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ABSTRACT: The interpretation of induced wall motion abnormalities during dobutamine stress echocardiography is affected in the case
of impaired image quality.
In 48 consecutive patients (mean age 62±9 years, 32 males, 16 females) with suspected coronary disease undergoing coronary
angiography, the transpulmonary contrast agent BY 963 was given i.v. as bolus during dobutamine stress echocardiography (10–40μgkgmin,
plus max. 1mg atropine) to analyze improvements in endocardial border delineation. For each of the 16 segments of the left
ventricle, the endocardial border delineation was evaluated.
Using BY 963 the average number of non-evaluable segments decreased by 58% from 5.2% to 2.2% at rest (p=0.008) and by 56%
from 5.9% to 2.6% at maximal stress (p=0.003) as compared to the non-contrast study for all patients. In patients with impaired
image quality, defined as at least 1 non-evaluable segment at rest without contrast enhancement (N=14), the number of non-evaluable
segments decreased from 19.2% to 8.2% (p=0.004) at rest and from 19.2% to 9.6% (p=0.006) at maximal stress. The greatest decrease
of non-evaluable segments was seen in the lateral and anterior segments of the apical views (maximum of 80%). The improved
endocardial border delineation resulted in an improved agreement between two observers in the interpretation of the dobutamine
stress echocardiograms as positive or negative (kappa=0.38 without contrast, kappa=0.58 with contrast). Contrast application
resulted in a slight improvement of diagnostic accuracy of dobutamine stress echocardiography in the detection of angiographically
proven significant coronary artery disease.
Conclusion: In patients with impaired endocardial border delineation the use of the echo contrast agent BY 963 reduces the number of
non-evaluable segments. Improvement of endocardial delineation is greatest for lateral and anterior segments in the apical
views.
Die Interpretation induzierter Wandbewegungsstörungen während der Dobutamin-Belastungsechokardiographie ist bei einem Teil
der Patienten durch unzureichende Endokardabgrenzbarkeit beeinträchtigt.
Bei 48 konsekutiven Patienten (mittleres Alter 62±9 Jahre, 32 Männer, 16 Frauen) mit vermuteter koronarer Herzkrankheit, bei
denen die Indikation zur Koronarangiographie gestellt worden war, wurde untersucht ob die intravenöse Applikation des lungengängigen
Echokontrastmittels BY 963 eine verbesserte Endokarderkennbarkeit im linken Ventrikel sowohl in Ruhe als auch unter Dobutaminbelastung
(10 bis 40μg/kg/min + maximal 1mg Atropin) erlaubt. Für jedes der 16 linksventrikulären Segmente wurde die endokardiale Erkennbarkeit
beurteilt.
Durch Einsatz des Kontrastmittels BY 963 ließ sich die durchschnittliche Zahl nicht-auswertbarer Segmente um 58% von 5,2%
auf 2,2% in Ruhe (p=0,008) und um 56% von 5,9% auf 2,6% unter maximaler Belastung (p=0,003) senken. Bei Patienten mit eingeschränkter
Bildqualität (N=14), definiert als fehlende Beurteilbarkeit mindestens eines Wandsegmentes in Ruhe, konnte die durchschnittliche
Zahl nicht-auswertbarer Segmente von 19,2% auf 8,2% (p=0,004) vor Belastung und von 19,2% auf 9,6% (p=0,006) unter maximaler
Belastung gesenkt werden. Die größte Abnahme nicht-auswertbarer Segmente zeigte sich in den lateralen und anterioren Segmenten
der apikalen Schnittebenen (maximal um 80%). Die verbesserte endokardiale Abgrenzbarkeit resultierte in einer größeren Übereinstimmung
zwischen zwei Untersuchern in der Bewertung der Dobutamin-Belastungsechokardiogramme als normal oder pathologisch (Kappa=0,38
ohne Kontrast, Kappa=0,58 mit Kontrast). Die diagnostische Genauigkeit der Dobutamin-Belastungsechokardiographie in der Erfassung
einer angiographisch signifikanten koronaren Herzkrankheit stieg geringfügig an.
