Three-dimensional echocardiography in the evaluation of global and regional function in patients with recent myocardial infarction: a comparison with magnetic resonance imaging.
Thorstensen Anders,Dalen Håvard,Hala Pavel,Kiss Gabriel,D'hooge Jan,Torp Hans,Støylen Asbjørn,Amundsen Brage
Echocardiography (Mount Kisco, N.Y.)
We aimed to compare three-dimensional (3D) and two-dimensional (2D) echocardiography in the evaluation of patients with recent myocardial infarction (MI), using late-enhancement magnetic resonance imaging (LE-MRI) as a reference method. Echocardiography and LE-MRI were performed approximately 1 month after first-time MI in 58 patients. Echocardiography was also performed on 35 healthy controls. Left ventricular (LV) ejection fraction by 3D echocardiography (3D-LVEF), 3D wall-motion score (WMS), 2D-WMS, 3D speckle tracking-based longitudinal, circumferential, transmural and area strain, and 2D speckle tracking-based longitudinal strain (LS) were measured. The global correlations to infarct size by LE-MRI were significantly higher (P < 0.03) for 3D-WMS and 2D-WMS compared with 3D-LVEF and the 4 different measurements of 3D strain, and 2D global longitudinal strain (GLS) was more closely correlated to LE-MRI than 3D GLS (P < 0.03). The segmental correlations to infarct size by LE-MRI were also significantly higher (P < 0.04) for 3D-WMS, 2D-WMS, and 2D LS compared with the other indices. Three-dimensional WMS showed a sensitivity of 76% and a specificity of 72% for identification of LV infarct size >12%, and a sensitivity of 73% and a specificity of 95% for identification of segments with transmural infarct extension. Three-dimensional WMS and 2D gray-scale echocardiography showed the strongest correlations to LE-MRI. The tested 3D strain method suffers from low temporal and spatial resolution in 3D acquisitions and added diagnostic value could not be proven.
10.1111/echo.12115
Detection of abnormal myocardial deformation during acute myocardial ischemia using three-dimensional speckle tracking echocardiography.
Hioki Ayana,Asanuma Toshihiko,Masuda Kasumi,Sakurai Daisuke,Nakatani Satoshi
Journal of echocardiography
BACKGROUND:Three-dimensional (3D) speckle tracking echocardiography can simultaneously evaluate circumferential, longitudinal, and radial strain without being affected by through-plane motion. Moreover, the assessment of area change ratio may allow measuring regional myocardial deformation more accurately. We investigated the changes in each deformation parameter during acute coronary flow reduction, and evaluated whether the spatial extent of the abnormal values in each deformation parameter corresponded to that of the perfusion abnormality. METHODS:In 10 dogs, myocardial strains of three directions and area change ratio were analyzed at baseline and during three different ischemic conditions. The peak systolic value and the post-systolic index (PSI) were measured in both the ischemic and normal segments. The function abnormality, derived from the deformation parameter, and the perfusion abnormality, derived from Evans blue staining, were evaluated in each segment during complete occlusion and the concordance rate between both abnormalities was calculated. RESULTS:In all deformation parameters, the peak systolic value tended to gradually decrease and the PSI tended to gradually increase with the severity of flow reduction in the ischemic segment. Especially in area change ratio, significant changes were observed in both the peak systolic value and the PSI during occlusion compared to baseline. The concordance rate was the highest in the PSI assessed by area change ratio. CONCLUSIONS:Among 3D myocardial deformation parameters, area change ratio demonstrated better detectability of acute coronary flow reduction than conventional strain components. Area change ratio may be a useful parameter for detecting acute ischemia by 3D speckle tracking echocardiography.
10.1007/s12574-019-00449-6
Fusion of Three-Dimensional Echocardiographic Regional Myocardial Strain with Cardiac Computed Tomography for Noninvasive Evaluation of the Hemodynamic Impact of Coronary Stenosis in Patients with Chest Pain.
