• Journal of Cardiovascular Imaging
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• 제30권4호
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• pp.279-289
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• 2022

BACKGROUND: In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. METHODS: A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. RESULTS: Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. CONCLUSIONS: The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.

• Journal of Cardiovascular Imaging
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• 제31권4호
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• pp.180-187
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• 2023

BACKGROUND: Two-dimensional (2D) transesophageal echocardiography (TEE) is commonly used for assessing patients undergoing transcatheter atrial septal defect (ASD) device closure. 3D TEE, albeit providing high resolution en-face images of ASD, is used in only a fraction of cases. We aimed to perform a comparative analysis between 3D and 2D TEE assessment for ASD device planning. METHODS: This was a prospective, observational study conducted over a period of one year. Patients deemed suitable for device closure underwent 2D and 3D TEE at baseline. Defect characteristics, assessed separately in both modalities, were compared. Using regression analysis, we aimed to derive an equation for predicting device size using 3D TEE parameters. RESULTS: Thirty patients were included in the study, majority being females (83%). The mean age of the study population was 40.5 ± 12.05 years. Chest pain, dyspnea and palpitations were the common presenting complaints. All patients had suitable rims on 2D TEE. A good agreement was noted between 2D and 3D TEE for measured ASD diameters. 3D TEE showed that majority of defects were circular in shape (60%). The final device size used had high degree of correlation with 3D defect area and circumference. An equation was devised to predict device size using 3D defect area and circumference. The mean device size obtained from the equation was similar to the actual device size used in the study population (p = 0.31). CONCLUSIONS: Device sizing based on 3D TEE parameters alone is equally effective for transcatheter ASD closure as compared to 2D TEE.

• Nuclear Medicine and Molecular Imaging
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• 제42권6호
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• pp.435-443
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• 2008

