151
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Diagnostic capability of feature-tracking cardiovascular magnetic resonance to detect infarcted segments: a comparison with tagged magnetic resonance and wall thickening analysis. Clin Radiol 2017; 72:828-834. [DOI: 10.1016/j.crad.2017.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 01/05/2023]
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152
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Baeßler B, Treutlein M, Schaarschmidt F, Stehning C, Schnackenburg B, Michels G, Maintz D, Bunck AC. A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking. J Cardiovasc Magn Reson 2017; 19:71. [PMID: 28931401 PMCID: PMC5607501 DOI: 10.1186/s12968-017-0387-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/12/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (CMR) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional Lake Louise criteria (LLC). METHODS CMR data from 67 patients with suspected acute myocarditis were retrospectively analyzed. Seventeen age- and gender-matched healthy subjects served as control. T2-mapping data were acquired using a Gradient-Spin-Echo T2-mapping sequence in short-axis orientation. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values and pixel-standard deviation (SD) were recorded. Afterwards, the parameters maxT2 (the highest segmental T2 value) and madSD (the mean absolute deviation (MAD) of the pixel-SDs) were calculated for each subject. Cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. RESULTS A multiparametric imaging model containing madSD and LV global circumferential strain (GCSLV) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [AUC] 0.84) when compared to any model containing a single imaging parameter or to LLC (AUC 0.79). Adding late gadolinium enhancement (LGE) to the model resulted in a further increased diagnostic performance (AUC 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. CONCLUSIONS A multiparametric CMR imaging model including the novel T2-mapping derived parameter madSD, the feature tracking derived strain parameter GCSLV and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC.
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Affiliation(s)
- Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Melanie Treutlein
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Frank Schaarschmidt
- Institute of Biostatistics, Faculty of Natural Sciences, Leibniz Universität Hannover, Hannover, Germany
| | | | | | - Guido Michels
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander C. Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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153
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Differences in myocardial strain between pectus excavatum patients and healthy subjects assessed by cardiac MRI: a pilot study. Eur Radiol 2017; 28:1276-1284. [DOI: 10.1007/s00330-017-5042-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/12/2022]
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154
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Shang Q, Patel S, Steinmetz M, Schuster A, Danford DA, Beerbaum P, Sarikouch S, Kutty S. Myocardial deformation assessed by longitudinal strain: Chamber specific normative data for CMR-feature tracking from the German competence network for congenital heart defects. Eur Radiol 2017; 28:1257-1266. [PMID: 28875228 DOI: 10.1007/s00330-017-5034-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Left ventricular two-dimensional global longitudinal strain (LS) is superior to ejection fraction (EF) as predictor of outcome. We provide reference data for atrial and ventricular global LS during childhood and adolescence by CMR feature tracking (FT). METHODS We prospectively enrolled 115 healthy subjects (56 male, mean age 12.4 ± 4.1 years) at a single institution. CMR consisted of standard two-dimensional steady-state free-precession acquisitions. CMR-FT was performed on ventricular horizontal long-axis images for derivation of right and left atrial (RA, LA) and right and left ventricular (RV, LV) peak global LS. End-diastolic volumes (EDVs) and EF were measured. Correlations were explored for LS with age, EDV and EF of each chamber. RESULTS Mean±SD of LS (%) for RA, RV, LA and LV were 26.56±10.2, -17.96±5.4, 26.45±10.6 and -17.47±5, respectively. There was a positive correlation of LS in LA, LV, RA and RV with corresponding EF (all P<0.05); correlations with age were weak. Gender-wise differences were not significant for atrial and ventricular LS, strain rate and displacement. Inter- and intra-observer comparisons showed moderate agreements. CONCLUSIONS Chamber-specific nomograms for paediatric atrial and ventricular LS are provided to serve as clinical reference, and to facilitate CMR-based deformation research. KEY POINTS • No normative data exist for CMR-derived global longitudinal strain in the young. • This prospective study provides reference data for atrial and ventricular longitudinal strain. • The data will serve as reference for CMR-based clinical and research use.
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Affiliation(s)
- Quanliang Shang
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital and Medical Center, Omaha, NE, USA
- Department of Radiology, Second Xiangya Hospital, Central South University , Changsha, Hunan Province, China
| | - Shivani Patel
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Michael Steinmetz
- Department of Paediatric Cardiology, Georg-August-University and German Centre for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pulmonology, Georg-August-University and German Centre for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany
| | - David A Danford
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital and Medical Center, Omaha, NE, USA
| | | | | | - Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital and Medical Center, Omaha, NE, USA.
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155
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Nguyen KL, Hu P, Ennis DB, Shao J, Pham KA, Chen JJ. Cardiac MRI: a Translational Imaging Tool for Characterizing Anthracycline-Induced Myocardial Remodeling. Curr Oncol Rep 2017; 18:48. [PMID: 27292153 DOI: 10.1007/s11912-016-0533-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular side effects of cancer therapeutics are the leading causes of morbidity and mortality in cancer survivors. Anthracyclines (AC) serve as the backbone of many anti-cancer treatment strategies, but dose-dependent myocardial injury limits their use. Cumulative AC exposure can disrupt the dynamic equilibrium of the myocardial microarchitecture while repeated injury and repair leads to myocyte loss, interstitial myocardial fibrosis, and impaired contractility. Although children are assumed to have greater myocardial plasticity, AC exposure at a younger age portends worse prognosis. In older patients, there is lower overall survival once they develop cardiovascular disease. Because aberrations in the myocardial architecture predispose the heart to a decline in function, early detection with sensitive imaging tools is crucial and the implications for resource utilization are substantial. As a comprehensive imaging modality, cardiac magnetic resonance (CMR) imaging is able to go beyond quantification of ejection fraction and myocardial deformation to characterize adaptive microstructural and microvascular changes that are important to myocardial tissue health. Herein, we describe CMR as an established translational imaging tool that can be used clinically to characterize AC-associated myocardial remodeling.
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Affiliation(s)
- Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA.
| | - Peng Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiaxin Shao
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kimberly A Pham
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
| | - Joseph J Chen
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
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156
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Cardiovascular magnetic resonance feature tracking in small animals - a preliminary study on reproducibility and sample size calculation. BMC Med Imaging 2017; 17:51. [PMID: 28835220 PMCID: PMC5569535 DOI: 10.1186/s12880-017-0223-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular magnetic resonance feature tracking (CMR-FT) is a novel tissue tracking technique developed for noninvasive assessment of myocardial motion and deformation. This preliminary study aimed to evaluate the observer’s reproducibility of CMR-FT in a small animal (mouse) model and define sample size calculation for future trials. Methods Six C57BL/6 J mice were selected from the ongoing experimental mouse model onsite and underwent CMR with a 3 Tesla small animal MRI scanner. Myocardial deformation was analyzed using dedicated software (TomTec, Germany) by two observers. Left ventricular (LV) longitudinal, circumferential and radial strain (EllLAX, EccSAX and ErrSAX) were calculated. To assess intra-observer agreement data analysis was repeated after 4 weeks. The sample size required to detect a relative change in strain was calculated. Results In general, EccSAX and EllLAX demonstrated highest inter-observer reproducibility (ICC 0.79 (0.46–0.91) and 0.73 (0.56–0.83) EccSAX and EllLAX respectively). In contrast, at the intra-observer level EllLAX was more reproducible than EccSAX (ICC 0.83 (0.73–0.90) and 0.74 (0.49–0.87) EllLAX and EccSAX respectively). The reproducibility of ErrSAX was weak at both observer levels. Preliminary sample size calculation showed that a small study sample (e.g. ten animals to detect a relative 10% change in EccSAX) could be sufficient to detect changes if parameter variability is low. Conclusions This pilot study demonstrates good to excellent inter- and intra-observer reproducibility of CMR-FT technique in small animal model. The most reproducible measures are global circumferential and global longitudinal strain, whereas reproducibility of radial strain is weak. Furthermore, sample size calculation demonstrates that a small number of animals could be sufficient for future trials.
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157
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Morais P, Queirós S, Heyde B, Engvall J, 'hooge JD, Vilaça JL. Fully automatic left ventricular myocardial strain estimation in 2D short-axis tagged magnetic resonance imaging. Phys Med Biol 2017; 62:6899-6919. [PMID: 28783715 DOI: 10.1088/1361-6560/aa7dc2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiovascular diseases are among the leading causes of death and frequently result in local myocardial dysfunction. Among the numerous imaging modalities available to detect these dysfunctional regions, cardiac deformation imaging through tagged magnetic resonance imaging (t-MRI) has been an attractive approach. Nevertheless, fully automatic analysis of these data sets is still challenging. In this work, we present a fully automatic framework to estimate left ventricular myocardial deformation from t-MRI. This strategy performs automatic myocardial segmentation based on B-spline explicit active surfaces, which are initialized using an annular model. A non-rigid image-registration technique is then used to assess myocardial deformation. Three experiments were set up to validate the proposed framework using a clinical database of 75 patients. First, automatic segmentation accuracy was evaluated by comparing against manual delineations at one specific cardiac phase. The proposed solution showed an average perpendicular distance error of 2.35 ± 1.21 mm and 2.27 ± 1.02 mm for the endo- and epicardium, respectively. Second, starting from either manual or automatic segmentation, myocardial tracking was performed and the resulting strain curves were compared. It is shown that the automatic segmentation adds negligible differences during the strain-estimation stage, corroborating its accuracy. Finally, segmental strain was compared with scar tissue extent determined by delay-enhanced MRI. The results proved that both strain components were able to distinguish between normal and infarct regions. Overall, the proposed framework was shown to be accurate, robust, and attractive for clinical practice, as it overcomes several limitations of a manual analysis.