Schlußfolgerung: Bei Patienten mit eingeschränkter Endokarderkennbarkeit führt der Einsatz des Echokontrastmittels BY 963 zu einer verminderten
Zahl nicht-auswertbarer Segmente, wobei die Verbesserung in den lateralen und anterioren Segmenten der apikalen Schnittebenen
am ausgeprägtesten ist.
Key words Dobutamine stress echocardiography – contrast agent – endocardial detection – BY 963Schlüsselwörter Dobutamin-¶Belastungsechokardiographie –¶Kontrastmittel –¶Endokarderkennung – BY 963
Zeitschrift für Kardiologie 04/2012; 89(3):186-194. · 0.97 Impact Factor
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ABSTRACT: To evaluate whether myocardial strain and strain rate calculated from two dimensional echocardiography by automatic frame-by-frame tracking of natural acoustic markers enables objective description of regional left ventricular (LV) function.
In 64 patients parasternal two dimensional echocardiographic views at the apical, mid-ventricular and basal levels were obtained. An automatic frame-by-frame tracking system of natural acoustic echocardiographic markers was used to calculate radial strain, circumferential strain, radial strain rate and circumferential strain rate for each LV segment in a 16 segment model. Cardiac magnetic resonance imaging (cMRI) was performed to define segmental LV function as normokinetic, hypokinetic or akinetic.
Image quality was sufficient for adequate strain and strain-rate analysis from two dimensional echocardiographic images obtained from parasternal views in 88% of segments. Obtained radial strain data were highly reproducible and analysis was affected by only small intraobserver (mean 4.4 (SD 1.6)%) and interobserver variabilities (7.3 (2.5)%). Each of the analysed strain and strain-rate parameters was significantly different between segments defined as normokinetic, hypokinetic or akinetic by cMRI (radial strain 36.8 (10.5)%, 24.1 (7.5)% and 13.4 (4.8)%, respectively, p < 0.001). Peak systolic radial strain enabled detection of hypokinesis or akinesis with a sensitivity of 83.5% and a specificity of 83.5% (cut off value 29.1%, receiver operating characteristic (ROC) curve area 0.905, 95% CI 0.883 to 0.923). Peak systolic radial strain analysis also enabled detection of akinesis versus hypokinesis with a sensitivity of 82.7% and a specificity of 94.5% (cut off value 21.0%, ROC curve area 0.946). Peak systolic radial strain-rate analysis was less accurate than peak systolic radial strain analysis to detect cMRI-defined segmental function abnormalities. The accuracy of peak systolic circumferential strain and strain rate was similar to that of corresponding radial parameters.
Frame-by-frame tracking of acoustic markers in two dimensional echocardiographic images enables accurate analysis of regional systolic LV function.
Heart (British Cardiac Society) 08/2006; 92(8):1102-8. · 4.22 Impact Factor
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Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2005; 177.
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ABSTRACT: Dobutamine stress echocardiography (DSE) is used widely to evaluate myocardial viability, but is limited by the subjective nature of test interpretation. Assessment of systolic function by pulsed tissue Doppler imaging (TDI) during dobutamine stimulation may allow a more objective evaluation of myocardial functional reserve and, thus, myocardial viability. In 30 patients (58 +/- 9 years) with prior myocardial infarction, pulsed TDI with low dose dobutamine stress (10 microg/kg/min) was performed to assess myocardial viability. Qualitative assessment of two-dimensional (2-D) DSE and positron emission tomography (PET) were used for comparison. Peak systolic myocardial velocity was measured for each left ventricular segment (16 segments) at baseline and low dose dobutamine stress using pulsed TDI. The absolute and relative increases of peak systolic velocity from rest to low dose dobutamine stress were calculated. Three hundred sixty-four segments with adequate pulsed TDI tracing were divided according to either 2-D DSE or PET findings into normal, viable (mismatch), and nonviable (match) segments. The increase of peak systolic myocardial velocity from baseline to low dose dobutamine was significantly different between segments defined as normal, viable, and nonviable by 2-D DSE (2.71 +/- 1.91 cm/sec, 1.86 +/- 2.15 cm/sec, and 0.99 +/- 1.16 cm/sec, respectively; P < 0.001). The increase of peak systolic myocardial velocity from rest to low dose dobutamine for normal, mismatch, and match segments defined by PET was 2.72 +/- 1.96, 1.01 +/- 0.96 and 0.80 +/- 1.07 cm/sec, respectively (P < 0.001). In conclusion, the increase of peak systolic myocardial velocity during low dose dobutamine stimulation determined by pulsed TDI distinguishes between different myocardial viability states. It complements the standard interpretation of stress echocardiograms.