목적 : 게이트 심근 관류 SPECT는 심근 관류 소견 뿐 아니라, 좌심실의 벽운동, 벽의 두꺼워짐, 좌심실 용적, 좌심실 박출율 등의 부가적인 정보를 제공한다. 심근영상에서 이들 정보를 얻기 위한 여러 가지 프로그램들이 제공되고 있다. 이 연구에서는 게이트 심근 관류 SPECT 분석 프로그램인 Quantitative Gated SPECT (QGS), 4D-MSPECT 소프트웨어를 이용하여 좌심실 박출율, 확장기말 좌심실 용적, 좌심근 질량을 구하고 이면성 심초음파검사를 통해 좌심실 박출율과 좌심근 질량을 구해 비교하였다. 대상 및 방법 : 핵의학과에 심근관류 SPECT 검사를 위해 의뢰되었던 환자 중 심근관류 SPECT에서 관류소견이 정상이었던 114명(남자51명, 여자 63명, 평균 $61.3{\pm}13.3$세, 29-85세)의 자료를 후향적으로 분석하였다. 게이트 심근 관류 SPECT는 이데노신 (0.14 mg/kg/min)을 6분간 부하하면서 Tc-99m Tetrofosmin (Myoview)을 주사하여 부하기 영상을 얻고, 4시간 후 휴식기 영상을 얻었다. Quantitative Gated SPECT (QGS), 4D-MSPECT 소프트웨어를 이용하여 좌심실 박출율, 확장기말 좌심실 용적, 좌심근질량을 구하고 이면성 심초음파검사를 이용하여 좌심실 박출율, 좌심근질량을 구하였다. 각 방법 사이의 상관계수를 구하고 Bland-Altman분석을 이용하여 변이의 범위를 분석하였다. 결과: 좌심실 박출율의 분석에서 QGS와 4D-MSPECT사이의 상관계수는 부하기/휴식기 각각 0.95/0.96로 강한 상관관계를 보였고, QGS와 심초음파 검사 사이의 상관계수는 0.79, 4D-MSPECT SPECT와 심초음파 검사 사이의 상관계수는 0.79로 좋은 상관관계를 보였다 (p<0.001). 확장기말 좌심실 용적의 경우 QGS와 4D-MSPECT SPECT 사이의 상관계수는 부하기/휴식기 모두 0.99로 강한 상관관계를 보였다(p<0.001). 좌심근 질량의 경우 QGS와 4D-MSPECT사이의 상관계수는 부하기/휴식기 각각 0.94/0.95로 강한 상관관계를 보였고, QGS와 심초음파 검사 사이의 상관계 수는 0.76, 4D-MSPECT SPECT와 심초음파 검사 사이의 상관계수는 0.73로 좋은 상관관계를 보였다(p<0.001). Bland-Altman 방법으로 분석하였을 때, 좌심실 박출율의 경우 QGS와 4D-MSFECT 검사 사이의 변이의 95% 신뢰구간은 부하기/휴식기 각각 $-12.7%\;{\sim}\;7.3%/-12.2%\;{\sim}\;6.5%$였고, QGS와 심초음파 검사의 경우 $-17.4%\;{\sim}\;24%$, 4D-MSPECT SPECT와 심초음파 검사 경우 $-14.8%\;{\sim}\;27%$였다. 확장기말 좌심실 용적의 경우 QGS와 4D-MSPECT검사 사이의 변이의 95% 신뢰구간은 부하기/휴식기 각각 $-24.6\;mL\;{\sim}\;3.8\;mL/-28.6\;mL\;{\sim}\;6.1\;mL$였다. 좌심근 질량의 경우 QGS와 4D-MSFECT 검사 사이의 변이의 95%신뢰간은 부하기/휴식기 각각 $-40.4\;g\;{\sim}\;14.4\;g$과 $-33.8\;g\;{\sim}\; 14.1\;g$이었고, QGS와 심초음파 검사 사이는 $-148.7\;g\;{\sim}\;21.8\;g$이었으며, 4D-MSPECT와 심초음파 검사 사이는 $-142.8\;g\;{\sim}\;35.5\;g$이었다. 결론: 좌심실 박출율, 확장기말 좌심실 용적, 좌심근 질량 등을 구하는 자동정량화 소프트웨어 QGS, 4D-MSPECT, 심초음파 검사(좌심실 박출율, 좌심근 질량) 상호간에 좋은 상관관계가 있었다. 하지만 Bland-Altman분석에서 QGS, 4D-MSPECT, 심초음파 검사간의 변이의 범위가 큰 편이어서 서로 바꾸어 사용할 수는 없었다.

• Journal of Biomedical and Translational Research
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• 제19권4호
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• pp.79-85
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• 2018

Echocardiography is one of the most useful diagnostic techniques for differentiating heart disease as well as mitral valve lesion. Forty client-owned small breed dogs (weight, 2.3-13.2 kg) aged between 8-17 years with myxomatous mitral valve degeneration (MMVD) were included in the present study. The diagnosis of MMVD in dogs was made based on the clinical signs, chest radiography data, and echocardiographic findings. Echocardiographic examinations were conducted in accordance with recommended standards for dogs. M-mode, Doppler, and 2D echocardiography were performed in left and right lateral recumbency. 2D echocardiography was used to measure LA and Ao diameter from 2D short axis at the level of the aortic valve. In the comparison of conventional echocardiography indices in dogs with different stages of heart failure with MMVD, significant differences were observed in E/A ratio (p=0.005), EDV (p<0.001), EDVI (p<0.001), E-peak velocity (p= 0.001), ESV (p=0.028), ESVI (p=0.004), LA (p<0.001), LA/Ao Ratio (p<0.001), LVIDd (p<0.001), LVIDd/Ao Ratio (p<0.001), LVIDs (p=0.036), LVIDs/Ao Ratio (p=0.002), and MR Velocity (p=0.026). In addition, distinct correlations were found in EDV (r=0.712), LA/Ao ration (r=0.830), LVIDd (r=0.724), and LVIDd/Ao ratio (r=0.759). This study found that known conventional echocardiographic indices, including EDV, LA/Ao ratio, LVIDd dimension, and LVIDd/Ao ratio correlated with the severity of MMVD in point of significant differences and distinct correlations.

