Objective quantification of global and regional left ventricular systolic function by endocardial tracking of contrast echocardiographic sequences.

BACKGROUND Echocardiographic assessment of LV wall motion is still most frequently done visually. This study was designed to validate a new system for semi-automatic quantification of global and regional LV systolic function from contrast-enhanced cross-sectional echocardiograms. METHODS Measurements of LV volumes were validated in 50 patients using magnetic resonance (MR) as reference. The regional identification of the endocardial boundary was validated frame-by-frame against the visually identified border in another 27 patients. Finally, the applicability of the system for quantifying stress-echocardiographic exams was assessed in 52 patients undergoing dobutamine interventions. Echocardiographic sequences were digitally processed using custom-built algorithms, based on local phase feature descriptors, deformable contour fitting, and prospective training. RESULTS Compared to MR, the tracing system showed reasonable accuracy, with relative errors for end-diastolic volume, end-systolic volume, and EF of 21+/-20%, 27+/-33%, and--4+/-18%, respectively. Regional agreement of the instantaneous contours with visually traced borders was within the limits of visual reproducibility. The system was suitable for tracking stress-echo studies from all patients except two (96%). Quantification of regional radial shortening allowed to discriminate segments showing an abnormal regional wall motion with an overall area under the ROC curve of 0.87. CONCLUSIONS A reliable and accurate quantification of LV systolic function can be obtained by processing contrast echocardiograms. Values of LV volumes, ejection fraction, and regional endocardial shortening adequately correlate with currently available reference methods. Readily applicable to baseline and stress studies, endocardial tracking techniques increase the reliability of echocardiography for the assessment of global and regional systolic function.

[1]  Sigmund Frigstad,et al.  Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. , 2004, Journal of the American College of Cardiology.

[2]  V. Positano,et al.  Semiautomatic detection of left ventricular contours in contrast-enhanced echocardiographic images: Comparison with magnetic resonance imaging. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  E. Caiani,et al.  Objective assessment of left ventricular wall motion from contrast-enhanced power modulation images. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  F. T. ten Cate,et al.  Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. , 2005, European Heart Journal.

[5]  T. Ryan,et al.  American society of echocardiography , 2000 .

[6]  V. Mor-Avi,et al.  Detection of regional temporal abnormalities in left ventricular function during acute myocardial ischemia. , 2001, American journal of physiology. Heart and circulatory physiology.

[7]  L. Sugeng,et al.  Power Doppler Imaging as a Basis for Automated Endocardial Border Detection During Left Ventricular Contrast Enhancement , 2000, Echocardiography.

[8]  J. Seward,et al.  Stress echocardiography. Part II. Dobutamine stress echocardiography: techniques, implementation, clinical applications, and correlations. , 1995, Mayo Clinic proceedings.

[9]  Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: a prospective, randomly assigned, blinded study. , 2001, Journal of the American College of Cardiology.

[10]  Salim Yusuf,et al.  Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. , 1991, The New England journal of medicine.

[11]  Timothy F. Cootes,et al.  Active Shape Models-Their Training and Application , 1995, Comput. Vis. Image Underst..

[12]  J. Voigt,et al.  Comparison of deformation imaging and velocity imaging for detecting regional inducible ischaemia during dobutamine stress echocardiography. , 2004, European heart journal.

[13]  Gustavo Rincon,et al.  Lumen Loss in Transplant Coronary Artery Disease Is a Biphasic Process Involving Early Intimal Thickening and Late Constrictive Remodeling Results From a 5-Year Serial Intravascular Ultrasound Study , 2001 .

[14]  R. D. Hogan,et al.  Echocardiographic definition of the left ventricular centroid. II. Determination of the optimal centroid during systole in normal and infarcted hearts. , 1990, Journal of the American College of Cardiology.

[15]  D. Kraitchman,et al.  Effect of dobutamine on regional left ventricular function measured by tagged magnetic resonance imaging in normal subjects. , 1999, The American journal of cardiology.

[16]  J. G. Miller,et al.  On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging. , 1992, Journal of the American College of Cardiology.

[17]  T R Porter,et al.  Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin. , 1994, Journal of the American College of Cardiology.

[18]  Miguel. Mulet Parada.  Intensity independent feature extraction and tracking in echocardiographic sequences. , 2000 .

[19]  A de Roos,et al.  Quantitation of global and regional left ventricular function by cine magnetic resonance imaging during dobutamine stress in normal human subjects. , 1993, European heart journal.

[20]  V. Mor-Avi,et al.  Automated endocardial border detection and evaluation of left ventricular function from contrast-enhanced images using modified acoustic quantification. , 2002, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  D J Pennell,et al.  Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. , 2000, Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance.

[22]  R Erbel,et al.  Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms. , 1996, Journal of the American College of Cardiology.

[23]  J. Alison Noble,et al.  2D+T acoustic boundary detection in echocardiography , 2000, Medical Image Anal..

[24]  L. Fauchier,et al.  Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy: a prognostic study with fourier phase analysis of radionuclide angioscintigraphy. , 2002, Journal of the American College of Cardiology.

[25]  E. García,et al.  Validation of a computerized edge detection algorithm for quantitative two-dimensional echocardiography. , 1983, Circulation.

[26]  F L Bookstein,et al.  Automatic computer processing of digital 2-dimensional echocardiograms. , 1983, The American journal of cardiology.

[27]  J. Kisslo,et al.  Opacification and border delineation improvement in patients with suboptimal endocardial border definition in routine echocardiography: results of the Phase III Albunex Multicenter Trial. , 1991, Journal of the American College of Cardiology.

[28]  Harald Becher,et al.  Analysis of regional left ventricular function by cineventriculography, cardiac magnetic resonance imaging, and unenhanced and contrast-enhanced echocardiography: a multicenter comparison of methods. , 2006, Journal of the American College of Cardiology.

[29]  L Weinert,et al.  Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images. , 1999, Journal of the American College of Cardiology.

[30]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.