Mor-Avi Victor,Patel Mita B,Maffessanti Francesco,Singh Amita,Medvedofsky Diego,Zaidi S Javed,Mediratta Anuj,Narang Akhil,Nazir Noreen,Kachenoura Nadjia,Lang Roberto M,Patel Amit R
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
BACKGROUND:Combined evaluation of coronary stenosis and the extent of ischemia is essential in patients with chest pain. Intermediate-grade stenosis on computed tomographic coronary angiography (CTCA) frequently triggers downstream nuclear stress testing. Alternative approaches without stress and/or radiation may have important implications. Myocardial strain measured from echocardiographic images can be used to detect subclinical dysfunction. The authors recently tested the feasibility of fusion of three-dimensional (3D) echocardiography-derived regional resting longitudinal strain with coronary arteries from CTCA to determine the hemodynamic significance of stenosis. The aim of the present study was to validate this approach against accepted reference techniques. METHODS:Seventy-eight patients with chest pain referred for CTCA who also underwent 3D echocardiography and regadenoson stress computed tomography were prospectively studied. Left ventricular longitudinal strain data (TomTec) were used to generate fused 3D displays and detect resting strain abnormalities (RSAs) in each coronary territory. Computed tomographic coronary angiographic images were interpreted for the presence and severity of stenosis. Fused 3D displays of subendocardial x-ray attenuation were created to detect stress perfusion defects (SPDs). In patients with stenosis >25% in at least one artery, fractional flow reserve was quantified (HeartFlow). RSA as a marker of significant stenosis was validated against two different combined references: stenosis >50% on CTCA and SPDs seen in the same territory (reference standard A) and fractional flow reserve < 0.80 and SPDs in the same territory (reference standard B). RESULTS:Of the 99 arteries with no stenosis >50% and no SPDs, considered as normal, 19 (19%) had RSAs. Conversely, with stenosis >50% and SPDs, RSAs were considerably more frequent (17 of 24 [71%]). The sensitivity, specificity, and accuracy of RSA were 0.71, 0.81, and 0.79, respectively, against reference standard A and 0.83, 0.81, and 0.82 against reference standard B. CONCLUSIONS:Fusion of CTCA and 3D echocardiography-derived resting myocardial strain provides combined displays, which may be useful in determination of the hemodynamic or functional impact of coronary abnormalities, without additional ionizing radiation or stress testing.
10.1016/j.echo.2018.01.019
Comparison of quantitative wall-motion analysis and strain for detection of coronary stenosis with three-dimensional dobutamine stress echocardiography.
Parker Katherine M,Clark Alexander P,Goodman Norman C,Glover David K,Holmes Jeffrey W
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND:Quantitative analysis of wall motion from three-dimensional (3D) dobutamine stress echocardiography (DSE) could provide additional diagnostic information not available from qualitative analysis. In this study, we compare the effectiveness of 3D fractional shortening (3DFS), a measure of wall motion computed from 3D echocardiography (3DE), to strain and strain rate measured with sonomicrometry for detecting critical stenoses during DSE. METHODS:Eleven open-chest dogs underwent DSE both with and without a critical stenosis. 3DFS was measured from 3DE images acquired at peak stress. 3DFS was normalized by subtracting average 3DFS during control peak stress (∆3DFS). Strains in the perfusion defect (PD) were measured from sonomicrometry, and PD size and location were measured with microspheres. RESULTS:A ∆3DFS abnormality indicated the presence of a critical stenosis with high sensitivity and specificity (88% and 100%, respectively), and ∆3DFS abnormality size correlated with PD size (R(2) = 0.54). The sensitivity and specificity for ∆3DFS were similar to that for area strain (88%, 100%) and circumferential strain and strain rate (88%, 92% and 88%, 86%, respectively), while longitudinal strain and strain rate were less specific. ∆3DFS correlated significantly with both coronary flow reserve (R(2) = 0.71) and PD size (R(2) = 0.97), while area strain correlated with PD size only (R(2) = 0.67), and other measures were not significantly correlated with flow reserve or PD size. CONCLUSION:Quantitative wall-motion analysis using ∆3DFS is effective for detecting critical stenoses during DSE, performing similar to 3D strain, and provides potentially useful information on the size and location of a perfusion defect.
10.1111/echo.12636
Real-time three-dimensional left ventricular contraction in patients with diastolic dysfunction.
Hatipoğlu Suzan,Babur Güler Gamze,Kaya Özgür,Kahveci Gökhan,Güler Ekrem,Eroğlu Elif,Özdemir Nihal
Journal of medical ultrasonics (2001)
PURPOSE:Systolic alterations in left ventricular (LV) myocardial function have been reported previously in patients with diastolic dysfunction (DD). Recent advances in real-time three-dimensional echocardiography (3DE) enable the measurement of a set of parameters previously difficult to obtain with standard two-dimensional echocardiography (2DE). The aim of this study was to evaluate global 3DE LV contraction in patients with and without DD who had normal ejection fraction (EF). METHODS:Sixty-five patients (average age 56 ± 6 years; 31 females and 34 males) with normal EF (>50 %) referred to echocardiographic examination for the evaluation of DD were included. In addition to measuring conventional echocardiographic parameters, they were also evaluated with 3DE. End diastolic volume, end systolic volume, EF, corrected standard deviation (SD) of time to minimal systolic volume for 16 segments its dispersion, average excursion of the segments and the SD of segmental motion (excursion-SD) were recorded. RESULTS:When we tested the differences among three groups of diastolic function (normal, Grade 1, and Grade 2), the results showed that coronary artery disease, left atrial volume, septum, posterior wall, E, A, E/A, deceleration time, E' septum, E' lateral, and excursion-SD were significantly different. An ordered logistic regression analysis revealed that excursion-SD (p < 0.001) and septum (p < 0.001) measurements were statistically significant for predicting DD grade. CONCLUSION:In our patient population, a decline in excursion-SD values was observed with increasing DD grade. In other words, the amount of segmental difference in terms of excursion was reduced.
