Simultaneous real-time echocardiographic imaging of myocardial perfusion and regional function using color-encoded, contrast-enhanced power modulation.

We hypothesized that color-encoded, contrast-enhanced, power modulation imaging could allow simultaneous quantification of myocardial perfusion and regional left ventricular function. We studied 12 anesthetized, closed-chest pigs at baseline, during acute ischemia, and during reperfusion, and 8 patients after acute myocardial infarction. Color kinesis was used to color encode endocardial motion during real-time contrast perfusion imaging with high-energy ultrasound pulses.

Normal values of left ventricular systolic and diastolic function derived from signal-averaged acoustic quantification waveforms: a multicenter study.

Automated border-detection techniques such as acoustic quantification have proven accurate and useful for quantifying left ventricular (LV) function. We acquired LV acoustic quantification waveforms from the parasternal short-axis window in 140 healthy patients in the age range of 16 to 78 years. Signal-averaged waveforms were analyzed for parameters of systolic and diastolic performance.

Innovations in transesophageal echocardiographic imaging.

Over the last three decades, the continuing development of transesophageal echocardiography (TEE) has represented a major advance in our ability to visualize cardiovascular structures with ultrasound. TEE serves as a valuable complement to transthoracic echocardiography (TTE) by allowing: images to be obtained with less attenuation from structures such as the lung, muscle, bone, and soft tissue; high resolution visualization of structures not well seen by TTE, such as left atrial appendage, descending thoracic aorta, and prosthetic heart valves; and assessment of hemodynamics and flow disorders in greater detail. This article provides a brief overview of current as well as emerging clinical applications of transesophageal echocardiography.

Resting "Solar Polar" map pattern and reduced apical flow reserve: characteristics of apical hypertrophic cardiomyopathy on SPECT myocardial perfusion imaging.

Background: Patients with apical hypertrophic cardiomyopathy (ACM) are often referred for myocardial perfusion single photon emission computed tomography (SPECT) as a result of marked T-wave inversion and chest pain syndromes. Stress perfusion defects have been reported in ACM, but the characteristic SPECT pattern as well as the typical findings on volume-weighted polar maps has not been described.

Methods And Results: Dual-isotope rest (thallium 201) and exercise or adenosine stress (technetium 99m tetrofosmin) myocardial perfusion SPECT was performed in 11 patients with ACM, including 8 with either normal coronary arteriography (n = 5) or a low pretest probability of coronary artery disease (CAD) (n = 3), and 14 control patients with concentric left ventricular hypertrophy.

Assessment of global and regional left ventricular diastolic function in hypertensive heart disease using automated border detection techniques.

Acoustic quantification (AQ) and color kinesis (CK) are techniques that involve automated detection and tracking of endocardial borders. These methods are useful for the evaluation of global and regional left ventricular (LV) systolic function and more recently have been applied to evaluating LV diastolic performance. Assessment of diastolic dysfunction in hypertensive heart disease is a relevant clinical issue in which these techniques have proven useful.

Interpretation of left ventricular wall motion during stress testing.

This article describes the obstacles to stress echocardiographic interpretation, and reviews the techniques currently available that offer a more objective approach to stress wall motion analysis than the conventional visual methodology. These techniques include Doppler-based methods, such as myocardial Doppler velocity and strain rate imaging, as well as automated border detection techniques, such as acoustic quantification and color kinesis.

Use of contrast enhancement for the assessment of left ventricular function.

Endocardial visualization is essential for accurate interpretation of regional wall thickening abnormalities, which constitute the diagnostic hallmark of coronary artery disease, and for reproducible assessment of left ventricular (LV) ejection fraction. Unfortunately, in many cardiac patients, poor image quality does not allow consistent visualization, let alone automated detection, of the endocardial boundary in all segments throughout the cardiac cycle. Continuing efforts directed towards improving endocardial visualization made by both echocardiographic imaging equipment manufacturers and researchers have recently produced new objective, quantitative approaches for the assessment of global and regional LV function.

