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Mora V, Geraldo J, Roldán I, Galiana E, Gil C, Escribano P, Arbucci R, Hidalgo A, Gramage P, Trainini J, Carreras F, Lowenstein J. A New Coding System for the Identification of Left Ventricular Rotation Patterns and Their Relevance to Myocardial Function. Ann Biomed Eng 2024; 52:2509-2520. [PMID: 38853207 DOI: 10.1007/s10439-024-03539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
Rotational mechanics is a fundamental determinant of left ventricular ejection fraction (LVEF). The coding system currently employed in clinical practice does not distinguish between rotational patterns. We propose an alternative coding system that makes possible to identify the rotational pattern of the LV and relate it to myocardial function. Echocardiographic images were used to generate speckle tracking-derived transmural global longitudinal strain (tGLS) and rotational parameters. The existence of twist (basal and apical rotations in opposite directions) is expressed as a rotational gradient with a positive value that is the sum of the basal and apical rotation angles. Conversely, when there is rigid rotation (basal and apical rotations in the same direction) the resulting gradient is assigned a negative value that is the subtraction between the two rotation angles. The rotational patterns were evaluated in 87 healthy subjects and 248 patients with LV hypertrophy (LVH) and contrasted with their myocardial function. Our approach allowed us to distinguish between the different rotational patterns. Twist pattern was present in healthy controls and 104 patients with LVH and normal myocardial function (tGLS ≥ 17%, both). Among 144 patients with LVH and myocardial dysfunction (tGLS < 17%), twist was detected in 83.3% and rigid rotation in 16.7%. LVEF was < 50% in 34.7%, and all patients with rigid rotation had a LVEF < 50%. The gradient rotational values showed a close relationship with LVEF (r = 0.73; p < 0.001). The proposed coding system allows us to identify the rotational patterns of the LV and to relate their values with LVEF.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Juan Geraldo
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Ildefonso Roldán
- Cardiology Department, Universitat de València, Hospital Universitario Dr Peset, Avda Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Ester Galiana
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Celia Gil
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Pablo Escribano
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Rosina Arbucci
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
| | - Alberto Hidalgo
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Paula Gramage
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Jorge Trainini
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
| | - Francesc Carreras
- Department of Cardiology, Hospital Sant Pau, 08025, Barcelona, Spain
| | - Jorge Lowenstein
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
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Fan L, Wang H, Kassab GS, Lee LC. Review of cardiac-coronary interaction and insights from mathematical modeling. WIREs Mech Dis 2024; 16:e1642. [PMID: 38316634 PMCID: PMC11081852 DOI: 10.1002/wsbm.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/10/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Cardiac-coronary interaction is fundamental to the function of the heart. As one of the highest metabolic organs in the body, the cardiac oxygen demand is met by blood perfusion through the coronary vasculature. The coronary vasculature is largely embedded within the myocardial tissue which is continually contracting and hence squeezing the blood vessels. The myocardium-coronary vessel interaction is two-ways and complex. Here, we review the different types of cardiac-coronary interactions with a focus on insights gained from mathematical models. Specifically, we will consider the following: (1) myocardial-vessel mechanical interaction; (2) metabolic-flow interaction and regulation; (3) perfusion-contraction matching, and (4) chronic interactions between the myocardium and coronary vasculature. We also provide a discussion of the relevant experimental and clinical studies of different types of cardiac-coronary interactions. Finally, we highlight knowledge gaps, key challenges, and limitations of existing mathematical models along with future research directions to understand the unique myocardium-coronary coupling in the heart. This article is categorized under: Cardiovascular Diseases > Computational Models Cardiovascular Diseases > Biomedical Engineering Cardiovascular Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Lei Fan
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Haifeng Wang
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, California, USA
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
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3
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McIntyre CW. Update on Hemodialysis-Induced Multiorgan Ischemia: Brains and Beyond. J Am Soc Nephrol 2024; 35:653-664. [PMID: 38273436 PMCID: PMC11149050 DOI: 10.1681/asn.0000000000000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Hemodialysis is a life-saving treatment for patients with kidney failure. However, patients requiring hemodialysis have a 10-20 times higher risk of cardiovascular morbidity and mortality than that of the general population. Patients encounter complications such as episodic intradialytic hypotension, abnormal perfusion to critical organs (heart, brain, liver, and kidney), and damage to vulnerable vascular beds. Recurrent conventional hemodialysis exposes patients to multiple episodes of circulatory stress, exacerbating and being aggravated by microvascular endothelial dysfunction. This promulgates progressive injury that leads to irreversible multiorgan injury and the well-documented higher incidence of cardiovascular disease and premature death. This review aims to examine the underlying pathophysiology of hemodialysis-related vascular injury and consider a range of therapeutic approaches to improving outcomes set within this evolved rubric..
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Affiliation(s)
- Christopher W McIntyre
- Lilibeth Caberto Kidney Clinical Research Unit, Lawson Health Research Institute, London, Ontario, Canada, and Departments of Medicine, Medical Biophysics and Pediatrics, Western University, London, Ontario, Canada
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4
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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Cardoso CB, Brandão CVS, Juliani PS, Filadelpho AL, Pereira GJ, Lourenço MLG, Hataka A, Padovani CR. Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study. Animals (Basel) 2023; 13:1996. [PMID: 37370507 DOI: 10.3390/ani13121996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1-G1) and medium to large (Group 2-G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals' weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.
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Affiliation(s)
- Catarina Borges Cardoso
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Cláudia Valéria Seullner Brandão
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Paulo Sérgio Juliani
- Cardiovascular Surgery Service, WeVets Veterinary Hospital, São Paulo 02511-000, SP, Brazil
| | - André Luis Filadelpho
- Institute of Biosciences, Department of Anatomy-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Geovane José Pereira
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Maria Lúcia Gomes Lourenço
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Carlos Roberto Padovani
- Institute of Biosciences, Department of Biostatistics-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
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6
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Mora V, Roldán I, Romero E, Saad A, Gil C, Contreras MB, Trainini J, Escribano P, Gimeno P, Arbucci R, Valls A, Lowenstein J. Myocardial Wringing and Rigid Rotation in Cardiac Amyloidosis. CJC Open 2023; 5:128-135. [PMID: 36880078 PMCID: PMC9984891 DOI: 10.1016/j.cjco.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background The motion of the heart is a result of the helicoidal arrangement of the myofibers in the organ's wall. We aimed to study the relationship between the wringing motion state and the degree of ventricular function in patients with cardiac amyloidosis (CA). Methods Fifty patients with CA and decreased global longitudinal strain (LS) were evaluated using 2-dimensional speckle-tracking echocardiography. We have expressed LS as positive values to facilitate understanding. Normal twist, which occurs when basal and apical rotations occur in opposite directions, was coded as positive. When the apex and base rotate in the same direction (rigid rotation), twist was coded as negative. Left ventricular (LV) wringing (calculated as twist/LS, which takes into account actions that occur simultaneously during LV systole [ie, longitudinal shortening and twist]) was evaluated according to LV ejection fraction (LVEF). Results Most of the patients (66%) who participated in the study were diagnosed with transthyretin amyloidosis. A positive relationship was observed between wringing and LVEF (r = 0.75, P < 0.0001). In advanced stages of ventricular dysfunction, rigid rotation appeared in 66.6% of patients with LVEF ≤ 40%, in whom negative values of twist and wringing were observed. LV wringing proved to be a good discriminator of LVEF (area under the curve 0.90, P < 0.001, 95% confidence interval 0.79-0.97); for example, wringing < 1.30°/% detected LVEF < 50% with 85.7% sensibility and 89.7% specificity. Conclusions Wringing, which integrates twist and simultaneous LV longitudinal shortening, is a conditioning rotational parameter of the degree of ventricular function in patients with CA.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Ildefonso Roldán
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Elena Romero
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Ariel Saad
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Celia Gil
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - M Belen Contreras
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Jorge Trainini
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Pablo Escribano
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Pau Gimeno
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Rosina Arbucci
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Amparo Valls
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Jorge Lowenstein
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
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7
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Garcia-Canadilla P, Mohun TJ, Bijnens B, Cook AC. Detailed quantification of cardiac ventricular myocardial architecture in the embryonic and fetal mouse heart by application of structure tensor analysis to high resolution episcopic microscopic data. Front Cell Dev Biol 2022; 10:1000684. [DOI: 10.3389/fcell.2022.1000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
The mammalian heart, which is one of the first organs to form and function during embryogenesis, develops from a simple tube into a complex organ able to efficiently pump blood towards the rest of the body. The progressive growth of the compact myocardium during embryonic development is accompanied by changes in its structural complexity and organisation. However, how myocardial myoarchitecture develops during embryogenesis remain poorly understood. To date, analysis of heart development has focused mainly on qualitative descriptions using selected 2D histological sections. High resolution episcopic microscopy (HREM) is a novel microscopic imaging technique that enables to obtain high-resolution three-dimensional images of the heart and perform detailed quantitative analyses of heart development. In this work, we performed a detailed characterization of the development of myocardial architecture in wildtype mice, from E14.5 to E18.5, by means of structure tensor analysis applied to HREM images of the heart. Our results shows that even at E14.5, myocytes are already aligned, showing a gradual change in their helical angle from positive angulation in the endocardium towards negative angulation in the epicardium. Moreover, there is gradual increase in the degree of myocardial organisation concomitant with myocardial growth. However, the development of the myoarchitecture is heterogeneous showing regional differences between ventricles, ventricular walls as well as between myocardial layers, with different growth patterning between the endocardium and epicardium. We also found that the percentage of circumferentially arranged myocytes within the LV significantly increases with gestational age. Finally, we found that fractional anisotropy (FA) within the LV gradually increases with gestational age, while the FA within RV remains unchanged.
