- Email: [email protected]
Biplane apex echocardiography versus biplane cineangiography in the assessment of left ventricular volume and function: Validation by direct measurements
ABSTRACTS
BIPLANE APEX ECHOCARDIOGRAPHY VERSUS BIPLANE CINEANGIOGRAPHY IN THE ASSESSMENT OF LEFT VENTRICULAR VOLUME AND VALIDATION BY DIRECT MEASUREMENTS FUNCTION: William Bonnner, MD, FACC; Tam Chun; Oi Ling Kwan, BS; Alexander Neumann, BS; Dean T. Mason, MD, FACC; Anthony N. DeMaria, MD, FACC, University of California, Davis, CA. No data are available comparing the accuracy of cineangiography (Cine) and Z-dimensional echocardiography(2DE) against direct measurements in the evaluation of left ventricular (LV) volume and function. Therefore, we obtained measurements of volume in 18 human LV casts and 2 contracting heart models by 2DE, tine, and water displacement; while LV shortening was assessed by 2DE, tine, and motion photography in the contracting heart models. Estimates of volume and function by 2DE and tine were also compared in 20 pts. Comparable biplane 2DE and angulated tine and optical images were outlined and volumes were calculated using Simpson's Rule. Actual LV cast volumes correlated closely with those values obtained by Comparisons between actual both 2DE and tine (r=.97). measurements and 2DE and tine estimates for the models and patients were made by computing the following correlation coefficients: Segmental Ejection LV Stroke Shortening Fraction LV-models Volume Volume --~ .99 .96 2DE vs actual .97 .98 .97 .99 tine vs actual .97 .97 .98 .96 ZOE vs tine .97 .96 LV-patients .84 2DE vs tine .80 .80 Thus, in LV casts and contracting models, biplane apical 2DE predicts LV volume and function with comparable The reduced correlation between accuracy to LV tine. biplane apical 2DE and tine in patients may be related to measurement errors referrable to either method.
A PRACTICAL TWO-DIMENSIONAL ECHOCARDIOGRAPHIC MODEL TO ASSESS VOLUME IN THE ISCHEMIC LEFT VENTRICLE Pascal Gueret, MD; HL Wyatt, PhD; Samuel Meerbaum, PhD, FACC; Eliot Corday, MD, FACC, Cedars-Sinai Medical Center, Los Angeles, Calif. Most techniques currently available for left ventricular volume (LVV) quantification do not adequately account for regional myocardial dyssynergy (DYS). Previous in vitro studies show that 2-dimensional echocardiography (2DE) may account for LV-asymmetry when short-axis areas (A) are utilized for reconstruction. The present in vivo study was designed to test 2DE short-axis models for LVV versus single plane cineangiography before and after proximal left anterior descending intracoronary balloon occlusion (0). In 11 closed chest dogs, LVV at end-diastole (EDV) and at end-systole (ESV) were quantified and ejection fraction (EF) calculated in control and during regional ischemia. Simpson's reconstruction using A from 5 LV short-axis levels and LV length (L) showed good LVV correlations before and after 0 (r from .89 to .92). A simplified formula (LVV=5/6 AL) utilized A from either the mitral valve level area (MV-A) proximal to 0 or the mid-papillary level area (MP-A) distal to 0; correlation coefficients for EDV, ESV and EF were (*=nonsignificant): MV-A MP-A EDV ESV EDV ESV EF CONTROL .97 .:: .95 *El .89 .84 LAD-O .9D .56* .60* .82 .87 .92 In control, good results were observed using either MV-A or MP-A. With pronounced systolic DYS due to 0, results were poor for ESV and EF using MV-A, but were satisfactory using MP-A (pc.001). EDV correlated well in 0 as well as in control. CONCLUSION: In dogs with ischemic myocardium, LVV in vivo may be satisfactorily assessed by 2DE using either multiple short-axis section analysis or a clinically applicable simplifed formula, 5/6 AL if the section-A is from the zone of LV asymmetry.
THREE-DIMENSIONAL DISPLAY AND VOLUME DETERMINATION OF THE LEFT VENTRICLE BY TWO-DIMENSIONAL ECHOCARDIOGRAPHY Keiko Ueda,MD; Keiichi Kuwaki, MD; Kiyoshi Inoue, MD; Tokyo
Metropolitan
Using
a
lnd.,
Model
new
(Toshiba, (2DE),
we
apical to
the
images
usuallv
area
system
of was
the
Extremely method
Accurate
from
these
non-invasively
for by
and
good was
whole serial
area
the
LV
patients
olanimetered
new
this LV
area-length
trans-
method
cavitv
was
and
with
a
light-
LV
volume
In
20
method.
volume
the
anteri-
2DE
Angiographic
volume.
were
from
from a
by
were
diastolic
Transarea
interval
area
left
trans-apical
using
images.
an
20 LV
8-10
method
image
determinations
compared
with
the
volume
processor.
correlation
(r-=0.92,
~~0.01)
among
the
obtained.
cross-sectional
determinations And
image
angiographic
obtained two
serial
made
systolic
patints,
of
reconstructin
5" angle
a
Whole
summed
images
angiography.
