51
|
Rüssel IK, Brouwer WP, Germans T, Knaapen P, Marcus TJ, van der Velden J, Götte MJW, van Rossum AC. Increased left ventricular torsion in hypertrophic cardiomyopathy mutation carriers with normal wall thickness. J Cardiovasc Magn Reson 2011; 13:3. [PMID: 21219655 PMCID: PMC3025877 DOI: 10.1186/1532-429x-13-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/10/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increased left ventricular (LV) torsion has been observed in patients with manifest familial hypertrophic cardiomyopathy (HCM), and is thought to be caused by subendocardial dysfunction. We hypothesize that increased LV torsion is already present in healthy mutation carriers with normal wall thickness. METHODS Seventeen carriers with an LV wall thickness <10 mm, and seventeen age and gender matched controls had cardiovascular magnetic resonance (CMR) cine imaging and tissue tagging. LV volumes and mass were calculated from the cine images. LV torsion, torsion rate, endocardial circumferential strain and torsion-to-endocardial-circumferential-shortening (TECS) ratio, which reflects the transmural distribution in contractile function, were determined using tissue tagging. RESULTS LV volumes, mass and circumferential strain were comparable between groups, whereas LV ejection fraction, torsion and TECS-ratio were increased in carriers compared to controls (63 ± 3% vs. 60 ± 3%, p = 0.04, 10.1 ± 2.5° vs. 7.7 ± 1.2°, p = 0.001, and 0.52 ± 0.14°/% vs. 0.42 ± 0.10°/%, p = 0.02, respectively). CONCLUSIONS Carriers with normal wall thickness display increased LV torsion and TECS-ratio with respect to controls, which might be due to subendocardial myocardial dysfunction. As similar abnormalities are observed in patients with manifest HCM, the changes in healthy carriers may be target for clinical intervention to delay or prevent the onset of hypertrophy.
Collapse
MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Case-Control Studies
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mutation
- Myocardial Contraction/genetics
- Netherlands
- Torsion Abnormality/genetics
- Torsion Abnormality/pathology
- Torsion Abnormality/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/genetics
Collapse
Affiliation(s)
- Iris K Rüssel
- Department of Clinical Physics, Hagaziekenhuis, The Hague, The Netherlands
| | - Wessel P Brouwer
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim J Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marco JW Götte
- Department of cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
52
|
Impact of Systolic and Diastolic Deformation Indexes Assessed by Strain-Encoded Imaging to Predict Persistent Severe Myocardial Dysfunction in Patients After Acute Myocardial Infarction at Follow-Up. J Am Coll Cardiol 2010; 56:1056-62. [DOI: 10.1016/j.jacc.2010.02.070] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 01/08/2010] [Accepted: 02/01/2010] [Indexed: 11/17/2022]
|
53
|
Yang H, Carasso S, Woo A, Jamorski M, Nikonova A, Wigle ED, Rakowski H. Hypertrophy pattern and regional myocardial mechanics are related in septal and apical hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2010; 23:1081-9. [PMID: 20650608 DOI: 10.1016/j.echo.2010.06.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is associated with considerable phenotypic heterogeneity. Previous studies have shown a relationship between the degree and location of hypertrophy and the prognosis of patients. The aim of this study was to compare left ventricular (LV) circumferential and longitudinal regional mechanics in patients with septal HCM and apical HCM to study the relationship between hypertrophy and function as assessed by myocardial mechanics. METHODS Seventy-two patients with HCM (27 with apical HCM, 45 with septal HCM) were compared with 25 clinically normal and age-matched subjects. Myocardial mechanics were assessed using Velocity Vector Imaging, which extracts myocardial motion estimates from B-mode clips by tracking user-defined points and feature tracking. The Velocity Vector Imaging software generated data on global and regional systolic and diastolic longitudinal and circumferential strain, strain rate, and rotational angle velocities. One-way analysis of variance with post hoc multiple comparisons was used among the three groups. RESULTS Normal subjects had relatively uniform strain and strain rates for all LV segments. Compared with the normal group, patients with septal HCM had decreased LV regional longitudinal strain rates and strain at both the basal and mid septal and lateral segments (all P < .01). Compared with patients with apical HCM, those with septal HCM had higher LV circumferential strain rates and strain at the basal and mid segments (P < .05 to P < .01). There were significant differences in rotational velocities at the mid segments among the three groups (P < .05 to P < .001). CONCLUSIONS Patients with HCM have abnormalities in myocardial mechanics that are related to the site of abnormal myocardial hypertrophy.
Collapse
Affiliation(s)
- Hua Yang
- Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
54
|
François CJ, Schiebler ML, Reeder SB. Cardiac MRI evaluation of nonischemic cardiomyopathies. J Magn Reson Imaging 2010; 31:518-30; quiz 517. [PMID: 20187194 DOI: 10.1002/jmri.22030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this manuscript is to review the major MRI findings in patients with nonischemic cardiomyopathies. Cardiac MRI has become an integral part in the diagnosis and management of patients with nonischemic cardiomyopathies. Findings on cardiac MRI studies can help distinguish between different types of cardiomyopathies and can provide valuable diagnostic and prognostic information.
Collapse
|
55
|
Maron MS, Pandian NG. Risk Stratification in Hypertrophic Cardiomyopathy: Is Two-Dimensional Echocardiographic Strain Ready for Prime Time? J Am Soc Echocardiogr 2010; 23:591-4. [DOI: 10.1016/j.echo.2010.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
56
|
Abstract
Non-invasive evaluation of diastolic function continues to play a critical role in furthering our understanding of diastole, improving the diagnosis of diastolic dysfunction, evaluating left ventricular filling pressures, and providing important prognostic information for patients with heart failure. Echocardiography, cardiovascular magnetic resonance, and nuclear cardiology each provide important tools for evaluating diastolic performance. This review will focus on the techniques from multiple cardiovascular imaging modalities which have been used for the clinical assessment of diastolic function.
