Francois Tournoux

High-Frame-Rate Echocardiography Using Coherent Compounding With Doppler-Based Motion-Compensation

High-frame-rate ultrasonography based on coherent compounding of unfocused beams can potentially transform the assessment of cardiac function. As it requires successive waves to be combined coherently, this approach is sensitive to high-velocity tissue motion. We investigated coherent compounding of tilted diverging waves, emitted from a 2.5 MHz clinical phased array transducer. To cope with high myocardial velocities, a triangle transmit sequence of diverging waves is proposed, combined with tissue Doppler imaging to perform motion compensation (MoCo). The compound sequence with integrated MoCo was adjusted from simulations and was tested in vitro and in vivo. Realistic myocardial velocities were analyzed in an in vitro spinning disk with anechoic cysts. While a 8 dB decrease (no motion versus high motion) was observed without MoCo, the contrast-to-noise ratio of the cysts was preserved with the MoCo approach. With this method, we could provide high-quality in vivo B-mode cardiac images with tissue Doppler at 250 frames per second. Although the septum and the anterior mitral leaflet were poorly apparent without MoCo, they became well perceptible and well contrasted with MoCo. The septal and lateral mitral annulus velocities determined by tissue Doppler were concordant with those measured by pulsed-wave Doppler with a clinical scanner (r2 = 0.7, y = 09.x + 0.5, N = 60). To conclude, high-contrast echo-cardiographic B-mode and tissue Doppler images can be obtained with diverging beams when motion compensation is integrated in the coherent compounding process.

Doppler Vortography: A Color Doppler Approach to Quantification of Intraventricular Blood Flow Vortices

We propose a new approach to quantification of intracardiac vorticity based on conventional color Doppler images -Doppler vortography. Doppler vortography relies on the centrosymmetric properties of the vortices. Such properties induce particular symmetries in the Doppler flow data that can be exploited to describe the vortices quantitatively. For this purpose, a kernel filter was developed to derive a parameter, the blood vortex signature (BVS), that allows detection of the main intracardiac vortices and estimation of their core vorticities. The reliability of Doppler vortography was assessed in mock Doppler fields issued from simulations and in vitro data. Doppler vortography was also tested in patients and compared with vector flow mapping by echocardiography. Strong correlations were obtained between Doppler vortography-derived and ground-truth vorticities (in silico: r2 = 0.98, in vitro: r2 = 0.86, in vivo: r2 = 0.89). Our results indicate that Doppler vortography is a potentially promising echocardiographic tool for quantification of vortex flow in the left ventricle.

Staggered Multiple-PRF Ultrafast Color Doppler

Color Doppler imaging is an established pulsed ultrasound technique to visualize blood flow non-invasively. High-frame-rate (ultrafast) color Doppler, by emissions of plane or circular wavefronts, allows severalfold increase in frame rates. Conventional and ultrafast color Doppler are both limited by the range-velocity dilemma, which may result in velocity folding (aliasing) for large depths and/or large velocities. We investigated multiple pulse-repetition-frequency (PRF) emissions arranged in a series of staggered intervals to remove aliasing in ultrafast color Doppler. Staggered PRF is an emission process where time delays between successive pulse transmissions change in an alternating way. We tested staggered dual- and triple-PRF ultrafast color Doppler, 1) in vitro in a spinning disc and a free jet flow, and 2) in vivo in a human left ventricle. The in vitro results showed that the Nyquist velocity could be extended to up to 6 times the conventional limit. We found coefficients of determination r2 ≥ 0.98 between the de-aliased and ground-truth velocities. Consistent de-aliased Doppler images were also obtained in the human left heart. Our results demonstrate that staggered multiple-PRF ultrafast color Doppler is efficient for high-velocity high-frame-rate blood flow imaging. This is particularly relevant for new developments in ultrasound imaging relying on accurate velocity measurements.

Intracardiac vortex dynamics by high-frame-rate Doppler vortography – in vivo comparison with vector flow mapping and 4-D flow MRI

Recent studies have suggested that intracardiac vortex flow imaging could be of clinical interest to early diagnose the diastolic heart function. Doppler vortography has been introduced as a simple color Doppler method to detect and quantify intraventricular vortices. This method is able to locate a vortex core based on the recognition of an antisymmetric pattern in the Doppler velocity field. Because the heart is a fast-moving organ, high frame rates are needed to decipher the whole blood vortex dynamics during diastole. In this paper, we adapted the vortography method to high-frame-rate echocardiography using circular waves. Time-resolved Doppler vortography was first validated in vitro in an ideal forced vortex. We observed a strong correlation between the core vorticity determined by high-frame-rate vortography and the ground-truth vorticity. Vortography was also tested in vivo in ten healthy volunteers using high-frame-rate duplex ultrasonography. The main vortex that forms during left ventricular filling was tracked during two–three successive cardiac cycles, and its core vorticity was determined at a sampling rate up to 80 duplex images per heartbeat. Three echocardiographic apical views were evaluated. Vortography-derived vorticities were compared with those returned by the 2-D vector flow mapping approach. Comparison with 4-D flow magnetic resonance imaging was also performed in four of the ten volunteers. Strong intermethod agreements were observed when determining the peak vorticity during early filling. It is concluded that high-frame-rate Doppler vortography can accurately investigate the diastolic vortex dynamics.

Analyzing left ventricular function in mice with Doppler echocardiography.

Mice are widely used in heart failure research. Accurate evaluation of cardiac structure and function is key to modern cardiovascular research. Doppler echocardiography is a simple, reproducible, and non-invasive method, which allows a longitudinal study of these small animals. Besides common parameters such as left ventricular chamber size, mass, and function, new emerging echo tools are of great interest for small animal imaging. In this review, we describe the technical issues linked to murine cardiovascular anatomy and physiology and the most current echo parameters that can be used.