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Zhang K, Kumar N, Alfirevic A, Sale S, You J, Bauer A, Duncan AE. Left Ventricular Twist Mechanics Before and After Aortic Valve Replacement: A Feasibility Study and Exploratory Analysis. Semin Cardiothorac Vasc Anesth 2022; 26:226-236. [PMID: 35848424 PMCID: PMC10156174 DOI: 10.1177/10892532221114791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. We examined whether intraoperative assessment of left ventricular (LV) twist mechanics is feasible with transesophageal echocardiography (TEE). We then explored whether twist mechanics were altered by hemodynamic conditions or patient comorbidities. Methods. In this sub-analysis of clinical trial data, transgastric short-axis echocardiographic images of the LV base and apex were collected in patients having aortic valve replacement (AVR) at baseline and end of surgery. Transvalvular gradients and LV systolic and diastolic function were assessed using two-dimensional (2D) and Doppler echocardiography. 2D speckle-tracking echocardiography was used for off-line analysis of LV twist, twisting rate, and untwisting rate. We examined the intraoperative change in twist mechanics before and after AVR. LV twist mechanics were also explored by diabetic status, need for coronary artery bypass grafting (CABG), and use of epinephrine/norepinephrine. Results. Of 40 patients, 16 patients had acceptable TEE images for off-line LV twist analysis. Baseline median [Q1, Q3] LV twist was 12 [7, 16]°, twisting rate was 72 [41, 97]°/sec, and untwisting rate was -91 [-154, -56]°/s. Median [Q1, Q3] change in LV twist at end of surgery was -2 [-5, 3]°, twisting rate was 7 [-33, 31]°/s, and untwisting rate was 0 [-11, 43]°/s. No difference was noted between diabetic and non-diabetic patients or AVR and AVR-CABG patients. Conclusion. LV twist was augmented in patients with aortic stenosis, though twist indices were not affected by reduced afterload, diabetes, or coronary artery disease. Intraoperative assessment of twist mechanics may provide unique information on LV systolic and diastolic function, though fewer than 50% of TEE examinations successfully assessed twist. Clinical Trial Registry. This work is a sub-analysis of a clinical trial, registered on ClinicalTrials.gov on August 19, 2010 (NCT01187329), Andra Duncan, Principal Investigator.
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Affiliation(s)
- Kan Zhang
- Anesthesiology Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Nikhil Kumar
- Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Andrej Alfirevic
- Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Shiva Sale
- Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Jing You
- Departments of Quantitative Health Sciences and Outcomes Research, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Bauer
- Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Andra E Duncan
- Department of Cardiothoracic Anesthesia, 2569Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Cleveland clinic, 2569Cleveland, OH, USA
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9
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Temporospatial characterization of ventricular wall motion with real-time cardiac magnetic resonance imaging in health and disease. Sci Rep 2022; 12:4070. [PMID: 35260729 PMCID: PMC8904443 DOI: 10.1038/s41598-022-08094-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/21/2022] [Indexed: 11/11/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) has been largely dependent on retrospective cine for data acquisition. Real-time imaging, although inferior in image quality to retrospective cine, is more informative about motion dynamics. We herein developed a real-time cardiac MRI approach to temporospatial characterization of left ventricle (LV) and right ventricle (RV) wall motion. This approach provided two temporospatial indices, temporal periodicity and spatial coherence, for quantitative assessment of ventricular function. In a cardiac MRI study, we prospectively investigated temporospatial characterization in reference to standard volumetric measurements with retrospective cine. The temporospatial indices were found to be effective for evaluating the difference of ventricular performance between the healthy volunteers and the heart failure (HF) patients (LV temporal periodicity 0.24 ± 0.037 vs. 0.14 ± 0.021; RV temporal periodicity 0.18 ± 0.030 vs. 0.10 ± 0.014; LV spatial coherence 0.52 ± 0.039 vs. 0.38 ± 0.040; RV spatial coherence 0.50 ± 0.036 vs. 0.35 ± 0.035; all in arbitrary unit). The HF patients and healthy volunteers were well differentiated in the scatter plots of spatial coherence and temporal periodicity while they were mixed in those of end-systolic volume (ESV) and ejection fraction (EF) from volumetric measurements. This study demonstrated the potential of real-time cardiac MRI for intricate analysis of ventricular function beyond retrospective cine.
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10
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Chen Z, Zhang S, Fang A, Shao J, Shen H, Sun B, Guo G, Liu L. Early changes in left ventricular myocardial function by 2D speckle tracking layer-specific technique in neonates with hyperbilirubinemia. Quant Imaging Med Surg 2022; 12:796-809. [PMID: 34993119 DOI: 10.21037/qims-21-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022]
Abstract
Background Hyperbilirubinemia (HBN) can cause myocardial injury in neonates. Advancement in myocardial deformation imaging allows the detection of subclinical changes in myocardial contractility. The present study aimed to evaluate the changes in left ventricular contractility in newborns with hyperbilirubinemia by 2D speckle tracking imaging (STI). Methods A group of 134 neonates who reached the diagnostic level of HBN as the HBN group was selected. The control group included 56 healthy newborns. The interventricular septum, anterior partition, anterior wall, sidewall, posterior wall, and inferior wall were separated into the basal, middle, and apical segments. In each segment, speckle tracking analysis was performed in the subintimal, middle, and subadventitial myocardium. The overall longitudinal strain of the myocardium in different ventricular walls and segments and global longitudinal strain (GLS) were computed. At the same time, the laboratory results of blood gas analysis, blood routine tests, liver function, and myocardial enzyme spectrum in HBN neonates were collected and correlated with the left ventricular stratified strain parameters. Results The gradient of the left ventricular GLS had the same characteristics in both groups of newborns. There was a decreasing trend of longitudinal strain (LS) from the intima to the adventitia (i.e., GLSendo > GLSmid > GLSepi). This gradient was also present in stratified LS in each myocardial segment (P<0.001). The LS showed an increasing trend from the basal to the apical segment (P<0.001). The LS of the ventricular septum, anterior wall (or anterior septum), inferior wall, lateral wall, and posterior wall showed a decreasing trend (P<0.001). Stratified strain parameters of the ventricular wall (i.e., the 3-layer myocardium: LSendo-SEPT, LSmid-SEPT, and LSepi-SEPT) were all significantly lower in the HBN group than in the control group (P=0.019, P=0.019, and P=0.023, respectively). LSedo-ANT, LSmid-ANT, and LSepi-ANT were also reduced, and the difference between LSendo-ANT and LSepi-ANT was statistically significant. The segmental stratified strain parameters (i.e., the apical 3-layer myocardium: LSepi-a, LSmid-a, and LSepi-a) decreased, and the difference in LSepi-a was statistically significant (P=0.043). Overall strain parameters (i.e., the 3-layer myocardial overall strain: GLSendo, GLSmid, and GLSepi) were reduced, but the difference was not statistically significant (P=0.612, P=0.653, and P=0.585, respectively). The subclinical changes in systolic function in the HBN group, reflected by the parameters of longitudinal myocardial strain, correlate to some extent with multiple results of laboratory tests. Conclusions 2DSTI stratified strain technology can quantitively evaluate changes in the LS of the left ventricle in different ventricular walls, wall segments, and layers of the myocardium.
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Affiliation(s)
- Zimian Chen
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Suming Zhang
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Aijuan Fang
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Jun Shao
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Hong Shen
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Bugao Sun
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Guanjun Guo
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Lei Liu
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
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11
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Coffin BD, Hudson AR, Lee A, Feinberg AW. FRESH 3D Bioprinting a Ventricle-like Cardiac Construct Using Human Stem Cell-Derived Cardiomyocytes. Methods Mol Biol 2022; 2485:71-85. [PMID: 35618899 DOI: 10.1007/978-1-0716-2261-2_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Here we describe a method to engineer a contractile ventricle-like chamber composed of human stem cell-derived cardiomyocytes using freeform reversible embedding of suspended hydrogels (FRESH) 3D bioprinting. To do this, we print a support structure using a collagen type I ink and a cellular component using a high-density cell ink supplemented with fibrinogen. The gelation of the collagen and the fibrinogen into fibrin is initiated by pH change and enzymatic crosslinking, respectively. Fabrication of the ventricle-like chamber is completed in three distinct phases: (i) materials preparation, (ii) bioprinting, and (iii) tissue maturation. In this protocol, we describe the method to print the construct from a high-density cell ink composed of human stem cell-derived cardiomyocytes and primary fibroblasts (~300 × 106 cells/mL) using our open-source dual-extruder bioprinter. Additional details are provided on FRESH support preparation, bioink preparation, dual-extruder needle alignment, print parameter selection, and post-processing. This protocol can also be adapted by altering the 3D model design, cell concentration, or cell type to FRESH 3D bioprint other cardiac tissue constructs.
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Affiliation(s)
- Brian D Coffin
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Andrew R Hudson
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Andrew Lee
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Adam W Feinberg
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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12
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Guven B, Mese T, Yilmazer MM, Ozdemir R, Demirpence S, Doksoz O. Right ventricular regional deformation analysis in patients operated for tetralogy of Fallot. Acta Cardiol 2021; 76:280-287. [PMID: 32077378 DOI: 10.1080/00015385.2020.1723880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed to compare the findings of a segmental speckle-tracking strain of right ventricle with those of cardiac magnetic resonance imaging in this setting. METHODS In 26 patients with operated tetralogy of Fallot (mean age, 15.35 ± 2.3 years; range 11-18 years), right ventricular segmental speckle-straining (the basal, mid, apical segments of right ventricular septum and lateral free wall, and right ventricular apex) were determined using two-dimensional echocardiography. The echocardiographic findings were compared to right ventricular ejection fraction, right ventricular indexed end-diastolic volume, indexed end-systolic volume and pulmonary regurgitation fraction at cardiac magnetic resonance. RESULTS Right ventricular global speckle strain was -18.6 ± 3.7and lateral free wall strain was -17.8 ± 4.9. Indexed right ventricular end diastolic volume was 171.7 ± 23.3 ml/m2, indexed right ventricular end systolic volume was 95.1 ± 35.0 ml/m2 and right ventricular ejection fraction was 44.76 ± 9.39%. Basal inferior septum is correlated with indexed right ventricular end-diastolic volume (RVEDV; r = -0.521, p = 0.015) and pulmonary regurgitation fraction (r = -0.584, p = 0.015). Cardiac magnetic resonance (CMR)-derived RVEDV is correlated with lateral free wall (r = -0.465, p = 0.034) and Global RV (r = 0.442, p = 0.045). CONCLUSION Right ventricular basal inferior septal and apical longitudinal strain correlates with the measures of right ventricular performance on CMR. These parameters would be useful to monitor right ventricular performance in patients after tetralogy of Fallot repair.
