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WO2002051316A1 - Evaluation de la contractilite du myocarde - Google Patents

Evaluation de la contractilite du myocarde Download PDF

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Publication number
WO2002051316A1
WO2002051316A1 PCT/GB2001/005612 GB0105612W WO02051316A1 WO 2002051316 A1 WO2002051316 A1 WO 2002051316A1 GB 0105612 W GB0105612 W GB 0105612W WO 02051316 A1 WO02051316 A1 WO 02051316A1
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Prior art keywords
myocardial
iva
during
velocity
acceleration
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Andrew Nicholas Redington
Michael Friedrich Vogel
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Clinical applications
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/06—Measuring blood flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/488—Diagnostic techniques involving Doppler signals

Definitions

  • the present invention relates to a novel method of measurement ventricular contractility and its use in clinical monitoring of patients.
  • ventricular function is essential for the diagnosis, treatment and long-term follow-up of patients with any heart disease. This applies to both the left and the right ventricle. Ideally any method used to serially monitor left or right ventricular function should be non-invasive, easily repeatable, reproducible and not influenced by changes in loading conditions. While the assessment of left ventricular (LN) function constitutes an essential part of daily clinical practice in acquired heart disease, there has also been an increasing interest to assess right ventricular (RV) function in both acquired and congenital heart disease.
  • LN left ventricular
  • RV right ventricular
  • ⁇ on-invasive methods such as MRI or 3 dimensional echocardiography can be used accurately to measure end- diastolic and end-systolic LN and RN volumes and calculate ejection fraction but these methods are time consuming and, more importantly, these indices are extremelyly load dependent.
  • the validity of any single beat derived ejection phase index of contractile function is questionable, as changes in loading conditions, especially afterload, markedly influence such measurements.
  • Tissue Doppler echocardiography has the potential to assess ventricular function by measuring myocardial velocities during ejection. However, the magnitude of ejection phase myocardial velocities has been shown to be pre- and afterload dependent.
  • the measurement of contractile function is widely used for evaluating the effect of drugs on the heart and the present invention provides a non-invasive method for measuring contractile function based on Doppler echocardiography which can be applied irrespective of the geometric shape of the heart ventricles and thus has a greater potential for widespread use than the conventional non-invasive indices used thus far.
  • a method for the measurement of myocardial contractile function of a patient which method comprises measuring the myocardial acceleration of the heart during isovolumic contraction using TDE and obtaining an index of myocardial contractility therefrom.
  • the myocardial acceleration during isovolumic contraction can be calculated from the myocardial velocity during isovolumic contraction by measuring the difference in myocardial velocity of a heart by TDE at two different times and dividing the difference in velocity by the time. Peak myocardial acceleration can be measured from the same data and behaves in a similar way as the average acceleration.
  • IVA and myocardial velocities during isovolumic contraction from which INA is derived is measured at the base of the heart in the free wall of the ventricle immediately underneath the hinge points of the atrioventricular (mitral and tricuspid) valves.
  • the measurements made can be fed to a calculating means such as a computer where the calculation of INA can be stored and presented in a suitable form e.g. a printout or saved and displayed on a NDU screen etc.
  • TDE has been used to measure the myocardial velocities during isovolumic contraction and is described in Pellerin D, Berdeaux A, Cohen L, et al. Pre-ejectional left ventricular wall motions studied on conscious dogs using Doppler myocardial imaging: relationships with indices of left ventricular function. Ultrasound Med Biol 1 998;24: 1271-1283.
  • the measurement of myocardial acceleration during isovolumic contraction has first been described by: Nogel M. Schmidt M.R., Kristiansen S. et al. Myocardial acceleration during isovolumic contraction: a novel load-independent index of contractility derived from TDE. Comparison with LN pressure- volume relations in an animal model. Eur. Heart J 2001; 22 abstr. Suppl.
  • a diagnostic device for scanning an organ such as a heart is described in US Patent 6248070; the above references are herein incorporated by reference.
  • Tissue Doppler Echocardiography is sometimes referred to as Tissue Doppler
  • the invention also provides an apparatus for measuring isovolumetric myocardial acceleration (INA) which apparatus comprises a TDE means for measuring the myocardial velocity at two different times whereby the INA can be calculated by dividing the difference in myocardial velocity by the time.
  • INA isovolumetric myocardial acceleration
