Prospect Cardiac Packages. S-Sharp

Prospect Cardiac Packages S-Sharp

B mode: Teichholz: Teichholz formula LV Volume 2D: modified Simpson's rule method ALM: area length method LV Volume (Intg.): integral method M mode: Long axis: Teichholz formula Short axis: Teichholz formula PW mode: VTI E/A Ratio SD RI PI Blood flow Prospect Cardiac Packages

B mode: Teichholz

Work Flow A. Click Teichholz in the cardiac package B. Enter the weight of the animal C. This package can be used in long axis view or short axis view. Find the frame where the heart is in full diastole. D. Click IVS;d or LVAW;d box to start the measurements in the following order: IVS;d/LVAW;d LVID;d LVPW;d. Ensure all the line segments are perpendicular to the walls. E. Find the systolic frame and complete the same procedure. F. The calculated parameters can be viewed in the report.

Measurements and Calculations LV long axis Measurements Diastolic: IVS, LVID, LVPW Systolic: IVS, LVID, LVPW Weight Calculations LV mass(u) LV mass(c) LVMI FS LA EDV LA ESV SV LVEF PWTH RWT;d RWT;s IVS;d/LVPW;d IVS;s/LVPW;s LV short axis Diastolic: LVAW, LVID, LVPW Systolic: LVAW, LVID, LVPW Weight LV mass(u) LV mass(c) LVMI FS SA EDV SA ESV SV LVEF PWTH RWT;d RWT;s

Parameters Definition (I) Long axis view: IVS;d/s : Inter ventricular septum (diastole/systole) LVID;d/s : Left ventricular internal diameter (diastole/systole) LVPW;d/s : Left ventricular posterior wall (diastole/systole) Short axis view: LVAW;d/s : Left ventricular anterior wall (diastole/systole) LVID;d/s : Left ventricular internal diameter (diastole/systole) LVPW;d/s : Left ventricular posterior wall (diastole/systole)

Parameters Definition (II) LV mass(u): uncorrected LV mass (mg) LV mass (U) = 1.05 IVS; d + LVID; d + LVPW; d 3 LVID; d 3 ; LV mass(c): corrected LV mass (mg) LV mass (C) = 0.8 LV mass (U) LVMI: LV mass index (g/m 2 ) LV mass LVMI = ; BSA: body surface area BSA **BSA is calculated according to Meeh s Formula (1879) BSA m 2 = K BW 2 3 ; BW(body weight): kg Rubner: Constant K is accepted as 0.091 for rats and mice FS: fractional shortening (%) LVID;d LVID;s FS = LVID;d 100%

Parameters Definition (III) EDV: end diastolic volume (μl) EDV = (7.0/(2.4+LVID;d)) LVID;d 3 ESV: end systolic volume (μl) ESV = (7.0/(2.4+LVID;s)) LVID;s 3 SV: stroke volume (μl) SV = EDV ESV EF: ejection fraction (%) EF = EDV ESV 100% EDV PWTH: percentage of posterior wall thickening (%) LVPW;s LVPW;d PWTH = 100% LVPW;d RWT: Relative wall thickness RWT;d = (2 LVPW; d)/lvid; d RWT;s = (2 LVPW; s)/lvid; s

Diastole Systole

B mode: LV Volume 2D

Work Flow Modified Simpson's rule method is designed to be used on one long axis view along with 3 short axis views taken from mitral valve (MV), papillary muscle(pap), apical (apex) levels. This method allows more precision when the cardiac geometry isn t typical. A. Click LV Volume 2D in the cardiac package B. Find the diastolic frame in long axis view. Click LV Length;d box under Diastolic tag and complete the measurement of left ventricular length in diastole. Perform the same procedure in systole. C. Same procedures are performed to complete the measurement of area on 3 short axis view in both diastole and systole. D. End diastolic volume (EDV) and end systolic volume (ESV) will show up in the box automatically after the measurements are completed. Other calculated parameters can be viewed in the report.

