information, since it may be considered the common nominator for all HCM connected complications. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) has emerged as the reference noninvasive method for visualizing and quantifying myocardial fibrosis in patients with HCM. T1 mapping, a promising new CMR technique, may provide an advantage over conventional LGE-CMR, by permitting a more valid quantification of diffuse fibrosis. On the other hand, echocardiography offers a significantly more portable, affordable, and easily accessible solution for the study of fibrosis. Various echocardiographic techniques ranging from integrated backscatter and contrast-enhanced ultrasound to two- (2D) or three-dimensional (3D) deformation and shear wave imaging may offer new insights into substrate characterization in HCM. The aim of this review is to describe thoroughly all different modalities that may be used in everyday clinical practice for HCM fibrosis evaluation (with special focus on echocardiographic techniques), to concisely present available evidence and to argue in favor of multi-modality imaging application. It is essential to understand that the role of various imaging modalities is not competitive but complementary, since the information provided by each one is necessary to illuminate the complex pathophysiologic pathways of HCM, offering a personalized approach and treatment in every patient.
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28
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Petrescu A, D'hooge J, Voigt JU. Concepts and applications of ultrafast cardiac ultrasound imaging. Echocardiography 2021; 38:7-15. [PMID: 33471395 DOI: 10.1111/echo.14971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
The concept of ultrafast echocardiographic imaging has been around for decades. However, only recent progress in ultrasound machine hardware and computer technology allowed to apply this concept to echocardiography. High frame rate echocardiography can visualize phenomena that have never been captured before. It enables a wide variety of potential new applications, including shear wave imaging, speckle tracking, ultrafast Doppler imaging, and myocardial perfusion imaging. The principles of these applications and their potential clinical use will be presented in this manuscript.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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29
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Papadacci C, Finel V, Villemain O, Tanter M, Pernot M. 4D Ultrafast Ultrasound Imaging of Naturally Occurring Shear Waves in the Human Heart. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:4436-4444. [PMID: 32857692 DOI: 10.1109/tmi.2020.3020147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objectives were to develop a novel three-dimensional technology for imaging naturally occurring shear wave (SW) propagation, demonstrate feasibility on human volunteers and quantify SW velocity in different propagation directions. Imaging of natural SWs generated by valve closures has emerged to obtain a direct measurement of cardiac stiffness. Recently, natural SW velocity was assessed in two dimensions on parasternal long axis view under the assumption of a propagation direction along the septum. However, in this approach the source localization and the complex three-dimensional propagation wave path was neglected making the speed estimation unreliable. High volume rate transthoracic acquisitions of the human left ventricle (1100 volume/s) was performed with a 4D ultrafast echocardiographic scanner. Four-dimensional tissue velocity cineloops enabled visualization of aortic and mitral valve closure waves. Energy and time of flight mapping allowed propagation path visualization and source localization, respectively. Velocities were quantified along different directions. Aortic and mitral valve closure SW velocities were assessed for the three volunteers with low standard deviation. Anisotropic propagation was also found suggesting the necessity of using a three-dimensional imaging approach. Different velocities were estimated for the three directions for the aortic (3.4± 0.1 m/s, 3.5± 0.3 m/s, 5.4± 0.7 m/s) and the mitral (2.8± 0.5 m/s, 2.9± 0.3 m/s, 4.6± 0.7 m/s) valve SWs. 4D ultrafast ultrasound alleviates the limitations of 2D ultrafast ultrasound for cardiac SW imaging based on natural SW propagations and enables a comprehensive measurement of cardiac stiffness. This technique could provide stiffness mapping of the left ventricle.
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30
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Pernot M, Villemain O. Myocardial Stiffness Assessment by Ultrasound: Are We Ready for the Clinical "Lift Off"? JACC Cardiovasc Imaging 2020; 13:2314-2315. [PMID: 33008759 DOI: 10.1016/j.jcmg.2020.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mathieu Pernot
- Physics for Medicine, INSERM U1273, ESPCI, CNRS, PSL Research University, Paris, France.
