Projeto nº. NVKP_16-1-2016-0017 ('Programa Nacional do Coração') foi implementado com o apoio do Fundo Nacional de Pesquisa, Desenvolvimento e Inovação da Hungria, financiado sob o regime de financiamento NVKP_16. A pesquisa foi financiada pelo Programa de Excelência Temática (2020-4.1.1.-TKP2020) do Ministério da Inovação e Tecnologia na Hungria, no âmbito dos programas temáticos de Desenvolvimento Terapêutico e Bioimagem da Universidade Semmelweis.

Este protocolo segue as diretrizes do Comitê Regional e Institucional de Ética em Ciência e Pesquisa da Universidade Semmelweis. O presente protocolo se aplica a um fornecedor específico. Embora algumas etapas permaneçam válidas independentemente da máquina de ultrassom e do software de pós-processamento, podem existir diferenças importantes se usar as soluções de outros fornecedores.
1. Requisitos técnicos
<ol><li>Utilize uma máquina de ecocardiografia capaz de imagens 3D.</li>
	<li>Conecte um transdutor de matriz transtorácica 3D capaz de fases.</li>
	<li>Aplique o ECG embutido de 3 chumbo do sistema de ultrassom para permitir que o sistema sincronize as gravações e análises ao ciclo cardíaco.</li>
</ol>2. Aquisição das imagens ecocardiográficas 3D
<ol><li>Posicione o paciente na posição de decúbito lateral esquerdo (paciente deitado no lado esquerdo com o braço esquerdo esticado acima da cabeça).</li>
	<li>Certifique-se de que o rastreamento do ECG na tela é de boa qualidade. NOTA: Este é um pré-requisito para o pós-processamento, pois o software detectará os diferentes pontos do ciclo cardíaco com base no sinal ECG.</li>
	<li>Descongele a imagem e comece a examinar o paciente com o transdutor. Visualize uma visão apical convencional de quatro câmaras.</li>
	<li>Otimize a qualidade da imagem ajustando a largura do setor para LV, diminuindo a profundidade para truncar o átrio esquerdo e usando um ligeiro sobregain. NOTA: Certifique-se de que toda a LV e também a superfície epicárardial são visíveis.</li>
	<li>Pressione o botão 4D para mudar para o modo 3D. NOTA: Ao pressionar o botão Multi-Slice... na tela sensível ao toque, quatro opções estarão disponíveis (5, 7, 8, 12 fatias) para visualizar demais o conjunto de dados 3D usando cortes de eixo curto e longo padrão. Se necessário, o posicionamento do transdutor pode ser corrigido para garantir a inclusão de toda a espessura da parede LV do nível apical a mitral da válvula no conjunto de dados 3D piramim. Recomenda-se o uso de 12 fatias (com nove visualizações ajustáveis de eixo curto).</li>
	<li>Adquira imagens 3D usando o modo Multi Beat ou Single Beat .<ol>
<li>Use o modo Multi Beat para obter maior resolução espacial e temporal, onde o conjunto de dados será reconstruído a partir de 2, 3, 4 ou 6 ciclos cardíacos (isso pode ser configurado na tela) - respiração expiratória final do paciente e posicionamento transdutor estável necessário para minimizar artefatos de costura. NOTA: A aquisição do Single Beat é de menor resolução espacial e temporal; no entanto, a maioria dos transdutores modernos têm melhor qualidade e, portanto, podem ser usados para adquirir conjuntos de dados 3D adequados sem reconstrução para passar por análises mais aprofundadas. Como recomendação geral, são recomendadas taxas de volume acima de 15 volumes por segundo para análise suplementar.</li>
		<li>Quando o volume total for reconstruído a partir dos subvolumes, e toda a LV estiver visível, congele a imagem. Usando os botões Cycle Select e Number of Cycles , selecione os ciclos cardíacos adquiridos ideais e pressione a Image Store. NOTA: Os artefatos de costura são subvolumes espacial ou temporariamente desalinhados próximos um do outro. Conjuntos de dados com uma queda significativa de paredes LV ou com artefatos de costura geralmente não são adequados para análises adicionais. A qualidade do conjunto de dados 3D já adquirido pode ser verificada duas vezes usando o modo Multi-Slice.</li>
	</ol>
</li>
</ol>3. Pós-processamento para quantificar a morfologia e a função de LV
<ol><li>Selecione um conjunto de dados 3D apropriado para análise suplementar. NOTA: Esta parte do protocolo requer as imagens 3D adquiridas e salvas previamente adquiridas e salvas de boa qualidade e pode ser realizada na máquina de ultrassom e em uma estação de trabalho separada, também.</li>
	<li>Clique em Measure | Volume e, em seguida, selecione 4D Auto LVQ.</li>
	<li>Na tela quádrupla (três visões apical: vistas de quatro, duas e três câmaras e uma visão de eixo curto, esta última pode ser ajustada por um plano horizontal em vistas de longo eixo), o software pede modificar o alinhamento de fatias apical às visualizações padrão. Se necessário, corrija manualmente as visualizações a apical inclinando e rotação para mostrar a visão padrão correspondente, eliminando assim o estreitamento. Coloque inclinando para alinhar a pinça com o eixo longo da LV arrastando e movendo as pinças em vistas de longo eixo. Defina a rotação pelo correspondente ou pelo Girador Todos os botões da máquina ou ajustando as pinças na imagem do eixo curto. NOTA: A recomendação do software pode ser redefinida pressionando o botão Auto Align .</li>
