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Buss SJ, Breuninger K, Lehrke S, Voss A, Galuschky C, Lossnitzer D, Andre F, Ehlermann P, Franke J, Taeger T, Frankenstein L, Steen H, Meder B, Giannitsis E, Katus HA, Korosoglou G. Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2014; 16:307-15. [PMID: 25246506 DOI: 10.1093/ehjci/jeu181] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS To investigate the prognostic impact of left-ventricular (LV) cardiac magnetic resonance (CMR) deformation imaging in patients with non-ischaemic dilated cardiomyopathy (DCM) compared with late-gadolinium enhancement (LGE) quantification and LV ejection fraction (EF). METHODS AND RESULTS A total of 210 subjects with DCM were examined prospectively with standard CMR including measurement of LGE for quantification of myocardial fibrosis and feature tracking strain imaging for assessment of LV deformation. The predefined primary endpoint, a combination of cardiac death, heart transplantation, and aborted sudden cardiac death, occurred in 26 subjects during the median follow-up period of 5.3 years. LV radial, circumferential, and longitudinal strains were significantly associated with outcome. Using separate multivariate analysis models, global longitudinal strain (average of peak negative strain values) and mean longitudinal strain (negative peak of the mean curve of all segments) were independent prognostic parameters surpassing the value of global and mean LV radial and circumferential strain, as well as NT-proBNP, EF, and LGE mass. A global longitudinal strain greater than -12.5% predicted outcome even in patients with EF < 35% (P < 0.01) and in those with presence of LGE (P < 0.001). Mean longitudinal strain was further investigated using a clinical model with predefined cut-offs (EF < 35%, presence of LGE, NYHA class, mean longitudinal strain greater than -10%). Mean longitudinal strain exhibited an independent prognostic value surpassing that provided by NYHA, EF, and LGE (HR = 5.4, P < 0.01). CONCLUSION LV longitudinal strain assessed with CMR is an independent predictor of survival in DCM and offers incremental information for risk stratification beyond clinical parameters, biomarker, and standard CMR.
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Affiliation(s)
- Sebastian J Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Kristin Breuninger
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Stephanie Lehrke
- Department of Radiology, Ev.-Luth. Diakonissenanstalt, Knuthstraße 1, Flensburg 24939, Germany
| | - Andreas Voss
- Department of Psychology, University of Heidelberg, Hauptstrasse 47-51, Heidelberg 69117, Germany
| | | | - Dirk Lossnitzer
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Jennifer Franke
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Tobias Taeger
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Henning Steen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Benjamin Meder
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, Heidelberg 69120, Germany
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Park JH, Kusunose K, Motoki H, Kwon DH, Grimm RA, Griffin BP, Marwick TH, Popović ZB. Assessment of Right Ventricular Longitudinal Strain in Patients with Ischemic Cardiomyopathy: Head-to-Head Comparison between Two-Dimensional Speckle-Based Strain and Velocity Vector Imaging Using Volumetric Assessment by Cardiac Magnetic Resonance as a “. Echocardiography 2014; 32:956-65. [DOI: 10.1111/echo.12740] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
- Cardiology Division of Internal Medicine; Chungnam National University; Chungnam National University Hospital; Daejeon Korea
| | - Kenya Kusunose
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
| | - Deborah H. Kwon
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
| | - Richard A. Grimm
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
| | - Brian P. Griffin
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
| | - Thomas H. Marwick
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
- Menzies Research Institute; Tasmania, Hobart Australia
| | - Zoran B. Popović
- Department of Cardiovascular Medicine; Cleveland Clinic; Cleveland Ohio
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253
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Lu JC, Connelly JA, Zhao L, Agarwal PP, Dorfman AL. Strain measurement by cardiovascular magnetic resonance in pediatric cancer survivors: validation of feature tracking against harmonic phase imaging. Pediatr Radiol 2014; 44:1070-6. [PMID: 24760125 DOI: 10.1007/s00247-014-2992-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/24/2014] [Accepted: 03/30/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Left ventricular strain may be a more sensitive marker of left ventricular dysfunction than ejection fraction in pediatric cancer survivors after anthracycline therapy, but there is limited validation of strain measurement by feature tracking on cardiovascular magnetic resonance (MR) images. OBJECTIVE To compare left ventricular circumferential and radial strain by feature tracking vs. harmonic phase imaging analysis (HARP) in pediatric cancer survivors. MATERIALS AND METHODS Twenty-six patients (20.2 ± 5.6 years old) underwent cardiovascular MR at least 5 years after completing anthracycline therapy. Circumferential and radial strain were measured at the base, midventricle and apex from short-axis myocardial tagged images by HARP, and from steady-state free precession images by feature tracking. RESULTS Left ventricular ejection fraction more closely correlated with global circumferential strain by feature tracking (r = -0.63, P = 0.0005) than by HARP (r = -0.39, P = 0.05). Midventricular circumferential strain did not significantly differ by feature tracking or HARP (-20.8 ± 3.4 vs. -19.5 ± 2.5, P = 0.07), with acceptable limits of agreement. Midventricular circumferential strain by feature tracking strongly correlated with global circumferential strain by feature tracking (r = 0.87, P < 0.0001). Radial strain by feature tracking had poor agreement with HARP, particularly at higher values of radial strain. Intraobserver and interobserver reproducibility was excellent for feature tracking circumferential strain, but reproducibility was poor for feature tracking radial strain. CONCLUSION Midventricular circumferential strain by feature tracking is a reliable and reproducible measure of myocardial deformation in patients status post anthracycline therapy, while radial strain measurements are unreliable. Further studies are necessary to evaluate potential relation to long-term outcomes.
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Affiliation(s)
- Jimmy C Lu
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, 1540 E. Hospital Drive, Ann Arbor, MI, 48109-4204, USA,
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Kowallick JT, Kutty S, Edelmann F, Chiribiri A, Villa A, Steinmetz M, Sohns JM, Staab W, Bettencourt N, Unterberg-Buchwald C, Hasenfuß G, Lotz J, Schuster A. Quantification of left atrial strain and strain rate using Cardiovascular Magnetic Resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 2014; 16:60. [PMID: 25196447 PMCID: PMC4422260 DOI: 10.1186/s12968-014-0060-6] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/28/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular Magnetic Resonance myocardial feature tracking (CMR-FT) is a quantitative technique tracking tissue voxel motion on standard steady-state free precession (SSFP) cine images to assess ventricular myocardial deformation. The importance of left atrial (LA) deformation assessment is increasingly recognized and can be assessed with echocardiographic speckle tracking. However atrial deformation quantification has never previously been demonstrated with CMR. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative derivation of LA strain and strain rate (SR) myocardial mechanics. METHODS 10 healthy volunteers, 10 patients with hypertrophic cardiomyopathy (HCM) and 10 patients with heart failure and preserved ejection fraction (HFpEF) were studied at 1.5 Tesla. LA longitudinal strain and SR parameters were derived from SSFP cine images using dedicated CMR-FT software (2D CPA MR, TomTec, Germany). LA performance was analyzed using 4- and 2-chamber views including LA reservoir function (total strain [εs], peak positive SR [SRs]), LA conduit function (passive strain [εe], peak early negative SR [SRe]) and LA booster pump function (active strain [εa], late peak negative SR [SRa]). RESULTS In all subjects LA strain and SR parameters could be derived from SSFP images. There was impaired LA reservoir function in HCM and HFpEF (εs [%]: HCM 22.1 ± 5.5, HFpEF 16.3 ± 5.8, Controls 29.1 ± 5.3, p < 0.01; SRs [s⁻¹]: HCM 0.9 ± 0.2, HFpEF 0.8 ± 0.3, Controls 1.1 ± 0.2, p < 0.05) and impaired LA conduit function as compared to healthy controls (εe [%]: HCM 10.4 ± 3.9, HFpEF 11.9 ± 4.0, Controls 21.3 ± 5.1, p < 0.001; SRe [s]⁻¹: HCM -0.5 ± 0.2, HFpEF -0.6 ± 0.1, Controls -1.0 ± 0.3, p < 0.01). LA booster pump function was increased in HCM while decreased in HFpEF (εa [%]: HCM 11.7 ± 4.0, HFpEF 4.5 ± 2.9, Controls 7.8 ± 2.5, p < 0.01; SRa [s⁻¹]: HCM -1.2 ± 0.4, HFpEF -0.5 ± 0.2, Controls -0.9 ± 0.3, p < 0.01). Observer variability was excellent for all strain and SR parameters on an intra- and inter-observer level as determined by Bland-Altman, coefficient of variation and intraclass correlation coefficient analyses. CONCLUSIONS CMR-FT based atrial performance analysis reliably quantifies LA longitudinal strain and SR from standard SSFP cine images and discriminates between patients with impaired left ventricular relaxation and healthy controls. CMR-FT derived atrial deformation quantification seems a promising novel approach for the study of atrial performance and physiology in health and disease states.
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Affiliation(s)
- Johannes Tammo Kowallick
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Shelby Kutty
- Children's Hospital and Medical Center Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Omaha, Nebraska.
| | - Frank Edelmann
- Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Jan Martin Sohns
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Wieland Staab
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Nuno Bettencourt
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Christina Unterberg-Buchwald
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, Göttingen, Germany.
- Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany.