10.1007/s10396-016-0711-3
Real time three-dimensional stress echocardiography advantages and limitations.
Abusaid Ghassan H,Ahmad Masood
Echocardiography (Mount Kisco, N.Y.)
The role of two-dimensional stress echocardiography (2D-SE) is well established for diagnosis and prognosis of patients with known or suspected coronary artery disease. 2D-SE has its limitations as multiple views of the left ventricle (LV) must be obtained within 90 seconds of peak stress from more than window to completely visualize all LV segments. 2D-SE is operator-dependent and requires advanced skills to match the same myocardial segments during stress. LV foreshortening is a frequently encountered problem in 2D-SE that may result in false negative studies. Real time three-dimensional SE (RT-3D-SE) can overcome many limitations of 2D-SE. In 3D-SE, overall wall motion of the entire LV is assessed simultaneously in different planes. 3D images can be displayed in multiplane or multislice views for ease of comparison with greater accuracy and interobserver agreement when compared to 2D. 3D-SE is quantitative, provides rapid image acquisition, requires lower level of operator skills, and avoids LV foreshortening by correct alignment of imaging planes. 3D-SE is easily applied during pharmacologic stress and is feasible during exercise-induced stress. Despite these advantages, 3D has lower temporal and spatial resolution than 2D and requires longer analysis time. With advances in transducer technology, smaller matrix footprints, and automated softwares, 3D full LV volume image acquisition can be obtained with a single beat that is less prone to artifacts. We will discuss the current application of RT-3D-SE, highlight the pros and cons of 3D-SE over conventional 2D-SE, and review major studies on 3D-SE and future implications.
10.1111/j.1540-8175.2011.01626.x
Image-based cardiac gating for three-dimensional intravascular ultrasound imaging.
Nadkarni Seemantini K,Boughner Derek,Fenster Aaron
Ultrasound in medicine & biology
Three-dimensional (3-D) intravascular ultrasound (US), or IVUS, provides valuable insight into the tissue characteristics of the coronary wall and plaque composition. However, artefacts due to cardiac motion and vessel wall pulsation limit the accuracy and variability of coronary lumen and plaque volume measurement in 3-D IVUS images. ECG-gated image acquisition can reduce these artefacts but it requires recording the ECG signal and may increase image acquisition time. The goal of our study was to reconstruct a 3-D IVUS image with negligible cardiac motion and vessel pulsation artefacts, by developing an image-based gating method to track 2-D IVUS images over the cardiac cycle. Our approach involved selecting 2-D IVUS images belonging to the same cardiac phase from an asynchronously-acquired series, by tracking the changing lumen contour over the cardiac cycle. The algorithm was tested with IVUS images of a custom-built coronary vessel phantom and with patient images. The artefact reduction achieved using the image-gating approach was > 86% in the in vitro images and > 80% in the in vivo images in our study. Our study shows that image-based gating of IVUS images provides a useful method for accurate reconstruction of 3-D IVUS images with reduced cardiac motion artefact.
10.1016/j.ultrasmedbio.2004.08.025
Comparison of 2- and 3-dimensional exercise echocardiography for the detection of coronary artery disease.
Peteiro Jesús,Piñon Pablo,Perez Ruth,Monserrat Lorenzo,Perez Diego,Castro-Beiras Alfonso
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
BACKGROUND:Although 3-dimensional echocardiography (3DE) has been applied during dobutamine echocardiography it has not been used during exercise echocardiography. We sought to compare feasibility and accuracy of 3DE and 2-dimensional echocardiography (2DE) during exercise echocardiography. METHODS:100 patients underwent peak and postexercise (PEx) 2DE and 3DE on separate days. Coronary artery disease was detected in 58 patients. A quality score was calculated by assigning 0 to 3 points to each wall (apicoseptal, posterolateral, anterior, inferior). RESULTS:Feasibility of peak 2DE, peak 3DE, PEx 2DE, and PEx 3DE was 99%, 92%, 100%, and 95%, respectively (2DE at peak or PEx vs peak 3DE, P < .05). Agreement between 2DE and 3DE was 82% at peak (kappa = 0.62) and 78% at PEx (kappa = 0.55). Quality score less than 2 was seen in 4% of the walls with peak 2DE, in none with PEx 2DE, in 18% by peak 3DE, and in 14% by PEx 3DE. The mean quality score was lower with 3DE at peak and at PEx (2.4 +/- 0.9 vs 2.9 +/- 0.3; and 2.5 +/- 0.8 vs 3.0 +/- 0.1, both P < .0001). Acquisition time was shorter with 3DE at peak and PEx (22 +/- 8 vs 43 +/- 14 seconds; and 15 +/- 5 vs 31 +/- 14 seconds, both P < .0001). Sensitivity of peak 2DE, peak 3DE, PEx 2DE, and PEx 3DE was 84%, 78%, 71%, and 58%, respectively (P < .05 vs peak 3DE and peak 2DE). Specificity was 76%, 73%, 93%, and 88%, respectively. Accuracy for peak 2DE was 81% (area under the curve [AUC] 0.81, 95% confidence interval [CI] = 0.71-0.91); for peak 3DE was 76% (AUC 0.76, 95% CI = 0.65-0.86); for PEx 2DE was 80% (AUC 0.84, 95% CI = 0.75-0.92); and for PEx 3DE was 71% (AUC 0.73, 95% CI = 0.62-0.83). CONCLUSIONS:Three-dimensional echocardiography during exercise is comparable with 2DE in terms of sensitivity and specificity but feasibility is lower.