	<li>Após o término do alinhamento de exibição, clique na próxima etapa EDV. O quadro end-diastólico (ED) é detectado automaticamente usando o sinal ECG, mas pode ser corrigido manualmente, se necessário.</li>
	<li>Detecção semiautomática de superfície endo e epicárida de LV<ol><li>Selecione dois pontos de referência manualmente em qualquer exibição apical. Em primeiro lugar, identifique o ápice lv e, em seguida, o meio da base LV (nível de anulo mitral) em qualquer visão apical. O algoritmo contornará automaticamente a borda endocárrica de toda a LV. NOTA: Há mais duas opções: Manual, o que significa que dois marcos basais e um apical devem ser definidos em todas as exibições apical, e Auto Init, que irá contornar automaticamente o LV sem qualquer interação do usuário.</li>
		<li>Verifique a credibilidade do contorno em três visões apical, três visões de eixo curto de diferentes níveis e um quarto eixo curto controlado pelo usuário, para permitir a verificação visual da superfície detectada. A correção do contorno é possível adicionando manualmente pontos que serão incorporados na linha de contorno. NOTA: Com o Desfazer, o ponto adicionado anteriormente pode ser excluído. O botão de reset redefine o contorno para iniciar toda a seção desde o início. A visibilidade do contorno pode ser ajustada para permitir a apreciação da superfície do endocárdio na imagem em escala cinza. O contorno endocárdio e epicoardial deve ser realizado de forma precisa e consistente. Para obter uma recomendação detalhada, verifique a seguinte referência6.</li>
		<li>Escolha o próximo passo, que é o ESV.</li>
		<li>Repita o mesmo procedimento (3.5.1-3.5.2) como mencionado nos pontos anteriores para identificar e corrigir o contorno endocárdial no quadro end-sistólico. NOTA: O quadro end-sistólico (ES) é detectado automaticamente usando o sinal ECG, mas pode ser corrigido manualmente, se necessário. Os valores do volume de dia diastólica final (EDV), volume sistólico final (ESV), fração de ejeção (EF), frequência cardíaca (RH), volume de derrame (SV), saída cardíaca (CO) e índice de esferografia (IPE) já são exibidos na tela.</li>
		<li>Pressione a forma de onda volume para o próximo passo. O software exibe um modelo 3D dinâmico do LV e também a curva de volume de tempo à medida que traça a superfície do endocárdio ao longo do ciclo cardíaco quadro por quadro (Figura 1). NOTA: Aqui, há a possibilidade de editar a borda do endocárdio em qualquer quadro.</li>
		<li>Para o próximo passo, pressione LV Mass. O software contorna automaticamente o contorno epictárido LV no quadro de diastólica final e calcula a massa LV (EDMass). NOTA: Se necessário, edite o contorno da superfície epicárardia adicionando pontos a incluir (mesmo método descrito anteriormente) em qualquer plano de curto ou longo eixo. Pode ser selecionado qual contorno ajustar: Endo, Epi ou Endo+Epi.</li>
		<li>Pressione o ROI de tensão 4D para o próximo passo. O software contorna automaticamente o contorno epictárário LV no quadro sistólica final e calcula a massa sistólica final da LV (ESMass). NOTA: Se necessário, edite o contorno sistólico final da superfície epicárardial adicionando pontos a incluir (mesmo método descrito anteriormente) em qualquer plano de eixo curto ou longo. O ESMass deve ser de valor semelhante ao EDMass. Esta etapa é essencial para calcular valores de tensão 3D por rastreamento de manchas.</li>
		<li>Pressione os resultados da tensão 4D para a próxima etapa. O software visualiza o rastreamento do miocárdio 3D em vários planos de curto e longo eixo e valores correspondentes de tensão dos 17 segmentos de LV padrão ao longo do ciclo cardíaco, quadro por quadro. Curvas de tensão temporal e gráfico de olho de touro também são exibidas. Os seguintes parâmetros são calculados e podem ser demonstrados: tensão longitudinal, tensão circunferencial, tensão radial, tensão da área, rotação e torção. NOTA: Existe a possibilidade de excluir um determinado segmento de LV da análise se for considerado como tendo baixa qualidade de rastreamento por observação visual de imagens ou com base na curva de tensão temporal. No entanto, o software recomenda por padrão a aprovação ou rejeição do segmento. Os valores de tensão codificados por cores podem ser visualizados em um modelo 3D dinâmico da LV alterando o "Layout".</li>
	</ol></li>
	<li>Para encerrar a análise, pressione Approve & Exit.</li>
</ol>

