WO2011070166A1 - Système pour quantifier et visualiser le profil de rotation ventriculaire du cœur - Google Patents

Système pour quantifier et visualiser le profil de rotation ventriculaire du cœur Download PDF

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WO2011070166A1
WO2011070166A1 PCT/EP2010/069408 EP2010069408W WO2011070166A1 WO 2011070166 A1 WO2011070166 A1 WO 2011070166A1 EP 2010069408 W EP2010069408 W EP 2010069408W WO 2011070166 A1 WO2011070166 A1 WO 2011070166A1
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Prior art keywords
rotation
heart
planes
ventricular
pattern
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PCT/EP2010/069408
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English (en)
Inventor
Anna BJÄLLMARK
Ulf Gustafsson
Lars-Åke BRODIN
Anders Waldenström
Matilda Larsson
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Bjaellmark Anna
Ulf Gustafsson
Brodin Lars-Aake
Waldenstroem Anders
Matilda Larsson
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Application filed by Bjaellmark Anna, Ulf Gustafsson, Brodin Lars-Aake, Waldenstroem Anders, Matilda Larsson filed Critical Bjaellmark Anna
Priority to EP10794946A priority Critical patent/EP2509509A1/fr
Publication of WO2011070166A1 publication Critical patent/WO2011070166A1/fr
Priority to US13/492,502 priority patent/US8996093B2/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0883—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/06—Measuring blood flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/13—Tomography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/488—Diagnostic techniques involving Doppler signals
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01S—RADIO DIRECTION-FINDING; RADIO NAVIGATION; DETERMINING DISTANCE OR VELOCITY BY USE OF RADIO WAVES; LOCATING OR PRESENCE-DETECTING BY USE OF THE REFLECTION OR RERADIATION OF RADIO WAVES; ANALOGOUS ARRANGEMENTS USING OTHER WAVES
    • G01S15/00—Systems using the reflection or reradiation of acoustic waves, e.g. sonar systems
    • G01S15/88—Sonar systems specially adapted for specific applications
    • G01S15/89—Sonar systems specially adapted for specific applications for mapping or imaging
    • G01S15/8906—Short-range imaging systems; Acoustic microscope systems using pulse-echo techniques
    • G01S15/8993—Three dimensional imaging systems
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/0002—Inspection of images, e.g. flaw detection
    • G06T7/0012—Biomedical image inspection
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/0002—Inspection of images, e.g. flaw detection
    • G06T7/0012—Biomedical image inspection
    • G06T7/0014—Biomedical image inspection using an image reference approach
    • G06T7/0016—Biomedical image inspection using an image reference approach involving temporal comparison
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/20—Analysis of motion
    • G06T7/246—Analysis of motion using feature-based methods, e.g. the tracking of corners or segments
    • G06T7/251—Analysis of motion using feature-based methods, e.g. the tracking of corners or segments involving models
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/055—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves  involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/48—Diagnostic techniques
    • A61B8/485—Diagnostic techniques involving measuring strain or elastic properties
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/10—Image acquisition modality
    • G06T2207/10132—Ultrasound image
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30048—Heart; Cardiac

Definitions

  • a system to quantify and visualize ventricular rotation pattern of the heart is provided.
  • the present invention relates to a system according to the preamble of the independent claim.
  • the object of the present application is to achieve a system that presents a novel way to quantify and visualize the ventricular rotation pattern of the heart.
  • the present invention is aimed to be used in the routine clinical practice at cardiology departments to improve the diagnostics of different cardiac diseases, through easy interpretable quantification and visualization of the rotation pattern of the left and right ventricles.
  • the non-invasive analysis system comprises one or more data collecting units and an analysis unit, which analysis unit is adapted to quantify and visualize ventricular rotation pattern of the heart.
  • the one or more data collecting units are adapted to register rotational information about the cardiac movement for a number of time points and for a number of levels in the heart throughout the cardiac cycle and said analysis unit is adapted to calculate rotation planes for different levels in the heart over time, and to construct rotation planes from at least two rotation lines originating from the same level in the heart, and wherein each of the rotation lines are created between a pair of points having matching rotation values located in ventricular walls, and to calculate a rotation axis for the rotation plane for each selected level, and that said analysis unit further is adapted to create a model of the rotational pattern of the heart, wherein deflection and direction of the rotation axes for the rotation planes at selected levels of the ventricles are quantified and visualized.