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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255
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Imai M, Ambale Venkatesh B, Samiei S, Donekal S, Habibi M, Armstrong AC, Heckbert SR, Wu CO, Bluemke DA, Lima JAC. Multi-ethnic study of atherosclerosis: association between left atrial function using tissue tracking from cine MR imaging and myocardial fibrosis. Radiology 2014; 273:703-13. [PMID: 25019562 DOI: 10.1148/radiol.14131971] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the association between left atrial ( LA left atrium ) function and left ventricular myocardial fibrosis using cardiac magnetic resonance (MR) imaging in a multi-ethnic population. MATERIALS AND METHODS For this HIPAA-compliant study, the institutional review board at each participating center approved the study protocol, and all participants provided informed consent. Of 2839 participants who had undergone cardiac MR in 2010-2012, 143 participants with myocardial scar determined with late gadolinium enhancement and 286 age-, sex-, and ethnicity-matched control participants were identified. LA left atrium volume, strain, and strain rate were analyzed by using multimodality tissue tracking from cine MR imaging. T1 mapping was applied to assess diffuse myocardial fibrosis. The association between LA left atrium parameters and myocardial fibrosis was evaluated with the Student t test and multivariable regression analysis. RESULTS The scar group had significantly higher minimum LA left atrium volume than the control group (mean, 22.0 ± 10.5 [standard deviation] vs 19.0 ± 7.8, P = .002) and lower LA left atrium ejection fraction (45.9 ± 10.7 vs 51.3 ± 8.7, P < .001), maximal LA left atrium strain ( Smax maximum LA strain ) (25.4 ± 10.7 vs 30.6 ± 10.6, P < .001) and maximum LA left atrium strain rate ( SRmax maximum LA strain rate ) (1.08 ± 0.45 vs 1.29 ± 0.51, P < .001), and lower absolute LA left atrium strain rate at early diastolic peak ( SRE LA strain rate at early diastolic peak ) (-0.77 ± 0.42 vs -1.01 ± 0.48, P < .001) and LA left atrium strain rate at atrial contraction peak ( SRA LA strain rate at atrial contraction peak ) (-1.50 ± 0.62 vs -1.78 ± 0.69, P < .001) than the control group. T1 time 12 minutes after contrast material injection was significantly associated with Smax maximum LA strain (β coefficient = 0.043, P = .013), SRmax maximum LA strain rate (β coefficient = 0.0025, P = .001), SRE LA strain rate at early diastolic peak (β coefficient = -0.0016, P = .027), and SRA LA strain rate at atrial contraction peak LA strain rate at atrial contraction peak (β coefficient -0.0028, P = .01) in the regression model. T1 time 25 minutes after contrast material injection was significantly associated with SRmax maximum LA strain rate (β coefficient = 0.0019, P = .016) and SRA LA strain rate at atrial contraction peak (β coefficient = -0.0022, P = .034). CONCLUSION Reduced LA left atrium regional and global function are related to both replacement and diffuse myocardial fibrosis processes. Clinical trial registration no.: NCT00005487
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Affiliation(s)
- Masamichi Imai
- From the Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287-0409 (M.I., B.A.V., S.S., S.D., A.C.A., J.A.C.L.); Department of Cardiology, Johns Hopkins Hospital, Baltimore, Md (M.H.); Cardiovascular Health Research Unit, Washington University, St Louis, Mo (S.R.H.); and Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md (C.O.W., D.A.B.)
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256
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Gao H, Allan A, McComb C, Luo X, Berry C. Left ventricular strain and its pattern estimated from cine CMR and validation with DENSE. Phys Med Biol 2014; 59:3637-56. [PMID: 24922458 DOI: 10.1088/0031-9155/59/13/3637] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Measurement of local strain provides insight into the biomechanical significance of viable myocardium. We attempted to estimate myocardial strain from cine cardiovascular magnetic resonance (CMR) images by using a b-spline deformable image registration method. Three healthy volunteers and 41 patients with either recent or chronic myocardial infarction (MI) were studied at 1.5 Tesla with both cine and DENSE CMR. Regional circumferential and radial left ventricular strains were estimated from cine and DENSE acquisitions. In all healthy volunteers, there was no difference for peak circumferential strain (- 0.18 ± 0.04 versus - 0.18 ± 0.03, p = 0.76) between cine and DENSE CMR, however peak radial strain was overestimated from cine (0.84 ± 0.37 versus 0.49 ± 0.2, p < 0.01). In the patient study, the peak strain patterns predicted by cine were similar to the patterns from DENSE, including the strain evolution related to recovery time and strain patterns related to MI scar extent. Furthermore, cine-derived strain disclosed different strain patterns in MI and non-MI regions, and regions with transmural and non-transmural MI as DENSE. Although there were large variations with radial strain measurements from cine CMR images, useful circumferential strain information can be obtained from routine clinical CMR imaging. Cine strain analysis has potential to improve the diagnostic yield from routine CMR imaging in clinical practice.
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Affiliation(s)
- Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QW, UK
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257
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Meyer CG, Frick M, Lotfi S, Altiok E, Koos R, Kirschfink A, Lehrke M, Autschbach R, Hoffmann R. Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging 2014; 15:1168-76. [PMID: 24906997 DOI: 10.1093/ehjci/jeu103] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study analysed the impact of transapical (TA) vs. transfemoral (TF) access site transcatheter aortic valve implantation (TAVI) on post-procedural regional left ventricular (LV) function using cardiac magnetic resonance (CMR) feature tracking (FT). METHODS AND RESULTS CMR was performed 3 months after TAVI on 44 consecutive patients with normal LV ejection fraction prior to TAVI. Twenty patients had TA-TAVI, and 24 had TF-TAVI. Standard cine imaging was performed in three standard cardiac long-axis views (two-, four- and three-chamber views). Myocardial peak systolic radial strain (PSRS) and peak systolic longitudinal strain (PSLS) were analysed based on CMR-FT considering 49 segments in each of the three views. There were no differences in PSRS and PSLS for the basal and mid-ventricular segments between TA- and TF-TAVI groups. In contrast, PSRS and PSLS of apical segments and apical cap were reduced in the TA- compared with the TF-TAVI group (PSRS: 15.7 ± 6.4 vs. 35.9 ± 15.7%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -16.9 ± 4.3%, respectively, P < 0.001). Comparison of all non-apical segments vs. apical segments and apical cap demonstrated no difference in the TF group (PSRS: 34.6 ± 9.0 vs. 35.9 ± 15.7%; respectively, P = 0.702; PSLS: -17.8 ± 4.6 vs. -16.9 ± 4.3%; respectively, P = 0.802). After TA-TAVI, PSRS and PSLS of the apical segments were reduced compared with the non-apical segments (PSRS: 15.7 ± 6.4 vs. 33.5 ± 7.0%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -15.5 ± 3.5%, respectively, P < 0.001). CONCLUSION Apical LV function abnormalities can be detected at 3-month follow-up in all TA-TAVI patients using CMR-FT. TA-TAVI results in significant impairment of apical LV function compared with TF-TAVI.
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Affiliation(s)
- Christian G Meyer
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Michael Frick
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Shahram Lotfi
- Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany
| | - Ertunc Altiok
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Ralf Koos
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Annemarie Kirschfink
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Michael Lehrke
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Rüdiger Autschbach
- Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany
| | - Rainer Hoffmann
- Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
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Habibi M, Venkatesh BA, Lima JA. Feature Tracking Cardiac Magnetic Resonance Imaging in the Assessment of Left Atrial Function. J Am Coll Cardiol 2014; 63:2434-5. [DOI: 10.1016/j.jacc.2013.12.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
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259
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Taylor RJ, Umar F, Moody WE, Meyyappan C, Stegemann B, Townend JN, Hor KN, Miszalski-Jamka T, Mazur W, Steeds RP, Leyva F. Feature-tracking cardiovascular magnetic resonance as a novel technique for the assessment of mechanical dyssynchrony. Int J Cardiol 2014; 175:120-5. [PMID: 24852836 DOI: 10.1016/j.ijcard.2014.04.268] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/27/2014] [Accepted: 04/30/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myocardial tagging using cardiovascular magnetic resonance (CMR) is the gold-standard for the assessment of myocardial mechanics. Feature-tracking cardiovascular magnetic resonance (FT-CMR) has been validated against myocardial tagging. We explore the potential of FT-CMR in the assessment of mechanical dyssynchrony, with reference to patients with cardiomyopathy and healthy controls. METHODS Healthy controls (n=55, age: 42.9 ± 13 yrs, LVEF: 70 ± 5%, QRS: 88 ± 9 ms) and patients with cardiomyopathy (n=108, age: 64.7 ± 12 yrs, LVEF: 29 ± 6%, QRS: 147 ± 29 ms) underwent FT-CMR for the assessment of the circumferential (CURE) and radial (RURE) uniformity ratio estimate based on myocardial strain (both CURE and RURE: 0 to 1; 1=perfect synchrony) RESULTS CURE (0.79 ± 0.14 vs. 0.97 ± 0.02) and RURE (0.71 ± 0.14 vs. 0.91 ± 0.04) were lower in patients with cardiomyopathy than in healthy controls (both p<0.0001). CURE (area under the receiver-operator characteristic curve [AUC]: 0.96), RURE (AUC: 0.96) and an average of these (CURE:RUREAVG, AUC: 0.98) had an excellent ability to discriminate between patients with cardiomyopathy and controls (sensitivity 90%; specificity 98% at a cut-off of 0.89). The time taken for semi-automatically tracking myocardial borders was 5.9 ± 1.4 min. CONCLUSION Dyssynchrony measures derived from FT-CMR, such as CURE and RURE, provide almost absolute discrimination between patients with cardiomyopathy and healthy controls. The rapid acquisition of these measures, which does not require specialized CMR sequences, has potential for the assessment of mechanical dyssynchrony in clinical practice.
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Affiliation(s)
- Robin J Taylor
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Fraz Umar
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - William E Moody
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Chitra Meyyappan
- Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | | | - John N Townend
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Kan N Hor
- Department of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tomasz Miszalski-Jamka
- Department of Clinical Radiology and Imaging Diagnostics, 4th Military Hospital, Wrocław, Center for Diagnosis, Prevention and Telemedicine, John Paul II Hospital, Krakow, Poland
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Richard P Steeds
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Francisco Leyva
- Department of Cardiology, The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom; Centre for Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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Singh A, Steadman CD, Khan JN, Horsfield MA, Bekele S, Nazir SA, Kanagala P, Masca NGD, Clarysse P, McCann GP. Intertechnique agreement and interstudy reproducibility of strain and diastolic strain rate at 1.5 and 3 Tesla: a comparison of feature-tracking and tagging in patients with aortic stenosis. J Magn Reson Imaging 2014; 41:1129-37. [PMID: 24700404 DOI: 10.1002/jmri.24625] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/04/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine the interstudy reproducibility of myocardial strain and peak early-diastolic strain rate (PEDSR) measurement on cardiovascular magnetic resonance imaging (MRI) assessed with feature tracking (FT) and tagging, in patients with aortic stenosis (AS). MATERIALS AND METHODS Cardiac MRI was performed twice (1-14 days apart) in 18 patients (8 at 1.5 Tesla [T], 10 at 3T) with moderate-severe AS. Circumferential peak systolic strain (PSS) and PEDSR were measured in all patients. Longitudinal PSS and PEDSR were assessed using FT in all patients, and tagging in the 3T sub-group. RESULTS PSS was higher with FT than tagging (21.0 ± 1.9% versus 17.0 ± 3.4% at 1.5T, 21.4 ± 4.0% versus 17.7 ± 3.0% at 3T, P < 0.05), as was PEDSR (1.3 ± 0.3 s(-1) versus 1.0 ± 0.3 s(-1) , P = 0.10 at 1.5T and 1.3 ± 0.4 s(-1) versus 0.8 ± 0.3 s(-1) , P < 0.05 at 3T). The reproducibility of PSS was excellent with FT (coefficient of variation [CoV] 9-10%) and good with tagging at 1.5T (13-19%). Reproducibility of circumferential PEDSR was best at 1.5T when only basal/mid slices were included (CoV 12%), but moderate to poor at 3T (29-35%). Reproducibility of longitudinal strain was good with FT (10-16%) but moderate for PEDSR (∼30%). CONCLUSION In patients with AS, FT consistently produces higher values compared with tagging. The interstudy reproducibility of PSS is excellent with FT and good with tagging. The reproducibility of circumferential PEDSR at 1.5T is good when only basal and mid slices are used.