<ol>
	<li>Guta, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+echocardiography+to+assess+left+ventricular+geometry+and+function.">Three-dimensional echocardiography to assess left ventricular geometry and function.</a> Expert Review of Cardiovascular Therapy. 17 (11), 801-815 (2019).</li><li>Surkova, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+Clinical+Applications+of+Three-Dimensional+Echocardiography:+When+the+Technique+Makes+the+Difference.">Current Clinical Applications of Three-Dimensional Echocardiography: When the Technique Makes the Difference.</a> Current Cardiology Reports. 18 (11), 109 (2016).</li><li>Lang, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recommendations+for+cardiac+chamber+quantification+by+echocardiography+in+adults:+an+update+from+the+American+Society+of+Echocardiography+and+the+European+Association+of+Cardiovascular+Imaging.">Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.</a> Journal of the American Society of Echocardiography. 28 (1), 1-39 (2015).</li><li>Matyas, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+speckle-tracking+echocardiography+with+invasive+hemodynamics+for+the+detection+of+characteristic+cardiac+dysfunction+in+type-1+and+type-2+diabetic+rat+models.">Comparison of speckle-tracking echocardiography with invasive hemodynamics for the detection of characteristic cardiac dysfunction in type-1 and type-2 diabetic rat models.</a> Cardiovascular Diabetology. 17 (1), 13 (2018).</li><li>Kovacs, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+hemodialysis,+left+ventricular+mass+and+FGF-23+on+myocardial+mechanics+in+end-stage+renal+disease:+a+three-dimensional+speckle+tracking+study.">Impact of hemodialysis, left ventricular mass and FGF-23 on myocardial mechanics in end-stage renal disease: a three-dimensional speckle tracking study.</a> International Journal of Cardiovascular Imaging. 30 (7), 1331-1337 (2014).</li><li>Muraru, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comprehensive+analysis+of+left+ventricular+geometry+and+function+by+three-dimensional+echocardiography+in+healthy+adults.">Comprehensive analysis of left ventricular geometry and function by three-dimensional echocardiography in healthy adults.</a> Journal of the American Society of Echocardiography. 26 (6), 618-628 (2013).</li><li>Lakatos, B. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+Cardiac+Remodeling+and+Exercise+Capacity+in+Elite+Athletes:+Incremental+Value+of+Left+Atrial+Morphology+and+Function+Assessed+by+Three-Dimensional+Echocardiography.">Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography.</a> Journal of the American Society of Echocardiography. 33 (1), 101-109 (2020).</li><li>Muraru, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intervendor+Consistency+and+Accuracy+of+Left+Ventricular+Volume+Measurements+Using+Three-Dimensional+Echocardiography.">Intervendor Consistency and Accuracy of Left Ventricular Volume Measurements Using Three-Dimensional Echocardiography.</a> Journal of the American Society of Echocardiography. 31 (2), 158-168 (2018).</li><li>Kalam, K., Otahal, P., Marwick, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prognostic+implications+of+global+LV+dysfunction:+a+systematic+review+and+meta-analysis+of+global+longitudinal+strain+and+ejection+fraction.">Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction.</a> Heart. 100 (21), 1673-1680 (2014).</li><li>Muraru, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+novel+automated+border-detection+algorithm+for+rapid+and+accurate+quantitation+of+left+ventricular+volumes+based+on+three-dimensional+echocardiography.">Validation of a novel automated border-detection algorithm for rapid and accurate quantitation of left ventricular volumes based on three-dimensional echocardiography.</a> European Journal of Echocardiography. 11 (4), 359-368 (2010).</li><li>Doronina, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Female+Athlete's+Heart:+Comparison+of+Cardiac+Changes+Induced+by+Different+Types+of+Exercise+Training+Using+3D+Echocardiography.">The Female Athlete's Heart: Comparison of Cardiac Changes Induced by Different Types of Exercise Training Using 3D Echocardiography.</a> BioMed Research International. 2018, 3561962 (2018).</li><li>Takeuchi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+left+ventricular+mass+by+real-time+three-dimensional+echocardiography:+validation+against+magnetic+resonance+and+comparison+with+two-dimensional+and+m-mode+measurements.">Measurement of left ventricular mass by real-time three-dimensional echocardiography: validation against magnetic resonance and comparison with two-dimensional and m-mode measurements.</a> Journal of the American Society of Echocardiography. 21 (9), 1001-1005 (2008).</li><li>Armstrong, A. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LV+mass+assessed+by+echocardiography+and+CMR,+cardiovascular+outcomes,+and+medical+practice.">LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice.</a> JACC Cardiovasc Imaging. 5 (8), 837-848 (2012).</li><li>Olah, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+the+dynamic+changes+in+left+ventricular+morphology+and+function+induced+by+exercise+training+and+detraining.">Characterization of the dynamic changes in left ventricular morphology and function induced by exercise training and detraining.</a> International Journal of Cardiology. 277, 178-185 (2019).</li><li>Nagy, V. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+Right+Ventricular+Global+Longitudinal+Strain+in+Predicting+Early+and+Long-Term+Mortality+in+Cardiac+Resynchronization+Therapy+Patients.">Role of Right Ventricular Global Longitudinal Strain in Predicting Early and Long-Term Mortality in Cardiac Resynchronization Therapy Patients.</a> PLoS One. 10 (12), e0143907 (2015).</li><li>Kovacs, A., Lakatos, B., Tokodi, M., Merkely, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Right+ventricular+mechanical+pattern+in+health+and+disease:+beyond+longitudinal+shortening.">Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening.</a> Heart Failure Reviews. 24 (4), 511-520 (2019).</li><li>Badano, L. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+three-dimensional+speckle+tracking+to+assess+left+ventricular+myocardial+mechanics:+inter-vendor+consistency+and+reproducibility+of+strain+measurements.">Use of three-dimensional speckle tracking to assess left ventricular myocardial mechanics: inter-vendor consistency and reproducibility of strain measurements.</a> European Heart Journal - Cardiovascular Imaging. 14 (3), 285-293 (2013).</li></ol>

