The role of automatic endocardial edge detection in the evaluation of left ventricular diastolic function in children

doi:10.1016/S0894-7317(96)90100-5

Journal of the American Society of Echocardiography

Volume 9, Issue 1, January–February 1996, Pages 18-26

https://doi.org/10.1016/S0894-7317(96)90100-5 Get rights and content

Abstract

Forty-nine normal children underwent echocardiography to study the role of automatic border detection (ABD) in diastolic evaluation by (1) determining the relationship of diastolic ABD indexes to heart rate and traditional diastolic indexes and (2) establishing inter-observer variability. ABD diastolic indexes were less associated with heart rate than were M-mode and Doppler diastolic indexes. ABD left ventricular peak filling rate correlated with Doppler mitral E wave peak velocity. Interobserver variability for ABD indexes ranged from 4% to 24%. We then compared the ability of ABD left ventricular filling rate to M-mode and Doppler indexes to detect diastolic dysfunction in a test group of 20 children with diastolic disease. ABD left ventricular peak filling rate had the highest sensitivity of all indexes (90%). Thus ABD left ventricular peak filling rate is an accurate index of diastolic function that is readily usable by almost all clinical laboratories.

References (23)

WH Gaasch et al.
Left ventricular compliance: mechanisms and clinical implications
Am J Cardiol
(1976)
SM Shapiro et al.
In search of the holy grail: the study of diastolic ventricular function by the use of echocardiography
J Am Coll Cardiol
(1991)
JE Perez et al.
On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging
J Am Coll Cardiol
(1992)
PD Lindower et al.
Quantification of left ventricular function with an automated border detection system and comparison with radionuclide ventriculography
Am J Cardiol
(1994)
GG Janos et al.
Differentiation of constrictive pericarditis and restrictive cardiomyopathy using digitized echocardiography
J Am Coll Cardiol
(1983)
SD Colan et al.
Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy
J Am Coll Cardiol
(1985)
TW Riggs et al.
Doppler echocardiographic evaluation of right and left ventricular diastolic function in normal neonates
J Am Coll Cardiol
(1989)
RA Nishimura et al.
Assessment of diastolic function of the heart: background and current application of Doppler echocardiography
PS Douglas et al.
Alterations in diastolic function in response to progressive left ventricular hypertrophy
J Am Coll Cardiol
(1989)
MA Fifer et al.
Early diastolic left ventricular function in children and adults with aortic stenosis
J Am Coll Cardiol
(1985)

CP Appleton et al.

Influence of incremental changes in heart rate on mitral flow velocity: assessment in lightly sedated, conscious dogs

J Am Coll Cardiol

(1991)

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Background: Acute cardiac allograft rejection is associated with early diastolic dysfunction. The development of chronic rejection is dependent on the frequency and severity of acute rejection episodes. Therefore, early diagnosis and therapy influence long-term survival significantly. For the first time, acoustic quantification, a new echocardiographic technology for on-line measurement of cardiac volumes and their changes, facilitates quantitative assessment of systolic and diastolic function noninvasively. %Methods: Since May 1996, all consecutive patients after cardiac transplantation (n = 94) underwent 475 endomyocardial biopsies and the same number of echocardiographic studies within 6 hours after biopsy before the histological results were available.
Nineteen patients showed 23 episodes of acute rejection (ISHLT ≥ 2). There was a significant decrease in left ventricular peak filling rate [PFR: end-diastolic volume (EDV)/second) as a parameter of diastolic function during rejection (2.9 ± 0.4, n = 23) as compared to PFR measured under nonrejection status (4.5 ± 0.8; n = 452; p < 0.0001). Most importantly we found that in these 19 patients showing rejection, the PFR was normal in the last examination before rejection, but was significantly reduced during rejection (2.9 ± 0.4 vs 4.5 ± 0.7; n = 23, p < 0.0001). After successful rejection therapy, PFR again normalized in all patients, with the exception of 1 patient with steroid-refractory humoral rejection. We calculated sensitivity and specificity for several cutpoints for the event “first rejection” in 15 patients and plotted them in a receiver operating characteristic curve, showing that a PFR ≥ 4.0 EDV/second is never associated with treatable rejection. A decrease of PFR of more than 18% from its prevalue of the last biopsy with no rejection increases the accuracy for the diagnosis of rejection significantly.
We conclude that diastolic dysfunction during acute cardiac allograft rejection can be accurately detected by noninvasive measurement of peak filling rate with acoustic quantification echocardiography. Monitoring of this parameter provides reliable discrimination between treatable and nontreatable rejection.
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Original articleThe role of automatic endocardial edge detection in the evaluation of left ventricular diastolic function in children

Abstract

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Original article
The role of automatic endocardial edge detection in the evaluation of left ventricular diastolic function in children