Guidance for accurate and consistent tissue Doppler velocity measurement: comparison of echocardiographic methods using a simple vendor-independent method for local validation

Dhutia, Niti M.; Zolgharni, Massoud; Willson, Keith; Cole, Graham; Nowbar, Alexandra N.; Dawson, David M.; Zielke, Sayeh; Whelan, Carol; Newton, Jim; Mayet, Jamil; Manisty, Charlotte; Francis, Dárrel P.

doi:10.1093/ehjci/jeu040

Cited by 18 publications

(20 citation statements)

References 26 publications

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“…Whilst example images from guidelines and teaching documents suggest measuring the outer edge of the envelope [1, 2, 23, 24], experimental data suggest that it is the middle of the trace that agrees best with other modalities [12]. It has been controversial which convention introduces more measurement error and/or reduces reproducibility [13].…”

Section: Resultsmentioning

confidence: 99%

“…It is controversial whether to measure the middle or outer edge of a tissue Doppler trace [12, 13]. There was no significant difference in agreement between experts and the automated algorithm and agreement between experts for measurements made at the edge and middle of the Doppler trace.…”

Section: Discussionmentioning

confidence: 99%

“…Statistically this value corresponds to the mode of the filtered velocities at that time-point. If the distribution of velocities near the mode is approximately symmetrical, it will also be the mean velocity [12]. The outer edge of the tissue Doppler envelope was identified for each vertical column by locating the location of the sharpest drop in filtered pixel intensities (i.e., largest gradient in amplitude), moving outwards from the middle pixel.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously found that peak velocity measurements made at the middle of the Doppler envelope agree with different modalities better than measurements made at the outer edge of the Doppler envelope [12]. However, whether measuring from the middle or edge of the Doppler envelope is the more reproducible strategy remains controversial [13].…”

Section: Introductionmentioning

confidence: 99%

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Open-source, vendor-independent, automated multi-beat tissue Doppler echocardiography analysis

Dhutia

Zolgharni

Mielewczik

et al. 2017

Int J Cardiovasc Imaging

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Current guidelines for measuring cardiac function by tissue Doppler recommend using multiple beats, but this has a time cost for human operators. We present an open-source, vendor-independent, drag-and-drop software capable of automating the measurement process. A database of ~8000 tissue Doppler beats (48 patients) from the septal and lateral annuli were analyzed by three expert echocardiographers. We developed an intensity- and gradient-based automated algorithm to measure tissue Doppler velocities. We tested its performance against manual measurements from the expert human operators. Our algorithm showed strong agreement with expert human operators. Performance was indistinguishable from a human operator: for algorithm, mean difference and SDD from the mean of human operators’ estimates 0.48 ± 1.12 cm/s (R2 = 0.82); for the humans individually this was 0.43 ± 1.11 cm/s (R2 = 0.84), −0.88 ± 1.12 cm/s (R2 = 0.84) and 0.41 ± 1.30 cm/s (R2 = 0.78). Agreement between operators and the automated algorithm was preserved when measuring at either the edge or middle of the trace. The algorithm was 10-fold quicker than manual measurements (p < 0.001). This open-source, vendor-independent, drag-and-drop software can make peak velocity measurements from pulsed wave tissue Doppler traces as accurately as human experts. This automation permits rapid, bias-resistant multi-beat analysis from spectral tissue Doppler images.Electronic supplementary materialThe online version of this article (doi:10.1007/s10554-017-1092-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Open-source, vendor-independent, automated multi-beat tissue Doppler echocardiography analysis

Dhutia

Zolgharni

Mielewczik

et al. 2017

Int J Cardiovasc Imaging

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“…Measurements were averaged from three cardiac cycles if the patient was in sinus rhythm and from five cardiac cycles in those with atrial fibrillation. Tissue Doppler measurements were taken from the modal velocity (or peak intensity of the Doppler signal) rather than the peak of the waves, given the variable accuracy of peak tissue Doppler measurements in various machines [15]. A repeat study was performed as soon as feasible from day 3 of admission.…”

Section: Methodsmentioning

confidence: 99%

Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)

Clancy¹,

Slama²,

Huang³

et al. 2017

Crit Care

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BackgroundLeft ventricular diastolic dysfunction is associated with mortality outcomes in severe sepsis and septic shock. There are ongoing issues with diagnosing diastolic dysfunction in this cohort, partly owing to the poor applicability of traditional parameters in the hyperdynamic circulation. In this feasibility study, we sought to assess the utility of a novel parameter (septal e′/s′) to identify diastolic dysfunction in patients with severe sepsis and septic shock who had normal systolic function against the 2016 American Society Echocardiography and European Association of Cardiovascular Imaging (ASE/EACI) guidelines on diastolic dysfunction.MethodsIn this prospective observational pilot study, patients identified as having severe sepsis and septic shock underwent transthoracic echocardiography on day 1 and day 3 of their intensive care unit admission. In patients with normal systolic function, septal e′/s′ was calculated using the peak modal velocity of the s′ compared with the e′ from the septal annulus tissue Doppler imaging and compared with their diastolic grade according to the 2016 ASE/EACI guidelines on diastolic dysfunction.ResultsOn day 1 of admission, 44 of 62 patients with severe sepsis and septic shock had normal systolic function. There was a strong association of those with diastolic dysfunction having a reduced septal e′/s′ compared with patients with normal diastolic function (AUC 0.91). A similar relationship was seen with patients who had indeterminate diastolic dysfunction. On day 3, 37 patients had normal systolic function. Again, there was a strong association of those with diastolic dysfunction and a reduced septal e′/s′ (AUC 0.95).ConclusionsA reduction in septal e′/s′ may indicate diastolic dysfunction in patients with severe sepsis and septic shock who have normal systolic function. As opposed to limited traditional measures of diastolic dysfunction, it is applicable in those with hyperdynamic systolic function.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1727-9) contains supplementary material, which is available to authorized users.

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The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research

et al. 2018

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Guidance for accurate and consistent tissue Doppler velocity measurement: comparison of echocardiographic methods using a simple vendor-independent method for local validation

Cited by 18 publications

References 26 publications

Open-source, vendor-independent, automated multi-beat tissue Doppler echocardiography analysis

Open-source, vendor-independent, automated multi-beat tissue Doppler echocardiography analysis

Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)

The use of echocardiographic indices in defining and assessing right ventricular systolic function in critical care research

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