| | - Olivier Villemain
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Translational Medicine Department, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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31
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Petrescu A, Bézy S, Cvijic M, Santos P, Orlowska M, Duchenne J, Pedrosa J, Van Keer JM, Verbeken E, von Bardeleben RS, Droogne W, Bogaert J, Van Cleemput J, D'hooge J, Voigt JU. Shear Wave Elastography Using High-Frame-Rate Imaging in the Follow-Up of Heart Transplantation Recipients. JACC Cardiovasc Imaging 2020; 13:2304-2313. [PMID: 33004291 DOI: 10.1016/j.jcmg.2020.06.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether propagation velocities of naturally occurring shear waves (SWs) at mitral valve closure (MVC) increase with the degree of diffuse myocardial injury (DMI) and with invasively determined LV filling pressures as a reflection of an increase in myocardial stiffness in heart transplantation (HTx) recipients. BACKGROUND After orthotopic HTx, allografts undergo DMI that contributes to functional impairment, especially to increased passive myocardial stiffness, which is an important pathophysiological determinant of left ventricular (LV) diastolic dysfunction. Echocardiographic SW elastography is an emerging approach for measuring myocardial stiffness in vivo. Natural SWs occur after mechanical excitation of the myocardium, for example, after MVC, and their propagation velocity is directly related to myocardial stiffness, thus providing an opportunity to assess myocardial stiffness at end-diastole. METHODS A total of 52 HTx recipients who underwent right heart catheterization (all) and cardiac magnetic resonance (CMR) (n = 23) during their annual check-up were prospectively enrolled. Echocardiographic SW elastography was performed in parasternal long axis views of the LV using an experimental scanner at 1,135 ± 270 frames per second. The degree of DMI was quantified with T1 mapping. RESULTS SW velocity at MVC correlated best with native myocardial T1 values (r = 0.75; p < 0.0001) and was the best noninvasive parameter that correlated with pulmonary capillary wedge pressures (PCWP) (r = 0.54; p < 0.001). Standard echocardiographic parameters of LV diastolic function correlated poorly with both native T1 and PCWP values. CONCLUSIONS End-diastolic SW propagation velocities, as measure of myocardial stiffness, showed a good correlation with CMR-defined diffuse myocardial injury and with invasively determined LV filling pressures in patients with HTx. Thus, these findings suggest that SW elastography has the potential to become a valuable noninvasive method for the assessment of diastolic myocardial properties in HTx recipients.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pedro Santos
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - João Pedrosa
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan M Van Keer
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | | | - Walter Droogne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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Keijzer LBH, Caenen A, Voorneveld J, Strachinaru M, Bowen DJ, van de Wouw J, Sorop O, Merkus D, Duncker DJ, van der Steen AFW, de Jong N, Bosch JG, Vos HJ. A direct comparison of natural and acoustic-radiation-force-induced cardiac mechanical waves. Sci Rep 2020; 10:18431. [PMID: 33116234 PMCID: PMC7595170 DOI: 10.1038/s41598-020-75401-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
Natural and active shear wave elastography (SWE) are potential ultrasound-based techniques to non-invasively assess myocardial stiffness, which could improve current diagnosis of heart failure. This study aims to bridge the knowledge gap between both techniques and discuss their respective impacts on cardiac stiffness evaluation. We recorded the mechanical waves occurring after aortic and mitral valve closure (AVC, MVC) and those induced by acoustic radiation force throughout the cardiac cycle in four pigs after sternotomy. Natural SWE showed a higher feasibility than active SWE, which is an advantage for clinical application. Median propagation speeds of 2.5-4.0 m/s and 1.6-4.0 m/s were obtained after AVC and MVC, whereas ARF-based median speeds of 0.9-1.2 m/s and 2.1-3.8 m/s were reported for diastole and systole, respectively. The different wave characteristics in both methods, such as the frequency content, complicate the direct comparison of waves. Nevertheless, a good match was found in propagation speeds between natural and active SWE at the moment of valve closure, and the natural waves showed higher propagation speeds than in diastole. Furthermore, the results demonstrated that the natural waves occur in between diastole and systole identified with active SWE, and thus represent a myocardial stiffness in between relaxation and contraction.
