Atlas of Tissue Doppler Echocardiography — TDE PDF
Preview Atlas of Tissue Doppler Echocardiography — TDE
Atlas of Tissue Doppler Echocardiography - TDE R. Erbel H. J. Nesser J. Drozdz (Eds.) Atlas of Tissue Doppler Echocardiography - TOE With 130 Figures, Most in Color STEINKOPFF Springer Raimund Erbel, MD, FESC, FACC Dept. of Cardiology, University-GHS Essen Hufelandstrasse 55, D-45122 Essen, Germany H. Joachim Nesser, MD Division of Cardiology, K. d. Elisabethinen Fadingerstrasse 1, A -4010 Linz, Austria Jaroslaw Drozdz, MD Dept. of Cardiology, University of Lodz Jonscher Hospital, Milionowa 14 Lodz, 93-113, Poland ISBN-13: 978-3-642-47069-1 e-ISBN-13: 978-3-642-47067-7 DOl: 10.1007/978-3-642-47067-7 Die Deutsche Bibliothek - CIP-Einheitsaufnahme Atlas oftissue doppler echocardiography: TDE / R. Erbel ... (ed.). - Darmstadt: Steinkopff, 1995 NE: Erbel, Raimund [Hrsg.]: TDE This work is subject to copyright. All rights are reserved, whether the whole or part of the mate rial is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction of microfilms or in other ways, and storage in data banks. Duplica tion of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © by Dr. Dietrich Steinkopff Verlag, Darmstadt, 1995 Softcover reprint of the hardcover I st edition 1995 Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Medical Editor: Sabine Ibkendanz - English Editor: James C. Willis Produktion Editing: PRO EDIT GmbH, Heidelberg Printing on acid free paper Preface This is the first book to present an overview of the exciting new cardiac imaging technique of tissue Doppler echocardiography (TDE). In order to understand the background of this technique, it is necessary to compare the physical properties of blood, which reflects ultrasound poorly but moves with high velocity (up to 150 cm/s) with those of the myocar dium, which reflects ultrasound strongly but moves with low velocity (less than 10 cm/s). In tissue Doppler imaging, existing Doppler technology has been modified to bypass the high-pass filter and enhance calculation of low velocities, thus enabling selective visualization of the myocardium rather than of the blood. Because the color Doppler tissue images are super imposed on the conventional two-dimensional ultrasound images, this technique is known as TDE. Following a brief introduction, the history of ultrasound and Doppler imaging is presented. It is now about 150 years since the death of Christian Doppler, who described the "Doppler" effect, and more than 100 years since Pierre Curie discovered the piezoelectric effects of crystals. TDE was developed by Nobuo Yamazaki and Yoshitaka Mine at the Medi cal Engineering Laboratory, Toshiba Corporation, Tochigi, Japan. En gineers involved in the development of the technique have provided important technical information, which the reader will find an invaluable background to potential applications ofTDE. An extensive chapter summarizes the normal features of TDE, which is an important introduction to some of the pathological conditions describ ed later. In order to properly appreciate the rapid changes in the magni tude and direction of tissue velocities, TDE requires digital cine loop archiving and frame-by-frame analysis. TDE is strongly angle dependent and is influenced by total heart movement, a new aspect for echocardio graphy. Successive chapters document TDE images obtained in patients with coro nary artery disease and with hypertrophic, dilated, and restrictive cardio myopathies. The enhancement of structure identification by TDE is ex plained, with particular reference to the measurement of right ventricular wall thickness. Adjacent thoracic and pericardial structures are not color coded, in contrast to the right ventricular myocardium, thus allowing pre cise delineation. The potential use ofTDE to assess regional systolic and diastolic function is then discussed. M-mode TDE affords the possibility of measuring global and regional systolic and diastolic time intervals (STIIDTI) of both the left and right ventricles. VI Preface The final chapters explain how TDE may be useful in the assessment and understanding of disturbances of cardiac rhythm and document expe rience with a variety of subjects, including tumors and spontaneous echo contrast. Our first book on echocardiography, Fortschritte der Echokardiographie1, which was published 10 years ago, included transesophageal and color Doppler imaging; it was followed in 1989 by Transesophageal Echocardio graphy -A New Window to the