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Affiliation(s)
- Pedro Morais
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KULeuven-University of Leuven, Leuven, Belgium. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal. Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
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158
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Jolly MP, Jordan JH, Meléndez GC, McNeal GR, D’Agostino RB, Hundley WG. Automated assessments of circumferential strain from cine CMR correlate with LVEF declines in cancer patients early after receipt of cardio-toxic chemotherapy. J Cardiovasc Magn Reson 2017; 19:59. [PMID: 28768517 PMCID: PMC5541737 DOI: 10.1186/s12968-017-0373-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with cancer receiving potentially cardio-toxic chemotherapy, measurements of left ventricular (LV) circumferential or longitudinal strain are often used clinically to identify myocardial dysfunction. Using a new software algorithm, we sought to determine in individuals receiving treatment for cancer the association between automated assessments of LV mean mid-wall circumferential strain and conventional measures of LV ejection fraction (EF) both obtained from cardiovascular magnetic resonance (CMR) cine balanced steady-state free-precession (bSSFP) white-blood acquisitions. METHODS Before and 3 months after initiating treatment with potentially cardio-toxic chemotherapy, 72 individuals (aged 54 ± 14 years with breast cancer [39%], lymphoma [49%], or sarcoma [12%]) underwent serial CMR cine bSSFP assessments of LV volumes and EF, and mean mid-wall circumferential strain determined from these same cine images as well as from additional tagged CMR images. On the cine images, assessments of strain were obtained using the newly developed deformation-based segmentation algorithm. Assessments of LV volumes/EF from the cine images and strain from tagged CMR were accomplished using commercially available software. All measures were analyzed in a blinded fashion independent of one another. RESULTS Acceptable measures for the automated assessments of mean mid-wall circumferential strain from the cine images were obtained in 142 of 144 visits (98.6%) with an overall analysis time averaging 6:47 ± 1:06 min. The results from these automated measures averaged -18.8 ± 2.9 at baseline and -17.6 ± 3.1 at 3 months (p = 0.001). Left ventricular EF declined slightly from 65 ± 7% at baseline to 62 ± 7% at 3 months (p = 0.0002). The correlation between strain from cine imaging and LVEF was r = -0.61 (p < 0.0001). In addition, the 3-month changes in LV strain and LVEF were correlated (r = -0.49; p < 0.0001). The correlation between cine and tagged derived assessments of strain was r = 0.23; p = 0.01. CONCLUSIONS Automated measures of LV mean mid-wall circumferential strain can be obtained in 6¾ minutes from cine bSSFP LV short-axis images (used concurrently to assess LV volumes and EF) in 98.6% of patients receiving treatment for cancer with potentially cardio-toxic chemotherapy. These cine derived measures of circumferential strain correlate with early subclinical declines in LVEF.
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Affiliation(s)
- Marie-Pierre Jolly
- Medical Imaging Technologies, Siemens Healthineers, 755 College Road East, Princeton, NJ 08540-6632 USA
| | - Jennifer H. Jordan
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 USA
| | - Giselle C. Meléndez
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 USA
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Gary R. McNeal
- Cardiovascular MR R&D, Siemens Healthineers, Chicago, IL USA
| | - Ralph B. D’Agostino
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - W. Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 USA
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159
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Schrauben EM, Cowan BR, Greiser A, Young AA. Left ventricular function and regional strain with subtly-tagged steady-state free precession feature tracking. J Magn Reson Imaging 2017; 47:787-797. [PMID: 28722247 DOI: 10.1002/jmri.25819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/06/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide regional strain and ventricular volume from a single acquisition, using subtly tagged steady-state free precession (SubTag SSFP) feature tracking. MATERIALS AND METHODS The effects on regional strain of tag strength in gradient recalled echo (GRE) tagging, flip angle in untagged balanced SSFP, and both in SubTag SSFP were examined in the mid left ventricle of 15 healthy volunteers at 3T. Optimal parameters were determined from varying both tag strength and SSFP flip angle using full tag saturation GRE as the reference standard. SubTag SSFP was acquired in 15 additional healthy volunteers for whole-heart volume and strain assessment using the optimized parameters. Values measured by two image analysts were compared to clinical reference standards from untagged SSFP (volumes) and GRE tagging (strains). RESULTS Regional strain accuracy was maintained with decreasing total tagging flip angle (β); less than 3% differences for β ≥ 26°. For untagged SSFP flip angle (α), whole-wall strain differences became statistically significant when α < 40°. A SubTag SSFP acquisition with α = 40° and β = 46° showed the best combination of tagging strength, blood-myocardial contrast, and tag persistence at end-systole for regional strain estimation. SubTag SSFP also showed excellent agreement with untagged SSFP for volumetrics (percent difference: end-diastolic volume = 0.6%, end-systolic volume = 0.4%, stroke volume = 1.2%, ejection fraction = 0.6%, mass = 1.1%). CONCLUSION Feature tracking for regional myocardial strain assessment is dependent on image features, mainly the tag strength, persistence, and image contrast. SubTag SSFP balances these criteria to provide accurate regional strain and volumetric assessment in a single acquisition. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:787-797.
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Affiliation(s)
- Eric M Schrauben
- Translational Medicine, the Hospital for Sick Children, Toronto, Canada
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | | | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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160
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Assessment of Longitudinal Shortening in Cardiomyopathies with Cardiac Magnetic Resonance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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161
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Li R, Yang ZG, Xu HY, Shi K, Liu X, Diao KY, Guo YK. Myocardial Deformation in Cardiac Amyloid Light-chain Amyloidosis: Assessed with 3T Cardiovascular Magnetic Resonance Feature Tracking. Sci Rep 2017. [PMID: 28630445 PMCID: PMC5476571 DOI: 10.1038/s41598-017-03699-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Clinically, assessment of myocardial function is essential in patients with amyloid light-chain cardiac amyloidosis (AL-CA) to predict outcome and determine therapeutic approach. The aim of this study was to investigate the feasibility of cardiovascular magnetic resonance (CMR)-derived feature tracking algorithm for assessing left ventricular (LV) myocardial deformation in AL-CA, and to determine if these abnormal myocardial deformation parameters are correlated to impaired LV myocardial microvascular dysfunction. A total of 42 AL-CA patients, including 26 with preserved systolic function and 16 with impaired LVEF, and 35 healthy controls were enrolled and underwent CMR examination. Our result indicated that AL-CA patients had significantly reduced global peak strain (PS) (longitudinal, circumferential, and radial) (all P < 0.05). AL-CA patients with normal LVEF showed preserved longitudinal PS at apical and significantly reduced longitudinal PS at mid and basal segments. By Spearman’s rank correlation analysis, the LV regional radial, circumferential, and longitudinal myocardial deformation values were correlated to myocardial upslope and MaxSI in CA, regardless of LVEF. This study indicated that the abnormal LV myocardial deformation of AL-CA patients can be monitored using feature tracking CMR, even in those with preserved LVEF; and the myocardial deformation was associated with coronary microvascular dysfunction.
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Affiliation(s)
- Rui Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.,Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong, Sichuan, 637000, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan, 610041, China.
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162
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Lapinskas T, Schnackenburg B, Kouwenhoven M, Gebker R, Berger A, Zaliunas R, Pieske B, Kelle S. Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017. [PMID: 28620752 PMCID: PMC5813049 DOI: 10.1007/s10334-017-0639-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective This study aimed to investigate the advantages of recently developed cardiac imaging techniques of fat–water separation and feature tracking to characterize better individuals with chronic myocardial infarction (MI). Materials and methods Twenty patients who had a previous MI underwent CMR imaging. The study protocol included routine cine and late gadolinium enhancement (LGE) technique. In addition, mDixon LGE imaging was performed in every patient. Left ventricular (LV) circumferential (EccLV) and radial (ErrLV) strain were calculated using dedicated software (CMR42, Circle, Calgary, Canada). The extent of global scar was measured in LGE and fat–water separated images to compare conventional and recent CMR imaging techniques. Results The infarct size derived from conventional LGE and fat–water separated images was similar. However, detection of lipomatous metaplasia was only possible with mDixon imaging. Subjects with fat deposition demonstrated a significantly smaller percentage of fibrosis than those without fat (10.68 ± 5.07% vs. 13.83 ± 6.30%; p = 0.005). There was no significant difference in EccLV or ErrLV between myocardial segments containing fibrosis only and fibrosis with fat. However, EccLV and ErrLV values were significantly higher in myocardial segments adjacent to fibrosis with fat deposition than in those adjacent to LGE only. Conclusions Advanced CMR imaging ensures more detailed tissue characterization in patients with chronic MI without a relevant increase in imaging and post-processing time. Fatty metaplasia may influence regional myocardial deformation especially in the myocardial segments adjacent to scar tissue. A simplified and shortened myocardial viability CMR protocol might be useful to better characterize and stratify patients with chronic MI.
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Affiliation(s)
- Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania. .,Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
| | | | - Marc Kouwenhoven
- Philips Healthcare, Veenpluis 4-6, 5684 PC, Best, The Netherlands
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Alexander Berger
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu Street 2, 50161, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
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163
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Kuetting DLR, Feisst A, Dabir D, Homsi R, Sprinkart AM, Luetkens J, Schild HH, Thomas DK. Comparison of magnetic resonance feature tracking with CSPAMM HARP for the assessment of global and regional layer specific strain. Int J Cardiol 2017. [PMID: 28624332 DOI: 10.1016/j.ijcard.2017.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Layer specific strain assessment is increasingly being employed clinically. Cardiac magnetic resonance (MR) Feature Tracking (FT) is considered to be an adequate alternative for strain assessment. The aim of this study is to investigate the feasibility of FT derived layer specific strain assessment. METHODS CSPAMM and SSFP-Cine sequences were acquired in 38 individuals (19 patients with HFpEF, 19 controls) in identical midventricular short-axis locations. Global endocardial-, midmyocardial-, epicardial- peak systolic circumferential strain (PSCS) and regional epicardial PSCS were calculated and intra- as well inter-observer variability were assessed. RESULTS FT derived global epicardial and endocardial PSCS (7.9±2.3%; -19.6±4.9%) were significantly lower than tagging derived global epicardial and endocardial PSCS (-13.2±2.8%; -32.3±5.9%) (each p<0.001), while FT derived endocardial PSCS and tagging derived midmyocardial PSCS showed a strong correlation (r=0.71) and no significant differences. Global intra- and inter-observer variability of FT derived endocardial PSCS circumferential measures were acceptable (coefficient of variation 6.5% and 5.7%) while reproducibility of epicardial PSCS (coefficient of variation 16.8% and 18.1%) was poor. CONCLUSION The FT algorithm allows for reliable assessment of midmyocardial strain, while underestimating epicardial and endocardial strain and delivering less reproducible results than the gold standard of tagging.
