Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum. Acoustic Radiation Force (ARF)-based methods have been demonstrated to be a viable tool for noninvasively estimating tissue elastic properties, and shear wave velocimetry has been used to quantitatively measure the stiffening and relaxation of myocardial tissue in open-chest experiments. Dynamic stiffness metrics may prove to be indicators for certain cardiac diseases, but a clinically-viable means of remotely generating and tracking transverse wave propagation in myocardium is needed. Intracardiac echocardiography (ICE) catheter-tip transducers are demonstrated here as a viable tool for making this measurement. ICE probes achieve favorable proximity to the myocardium, enabling the use of shear wave velocimetry from within the right ventricle throughout the cardiac cycle. This work describes the techniques used to overcome the challenges of using a small probe to perform ARF-driven shear wave velocimetry, and presents in vivo porcine data showing the effectiveness of this method in the interventricular septum.

Acoustic radiation force impulse (ARFI) imaging and shear wave elasticity imaging (SWEI) use the dynamic response of tissue to impulsive mechanical stimulus to characterize local elasticity. A variant of conventional, multiple track location SWEI (MTL-SWEI), denoted single track location SWEI (STL-SWEI) offers the promise of creating speckle-free shear wave images. This work compares the three imaging modalities using a high push and track beam density combined acquisition sequence to image inclusions of different sizes and contrasts. STL-SWEI is shown to have significantly higher CNR than MTL-SWEI, allowing for operation at higher resolution. ARFI and STL-SWEI perform similarly in the larger inclusions, with STL-SWEI providing better visualization of small targets ≤2.5 mm in diameter. The processing of each modality introduces different trade-offs between smoothness and resolution of edges and structures; these are discussed in detail.

Four pigs, three with focal infarctions in the apical intraventricular septum (IVS) and/or left ventricular free wall (LVFW), were imaged with an intracardiac echocardiography (ICE) transducer. Custom beam sequences were used to excite the myocardium with focused acoustic radiation force (ARF) impulses and image the subsequent tissue response. Tissue displacement in response to the ARF excitation was calculated with a phase-based estimator, and transverse wave magnitude and velocity were each estimated at every depth. The excitation sequence was repeated rapidly, either in the same location to generate 40 Hz M-Modes at a single steering angle, or with a modulated steering angle to synthesize 2-D displacement magnitude and shear wave velocity images at 17 points in the cardiac cycle. Both types of images were acquired from various views in the right and left ventricles, in and out of infarcted regions. In all animals, ARFI and SWEI estimates indicated diastolic relaxation and systolic contraction in non-infarcted tissues. The M-Mode sequences showed high beat-to-beat spatio-temporal repeatability of the measurements for each imaging plane. In views of noninfarcted tissue in the diseased animals, no significant elastic remodeling was indicated when compared to the control. Where available, views of infarcted tissue were compared to similar views from the control animal. In views of the LVFW, the infarcted tissue presented as stiff and non-contractile compared to the control. In a view of the IVS, no significant difference was seen between infarcted and healthy tissue, while in another view, a heterogeneous infarction was seen presenting itself as non-contractile in systole.

Background Visual confirmation of radiofrequency ablation (RFA) lesions during clinical cardiac ablation procedures could improve procedure efficacy, safety, and efficiency. It was previously shown that acoustic radiation force impulse (ARFI) imaging can identify RFA lesions in vitro and in vivo in an animal model. This is the “first-in-human” feasibility demonstration of intracardiac ARFI imaging of RFA lesions in patients undergoing catheter ablation for atrial flutter (AFL) or atrial fibrillation (AF). Methods and Results Patients scheduled for right atrial (RA) ablation for AFL or left atrial (LA) ablation for drug refractory AF were eligible for imaging. Diastole-gated intracardiac ARFI images were acquired using one of two equipment configurations: (1) a Siemens ACUSON S2000™ ultrasound scanner and 8/10Fr AcuNav™ ultrasound catheter, or (2) a CARTO 3™ integrated Siemens SC2000™ and 10Fr SoundStar™ ultrasound catheter. A total of 11 patients (AFL = 3; AF = 8) were imaged. ARFI images were acquired of ablation target regions, including the RA cavotricuspid isthmus (CTI), and the LA roof, pulmonary vein ostia, posterior wall, posterior mitral valve annulus, and the ridge between the pulmonary vein and LA appendage. ARFI images revealed increased relative myocardial stiffness at ablation catheter contact sites after RFA and at anatomical mapping-tagged RFA treatment sites. Conclusions ARFI images from a pilot group of patients undergoing catheter ablation for AFL and AF demonstrate the ability of this technique to identify intra-procedure RFA lesion formation. The results encourage further refinement of ARFI imaging clinical tools and continued investigation in larger clinical trials.

Shear wave imaging techniques build maps of local elasticity estimating the local group velocity of induced mechanical waves. Velocity estimates are formed using the time delay in the motion profile of the medium at two or more points offset from the shear wave source. Because the absolute time-of-flight between any pair of locations scales with the distance between them, there is an inherent trade-off between robustness to time-of-flight errors and lateral spatial resolution based on the number and spacing of the receive points used for each estimate. This work proposes a method of using the time delays measured between all combinations of locations to estimate a noise-robust, high-resolution image. The time-of-flight problem is presented as an overdetermined system of linear equations that can be directly solved with and without spatial regularization terms. Finite element method simulations of acoustic radiation force-induced shear waves are used to illustrate the method, demonstrating superior contrast-to-noise ratio and lateral edge resolution characteristics compared to linear regression of arrival times. This technique may improve shear wave imaging in situations where time-of-flight noise is a limiting factor.