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Pulmonary transit time measurement by contrast-enhanced ultrasound in left ventricular dyssynchrony

Echo Research & Practice volume 3, pages 35–43 (2016)Cite this article

Abstract

Background: Pulmonary transit time (PTT) is an indirect measure of preload and left ventricular function, which can be estimated using the indicator dilution theory by contrast-enhanced ultrasound (CEUS). In this study, we first assessed the accuracy of PTT-CEUS by comparing it with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Secondly, we tested the hypothesis that PTT-CEUS correlates with the severity of heart failure, assessed by MRI and N-terminal pro-B-type natriuretic peptide (NT-proBNP).

Methods and results: Twenty patients referred to our hospital for cardiac resynchronization therapy (CRT) were enrolled. DCE-MRI, CEUS, and NT-proBNP measurements were performed within an hour. Mean transit time (MTT) was obtained by estimating the time evolution of indicator concentration within regions of interest drawn in the right and left ventricles in video loops of DCE-MRI and CEUS. PTT was estimated as the difference of the left and right ventricular MTT. Normalized PTT (nPTT) was obtained by multiplication of PTT with the heart rate. Mean PTT-CEUS was 10.5±2.4s and PTT-DCE-MRI was 10.4±2.0s (P=0.88). The correlations of PTT and nPTT by CEUS and DCE-MRI were strong; r=0.75 (P=0.0001) and r=0.76 (P=0.0001), respectively. Bland–Altman analysis revealed a bias of 0.1s for PTT. nPTT-CEUS correlated moderately with left ventricle volumes. The correlations for PTT-CEUS and nPTT-CEUS were moderate to strong with NT-proBNP; r=0.54 (P=0.022) and r=0.68 (P=0.002), respectively.

Conclusions: (n)PTT-CEUS showed strong agreement with that by DCE-MRI. Given the good correlation with NT-proBNP level, (n)PTT-CEUS may provide a novel, clinically feasible measure to quantify the severity of heart failure.

Clinical Trial Registry: NCT01735838

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Acknowledgments

The authors thank especially M Koehler and all personnel of the MRI department of the Catharina Hospital for their collaboration in performing the acquisitions. They also thank S Cai and F T A Nandiska for their support in data analysis.

Funding

This research is supported by the Dutch Technology Foundation STW, which is part of the Netherlands Organisation for Scientific Research (NWO), and which is partly funded by the Ministry of Economic Affairs. Project number: 11865.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive-Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    Ingeborg H. F. Herold MD, R. Arthur Bouwman PhD & Hendrikus H. M. Korsten PhD

  2. Department of Electrical Engineering, Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands

    Salvatore Saporito MSc, Massimo Mischi PhD, Hans C. van Assen PhD, Hendrikus H. M. Korsten PhD & Patrick Houthuizen PhD

  3. Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    Anouk G. W. de Lepper

  4. Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    Harrie C. M. van den Bosch MD

Authors
  1. Ingeborg H. F. Herold MD
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  2. Salvatore Saporito MSc
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  3. Massimo Mischi PhD
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  4. Hans C. van Assen PhD
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Correspondence to Ingeborg H. F. Herold MD.

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Herold, I.H.F., Saporito, S., Mischi, M. et al. Pulmonary transit time measurement by contrast-enhanced ultrasound in left ventricular dyssynchrony. Echo Res Pract 3, 35–43 (2016). https://doi.org/10.1530/ERP-16-0011

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Echo Research & Practice

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