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Affiliation(s)
- Daniel L R Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Andreas Feisst
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Darius Dabir
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Rami Homsi
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Alois M Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Julian Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Daniel K Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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164
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Yu Y, Yu S, Tang X, Ren H, Li S, Zou Q, Xiong F, Zheng T, Gong L. Evaluation of left ventricular strain in patients with dilated cardiomyopathy. J Int Med Res 2017; 45:2092-2100. [PMID: 28587541 PMCID: PMC5805211 DOI: 10.1177/0300060517712164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Dilated cardiomyopathy (DCM) can cause structural and functional changes in the left ventricle (LV). In this study, we evaluated whether cardiac magnetic resonance tissue-tracking (MR-TT) can be applied to the detection of LV abnormalities in patients with DCM. Methods We used MR-TT to analyze the global peak radial strain (GPRS), global peak circumferential strain (GPCS), and global peak longitudinal strain (GPLS) in every segment of the LV in 23 patients with DCM and 25 controls. The LV ejection fraction was also measured as a function indicator. Results Compared with the controls, the GPRS, GPCS, and GPLS were significantly reduced in patients with DCM, indicating global LV function impairment in all directions. We also identified a significant linear correlation between the GPRS, GPCS, and GPLS and the LV ejection fraction, indicating that LV function relies on coordinated wall motion from all directions. Moreover, we found that patients with DCM had a significantly reduced magnitude of the PRS, PCS, and PLS in most segments at different levels, indicating impaired myocardial function in most LV regions. Conclusions Our results demonstrate that LV myocardial strain in patients with DCM can be sensitively detected by MR-TT (not only the global LV function changes but also the segmental strain), which can help to identify the injured segment at an early stage and guide clinical treatment.
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Affiliation(s)
- Yaohan Yu
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Sisi Yu
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Xuepei Tang
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Haibo Ren
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Shuhao Li
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Qian Zou
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Fakui Xiong
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Tian Zheng
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
| | - Lianggeng Gong
- Department of MRI, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, China
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165
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Ghonim S, Voges I, Gatehouse PD, Keegan J, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease. Front Cardiovasc Med 2017; 4:30. [PMID: 28589126 PMCID: PMC5440586 DOI: 10.3389/fcvm.2017.00030] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/28/2017] [Indexed: 01/15/2023] Open
Abstract
Congenital heart disease (CHD) is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.
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Affiliation(s)
- Sarah Ghonim
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter D. Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Michael A. Gatzoulis
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Philip J. Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Sonya V. Babu-Narayan
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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166
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Lee JW, Jeong YJ, Lee G, Lee NK, Lee HW, Kim JY, Choi BS, Choo KS. Predictive Value of Cardiac Magnetic Resonance Imaging-Derived Myocardial Strain for Poor Outcomes in Patients with Acute Myocarditis. Korean J Radiol 2017; 18:643-654. [PMID: 28670159 PMCID: PMC5447640 DOI: 10.3348/kjr.2017.18.4.643] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/08/2016] [Indexed: 01/23/2023] Open
Abstract
Objective To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis. Materials and Methods We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. Results During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). Conclusion CMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Yeon Joo Jeong
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Nam Kyung Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Hye Won Lee
- Department of Cardiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Bum-Sung Choi
- Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
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Vo HQ, Marwick TH, Negishi K. MRI-Derived Myocardial Strain Measures in Normal Subjects. JACC Cardiovasc Imaging 2017; 11:196-205. [PMID: 28528164 DOI: 10.1016/j.jcmg.2016.12.025] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to perform a systematic review and meta-analysis to estimate the normal ranges of magnetic resonance imaging (MRI)-based feature tracking (FT) and to identify sources of variations. Similar analyses were also performed for strain encoding, displacement encoding with stimulated echoes, and myocardial tagging. BACKGROUND MRI-FT is a novel technique for quantification of myocardial deformation using MRI cine images. However, the reported 95% confidence intervals (CIs) from the 2 largest studies have no overlaps. METHODS Four databases (EMBASE, SCOPUS, PUBMED, and Web of Science) were systematically searched for MRI strains of the left (LV) and right (RV) ventricles. The key terms for MRI-FT were "tissue tracking," "feature tracking," "cardiac magnetic resonance," "cardiac MRI," "CMR," and "strain." A random effects model was used to pool LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and RVGLS. Meta-regressions were used to identify the sources of variations. RESULTS 659 healthy subjects were included from 18 papers for MRI-FT. Pooled mean of LVGLS was -20.1% (95% CI: -20.9% to -19.3%), LVGCS -23% (95% CI: -24.3% to -21.7%), LVGRS 34.1% (95% CI: 28.5% to 39.7%), and RVGLS -21.8% (95% CI: -23.3% to -20.2%). Although there were no publication biases except for LVGCS, significant heterogeneities were found. Meta-regression showed that variation of LVGCS was associated with field strength (β = 3.2; p = 0.041). Variations of LVGLS, LVGRS, and RVGLS were not associated with any of age, sex, software, field strength, sequence, LV ejection fraction, or LV size. LVGCS seems the most robust in MRI-FT. Among the MRI-derived strain techniques, the normal ranges were mostly concordant in LVGLS and LVGCS but varied substantially in LVGRS and RVGLS. CONCLUSIONS The pooled means of 4 MRI-derived myocardial strain methods in normal subjects are demonstrated. Differences in field strength were attributed to variations of LVGCS.
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Affiliation(s)
- Ha Q Vo
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Hasenfuß G, Lotz J, Chiribiri A, Nagel E, Schuster A. Quantitative assessment of left ventricular mechanical dyssynchrony using cine cardiovascular magnetic resonance imaging: Inter-study reproducibility. JRSM Cardiovasc Dis 2017; 6:2048004017710142. [PMID: 28567282 PMCID: PMC5438106 DOI: 10.1177/2048004017710142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/13/2017] [Accepted: 04/23/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the inter-study reproducibility of left ventricular (LV) mechanical dyssynchrony measures based on standard cardiovascular magnetic resonance (CMR) cine images. DESIGN Steady-state free precession (SSFP) LV short-axis stacks and three long-axes were acquired on the same day at three time points. Circumferential strain systolic dyssynchrony indexes (SDI), area-SDI as well as circumferential and radial uniformity ratio estimates (CURE and RURE, respectively) were derived from CMR myocardial feature-tracking (CMR-FT) based on the tracking of three SSFP short-axis planes. Furthermore, 4D-LV-analysis based on SSFP short-axis stacks and longitudinal planes was performed to quantify 4D-volume-SDI. SETTING A single-centre London teaching hospital. PARTICIPANTS 16 healthy volunteers. MAIN OUTCOME MEASURES Inter-study reproducibility between the repeated exams. RESULTS CURE and RURE as well as 4D-volume-SDI showed good inter-study reproducibility (coefficient of variation [CoV] 6.4%-12.9%). Circumferential strain and area-SDI showed higher variability between the repeated measurements (CoV 24.9%-37.5%). Uniformity ratio estimates showed the lowest inter-study variability (CoV 6.4%-8.5%). CONCLUSIONS Derivation of LV mechanical dyssynchrony measures from standard cine images is feasible using CMR-FT and 4D-LV-analysis tools. Uniformity ratio estimates and 4D-volume-SDI showed good inter-study reproducibility. Their clinical value should next be explored in patients who potentially benefit from cardiac resynchronization therapy.
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Affiliation(s)
- Johannes T Kowallick
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | | | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Roy Jogiya
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Gerd Hasenfuß
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Division of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research (DZHK, partner site Rhine-Main), Frankfurt, Germany
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
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169
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Khan JN, Nazir SA, Singh A, Shetye A, Lai FY, Peebles C, Wong J, Greenwood JP, McCann GP. Relationship of Myocardial Strain and Markers of Myocardial Injury to Predict Segmental Recovery After Acute ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.003457. [PMID: 27283007 DOI: 10.1161/circimaging.115.003457] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Late gadolinium-enhanced cardiovascular magnetic resonance imaging overestimates infarct size and underestimates recovery of dysfunctional segments acutely post ST-segment-elevation myocardial infarction. We assessed whether cardiovascular magnetic resonance imaging-derived segmental myocardial strain and markers of myocardial injury could improve the accuracy of late gadolinium-enhancement in predicting functional recovery after ST-segment-elevation myocardial infarction. METHODS AND RESULTS A total of 164 ST-segment-elevation myocardial infarction patients underwent acute (median 3 days) and follow-up (median 9.4 months) cardiovascular magnetic resonance imaging. Wall-motion scoring, feature tracking-derived circumferential strain (Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular obstruction, intramyocardial hemorrhage, and salvage index (MSI) were assessed in 2624 segments. We used logistic regression analysis to identify markers that predict segmental recovery. At acute CMR 32% of segments were dysfunctional, and at follow-up CMR 19% were dysfunctional. Segmental function at acute imaging and odds ratio (OR) for functional recovery decreased with increasing SEE, although 33% of dysfunctional segments with SEE 76% to 100% improved. SEE was a strong predictor of functional improvement and normalization (area under the curve [AUC], 0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI, 0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI, 0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization). Its predictive accuracy for improvement, as assessed by areas under the receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI, 0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95% CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI, 0.818-0.871]; OR, 1.07 [95% CI, 1.05-1.10] per +1% SEE for normalization), and for normalization was greater than the other predictors. MSI and Ecc remained as significant after adjustment for SEE but provided no significant increase in predictive accuracy for improvement and normalization compared with SEE alone. MSI had similar predictive accuracy to SEE for functional recovery but was not assessable in 25% of patients. Microvascular obstruction provided no incremental predictive accuracy above SEE. CONCLUSIONS This multicenter study confirms that SEE is a strong predictor of functional improvement post ST-segment-elevation myocardial infarction, but recovery occurs in a substantial proportion of dysfunctional segments with SEE >75%. Feature tracking-derived Ecc and MSI provide minimal incremental benefit to SEE in predicting segmental recovery. CLINICAL TRIAL REGISTRATION URL: http://www.isrctn.com. Unique identifier: ISRCTN70913605.
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Affiliation(s)
- Jamal N Khan
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Sheraz A Nazir
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Anvesha Singh
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Abhishek Shetye
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Florence Y Lai
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Charles Peebles
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Joyce Wong
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - John P Greenwood
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.)
| | - Gerry P McCann
- From the Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular BRU, Glenfield Hospital, United Kingdom (J.N.K., S.A.N., A.Singh, A.Shetye, F.Y.L., G.P.M.); Department of Cardiology, University Hospital Southampton NHS Trust, United Kingdom (C.P.); Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom (J.W.); and The Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, United Kingdom (J.P.G.).
