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Echocardiographic assessment of systolic and diastolic left ventricular function using an automatic boundary
L K Michalis1, M R Thomas, D E Jewitt
1Department of Cardiology, King's College Hospital, London, UK.
Insights
This study found that automatic boundary detection (ABD) in echocardiography can assess systolic and diastolic left ventricular function. While correlations varied, mean fractional area change (FAC) showed reasonable agreement with ejection fraction (EF) in patients.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Function Assessment
Background:
- Accurate assessment of left ventricular (LV) systolic and diastolic function is crucial in cardiology.
- Traditional methods for evaluating LV function involve invasive procedures and non-invasive echocardiography.
- Automated echocardiographic analysis offers potential for more efficient and reproducible functional assessment.
Purpose of the Study:
- To evaluate the efficacy of an echocardiographic automatic boundary detection (ABD) system in assessing left ventricular systolic and diastolic function.
- To compare ABD-derived parameters with conventional invasive and non-invasive indices of ventricular function in patients undergoing cardiac catheterization.
Main Methods:
- Fifty unselected patients undergoing left cardiac catheterization were assessed using an ABD system.
- ABD-derived parameters, including fractional area change (FAC), were compared with angiographic ejection fraction (EF) and left ventricular end-diastolic pressure (LVEDP).
- Analysis included correlations between ABD parameters and conventional indices in the whole group and in subgroups with normal or abnormal LV function.
Main Results:
- Adequate endocardial boundary detection was achieved in 68-82% of patients across different echocardiographic views.
- Mean FAC demonstrated a reasonable correlation with angiographic EF (r=0.62, p<0.0001) in the overall patient group.
- In patients with abnormal LV function (EF < 45%), FAC showed strong positive correlations with EF and negative correlations with LVEDP.
Conclusions:
- The echocardiographic ABD system is a feasible tool for assessing left ventricular systolic function, particularly in patients with impaired function.
- Mean FAC derived from ABD shows good correlation with ejection fraction, suggesting its utility in clinical practice.
- Further studies may explore the role of ABD in diastolic function assessment and its broader clinical applications.
Abstract:
Systolic and diastolic left ventricular function was assessed using an echocardiographic automatic boundary detection system (ABD) in 50 unselected patients undergoing left cardiac catheterisation. Automatic boundary detection system derived parameters (fractional area change [FAC], peak positive rate of area change [+dA/dt] and peak negative rate of area change [-dA/dt]) were compared with invasively (left ventricular angiography and pressures) and non invasively (Doppler mitral filling velocities and isovolumic relaxation time) acquired conventional indices of ventricular function. Adequate detection of endocardial boundaries and subsequent measurements using the ABD system were achieved in 40/50 (80%) patients in the short axis parasternal view, in 41/50 (82%) in the apical four chamber view and in 34/50 (68%) in both views. For the whole group of patients the FAC (maximal left ventricular diastolic area--minimal left ventricular systolic area/maximal left ventricular diastolic area) estimated in the short axis view correlated with the angiographic ejection fraction (EF) measured in the right oblique projection (r = 0.51, p < 0.001). There was only a weak correlation of the FAC estimated in the apical four chamber view with the EF (r = 0.36, p < 0.01). The mean FAC (mean value of the FAC in the short axis and apical four chamber views) correlated reasonably with the EF (r = 0.62, p < 0.0001). There was no correlation between ABD derived parameters and left ventricular end diastolic pressure (LVEDP) in these patients. In a subgroup of patients with normal coronary arteries and left ventricular function (n = 17), although there was no correlation between EF and FAC, there was a strong positive correlation between FAC (apical four chamber and mean) and LVEDP (r = 0.77, p < 0.01 and r = 0.87, p < 0.01 respectively). No correlation was found in these patients between EF and LVEDP. In a further subgroup of patients with angiographically abnormal left ventricular function (EF < 45%), there was a positive correlation between FAC (short axis, apical four chamber and mean) and EF (r = 0.52, p < 0.05, r = 0.83, p < 0.0001 and r = 0.80, p < 0.001 respectively) and a negative correlation between FAC (short axis and mean) and LVEDP (r = -0.52, p < 0.05 and r = -0.60, p < 0.01 respectively). There was also a negative correlation between LVEDP and EF in the same subgroup of patients (r = -0.65, p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)