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Objectives: This study sought to compare the prognostic value of 2-dimensional (2D) right ventricular (RV) speckle tracking (STE) against cardiac magnetic resonance (CMR) RV ejection fraction (EF) and feature tracking (FT) and conventional echocardiographic parameters on overall and cardiovascular (CV) survival in patients with heart failure with reduced EF (HFrEF)., Background: Prior works showed that RV systolic function predicts prognosis in HFrEF. 2D RVSTE had recently been proposed as new echocardiographic method to evaluate RV dysfunction., Methods: A total of 266 patients with HFrEF (mean LVEF 23 ± 7%, 60 ± 14 years of age; 29% women) underwent RV function assessment using CMR and 2D echocardiography and were followed for a primary endpoint of overall death and secondary endpoint of CV death., Results: Average CMR-RVEF was 42 ± 15%, average STE RV global longitudinal strain (STE-RVGLS) was -18.0 ± 4.9%, and average CMR-FT-RVGLS was -11.8 ± 4.3%. After a median follow-up of 4.7 years, 102 patients died, 84 of a CV cause. RVEF, FT-RVGLS, tricuspid annulus plane systolic excursion (TAPSE), fractional area change (FAC), and STE-RVGLS were significant univariate predictors of overall and cardiac death. In multivariate Cox regression, age, ischemic etiology, diabetes, New York Heart Association functional class III to IV, and beta-blocker treatment were independent clinical predictors of overall mortality. CMR-RVEF (chi-square to enter = 3.9; p < 0.05), FT-RVGLS (chi-square to enter 3.7; p = 0.05), FAC (chi-square to enter 6.2; p = 0.02), and TAPSE (chi-square to enter = 4.1; p = 0.04) provided additional prognostic value over these baseline parameters, but the additional predictive value of STE-RVGLS (chi-square to enter = 10.8; p < 0.001) was significantly (p < 0.05) higher than the other tests. Additional hazard ratio to predict overall mortality was 2.5 (95% confidence interval [CI]: 1.6 to 3.9) for STE-RVGLS <-19%, 2.15 (95% CI: 1.34 to 3.43) for TAPSE >15 mm, 1.6 (95% CI: 1.02 to 2.49) for FAC >39%, 1.93 (95% CI: 1.25 to 2.99) for RVEF >41%, and 1.87 (95% CI: 1.10 to 3.19) for CMR-FT-RVGLS <-15%., Conclusions: 2D RVGLS provides strong additional prognostic value to predict overall and CV mortality in HFrEF, with higher predictive value than CMR-RVEF, CMR-FT-RVGLS, TAPSE, or FAC. This supports use of STE-RVGLS to identify higher-risk HFrEF patients., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In prior work, the authors demonstrated that two-dimensional speckle-tracking (2DST) correlated well but systematically overestimated global longitudinal strain (LS) and circumferential strain (CS) compared with two-dimensional cardiac magnetic resonance tagging (2DTagg) and had poor agreement on a segmental basis. Because three-dimensional speckle-tracking (3DST) has recently emerged as a new, more comprehensive evaluation of myocardial deformation, this study was undertaken to evaluate whether it would compare more favorably with 2DTagg than 2DST., Methods: In a prospective two-center trial, 119 subjects (29 healthy volunteers, 63 patients with left ventricular dysfunction, and 27 patients with left ventricular hypertrophy) underwent 2DST, 3DST, and 2DTagg. Global, regional (basal, mid, and apical), and segmental (18 and 16 segments per patient) LS and CS by 2DST and 3DST were compared with 2DTagg using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Test-retest reproducibility of 3DST and 2DST was compared in 48 other patients., Results: Both global LS and CS by 3DST agreed better with 2DTagg (ICC = 0.89 and ICC = 0.83, P < .001 for both; bias = 0.5 ± 2.3% and 0.2 ± 3%) than 2DST (ICC = 0.65 and ICC = 0.55, P < .001 for both; bias = -5.5 ± 2.5% and -7 ± 5.3%). Unlike 2DST, 3DST did not overestimate deformation at the regional and particularly the apical levels and at the segmental level had lower bias (LS, 0.8 ± 2.8% vs -5.3 ± 2.4%; CS, -0.01 ± 2.8% vs -7 ± 2.8%, respectively) but similar agreement with 2DST (LS: ICC = 0.58 ± 0.16 vs 0.56 ± 0.12; CS: ICC = 0.58 ± 0.12 vs 0.51 ± 0.1) with 2DTagg. Finally, 3DST had similar global LS, but better global CS