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Affiliation(s)
- Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom; NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
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261
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Clinical significance of late gadolinium enhancement in patients<20 years of age with hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:1234-9. [PMID: 24513464 DOI: 10.1016/j.amjcard.2013.12.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 12/28/2022]
Abstract
Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging is associated with adverse events in adults with hypertrophic cardiomyopathy (HC). However, limited data exist on the extent and clinical significance of LGE in the pediatric population. In 30 patients (aged 14.1±3.2 years) with clinically diagnosed HC who underwent cardiovascular magnetic resonance imaging from 2007 to 2012, segments with hypertrophy and LGE were identified by 2 experienced readers blinded to outcome. Radial, circumferential, and longitudinal strains were evaluated using feature tracking software. The composite outcome was defined as cardiac death, nonsustained ventricular tachycardia, ventricular fibrillation, or appropriate implantable cardioverter-defibrillator discharge. LGE was present in 17 of 30 patients (57%), all in a midmyocardial pattern, with median 3 segments per patient (interquartile range [IQR] 2 to 5). No LGE was detected in patients without phenotypic hypertrophy. Segments with LGE had decreased radial (basal segments 20.7% vs 70.9%, p=0.01), circumferential (basal segments -23.2% vs -29.3%, p=0.04), and longitudinal strains (basal segments -13.8% vs -20.9%, p=0.04). After median follow-up of 26.9 months (IQR 7.5 to 34.3), 7 patients who had an adverse outcome (5 ventricular tachycardia, 1 appropriate implantable cardioverter-defibrillator discharge, and 1 death) had more segments of LGE (median 4, IQR 2 to 7 vs 0, IQR 0 to 2, p=0.01). One patient without LGE had ventricular tachycardia on exercise test. In conclusion, LGE occurs in a similar pattern in pediatric patients with HC as in adults, associated with hypertrophy, decreased myocardial strain, and adverse clinical outcomes. Further longitudinal studies are necessary to evaluate the rate of development of LGE and relation to outcomes in a larger cohort.
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262
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Moody WE, Taylor RJ, Edwards NC, Chue CD, Umar F, Taylor TJ, Ferro CJ, Young AA, Townend JN, Leyva F, Steeds RP. Comparison of magnetic resonance feature tracking for systolic and diastolic strain and strain rate calculation with spatial modulation of magnetization imaging analysis. J Magn Reson Imaging 2014; 41:1000-12. [PMID: 24677420 DOI: 10.1002/jmri.24623] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/04/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare cardiovascular magnetic resonance-feature tracking (CMR-FT) with spatial modulation of magnetization (SPAMM) tagged imaging for the calculation of short and long axis Lagrangian strain measures in systole and diastole. MATERIALS AND METHODS Healthy controls (n = 35) and patients with dilated cardiomyopathy (n = 10) were identified prospectively and underwent steady-state free precession (SSFP) cine imaging and SPAMM imaging using a gradient-echo sequence. A timed offline analysis of images acquired at identical horizontal long and short axis slice positions was performed using CMR-FT and dynamic tissue-tagging (CIMTag2D). Agreement between strain and strain rate (SR) values calculated using these two different methods was assessed using the Bland-Altman technique. RESULTS Across all participants, there was good agreement between CMR-FT and CIMTag for calculation of peak systolic global circumferential strain (-22.7 ± 6.2% vs. -22.5 ± 6.9%, bias 0.2 ± 4.0%) and SR (-1.35 ± 0.42 1/s vs. -1.22 ± 0.42 1/s, bias 0.13 ± 0.33 1/s) and early diastolic global circumferential SR (1.21 ± 0.44 1/s vs. 1.07 ± 0.30 1/s, bias -0.14 ± 0.34 1/s) at the subendocardium. There was satisfactory agreement for derivation of peak systolic global longitudinal strain (-18.1 ± 5.0% vs. -16.7 ± 4.8%, bias 1.3 ± 3.8%) and SR (-1.04 ± 0.29 1/s vs. -0.95 ± 0.32 1/s, bias 0.09 ± 0.26 1/s). The weakest agreement was for early diastolic global longitudinal SR (1.10 ± 0.40 1/s vs. 0.67 ± 0.32 1/s, bias -0.42 ± 0.40 1/s), although the correlation remained significant (r = 0.42, P < 0.01). CMR-FT generated these data over four times quicker than CIMTag. CONCLUSION There is sufficient agreement between systolic and diastolic strain measures calculated using CMR-FT and myocardial tagging for CMR-FT to be considered as a potentially feasible and rapid alternative.
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Affiliation(s)
- William E Moody
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Centre for Cardiovascular Sciences, School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK
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263
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Cheng-Baron J, Chow K, Pagano JJ, Punithakumar K, Paterson DI, Oudit GY, Thompson RB. Quantification of circumferential, longitudinal, and radial global fractional shortening using steady-state free precession cines: a comparison with tissue-tracking strain and application in Fabry disease. Magn Reson Med 2014; 73:586-96. [PMID: 24634139 DOI: 10.1002/mrm.25166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/11/2014] [Accepted: 01/13/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Conventional calculation of myocardial strain requires tissue-tracking. A surrogate for strain called global fractional shortening (GFS) is proposed based on changes in dimensions of endocardial and epicardial surfaces without tissue-tracking. METHODS Three-dimensional endocardial and epicardial left ventricular surfaces traced at end-diastole and end-systole using conventional steady-state free precession cine images were used to calculate GFScc (circumferential), GFSll (longitudinal), and GFSrr (radial) using fractional length changes in each direction over the heart surface. GFS values were validated using finite element models (FEM) and in vivo using tagging-derived strains (εcc ,εll ,εrr ) in patients with a wide range of ejection fraction (EF) and diagnosis (n=32). GFS was also measured in 31 patients with Fabry disease and matched healthy controls. RESULTS GFS values were within 3% of average FEM-derived Lagrangian strains and had good agreement in vivo (GFScc =-14 ± 4%, εcc =-14 ± 4%, R(2) =0.85; GFSll =-12 ± 4%, εll =-12 ± 4%, R(2) =0.72; GFSrr =46 ± 21%). εrr could not be measured reliably from tagging. Compared with healthy controls with matched EF, patients with Fabry disease had significantly increased GFScc (Endo) (-28 ± 3% versus -25 ± 2%), decreased GFScc(Epi) (-10 ± 2% versus -11 ± 2%) and decreased GFSll for all components. CONCLUSION GFS yields similar values to conventionally measured strains without requiring tissue-tracking. Compared with controls, patients with Fabry disease have significant differences in several GFS components.
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Affiliation(s)
- June Cheng-Baron
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
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264
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Buss SJ, Schulz F, Mereles D, Hosch W, Galuschky C, Schummers G, Stapf D, Hofmann N, Giannitsis E, Hardt SE, Kauczor HU, Katus HA, Korosoglou G. Quantitative analysis of left ventricular strain using cardiac computed tomography. Eur J Radiol 2014; 83:e123-30. [DOI: 10.1016/j.ejrad.2013.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/21/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
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265
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Wu L, Germans T, Güçlü A, Heymans MW, Allaart CP, van Rossum AC. Feature tracking compared with tissue tagging measurements of segmental strain by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2014; 16:10. [PMID: 24450803 PMCID: PMC3926943 DOI: 10.1186/1532-429x-16-10] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 01/13/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Left ventricular segmental wall motion analysis is important for clinical decision making in cardiac diseases. Strain analysis with myocardial tissue tagging is the non-invasive gold standard for quantitative assessment, however, it is time-consuming. Cardiovascular magnetic resonance myocardial feature-tracking (CMR-FT) can rapidly perform strain analysis, because it can be employed with standard CMR cine-imaging. The aim is to validate segmental peak systolic circumferential strain (peak SCS) and time to peak systolic circumferential strain (T2P-SCS) analysed by CMR-FT against tissue tagging, and determine its intra and inter-observer variability. METHODS Patients in whom both cine CMR and tissue tagging has been performed were selected. CMR-FT analysis was done using endocardial (CMR-FTendo) and mid-wall contours (CMR-FTmid). The Intra Class Correlation Coefficient (ICC) and Pearson correlation were calculated. RESULTS 10 healthy volunteers, 10 left bundle branch block (LBBB) and 10 hypertrophic cardiomyopathy patients were selected. With CMR-FT all 480 segments were analyzable and with tissue tagging 464 segments.Significant differences in mean peak SCS values of the total study group were present between CMR-FTendo and tissue tagging (-23.8 ± 9.9% vs -13.4 ± 3.3%, p<0.001). Differences were smaller between CMR-FTmid and tissue tagging (-16.4 ± 6.1% vs -13.4 ± 3.3%, p=0.001). The ICC of the mean peak SCS of the total study group between CMR-FTendo and tissue tagging was low (0.19 (95%-CI-0.10-0.49), p=0.02). Comparable results were seen between CMR-FTmid and tissue tagging. In LBBB patients, mean T2P-SCS values measured with CMR-FTendo and CMR-FTmid were 418 ± 66 ms, 454 ± 60 ms, which were longer than with tissue tagging, 376 ± 55 ms, both p<0.05. ICC of the mean T2P-SCS between CMR-FTendo and tissue tagging was 0.64 (95%-CI-0.36-0.81), p<0.001, this was better in the healthy volunteers and LBBB group, whereas the ICC between CMR-FTmid and tissue tagging was lower.The intra and inter-observer agreement of segmental peak SCS with CMR-FTmid was lower compared with tissue tagging; similar results were seen for segmental T2P-SCS. CONCLUSIONS The intra and inter-observer agreement of segmental peak SCS and T2P-SCS is substantially lower with CMR-FTmid compared with tissue tagging. Therefore, current segmental CMR-FTmid techniques are not yet applicable for clinical and research purposes.