  • non-invasive image acquisition is required to collect rotation values from different positions of the myocardium.
  • a kinematic model of the ventricles is constructed in order to determine the rotation planes at different levels of the heart and to identify the transition level of the ventricles.
  • the orientations of the rotation planes over time are visualized by plotting the motion of the normal vectors of the rotation planes, i.e. the rotation axis of the planes.
  • the invention presents a novel non-invasive way to assess the rotation axis of a ventricle. This provides further insight into the complexity of ventricular function and uniquely describes the cardiac rotation pattern, since all available techniques today only focus on single rotational amplitude values and not on how the ventricles rotate.
  • This new method is different to all other method used today for assessing cardiac function, as it does not describe the amplitude of a motion but the relationship in motions between different parts within a ventricle.
  • This invention introduces a new concept and new parameters to evaluate ventricular function and provides a unique overview of the rotation pattern of the ventricles.
  • Figure 1 shows a schematic description of a rotation plane calculation in the analysis unit, according to the present invention.
  • Figure 2 shows an example of how the visualization of the motion pattern of the rotation axes is performed in the analysis unit, according to the present invention.
  • Figure 3 illustrates the mean global torsion axis of the left ventricle, according to an embodiment of the present invention.
  • Figure 4 schematically shows the method for quantifying and visualizing ventricular rotation pattern of the heart, according to the present invention.
  • Figure 5 shows the results of the rotation axis at baseline and after acute regional ischemia in the LV in 6 pigs.
  • Figure 6 shows the results of the rotation axis at baseline and after cardiac
  • CRT resynchronization therapy
  • Figure 1 shows a schematic description of a rotation plane calculation.
  • the illustrations to the left and in the middle show the LV from three apical long-axis views.
  • the black filled dots represent points with measured rotation values
  • the small unfilled dots represent a matching rotation value (by interpolation) in the opposite wall to one of the measured rotation values at each level.
  • the line between a pair of matching points represents a rotation line, which is displayed as a black straight line between opposite walls in the Figure.
  • the illustration to the upper right displays the primary model with 18 coordinates (intersections of the black lines) and a calculated rotation plane as a mean of the calculated rotation lines at the basal level.
  • the normal vector to the plane (n) is the rotation axis of the rotation plane.
  • the deflection of the rotation axis is described by ls s , relative to the longitudinal axis of the LV.
  • the direction of the rotation axis in the xy-plane is described by n ⁇ ie.
  • Yy which is defined as 0° at the lateral wall with increasing angles
  • Ant anterior; Lat, lateral; Post, posterior; Inf, inferior; Sept, septal; Antsept, anteroseptal.
  • Figure 2 shows mean deflection ( i ⁇ l € s , represented by the axial scale in the plots, and mean direction (s gle ⁇ ..,. " ), represented by the circular scale in the plots, of the calculated rotation axes in 39 healthy subjects presented for discrete time points throughout the cardiac cycle at basal, mid-, apical and transition levels. Every discrete point has been color-coded as defined below the tomograms. Ant, anteroseptal; ant, anterior; lat, lateral; post, posterior; inf, inferior; sept, septal.
  • IVC mid-isovolumic contraction
  • AVO aortic valve opening
  • AVC aortic valve closure
  • IVR mid-isovolumic relaxation
  • MVO mitral valve opening
  • E-peak peak velocity of early diastolic filling
  • E-end end of early diastolic filling
  • A-onset start of atrial wave.
  • Figure 3 illustrates the left ventricle (LV) with the mean torsion axis of 39 healthy subjects at end systole.
  • the torsion axis is perpendicular to the rotation planes at any specific level and represents the rotation axis of the entire LV. It is based on the rotation planes at three levels (basal, mid- and apical levels).
  • Figure 5 shows the results of the rotation axis at three levels of the LV in 6 pigs at baseline and after 4 minutes of left anterior descending coronary artery occlusion.
  • the orientation of the rotation axis is displayed in the circular and linear graphs where deflection is presented in the axial scale as the distance from the centre and the direction is presented in the circular scale, where also anatomical positions are marked.
  • Figure 6 shows the position of the rotation axis at end of systole in 19 patients that have cardiac resynchronization therapy (CRT).
  • CRT cardiac resynchronization therapy
  • the circular and linear graphs show both the mean results at baseline and after CRT in responders(R) and non-responders (NR) to CRT as well as in 39 healthy humans.