test-retest variability than 2DST., Conclusions: Using 2DTagg as reference, 3DST had better agreement and less bias for global and regional LS and CS. At the segmental level, 3DST demonstrated comparable agreement but lower bias versus 2DTagg compared with 2DST. Also, test-retest variability for global CS by 3DST was better than by 2DST. This suggests that 3DST is superior to 2DST for analysis of global and regional myocardial deformation, but further refinement is needed for both 3DST and 2DST at the segmental level., (Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Despite widespread use to characterize and refine prognosis, validation data of two-dimensional (2D) speckle tracking (2DST) echocardiography myocardial strain measurement remain scarce., Methods and Results: Global and regional subendocardial peak-systolic Lagrangian longitudinal (LS) and circumferential strain (CS) by 2DST and 2D-tagged (2DTagg) cardiac magnetic resonance imaging were compared against sonomicrometry in a dynamic heart phantom and among each other in 136 patients included prospectively at 2 centers. The ability of regional LS and CS 2DST and 2DTagg to identify late gadolinium enhancement was compared using receiver operating characteristics curves. In vitro, both LS-2DST and 2DTagg highly agreed with sonomicrometry (intraclass correlation coefficient [ICC], 0.89 and ICC, 0.90, both P <0.001 with -3±2.8% and 0.34±4.35% bias, respectively). In patients, both global LS and global CS 2DST agreed well with 2DTagg (ICC, 0.89 and ICC, 0.80; P <0.001); however, they provided systematically greater values (relative bias of -37±27% and -25±37% for global LS and global CS, respectively). On regional basis, however, ICC (from 0.17 to 0.81) and relative bias (from -9 to -98%) between 2DST and 2DTagg varied strongly among segments. Ability to discriminate infarcted versus noninfarcted segments by late gadolinium enhancement was similarly good for regional LS 2DTagg and 2DST (area under the curve, 0.66 versus 0.59; P =0.08), while it was lower for CS 2DST than 2DTagg (area under the curve, 0.61 versus 0.75; P <0.001)., Conclusions: The high accuracy against sonomicrometry and good agreement of global LS and global CS by 2DST and 2DTagg confirm the overall validity of 2DST strain measurement. Yet, higher intertechnique segmental variability and lower ability for detecting infarct suggest that 2DST strain estimates may be less performant on regional than on global basis., (© 2017 American Heart Association, Inc.)

Aims: (i) To investigate geometric differences between apical views of the left ventricle (LV) derived from standard 2D echocardiography (std2D) and triplane (TP) views, as well as the "ideally" reconstructed 2D (rec2D) views derived from 3D full volume (3DFV) acquisitions, and their influence on the assessment of LV morphology and function. (ii) To determine the feasibility and accuracy of the automatic reconstruction of 2D apical views from 3DFV datasets., Methods and Results: In 59 patients with structurally normal, dilated, and hypertrophic hearts, rec2D was reconstructed manually and automatically and compared to std2D, TP, and 3DFV regarding the image plane orientation (true vs. ideal probe position, plane intersection angles), LV dimensions, volumes, and EF. The ideal probe position deviated from the true one by 6.9 ± 4.1 mm and 9.5 ± 4.5 mm, for manually and automatically rec2D, respectively, regardless of LV geometry. The mean difference ± SD between manual and automatic reconstruction was -2.5 ± 4.4 mm. LV long axis was measured minimally, but significantly longer in rec2D than std2D and TP. LV volumes and EF did not differ between methods. The intersection angle of the two-chamber view and the three-chamber view with the four-chamber view for manual and automatic reconstruction was 53° ± 7° and 129° ± 7° and 60° and 130°, respectively., Conclusion: Ideal reconstruction of nonforeshortened 2D images from 3DFV does not lead to a relevant improvement in image geometry or the assessment of LV morphology and function. The automatic reconstruction algorithm deviates only slightly from manual results., (© 2012, Wiley Periodicals, Inc.)