As medições morfológicas e funcionais representam pilares do diagnóstico, do manejo e do acompanhamento de doenças cardíacas; além disso, eles são poderosos preditores de resultado. Geralmente, a avaliação baseada em ecocardiografia 2D do LV é recomendada pelas diretrizes atuais da prática; no entanto, a ecocardiografia 3D tem se mostrado mais precisa, pois está livre de suposições geométricas relativas à forma lv7,8. A deformação por rastreame...

A avaliação da morfologia e função ventricular esquerda (LV) é o propósito predominante de investigações gerais e ainda mais específicas em cardiologia1. A ecocardiografia transtorácica amplamente disponível e não invasiva (TTE), que pode fornecer quantidades densas de informações, é o método de escolha para uma avaliação conveniente, rápida e econômica.
A medição da massa lv, volumes e fração de ejeção subsequente contém significativo valor diagnóstico e também prognóstico2. Quanto mais precisa for uma determinada medida, maior será seu valor. Uma melhor correlação com os valores derivados da ressonância magnética cardíaca padrão-ouro (RMC) é uma perseguição contínua por técnicas ecocardiográficas. Geralmente, as diretrizes de prática clínica recomendam o método do biplano Simpson para medição de volume de LV e ejeção de frações3. No entanto, o LV é uma estrutura tridimensional (3D) com uma forma muitas vezes irregular, e, portanto, vários planos tomográficos, sem dúvida, falharão em alguns cenários clínicos para delinear com precisão a morfologia e a função da LV. Os recentes avanços na tecnologia ultrassônica de hardware e software permitiram o desenvolvimento de imagens 3D em tempo real, o que revoluciona os protocolos ecocardiográficos.
Além disso, a necessidade de uma abordagem quantitativa sobre anormalidades no movimento da parede resultou no aumento da imagem de deformação4. Os parâmetros de tensão e taxa de tensão podem ser calculados pelo rastreamento de manchas usando imagens padrão em escala cinza. A ecocardiografia 3D também pode superar várias deficiências de uma avaliação de tensão bidimensional5. A partir de uma ferramenta científica cara, a ecocardiografia 3D começou a se tornar uma técnica poderosa usada na prática clínica cotidiana, e a quantificação da LV está certamente na primeira linha neste avanço.
O presente artigo tem como objetivo orientar o leitor através de um protocolo 3D detalhado, apresentando dicas e truques e também destacando as potenciais armadilhas para facilitar o uso generalizado, mas tecnicamente sólido desta importante técnica em relação à LV.