reason, LV
each
and
calculation by
at
device. by
2DE
the
this
taken
covered
muscle
For
array
echocardiogram
determination covers
Electronic
phased
three-dimensional
inferoposterior
holding
angle
single-plane
window
were
(Sumitomo
wide
serial
allow LV
base.
through
ducer
oen
echo
72”
Japan
two-dimensional
volume
routine
Tokyo,
processor
a
whether
would
accurate 2DE
2DE or
image
SSH-IlA)
(LV)
and
Hospital,
and
examined
undergoing apex
tomogram TP-300)
Model
ventricle ion
Police
were suggest
reconstruction obtained stedy
from
state
multiple
by LV
this
and
volume
method.
volume
cross-sectional
can
be
determined
image.
SELECTION CRITERIA FOR ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR PRESSURE AND PEAK GRADIENT IN PATIENTS WITH VALVULAR AORTIC STENOSIS Jason Kirkman, MD; Arthur 0. Hagan, MD; Thomas G. DiSessa, MO; Chinq Ti, MD; Linda H. Samtov, MD; William F. Friedman; MD; Walter V.R. Vieweg;.MD; UCSD Medical Center, San Diego, California M-mode echocardiography was employed to estimate the left ventricular peak systolic pressure (LVPSP) and the left ventricular-aortic valve peak pressure gradient in 47 patients being evaluated for aortic stenosis prior to cardiac catheterization. A wall thickness to cavity dimension ratio: LVPSP = 225 X systolic posterior wall thickness f end-systolic dimension, was employed. The aortic valve pressure gradient was determined by subtracting the cuff systolic blood pressure from the calculated left ventricular peak systolic pressure. All measurements were obtained at the level of the chordae; 10 of 47 echocardiograms were technically unsatisfactory. In 27 selected adult patients (22-89 yrs) left ventricular peak systolic pressure and aortic valve pressure gradient correlated poorly with catheterization (cath) data (r = 0.49 and 0.64 respectively). When 10 patients with significant left ventricular dilatation, wall motion abnormalities, poor left ventricular performance, or systemic hypertension were excluded from analysis, correlation of left ventricular peak systolic pressure and aortic valve pressure gradient with cath data improved markedly (r = 0.73 and 0.92 respectively). All 10 pediatric patients (age 7-10 yrs) had excellent correlation of left ventricular peak systolic pressure and aortic valve pressure gradient with cath data (r = 0.95 and 0.91 respectively). Echocardiography is a reliable method to estimate severity of aortic stenosis in children but in only selected adults.
February 1980
The American Journal of CARDIOLOGY
Volume 45
471
BIPLANE APEX ECHOCARDIOGRAPHY VERSUS BIPLANE CINEANGIOGRAPHY IN THE ASSESSMENT OF LEFT VENTRICULAR VOLUME AND VALIDATION BY DIRECT MEASUREMENTS FUNCTION: William Bonnner, MD, FACC; Tam Chun; Oi Ling Kwan, BS; Alexander Neumann, BS; Dean T. Mason, MD, FACC; Anthony N. DeMaria, MD, FACC, University of California, Davis, CA. No data are available comparing the accuracy of cineangiography (Cine) and Z-dimensional echocardiography(2DE) against direct measurements in the evaluation of left ventricular (LV) volume and function. Therefore, we obtained measurements of volume in 18 human LV casts and 2 contracting heart models by 2DE, tine, and water displacement; while LV shortening was assessed by 2DE, tine, and motion photography in the contracting heart models. Estimates of volume and function by 2DE and tine were also compared in 20 pts. Comparable biplane 2DE and angulated tine and optical images were outlined and volumes were calculated using Simpson's Rule. Actual LV cast volumes correlated closely with those values obtained by Comparisons between actual both 2DE and tine (r=.97). measurements and 2DE and tine estimates for the models and patients were made by computing the following correlation coefficients: Segmental Ejection LV Stroke Shortening Fraction LV-models Volume Volume --~ .99 .96 2DE vs actual .97 .98 .97 .99 tine vs actual .97 .97 .98 .96 ZOE vs tine .97 .96 LV-patients .84 2DE vs tine .80 .80 Thus, in LV casts and contracting models, biplane apical 2DE predicts LV volume and function with comparable The reduced correlation between accuracy to LV tine. biplane apical 2DE and tine in patients may be related to measurement errors referrable to either method.