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170
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Chitiboi T, Axel L. Magnetic resonance imaging of myocardial strain: A review of current approaches. J Magn Reson Imaging 2017; 46:1263-1280. [PMID: 28471530 DOI: 10.1002/jmri.25718] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/14/2017] [Indexed: 11/07/2022] Open
Abstract
Contraction of the heart is central to its purpose of pumping blood around the body. While simple global function measures (such as the ejection fraction) are most commonly used in the clinical assessment of cardiac function, MRI also provides a range of approaches for quantitatively characterizing regional cardiac function, including the local deformation (or strain) within the heart wall. While they have been around for some years, these methods are still undergoing further technical development, and they have had relatively little clinical evaluation. However, they can provide potentially useful new ways to assess cardiac function, which may be able to contribute to better classification and treatment of heart disease. This article provides some basic background on the physical and physiological factors that determine the motion of the heart, in health and disease and then reviews some of the ways that MRI methods are being developed to image and quantify strain within the myocardium. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1263-1280.
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Affiliation(s)
- Teodora Chitiboi
- NYU School of Medicine, Department of Radiology, New York, New York, USA
| | - Leon Axel
- NYU School of Medicine, Department of Radiology, New York, New York, USA
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171
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Interrelations of Epicardial Fat Volume, Left Ventricular T1-Relaxation Times and Myocardial Strain in Hypertensive Patients. J Thorac Imaging 2017; 32:169-175. [DOI: 10.1097/rti.0000000000000264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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172
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Puntmann VO, Isted A, Hinojar R, Foote L, Carr-White G, Nagel E. T1 and T2 Mapping in Recognition of Early Cardiac Involvement in Systemic Sarcoidosis. Radiology 2017; 285:63-72. [PMID: 28448233 DOI: 10.1148/radiol.2017162732] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine whether quantitative tissue characterization with T1 and T2 mapping supports recognition of myocardial involvement in patients with systemic sarcoidosis. Materials and Methods Fifty-three consecutive patients with a biopsy-proven extracardiac diagnosis of systemic sarcoidosis (21 men; median age, 45 years; interquartile range, 22 years) and 36 normotensive previously healthy control subjects (14 men; median age, 43 years; interquartile range, 18 years) underwent cardiovascular magnetic resonance imaging, which was performed to assess cardiac function and late gadolinium enhancement, and T1 and T2 mapping. A follow-up substudy was performed in 40 patients (mean follow-up interval, 144 days ± 35 [standard deviation]); of these 40 patients, 18 underwent anti-inflammatory treatment for systemic symptoms. Binary logistic regression and receiver operating characteristic curve analyses were used to assess discrimination between health and disease; Wilcoxon signed rank test was used to assess the effect of treatment. Results When compared with control subjects, patients had higher ventricular volume, higher myocardial native T1 and T2, and lower longitudinal strain and ejection fraction (P < .05 for all). Myocardial native T1 and T2 had higher discriminatory accuracy (area under the receiver operating characteristic curve [AUC]: 0.96 and 0.89, respectively) for separation between control subjects and patients when compared with the standard diagnostic criteria (AUC < 0.67). Native T1 was the independent discriminator between health and disease (specificity, 90%; sensitivity, 96%; accuracy, 94%). There was a significant reduction of native T1 and T2 in the patients who underwent treatment (z score: -3.72 and -2.88; P < .01) but not in the patients who did not (z score, -1.42 and -1.38; P > .15). Conclusion Quantitative myocardial tissue characterization with T1 and T2 mapping may enable noninvasive recognition of cardiac involvement and activity of myocardial inflammation in patients with systemic sarcoidosis. Future studies will be performed to confirm their role in risk stratification and guidance of clinical management. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Valentina O Puntmann
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
| | - Alexander Isted
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
| | - Rocio Hinojar
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
| | - Lucy Foote
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
| | - Gerald Carr-White
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
| | - Eike Nagel
- From the Department of Cardiology, Guy's and St Thomas' NHS Trust, London, England (V.O.P., A.I., R.H., L.F., G.C., E.N.); Institute of Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany (V.O.P., E.N.); Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany (V.O.P.); Department of Cardiovascular Imaging, King's College London, St. Thomas' Hospital, London, England (V.O.P.); Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain (R.H.); and King's College Hospital NHS Trust, Denmark Hill, London, England (G.C.)
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173
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Rahman ZU, Sethi P, Murtaza G, Virk HUH, Rai A, Mahmod M, Schoondyke J, Albalbissi K. Feature tracking cardiac magnetic resonance imaging: A review of a novel non-invasive cardiac imaging technique. World J Cardiol 2017; 9:312-319. [PMID: 28515849 PMCID: PMC5411965 DOI: 10.4330/wjc.v9.i4.312] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/01/2017] [Accepted: 03/23/2017] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality globally. Early diagnostic markers are gaining popularity for better patient care disease outcomes. There is an increasing interest in noninvasive cardiac imaging biomarkers to diagnose subclinical cardiac disease. Feature tracking cardiac magnetic resonance imaging is a novel post-processing technique that is increasingly being employed to assess global and regional myocardial function. This technique has numerous applications in structural and functional diagnostics. It has been validated in multiple studies, although there is still a long way to go for it to become routine standard of care.
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Affiliation(s)
- Zia Ur Rahman
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Pooja Sethi
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Ghulam Murtaza
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Hafeez Ul Hassan Virk
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Aitzaz Rai
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Masliza Mahmod
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Jeffrey Schoondyke
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
| | - Kais Albalbissi
- Zia Ur Rahman, Pooja Sethi, Jeffrey Schoondyke, Kais Albalbissi, Department of Internal Medicine, Divison of Cardiology, East Tennessee State University, Johnson City, TN 37064, United States
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174
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Kuetting DLR, Dabir D, Luetkens J, Feisst A, Homsi R, Thomas D, Schild HH, Sprinkart AM. Flip angle optimization for balanced SSFP: Cardiac cine imaging following the application of standard extracellular contrast agent (gadobutrol). J Magn Reson Imaging 2017; 47:255-261. [PMID: 28429574 DOI: 10.1002/jmri.25728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/22/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the effect of the flip angle (FA) on the blood-myocardium contrast and to define the FA leading to highest image quality in contrast-enhanced balanced steady-state free precession (bSSFP) images. bSSFP images provide excellent contrast between myocardium and blood with high signal-to-noise and contrast-to-noise ratios (SNR, CNR). In clinical practice, bSSFP images are typically acquired following the injection of extracellular contrast agents (ECAs), although ECAs decrease the blood-myocardium contrast. MATERIALS AND METHODS First, a theoretical optimization was performed to determine the FA that maximizes CNR in bSSFP imaging 2-20 minutes after application of ECA. Second signal-ratios, contrast, SNR, and CNR were assessed in vivo in 25 patients in bSSFP images at 1.5T acquired before (FA = 50°) and 10-15 minutes after (FAs = 50°, 80°, 90°, 100°) application of a double-dose contrast agent. Image quality was assessed by two readers. RESULTS Simulations yielded FAs in the range of 85-100° for optimal CNR in contrast-enhanced images. In vivo comparison of conventionally acquired cine images (FA 50°) showed an increase in CNR between blood and myocardium by 57% in diastole and 78% in systole in adapted contrast-enhanced bSSFP images (FA 100°). Contrast-enhanced images with an FA of 100° were rated highest in image quality assessment. CONCLUSION By means of FA adaptation a similar blood-myocardium contrast can be achieved in contrast-enhanced bSSFP as in unenhanced bSSFP imaging with an increase in CNR. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:255-261.
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Affiliation(s)
| | - Darius Dabir
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Andreas Feisst
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Rami Homsi
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
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175
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The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:1561-1569. [PMID: 28421305 PMCID: PMC5676834 DOI: 10.1007/s10554-017-1138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/09/2017] [Indexed: 12/28/2022]
Abstract
Prior myocardial infarction (MI) is associated with increased mortality and is prevalent in certain high risk patient groups. Electrocardiogram may be used in diagnosis, however, sensitivity is limited, thus non-invasive imaging techniques may improve diagnosis. We investigated whether global longitudinal strain (GLS) and longitudinal strain parameters are reduced in patients with prior MI but preserved left ventricular ejection fraction (LVEF). The study included 40 clinical patients with prior MI occurring >3 months previously (defined as subendocardial hyperenhancement on late Gadolinium enhancement imaging) with LVEF ≥ 55% and 40 controls matched for age and LVEF. GLS, global longitudinal strain rate (GLSR) and early diastolic longitudinal strain rate (GLSRe) were measured from cine imaging feature tracking analysis. Presence of wall motion abnormality (WMA) and minimum systolic wall thickening (SWT) were calculated from cine imaging. GLS was −17.3 ± 3.7% in prior MI versus −19.3 ± 1.9% in controls (p = 0.012). GLSR was −88.0 ± 33.7%/s in prior MI versus −103.3 ± 26.5%/s in controls (p = 0.005). GLSRe was 76.4 ± 28.4%/s in prior MI versus 95.5 ± 26.0%/s in controls (p = 0.001). GLS accurately identified prior MI [AUC 0.662 (95% CI 0.54–0.785) p = 0.012] whereas WMA [AUC 0.500 (95% CI 0.386–0.614) p = 1.0] and minimum SWT [AUC 0.609 (95% CI 0.483–0.735) p = 0.093] did not. GLS, GLSR and GLSRe are reduced in prior MI with preserved LVEF. Normal LVEF and lack of WMA cannot exclude prior MI. Prior MI should be considered when reduced GLS, GLSR or GLSRe are detected by non-invasive imaging.