<table><tbody><tr><td>3V-D/4V-D/4Vc-D</td><td>General Electric</td><td>n.a.</td><td>ultrasound probe</td></tr><tr><td>4D Auto LVQ</td><td>General Electric</td><td>n.a.</td><td>software for analysis</td></tr><tr><td>E9/E95</td><td>General Electric</td><td>n.a.</td><td>ultrasound machine</td></tr><tr><td>EchoPac v203</td><td>General Electric</td><td>n.a.</td><td>software for analysis</td></tr></tbody></table>

evaluation of left ventricular structure and function using 3d echocardiography

A quantificação tridimensional (3D) do ventrículo esquerdo (LV) fornece valor agregado significativo em termos de precisão diagnóstica e estratificação precisa de risco em vários distúrbios cardíacos. Recentemente, a ecocardiografia 3D tornou-se disponível na prática de cardiologia de rotina; no entanto, a aquisição de imagens de alta qualidade e a análise subsequente têm uma curva de aprendizado íngreme. O presente artigo tem como objetivo orientar o leitor através de um protocolo 3D detalhado, apresentando dicas e truques e também destacando as potenciais armadilhas para facilitar o uso generalizado, mas tecnicamente sólido desta importante técnica em relação à LV. Em primeiro lugar, mostramos a aquisição de um conjunto de dados 3D de alta qualidade com resolução espacial e temporal ideal. Em seguida, apresentamos os passos analíticos para uma quantificação detalhada da LV usando um dos softwares embutidos mais amplamente aplicados. Quantificaremos os volumes de LV, a esficidade, a massa e também a função sistólica medindo a fração de ejeção e a deformação do miocárdio (cepa longitudinal e circunferencial). Discutiremos e forneceremos exemplos clínicos sobre os cenários essenciais onde a transição de uma abordagem ecocardiográfica convencional para uma quantificação baseada em 3D é altamente recomendada.

A análise 3D da LV é viável na maioria dos pacientes. O caso 1 é um voluntário saudável com volumes e função ventriculares normais (Figura 1). O caso 2 (Figura 2) é um paciente do sexo masculino de 64 anos com cardiomiopatia dilatada e um amplo complexo QRS (160 ms) de morfologia do bloco do ramo do feixe esquerdo. As medidas de CMR padrão ouro foram as seguintes: volume de dianólica final: 243 mL, volume sistólico fi...

Watch this Scientific Journal Video about Evaluation of Left Ventricular Structure and Function using 3D Echocardiography at JoVE.com

Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Neste artigo, fornecemos um protocolo passo-a-passo de aquisição e análise para a avaliação volumostrica e análise de rastreamento de manchas do ventrículo esquerdo por ecocardiografia 3D, particularmente com foco em aspectos práticos que maximizam a viabilidade dessa técnica.

Avaliação da Estrutura e Função Ventricular Esquerda utilizando Ecocardiografia 3D

Three-dimensional (3D) quantification of the left ventricle (LV) provides significant added value in terms of diagnostic accuracy and precise risk ...

evaluation-left-ventricular-structure-function-using-3d

Research

JoVE Journal

Bioengineering

3.8K visualizações.  Semmelweis University. Neste artigo, fornecemos um protocolo passo-a-passo de aquisição e análise para a avaliação volumostrica e análise de rastreamento de manchas do ventrículo esquerdo por ecocardiografia 3D, particularmente com foco em aspectos práticos que maximizam a viabilidade dessa técnica.

Vídeo: Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

Transthoracic Echocardiography in Mice

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene expression. Transgenic and gene targeting methods can be used to generate mice with altered cardiac size and function,1-3 and as a result, in vivo techniques are needed to evaluate their cardiac phenotype. Transthoracic echocardiography, pulse wave Doppler (PWD), and tissue Doppler imaging (TDI) can be used to provide dimensional measurements of the mouse heart and to quantify the degree of cardiac systolic and diastolic performance. Two-dimensional imaging is used to detect abnormal anatomy or movements of the left ventricle, whereas M-mode echo is used for quantification of cardiac dimensions and contractility.4,5 In addition, PWD is used to quantify localized velocity of turbulent flow,6 whereas TDI is used to measure the velocity of myocardial motion.7 Thus, transthoracic echocardiography offers a comprehensive method for the noninvasive evaluation of cardiac function in mice.