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Affiliation(s)
- Baris Guven
- Department of Pediatric Cardiology, Izmir Tepecik Training Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
| | - Timur Mese
- Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
| | - Murat Muhtar Yilmazer
- Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
| | - Rahmi Ozdemir
- Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
| | - Savas Demirpence
- Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
| | - Onder Doksoz
- Department of Pediatric Cardiology, Dr Behcet Uz Children’s Hospital, Medical Faculty, University of Health Sciences, Izmir, Turkey
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13
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Elshafey WEH, Al Khoufi EA, Elmelegy EK. Effects of Sacubitril/Valsartan Treatment on Left Ventricular Myocardial Torsion Mechanics in Patients with Heart Failure Reduced Ejection Fraction 2D Speckle Tracking Echocardiography. J Cardiovasc Echogr 2021; 31:59-67. [PMID: 34485030 PMCID: PMC8388327 DOI: 10.4103/jcecho.jcecho_118_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is calculated from volumetric change without representing true myocardial properties. Strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Sacubitril/valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). The effect of sacubitril/valsartan angiotensin receptor neprilysin inhibitor (ARNI) on left ventricular (LV) ejection fraction (EF) and torsion dynamics in HFrEF patients has not been previously described. METHODS The study involved 73 patients with HFrEF, for all patients Full history was taken, full clinical examination was done. Baseline vital signs, ECG, NYHA classification, conventional echocardiography and STE were done at baseline study and after 6 and 11 months.Basal and apical LV short-axis images were acquired for further off-line analysis. Using commercially available two-dimensional strain software, apical, basal rotation, and LV torsion were calculated. RESULTS ARNI group of patients showed improvement of symptoms, LV global longitudinal strain (LVGLS)% and diastolic parameters including, E/A, E/e', TV, untwist onset and rate after 6 months of therapy in comparison to the traditionally treated patients. The improvement continued for 11 months with in additional significant improvement of systolic parameters in the form of LVGLS%, EF%, Twist, Apical and basal rotations, main dependent parameters for improvement of EF% was LVGLS% and Apical rotation. CONCLUSION To the best of our knowledge, this is the first study to demonstrate that therapy with sacubitril/valsartan in HFrEF patients could create a state of gradual and chronic LV deloading which cause relieving of myocardial wall tensions and decreasing the LV end diastolic pressure this state could cause cardiac reverse remodeling and reestablishment of starling forces proprieties of LV myocardium, which lead to increase of LV EF.
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Affiliation(s)
- Wassam Eldin Hadad Elshafey
- Cardiology Department, Faculty of Medicine, Menoufia University, Menoufia University Hospital, Shebein El Koom, Egypt
| | - Emad Ali Al Khoufi
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ehab Kamal Elmelegy
- Cardiology Department, Shebein EL Koom Teaching Hospital, Shebein El Koom, Egypt
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14
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Mora V, Roldán I, Bertolín J, Faga V, Pérez-Gil MDM, Saad A, Serrats R, Callizo R, Arbucci R, Lowenstein J. Influence of Ventricular Wringing on the Preservation of Left Ventricular Ejection Fraction in Cardiac Amyloidosis. J Am Soc Echocardiogr 2021; 34:767-774. [PMID: 33744403 DOI: 10.1016/j.echo.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 12/03/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this work was to determine the influence of myocardial wringing on ventricular function in patients with cardiac amyloidosis (CA). METHODS Fifteen healthy volunteers (group 1) and 34 patients with CA (17 with left ventricular ejection fractions [LVEFs] ≥ 53% [group 2] and 17 with LVEFs < 53% [group 3]) were evaluated using two-dimensional speckle-tracking echocardiography. A control group of mass-matched patients (n = 20) with left ventricular (LV) hypertrophy and LVEFs ≥ 53% was also included. Longitudinal strain (LS), circumferential strain, and LV twist and torsion were calculated. Deformation index (DefI), a new parameter of wringing, calculated as twist/LS, that takes into account actions that occur simultaneously during LV systole (i.e., longitudinal shortening and twist), was evaluated. Torsional and wringing parameters were calculated according to LVEF. RESULTS Lower global values of LS and circumferential strain were observed among patients with CA (LS: group 1, -20.6 ± 2.5%; group 2, -11.6 ± 4.1%; group 3, -9.0 ± 3.1%; circumferential strain: group 1, -22.7 ± 4.9%; group 2, -14.4 ± 8.0%; group 3, -13.6 ± 3.8%; P < .001 for both). Torsion did not vary between group 2 and group 1 (2.5 ± 1.1°/cm vs 2.7 ± 0.8°/cm, P = NS). In contrast, DefI was greater in group 2 than in group 1 (-1.8 ± 0.8°/% vs -1.0 ± 0.3°/%, P < .01). Torsion and DefI were lower in group 3 (1.2 ± 0.7°/cm and -1.1 ± 0.6°/%, respectively, P < .001 for both) than in group 2. DefI was similar in patients with LV hypertrophy (-1.7 ± 0.6°/%, P = NS) and group 2. CONCLUSIONS In patients with CA, preservation of LVEF depends on greater ventricular wringing. DefI, a parameter that integrates the twist and the simultaneous longitudinal shortening of the left ventricle, is a more accurate indicator of the efficacy of this mechanism.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain.
| | - Ildefonso Roldán
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Javier Bertolín
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Valentina Faga
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | | | - Ariel Saad
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Rocío Serrats
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Ricardo Callizo
- Department of Cardiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Rosina Arbucci
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
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15
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Analysis of left ventricular rotational deformation by 2D speckle tracking echocardiography: a feasibility study in athletes. Int J Cardiovasc Imaging 2021; 37:2369-2386. [PMID: 33738612 PMCID: PMC8302535 DOI: 10.1007/s10554-021-02213-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
2D speckle tracking echocardiography (2DSTE) is established to analyse left ventricular (LV) longitudinal function. The analysis of LV rotational deformation is challenging and requires standardization of image acquisition as well as postprocessing analysis. The aim of this study was to test the feasibility to analyse LV rotational deformation using 2DSTE by introducing a novel algorithm for the detection of artefacts. The study was performed in 20 healthy subjects serving as a control group and in 53 competitive sportsmen. Circumferential, radial strain (CS, RS) and LV rotation were analysed by 2DSTE in parasternal short axis views. The stepwise algorithm to exclude potential artefacts starts with the visual estimation of the image quality with respect to complete visualization of all myocardial segments during the entire cardiac cycle followed by the exclusion of data sets in participants with conduction abnormalities. The next step is the optimization of tracking areas and a cross-check of implausible strain waveforms in multiple acquired comparable cineloops. The last step is the exclusion of strain curves with persisting implausible waveforms if standardization failures and incorrect LV wall tracking are fixed. Plausible physiological strain curves were observed in 89% (n = 65/73) of all subjects. In controls all implausible waveforms could be verified as artefacts. The algorithm was applied in 53 professional athletes to test and confirm its feasibility. Abnormal CS waveforms were documented in 25 athletes, verified as artefacts due to tracking failures in 22 athletes and due to incorrect image acquisition in 3 athletes. CS artefacts were mostly located in the basal posterior and lateral LV segments. (endocardial: 6%, n = 4/70; p < 0.05) and basal posterior (endocardial: 8%, n = 5/70; p < 0.05) segments were highly susceptible to artefacts. 2DSTE of parasternal short axis views to analyse circumferential and radial deformation as well as LV rotation is feasible in athletes. The proposed algorithm helps to avoid artefacts and might contribute to standardization of this technique. 2DSTE might provide an interesting diagnostic tool for the detection of viral myocarditis, e.g. in athletes.
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16
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Stöbe S, Hagendorff A, Gutberlet M, Tayal B. Myocardial Work: A Modern Tool to Detect Possible Compensation Mechanism of Deformation in Acute Myocarditis with Preserved Left Ventricular Function. J Cardiovasc Echogr 2021; 30:206-210. [PMID: 33828942 PMCID: PMC8021083 DOI: 10.4103/jcecho.jcecho_48_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/14/2020] [Accepted: 10/18/2020] [Indexed: 01/22/2023] Open
Abstract
The architecture of the myocardial fibers defines the different components of left ventricular (LV) contraction. Subendocardial layers are primarily responsible for longitudinal LV deformation and subepicardial layers for circumferential LV deformation. The specific analysis of the different components of LV deformation by echocardiography might offer new diagnostic options in patients with acute myocarditis (?IM). This case report focuses on specific pathological findings of regional LV deformation in a patient with IM and preserved LV systolic function.
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Affiliation(s)
- Stephan Stöbe
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | | | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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17
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Chandika P, Heo SY, Kim TH, Oh GW, Kim GH, Kim MS, Jung WK. Recent advances in biological macromolecule based tissue-engineered composite scaffolds for cardiac tissue regeneration applications. Int J Biol Macromol 2020; 164:2329-2357. [DOI: 10.1016/j.ijbiomac.2020.08.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
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18
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Wang X, Qiao W, Xiao Y, Sun L, Ren W. Experimental Research on the Evaluation of Left Ventricular Function by Layered Speckle Tracking in a Constrictive Pericarditis Rat Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2219-2229. [PMID: 32395834 DOI: 10.1002/jum.15333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/08/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In animal models with constrictive pericarditis (CP), detecting the function of cardiac systole by conventional noninvasive ultrasound is a challenge. We aimed to detect cardiac dysfunction in rat models with CP in the early stage by layered speckle tracking. METHODS We compared a rat CP model (n = 23, injected with a solution of 1-mg/mL lipopolysaccharides [0.5 mL] and a 10% talc suspension [0.5 mL]) with a control group (n = 20, no injection). After 8 weeks, conventional echocardiography and layered speckle tracking were used to assess the left ventricular structures and functions in the groups. RESULTS The global circumferential strain (CS) and longitudinal strain (LS) were decreased in the CP group (P < .05). The CS of the epicardial and middle layers in the CP group was decreased (P < .05), but the endocardial layer was not statistically different. The LS of the epicardial layer was decreased (P < .05), but the middle and endocardial layers were not statistically different. The global free-wall and septal-wall CS of the CP group was decreased (P < .05), mainly due to the decrease of CS of the epicardial and middle layers. The global free-wall LS of the CP group was decreased (P < .05), mainly due to the decrease of LS of the epicardial and middle layers. There were no significant differences between the groups in global LS of the septal wall. CONCLUSIONS In the early stage of CP, subepicardial myocardial damage precedes that of the subendocardial myocardium, and free-wall damage precedes that of the septal wall.