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Affiliation(s)
- Lana B H Keijzer
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
| | - Annette Caenen
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
- IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
- Cardiovascular Imaging and Dynamics Lab, Catholic University of Leuven, Leuven, Belgium.
| | - Jason Voorneveld
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Daniel J Bowen
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jens van de Wouw
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Daphne Merkus
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Antonius F W van der Steen
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Nico de Jong
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Johan G Bosch
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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Strachinaru M, Bosch JG, Schinkel AFL, Michels M, Feyz L, de Jong N, Geleijnse ML, Vos HJ. Local myocardial stiffness variations identified by high frame rate shear wave echocardiography. Cardiovasc Ultrasound 2020; 18:40. [PMID: 32993683 PMCID: PMC7525991 DOI: 10.1186/s12947-020-00222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Shear waves are generated by the closure of the heart valves. Significant differences in shear wave velocity have been found recently between normal myocardium and disease models of diffusely increased muscle stiffness. In this study we correlate in vivo myocardial shear wave imaging (SWI) with presence of scarred tissue, as model for local increase of stiffness. Stiffness variation is hypothesized to appear as velocity variation. METHODS Ten healthy volunteers (group 1), 10 hypertrophic cardiomyopathy (HCM) patients without any cardiac intervention (group 2), and 10 HCM patients with prior septal reduction therapy (group 3) underwent high frame rate tissue Doppler echocardiography. The SW in the interventricular septum after aortic valve closure was mapped along two M-mode lines, in the inner and outer layer. RESULTS We compared SWI to 3D echocardiography and strain imaging. In groups 1 and 2, no change in velocity was detected. In group 3, 8/10 patients showed a variation in SW velocity. All three patients having transmural scar showed a simultaneous velocity variation in both layers. Out of six patients with endocardial scar, five showed variations in the inner layer. CONCLUSION Local variations in stiffness, with myocardial remodeling post septal reduction therapy as model, can be detected by a local variation in the propagation velocity of naturally occurring shear waves.
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Affiliation(s)
- Mihai Strachinaru
- Erasmus MC Rotterdam, Cardiology, Postbus 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Johan G Bosch
- Erasmus MC Rotterdam, Biomedical Engineering, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Erasmus MC Rotterdam, Cardiology, Postbus 2040, 3000, CA, Rotterdam, The Netherlands
| | - Michelle Michels
- Erasmus MC Rotterdam, Cardiology, Postbus 2040, 3000, CA, Rotterdam, The Netherlands
| | - Lida Feyz
- Erasmus MC Rotterdam, Cardiology, Postbus 2040, 3000, CA, Rotterdam, The Netherlands
| | - Nico de Jong
- Erasmus MC Rotterdam, Biomedical Engineering, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Erasmus MC Rotterdam, Cardiology, Postbus 2040, 3000, CA, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Erasmus MC Rotterdam, Biomedical Engineering, Rotterdam, The Netherlands
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Kvåle KF, Salles S, Lervik LCN, Støylen A, Løvstakken L, Samset E, Torp H. Detection of Tissue Fibrosis using Natural Mechanical Wave Velocity Estimation: Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2481-2492. [PMID: 32505615 DOI: 10.1016/j.ultrasmedbio.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
In the feasibility study described here, we developed and tested a novel method for mechanical wave velocity estimation for tissue fibrosis detection in the myocardium. High-frame-rate ultrasound imaging and a novel signal processing method called clutter filter wave imaging was used. A mechanical wave propagating through the left ventricle shortly after the atrial contraction was measured in the three different apical acquisition planes, for 20 infarct patients and 10 healthy controls. The results obtained were correlated with fibrosis locations from magnetic resonance imaging, and a sensitivity ≥60% was achieved for all infarcts larger than 10% of the left ventricle. The stability of the wave through several heart cycles was assessed and found to be of high quality. This method therefore has potential for non-invasive fibrosis detection in the myocardium, but further validation in a larger group of subjects is needed.
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Affiliation(s)
- Kaja F Kvåle
- Center for Cardiological Innovation (CCI), Oslo University Hospital, Oslo, Norway; GE Vingmed Ultrasound, Horten, Norway; Institute of Informatics, University of Oslo, Oslo, Norway.
