Visual assessment of intra ventricular flow from colour M-mode Doppler images
M Stugaard1, T Steen, A Lundervold
1Medical Department B, Rikshospitalet, University of Oslo, Norway.
Insights
Visual assessment of left ventricular filling patterns using Doppler ultrasound can distinguish between healthy and diseased ventricles. This method effectively identifies abnormalities in patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM).
Area of Science:
- Cardiology
- Medical Imaging
- Ultrasound Technology
Background:
- Left ventricular (LV) filling patterns are crucial indicators of cardiac health.
- Assessing these patterns visually using Doppler ultrasound can provide insights into LV function.
- Understanding the relationship between flow patterns and LV function is vital for diagnosing cardiac diseases.
Purpose of the Study:
- To determine if left intraventricular filling patterns can be visually assessed using color M-mode Doppler ultrasound.
- To explore the relationship between these flow patterns and left ventricular (LV) function.
- To evaluate the diagnostic capability of visual assessment for coronary artery disease (CAD) and dilated cardiomyopathy (DCM).
Main Methods:
- Color M-mode Doppler ultrasound was used to study left intraventricular filling.
- Patients with CAD or dilated cardiomyopathy (DCM) were grouped by LV function.
- Flow patterns were qualitatively assessed from printed images by blinded observers.
- Repeatability was evaluated using the kappa statistic.
Main Results:
- Visual assessment showed good intra-observer (kappa = 0.75) and moderate inter-observer (kappa = 0.53) repeatability.
- CAD patients with normal LV function showed patterns similar to controls.
- Patients with ejection fraction (EF) < 50% had distinct flow patterns.
- A visible delay in apical peak velocity correlated negatively with EF (rs = -0.62) and showed high sensitivity (83%) for DCM.
Conclusions:
- Visual assessment of intraventricular flow patterns is feasible and effective.
- This method can discriminate between normal and diseased ventricles.
- Doppler-derived flow patterns offer valuable diagnostic information for cardiac conditions like CAD and DCM.
Abstract:
Left intra ventricular filling was studied by colour M-mode Doppler ultrasound to determine whether the flow pattern can be assessed visually, and explore its relation to left ventricular (LV) function. Patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) were divided into three groups according to angiographically evaluated LV function. The groups were compared with a control group of 54 healthy volunteers. The mitral to apical delay of early diastolic flow was qualitatively assessed from printed colour M-mode images, twice by four independent observers blinded to the subject's status. The repeatability of the assessments as determined by the kappa statistic was good intra observer (kappa = 0.75) and moderate inter observer (kappa = 0.53). The CAD-group with angiographically normal LV function (n = 25) had flow patterns resembling those observed in the control group. The group with ejection fraction (EF) < 50% (n = 19) had flow patterns clearly different from the control group. Patients with regional wall motion abnormality (RWMA) but EF > 50% (n = 16) exhibited flow patterns intermediate between the control and the low EF group. Among the 50 CAD patients there was a negative correlation between EF and the presence of delay of apical peak velocity (Spearman's rs = -0.62, p < 0.0001). A visible delay of apical peak velocity had a sensitivity towards DCM of 83% and specificity of 75%. The sensitivity towards CAD with either RWMA or low EF was 55% and the specificity 75%. In conclusion, visual assessment of intra ventricular flow patterns was feasible and allowed discrimination between normal and diseased ventricles.
