Davies, Crispin H.

Jones, Michael

Li, Xiang-Ning

Li, Xiaokui

Mack, Gordon K.

Mori, Yoshiki

Rusk, Rosemary A.

Sahn, David J.

Zetts, Arthur D.

Elsevier - Publisher Connector 

JACC March 6, 2002 
dow set at 118¢6 KeV, image variability and image contrast. The differences between the 
IOC and the control groups were compared using the Students t-test. 
Results- Age, gender, ethnioity, weight and tracer dose were similar between the both 
groups. The image quality parameters results are given in table. 
Groups 1st image 2 nd image Change 
Scatter counts Controls 8.0 -+ 3.0 6.8 -+ 2.8 1.05 -+ 0.4 
IOC 8.4 -+ 3.0 6.4 + 2.3 2.0 _+ 1.6 
p-value 0.75 0.7 0.02 
Image contrast Controls 72 + 11 68.8 -+ 13 -3.2 -+ 7.8 
IOC 73.9 -+15 81.6 _+ 13 7.7_+ 8.2 
p-value 0.7 0.043 0.007 
Image variability Controls 17.8 -+ 3.5 19 _+ 2.9 -1.3 _+ 1.4 
IOC 17.7_+3.8 14.8_+3.5 2.9_+ 1.9 
p-value 0.9 0.008 0.0001 
(Counts are In millions, mean • SD) 
Concluaion- The use of iodinated oral contrast improved image quality. This simple, 
safe and inexpensive clinical technique can improve 99m Tc-sestamibi MP[. 
ORAL CONTRIBUTIONS 
875 Three-D imens iona l  Echocard iography  
Tuesday, March 19, 2002, 4:00 p.m.-5:00 p.m. 
Georgia World Congress Center, Ballroom II 
4:00 p.m. 
875-1 Mui t i -Thrasho ld  F low 3-D Color Doppler Reconstruction 
of Velocity of the Flow Acceleration Region for 
Quantification of Mitral Regurgitation: A Chronic Animal 
Model Study 
Xiaokui Li. Michael Jones, Xiang-Ning Li, Arthur D. Zetts, Rosemary A. Rusk, Yoshiki 
Mori, Crispin H. Davies, Gordon K. Mack, David J. Sahn, Oregon Health & Science 
Universi~ Portland, Oregon, NHLBI, Bethesda, Maryland. 
Background: Since mitral regurgitant orifice geometry is often quite complex, in this 
study we employed a scanline based digital color 3D reconstruction method that allows 
visualization of the flow convergence (FC) at any chosen velocity from the digital data 
processed offline. Methods: Mitral regurgitation (MR) was created in 4 sheep by chordal 
interruption 3-4 months before the study. During open chest study, an electromagnetic 
(EM) flow probe was sutured onto the mitral annulus ring to simultaneously record the 
transmitral flow data and was balanced against an aortic EM flow meter. Raw velocity 
scanline data were obtained for 180 ° (6 ° increment) rotations with a 7MHz TEE probe 
placed epicardially under 12 flow conditions (peak flow rate 30-130 ml/sec) obtained by 
volume loading, nitroprusside and angiotensin administration. The 3D data were trans- 
ferred to a Silicon Graphics system to develop a multi-threshold computation to digitally 
reconstruct spatial FC surface for any selected velocity threshold. Direct FC surface trac- 
ings were made by computing 10-20 slices across the convergence zone. Results: For 
MR peak flow rate, there was good correlation between 3D and EM data (r=0.92, 
SEE=8.73 ml, p<0.05). Each measurement took 1-2 minutes. Measurements could also 
be integrated at 5-8 points during the heart cycle to provide the regurgitant volume. Con- 
clusions: This 3D multi-threshold method could provide accurate estimation of mitral 
regurgitant flow clinically despite varying geometries. 
ABSTRACTS - Noninvasive Imaging 395A 
4:15 p.m. 
875-2 Geometric Differences of Mitral Valvular Apparatus 
Between Ischemic and Dilated Cardiomyopathy With 
Significant Mitral Regurgitation: Real-Time Three- 
Dimensional Echocardiography Study 
Jun Kwan. Takahiro Shiota, A. Marc Giliinov, Deborah A. Agler, Jian Xin Qin, Yong Jin 
Kim, James D. Thomas, The Cleveland Clinic Foundation, Cleveland, Ohio. 
Background: The aim of this study was to elucidate the geometric differences of mitral 
valve (MV) apparatus in patients with ischemic MR caused by posterior infarction (IMR) 
and functional MR due to idiopathic dilated cardiomyopathy (DCM), compared to normal 
control (NL) using real-time 3D echocardiography (RT3DE). Methods: Fourteen patients 
(9: posterior infarction 5: posterior and anterior infarction) with IMR, 13 patients with DCM 
and seven NL were studied. RT3DE volumetric images of MV apparatus were digitally 
transferred into a personal computer. Three different imaging long axis planes [Medial 
(M), Central (C) and Lateral (L),] of MV were generated at mid-systole by 3D computer 
software (TomTec). Commissure-commissure (CC) and septo-lateral (SL) distances were 
measured. Angles between annular plane and both posterior (~) end anterior mitral leaf- 
let (~) were measured in all three planes [(M<x, C~, L~) (M~,, C~, L~)]. Results: In medial 
