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Annular Motion: Assessment of Cardiac Function using Echocardiography and Magnetic Resonance Imaging
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concentrates on the assessment of cardiac function, both systolic and diastolic using variables originating from the longitudinal motion of the heart using both established and novel non-invasive imaging techniques. We developed a new magnetic resonance imaging (MRI) technique that creates an M-mode MRI image, analogous to the one used in echocardiography and enables quantitative assessment of cardiac motion. The MRI M-mode method was compared with M-mode echocardiography in a phantom study, by measuring mitral and tricuspid annular motion in 20 normal subjects, and in a study of right ventricular function in 17 patients after coronary artery bypass surgery. The agreement between M-mode MRI and Mmode echocardiography was good. However, the amplitudes were somewhat higher measured by MRI, probably because of less angle error in the MRI calculation, furthermore the lower resolution in the MRI image may have contributed.

Pulsed tissue Doppler, a recently developed Doppler modality that gives the possibility of recording instantaneous annular /or myocardial velocities on-line, was used to obtain reference values of mitral and tricuspid annular motion in 27 normal subjects of different ages. Diastolic left ventricular function was assessed in 15 patients with systemic hypertension and in 10 patients with moderate to severe aortic stenosis. Furthermore, pulsed tissue Doppler was used in the evaluation of right and left ventricular function in 15 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

The mitral and tricuspid annular velocity pattern in normal subjects is characterised by three major components: asystolic (SA) velocity, an early (EA) diastolic velocity, and a late (AA) diastolic velocity. In normal young subjects, the EA-peak velocity was highest; with increasing age, the EA-peak velocity decreases and the AA-peak velocity increases, with similar changes in both the mitral and tricuspid annular velocity pattern. In patients with left ventricular hypertrophy the EA/AA-ratio was significantly decreased compared with age- match normal subjects. Comparing ARVC patients with normal subjects the tricuspid annular EA-peak velocity was significantly decreased as well as the lateral SA-peak velocity. Our result indicates that abnormal diastolic tricuspid annular velocity pattern may be an early sign of right ventricular myocardial dysfunction in patients with ARVC. The septal mitral annular SA-peak velocity was significantly decreased in ARVC patients compared to the controls. This in accordance with subjective analysis of echocardiographic wall motion and T1-201 SPECT that showed left ventricular abnormalities in 93% of the patients predominantly located in the anteroseptal and posteroseptal segments.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 56 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 620
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27516Local ID: 12172ISBN: 91-7219-577-0 (print)OAI: oai:DiVA.org:liu-27516DiVA: diva2:248068
Public defence
2000-03-24, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-02Bibliographically approved
List of papers
1. M-mode magnetic resonance imaging: a new modality for assessing cardiac function
Open this publication in new window or tab >>M-mode magnetic resonance imaging: a new modality for assessing cardiac function
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1995 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 15, no 4, 397-407 p.Article in journal (Refereed) Published
Abstract [en]

Magnetic resonance imaging (MRI) studies of the heart have been used for some years, but there are few tools available to quantify cardiac motion. A method has been developed that creates an M-mode MRI image, analogous to the one used in echocardiography, to display motion along a line as a function of time. The M-mode image is created from MRI images acquired with an ordinary gradient echo cine sequence. In a cinematographic display of the images, a cursor line can be positioned in order to determine the orientation of the measurement. A resampling algorithm then calculates the appearance of the M-mode image along the cursor line. The MRI method has been compared to echocardiographic M-mode in a phantom study and by measuring mitral and tricuspid annulus motion in 20 normal subjects. The phantom study showed no significant differences between MRI and echocardiographic M-mode measurements (difference mm). The annulus motion exhibits a similar pattern using both methods and the measured amplitudes are in close agreement. M-mode MRI provides similar information to echocardiography, but the cursor line can be placed arbitrarily within the image plane and the method is thus not limited to certain acoustic windows. This makes M-mode MRI a promising technique for assessing cardiac motion.

Keyword
cardiac motion, heart, image processing, MRI, M-mode
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79469 (URN)10.1111/j.1475-097X.1995.tb00529.x (DOI)
Available from: 2012-08-02 Created: 2012-08-02 Last updated: 2017-12-07Bibliographically approved
2. Pulsed tissue Doppler evaluation of mitral annulus motion: A new window to assessment of diastolic function
Open this publication in new window or tab >>Pulsed tissue Doppler evaluation of mitral annulus motion: A new window to assessment of diastolic function
1999 (English)In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 19, no 1, 1-10 p.Article in journal (Refereed) Published
Abstract [en]

