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Ann Arbor, MI, United States

Addetia K.,University of Chicago | Takeuchi M.,University of Occupational and Environmental Health Japan | Maffessanti F.,University of Chicago | Nagata Y.,University of Occupational and Environmental Health Japan | And 3 more authors.
Circulation: Cardiovascular Imaging | Year: 2016

Background-Simultaneous assessment of longitudinal strain (LS) by 2D speckle-tracking echocardiography in all 4 cardiac chambers has not yet been explored. Our goal was to study LS curves obtained simultaneously from all 4 cardiac chambers in healthy subjects to gain insight into interchamber functional relationships. Methods and Results-We studied 259 healthy subjects (age 44±15; 118 men) in whom it was possible to obtain apical 4-chamber views that contained the entire left and right ventricles and both atria in the same sector. 2D speckle-tracking echocardiography was performed in all 4 chambers in the same cardiac cycle, while considering the interventricular septum as part of the left ventricle and including the interatrial septum in the LS measurements for both atria. LS was measured over time using vendor-independent software (Epsilon), resulting in peak LS and time-to-peak strain. Strain curves of the right ventricle and right atrium were larger in magnitude than those of the left ventricle and left atrium, whereas time-to-peak values were shorter. LS for the ventricles peaked earlier than the LS for the corresponding atria. Peak systolic LS values were larger in magnitude in women than in men. For both atria, LS declined with age and time-to-peak increased. Left ventricle LS declined minimally with age, but right ventricle free-wall LS augmented with age until the sixth decade. Conclusions-Simultaneous measurement of LS provides new insights into interchamber relationships. This new tool may prove useful in evaluating diseases that affect cardiac chambers differently. © 2016 American Heart Association, Inc. Source


Medvedofsky D.,University of Chicago | Addetia K.,University of Chicago | Hamilton J.,Epsilon Imaging | Leon Jimenez J.,Jerez de la Frontera Hospital | And 2 more authors.
International Journal of Cardiovascular Imaging | Year: 2015

Although parameters of right ventricular (RV) size and function are clinically important, echocardiographic assessment of this chamber is complex. Existing quantitative approaches rely on manual measurements performed on different images, and are thus time-consuming. Consequently, in clinical practice, qualitative assessment is usually used instead. We tested a new approach for automated measurements of RV size and function using speckle tracking by comparing them to the conventional manual methodology. Transthoracic images were obtained in 149 patients with a wide range of RV size and function, and were analyzed by an expert using conventional techniques to obtain RV end-diastolic and end-systolic areas, fractional area change, dimensions (basal and mid-cavity diameters and length), tricuspid annular plane systolic excursion and peak systolic velocity. Same parameters were obtained using the semi-automated software (Epsilon Imaging), which requires tracing of the RV endocardial boundary in a single frame in the RV focused view. Fifteen patients were excluded due to image quality (90 % feasibility). Time required for the automated analysis was approximately 30 s per patient, compared to 4 min for conventional analysis. The parameters obtained with the semi-automated approach were in good agreement with manual measurements: r-values 0.79–0.95 for RV size and 0.70–0.74 for function indices and biases of 2–22 % of the mean measured values, which were comparable to the intrinsic variability of the conventional technique. In conclusion, the semi-automated technique is feasible, fast and provides quantitative parameters of RV size and function, which are comparable to conventional measurements. © 2015, Springer Science+Business Media Dordrecht. Source


Rubin J.M.,University of Michigan | Feng M.,University of Michigan | Hadley S.W.,University of Michigan | Fowlkes J.B.,University of Michigan | Hamilton J.D.,Epsilon Imaging
Journal of Ultrasound in Medicine | Year: 2012

We prospectively evaluated real-time ultrasound speckle tracking for monitoring soft tissue motion for image-guided radiotherapy. Two human volunteers and 1 patient with a proven hepatocellular carcinoma, who was being prepared for radiation therapy treatment, were scanned using a clinical ultrasound scanner modified to acquire and store radiofrequency signals. Scans were performed of the liver in the volunteers and the patient. In the patient, the speckle-tracking results were compared to those measured on a treatment-planning 4-dimensional computed tomogram with tumors contoured manually in each phase and with estimates made by hand on gray scale ultrasound images. The surface of the right lung and the prostate were scanned in a volunteer. The liver and lung surface were scanned during respiration. To simulate prostate motion, the ultrasound probe was rocked in an anterior-posterior direction. The correlation coefficients of all motion measurements were significantly correlated at all sites (P <.00001 for all sites) with 0 time delays. Ultrasound speckle-tracking motion estimates of tumor motion were within 2 mm of estimates made by hand tracking on gray scale ultrasound images and the 4-dimensional computed tomogram. The total tumor motion was greater than 20 mm. The angular displacement of the prostate was within 0.02 radians (1.1°) with displacements measured by hand. Speckle tracking could be used to monitor organ motion during radiotherapy. © 2012 by the American Institute of Ultrasound in Medicine. Source