• Journal of Cardiovascular Imaging
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• 제30권3호
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• pp.185-196
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• 2022

BACKGROUND: Two-dimensional (2D) strain provides more predictive power than ejection fraction (EF) in patients with ST-elevation myocardial infarction (STEMI). 3D strain and EF are also expected to have better clinical usefulness and overcome several inherent limitations of 2D strain. We aimed to clarify the prognostic significance of 3D strain analysis in patients with STEMI. METHODS: Patients who underwent successful revascularization for STEMI were retrospectively recruited. In addition to conventional parameters, 3D EF, global longitudinal strain (GLS), global area strain (GAS), as well as 2D GLS were obtained. We constructed a composite outcome consisting of all-cause death or re-hospitalization for acute heart failure or ventricular arrhythmia. RESULTS: Of 632 STEMI patients, 545 patients (86.2%) had a reliable 3D strain analysis. During median follow-up of 49.5 months, 55 (10.1%) patients experienced the adverse outcome. Left ventricle EF, 2D GLS, 3D EF, 3D GLS, and 3D GAS were significantly associated with poor outcomes. (all, p < 0.001) The maximum likelihood-ratio test was performed to evaluate the additional prognostic value of 2D GLS or 3D GLS over the prognostic model consisting of clinical characteristics and EF, and the likelihood ratio was 15.9 for 2D GLS (p < 0.001) and 1.49 for 3D GLS (p = 0.22). CONCLUSIONS: The predictive power of 3D strain was slightly lower than the 2D strain. Although we can obtain 3D strains, volume, and EF simultaneously in same cycle, the clinical implications of 3D strains in STEMI need to be investigated further.

• Korean Journal of Radiology
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• 제22권8호
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• pp.1266-1278
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• 2021

Objective: We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. Materials and Methods: We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. Results: The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm², 0.82 ± 0.34 cm², and 0.80 ± 0.26 cm², respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94-0.97) and 0.87 (95% CI, 0.82-0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96-0.98) and 0.98 (95% CI, 0.97-0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89-0.94) and 0.91 (95% CI, 0.88-0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82-0.91) vs. 0.85 (95% CI, 0.79-0.89). Conclusion: High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.

• Korean Circulation Journal
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• 제52권1호
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• pp.74-83
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• 2022

Background and objectives: This study aimed to identify the characteristics and clinical outcomes of cancer patients who developed constrictive physiology (CP) after percutaneous pericardiocentesis. Methods: One-hundred thirty-three cancer patients who underwent pericardiocentesis were divided into 2 groups according to follow-up echocardiography (CP vs. non-CP). The clinical history, imaging findings, and laboratory results, and overall survival were compared. Results: CP developed in 49 (36.8%) patients after pericardiocentesis. The CP group had a more frequent history of radiation therapy. Pericardial enhancement and malignant masses abutting the pericardium were more frequently observed in the CP group. Fever and ST segment elevation were more frequent in the CP group, with higher C-reactive protein levels (6.6±4.3mg/dL vs. 3.3±2.5mg/dL, p<0.001). Pericardial fluid leukocytes counts were significantly higher, and positive cytology was more frequent in the CP group. In baseline echocardiography before pericardiocentesis, medial e' velocity was significantly higher in the CP group (8.6±2.1cm/s vs. 6.5±2.3cm/s, p<0.001), and respirophasic ventricular septal shift, prominent expiratory hepatic venous flow reversal, pericardial adhesion, and loculated pericardial fluid were also more frequent. The risk of all-cause death was significantly high in the CP group (hazard ratio, 1.53; 95% confidence interval,1.10-2.13; p=0.005). Conclusions: CP frequently develops after pericardiocentesis, and it is associated with poor survival in cancer patients. Several clinical signs, imaging, and laboratory findings suggestive of pericardial inflammation and/or direct malignant pericardial invasion are frequently observed and could be used as predictors of CP development.