Measurements: Area MV;d/s : short axis area at mitral valve level (diastole/systole) Area Pap;d/s : short axis area at papillary muscle level (diastole/systole) Area Apex;d/s : short axis area at apex level (diastole/systole) LV Length;d/s : left ventricular length (diastole/systole) Calculations: Measurements and Calculations LV EDV(Simp) : end diastolic volume LV ESV(Simp) : end systolic volume SV(Simp) : stroke volume EF(Simp) : ejection fraction FAC(Simp) : fractional area change FS(Simp) : fractional shortening

Parameters Definition (I) Volume(μl) = A mv + A Pap L + A apex L + π 3 2 3 6 **Amv: area of short axis at mitral valve level Apap: area of short axis at papillary muscle level Aapex: area of short axis at apical level L 3 3

SV(Simp) (μl) SV(Simp)= LV EDV Simp LV ESV(Simp) EF(Simp) (%) SV(Simp) EF(Simp) = 100% LV EDV(Simp) FS(Simp) (%) FS(Simp) = R;d R;s R;d ** R;d = 2 FAC(Simp) (%) FAC(Simp) = Parameters Definition (II) 100% Area Pap;d π ; R;s = 2 Area Pap;d Area Pap;s Area Pap;d Area Pap;s π 100%

Diastole

B mode: ALM

Work Flow Area length method (ALM) is designed to be used on long axis view and short axis view. A. Click ALM in the cardiac package B. Enter the weight of the animal C. Click Epi. Area, Endo. Area, LV Length box to start the measurement of short axis epicardial, endocardial area and left ventricular length in long axis respectively. D. LV mass and LV mass index will show up automatically after all the diastolic measurements are completed. E. Other calculated parameters can be viewed in the report.

Measurements: Epi. Area;d/s : epicardial short axis area(diastole/systole) Endo. Area;d/s : endocardial short axis area (diastole/systole) LV length;d/s : left ventricular length (diastole/systole) Weight Calculations: Measurements and Calculations LV EDV(ALM) : end diastolic volume LV ESV(ALM) : end systolic volume SV(ALM) : stroke volume EF(ALM) : ejection fraction Endo FAC(ALM) : fractional area change of endocardial short axis area FS(ALM) : fractional shortening LVM(ALM) : left ventricular mass LVMI(ALM) : left ventricular mass index

Parameters Definition (I) LVM(ALM): LV Mass (mg) LV mass = 1.05 5 6 A 1; d L + T 5 6 A 2; d L **T = A ;d 1 A ;d 2 π π **A 1 : epicardial short axis area A 2 : endocardial short axis area L : left ventricular length ; T: mean wall thickness LVMI(ALM): LV Mass Index (g/m 2 ) LVMI = LVM BSA **BSA is calculated according to Meeh s Formula (1879) BSA(m^2 )=K BW ^(2/3) ; BW(body weight): kg Rubner: Constant K is accepted as 0.091 for rats and mice

Parameters Definition (II) Endo FAC: endocardial fractional area change (%) Endo FAC = A 2 ;d A 2 ;s A 2 ;d 100% LV Volume: using the five-sixth area length (bullet) method (μl) EDV = 5 6 A 2; d LV length; d ESV = 5 6 A 2; s LV length; s FS: fractional shortening (%) FS = R;d R;s R;d 100% **R; d = 2 A 2 ;d ; R; s = 2 A 2 ;s π π

Diastole

B mode: LV Volume Intg.

