American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 20131540358 Nurse-Based Use of Handheld Ultrasound Examination forHeart FailureMikael Gustafsson,* Ulf Dahlström, Urban Alehagen,Peter Johansson Cardiology, Medicine and Care, Linköping,SwedenObjectives—Heart failure (HF) is a syndrome of high prevalenceand poor prognosis. Structured nurse-based visits, where basic clinicaldata such as body weight, edemas, New York Heart Association(NYHA) functional class, respiratory symptoms, and biomarkers are assessed,is a strategy implemented in recent years to improve the quality ofcare. Ultrasound lung imaging can reveal lung water by the appearance ofthe so-called “comet tail artifact” (CTA), which is reported to be easily recognizedafter a short period of training. Pleural effusion (PE) and dilatationof liver veins and the inferior vena cava (IVC) are also common findingsin decompensated HF that can be evaluated with ultrasound. Knowledge ofthese data may improve understanding of the current hemodynamic statusof HF patients. We hypothesized that HF clinic nurses with 1 day of trainingwould be able to record and correctly identify the CTA and PE using ahandheld ultrasound scanner (HHUS). We also tested whether they wouldbe able to correctly record the IVC diameter and liver veins.Methods—Using an HHUS (Vscan; GE Healthcare), 4 nursesrecorded cine loops from all lung lobes, pleura IVCs, and liver veins in 58consecutive HF outpatients. An experienced echocardiographer, blinded tothe results, reviewed all recorded image sequences in parallel.Results—In this outpatient population of HF patients with medianN-terminal pro-brain natriuretic peptide (NTproBNP) of 1670,nurses’ findings were CTA in 18, PE in 5, dilated IVC in 12, and dilatedliver veins in 18 cases. These conditions, all associated with HF, were significantly(P < .05) found to covariate. CTA and a dilated IVC also correlated(both r = 0.4; P < .05) with the biomarker NTproBNP. CTAs wereless abundant in NYHA I and II than in NYHA III (r = 0.10; P < .05).Agreement between nurse and echocardiographer findings was good forCTA (70%) and PE (90%), while IVC and liver vein assessments wereless accurate. The HHUS examination time was on average 8 minutes.Conclusions—Nurse-performed HHUS examination directedto assess signs of increased lung water content and elevated central venouspressure can provide additional information with a potential impacton management of HF patients.1520493 Performance Assessment of Cardiac Strain Imaging UsingRadiofrequency and Envelope SignalsChi Ma,* Tomy Varghese Medical Physics, University ofWisconsin, Wisconsin USAObjectives—Clinical cardiac strain images are currently generatedusing B-mode signals. Accurate regional myocardial function analysisrequires high spatial and temporal resolution in addition to fidelity tothe underlying deformation. Performance analysis of radiofrequency (RF),envelope, and B-mode signals in the context of cardiac strain imaging willyield a better understanding of their respective properties.Methods—In this study, strain estimation performance is comparedusing a tissue-mimicking phantom, finite-element–based cardiacsimulation, and clinical in vivo data to demonstrate the differences betweenthe use of RF, envelope, and B-mode signals. Two performancemetrics, ie, the regional mean value and the SD of the regional mean value,are studied.Results—In phantom studies, the signal-to-noise ratio improvementsof the RF signal for linear array and phased array geometry are5.80 and 9.48 dB, respectively, when compared with the envelope signalat the peak strain value. The cardiac simulation study shows that at thepeak strain value, the SDs of the estimated strain of the envelope signalfrom anterior and anterolateral segments are 1.55 and 1.12 times largerthan RF signal estimations, respectively. In vivo study results also showthat the standard deviation of estimated strain is lower with RF signals.Conclusions—Results in phantom studies show that RF signalsprovide superior performance under cyclic compression for both lineararray and phased array transducers when compared to the use ofenvelope signals. Cardiac simulation study and in vivo results also indicateperformance advantages of strain estimation using RF signals overenvelope signals. (Supported by National Institutes of Health grants5R21EB010098 and R01CA112192-S103.)Gynecologic UltrasoundModerator: Jodi Lerner, MD1541483 Three-Dimensional Ultrasound Assessment of Uterine CavityRemodeling After Surgical Correction of SubseptationsLaura Detti Obstetrics and Gynecology University of Tennessee,Memphis, Tennessee USAObjectives—Arcuate and subseptate uteri taken together accountfor 53% of all müllerian anomalies. Their incidence is even higherin patients with infertility and recurrent pregnancy loss, and restoration ofnormal fertility/pregnancy outcomes is achieved with surgical correction.We sought to evaluate uterine cavity measurements in patients with arcuateor subseptate uteri in the pre- and post-resection periods.Methods—This was a prospective cohort study. Patients diagnosedwith arcuate or subseptate uteri were evaluated with 3D ultrasoundbefore and after undergoing surgical resection of the anomalies by hysteroscopicseparation of the anterior from the posterior wall. Measurementsof the subseptum’s length (measured from the base to the tip of theseptum:
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013displacements, strains, and strain rates were determined by postprocessingusing QLab version 8.0 (Philips, Andover, MA).Results—The findings in the first and third trimesters are summarizedin Table 1. There was no statistically significant effect of age,race, or body mass index (BMI) on any of the measurements; except forBMI (P = .03) on mean velocity in the third trimester. Gestational age atthe time of the exam had a negative effect on mean velocity in the first(P
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