J Kisslo

Duke University Medical Center, Durham, North Carolina, United States

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Publications (167)922.93 Total impact

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    ABSTRACT: Background Right ventricular (RV) function is a strong predictor of mortality in pulmonary hypertension (PH), but two-dimensional (2D) echocardiography–derived assessments of RV function that could aid in risk assessment and management of patients with PH are of limited utility. RV longitudinal peak systolic strain (RVLS) derived from 2D speckle-tracking echocardiography is a relatively novel method for quantifying RV function but typically is derived from a single apical four-chamber view of the right ventricle and may have inherent limitations. The objective of this study was to determine the utility of regional and global RVLS calculated from multiple views of the right ventricle to comprehensively assess RV function in a cohort of patients with PH. Methods Regional and global RVLS were obtained from multiple views of the right ventricle (centered on the right ventricle–focused apical position) in 40 patients with PH, defined as a mean pulmonary artery pressure ≥ 25 mm Hg, most of whom also had pulmonary capillary wedge pressures ≤ 15 mm Hg and were thus defined as having pulmonary arterial hypertension. This was compared with other 2D echocardiography–derived parameters of RV function and functional parameters. Results Global RVLS calculated from multiple views had a superior correlation with 6-min walk distance compared with other parameters of RV function, including tricuspid annular plane systolic excursion, RV myocardial performance index, and fractional area change. Although global RVLS calculated from multiple views displayed a similar correlation with 6-min walk distance as global RVLS calculated from a single four-chamber view, analysis of regional strains provided by multiple views identified distinct patterns of RV dysfunction, consisting of global, free wall, or septal dysfunction, that were associated with specific clinical characteristics. Conclusions Global RVLS derived from multiple right ventricle–focused views yields a comprehensive quantitative assessment of regional and global RV function that correlates moderately with functional parameters and may be useful in the assessment of PH. Distinct patterns of regional RV dysfunction are associated with different clinical characteristics.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2014; · 2.98 Impact Factor
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    ABSTRACT: Background Progressive heart failure leading to transplantation or death is common in pediatric dilated cardiomyopathy (DCM), and treatment options are limited. Select children with DCM have improved after cardiac resynchronization therapy (CRT), but predicting response is challenging. Nonetheless, considering the frequency of death or transplantation in this population, identifying any candidate would be valuable. Classic-pattern dyssynchrony (CPD) identifies mechanical dyssynchrony patterns consistent with underlying electrical activation delays and strongly predicts CRT response in adult DCM but has not been evaluated in pediatric DCM. The aim of this study was to test the hypothesis that CPD is present in a subgroup of patients with pediatric DCM and is associated with activation delays. Methods Fifty-nine subjects with pediatric DCM (left ventricular end-diastolic diameter Z score > 2 and left ventricular ejection fraction < 40%) who underwent echocardiography with a functional protocol with apical images optimized for two-dimensional speckle-tracking strain analysis (EchoPAC) were retrospectively analyzed for CPD. Electrocardiograms were evaluated for activation delays (prolonged QRS duration and strict criteria for left bundle branch block [LBBB]). Forty control subjects with no cardiac disease and good imaging widows were also analyzed. Results The mean age was 5.4 years (range, 1 day to 20 years); idiopathic DCM was most common (57%). Severe cardiomyopathy was present in 75% (end-diastolic diameter Z score > 4.6 and left ventricular ejection fraction < 32%). CPD was identified in seven subjects (12%), and prolonged QRS durations were present in 13 (22%), but only two subjects met strict criteria for LBBB. Six of seven subjects in the CPD group had prolonged QRS durations, and two of seven had LBBB. No control subjects had CPD. The CPD analysis was highly feasible and reproducible. Conclusions In this severely affected cohort, the small CPD subgroup is potentially important because their progressive disease may respond to CRT. CPD is associated with activation delays, although not necessarily strict LBBB. This has important potential implications for prospective evaluation of CRT in this disease.