The total LV volume is calculated from the summation of a stack of disks in the cardiac long-axis view only. Work flow: LV Volume (Integral) A. Drawing a boundary along the endocardial border of the LV in both diastole and systole respectively. B. The LV cavity will be divided 20 sections and the volume data also will be shown up automatically. C. Other calculated parameters can be viewed in the report. Volume of each disk (μl) = π a i 2 2 L Total ventricular volume(μl) = π σ20 a i i=1 2 ** a i : the diameter of each disc L: the left ventricular length n: the number of sections n 2 L n

Measurements: LV EDV: end diastolic volume LV ESV: end systolic volume Calculations: Measurements and Calculations SV(Disk Intg.) : stroke volume EF(Disk Intg.) : ejection fraction

Diastole

Cardiac Package in M mode

Work Flow A. Cardiac package can be found in tool box measurement tools B. Enter the weight of animal and click the desired measurements on the list. C. Click on the M mode image to place the start and end points. Because IVS;d/LVAW;d LVID;d LVPW;d and IVS;s/LVAW;s LVID;s LVPW;s are continuously measurements, it can automatically start the next measurement until finishing LVPW;d/LVPW;s. D. Click heart rate for heart rate measurement. E. The cardiac index will be calculated if it has enough parameters and be shown in the box. Five sets of data measurement are allowed and the average will be calculated automatically.

Measurements and Calculations LV long axis Measurements Diastolic: IVS, LVID, LVPW Systolic: IVS, LVID, LVPW Weight Calculations LV mass(u) LV mass(c) LVMI FS LA EDV LA ESV SV CO EF PWTH RWT;d RWT;s IVS;d/LVPW;d IVS;s/LVPW;s LV short axis Diastolic: LVAW, LVID, LVPW Systolic: LVAW, LVID, LVPW Weight LV mass(u) LV mass(c) LVMI FS SA EDV SA ESV SV CO EF PWTH RWT;d RWT;s

EDV/ESV : Left ventricle volume (diastole/systole) μl EDV = (7.0/(2.4+LVID;d))*LVID;d 3 ESV = (7.0/(2.4+LVID;s))*LVID;s 3 FS : Fractional shortening % FS = LVID;d LVID;s LVID;d 100% EF : Ejection fraction % EF = EDV ESV EDV Parameters Definition (II) 100% SV : Stroke volume μl SV = EDV ESV CO : Cardiac output ml/min CO = SV HR LV mass mg LV mass (U) = 1.05 IVS; d + LVID; d + LVPW; d 3 LVID; d 3 ; U: uncorrected LV mass (C) = LV mass(u) 0.8; C: corrected RWT : Relative wall thickness RWT;d = (2 LVPW; d)/lvid; d RWT;s = (2 LVPW; s)/lvid; s

Uncorrected/Corrected LV Mass Uncorrected LV mass in M-mode Left ventricular mass was calculated according to a cubic formula, suggested by Litwin et al. (1993): LV mass (U) = 1.05 IVS; d + LVID; d + LVPW; d 3 LVID; d 3 ; (mg) U: uncorrected Corrected LV mass in M-mode Since the cubic model calculation doesn t correlate with postmortem findings optimally, the LV mass formula was modified as below (T. Reffelmann and R. A. Kloner, 2003): LV mass (C) = LV mass(u) 0.8; (mg) C: corrected

Short Axis Long Axis

PW mode: VTI

Work Flow Manual VTI A. Drawing a trace along the envelope of the blood flow waveforms for one cycle. B. After clicking the last point of the drawing trace, the value of the cardiac parameters in PW mode will be shown up automatically. Auto VTI A. Choose the Auto trace function +, - or +/- in the Image adjustment, and then adjust the bar of auto trace to find the most clearly envelope trace of blood flow waveforms. B. Choose a cycle of the blood flow waveforms which you interested in. Click the start point and the end point of the single cycle duration. C. After clicking the end point of the single cycle duration, the value of the cardiac parameters in PW mode will be shown up automatically.

