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. Author manuscript; available in PMC: 2014 Aug 1.
Published in final edited form as: JACC Cardiovasc Imaging. 2013 Jun 13;6(8):10.1016/j.jcmg.2012.12.013. doi: 10.1016/j.jcmg.2012.12.013

Respiratory-Mode Display of Echocardiographic Images Highlights Effects of Pericardial Disease

Michael V McConnell *, Holden H Wu *,†
PMCID: PMC3844669  NIHMSID: NIHMS494186  PMID: 23769491

Introduction

Echocardiography is commonly used to evaluate pericardial tamponade or constrictive pericarditis, where key findings include respirophasic changes in chamber sizes, such as right ventricular (RV) diastolic collapse and leftward shift of the interventricular septum.1,2 As these changes can be intermittent and subtle, and with overall motion dominated by cardiac contraction, the respiratory effects can be missed, particularly by less experienced sonographers or physicians-in-training. Recognition is important in order to guide M-mode and longer two-dimensional (2D) and Doppler acquisitions to evaluate respiratory effects more thoroughly,2,3 especially as short cine loops may not even capture these intermittent effects. An alternative 2D echo approach to facilitate recognition of respiratory changes would be to “freeze” cardiac contraction, thereby accentuating any motion due to respiration. In this iPix, such a “respiratory-mode” approach is presented, where RV collapse and septal shift are highlighted by displaying a cine loop using only image frames from a specific point in the cardiac cycle (i.e., diastole). Displaying images over the respiratory cycle, not just over the cardiac cycle, may aid in the detection of hemodynamic effects of pericardial disease.

Figure 1. Respiratory-Mode Display of RV Collapse.

Figure 1

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Parasternal long-axis 2D echo images in the case of a 38 yo F with non-small-cell lung cancer admitted with shortness of breath and a pericardial effusion on chest CT. The full cine display shows a small pericardial effusion with intermittent RV diastolic collapse (Fig. 1A). Selecting only the diastolic images from the same acquisition (Fig. 1B), and then displaying as a cine loop (Fig. 1C), minimizes cardiac motion and highlights the respirophasic motion of the RV free wall (arrow).

Figure 2. Normal Respiratory-Mode Display.

Figure 2

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Apical four-chamber 2D echo images in the case of a 54 yo M undergoing chemotherapy for Hodgkin’s disease. This baseline study shows normal left ventricular (LV) systolic function on the full cine display, without significant respiratory changes in the LV or RV (Fig. 2A). Selecting and displaying only the diastolic images as a cine loop (Fig. 2B) provides an example of a normal respiratory-mode display, with minimal cardiac motion and lack of respiratory changes clearly shown.

Figure 3. Respiratory-Mode Display of Constrictive Physiology.

Figure 3

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Follow-up apical four-chamber 2D echo images in the same patient as Figure 2. Shortly after starting chemotherapy, the patient was diagnosed with Staphylococcus aureus bacteremia and then developed a pericardial effusion, which was found to be purulent on pericardiocentesis. The full cine display now shows a thickened pericardium with intermittent leftward septal shift, consistent with constrictive physiology (Fig. 3A). Figure 3B shows a more complete implementation of respiratory-mode display in this case, where the diastolic images are reordered based on respiratory phase (from the respirometer tracing). This isolates and accentuates the display of septal shift (arrow) that occurs over the respiratory cycle, clearly evident on the respiratory-mode cine display (Fig. 3C).

Acknowledgments

Funding Sources: Dr. Wu has been supported by an NIH T32 Multidisciplinary Training Grant in Cardiovascular Imaging at Stanford (CVIS) and an American Heart Association Western States Postdoctoral Fellowship.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Relationship With Industry: The Departments of Medicine (Cardiovascular) and Electrical Engineering at Stanford University have MRI research collaborations with GE Healthcare, Inc. The Department of Radiological Sciences at UCLA has an MRI research collaboration with Siemens Medical Solutions USA, Inc.

References

  • 1.Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 2010;3:650–60. doi: 10.1016/j.jcmg.2010.04.009. [DOI] [PubMed] [Google Scholar]
  • 2.Feigenbaum H. Role of M-mode technique in today’s echocardiography. J Am Soc Echocardiogr. 2010;23:240–57. doi: 10.1016/j.echo.2010.01.015. [DOI] [PubMed] [Google Scholar]
  • 3.Picard MH, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, Keller AM, Malenka DJ, Masoudi FA, McCulloch M, Pellikka PA, Peters PJ, Stainback RF, Strachan GM, Zoghbi WA, American Society of Echocardiography American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011;24:1–10. doi: 10.1016/j.echo.2010.11.006. [DOI] [PubMed] [Google Scholar]

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