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176
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Jacob A, Krishnamurthi G, Mathur M. Estimation of myocardial deformation using correlation image velocimetry. BMC Med Imaging 2017; 17:25. [PMID: 28381245 PMCID: PMC5382518 DOI: 10.1186/s12880-017-0195-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/02/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tagged Magnetic Resonance (tMR) imaging is a powerful technique for determining cardiovascular abnormalities. One of the reasons for tMR not being used in routine clinical practice is the lack of easy-to-use tools for image analysis and strain mapping. In this paper, we introduce a novel interdisciplinary method based on correlation image velocimetry (CIV) to estimate cardiac deformation and strain maps from tMR images. Methods CIV, a cross-correlation based pattern matching algorithm, analyses a pair of images to obtain the displacement field at sub-pixel accuracy with any desired spatial resolution. This first time application of CIV to tMR image analysis is implemented using an existing open source Matlab-based software called UVMAT. The method, which requires two main input parameters namely correlation box size (CB) and search box size (SB), is first validated using a synthetic grid image with grid sizes representative of typical tMR images. Phantom and patient images obtained from a Medical Imaging grand challenge dataset (http://stacom.cardiacatlas.org/motion-tracking-challenge/) were then analysed to obtain cardiac displacement fields and strain maps. The results were then compared with estimates from Harmonic Phase analysis (HARP) technique. Results For a known displacement field imposed on both the synthetic grid image and the phantom image, CIV is accurate for 3-pixel and larger displacements on a 512 × 512 image with (CB,SB)=(25,55) pixels. Further validation of our method is achieved by showing that our estimated landmark positions on patient images fall within the inter-observer variability in the ground truth. The effectiveness of our approach to analyse patient images is then established by calculating dense displacement fields throughout a cardiac cycle, and were found to be physiologically consistent. Circumferential strains were estimated at the apical, mid and basal slices of the heart, and were shown to compare favorably with those of HARP over the entire cardiac cycle, except in a few (∼4) of the segments in the 17-segment AHA model. The radial strains, however, are underestimated by our method in most segments when compared with HARP. Conclusions In summary, we have demonstrated the capability of CIV to accurately and efficiently quantify cardiac deformation from tMR images. Furthermore, physiologically consistent displacement fields and circumferential strain curves in most regions of the heart indicate that our approach, upon automating some pre-processing steps and testing in clinical trials, can potentially be implemented in a clinical setting. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0195-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Athira Jacob
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, 21218, USA
| | - Ganapathy Krishnamurthi
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.
| | - Manikandan Mathur
- Department of Aerospace Engineering, Indian Institute of Technology Madras, Chennai, 600036, India
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177
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Assessment of a left circumflex coronary artery-left ventricle fistula by multimodality imaging in a child. Cardiol Young 2017; 27:570-572. [PMID: 27938446 DOI: 10.1017/s1047951116002043] [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] [Indexed: 02/05/2023]
Abstract
Multimodality imaging revealed a left circumflex coronary artery-left ventricle fistula in a 4-year-old boy. MRI tissue tracking revealed a slight abnormality in the left ventricular myocardial strain. Early surgery was suggested to avoid serious complications.
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178
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Schmidt B, Dick A, Treutlein M, Schiller P, Bunck AC, Maintz D, Baeßler B. Intra- and inter-observer reproducibility of global and regional magnetic resonance feature tracking derived strain parameters of the left and right ventricle. Eur J Radiol 2017; 89:97-105. [DOI: 10.1016/j.ejrad.2017.01.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/16/2017] [Accepted: 01/24/2017] [Indexed: 01/01/2023]
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179
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Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers. Sci Rep 2017; 7:45314. [PMID: 28349989 PMCID: PMC5368608 DOI: 10.1038/srep45314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
The cine magnetic resonance imaging based technique feature tracking-cardiac magnetic resonance (FT-CMR) is emerging as a novel, simple and robust method to evaluate myocardial strain. We investigated the distribution characteristics of left-ventricular myocardial strain using a novel cine MRI based deformation registration algorithm (DRA) in a cohort of healthy Chinese subjects. A total of 130 healthy Chinese subjects were enrolled. Three components of orthogonal strain (radial, circumferential, longitudinal) of the left ventricle were analyzed using DRA on steady-state free precession cine sequence images. A distinct transmural circumferential strain gradient was observed in the left ventricle that showed universal increment from the epicardial to endocardial myocardial wall (epiwall: -15.4 ± 1.9%; midwall: -18.8 ± 2.0%; endowall: -22.3 ± 2.3%, P < 0.001). Longitudinal strain showed a similar trend from epicardial to endocardial layers (epiwall: -16.0 ± 2.9%; midwall: -15.6 ± 2.7%; endowall: -14.8 ± 2.4%, P < 0.001), but radial strain had a very heterogeneous distribution and variation. In the longitudinal direction from the base to the apex of the left ventricle, there was a trend of decreasing peak systolic longitudinal strain (basal: -23.3 ± 4.6%; mid: -13.7 ± 7.3%; apical: -13.2 ± 5.5%; P < 0.001). In conclusion, there are distinct distribution patterns of circumferential and longitudinal strain within the left ventricle in healthy Chinese subjects. These distribution patterns of strain may provide unique profiles for further study in different types of myocardial disease.
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180
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Chan BT, Yeoh HK, Liew YM, Aziz YFA, Sridhar GS, Hamilton-Craig C, Platts D, Lim E. Left ventricular flow propagation velocity measurement: Is it cast in stone? Med Biol Eng Comput 2017; 55:1883-1893. [PMID: 28321684 DOI: 10.1007/s11517-017-1639-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
This study aims to investigate the measurement of left ventricular flow propagation velocity, V p, using phase contrast magnetic resonance imaging and to assess the discrepancies resulting from inflow jet direction and individual left ventricular size. Three V p measuring techniques, namely non-adaptive (NA), adaptive positions (AP) and adaptive vectors (AV) method, were suggested and compared. We performed the comparison on nine healthy volunteers and nine post-infarct patients at four measurement positions, respectively, at one-third, one-half, two-thirds and the conventional 4 cm distances from the mitral valve leaflet into the left ventricle. We found that the V p measurement was affected by both the inflow jet direction and measurement positions. Both NA and AP methods overestimated V p, especially in dilated left ventricles, while the AV method showed the strongest correlation with the isovolumic relaxation myocardial strain rate (r = 0.53, p < 0.05). Using the AV method, notable difference in mean V p was also observed between healthy volunteers and post-infarct patients at positions of: one-half (81 ± 31 vs. 58 ± 25 cm/s), two-thirds (89 ± 32 vs. 45 ± 15 cm/s) and 4 cm (98 ± 23 vs. 47 ± 13 cm/s) distances. The use of AV method and measurement position at one-half distance was found to be the most suitable method for assessing diastolic dysfunction given varying left ventricular sizes and inflow jet directions.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hak Koon Yeoh
- Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Seri Kembangan Engineering Sdn. Bhd., 61-1, Jalan Anggerik Vanilla T, Kota Kemuning, 40460, Shah Alam, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- Department of Biomedical Imaging, University Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Christian Hamilton-Craig
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia
| | - David Platts
- School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia.,Department of Echocardiography, The Prince Charles Hospital, Chermside, QLD, 4032, Australia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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181
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Chungsomprasong P, Hamilton R, Luining W, Fatah M, Yoo SJ, Grosse-Wortmann L. Left Ventricular Function in Children and Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2017; 119:778-784. [PMID: 28040191 DOI: 10.1016/j.amjcard.2016.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to determine if left ventricular (LV) contractility is reduced in children with arrhythmogenic right ventricular cardiomyopathy (ARVC). For this retrospective study, children and adolescents undergoing a workup for ARVC were characterized according to the revised Task Force Criteria (rTFC). LV strain, rotation, and torsion were measured by feature-tracking cardiovascular magnetic resonance imaging (CMR). Of 142 pediatric patients, 41% had no, 23% possible, 20% borderline, and 16% definite ARVC. LV ejection fraction (EF) did not differ between rTFC categories. Patients in higher rTFC categories had lower right ventricular (RV) EF z-scores (Z-), higher Z-RV end-diastolic volumes (EDVs) and larger Z-LVEDVs (p <0.001, p = 0.002 and 0.013, respectively). LV global circumferential strain was lower in higher rTFC categories (p = 0.018). Z-LVEDV correlated with Z-RVEDV, and Z-LVEF correlated with Z-RVEF (r = 0.69 and r = 0.55, both p <0.001). Z-LVEF and Z-RVEF correlated with LV global circumferential strain (r = 0.48 and r = 0.46, both p <0.001). Forty-eight patients (34%) underwent follow-up CMR investigations after a mean of 3.2 ± 1.9 (0.4 to 8.4) years. A decrease of Z-LVEF over time correlated with that of Z-RVEF (r = 0.35), and Z-LVEDV increase correlated with Z-RVEDV increase (r = 0.57). In conclusion, LV myocardial dysfunction is present in young patients with suspected ARVC. Progressive LV dysfunction assessed by conventional CMR and feature-tracking and enlargement over time parallel adverse remodeling of the RV.
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182
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Anwar S, Harris MA, Whitehead KK, Keller MS, Goldmuntz E, Fogel MA, Mercer-Rosa L. The Impact of the Right Ventricular Outflow Tract Patch on Right Ventricular Strain in Tetralogy of Fallot: A Comparison with Valvar Pulmonary Stenosis Utilizing Cardiac Magnetic Resonance. Pediatr Cardiol 2017; 38:617-623. [PMID: 28144689 DOI: 10.1007/s00246-016-1558-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
Abstract
A non-contractile transannular patch (TAP) in the right ventricular outflow tract (RVOT) contributes to ventricular dysfunction after tetralogy of Fallot (TOF) repair. We compared regional right ventricular (RV) strain in repaired TOF with valvar pulmonary stenosis (VPS) after balloon valvuloplasty to investigate the effects of TAP. Retrospective review of 26 cardiac magnetic resonance studies of TOF (n = 13) and VPS (n = 13) subjects matched by degree and duration of pulmonary regurgitation (PR). Feature tracking strain analysis was performed. Student's t tests, Pearson correlation, and linear regression were applied. RV ejection fraction (EF) was normal and similar between TOF and VPS (60 and 65%, respectively, p = 0.8). RV 4-chamber Lagrangian longitudinal strain (RV 4ch LS) was worse in both groups compared to normals but comparable to each other: -18.2 (95% CI -3.6 to -33) for TOF and -20.2 (95% CI -12.4 to -28) for VPS, p = 0.5. RVOT LS was worse than RV 4ch LS in TOF, p = 0.05, but not in VPS, p = 0.19. There were no significant differences in RVOT strain between groups, p = 0.18. RVOT strain and RV 4ch LS correlated positively with RV EF in VPS (r = 0.72, p = 0.003 and r = 0.55, p = 0.04). PR degree correlated negatively with RVOT LS for TOF and VPS. Longitudinal strain is diminished in VPS and TOF subjects with preserved RV EF. TAP could explain worse RVOT strain in TOF. Longitudinal studies are needed to ascertain if RV strain predicts worsening of RV EF.