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Affiliation(s)
- LiNa Wu
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
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266
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Schmidt R, Orwat S, Kempny A, Schuler P, Radke R, Kahr PC, Hellige A, Baumgartner H, Diller GP. Value of speckle-tracking echocardiography and MRI-based feature tracking analysis in adult patients after Fontan-type palliation. CONGENIT HEART DIS 2013; 9:397-406. [PMID: 24373377 DOI: 10.1111/chd.12156] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients are commonly affected by ventricular dysfunction and heart failure after Fontan palliation. Reliable quantification of ventricular function is of interest but hampered by complex ventricular anatomy and physiology. OBJECTIVES We aimed to assess myocardial function using a novel cardiac magnetic resonance imaging (CMR)-based feature-tracking (FT) technique and to study its clinical utility in Fontan patients. METHODS Retrospective study in consecutive patients attending our service. RESULTS We included 15 adult Fontan patients (age 27 ± 7 years) who underwent a standardized transthoracic echocardiographic investigation (TTE) with measurement of global strain using speckle tracking. Thirteen patients also underwent CMR, with assessment of myocardial deformation by FT, providing longitudinal and circumferential global strain for the single ventricle. The value of TTE-based strain measurements was limited by the fact that in 63% of patients at least one myocardial segment could not be adequately quantified due to limited acoustic windows. In contrast, CMR allowed for a complete visualization of all wall segments. Not surprisingly, there was poor agreement between the techniques but good or moderate interobserver variability for FT (coefficients of variability 6.6% and 14.3% for circumferential and longitudinal strain). Unlike ejection fraction, FT parameters correlated significantly with age at Fontan completion, New York Heart Association (NYHA) class, and peak oxygen uptake on cardiopulmonary exercise testing. CONCLUSIONS Assessment of myocardial function using CMR cine-based feature tracking is feasible in Fontan patients. Unlike echocardiographic techniques, FT is independent of inadequate acoustic windows and FT measurements relate to clinical parameters, suggesting that this approach could have clinical relevance in future.
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Affiliation(s)
- Renate Schmidt
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany
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267
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Harrild DM, Marcus E, Hasan B, Alexander ME, Powell AJ, Geva T, McElhinney DB. Impact of transcatheter pulmonary valve replacement on biventricular strain and synchrony assessed by cardiac magnetic resonance feature tracking. Circ Cardiovasc Interv 2013; 6:680-7. [PMID: 24300136 DOI: 10.1161/circinterventions.113.000690] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transcatheter pulmonary valve (TPV) replacement is an emerging therapy intended to restore pulmonary valve function in patients with right ventricular outflow tract conduit dysfunction; the impact of this technique on ventricular strain and synchrony is not known. METHODS AND RESULTS Cardiac magnetic resonance and ECG data acquired at 1 center as part of the US Melody TPV trial were analyzed. Biventricular strain and mechanical synchrony measurements were made based on short-axis and 4-chamber steady-state free precession images using feature tracking software. Post- versus pre-TPV replacement findings were compared for all patients (n=31) and subgroups with predominant pulmonary regurgitation (n=13) or stenosis (n=18). Most patients had tetralogy of Fallot (18/31). After TPV replacement, left ventricular (LV) circumferential strain increased for the whole cohort (P<0.001) and both subgroups (pulmonary regurgitation P=0.01; pulmonary stenosis P=0.02). LV longitudinal strain increased for the whole cohort (P=0.02) and pulmonary regurgitation subgroup (P=0.05); circumferential right ventricular strain increased for the pulmonary stenosis group only (P=0.05). LV longitudinal synchrony improved significantly in the pulmonary regurgitation group (maximum wall delay P=0.03; cross-correlation delay P=0.01). Electric measures of synchrony did not improve. CONCLUSIONS In patients with right ventricular outflow tract conduit dysfunction, TPV replacement is associated with improved global LV strain, as well as improved right ventricular strain and LV synchrony in subgroups. Given the associations between strain and synchrony and clinical outcomes, these findings support potential long-term benefits of TPV replacement.
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Affiliation(s)
- David M Harrild
- From the Department of Cardiology, Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA
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268
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Age-related normal range of left ventricular strain and torsion using three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 2013; 27:55-64. [PMID: 24238753 DOI: 10.1016/j.echo.2013.10.002] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Three-dimensional (3D) speckle-tracking echocardiography (STE) is an emerging technology used to quantify left ventricular (LV) function. However, the accuracy and normal values of LV strain and twist using 3D STE have not been established in a large group of normal subjects. The aims of this study were to (1) to evaluate the accuracy of 3D STE analysis of LV strain against a cardiac magnetic resonance (CMR) reference and (2) to establish age-related normal values of LV strain and torsion using real-time 3D echocardiographic (RT3DE) images. METHODS In protocol 1, RT3DE data sets and CMR images were acquired on the same day in 19 patients referred for clinically indicated CMR. Global LV longitudinal, circumferential, and radial strain was compared between the two modalities. In protocol 2, global and regional strain and twist and torsion were measured in 313 healthy subjects using 3D STE. RESULTS In protocol 1, good correlations for each LV strain component were noted between RT3DE imaging and CMR (r = 0.61-0.86, P < .001). In protocol 2, normal global longitudinal, circumferential, radial, and 3D strain were -20.3 ± 3.2%, -28.9 ± 4.6%, 88.0 ± 21.8%, and -37.6 ± 4.8%, respectively. A significant age dependency was observed for global longitudinal and 3D strain. Aging also affected LV torsion: the lowest values were found in children and adolescents, and values subsequently increased with age, while further aging was associated with a gradual reduction in basal rotation accompanied by an increase in apical rotation. CONCLUSIONS This study provides initial validation of 3D strain analysis from RT3DE images and reference values of normal 3D LV strain and torsion. The age-related differences in LV strain and torsion may reflect myocardial maturation and aging.
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269
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Onishi T, Saha SK, Ludwig DR, Onishi T, Marek JJ, Cavalcante JL, Schelbert EB, Schwartzman D, Gorcsan J. Feature tracking measurement of dyssynchrony from cardiovascular magnetic resonance cine acquisitions: comparison with echocardiographic speckle tracking. J Cardiovasc Magn Reson 2013; 15:95. [PMID: 24134158 PMCID: PMC4016574 DOI: 10.1186/1532-429x-15-95] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/20/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Analysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone. Our objective was to quantify LV dyssynchrony using feature tracking post processing of routine cardiovascular magnetic resonance (CMR) cine acquisitions (FT-CMR) in comparison to speckle tracking echocardiography. METHODS We studied 72 consecutive patients who had both steady-state free precession CMR and echocardiography. Mid-LV short axis CMR cines were analyzed using FT-CMR software and compared with echocardiographic speckle tracking radial dyssynchrony (time difference between the anteroseptal and posterior wall peak strain). RESULTS Radial dyssynchrony analysis was possible by FT-CMR in all patients, and in 67 (93%) by echocardiography. Dyssynchrony by FT-CMR and speckle tracking showed limits of agreement of strain delays of ± 84 ms. These were large (up to 100% or more) relative to the small mean delays measured in more synchronous patients, but acceptable (mainly <25%) in those with mean delays of >200 ms. Radial dyssynchrony was significantly greater in wide QRS patients than narrow QRS patients by both FT-CMR (radial strain delay 230 ± 94 vs. 77 ± 92* ms) and speckle tracking (radial strain delay 242 ± 101 vs. 75 ± 88* ms, all *p < 0.001). CONCLUSIONS FT-CMR delivered measurements of radial dyssynchrony from CMR cine acquisitions which, at least for the patients with more marked dyssynchrony, showed reasonable agreement with those from speckle tracking echocardiography. The clinical usefulness of the method, for example in predicting prognosis in CRT patients, remains to be investigated.
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Affiliation(s)
- Toshinari Onishi
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | | | - Daniel R Ludwig
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - Tetsuari Onishi
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - Josef J Marek
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - João L Cavalcante
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - Erik B Schelbert
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - David Schwartzman
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
| | - John Gorcsan
- The University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, USA
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Velocity Vector Imaging in the Measurement of Left Ventricular Myocardial Mechanics on Cardiac Magnetic Resonance Imaging: Correlations with Echocardiographically Derived Strain Values. J Am Soc Echocardiogr 2013; 26:1153-1162. [DOI: 10.1016/j.echo.2013.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Indexed: 12/15/2022]
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271
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Tee M, Noble JA, Bluemke DA. Imaging techniques for cardiac strain and deformation: comparison of echocardiography, cardiac magnetic resonance and cardiac computed tomography. Expert Rev Cardiovasc Ther 2013; 11:221-31. [PMID: 23405842 DOI: 10.1586/erc.12.182] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Myocardial function assessment is essential for determining the health of the myocardium. Global assessment of myocardial function is widely performed (by estimating the ejection fraction), but many common cardiac diseases initially affect the myocardium on a regional, rather than global basis. Regional myocardial wall motion can be quantified using myocardial strain analysis (a normalized measure of deformation). Myocardial strain can be measured in terms of three normal strains (longitudinal strain, radial strain and circumferential) and six shear strains. Cardiac MRI (cMRI) is usually considered the reference standard for measurement of myocardial strain. The most common cMRI method, termed tagged cMRI, allows full, 3D assessment of regional strain. However, due to its complexity and lengthy times for analysis, tagged cMRI is not usually used outside of academic centers. Tagged cMRI is also primarily used only in research studies. Echocardiography combined with tissue Doppler imaging or a speckle tracking technique is now widely available in the clinical setting. Myocardial strain measurement by echocardiography shows reasonable agreement with cMRI. Limited standardization and differences between vendors represent current limitations of the technique. Cardiac computed tomography (CCT) is the newest and most rapidly growing modality for noninvasive imaging of the heart. While CCT studies are most commonly applied to assess the coronary arteries, CCT is easily adapted to provide functional information for both the left and right ventricles. New methods for CCT assessment of regional myocardial function are being developed. This review outlines the current literature on imaging techniques related to cardiac strain analysis and discusses the strengths and weaknesses of various methods for myocardial strain analysis.