Collapse
Affiliation(s)
- Michael Salerno
- University of Virginia Health System, Box 800662, Charlottesville, VA 22908, USA.
| |
Collapse
|
57
|
Kwon DH, Desai MY. Cardiac magnetic resonance in hypertrophic cardiomyopathy: current state of the art. Expert Rev Cardiovasc Ther 2010; 8:103-11. [PMID: 20014937 DOI: 10.1586/erc.09.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypertrophic cardiomyopathy is a complex disorder with significant heterogeneity in clinical characteristics and natural history. Traditionally, the diagnosis has been based on clinical assessment and echocardiography; however, persistent challenges in its noninvasive evaluation remain. Hence, improved diagnostic techniques could lead to better risk stratification of patients, which would potentially identify patients likely to benefit from effective therapies. Recent studies have demonstrated the increasing utility of cardiac magnetic resonance in the management of this disease. With the increasing utilization of genetics, cardiac magnetic resonance is likely to play an even more important role in discerning the subtle morphologic differences seen in such patients with similar genotypic profiles.
Collapse
Affiliation(s)
- Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | |
Collapse
|
58
|
Determinants of myocardial energetics and efficiency in symptomatic hypertrophic cardiomyopathy. Eur J Nucl Med Mol Imaging 2010; 37:779-88. [PMID: 20069294 DOI: 10.1007/s00259-009-1350-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 12/01/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Next to hypertrophy, hypertrophic cardiomyopathy (HCM) is characterized by alterations in myocardial energetics. A small number of studies have shown that myocardial external efficiency (MEE), defined by external work (EW) in relation to myocardial oxidative metabolism (MVO(2)), is reduced. The present study was conducted to identify determinants of MEE in patients with HCM by use of dynamic positron emission tomography (PET) and cardiovascular magnetic resonance imaging (CMR). METHODS Twenty patients with HCM (12 men, mean age: 55.2 + or - 13.9 years) and 11 healthy controls (7 men, mean age: 48.1 + or - 10 years) were studied with [(11)C]acetate PET to assess MVO(2). CMR was performed to determine left ventricular (LV) volumes and mass (LVM). Univariate and multivariate analyses were employed to determine independent predictors of myocardial efficiency. RESULTS Between study groups, MVO(2) (controls: 0.12 + or - 0.04 ml x min(-1) x g(-1), HCM: 0.13 + or - 0.05 ml x min(-1) x g(-1), p = 0.64) and EW (controls: 9,139 + or - 2,484 mmHg x ml, HCM: 9,368 + or - 2,907 mmHg x ml, p = 0.83) were comparable, whereas LVM was significantly higher (controls: 99 + or - 21 g, HCM: 200 + or - 76 g, p < 0.001) and MEE was decreased in HCM patients (controls: 35 + or - 8%, HCM: 21 + or - 10%, p < 0.001). MEE was related to stroke volume (SV), LV outflow tract gradient, NH(2)-terminal pro-brain natriuretic peptide (NT-proBNP) and serum free fatty acid levels (all p < 0.05). Multivariate analysis revealed that SV (ss = 0.74, p < 0.001) and LVM (ss = -0.43, p = 0.013) were independently related to MEE. CONCLUSION HCM is characterized by unaltered MVO(2), impaired EW generation per gram of myocardial tissue and subsequent deteriorated myocardial efficiency. Mechanical external efficiency could independently be predicted by SV and LVM.
Collapse
|
59
|
Shehata ML, Cheng S, Osman NF, Bluemke DA, Lima JAC. Myocardial tissue tagging with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:55. [PMID: 20025732 PMCID: PMC2809051 DOI: 10.1186/1532-429x-11-55] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 12/21/2009] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is currently the gold standard for assessing both global and regional myocardial function. New tools for quantifying regional function have been recently developed to characterize early myocardial dysfunction in order to improve the identification and management of individuals at risk for heart failure. Of particular interest is CMR myocardial tagging, a non-invasive technique for assessing regional function that provides a detailed and comprehensive examination of intra-myocardial motion and deformation. Given the current advances in gradient technology, image reconstruction techniques, and data analysis algorithms, CMR myocardial tagging has become the reference modality for evaluating multidimensional strain evolution in the human heart. This review presents an in depth discussion on the current clinical applications of CMR myocardial tagging and the increasingly important role of this technique for assessing subclinical myocardial dysfunction in the setting of a wide variety of myocardial disease processes.
