Aims: In this study, we investigated the clinical usefulness of ultrasonic tissue characterization with integrated backscatter for the evaluation of myocardial histological abnormalities in comparison with endomyocardial biopsy findings in patients with hypertrophic cardiomyopathy. Methods: Twenty patients with hypertrophic cardiomyopathy and 20 normal subjects were enrolled in this study. We measured two parameters for the ultrasonic tissue characterization with integrated backscatter: the magnitude of the cardiac-cycle-dependent variation in integrated backscatter signals (cdv-IB) and the mean value of integrated backscatter signals calibrated by the pericardium (cal-IB). These parameters were measured at both the interventricular septum and the left ventricular posterior wall. Histological findings of right ventricular endomyocardial biopsy specimens were analyzed by computer image analyzer. Results: cdv-IB was significantly lower and cal-IB significantly higher in both the interventricular septum and the left ventricular posterior wall in patients with hypertrophic cardiomyopathy compared with normal subjects. In patients with hypertrophic cardiomyopathy, the degree of myocardial disarray, interstitial fibrosis, and nonhomogeneity of myocyte size showed positive correlations with cal-IB and negative correlations with cdv-IB. Conclusions: Ultrasonic tissue characterization with IB enables the noninvasive evaluation of myocardial histological abnormalities in patients with hypertrophic cardiomyopathy.

1.
Emoto R, Yokota Y, Fukuzaki H: Prognosis in hypertrophic cardiomyopathy – Echocardiographic follow-up and histological study. Jpn Circ J 1989;53:1031–1044.
2.
Perez JE, Miller JG, Wickline SA, Holland MR, Waggoner AD, Barzilai B, Sobel BE: Quantitative ultrasonic imaging: Tissue characterization and instantaneous quantification of cardiac function. Am J Cardiol 1992;69:104H–111H.
3.
Popp RL: Recent experience with ultrasonic tissue characterization. Am J Cardiol 1992;69:112H–116H.
4.
O’Brien PD, O’Brien WD Jr, Rhyne TL, Warltier DC, Sagar KB: Relation of ultrasonic backscatter and acoustic propagation properties to myofibrillar length and myocardial thickness. Circulation 1995;91:171–175.
5.
Vitale DF, Bonow RO, Calabro R, De Cristofaro M, Pacileo G, Caso P, Gerundo G, Bordini C, Losi MA, Rengo C, Rengo F: Myocardial ultrasonic tissue characterization in pediatric and adult patients with hypertrophic cardiomyopathy. Circulation 1996;94:2826–2830.
6.
Naito J, Masuyama T, Tanouchi J, Mano T, Kondo H, Yamamoto K, Nagano R, Hori M, Inoue M, Kamada T: Analysis of transmural trend of myocardial integrated ultrasonic backscatter for differentiation of hypertrophic cardiomyopathy and ventricular hypertrophy due to hypertension. J Am Coll Cardiol 1994;24:517–524.
7.
Lattanzi F, Spirito P, Pocano E, Mazzarisi A, Landini L, Distante A, Vecchio C, L’Abbate A: Quantitative assessment of ultrasonic myocardial reflectivity in hypertrophic cardiomyopathy. J Am Coll Cardiol 1991;17:1085–1090.
8.
Skorton DJ, Collins SM: Clinical potential of ultrasonic tissue characterization in cardiomyopathies. J Am Soc Echocardiogr 1988;1:69–77.
9.
Masuyama T, St Goar FG, Tye TL, Oppenheim G, Schnittger I, Popp RL: Ultrasonic tissue characterization of human hypertrophied hearts in vivo with cardiac cycle-dependent variation in integrated backscatter. Circulation 1989;80:925–934.
10.
Richardson P, Mckenna W, Bristow M, Maisch B, Mautner B, O’Connell J, Olsen E, Thiene G, Goodwin J, Gyarfas I, Martin I, Nordet P: Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996;93:841–842.
11.
American Society of Echocardiography Committee on Standards: Recommendations for quantification of the left ventricle by two dimensional echocardiography. J Am Soc Echocardiogr 1989;2:358–367.
12.
Fujimoto S, Mizuno R, Nakagawa Y, Kimura A, Yamaji K, Yutani C, Dohi K, Nakano H: Ultrasonic tissue characterization in patients with dilated cardiomyopathy: Comparison with findings from right ventricular endomyocardial biopsy. Int J Card Imaging 1999;15:391–396.
13.
Zoni A, Regolisti G, Aschieri D, Borghetti A: Myocardial ultrasonic tissue characterization in patients with different types of left ventricular hypertrophy: A videodensitometric approach. J Am Soc Echocardiogr 1997;10:74–82.
14.