10.1016/j.echo.2007.01.034
3D-speckle tracking echocardiography for assessment of coronary artery disease severity in stable angina pectoris.
Dogdus Mustafa,Simsek Evrim,Cinar Cahide Soydas
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND AND AIM:Stable angina pectoris is a common disease that may cause disability. Some noninvasive new methods can be useful for the detection of early-stage coronary artery disease. The relationship between coronary artery disease (CAD) severity and resting 3-dimensional-speckle tracking echocardiography (3D-STE) in stable angina pectoris patients was evaluated in this study. METHODS:One hundred and twenty consecutive patients between 18-80 years of age and without a history of CAD to whom elective coronary angiography was planned after positive stress test or myocardial perfusion scintigraphy were enrolled in the study. 3D-STE was performed and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured before coronary angiography. A Gensini score of ≥20 was accepted as critical CAD. Correlation between Gensini scores and 3D-STE results were evaluated. RESULTS:Mean age was 60.7 ± 10.01 years, and 55% of the patient population were male. There were not any significant differences between critical CAD and noncritical CAD groups for age, gender, history of hypertension, diabetes mellitus, hyperlipidemia, and Left Ventricular Ejection Fraction. Mean GLS was -12, GCS was -18.8, GRS was 33.4, GAS was -28.9, and mean Gensini score was 18.8. GLS and all other strain parameters were significantly worse in patients with critical CAD group compared with noncritical CAD group and also positive linear correlation was observed between Gensini score and all measured strain parameters (r = 0.568, P < 0.001 for Gensini score and GLS; r = 0.617, P < 0.001 for Gensini score and GAS). A GLS value of >-10 has 88.9% sensitivity and 92.9% specificity; A GAS value of >-21 has 97.2% sensitivity and 88.1% specificity to detect critical CAD. CONCLUSIONS:3D-STE is a noninvasive and handy parameter to detect subclinical left ventricular dysfunction and global strain values were significantly correlated with CAD severity. GAS has the sensitivity of 97.2% and specificity of 88.1% to detect critical CAD. Adding 3D strain echocardiography to exercise test or myocardial perfusion scintigraphy might increase sensitivity to detect critical CAD in clinical practice.
10.1111/echo.14214
Usefulness of real-time 3-dimensional echocardiography for the evaluation of coronary artery morphology in patients with Kawasaki disease.
Miyashita Michio,Karasawa Kensuke,Taniguchi Kazuo,Kanamaru Hiroshi,Ayusawa Mamoru,Sumitomo Naokata,Harada Kensuke
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
OBJECTIVES:This study was designed to evaluate the usefulness of real-time 3-dimensional echocardiography (RT-3DE) for evaluating coronary artery morphology in patients with Kawasaki disease. BACKGROUND:The diagnosis of coronary artery morphology in the acute phase of the disease is of prime importance for evaluating the likelihood of cardiovascular sequelae. Occasionally, visualization of the right coronary artery and bifurcated regions, including the circumflex artery, has proved challenging with traditional echocardiographic methods. METHODS:A total of 111 patients with Kawasaki disease were studied. Coronary aneurysms were detected in 8 patients (4 had giant aneurysms), and coronary dilation was found in 11 patients. Coronary artery visualization was evaluated and scored as 1 of 4 grades, 0 to 3 points, for both 2-dimensional echocardiography (2DE) and RT-3DE. Evaluation criteria for each coronary artery were defined according to the American Heart Association classification of coronary angiographic features. Total scores for each patient and for individual coronary branches were compared between 2DE and RT-3DE. RESULTS:The total scores for coronary artery visualization were, respectively, showing a significantly higher score for RT-3DE than for 2DE (P < .01). A mural thrombus could be clearly delineated in the giant coronary aneurysms by RT-3DE. CONCLUSIONS:RT-3DE is superior to 2DE for coronary artery visualization. This diagnostic system is expected to improve the screening of coronary artery abnormalities in Kawasaki disease.
10.1016/j.echo.2007.01.024
Prediction of Left Ventricular Filling Pressure by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Coronary Artery Disease.
