Systematic hand-held echocardiography in patients hospitalised with acute coronary syndrome.

AIMS: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy and time-efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting. METHODS AND RESULTS: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiography with agreement between key imaging parameters assessed using kappa statistics. The immediate clinical impact of hand-held echocardiography in this population was systematically evaluated.Overall, 262 patients (65±12 years, 71% male) participated. Agreement between hand-held and transthoracic echocardiography was good-to-excellent (kappa 0.60-1.00) with hand-held echocardiography having an overall negative predictive value of 95%. Hand-held echocardiography was performed rapidly (7.7±1.6 min) and completed a median of 5 [interquartile range 3-20] hours earlier than transthoracic echocardiography. Systematic hand-held echocardiography in all patients with acute coronary syndrome identified an important cardiac abnormality in 50% and the clinical management plan was changed by echocardiography in 42%. In 85% of cases, hand-held echocardiography was sufficient for patient decision-making and transthoracic echocardiography was no longer deemed necessary. CONCLUSIONS: In patients with acute coronary syndrome, hand-held echocardiography provides comparable results to transthoracic echocardiography, can be more rapidly applied and gives sufficient imaging information for decision-making in the vast majority of patients. Systematic echocardiography has clinical impact in half of patients, supporting the clinical utility of echocardiography in this population, and providing an evidence-base for current guidelines.

Dynamic Enhancement of B-Mode Cardiac Ultrasound Image Sequences.

Limited contrast, along with speckle and acoustic noise, can reduce the diagnostic value of echocardiographic images. This study introduces dynamic histogram-based intensity mapping (DHBIM), a novel approach employing temporal variations in the cumulative histograms of cardiac ultrasound images to contrast enhance the imaged structures. DHBIM is then combined with spatial compounding to compensate for noise and speckle. The proposed techniques are quantitatively assessed (32 clinical data sets) employing (i) standard image quality measures and (ii) the repeatability of routine clinical measurements, such as chamber diameter and wall thickness. DHBIM introduces a mean increase of 120.9% in tissue/chamber detectability, improving the overall repeatability of clinical measurements by 17%. The integrated approach of DHBIM followed by spatial compounding provides the best overall enhancement of image quality and diagnostic value, consistently outperforming the individual approaches and achieving a 401.4% average increase in tissue/chamber detectability with an associated 24.3% improvement in the overall repeatability of clinical measurements.

Temporal compounding: a novel implementation and its impact on quality and diagnostic value in echocardiography.

Temporal compounding can be used to suppress acoustic noise in transthoracic cardiac ultrasound by spatially averaging partially decorrelated images acquired over consecutive cardiac cycles. However, the reliable spatial and temporal alignment of the corresponding frames in consecutive cardiac cycles is vital for effective implementation of temporal compounding. This study introduces a novel, efficient, accurate and robust technique for the spatiotemporal alignment of consecutive cardiac cycles with variable temporal characteristics. Furthermore, optimal acquisition parameters, such as the number of consecutive cardiac cycles used, are derived. The effect of the proposed implementation of temporal compounding on cardiac ultrasound images is quantitatively assessed (32 clinical data sets providing a representative range of image qualities and diagnostic values) using measures such as tissue signal-to-noise ratio, chamber signal-to-noise ratio, tissue/chamber contrast and detectability index, as well as a range of clinical measurements, such as chamber diameter and wall thickness, performed during routine echocardiographic examinations. Temporal compounding (as implemented) consistently improved the image quality and diagnostic value of the processed images, when compared with the original data by: (i) increasing tissue and cavity signal-to-noise ratios as well as tissue/cavity detectability index, (ii) improving the corresponding clinical measurement repeatability and inter-operator measurement agreement, while (iii) reducing the number of omitted measurements caused by data corruption.

Temporal compounding of cardiac ultrasound data: Improving image quality and clinical measurement repeatability.

Echocardiography provides a powerful and versatile tool for assessing cardiac morphology and function. However, cardiac ultrasound suffers from speckle as well as static and dynamic noise. Over the last three decades, a number of studies have attempted to address the challenging problem of speckle/noise suppression in cardiac ultrasound data. No single method has managed to provide a widely accepted solution. Temporal Compounding is a noise suppression method that utilises spatial averaging of temporally aligned cardiac B-Mode data. Reliable temporal alignment is vital for effective Temporal Compounding. In this study we introduce a novel, accurate and robust technique for the temporal alignment of cardiac cycles with variable temporal characteristics and examine the effect of Temporal Compounding in four clinical measurements performed on routine echocardiographic examinations. Results from 32 patients demonstrate speckle/noise suppression, shadowing reduction, anatomical structure enhancement and improvement in measurement repeatability with no significant or systematic bias introduced. Temporally compound data may be able to provide a good alternative to B-Mode data in clinical measurements as well as a first step to further post-processing of cardiac ultrasound data.