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Affiliation(s)
- Michael Tee
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, UK
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272
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Orwat S, Diller GP, Baumgartner H. Imaging of congenital heart disease in adults: choice of modalities. Eur Heart J Cardiovasc Imaging 2013; 15:6-17. [PMID: 23913331 DOI: 10.1093/ehjci/jet124] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Major advances in noninvasive imaging of adult congenital heart disease have been accomplished. These tools play now a key role in comprehensive diagnostic work-up, decision for intervention, evaluation for the suitability of specific therapeutic options, monitoring of interventions and regular follow-up. Besides echocardiography, magnetic resonance (CMR) and computed tomography (CT) have gained particular importance. The choice of imaging modality has thus become a critical issue. This review summarizes strengths and limitations of the different imaging modalities and how they may be used in a complementary fashion. Echocardiography obviously remains the workhorse of imaging routinely used in all patients. However, in complex disease and after surgery echocardiography alone frequently remains insufficient. CMR is particularly useful in this setting and allows reproducible and accurate quantification of ventricular function and comprehensive assessment of cardiac anatomy, aorta, pulmonary arteries and venous return including complex flow measurements. CT is preferred when CMR is contraindicated, when superior spatial resolution is required or when "metallic" artefacts limit CMR imaging. In conclusion, the use of currently available imaging modalities in adult congenital heart disease needs to be complementary. Echocardiography remains the basis tool, CMR and CT should be added considering specific open questions and the ability to answer them, availability and economic issues.
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Affiliation(s)
- Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Str. 33, Muenster 48149, Germany
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273
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Lu JC, Ghadimi Mahani M, Agarwal PP, Cotts TB, Dorfman AL. Usefulness of right ventricular free wall strain to predict quality of life in "repaired" tetralogy of Fallot. Am J Cardiol 2013; 111:1644-9. [PMID: 23497777 DOI: 10.1016/j.amjcard.2013.01.336] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/28/2013] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Abstract
After repair of tetralogy of Fallot, the left ventricular ejection fraction and the right ventricular ejection fraction are associated with clinical status and outcomes, but the relation of strain, a potentially earlier marker of dysfunction, to quality of life has not been evaluated. In 58 patients with tetralogy of Fallot (median age 29 years, interquartile range 20 to 41) who underwent cardiovascular magnetic resonance imaging and completed the Short Form 36, Version 2 (a validated quality-of-life assessment), left ventricular global circumferential strain, left ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVLSFW) were measured from cine images using feature-tracking software. Age-adjusted z score ≤-1 for the physical component summary or subscales of physical functioning, role-physical, and general health was considered a clinically significant decrease in quality of life. Patients with RVLSFW less than the median had increased odds of decreased physical functioning (odds ratio [OR] 5.4, p = 0.01) and general health (OR 3.5, p = 0.04) subscale scores, which remained significant in patients with right ventricular ejection fractions ≥45% (physical functioning: OR 9.5, p = 0.03; general health: OR 5.9, p = 0.04). Left ventricular global circumferential strain and left ventricular global longitudinal strain did not predict decreased quality of life in this population. Intraobserver and interobserver variability was acceptable for left ventricular global circumferential strain (coefficients of variation 9.5% and 10.0%, respectively) but lower for left ventricular global longitudinal strain (coefficients of variation 17.2% and 16.8%, respectively) and poor for RVLSFW (coefficients of variation 19.9% and 28.8%, respectively). In conclusion, RVLSFW appears to have discriminative ability in this population for decreased quality of life and may yield incremental prognostic value beyond global right ventricular ejection fraction assessment, but further study is needed to evaluate methods to limit variability.
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Affiliation(s)
- Jimmy C Lu
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
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274
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Petersen SE, Matthews PM, Bamberg F, Bluemke DA, Francis JM, Friedrich MG, Leeson P, Nagel E, Plein S, Rademakers FE, Young AA, Garratt S, Peakman T, Sellors J, Collins R, Neubauer S. Imaging in population science: cardiovascular magnetic resonance in 100,000 participants of UK Biobank - rationale, challenges and approaches. J Cardiovasc Magn Reson 2013; 15:46. [PMID: 23714095 PMCID: PMC3668194 DOI: 10.1186/1532-429x-15-46] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/16/2013] [Indexed: 01/22/2023] Open
Abstract
UK Biobank is a prospective cohort study with 500,000 participants aged 40 to 69. Recently an enhanced imaging study received funding. Cardiovascular magnetic resonance (CMR) will be part of a multi-organ, multi-modality imaging visit in 3-4 dedicated UK Biobank imaging centres that will acquire and store imaging data from 100,000 participants (subject to successful piloting). In each of UK Biobank's dedicated bespoke imaging centres, it is proposed that 15-20 participants will undergo a 2 to 3 hour visit per day, seven days a week over a period of 5-6 years. The imaging modalities will include brain MRI at 3 Tesla, CMR and abdominal MRI at 1.5 Tesla, carotid ultrasound and DEXA scans using carefully selected protocols. We reviewed the rationale, challenges and proposed approaches for concise phenotyping using CMR on such a large scale. Here, we discuss the benefits of this imaging study and review existing and planned population based cardiovascular imaging in prospective cohort studies. We will evaluate the CMR protocol, feasibility, process optimisation and costs. Procedures for incidental findings, quality control and data processing and analysis are also presented. As is the case for all other data in the UK Biobank resource, this database of images and related information will be made available through UK Biobank's Access Procedures to researchers (irrespective of their country of origin and whether they are academic or commercial) for health-related research that is in the public interest.
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Affiliation(s)
- Steffen E Petersen
- Centre Lead for Advanced Cardiovascular Imaging, William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, The London Chest Hospital, Bonner Road, London E2 9JX, UK
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- GlaxoSmithKline Research and Development, Ltd, Munich, Germany
| | - Fabian Bamberg
- Department of Radiology, Ludwig-Maximilians University Munich, Munich, Germany
| | - David A Bluemke
- Radiology and Imaging Sciences, NIH Clinical Center, Oxford, UK
| | - Jane M Francis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthias G Friedrich
- Montreal Heart Institute, Université de Montréal and University of Calgary, Calgary, Canada
| | - Paul Leeson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Eike Nagel
- King’s College London British Heart Foundation Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ (NHS)Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences; The Rayne Institute, St. Thomas’ Hospital, London, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK
| | | | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, UK
| | - Steve Garratt
- UK Biobank, Spectrum Way, Adswood, Stockport, Cheshire SK3 0SA, UK
| | - Tim Peakman
- UK Biobank, Spectrum Way, Adswood, Stockport, Cheshire SK3 0SA, UK
| | - Jonathan Sellors
- UK Biobank, Spectrum Way, Adswood, Stockport, Cheshire SK3 0SA, UK
| | - Rory Collins
- UK Biobank, Spectrum Way, Adswood, Stockport, Cheshire SK3 0SA, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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275
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Puntmann VO, D'Cruz D, Smith Z, Pastor A, Choong P, Voigt T, Carr-White G, Sangle S, Schaeffter T, Nagel E. Native myocardial T1 mapping by cardiovascular magnetic resonance imaging in subclinical cardiomyopathy in patients with systemic lupus erythematosus. Circ Cardiovasc Imaging 2013; 6:295-301. [PMID: 23403334 DOI: 10.1161/circimaging.112.000151] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Increased systemic inflammation has been linked to myocardial dysfunction and heart failure in patients with systemic lupus erythematosus (SLE). Accurate detection of early myocardial changes may be able to guide preventive intervention. We investigated whether multiparametric imaging by cardiovascular magnetic resonance can detect differences between controls and asymptomatic SLE patients. METHODS AND RESULTS A total of 33 SLE predominantly female patients (mean age, 40±9 years) underwent cardiovascular magnetic resonance for routine assessment of myocardial perfusion, function, and late gadolinium enhancement. T1 mapping was performed in single short-axis slice before and after 15 minutes of gadolinium administration. Twenty-one subjects with a low pretest probability and normal cardiovascular magnetic resonance served as a control group. Both groups had similar left ventricular volumes and mass and normal global systolic function. SLE patients had significantly reduced longitudinal strain (controls versus SLE, -20±2% versus -17±3%; P<0.01) and showed intramyocardial and pericardial late gadolinium enhancement. SLE patients had significantly increased native myocardial T1 (1056±27 versus 1152±46 milliseconds; P<0.001) and extracellular volume fraction (26±5% versus 30±6%; P=0.007) and reduced postcontrast myocardial T1 (454±53 versus 411±62 milliseconds; P=0.01). T1-derived indices were associated with longitudinal strain (r=0.37-0.47) but not with the presence of late gadolinium enhancement. Native myocardial T1 values showed the greatest concordance with the presence of clinical diagnosis of SLE. CONCLUSIONS In patients with SLE and free of cardiac symptoms, there is evidence of subclinical perimyocardial impairment. We further demonstrate that T1 mapping may have potential to detect subclinical myocardial involvement in patients with SLE.
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Affiliation(s)
- Valentina O Puntmann
- Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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276
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Augustine D, Lewandowski AJ, Lazdam M, Rai A, Francis J, Myerson S, Noble A, Becher H, Neubauer S, Petersen SE, Leeson P. Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 2013; 15:8. [PMID: 23331550 PMCID: PMC3621526 DOI: 10.1186/1532-429x-15-8] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/08/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Feature tracking software offers measurements of myocardial strain, velocities and displacement from cine cardiovascular magnetic resonance (CMR) images. We used it to record deformation parameters in healthy adults and compared values to those obtained by tagging. METHODS We used TomTec 2D Cardiac Performance Analysis software to derive global, regional and segmental myocardial deformation parameters in 145 healthy volunteers who had steady state free precession (SSFP) cine left ventricular short (basal, mid and apical levels) and long axis views (horizontal long axis, vertical long axis and left ventricular out flow tract) obtained on a 1.5 T Siemens Sonata scanner. 20 subjects also had tagged acquisitions and we compared global and regional deformation values obtained from these with those from Feature Tracking. RESULTS For globally averaged measurements of strain, only those measured circumferentially in short axis slices showed reasonably good levels of agreement between FT and tagging (limits of agreement -0.06 to 0.04). Longitudinal strain showed wide limits of agreement (-0.16 to 0.03) with evidence of overestimation of strain by FT relative to tagging as the mean of both measures increased. Radial strain was systematically overestimated by FT relative to tagging with very wide limits of agreement extending to as much as 100% of the mean value (-0.01 to 0.23). Reproducibility showed similar relative trends with acceptable global inter-observer variability for circumferential measures (coefficient of variation 4.9%) but poor reproducibility in the radial direction (coefficient of variation 32.3%). Ranges for deformation parameters varied between basal, mid and apical LV levels with higher levels at base compared to apex, and between genders by both FT and tagging. CONCLUSIONS FT measurements of circumferential but not longitudinally or radially directed global strain showed reasonable agreement with tagging and acceptable inter-observer reproducibility. We record provisional ranges of FT deformation parameters at global, regional and segmental levels. They show evidence of variation with gender and myocardial region in the volunteers studied, but have yet to be compared with tagging measurements at the segmental level.