Transthoracic echocardiography offers a noninvasive method for the evaluation of cardiac function in mice. A combination of ultrasound and Doppler imaging modalities can be used to obtain dimensional measurements of the heart and intracardiac blood flow, which together provide an assessment of cardiac systolic and diastolic performance.

Ecocardiografia transtorácica em Ratos

In recent years, murine models have become the primary avenue for studying the molecular mechanisms of cardiac dysfunction resulting from changes in gene ...

Medicina

Ultrasonic Assessment of Myocardial Microstructure

Echocardiography is a widely accessible imaging modality that is commonly used to noninvasively characterize and quantify changes in cardiac structure and function. Ultrasonic assessments of cardiac tissue can include analyses of backscatter signal intensity within a given region of interest. Previously established techniques have relied predominantly on the integrated or mean value of backscatter signal intensities, which may be susceptible to variability from aliased data from low frame rates and time delays for algorithms based on cyclic variation. Herein, we describe an ultrasound-based imaging algorithm that extends from previous methods, can be applied to a single image frame&#160;and accounts for the full distribution of signal intensity values derived from a given myocardial sample. When applied to representative mouse and human imaging data, the algorithm distinguishes between subjects with and without exposure to chronic afterload resistance. The algorithm offers an enhanced surrogate measure of myocardial microstructure and can be performed using open-access image analysis software.

Echocardiography is commonly used to noninvasively characterize and quantify changes in cardiac structure and function. We describe an ultrasound-based imaging algorithm that offers an enhanced surrogate measure of myocardial microstructure and can be performed using open-access image analysis software.

Avaliação ultrassônica da microestrutura miocárdio

Echocardiography is a widely accessible imaging modality that is commonly used to noninvasively characterize and quantify changes in cardiac structure and ...

Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, the RV is significantly affected in pulmonary diseases such as pulmonary artery hypertension (PAH). In addition, the RV is remarkably sensitive to cardiac pathologies, including left ventricular (LV) dysfunction, valvular disease or RV infarction4. To understand the role of RV in the pathogenesis of cardiac diseases, a reliable and noninvasive method to access the RV structurally and functionally is essential.
A noninvasive trans-thoracic echocardiography (TTE) based methodology was established and validated for monitoring dynamic changes in RV structure and function in adult mice. To impose RV stress, we employed a surgical model of pulmonary artery constriction (PAC) and measured the RV response over a 7-day period using a high-frequency ultrasound microimaging system. Sham operated mice were used as controls. Images were acquired in lightly anesthetized mice at baseline (before surgery), day 0 (immediately post-surgery), day 3, and day 7 (post-surgery). Data was analyzed offline using software.
Several acoustic windows (B, M, and Color Doppler modes), which can be consistently obtained in mice, allowed for reliable and reproducible measurement of RV structure (including RV wall thickness, end-diastolic&#160;and end-systolic dimensions), and function (fractional area change, fractional shortening, PA peak velocity, and peak pressure gradient) in normal mice and following PAC.
Using this method, the pressure-gradient resulting from PAC was accurately measured in real-time using Color Doppler mode and was comparable to direct pressure measurements performed with a Millar high-fidelity microtip catheter. Taken together, these data demonstrate that RV measurements obtained from various complimentary views using echocardiography are reliable, reproducible and can provide insights regarding RV structure and function. This method will enable a better understanding of the role of RV cardiac dysfunction.

Right ventricle (RV) dysfunction is critical to the pathogenesis of cardiovascular disease, yet limited methodologies are available for its evaluation. Recent advances in ultrasound imaging provide a noninvasive and accurate option for longitudinal RV study. Herein, we detail a step-by-step echocardiographic method using a murine model of RV pressure overload.

Avaliação da Estrutura e Função do Ventrículo Direito em modelo de camundongo Pulmonary Artery constrição por Ecocardiografia transtorácica

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, ...

Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in rodents, with detailed descriptions of the appropriate methods for anesthesia, the echocardiographic windows used, the imaging planes and probe orientations for image acquisition, the methods for data analysis, and the limitations of emerging technologies for the evaluation of cardiac and valvular function. Importantly, we also highlight several future areas of research in cardiac and heart valve imaging that may be leveraged to gain insights into the pathogenesis of valve disease in preclinical animal models. We propose that using a systematic approach to evaluating cardiac and heart valve function in mice can result in more robust and reproducible data, as well as facilitate the discovery of previously underappreciated phenotypes in genetically-altered and/or physiologically-stressed mice.