Remote ischaemic preconditioning shortens QT intervals during exercise in healthy subjects

Abstract The protective action of remote ischaemic preconditioning (RIPC) has been demonstrated in the context of surgical interventions in cardiology. Application of RIPC to sports performance has been proposed, but its effect on the electrocardiogram (ECG) during exercise remains unknown. This exploratory study aims to measure the changes in ventricular repolarization observed during exercise following RIPC in healthy subjects. In an experimental randomized crossover study, 17 subjects underwent two bouts of constant load exercise tests at 75% and 115% of gas exchange threshold (GET). Prior to exercise, they were allocated to either control or RIPC intervention with four cycles of 5 min of ischaemia followed by 5 min of reperfusion. ECG was continuously recorded during the protocol. QT and RR intervals were measured every 30 s (on an average tracing of the preceding 10 s). Although the time course of RR intervals did not differ between the two interventions (p = .56 at 75% GET and p = .74 at 115% GET), a significant shortening of QT intervals (measured from Q onset to T end) was observed during exercise (mean ± standard deviation of RIPC vs. control: −32 ± 19 ms at 75% GET (p < .001) and −34 ± 12 ms at 115% GET (p < .001)) as well as during recovery (−21 ± 8 ms at 75% GET (p < .001) and −16 ± 11 ms at 115% GET (p < .001)). This effect was not present at rest. These RIPC-related changes were clearly identifiable on the QT–RR loops after hysteresis reduction. RIPC therefore induces heart rate-independent shortening of QT intervals that is revealed during exercise.

An Unusual Case of Rise in Pulmonary Arterial Pressure and Right Ventricular Dysfunction

Graphical abstract

Ultrafast myocardial elastography using coherent compounding of diverging waves during simulated stress tests: An in vitro study

Objective myocardial deformation assessment during stress tests could help clinicians to better diagnose myocardial ischemia. However, the use of conventional focused echocardiography is compromised at increased heart rates due to its limited lateral field of view and frame rate. Ultrafast echocardiography using coherent compounding of diverging waves improves temporal resolution while maintaining a large field of view and could be a valuable alternative during stress tests. This study aimed to illustrate the feasibility of estimating myocardial strain using ultrafast echocardiography combined with a Lagrangian speckle model estimator (LSME) at increased heart rates. Myocardial strain assessment was tested on a dynamic cardiac phantom at heart rates ranging from 60 to 180 beats-per-minute (bpm). Ultrafast echocardiography was obtained with a Verasonics platform equipped with a 2.5 MHz phased array transducer (PRF: 4500 Hz). Negative effects of side lobes and phase delays during the large tilted transmission and compounding of diverging waves were suppressed through a triangle transmit sequence and motion compensation strategy. The robustness and accuracy of affine strain estimation were then enhanced using radiofrequency least-squares-based LSME combined with a coarse-to-fine strain estimation and a time-ensemble estimation strategy. 2D myocardial strain images at systole and early-diastole as well as regional strain curves were estimated. Myocardial strains with high contrast-to-noise and signal-to-noise ratios were obtained at all simulated heart rates. Regional strain curves were accurately estimated and periods matched those of the phantom pump cycles. These preliminary results suggest that the use of ultrafast echocardiography combined with the modified LSME could be useful clinically to provide an accurate and objective method of myocardial strain assessment at high heart rates.

Ultrafast myocardial elastography using coherent compounding of diverging waves during simulated exercise

Objective myocardial deformation assessment during exercise could help the clinician to better diagnose myocardial ischemia. However, the use of conventional focus echocardiography is compromised at increased heart rates due to its limited lateral view field and frame rate. Ultrafast echocardiography using coherent compounding of diverging waves improves temporal resolution while maintaining a large view field (Jonahan, IEEE TMI, 2016) and could be a valuable alternative during exercise. This study aimed to demonstrate that ultrafast echocardiography combined with a Lagrangian speckle model estimator (LSME) can offer high-quality myocardial strain measurements at increased heart rate.

Intraventricular vector flow mapping—a Doppler-based regularized problem with automatic model selection

We propose a regularized least-squares method for reconstructing 2D velocity vector fields within the left ventricular cavity from single-view color Doppler echocardiographic images. Vector flow mapping is formulated as a quadratic optimization problem based on an [Formula: see text]-norm minimization of a cost function composed of a Doppler data-fidelity term and a regularizer. The latter contains three physically interpretable expressions related to 2D mass conservation, Dirichlet boundary conditions, and smoothness. A finite difference discretization of the continuous problem was adopted in a polar coordinate system, leading to a sparse symmetric positive-definite system. The three regularization parameters were determined automatically by analyzing the L-hypersurface, a generalization of the L-curve. The performance of the proposed method was numerically evaluated using (1) a synthetic flow composed of a mixture of divergence-free and curl-free flow fields and (2) simulated flow data from a patient-specific CFD (computational fluid dynamics) model of a human left heart. The numerical evaluations showed that the vector flow fields reconstructed from the Doppler components were in good agreement with the original velocities, with a relative error less than 20%. It was also demonstrated that a perturbation of the domain contour has little effect on the rebuilt velocity fields. The capability of our intraventricular vector flow mapping (iVFM) algorithm was finally illustrated on in vivo echocardiographic color Doppler data acquired in patients. The vortex that forms during the rapid filling was clearly deciphered. This improved iVFM algorithm is expected to have a significant clinical impact in the assessment of diastolic function.