  • the invention relates to a noninvasive analysis system to quantify and visualize the rotation pattern of ventricles of the heart.
  • the analysis system comprises two subsystem where subsystem 1 is a data collecting unit and subsystem 2 is an analysis unit.
  • the data collecting unit includes one or many non-invasive image generating means, or the data collecting unit facilitates registration of variables quantifying the rotation pattern of the ventricles.
  • One example is the ultrasound technique, which will be described in the following.
  • Subsystem 2 the analysis unit, performs the calculation of rotation planes and rotation axes by constructing a model of the ventricles based upon rotation parameters registered by subsystem 1. The construction of a model is shown in figure 1 and will be described for the left ventricle of the heart.
  • Subsystem 2 also includes a visualization unit where the motion patterns of the rotation axes are displayed in axial-circular plots. Subsystem 2 may be separate or may be integrated in subsystem 1.
  • the data collecting system may be an ultrasound system using a reflector-based technique, an ultrasound system using a Doppler-technique, a magnetic resonance tomography system, or any imaging system with ability to quantify rotation amplitudes. Definitions
  • Rotation line - a line between a pair of points with similar rotation values located in two opposite ventricular walls in an apical long-axis view of the LV, where at least one point is located at either the basal, mid- or apical level, see Figure 1.
  • Rotation plane - a plane constructed by at least two rotation lines originating from the same level, see Figure 1.
  • Rotation axis - the central normal vector of a rotation plane, i.e. the axis around which the LV rotates in a rotation plane, see Figure 1.
  • Transition plane - a rotation plane with rotation values close to zero.
  • Direction the direction of a rotation axis in the transverse plane of the LV, defined as angle ⁇ ywith.0° at the lateral wall and increasing angles counter-clockwise, see Figure 1 to the lower right.
  • z-level the distance in percent between the apex and the mean z-coordinate of a rotation or transition plane, where 0% corresponds to the apex and 100% to the base.
  • Twist-ratio the ratio of apical rotation to sign-reversed basal rotation.
  • the image acquisition can be performed with different 2D or 3D imaging modalities, such as ultrasound and magnetic resonance tomography.
  • the image acquisition will here be explained according to the 2D ultrasound technique.
  • Standard echocardiographic short- axis images at basal, mid- ventricular and apical levels, as well as apical four-chamber views are recorded using an ultrasound system.
  • End-systolic and end-diastolic diameters are measured in each short-axis image as well as the approximate distance to each level in respect to the apex in the apical images.
  • Time to aortic valve closure is measured from the beginning of QRS as reference time for end of systole.
  • Regional rotation of the ventricular wall is analyzed at each short-axis level using a commercial software for wall motion analysis.
  • the analyzed region was divided into six segments.
  • the beginning and end of the analysis is set at the start of QRS in the superimposed ECG including one cardiac cycle.
  • each rotation analysis is exported to a text file, where the rotation is presented in degrees as the mean of each segment at every sampled frame.
  • the rotation axis software is based on a simplified model of the LV that is constructed from the 18 geometric measuring points describing the six segments in short-axis views at the basal, mid- and apical levels and the distances from the apex to each level ( Figure 1).
  • the rotation data and geometric data are imported to Matlab 7.0.1 (Math Works Inc., Natick, MA, USA) where the rotation axis software was developed. Every rotation value is assigned an xyz-coordinate, with z along the longitudinal axis of the LV and x, y in the short-axis plane of the LV. This results in a primary model of 18 coordinates with both a position and a rotation value, one every 60 degrees in the short-axis plane at the three levels ( Figure 1).
  • the time from the Q-wave in the ECG to AVC is added in the data input for analyzing the rotation axis.
  • the software is initiated by automated selection of one cardiac cycle, by the identification of the time of zero rotation, which is the same as the defined cardiac cycle in the speckle tracking analysis.
  • the geometry change during the cardiac cycle is accounted for in the model by setting end-diastolic diameters at the start and end of the cardiac cycle and by setting end-systolic diameters at the time of AVC. In between those measured diameters, linear interpolation in time is applied to obtain coordinates throughout the cardiac cycle. To create a model with high spatial resolution, linear interpolation is applied in the longitudinal direction to generate coordinates every 0.1 mm between the basal, mid- and apical levels.