Ma Hong,Xie Rong-Ai,Gao Li-Jian,Zhang Jin-Ping,Wu Wei-Chun,Wang Hao
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
OBJECTIVES:The purpose of this study was to investigate the diagnostic value of 3-dimensional (3D) speckle-tracking echocardiography for estimating left ventricular filling pressure in patients with coronary artery disease (CAD) and a preserved left ventricular ejection fraction. METHODS:Altogether, 84 patients with CAD and 30 age- and sex-matched healthy control participants in sinus rhythm were recruited prospectively. All participants underwent conventional and 3D speckle-tracking echocardiography. Global strain values were automatically calculated by 3D speckle-tracking analysis. The left ventricular end-diastolic pressure (LVEDP) was determined invasively by left heart catheterization. Echocardiography and cardiac catheterization were performed within 24 hours. RESULTS:Compared with the controls, patients with CAD showed lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain. Patients with CAD who had an elevated LVEDP had much lower levels of all 4 3D-speckle-tracking echocardiographic variables. Pearson correlation analysis revealed that the LVEDP correlated positively with the early transmitral flow velocity/early diastolic myocardial velocity (E/E') ratio, global longitudinal strain, global circumferential strain, and global area strain. It correlated negatively with global radial strain. Receiver operating characteristic curve analysis revealed that these 3D speckle-tracking echocardiographic indices could effectively predict elevated left ventricular filling pressure (LVEDP >15 mm Hg) in patients with CAD (areas under the curve: global longitudinal strain, 0.78; global radial strain, 0.77; global circumferential strain, 0.75; and global area strain, 0.74). These parameters, however, showed no advantages over the commonly used E/E' ratio (area under the curve, 0.84). CONCLUSIONS:Three-dimensional speckle-tracking echocardiography was a practical technique for predicting elevated left ventricular filling pressure, but it might not be superior to the commonly used E/E' ratio in patients with CAD who have a normal left ventricular ejection fraction.
10.7863/ultra.15.14.11010
Real-time three-dimensional echocardiographic assessment of left ventricular remodeling index in patients with hypertensive heart disease and coronary artery disease.
Chen Ming,Wang Jing,Xie Mingxing,Wang Xinfang,Lv Qing,Wang Lei,Li Yan,Fu Manli
Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban
Left ventricular remodeling index (LVRI) was assessed in patients with hypertensive heart disease (HHD) and coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT3DE). RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controls (NC) were acquired. Left ventricular end-diastolic volume (EDV) and left ventricular end-diastolic epicardial volume (EDVepi ) were detected by RT3DE and two-dimensional echocardiography Simpson biplane method (2DE). LVRI (left ventricular mass /EDV) was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups (P<0.01). There was no significant difference in NC group (P>0.05), but significant difference in HHD and CAD intra-group (P<0.05). There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups (r=0.69, P<0.01; r=0.68, P<0.01), but no significant correlation in CAD group (r=0.30, P>0.05). It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.
10.1007/s11596-009-0126-0
Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction.
Medicine
To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.
10.1097/MD.0000000000038058
Quantitative assessment of diffuse coronary artery disease using a three-dimensional reconstruction method compared with intravascular ultrasound images.
Tsuchiya T,Shimizu M,Yoshio H,Ino H,Okeie K,Yasuda T,Mabuchi H
Coronary artery disease
BACKGROUND:It can be difficult to estimate the degree of stenosis in patients with diffuse coronary artery disease (CAD), because of the lack of a normal reference segment. If the size of normal coronary lumen has a direct relation to size of distal myocardial bed, it could be used to estimate the 'normal' cross-sectional area of coronary lumen. Accordingly, we could estimate the degree of stenosis of coronary arteries with diffuse disease by comparing them with calculated 'normal' areas of lumen. OBJECTIVE:To assess the validity of the above hypothesis. METHOD:Fourteen subjects without coronary atherosclerosis (group A) and 16 patients with CAD (group B) underwent simultaneous bidirectional coronary arteriography. Using these coronary arteriograms, we determined the relationship between cross-sectional area of coronary lumen measured by using a computerized edge-detection system and summed distal branch length calculated by using our computerized three-dimensional reconstruction method. RESULTS:For group A, we found a close correlation between area of lumen and branch length (r= 0.948). However, for group B, there were some segments for which the measured area of lumen was clearly smaller than that expected from the relationship for group A. From this relationship for group A, we calculated the stenosis ratios of 22 segments and, to confirm their accuracy, we compared the stenotic ratios with those measured on intravascular ultrasound images. The stenotic ratio of each segment of stenotic coronary artery calculated by our method agreed significantly well with the results obtained from the ultrasound measurements (r= 0.980). CONCLUSIONS:These observations validate a novel approach to quantifying diffuse CAD using clinical arteriograms.
10.1097/00019501-200103000-00006
Three Dimensional Carotid and Femoral Ultrasound is not Superior to Two Dimensional Ultrasound as a Predictor of Coronary Atherosclerosis Among Men With Intermediate Cardiovascular Risk.
