scholarly journals P900 The Heart Model: Automated LVEF calculation in the real world

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Dhunnoo ◽  
A Mills ◽  
E F Lloyd ◽  
A Sabra ◽  
A Margulescu ◽  
...  
Keyword(s):  
Correlation Coefficients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Heart Model ◽  
Altman Plot ◽  
Endocardial Border ◽  
Independent Observer ◽  
Ventricular Ejection Fraction ◽  
Bland Altman Plot ◽  
Chamber View

Abstract Background Heart Model (HM) is a proprietary, model-based algorithm for measurement of left ventricular ejection fraction (LVEF) in a 3D dataset acquired from an apical 4-chamber view by transthoracic echocardiography (TTE). There is evidence for superior reproducibility compared to 2D echo methods for LVEF measurement. Objective To assess the correlation of LVEF by HM with conventional, 2D LVEF methods. Methods All TTEs performed between 04-08/02/2019 by 2 HM-trained sonographers were included. Demographic characteristics, indication for TTE, LVEF by Simpson"s (LVEF_S), by "eyeballing" (LVEF_EB) and by HM (LVEF_HM), were recorded; LVEF for each study was also estimated by eye-balling by an experienced observer unaware of the reported LVEF (LVEF_IND). We compared LVEF by each method, their reciprocal correlations and their correlation with LVEF_HM. Image quality was rated excellent (endocardial border visible for all segments in the 3 apical views), good (< 1 segment was not visible / view), adequate (< 3 segments were not visible) and limited (<4 segments were not visible). Indications for TTE were: assessment of LVEF in 1/3 of the studies, murmurs in 1/5, and other indications in the rest. Results We included 74 patients (42 M, mean age (SD) 69.8(13.9), range 18-92 years). Forty-nine (66%) patients were in sinus rhythm, 23 (31%) were in AF, and the rest were in various paced rhythms. Fifty patients (68%) had excellent, good or adequate images. The EFs calculated by different methods are shown in the Table (p > 0.05 for all), an the Bland Altman plot (LVEF_EB vs HM) in the figure. LVEF_HM correlated modestly with the other methods if all studies were included (r = 0.535 LVEF_HM vs. LVEF_EB); the correlation improved if only good-quality studies were included (r = 0.769, p < 0.001 for both). All combinations of LVEF_IND, LVEF_EB and LVEF_S had correlation coefficients >0.93. Conclusions The Heart Model algorithm for LVEF measurement correlates well with traditional 2D methods in patients with good endocardial border definition, where its use can potentially improve reproducibility and reduce exam duration. LVEF by method (good-quality studies) N = 50 Simpson"s Eyeballing HeartModel Independent Mean(%) 48.6 48.9 50.9 48.8 SD(%) 17.8 16.6 14.9 15.7 Median(%) 54.5 52.5 53 50 Range(%) 16-74 17.5-72.5 19-88 15-75 SD - standard deviation Independent - LVEF estimate (eyeballing) by independent observer unaware of reported EFs. LVEF_EB was chosen as it was available inall the reports. Abstract P900 Figure. Bland Altman Plot (LVEF_EB vs LVEF_HM)

scholarly journals Ultrasound Study of Layer-specific Strain and Perfusion of Left Ventricular Myocardium in Patients With Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Sha Tang ◽  
Lina Guan ◽  
Yuming Mu
Keyword(s):  
Dilated Cardiomyopathy ◽  
Correlation Coefficients ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Left Ventricular Myocardium ◽  
Ventricular Ejection Fraction ◽  
Myocardial Microcirculation

Abstract BackgroundTo investigate the changes in deformation and myocardial microcirculation perfusion of left ventricular three-layer myocardium in patients with dilated cardiomyopathy (DCM) by using speckle tracking imaging (STI) and myocardial contrast echocardiography (MCE).MethodsTwenty-four patients with DCM and 19 healthy controls were selected. Two-dimensional and MCE dynamic images of apical four-chamber, two-chamber, and three-chamber sections and left ventricular mitral valve, papillary muscle and apex sections were collected. The peak values of longitudinal strain (LS), circumferential strain (CS), cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) were obtained by Qlab 10.8 workstation values, and myocardial blood flow (MBF) was calculated with A×β to evaluate the deformation and coronary microvascular perfusion of left ventricular three-layer myocardium.ResultsThe brain natriuretic peptide (BNP), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVEDS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVI), E peak in early diastolic period/A peak velocity in late diastolic period (E/A) and average E/e' in the DCM group were higher than those in the control group (P < 0.05); left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS) rate, stroke volume (SV), cardiac output (CO), cardiac index (CI), A peak, and the e' and a' velocities of both the lateral wall and interventricular septum were smaller than those in the control group (P<0.05). The LS, CS, A, β, and A×β of the DCM group were all lower than those of the control group (P < 0.05). The pattern of myocardial strain and perfusion among myocardial layers was subendocardial>middle>subepicardial. The correlation coefficients of LS with A, β, and A×β were -0.500, -0.279 and -0.190, respectively, and the correlation coefficients of CS with A, β, and A×β were -0.383, -0.255 and -0.208, respectively.ConclusionsThe deformation of the three-layer myocardium and coronary microcirculation perfusion in DCM patients were diffusely damaged from the endocardium to the epicardium, layer by layer. The longitudinal function of the left ventricular myocardium was closely related to changes in myocardial microcirculation perfusion.