| | - Sebastien Salles
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon, France
| | - Lars Christian N Lervik
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eigil Samset
- Center for Cardiological Innovation (CCI), Oslo University Hospital, Oslo, Norway; GE Vingmed Ultrasound, Horten, Norway; Institute of Informatics, University of Oslo, Oslo, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Keijzer LBH, Strachinaru M, Bowen DJ, Caenen A, van Steen AFWD, Verweij MD, de Jong N, Bosch JG, Vos HJ. Parasternal Versus Apical View in Cardiac Natural Mechanical Wave Speed Measurements. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:1590-1602. [PMID: 32149686 DOI: 10.1109/tuffc.2020.2978299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Shear wave speed measurements can potentially be used to noninvasively measure myocardial stiffness to assess the myocardial function. Several studies showed the feasibility of tracking natural mechanical waves induced by aortic valve closure in the interventricular septum, but different echocardiographic views have been used. This article systematically studied the wave propagation speeds measured in a parasternal long-axis and in an apical four-chamber view in ten healthy volunteers. The apical and parasternal views are predominantly sensitive to longitudinal or transversal tissue motion, respectively, and could, therefore, theoretically measure the speed of different wave modes. We found higher propagation speeds in apical than in the parasternal view (median of 5.1 m/s versus 3.8 m/s, , n = 9 ). The results in the different views were not correlated ( r = 0.26 , p = 0.49 ) and an unexpectedly large variability among healthy volunteers was found in apical view compared with the parasternal view (3.5-8.7 versus 3.2-4.3 m/s, respectively). Complementary finite element simulations of Lamb waves in an elastic plate showed that different propagation speeds can be measured for different particle motion components when different wave modes are induced simultaneously. The in vivo results cannot be fully explained with the theory of Lamb wave modes. Nonetheless, the results suggest that the parasternal long-axis view is a more suitable candidate for clinical diagnosis due to the lower variability in wave speeds.
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Villemain O, Baranger J, Friedberg MK, Papadacci C, Dizeux A, Messas E, Tanter M, Pernot M, Mertens L. Ultrafast Ultrasound Imaging in Pediatric and Adult Cardiology. JACC Cardiovasc Imaging 2020; 13:1771-1791. [DOI: 10.1016/j.jcmg.2019.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
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Voigt JU, Cvijic M. 2- and 3-Dimensional Myocardial Strain in Cardiac Health and Disease. JACC Cardiovasc Imaging 2020; 12:1849-1863. [PMID: 31488253 DOI: 10.1016/j.jcmg.2019.01.044] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/08/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
Advances in speckle-tracking echocardiography allowed the rise of deformation imaging as a feasible, robust, and valuable tool for clinical routine. The global or segmental measurement of strain can objectively quantify myocardial deformation and can characterize myocardial function in a novel way. However, the proper interpretation of deformation measurements requires understanding of cardiac mechanics and the influence of loading conditions, ventricular geometry, conduction delays, and myocardial tissue characteristics on the measured values. The purpose of this manuscript is to review the basic concepts of deformation imaging, briefly describe imaging modalities for strain assessment, and discuss in depth the underlying physical and pathophysiological mechanisms which lead to the respective findings in a specific disease.
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Affiliation(s)
- Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Blankstein R, Shaw L, Chandrashekhar Y. Amyloidosis Imaging. JACC Cardiovasc Imaging 2020; 13:1392-1394. [DOI: 10.1016/j.jcmg.2020.05.002] [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: 11/24/2022]
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39
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Sabbadini A, Keijzer LBH, Vos HJ, de Jong N, Verweij MD. Fundamental modeling of wave propagation in temporally relaxing media with applications to cardiac shear wave elastography. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 147:3091. [PMID: 32486810 DOI: 10.1121/10.0001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
Shear wave elastography (SWE) might allow non-invasive assessment of cardiac stiffness by relating shear wave propagation speed to material properties. However, after aortic valve closure, when natural shear waves occur in the septal wall, the stiffness of the muscle decreases significantly, and the effects of such temporal variation of medium properties on shear wave propagation have not been investigated yet. The goal of this work is to fundamentally investigate these effects. To this aim, qualitative results were first obtained experimentally using a mechanical setup, and were then combined with quantitative results from finite difference simulations. The results show that the amplitude and period of the waves increase during propagation, proportional to the relaxation of the medium, and that reflected waves can originate from the temporal stiffness variation. These general results, applied to literature data on cardiac stiffness throughout the heart cycle, predict as a major effect a period increase of 20% in waves propagating during a healthy diastolic phase, whereas only a 10% increase would result from the impaired relaxation of an infarcted heart. Therefore, cardiac relaxation can affect the propagation of waves used for SWE measurements and might even provide direct information on the correct relaxation of a heart.