    Journal of the American Society of Echocardiography. 01/2014;
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    ABSTRACT: Background Although quantitative right ventricular (RV) strain analysis may be useful in congenital and acquired heart disease populations with RV failure, a comprehensive, standardized approach is lacking. An 18-segment RV strain analysis obtained from three standardized RV apical echocardiographic images was used to determine the feasibility, normal values, and reproducibility of the method in normal adults. Methods Forty healthy, prospectively enrolled volunteers with no cardiac histories and normal QRS durations underwent echocardiography optimized for strain analysis including three RV apical views. Two-dimensional speckle-tracking longitudinal strain analysis was performed using EchoPAC software. Eleven retrospectively identified subjects with RV disease were included as a pilot population. All had been imaged using the same protocol including the three RV apical views. Results All control subjects had normal anatomic morphology and function by echocardiography. Feasibility of the RV strain analysis was good (adequate tracking in 696 of 720 segments [97%]). RV global peak systolic strain was −23 ± 2%. Peak strain was highest in the RV free wall and lowest in the septum. Dyssynchrony indices demonstrated no dyssynchrony using left ventricular criteria. Reproducibility of most strain measures was acceptable. This methodology identified important disease not seen in the four-chamber apical view alone in the pilot population of 11 patients with RV disease. Strain patterns and values were different from those in the control population, indicating that differences do exist from normal. Conclusions Eighteen-segment RV strain analysis is feasible, with strain measures falling into discrete ranges in this normal population. Those with RV disease illustrate the potential utility of this approach. These data indicate that this model can be used for more detailed studies evaluating abnormal RV populations, in which its full potential can be assessed.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2014; · 2.98 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 09/2013; · 1.06 Impact Factor
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    ABSTRACT: Perioperative transesophageal echocardiography is essential for decision-making for mitral valve surgery. While two-dimensional transesophageal echocardiography represents the standard of care, tracking of dynamic changes using three-dimensional imaging permits assessment of morphologic and functional characteristics of the mitral valve. The authors hypothesized that quantitative three-dimensional analysis would reveal distinct differences among diseased, repaired, and normal mitral valves. Case-control observational clinical study. Tertiary care hospital. Using novel mitral valve quantification software, the authors retrospectively analyzed 80 datasets of cardiac surgery patients who underwent intraoperative transesophageal echocardiographic imaging. Twenty patients with degenerative mitral regurgitation were evaluated before and after mitral valve repair. Twenty patients had functional mitral regurgitation, and 20 patients had no mitral valve disease. Primary outcome measures of dynamic mitral valve function were: 1) three-dimensional annulus area, 2) annular displacement distance, 3) annular displacement velocity, and 4) annular area fraction. Other mitral annular tracking indices, in addition to intraobserver reliability and interobserver agreement, also were reported. Annulus area was enlarged in degenerative and functional mitral regurgitation. Annular displacement distance was decreased in functional mitral regurgitation and repaired valves. Annular displacement velocity was decreased in functional mitral regurgitation. Annular area fraction was decreased in functional mitral regurgitation and repaired valves. Intraobserver reliability and interobserver agreement were high for all 4 analyzed indices. Normal, functional regurgitant, degenerative, and repaired mitral valves have distinctly different dynamic signatures of anatomy and function as reliably determined by perioperative echocardiographic tracking.
    Journal of cardiothoracic and vascular anesthesia 09/2013; · 1.06 Impact Factor
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    ABSTRACT: The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently been independently published for both ECG and echocardiography. The relationship between the 2 modalities and the relation to cardiac resynchronization therapy (CRT) response was investigated. Sixty-six patients with LBBB by conventional criteria had a standard 12-lead ECG and 2-dimensional strain echocardiography performed before CRT implantation. Criteria for LBBB by echocardiography included early termination of contraction in one wall and prestretch and late contraction in opposing wall(s). New strict criteria by ECG included QRS duration ≥140 ms (men) or 130 ms (women), QS or rS in leads V1 and V2, and mid-QRS notching or slurring in ≥2 of leads V1, V2, V5, V6, I, and aVL. Response was defined as >15% decrease in left ventricular end-systolic volume after 6 months. In 64 of 66 patients, ECG analysis was possible. Echo and ECG readings for LBBB presence were concordant in 54 (84%) of 64. Thirty-seven (82%) of 45 patients with LBBB by strict ECG criteria responded to CRT, whereas only 4 (21%) of the 19 patients without LBBB responded (sensitivity 90% and specificity 65%). Thirty-six (95%) of 38 patients with concordance for the presence of LBBB responded to CRT. In patients with concordance for the absence of LBBB, 15 (94%) of 16 did not respond. For the first time, a close relation has been demonstrated between electrical activation by ECG and mechanical contraction by echocardiography. These findings may help identify CRT candidates.