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Affiliation(s)
- Daniel Augustine
- Oxford Cardiovascular Clinical Research Facility, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Merzaka Lazdam
- Oxford Cardiovascular Clinical Research Facility, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Aitzaz Rai
- Oxford Cardiovascular Clinical Research Facility, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Jane Francis
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Alison Noble
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Harald Becher
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Barts and the London NIHR CVBRU, Queen Mary, University of London, London, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
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277
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Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 2013. [PMID: 23331550 DOI: 10.1186/1532- 429x-15-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feature tracking software offers measurements of myocardial strain, velocities and displacement from cine cardiovascular magnetic resonance (CMR) images. We used it to record deformation parameters in healthy adults and compared values to those obtained by tagging. METHODS We used TomTec 2D Cardiac Performance Analysis software to derive global, regional and segmental myocardial deformation parameters in 145 healthy volunteers who had steady state free precession (SSFP) cine left ventricular short (basal, mid and apical levels) and long axis views (horizontal long axis, vertical long axis and left ventricular out flow tract) obtained on a 1.5 T Siemens Sonata scanner. 20 subjects also had tagged acquisitions and we compared global and regional deformation values obtained from these with those from Feature Tracking. RESULTS For globally averaged measurements of strain, only those measured circumferentially in short axis slices showed reasonably good levels of agreement between FT and tagging (limits of agreement -0.06 to 0.04). Longitudinal strain showed wide limits of agreement (-0.16 to 0.03) with evidence of overestimation of strain by FT relative to tagging as the mean of both measures increased. Radial strain was systematically overestimated by FT relative to tagging with very wide limits of agreement extending to as much as 100% of the mean value (-0.01 to 0.23). Reproducibility showed similar relative trends with acceptable global inter-observer variability for circumferential measures (coefficient of variation 4.9%) but poor reproducibility in the radial direction (coefficient of variation 32.3%). Ranges for deformation parameters varied between basal, mid and apical LV levels with higher levels at base compared to apex, and between genders by both FT and tagging. CONCLUSIONS FT measurements of circumferential but not longitudinally or radially directed global strain showed reasonable agreement with tagging and acceptable inter-observer reproducibility. We record provisional ranges of FT deformation parameters at global, regional and segmental levels. They show evidence of variation with gender and myocardial region in the volunteers studied, but have yet to be compared with tagging measurements at the segmental level.
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278
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Bhatti S, Al-Khalidi H, Hor K, Hakeem A, Taylor M, Quyyumi AA, Oshinski J, Pecora AL, Kereiakes D, Chung E, Pedrizzetti G, Miszalski-Jamka T, Mazur W. Assessment of Myocardial Contractile Function Using Global and Segmental Circumferential Strain following Intracoronary Stem Cell Infusion after Myocardial Infarction: MRI Feature Tracking Feasibility Study. ISRN RADIOLOGY 2013; 2013:371028. [PMID: 24959555 PMCID: PMC4045523 DOI: 10.5402/2013/371028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/03/2012] [Indexed: 11/23/2022]
Abstract
Background. Magnetic resonance imaging (MRI) strain analysis is a sensitive method to assess myocardial function. Our objective was to define the feasibility of MRI circumferential strain (εcc) analysis in assessing subtle changes in myocardial function following stem cell therapy. Methods and Results. Patients in the Amorcyte Phase I trial were randomly assigned to treatment with either autologous bone-marrow-derived stem cells infused into the infarct-related artery 5 to 11 days following primary PCI or control. MRI studies were obtained at baseline, 3, and 6 months. εcc was measured in the short axis views at the base, mid and apical slices of the left ventricle (LV) for each patient (13 treatments and 10 controls). Mid-anterior LV εcc improved between baseline −18.5 ± 8.6 and 3 months −22.6 ± 7.0, P = 0.03. There were no significant changes in εcc at 3 months and 6 months compared to baseline for other segments. There was excellent intraobserver and interobserver agreement for basal and mid circumferential strain. Conclusion. MRI segmental strain analysis is feasible in assessment of regional myocardial function following cell therapy with excellent intra- and inter-observer variability's. Using this method, a modest interval change in segmental εcc was detected in treatment group.
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Affiliation(s)
- Sabha Bhatti
- University of Cincinnati Hospital, Cincinnati, OH, USA
| | | | - Kan Hor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abdul Hakeem
- University of Cincinnati Hospital, Cincinnati, OH, USA
| | - Michael Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dean Kereiakes
- The Christ Hospital Heart and Vascular Center, Suite 138, 2123 Auburn Avenue, Cincinnati, OH 45219, USA
| | - Eugene Chung
- The Christ Hospital Heart and Vascular Center, Suite 138, 2123 Auburn Avenue, Cincinnati, OH 45219, USA
| | | | | | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center, Suite 138, 2123 Auburn Avenue, Cincinnati, OH 45219, USA
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279
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Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, Makowski MR, Bigalke B, Perera D, Beerbaum P, Nagel E. The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol 2012; 82:296-301. [PMID: 23246014 DOI: 10.1016/j.ejrad.2012.11.012] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a promising novel method for quantification of myocardial wall mechanics from standard steady-state free precession (SSFP) images. We sought to determine whether magnetic field strength affects the intra-observer reproducibility of CMR-FT strain analysis. METHODS We studied 2 groups, each consisting of 10 healthy subjects, at 1.5 T or 3T Analysis was performed at baseline and after 4 weeks using dedicated CMR-FT prototype software (Tomtec, Germany) to analyze standard SSFP cine images. Right ventricular (RV) and left ventricular (LV) longitudinal strain (Ell(RV) and Ell(LV)) and LV long-axis radial strain (Err(LAX)) were derived from the 4-chamber cine, and LV short-axis circumferential and radial strains (Ecc(SAX), Err(SAX)) from the short-axis orientation. Strain parameters were assessed together with LV ejection fraction (EF) and volumes. Intra-observer reproducibility was determined by comparing the first and the second analysis in both groups. RESULTS In all volunteers resting strain parameters were successfully derived from the SSFP images. There was no difference in strain parameters, volumes and EF between field strengths (p>0.05). In general Ecc(SAX) was the most reproducible strain parameter as determined by the coefficient of variation (CV) at 1.5 T (CV 13.3% and 46% global and segmental respectively) and 3T (CV 17.2% and 31.1% global and segmental respectively). The least reproducible parameter was Ell(RV) (CV 1.5 T 28.7% and 53.2%; 3T 43.5% and 63.3% global and segmental respectively). CONCLUSIONS CMR-FT results are similar with reasonable intra-observer reproducibility in different groups of volunteers at 1.5 T and 3T. CMR-FT is a promising novel technique and our data indicate that results might be transferable between field strengths. However there is a considerable amount of segmental variability indicating that further refinements are needed before CMR-FT can be fully established in clinical routine for quantitative assessment of wall mechanics and strain.
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Affiliation(s)
- Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, King's College London British Heart Foundation (BHF) Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
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280
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Miller CA, Borg A, Clark D, Steadman CD, McCann GP, Clarysse P, Croisille P, Schmitt M. Comparison of local sine wave modeling with harmonic phase analysis for the assessment of myocardial strain. J Magn Reson Imaging 2012; 38:320-8. [PMID: 23239005 DOI: 10.1002/jmri.23973] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 10/29/2012] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare local sine-wave modeling (SinMod) with harmonic phase analysis (HARP), for assessment of left ventricular (LV) circumferential strain (εcc) from tagged cardiovascular magnetic resonance images. MATERIALS AND METHODS Mid-ventricular spatial modulation of magnetization was performed in 60 participants (15 each with hypertrophic, dilated or ischemic cardiomyopathy and 15 healthy controls) at 1.5 Tesla. Global and segmental peak transmural εcc were measured using HARP and SinMod. Repeated measurements were performed on 25% of examinations to assess observer variability. Effect of contrast was assessed in 10 additional patients. RESULTS SinMod showed a high level of agreement with HARP for global εcc (mean difference -0.02, 95% limits of agreement -6.46 to 6.43%). Agreement was much lower for segmental εcc. Both methods showed excellent observer agreement for global εcc (intraclass correlation coefficient >0.75). Observer agreement for segmental εcc was also excellent with SinMod, but was significantly lower with HARP. Analysis time was significantly shorter using SinMod. Pre- and postcontrast εcc measurements were not significantly different using either technique, although postcontrast measurements showed greater variability with HARP. CONCLUSION SinMod and HARP-based measurements of global εcc have a high level of agreement, but segmental agreement is substantially lower. SinMod has generally lower observer variability, is faster and is less affected by contrast, but requires further validation.
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Affiliation(s)
- Christopher A Miller
- Division of Cardiology and Cardiothoracic Surgery, University Hospital of South Manchester, Manchester, United Kingdom.
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281
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Standard and feature tracking magnetic resonance evidence of myocardial involvement in Churg-Strauss syndrome and granulomatosis with polyangiitis (Wegener's) in patients with normal electrocardiograms and transthoracic echocardiography. Int J Cardiovasc Imaging 2012; 29:843-53. [PMID: 23212274 PMCID: PMC3644401 DOI: 10.1007/s10554-012-0158-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/14/2012] [Indexed: 01/08/2023]
Abstract
The aim of the study was to evaluate the presence and spectrum of cardiac abnormalities identified by cardiac magnetic resonance (CMR) in subjects in clinical remission of Churg-Strauss syndrome (CSS) and granulomatosis with polyangiitis (Wegener's) (WG) with normal ECG and transthoracic echocardiography (TTE). Eleven (7 females, 4 males, mean age 42.4 ± 9.6 years) CSS and 10 (4 females, 6 males, mean age 45.3 ± 10.9 years) WG patients in clinical remission with normal ECG and TTE underwent CMR. Segmental peak-systolic myocardial strain (εps) was measured using feature tracking cine-sequence based technique. Left ventricular (LV) ejection fraction, end-diastolic volume and myocardial mass indexes were 66.2 ± 5.8 %, 66.1 ± 6.6 ml/m(2), and 61.0 ± 8.9 g/m(2), respectively. No patient showed regional wall motion abnormalities and signs of myocarditis. Nine CSS and 8 WG patients demonstrated decreased segmental longitudinal, circumferential or radial εps and myocardial late gadolinium enhancement (LGE) (6 subendocardial, 10 midwall, 8 subepicardial) areas. In CSS and WG subjects with LVLGE lesions the mean LVLGE extent was 2.0 ± 1.6 % and 2.3 ± 1.5 % (p = 0.65), respectively. Segmental εps was decreased longitudinally (-11.8 ± 5.6 %) for subendocardial LGE, radially (13.7 ± 8.7 %) for subepicardial LGE, and circumferentially (-16.6 ± 4.2 %), longitudinally (-13.2 ± 5.5 %) and radially (18.8 ± 8.1 %) for midwall LGE, if compared to longitudinal (-22.7 ± 5.1 %), circumferential (-23.6 ± 5.6 %) and radial (34.2 ± 15.7 %) εps in controls (11 females, 10 males, mean age 43.9 ± 10.5 years) (all p < 0.01). Despite clinical remission, normal ECG and TTE, most CSS and WG patients demonstrate decreased segmental εps and non-ischemic LGE lesions without signs of myocarditis.
