Objectives To compare regional left ventricular (LV) volume curves obtained with real time three-dimensional echocardiography (RT3DE) with two-dimensional circumferential strain curves obtained by MRI in cardiac resynchronization therapy candidates. Background Several methods using either ultrasound or MRI are used to quantify mechanical dyssynchrony (MD). Theoretically, LV volume and circumferential strain seem related, since both measures are connected to the radius of the ventricle. Methods In 21 patients with chronic heart failure, RT3DE and tagged MRI were performed subsequently. Regional LV volume was computed from the ultrasound images. From the MR images, regional circumferential strain was calculated. Cross-correlations with time lags of 1% of the cardiac cycle were performed to compare the curves in corresponding LV segments. Furthermore, peak septal to lateral (SL) delays were compared between modalities. Results High correlations were found between the curves (r 2 = 0.65 ± 0.19), but regional differences in time delay between modalities were observed. In the septum, the volume curve was earlier than the strain curve by 1.8 ± 17.0 time-lags (n.s.), while in the lateral wall, the volume curve was earlier by 3.3 ± 12.0 time-lags (P < 0.02). There was a non-significant difference between SL delays in the two modalities (volume: −1.0 ± 8.6%, strain: 3.0 ± 12.7%, P = 0.17, a positive sign indicates that the lateral wall is delayed). Conclusions High correlations were observed between both modalities, but regional differences in time-delay were found. This is possibly inherent to the method of echocardiographic volume calculation and hampers the comparison of both measures for the quantification of MD.

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Reproducibility of volumetric intravascular ultrasound radiofrequency-based analysis of coronary plaque composition invivo

Hartmann, Marc; Mattern, Eline; Huisman, Jennifer; Houwelingen, Gert; Man, Frits; Stoel, Martin; Danse, Peter; Louwerenburg, Hans; Birgelen, Clemens

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9338-9pmid: 18704753

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Longitudinal left ventricular systolic function is impaired in patients with coronary slow flow

Nurkalem, Zekeriya; Gorgulu, Sevket; Uslu, Nevzat; Orhan, Ahmet; Alper, Ahmet; Erer, Betul; Zencirci, Ertugrul; Aksu, Huseyın; Eren, Mehmet

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9341-1pmid: 18626788

Slow coronary flow (SCF) is a well recognized clinical entity, characterized by delayed opacification of coronary arteries in the presence of normal coronary angiogram. There is currently no data evaluating myocardial systolic function in SCF phenomenon. This study was performed to evaluate regional and global systolic function using tissue Doppler imaging (TDI), strain (S) and strain rate imaging (SRI) in patients with slow coronary flow. A total of 35 patients with slow coronary flow and otherwise normal coronary arteries (mean age 48 ± 7 years) (SCF group) and 21 patients with normal coronary angiograms (mean age 50 ± 12 years) (control group) were included in the study. These patients were prospectively assessed for evaluation of regional and global left ventricular function by conventional echocardiography, systolic TDI, peak S, and peak systolic strain rates (SRs) There was a significant difference in peak SRs (−1.1 ± 0.2 vs. −1.8 ± 0.2 1/s, P ≤ 0.0001) but similar in systolic TDI (42 ± 20 vs. 44 ± 21 mm/s, P = 0.77) and S (20.7 ± 7.7 vs. 23.7 ± 8.8, P = 0.14) between groups. SRs showed a good correlation with mean TIMI frame count (r = −0.80, P ≤ 0.0001). As the number of coronary artery with SCF increased global strain rate decreased further. In case of one or two or three coronary artery with SCF global strain rates were 1.4 ± 0.2; 1.1 ± 0.3; 0.9 ± 0.2 1/s, respectively, P ≤ 0.0001. Although ejection fraction was preserved, global and regional strain rate were decreased in SCF. In brief, there is an impairment in longitudinal left ventricular systolic function in patients with SCF.

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Is E/E′ reliable in patients with regional wall motion abnormalities to estimate left ventricular filling pressure?

Lim, Hong-Seok; Kang, Soo-Jin; Choi, Jung-Hyun; Ahn, Sung-Gyun; Choi, Byoung-Joo; Choi, So-Yeon; Yoon, Myeong-Ho; Hwang, Gyo-Seung; Tahk, Seung-Jea; Shin, Joon-Han

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9340-2pmid:

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E/E′: a prime number?

