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How accurate is visual assessment of synchronicity in myocardial motion? An in vitro study with computer-simulated regional delay in myocardial motion: clinical implications for rest and stress echocardiography studies
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
1999 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 12, no 9, 698-705 p.Article in journal (Refereed) Published
Abstract [en]

Asynchronicity in echocardiographic images is normally assessed visually. No prior quantitative studies have determined the limitations of this approach. To quantify visual recognition of myocardial asynchronicity in echocardiographic images, computer-simulated delay phantom loops were generated from a 3.3 MHz digital image data from a normal left ventricular short-axis heart cycle acquired at 55 frames per second. Six expert observers visually assessed 30 abnormal and 3 normal loops with differing computer-induced delay patterns on 3 occasions and in this optimally simulated environment could recognize only single delays of 89 ms or more. This was improved to 71 ms or more by use of side-by-side (normal versus abnormal) comparative review. Thus visual assessment of clinically important regional delay in rest or stress echo images is limited.

Place, publisher, year, edition, pages
1999. Vol. 12, no 9, 698-705 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26982DOI: 10.1016/S0894-7317(99)70019-2Local ID: 11617OAI: oai:DiVA.org:liu-26982DiVA: diva2:247533
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
In thesis
1. Quantification of cardiovascular flow and motion: aspects of regional myocardial function and flow patterns in the aortic root and the aorta
Open this publication in new window or tab >>Quantification of cardiovascular flow and motion: aspects of regional myocardial function and flow patterns in the aortic root and the aorta
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Quantification of cardiovascular flow and motion is essential in the diagnosis, treatment and follow-up of cardiovascular disease. The accuracy and quantification of many imaging methods used in this field have important shortfalls, however, that result from limitations in spatial and temporal dimensions. Improvement in application of these methods requires an in-depth understanding of the technical and perceptual aspects that contribute to errors in their use.

Visual assessment of echocardiographic images for asynchrony in regional myocardial motion during systolic contraction is an example of the need for better definition of limitations. The discernible delay in wall motion improved from 89 ms to 71 ms by allowing side-by-side comparison to normal motion. Clinically important delays are almost certainly missed with current "eyeballing" methods. Different and more quantitative approaches to this problem have been developed. Anatomic M-mode (AMM) assesses motion along an arbitrary line within a two-dimensional (2D) image, and was demonstrably robust in the clinical setting when used with second harmonic imaging at a depth less than 20 cm and with angle correction ofless than 60°. Doppler myocardial (DMI) imaging and strain rate imaging (SRI) were also shown to reliably demonstrate the effects of inotropic stimulation, total and severe ischemia on asynchrony in a closed chest pig model. Quantification of the changes induced by inotropy and total ischemia was possible with both methods, but the effects of stunning were not. Regional myocardial function and cardiovascular flow can also be assessed with time-resolved, three-directional, three-dimensional (3D) velocity data acquired using phase contrast magnetic resonance imaging (PC-MRI). This multidimensional data demonstrated longitudinal velocity gradients along all four walls of the left ventricle, with miuirnal apical longitudinal motion. The 3D velocity vector from single points in the ventricular wall shows that the motion over the cardiac cycle is complex in all dimensions. The flow patterns in the aortic root were also studied using time-resolved 3D PC-MRI in normal volunteers and patients who had undergone aortic-valve sparing surgery using straight Dacron grafts. In normals, vortices appeared in the sinuses of Valsalva in late systole, increased in size with the deceleration of aortic outflow and moved together as the valve closed in early diastole. These normal flow structures have never before been demonstrated in three dimensions in man. In the postoperative patients, lacking both sinuses and sinotubular junction, vortices were not observed.

Many imaging methods can be improved by a critical definition of the limits oftheir reliability. This can prompt the modifications and new methods which allow us to move beyond the original shortcomings and contribute new knowledge regarding the pathophysiology of cardiovascular disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 832
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24209 (URN)3803 (Local ID)91-7373-804-2 (ISBN)3803 (Archive number)3803 (OAI)
Public defence
2004-02-20, Elsa Brändströmssalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-29Bibliographically approved

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Escobar Kvitting, John-PederWigström, Lars

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