scholarly journals Ultrasound Study of Layer-specific Strain and Perfusion of Left Ventricular Myocardium in Patients With Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Sha Tang ◽  
Lina Guan ◽  
Yuming Mu
Keyword(s):  
Dilated Cardiomyopathy ◽  
Correlation Coefficients ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Left Ventricular Myocardium ◽  
Ventricular Ejection Fraction ◽  
Myocardial Microcirculation

Abstract BackgroundTo investigate the changes in deformation and myocardial microcirculation perfusion of left ventricular three-layer myocardium in patients with dilated cardiomyopathy (DCM) by using speckle tracking imaging (STI) and myocardial contrast echocardiography (MCE).MethodsTwenty-four patients with DCM and 19 healthy controls were selected. Two-dimensional and MCE dynamic images of apical four-chamber, two-chamber, and three-chamber sections and left ventricular mitral valve, papillary muscle and apex sections were collected. The peak values of longitudinal strain (LS), circumferential strain (CS), cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) were obtained by Qlab 10.8 workstation values, and myocardial blood flow (MBF) was calculated with A×β to evaluate the deformation and coronary microvascular perfusion of left ventricular three-layer myocardium.ResultsThe brain natriuretic peptide (BNP), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVEDS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVI), E peak in early diastolic period/A peak velocity in late diastolic period (E/A) and average E/e' in the DCM group were higher than those in the control group (P < 0.05); left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS) rate, stroke volume (SV), cardiac output (CO), cardiac index (CI), A peak, and the e' and a' velocities of both the lateral wall and interventricular septum were smaller than those in the control group (P<0.05). The LS, CS, A, β, and A×β of the DCM group were all lower than those of the control group (P < 0.05). The pattern of myocardial strain and perfusion among myocardial layers was subendocardial>middle>subepicardial. The correlation coefficients of LS with A, β, and A×β were -0.500, -0.279 and -0.190, respectively, and the correlation coefficients of CS with A, β, and A×β were -0.383, -0.255 and -0.208, respectively.ConclusionsThe deformation of the three-layer myocardium and coronary microcirculation perfusion in DCM patients were diffusely damaged from the endocardium to the epicardium, layer by layer. The longitudinal function of the left ventricular myocardium was closely related to changes in myocardial microcirculation perfusion.

Abstract 15: The Use of Handheld Focused Cardiac Ultrasound (FoCUS) for EF Assessment at Parkland Memorial Hospital: A Quality Improvement Initiative With Novel Applications for Clinical Outcomes

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Samreen Raza ◽  
Rebecca Vigen ◽  
Susan Matulevicius
Keyword(s):  
Image Quality ◽  
Gold Standard ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Quality Improvement Initiative ◽  
Cardiac Ultrasound ◽  
Endocardial Border ◽  
Ventricular Ejection Fraction ◽  
Focused Cardiac Ultrasound ◽  
Patient Reported

Background: Focused cardiac ultrasound (FCU) has been used to answer clinical questions. Chemotherapy-related cardiotoxicity (CRR) is an entity that requires serial echocardiography. It is unknown whether FCU can be used to screen for CRR using advanced practice providers (APPs). The goal of this study is to determine if FCU can be used to reliably evaluate left ventricular ejection fraction (EF) by an APP to assess for CRR. Methods: The study was conducted at the Echo lab and the Oncology clinic. An Oncology APP was trained on the use of FCU and EF analysis. The APP was trained to obtained standard 2D views for EF assessment and on EF interpretation. The EF assessment was compared to sonographer echocardiogram on the same day. EF was assessed by a cardiologist and this was deemed to be the gold standard. The studies were all analyzed by two separate blinded cardiologists and the degree of correlation was analyzed. Linear regression modeling to analyze correlation between EF interpretation between all blinded observers and Bland Altman analysis was performed. Image quality was evaluated for all FCU images by a single blinded cardiologist and segmental endocardial border delineation was scored. Results: A total of 91 patients were scanned in Phase I of the study. The correlation coefficient between cardiologists was r=0.93. The correlation between cardiologist and APP were r=0.79 and 0.76 respectively. For the images obtained by the APP, the correlation between the APP and cardiologists were =0.83 and re=0.78. The correlation between APP and EF gold standard was r=0.77. The correlation between experienced cardiologists interpreting the FCU images was r=0.87. All images were determined to be interpretable. Conclusions: There was good correlation between cardiologists with respect to EF analysis. There was also good correlation between APP and cardiologists for EF analysis. Image quality from FCU was found to be good and acceptable for interpretation. This study demonstrates it is feasible to train an APP on obtaining images for EF analysis and they can be trained on EF interpretation with good correlation with experienced echocardiographers. We will evaluate outcomes associated with its use including delays to chemotherapy imposed by traditional echocardiography, cost to the health care system and patient-reported outcomes.

