J Cardiovasc Ultrasound.  2013 Dec;21(4):155-162. 10.4250/jcu.2013.21.4.155.

Current Clinical Application of Intracardiac Flow Analysis Using Echocardiography

• Hong GR
• Kim M
• Pedrizzetti G
• Vannan MA

• KMID: 2135412
• DOI: http://doi.org/10.4250/jcu.2013.21.4.155

Abstract

In evaluating the cardiac function, it is important to have a comprehensive assessment of structural factors, such as the myocardial or valvular function and intracardiac flow dynamics that pass the heart. Vortex flow that form during left ventricular filling have specific geometry and anatomical location that are critical determinants of directed blood flow during ejection. The formation of abnormal vortices relates to the abnormal cardiac function. Therefore, vortex flow may offer a novel index of cardiac dysfunction. Intracardiac flow visualization using ultrasound technique has definite advantages with a higher temporal resolution and availability in real time clinical setting. Vector flow mapping based on color-Doppler and contrast echocardiography using particle image velocimetry is currently being used for visualizing the intracardiac flow. The purpose of this review is to provide readers with an update on the current method for analyzing intracardiac flow using echocardiography and its clinical applications.

Keyword

Intracardiac flow; Vortex; Echocardiography; Particle image velocimetry

MeSH Terms

Echocardiography*
Heart
Rheology
Ultrasonography

Figure

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  Fig. 1 Four-dimensional flow magnetic resonance imaging (MRI) and visualization of 3-dimensional flow. Four-dimensional cine MRI views of left ventricle and ascending aorta in normal subject in diastole (A) and systole (B).

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  Fig. 2 Examples of blood velocity mapping in a normal left ventricle overlaid on a sequence of anatomical B-mode apical long-axis images during early diastole (A), isovolumic contraction (B). Redrawn from Garcia et al.21)

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  Fig. 3 Example of left ventricular vortex flow analyzed by contrast echocardiography using particle image velocimetry method. The echo freeze frames represent the velocity vector on the scan-plane, superimposed to the reconstructed Doppler representation (A). Parametric representations of steady streaming field (B), pulsatile strength field (C) and vortex size change throughout the cardiac cycle (D). Redrawn from Hong et al.2)

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  Fig. 4 Description of quantitative parameters of the vortex location and shape. Vortex depth (A, black line), vortex transverse position (B, black line), vortex length (C, black arrow), and vortex width (D, black arrow). Redrawn from Son et al.30)

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  Fig. 5 Parametric representation of the steady streaming field in the non-thrombus (A) and thrombus group (B) are evaluated in apical 4-chamber view. The center of the average vortex flow was located near the apex in the non-thrombus group (A). However, in the thrombus group, the vortex was located in the center of the left ventricle (LV), much farther from the apex and did not reach to the LV apex (B). A black arrow indicates different vortex flow pattern in the apex between the 2 groups. Redrawn from Son et al.30) VD: vortex depth.

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  Fig. 6 The echo freeze frames (A and D) parametric representation of steady streaming field (B and E) and the pulsatile strength field (C and F) in the control group (upper panel) and the atrial fibrillation (AF) group (lower panel). The left atrial flow in controls showed several vortices with strong pulsatility in the periphery (B and C, red-colored area), whereas a large, merged, and spherical vortex with weak pulsatility (E and F, blue-colored area) was noted in the AF group. Redrawn from Park et al.42) Ao: aorta, LV: left ventricle, RS: relative strength.

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