Echocardiography 11/2001; 18(8):657-64. · 1.24 Impact Factor
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ABSTRACT: To evaluate the ability of tissue tracking for rapid assessment of left ventricular function by determination of the systolic mitral annular displacement. Tissue tracking is a new echocardiographic modality based on Doppler Tissue imaging allowing rapid visual assessment of the systolic baso-apical displacement of each myocardial segment in apical views by a graded colour display.
We studied 90 patients (69 male, age 60.4 +/- 10.1 years) with different left ventricular function (25 subjects with normal left ventricular function, 25 patients with homogeneous depression of left ventricular function and 40 patients with prior myocardial infarction). Systolic mitral annular displacement was determined by tissue tracking and M-mode echocardiography. Apical two-, three- and four-chamber views were used to determine the mitral annular displacement of six sites. Left ventricular ejection fraction was determined by two-dimensional echocardiography using Simpson's rule. Tissue tracking was possible in all patients. In the 50 patients with normal left ventricular function or homogeneous depression of left ventricular function, mean mitral annular displacement correlated closely with mitral annular displacement determined by M-mode (r=0.99,P <0.001) and with left ventricular ejection fraction (r=0.97, P<0.001). Left ventricular ejection fraction < or = 30% could be predicted with a sensitivity of 98% and a specificity of 78% using a cut-off value of 4.8mm for the mitral annular displacement determined by tissue tracking. In patients with prior myocardial infarction correlation between the mean mitral annular displacement and left ventricular ejection fraction was lower (r=0.87, P<0.001).
Systolic mitral annular displacement determined by tissue tracking correlates closely with mitral annular displacement determined by M-mode and with left ventricular ejection fraction. Thus, tissue tracking allows rapid semiquantitative evaluation of global left ventricular function by assessment of systolic mitral annular displacement.
European Heart Journal – Cardiovascular Imaging 09/2001; 2(3):197-202. · 2.32 Impact Factor
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[hide abstract]
ABSTRACT: The interpretation of induced wall motion abnormalities during dobutamine stress echocardiography is affected in the case of impaired image quality. In 48 consecutive patients (mean age 62 +/- 9 years, 32 males, 16 females) with suspected coronary disease undergoing coronary angiography, the transpulmonary contrast agent BY 963 was given i.v. as bolus during dobutamine stress echocardiography (10-40 micrograms kg min, plus max. 1 mg atropine) to analyze improvements in endocardial border delineation. For each of the 16 segments of the left ventricle, the endocardial border delineation was evaluated. Using BY 963 the average number of non-evaluable segments decreased by 58% from 5.2% to 2.2% at rest (p = 0.008) and by 56% from 5.9% to 2.6% at maximal stress (p = 0.003) as compared to the non-contrast study for all patients. In patients with impaired image quality, defined as at least 1 non-evaluable segment at rest without contrast enhancement (N = 14), the number of non-evaluable segments decreased from 19.2% to 8.2% (p = 0.004) at rest and from 19.2% to 9.6% (p = 0.006) at maximal stress. The greatest decrease of non-evaluable segments was seen in the lateral and anterior segments of the apical views (maximum of 80%). The improved endocardial border delineation resulted in an improved agreement between two observers in the interpretation of the dobutamine stress echocardiograms as positive or negative (kappa = 0.38 without contrast, kappa = 0.58 with contrast). Contrast application resulted in a slight improvement of diagnostic accuracy of dobutamine stress echocardiography in the detection of angiographically proven significant coronary artery disease. CONCLUSION: In patients with impaired endocardial border delineation the use of the echo contrast agent BY 963 reduces the number of non-evaluable segments. Improvement of endocardial delineation is greatest for lateral and anterior segments in the apical views.