This protocol provides a detailed description of the echocardiographic approach for comprehensive phenotyping of heart and heart valve function in mice.

Abordagens ecocardiograma e protocolos de Comprehensive Caracterização fenotípica de doença cardíaca valvular em ratos

The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in ...

Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the examiners&#39; expertise. Speckle tracking Echocardiography (STE) is a promising but technically challenging method that can be used to quantitatively assess regional and global systolic and diastolic myocardial performance. Myocardial strain and strain rate can be measured in all three dimensions&#160;&#8212; radial, circumferential, longitudinal &#8212; of myocardial deformation. Standard cross-sectional two-dimensional B-mode images are recorded and subsequently postprocessed by automated continuous frame-by-frame tracking and motion analysis of speckles within the myocardium. Images are recorded as digital loops and synchronized to a 3-lead EKG for timing purposes. Longitudinal deformation is assessed in the apical 4-, 3-, and 2-chamber views. Circumferential and radial deformation are measured in the parasternal short axis plane.
Optimal image quality and accurate tissue tracking are paramount for the correct determination of myocardial performance parameters. Utilizing transthoracic STE in a healthy volunteer, the present article is a detailed outline of the essential steps and potential pitfalls of quantitative echocardiographic myocardial deformation analysis.

Speckle tracking echocardiography is an emerging diagnostic imaging technique for the quantitative assessment of global and regional myocardial performance. Standard view echocardiographic motion images are recorded and deformation parameters are subsequently measured by automated continuous frame-by-frame tracking and motion analysis of speckles within the B-mode images of the myocardium.

Transtorácica salpico de rastreamento A ecocardiografia para a avaliação quantitativa do Ventrículo Esquerdo do miocárdio Deformação

The value of conventional echocardiography is limited by differences in inter-individual image interpretation and therefore largely dependent on the ...

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice.
Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software.
Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

The following protocol describes the methodology for the acquisition and analysis of echocardiographic images used to obtain the Left Atrial Volume (LAV), Aorta (Ao) diameter, and Pulmonary Artery (PA) diameter in mice. This technique is a non-invasive, non-terminal procedure that allows assessment of the cardiopulmonary function.

Murino Ecocardiografia de Esquerda Atrium, Aorta, ea artéria pulmonar

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins

The dimensions of the pulmonary veins are important parameters when planning pulmonary vein isolation (PVI), especially with the cryoballoon ablation technique. Acknowledging the dimensions and anatomical variations of the pulmonary veins (PVs) may improve the outcome of the intervention. Conventional 2D transoesophageal echocardiography can only provide limited data about the dimensions of the PVs; however, 3D echocardiography can further evaluate relevant diameters and areas of the PVs, as well as their spatial relationship to surrounding structures. In previous literature data, parameters influencing the success rate of PVI have already been identified. These are the left lateral ridge, the intervenous ridge, the ostial area of the PVs and the ovality index of the ostium. Proper imaging of the PVs by 3D echocardiography is a technically challenging method. One crucial step is the collection of images. Three individual transducer positions are necessary to visualize the important structures; these are the left lateral ridge, the ostium of the PVs and the intervenous ridge of the left and right PVs. Next, 3D images are acquired and saved as digital loops. These datasets are cropped, which result in the en face views displaying spatial relationships. This step can also be employed to determine the anatomical variations of the PVs. Finally, multiplanar reconstructions are created to measure each individual parameter of the PVs.
Optimal quality and orientation of the acquired images are paramount for the appropriate assessment of PV anatomy. In the present work, we examined the 3D visibility of the PVs and the suitability of the above method in 80 patients. The aim was to provide a detailed outline of the essential steps and potential pitfalls of PV visualization and assessment with 3D echocardiography.

The dimensions of the pulmonary veins (PV) are important parameters when planning pulmonary vein isolation. 2D transoesophageal echocardiography can only provide limited data about the PVs; however, 3D echocardiography can evaluate relevant diameters and areas of the PVs, as well as their spatial relationship to surrounding structures.

Método Ecocardiográfico Tridimensional para a Visualização e Avaliação de Parâmetros Específicos das Veias Pulmonares

The dimensions of the pulmonary veins are important parameters when planning pulmonary vein isolation (PVI), especially with the cryoballoon ablation ...

