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Validation of the accuracy of both right and left ventricular outflow volume determinations and semiautomated calculation of shunt volumes through atrial septal defects by digital color Doppler flow mapping in a chronic animal model

Takahiro Shiota, MD, FACC^*, Michael Jones, MD, Satoshi Aida, BS, Masahide Chikada, MD, Hiroyuki Tsujino, MS, Taher El-Kadi, MD, AFACC and David J. Sahn, MD, FACC

^* Cleveland Clinic Foundation, Cleveland, Ohio, USA
Laboratory of Animal Medicine and Surgery, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Toshiba Corporation, Tokyo, Japan
Oregon Health Sciences University, Portland, Oregon, USA

View larger version (117K): [in a new window]   Figure 1 Examples of selected two-dimensional color Doppler images for measurements of forward flow volume in the left ventricular outflow tract (LVOT) (top) and right ventricular outflow tract (RVOT) (bottom). Note that the sampling volume is at a depth of 3.5 cm for the RVOT, but it is almost 8 cm from the apex in the LVOT view. Ao = aorta; LV = left ventricle; PA = pulmonary artery; RV = right ventricle.

View larger version (17K): [in a new window]   Figure 2 Schema of the principle for calculating actual flow rate (Q = V x S) using Doppler-imaged flow velocity in a region of interest. Note that obliquity decreases velocities by a cosine function but increases areas by the same function. Five parallel velocity interrogations in a region of interest were averaged by the ultrasound system (see text). S = area, SD = Doppler area, V = velocity, VD = Doppler velocity.

View larger version (20K): [in a new window]   Figure 3 (A) Linear regression analyses between forward flow volumes through the left ventricular outflow tract (LVOT) obtained by the electromagnetic flowmeters (EM) and those obtained by the new digital method (ACM). (B) Linear regression analyses between forward flow volumes through the right ventricular outflow tract (RVOT) obtained by EM and those obtained by ACM. SEE = standard error of estimate.

View larger version (18K): [in a new window]   Figure 4 Linear regression analyses of shunt flow volumes through atrial septal defects (ASDs) (A) and pulmonary/systemic flow (Qp/Qs) ratios (B), comparing the electromagnetic flowmeter method (EM) to the new digital semiautomatic method (ACM). SEE = standard error of estimate.

View larger version (83K): [in a new window]   Figure 5 (A) Linear regression analyses of shunt flow volumes through atrial septal defects (ASDs) and pulmonary minus systemic flow (Qp minus Qs) in patients obtained by the new digital semiautomatic method (ACM). (B) Agreements for flow volumes through ASDs and Qp minus Qs obtained by ACM examined according to the method of Bland and Altman (18). SEE = standard error of estimate.