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Affiliation(s)
- Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Ultrasound, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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19
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Relationship between right and left ventricular diastolic dysfunction assessed by 2-dimensional speckle-tracking echocardiography in adults with repaired tetralogy of Fallot. Int J Cardiovasc Imaging 2020; 37:569-576. [PMID: 33006716 PMCID: PMC8702514 DOI: 10.1007/s10554-020-02045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
Several studies have reported a correlation between right ventricular (RV) and left ventricular (LV) systolic dysfunction in adults with repaired tetralogy of Fallot (TOF). However, data are lacking regarding the relationship between RV and LV diastolic dysfunction assessed by 2-dimensional speckle-tracking echocardiography. We studied 69 adults with repaired TOF (mean age 34 years, 61% male) who had been regularly followed up and had routinely undergone echocardiography. In addition to conventional echocardiography, global longitudinal strain (GLS) and early diastolic strain rate (SRe) of both ventricles were assessed using 2-dimensional speckle-tracking echocardiography. Results were compared with 30 age- and sex-matched controls. RV and LV GLS were decreased in TOF patients compared with controls (− 18.4 ± 3.3% vs. −23.5 ± 4.2%, p < 0.001 and − 16.0 ± 3.8% vs. −20.0 ± 3.0%, p < 0.001, respectively). RV and LV SRe were also decreased in TOF patients compared with controls (1.22 ± 0.34 sec− 1 vs. 1.47 ± 0.41 sec− 1, p = 0.003 and 1.29 ± 0.42 sec− 1 vs. 1.63 ± 0.42 sec− 1, p < 0.001, respectively). A correlation between RV and LV SRe was found in TOF patients (r = 0.43, p < 0.001) as well as between RV and LV GLS (r = 0.45, p < 0.001). Two-dimensional speckle-tracking echocardiography reveals subclinical RV and LV diastolic dysfunction in adults with repaired TOF. A correlation is observed between RV and LV diastolic dysfunction as well as between RV and LV systolic dysfunction.
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20
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Dejea H, Bonnin A, Cook AC, Garcia-Canadilla P. Cardiac multi-scale investigation of the right and left ventricle ex vivo: a review. Cardiovasc Diagn Ther 2020; 10:1701-1717. [PMID: 33224784 DOI: 10.21037/cdt-20-269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The heart is a complex multi-scale system composed of components integrated at the subcellular, cellular, tissue and organ levels. The myocytes, the contractile elements of the heart, form a complex three-dimensional (3D) network which enables propagation of the electrical signal that triggers the contraction to efficiently pump blood towards the whole body. Cardiovascular diseases (CVDs), a major cause of mortality in developed countries, often lead to cardiovascular remodeling affecting cardiac structure and function at all scales, from myocytes and their surrounding collagen matrix to the 3D organization of the whole heart. As yet, there is no consensus as to how the myocytes are arranged and packed within their connective tissue matrix, nor how best to image them at multiple scales. Cardiovascular imaging is routinely used to investigate cardiac structure and function as well as for the evaluation of cardiac remodeling in CVDs. For a complete understanding of the relationship between structural remodeling and cardiac dysfunction in CVDs, multi-scale imaging approaches are necessary to achieve a detailed description of ventricular architecture along with cardiac function. In this context, ventricular architecture has been extensively studied using a wide variety of imaging techniques: ultrasound (US), optical coherence tomography (OCT), microscopy (confocal, episcopic, light sheet, polarized light), magnetic resonance imaging (MRI), micro-computed tomography (micro-CT) and, more recently, synchrotron X-ray phase contrast imaging (SR X-PCI). Each of these techniques have their own set of strengths and weaknesses, relating to sample size, preparation, resolution, 2D/3D capabilities, use of contrast agents and possibility of performing together with in vivo studies. Therefore, the combination of different imaging techniques to investigate the same sample, thus taking advantage of the strengths of each method, could help us to extract the maximum information about ventricular architecture and function. In this review, we provide an overview of available and emerging cardiovascular imaging techniques for assessing myocardial architecture ex vivo and discuss their utility in being able to quantify cardiac remodeling, in CVDs, from myocyte to whole organ.
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Affiliation(s)
- Hector Dejea
- Paul Scherrer Institut, Villigen PSI, Villigen, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Anne Bonnin
- Paul Scherrer Institut, Villigen PSI, Villigen, Switzerland
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, UK
| | - Patricia Garcia-Canadilla
- Institute of Cardiovascular Science, University College London, London, UK.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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21
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Nishitani S, Torii N, Imai H, Haraguchi R, Yamada S, Takakuwa T. Development of Helical Myofiber Tracts in the Human Fetal Heart: Analysis of Myocardial Fiber Formation in the Left Ventricle From the Late Human Embryonic Period Using Diffusion Tensor Magnetic Resonance Imaging. J Am Heart Assoc 2020; 9:e016422. [PMID: 32993423 PMCID: PMC7792405 DOI: 10.1161/jaha.120.016422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Detection of the fiber orientation pattern of the myocardium using diffusion tensor magnetic resonance imaging lags ≈12 weeks of gestational age (WGA) behind fetal myocardial remodeling with invasion by the developing coronary vasculature (8 WGA). We aimed to use diffusion tensor magnetic resonance imaging tractography to characterize the evolution of fiber architecture in the developing human heart from the later embryonic period. Methods and Results Twenty human specimens (8–24 WGA) from the Kyoto Collection of Human Embryos and Fetuses, including specimens from the embryonic period (Carnegie stages 20–23), were used. Diffusion tensor magnetic resonance imaging data were acquired with a 7T magnetic resonance system. Fractional anisotropy and helix angle were calculated using standard definitions. In all samples, the fibers ran helically in an organized pattern in both the left and right ventricles. A smooth transmural change in helix angle values (from positive to negative) was detected in all 16 directions of the ventricles. This feature was observed in almost all small (Carnegie stage 23) and large samples. A higher fractional anisotropy value was detected at the outer side of the anterior wall and septum at Carnegie stage 20 to 22, which spread around the ventricular wall at Carnegie stage 23 and in the early fetal samples (11–12 WGA). The fractional anisotropy value of the left ventricular walls decreased in samples with ≥13 WGA, which remained low (≈0.09) in larger samples. Conclusions From the human late embryonic period (from 8 WGA), the helix angle arrangement of the myocardium is comparable to that of the adult, indicating that the myocardial structure blueprint, organization, and integrity are already formed.
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Affiliation(s)
- Saori Nishitani
- Human Health Science Graduate School of Medicine Kyoto University Kyoto Japan
| | - Narisa Torii
- Human Health Science Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hirohiko Imai
- Department of Systems Science Graduate School of Informatics Kyoto University Kyoto Japan
| | - Ryo Haraguchi
- Graduate School of Applied Informatics University of Hyogo Kobe Japan
| | - Shigehito Yamada
- Human Health Science Graduate School of Medicine Kyoto University Kyoto Japan.,Congenital Anomaly Research Center Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tetsuya Takakuwa
- Human Health Science Graduate School of Medicine Kyoto University Kyoto Japan
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22
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Stöbe S, Richter S, Seige M, Stehr S, Laufs U, Hagendorff A. Echocardiographic characteristics of patients with SARS-CoV-2 infection. Clin Res Cardiol 2020; 109:1549-1566. [PMID: 32803387 PMCID: PMC7428201 DOI: 10.1007/s00392-020-01727-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 12/25/2022]
Abstract
Background Myocardial involvement induced by SARS-CoV-2 infection might be important for long-term prognosis. The aim of this observational study was to characterize the myocardial effects during SARS-CoV-2 infections by echocardiography. Results and methods An extended echocardiographic image acquisition protocol was performed in 18 patients with SARS-CoV-2 infection assessing LV longitudinal, radial, and circumferential deformation including rotation, twist, and untwisting. Furthermore, LV deformation was analyzed in an age-matched control group of healthy individuals (n = 20). The most prevalent finding was a reduced longitudinal strain observed predominantly in more than one basal LV segment (n = 10/14 patients, 71%). This pattern reminded of a “reverse tako-tsubo” morphology that is not typical for other viral myocarditis. Additional findings included a biphasic pattern with maximum post-systolic or negative regional radial strain predominantly basal (n = 5/14 patients, 36%); the absence or dispersion of basal LV rotation (n = 6/14 patients, 43%); a reduced or positive regional circumferential strain in more than one segment (n = 7/14 patients, 50%); a net rotation showing late post-systolic twist or biphasic pattern (n = 8/14 patients, 57%); a net rotation showing polyphasic pattern and/or higher maximum net values during diastole (n = 8/14 patients, 57%). Conclusion Myocardial involvement due to SARS-CoV-2-infection was highly prevalent in the present cohort—even in patients with mild symptoms. It appears to be characterized by specific speckle tracking deformation abnormalities in the basal LV segments. These data set the stage to prospectively test whether these parameters are helpful for risk stratification and for the long-term follow-up of these patients.
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Affiliation(s)
- Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Sarah Richter
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Röntgenstr. 1, 06129, Halle (Saale), Germany
| | - Markus Seige
- Department of Internal Medicine I, Martha-Maria Hospital Halle-Dölau, Röntgenstr. 1, 06129, Halle (Saale), Germany
| | - Sebastian Stehr
- Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Ulrich Laufs
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
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23
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Zhai YN, Li AL, Tao XC, Xie WM, Wan J, Zhang Y, Zhai ZG, Liu M. Regional right ventricular longitudinal systolic strain for detection of severely impaired right ventricular performance in pulmonary hypertension. Echocardiography 2020; 37:592-600. [PMID: 32240547 DOI: 10.1111/echo.14639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Right ventricular (RV) function is identified as a key determinant of the outcome in patients with pulmonary hypertension (PH). Several studies have assessed the role of peak global longitudinal RV strain in PH patients; however, less emphasis was given to the RV regional longitudinal strain. The aim of this study was to evaluate the regional RV systolic strain in PH patients and investigate the relationship of these parameters with the severity of PH. METHODS RV regional longitudinal peak systolic strain (LPSS) and strain rate (LPSSR) were measured using speckle tracking echocardiography on 100 patients with PH who underwent right heart catheterization, and 29 control subjects. Severe PH was identified by a decreased cardiac index (CI) (<2.0 L/min/m2 ). RESULTS LPSS and LPSSR of the RV free wall were significantly lower in PH patients than control subjects, especially when comparing the basal and mid regions (P < .001). When comparing severe PH and nonsevere PH, basal and mid LPSS and LPSSR were significantly lower (P < .001). RV free wall mid LPSSR correlated with CI (r = -.703, P < .001). In the multiple logistic regression analysis, mid LPSSR was identified as an independent predictor of severe PH (odds ratio 1.82; 95% confidential interval 1.39-2.40; P < .001). In the receiver operating characteristics curve analysis, a cutoff value of mid LPSSR of -0.92 s-1 predicted severe PH, with a sensitivity and specificity of 75.0% and 93.7%, respectively (AUC = 0.889, P < .001). CONCLUSIONS RV free wall mid longitudinal peak systolic strain rate may be useful for the detection of severely impaired RV performance in PH.