VTI: Velocity time integral Flow velocity varies during ejection in a pulsatile system, so the VTI measurement represents the average velocity-time integral during an area enclosed by baseline and Doppler spectrum. Peak velocity The maximum velocity of the chose cycle. Peak pressure: Peak pressure gradient Gradients are calculated from velocity information, and peak gradient obtained from the peak velocity using the Bernoulli equation as: Peak pressure gradient (ΔP max ) = 4 V max /1000 2 (mmhg) **V(mm/s) Mean velocity The average value of the velocities during the chose cycle. V mean = σn i=1 VΤn ; n: the number of velocity values in chose cycle Mean pressure: Mean pressure gradient The mean gradient is calculated by averaging the instantaneous gradients over the ejection period. Mean pressure gradient = [σ n i=1 Acceleration Deceleration Parameters Definition ΔP i ]/n = [4 σn i=1 V i /1000 2 ]/n (mmhg) **V(mm/s)

Manual VTI Auto VTI

PW mode: E/A Ratio

E/A ratio (I) Work flow A. Click 8~9 points on the mitral valve or tricuspid valve flow waveform according to the inflection points and the time duration definition in one cycle. B. Start the first point is from the start of E wave. C. After clicking the end point of the single cycle duration, the parameters of the mitral valve flow or tricuspid valve flow in PW mode will show up automatically. Acc: Acceleration rate of E wave of mitral inflow The acceleration rate is presented as the slope of early E wave. E: E wave The filling velocity during the weight of the collected blood in each atrium causes it to fall into the ventricles below when the atrioventricular valves open. DT: Deceleration time The time taken from the maximum E point to baseline.

A: A wave The speed of the blood filling the ventricle in the second step occurs in which the atria contract to squeeze out that last bit. E/A: EA ratio The E/A ratio is the ratio of the early (E) to late (A) ventricular filling velocities. IVCT: Isovolumic contraction time During the time period between the closure of the atrioventricular valves and the opening of the aortic and pulmonic valves ET: Ejection time The time of ejection of blood from the left ventricle beginning with aortic valve opening and ending with aortic valve closure. IVRT: Isovolumic relaxation time IVRT is an interval in the cardiac cycle from the closure of the aortic valve to onset of filling by opening of the atrioventricular valve. MPI: Myocardial Performance Index (Tei index) MPI = IVCT+IVRT ET E/A ratio (II)

PW mode: SD RI PI

Work Flow (I) Step 1 : Click tool box button, then click measurement tools Step 2 : Click in S/D ratio button In the cardiac package panel Step 3 : Choose the Auto Trace function Max +/- for the image adjustment, and then adjust the bar of auto trace to find the most clearly envelope trace of blood flow waveforms

Work Flow (II) Step 4 : Choose a cycle of the blood flow waveforms which you re interested in. Click the start point and the end point of the single cycle duration Step 5 : After clicking the end point of the single cycle duration, the value of the cardiac parameters in PW mode will be shown up automatically.

Parameters Definitions (I)

Parameters Definitions (II) http://renalfellow.blogspot.com/2008/07/what-is-resistive-index.html

Parameters Definitions (III) Resistive Index (RI): The arterial resistivity index, developed by Leandre Pourcelot, is a measure of pulsatile blood flow that reflects the resistance to blood flow caused by microvascular bed distal to the site of measurement. Pulsability index (PI): Blood velocities in arteries are higher during systole than during diastole. This value decreases with distance from the heart. It is also to observe the resistance of blood vessels. A reversal of diastolic flow would be indicate severe abnormal pattern. S/D ratio: The umbilical artery blood flow systolic to end-diastolic ratio is used as a measure of fetal compromise. The ratio decreases towards term, from about 3.5 at 24 weeks to about 2.2 at term. As the diastolic flow becomes diminished in fetal compromise, the systolic/diastolic ratio will rise. All indices theoretically independent of the angle of insonation

Blood Flow

Volume of Blood Flow Work flow A. Click vessel diameter box to start measurement of internal vessel diameter in B mode. B. Measure VTI of the same vessel in PW spectrum. VTI can be completed by using either manual/auto-trace VTI in cardiac package or directly clicking VTI box to start manual VTI. C. After completing measurement of vessel diameter and VTI, the volume of blood flow will be calculated and show up in the box automatically. Volume(μl) = VTI π D 2 2 ; D: vessel diameter