TY - JOUR
T1 - Saline contrast enhancement of tricuspid regurgitant jets detected by doppler color flow imaging
AU - Waggoner, Alan D.
AU - Barzilai, Benico
AU - Pérez, Julio E.
N1 - Funding Information:
oppler color flow imaging provides real-time Contrast techniques have been used to improve visualization of the spatial distribution of the sys- detec&nofpedcvelocRksbyDopplerspectral D tolic flow disturbance of tricuspid regurgitation analysis. To define the effect of contrast enhance-(TR). It allows quantification of jet width, length and mentonthetricu&dregurgRatkn(TR)jetarea area (relative to right atria1 size) and may better reflect andlength,29patkntswerestudii(2Stranstho-the severity of TR compared to right ventricular angiog- rack, 4 tra nwophagetal) wRh ?-dimendond color raphy.lv2 Jet boundary definition can be difficult in cer- fiow imaging. Thee-to S-ml of agRated saline was tain patients, however, due to technical limitations such injscted and images were obtained from 4-chamber as attenuation caused by the depth of the flow distur- views at 12-or l&cm depth setting. Color gain bance, limited display of low velocities, limitations in was optimized to display TR jet at baseline and gain, axial or lateral resolution and spatial filtering of then reduced to minimd settings before injection. the imaging system.3 Previous investigators have report- SofTRjetareaandlengthwere ed on the use of contrast enhancement of ultrasonic sig- mads in 3 to S consecutive cycles. A ratio of TR jet nals displayed by M-mode, 2-dimensional echocardiog- areato24hedold area was derived. TR jet raphy, pulsed and, recently, continuous wave Doppler area at baseline was 4.7 f 3.6 cm2 and increased techniques to detect TR.4-8 We report our use of pe- dgnifhntly (p <O.OOOl) in 26 patii to 8.1 f ripheral intravenous saline injections in patients to en- 6.3 cm* after contrast enhancement. Jet length at hance the visualization of TR jets by color flow imag- basdim was 3A f 1.7 cm and incred signifi-ing. We also define the factors responsible for improved ~$~IOOl) in 20 patients to 4.1 f 1.8 cm detection of the TR jet and its implications for semi- enhaneement.TheratioofTRjet quantitative estimation of the severity of regurgitant jets area to right atrid area also increased significantly in general by Doppler color flow imaging. @<O.OOOl)t o>020in lSof2Spatientsafteren- hancement. hnmases in jet area and length were not asso&ted with changes in TR jet or diastdic Mow veIocRks measured by continuous wave DoppleratbaseIneandaftercontrast.Thus,con- trast enhaneament i-se8 the anlplitude of Boppler signals responsibk for transvalvular and mgu@tad fiow. By reck&g the effect of attenua- tion ad improting signal-to-noise ratio, R improves deheation of the TR jet using color flow imaging. (Am J Cardid 1990;65:1368-1371) From the Cardiovascular Division and the Echocardiography Laboratory, Washington University Medical Center and Barnes Hospital, St. Louis, Missouri. This study was supported in part by grant HL 17646 (SCOR in Ischemic Heart Disease) from the National Institutes of Health, Bethesda, Maryland. Manuscript received December 7,1989; revised manuscript received and accepted January 23,199O.
PY - 1990/6/1
Y1 - 1990/6/1
N2 - Contrast techniques have been used to improve detection of peak velocities by Doppler spectral analysis. To define the effect of contrast enhancement on the tricuspid regurgitation (TR) jet area and length, 29 patients were studied (25 transthoracic, 4 transesophageal) with 2-dimensional color flow Imaging. Three- to 5-ml of agitated saline was injected and images were obtained from 4-chamber views at 12- or 16-cm depth setting. Color gain was optimized to display TR jet at baseline and then reduced to minimal settings before injection. Measurements of TR jet area and length were made in 3 to 5 consecutive cycles. A ratio of TR jet area to 2-dimensional area was derived. TR jet area at baseline was 4.7 ± 3.6 cm2 and increased significantly (p <0.0001) in 26 patients to 8.1 ± 6.3 ant after contrast enhancement. Jet length at baseline was 3.4 ± 1.7 an and increased significantly (p <0.0001) in 20 patients to 4.1 ± 1.8 cm after contrast enhancement. The ratio of TR jet area to right atrial area also increased significantly (p <0.0001) to >0.20 in 18 of 28 patients after enhancement. Increases in jet area and length were not associated with changes in TR jet or diastolic inflow velocities measured by continuous wave Doppler at baseline and after contrast. Thus, contrast enhancement increases the amplitude of Doppler signals responsible for transvalvular and regurgitant flow. By reducing the effect of attenuation and improving signal-to-noise ratio, it improves delineation of the TR jet using color flow imaging.
AB - Contrast techniques have been used to improve detection of peak velocities by Doppler spectral analysis. To define the effect of contrast enhancement on the tricuspid regurgitation (TR) jet area and length, 29 patients were studied (25 transthoracic, 4 transesophageal) with 2-dimensional color flow Imaging. Three- to 5-ml of agitated saline was injected and images were obtained from 4-chamber views at 12- or 16-cm depth setting. Color gain was optimized to display TR jet at baseline and then reduced to minimal settings before injection. Measurements of TR jet area and length were made in 3 to 5 consecutive cycles. A ratio of TR jet area to 2-dimensional area was derived. TR jet area at baseline was 4.7 ± 3.6 cm2 and increased significantly (p <0.0001) in 26 patients to 8.1 ± 6.3 ant after contrast enhancement. Jet length at baseline was 3.4 ± 1.7 an and increased significantly (p <0.0001) in 20 patients to 4.1 ± 1.8 cm after contrast enhancement. The ratio of TR jet area to right atrial area also increased significantly (p <0.0001) to >0.20 in 18 of 28 patients after enhancement. Increases in jet area and length were not associated with changes in TR jet or diastolic inflow velocities measured by continuous wave Doppler at baseline and after contrast. Thus, contrast enhancement increases the amplitude of Doppler signals responsible for transvalvular and regurgitant flow. By reducing the effect of attenuation and improving signal-to-noise ratio, it improves delineation of the TR jet using color flow imaging.
UR - http://www.scopus.com/inward/record.url?scp=0025292333&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(90)91329-5
DO - 10.1016/0002-9149(90)91329-5
M3 - Article
C2 - 2343825
AN - SCOPUS:0025292333
SN - 0002-9149
VL - 65
SP - 1368
EP - 1371
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 20
ER -