    American heart journal 08/2013; 166(2):340-8. · 4.65 Impact Factor
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    ABSTRACT: This study sought to hypothesize that global longitudinal strain (GLS) as a measure of infarct size, and mechanical dispersion (MD) as a measure of myocardial deformation heterogeneity, would be of incremental importance for the prediction of sudden cardiac death (SCD) or malignant ventricular arrhythmias (VA) after acute myocardial infarction (MI). SCD after acute MI is a rare but potentially preventable late complication predominantly caused by malignant VA. Novel echocardiographic parameters such as GLS and MD have previously been shown to identify patients with chronic ischemic heart failure at increased risk for arrhythmic events. Risk prediction during admission for acute MI is important because a majority of SCD events occur in the early period after hospital discharge. We prospectively included patients with acute MI and performed echocardiography, with measurements of GLS and MD defined as the standard deviation of time to peak negative strain in all myocardial segments. The primary composite endpoint (SCD, admission with VA, or appropriate therapy from a primary prophylactic implantable cardioverter-defibrillator [ICD]) was analyzed with Cox models. A total of 988 patients (mean age: 62.6 ± 12.1 years; 72% male) were included, of whom 34 (3.4%) experienced the primary composite outcome (median follow-up: 29.7 months). GLS (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 1.25 to 1.53; p < 0.0001) and MD (HR/10 ms: 1.38; 95% CI: 1.24 to 1.55; p < 0.0001) were significantly related to the primary endpoint. 1.24; 95% CI: 1.10 to 1.40; p = 0.0004) and MD (HR/10 ms: 1.15; 95% CI: 1.01 to 1.31; p = 0.0320) remained independently prognostic after multivariate adjustment. Integrated diagnostic improvement (IDI) and net reclassification index (NRI) were significant for the addition of GLS (IDI: 4.4% [p < 0.05]; NRI: 29.6% [p < 0.05]), whereas MD did not improve risk reclassification when GLS was known. Both GLS and MD were significantly and independently related to SCD/VA in these patients with acute MI and, in particular, GLS improved risk stratification above and beyond existing risk factors.
    JACC. Cardiovascular imaging 07/2013; · 14.29 Impact Factor
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    ABSTRACT: Optimization of the interventricular delay (VV-optimization) in cardiac resynchronization therapy (CRT) patients can be performed by evaluation of mechanical dyssynchrony. However, there is no consensus on which method to use. In this study, three conceptually different methods were evaluated. Thirty consecutive CRT patients were included. At day 1, patients were atrioventricular and VV optimized by left ventricular outflow tract (LVOT) velocity time integral (VTI). At 6 months, 2D strain (2DS) echocardiography and tissue Doppler imaging (TDI) was performed at six different VV-programming delay in steps of 20 ms. LVOT and three indices of dyssynchrony were evaluated at each setting: standard deviation (SD) of time-to-peak strain in 12 segments (2DS-SD), SD of time-to-peak velocities in 12 segments (TDI-SD), and maximal activation delay (AD-max) by cross-correlation analysis (XCA) of TDI-derived myocardial acceleration curves. Feasibility was 90% for 2DS-SD and TDI-SD and 97% for AD-max. Coefficients of variation for intraobserver variability were 13% for 2DS-SD, 11% for TDI-SD, and 6% for AD-max. A relative increase in LVOT VTI > 10% was observed in 5/12 (42%) nonresponders and 7/18 (39%) responders to CRT. Optimization by all three dyssynchrony indices significantly increased LVOT VTI compared to simultaneous pacing and optimal setting at day 1 (P < 0.05, all). LVOT VTI was highest when using AD-max, and AD-max showed the best agreement (k = 0.71). VV optimization at 6 months acutely benefits both responders and nonresponders; however, dyssynchrony indices do not perform equally well. XCA has a high feasibility and reproducibility and appears to be superior to time-to-peak techniques.