Abstract Aims To validate Echo Particle Image Velocimetry (PIV) Methods High fidelity string and rotating phantoms moving with different speed patterns were imaged with different high-end ultrasound systems at varying insonation angles and frame rates. Images were analyzed for velocity and direction and for complex motion patterns of blood flow with dedicated software. Post-processing was done with MATLAB-based tools (Dflow, JUV, University Leuven). Results Velocity estimation was accurate up to a velocity of 42 cm/s (r = 0.99, p Conclusion Echo-PIV appears feasible. Velocity estimates are accurate, but the maximal detectable velocity depends strongly on acquisition parameters. Direction estimation works sufficiently, even at higher velocities. Echo-PIV appears to be a promising technical approach to investigate flow patterns by echocardiography.

Aims Although recommended by current guidelines, adoption of three-dimensional echocardiographic (3DE) chamber quantification in clinical practice has lagged because of time-consuming analysis. We recently validated an automated algorithm that measures left atrial (LA) and left ventricular (LV) volumes and ejection fraction (EF). This study aimed to determine the accuracy and reproducibility of these measurements in a multicentre setting. Methods and results 180 patients underwent 3DE imaging (Philips) at six sites. Images were analysed using automated HeartModel (HM) software with endocardial border correction when necessary and by manual tracing. Measurements were performed by each site and by the Core Laboratory (CL) as the reference. Inter-technique comparisons included HM measurements by the sites against manual tracing by CL, and showed strong correlations (r-values: LVEDV: 0.97, LVESV: 0.97, LVEF: 0.88, LAV: 0.96), with the automated technique slightly underestimating LV volumes (biases: LVEDV: -14 ± 20 ml, LVESV: -6 ± 20 ml), LVEF (-2 ± 7%) and LAV (-9 ± 10 ml). Intra-technique comparisons included HM measurements by the sites against CL, with and without corrections. Corrections were unnecessary or minimal in most patients, and improved the measurements only modestly. Comparisons without corrections showed perfect agreement for all parameters. With corrections, correlations were better (r-values: LVEDV: 0.99, LVESV: 0.99, LVEF: 0.94, LAV: 0.99) and biases (LVEDV: -8 ± 12 ml, LVESV: -6 ± 12 ml, LVEF: 1 ± 5%, LAV: -10 ± 6 ml) smaller than in inter-technique comparison. All automated measurements with corrections were more reproducible than manual measurements. Conclusion Automated 3DE analysis of left-heart chambers is an accurate alternative to conventional manual methodology, which yields almost the same values across laboratories and is more reproducible. This technique may contribute towards full integration of 3DE quantification into clinical routine. [ABSTRACT FROM AUTHOR]

Background: Myocardial T1, T2 and T2* imaging techniques become increasingly used in clinical practice. While normal values for T1, T2 and T2* times are well established for 1.5 Tesla (T) cardiovascular magnetic resonance (CMR), data for 3T remain scarce. Therefore we sought to determine normal reference values relative to gender and age and day to day reproducibility for native T1, T2, T2* mapping and extracellular volume (ECV) at 3T in healthy subjects. Methods: After careful exclusion of cardiovascular abnormality, 75 healthy subjects aged 20 to 90 years old (mean 56 ± 19 years, 47% women) underwent left-ventricular T1 (3-(3)-3-(3)-5 MOLLI)), T2 (8 echo- spin echo-imaging) and T2 * (8 echo gradient echo imaging) mapping at 3T CMR (Philips Ingenia 3T and computation of extracellular volume after administration of 0.2 mmol/kg Gadovist). Inter- and intra-observer reproducibility was estimated by intraclass correlation coefficient (ICC). Day to day reproducibility was assessed in 10 other volunteers. Results: Mean myocardial T1 at 3T was 1122 ± 57 ms, T2 52 ± 6 ms, T2* 24 ± 5 ms and ECV 26.6 ± 3.2%. T1 (1139 ± 37 vs 1109 ± 73 ms, p <0.05)andECV(28±3vs25±2%, p <0.001),butnotT2(53±8vs51±4,p=NS)were significantly greater in age matched women than in men. T1 (r = 0.40, p < 0.001) and ECV (r = 0.37, p = 0.001) increased, while T2 decreased significantly (r = -0.25, p < 0.05) with increasing age. T2* was not influenced by either gender or age. Intra and inter-observer reproducibility was high (ICC ranging between 0.81-0.99), and day to day coefficient of variation was low (6.2% for T1, 7% for T2, 11% for T2* and 11.5% for ECV). Conclusions: We provide normal myocardial T2, T2*,T1 and ECV reference values for 3T CMR which are significantly different from those reported at 1.5 Tesla CMR. Myocardial T1 and ECV values are gender and age dependent. Measurement had high inter and intra-observer reproducibility and good day-to-day reproducibility. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology of paradoxical low-gradient (LG) severe aortic stenosis (SAS) remains controversial. As low transvalvular flow has been implicated, we sought to investigate the impact of left ventricular outflow tract (LVOT) ellipticity on the estimation of the LV stroke volume, the calculation of the aortic valve area (AVA) by use of the continuity equation and on AS severity grading. Methods: We studied 190 consecutive patients (mean age: 72 ± 13 years; male: 57%) with SAS (indexed AVA < 0.6 cm²/m²) and preserved LV ejection fraction, including 120 patients with severe high gradient (HG) AS and 70 with severe paradoxical LG-AS. AS severity, LV volumes and LVOT ellipticity were assessed by 2D-Doppler echocardiography and cardiac magnetic resonance (CMR). Results: The LVOT exhibited an elliptical shape on CMR images, with a shorter anterior-posterior than median-lateral diameter (2.2 ± 0.2 vs 2.8 ± 0.3 cm, p < 0.01). Accordingly, the LVOT area measured by planimetry was larger than by 2D-echocardiography, assuming a circular orifice (4.9 ± 0.9 cm² vs 3.7 ± 0.8 cm², p < 0.01). Inputting the elliptical LVOT area into the continuity equation resulted in a 29% increase in the indexed AVA (from 0.41 ± 0.09 cm² to 0.54 ± 0.10 cm²). Accordingly, 30 (43%) patients with severe paradoxical LG-SAS were reclassified as having moderate AS. Similar results were obtained when considering 3D-echo for direct planimetry of the LVOT in a subset of 75 patients. Conclusions: Our results confirm that the LVOT is elliptical in shape and that taking this parameter into account in the calculation of the AVA results in reclassification of 43% of patients with severe paradoxical LG-AS into moderate AS. [ABSTRACT FROM AUTHOR]

Aims Survival in patients (pts) with pulmonary hypertension ( PH) differs between subgroups at similar levels of pressure overload. We set to analyze right ventricular ( RV) morphology and function in different types of PH using conventional and deformation imaging echocardiography. Material and Methods Thirty-four pts with PH: 12 pts with idiopathic pulmonary arterial hypertension ( IPAH, 42.2 ± 13 years), 11 pts with chronic thromboembolic PH ( CTEPH, 50.8 ± 12 years), 11 pts with Eisenmenger syndrome [ ES 41.2 ± 15 years, 4 with atrial septal defect ( ASD) and 7 with ventricular septal defect ( VSD)], and 13 age-matched healthy individuals (38.1 ± 15 years) were evaluated. The following echocardiographic parameters were measured: echo-derived systolic pulmonary pressure ( sPAPecho), RV end-diastolic diameter ( RVEDD), RV wall thickness ( RVWT), TAPSE, RV fractional area change ( RVFAC), Tei index, peak systolic velocity of the tricuspid ring (S't), and speckle tracking-derived RV free wall strain. Furthermore, right heart catheterization ( RHC) was performed in pts with PH and mean, and systolic pulmonary artery pressure ( mPAPcath, sPAPcath), cardiac output ( CO), cardiac index ( COi), and pulmonary vascular resistance ( PVR) were noted. Results The levels of mPAPcath and sPAPcath were similar between pts with PH ( pANOVA = NS). Patients with ES had higher COi compared to other groups (2.94 ± 0.79, 2.28 ± 0.69, and 1.74 ± 0.46 L/min/m2 for pts with ES, IPAH, and CTEPH respectively, pANOVA = 0.004, P post hoc ES versus all other groups < 0.05). TAPSE, Tei index, and S't were similar between groups and impaired versus controls ( pANOVA < 0.001, P post hoc between groups of patients = NS). Patients with ES had better RVFAC (41.1 ± 9, 30.5 ± 10.8, 23.2 ± 9.8%) and RV free wall strain (−20.6 ± 3.5, −16.3 ± 7.5, −10.8 ± 5%), as well as an increased thickness of the RV free wall compared to other groups of patients (9.2 ± 1.5, 7.2 ± 1 and 7.2 ± 1.6 mm for pts with ES, IPAH and CTEPH, respectively) ( pANOVA<0.001, P post hoc <0.05 ES versus all other groups). RVFAC and RV free wall strain significantly correlated with COi (r = 0.53, P = 0.006 and r = −0.77, P < 0.001, respectively). Conclusion Patients with ES have a more hypertrophied RV free wall, better RV performance as assessed by RVFAC and RV free wall strain and increased COi compared to other types of PH. Furthermore, RV performance appears to be less dependent on the level of pressure overload. These findings could contribute to the better survival profile of patients with ES. [ABSTRACT FROM AUTHOR]