Abstract 19601: Differential Patient Perceptions of Limitations to Quality of Life in a Large Ambulatory Heart Failure Population

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Emer Joyce ◽  
Sabrina Badloe ◽  
Lynne W Stevenson ◽  
Akshay Desai ◽  
Christine Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Correlation Coefficients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Medical Problems ◽  
Ventricular Ejection Fraction ◽  
Visual Analog Scales ◽  
The Impact

Introduction: Clinical assessment of quality of life (QOL) is being increasingly adopted in the ambulatory management of heart failure (HF). Little is known about the impact of other conditions on QOL in clinical practice. Methods: Patients routinely presenting to the HF clinic completed a self-administered 1-page questionnaire prior to the visit that assessed QOL, functional status, and degree to which their HF, as well as other conditions, affected their QOL. Visual analog scales (VAS) were used to assess a) overall QOL, b) ease of breathing, and c) energy > fatigue. Scores ranged from 0 to 100 (higher scores representing better health status). Patients were asked if their QOL was affected more, equally, or less by their HF compared to other medical conditions. Data was analyzed with Pearson’s correlation coefficients, ANOVA and Chi-square tests. Results: A total of 1069 patients completed baseline QOL (mean age 57±16 years, 56% left ventricular ejection fraction [LVEF] ≥40%, 41% female). Mean QOL score was 63±28. Only 48% of patients felt that HF affected their QOL most while 20% felt HF was equal to other illnesses, 18% cited other medical problems and 14% non-medical problems as most important for their QOL. Patients reporting HF as the primary factor influencing QOL had significantly lower scores on all 3 VAS measures, the highest proportion of patients with low LVEF and the strongest correlation between QOL and VAS Breathing (R=0.68) (Table). Conclusions: Patients describing HF as their major limitation had the lowest QOL score and were most affected by dyspnea and fatigue. However, over half of ambulatory HF patients rate other medical and/or non-medical factors as equal or greater limitations to their QOL, suggesting this important clinical outcome will be difficult to impact by therapies targeted at HF alone, particularly in those with LVEF ≥40%.

scholarly journals Ultrasound Study of Layer-specific Strain and Perfusion of Left Ventricular Myocardium in Patients With Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Sha Tang ◽  
Lina Guan ◽  
Yuming Mu
Keyword(s):  
Dilated Cardiomyopathy ◽  
Correlation Coefficients ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Left Ventricular Myocardium ◽  
Ventricular Ejection Fraction ◽  
Myocardial Microcirculation

Abstract BackgroundTo investigate the changes in deformation and myocardial microcirculation perfusion of left ventricular three-layer myocardium in patients with dilated cardiomyopathy (DCM) by using speckle tracking imaging (STI) and myocardial contrast echocardiography (MCE).MethodsTwenty-four patients with DCM and 19 healthy controls were selected. Two-dimensional and MCE dynamic images of apical four-chamber, two-chamber, and three-chamber sections and left ventricular mitral valve, papillary muscle and apex sections were collected. The peak values of longitudinal strain (LS), circumferential strain (CS), cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) were obtained by Qlab 10.8 workstation values, and myocardial blood flow (MBF) was calculated with A×β to evaluate the deformation and coronary microvascular perfusion of left ventricular three-layer myocardium.ResultsThe brain natriuretic peptide (BNP), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVEDS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVI), E peak in early diastolic period/A peak velocity in late diastolic period (E/A) and average E/e' in the DCM group were higher than those in the control group (P < 0.05); left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS) rate, stroke volume (SV), cardiac output (CO), cardiac index (CI), A peak, and the e' and a' velocities of both the lateral wall and interventricular septum were smaller than those in the control group (P<0.05). The LS, CS, A, β, and A×β of the DCM group were all lower than those of the control group (P < 0.05). The pattern of myocardial strain and perfusion among myocardial layers was subendocardial>middle>subepicardial. The correlation coefficients of LS with A, β, and A×β were -0.500, -0.279 and -0.190, respectively, and the correlation coefficients of CS with A, β, and A×β were -0.383, -0.255 and -0.208, respectively.ConclusionsThe deformation of the three-layer myocardium and coronary microcirculation perfusion in DCM patients were diffusely damaged from the endocardium to the epicardium, layer by layer. The longitudinal function of the left ventricular myocardium was closely related to changes in myocardial microcirculation perfusion.

