Novel ultrasound-contrast-agent dilution method for assessment of left ventricular ejection faction

Background: Left ventricular ejection fraction (LVEF) is an important determinant of prognosis. We evaluated the accuracy of a novel fast method for LVEF quantification based on indicator dilution curve (IDC) principles (figure 1) and compared the results with contrast-enhanced biplane LVEF assessment. Method: a 10 ml diluted (1:100) ultrasound-contrast bolus (SonoVue ®) was injected intravenously in thirty patients (pts) (20 male, age 65 ± 10) with known or suspected heart disease. In 22 pts multiple recordings were made and in 12 pts injections were repeated after implantation of a biventricular pacemaker, leading to 68 measurements. The developed algorithm used the left atrium and LV IDC for the LVEF measurement. For the biplane enhanced LVEF measurements a 0.5 ml pure ultrasound-contrast bolus (SonoVue ®) was administered to obtain multiple four- and two-chamber recordings. Results: according to contrast enhanced biplane assessments, the LVEF ranged from 10 to 75 % while the LV end-diastolic volume ranged from 80 to 521 ml. The mean LVEF measured by the biplane and the IDC method was 33 ± 17 % and 35 ± 18 %, respectively. A correlation coefficient r=0.91 was observed between the two methods (figure 2). Conclusion: A new fast method for LVEF assessment based on IDC principles is described and comparison with contrast enhanced biplane LVEF quantification shows accurate results. The proposed method also allows simultaneous quantification of right ventricular EF based on the same IDC principles

Novel ultrasound contrast agent dilution method for the assessment of ventricular ejection fraction

Aims: Left ventricular (LV) ejection fraction is an important determinant of prognosis in heart failure. We evaluated the accuracy of a novel algorithm for LV ejection fraction quantification based on indicator dilution curve (IDC) principles using ultrasound contrast as indicator, and compared the results with contrast enhanced biplane LV ejection fraction assessment. Method: A diluted ultrasound contrast bolus (SonoVue®) was injected intravenously in 31 patients (19 male, age 65 ± 11) with known or suspected heart disease. A total of 68 recordings were made. The developed algorithm used the left atrium and LV IDC for LV ejection fraction measurement. Biplane enhanced LV ejection fraction measurements with pure ultrasound contrast (SonoVue®) were determined in multiple four- and two-chamber recordings as reference. Results: The mean LV ejection fraction measured by biplane and IDC method was 33 ± 17% and 35 ± 18%, respectively. A correlation coefficient r = 0.93 was observed between the two methods. Bland–Altman analysis demonstrated a slight LV ejection fraction overestimation with IDC (mean 1.9 ± 6.3%). Conclusion: A new fast method for LV ejection fraction assessment based on IDC principles is described and comparison with contrast enhanced biplane LV ejection fraction quantification shows accurate results

Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death

Aims This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation.Methods and results We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality.Conclusion Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.Cardiolog

Optimization of pulsed wave tissue Doppler to predict left ventricular reverse remodeling after cardiac resynchronization therapy

OBJECTIVE: The optimal use of pulsed wave Doppler tissue imaging (DTI) in predicting left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT) was investigated. METHODS: DTI was performed in 69 patients before and 3 months after CRT. Echocardiographic reverse remodeling was observed in 38 patients. LV dyssynchrony was measured with the time to onset or peak systolic velocity in 2- and 6-basal segment models. RESULTS: The time to onset and either the standard deviation of 6 segments of > 20 ms or a delay of > or = 60 ms between any 2 of 6 segments had a similar predictive accuracy (sensitivity, 97% and 95%, respectively; specificity, 74% and 73%, respectively). The time to peak systolic velocity or evaluating 2 segments was less accurate. CONCLUSIONS: Evaluation of 6 segments is necessary to predict LV reverse remodeling after CRT. The time to onset of systolic velocity is superior to the time to peak velocity

Novel ultrasound-contrast-agent dilution method for assessment of left ventricular ejection faction

Background: Left ventricular ejection fraction (LVEF) is an important determinant of prognosis. We evaluated the accuracy of a novel fast method for LVEF quantification based on indicator dilution curve (IDC) principles (figure 1) and compared the results with contrast-enhanced biplane LVEF assessment. Method: a 10 ml diluted (1:100) ultrasound-contrast bolus (SonoVue ®) was injected intravenously in thirty patients (pts) (20 male, age 65 ± 10) with known or suspected heart disease. In 22 pts multiple recordings were made and in 12 pts injections were repeated after implantation of a biventricular pacemaker, leading to 68 measurements. The developed algorithm used the left atrium and LV IDC for the LVEF measurement. For the biplane enhanced LVEF measurements a 0.5 ml pure ultrasound-contrast bolus (SonoVue ®) was administered to obtain multiple four- and two-chamber recordings. Results: according to contrast enhanced biplane assessments, the LVEF ranged from 10 to 75 % while the LV end-diastolic volume ranged from 80 to 521 ml. The mean LVEF measured by the biplane and the IDC method was 33 ± 17 % and 35 ± 18 %, respectively. A correlation coefficient r=0.91 was observed between the two methods (figure 2). Conclusion: A new fast method for LVEF assessment based on IDC principles is described and comparison with contrast enhanced biplane LVEF quantification shows accurate results. The proposed method also allows simultaneous quantification of right ventricular EF based on the same IDC principles