Bioengenharia

Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional imaging to study the cardiac anatomy of the left ventricle and M-mode echo to assess its dimensions. However, this could limit a comprehensive study. Herein, we describe a protocol that allows an assessment of the heart chamber size, left ventricular function (systolic and diastolic) and valvular function. A conventional medical ultrasound machine was used in this protocol and different echo views were obtained through left parasternal, apical and suprasternal windows. In the left parasternal window, the long and short axis were acquired to analyze left chamber dimensions, right ventricle and pulmonary artery dimensions, and mitral, pulmonary and aortic valve function. The apical window allows the measurement of heart chamber dimensions and evaluation of systolic and diastolic parameters. It also allows Doppler assessment with detection and quantification of heart valve disturbances (regurgitation or stenosis). Different segments and walls of the left ventricle are visualized throughout all views. Finally, the ascending aorta, aortic arch, and descending aorta can be imaged through the suprasternal window. A combination of ultrasound imaging, Doppler flow and tissue Doppler assessment have been obtained to study cardiac morphology and function. This represents an important contribution to improve the assessment of cardiac function in adult rats with impact for research using these animal models.

A non-invasive protocol for transthoracic echocardiography assessment of cardiac anatomy and function for adult rats is presented in the current study. The heart valves, all four cardiac chambers and the ascending aorta, aortic arch and descending aorta are studied in detail.

Avaliação ecocardiográfica da anatomia e função cardíaca em ratos adultos

The use of experimental animal models has become crucial in cardiovascular science. Most studies using rodent models are focused on two-dimensional ...

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ventricular (RV) function has strong diagnostic and prognostic power in various cardiovascular disorders. Due to its complex morphology and function, assessment of the RV by conventional two-dimensional echocardiography is limited: the everyday clinical practice usually relies on simple linear dimensions and functional measures. Three-dimensional (3D) echocardiography overcame these limitations by providing volumetric quantification of the RV free of geometrical assumptions. Here, we offer a step-by-step guide to obtain and analyze 3D echocardiographic data of the RV using the leading commercially available software. We will quantify 3D RV volumes and ejection fraction. Several technical aspects may help to improve the quality of RV acquisition and analysis as well, which we present in a practical manner. We review the current opportunities and the limiting factors of this method and also highlight the potential applications of 3D RV assessment in current clinical practice.

Here, we provide a step-by-step acquisition and analysis protocol for the 3D volumetric assessment of the right ventricle, mainly focusing on the practical aspects that maximize the feasibility of this technique.

Avaliação Morfológica e Funcional do Ventrículo Direito Utilizando Ecocardiografia 3D

Traditionally, it was believed that the right side of the heart has a minor role in circulation; however, more and more data suggest that right ...

The Use of 3D Echocardiography in Surgical Planning of the Mitral Valve in Pediatric Cardiology

Mitral valve disease in pediatric cardiology is complex and can involve a combination of annular, leaflet, chordae tendineae and papillary muscle abnormalities. Transthoracic two-dimensional echocardiography (2DE) remains the primary diagnostic imaging technique utilized in pediatric surgical planning. However, given that the mitral valve is a three-dimensional (3D) structure, the addition of 3D echocardiography (3DE) to better define the mechanisms of stenosis and/or regurgitation is advantageous. Transthoracic 3DE technology has improved with advances in probe technology and ultrasound scanners, producing images with good spatial resolution and adequate temporal resolution. Specifically, the addition of pediatric 3D transducers with higher frequencies and a smaller footprint provides better 3DE imaging in children. Improved efficiency of 3DE acquisition and analysis allow 3D assessment of the mitral valve to be more easily integrated by the sonographer, the cardiologist and the surgeon in mitral valve assessment. This improvement was also made possible by the postprocessing software optimization.
In this method paper, we aim to describe the transthoracic 3DE assessment of the mitral valve in children and its use in the surgical planning of pediatric mitral valve disease. Firstly, the 3DE assessment begins by selecting the correct probe and by obtaining a view of the mitral valve. Then, the appropriate data acquisition method should be selected based on the individual patient. Next, optimization of the data set is critical in order to properly balance spatial and temporal resolution. During live scanning or following acquisition, the data set can be cropped using innovative tools that allow the user to quickly obtain an infinite number of cut planes or volumetric reconstructions. The cardiologist and surgeon can view the mitral valve en face; thus, accurately reconstructing its morphology in order to support medical or surgical planning. Finally, a review of some clinical applications is proposed, showing examples in pediatric mitral valve managements.

<meta charset="utf8"></head><body>O Uso da Ecocardiografia 3D no Planejamento Cirúrgico da Valva Mitral em Cardiologia Pediátrica

3D echocardiography of the mitral valve in pediatric cardiology produces full anatomic reconstructions that contribute to improved surgical management. Here, we outline a protocol for 3D acquisition and post-processing of the mitral valve in pediatric cardiology.