The International Journal of Cardiovascular Imaging

Cimadevilla, Oliva; Martín Fernández, María; Luyando, Luis; Saura, Francisco

doi: 10.1007/s10554-010-9635-ypmid: 20467817

Cannavale, Giuseppe; Higgins, Charles; Ordovas, Karen

doi: 10.1007/s10554-010-9667-3pmid: 20614189

Unroofed coronary sinus is a rare congenital cardiac anomaly in which a communication occurs between the coronary sinus and the left atrium due to the partial or complete absence of roof of the coronary sinus. Its diagnosis is important to prevent pulmonary hypertension and brain abscess or cerebral emboli. We report a case of a symptomatic 35-year-old man in which no atrial septal defects were visualized by transesophageal echocardiography but MRI permitted the diagnosis of this rare cardiac anomaly and assessment of shunt severity.

Goderie, T.; Soest, G.; Garcia-Garcia, H.; Gonzalo, N.; Koljenović, S.; Leenders, G.; Mastik, F.; Regar, E.; Oosterhuis, J.; Serruys, P.; Steen, A.

doi: 10.1007/s10554-010-9631-2

Xue, Haihong; Sun, Kun; Yu, Jianguo; Chen, Binjin; Chen, Guozhen; Hong, Wenjing; Yao, Liping; Wu, Lanping

doi: 10.1007/s10554-010-9649-5pmid: 20535561

Virtual endoscopy (VE) is a new post-processing method that uses volumetric data sets to simulate the tracks of a “conventional” flexible endoscope. However, almost all studies of this method have involved virtual visualizations of the cardiovascular structures applied to computed tomography (CT) and magnetic resonance (MR) datasets. This paper introduces a novel visualization method called the “three-dimensional echocardiographic intracardiac endoscopic simulation system (3DE IESS)”, which uses 3D echocardiographic images in a virtual reality (VR) environment to diagnose congenital heart disease. The aim of this study was to analyze the feasibility of VE in the evaluation of congenital heart disease in children and its accuracy compared with 2DE. Three experienced pediatric cardiologists blinded to the patients’ diagnoses separately reviewed 40 two-dimensional echocardiographic (2DE) datasets and 40 corresponding VE datasets and judged whether abnormal intracardiac anatomy was present in terms of a five-point scale (1 = definitely absent; 2 = probably absent; 3 = cannot be determined; 4 = probably present; and 5 = definitely present). Compared with clinical diagnosis, the diagnostic accuracy of VE was 98.7% for ASD, 92.4% for VSD, 92.6% for TOF, and 94% for DORV, respectively. Diagnostic accuracy of VE was significantly higher than that of 2DE for TOF and DORV except for ASD and VSD. The receiver operating characteristic (ROC) curve for VE was closer to the optimal performance point than was the ROC curve for 2DE. The area under the ROC curve was 0.96 for VE and 0.93 for 2DE. Kappa values (range, 0.73–0.79) for VE and 2DE indicated substantial agreement. 3D echocardiographic VE can enhance our understanding of intracardiac structures and facilitate the evaluation of congenital heart disease.

Zhu, Hui; Zhang, Wei; Zhong, Ming; Zhang, Gong; Zhang, Yun

doi: 10.1007/s10554-010-9637-9pmid: 20490688

Ultrasonic tissue characterization has the potential to provide quantitative information which could characterize the functional and structural state of cardiac muscle. In this study we aimed to determine whether the integrated backscatter is measurable and quantifiable in left atrial posterior walls in patients with chronic atrial fibrillation (AF) and can be used to identify changes in atrial structure and contractility. In 26 patients with chronic atrial fibrillation and 20 patients in sinus rhythm (SR), integrated backscatter signal (IBS) was analyzed by acoustic densitometry. Real time IBS was measured from the parasternal long axis view of the left atrial posterior walls. Cyclic variation of IBS (CVIB) was expressed as the difference between end-diastolic (peak) and end-systolic (nadir) IBS values averaged over all cardiac cycles. CVIB values obtained from left atrial posterior wall in atrial fibrillation group were statistically different from control group (P < 0.05). IBS of the left atrial posterior wall indexed by pericardium (IBS%) were higher in patients with AF than in patients with SR (P < 0.05). CVIB and mean IBS values which were obtained with IBS method may be useful to determine myocardial contractile performance and myocardial structural properties, respectively. IBS of the LA posterior wall indexed by pericardium provides an objective quantitative measure of atrial fibrosis.

Li, Chi; Carreras, Francesc; Leta, Rubén; Carballeira, Lidia; Pujadas, Sandra; Pons-Lladó, Guillem

doi: 10.1007/s10554-010-9644-xpmid: 20711677

Myocardium deformation and displacement analysis by echocardiography has proven useful to evaluate the synchrony of myocardial mechanics. The aim of our study was to evaluate the mean standard deviation of time to longitudinal peak displacement in 16 cardiac segments by 3D echo wall motion Speckle Tracking analysis. We studied 15 patients with ventricular dyssynchrony—defined by a QRS > 120 ms in the ECG. We obtained the differences between time peaks of endocardial longitudinal displacement for 16 segments of the heart by 3D echo Speckle Tracking. We compared the temporal dispersion of these peaks with results obtained in a control group of 13 healthy individuals without dyssynchrony. The results showed a significant difference (p < 0,001) between the dispersion of standard deviation in the 13 patients in the control group (34 ms ± 19) and the 15 patients in the dyssynchrony group (117 ms ± 57). We describe a new parameter obtained by 3D echo wall motion Speckle Tracking analysis for the detection of dyssynchrony. It can be useful to identify dyssynchrony of left ventricular myocardial mechanics, to indicate the resynchronization therapy, to optimize the parameters of the device and to achieve a less operator-dependent evaluation.