  • INA was compared to elastance during contractility modulation by Esmolol and Dobutamine infusion, and during preload reduction and afterload increase by transient balloon occlusion of the inferior vena cava, and pulmonary artery, respectively. Data were also obtained during atrial pacing rates of 110,130,150,170, 190, and 210 beats/mm. Esmolol led to a decrease in INA and dP/dt max but the fall in emax and PRSW failed to reach significance in the RN, while in the LN both e es and IVA fell simultaneously. During Dobutamine infusion IVA, P dt m a x , PRSW, and e max or e es , respectively, all increased significantly.
  • IVA ejection systolic myocardial velocities fell but IVA remained constant up to an acute reduction of LN volume by 10% and a LN systolic pressure increase by 30%, as well as a reduction of RN volume by 54 %, and a RN systolic pressure increase of 58%.
  • a custom-made 8 polar (total interelectrode distance 3cm)5F combination conductance-pressure catheter (Millar Instruments) was placed into the apex of the LV or RV, respectively under fluoroscopic guidance.
  • the micromanometer pressure transducer output was fed to a custom-built amplifier.
  • the conductance electrodes were connected to a signal processing unit (Sigma 5DF, Cardiodynamics Corp).
  • a 20 mm Latex balloon catheter (Boston Scientific) was placed via the right external jugular vein in the junction of the inferior vena cava and the right atrium, and subsequently inflated to modify preload.
  • a Rashkind balloon septostomy catheter (Meditec) was placed in the descending aorta or main pulmonary artery and prepared for inflation to modify LV or RV afterload, respectively. Following modification of loading conditions, the balloon catheter in the pulmonary artery was removed and replaced by a standard 7F thermodilution catheter (Baxter Healthcare) connected to a dedicated cardiac output processing computer (Com2, Baxter ,Edwards).
  • a 5F pacing wire was inserted into the left external jugular vein, advanced into the right atrium and connected to an external pacemaker generator (Medtronic). The right atrium was paced at a constant rate of 130 beats/mm during pre-and afterload changes and during contractility modulation by Esmolol and Dobutamine.
  • Transthoracic echocardiography was performed using the GE Vingmed Vivid V ultrasound scanner with a frame rate between 131 and 248 Hertz.
  • the LV or RV free wall was imaged and colour coded myocardial velocities recorded at the base immediately below the insertion of the mitral or tricuspid valve leaflets, respectively. Recordings were made simultaneously with ECG.
  • a cineloop of at least 6 consecutive heart beats was stored digitally for off-line analysis.
  • TDE was performed continuously during partial occlusion of the inferior vena cava, and a cineloop of 6 consecutive cardiac cycles at different stages of ventricular volume was recorded. An electrical timing signal was recorded to synchronize TDE and pressure and volume data during balloon inflation.
  • the pacemaker rate which otherwise was kept constant at 130 beats/minute was reduced to 110 for one minute, and rapidly increased by increments of 10 beats/mm to a maximum rate of 210 beats/mm.
  • TDE data and ventricular pressure recordings were obtained.
  • Dobutamine was infused at a rate of lOmcgs kg/min for 10 minutes.
  • Conductance catheter derived pressure- volume data were obtained during transient preload reduction by balloon occlusion (above Brookes et al reference) at steady state before commencing Dobutamine, and after Dobutamine had been administered for at least 10 minutes. TDE data were also recorded immediately prior to each conductance catheter measurement.
  • Peak myocardial velocities during isovolumic contraction (q-wave to onset of systolic ejection), systolic ejection (s-wave), as well as acceleration during isovolumic contraction were recorded. Acceleration was calculated as the difference between baseline and peak velocity divided by their time interval. Measurements of myocardial acceleration and velocities were calculated from 3 consecutive cardiac cycles with the average of the 3 measurements recorded.
  • a second independent observer, who was blinded to the results of the TDE derived data analysis measured IVA in 40 datasets to assess inter-observer variability and the first observer measured these 40 datasets on a different day to assess intra-observer variability. In the LN experiments 50 datasets each were measured by different observers to assess inter- observer variability.
  • TDE derived parameters and pressure volume data at the various stages of pre- and afterload modification were analysed using A ⁇ OVA for repeated measurements.
  • Linear regression analysis was used to compare changes in Emax to changes in isovolumic contraction myocardial acceleration (IVA) and velocity (IN V).
  • INA is a sensitive tool to detect a reduction or improvement in contractility.
  • the contractile force of the heart increases with heart rate.
  • INA is a sensitive tool to detect changes in contractility (force) during changes in heart rate (frequency).
  • IVA The utility of IVA to detect changes in contractile function during its pharmacologic modulation was assessed in 13 patients. These were examined with IVA measurements by Doppler echocardiography and concomitant conductance catheterization. In all these patients, an infusion of lOmcgs/kg/min of Dobutamine to increase contractile function was given and IVA increased in a similar way as e es .
  • IVA a) is load independent, b) changes with heart rate (force-frequency relation ), c) is able to detect changes in contractility during pharmacologic modulation in humans.
  • IVA isovolumic acceleration
  • IW isovolumic velocity
  • acc acceleration