Zeitschrift für Kardiologie 04/2000; 89(3):186-94. · 0.97 Impact Factor
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ABSTRACT: Recent studies have evaluated the diagnostic accuracy and predictive value of dobutamine echocardiography without considering the additional information implied by the magnitude of induced wall motion abnormalities. We sought to evaluate the positive predictive value of dobutamine echocardiography for coronary artery disease from the extent and severity of the induced wall motion abnormality. In addition, we intended to determine factors associated with false-negative dobutamine echocardiography.
Two hundred and eighty-three consecutive patients with suspected coronary artery disease underwent dobutamine echocardiography (up to 40 microg x kg(-1) x min(-1)+atropine up to 1 mg) and coronary angiography. The number of segments and the degree of deterioration were used to describe the extent and severity of induced wall motion abnormality. Analysis of clinical, procedural and echocardiographic variables was performed to determine factors associated with false-negative results. The positive predictive value of dobutamine echocardiography increased from 85% to 90%, 94% and 94% with deterioration of wall motion by one grade in >/=1, >/=2, >/=3 and >/=4 segments, respectively (P<0.05). Deterioration of wall motion by two grades in one segment had a positive predictive value of 96% as compared to 85% for deterioration by only one grade in one segment (P<0.05). Patients with false-negative test results received atropine more frequently (28% vs 13%, odds ration [OR]=3.87, 95% confidence interval [CI]=1.54-9.75, P=0.028) than patients with a correct positive result. However, angina (15 vs 37%, OR=0.26, 95% CI=0.09-0.71, P=0.010), ECG changes during dobutamine stress (15% vs 35%, OR=0.49, 95% CI 0.19-1.25, P=0.014) and high image quality (OR 1.59, 95% CI 1.07-2.37, P=0.015) were less frequent. The sensitivity of dobutamine echocardiography increased from 67% to 71% and 86% (P<0.05) with increasing achieved maximal heart rate (<75%, 75-85% and >85% of maximal heart rate).
The positive predictive value of dobutamine echocardiography increases significantly as the extent and severity of induced wall motion abnormality increases. Thus, the degree of test positivity should be reported in clinical practice. Despite high pharmacological drug doses, the haemodynamic response may still be insufficient in some patients to induce myocardial ischaemia, resulting in false-negative dobutamine echo tests. To maximize the sensitivity of dobutamine echocardiography, the highest haemodynamic stress level, with a heart rate above 85% of the predicted heart rate, should be reached.
European Heart Journal 11/1999; 20(20):1485-92. · 10.48 Impact Factor
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DMW - Deutsche Medizinische Wochenschrift 10/1999; 124(38):1101-6. · 0.53 Impact Factor
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ABSTRACT: The reconstruction of three-dimensional data sets from two-dimensional echocardiographic images offers several fundamental advantages: 1. more complete data than present in the few standard 2D-view; 2. off-line generation of any desired plane, cut, or perspective after the data set has been acquired; 3. access to quantitative parameters like surface areas (e.g., of valve leaflets or portions of leaflets), volumes, and others, without geometric assumptions. The mitral valve has been the focus of several studies using various techniques of reconstruction of transthoracic or transesophageal images. These studies have shown the mitral annulus to be a non-planar, "saddle-shaped" structure, with an average distance of highest to lowest points of 14 mm in normals. This recognition of mitral annular non-planarity has led to a more stringent echocardiographic definition of mitral valve prolapse. Further studies have shown systolic shrinkage of mitral annular area by about 30% and systolic apico-basal translation of the annulus by approximately 1 cm in normals. In patients with dilated cardiomyopathy, the annulus is flattened, and both cyclic change in annular area and apico-basal translation are significantly reduced. 3D-studies of the left ventricular outflow tract in hypertrophic obstructive cardiomyopathy allow measurement of outflow tract and leaflet surface areas and dynamic spatial visualization of systolic anterior motion of the anterior mitral leaflet. Automated techniques to reconstruct the full grey value data set from a high number of parallel or rotational transesophageal planes allow impressive visualization of normal and diseased mitral and aortic valves or valve prostheses, with special emphasis on generating "surgical" views and perspectives, which cannot be obtained by conventional tomographic imaging.(ABSTRACT TRUNCATED AT 250 WORDS)
Herz 09/1995; 20(4):236-42. · 0.92 Impact Factor