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282
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Lewandowski AJ, Augustine D, Lamata P, Davis EF, Lazdam M, Francis J, McCormick K, Wilkinson AR, Singhal A, Lucas A, Smith NP, Neubauer S, Leeson P. Preterm heart in adult life: cardiovascular magnetic resonance reveals distinct differences in left ventricular mass, geometry, and function. Circulation 2012; 127:197-206. [PMID: 23224059 DOI: 10.1161/circulationaha.112.126920] [Citation(s) in RCA: 346] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preterm birth leads to an early switch from fetal to postnatal circulation before completion of left ventricular in utero development. In animal studies, this results in an adversely remodeled left ventricle. We determined whether preterm birth is associated with a distinct left ventricular structure and function in humans. METHODS AND RESULTS A total of 234 individuals 20 to 39 years of age underwent cardiovascular magnetic resonance. One hundred two had been followed prospectively since preterm birth (gestational age=30.3±2.5 week; birth weight=1.3±0.3 kg), and 132 were born at term to uncomplicated pregnancies. Longitudinal and short-axis cine images were used to quantify left ventricular mass, 3-dimensional geometric variation by creation of a unique computational cardiac atlas, and myocardial function. We then determined whether perinatal factors modify these left ventricular parameters. Individuals born preterm had increased left ventricular mass (66.5±10.9 versus 55.4±11.4 g/m(2); P<0.001) with greater prematurity associated with greater mass (r = -0.22, P=0.03). Preterm-born individuals had short left ventricles with small internal diameters and a displaced apex. Ejection fraction was preserved (P>0.99), but both longitudinal systolic (peak strain, strain rate, and velocity, P<0.001) and diastolic (peak strain rate and velocity, P<0.001) function and rotational (apical and basal peak systolic rotation rate, P =0.05 and P =0.006; net twist angle, P=0.02) movement were significantly reduced. A diagnosis of preeclampsia during the pregnancy was associated with further reductions in longitudinal peak systolic strain in the offspring (P=0.02, n=29). CONCLUSIONS Individuals born preterm have increased left ventricular mass in adult life. Furthermore, they exhibit a unique 3-dimensional left ventricular geometry and significant reductions in systolic and diastolic functional parameters. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01487824.
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Affiliation(s)
- Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
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283
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Padiyath A, Gribben P, Abraham JR, Li L, Rangamani S, Schuster A, Danford DA, Pedrizzetti G, Kutty S. Echocardiography and cardiac magnetic resonance-based feature tracking in the assessment of myocardial mechanics in tetralogy of Fallot: an intermodality comparison. Echocardiography 2012; 30:203-10. [PMID: 23167248 DOI: 10.1111/echo.12016] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We investigated intermodality agreements of strains from two-dimensional echocardiography (2DE) and cardiac magnetic resonance (CMR) feature tracking (FT) in the assessment of right (RV) and left ventricular (LV) mechanics in tetralogy of Fallot (TOF). Patients were prospectively studied with 2DE and CMR performed contiguously. LV and RV strains were computed separately using 2DE and CMR-FT. Segmental and global longitudinal strains (GLS) for the LV and RV were measured from four-chamber views; LV radial (global radial strain [GRS]) and circumferential strains (GCS) measured from short-axis views. Intermodality and interobserver agreements were examined. In 40 patients (20 TOF, mean age 23 years and 20 adult controls), LV, GCS showed narrowest intermodality limits of agreement (mean percentage error 9.5%), followed by GLS (16.4%). RV GLS had mean intermodality difference of 25.7%. GLS and GCS had acceptable interobserver agreement for the LV and RV with both 2DE and CMR-FT, whereas GRS had high interobserver and intermodality variability. In conclusion, myocardial strains for the RV and LV derived using currently available 2DE and CMR-FT software are subject to considerable intermodality variability. For both modalities, LV GCS, LV GLS, and RV GLS are reproducible enough to warrant further investigation of incremental clinical merit.
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284
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Cardiac Magnetic Resonance Imaging: Recent Advances and New Insights in Cardiovascular Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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285
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Jeung MY, Germain P, Croisille P, ghannudi SE, Roy C, Gangi A. Myocardial Tagging with MR Imaging: Overview of Normal and Pathologic Findings. Radiographics 2012; 32:1381-98. [DOI: 10.1148/rg.325115098] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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286
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Xavier M, Lalande A, Walker PM, Brunotte F, Legrand L. An Adapted Optical Flow Algorithm for Robust Quantification of Cardiac Wall Motion From Standard Cine-MR Examinations. ACTA ACUST UNITED AC 2012; 16:859-68. [DOI: 10.1109/titb.2012.2204893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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287
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Parsai C, O’Hanlon R, Prasad SK, Mohiaddin RH. Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies. J Cardiovasc Magn Reson 2012; 14:54. [PMID: 22857649 PMCID: PMC3436728 DOI: 10.1186/1532-429x-14-54] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 07/10/2012] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular Magnetic Resonance (CMR) is recognised as a valuable clinical tool which in a single scan setting can assess ventricular volumes and function, myocardial fibrosis, iron loading, flow quantification, tissue characterisation and myocardial perfusion imaging. The advent of CMR using extrinsic and intrinsic contrast-enhanced protocols for tissue characterisation have dramatically changed the non-invasive work-up of patients with suspected or known cardiomyopathy. Although the technique initially focused on the in vivo identification of myocardial necrosis through the late gadolinium enhancement (LGE) technique, recent work highlighted the ability of CMR to provide more detailed in vivo tissue characterisation to help establish a differential diagnosis of the underlying aetiology, to exclude an ischaemic substrate and to provide important prognostic markers. The potential application of CMR in the clinical approach of a patient with suspected non-ischaemic cardiomyopathy is discussed in this review.
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Affiliation(s)
- Chirine Parsai
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- Cardiology and CMR Unit, Polyclinique Les Fleurs, Toulon, France
| | - Rory O’Hanlon
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland
| | - Sanjay K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raad H Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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288
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Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E. Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 2012; 14:43. [PMID: 22721175 PMCID: PMC3461471 DOI: 10.1186/1532-429x-14-43] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 06/21/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a recently described method of post processing routine cine acquisitions which aims to provide quantitative measurements of circumferentially and radially directed ventricular wall strain. Inter-study reproducibility is important for serial assessments however has not been defined for CMR-FT. METHODS 16 healthy volunteers were imaged 3 times within a single day. The first examination was performed at 0900 after fasting and was immediately followed by the second. The third, non-fasting scan, was performed at 1400.CMR-FT measures of segmental and global strain parameters were calculated. Left ventricular (LV) circumferential and radial strain were determined in the short axis orientation (Ecc(SAX) and Err(SAX) respectively). LV and right ventricular longitudinal strain and LV radial strain were determined from the 4-chamber orientation (Ell(LV), Ell(RV), and Err(LAX) respectively). LV volumes and function were also analysed.Inter-study reproducibility and study sample sizes required to demonstrate 5% changes in absolute strain were determined by comparison of the first and second exams. The third exam was used to determine whether diurnal variation affected reproducibility. RESULTS CMR-FT strain analysis inter-study reproducibility was variable. Global strain assessment was more reproducible than segmental analysis. Overall Ecc(SAX) was the most reproducible measure of strain: coefficient of variation (CV) 38% and 20.3% and intraclass correlation coefficient (ICC) 0.68 (0.55-0.78) and 0.7 (0.32-0.89) for segmental and global analysis respectively. The least reproducible segmental measure was Ell(RV): CV 60% and ICC 0.56 (0.41-0.69) whilst the least reproducible global measure was Err(LAX): CV 33.3% and ICC 0.44 (0-0.77). Variable reproducibility was also reflected in the calculated sample sizes, which ranged from 11 (global Ecc(SAX)) to 156 subjects (segmental Ell(RV)). The reproducibility of LV volumes and function was excellent. There was no diurnal variation in global strain or LV volumetric measurements. CONCLUSIONS Inter-study reproducibility of CMR-FT varied between different parameters, as summarized above and was better for global rather than segmental analysis. It was not measurably affected by diurnal variation. CMR-FT may have potential for quantitative wall motion analysis with applications in patient management and clinical trials. However, inter-study reproducibility was relatively poor for segmental and long axis analyses of strain, which have yet to be validated, and may benefit from further development.