Diastolic dysfunction is an important cause of cardiac heart failure. To date detailed assessment of diastolic left ventricular (LV) function has required invasive methods which are impractical in the clinical routine. The prevailing non-invasive method has been Doppler echocardiography with use of mitral inflow and pulmonary vein inflow parameters, measurements providing no direct assessment of either ventricular relaxation or compliance, and influenced by multiple haemodynamic factors. We sought to determine the tissue Doppler pattern from the mitral annulus motion in normals and in patients with expected LV-diastolic dysfunction. Using pulsed tissue Doppler we recorded peak velocities from the mitral annulus motion in 16 young normals, 10 older normals and in two groups of patients expected to have an LV-diastolic relaxation abnormality, i.e. 15 patients with systemic hypertension and 10 patients with significant aortic stenosis. The peak early diastolic (E) annulus velocity was significantly (< 0·001) lower in older normals compared with young, and the late diastolic velocity (A) was higher (< 0·01). Compared with the older normals, patients showed significantly lower E-velocities (< 0·05 hypertensive patients), more pronounced in the patients with aortic stenosis (< 0·001), but the A-velocities were not higher. In systole a decrease in peak velocity was noted with increasing age and in patients with aortic stenosis. In conclusion, pulsed tissue Doppler measurement of annulus motion seems to provide valuable and easily obtainable information about LV-diastolic function, and furthermore there is a striking change in velocity pattern with increasing age which necessitates age-matched reference values.

Keyword
diastolic function, echocardiography, tissue Doppler
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26987 (URN)10.1046/j.1365-2281.1999.00137.x (DOI)11623 (Local ID)11623 (Archive number)11623 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Lack of effect of synthetic pericardial substitute on right ventricular function after coronary artery bypass surgery: An echocardiographic and magnetic resonance imaging study
Open this publication in new window or tab >>Lack of effect of synthetic pericardial substitute on right ventricular function after coronary artery bypass surgery: An echocardiographic and magnetic resonance imaging study
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2000 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 3, 331-338 p.Article in journal (Refereed) Published
Abstract [en]

Abnormal right heart function after cardiac surgery is a well-known finding. Inadequate preservation during the operation and restricted cardiac motion due to pericardial adhesions have been proposed as underlying mechanisms. This study focuses on the impact of a pericardial substitute implantation on right ventricular function, using echocardiography and magnetic resonance imaging. A test group of six patients (mean age 54 years) was examined before surgery, and 4-15 days and 5-9 months after coronary artery bypass surgery, where the pericardium was closed with a biodegradable pericardial patch. A group of 11 patients (mean age 63 years) in whom the pericardium was left open served as controls. Tricuspid annulus motion was markedly decreased, abnormal septal motion was present and decreased systolic to diastolic ratio in the vena cava superior flow was present in all patients in both groups one week after surgery. At the late follow-up, all patients still had decreased tricuspid annulus motion, while 17% of the patients in the test group and 22% of the patients in the control group (ns) demonstrated normal septal motion. We conclude that closing the pericardium with a biodegradable patch does not affect the postoperative changes in right heart function normally seen after open-heart surgery.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26784 (URN)10935782 (PubMedID)11389 (Local ID)11389 (Archive number)11389 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy
Open this publication in new window or tab >>Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy
2001 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 86, no 1, 31-38 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).

DESIGN Prospective observational study.

SETTING University Hospital.

SUBJECTS 15 patients with ARVC and a control group of 25 healthy subjects.

METHODS Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.

RESULTS Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (EA) velocity and an accompanying decrease in early (EA) to late diastolic (AA) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.

CONCLUSIONS Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26984 (URN)10.1136/heart.86.1.31 (DOI)11620 (Local ID)11620 (Archive number)11620 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
5. Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy: A scintigraphic and echocardiographic study
Open this publication in new window or tab >>Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy: A scintigraphic and echocardiographic study
2005 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 25, no 3, 171-177 p.Article in journal (Refereed) Published
Abstract [en]

Background:  Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) is a common finding in autopsy studies. In clinical studies using myocardial scintigraphy, MRI and echocardiography, contradictory results have been reported. In this study, we therefore investigated a group of 15 patients with ARVC using thallium-201 (Tl) single-photon emission tomography (SPECT) and echocardiography including assessment of mitral annular motion with M-mode and pulsed tissue Doppler.

Methods:  Exercise and rest Tl-201 SPECT were performed in 15 patients with ARVC. The time from diagnosis of the disease varied from less than 1–16 years. All patients fulfilled the established diagnostic criteria for ARVC. An echocardiographic examination, including assessment of left and right ventricular motion and measurements of the mitral annulus motion with M-mode and pulsed tissue Doppler was performed in the patients and in 25 normal subjects.

Results:  Tl-201 uptake defects in the left ventricular myocardium were present in all except one patient (93%). The uptake defects were predominantly located to the anteroseptal and basal posterior segments. Wall motion abnormalities were seen in the same segments, and in addition to this, in the septal area. In line with this, the total amplitude and the peak systolic velocity of mitral annular motion at the septal point were significantly decreased in the patients compared with the control group.

Conclusions:  Our data show that left ventricular involvement is common in ARVC. Tl-201 SPECT and echocardiographic abnormalities were seen not only in patients with long-lasting symptoms but also in asymptomatic patients and in those with short duration of symptoms.

Keyword
annular motion, pulsed tissue Doppler, T1-201 scintigraphy, wall motion abnormalities
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28426 (URN)10.1111/j.1475-097X.2005.00607.x (DOI)13565 (Local ID)13565 (Archive number)13565 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved

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