  • every coordinate in the model is given a rotation value at every sampled frame throughout the cardiac cycle, using linear interpolation between the 18 measured values of rotation.
  • a rotation line Between opposite sides, as in each apical long-axis view, one pair of points with similar rotation values is selected (one by measurement and the other by interpolation) to define a rotation line, see Figure 1.
  • the rotation line originated from one of the two measured rotation values at each level.
  • the rotation line that best corresponded to small difference in rotation values with a mean z- coordinate close to the addressed level is selected to influence the calculation of the rotation plane at this level.
  • the selection procedure of rotation lines can generally be described as follows.
  • the rotation line with the mean z-coordinate nearest the corresponding level is selected. If no rotation line satisfied this first criterion, the line with the smallest difference in rotation values is selected, if the difference in rotation values is smaller than 0.5°. If the difference is not smaller than 0.5° for any line, no line is selected from that level, and is considered a missing value.
  • a rotation plane at that specific level can be calculated. Three coordinates are the minimum number needed to define a plane.
  • the six coordinates from the three lines are condensed to three coordinates that are used to calculate a rotation plane, according to (1-3), where ant (xyz) , antsept ⁇ ,z sept x,y,z) , inf (xyz) , post (xyz) , at (xyz) ,
  • P 5 (3) The plane constructed by the points P 1. ..F? an d is defined as the plane of rotation at the corresponding level. If one of the xyz-coordinates is missing, the corresponding mean point, i3 ⁇ 4, P 2 or P 3 , becomes equal to the non-missing xyz- coordinate. If both xyz- coordinates are missing in one of the equations 1-3, the corresponding mean point is assigned a xyz-coordinate from one of the other equations 1-3. The xyz-coordinate that replaces the mean point that could not be calculated is then discarded in the equation where it is originally included. To express the motion pattern of the rotation plane, the normal vector to the plane (n), i.e. the rotation axis, is calculated as the cross product of the two vectors 3 ⁇ 4 and l3 ⁇ 4 . between the points P P z and P g according to (4-6).
  • a transition plane describing a level in the LV with rotation values close to zero is also calculated.
  • This plane is calculated in the same way as the planes at the three levels by using the equations 1-8.
  • the xyz-coordinate in each wall is obtained by identifying the zero-coordinates, i.e. the coordinates where the rotation values shifts from positive to negative.
  • the present invention also relates to a method for quantifying and visualizing ventricular rotation pattern of the ventricle, as illustrated in Figure 4.
  • the method includes: a) registration of rotational information about the cardiac movement for a number of time points and for a number of levels in the heart throughout the cardiac cycle, b) detecting points located in the ventricular walls having matching rotation values, c) creating rotation lines between said pair of points, d) constructing rotation planes from at least two rotation lines originating from the same level in the heart, or from at least three coordinates, e) calculating rotation planes for a number of different levels in the heart over time, f) calculating a rotation axis for each rotation plane for each selected level, g) creating a model of the rotational pattern of the heart, wherein deflection and direction of the rotation axes for the rotation planes at selected levels of the ventricles are quantified and visualized.
  • the method for quantifying and visualizing ventricular rotation pattern of the heart further includes the sub step: h) calculating a curved rotation axis influenced by the rotation axes at every level of the left ventricle, i.e. a global torsion axis of the left ventricle.
  • the rotation axis software was applied in a group of 39 healthy individuals and in a patient with anteroseptal myocardial infarction.
  • the deflection and direction of the rotation axes were calculated in every recorded image frame throughout the cardiac cycle and presented at 12 time points, see Figure 2.
  • the deflections of the axes were greatest at the basal level in most of the time points throughout the cardiac cycle and were, in general, least pronounced at the mid-level.
  • the deflection of the rotation axes differed significantly from zero in all tested time points, i.e. the rotation axes were not congruent to the longitudinal axis of the LV.
  • the Rayleigh's tests for uniformity demonstrated significant mean directions of the rotation axes for the majority of the tested time points.
  • the rotation axis at basal and mid levels was directed towards the inferoseptal area during late systole and early diastole and showing only small variations during this period.
  • the axis was directed towards the anteroseptal area, also with only small variations during this period. This indicates that there was a uniform change in rotation throughout the ventricle during late systole and early diastole, even though most of the rotation of the ventricle occurred during this period. This shows that this method does not describe the amplitude of rotation but the relationship in rotation between different pars of the ventricle.