Lindqvist, Per; Broyd, Chris; Henein, Michael

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9356-7pmid: 18720027

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Gated myocardial perfusion SPECT asynchrony measurements in patients with left bundle branch block

Nichols, Kenneth; Tosh, Andrew; Siddiqi, Saadi; Chen, Ji; Garcia, Ernest; Palestro, Christopher; Reichek, Nathaniel

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9354-9pmid: 18695994

Purpose This investigation sought to determine which newly available asynchrony parameter derived from gated myocardial perfusion SPECT (GMPS) systolic wall thickening data best distinguishes patients with left bundle branch block (LBBB) from normal subjects. Methods and materials Emory Cardiac Toolbox (ECTb) algorithms were used to compute left ventricular (LV) global and regional function and perfusion indices with regional contraction phases for 20 patients with LBBB, and in 9 control (CTL) subjects who had no function or perfusion abnormalities. Histogram plots of phase frequencies versus R–R interval times included phase standard deviation (SD), bandwidth (BW), skewness and kurtosis. Z-score asynchrony measures were derived for phases sampled using the conventional 17-segment model. Results In CTLs contraction occurred nearly simultaneously in all segments, while LBBBs exhibited a wide variety of heterogeneous contraction patterns. Global parameters that differed between LBBBs versus CTLs included EF, end-systolic volume and end-diastolic volume, and asynchrony measures that were different included BW, phase SD and z-scores. Z-scores most strongly discriminated LBBBs from CTLs (93% of cases correctly predicted, logistic regression χ2 = 29.7, P < 0.0001). Z-scores, phase SD and lateral–septal wall timing were highly reproducible (r = 0.99, 0.99 and r = 0.87, respectively), with no significant inter-observer differences. Conclusion While traditional global function parameters were different in LBBBs and CTLs, asynchrony parameters characterized LBBB most strongly.

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Gated SPECT in left bundle branch block: from improved diagnosis to improved treatment

Wall, E.; Bax, J.; Jukema, J.; Schalij, M.

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9376-3pmid: 18855119

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Late gadolinium enhancement: precursor to cardiomyopathy in Duchenne muscular dystrophy?

Puchalski, Michael; Williams, Richard; Askovich, Bojana; Sower, C.; Hor, Kan; Su, Jason; Pack, Nathan; Dibella, Edward; Gottliebson, William

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9352-ypmid: 18686011

Background Progressive cardiomyopathy is a common cause of death in Duchenne muscular dystrophy (DMD), presumably secondary to fibrosis of the myocardium. The posterobasal and left lateral free wall of the left ventricle (LV) are initial sites of myocardial fibrosis pathologically. The purposes of this study were to assess whether cardiac magnetic resonance imaging (CMRI), utilizing late gadolinium enhancement (LGE), could identify fibrosis in selective areas of the myocardium, and to assess the relationship of the presence and extent of fibrosis to LV function. Methods The cardiology databases at Primary Children’s Medical Center and Cincinnati Children’s Hospital Medical Center were reviewed to identify patients with DMD who had undergone a CMRI within the last 2 years. Age, LV ejection fraction, LV mass, presence and location of LGE were documented. Volumes were measured using MASS (Medis, Inc.) to calculate ejection fraction and mass. LGE images were acquired and when positive, customized computer assisted sizing of the areas of late gadolinium enhancement were performed on all slices. Normal function was defined as LV ejection fraction >54%. Results A total of 74 patients with DMD had complete data sets (median age 13.7 years, range 7.7–26.4). Twenty-four patients (32%) had LGE involving the posterobasal region of the LV in a sub-epicardial distribution. Those patients with more involvement had spread to the inferior and left lateral free wall with progressive transmural fibrous replacement. There was relative sparing of the interventricular septum and right ventricle. Patients with LGE were significantly older than those without (mean age 16.4 vs 12.9 years, P < 0.001). LGE was positively associated with BSA-adjusted LV mass, LV end-diastolic volume, LV end-systolic volume, and RV end-systolic volume but inversely correlated with ejection fraction of the LV (P < 0.001) and RV (P = 0.004). Conclusions LGE by CMRI is able to detect fibrosis in selective regions of myocardium in patients with DMD. Unfavorable LV remodeling, with a corresponding decreased ejection fraction, is associated with the presence of LGE. Serial studies are warranted to determine if LGE precedes a decrease in function, and if early medical management is useful in preventing progression once LGE is documented.