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Affiliation(s)
- A Sabbadini
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
| | - L B H Keijzer
- Biomedical Engineering, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - H J Vos
- Biomedical Engineering, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - N de Jong
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
| | - M D Verweij
- Applied Sciences, Delft University of Technology, Lorentzweg 1, Delft, 2628 CJ, The Netherlands
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Matrone G, Ramalli A, D'hooge J, Tortoli P, Magenes G. A Comparison of Coherence-Based Beamforming Techniques in High-Frame-Rate Ultrasound Imaging With Multi-Line Transmission. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:329-340. [PMID: 31581082 DOI: 10.1109/tuffc.2019.2945365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
One of the current challenges in ultrasound imaging is achieving higher frame rates, particularly in cardiac applications, where tracking the heart motion and other rapid events can provide potential valuable diagnostic information. The main drawback of ultrasound high-frame-rate strategies is that usually they partly sacrifice image quality in order to speed up the acquisition time. In particular, multi-line transmission (MLT), which consists in transmitting multiple ultrasound beams simultaneously in different directions, has been proven able to improve frame rates in echocardiography, unfortunately generating artifacts due to inter-beam crosstalk interferences. This work investigates the possibility to effectively suppress crosstalk artifacts in MLT while improving image quality by applying beamforming techniques based on backscattered signals spatial coherence. Several coherence-based algorithms (i.e., short-lag filtered-delay multiply and sum beamforming, coherence and generalized coherence factor, phase and sign coherence, and nonlinear beamforming with p th root compression) are implemented and compared, and their performance trends are evaluated when varying their design parameters. Indeed, experimental results of phantom and in vivo cardiac acquisitions demonstrate that this class of algorithms can provide significant benefits compared with delay and sum, well-suppressing artifacts (up to 48.5-dB lower crosstalk), and increasing image resolution (by up to 46.3%) and contrast (by up to 30 dB in terms of contrast ratio and 12.6% for generalized contrast-to-noise ratio) at the same time.
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41
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Nagueh SF, Chandrashekhar Y. Noninvasive Imaging for the Evaluation of Diastolic Function. JACC Cardiovasc Imaging 2020; 13:339-342. [DOI: 10.1016/j.jcmg.2019.12.006] [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: 10/25/2022]
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42
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Keijzer LBH, Strachinaru M, Bowen DJ, Geleijnse ML, van der Steen AFW, Bosch JG, de Jong N, Vos HJ. Reproducibility of Natural Shear Wave Elastography Measurements. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3172-3185. [PMID: 31564460 DOI: 10.1016/j.ultrasmedbio.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
For the quantification of myocardial function, myocardial stiffness can potentially be measured non-invasively using shear wave elastography. Clinical diagnosis requires high precision. In 10 healthy volunteers, we studied the reproducibility of the measurement of propagation speeds of shear waves induced by aortic and mitral valve closure (AVC, MVC). Inter-scan was slightly higher but in similar ranges as intra-scan variability (AVC: 0.67 m/s (interquartile range [IQR]: 0.40-0.86 m/s) versus 0.38 m/s (IQR: 0.26-0.68 m/s), MVC: 0.61 m/s (IQR: 0.26-0.94 m/s) versus 0.26 m/s (IQR: 0.15-0.46 m/s)). For AVC, the propagation speeds obtained on different day were not statistically different (p = 0.13). We observed different propagation speeds between 2 systems (AVC: 3.23-4.25 m/s [Zonare ZS3] versus 1.82-4.76 m/s [Philips iE33]), p = 0.04). No statistical difference was observed between observers (AVC: p = 0.35). Our results suggest that measurement inaccuracies dominate the variabilities measured among healthy volunteers. Therefore, measurement precision can be improved by averaging over multiple heartbeats.
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Affiliation(s)
- Lana B H Keijzer
- Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
| | - Mihai Strachinaru
- Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands; Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Dan J Bowen
- Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | | | - Antonius F W van der Steen
- Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands; Acoustical Wavefield Imaging, ImPhys, Delft University of Technology, The Netherlands
| | - Johan G Bosch
- Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Nico de Jong
- Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands; Acoustical Wavefield Imaging, ImPhys, Delft University of Technology, The Netherlands
| | - Hendrik J Vos
- Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands; Acoustical Wavefield Imaging, ImPhys, Delft University of Technology, The Netherlands
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43
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Pernot M, Villemain O. In the Heart of Stiffness. JACC Cardiovasc Imaging 2019; 12:2399-2401. [DOI: 10.1016/j.jcmg.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/27/2022]
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Cvijic M, Bézy S, Petrescu A, Santos P, Orlowska M, Chakraborty B, Duchenne J, Pedrosa J, Vanassche T, D’hooge J, Voigt JU. Interplay of cardiac remodelling and myocardial stiffness in hypertensive heart disease: a shear wave imaging study using high-frame rate echocardiography. Eur Heart J Cardiovasc Imaging 2019; 21:664-672. [DOI: 10.1093/ehjci/jez205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/13/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
To determine myocardial stiffness by means of measuring the velocity of naturally occurring myocardial shear waves (SWs) at mitral valve closure (MVC) and investigate their changes with myocardial remodelling in patients with hypertensive heart disease.
