Caractérisation de vortex intraventriculaires par échographie Doppler ultrarapide

Heart disease is one of the leading causes of death in the world (first cause in North America [192]), and causes high health care costs for society. The prevalence of heart failure increases dramatically with age and, due to the ageing of the population, will remain a major concern in the future, not only for developed countries, but also for developing countries. It is therefore crucial to have a good understanding of its mechanism to obtain an early diagnosis and a better prognosis for patients. Diastolic dysfunction is one of the variations of heart failure and leads to insufficient filling of the ventricle. To better understand the dysfunction, several studies have examined the blood motion in the ventricle. It is known that at the beginning of diastole, the filling flow creates a vortex pattern known as a vortex ring. This development of the ring by blood flow after passage through a valve was first described in 1513 by Leonardo Da Vinci (Fig. 0.1). After molding a glass phantom in an aorta and adding seeds to visually observe the flow through the phantom, he could describe the vortex ring development of the blood coming out of the aortic valve. His work was confirmed 500 years later with the emergence of MRI [66]. The same pattern can be observed in the left ventricle when the flow emerges from the mitral valve, referred to as the diastolic vortex. The flow motion (in our case the blood) is directly related to its environment : shape of the ventricle, shape of the valve, stiffness of the walls... There is therefore a growing interest in further studies on this diastolic vortex that could lead to valuable information on diastolic function. The imaging modalities which can be used to visualize the vortex are MRI and ultrasound. This thesis presents the work carried out to allow a better characterization of the diastolic vortex in the left ventricle by Doppler ultrasound imaging. For temporal monitoring of vortex dynamics, a high temporal resolution is required, since the ventricular diastole is about 0.5 s on average for a resting human heart. The quality of Doppler signals is also of utmost importance to get an accurate estimate of the blood flow velocity in the ventricle. To study this vortex, we focused on evaluating the core vorticity evaluation and especially on its evolution in time. The work is divided in three parts, and for each of them an article has been written : 1. Ultrafast Doppler sequence : The sequence is based on diverging waves, which resulted in a high frame rate. In combination with vortography, a method to locate the vortex core and derive its vorticity, the vortex dynamics could be tracked over time. This ix sequence could establish a proof of concept based on in vitro and in vivo acquisitions on healthy human volunteers. 2. Triplex sequence : Based on the ultrafast sequence, we were interested in adding information on the wall motion. The triplex sequence is able to recover not only the blood motion with a high framerate but also tissue Doppler. In the end, we could derive color, tissue, and spectral Doppler, along with a high quality Bmode by using motion compensation. The interdependence between vortex and walls dynamics could be highlighted by acquiring all the required parameters over a single cardiac cycle. 3. Automatic clutter filter : Vorticity quantification depends directly on the estimation of Doppler velocity. However, due to their low amplitude, blood signals must be filtered. Indeed, acquired signals are actually an addition of tissue and blood signals. Filtering is a critical step for an unbiased and accurate velocity estimation. The last part of this doctoral thesis has focused on the design of an efficient filter that takes advantage of the temporal and spatial dimensions of the acquisitions. Thus the tissue alongside the noise is removed. Particular care was taken to automatize the filter by applying information criteria based on information theory.

Keyphrases: Doppler, vortex, ultrasound imaging, ultrafast, filter, echocardiography, high-frame-rate, diverging wave, HOSVD, AIC