A PRACTICAL TWO-DIMENSIONAL ECHOCARDIOGRAPHIC MODEL TO ASSESS VOLUME IN THE ISCHEMIC LEFT VENTRICLE Pascal Gueret, MD; HL Wyatt, PhD; Samuel Meerbaum, PhD, FACC; Eliot Corday, MD, FACC, Cedars-Sinai Medical Center, Los Angeles, Calif. Most techniques currently available for left ventricular volume (LVV) quantification do not adequately account for regional myocardial dyssynergy (DYS). Previous in vitro studies show that 2-dimensional echocardiography (2DE) may account for LV-asymmetry when short-axis areas (A) are utilized for reconstruction. The present in vivo study was designed to test 2DE short-axis models for LVV versus single plane cineangiography before and after proximal left anterior descending intracoronary balloon occlusion (0). In 11 closed chest dogs, LVV at end-diastole (EDV) and at end-systole (ESV) were quantified and ejection fraction (EF) calculated in control and during regional ischemia. Simpson's reconstruction using A from 5 LV short-axis levels and LV length (L) showed good LVV correlations before and after 0 (r from .89 to .92). A simplified formula (LVV=5/6 AL) utilized A from either the mitral valve level area (MV-A) proximal to 0 or the mid-papillary level area (MP-A) distal to 0; correlation coefficients for EDV, ESV and EF were (*=nonsignificant): MV-A MP-A EDV ESV EDV ESV EF CONTROL .97 .:: .95 *El .89 .84 LAD-O .9D .56* .60* .82 .87 .92 In control, good results were observed using either MV-A or MP-A. With pronounced systolic DYS due to 0, results were poor for ESV and EF using MV-A, but were satisfactory using MP-A (pc.001). EDV correlated well in 0 as well as in control. CONCLUSION: In dogs with ischemic myocardium, LVV in vivo may be satisfactorily assessed by 2DE using either multiple short-axis section analysis or a clinically applicable simplifed formula, 5/6 AL if the section-A is from the zone of LV asymmetry.
THREE-DIMENSIONAL DISPLAY AND VOLUME DETERMINATION OF THE LEFT VENTRICLE BY TWO-DIMENSIONAL ECHOCARDIOGRAPHY Keiko Ueda,MD; Keiichi Kuwaki, MD; Kiyoshi Inoue, MD; Tokyo
Metropolitan
Using
a
lnd.,
Model
new
(Toshiba, (2DE),
we
apical to
the
images
usuallv
area
system
of was
the
Extremely method
Accurate
from
these
non-invasively
for by
and
good was
whole serial
area
the
LV
patients
olanimetered
new
this LV
area-length
trans-
method
cavitv
was
and
with
a
light-
LV
volume
In
20
method.
volume
the
anteri-
2DE
Angiographic
volume.
were
from
from a
by
were
diastolic
Transarea
interval
area
left
trans-apical
using
images.
an
20 LV
8-10
method
image
determinations
compared
with
the
volume
processor.
correlation
(r-=0.92,
~~0.01)
among
the
obtained.
cross-sectional
determinations And
image
angiographic
obtained two
serial
made
systolic
patints,
of
reconstructin
5" angle
a
Whole
summed
images
angiography.
reason, LV
each
and
calculation by
at
device. by
2DE
the
this
taken
covered
muscle
For
array
echocardiogram
determination covers
Electronic
phased
three-dimensional
inferoposterior
holding
angle
single-plane
window
were
(Sumitomo
wide
serial
allow LV
base.
through
ducer
oen
echo
72”
Japan
two-dimensional
volume
routine
Tokyo,
processor
a
whether
would
accurate 2DE
2DE or
image
SSH-IlA)
(LV)
and
Hospital,
and
examined
undergoing apex
tomogram TP-300)
Model
ventricle ion
Police
were suggest
reconstruction obtained stedy
from
state
multiple
by LV
this
and
volume
method.
volume
cross-sectional
can
be
determined
image.
SELECTION CRITERIA FOR ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT VENTRICULAR PRESSURE AND PEAK GRADIENT IN PATIENTS WITH VALVULAR AORTIC STENOSIS Jason Kirkman, MD; Arthur 0. Hagan, MD; Thomas G. DiSessa, MO; Chinq Ti, MD; Linda H. Samtov, MD; William F. Friedman; MD; Walter V.R. Vieweg;.MD; UCSD Medical Center, San Diego, California M-mode echocardiography was employed to estimate the left ventricular peak systolic pressure (LVPSP) and the left ventricular-aortic valve peak pressure gradient in 47 patients being evaluated for aortic stenosis prior to cardiac catheterization. A wall thickness to cavity dimension ratio: LVPSP = 225 X systolic posterior wall thickness f end-systolic dimension, was employed. The aortic valve pressure gradient was determined by subtracting the cuff systolic blood pressure from the calculated left ventricular peak systolic pressure. All measurements were obtained at the level of the chordae; 10 of 47 echocardiograms were technically unsatisfactory. In 27 selected adult patients (22-89 yrs) left ventricular peak systolic pressure and aortic valve pressure gradient correlated poorly with catheterization (cath) data (r = 0.49 and 0.64 respectively). When 10 patients with significant left ventricular dilatation, wall motion abnormalities, poor left ventricular performance, or systemic hypertension were excluded from analysis, correlation of left ventricular peak systolic pressure and aortic valve pressure gradient with cath data improved markedly (r = 0.73 and 0.92 respectively). All 10 pediatric patients (age 7-10 yrs) had excellent correlation of left ventricular peak systolic pressure and aortic valve pressure gradient with cath data (r = 0.95 and 0.91 respectively). Echocardiography is a reliable method to estimate severity of aortic stenosis in children but in only selected adults.
February 1980
The American Journal of CARDIOLOGY
Volume 45
471