Abstract 14082: The Effect of Diagnostic Ultrasound Mediated High Mechanical Impulses on Cardiac Output During an Ultrasound Enhancing Agent Infusion

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Swethika Sundaravel ◽  
Jessica Roettger ◽  
Arif Albulushi ◽  
Joan Olson ◽  
Feng Xie ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Contrast Echocardiography ◽  
Diagnostic Ultrasound ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mechanical Index ◽  
Endocardial Border ◽  
Ventricular Ejection Fraction ◽  
The Impact

Introduction: Diagnostic ultrasound high mechanical index (MI) impulses are used during an ultrasound enhancing agent (UEA) infusion to improve endocardial border resolution and study myocardial perfusion. They have also been shown to cause endothelial shear, resulting in prolonged increases in ATP release and augment microvascular flow. The potential for these high MI impulses to alter cardiac output (CO) are unknown. Hypothesis: To study the impact of high MI impulses on CO Methods: Fifty one patients (mean age 63±15 years; 41% female) referred for contrast echocardiography underwent very low MI imaging with intermittent high MI impulses (1.6-1.7 Megahertz) in three different apical windows during either a Definity (Lantheus Medical) or Lumason (Bracco Diagnostics) infusion or bolus. CO was determined from Doppler measurements of left ventricular outflow tract stroke volume and heart rate. Mean contrast enhanced biplane left ventricular ejection fraction (LVEF) was 53±15%; (range 10-75%). CO from baseline without contrast (COwoC) and baseline after contrast (COwC) before high MI impulses were compared to CO after contrast and after high MI impulses (COaHMI). All CO measurements were made by an independent reviewer blinded to time of measurement (before or after high MI impulses). Results: Although heart rate did not change before and after intermittent high MI impulse administration, COaHMI increased significantly when compared to COwoC and COwC (p< 0.001 for both comparisons; Figure). In nine patients (18%), CO increased by more than 20%. In patients with LVEF < 40% COwC was 2.4±0.8 liters per minute (LPM) and COaHMI increased to 2.7± 0.8 LPM (p=0001). In patients with LVEF≥40%, COwC was 3.4±1.06 LPM while COaHMI increased to 3.8± 1.2 LPM (p=0.00001). Conclusions: Application of diagnostic guided high MI impulses during a commercially available microbubble infusion significantly increases CO irrespective of underlying left ventricular systolic function.

Associations of Vasopressor Requirements With Echocardiographic Parameters After Out-of-Hospital Cardiac Arrest

2021 ◽  
pp. 088506662199893
Author(s):  
Meir Tabi ◽  
Barry J. Burstein ◽  
Nandan S. Anavekar ◽  
Kianoush B. Kashani ◽  
Jacob C. Jentzer
Keyword(s):  
Cardiac Arrest ◽  
Correlation Coefficients ◽  
Left Ventricular ◽  
Temperature Management ◽  
Left Ventricular Ejection ◽  
Categorical Variables ◽  
Stroke Work ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Parameters ◽  
Hospital Cardiac Arrest

Background: Post-arrest hypotension is common after out of hospital cardiac arrest (OHCA) and many patients resuscitated after OHCA will require vasopressors. We sought to determine the associations between echocardiographic parameters and vasopressor requirements in OHCA patients. Methods: We retrospectively analyzed adult patients with OHCA treated with targeted temperature management between December 2005 and September 2016 who underwent a transthoracic echocardiogram (TTE). Categorical variables were compared using 2-tailed Fisher’s exact and Pearson’s correlation coefficients and variance (r2) values were used to assess relationships between continuous variables. Results: Among 217 included patients, the mean age was 62 ± 12 years, including 74% males. The arrest was witnessed in 90%, the initial rhythm was shockable in 88%, and 58% received bystander CPR. At the time of TTE, 41% of patients were receiving vasopressors; this group of patients was older, had greater severity of illness, higher inpatient mortality and left ventricular ejection fraction (LVEF) was modestly lower (36.8 ± 17.1% vs. 41.4 ± 16.4%, P = 0.04). Stroke volume, cardiac power output and left ventricular stroke work index correlated with number of vasopressors (Pearson r −0.24 to −0.34, all P < 0.002), but the correlation with LVEF was weak (Pearson r −0.13, P = 0.06). Conclusions: In patients after OHCA, left ventricular systolic dysfunction was associated with the need for vasopressors, and Doppler TTE hemodynamic parameters had higher correlation coefficients compared with vasopressor requirements than LVEF. This emphasizes the complex nature of shock after OHCA, including pathophysiologic processes not captured by TTE assessment alone.

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