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Hematology (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)

Abstract

Procédé visant à mesurer des modifications de la fonction de contraction ventriculaire, qui utilise une mesure de l'accélération du rythme cardiaque pendant la période de contraction isovolumique par échocardiographie Doppler. L'indice obtenu est appelé IVA pour accélération isovolumique. Pendant la réduction de précharge par blocage du retour veineux vers le coeur (occlusion IVC) l'IVA ne réagit pas à des changements soudains de volume du ventricule gauche pouvant atteindre 10 %, et 30 % dans le ventricule droit. De ce fait, l'IVA n'est pas influencé par des changements de précharge d'ordre physiologique. Pendant l'augmentation post-charge, l'IVA demeure constant jusqu'à ce qu'une augmentation non physiologique de la pression artérielle ait lieu, laquelle agit à son tour sur la contractilité. Une augmentation soudaine de pression pouvant atteindre 30 % dans le ventricule gauche, et 50 % dans le ventricule droit, n'influence par l'IVA mesuré. L'IVA permet de détecter des modifications de la fonction de contraction pendant une modulation de contractilité produite par perfusion de dobutamine chez l'homme et l'animal. L'IVA permet de détecter de manière non effractive le rapport force-fréquence.
PCT/GB2001/005612 2000-12-22 2001-12-21 Evaluation de la contractilite du myocarde Ceased WO2002051316A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0031664.6 2000-12-22
GB0031664A GB0031664D0 (en) 2000-12-22 2000-12-22 Assessment of mycocardial contractility by measuring IVA (Isovolumic acceleration)

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WO2002051316A1 true WO2002051316A1 (fr) 2002-07-04

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2004098381A3 (fr) * 2003-04-30 2005-05-26 Medtronic Inc Procede et dispositif d'evaluation de l'etat de contraction ventriculaire
RU2561289C1 (ru) * 2014-10-30 2015-08-27 государственное бюджетное образовательное учреждение высшего профессионального образования "Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова" Министерства здравоохранения Российской Федерации Способ диагностики степени дисфункции камер сердца у больных хронической обструктивной болезнью легких

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0592967A2 (fr) * 1992-10-16 1994-04-20 Acuson Corporation Système et procédé d'imagerie ultrasonore de tissus, avec traitement Doppler en vitesse et accélération
US5785654A (en) * 1995-11-21 1998-07-28 Kabushiki Kaisha Toshiba Ultrasound diagnostic apparatus
US6053869A (en) * 1997-11-28 2000-04-25 Kabushiki Kaisha Toshiba Ultrasound diagnostic apparatus and ultrasound image processing apparatus

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0592967A2 (fr) * 1992-10-16 1994-04-20 Acuson Corporation Système et procédé d'imagerie ultrasonore de tissus, avec traitement Doppler en vitesse et accélération
US5785654A (en) * 1995-11-21 1998-07-28 Kabushiki Kaisha Toshiba Ultrasound diagnostic apparatus
US6053869A (en) * 1997-11-28 2000-04-25 Kabushiki Kaisha Toshiba Ultrasound diagnostic apparatus and ultrasound image processing apparatus

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2004098381A3 (fr) * 2003-04-30 2005-05-26 Medtronic Inc Procede et dispositif d'evaluation de l'etat de contraction ventriculaire
RU2561289C1 (ru) * 2014-10-30 2015-08-27 государственное бюджетное образовательное учреждение высшего профессионального образования "Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова" Министерства здравоохранения Российской Федерации Способ диагностики степени дисфункции камер сердца у больных хронической обструктивной болезнью легких

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