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Affiliation(s)
- Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Matthew A Harris
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Kevin K Whitehead
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Marc S Keller
- Division of Radiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mark A Fogel
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia PA. 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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183
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Berganza FM, de Alba CG, Özcelik N, Adebo D. Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children. Pediatr Cardiol 2017; 38:566-574. [PMID: 28058478 DOI: 10.1007/s00246-016-1549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Abstract
Cardiac magnetic resonance imaging is an important tool to evaluate cardiac anatomy and ventricular size and function after repaired tetralogy of Fallot. Magnetic resonance tissue tagging is the gold standard for evaluation of myocardial strain. However, myocardial tagging strain requires tagged images to be obtained prospectively, during the scan and with limited temporal resolution. Cardiac magnetic resonance feature tracking is a new tool that allows the retrospective analysis of cine images. There is limited experience with cardiac magnetic resonance feature tracking strain analysis in children. The medical records of patients with repaired tetralogy of Fallot that had a cardiac magnetic resonance (CMR) study from December 2013 to June 2015 were reviewed. The control group included patients who underwent a CMR with normal cardiac anatomy and ventricular function. Global longitudinal, circumferential and radial strain parameters (2D and 3D) were obtained by retrospectively contouring cine images from ventricular short axis, two chamber and four chamber views using post-processing software (Circle CVi42, Calgary, Canada). The correlation between conventional ventricular function parameters and ventricular strain was performed using Pearson's correlation. The mean age of tetralogy of Fallot and control subjects was 12.4 and 14.1 years, respectively. In patients after repaired tetralogy of Fallot, the mean left ventricular global 2D and 3D circumferential strains were -17.4 ± 2.9 and -10.1 ± 3, respectively. The mean indexed right ventricular end-diastolic volume was 135.4 cc m2 ± 46 compared to 75.7 cc m2 ± 17 in control subjects (P = 0.0001, CI 95%). Left ventricular global circumferential 3D strain showed a statistically significant difference in patients after TOF repair compared to normal subjects (-10.1 ± 3 vs. -14.71 ± 1.9, P = 0.00001). A strong correlation between left ventricular global circumferential 3D strain and right ventricular end-diastolic volume (P ≤ 0.0001) was noted. We found a strong correlation between left ventricular circumferential 3D strain and indexed right ventricular end-diastolic volume, as well as a strong correlation between left ventricular longitudinal 2D strain and right ventricular ejection fraction. Circumferential 3D strain may be a suitable tool to detect early abnormalities of ventricular myocardium even before the ejection fraction becomes compromised. Large-scale prospective studies are recommended.
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Affiliation(s)
- Fernando M Berganza
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | | | - Nazire Özcelik
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Dilachew Adebo
- Division of Pediatric Cardiology, Memorial Hermann Children's Hospital, University of Texas Medical School at Houston, Houston, TX, USA.
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184
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Keller EJ, Fang S, Lin K, Freed BH, Smith PM, Spottiswoode BS, Davids R, Carr M, Jolly MP, Markl M, Carr JC, Collins JD. The consistency of myocardial strain derived from heart deformation analysis. Int J Cardiovasc Imaging 2017; 33:1169-1177. [DOI: 10.1007/s10554-017-1090-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/02/2017] [Indexed: 11/24/2022]
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185
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Khan JN, McCann GP. Cardiovascular magnetic resonance imaging assessment of outcomes in acute myocardial infarction. World J Cardiol 2017; 9:109-133. [PMID: 28289525 PMCID: PMC5329738 DOI: 10.4330/wjc.v9.i2.109] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/02/2016] [Accepted: 01/02/2017] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging uniquely characterizes myocardial and microvascular injury in acute myocardial infarction (AMI), providing powerful surrogate markers of outcomes. The last 10 years have seen an exponential increase in AMI studies utilizing CMR based endpoints. This article provides a contemporary, comprehensive review of the powerful role of CMR imaging in the assessment of outcomes in AMI. The theory, assessment techniques, chronology, importance in predicting left ventricular function and remodelling, and prognostic value of each CMR surrogate marker is described in detail. Major studies illustrating the importance of the markers are summarized, providing an up to date review of the literature base in CMR imaging in AMI.
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Affiliation(s)
- Jamal N Khan
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
| | - Gerry P McCann
- Jamal N Khan, Gerry P McCann, Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Cardiovascular Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, United Kingdom
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186
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Morais P, Marchi A, Bogaert JA, Dresselaers T, Heyde B, D’hooge J, Bogaert J. Cardiovascular magnetic resonance myocardial feature tracking using a non-rigid, elastic image registration algorithm: assessment of variability in a real-life clinical setting. J Cardiovasc Magn Reson 2017; 19:24. [PMID: 28209163 PMCID: PMC5314711 DOI: 10.1186/s12968-017-0333-y] [Citation(s) in RCA: 65] [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: 10/04/2016] [Accepted: 01/26/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a promising technique for quantification of myocardial strain from steady-state free precession (SSFP) cine images. We sought to determine the variability of CMR-FT using a non-rigid elastic registration algorithm recently available in a commercial software package (Segment, Medviso) in a real-life clinical setting. METHODS Firstly, we studied the variability in a healthy volunteer who underwent 10 CMR studies over five consecutive days. Secondly, 10 patients were selected from our CMR database yielding normal findings (normal group). Finally, we prospectively studied 10 patients with known or suspected myocardial pathology referred for further investigation to CMR (patient group). In the patient group a second study was performed respecting an interval of 30 min between studies. All studies were manually segmented at the end-diastolic phase by three observers. In all subjects left ventricular (LV) circumferential and radial strain were calculated in the short-axis direction (EccSAX and ErrSAX, respectively) and longitudinal strain in the long-axis direction (EllLAX). The level of CMR experience of the observers was 2 weeks, 6 months and >20 years. RESULTS Mean contouring time was 7 ± 1 min, mean FT calculation time 13 ± 2 min. Intra- and inter-observer variability was good to excellent with an coefficient of reproducibility (CR) ranging 1.6% to 11.5%, and 1.7% to 16.0%, respectively and an intraclass correlation coefficient (ICC) ranging 0.89 to 1.00 and 0.74 to 0.99, respectively. Variability considerably increased in the test-retest setting with a CR ranging 4.2% to 29.1% and an ICC ranging 0.66 to 0.95 in the patient group. Variability was not influenced by level of expertise of the observers. Neither did the presence of myocardial pathology at CMR negatively impact variability. However, compared to global myocardial strain, segmental myocardial strain variability increased with a factor 2-3, in particular for the basal and apical short-axis slices. CONCLUSIONS CMR-FT using non-rigid, elastic registration is a reproducible approach for strain analysis in patients routinely scheduled for CMR, and is not influenced by the level of training. However, further improvement is needed to reliably depict small variations in segmental myocardial strain.
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Affiliation(s)
- Pedro Morais
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KULeuven - University of Leuven, Herestraat 49, Leuven, Belgium
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Instituto de Engenharia Mecânica e Gestão Industrial, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Alberto Marchi
- Department of Imaging and Pathology, KU Leuven – University of Leuven, Herestraat 49, Leuven, Belgium
| | - Julie A. Bogaert
- Department of Imaging and Pathology, KU Leuven – University of Leuven, Herestraat 49, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven – University of Leuven, Herestraat 49, Leuven, Belgium
| | - Brecht Heyde
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KULeuven - University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jan D’hooge
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KULeuven - University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven – University of Leuven, Herestraat 49, Leuven, Belgium
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187
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Dick A, Schmidt B, Michels G, Bunck AC, Maintz D, Baeßler B. Left and right atrial feature tracking in acute myocarditis: A feasibility study. Eur J Radiol 2017; 89:72-80. [PMID: 28267553 DOI: 10.1016/j.ejrad.2017.01.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated. METHODS CMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [εs], peak positive SR [SRs]), conduit function (passive strain [εe], peak early negative SR [SRe]) and booster pump function (active strain [εa], peak late negative SR [SRa]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV). RESULTS FT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA εs: 32±17 vs. 46±13, p=0.019; LA SRs: 1.5±0.5 vs. 1.8±0.5, p=0.117; LA SRe: -1.3±0.5 vs. -1.9±0.5, p<0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SRe proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SRe with a cut-off of -1.6s-1 resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters showed a tendency to parallel those of the LA and showed no additional effect with respect to the diagnostic potential in acute myocarditis. CONCLUSIONS Myocarditis patients exhibit an impaired atrial reservoir and conduit function, what might be indicative of ventricular diastolic dysfunction. LA SRe was the best predictor for the presence of acute myocarditis in our study, pointing towards the discriminative power of atrial strain analysis in the CMR-based diagnosis of acute myocarditis.
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Affiliation(s)
- Anastasia Dick
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Björn Schmidt
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Guido Michels
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Alexander C Bunck
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Bettina Baeßler
- Department of Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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188
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Truong VT, Safdar KS, Kalra DK, Gao X, Ambach S, Taylor MD, Moore R, Taylor RJ, Germann J, Toro-Salazar O, Jefferies JL, Bartone C, Raman SV, Ngo T, Mazur W. Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values. Magn Reson Imaging 2017; 38:189-195. [PMID: 28093270 DOI: 10.1016/j.mri.2017.01.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT). METHODS A total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT. The age range was 4-81years with a median of 32years (interquartile range, 15 to 56years). RESULTS Analysis time per patient was <5min. The peak longitudinal strain (Ell) was -22.11±3.51%. The peak circumferential strains (Ecc) for global, basal, mid-cavity and apical segments were as follows: -11.69±2.25%, -11.00±2.45%, -11.17±3.36%, -12.90±3.34%. There were significant gender differences in peak Ecc at the base (P=0.04) and the mid-cavity (P=0.03) with greater deformation in females than in males. On Bland-Altman analysis, peak Ell (mean bias, 0.22±1.67; 95% CI -3.05 to 3.49) and mid-cavity Ecc (mean bias, 0.036±1.75; 95% CI, -3.39 to 3.47) had the best intra-observer agreement and inter-observer agreement, respectively. CONCLUSIONS RV longitudinal and circumferential strains can be quickly assessed with good intra-observer and inter-observer variability using TT.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, OH, USA; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | | | - Xuexin Gao
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | - Stephanie Ambach
- The University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, USA
| | - Michael D Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ryan Moore
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robin J Taylor
- Centre for Cardiovascular Sciences University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Joshua Germann
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - John L Jefferies
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Subha V Raman
- The Ohio State University Medical Center, Columbus, OH, USA
| | - Tam Ngo
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Wojciech Mazur
- The Christ Hospital Health Network, Cincinnati, OH, USA.