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Affiliation(s)
- Ya-Nan Zhai
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Ai-Li Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xin-Cao Tao
- Department of Respiratory and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wan-Mu Xie
- Department of Respiratory and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wan
- Department of Respiratory and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yu Zhang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Guo Zhai
- Department of Respiratory and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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24
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Severino P, Maestrini V, Mariani MV, Birtolo LI, Scarpati R, Mancone M, Fedele F. Structural and myocardial dysfunction in heart failure beyond ejection fraction. Heart Fail Rev 2020; 25:9-17. [PMID: 31317296 PMCID: PMC6985184 DOI: 10.1007/s10741-019-09828-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure is a multifaceted syndrome addressing for a high rate of death among the general population. The common approach to this disease has been always based on the evaluation of the left ventricular ejection fraction by two-dimensional echocardiography with Simpson's method. Mounting evidences have demonstrated the pitfalls of this method and have suggested that the management of heart failure requires a deep knowledge of the pathophysiological insights of the disease and cannot rely only on the evaluation of the left ventricular ejection fraction. Several advanced imaging technologies overwhelm the evaluation of ejection fraction and could provide a better understanding of the myocardial abnormalities underlying heart failure. Considering the limitation of left ventricular ejection fraction and the systemic involvement of heart failure, classifications of heart failure based on ejection fraction should be substituted with a comprehensive "staging" of multiorgan damage, not only considering the heart but also the lungs, kidneys, and liver, such as the HLM staging system. Such a holistic approach based on the HLM staging system and multimodality imaging can provide a global assessment of patient features allowing for targeted therapies and better heart failure management.
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Affiliation(s)
- Paolo Severino
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Viviana Maestrini
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Rossana Scarpati
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
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25
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Maher E, Elshehaby W, El Amrousy D, El Razaky O. Left Ventricular Layer-Specific Myocardial Strains in Children with Recovered Primary Dilated Cardiomyopathy: What Lies Beneath the Iceberg? Pediatr Cardiol 2020; 41:101-107. [PMID: 31680221 DOI: 10.1007/s00246-019-02228-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023]
Abstract
We aimed to detect residual cardiac dysfunction-if any-in children with recovered primary dilated cardiomyopathy (DCM) by using the left ventricular (LV) layer-specific myocardial strains. Fifty children with recovered primary DCM both clinically and echocardiographically were included as the patient group. Fifty healthy children of matched age and sex served as the control group. Echocardiographic evaluation was performed for all included children in the form of conventional echocardiography, tissue Doppler imaging (TDI), two-dimensional speckle tracking echocardiography (2D-STE), and LV layer-specific myocardial strain. Both LV systolic and diastolic functions measured by conventional echocardiography were similar in children with recovered DCM and the control group. There was a significant reduction in LV systolic and diastolic functions measured by TDI in the patient group. Moreover, there was a significant reduction of LV global longitudinal systolic strain (GLSS) by 2D-STE in children with recovered DCM. Interestingly, there was a significant reduction of LV layer-specific myocardial strain from endocardium to epicardium in children with recovered DCM compared to the healthy control. There was a significant positive correlation between different layer-specific myocardial strains and LV GLSS, LV ejection fraction, and LV peak systolic velocity. Left ventricular layer-specific myocardial strain can be a promising tool for early identifications of LV dysfunction in children with DCM. Subtle cardiac dysfunction is present in patients with recovered DCM, so long-term follow-up is recommended in these patients.
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Affiliation(s)
- Enas Maher
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | | | - Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt.
| | - Osama El Razaky
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
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26
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Pagano F, Picchio V, Chimenti I, Sordano A, De Falco E, Peruzzi M, Miraldi F, Cavarretta E, Zoccai GB, Sciarretta S, Frati G, Marullo AGM. On the Road to Regeneration: "Tools" and "Routes" Towards Efficient Cardiac Cell Therapy for Ischemic Cardiomyopathy. Curr Cardiol Rep 2019; 21:133. [PMID: 31673821 DOI: 10.1007/s11886-019-1226-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Cardiac regenerative medicine is a field bridging together biotechnology and surgical science. In this review, we present the explored surgical roads to cell delivery and the known effects of each delivery method on cell therapy efficiency. We also list the more recent clinical trials, exploring the safety and efficacy of delivery routes used for cardiac cell therapy approaches. RECENT FINDINGS There is no consensus in defining which way is the most suitable for the delivery of the different therapeutic cell types to the damaged heart tissue. In addition, it emerged that the "delivery issue" has not been systematically addressed in each clinical trial and for each and every cell type capable of cardiac repair. Cardiac damage occurring after an ischemic insult triggers a cascade of cellular events, eventually leading to heart failure through fibrosis and maladaptive remodelling. None of the pharmacological or medical interventions approved so far can rescue or reverse this phenomenon, and cardiovascular diseases are still the leading cause of death in the western world. Therefore, for nearly 20 years, regenerative medicine approaches have focused on cell therapy as a promising road to pursue, with numerous preclinical and clinical testing of cell-based therapies being studied and developed. Nonetheless, consistent clinical results are still missing to reach consensus on the most effective strategy for ischemic cardiomyopathy, based on patient selection, diagnosis and stage of the disease, therapeutic cell type, and delivery route.
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Affiliation(s)
- Francesca Pagano
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Vittorio Picchio
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
| | - Isotta Chimenti
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Alessia Sordano
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
| | - Elena De Falco
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | | | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Latina, Italy
| | - Elena Cavarretta
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Sebastiano Sciarretta
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giacomo Frati
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Antonino G M Marullo
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
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27
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Sun X, Zhao B, Chen Y, Pan M, Wang B, Peng X. Preliminary results analysis for left ventricular systolic function in normal fetuses by automated cardiac motion quantitation. J Matern Fetal Neonatal Med 2019; 34:2701-2709. [PMID: 31599167 DOI: 10.1080/14767058.2019.1670810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fetal heart evaluation has been proven to have the utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. The purpose of this study is to introduce a novel method that can measure the global and regional longitudinal strain of left ventricle in fetuses, described as automated cardiac motion quantitation (aCMQ). Furthermore, to evaluate the feasibility and value of aCMQ. METHODS A cross-sectional study was conducted in 138 fetuses with normal heart structure, then were divided into four groups by gestational age, standard four-chamber view clips were collected, the global and segmental longitudinal peak systolic strain of the left ventricle were measured by aCMQ, interobserver and intraobserver variability was analyzed. RESULTS The success rate of aCMQ analysis was 90.6% (125/138). aCMQ can obtain more comprehensive data to evaluate fetal cardiac function by on-line analysis, including the left ventricular end-systolic volume (LVESV, 0.64 ± 0.16 ml), the left ventricular end-diastolic volume (LVEDV, 0.85 ± 0.35 ml), strain and so on. There was no significant correlation between the gestational age and the global and segmental longitudinal peak strain of the left ventricle (all p > .05). The base and middle segmental strain values of left ventricular free wall were similar to those of the interventricular septum. No significant differences were found in base segments and middle segments for left ventricular free wall (LVLW) and the interventricular septum (IVS) (p > .05). The strain of the apex segment was higher than that of the base and middle segment (p < .05), and there were significant differences between the apex and the base and the middle (p < .05). Interobserver and intraobserver variability showed a small bias among the observers. CONCLUSIONS The global and regional strain values of fetus have no correlation with gestational ages, and the strain values of apical segment are higher than those of basal and middle segments. The base and middle segmental strain values of left ventricular free wall were similar to those of the interventricular septum. aCMQ is a novel method of two dimensional speckle tracking echocardiography to assess the global and regional systolic function of fetuses. It's a feasible and reproducible approach to evaluate normal cardiac function of fetus quantitatively and may have potential in fetuses with congenital heart diseases.
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Affiliation(s)
- Xiaolu Sun
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Bowen Zhao
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Yan Chen
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Mei Pan
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Bei Wang
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Xiaohui Peng
- Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Technical Guidance Center for Fetal Echocardiography of Zhejiang Province & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
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28
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Cui H, Wu Y, Wei S, Gao C, Jiang S. The Pacopexy procedure for left ventricular aneurysm: a 10-year clinical experience. Surg Today 2019; 50:134-143. [PMID: 31515619 DOI: 10.1007/s00595-019-01870-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate our 10-year clinical experience of performing the Pacopexy procedure for left ventricular aneurysm (LVA). METHODS Between January, 1998 and November, 2015, a cohort of 92 patients with LVA underwent surgery to reshape the left ventricle. Fifty-seven patients underwent the Dor procedure and 35 underwent the Pacopexy procedure to emphasize the conical shape, whereby patch placement followed an oblique trajectory between the left ventricular apex and the septum below the aortic valve. RESULTS The early-mortality rate was 4.34% (4/92; n = 2 in each group). The 10-year survival rate was 70.4 ± 7.9% in the Pacopexy group vs 41.7 ± 7.2% in the Dor group (p < 0.05), and the rate of freedom from hospital re-admission for heart failure (HF) or cardiac death was 60.0 ± 8.6% vs 28.8 ± 6.8%, respectively (p < 0.05). The Dor procedure and left ventricular end systolic volume index (LVESVI) ≥ 60 ml/m2 were strongly and significantly associated with long-term mortality and hospital re-admission for HF. CONCLUSIONS The Pacopexy procedure is a reproducible surgical option for the treatment of LVA. The improved configuration achieved by the Pacopexy procedure has resulted in good long-term survival and a high degree of freedom from re-admission for HF in patients with advanced LVA.
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Affiliation(s)
- Huimin Cui
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yuanbin Wu
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Shengli Jiang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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29
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Fan Y, Ronan W, Teh I, Schneider JE, Varela CE, Whyte W, McHugh P, Leen S, Roche E. A comparison of two quasi-static computational models for assessment of intra-myocardial injection as a therapeutic strategy for heart failure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3213. [PMID: 31062508 DOI: 10.1002/cnm.3213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
Myocardial infarction, or heart attack, is the leading cause of mortality globally. Although the treatment of myocardial infarct has improved significantly, scar tissue that persists can often lead to increased stress and adverse remodeling of surrounding tissue and ultimately to heart failure. Intra-myocardial injection of biomaterials represents a potential treatment to attenuate remodeling, mitigate degeneration, and reverse the disease process in the tissue. In vivo experiments on animal models have shown functional benefits of this therapeutic strategy. However, a poor understanding of the optimal injection pattern, volume, and material properties has acted as a barrier to its widespread clinical adoption. In this study, we developed two quasistatic finite element simulations of the left ventricle to investigate the mechanical effect of intra-myocardial injection. The first model employed an idealized left ventricular geometry with rule-based cardiomyocyte orientation. The second model employed a subject-specific left ventricular geometry with cardiomyocyte orientation from diffusion tensor magnetic resonance imaging. Both models predicted cardiac parameters including ejection fraction, systolic wall thickening, and ventricular twist that matched experimentally reported values. All injection simulations showed cardiomyocyte stress attenuation, offering an explanation for the mechanical reinforcement benefit associated with injection. The study also enabled a comparison of injection location and the corresponding effect on cardiac performance at different stages of the cardiac cycle. While the idealized model has lower fidelity, it predicts cardiac function and differentiates the effects of injection location. Both models represent versatile in silico tools to guide optimal strategy in terms of injection number, volume, site, and material properties.