Muzzarelli, Stefano; Pfisterer, Matthias; Müller-Brand, Jan; Zellweger, Michael

doi: 10.1007/s10554-010-9627-ypmid: 20411429

We aimed to evaluate the differences between exercise testing (ET), myocardial perfusion SPECT (MPS) and a combination of ET and MPS based risk assessment as outlined by the guidelines with respect to their “gate-keeper” role to coronary angiography (cath) and the associated diagnostic procedural costs if prognostic considerations, as those proposed by the current guidelines and the recent literature, were taken into account. The Duke-score and the summed difference score (SDS; extent of ischemia) were assessed in 955 consecutive patients referred for MPS combined with ET. According to the guidelines and the available literature, three different algorithms for risk stratification were retrospectively applied: (1) ET based risk stratification and cath if intermediate or high risk Duke-score; (2) MPS based risk stratification and cath if SDS ≥ 8; (3) combined approach with ET as first step and MPS in case of intermediate risk Duke-score. A cath would have been suggested in every patient with either high risk Duke-score or SDS ≥ 8 in patients with intermediate risk Duke-score. The referral rate to cath was 27% according to the ET alone, 13% using MPS, and finally 12% applying the combined risk stratification. The cost of the diagnostic work-up including cath were: 615€, 1’299€, and 598€ per patient, respectively. The coronary angiography referral rate widely depends on the diagnostic modality used for risk stratification and according to the referral criteria provided by the guidelines. In the present study, the use of a stress imaging modality (MPS) and published prognostic data was associated with a lower referral rate to cath as compared to exercise testing alone and thus underlines the advantage of a risk based approach applying stress imaging in patients with intermediate risk Duke-score.

Neill, Johanne; Harbinson, Mark; Adgey, Jennifer

doi: 10.1007/s10554-010-9641-0pmid: 20563885

The purpose of this study was to compare semi-quantitative visual scores of perfusion, motion and thickening with an automated hypoperfusion index (HI) in patients with suspected acute inferolateral perfusion defects. In the absence of perfusion defects motion and thickening abnormalities were assessed. Sixty-eight patients with chest pain at rest and either ST depression ≥0.1 mV in ≥1 of leads I, aVL, V1–V6 on 12-lead ECG or ST elevation ≥0.05 mV in ≥1 posterior lead on the body surface map comprised the study population. A rest gated perfusion scan was performed within 24 h of symptoms. Scans were scored for perfusion, motion and thickening semi-quantitatively. The scores were compared to the automated HI. A 12 h Troponin T >0.09 ng/ml indicated myocardial infarction (MI). Sixty-five patients (96%, 65/68) had MI. The summed perfusion score correlated well with the HI (ρ = 0.90, P < 0.01) and agreement between scorers was good (κ = 0.77, 95% CI = 0.57–0.94). The summed motion score correlated with the HI (ρ = −0.61, P < 0.01) and agreement between scorers was moderate (κ = 0.65, 95% CI = 0.52–0.79). Summed thickening score correlated with HI (ρ = −0.67, P < 0.01) and agreement between scorers was good (κ = 0.74, 95% CI = 0.64–0.88). Of the 1156 segments assessed (68 × 17), 542 had normal perfusion. Of these normally perfused segments, 113 (21%, 113/542) had a motion abnormality and 102 (19%, 102/542) had a thickening abnormality. Three patients with proven myocardial infarction had normal myocardial perfusion (HI ≤ 5) but exhibited wall motion and thickening abnormalities. In conclusion, assessment of wall motion and thickening in addition to perfusion in acute myocardial perfusion imaging may improve the diagnostic sensitivity for acute MI. Of the scores addressing motion and thickening, interobserver agreement was better for the summed thickening score.

Wall, E.; Scholte, A.; Bax, J.

doi: 10.1007/s10554-010-9650-zpmid: 20532632

Sadat, Umar; Teng, Zhongzhao; Young, Victoria; Graves, Martin; Gillard, Jonathan

doi: 10.1007/s10554-010-9648-6pmid: 20532633

Atherosclerotic plaque burden has a strong correlation with plaque vulnerability. Three-dimensional (3D) volumetric assessment of atherosclerotic plaques has been suggested as an accurate method of quantifying plaque burden but has not been performed. In this study we use high-resolution magnetic resonance (MR) imaging to compare 3D volume differences of asymptomatic and acutely symptomatic carotid plaques (i.e. had cerebrovascular ischaemic symptoms within the previous 72 h of MR imaging). One hundred patients (46 acutely symptomatic and 54 asymptomatic) with atherosclerotic carotid artery disease underwent carotid MR imaging. Manual segmentation of plaque components was done to delineate lipid, fibrous tissue and plaque haemorrhage (PH). 3D-volume reconstruction of plaque components was done and used for comparison. Acutely symptomatic plaques had a lower normalized wall index and normalized volume index than the asymptomatic group (P = 0.04 and 0.01 respectively). Median percentage lipid volume was higher for asymptomatic plaques (28 vs. 5%, P = 0.004). However, the median percentage volume and prevalence of PH was higher in the acutely symptomatic group (P = 0.01 and 0.02 respectively). Acutely symptomatic plaques have less lipid content immediately after the acute event than asymptomatic plaques. This is most likely because of the escape of lipid-rich atheromatous debris into the blood stream at the time of plaque rupture. Due to this paradox, “high” lipid content of a plaque may not be a reliable feature of estimating its vulnerability immediately following the acute event. PH, which is prevalent and consistent in such plaques, may be a better indicator of plaque vulnerability during that period.