Hearf-. We hope that this new book, Tissue Doppler Echocardiography, will demonstrate that a further chapter has been opened in the history of echocardiography. We wish to thank our collaborating authors for their intensive work. Parti cular praise must go to Thomas Buck for organizing the publication; David R. Wallbridge for his editorial assistance; Petra Merz for her secretarial work; Christiane Plato for her work in the echo cardiographic laboratory; and Ilse Scharein for her photographic work. The close cooperation of the publishing staff, particularly Sabine Ibkendanz, is also acknowledged. The pictures presented in this book would not have been possible without the support of Toshiba Medical Systems. Mr. K. Machida (Europe), Mr. U. StOcker, and Mr. W. Randhan (Germany) have been most generous in their assistance. R. Erbel H.I. Nesser J Drozdz The work was supported by the Herz-Kreislaufzentrum Essen, Gesell schaft fUr Herz-Kreislaufforschung e. V. References 1. Erbel R, Meyer J, Brennecke R (eds) (1985) Fortschritte der Echokardiographie. Sprin ger, Berlin Heidelberg New York 2. Erbel R, Khandheria D, Brennecke R, Meyer J, Seward JP, Tajik A (eds) (1989) Trans esophageal echocardiography - a new window to the heart. Springer, Berlin Heidelberg New York List of Contents Chapter 1 Introduction ............... . 1 R. Erbel Chapter 2 Milestones in Cardiovascular Ultrasound 3 H. J. Nesser Chapter 3 Principle of Doppler Tissue Velocity Measurements. 9 N.Yamazaki Chapter 4 Image Processing .................... 17 H. U. Stocker Chapter 5 Normal Pattern of Myocardial Velocity ........ 23 J. Drozdz, R. Erbel, D. Wallbridge Chapter 6 Movement of the Total Heart . . . . . . 45 J. Drozdz Chapter 7 Assessment of Right Ventricular Wall Thickness by Tissue Doppler Echocardiography ...... 53 H. J. Nesser Chapter 8 Ischemic Heart Disease ................. 69 J. Drozdz, R. Erbel Chapter 9 TOE and Stress Echocardiography . . . . . . . . . . . 91 T. Buck Chapter 10 Hypertrophic Cardiomyopathy 95 D. R. Wallbridge Chapter 11 Cardiac Amyloidosis · 101 J. Drozdz, R. Erbel Chapter 12 Aortic Wall Velocity . . . . . · 115 J. Drozdz, R. Erbel, J. Zamorano Chapter 13 Hemodynamics by TOE .133 J. Zamorano Chapter 14 Miscellaneous · 141 F. SchOn Perspectives . · 167 R. Erbel Subject Index .169 List of Contributors Thomas Buck, MD David R. Wallbridge, MD Dept. of Cardiology Dept. of Cardiology/Pathophysiology University-GHS Essen University-GHS Essen Hufelandstrasse 55 Hufelandstrasse 55 D-45112 Essen - Germany D-45112 Essen - Germany Nobuo Yamazaki Frank SchOn, MD Toshiba Corporation Schwarzenbergstrasse 25 a Medical Engineering Laboratory D-45472 Mtilheim an der Ruhr 1385, Shimoishigami Germany Otawara-Shi, Toshigi-Ken 324 Japan Hans Ulrich Stocker Jose Zamorano, MD Toshiba Medical Systems Servicio de Cardiologia (Germany) Hospital Clinico Hellersbergstrasse 4 Plaza de Cristo Rey D-41460 Neuss - Germany E-28040 Madrid - Spain Chapter 1 Introduction R. Erbel Echocardiography has become the diagnostic r----------,a·Oem workhorse in cardiology and has evolved to a method enabling cardiovascular hemodynamics to be analyzed. Ventricular function frequently needs to be assessed in the echocardiographic laboratory, and both global and regional indices are currently derived from two-dimensional echo cardiography. Guidelines for the analysis of left Diastole II'Ocm r---------'a·Oem ventricular volume and ejection fraction have been published by the American Society of Echo cardiography [1], but similar standards have yet to be established for the right ventricle and the atria. Regional wall motion is determined either semi quantitatively, by dividing the left ventricle into 16 segments and scoring the degree of abnormality in each of these, or quantitatively, using the center Systole II'Oem line, radiant, and trajectory methods. The limita tions of these methods, due to cardiac motion, Fig. 1.1. Successive cavity outlines from the left rotation of the heart, and changes in the centre of ventriculogram showing inferior akinesia and an gravity of the left ventricle, become more impor area of abnormal movement of the anterior wall tant after myocardial infarction or cardiac surgery during diastole. (From [2]) or in subjects with cardiomyopathy. While global diastolic function can be relatively easily assessed by analyzing the transmitral and pulmonary venous flow patterns, measurement of regional diastolic function by echocardiography is more problematic. Research in this field is called