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Affiliation(s)
- Yiling Fan
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - William Ronan
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Claudia E Varela
- Institute for Medical Engineering Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts
| | - William Whyte
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland (RCSI), Dublin, 2, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin (TCD), College Green, Dublin, 2, Ireland
- Advanced Materials and BioEngineering Research (AMBER) Centre, RCSI, NUIG & TCD, Dublin, 2, Ireland
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts
| | - Peter McHugh
- Biomechanics Research Centre, Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Sean Leen
- Mechanical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Ellen Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
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30
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Garcia-Canadilla P, Dejea H, Bonnin A, Balicevic V, Loncaric S, Zhang C, Butakoff C, Aguado-Sierra J, Vázquez M, Jackson LH, Stuckey DJ, Rau C, Stampanoni M, Bijnens B, Cook AC. Complex Congenital Heart Disease Associated With Disordered Myocardial Architecture in a Midtrimester Human Fetus. Circ Cardiovasc Imaging 2019; 11:e007753. [PMID: 30354476 DOI: 10.1161/circimaging.118.007753] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In the era of increasingly successful corrective interventions in patients with congenital heart disease (CHD), global and regional myocardial remodeling are emerging as important sources of long-term morbidity/mortality. Changes in organization of the myocardium in CHD, and in its mechanical properties, conduction, and blood supply, result in altered myocardial function both before and after surgery. To gain a better understanding and develop appropriate and individualized treatment strategies, the microscopic organization of cardiomyocytes, and their integration at a macroscopic level, needs to be completely understood. The aim of this study is to describe, for the first time, in 3 dimensions and nondestructively the detailed remodeling of cardiac microstructure present in a human fetal heart with complex CHD. METHODS AND RESULTS Synchrotron X-ray phase-contrast imaging was used to image an archival midgestation formalin-fixed fetal heart with right isomerism and complex CHD and compare with a control fetal heart. Analysis of myocyte aggregates, at detail not accessible with other techniques, was performed. Macroanatomic and conduction system changes specific to the disease were clearly observable, together with disordered myocyte organization in the morphologically right ventricle myocardium. Electrical activation simulations suggested altered synchronicity of the morphologically right ventricle. CONCLUSIONS We have shown the potential of X-ray phase-contrast imaging for studying cardiac microstructure in the developing human fetal heart at high resolution providing novel insight while preserving valuable archival material for future study. This is the first study to show myocardial alterations occur in complex CHD as early as midgestation.
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Affiliation(s)
- Patricia Garcia-Canadilla
- Institute of Cardiovascular Science (P.G.-C., A.C.C.), University College London, United Kingdom.,Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (P.G.-C., C.Z., C.B., B.B.)
| | - Hector Dejea
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland (H.D., A.B., M.S.).,Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland (H.D., M.S.)
| | - Anne Bonnin
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland (H.D., A.B., M.S.)
| | - Vedrana Balicevic
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia (V.B., S.L.)
| | - Sven Loncaric
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia (V.B., S.L.)
| | - Chong Zhang
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (P.G.-C., C.Z., C.B., B.B.)
| | - Constantine Butakoff
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (P.G.-C., C.Z., C.B., B.B.)
| | - Jazmin Aguado-Sierra
- Barcelona Supercomputing Center-Centro Nacional de Supercomputación, Campus Nord Universitat Politecnica de Catalunya, Barcelona, Spain (J.A.-S., M.V.)
| | - Mariano Vázquez
- Barcelona Supercomputing Center-Centro Nacional de Supercomputación, Campus Nord Universitat Politecnica de Catalunya, Barcelona, Spain (J.A.-S., M.V.).,IIIA-CSIC, Bellaterra, Spain (M.V.)
| | - Laurence H Jackson
- Division of Medicine, Centre for Advanced Biomedical Imaging (L.H.J., D.J.S.), University College London, United Kingdom
| | - Daniel J Stuckey
- Division of Medicine, Centre for Advanced Biomedical Imaging (L.H.J., D.J.S.), University College London, United Kingdom
| | - Cristoph Rau
- Diamond Manchester Imaging Branchline (I13-2), Diamond Lightsource, Oxford, United Kingdom (C.R.)
| | - Marco Stampanoni
- Swiss Light Source, Paul Scherrer Institut, Villigen, Switzerland (H.D., A.B., M.S.).,Institute for Biomedical Engineering, ETH Zurich, Zurich, Switzerland (H.D., M.S.)
| | - Bart Bijnens
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (P.G.-C., C.Z., C.B., B.B.).,Institución Catalana de Investigación y Estudios Avanzados, Barcelona, Spain (B.B.)
| | - Andrew C Cook
- Institute of Cardiovascular Science (P.G.-C., A.C.C.), University College London, United Kingdom
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31
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Enriquez A, Briceno D, Tapias C, Shirai Y, Muser D, Liang J, Hayashi T, Santangeli P, Frankel DS, Supple GE, Schaller RD, Arkles J, Rodriguez D, Callans DJ, Marchlinski FE, Saenz L, Garcia FC. Ischemic ventricular tachycardia from below the posteromedial papillary muscle, a particular entity: Substrate characterization and challenges for catheter ablation. Heart Rhythm 2019; 16:1174-1181. [DOI: 10.1016/j.hrthm.2019.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 11/16/2022]
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32
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In Memoriam. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Liu W, Li Y, Wang W, Li J, Cong J. Layer-specific longitudinal strain analysis by speckle tracking echocardiography in women with early and late onset preeclampsia. Pregnancy Hypertens 2019; 17:172-177. [PMID: 31487637 DOI: 10.1016/j.preghy.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Weinai Liu
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yong Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Wugang Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Junfang Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Juan Cong
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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The impact of right ventricular function on prognosis in patients with stage III non-small cell lung cancer after concurrent chemoradiotherapy. Int J Cardiovasc Imaging 2019; 35:1009-1017. [DOI: 10.1007/s10554-019-01590-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
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35
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Xu TY, Yang Y, Li JJ, Li Y, Wang JG. Left ventricular deformation in relation to the geometric pattern in hypertensive patients. Medicine (Baltimore) 2019; 98:e14257. [PMID: 30681621 PMCID: PMC6358350 DOI: 10.1097/md.0000000000014257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to evaluate left ventricular deformation in relation to the geometric pattern in hypertensive patients with normal left ventricular ejection fraction using speckle tracking echocardiography (STE).Transthoracic echocardiography was performed in 80 hypertensive patients and 50 age- and gender-matched normotensive subjects. Left ventricular geometric pattern was defined according to left ventricular mass index and relative wall thickness as normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. Quantitative measurements of longitudinal, circumferential, and radial strain were performed for endocardial, middle, and epicardial layers of the left ventricular wall at each segment.The longitudinal strain in hypertension was lower for all 3 layers in concentric (n = 20) and eccentric hypertrophy (n = 20) than normotensive subjects (n = 50, P < .01). It was also significantly lower for the endocardial layer in concentric remodeling (n = 20, P = .04 vs normotensive subjects). The circumferential strain in hypertension was higher in normal geometry or concentric remodeling, lower in concentric hypertrophy, and at similar level in eccentric hypertrophy, in comparison with normotensive subjects. The difference from normotensive subjects was statistically significant for the endocardial and middle layers in normal geometry (P < .03), for the endocardial layer in concentric remodeling (P < .02), and for the middle and epicardial layers in concentric hypertrophy (P≤.001). The radial strain and twist did not differ between normotensive and hypertensive subjects (P > .08).Left ventricular deformation in hypertension occurs with various geometric patterns disproportionately in the endocardial, middle and epicardial layers and differently in the longitudinal and circumferential orientations.
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Sun JP, Xu TY, Ni XD, Yang XS, Hu JL, Wang SC, Li Y, Bahler RC, Wang JG. Echocardiographic strain in hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy. Echocardiography 2018; 36:257-265. [PMID: 30561121 DOI: 10.1111/echo.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The myocardial structure differs between secondary left ventricular hypertrophy (LVH) and hypertrophic cardiomyopathy (HCM). We investigated left ventricular function of these two types of hypertrophy using multilayer strain analysis with two-dimensional echocardiography. METHODS Transthoracic echocardiography (Vivid-E9) was performed in 240 patients with preserved left ventricular ejection fraction (LVEF ≥50%) and with either HCM (n = 80, 63 men, age 49.8 ± 14.1 years), hypertensive LVH (n = 80, 63 men, age 51.4 ± 13.3 years) or normal blood pressure and left ventricular structure (n = 80, 63 men, 50.8 ± 12.4 years). Quantitative multilayer longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were analyzed. The ratio of endo-/epi-myocardial strain was calculated. RESULTS Longitudinal strain was significantly (P < 0.001) lower in HCM patients than normal controls (15.2 ± 4.2% vs 23.1 ± 2.7%), especially in hypertrophic segments (14.5 ± 4.4% vs 17.2 ± 3.2% in nonhypertrophic segments, P < 0.01). LS was lower in patients with hypertensive LVH, similarly in all left ventricular segments (20.7 ± 3.7%, P < 0.001 vs controls). CS was lower in the mid- and epicardium (P < 0.01), but not endocardium in HCM (P = 0.4), and preserved in all myocardial layers in hypertensive LVH. The endo-/epi-myocardial ratios of both LS and CS were higher in HCM than hypertensive LVH (P < 0.01). RS was higher (P < 0.01) in HCM than hypertensive LVH and controls. Endocardial CS and global RS were correlated with LVEF (r ≥ 0.32, P < 0.01). CONCLUSIONS Hypertrophic cardiomyopathy patients had marked reductions in LS and CS, whereas patients with hypertensive LVH had less reduction in LS and preserved CS. The increased endo-/epi-myocardial ratios of LS and CS may be useful in differentiating HCM from hypertensive LVH.