  • the rotation axis changed from being directed towards the inferoseptal area at basal and mid levels at baseline to being directed towards the anterior area after LAD occlusion. There was a significant difference in the direction of the rotation axis at all three levels and a significant difference in deflection at basal and apical levels (figure 5). Also, a significant difference in the symmetry of the rotational motion during late systole and early diastole was found at both basal and apical levels. This indicates that the rotation pattern did not only change after LAD occlusion but it also became less symmetric, meaning that the changes in regional rotation was not uniform. No significant changes in conventional measurements of rotation could be found.
  • the novel system and method introduces a new concept to evaluate LV function, by estimating planes of rotation at different levels of the LV and by describing the motion pattern of the rotation axes.
  • the LV does not rotate around its longitudinal axis in normal conditions, but around another axis, the direction of which changes in a complex manner during the cardiac cycle.
  • a unique overview of the rotation pattern of the LV is achieved.
  • the preliminary results indicate that the rotation axis method is more sensitive than conventional measurements of ventricular rotation to changes in the rotation pattern.
  • the system and method is advantageous in that it describes the circumferential movement pattern of the entire ventricle and not only regional movement pattern within the ventricle.
  • this method seemed suitable for differentiating stable from unstable rotation patterns, where a stable rotation pattern describes uniform changes in rotation amplitudes. Moreover, absence of a transition plane indicates that all levels of the LV are rotating in the same direction, meaning that there is no effective twist. Absence and the position of the transition plane might both be markers of dysfunction. Clear differences in rotation pattern between the healthy group and the patient with ischemia and anteroseptal post infarction were seen. Thus, this new method could be used for early detection of cardiac diseases and for selection of patients for and optimization of cardiac resynchronization therapy.

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Abstract

Différentes modalités ont été utilisées pour décrire le mouvement de rotation des ventricules du coeur et des études ont indiqué qu'une rotation du ventricule gauche (LV) est une composante intégrante additionnelle de la fonction LV. À ce jour, seuls les amplitudes et les temps de rotation ont été rapportés, tandis qu'aucun procédé n'est disponible pour décrire totalement le profil de rotation des ventricules. La présente invention concerne un système qui présente une nouvelle façon de quantifier et visualiser le profil de rotation ventriculaire du coeur. Nous présentons un nouveau procédé qui évalue et décrit le profil de rotation en calculant l'axe de rotation du ventricule. Une acquisition d'image non invasive est requise pour collecter des valeurs de rotation à partir de différentes positions du myocarde. Ensuite, un modèle cinématique d'un ventricule est construit pour déterminer les plans de rotation à différents niveaux du coeur. Les mouvements des plans de rotation sont visualisés en représentant graphiquement les vecteurs normaux des plans au cours du temps, c'est-à-dire l'axe de rotation des plans. Ce nouveau procédé est différent de tous les autres procédés utilisés à ce jour pour évaluer la fonction cardiaque, étant donné qu'il ne décrit pas l'amplitude d'un mouvement mais la relation en mouvement entre différentes parties dans un ventricule. Les résultats préliminaires indiquent que l'axe de rotation est plus sensible aux changements du profil de rotation que des mesures conventionnelles de rotation ventriculaire. Ce nouveau procédé pourrait être utilisé pour la détection précoce de maladies cardiaques et pour la sélection de patients pour et l'optimisation d'une thérapie de resynchronisation cardiaque.
PCT/EP2010/069408 2009-12-10 2010-12-10 Système pour quantifier et visualiser le profil de rotation ventriculaire du cœur WO2011070166A1 (fr)

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EP10794946A EP2509509A1 (fr) 2009-12-12 2010-12-10 Système pour quantifier et visualiser le profil de rotation ventriculaire du coeur
US13/492,502 US8996093B2 (en) 2009-12-10 2012-06-08 System to quantify and visualize ventricular rotation pattern of the heart

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SE0901546A SE534636C2 (sv) 2009-12-12 2009-12-12 Ett system för kvantifiering och visualisering av hjärtats rotationsmönster
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US9265951B2 (en) 2010-02-12 2016-02-23 The Brigham And Women's Hospital System and method for automated adjustment of cardiac resynchronization therapy control parameters
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US9707400B2 (en) 2014-08-15 2017-07-18 Medtronic, Inc. Systems, methods, and interfaces for configuring cardiac therapy
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