diastology. Regional impairment of diastolic and systolic function may precede changes in more global indices of function due to compensatory hyperactivity of healthy tissue. The pioneering work of Gibson in the 1970s high lighted the importance of ventricular asynchrony in cardiac disease. Using frame-by-frame analysis of ventricular angiograms, he demonstrated that o 9CO Time (msl abnormalities of early diastolic filling were pre sent in subjects with coronary artery disease [2] Fig. 1.2. Plots of regional wall movement against (Figs. 1.1, 1.2) and hypertrophic cardiomyopathy time from the left ventriculogram of a patient with [3]. Echocardiographic methods that include only coronary artery disease. During isovolumic rela end-diastolic and end-systolic frames are unable xation, indicated by the two bold lines, there is to determine such changes. outward movement along the anterior border and With the development of M-mode echocardiogra inward movement along the inferior border. phy, attention was directed toward the quantifica- (From [2]) 2 Chapter 1 Introduction tion of the excursion of the left ventricular poste TDE shows potential in the assessment of abnor rior wall. In retrospect, it is perhaps easy to under malities of ventricular function in patients with stand why neither endocardial nor epicardial cardiomyopathies. Analysis of the patterns of posterior wall velocities provided an accurate myocardial velocities may be helpful to distin measure of total left ventricular performance in guish between amyloidosis and hypertrophic car patients with coronary artery disease [4]. Never diomyopathy. Whether differences exist between theless, interesting observations were made, such TDE patterns in hypertrophic cardiomyopathy as the fact that exercise-induced angina was and arterial hypertension remains to be establish accompanied by the development of abnormal ed. diastolic velocities in the presence of preserved The role of TDE in the evaluation of cardiac systolic function [5]. Somewhat later, Isaaz [6] tumors, thrombi, and vegetations requires further showed that conventional pulsed Doppler imag evaluation. Measurements of wall thickness are ing can be used for the direct analysis of the left improved, particularly for the right ventricle. The ventricular posterior wall and that it appears to be aorta is also easily studied byTDE, with the possi more informative than the M-mode technique for bility of new insights into altered aortic complian systolic measurements. ce in systemic hypertension. Tissue Doppler echo cardiography (TDE) displays It is hoped that the various chapters of the book color-coded tissue velocities as an overlay on con will give the reader a first insight into the emerg ventional images. After a short period of experi ing technique ofTDE. mental validation, clinical applications continue to emerge. The distribution of velocities across the myocardium can be observed and transmural gra References dients calculated. This may facilitate the study of subendocardial function as an early indicator of 1. Schiller NB, Shah PM, Crawford M, DeMaria A, myocardial ischemia or as a marker of viable myo Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger J, Silverman AH, Tajik AJ cardium. (1989) Recommendations for quantification of the The ability of TDE to demonstrate ventricular left ventricle by two-dimensional echocardiography. asynchrony with high temporal resolution is an J Am Soc Echocardiogr 2: 358-367 exciting step forward. This may prove very useful 2. Gibson DG, Prewitt TA, Brown DJ (1976) Analysis of left ventricular wall movement during isovolumic for assessing global and regional left ventricular relaxation and its relation to coronary artery disease. function, but it must take into account the whole Br Heart J 38: 1010-1019 heart motion, a completely new area for echo 3. Sanderson JE, Gibson DG, Brown DJ, Goodwin JF cardiography. The color interfaces of M-mode (1977) Left ventricular filling in hyertrophic car TDE can be used to measure the duration of the diomyopathy. An angiographic study. Br Heart J 39:661--670 different phases of the cardiac cycle, including 4. Ludbrook P, Karliner JS, London A, Peterson KL, regional systolic (STI) and diastolic time intervals Leopold GR, O'Rourke RA (1974) Posterior wall (DTI) , for both left and right ventricles. velocity: an unreliable index of total left ventricular Abnormal electrical activation of the heart, by an performance in patients with coronary artery disease. Am J CardioI33:475-482 accessory pathway or ventricular ectopic focus, 5. Fogelman AM, Abbasi AS, Pearce ML, Kattus AA may be recognized by TDE contraction patterns. (1972) Echocardiographic study of the abnormal It has already been shown that TDE can detect motion of the posterior left ventricular wall during the position of accessory pathways in Wolff-Par angina pectoris. Circulation 46: 905-913 kinson-White (WPW) syndrome and that the 6. Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C (1989) Doppler echocardio early signs of contraction disappear after ablation. graphic measurement of low velocity motion of the Thus TDE may be a useful noninvasive technique left ventricular posterior wall. Am J Cardiol 64: for electrophysiology. 66-75 Chapter 2 Milestones in Cardiovascular Ultrasound H. 1. Nesser The engineering aspects using ultrasound for In 1969, a very important contribution to the diagnostic purposes date far back, to the year development of cardiac ultrasound was provided 1883, when Galton developed a pipe producing by Gramiak creating the contrast echo technique vibrations as high as 25000 cycles per second. [30). During the First World War, Langevin made It may be of interest that the term "Echocardio experiments generating ultrasound waves by graphy" was introduced by the American Institute quartz crystals. The intensity of the waves was of Ultrasound in accordance with the term sufficient enough to kill fish in a water tank. The "Echoencephalography" . first to describe an ultrasound technique to local ize flaws in metals was Sokolov [67] in 1929. During the Second World War, ultrasound was Two-dimensional Echocardiography particularly used to fix the position of underwater objects and was a goal of military research. It was Whereas M-mode echocardiography only pro Firestone [26], who again initiated the technique duced small detailed images of the heart, two for non destructive testing. dimensional sector scanning developed in the mid One of the first to register reflected ultrasonic 1970s, allowed real-time tomographic images of waves from cardiac structures was Keidel in 1950, cardiac morphology and function [1,81]. who measured cardiac volumes [43]. Ultrasonic two-dimensional imaging was prima In 1954, the term "ultrasonic cardiogram" was rily used in radiological and obstetric applications created by Hertz and Edler. Their early works [81]. Asberg described the first scanner operating included descriptions of the left ventricular poste at seven frames per second already in 1967 [1]. rior wall and the anterior mitral leaflet [14). Dur Five years later, in 1972, King demonstrated two ing the late 1950s Edler was engaged, with using dimensional imagings with a static contact B the technique to analyze valve diseases such as scanner [45]. Eventually, this technique achieved mitral valve stenosis [15, 16). A left atrial throm clinical importance, when Bom [4] and coworkers bus was reported by him [17] in 1955, and by Effert constructed the linear array system. In 1974, the [19] a left atrial myxoma in 1959. mechanical real-time sector scanner was intro In 1957, Reid and Wild were the first in the United duced by Griffith and Henry [31]. The electronic States to use medical ultrasound to examine excis phased array sector scanner was developed by ed hearts [82). Reid and Joyner [40] worked to Somer [68] in 1968, but it was not until 1974 that gether to start the first clinical applications of Thurstone and von Ramm [76] took the next steps cardiac ultrasound in the USA. Their article deal to non invasively diagnose heart diseases with this ing with mitral valve disease was published in Cir technology in the USA. culation in 1963. Because of the increased diagnostic safety, myo Feigenbaum and associates at Indiana University cardial infarction, cardiomyopathies and coronary began to work with cardiac ultrasound in 1963. In artery disease were analyzed with the new tech this year pericardial effusion was first detected in nique [39,71]. At present three-dimensional echo his laboratory with the use of ultrasound [22). cardiography, clinically initiated by Wollschlager Measurements of myocardial wall thickness [23], and coworkers [83], is one of the endpoints of a left ventricular dimensions [24] and left ventricu long history of imaging cardiac structures and lar stroke volume [25] were also first reported by function. Today, it is still under clinical investiga the same group. tion.
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