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Duchenne muscular dystrophy; a cardiomyopathy that can be prevented?

Mulder, Barbara; Wall, Ernst

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9370-9pmid: 18830686

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Early detection of cardiomyopathy in Duchenne muscular dystrophy, is there a role for MRI?

Baur, Leo

2008 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-008-9371-8pmid: 18855120

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Intravascular ultrasound radiofrequency (RF-IVUS) data permit the analysis of coronary plaque composition in vivo and is used as an endpoint of ongoing pharmacological intervention trials. We assessed the reproducibility of volumetric RF-IVUS analyses in mild-to-moderately diseased atherosclerotic human coronary arteries in vivo. A total of 9,212 IVUS analyses on cross-sectional IVUS frames was performed to evaluate the reproducibility of volumetric RF-IVUS measurements in 33 coronary segments with a length of 27 ± 7 mm. For vessel, lumen, and plaque + media volume the relative measurement differences (P = NS for all) were (A = intraobserver comparison, same pullback) −0.40 ± 1.0%; −0.48 ± 1.4%; −0.35 ± 1.6%, (B = intraobserver comparison, repeated pullback) −0.42 ± 1.2%; −0.52 ± 1.8%; −0.43 ± 4.5% (C = interobserver comparison, same pullback) 0.71 ± 1.8%; 0.71 ± 2.2%, and 0.89 ± 5.0%, respectively. For fibrous, fibro-lipidic, calcium, and necrotic-core volumes the relative measurement differences (P = NS for all) were (A) 0.45 ± 2.1%; −1.12 ± 4.9%; −0.84 ± 2.1%; −0.22 ± 1.8%, (B) 1.40 ± 4.1%; 1.26 ± 6.7%; 2.66 ± 7.4%; 0.85 ± 4.4%, and (C) −1.60 ± 4.9%; 3.85 ± 8.2%; 1.66 ± 7.5%, and −1.58 ± 4.7%, respectively. Of note, necrotic-core volume showed on average the lowest measurement variability. Thus, in mild-to-moderate atherosclerotic coronary artery disease the reproducibility of volumetric compositional RF-IVUS measurements from the same pullback is relatively high, but lower than the reproducibility of geometrical IVUS measurements. Measurements from repeated pullbacks and by different observers show acceptable reproducibilities; the volumetric measurement of the necrotic-core shows on average the highest reproducibility of the compositional RF-IVUS measurements

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Background There is limited data on the diagnostic utility of the transmitral to mitral annular velocity (E/E′) by tissue Doppler imaging (TDI) in the presence of regional wall motion abnormalities (RWMA). We aimed to investigate whether the E/E′ is reliable in estimating left ventricular filling pressure (LVFP) despite RWMA. Methods One hundred thirty consecutive patients with myocardial infarction (MI) and subsequent RWMA referred for cardiac catheterization and echocardiography to measure LV pre-A pressure (LVPPRE-A) and Doppler signals from the mitral inflow with tissue Doppler imaging (TDI) of the mitral annulus. All patients were classified into three groups according to RWMA of the segment adjacent to the E′-measuring point using TDI: 83 patients with normal wall motions of the basal septal and basal lateral segments (group A); 28 patients with RWMA of the basal septum (group B); and 19 patients with RWMA of the basal lateral segment (group C). Results Septal E/E′ correlated with LVPPRE-A in groups A and C (r = 0.383, P < 0.001; r = 0.482, P = 0.037, respectively). Lateral E/E′ and LVPPRE-A showed good correlation in groups A, B and C (r = 0.470, P < 0.001; r = 0.416, P = 0.028; r = 0.727, P < 0.001, respectively). The largest area under the receiver operating curve was obtained by the lateral E/E′ for the prediction of a high LVFP, irrespective of the location of RWMA. Conclusions In selected patients with abnormal wall motion of the basal septum, E/E′ measured at the septum was not representative for LVFP. Lateral E/E′ is reliable for the prediction of high LVFP, regardless of the site of RWMA.