and central planes, c~ and ~ of both IMR and DCM significantly increased compared to 
NL. In lateral plane, c~ of both groups significantly increased, while ~ of IMR was not sig- 
nificantly different from NL. 
CC(cm) SL(cm) M~(°) Cc~(°) Lc~(°) M~(°) C~(°) L~(°) 
NL 2.8+0.1 2.4-+0.1 32+5 32-+6 34+4 21+3 23+5 23+3 
IMR 3.1_+0.1++ 2.7_+0.2++* 64_+8++ 58_+9++ 55_+7++ 40-J:5++ 32_+8 + 25_+6** 
DCM 3.2_+0.2++ 2.9-+0.2++ 60-+8 + -` 60-+7++ 59_+7++ 37_+8++ 35_+8++ 33+7++ 
+ : p <0.05, ++ : p <0.01 compared with NL, * : p <0.05, ** : p <0.01 compared with DCM 
Conclusion: Mitral annulus dilated more toward SL direction in DCM than IMR. Geomet- 
ric change of MV in DCM was relatively symmetrical showing tethering of both leaflets 
from medial to lateral side while it was asymmethcal in IMR, showing no significant teth- 
ering of anterior leaflet laterally. 
4:30 p.m. 
875-3 Detection of Proximal Functional Occlusion of Three 
Major Coronary Arteries by Contrast-Enhanced 
Transeaophageal Doppler Echocardiography 
Masami Nishino. Shiro Hoshida, Shinichiro Suna, Masayuki Taniike, Yasuyuki Egami, 
Toshihiro Takeda, Ryu Shutta, Masayoshi Kawabata, Hideo Tanahashi, Jun Tanouchi, 
Yoshio Yamada, Osaka Rosai Hospital, Sakai, Osaka, Japan. 
Backgrounds: Recently, trensthoracic Doppler echocardiography (TTDE) has been use- 
ful for detecting coronary flow at the distal left anterior descending artery (LAD), and 
however, it is very difficult to detect the proximal LAD coronary flow, also left circumflex 
(LCX) and right coronary artery (RCA) flow using "t-I'DE. It is clinically more important to 
evaluate proximal coronary lesions as compared to distal lesions. On the other hand, 
usefulness of Levovist to enhance various Doppler signals has been reported. Thus, in 
this study, we investigated whether transesophageal Doppler echocardiography (TEDE) 
using Levovist can evaluate coronary lesion of the proximal sites in LAD, LCX, and RCA. 
Methods: We studied consecutive 43 patients with suspected coronary artery disease 
who underwent TEDE with 5-MHz multiplane transesophageal probe after sedation by 
intravenous injection of a small amount of propofol. Within one week after TEDE, diag- 
nostic coronary angiography was performed in each patient. Using TEDE, color Doppler 
flow mapping was detectable in 100% at proximal LAD, 79% at proximal LCX, and 72% 
at proximal RCA before and it was detectable in 100 % at each coronary artery after 
injection of Levovist (300 mg/ml in 2ml). Coronary angiogram revealed proximal LAD 
occlusion in two patients, proximar LCX occlusion in three patients, and proximal RCA 
occlusion in two patients that were all accompanied with collateral flow. In these 7 
patients, contrast enhanced TEDE detected abrupt disappearance of color Doppler flow 
with retrograded distal flow (which supplied by collateral flow from the other coronary 
arteries) clearly, and these positions of abrupt disappearance of color Doppler flow cor- 
rectly located the occlusion along the vessel that were shown by coronary angiogram. 
However, TEDE without Levovist could not detect abrupt disappearance of cotor Doppler 
flow or retrograded flow in the two occlusion lesions of LCX and in the two lesions of 
RCA. Conclusion: Contrast enhanced transesophageal Doppler echocardiography can 
detect proximal LAD, LCX and RCA functional occlusion with collateral flow accurately. 
4:45 p.m. 
875-4 SpaUo-Temporal Brushlet Denoising Improves Real 
Time Three-Dimensional Calculation of Right 
Ventricular Function in Pr imary  Pulmonary 
Hypertension Patients 
Deborah R. Gersony, Elsa D. Angelini, Josh Donis, Ciarito Dimayuga, Robyn J. Barst, 
Rola Saouaf, Marco R. Di Tullio, Andrew F. Laine, Shunichi Homma, Columbia 
University, New York, New York. 
Background: Assessment of right ventricular (RV) function is clinically relevant in the fol- 
low-up of patients with primary pulmonary hypertension (PPH). No single achocardio- 
graphic approach has gained wide acceptance as being both reliable and accurate. We 
compared 2-dimensional (2D) and real-time three-dimensional (RT-3D) echocardio- 
graphic imaging to magnetic resonance imaging (MRI). Comparison was made both 


Multi-threshold flow 3-D color doppler reconstruction of velocity of the flow acceleration region for quantification of mitral regurgitation: a chronic animal model study 

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Multi-threshold flow 3-D color doppler reconstruction of velocity of the flow acceleration region for quantification of mitral regurgitation: a chronic animal model study

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