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Updated: Jun 2, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Left ventricular endocardial and epicardial border length delineation with perflutren contrast during transthoracic
Vincent L Sorrell1, William D Ross, Sachin Kumar
1Department of Medicine, Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona, USA. vsorrell@email.arizona.edu
Insights
Contrast echocardiography significantly improves visualization of both the endocardial border length (EnBL) and epicardial border length (EpBL) in the left ventricle. This enhancement aids in assessing myocardial ischemia by improving wall thickening evaluation.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Medical Ultrasound
Background:
- Optimal endocardial border visualization is crucial for accurate echocardiography.
- Endocardial "dropout" can lead to misinterpretation of regional wall motion.
- Left ventricular opacification (LVO) with contrast enhances endocardial border visualization.
Purpose of the Study:
- To determine if contrast LVO improves epicardial border length (EpBL) visualization.
- To assess the impact of contrast on both endocardial border length (EnBL) and EpBL.
Main Methods:
- Retrospective observational study of 73 patients receiving echocardiographic contrast.
- Standardized offline analysis of endocardial and epicardial segments in diastole and systole.
- Comparison of visualized border lengths with and without contrast enhancement.
Main Results:
- Contrast improved EnBL by 65% (diastole) and 45% (systole).
- Contrast improved EpBL by 61% (diastole) and 57% (systole).
- All improvements were statistically significant (P < 0.05).
Conclusions:
- Contrast LVO enhances EnBL visualization, confirming previous findings.
- This study is the first to show contrast LVO also enhances EpBL visualization.
- Improved EnBL and EpBL aid in evaluating left ventricular wall thickening for myocardial ischemia.
Objective:
Precise estimation of wall motion abnormalities during routine echocardiography rests on optimal endocardial border visualization. Endocardial "dropout" may result in the misinterpretation of regional wall motion. Left ventricular opacification (LVO) with intravenous contrast improves the visualization of the left ventricular endocardial border length (EnBL). The purpose of this study was to determine if contrast also improves the visualization of the epicardial border length (EpBL) in addition to the EnBL.
Method:
This is a single center retrospective observational study. From 200 consecutive patients referred to the Echocardiography Laboratory for the assessment and evaluation of coronary artery disease, 73 patients who received contrast were enrolled. All the images were standardized using offline software. The visualized segments of the epicardium and endocardium were measured in diastole and systole, without and with contrast-enhancement and these segments were summed to provide the total visualized EnBL and EpBL.
Results:
Contrast enhanced imaging improved EnBL by 65% and 45% in end-diastolic and end-systolic views, respectively. Similarly, EpBL was improved by 61% and 57% in end-diastolic and end-systolic views, respectively (all P values <0.05).
Conclusion:
Contrast LVO improves the EnBL as previously reported. Additionally, based upon the blinded review of 1,752 regional myocardial wall segments, this study is the first to suggest that contrast also enhances the visualization of the EpBL. This finding has direct clinical implications as the improvement in both EnBL and EpBL with contrast may assist in evaluation of regional left ventricular wall thickening which is a critical parameter used to assess for myocardial ischemia.
