Three-dimensional assessment of two-dimensional technique for evaluation of right ventricular function by tricuspid annulus motionSmith, Jordan; Bolson, Edward; Wong, Selwyn; Hubka, Michal; Sheehan, Florence
doi: 10.1023/A:1023655705807pmid: 12834155
Background: Measurement of tricuspid annulus motion (TAM) is an easy way to estimate right ventricular ejection fraction (RVEF). However the accuracy of two-dimensional (2-D) methods for analyzing the three-dimensional (3-D) structure of the tricuspid annulus has not been evaluated. Objective: This study evaluated the accuracy with which 2-D measurements of TAM reflect RVEF using 3-D reconstructions of the heart at end diastole (ED) and end systole (ES). Methods: 2-D echocardiographic studies were performed on 12 subjects and used to reconstruct the RV and tricuspid annulus in 3-D at ED and ES. Measurements of TAM from medial and lateral positions on the annulus were selected from the standard echocardiographic apical four-chamber view. The minimum and maximum possible TAM values, RV volumes, and movement of the apex of the heart along the trajectory of TAM were calculated from the 3-D reconstructions. Results: TAM correlated highly with RVEF (r ≥ 0.90). Values found by 2-D and 3-D techniques were not significantly different. Correcting TAM for apex motion did not improve correlation. Summation of medial and lateral TAM data increased correlation values slightly relative to lateral TAM alone. Regional aberrant contractility degraded the predictive value of TAM. Conclusion: Estimation of RVEF from 2-D echo measurement of TAM is accurate, especially when medial and lateral TAM are summed, except in patients with severe apical RV dysfunction.
Left atrial and ventricular dimensions in highly trained cyclistsHoogsteen, J.; Hoogeveen, A.; Schaffers, H.; Wijn, P.F.F.; van der Wall, E.E.
doi: 10.1023/A:1023684430671pmid: 12834157
Objectives: This study sought to investigate the development of left ventricular remodeling during active cycling. Methods: A group of 17-year-old (±0.2 years) highly trained competitive cyclists (group I, n = 66) and a group of 29-year old (± 2.6 years) professional cyclists (group II, n = 35) underwent two-dimensional (2D) echocardiography. Data from groups I and II were compared with values of normal untrained subjects based on the literature. Results: Left atrial dimensions were significantly increased in group II as compared to group I (44 ± 5 vs. 36 ± 4 mm, p < 0.005). Left ventricular end diastolic diameter was significantly increased in group II as compared to group I (61 ± 5 vs. 54 ± 6 mm, p < 0.005). Left ventricular mass was also significantly increased in group II as compared to group I (321 ± 77 vs. 246 ± 59 g, p < 0.005). Wall stress showed a significant inverse relation: 104 ± 42 mmHg in group I vs. 83 ± 14 mmHg in group II (p < 0.005). The early filling phase of the left ventricular inflow was significantly larger in both athlete groups in relation to the normal value. The E-wave in the athletes compared to the E-wave in normal subjects was 0.87 ± 0.17 vs. 0.71 ± 0.14 m/s in group I, p < 0.005, 0.82 ± 0.17 vs. 0.71 ± 0.14 m/s in group II, p < 0.05. Late filling phase and the ratio of the diastolic filling pattern did not show significant differences between the two groups. Conclusions: Left atrial and left ventricular remodeling starts early in the athlete's career. Athletes of 17 years of age already show significant left atrial and left ventricular dilatation compared to data of untrained subjects described in literature. The process of dilatation continues during the athlete's career. Also left ventricular mass is increased at a young age which continues for several years. More than 60% of the athletes in both groups demonstrated an intermediate form of left ventricular hypertrophy. Diastolic function of the left ventricle remains normal during a long period of athletic career performance.
Importance of wall motion analysis in the diagnosis of left main disease using stress nuclear myocardial perfusion imagingKumar, Shekar; Movahed, Asssad
doi: 10.1023/A:1023606223940pmid: 12834158
We describe a case of a 54-year-old male who underwent exercise technetium-99m sestamibi myocardial perfusion imaging prior to his renal transplantation. With exercise, the patient's myocardial perfusion imaging did not show any transient or fixed myocardial perfusion abnormalities due to balanced ischemia. However, wall motion analysis showed a new global left ventricular systolic dysfunction on post-exercise images. Coronary angiography showed severe left main coronary lesion involving ostia of left anterior descending, ramus intermedius and left circumflex coronary arteries with moderate right coronary artery disease. If one had used the perfusion imaging alone in this patient, the severe multivessel disease including left main coronary disease could have been missed. In this article we emphasize the importance of wall motion analysis in patients undergoing myocardial perfusion imaging.