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Affiliation(s)
- Jing-Ping Sun
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting-Yan Xu
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xian-Da Ni
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing-Sheng Yang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun-Li Hu
- Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Shao-Chun Wang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Li
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Robert C Bahler
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ji-Guang Wang
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Influence of fiber connectivity in simulations of cardiac biomechanics. Int J Comput Assist Radiol Surg 2018; 14:63-72. [DOI: 10.1007/s11548-018-1849-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
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38
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Mora V, Roldán I, Romero E, Romero D, Bertolín J, Ugalde N, Pérez-Olivares C, Rodriguez-Israel M, Pérez-Gozalbo J, Lowenstein JA. Comprehensive assessment of left ventricular myocardial function by two-dimensional speckle-tracking echocardiography. Cardiovasc Ultrasound 2018; 16:16. [PMID: 30223828 PMCID: PMC6142420 DOI: 10.1186/s12947-018-0135-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) results from the combined action of longitudinal and circumferential contraction, radial thickening, and basal and apical rotation. The study of these parameters together may lead to an accurate assessment of the cardiac function. Methods Ninety healthy volunteers, categorized by gender and age (≤ 55 and > 55 years), were evaluated using two-dimensional speckle tracking echocardiography. Transversal views of the left ventricle (LV) were obtained to calculate circumferential strain and left ventricular twist, while three apical views were obtained to determine longitudinal strain (LS) and mitral annular plane systolic excursion (MAPSE). We established the integral myocardial function of the LV according to: 1. The Combined Deformation Parameter (CDP), which includes Deformation Product (DP) - Twist x LS (° x %) - and Deformation Index (DefI) -Twist / LS (° / %)-; and 2. the Torsion Index (TorI): Twist / MAPSE (° / cm). Results The mean age of our patients was 50.3 ± 11.1 years. CDP did not vary with gender or age. The average DP was − 432 ± 172 ° x %, and the average DefI was − 0.96 ± 0.36 ° / %. DP provides information about myocardial function (normal, pseudonormal, depressed), and the DefI quotient indicates which component (s) is/are affected in cases of abnormality. TorI was higher in volunteers over 55 years (16.5 ± 15.2 vs 13.1 ± 5.0 °/cm, p = 0.003), but did not vary with gender. Conclusions The proposed parameters integrate values of twisting and longitudinal shortening. They allow a complete physiological assessment of cardiac systolic function, and could be used for the early detection and characterization of its alteration.
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Affiliation(s)
- Vicente Mora
- Cardiology Department, Hospital Dr Peset, Valencia, Spain.
| | | | - Elena Romero
- Cardiology Department, Hospital Dr Peset, Valencia, Spain
| | - Diana Romero
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
| | | | - Natalia Ugalde
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Jorge A Lowenstein
- Cardiodiagnosis Department Medical Research of Buenos Aires, Buenos Aires, Argentina
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Xu L, Wang N, Chen X, Liang Y, Zhou H, Yan J. Quantitative evaluation of myocardial layer-specific strain using two-dimensional speckle tracking echocardiography among young adults with essential hypertension in China. Medicine (Baltimore) 2018; 97:e12448. [PMID: 30278524 PMCID: PMC6181480 DOI: 10.1097/md.0000000000012448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022] Open
Abstract
The myocardial wall of the left ventricle is a complex, multilayered structure, which is altered in young adults with hypertension. The aim of this study was to define the characteristics of longitudinal and circumferential strain in young adults with hypertension.Two-dimensional speckle tracking echocardiography was used to analyze longitudinal and circumferential strain parameters in 67 young adults with hypertension, 70 older young adults with essential hypertension and 62 healthy adults.The global longitudinal strain (GLS) and global circumferential strain (GCS) was the highest at endocardium, and lowest at epicardium. A layer-specific analysis of myocardial deformation in all adults revealed that all of the peak systolic longitudinal strain (LS) and the peak systolic circumferential strain (CS) in the endocardium, mid-myocardium and epicardium were gradually increased from the base to the apex. The peak systolic LS showed significant differences at basal, mid-ventricular, and apical level among normal adults, young NLVH (nonleft ventricular hypertrophy), and young LVH (left ventricular hypertrophy). In all the adults with hypertension, young adults were associated with higher peak systolic longitudinal strain values compared with older adults, but the small differences of LS may be meaningless in clinical settings. Between the young LVH and older LVH, the peak systolic CS showed significant differences except data of epicardium at basal and mid-ventricular level.This study provides reference values for layer-specific strain in young adults with hypertension. This detailed strain analysis provides layer-oriented information to reveal the different characteristics of circumferential and longitudinal strain in young adults with hypertension. This systolic dysfunction could be detected conveniently and accurately by 2DSTE.
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Affiliation(s)
- Liangjie Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University
| | - Ning Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University
| | - Xinxin Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University
| | - Yi Liang
- Department of Cardiology, Affiliated Hospital of Jiangsu University
| | - Hong Zhou
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University
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40
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Mora V, Roldán I, Romero E, Saurí A, Romero D, Pérez-Gozalbo J, Ugalde N, Bertolín J, Rodriguez-Israel M, Delgado CPO, Lowenstein JA. Myocardial Contraction during the Diastolic Isovolumetric Period: Analysis of Longitudinal Strain by Means of Speckle Tracking Echocardiography. J Cardiovasc Dev Dis 2018; 5:E41. [PMID: 30096870 PMCID: PMC6162423 DOI: 10.3390/jcdd5030041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND According to the ventricular myocardial band model, the diastolic isovolumetric period is a contraction phenomenon. Our objective was to employ speckle-tracking echocardiography (STE) to analyze myocardial deformation of the left ventricle (LV) and to confirm if it supports the myocardial band model. METHODS This was a prospective observational study in which 90 healthy volunteers were recruited. We evaluated different types of postsystolic shortening (PSS) from an LV longitudinal strain study. Duration of latest deformation (LD) was calculated as the time from the start of the QRS complex of the ECG to the latest longitudinal deformation peak in the 18 segments of the LV. RESULTS The mean age of our subjects was 50.3 ± 11.1 years. PSS was observed in 48.4% of the 1620 LV segments studied (19.8%, 13.5%, and 15.1% in the basal, medial, and apical regions, respectively). PSS was more frequent in the basal, medial septal, and apical anteroseptal segments (>50%). LD peaked in the interventricular septum and in the basal segments of the LV. CONCLUSIONS The pattern of PSS and LD revealed by STE suggests there is contraction in the postsystolic phase of the cardiac cycle. The anatomical location of the segments in which this contraction is most frequently observed corresponds to the main path of the ascending component of the myocardial band. This contraction can be attributed to the protodiastolic untwisting of the LV.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Dr Peset, 46017 Valencia, Spain.
| | - Ildefonso Roldán
- Department of Cardiology, Hospital Dr Peset, 46017 Valencia, Spain.
| | - Elena Romero
- Department of Cardiology, Hospital Dr Peset, 46017 Valencia, Spain.
| | - Assumpció Saurí
- Department of Cardiology, Hospital Dr Peset, 46017 Valencia, Spain.
| | - Diana Romero
- Cardiodiagnosis Department, Medical Research of Buenos Aires, CP 1425 Buenos Aires, Argentina.
| | | | - Natalia Ugalde
- Cardiodiagnosis Department, Medical Research of Buenos Aires, CP 1425 Buenos Aires, Argentina.
| | - Javier Bertolín
- Department of Cardiology, Hospital Dr Peset, 46017 Valencia, Spain.
| | - Melisa Rodriguez-Israel
- Cardiodiagnosis Department, Medical Research of Buenos Aires, CP 1425 Buenos Aires, Argentina.
| | | | - Jorge A Lowenstein
- Cardiodiagnosis Department, Medical Research of Buenos Aires, CP 1425 Buenos Aires, Argentina.
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41
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MacIver DH, Partridge JB, Agger P, Stephenson RS, Boukens BJD, Omann C, Jarvis JC, Zhang H. The end of the unique myocardial band: Part II. Clinical and functional considerations. Eur J Cardiothorac Surg 2018; 53:120-128. [PMID: 29029119 DOI: 10.1093/ejcts/ezx335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022] Open
Abstract
Two of the leading concepts of mural ventricular architecture are the unique myocardial band and the myocardial mesh model. We have described, in an accompanying article published in this journal, how the anatomical, histological and high-resolution computed tomographic studies strongly favour the latter concept. We now extend the argument to describe the linkage between mural architecture and ventricular function in both health and disease. We show that clinical imaging by echocardiography and magnetic resonance imaging, and electrophysiological studies, all support the myocardial mesh model. We also provide evidence that the unique myocardial band model is not compatible with much of scientific research.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology & Environment, Batemans Bay, NSW, Australia
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bastiaan J D Boukens
- Department of Medical Biology, Academic Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
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42
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MacIver DH, Stephenson RS, Jensen B, Agger P, Sánchez-Quintana D, Jarvis JC, Partridge JB, Anderson RH. The end of the unique myocardial band: Part I. Anatomical considerations. Eur J Cardiothorac Surg 2018; 53:112-119. [PMID: 28958005 DOI: 10.1093/ejcts/ezx290] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023] Open
Abstract
The concept of the 'unique myocardial band', which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjarke Jensen
- Department of Medical Biology, Academic Medical Center, Amsterdam University, Netherlands
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Denmark
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Jonathan C Jarvis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology and Environment, Batemans Bay, NSW, Australia
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
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Lunkenheimer PP, Niederer P, Lunkenheimer JM, Redmann K, Smerup M, Schmitt B, Saggau W, Batista RJV. [Antagonistic function of the heart muscle : Part II: Clinical implications]. Herz 2018; 45:178-185. [PMID: 30054715 DOI: 10.1007/s00059-018-4735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
In the hypertrophic heart the myostructural afterload in the form of endoepicardial networks is predominant, which enhances myocardial hypertrophy. The intrinsic antagonism is derailed. Likewise, the connective tissue scaffold, i.e. the stromatogenic afterload, is enriched in the response to the derailment of antagonism in a hypertrophic heart up to regional captivation of the heart musculature. Due to the selective susceptibility of the auxotonic, contracting oblique transmural myocardial network for low dose negative inotropic medication, this promises to attenuate progress in myocardial hypertrophy. Volume reduction surgery is most effective in reducing wall stress as long as the myocardium is not critically fettered by fibrosis. The use of external mechanical circulatory support is then effective if the heart is supported in its resting mode, which means around a middle width and at minimal amplitude of motion. The takotsubo cardiomyopathy might possibly reflect an isolated, extreme stimulation of the intrinsic antagonism as a response to hormonally induced sensitization of the myocardium to catecholamine. A particular significant conclusion with respect to the diseased heart is that clinical diagnostics need new impulses with a focus on the analysis of local motion patterns and on myocardial stiffness reflecting disease-dependent antagonistic intensity. This would become a relevant diagnostic marker if corresponding (noninvasive) measurement techniques would become available.
