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      Current Clinical Application of Intracardiac Flow Analysis Using Echocardiography

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          Abstract

          In evaluating the cardiac function, it is important to have a comprehensive assessment of structural factors, such as the myocardial or valvular function and intracardiac flow dynamics that pass the heart. Vortex flow that form during left ventricular filling have specific geometry and anatomical location that are critical determinants of directed blood flow during ejection. The formation of abnormal vortices relates to the abnormal cardiac function. Therefore, vortex flow may offer a novel index of cardiac dysfunction. Intracardiac flow visualization using ultrasound technique has definite advantages with a higher temporal resolution and availability in real time clinical setting. Vector flow mapping based on color-Doppler and contrast echocardiography using particle image velocimetry is currently being used for visualizing the intracardiac flow. The purpose of this review is to provide readers with an update on the current method for analyzing intracardiac flow using echocardiography and its clinical applications.

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          Particle-Imaging Techniques for Experimental Fluid Mechanics

          Ronald J. Adrian (1991)
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            Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry.

            Abinav Baweja, T. J. Kim, Namsik Chung … (2008)
            The aims of this study were to: 1) assess the feasibility of left ventricular (LV) vortex flow analysis using contrast echocardiography (CE); and 2) characterize and quantify LV vortex flow in normal subjects and patients with LV systolic dysfunction. Vortices that form during LV filling have specific geometry and anatomical locations that are critical determinants of directed blood flow during ejection. Therefore, it is clinically relevant to assess the vortex flow patterns to better understand the LV function. Twenty-five patients (10 normal and 15 patients with abnormal LV systolic function) underwent CE with intravenous contrast agent, Definity (Bristol-Myers Squibb Medical Imaging, Inc., North Billerica, Massachusetts). The velocity vector and vorticity were estimated by particle image velocimetry. Average vortex parameters including vortex depth, transverse position, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also estimated. Vortex depth and vortex length were significantly lower in the abnormal LV function group (0.443 +/- 0.04 vs. 0.482 +/- 0.06, p < 0.05; 0.366 +/- 0.06 vs. 0.467 +/- 0.05, p < 0.01, respectively). Vortex width was greater (0.209 +/- 0.05 vs. 0.128 +/- 0.06, p < 0.01) and sphericity index was lower (1.86 +/- 0.5 vs. 3.66 +/- 0.6, p < 0.001) in the abnormal LV function group. Relative strength (1.13 +/- 0.4 vs. 2.10 +/- 0.8, p < 0.001), vortex relative strength (0.57 +/- 0.2 vs. 1.19 +/- 0.5, p < 0.001), and vortex pulsation correlation (0.63 +/- 0.2 vs. 1.31 +/- 0.5, p < 0.001) were significantly lower in the abnormal LV function group. It was feasible to quantify LV vorticity arrangement by CE using particle image velocimetry in normal subjects and those with LV systolic dysfunction, and the vorticity imaging by CE may serve as a novel approach to depict vortex, the principal quantity to assess the flow structure.
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              Emerging trends in CV flow visualization.

              Partho P. Sengupta, Gianni Pedrizzetti, Philip J Kilner … (2012)
              Blood flow patterns are closely linked to the morphology and function of the cardiovascular system. These patterns reflect the exceptional adaptability of the cardiovascular system to maintain normal blood circulation under a wide range of workloads. Accurate retrieval and display of flow-related information remains a challenge because of the processes involved in mapping the flow velocity fields within specific chambers of the heart. We review the potentials and pitfalls of current approaches for blood flow visualization, with an emphasis on acquisition, display, and analysis of multidirectional flow. This document is divided into 3 sections. First, we provide a descriptive outline of the relevant concepts in cardiac fluid mechanics, including the emergence of rotation in flow and the variables that delineate vortical structures. Second, we elaborate on the main methods developed to image and visualize multidirectional cardiovascular flow, which are mainly based on cardiac magnetic resonance, ultrasound Doppler, and contrast particle imaging velocimetry, with recommendations for developing dedicated imaging protocols. Finally, we discuss the potential clinical applications and technical challenges with suggestions for further investigations. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Ultrasound
                Journal ID (iso-abbrev): J Cardiovasc Ultrasound
                Journal ID (publisher-id): JCU
                Title: Journal of Cardiovascular Ultrasound
                Publisher: Korean Society of Echocardiography
                ISSN (Print): 1975-4612
                ISSN (Electronic): 2005-9655
                Publication date (Print): December 2013
                Publication date (Electronic): 27 December 2013
                Volume: 21
                Issue: 4
                Pages: 155-162
                Affiliations
                [1 ]Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
                [2 ]School of Medicine, University of Queensland, Herston, QLD, Australia.
                [3 ]University of Trieste, Trieste, Italy.
                [4 ]Department of Cardiovascular Medicine, Piedmont Heart Institute, Atlanta, GA, USA.
                Author notes
                Address for Correspondence: Geu-Ru Hong, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-8443, Fax: +82-2-393-2041, grhong@ 123456yuhs.ac
                Article
                DOI: 10.4250/jcu.2013.21.4.155
                PMC ID: 3894365
                PubMed ID: 24459561
                SO-VID: 18d82e27-638e-4930-b43e-51dde9d91249
                Copyright © Copyright © 2013 Korean Society of Echocardiography
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 December 2013
                Date revision received : 23 December 2013
                Date accepted : 23 December 2013
                Categories
                Subject: Review

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: intracardiac flow,vortex,particle image velocimetry,echocardiography
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: intracardiac flow, vortex, particle image velocimetry, echocardiography

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