Collapse
Affiliation(s)
- Monda L Shehata
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nael F Osman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, National Institutes of Health, Bethesda, MD, USA
| | - João AC Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
60
|
Kindberg K, Carlhäll C, Karlsson M, Nguyen TC, Cheng A, Langer F, Rodriguez F, Daughters GT, Miller DC, Ingels NB. Transmural strains in the ovine left ventricular lateral wall during diastolic filling. J Biomech Eng 2009; 131:061004. [PMID: 19449958 DOI: 10.1115/1.3118774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rapid early diastolic left ventricular (LV) filling requires a highly compliant chamber immediately after systole, allowing inflow at low driving pressures. The transmural LV deformations associated with such filling are not completely understood. We sought to characterize regional transmural LV strains during diastole, with focus on early filling, in ovine hearts at 1 week and 8 weeks after myocardial marker implantation. In seven normal sheep hearts, 13 radiopaque markers were inserted to silhouette the LV chamber and a transmural beadset was implanted into the lateral equatorial LV wall to measure transmural strains. Four-dimensional marker dynamics were obtained 1 week and 8 weeks thereafter with biplane videofluoroscopy in closed-chest, anesthetized animals. LV transmural strains in both cardiac and fiber-sheet coordinates were studied from filling onset to the end of early filling (EOEF, 100 ms after filling onset) and at end diastole. At the 8 week study, subepicardial circumferential strain (ECC) had reached its final value already at EOEF, while longitudinal and radial strains were nearly zero at this time. Subepicardial ECC and fiber relengthening (Eff) at EOEF were reduced to 1 compared with 8 weeks after surgery (ECC:0.02+/-0.01 to 0.08+/-0.02 and Eff:0.00+/-0.01 to 0.03+/-0.01, respectively, both P<0.05). Subepicardial ECC during early LV filling was associated primarily with fiber-normal and sheet-normal shears at the 1 week study, but to all three fiber-sheet shears and fiber relengthening at the 8 week study. These changes in LV subepicardial mechanics provide a possible mechanistic basis for regional myocardial lusitropic function, and may add to our understanding of LV myocardial diastolic dysfunction.
Collapse
Affiliation(s)
- K Kindberg
- Department of Management and Engineering, Linköping University, Linköping SE-581 83, Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
61
|
Neizel M, Lossnitzer D, Korosoglou G, Schäufele T, Lewien A, Steen H, Katus HA, Osman NF, Giannitsis E. Strain-encoded (SENC) magnetic resonance imaging to evaluate regional heterogeneity of myocardial strain in healthy volunteers: Comparison with conventional tagging. J Magn Reson Imaging 2009; 29:99-105. [PMID: 19097105 DOI: 10.1002/jmri.21612] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the ability of strain-encoded (SENC) magnetic resonance imaging (MRI) for regional systolic and diastolic strain analysis of the myocardium in healthy volunteers. MATERIALS AND METHODS Circumferential and longitudinal peak systolic strain values of 75 healthy volunteers (35 women and 40 men, mean age 44 +/- 12 years) were measured using SENC at 1.5T. MR tagging was used as the reference standard for measuring regional function. Diastolic function was assessed in the 10 youngest (24 +/- 8 years) and 10 oldest (62 +/- 5 years) subjects. RESULTS Peak strain values assessed with SENC were comparable to those obtained by MR tagging, showing narrow limits of agreement (limits of agreement -5.6% to 8.1%). Regional heterogeneity was observed between different segments of the left ventricle (LV) by both techniques (P < 0.001). Longitudinal strain obtained by SENC was also heterogenous (P < 0.001). Interestingly, no age- or gender-specific differences in peak systolic strain were observed, whereas the peak rate of relaxation of circumferential strain rate was decreased in the older group. CONCLUSION SENC is a reliable tool for accurate and objective quantification of regional myocardial systolic as well as diastolic function. In agreement with tagged MRI, SENC detected slightly heterogeneous myocardial strain within LV segments.
Collapse
Affiliation(s)
- Mirja Neizel
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
62
|
Korosoglou G, Lossnitzer D, Schellberg D, Lewien A, Wochele A, Schaeufele T, Neizel M, Steen H, Giannitsis E, Katus HA, Osman NF. Strain-encoded cardiac MRI as an adjunct for dobutamine stress testing: incremental value to conventional wall motion analysis. Circ Cardiovasc Imaging 2009; 2:132-40. [PMID: 19808579 DOI: 10.1161/circimaging.108.790105] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-dose dobutamine stress MRI is safe and feasible for the diagnosis of coronary artery disease (CAD) in humans. However, the assessment of cine scans relies on the visual interpretation of regional wall motion, which is subjective. Recently, strain-encoded MRI (SENC) has been proposed for the direct color-coded visualization of myocardial strain. The purpose of our study was to compare the diagnostic value of SENC with that provided by conventional wall motion analysis for the detection of inducible ischemia during dobutamine stress MRI. METHODS AND RESULTS Stress-induced ischemia was assessed by wall motion analysis and by SENC in 101 patients with suspected or known CAD and in 17 healthy volunteers who underwent dobutamine stress MRI in a clinical 1.5-T scanner. Quantitative coronary angiography deemed as the standard reference for the presence or absence of significant CAD (> or =50% diameter stenosis). On a coronary vessel level, SENC detected inducible ischemia in 86 of 101 versus 71 of 101 diseased coronary vessels (P<0.01 versus cine) and showed normal strain response in 189 of 202 versus 194 of 202 vessels with <50% stenosis (P=NS versus cine). On a patient level, SENC detected inducible ischemia in 63 of 64 versus 55 of 64 patients with CAD (P<0.05 versus cine) and showed normal strain response in 32 of 37 versus 34 of 37 patients without CAD (P=NS versus cine). Quantification analysis demonstrated a significant correlation between strain rate reserve and coronary artery stenosis severity (r(2)=0.56, P<0.001), and a cutoff value of strain rate reserve of 1.64 was deemed as a highly accurate marker for the detection of > or =50% stenosis (area under the curve, 0.96; SE, 0.01; 95% CI, 0.94 to 0.98; P<0.001). CONCLUSIONS The direct color-coded visualization of strain on MR images is a useful adjunct for dobutamine stress MRI, which provides incremental value for the detection of CAD compared with conventional wall motion readings on cine images.