    Pacing and Clinical Electrophysiology 07/2013; · 1.75 Impact Factor
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    ABSTRACT: Evaluation of myocardial deformation by two-dimensional speckle-tracking is useful for clinical and research purposes. However, differences may exist among different ultrasound machines, software packages, frame rates, and observers. Thirty patients underwent echocardiography on both GE (Vivid 9; GE Vingmed Ultrasound AS, Horten, Norway) and Philips (iE33; Philips Ultrasound, Bothell, WA) ultrasound systems. From each study, two sets of images were stored in Digital Imaging and Communications in Medicine format, optimized for strain evaluation: one set of images at the acquisition frame rate (55-90 frames/sec) and one set of images at a compressed frame rate of 30 frames/sec. Vendor-independent software (VIS; TomTec 2D Cardiac Performance Analysis, Munich, Germany) was used to measure strain in multiple directions and was compared with vendor-specific software (GE EchoPAC; GE Vingmed Ultrasound AS). Intraobserver and interobserver coefficients of variation ranged from 5.5% to 8.7% for longitudinal strain, from 10.7% to 20.8% for circumferential, and from 15.3% to 33.4% for radial and transverse strain. Strain values obtained using VIS were comparable with those obtained using vendor-specific software for longitudinal strain, regardless of ultrasound machine or frame rate. For circumferential strain, a consistent large bias was observed between VIS and vendor-specific software, with higher values using VIS. Slightly higher strain values were observed by analysis at the acquisition frame rate compared with the low frame rate, but no consistent bias was observed between images from different vendors. Global longitudinal strain consistently showed good reproducibility, while reproducibility was moderate for circumferential strain and poor in the radial direction. Retrospective analysis of legacy Digital Imaging and Communications in Medicine data at 30 frames/sec can be reliably performed for longitudinal strain.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 09/2012; 25(11):1195-203. · 2.98 Impact Factor
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    ABSTRACT: A classical strain pattern of early contraction in one wall and prestretching of the opposing wall followed by late contraction has previously been associated with left bundle branch block (LBBB) activation and short-term response to cardiac resynchronization therapy (CRT). Aims of this study were to establish the long-term predictive value of an LBBB-related strain pattern and to identify changes in contraction patterns during short-term and long-term CRT. Sixty-seven patients with standard CRT criteria were prospectively enrolled between early 2009 and late 2010. Echocardiography including regional strain analysis by 2-dimensional speckle tracking was performed 1 week before implantation, at day 1, and 6 months after. Response was defined as a decrease in left ventricular end-systolic volume ≥ 15%. The predictive ability of a classical pattern was compared with time-to-peak measurements from velocity and deformation analysis. Forty-three patients (65%) were classified as responders. The presence of a classical pattern showed 91% specificity and 95% sensitivity for response and performed significantly better than time-to-peak parameters in prediction of response to CRT (P < .001, all). In responders, CRT acutely increased septal longitudinal peak systolic strain (-8.7% ± 3.6% to -11.1% ± 3%, P < .001) but not in nonresponders. The classical pattern is highly predictive of response to CRT and superior to time-to-peak methods. Patients who obtain long-term reverse remodeling are characterized by short-term reversal of the classical strain pattern. These findings emphasize the value of recognizing potentially reversible strain patterns in selection of CRT candidates.
    American heart journal 04/2012; 163(4):697-704. · 4.65 Impact Factor
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    ABSTRACT: AimsPre-implant assessment of longitudinal mechanical dyssynchrony using cross-correlation analysis (XCA) was tested for association with long-term survival and compared with other tissue Doppler imaging (TDI)-derived indices.Methods and resultsIn 131 patients referred for cardiac resynchronization therapy (CRT) from two international centres, mechanical dyssynchrony was assessed from TDI velocity curves using time-to-peak opposing wall delay (OWD) ≥80 ms, Yu index ≥32 ms, and the maximal activation delay (AD-max) >35 ms. AD-max was calculated by XCA of the TDI-derived myocardial acceleration curves. Outcome was a composite of all-cause mortality, cardiac transplantation, or implantation of a ventricular assist device (left ventricular assist device) and modelled using the Cox proportional hazards regression. Follow-up was truncated at 1460 days. Dyssynchrony by AD-max was independently associated with improved survival when adjusted for QRS > 150 ms and aetiology {hazard ratio (HR) 0.35 [95% confidence interval (CI) 0.16-0.77], P = 0.01}. Maximal activation delay performed significantly better than Yu index, OWD, and the presence of left bundle branch block (P < 0.05, all, for difference between parameters). In subgroup analysis, patients without dyssynchrony and QRS between 120 and 150 ms showed a particularly poor survival [HR 4.3 (95% CI 1.46-12.59), P < 0.01, compared with the group with dyssynchrony and QRS between 120 and 150 ms].ConclusionMechanical dyssynchrony assessed by AD-max was associated with long-term survival after CRT and was significantly better associated compared with other TDI-derived indices. Patients without dyssynchrony and QRS between 120 and 150 ms had a particularly poor prognosis. These results indicate a valuable role for XCA in selection of CRT candidates.