Novel ultrasound contrast agent dilution method for the assessment of ventricular ejection fraction

Aims: Left ventricular (LV) ejection fraction is an important determinant of prognosis in heart failure. We evaluated the accuracy of a novel algorithm for LV ejection fraction quantification based on indicator dilution curve (IDC) principles using ultrasound contrast as indicator, and compared the results with contrast enhanced biplane LV ejection fraction assessment. Method: A diluted ultrasound contrast bolus (SonoVue®) was injected intravenously in 31 patients (19 male, age 65 ± 11) with known or suspected heart disease. A total of 68 recordings were made. The developed algorithm used the left atrium and LV IDC for LV ejection fraction measurement. Biplane enhanced LV ejection fraction measurements with pure ultrasound contrast (SonoVue®) were determined in multiple four- and two-chamber recordings as reference. Results: The mean LV ejection fraction measured by biplane and IDC method was 33 ± 17% and 35 ± 18%, respectively. A correlation coefficient r = 0.93 was observed between the two methods. Bland–Altman analysis demonstrated a slight LV ejection fraction overestimation with IDC (mean 1.9 ± 6.3%). Conclusion: A new fast method for LV ejection fraction assessment based on IDC principles is described and comparison with contrast enhanced biplane LV ejection fraction quantification shows accurate results

Relation of isovolumic times after cardiac resynchronization therapy to improvement in exercise capacity

M-mode echocardiography (using the septal-to-posterior wall motion delay [SPWMD]) and color-coded tissue Doppler imaging (TDI; using the septal-to-lateral delay in peak systolic velocity) have been proposed for assessment of left ventricular (LV) dyssynchrony and prediction of response to cardiac resynchronization therapy (CRT). In this study, a head-to-head comparison between M-mode echocardiography and color-coded TDI was performed for assessment of LV dyssynchrony and prediction of response to CRT. Consecutive (n ?? 98) patients with severe heart failure (New York Heart Association class III/IV), LV ejection fraction 120 ms underwent CRT. Before pacemaker implantation, LV dyssynchrony was assessed by M-mode echocardiography (SPWMD) and color-coded TDI (septal-to-lateral delay). At baseline and 6 months after implantation, clinical and echocardiographic parameters were evaluated. SPWMD measurement was not feasible in 41% of patients due to akinesia of the septal and/or posterior walls or poor acoustic windows. Conversely, the septal-to-lateral delay could be assessed in 96% of patients. At 6-month follow-up, 75 patients (77%) were classified as responders to CRT (improvement >1 New York Heart Association class). The sensitivity and specificity of SPWMD were lower compared with those of septalto-lateral delay (66% vs 90%,

The influence of myocardial scar and dyssynchrony on reverse remodeling in cardiac resynchronization therapy

Aim: The influence of location and extent of transmural scar and its relation with dyssynchrony in cardiac resynchronization therapy (CRT) was investigated as posterolateral scar tissue has been invoked as a cause of non-response to CRT. Methods and results: Fifty-seven patients eligible for CRT were assessed for transmural scar with gadolinium-enhanced MRI and for left ventricular (LV) dyssynchrony with tissue Doppler. After implant, both atrioventricular and interventricular pacing intervals were optimized. LV reverse remodeling was defined as 10% decrease in LV end-systolic volume after 3 months. Sixteen patients had transmural scar in the posterolateral (PL) area (LV lead location), 14 at a remote site (non-PL) and 27 patients had no scar. LV reverse remodeling was observed in respectively 25%, 64% and 89% (P = 0.0001). Univariate analyses showed a relation with LV dyssynchrony (P = 0.004) and with absence of PL scar (P = 0.04) but not with QRS duration and the extent of LV scar tissue. In multivariate analysis, only LV dyssynchrony (OR: 19.62; 95% CI: 2.5–151.9; P = 0.004) independently predicted LV reverse remodeling. Conclusion: In this study LV dyssynchrony remains the most important determinant of response to CRT, even in the presence of posterolateral scar provided atrioventricular and interventricular pacing intervals are optimized