Collapse
|
63
|
Ennis DB, Nguyen TC, Itoh A, Bothe W, Liang DH, Ingels NB, Miller DC. Reduced systolic torsion in chronic "pure" mitral regurgitation. Circ Cardiovasc Imaging 2009; 2:85-92. [PMID: 19808573 DOI: 10.1161/circimaging.108.785923] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Global left ventricular (LV) torsion declines with chronic ischemic mitral regurgitation (MR), which may accelerate the LV remodeling spiral toward global cardiomyopathy; however, it has not been definitively established whether this torsional decline is attributable to the infarct, the MR, or their combined effect. We tested the hypothesis that chronic "pure" MR alone reduces global LV torsion. METHODS AND RESULTS Chronic "pure" MR was created in 13 sheep by surgically punching a 3.5- to 4.8-mm hole (HOLE) in the mitral valve posterior leaflet. Nine control (CNTL) sheep were operated on concurrently. At 1 (WK-01) and 12 weeks (WK-12) postoperatively, the 4D motion of implanted radiopaque markers was used to calculate global LV torsion. MR-grade in HOLE was greater than CNTL at WK-01 and WK-12 (2.5+/-1.1 versus 0.6+/-0.5, P<0.001 at WK-12). HOLE LV mass index was larger at WK-12 compared with CNTL (195+/-14 versus 170+/-17 g/m(2), P<0.01), indicating LV remodeling. Global LV systolic torsion decreased in HOLE from WK-01 to WK-12 (4.1+/-2.8 degrees versus 1.7+/-1.7 degrees , P<0.01), but did not change in CNTL (5.5+/-1.8 degrees versus 4.2+/-2.7 degrees , P=NS). Global LV torsion was lower in HOLE relative to CNTL at WK-12 (P<0.05) but not at WK-01 (P=NS). CONCLUSIONS Twelve weeks of chronic "pure" MR resulting in mild global LV remodeling is associated with significantly increased LV mass index and reduced global LV systolic torsion, but no other significant changes in hemodynamics. MR alone is a major component of torsional deterioration in "pure" MR and may be an important factor in chronic ischemic mitral regurgitation.
Collapse
Affiliation(s)
- Daniel B Ennis
- Department of Cardiothoracic Surgery and the Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305-5488, USA.
| | | | | | | | | | | | | |
Collapse
|
64
|
Shehata ML, Turkbey EB, Vogel-Claussen J, Bluemke DA. Role of cardiac magnetic resonance imaging in assessment of nonischemic cardiomyopathies. Top Magn Reson Imaging 2008; 19:43-57. [PMID: 18690160 DOI: 10.1097/rmr.0b013e31816fcb22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnosis of nonischemic cardiomyopathy is a challenging process that influences patient morbidity and mortality. Currently, the well known World Health Organization classification has been revisited by an American Heart Association expert consensus panel. The contemporary classification is compatible with the rapid evolution in molecular genetics and evolving diagnostic tools such as cardiac magnetic resonance imaging (MRI). Magnetic resonance imaging is a robust diagnostic tool that offers various techniques to assess the function, morphology, perfusion, and scarring of myocardial tissue thus providing better understanding of the underlying causes of nonischemic cardiomyopathies. In this review, we discuss the current role of cardiac MRI in the evaluation of nonischemic cardiomyopathy, in the context of the current American Heart Association classification of these disorders.
Collapse
Affiliation(s)
- Monda L Shehata
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | |
Collapse
|
65
|
Arena R, Owens DS, Arevalo J, Smith K, Mohiddin SA, McAreavey D, Ulisney KL, Tripodi D, Fananapazir L, Plehn JF. Ventilatory efficiency and resting hemodynamics in hypertrophic cardiomyopathy. Med Sci Sports Exerc 2008; 40:799-805. [PMID: 18408621 DOI: 10.1249/mss.0b013e31816459a1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE In patients with systolic heart failure, the ability of cardiopulmonary exercise testing (CPX) variables to reflect pathophysiology is well established. The relationship between CPX and pathophysiology has, however, not been thoroughly investigated in patients with nonobstructive hypertrophic cardiomyopathy (NHCM). The objective of this study was to assess the ability of CPX variables to reflect resting hemodynamics in patients with nonobstructive hypertrophic cardiomyopathy NHCM. METHODS We performed CPX and right heart catheterization on 83 subjects with NHCM (51 male/32 female, mean age = 38 +/- 10 yr, NYHA I-III mean = 1.7). Peak oxygen consumption ( O2) and minute ventilation/carbon dioxide ratio (V E/VCO2) at peak exercise were compared to resting hemodynamics including pulmonary artery systolic, diastolic and mean pressures (PASP, PADP and MPAP), and pulmonary capillary wedge pressure (PCWP). RESULTS Elevations in PCWP (> or = 15 mm Hg), PASP (> or =30 and > or = 40 mm Hg), PADP (> 15 mm Hg) and MPAP (> or = 20 mm Hg) were detected in 22, 33, 10, and 23% of subjects, respectively. Peak V E/VCO2 (positive correlation) and peak VO2 (negative correlation) correlated modestly with all pressure measurements (r = 0.33-0.51, P < 0.01 for all measurements). By receiver operating curve analysis, a V E/VCO2 >35.5 exhibited the best diagnostic accuracy with a curve areas of 0.81 for PAP > or = 30 mm Hg (sensitivity/specificity = 86%/67%), 0.87 for PAP > or = 40 mm Hg (77%/100%), 0.86 for MPAP > 20 mm Hg (83%/79%), and 0.84 for PCWP > or = 15 mm Hg (80%/76%). CONCLUSIONS CPX can accurately identify abnormal resting hemodynamics in patients with NHCM. Further testing of this modality in other forms of diastolic dysfunction may be warranted.