    European Heart Journal 03/2012; · 14.10 Impact Factor
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    ABSTRACT: Aim The presence of septal hypertrophy in hypertrophic cardiomyopathy (HCM) is common. To date, there has been no accepted classification of septal morphology in HCM. Furthermore, the possible relationship between septal morphology and clinical features of HCM is undefined. METHODS AND RESULTS: Seventy-five consecutive adult patients with HCM were enrolled. Septal morphologies were retrospectively categorized into one of four patterns of hypertrophy based on transthoracic echocardiography. Left ventricular diastolic function by Doppler echocardiography and late gadolinium enhancement (LGE) by magnetic resonance imaging were assessed in all patients. Patients were followed for a mean of 45 ± 32 months. Catenoid septum was the most common morphologic subtype (46 of 75, 61%), followed by simple sigmoid (22 of 75, 29%), neutral (4 of 75, 5%), and apical (3 of 75, 4%). Inter-observer reproducibility of septal classifications was high (κ = 0.95). Patients with the catenoid subtype presented at a younger age, had worse diastolic function, and high rates of LGE. The presence of catenoid septal morphology was independently associated with LGE in multivariable logistic regression analysis. Implantable cardioverter-defibrillator implantation for prevention of sudden cardiac death occurred only in patients with this septal morphology. CONCLUSION: We propose a simple, reproducible classification system of patterns of septal hypertrophy in HCM. These patterns of hypertrophy are associated with significant differences in clinical, haemodynamic, and myocardial characteristics. Further studies are needed to evaluate the relationship between septal morphology and outcome or response to therapies in HCM.
    European Heart Journal – Cardiovascular Imaging 11/2010; 12(2):131-9. · 2.39 Impact Factor
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    Anesthesia and analgesia 01/2007; 103(6):1416-25. · 3.08 Impact Factor
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    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2006; 19(11):1303-13. · 2.98 Impact Factor
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    ABSTRACT: In 107 patients with coronary disease and severe left ventricular dysfunction, we examined the prognostic power of viability identified by dobutamine stress echocardiography. At a mean follow-up of 27 months, patients with viable myocardium who underwent revascularization had a significant survival advantage over all other patients (2-year survival 83.5% vs 57.2%, p = 0.0037).
    The American Journal of Cardiology 06/2004; 93(10):1275-9. · 3.21 Impact Factor
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    ABSTRACT: To determine whether internal medicine house staff with limited training in echocardiography can use point-of-care echocardiography to make simple, clinically important diagnoses. Availability of small, portable ultrasound devices could make point-of-care echocardiography widely available. The training required to perform point-of-care echocardiography has not been established. Medical house staff participated in a 3-hour point-of-care echocardiography training program. Patients scheduled for standard echocardiography as part of clinical care underwent point-of-care echocardiography within 24 hours to assess four common clinically important diagnoses. Each standard echocardiogram was interpreted twice. Agreement (kappa) was calculated between point-of-care and standard echocardiography by using standard echocardiography as the gold standard and between the two interpretations of standard echocardiography. Agreement (kappa) between point-of-care echocardiography and standard echocardiography was 75% (0.51) for left ventricular dysfunction (ejection fraction <55%), 79% (0.31) for moderate or severe mitral regurgitation, 92% (0.32) for aortic valve thickening or immobility, and 98% (0.51) for moderate or large pericardial effusion. Agreement between the two interpretations of standard echocardiography was 83% (0.63) for left ventricular dysfunction, 92% (0.68) for moderate or severe mitral regurgitation, 95% (0.62) for aortic valve thickening or immobility, and 97% (0.53) for moderate or large pericardial effusion. Medical house staff with limited training in echocardiography can use point-of-care echocardiography to assess left ventricular function and pericardial effusion with moderate accuracy that is lower than that of standard echocardiography. Assessment of valvular disease and other diagnoses likely requires more training and/or experience in echocardiography.
    American heart journal 03/2004; 147(3):476-81. · 4.65 Impact Factor
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    ABSTRACT: Echocardiograms of 290 patients with dilated cardiomyopathy (ejection fraction < or =35%) were reviewed for the presence of left ventricular (LV) apical abnormalities; outcomes of stroke and death were then correlated with the presence of LV thrombus. During a follow-up of 31 months, 15 patients had a stroke or transient ischemic attack after the index echocardiogram (5.2%). Patients with LV thrombus on echocardiography had a significantly higher rate of stroke (adjusted odds ratio 3.4, p = 0.027) than those without echocardiographic evidence of thrombi. There was no difference in mortality between patients with and without thrombus (20.9% vs 21.1%, p = 0.726).
    The American Journal of Cardiology 02/2004; 93(4):500-3. · 3.21 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2003; 41(6):426-426.