Jarauta Estíbaliz,Laclaustra Martin,Villa-Pobo Rosa,Langarita Raquel,Marco-Benedi Victoria,Bea Ana M,León-Latre Montse,Casasnovas Jose A,Civeira Fernando
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
BACKGROUND:Current cardiovascular disease (CVD) risk stratification scales, drawn up from traditional risk factors, have important limitations. The detection of subclinical atherosclerosis, by a non-invasive technique such as peripheral arteries ultrasound (US) may improve cardiovascular risk (CVR) stratification, especially in intermediate risk population. Our aim was to compare the predictive power of atherosclerotic plaques detected in carotid and femoral arteries by 2-dimensional (2D) vs. 3-dimensional (3D) US for positive coronary artery calcium score (CACS), used as a proxy for CVD, in a middle-aged sample with intermediate 10-year CVR (7.5-20%). METHODS:To detect atherosclerotic plaques by 2D vs. 3D US scan of carotid and femoral arteries and comparison of their association with CACS obtained by computed tomography (CT) of subjects with intermediate CVR belonging to the Aragon Workers' Health Study. RESULTS:120 men were included, with a 10.4% average 10 years CVR. Forty-one (34.2%) participants had CACS ≥ 1. 90 participants (75%) had at least one plaque detected by 2D scan while 85 participants (70.8%) had at least a plaque detected by 3D US. Conventional CVR estimates c-statistic for CACS was .590. Although the variables most predicted of CACS ≥ 1 were those measured by 3D US (total plaque volume and mean of plaque density, c-statistics: .743 and .750 respectively), their predictive capacity was not statistically significantly different from the number of territories with plaque, measured either by 2D and 3D US (c-statistics .728 to .740 respectively). CONCLUSION:Subclinical atherosclerosis measured by 2D and 3D US were better predictors of CACS ≥ 1 than CVR estimated by conventional guidelines. In our sample, 3D US did not show any significant advantages with respect to 2D US for the prediction of coronary atherosclerosis.
10.1016/j.ejvs.2019.07.039
Value of real-time three-dimensional adenosine stress contrast echocardiography in patients with known or suspected coronary artery disease.
Aggeli Constantina,Felekos Ioannis,Roussakis George,Kazazaki Christina,Lagoudakou Stauroula,Pietri Panagiota,Tousoulis Dimitrios,Pitsavos Christos,Stefanadis Christodoulos
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology
AIM:The aim of this study was to evaluate the feasibility of myocardial wall-motion and perfusion assessment using contrast echocardiography during real-time three-dimensional (RT3D) adenosine stress test, and compare its diagnostic accuracy with the two-dimensional (2D) method using coronary angiography as reference. METHODS AND RESULTS:Patients with known or suspected coronary artery disease (CAD) have been submitted to adenosine stress contrast echocardiography and coronary angiography, within a 1-month period. Two-dimensional apical four, two, and three chamber, as well as three-dimensional (3D) pyramidal full-volume data sets were acquired at rest and at peak stress. The 17-segment division of the left ventricle was used and each segment was evaluated based on wall motion and perfusion. Sixty patients (age: 60.1 ± 8.5 years, 38 men) were enrolled, i.e. 1020 segments were evaluated at rest and at peak stress. Wall-motion analysis per patient revealed that the sensitivity and specificity of 2D to detect CAD were 80 and 82% and of RT3D echocardiography were 82 and 64%, respectively, whereas in the per patient perfusion analysis the respective percentages were 88, 64% for 2D and 90, 73% for RT3D. Regarding left anterior descending artery and right coronary system, there seems to be no statistical significant difference in terms of wall-motion and perfusion evaluation between the two modalities. CONCLUSIONS:Real-time 3D adenosine stress echocardiography is a feasible and valuable technique to evaluate myocardial wall motion and perfusion in patients with suspected CAD, despite existing problems concerning lower spatial and temporal resolution when compared with 2D echocardiography.
10.1093/ejechocard/jer103
Real-time three-dimensional echocardiography of left atrial volume and function in patients with severe multi-vessel coronary artery disease.