Collapse
Affiliation(s)
- Ross Arena
- Department of Physiology and Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298-0224, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Raman SV, Donnally MR, McCarthy B. Dobutamine stress cardiac magnetic resonance imaging to detect myocardial ischemia in women. ACTA ACUST UNITED AC 2008; 11:135-40. [PMID: 18607148 DOI: 10.1111/j.1751-7141.2008.08243.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease.
Collapse
Affiliation(s)
- Subha V Raman
- Davis Heart and Lung Research Institute, The Ohio State University Division of Cardiovascular Medicine, 473 West 12th Avenue, Columbus, OH 43210, USA.
| | | | | |
Collapse
|
67
|
Abstract
Continued advances in radiofrequency hardware and tailored software have, in recent times, greatly increased the power and performance of magnetic resonance imaging for noninvasive evaluation of cardiovascular diseases. Magnetic resonance imaging can uniquely be manipulated to trade temporal resolution and spatial resolution against each other, depending on whether detailed structural or functional information is required. However, to date, a number of cardiovascular magnetic resonance applications have been somewhat limited due to signal-to-noise ratio constraints, reflecting the narrow imaging window imposed by physiological cardiac motion. By increasing the operating field strength from 1.5 to 3 T, it is possible (in principle) to double the signal-to-noise ratio, which in turn may be "traded" for improvements in spatial resolution, coverage, or imaging speed. In this context, the development of parallel imaging has set the stage for impressive performance improvements in contrast-enhanced magnetic resonance angiography at 3 T. Indeed, one could argue that without parallel acquisition, the bang for the buck in going from 1.5 to 3 T would be limited. In this paper, we discuss the current status of 3-T magnetic resonance imaging for cardiovascular imaging, considering the relative gains and limitations relative to 1.5 T.
Collapse
|
68
|
Kim YJ, Choi BW, Hur J, Lee HJ, Seo JS, Kim TH, Choe KO, Ha JW. Delayed enhancement in hypertrophic cardiomyopathy: Comparison with myocardial tagging MRI. J Magn Reson Imaging 2008; 27:1054-60. [DOI: 10.1002/jmri.21366] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
69
|
Korosoglou G, Youssef AA, Bilchick KC, Ibrahim ES, Lardo AC, Lai S, Osman NF. Real-time fast strain-encoded magnetic resonance imaging to evaluate regional myocardial function at 3.0 Tesla: Comparison to conventional tagging. J Magn Reson Imaging 2008; 27:1012-8. [DOI: 10.1002/jmri.21315] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
70
|
Tecelão SRR, Zwanenburg JJM, Kuijer JPA, de Cock CC, Germans T, van Rossum AC, Marcus JT. Quantitative comparison of 2D and 3D circumferential strain using MRI tagging in normal and LBBB hearts. Magn Reson Med 2007; 57:485-93. [PMID: 17326172 DOI: 10.1002/mrm.21142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The response to cardiac resynchronization therapy (CRT), which is applied to patients with heart failure (HF) and left bundle-branch block (LBBB), can be predicted from the mechanical dyssynchrony measured on circumferential strain. Circumferential strain can be assessed by either 2D or 3D strain analysis. In this study was evaluated the difference between 2D and 3D circumferential strain using MR tagging with high temporal resolution (14 ms). Six healthy volunteers and five patients with LBBB were evaluated. We compared the 2D and 3D circumferential strains by computing the mechanical dyssynchrony and the cross correlation (r) between 2D and 3D strain curves, and by quantifying the differences in peak circumferential shortening, time to onset, and time to peak of shortening. The obtained maximum r(2) values were 0.97 +/- 0.03 and 0.87 +/- 0.16 for the healthy and LBBB populations, respectively, and thus showed a good similarity between 2D and 3D strain curves. No significant difference was observed between 2D and 3D in time to onset, time to peak, or peak circumferential shortening. Thus, to measure dyssynchrony, 2D strain analysis will suffice. Since 2D analysis is easier to implement than 3D analysis, this finding brings the application of MRI tagging and strain analysis closer to the clinical routine.
Collapse
Affiliation(s)
- Sandra R R Tecelão
- Institute of Biophysics and Biomedical Engineering, University of Lisbon, Lisbon, Portugal.
| | | | | | | | | | | | | |
Collapse
|
71
|
Gilson WD, Kraitchman DL. Cardiac magnetic resonance imaging in small rodents using clinical 1.5 T and 3.0 T scanners. Methods 2007; 43:35-45. [PMID: 17720562 PMCID: PMC2075472 DOI: 10.1016/j.ymeth.2007.03.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 02/15/2007] [Accepted: 03/27/2007] [Indexed: 11/24/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging can provide noninvasive, high resolution images of heart anatomy, viability, perfusion, and function. However, the adoption of clinical CMR imaging protocols for small rodents has been limited due to the small heart size and rapid heart rates. Therefore, most CMR studies in small rodents have been performed on non-clinical, high-field MR magnets. Because such high-field systems are not readily available at most institutions, the technical aspects that are needed to perform CMR on clinical 1.5 T and 3.0 T MR scanners are presented in this paper. Equipment requirements are presented, and a comprehensive description of the methods needed to complete a CMR exam including the animal preparation, imaging, and image analysis are discussed. In addition, the advanced applications of myocardial tagging and delayed-contrast-enhanced imaging are reviewed for the assessment of regional contractile function and myocardial viability, respectively.