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Affiliation(s)
- P P Lunkenheimer
- Experimentelle Thorax‑, Herz- und Gefäßchirurgie, Universitätskliniken Münster, Münster, Deutschland.
| | - P Niederer
- Institute of Biomedical Engineering, ETH and University Zürich, Zürich, Schweiz
| | - J M Lunkenheimer
- Krankenhaus der Augustinerinnen/Severinsklösterchen, Jakobstr. 27-31, Köln, Deutschland
| | - K Redmann
- Universitätskliniken, Münster, Deutschland
| | - M Smerup
- Thoraxkirurgisk Klinik, University Hospital, Kopenhagen, Dänemark
| | - B Schmitt
- Abteilung für angeborene Herzfehler, Deutsches Herzzentrum, Berlin, Deutschland
| | - W Saggau
- Klinik für Herzchirurgie, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - R J V Batista
- , Rua Carlos Rasera 8, Vista Alegre, Curitiba PR, Brasilien
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Lunkenheimer PP, Niederer P, Lunkenheimer JM, Keller H, Redmann K, Smerup M, Anderson RH. [The antagonistic function of the heart muscle sustains the autoregulation according to Frank and Starling : Part I: Structure and function of heart muscle]. Herz 2018; 45:170-177. [PMID: 30054713 DOI: 10.1007/s00059-018-4734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
In the tradition of Harvey and according to Otto Frank the heart muscle structure is arranged in a strictly tangential fashion hence all contractile forces act in the direction of ventricular ejection. In contrast, morphology confirms that the heart consists of a 3-dimensional network of muscle fibers with up to two fifths of the chains of aggregated myocytes deviating from a tangential alignment at variable angles. Accordingly, the myocardial systolic forces contain, in addition to a constrictive also a (albeit smaller) radially acting component. Using needle force probes we have correspondingly measured an unloading type of force in a tangential direction and an auxotonic type in dilatative transversal direction of the ventricular walls to show that the myocardial body contracts actively in a 3-dimensional pattern. This antagonism supports the autoregulation of heart muscle function according to Frank and Starling, preserving ventricular shape, enhances late systolic fast dilation and attenuates systolic constriction of the ventricle wall. Auxotonic dilating forces are particularly sensitive to inotropic medication. Low dose beta-blocker is able to attenuate the antagonistic activity. All myocardial components act against four components of afterload, the hemodynamic, the myostructural, the stromatogenic and the hydraulic component. This complex interplay critically complicates clinical diagnostics. Clinical implications are far-reaching (see Part II, https://doi.org/10.1007/s00059-018-4735-x).
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Affiliation(s)
- P P Lunkenheimer
- Experimentelle Thorax‑, Herz- und Gefäßchirurgie, Universitätskliniken Münster, Münster, Deutschland.
| | - P Niederer
- Institute of Biomedical Engineering, ETH and University Zürich, Zürich, Schweiz
| | - J M Lunkenheimer
- Krankenhaus der Augustinerinnen/Severinsklösterchen, Jakobstr. 27-31, Köln, Deutschland
| | - H Keller
- Klinik Hirslanden, Zürich, Schweiz
| | - K Redmann
- Universitätskliniken, Münster, Deutschland
| | - M Smerup
- Thoraxkirurgisk Klinik, University Hospital, Kopenhagen, Dänemark
| | - R H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle, Großbritannien
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Cannata' A, Merlo M, Artico J, Gentile P, Camparini L, Cristallini J, Porcari A, Loffredo F, Sinagra G. Cardiovascular aging: the unveiled enigma from bench to bedside. J Cardiovasc Med (Hagerstown) 2018; 19:517-526. [PMID: 30024423 DOI: 10.2459/jcm.0000000000000694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: The rapid increase in the median age of the world's population requires particular attention towards older and more fragile people. Cardiovascular risk factors, time and comorbidities play a vicious role in the development of heart failure, both with reduced and preserved ejection fraction, in the elderly. Understanding the mechanisms underlying the pathophysiological processes observed with aging is pivotal to target those patients and their therapeutic needs properly. This review aims to investigate and to dissect the main pathways leading to the aging cardiomyopathy, helping to understand the relationship from bench to bedside of the clinical phenotype.
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Affiliation(s)
- Antonio Cannata'
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste.,International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Marco Merlo
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
| | - Jessica Artico
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
| | - Piero Gentile
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
| | - Luca Camparini
- International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Jacopo Cristallini
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
| | - Aldostefano Porcari
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
| | - Francesco Loffredo
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste.,International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular and Thoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste
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Hoffman JIE. Will the real ventricular architecture please stand up? Physiol Rep 2018; 5:5/18/e13404. [PMID: 28947592 PMCID: PMC5617926 DOI: 10.14814/phy2.13404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 12/28/2022] Open
Abstract
Ventricular twisting, essential for cardiac function, is attributed to the contraction of myocardial helical fibers. The exact relationship between ventricular anatomy and function remains to be determined, but one commonly used explanatory model is the helical ventricular myocardial band (HVMB) model of Torrent‐Guasp. This model has been successful in explaining many aspects of ventricular function, (Torrent‐Guasp et al. Eur. J. Cardiothorac. Surg., 25, 376, 2004; Buckberg et al. Eur. J. Cardiothorac. Surg., 47, 587, 2015; Buckberg et al. Eur. J. Cardiothorac. Surg. 47, 778, 2015) but the model ignores important aspects of ventricular anatomy and should probably be replaced. The purpose of this review is to compare the HVMB model with a different model (nested layers). A complication when interpreting experimental observations that relate anatomy to function is that, in the myocardium, shortening does not always imply activation and lengthening does not always imply inactivation.
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Affiliation(s)
- Julien I E Hoffman
- Department of Pediatrics, University of California, San Francisco, California
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What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions. J Cardiovasc Dev Dis 2018; 5:jcdd5020033. [PMID: 29867011 PMCID: PMC6023278 DOI: 10.3390/jcdd5020033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/08/2023] Open
Abstract
Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.
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Is mitral annular ascent useful in studying left ventricular function through left atrio-ventricular interactions? Indian Heart J 2018; 70:368-372. [PMID: 29961452 PMCID: PMC6034026 DOI: 10.1016/j.ihj.2017.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 08/13/2017] [Accepted: 08/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background The mitral annulus (MA) is a crucial structure that is in constant motion throughout the cardiac cycle. The main purpose of this study was to determine if M-mode evaluation of the longitudinal motion of the MA could be useful to examine atrio-ventricular interactions. Methods Echocardiographic data obtained from 150 patients (mean age 56 ± 16; 82 males) from the University of Cincinnati College of Medicine was evaluated to examine if any relationship exists between MA motion and measures of atrio-ventricular interactions. Results Even though left atrial size, left ventricular (LV) mass index, LV ejection fraction (LVEF) and degree of LV diastolic dysfunction (LVDD) were significant echocardiographic variables affecting MA motion; LVEF and the degree of LVDD were the main determinants of MA excursion during systole (MAPSE) and after atrial contraction (MAa). Our results confirm the surrogate value of MAPSE with regards to LVEF and also show that the extent of MA excursion during systole is the main determinant of MAa. The effect of LV diastolic function applies more strongly to MAPSE than to MAa. However, the maximal MAa amplitude varies in accordance to the type of LVDD. Conclusions We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.
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Juliani PS, Das-Neves-Pereira JC, Monteiro R, Correia AT, Moreira LFP, Jatene FB. Left ventricular chamber geometry in cardiomyopathies: insights from a computerized anatomical study. ESC Heart Fail 2018; 5:355-364. [PMID: 29465824 PMCID: PMC5933952 DOI: 10.1002/ehf2.12261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/22/2017] [Indexed: 11/20/2022] Open
Abstract
Aims Some authors have hypothesized that left ventricular chamber dilatation in ischaemic and idiopathic cardiomyopathies results in spherical transformation. Aiming to characterize how this transformation occurs, a study was performed by comparing normal and dilated specimens regarding sphericity and proportionality in left heart chambers. It is important to provide data for the development of therapeutic strategies in these diseases. Methods and results An anatomical study was performed by comparing normal (n = 10), ischaemic (n = 15), and idiopathic (n = 18) dilated human cardiomyopathic specimens regarding left ventricular chambers and their segmental proportionality to normal hearts. It was performed by capturing and processing images with proper software in three different levels of left ventricular chamber (basal, equatorial, and apical). These obtained data were analysed based on sphericity and proportionality by two dedicated indexes. Spherical shape: Calculated segmental indexes showed that dilated specimens were not spherical because they were smaller than as expected for a spherical shape (all values were <70% of a perfect sphere). Proportionality: There was no difference between basal index perimeters among groups, but apical index was lower in dilated specimens than in normal hearts, and so dilatation was not proportional to normal hearts. Conclusions Left ventricular chambers of anatomical specimens with dilated cardiomyopathies did not display a spherical shape and were not proportional to normal hearts.
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Affiliation(s)
- Paulo Sérgio Juliani
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
| | - João-Carlos Das-Neves-Pereira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
| | - Rosangela Monteiro
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
| | - Aristides Tadeu Correia
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
| | - Luiz Felipe Pinho Moreira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina, Serviço de Cirurgia Toracica, Universidade de São Paulo, Av. Doutor Enéas de Carvalho Aguiar, 44, 5° andar, bloco II, sala 7, 04503-000, São Paulo, SP, Brazil
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50
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Triposkiadis F, Giamouzis G, Boudoulas KD, Karagiannis G, Skoularigis J, Boudoulas H, Parissis J. Left ventricular geometry as a major determinant of left ventricular ejection fraction: physiological considerations and clinical implications. Eur J Heart Fail 2017; 20:436-444. [DOI: 10.1002/ejhf.1055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/23/2017] [Accepted: 08/12/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Gregory Giamouzis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | | | - Georgios Karagiannis
- Department of Cardiology, Hillingdon Hospital; Department of Transplantation; Harefield Hospital; London UK
| | - John Skoularigis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - Harisios Boudoulas
- The Ohio State University, Columbus, OH, USA; Biomedical Research Foundation Academy of Athens, Athens, and; Aristotelian University of Thessaloniki; Thessaloniki Greece
| | - John Parissis
- Department of Cardiology; Athens University Hospital Attikon; Athens Greece
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