Real-time three-dimensional echocardiography using a novel matrix array transducer.

Three-dimensional echocardiography has multiple advantages over two-dimensional echocardiography, such as accurate left ventricular quantification and improved spatial relationships. However, clinical use of three-dimensional echocardiography has been impeded by tedious and time-consuming methods for data acquisition and post-processing. A newly developed matrix array probe, which allows real-time three-dimensional imaging with instantaneous on-line volume-rendered reconstruction, direct manipulation of thresholding, and cut planes on the ultrasound unit may overcome the aforementioned limitations.

Expanding the differential diagnosis of hemoptysis: mycotic aortic aneurysms.

The differential diagnosis of hemoptysis includes a wide spectrum of infectious, autoimmune, and neoplastic diseases as well as chest trauma. The clinical presentation of a mycotic aortic aneurysm is often nonspecific, but mortality is high, especially after aneurysmal rupture. A high index of suspicion is warranted in any patient presenting with hemoptysis and a recent past history of subacute bacterial endocarditis, intravascular interventions, known aortic aneurysm, and/or immunocompromised state.

Biplane stress echocardiography using a prototype matrix-array transducer.

Background: Rapid image acquisition after cessation of exercise is essential for accurate stress echocardiography. Recently, a prototype matrix-array transducer has been developed that allows simultaneous acquisition of 2 imaging planes (biplane [BP] imaging).

Methods: In all, 19 healthy volunteers underwent 2 separate stress echocardiographic studies.

Unsuspected clinically important findings detected with a small portable ultrasound device in patients admitted to a general medicine service.

Objective: We sought to determine whether physicians with training in echocardiography could successfully use a small echocardiographic device to detect occult cardiovascular disease in patients admitted to a general medical service.

Methods: In all, 103 consecutive patients had a physician-performed bedside echocardiographic examination with a small portable ultrasound device.

Results: Of patients, 70% did not have a clinical indication for echocardiography and of these patients, 39% had an abnormal study with the portable ultrasound device.

The hand-carried echocardiographic device as an aid to the physical examination.

Physical examination skills have been declining over the past several decades while technology has made diagnostic testing increasingly sophisticated. For patients with cardiovascular disease, the best approach to bedside diagnosis would be one that combines both physical examination and ready access to technology at the time of the patient encounter. Most cardiac testing is not performed at the bedside due to equipment size and time limitations for these tests.

Dynamic three-dimensional color flow Doppler: an improved technique for the assessment of mitral regurgitation.

Background: Prior studies have reconstructed mitral regurgitant flow in three dimensions displaying gray scale renditions of the jets, which were difficult to differentiate from surrounding cardiac structures. Recently, a color-coded display of three-dimensional (3D) regurgitant flow has been developed. However, this display was unable to integrate cardiac anatomy, thereby losing spatial information, which made it difficult to determine the jet origin and its spatial trajectory.

Use of echocardiography for the phenotypic assessment of genetically altered mice.

Transgenic mice displaying abnormalities in cardiac development and function represent a powerful new tool for understanding molecular mechanisms underlying normal cardiovascular function and the pathophysiological bases of human cardiovascular disease. Complete cardiac evaluation of phenotypic changes in mice requires the ability to noninvasively assess cardiovascular structure and function in a serial manner. However, the small mouse heart beating at rates in excess of 500 beats/min presents unique methodological challenges.

Percutaneous closure of a ruptured sinus of Valsalva aneurysm using the Amplatzer Duct Occluder.

Sinus of Valsalva aneurysms are rare congenital anomalies. When they rupture, they can lead to the development of biventricular failure as a result of systemic-pulmonary shunting. Surgical repair has been the traditional treatment for these aneurysms.

Quantification of regional myocardial perfusion using semiautomated translation-free analysis of contrast-enhanced power modulation images.

