New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation

Figures

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  Figure 1. XStrain 4D global LV analysis. At the end of each scanning section, the three apical views are acquired. Then, after left ventricular (LV) endocardial border tracking, the software analyzes LV regional deformation parameters. Finally, the Beutel 3D reconstruction allows quantification of global LV function (global longitudinal strain (GLS)—ejection fraction). XStrainTM 4D, done with MyLab X8 eXP—Esaote S.p.A., Florence, Italy.

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  Figure 2. XStrain 4D regional LV analysis. Left ventricular (LV) regional deformation parameters in three coronary perfusion regions: left circumflex (A), left anterior descending (B), and right coronary artery (C).

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  Figure 3. LV vortex analysis. During diastasis, left ventricular (LV) vortex maintains its rotary motion. Subsequently, at the moment of atrial contraction (late filling), a second vortex ring occurs, and the late filling jet combines with the residual early vortex ring. During the isovolumic contraction period, the vortex redirects blood toward the LV outflow tract, with formation of a large anterior vortex across the inflow–outflow region. HyperDoppler software by Esaote S.p.A on MyLab X8 eXP scanner.

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  Figure 4. Coronary flow analysis. The distal left anterior descending (LAD) tract is more suitable to investigate coronary microvascular function because it is between large epicardial arteries and microvasculature (A). The acoustic window is, in the left decubitus position, around the midclavicular line in the fourth or fifth intercostal space (B). After detecting by color the LAD image (C), coronary flow by Doppler is represented by a biphasic wave, with a lower peak during systole and a higher peak during diastole, for the effect of myocardial contraction (D).

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  Figure 5. Vascular morphologic and functional analysis. Radio Frequency-Quality Intima Media Thickness (RFQIMT): during the scanning of the carotid artery a real-time feedback on measurement quality via quality indicators overlaid on the ultrasound image at the position of the vessel wall (orange lines) and the far wall intima layer (green line) (A,B). Radio Frequency Quality Arterial Stiffness (RFQAS) targets the measurement of the blood vessel stiffness of a subject in a selected area of investigation. The blood vessel wall stiffness is expressed as pulse wave velocity obtained from brachial blood pressure and the accurate measurements of diameter and change in diameter. Moreover, the local blood pressure at the site of the ultrasound measurement is given (C,D). RFQIMT and RFQAS, respectively—Esaote.

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  Figure 6. From standard echocardiography to new technologies. The incremental contribution of new echo technologies to provide valuable insights in the pathogenesis of cardiovascular disease, with distinct patterns of myocardial, vascular, and microcirculatory dysfunction. LV: left ventricle. LA: left atrial.