Collapse
Affiliation(s)
- Wesley D Gilson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N. Caroline Street, Box 0845, JHOC 4240, Baltimore, MD 21287, USA.
| | | |
Collapse
|
72
|
O'Hanlon R, Assomull RG, Prasad SK. Use of cardiovascular magnetic resonance for diagnosis and management in hypertrophic cardiomyopathy. Curr Cardiol Rep 2007; 9:51-6. [PMID: 17362685 DOI: 10.1007/s11886-007-0010-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder characterized by unexplained myocardial hypertrophy. The condition is associated with sudden cardiac death and is therefore often diagnosed postmortem, especially in the young and in competitive athletes. For this reason, intense research focuses on developing strategies to minimize this tragic consequence. Cardiovascular magnetic resonance (CMR) is a novel imaging modality that provides high-resolution images in an infinite number of planes with additional sequences that allows for tissue characterization and quantification of flow. The most exciting development is the application of late gadolinium-enhanced (LGE) imaging, which allows for in vivo detection of myocardial fibrosis. This review summarizes the current applications of CMR in HCM and also speculates on future applications, particularly the potential for risk stratification using LGE-CMR.
Collapse
MESH Headings
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/therapy
- Contrast Media
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Diagnosis, Differential
- Endomyocardial Fibrosis/diagnosis
- Gadolinium DTPA
- Humans
- Magnetic Resonance Imaging, Cine/trends
- Risk Factors
- Stroke Volume
- Ventricular Outflow Obstruction/diagnosis
- Ventricular Outflow Obstruction/physiopathology
Collapse
Affiliation(s)
- Rory O'Hanlon
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | | | | |
Collapse
|
73
|
Rademakers FE, Bogaert J. Cardiac dysfunction in heart failure with normal ejection fraction: MRI measurements. Prog Cardiovasc Dis 2006; 49:215-27. [PMID: 17084181 DOI: 10.1016/j.pcad.2006.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular magnetic resonance is a non-invasive 3-dimensional imaging technique which can provide morphologic and functional information as well as tissue characterization without the use of ionizing radiation or nephrotoxic contrast agents. It has a high accuracy and reproducibility and is optimally suited to quantify structural and functional abnormalities and to follow a patient over time. In the setting of heart failure with normal ejection fraction it can be used as an alternative to echocardiography in those patients with suboptimal image quality but it can also provide unique information for the differential diagnosis and the underlying physiopathology of this syndrome.
Collapse
|
74
|
Anisotropic elastography for local passive properties and active contractility of myocardium from dynamic heart imaging sequence. Int J Biomed Imaging 2006; 2006:45957. [PMID: 23165032 PMCID: PMC2324035 DOI: 10.1155/ijbi/2006/45957] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 09/19/2006] [Indexed: 11/18/2022] Open
Abstract
Major heart diseases such as ischemia and hypertrophic myocardiopathy are accompanied with significant changes in the passive mechanical properties and active contractility of myocardium. Identification of these changes helps diagnose heart diseases, monitor therapy, and design surgery. A dynamic cardiac elastography (DCE) framework is developed to assess the anisotropic viscoelastic passive properties and active contractility of myocardial tissues, based on the chamber pressure and dynamic displacement measured with cardiac imaging techniques. A dynamic adjoint method is derived to enhance the numerical efficiency and stability of DCE. Model-based simulations are conducted using a numerical left ventricle (LV) phantom with an ischemic region. The passive material parameters of normal and ischemic tissues are identified during LV rapid/reduced filling and artery contraction, and those of active contractility are quantified during isovolumetric contraction and rapid/reduced ejection. It is found that quasistatic simplification in the previous cardiac elastography studies may yield inaccurate material parameters.
Collapse
|
75
|
Liu W, Ashford MW, Chen J, Watkins MP, Williams TA, Wickline SA, Yu X. MR tagging demonstrates quantitative differences in regional ventricular wall motion in mice, rats, and men. Am J Physiol Heart Circ Physiol 2006; 291:H2515-21. [PMID: 16751290 DOI: 10.1152/ajpheart.01016.2005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rats and genetically manipulated mouse models have played an important role in the exploration of molecular causes of cardiovascular diseases. However, it has not been fully investigated whether mice or rats and humans manifest similar patterns of ventricular wall motion. Although similarities in anatomy and myofiber architecture suggest that fundamental patterns of ventricular wall motion may be similar, the considerable differences in heart size, heart rate, and sarcomeric protein isoforms may yield quantitative differences in ventricular wall mechanics. To further our understanding of the basic mechanisms of myofiber contractile performance, we quantified regional and global indexes of ventricular wall motion in mice, rats, and men using magnetic resonance (MR) imaging. Both regular cine and tagged MR images at apical, midventricular, and basal levels were acquired from six male volunteers, six Fischer 344 rats, and seven C57BL/6 mice. Morphological parameters and ejection fraction were computed directly from cine images. Myocardial twist (rotation angle), torsion (net twist per unit length), circumferential strain, and normalized radial shortening were calculated by homogeneous strain analysis from tagged images. Our data show that ventricular twist was conserved among the three species, leading to a significantly smaller torsion, measured as net twist per unit length, in men. However, both circumferential strain and normalized radial shortening were the largest in male subjects. Although other parameters, such as circumferential-longitudinal shear strain, need to be evaluated, and the causes of these differences in contractile mechanics remain to be elucidated, the preservation of twist appears fundamental to cardiac function and should be considered in studies that extrapolate data from animals to humans.