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    ABSTRACT: A novel imaging system has been introduced which uses a dedicated two-dimensional echo probe for rapid beam forming to scan a pyramidal volume in real time. Real-time volumetric echocardiography has the potential to determine accurate cardiovascular anatomy, volume and function in the beating heart without reconstructions. The results of animal and human studies using volumetric echocardiography are evaluated for the potential for clinical applications. IMAGING METHODOLOGY: A new type of ultrasound imaging, high-speed volumetric scanning based on phased array principles permits real-time three-dimensional, volumetric echocardiography (real-time 3-DE). The system requires no off-line reconstruction techniques, thus enabling dynamic three-dimensional visualization and quantification of the heart in real time using a transthoracic approach. Real-time 3-DE uses a 2-D matrix phased array transducer. Image formation employs 16:1 parallel processing to scan a pyramidal volume composed of multiple steering directions in the azimuth dimension and in the elevation dimension. The finished transducer is mounted in a hand-held case with a circular aperture of 16 mm diameter. The array consists of approximately 1,600 elements, operating at 2.5 MHz. Real-time 3-DE permits simultaneous, multiple plane display of two sector arcs (B-scans) and C-scan (parallel to the transducer face or inclined) on a single monitor, conveying the three-dimensional nature of the ultrasound data. This system also allows these planes to be angled for extra diagnostic flexibility. The motion of all the structures during the cardiac cycle can be evaluated in dynamic mode. Real-time 3-DE was assessed for accuracy of volume measurement by measuring the volume of balloons of different size and shape, and the hearts of 15 closed chest dogs with myocardial contrast enhancement, and compared to the volumes measured by left ventricular angiography in the dogs. Real-time 3-DE was used to evaluate the endocardial border determination of the entire left ventricle by injecting contrast agent in 12 patients. The endocardial border determination of each segment was scored, and the endocardial border score index calculated. Both real-time 3-D images and cine magnetic resonance imaging (MRI) were performed in 16 patients to assess the accuracy of volume measurement of the left ventricle in humans. The endocardial border of the left ventricle was manually traced, and the volumes calculated by Simpson's rule. The volumes measured by real-time 3-DE correlated well with the true volumes for different sizes of balloon and for asymmetric balloons. The end-diastolic volume and end-systolic volume linear correlation of real-time 3-DE versus angiography measurements using manual tracing in vivo also gave a good correlation (r = 0.97, p < 0.001; r = 0.92, p < 0.01). Fifty-eight of 192 segments were rated as good at baseline and 143 rated as good after Levovist injection. Endocardial border determination was improved by Levovist injection in 100 of 137 segments (74.6%). The endocardial border score index was significantly higher after Levovist administration than at baseline (p < 0.003). The end-diastolic volume and end-systolic volume of the left ventricle measured by real-time 3-DE in humans correlated well with those measured by MRI (end-diastolic volume: r = 0.97, p < 0.001; end-systolic volume: r = 0.96, p < 0.001). Transthoracic real-time, volumetric echocardiography opens a new and exciting field of echocardiography. The results of these studies demonstrate that this system can accurately measure the ventricular volume and function without use of geometric assumptions. This volumetric mode or V-mode scanning is a new imaging modality that provides a practical methodology to investigate important clinical and research questions.
    Journal of Cardiology 01/2001; 37 Suppl 1:93-101. · 2.30 Impact Factor
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    ABSTRACT: The heart is a dynamic organ with complexities in its shape. As such, it places special demands on three-dimensional techniques for reconstruction. Real-time volumetric echocardiography, which is based on phased array and parallel processing principles to enhance line density within a scan volume, provides rapid image acquisition. We introduce the principle, potential clinical importance, current limitations, and future of volumetric imaging methods.
    Echocardiography 12/2000; 17(8):773-9. · 1.26 Impact Factor

Publication Stats

3k Citations
922.93 Total Impact Points


  • 1979–2014
    • Duke University Medical Center
      • • Department of Medicine
      • • Department of Surgery
      • • Division of General Internal Medicine
      • • Division of Cardiology
      Durham, North Carolina, United States
  • 1994–2000
    • Duke University
      • Department of Biomedical Engineering (BME)
      Durham, North Carolina, United States
  • 1991
    • New York Medical College
      New York City, New York, United States
  • 1990
    • Westchester Medical Center
      Valhalla, New York, United States
  • 1984
    • California State University, Sacramento
      Sacramento, California, United States