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189
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Kuetting DLR, Homsi R, Sprinkart AM, Luetkens J, Thomas DK, Schild HH, Dabir D. Quantitative assessment of systolic and diastolic function in patients with LGE negative systemic amyloidosis using CMR. Int J Cardiol 2016; 232:336-341. [PMID: 28153537 DOI: 10.1016/j.ijcard.2016.12.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In clinical routine myocardial affection in amyloidosis is assessed by qualitative late gadolinium enhancement (LGE). Recent studies suggest that early cardiac involvement in amyloidosis may be overlooked by qualitative LGE assessment. The aim of this study was to assess possible early cardiac involvement in LGE negative AL patients by means of systolic and diastolic strain assessment and quantitative enhancement. METHODS 51 individuals (17 Patients with LGE positive light-chain amyloidosis (AL) (Group A), 17 Patients with LGE negative systemic AL (Group B), and 17 healthy controls (Group C)) were investigated. SSFP-Cine sequences were acquired in short axis slices as well as horizontal long axis views. Standard CMR parameters as well as Feature Tracking (FT) derived systolic and diastolic circumferential and longitudinal strain parameters were calculated. Additionally, contrast enhanced MRI images were analyzed to quantitatively determine the extent of enhancement. RESULTS AL patients with and without LGE both had significantly lower early diastolic strain rate (EDSR) values and peak systolic longitudinal strain (PSLS) values than healthy controls (EDSR: Group A 63.1±17.6; Group B: 74.46±11.8; Group C: 86.82±12.7; F(2.48)=10.7 p<0.001); (PSLS: Group A: -13.44±1.9%; Group B: -20.31±1.2%; Group C: -23.11±1.4%; F(2.48)=167.6; p<0.001). Analysis of quantitative LGE enhancement revealed increased enhancement in qualitative LGE negative AL patients compared to healthy controls (Group A: 19.6±8.9%; Group B: 8.2±3.9%; Group C: 2.4±1.3% F(2.48)=52.2; p<0.001). CONCLUSION CMR strain analysis detects early systolic and diastolic strain impairment in AL patients lacking qualitative LGE enhancement.
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Affiliation(s)
- Daniel L R Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Rami Homsi
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Alois M Sprinkart
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Julian Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Daniel K Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
| | - Darius Dabir
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany.
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190
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Nelson MD, Sharif B, Shaw JL, Cook-Wiens G, Wei J, Shufelt C, Mehta PK, Thomson LEJ, Berman DS, Thompson RB, Handberg EM, Pepine CJ, Li D, Bairey Merz CN. Myocardial tissue deformation is reduced in subjects with coronary microvascular dysfunction but not rescued by treatment with ranolazine. Clin Cardiol 2016; 40:300-306. [PMID: 28004395 DOI: 10.1002/clc.22660] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 10/29/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with coronary microvascular dysfunction (CMD) often have diastolic dysfunction, representing an important therapeutic target. Ranolazine-a late sodium current inhibitor-improves diastolic function in animal models and subjects with obstructive coronary artery disease (CAD). HYPOTHESIS We hypothesized that ranolazine would beneficially alter diastolic function in CMD. METHODS To test this hypothesis, we performed retrospective tissue tracking analysis to evaluate systolic/diastolic strain, using cardiac magnetic resonance imaging cine images acquired in a recently completed, randomized, double-blind, placebo-controlled, crossover trial of short-term ranolazine in subjects with CMD and from 43 healthy reference controls. RESULTS Diastolic strain rate was impaired in CMD vs controls (circumferential diastolic strain rate: 99.9% ± 2.5%/s vs 120.1% ± 4.0%/s, P = 0.0003; radial diastolic strain rate: -199.5% ± 5.5%/s vs -243.1% ± 9.6%/s, P = 0.0008, case vs control). Moreover, peak systolic circumferential strain (CS) and radial strain (RS) were also impaired in cases vs controls (CS: -18.8% ± 0.3% vs -20.7% ± 0.3%; RS: 35.8% ± 0.7% vs 41.4% ± 0.9%; respectively; both P < 0.0001), despite similar and preserved ejection fraction. In contrast to our hypothesis, however, we observed no significant changes in left ventricular diastolic function in CMD cases after 2 weeks of ranolazine vs placebo. CONCLUSIONS The case-control comparison both confirms and extends our prior observations of diastolic dysfunction in CMD. That CMD cases were also found to have subclinical systolic dysfunction is a novel finding, highlighting the utility of this retrospective approach. In contrast to previous studies in obstructive CAD, ranolazine did not improve diastolic function in CMD.
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Affiliation(s)
- Michael D Nelson
- Applied Physiology and Advanced Imaging Laboratory, University of Texas at Arlington, Arlington, Texas.,Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.,Barbra Streisand Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jaime L Shaw
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Galen Cook-Wiens
- Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, California
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Puja K Mehta
- Barbra Streisand Women's Heart Center, Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Emory Women's Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Louise E J Thomson
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Emory Women's Heart Center, Emory University School of Medicine, Atlanta, Georgia.,Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Eileen M Handberg
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - C Noel Bairey Merz
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
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191
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A Novel Method for Estimating Myocardial Strain: Assessment of Deformation Tracking Against Reference Magnetic Resonance Methods in Healthy Volunteers. Sci Rep 2016; 6:38774. [PMID: 27941903 PMCID: PMC5150576 DOI: 10.1038/srep38774] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 01/28/2023] Open
Abstract
We developed a novel method for tracking myocardial deformation using cardiac magnetic resonance (CMR) cine imaging. We hypothesised that circumferential strain using deformation-tracking has comparable diagnostic performance to a validated method (Displacement Encoding with Stimulated Echoes- DENSE) and potentially diagnostically superior to an established cine-strain method (feature-tracking). 81 healthy adults (44.6 ± 17.7 years old, 47% male), without any history of cardiovascular disease, underwent CMR at 1.5 T including cine, DENSE, and late gadolinium enhancement in subjects >45 years. Acquisitions were divided into 6 segments, and global and segmental peak circumferential strain were derived and analysed by age and sex. Peak circumferential strain differed between the 3 groups (DENSE: −19.4 ± 4.8%; deformation-tracking: −16.8 ± 2.4%; feature-tracking: −28.7 ± 4.8%) (ANOVA with Tukey post-hoc, F-value 279.93, p < 0.01). DENSE and deformation-tracking had better reproducibility than feature-tracking. Intra-class correlation co-efficient was >0.90. Larger magnitudes of strain were detected in women using deformation-tracking and DENSE, but not feature-tracking. Compared with a reference method (DENSE), deformation-tracking using cine imaging has similar diagnostic performance for circumferential strain assessment in healthy individuals. Deformation-tracking could potentially obviate the need for bespoke strain sequences, reducing scanning time and is more reproducible than feature-tracking.
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192
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André F, Robbers-Visser D, Helling-Bakki A, Föll A, Voss A, Katus HA, Helbing WA, Buss SJ, Eichhorn JG. Quantification of myocardial deformation in children by cardiovascular magnetic resonance feature tracking: determination of reference values for left ventricular strain and strain rate. J Cardiovasc Magn Reson 2016; 19:8. [PMID: 28103933 PMCID: PMC5248452 DOI: 10.1186/s12968-016-0310-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective assessment of global and regional cardiac function in children has shown to be clinically relevant but is challenging to conduct. Cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic modality especially in patients with cardiomyopathy or congenital heart disease. However, data on the normal cardiac deformation in children assessed by CMR is lacking at present. Thus, the aim of this study was to provide reference values for cardiac strain and strain rate in children and adolescents derived from CMR feature tracking (FT) measurements. METHODS In this binational study, eighty children and adolescents (age 0.4-18.0 years, 41 male, 39 female) free from cardiac diseases from two centers underwent CMR in 1.5 T whole-body scanners in supine position. Global peak radial, circumferential and longitudinal systolic strains as well as the corresponding early peak diastolic strain rates were assessed applying FT on short axis as well as 3- and 4-chamber views of standard cine steady-state free precession images. RESULTS The difference between genders yielded no significance for all assessed strains. Yet, all strains showed a significant parabolic relation to age and an even stronger one to body surface area (BSA). Therefore, BSA-specific reference values were determined using a polynomial regression model. The apical cardiac segments featured significant higher peak circumferential but lower peak radial systolic strains than the midventricular and basal segments (all p < 0.001). CONCLUSIONS The assessment of cardiac deformation by CMR-FT is feasible in children. This is the first CMR study providing specific reference values for FT-derived strain and strain rate in the pediatric age range.