Collapse
Affiliation(s)
- Wei Liu
- Dept. of Biomedical Engineering, Case Western Reserve Univ., Wickenden 427, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | | | | | | | | | | | | |
Collapse
|
76
|
McVeigh E. Measuring mechanical function in the failing heart. J Electrocardiol 2006; 39:S24-7. [PMID: 16963066 PMCID: PMC1963464 DOI: 10.1016/j.jelectrocard.2006.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 05/03/2006] [Indexed: 11/18/2022]
Abstract
A common pathology in heart failure is a detrimental change in the mechanics of both contraction and filling. In familial hypertrophic cardiomyopathy, a genetic disease characterized by left ventricular hypertrophy and myofiber disarray, left ventricular diastolic dysfunction is common and contributes to congestive heart failure. In dilated cardiomyopathy, a common correlate to reduced wall thickening and increased chamber volume is an asynchronous activation of the left ventricle due to left bundle branch block. Local measures of the timing and magnitude of myocardial shortening and relaxation can be obtained with magnetic resonance (MR) tissue tagging, MR cine phase contrast, or MR cine displacement encoding. In familial hypertrophic cardiomyopathy, these methods have been shown to quantify the restrictive filling of the ventricle. Characterizing the regions of the failing heart which are activated late has allowed investigators to measure the change in protein expression in those regions compared to normal myocardium. Also, these MR imaging methods have led to a better quantification of the asynchronous activation in dilated cardiomyopathy, which can be used to predict response to resynchronization therapy with pacing.
Collapse
Affiliation(s)
- Elliot McVeigh
- Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD 20892-1061, USA.
| |
Collapse
|
77
|
Markham LW, Michelfelder EC, Border WL, Khoury PR, Spicer RL, Wong BL, Benson DW, Cripe LH. Abnormalities of Diastolic Function Precede Dilated Cardiomyopathy Associated with Duchenne Muscular Dystrophy. J Am Soc Echocardiogr 2006; 19:865-71. [PMID: 16824995 DOI: 10.1016/j.echo.2006.02.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Larry W Markham
- Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | | | | | | | | | | | | | | |
Collapse
|
78
|
Goto K, Mikami T, Onozuka H, Kaga S, Inoue M, Komatsu H, Komuro K, Yamada S, Tsutsui H, Kitabatake A. Role of Left Ventricular Regional Diastolic Abnormalities for Global Diastolic Dysfunction in Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2006; 19:857-64. [PMID: 16824994 DOI: 10.1016/j.echo.2006.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND The usefulness of Doppler strain rate imaging for assessment of left ventricular regional diastolic function has not been fully determined. OBJECTIVE We aimed to clarify the relationships between diastolic strain rates and global diastolic function and find a useful index for regional diastolic function in patients with hypertrophic cardiomyopathy (HCM). METHODS Strain rate curves were obtained using an apical approach at 12 different sites of the left ventricular myocardium in 25 patients with HCM and 20 control subjects, and peak early diastolic strain rate (ESR), peak late diastolic strain rate, and the time from QRS to ESR were measured. The flow propagation velocity was measured using color M-mode Doppler echocardiography as a global diastolic index. RESULTS Each of the spatially averaged values of ESR and ESR/peak late diastolic strain rate and the coefficients of variation of time from QRS to ESR was significantly correlated with flow propagation velocity, but the best correlation was observed in ESR. Although both ESR and peak late diastolic strain rate of each myocardial segment of patients with HCM tended to decrease as the wall thickness increased, only ESR significantly decreased even in the segments without apparent hypertrophy. CONCLUSIONS In patients with HCM, the reduction of ESR was more closely associated with global diastolic dysfunction than asynchrony, and ESR may be a useful and sensitive index for regional diastolic function.
Collapse
Affiliation(s)
- Kazutomo Goto
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
79
|
Serri K, Reant P, Lafitte M, Berhouet M, Le Bouffos V, Roudaut R, Lafitte S. Global and Regional Myocardial Function Quantification by Two-Dimensional Strain. J Am Coll Cardiol 2006; 47:1175-81. [PMID: 16545649 DOI: 10.1016/j.jacc.2005.10.061] [Citation(s) in RCA: 384] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 09/16/2005] [Accepted: 10/03/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency. METHODS Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view. RESULTS Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were -15.1 +/- 6.2% versus -20.3 +/- 5.6%, 23.3 +/- 17.0% versus 27.2 +/- 14.9%, -16.8 +/- 7.1% versus 19.6 +/- 5.2%, and 25.2 +/- 13.9% versus 36.8 +/- 17.2%, respectively (all p < 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined: -9.2 +/- 4.7% versus -12.7 +/- 7.1% (p = 0.001). Average interobserver and intraobserver variabilities were 11% and 11.3%, respectively. CONCLUSIONS Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.