• Journal of Chest Surgery
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• 제15권3호
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• pp.346-354
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• 1982

A Complete transposition of the great arteries combined with V.S.D, A.S.D, dextrocardia, and P.S is a rare congenital anomaly. The patient was a 10 year-old female whose complaints were frequent URI, exertional dyspnea, and cyanosis at rest since birth. Cheat X-ray films showed Dextrocardia ; situs inversus, moderate cardiomegaly, and Characteristic egg-shape heart shadow. E.K.G, Echocardiography, Cardiac Catheterization, and Angio-Cardiography were performed. Open heart Surgery was done under diagnosis of d-TGA, Dextrocardia, V.S.D, A.S.D, and P.S. At the time of Operation, Dextroeardia, T.G.A, Secndum type A.S.D, A.S.D, and P.S. At the time of Operation, Dextroeardia, T.G.A, Secndum type A.S.D. ($2.0{\times}2.0cm$. in diameter), V.S.D. type II ($1.5cm{\times}1.5cm$ in diameter), and pulmonary valvular stenosis were noted. Mustard operation using pericardial Baffle in the atrium for T.G.A. was perforsned. Teflon patch graft for closure of V.S.D. through tricuspid orifice and pulmonary Valvulotomy through pulmonary arteriotomy were performed. The post-op, low cardiac output Syndrome and dysrhythmicawere developed till Postoperative day #7, so that was controlled by inotropic and antiarrhythmic agents. After that, patient's conditions were Uneventful.

• 대한의용생체공학회:의공학회지
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• 제15권4호
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• pp.447-454
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• 1994

기하학적인 모델을 이용한 좌심실에 대한 단축 2D 심초음파도에서의 심내벽 윤관석의 완전 자동검출방법을 제안하였다. 이 방법은 3단계의 과정에 걸쳐 수행된다. 첫번째 단계는 부표본화된 영상에 초기 중심 추정 알고리듬을 적용하여 초기 중심을 추정한다. 두번째 단계에서는 원 영상에 중심추성 알고리듬을 적용하여 정확한 중심과 타원추정에 필요한 정보를 구한다음, 심내벽에 근사하는 타원모델을 추정한다. 세번째 단계는 추정한 타원모델에 근거한 코스트 함수로서 심내벽 윤관석을 검출한다. 제안된 방법을 조작자의 수동적인 개입없이도 효과적인 결과를 보여준다.

• Journal of Cardiovascular Imaging
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• 제31권3호
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• pp.125-132
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• 2023

BACKGROUND: There is limited data on the residual echocardiographic findings including strain analysis among post-coronavirus disease (COVID) patients. The aim of our study is to prospectively phenotype post-COVID patients. METHODS: All patients discharged following acute COVID infection were systematically followed in the post-COVID-19 Recovery Clinic at Vancouver General Hospital and St. Paul's Hospital. At 4-18 weeks post diagnosis, patients underwent comprehensive echocardiographic assessment. Left ventricular ejection fraction (LVEF) was assessed by 3D, 2D Biplane Simpson's, or visual estimate. LV global longitudinal strain (GLS) was measured using a vendor-independent 2D speckle-tracking software (TomTec). RESULTS: A total of 127 patients (53% female, mean age 58 years) were included in our analyses. At baseline, cardiac conditions were present in 58% of the patients (15% coronary artery disease, 4% heart failure, 44% hypertension, 10% atrial fibrillation) while the remainder were free of cardiac conditions. COVID-19 serious complications were present in 79% of the patients (76% pneumonia, 37% intensive care unit admission, 21% intubation, 1% myocarditis). Normal LVEF was seen in 96% of the cohort and 97% had normal right ventricular systolic function. A high proportion (53%) had abnormal LV GLS defined as < 18%. Average LV GLS of septal and inferior segments were lower compared to that of other segments. Among patients without pre-existing cardiac conditions, LVEF was abnormal in only 1.9%, but LV GLS was abnormal in 46% of the patients. CONCLUSIONS: Most post-COVID patients had normal LVEF at 4-18 weeks post diagnosis, but over half had abnormal LV GLS.