The method for evaluating cardiac f

unction by echocardiography

Yasuhiro Maejima MD, PhD

10. 16. 2008. Research Meeting

The features of echocardiography

1. Echocardiography is used to diagnose cardiovascular diseases. In fact, it is one of th

e most widely used diagnostic tests for heart disease. It can provide a wealth of hel

pful information, including the size and shape of the heart, its pumping capacity and

the location and extent of any damage to its tissues.

2. It is especially useful for assessing diseases of the heart as follows:

(1) Coronary artery disease: wall motion, systolic function

(2) Cardiomyopathy (hypertrophic, dilated, etc): wall thickness, systolic function

(3) Valvular heart disease: valvular dysfunction (stenosis, regurgitation)

(4) Others: Pericardial diseases, Aortic diseases, Pulmonary vascular diseases

3. The biggest advantage to echocardiography is that it is noninvasive (doesn't involve

breaking the skin or entering body cavities) and can do repeatedly.

M-mode & 2-D echocardiography• Ultrasound is an acoustic wave with a frequency higher than 20 kHz.

Echocardiography: 2.5 〜 3.5MHz (Human), 10 〜 12.5MHz (Mouse)

• An echocardiogram is a recording of the reflected ultrasonic beam.There are

two major types of echocardiography: M-mode and two-dimensional (2-D).

• In the M-mode, a single beam of ultrasound is used. The reflections of the si

gnal are recorded and displayed as monochronic dots. The location is proporti

onal to the distance from the reflective region, and the intensity contains the in

formation about acoustic impedance of the region. The M-mode has excellent

axial resolution, but it carries essentially one-dimensional information.

•The 2-D echocardiograph typically uses a multielement transducer, which ge

nerates a single ultrasonic beam with changing direction. This technique allow

s one to create a two-dimensional image, which has good lateral resolution bu

t lacks accuracy in the axial dimension.

2-D Echocardiography

Long axis view of the heart (Human)

Left ventricleAortaInterventricular septum

Right ventricle

Aortic valve

Mitral valve

Left atrium

Left ventricle

Left atrium

Aortic valve

Mitral valve

Right ventricle

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Left ventricle

Mitral valveLeft atrium

Aorta

Right ventricle

Long axis view of the heart in 2-D echocardiography (Mouse)

Left ventricle Papillary muscle

Interventricular septum

Right ventricle

Middle portion

Apical portion

Short axis view of the heart

Left ventricle

Right ventricle

Papillary muscle Left ventricle

M-mode image2-D short axis image

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2-D image → M-mode image

Human Mouse

Measurement parameters of left ventricle

End-systolic left ventricular diameter 　　 （Ｌ VEDD ）

End-diastolic septal wall thickness (DSEP WT)

End-diastolic left ventricular diameter　　 （Ｌ VEDD ）

Right ventricle diameter

End-systolic posterior wall thickness (SPW WT)

End-diastolic posterior wall thickness (DPW WT)

End-systolic septal wall thickness (SSEP WT)

(Teicholz LE et al. Am J Cardiol. 1976)

2.4 + LVEDD

LVEF =

× 100

7× LVEDD3

2.4 + LVESD7× LVESD3

-

2.4 + LVEDD7× LVEDD3

Left ventricular ejection fraction (LVEF)

End Systolic Volume - End Diastolic Volume

End Diastolic Volume × 100

=

When we evaluate LVEF by M-mode echocardiography, we regard the heart as a oval solid of revolution. So we measure LVEDD and LVESD and then calculate an approximate value of LVEF by the formula as described below:

Normal

Anterior MI

Abnormality of LV wall motion in acute myocardial infarction (short axis view)

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Abnormality of LV wall motion in acute myocardial infarction (apical view)

Normal

Anterior MI

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Images of mouse heart in acute myocardial infarction

Long axis

M-mode

LVEDD - LVESDLeft ventricular fractional shortening (%FS) =

LVEDD× 100

(Quinones MA et al. Chest. 1978)

LVEF (Simpson’s method) = π4 × Σ rn2 ×

L20

End-diastolic phase

L

r1,2,

3, ・・・

Alternative ways of evaluating LV systolic function

End-systolic phase

Image J: http://rsbweb.nih.gov/ij/ (Windows, Mac OS X)

Scion image: http://www.scioncorp.com/ (Windows Xp)

1. Download image analyzing software.

The method of evaluating echocardiographic data

2. Open the data file that was made by Excel file.

3. Input the information

about your mice in

the data file

(red letters).

4. Open the raw data sent from Shumin by image

analyzing software (“.bmp” file).

5. Click “Point selections” button (Image J).

6. To begin analyzing the echo data, click on the picture of

raw data, push “Ctrl +M” button, and then you can see the

table of “Results”.① ②

③

①＆②

③

7. Click the specific point that indicates DSEP WT, LVEDD,

DPW WT, SSEP WT, LVESD and SPW WT on the raw data

and repeat this process for three times.

Re:Measurement parameters of left ventricle

Ｌ VEDD

DSEP WT

Ｌ VEDD

SPW WTDPW WT

SSEP WT

8. Click the specific point that indicates R-R interval, time and

length on the raw data as described below:

① R-R interval: 4 points

② Time (0.2 sec): 2 points

③ Length (10 mm)R-R: 2 points

10. Copy the data of “X and Y” values from “Results” table.

Then, paste that data on the specific area of data file.

→ We can get ECHO DATA !

Notice for evaluating echo data in M-mode

False (part of mitral valve)

True posterior wall

When you evaluate echocardiographic data, be careful for confusing structures that is easy to mistake for LV wall: valves, papillary muscles.