Collapse
Affiliation(s)
- Karim Serri
- Cardiologic Hospital, Bordeaux 2 University, Pessac, France
| | | | | | | | | | | | | |
Collapse
|
80
|
Utsunomiya D, Tomiguchi S, Awai K, Shiraishi S, Nakaura T, Yamashita Y. Mutidetector-row CT and quantitative gated SPECT for the assessment of left ventricular function in small hearts: the cardiac physical phantom study using a combined SPECT/CT system. Eur Radiol 2006; 16:1818-25. [PMID: 16456651 DOI: 10.1007/s00330-005-0102-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 11/15/2005] [Accepted: 11/25/2005] [Indexed: 01/08/2023]
Abstract
UNLABELLED The aim of this study was to compare results of left ventricular (LV) function obtained by quantitative gated single-photon emission tomography (QGS) and multidetector-row spiral computed tomography (MDCT) with reference parameters using an electrocardiogram-gated cardiac physical phantom. The phantom study was performed using a combined SPECT/CT system. Flexible membranes formed the inner and outer walls of the simulated LV. The stroke volume was adjusted (45 mL or 58 mL) and the fixed 42-mL end-systolic volume (ESV) produced two different volume combinations. The LV function parameters were estimated by means of MDCT and QGS. Differences in true and measured volumes were compared among CT with a reconstructed image thickness of 2.5 mm and 5.0 mm and QGS volumetric values. Each scan was repeated three-times. The estimation of LV volumes using both QGS and MDCT analyses were reproducible very well. QGS overestimated ejection fraction (EF) by approximately 20%; MDCT volumetry overestimated EF by approximately 5% in each volume setting. The differences in true and measured values for EF and ESV obtained with QGS were significantly greater than obtained with MDCT. CONCLUSION MDCT provides a reliable estimation of functional LV parameters, whereas QGS tends to significantly overestimate the EF in small hearts.
Collapse
Affiliation(s)
- Daisuke Utsunomiya
- Diagnostic Imaging Center, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto-shi, Kumamoto, 861-4101, Japan.
| | | | | | | | | | | |
Collapse
|
81
|
Sakata M, Mori K, Hayabuchi Y, Suzuki M, Nakagawa R, Kagami S, Baba H. Myocardial Systolic Strain in Normal Children Using a Tissue Tracking System. J Echocardiogr 2006. [DOI: 10.2303/jecho.4.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
82
|
Valeti VU, Chun W, Potter DD, Araoz PA, McGee KP, Glockner JF, Christian TF. Myocardial tagging and strain analysis at 3 Tesla: Comparison with 1.5 Tesla imaging. J Magn Reson Imaging 2006; 23:477-80. [PMID: 16508953 DOI: 10.1002/jmri.20527] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether imaging at 3 T could improve and prolong the tag contrast compared to images acquired at 1.5 T in normal volunteers, and whether such improvement would translate into the ability to perform strain measurements in diastole. MATERIALS AND METHODS Normal volunteers (N = 13) were scanned at 1.5 T (GE Signa CV/i) and 3.0 T (GE VH/i). An ECG-triggered, segmented k-space, spoiled-gradient-echo grid-tagged sequence was used during cine acquisition. Tag contrast was determined by the difference of the mean signal intensity (SI) of the tagline to the mean SI of the myocardium divided by the standard deviation (SD) of the noise (CNR(tag)). Matched short-axis (SA) slices were analyzed. Strain measurements were performed on images using a 2D strain analysis software program (harmonic phase (HARP)). RESULTS The average CNR(tag) over the cardiac cycle was superior at 3 T compared to 1.5 T for all slices (3 T: 23.4 +/- 12.1, 1.5 T: 9.8 +/- 8.4; P < 0.0001). This difference remained significant at cycle initiation, end-systole, and the end R-R interval (at cycle termination: 3 T = 14.0 +/- 11.0 vs. 1.5 T = 4.4 +/- 3.5; P < 0.01). Strain measures were obtainable only in early systole for 1.5 T images, but were robust throughout the entire R-R interval for 3 T images. CONCLUSION Imaging at 3 T had a significant benefit for myocardial tag persistence through the cardiac cycle. The improvement allowed strain analysis to be performed into diastole.
Collapse
Affiliation(s)
- V Uma Valeti
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
| | | | | | | | | | | | | |
Collapse
|
83
|
Zwanenburg JJM, Götte MJW, Kuijer JPA, Hofman MBM, Knaapen P, Heethaar RM, van Rossum AC, Marcus JT. Regional timing of myocardial shortening is related to prestretch from atrial contraction: assessment by high temporal resolution MRI tagging in humans. Am J Physiol Heart Circ Physiol 2005; 288:H787-94. [PMID: 15486034 DOI: 10.1152/ajpheart.00610.2004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Earlier studies have shown substantial nonuniformity in normal left ventricular (LV) myocardial function concerning both the degree of shortening and timing of shortening. We hypothesized that nonuniform LV function may be related to nonuniform prestretch induced by atrial contraction. Eleven healthy human subjects were studied using MRI myocardial tagging and strain analysis. The amount of circumferential prestretch was assessed in 30 LV segments. Prestretch was defined as the difference in strain between end diastole (at ECG R wave) and diastasis. Furthermore, both the degree of shortening (quantified as peak circumferential shortening, peak systolic shortening rate, and amount of postsystolic shortening) and timing of shortening (quantified as the onset time of shortening and time to peak shortening) were assessed. LV prestretch was found to be nonuniform, with the highest values in the lateral wall. The amount of segmental prestretch correlated significantly with peak shortening ( r = 0.79), peak shortening rate ( r = 0.50), amount of postsystolic shortening ( r = 0.67), onset time of shortening ( r = −0.57), and time to peak shortening ( r = 0.71) ( P < 0.001 for each of these relations). These relations may be explained by regional differences in wall stress or by a regional Frank-Starling effect. The correlation between timing of shortening and prestretch demonstrates that mechanical timing is not determined by electrical phenomena alone. In conclusion, regional variation in LV function correlates with the nonuniform prestretch from atrial contraction.
Collapse
Affiliation(s)
- J J M Zwanenburg
- Department of Physics and Medical Technology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
84
|
Abstract
This article reviews the current MR imaging literature with respect to ischemic heart disease and focuses on the clinical practicalities of cardiac MR imaging today.
Collapse
|