Effects of region of interest tracking on the diagnosis of left ventricular dyssynchrony from Doppler tissue images

• Authors: Brandon K. Fornwalt, Emory University; Joshua A. Thomas, Emory University; Mohit Bhasin, Emory University; John Merlino, Emory University; Angel Rodrigo Leon, Emory University; Derek Fyfe, Emory University; John Oshinski, Emory University
• Journal Title: Journal of The American Society of Echocardiography
• Volume: Volume 21, Number 3
• Publisher: Elsevier: 12 months | 2008-03-01, Pages 234-240
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.echo.2007.10.008
• Subjects: Health Sciences, Medicine and Surgery; Engineering, Biomedical; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; tissue doppler; region of interest; asynchrony; cardiac resynchronization therapy; dyssynchrony; CARDIAC RESYNCHRONIZATION THERAPY; NONISCHEMIC HEART-FAILURE; BUNDLE-BRANCH BLOCK; NORMAL QRS DURATION; STRAIN; ASYNCHRONY; ECHOCARDIOGRAPHY; CARDIOMYOPATHY; VALIDATION; PREDICTORS

Abstract

Background: Left ventricular dyssynchrony is often diagnosed by comparing velocity curves from Doppler tissue images of two or more myocardial regions. Velocity curves are generated by placing sample volumes or regions of interest (ROIs) within the myocardium. ROIs need to be manually relocated to maintain a midmyocardial location as the heart moves, but are frequently left in a stationary position. The error caused by use of a stationary ROI may affect the diagnosis of dyssynchrony, but this has not been quantified. Objective: We hypothesized that using a stationary ROI to quantify dyssynchrony from Doppler tissue images would affect the diagnosis of dyssynchrony in patients with heart failure. Methods: We quantified dyssynchrony in 18 patients with heart failure using 4 published dyssynchrony parameters: septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, SD of the 12 basal and midwall times to peak, and cross-correlation delay (XCD). Each dyssynchrony parameter was measured using both tracked and stationary ROIs. Results: Use of a stationary ROI did not change the diagnosis of dyssynchrony when using XCD. However, ROI tracking changed the diagnosis of dyssynchrony in 17%, 11%, and 17% of patients when using septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, and SD of the 12 basal and midwall times to peak, respectively. XCD showed the lowest percent difference between tracked and stationary ROIs (4 ± 9% vs 22 ± 53%, 50 ± 167%, and 12 ± 30%, respectively, for septal-to-lateral delay, maximum difference in the basal 2- or 4-chamber times to peak, and SD of the 12 basal and midwall times to peak). Conclusion: Manual ROI tracking is required when using conventional time-to-peak parameters to diagnose dyssynchrony. XCD diagnosis of dyssynchrony can be performed accurately with a stationary ROI.