Yang Lingjie,Ma Li,Li Yanhong,Mu Yuming,Liu Liyun
Journal of medical ultrasonics (2001)
PURPOSE:To evaluate the changes in left atrial (LA) volume and function in patients with severe multi-vessel coronary artery disease (CAD) by real-time three-dimensional echocardiography (RT-3DE). METHODS:One hundred and eight subjects were stratified based on coronary angiography (CAG) imaging, comprising 48 patients with severe multi-vessel CAD, 31 patients with severe single-vessel CAD, and 29 controls. RT-3DE was performed in all groups. LA volume parameters were measured. LA ejection fractions (EF) and LA function index (LAFI) were also calculated. RESULTS:There were no significant differences between the single-vessel CAD group and the control group, while LA passive emptying fraction (LAVpEF) was significantly reduced in the single-vessel CAD group. In the multi-vessel CAD group, LAVpEF and LAFI were lower, while LA presystolic volume (LAVpre) was prominently higher as compared with the other groups, and LA active emptying volume (LAVa) was higher than that in the control group (p < 0.05). Receiver-operating characteristic (ROC) analysis showed that the area under the curve (AUC) of LAVpEF was the largest parameter; the optimal cut-off value, AUC, sensitivity, and specificity were 0.50, 0.864, 93.7, and 72.4 %, respectively. CONCLUSION:Specifically, conduit function reflects the early changes in LA function, and CAD damage is aggravated with increasing coronary lesions, whereas the booster pump function of severe multi-vessel CAD can increase in compensation. We speculate that LAVpEF may be the most ideal threshold for detecting and differentiating severe CAD patients from controls.
10.1007/s10396-016-0754-5
Real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging in the evaluation of left atrial function in patients with triple-vessel coronary artery disease without myocardial infarction.
Journal of clinical ultrasound : JCU
OBJECTIVE:To evaluate left atrial function in patients with triple-vessel disease (TVD) without myocardial infarction by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STE). METHODS:Sixty patients with coronary artery disease (CAD) without myocardial infarction were classified into two groups in accordance with the coronary angiography results: group B (all triple-vessel stenosis ≥ 50% and < 75%) and group C (all triple-vessel stenosis ≥ 75%). Thirty healthy individuals were selected as group A. LA volume related parameters including left atrial maximum volume index (LAVImax), LA passive and active ejection fraction (LAPEF, LAAEF) and LA total ejection fraction (LATEF) were measured by RT-3DE. The global peak atrial longitudinal systolic strain (LASRs), early and late diastolic LA strain (LASRe and LASRa) rates were measured by 2D-STE. RESULTS:We found statistically significant differences between 2D-STE and RT-3DE related parameters of these three groups. Furthermore, in groups B and C, N-terminal fragment brain natriuretic peptides (NT-pro-BNP) and left ventricular end-diastolic pressure (LVEDP) were found to be significantly correlated with LASRs and LASRa. And NT-pro-BNP had a moderate correlation with LVEDP. CONCLUSIONS:2D-STE and RT-3DE can assess the LA function in patients with TVD without myocardial infarction. And LA strain values may provide additional information for predicting increased LVEDP and NT-pro-BNP.
10.1002/jcu.23188
Three-Dimensional Fluid Dynamical Features of Coronary Plaque Rupture Provoking Acute Coronary Syndrome.
Journal of atherosclerosis and thrombosis
AIM:Coronary plaque rupture is the main cause of acute coronary syndrome (ACS), but the role of blood flow features around plaque rupture for ACS is still unknown. The present study aimed to assess the relationship between the geometric configuration of ruptured plaque and ACS occurrence using computational fluid dynamics (CFD) by moving particle method in patients with coronary artery disease. METHODS:In this study, 45 patients with coronary artery disease who underwent three-dimensional intravascular ultrasound (IVUS) and had a coronary ruptured plaque (24 plaques with provoked ACS, 21 without) were included. To compare the difference in blood flow profile around ruptured plaque between the patients with and without ACS, the IVUS images were analyzed via the novel CFD analysis. RESULTS:There were no significant differences in localized flow profile around ruptured plaque between the two groups when the initial particle velocity was 10.0 cm/s corresponded to a higher coronary flow velocity at ventricular diastole. However, when it was 1.0 cm/s corresponded to lower coronary flow velocity at ventricular systole, particles with lower velocity (0 ≤ V ≤ 5 cm/s) were more prevalent around ACS-PR ( p=0.035), whereas particles with higher velocity (10 ≤ V ≤ 20 cm/s) were more often detected in silent plaque ruptures (p=0.018). CONCLUSIONS:Three-dimensional IVUS revealed that coronary plaque rupture was a complex one with a wide variety of its stereoscopic configuration, leading to various patterns of the local coronary flow profile. A novel CFD analysis suggested that the local flow was more stagnant around ACS-provoked ruptures than in silent ones.
10.5551/jat.60509
Echocardiographic evaluation of coronary artery disease.
Chatzizisis Yiannis S,Murthy Venkatesh L,Solomon Scott D
Coronary artery disease
Although the availability and utilization of other noninvasive imaging modalities for the evaluation of coronary artery disease have expanded over the last decade, echocardiography remains the most accessible, cost-effective, and lowest risk imaging choice for many indications. The clinical utility of mature echocardiographic methods (i.e. two-dimensional echocardiography, stress echocardiography, contrast echocardiography) across the spectrum of coronary artery disease has been well established by numerous clinical studies. With continuing advancements in ultrasound technology, emerging ultrasound technologies such as three-dimensional echocardiography, tissue Doppler imaging, and speckle tracking methods hold significant promise to further widen the scope of clinical applications and improve diagnostic accuracy. In this review, we provide an update on the role of echocardiography in the diagnosis, management, and prognosis of coronary artery disease and introduce emerging technologies that are anticipated to further increase the clinical utility of echocardiography in the evaluation of patients with coronary artery disease.