Quantitative analysis of myocardial perfusion is currently based on manual tracing and frame-by-frame realignment of regions of interest. We developed a technique for semiautomated identification of myocardial regions from power modulation images as a potential tool for quantification of myocardial contrast enhancement. This approach was tested in 13 anesthetized pigs during continuous intravenous infusion of contrast at baseline, left anterior descending coronary artery occlusion, and reperfusion.

Automated calculation of the Tei index from signal averaged left ventricular acoustic quantification wave forms.

The Tei index is a combined measurement of systolic and diastolic left ventricular (LV) performance and may be more useful for the diagnosis of global cardiac dysfunction than either systolic or diastolic measures alone. We sought to determine whether the Tei index could be accurately calculated from LV area waveforms generated with automated border detection. Twenty-four patients were studied in 3 groups: systolic dysfunction, diastolic dysfunction, and normal.

The role of contrast enhancement in echocardiographic assessment of left ventricular function.

With or without contrast, echocardiographic evaluation of left ventricular (LV) function is qualitative, subjective, and experience dependent, because it is mostly based on visual interpretation of gray-scale 2-dimensional images or, at best, relies on tedious and time-consuming manual tracing of the endocardial boundaries. Adequate endocardial visualization is essential for accurate interpretation of regional wall thickening abnormalities, which constitute the diagnostic hallmark of coronary artery disease, and for reproducible assessment of LV ejection fraction. Studies performed in the last decade have estimated the number of patients with suboptimal endocardial delineation by fundamental imaging at 30%.

Myocardial contrast echocardiography in acute coronary syndromes.

Myocardial contrast echocardiography (MCE) is an emerging technique in which microbubble contrast agents are visualized in the coronary microvasculature. MCE is an ideal modality for the noninvasive evaluation of acute coronary syndromes because it provides portable, simultaneous assessment of regional wall motion and myocardial perfusion. Recent advances in microbubble contrast agents and ultrasound imaging technology have allowed new clinical applications of MCE in acute coronary syndromes.

Improvement in echocardiographic evaluation of left ventricular wall motion using still-frame parametric imaging.

Background: Conventional echocardiographic assessment of left ventricular wall motion is based on visual interpretation of dynamic images, which depends on readers' experience. We tested the feasibility of evaluating endocardial motion using still-frame parametric images.

Methods And Results: In protocol 1, integrated backscatter images were obtained in 8 anesthetized pigs at baseline, 5, and 60 seconds after left anterior descending coronary occlusion and during reperfusion.

Is there a long-term predictive value of intraoperative low-dose dobutamine echocardiography in patients who have coronary artery bypass graft surgery with cardiopulmonary bypass?

Unlabelled: In patients with coronary artery disease, chronic regional left ventricular systolic dysfunction at rest may be caused by hibernating or by infarcted myocardium. Intraoperative low-dose dobutamine (LDD) echocardiography reliably predicts the immediate recovery of regional myocardial function after coronary artery bypass graft (CABG) surgery. We sought to determine whether intraoperative LDD echocardiography would also predict recovery of regional function after 1 yr.

Automated endocardial border detection and evaluation of left ventricular function from contrast-enhanced images using modified acoustic quantification.

Automated border detection (ABD) techniques have been used for the quantitative assessment of left ventricular (LV) performance but require adequate visualization of the endocardial border to accurately track the blood-tissue interface. We sought to evaluate whether ABD could be used in conjunction with an infusion of echocardiographic contrast to objectively quantify LV systolic performance. Twenty-one subjects had LV volume and ejection fraction (EF) assessed by hand-tracing and prototype ABD software during contrast infusion.

Papillary fibroelastoma of the aortic valve.

We hereby report the case of a patient with a papillary fibroelastoma involving the right coronary cusp of the aortic valve that was diagnosed with the use of transesophageal echocardiography after workup for recurrent transient ischemic attacks.