title: Myocardial deformation analysis in contrast echocardiography: first results using two-dimensional cardiac performance analysis.
abstract: BACKGROUND
  Contrast echocardiography (CE) provides closer agreement with magnetic resonance imaging (MRI) for left ventricular (LV) volumes and ejection fraction (EF) than noncontrast echocardiography. However, the feasibility and role of myocardial deformation analysis on contrast echocardiographic images have not been well established. The aim of this study was to assess the feasibility of deformation analysis on CE using a new software tool that provides simultaneous measurements for LV volumes and EF.
  
  
  METHODS
  Data from 52 patients who were recruited for the Alberta Heart Failure Etiology and Analysis Research Team Study (34 men; mean age, 64 ± 9 years) and underwent CE and MRI were considered. Contrast bolus injections were administered for optimal endocardial definition. Offline LV volume analysis was performed by standard manual tracing. A single frame was traced manually for two-dimensional (2D) cardiac performance analysis (CPA), which automatically calculated LV volumes, EF, and global longitudinal strain (GLS). Volumes obtained with 2D CPA were compared with those measured with standard CE and MRI. GLS from noncontrast echocardiographic recordings was also calculated with 2D CPA and compared with CE-derived and MRI-derived GLS.
  
  
  RESULTS
  Tracing of contrast echocardiographic images with 2D CPA was possible in 49 out of 52 patients, and measurements correlated well with standard CE and MRI (EF: r = 0.93, P < .001, and r = 0.85, P < .001, respectively). Mean GLS from noncontrast echocardiographic and contrast echocardiographic recordings was -13.4 ± 5.8 and -15.3 ± 4.64, respectively (P = .056), and the latter correlated well with MRI-derived GLS (r = 0.78 vs 0.81, respectively).
  
  
  CONCLUSIONS
  Simultaneous volumetric and deformation analysis on contrast echocardiographic recordings is feasible and reproducible. While volumes and EF obtained with the new software compare well with those obtained from standard CE and MRI, GLS from CE shows a good correlation with strain measured with MRI.
authors.affiliation: Cardiac and Thoracic Department, University of Pisa, Pisa, Italy; Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: Alda
authors.initials: A
authors.lastname: Huqi
authors.forename: Allen
authors.initials: A
authors.lastname: He
authors.forename: Berthold
authors.initials: B
authors.lastname: Klas
authors.forename: Ian
authors.initials: I
authors.lastname: Paterson
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.forename: Marleen
authors.initials: M
authors.lastname: Irwin
authors.forename: Justin
authors.initials: J
authors.lastname: Ezekowitz
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Choy
authors.forename: Harald
authors.initials: H
authors.lastname: Becher
mesh_terms: D000368:Aged; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006244:Hardness; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D003287:Contrast Media
keywords: 2D; CE; CPA; Cardiac magnetic resonance; Cardiac performance analysis; Contrast echocardiography; EF; ESV; Ejection fraction; End-systolic volume; GLS; Global longitudinal strain; HF; Heart failure; LV; Left ventricular; MRI; Magnetic resonance imaging; Speckle-tracking analysis; Two-dimensional; Volumetric analysis