10.1097/MCA.0000000000000028
Quantitative coronary three-dimensional geometry and its association with atherosclerotic disease burden and composition.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
BACKGROUND:Isolate features of the coronary anatomy have been associated with the pathophysiology of atherosclerotic disease. Computational methods have been described to allow precise quantification of the complex three-dimensional (3D) coronary geometry. The present study tested whether quantitative parameters that describe the spatial 3D coronary geometry is associated with the extension and composition of the underlying coronary artery disease (CAD). METHODS:Patients with CAD scheduled for percutaneous intervention were investigated with coronary computed tomography angiography (CCTA), and invasive coronary angiography, and virtual histology intravascular ultrasound (IVUS-VH). For all target vessels, 3D centerlines were extracted from CCTA images and processed to quantify 23 geometric indexes, grouped into 3 main categories as follows: (i) length-based; (ii) curvature-based, torsion-based, and curvature/torsion-combined; (iii) vessel path-based. The geometric variables were compared with IVUS-VH parameters assessing the extent and composition of coronary atherosclerosis. RESULTS:A total of 36 coronary patients (99 vessels) comprised the study population. From the 23 geometric indexes, 18 parameters were significantly (p < 0.05) associated with at least 1 IVUS-VH parameter at a univariate analysis. All three main geometric categories provided parameters significantly related with atherosclerosis variables. The 3D geometric indexes were associated with the degree of atherosclerotic extension, as well as with plaque composition. Geometric features remained significantly associated with all IVUS-VH parameters even after multivariate adjustment for clinical characteristics. CONCLUSIONS:Quantitative 3D vessel morphology emerges as a relevant factor associated with atherosclerosis in patients with established CAD.
10.1002/ccd.30639
Values of three-dimensional speckle tracking imaging for the diagnosis of coronary artery disease.
Scandinavian cardiovascular journal : SCJ
Coronary artery disease (CAD) is a top life-threatening disease and early and sensitive detection of CAD remains a challenge. This study aimed to assess the value of three-dimensional speckle tracking imaging (3D-STI) in diagnosing CAD patients and investigate the parameters of 3D-STI associated with disease severity. A total of 260 suspected CAD patients who met the study criteria underwent coronary angiography within one week after the ultrasound examination. Based on the examination results, 142 patients were confirmed to have CAD (CAD group), while 118 patients were classified as non-CAD (NCAD group). Age, gender, family history, smoking status, diabetes, hypertension, dyslipidemia, electrocardiogram, BMI, heart rate, and left ventricular ejection fraction were compared between the two groups. Additionally, 3D-STI parameters including left ventricular global radial strain (GRS), left ventricular global longitudinal strain (GLS), left ventricular global area strain (GAS), and left ventricular global circumferential strain (GCS) were analyzed. No significant differences were found between the CAD and NCAD groups in terms of demographics, smoking history, physiological measurements, and common comorbidities such as diabetes mellitus and dyslipidemia. However, when comparing the 3D-STI parameters, all four parameters, including GLS, GRS, GCS, and GAS, were significantly different in the CAD group compared to the NCAD group. The results suggest that 3D-STI parameters have diagnostic value for CAD, and their changes are associated with CAD severity. Combined detection of these parameters enhances diagnostic accuracy compared to individual detection.
10.1080/14017431.2024.2373091
Recent advances in vascular ultrasound imaging technology and their clinical implications.
Golemati Spyretta,Cokkinos Demosthenes D
Ultrasonics
In this paper recent advances in vascular ultrasound imaging technology are discussed, including three-dimensional ultrasound (3DUS), contrast-enhanced ultrasound (CEUS) and strain- (SE) and shear-wave-elastography (SWE). 3DUS imaging allows visualisation of the actual 3D anatomy and more recently of flow, and assessment of geometrical, morphological and mechanical features in the carotid artery and the aorta. CEUS involves the use of microbubble contrast agents to estimate sensitive blood flow and neovascularisation (formation of new microvessels). Recent developments include the implementation of computerised tools for automated analysis and quantification of CEUS images, and the possibility to measure blood flow velocity in the aorta. SE, which yields anatomical maps of tissue strain, is increasingly being used to investigate the vulnerability of the carotid plaque, but is also promising for the coronary artery and the aorta. SWE relies on the generation of a shear wave by remote acoustic palpation and its acquisition by ultrafast imaging, and is useful for measuring arterial stiffness. Such advances in vascular ultrasound technology, with appropriate validation in clinical trials, could positively change current management of patients with vascular disease, and improve stratification of cardiovascular risk.
10.1016/j.ultras.2021.106599