Solomon SD, Kytomaa H, Celi AC, Maas LC, Chou L, Hopkins J, Caguioa E, Lee RT: Myocardial ultrasonic tissue characterization by autocorrelation of two-dimensional ultrasonic backscatter. J Am Soc Echocardiogr 1994;7:631–640.
15.
Chandrasekaran K, Aylward PE, Fleagle SR, Burns TL, Seward JB, Tajik AJ, Collins SM, Skorton DJ: Feasibility of identifying amyloid and hypertrophic cardiomyopathy with the use of computerized quantitative texture analysis of clinical echocardiographic data. J Am Coll Cardiol 1989;15:832–840.
16.
Maron BJ, Wolfson JK, Roberts WC: Relation between extent of cardiac muscle cell disorganization and left ventricular wall thickness in hypertrophied cardiomyopathy. Am J Cardiol 1992;70:785–790.
17.
O’Donnell M, Mimbs JW, Miller JG: The relationship between collagen and ultrasonic backscatter in myocardial tissue. J Acoust Soc Am 1981;69:580–588.
18.
Jalil JE, Doering CW, Janicki JS, Pick R, Shoroff SG, Weber KT: Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventricle. Circ Res 1989;64:1041–1050.
19.
Wickline SA, Thomas LJ 3rd, Miller JG, Sobel BE, Perez JE: A relationship between ultrasonic integrated backscatter and myocardial contractile function. J Clin Invest 1985;76:2151–2160.
20.
Wickline SA, Thomas LJ 3rd, Miller JG, Sobel BE, Perez JE: The dependence of myocardial ultrasonic integrated backscatter on contractile performance. Circulation 1985;72:183–192.
21.
Milunski MR, Mohr GA, Perez JE, Vered Z, Wear KA, Gessler CJ, Sobel BE, Miller JG, Wickline SA: Ultrasonic tissue characterization with integrated backscatter. Acute myocardial ischemia, reperfusion, and stunned myocardium in patients. Circulation 1989;80:491–503.
22.
Vandenberg BF, Kerber RE, Skorton DJ: Detection of myocardial viability with ultrasound tissue characterization: Myocardial contrast echocardiography and integrated backscatter imaging. Am J Card Imaging 1994;8:113–122.
23.
Wickline SA, Thomas LJ III, Miller JG, Sobel BE, Perez JE: Sensitive detection of the effects of reperfusion on myocardium by ultrasonic tissue characterization with integrated backscatter. Circulation 1986;74:389–400.
24.
Naito J, Masuyama T, Mano T, Kondo H, Yamamoto K, Nagano R, Doi Y, Hori M, Kamada T: Ultrasonic myocardial tissue characterization in patients with dilated cardiomyopathy: Value in noninvasive assessment of myocardial fibrosis. Am Heart J 1996;131:115–121.
25.
Di Bello V, Talarico L, Picano E, Giorgi D, Bertini A, Pasterni M, Giusti C: Increased myocardial echo density in left ventricular pressure and volume overload in human aortic valvular disease: An ultrasonic tissue characterization study. J Am Soc Echocardiogr 1997;10:320–329.
26.
Naito J, Masuyama T, Mano T, Yamamoto K, Doi Y, Kondo H, Nagano R, Inoue R, Hori M: Influence of preload, and contractility on myocardial ultrasonic tissue characterization with integrated backscatter. Ultrasound Med Biol 1995;21:853–860.
27.
Mottley JG, Miller JG: Anisotrophy of ultrasonic backscatter of myocardial tissue: I. Theory and measurements in vitro. J Acoust Soc Am 1988;83:755–761.
28.
Madaras EI, Perez J, Sobel BE, Mottley JG, Miller JG: Anisotropy of the ultrasonic backscatter of myocardial tissue: II. Measurements in vivo. J Acoust Soc Am 1988;83:762–769.
29.
Maron BJ, Roberts WC: Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum of patients with hypertrophic cardiomyopathy. Circulation 1979;59:689–706.
30.
Spirito P, Maron BJ: Relation between extent of left ventricular hypertrophy and diastolic filling abnormalities in hypertrophic cardiomyopathy. J Am Coll Cardiol 1990;15:808–813.
31.
Maron BJ, Roberts WC: Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum of patients with hypertrophic cardiomyopathy. Circ Res 1979;59:689–706.
32.
Sagar KB, Rhyne TL, Warltier DC, Pelc L, Wann LS: Intramyocardial variability in integrated backscatter: Effects of coronary occlusion and reperfusion. Circulation 1987;75:436–442.
33.
Greenbaum RA, Ho SY, Gibson DG, Becker AE: Left ventricular fiber architecture in man. Br Heart J 1981;45:248–263.
34.
Bhandari AK, Nanda NC: Myocardial texture characterization by two-dimensional echocardiography. Am J Cardiol 1983;51:817–825.
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