Methods and results
Thirty-three treated arterial hypertension (HT) patients with hypertrophic left ventricular (LV) remodelling (59 ± 14 years, 55% male) and 26 aged matched healthy controls (55±15 years, 77% male) were included. HT patients were further divided into a concentric remodelling (HT1) group (13 patients) and a concentric hypertrophy (HT2) group (20 patients). LV parasternal long-axis views were acquired with an experimental ultrasound scanner at 1266 ± 317 frames per seconds. The SW velocity induced by MVC was measured from myocardial acceleration maps. SW velocities differed significantly between HT patients and controls (5.83 ± 1.20 m/s vs. 4.04 ± 0.96 m/s; P < 0.001). In addition, the HT2 group had the highest SW velocities (P < 0.001), whereas values between controls and the HT1 group were comparable (P = 0.075). Significant positive correlations were found between SW velocity and LV remodelling (interventricular septum thickness: r = 0.786, P < 0.001; LV mass index: r = 0.761, P < 0.001). SW velocity normalized for wall stress indicated that myocardial stiffness in the HT2 group was twice as high as in controls (P < 0.001), whereas values of the HT1 group overlapped with the controls (P = 1.00).
Conclusions
SW velocity as measure of myocardial stiffness is higher in HT patients compared with healthy controls, particularly in advanced hypertensive heart disease. Patients with concentric remodelling have still normal myocardial properties whereas patients with concentric hypertrophy show significant stiffening.
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Affiliation(s)
- Marta Cvijic
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Pedro Santos
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Bidisha Chakraborty
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - João Pedrosa
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan D’hooge
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Affiliation(s)
- Partho P Sengupta
- Division of Cardiology, WVU Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Y Chandrashekhar
- Division of Cardiology, University of Minnesota and Veterans Affairs Medical Center, Minneapolis, Minnesota.
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46
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Santos P, Petrescu AM, Pedrosa JP, Orlowska M, Komini V, Voigt JU, D'hooge J. Natural Shear Wave Imaging in the Human Heart: Normal Values, Feasibility, and Reproducibility. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:442-452. [PMID: 30442606 DOI: 10.1109/tuffc.2018.2881493] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Left ventricular myocardial stiffness could offer superior quantification of cardiac systolic and diastolic function when compared to the current diagnostic tools. Shear wave elastography in combination with acoustic radiation force has been widely proposed to noninvasively assess tissue stiffness. Interestingly, shear waves can also result from intrinsic cardiac mechanical events (e.g., closure of valves) without the need for external excitation. However, it remains unknown whether these natural shear waves always occur, how reproducible they can be detected and what the normal range of shear wave propagation speed is. The present study, therefore, aimed at establishing the feasibility of detecting shear waves created after mitral valve closure (MVC) and aortic valve closure (AVC), the variability of the measurements, and at reporting the normal values of propagation velocity. Hereto, a group of 30 healthy volunteers was scanned with high-frame rate imaging (>1000 Hz) using an experimental ultrasound system transmitting a diverging wave sequence. Tissue Doppler velocity and acceleration were used to create septal color M-modes, on which the shear waves were tracked and their velocities measured. Overall, the methodology was capable of detecting the transient vibrations that spread throughout the intraventricular septum in response to the closure of the cardiac valves in 92% of the recordings. Reference velocities of 3.2±0.6 m/s at MVC and 3.5±0.6 m/s at AVC were obtained. Moreover, in order to show the diagnostic potential of this approach, two patients (one with cardiac amyloidosis and one undergoing a dobutamine stress echocardiography) were scanned with the same protocol and showed markedly higher propagation speeds: the former presented velocities of 6.6 and 5.6 m/s; the latter revealed normal propagation velocities at baseline, and largely increased during the dobutamine infusion (>15 m/s). Both cases showed values consistent with the expected changes in stiffness and cardiac loading conditions.
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