SAN DIEGO--(BUSINESS WIRE)--Epsilon Imaging, Inc., a visualization and analysis software provider transforming cardiac diagnostic workflow, today announced four studies were presented at the ACC’ 15 Scientific Sessions; these studies all demonstrated improved quality in assessment of heart function with EchoInsight visualization and analysis. “Simultaneous Assessment of Longitudinal Strain in All 4 Cardiac Chambers: A New Method to Characterize Cardiomyopathy,” presented by Karima Addetia, MD, Masaaki Takeuchi, MD, et al. from the University of Chicago Medicine and University of Occupational and Environmental Health. The study analyzed 109 normal subjects and 62 patients with dilated cardiomyopathy using apical 4-chamber views with echo that included the left and right ventricles and both atria. 2D speckle tracking was used in all 4 chambers in the same cardiac cycle with EchoInsight to obtain longitudinal strain. The study concluded simultaneous measurement of longitudinal strain provides new insight into inter-chamber relationships and may prove useful in evaluating cardiomyopathies. “Left Atrial Strain Predicts Atrial Fibrillation Recurrence in Patients with Paroxysmal Atrial Fibrillation and Preserved Ejection Fraction Treated with Catheter Ablation,” presented by Mislav Vrsalovic, MD, et al. from the University of Michigan. This study investigated novel echo strain parameters as predictors of outcome in atrial fibrillation patients treated with radiofrequency catheter ablation in 110 patients. Left atrial (LA) and ventricular (LV) global longitudinal strains were measured with 2D speckle tracking using EchoInsight. Patients were followed for atrial fibrillation recurrence after catheter ablation. The study concluded LA strain by 2D speckle tracking echo is a strong and independent predictor of atrial fibrillation recurrence after catheter ablation therapy in patients with paroxysmal atrial fibrillation and preserved EF. “Right Ventricular Longitudinal Strain: A Superior Measure of Outcomes in Patients with Pulmonary Arterial Hypertension,” presented by Karima Addetia, MD, et al. from the University of Chicago Medicine. This study compared free wall longitudinal strain of the right ventricle (RV) together with other 2D echo parameters in 93 patients. In addition, measurements were assessed for predicting all-cause mortality in pulmonary arterial hypertension patients. TAPSE (M-mode) and S’ (pulsed-wave Doppler) were measured in the basal segment of the right ventricular free wall. Fractional area change (FAC) and free wall longitudinal strains were measured using EchoInsight. The study concluded that RV free wall longitudinal strain is more predictive of all-cause pulmonary arterial hypertension mortality over TAPSE, S’ or FAC and should be included in 2D echo protocols when evaluating and managing these patients. “Right Ventricular Global and Regional Function as Assessed by Two-Dimensional Strain Imaging in Patients with Hypertrophic Cardiomyopathy,” presented by Alexandros Briasoulis, MD, et al. from the Wayne State University/Detroit Medical Center. This study analyzed RV strain in patients with left ventricular hypertrophy secondary to either hypertrophic cardiomyopathy or hypertension without pulmonary hypertension. Echo was performed in 32 patients with hypertrophic cardiomyopathy, 21 patients with hypertension without pulmonary hypertension, and 11 healthy subjects. EchoInsight was used for segmental longitudinal strain analysis in apical views. RV global longitudinal strain was calculated by averaging septal and right free wall strains. An RV global longitudinal strain cut-off value of >-14.9% differentiated hypertrophic cardiomyopathy and hypertension without pulmonary hypertension with a 84% sensitivity and a 95% specificity. The study concluded RV strain parameters are impaired in patients with hypertrophic cardiomyopathy. Assessment of two-dimensional RV strain parameters could help differentiate between hypertrophic cardiomyopathy and hypertension without pulmonary hypertension. By delivering valuable echo tools designed to improve quantification of the heart, EchoInsight improves diagnostic confidence, standardization and analysis efficiency. Designed for the clinical environment, EchoInsight visualization and analysis meets today’s clinical needs and healthcare system challenges: Attend an educational webinar, “Improving Patient Management in Cardio Oncology With Latest Recommendations and Strain Imaging,” with Dr. Nausheen Akhter, Northwestern Hospital and Medical Center on May 13, 2015 at 12:00-1:00 PM CT. As a provider of workflow enhancing solutions for cardiology, Epsilon Imaging is transforming cardiac diagnostic workflow with a vendor neutral suite of visualization and analysis software applications designed for echocardiography. EchoInsight provides clinical applications for improved quantification of the heart with clinical strain imaging. Applications assist clinicians to enhance, standardize, and streamline interpretation and monitoring of echo studies. Initial applications include cardio oncology, RV and stress echo. Learn more by visiting epsilon-imaging.com.