Aims Echocardiographic particle image velocimetry (EPIV) has been used for tracking contrast-enhanced intracavitary blood flow. Little is known, however, how basic imaging parameters (line density, frame rate, contrast bubble density) affect the quality of such tracking results. Our study aimed at investigating this by using simulated echo data sets. Methods and results A computational three-dimensional (3D) blood flow field of the left ventricle (LV) was built using Fluent 12.1 (ANSYS Inc., USA). Then, the 3D motion of contrast microbubbles was simulated and 2D B-mode image loops were obtained (f = 4.5 MHz; 50 sector angle) and analysed using flow tracking software (Omega Flow, Siemens, USA). Vorticity and the resulting in-plane velocity vector field was calculated at different frame rates (227, 113, 76, and 57 fps) and bubble densities (100, 63, 36, 19, 10, and 3 bubbles/mL) and compared with the ground truth known from the computational LV flow model. The normal distribution of the amplitude error and angle error histograms confirmed the overall good performance of the tracking method. In the standard deviation analysis of error histograms, tracked velocity amplitudes correlated best with the ground truth at 10 bubbles/mL and 227 fps (45.81 ± 3.43%, P < 0.05), while the best performance of flow direction estimates was at 10 bubbles/mL and 76 fps (25.41 ± 1.22°, P < 0.05). The correlation of estimated and true vorticity tended to grow with increasing frame rate and was optimal at 19 bubbles/mL and 113 fps (r = 0.79 ± 0.02). Conclusion To achieve accurate vorticity measurements, frame rate acquisitions as 113 fps and contrast bubble density of 19 bubbles/mL are needed. [ABSTRACT FROM AUTHOR]

Cardiac motion atlases provide a space of reference in which the motions of a cohort of subjects can be directly compared. Motion atlases can be used to learn descriptors that are linked to different pathologies and which can subsequently be used for diagnosis. To date, all such atlases have been formed and applied using data from the same modality. In this work we propose a framework to build a multimodal cardiac motion atlas from 3D magnetic resonance (MR) and 3D ultrasound (US) data. Such an atlas will benefit from the complementary motion features derived from the two modalities, and furthermore, it could be applied in clinics to detect cardiovascular disease using US data alone. The processing pipeline for the formation of the multimodal motion atlas initially involves spatial and temporal normalisation of subjects’ cardiac geometry and motion. This step was accomplished following a similar pipeline to that proposed for single modality atlas formation. The main novelty of this paper lies in the use of a multi-view algorithm to simultaneously reduce the dimensionality of both the MR and US derived motion data in order to find a common space between both modalities to model their variability. Three different dimensionality reduction algorithms were investigated: principal component analysis, canonical correlation analysis and partial least squares regression (PLS). A leave-one-out cross validation on a multimodal data set of 50 volunteers was employed to quantify the accuracy of the three algorithms. Results show that PLS resulted in the lowest errors, with a reconstruction error of less than 2.3 mm for MR-derived motion data, and less than 2.5 mm for US-derived motion data. In addition, 1000 subjects from the UK Biobank database were used to build a large scale monomodal data set for a systematic validation of the proposed algorithms. Our results demonstrate the feasibility of using US data alone to analyse cardiac function based on a multimodal motion atlas. [ABSTRACT FROM AUTHOR]