Uptake of technetium 99m HDP in cardiac amyloidosisKulhanek, Jan; Movahed, Assad
doi: 10.1023/A:1023608115278pmid: 12834159
We present a report and a brief summary of literature focused on a patient with suspected cardiac amyloidosis from transthoracic echocardiography and tc-99m HDP scintigraphy. Imaging demonstrated significantly increased uptake of the bone tracer within the myocardium in comparison to the highest skeletal uptake. Literature described several cases of abnormal myocardial uptake of various imaging tracers in various disease states.
The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery diseaseGroutars, Reginald; Verzijlbergen, J.; Tiel-van Buul, Monique; Zwinderman, Aeilco; Ascoop, Carl; van Hemel, Norbert; van der Wall, Ernst
doi: 10.1023/A:1023637804898pmid: 12834160
Background: In order to evaluate the diagnostic efficacy of the 1-day separate acquisition dual-isotope single-photon emission computed tomography (SPECT) protocol, using 201Tl for the rest and 99mTc-tetrofosmin for the stress images, a consecutive series of patients with suspected or known coronary artery disease (CAD) was studied that also underwent coronary angiography. Methods: The results of myocardial SPECT, using a semi-quantitative visual analysis, were acquired in 123 patients and compared with the results of coronary angiography. Sensitivity and specificity were calculated, using thresholds of ≥50 and ≥70% stenosis. As an alternative for specificity, the normalcy rate was determined in a separate group of 87 patients with a <5% pre-test likelihood of CAD. Results: The prevalence of CAD using ≥50 and ≥70% stenosis was 88 and 78%, respectively. The sensitivity for detection of patients with ≥50 and ≥70% stenosis was 94 and 97%, respectively while specificity was 62 and 59%, respectively. The high rate of false positive perfusion defects resulting in a low specificity could be explained by specific clinical issues. However, the routine assessment with additional clinical and electrocardiographic data resulted in a correct interpretation of most of the false positive perfusion defects. The positive predictive value was 92 and 85% and the negative predictive value 46 and 77%, using thresholds of ≥50 and ≥70% stenosis, respectively. The normalcy rate was 91%. Conclusion: The one-day separate acquisition rest 201Tl/stress 99mTc-tetrofosmin SPECT protocol is an efficient procedure for myocardial perfusion scintigraphy with high sensitivity for detection of CAD. Specific clinical issues caused a low value for specificity. Therefore, clinical information and knowledge of the electrocardiogram is essential for a correct interpretation of SPECT images.
Three- and four-dimensional reconstruction of intra-cardiac anatomy from two-dimensional magnetic resonance imagesMiquel, M.E.; Hill, D.L.G.; Baker, E.J.; Qureshi, S.A.; Simon, R.D.B.; Keevil, S.F.; Razavi, R.S.
doi: 10.1023/A:1023671031207pmid: 12834161
The present study was designed to evaluate the feasibility and clinical usefulness of three-dimensional (3D) reconstruction of intra-cardiac anatomy from a series of two-dimensional (2D) MR images using commercially available software. Sixteen patients (eight with structurally normal hearts but due to have catheter radio-frequency ablation of atrial tachyarrhythmias and eight with atrial septal defects (ASD) due for trans-catheter closure) and two volunteers were imaged at 1T. For each patient, a series of ECG-triggered images (5 mm thick slices, 2–3 mm apart) were acquired during breath holding. Depending on image quality, T
1- or T
2-weighted spin-echo images or gradient-echo cine images were used. The 3D reconstruction was performed off-line: the blood pools within cardiac chambers and great vessels were semi-automatically segmented, their outer surface was extracted using a marching cube algorithm and rendered. Intra- and inter-observer variability, effect of breath-hold position and differences between pulse sequences were assessed by imaging a volunteer. The 3D reconstructions were assessed by three cardiologists and compared with the 2D MR images and with 2D and 3D trans-esophagal and intra-cardiac echocardiography obtained during interventions. In every case, an anatomically detailed 3D volume was obtained. In the two patients where a 3 mm interval between slices was used, the resolution was not as good but it was still possible to visualize all the major anatomical structures. Spin-echo images lead to reconstructions more detailed than those obtained from gradient-echo images. However, gradient-echo images are easier to segment due to their greater contrast. Furthermore, because images were acquired at least at ten points in the cardiac cycles for every slice it was possible to reconstruct a cine loop and, for example, to visualize the evolution of the size and margins of the ASD during the cardiac cycle. 3D reconstruction proved to be an effective way to assess the relationship between the different parts of the cardiac anatomy. The technique was useful in planning interventions in these patients.