SAN DIEGO--(BUSINESS WIRE)--Epsilon Imaging, Inc., a visualization and analysis software provider transforming cardiac diagnostic workflow, today announced four studies were presented at the ACC’ 15 Scientific Sessions; these studies all demonstrated improved quality in assessment of heart function with EchoInsight visualization and analysis. “Simultaneous Assessment of Longitudinal Strain in All 4 Cardiac Chambers: A New Method to Characterize Cardiomyopathy,” presented by Karima Addetia, MD, Masaaki Takeuchi, MD, et al. from the University of Chicago Medicine and University of Occupational and Environmental Health. The study analyzed 109 normal subjects and 62 patients with dilated cardiomyopathy using apical 4-chamber views with echo that included the left and right ventricles and both atria. 2D speckle tracking was used in all 4 chambers in the same cardiac cycle with EchoInsight to obtain longitudinal strain. The study concluded simultaneous measurement of longitudinal strain provides new insight into inter-chamber relationships and may prove useful in evaluating cardiomyopathies. “Left Atrial Strain Predicts Atrial Fibrillation Recurrence in Patients with Paroxysmal Atrial Fibrillation and Preserved Ejection Fraction Treated with Catheter Ablation,” presented by Mislav Vrsalovic, MD, et al. from the University of Michigan. This study investigated novel echo strain parameters as predictors of outcome in atrial fibrillation patients treated with radiofrequency catheter ablation in 110 patients. Left atrial (LA) and ventricular (LV) global longitudinal strains were measured with 2D speckle tracking using EchoInsight. Patients were followed for atrial fibrillation recurrence after catheter ablation. The study concluded LA strain by 2D speckle tracking echo is a strong and independent predictor of atrial fibrillation recurrence after catheter ablation therapy in patients with paroxysmal atrial fibrillation and preserved EF. “Right Ventricular Longitudinal Strain: A Superior Measure of Outcomes in Patients with Pulmonary Arterial Hypertension,” presented by Karima Addetia, MD, et al. from the University of Chicago Medicine. This study compared free wall longitudinal strain of the right ventricle (RV) together with other 2D echo parameters in 93 patients. In addition, measurements were assessed for predicting all-cause mortality in pulmonary arterial hypertension patients. TAPSE (M-mode) and S’ (pulsed-wave Doppler) were measured in the basal segment of the right ventricular free wall. Fractional area change (FAC) and free wall longitudinal strains were measured using EchoInsight. The study concluded that RV free wall longitudinal strain is more predictive of all-cause pulmonary arterial hypertension mortality over TAPSE, S’ or FAC and should be included in 2D echo protocols when evaluating and managing these patients. “Right Ventricular Global and Regional Function as Assessed by Two-Dimensional Strain Imaging in Patients with Hypertrophic Cardiomyopathy,” presented by Alexandros Briasoulis, MD, et al. from the Wayne State University/Detroit Medical Center. This study analyzed RV strain in patients with left ventricular hypertrophy secondary to either hypertrophic cardiomyopathy or hypertension without pulmonary hypertension. Echo was performed in 32 patients with hypertrophic cardiomyopathy, 21 patients with hypertension without pulmonary hypertension, and 11 healthy subjects. EchoInsight was used for segmental longitudinal strain analysis in apical views. RV global longitudinal strain was calculated by averaging septal and right free wall strains. An RV global longitudinal strain cut-off value of >-14.9% differentiated hypertrophic cardiomyopathy and hypertension without pulmonary hypertension with a 84% sensitivity and a 95% specificity. The study concluded RV strain parameters are impaired in patients with hypertrophic cardiomyopathy. Assessment of two-dimensional RV strain parameters could help differentiate between hypertrophic cardiomyopathy and hypertension without pulmonary hypertension. By delivering valuable echo tools designed to improve quantification of the heart, EchoInsight improves diagnostic confidence, standardization and analysis efficiency. Designed for the clinical environment, EchoInsight visualization and analysis meets today’s clinical needs and healthcare system challenges: Attend an educational webinar, “Improving Patient Management in Cardio Oncology With Latest Recommendations and Strain Imaging,” with Dr. Nausheen Akhter, Northwestern Hospital and Medical Center on May 13, 2015 at 12:00-1:00 PM CT. As a provider of workflow enhancing solutions for cardiology, Epsilon Imaging is transforming cardiac diagnostic workflow with a vendor neutral suite of visualization and analysis software applications designed for echocardiography. EchoInsight provides clinical applications for improved quantification of the heart with clinical strain imaging. Applications assist clinicians to enhance, standardize, and streamline interpretation and monitoring of echo studies. Initial applications include cardio oncology, RV and stress echo. Learn more by visiting epsilon-imaging.com.

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