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Affiliation(s)
- Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Daniëlle Robbers-Visser
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Angela Föll
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Andreas Voss
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Joachim G. Eichhorn
- Klinikum Leverkusen, Children’s Hospital, Am Gesundheitspark 11, 51375 Leverkusen, Germany
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193
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Gao B, Liu W, Wang L, Liu Z, Croisille P, Delachartre P, Clarysse P. Estimation of cardiac motion in cine-MRI sequences by correlation transform optical flow of monogenic features distance. Phys Med Biol 2016; 61:8640-8663. [DOI: 10.1088/1361-6560/61/24/8640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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194
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Hinojar R, Foote L, Sangle S, Marber M, Mayr M, Carr-White G, D'Cruz D, Nagel E, Puntmann VO. Native T1 and T2 mapping by CMR in lupus myocarditis: Disease recognition and response to treatment. Int J Cardiol 2016; 222:717-726. [DOI: 10.1016/j.ijcard.2016.07.182] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022]
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195
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Bhatti S, Vallurupalli S, Ambach S, Magier A, Watts E, Truong V, Hakeem A, Mazur W. Myocardial strain pattern in patients with cardiac amyloidosis secondary to multiple myeloma: a cardiac MRI feature tracking study. Int J Cardiovasc Imaging 2016; 34:27-33. [PMID: 27743139 DOI: 10.1007/s10554-016-0998-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
Cardiac MRI is frequently used in the diagnosis of cardiac amyloidosis. Feature tracking is a novel method of analyzing myocardial strain at the myocardial borders. We investigated myocardial deformation mechanics of both the right and left ventricles in patients with multiple myeloma with suspected cardiac amyloidosis. Comprehensive strain analysis was performed in 43 patients with multiple myeloma and suspected cardiac amyloidosis. MRI strain by feature tracking was measured using 2D cardiac performance analysis MR software (Tomtec, Germany). Global longitudinal (GLS) and global circumferential (GLC) strain were calculated in endo and epicardium. In addition, right ventricular longitudinal strain was measured in the endocardium only. All patients later underwent endomyocardial biopsy. Average wall thickness in biopsy proven cardiac amyloidosis group (22 patients) was 1.4 ± 0.4 cm with wall thickness ≤ 1.2 cm in 36 %. LGE was present in all patients with biopsy confirmed disease. There was significantly decreased global longitudinal strain and strain rate in the epicardial and endocardial layers. Global circumferential strain was significantly reduced in the epicardial layer but not the endocardium. GLS was significantly decreased at the base in both layers compared to the mid and apical regions of the myocardium. However, the base to apex GLS gradient was suggestive of apical sparing in the endocardial layer among patients with amyloidosis (-8.2 ± 2 vs. -2.7 ± 1; p = 0.001) but not the epicardial layer. Apical sparing was evident even in those with normal thickness CA. This feature tracking MRI analysis sheds light on strain mechanics in a cohort of multiple myeloma associated cardiac amyloidosis with a significant number of cases with normal LV wall thickness and explains mechanism of apical sparing effect.
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Affiliation(s)
- Sabha Bhatti
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Srikanth Vallurupalli
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephanie Ambach
- Heart and Vascular center, The Christ Hospital, Cincinnati, OH, USA
| | - Adam Magier
- Heart and Vascular center, The Christ Hospital, Cincinnati, OH, USA
| | - Evan Watts
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vien Truong
- Heart and Vascular center, The Christ Hospital, Cincinnati, OH, USA
| | - Abdul Hakeem
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wojciech Mazur
- Heart and Vascular center, The Christ Hospital, Cincinnati, OH, USA
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196
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Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging 2016; 8:1444-1460. [PMID: 26699113 DOI: 10.1016/j.jcmg.2015.11.001] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.
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Affiliation(s)
- Piet Claus
- Laboratory for Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eike Nagel
- Institute of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research ([DZHK], partner site Rhine-Main), Frankfurt, Germany.
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197
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Langton JEN, Lam HI, Cowan BR, Occleshaw CJ, Gabriel R, Lowe B, Lydiard S, Greiser A, Schmidt M, Young AA. Estimation of myocardial strain from non-rigid registration and highly accelerated cine CMR. Int J Cardiovasc Imaging 2016; 33:101-107. [PMID: 27624468 DOI: 10.1007/s10554-016-0978-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/08/2016] [Indexed: 12/01/2022]
Abstract
Sparsely sampled cardiac cine accelerated acquisitions show promise for faster evaluation of left-ventricular function. Myocardial strain estimation using image feature tracking methods is also becoming widespread. However, it is not known whether highly accelerated acquisitions also provide reliable feature tracking strain estimates. Twenty patients and twenty healthy volunteers were imaged with conventional 14-beat/slice cine acquisition (STD), 4× accelerated 4-beat/slice acquisition with iterative reconstruction (R4), and a 9.2× accelerated 2-beat/slice real-time acquisition with sparse sampling and iterative reconstruction (R9.2). Radial and circumferential strains were calculated using non-rigid registration in the mid-ventricle short-axis slice and inter-observer errors were evaluated. Consistency was assessed using intra-class correlation coefficients (ICC) and bias with Bland-Altman analysis. Peak circumferential strain magnitude was highly consistent between STD and R4 and R9.2 (ICC = 0.876 and 0.884, respectively). Average bias was -1.7 ± 2.0 %, p < 0.001, for R4 and -2.7 ± 1.9 %, p < 0.001 for R9.2. Peak radial strain was also highly consistent (ICC = 0.829 and 0.785, respectively), with average bias -11.2 ± 18.4 %, p < 0.001, for R4 and -15.0 ± 21.2 %, p < 0.001 for R9.2. STD circumferential strain could be predicted by linear regression from R9.2 with an R2 of 0.82 and a root mean squared error of 1.8 %. Similarly, radial strain could be predicted with an R2 of 0.67 and a root mean squared error of 21.3 %. Inter-observer errors were not significantly different between methods, except for peak circumferential strain R9.2 (1.1 ± 1.9 %) versus STD (0.3 ± 1.0 %), p = 0.011. Although small systematic differences were observed in strain, these were highly consistent with standard acquisitions, suggesting that accelerated myocardial strain is feasible and reliable in patients who require short acquisition durations.
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Affiliation(s)
| | - Hoi-Ieng Lam
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Brett R Cowan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Ruvin Gabriel
- Auckland District Health Board, Auckland, New Zealand
| | - Boris Lowe
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1142, New Zealand.
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198
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Comparison of left ventricular function assessment between echocardiography and MRI in Duchenne muscular dystrophy. Pediatr Radiol 2016; 46:1399-408. [PMID: 27173979 DOI: 10.1007/s00247-016-3622-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/23/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiomyopathy in Duchenne muscular dystrophy (DMD) is associated with death in approximately 40% of patients. Echocardiography is routinely used to assess left ventricular (LV) function; however, it has limitations in these patients. OBJECTIVE We compared echocardiographic measures of cardiac function assessment to cardiac MRI. MATERIALS AND METHODS We included children and young adults with DMD who had MRI performed between January 2010 and July 2015. We measured echocardiographic and MRI parameters of function assessment, including strain. Presence of late gadolinium enhancement (LGE) was assessed by MRI. Subjects were divided into two groups based on MRI left ventricular ejection fraction (LVEF): group I, LVEF ≥55% and group II, LVEF <55%. RESULTS We included 41 studies in 33 subjects, with 25 in group I and 16 in group II. Mean age of subjects was 13.6 ± 2.8 years and mean duration between echocardiogram and MRI was 7.6 ± 4.1 months. Only 8 of 16 (50%) patients in group II had diminished function on echocardiogram. Echocardiographic images were suboptimal in 16 subjects (39%). Overall, echocardiographic parameters had weak correlation with MRI-derived ejection fraction percentage. MRI-derived myocardial strain assessment has better correlation with MRI ejection fraction as compared to echocardiography-derived strain parameters. CONCLUSION Echocardiography-based ventricular functional assessment has weak correlation with MRI parameters in children and young adults with Duchenne muscular dystrophy. While this correlation improves in the subset of subjects with adequate echocardiographic image quality, it remains modest and potentially suboptimal for clinical management. Accordingly, we conclude that MRI should be performed routinely and early in children with DMD, not only for LGE imaging but also for functional assessment.
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199
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Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson 2016; 18:51. [PMID: 27561421 PMCID: PMC5000424 DOI: 10.1186/s12968-016-0269-7] [Citation(s) in RCA: 280] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/27/2016] [Indexed: 01/29/2023] Open
Abstract
Tissue tracking technology of routinely acquired cardiovascular magnetic resonance (CMR) cine acquisitions has increased the apparent ease and availability of non-invasive assessments of myocardial deformation in clinical research and practice. Its widespread availability thanks to the fact that this technology can in principle be applied on images that are part of every CMR or echocardiographic protocol. However, the two modalities are based on very different methods of image acquisition and reconstruction, each with their respective strengths and limitations. The image tracking methods applied are not necessarily directly comparable between the modalities, or with those based on dedicated CMR acquisitions for strain measurement such as tagging or displacement encoding. Here we describe the principles underlying the image tracking methods for CMR and echocardiography, and the translation of the resulting tracking estimates into parameters suited to describe myocardial mechanics. Technical limitations are presented with the objective of suggesting potential solutions that may allow informed and appropriate use in clinical applications.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Piet Claus
- Department of Cardiovascular Diseases, Laboratory for Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium
| | - Philip J Kilner
- CMR Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Interdisciplinary Cardiovascular Imaging, Internal Medicine III and Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Main, Germany.
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200
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Yang LT, Yamashita E, Nagata Y, Kado Y, Oshima S, Otsuji Y, Takeuchi M. Prognostic value of biventricular mechanical parameters assessed using cardiac magnetic resonance feature-tracking analysis to predict future cardiac events. J Magn Reson Imaging 2016; 45:1034-1045. [PMID: 27531830 DOI: 10.1002/jmri.25433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/04/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To study and compare the prognostic value of cardiac magnetic resonance feature tracking (MR-FT) of biventricular strain parameters with a conventional method. MATERIALS AND METHODS We retrospectively enrolled 364 patients undergoing clinically indicated cardiac MR examinations (1.5 or 3T scanner). Standard steady-state free precession (SSFP) images were used for analysis. Left ventricular (LV) and right ventricular (RV) ejection fraction (EF) were measured using conventional disk-area summation methods. Biventricular strain parameters were measured using MR-FT. All patients were followed to record major adverse cardiac events (MACEs). RESULTS The correlations between LV volumes and LVEF using both methods were excellent (r = 0.87-0.98). RV strain parameters were modestly correlated with RVEF (r = 0.44-0.63). During a median follow-up of 15 months, 36 patients developed MACEs. All MR-FT-derived parameters except for RV global longitudinal strain were significantly associated with future MACEs (P < 0.05) in univariate analysis. In stepwise Cox proportional hazard models, RV global radial strain (RVGRS) provided incremental prognostic value in models adjusted for age, gender, conventional LVEF (hazard ratio 0.93; P = 0.029) or RVEF (hazard ratio 0.93; P = 0.038). LV global transverse strain (LVGTS) also offered additional value over age, gender, conventional LVEF (hazard ratio 0.94; P = 0.041), or RVEF (hazard ratio 0.94; P = 0.004). Kaplan-Meier analysis showed significant survival differences in subgroups stratified by the median value of LVGTS, RVGRS, and LVEF using MR-FT (all log-rank P < 0.05). CONCLUSION Deformation analysis of both ventricles using MR-FT provided significant prognostic power similar to parameters obtained using conventional methods. MR-FT is a promising alternative both for ventricular chamber quantification and for providing information of future cardiac events. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:1034-1045.
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Affiliation(s)
- Li Tan Yang
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan.,Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Eiji Yamashita
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yuichiro Kado
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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