High volume-rate echocardiography may be capable of assessing cardiac function in a single heartbeat

High volume-rate echocardiography for simultaneous imaging of electromechanical activation and cardiac strain of the whole heart in a single heartbeat in humans

1. Non-invasive high volume-rate echocardiography was shown to be a novel but efficacious means of assessing cardiac function in a single heartbeat. 

Evidence Rating Level: 3 (Average)

Currently, there are no noninvasive techniques to image the mechanical and electrical function of the heart. This is important as the mechanical and electrical function of the heart are interconnected and pathologies in one can affect the other. To solve this problem, this group developed electromechanical wave imaging (EWI) which is a high framerate (500-2000 frames/s) ultrasound-based technique to map the propagation and onset of myocardial shortening which follows local electrical activation. This technique has been validated in vivo and can outperform 12-lead ECG for localizing atrial and ventricular arrhythmia, localizing accessory pathways, and can differentiate non-responders from super-responders to cardiac resychronization therapy. As the technology has progressed, to assess cardiac strain using metrics such as global longitudinal strain (GLS) using speckle tracking echocardiography (STE). A limitation for this technique is it needs to stitch data from multiple heartbeats together which is inadequate for patients with heart rhythm disorders and patients who cannot hold their breath during imaging. Therefore, this group aimed to develop a method with motion tracking to perform simultaneously imaging electromechanical activation and cardiac strain of the whole heart in humans in vivo in a single heartbeat. 16 young and healthy volunteers (28.1±4.2 y.o., 6 females, 9 males) were analyzed. The whole heart activation sequence was consistent across volunteers and consistent with previously reported normal activation sequences. Volumetric analysis of the right and left atria and ventricles were also consistent across all volunteers. This shows that a noninvasive high-volume rate imaging of the heart in a single heartbeat is feasible and can be used for point of care screening, diagnosis, and therapy guidance. Future studies should look at correlating these findings individuals with heart disease to confirm the accuracy in non-standard heart rhythms and volumes. 102 participant data were analyzed 

Image: PD

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