Anatomic M-Mode Echocardiography: A New Approach to Assess Regional Myocardial Function—A Comparative In Vivo and In Vitro Study of Both Fundamental and Second Harmonic Imaging Modes,☆☆,

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Abstract

Objective: To evaluate the accuracy of anatomic M-mode echocardiography (AMM). Methods: Eight phantoms were rotated on a device at different insonation depths (IDs) in a water beaker. They were insonated with different transducer frequencies in fundamental imaging (FI) and second harmonic imaging (SHI), and the diameters were assessed with conventional M-mode echocardiography (CMM) and AMM with the applied angle correction (AC) after rotation. In addition, left ventricular wall dimensions were measured with CMM and AMM in FI and SHI in 10 volunteers. Results: AC had the greatest effect on the measurement error in AMM followed by ID (AC: R2 = 0.295, ID: R2 = 0.268; P < .0001). SHI improved the accuracy, and a difference no longer existed between CMM and AMM with an AC up to 60 degrees. In vivo the limit of agreement between AMM and CMM was -1.7 to +1.8 mm in SHI. Conclusion: Within its limitations (AC < 60 degrees; ID < 20 cm), AMM could be a robust tool in clinical practice. (J Am Soc Echocardiogr 1999;12:300-7.)

Section snippets

METHODS

The study contains 2 in vitro and 1 in vivo investigations in normal subjects.

In Vitro Study 1

With AMM, 5 phantoms were studied at 4 different IDs with 3 different insonation frequencies at 7 different ACs. This resulted in a total number of 420 AMM measurements. Because the CMM measurements were done exclusively at 0-degree AC, a total of 60 measurements were performed with CMM. To compare the accuracy of the different AMM measurements with the CMM measurements regarding the single variables (insonation frequency, phantom size, ID, and degree of AC), the results of the AMM measurements

In Vitro Study 1

To date, quantitative assessment of regional myocardial function remains a challenge in echocardiography. Techniques such as the centerline method require off-line analysis and assess only the magnitude of endocardial inward motion. M-Mode measurements with high temporal and spatial resolution are limited to the number of myocardial segments that can be insonated at 90 degrees. Therefore a new technique such as the AMM, which increases the number of measurable myocardial segments, could be a

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The study was supported by a grant of the Swedish Medical Research Council (No. K97-14X-09481-07AK-U0945). Jörg Strotmann was supported by the German Heart Foundation.

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Reprint requests: Jörg M. Strotmann MD, II Medizinische Klinik/Klinikum Mannheim, Theodor Kutzer-Ufer 1-3, 68135 Mannheim, Germany.

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