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Affiliation(s)
- Geraint Morton
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Andreas Schuster
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Roy Jogiya
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Shelby Kutty
- Joint Division of Pediatric Cardiology, University of Nebraska College of Medicine/ Creighton University School of Medicine, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Philipp Beerbaum
- Departments for Radiology and Paediatric Cardiology, St Radboud Medical University, Nijmegen, The Netherlands
| | - Eike Nagel
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas' Hospital, London, SE1 7EH, United Kingdom
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289
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O’Regan DP, Shi W, Ariff B, Baksi AJ, Durighel G, Rueckert D, Cook SA. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration. J Cardiovasc Magn Reson 2012; 14:41. [PMID: 22720881 PMCID: PMC3411469 DOI: 10.1186/1532-429x-14-41] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 06/21/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Progressive heart failure due to remodeling is a major cause of morbidity and mortality following myocardial infarction. Conventional clinical imaging measures global volume changes, and currently there is no means of assessing regional myocardial dilatation in relation to ischemic burden. Here we use 3D co-registration of Cardiovascular Magnetic Resonance (CMR) images to assess the long-term effects of ischemia-reperfusion injury on left ventricular structure after acute ST-elevation myocardial infarction (STEMI). METHODS Forty six patients (age range 33-77 years) underwent CMR imaging within 7 days following primary percutaneous coronary intervention (PPCI) for acute STEMI with follow-up at one year. Functional cine imaging and Late Gadolinium Enhancement (LGE) were segmented and co-registered. Local left ventricular wall dilatation was assessed by using intensity-based similarities to track the structural changes in the heart between baseline and follow-up. Results are expressed as means, standard errors and 95% confidence interval (CI) of the difference. RESULTS Local left ventricular remodeling within infarcted myocardium was greater than in non-infarcted myocardium (1.6%±1.0 vs 0.3%±0.9, 95% CI: -2.4% - -0.2%, P=0.02). One-way ANOVA revealed that transmural infarct thickness had a significant effect on the degree of local remodeling at one year (P<0.0001) with greatest wall dilatation observed when infarct transmurality exceeded 50%. Infarct remodeling was more severe when microvascular obstruction (MVO) was present (3.8%±1.3 vs -1.6%±1.4, 95% CI: -9.1% - -1.5%, P=0.007) and when end-diastolic volume had increased by >20% (4.8%±1.4 vs -0.15%±1.2, 95% CI: -8.9% - -0.9%, P=0.017). CONCLUSIONS The severity of ischemic injury has a significant effect on local ventricular wall remodeling with only modest dilatation observed within non-ischemic myocardium. Limitation of chronic remodeling may therefore depend on therapies directed at modulating ischemia-reperfusion injury. CMR co-registration has potential for assessing dynamic changes in ventricular structure in relation to therapeutic interventions.
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Affiliation(s)
- Declan P O’Regan
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Wenzhe Shi
- Department of Computing, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Ben Ariff
- Department of Imaging, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - A John Baksi
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Giuliana Durighel
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK
| | - Stuart A Cook
- Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
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290
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Koestenberger M. Transthoracic echocardiography in children and young adults with congenital heart disease. ISRN PEDIATRICS 2012; 2012:753481. [PMID: 22778987 PMCID: PMC3384910 DOI: 10.5402/2012/753481] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/19/2012] [Indexed: 11/23/2022]
Abstract
Transthoracic echocardiography (TTE) is the first-line tool for diagnosis and followup of pediatric and young adult patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged more recently: tissue Doppler imaging, tissue tracking (strain and strain rate), vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic acceleration (IVA), the ratio of systolic to diastolic duration (S/D ratio), and two dimensional measurements of systolic right ventricular (RV) function (e.g., tricuspid annular plane systolic excursion, TAPSE). These may become valuable indicators of ventricular performance, compliance, and disease progression. In addition, three-dimensional (3D) echocardiography when performed for the assessment of valvular function, device position, and ventricular volumes is being integrated into routine clinical care. In this paper, the potential use and limitations of these new echocardiographic techniques in patients with CHD are discussed. A particular focus is on the echocardiographic assessment of right ventricular (RV) function in conditions associated with increased right ventricular volume (e.g., pulmonary regurgitation after tetralogy of Fallot repair) or pressure (e.g., pulmonary hypertension) in children and young adults.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 30, 8036 Graz, Austria
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291
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Kempny A, Fernández-Jiménez R, Orwat S, Schuler P, Bunck AC, Maintz D, Baumgartner H, Diller GP. Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 2012; 14:32. [PMID: 22650308 PMCID: PMC3464868 DOI: 10.1186/1532-429x-14-32] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 05/31/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature tracking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. METHODS Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steady-state-free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). RESULTS Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P < 0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO2-slope. CONCLUSIONS Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its inter-observer reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. 'Global strain' calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study.
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Affiliation(s)
- Aleksander Kempny
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | | | - Stefan Orwat
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Pia Schuler
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Alexander C Bunck
- Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - David Maintz
- Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Gerhard-Paul Diller
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
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292
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Heydari B, Jerosch-Herold M, Kwong RY. Imaging for planning of cardiac resynchronization therapy. JACC Cardiovasc Imaging 2012; 5:93-110. [PMID: 22239899 DOI: 10.1016/j.jcmg.2011.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/14/2011] [Accepted: 11/15/2011] [Indexed: 10/14/2022]
Abstract
Cardiac resynchronization therapy (CRT) is a novel therapy for patients with refractory heart failure (HF). Large clinical trials evaluating CRT have demonstrated significant improvements in cardiac survival, decreases in recurrent HF hospitalization, and improvements in indexes of quality of life. Although numerous mechanisms are involved in CRT's therapeutic effects, correction of both interventricular and intraventricular mechanical dyssynchrony has been postulated as the key mechanism. To date, most large randomized controlled trials evaluating CRT have identified dyssynchronous patients on the basis of prolongation of the QRS complex from the baseline electrocardiogram. Concerns have been raised regarding the use of this measure for patient selection, stemming from a significant 30% to 40% nonresponse rate to CRT. Because of the cost and invasive nature of CRT, optimal patient selection for this therapy has become a priority for HF specialists and electrophysiologists. Cardiac imaging modalities have attempted to fulfill this need to improve patient selection by identifying mechanical dyssynchrony. Although early echocardiographic studies reported promising results, more recent larger scale studies have curtailed this enthusiasm, with a lack of established selection criteria for CRT in the current practice guidelines. This review summarizes the evidence to date and the potential role of imaging modalities in the selection and care of patients with HF referred for CRT.
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Affiliation(s)
- Bobak Heydari
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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293
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Reduced global longitudinal and radial strain with normal left ventricular ejection fraction late after effective repair of aortic coarctation: a CMR feature tracking study. Int J Cardiovasc Imaging 2012; 29:141-50. [PMID: 22581073 DOI: 10.1007/s10554-012-0061-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 04/28/2012] [Indexed: 12/28/2022]
Abstract
We sought to determine whether global and regional left ventricular (LV) strain parameters were altered in repaired coarctation of the aorta (COA) with normal LV ejection fraction (EF) when compared with healthy adult controls, and whether such alterations were related to LV hypertrophy (LVH). We identified 81 patients after COA repair (31 female, age 25 ± 8.5 years) with inclusion criteria at follow-up CMR of: age ≥13 years, time post-repair ≥10 years, no aortic valve disease, LV-EF >50%). LV deformation indices derived using CMR-feature tracking and volumetric EF were compared between COA patients and normal controls (n = 20, 10 female, age 37 ± 7 years), and between COA with versus without LVH. In repaired COA versus controls, LV-EF (%) was 62 ± 7.2 versus 58 ± 3.0 (p = 0.01), and LV mass (g/m(2)) 66 ± 16.8 versus 57.7 ± 6.0 (p = 0.0001). LV global longitudinal strain (GLS) was decreased to -17.0 ± 4.7% in COA (-20 ± 5% in controls, p = 0.02), and global radial strain (GRS) reduced to 40 ± 15% (50 ± 12.4% in controls, p = 0.003). The global circumferential strain (GCS) was preserved in COA at -23 ± 4.7% (-24.6 ± 2.4% in controls, p = 0.14). Regionally, LS decrease was marked in the basal segments (septal, p = 0.005, lateral, p = 0.013). In COA with LVH (n = 45, mass 76.3 ± 12.8 g/m(2)) versus without LVH (n = 36, mass 52.2 ± 10 g/m(2)), GLS was more markedly decreased (-15.7 ± 4.8 vs. -18.5 ± 4.2%, p = 0.016, but GRS and GCS were similar (p = 0.49 and 0.27). In post-repair COA with normal LV-EF, GLS and GRS are reduced whilst GCS is preserved. GLS reduction is more pronounced in the presence of LVH. GLS may qualify as indicator of early LV dysfunction.
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294
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Grover S, Srinivasan G, Selvanayagam JB. Myocardial viability imaging: does it still have a role in patient selection prior to coronary revascularisation? Heart Lung Circ 2012; 21:468-79. [PMID: 22521496 DOI: 10.1016/j.hlc.2012.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/06/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
Abstract
Patients with severe left ventricular (LV) dysfunction and multi-vessel coronary artery disease (CAD) are at high risk during revascularisation, however they are also likely to derive the most benefit. Historically, the detection of dysfunctional but potentially viable myocardium ('stunned or hibernating myocardium') has been central to the decision-making regarding revascularisation. A number of recent studies have challenged this paradigm, questioning the role of viability testing in this population. In this review, we will examine the position of viability testing and how it is best incorporated in the modern era of coronary revascularisation. We will outline the role of currently available imaging modalities in viability assessment. Myocardial viability testing will continue to play a role in revascularisation decisions, although larger randomised trials with clinical outcome end-points are needed to further define its role.
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Affiliation(s)
- Suchi Grover
- Department of Cardiovascular Medicine, Discipline of Medicine, Flinders University of South Australia, Flinders Medical Centre, Australia
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295
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Update on Dobutamine Stress Magnetic Resonance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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296
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Verhaert D, Thavendiranathan P, Giri S, Mihai G, Rajagopalan S, Simonetti OP, Raman SV. Direct T2 quantification of myocardial edema in acute ischemic injury. JACC Cardiovasc Imaging 2012; 4:269-78. [PMID: 21414575 DOI: 10.1016/j.jcmg.2010.09.023] [Citation(s) in RCA: 282] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/04/2010] [Accepted: 09/13/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the utility of rapid, quantitative T2 mapping compared with conventional T2-weighted imaging in patients presenting with various forms of acute myocardial infarction. BACKGROUND T2-weighted cardiac magnetic resonance (CMR) identifies myocardial edema before the onset of irreversible ischemic injury and has shown value in risk-stratifying patients with chest pain. Clinical acceptance of T2-weighted CMR has, however, been limited by well-known technical problems associated with existing techniques. T2 quantification has recently been shown to overcome these problems; we hypothesized that T2 measurement in infarcted myocardium versus remote regions versus zones of microvascular obstruction in acute myocardial infarction patients could help reduce uncertainty in interpretation of T2-weighted images. METHODS T2 values using a novel mapping technique were prospectively recorded in 16 myocardial segments in 27 patients admitted with acute myocardial infarction. Regional T2 values were averaged in the infarct zone and remote myocardium, both defined by a reviewer blinded to the results of T2 mapping. Myocardial T2 was also measured in a group of 21 healthy volunteers. RESULTS T2 of the infarct zone was 69 ± 6 ms compared with 56 ± 3.4 ms for remote myocardium (p < 0.0001). No difference in T2 was observed between remote myocardium and myocardium of healthy volunteers (56 ± 3.4 ms and 55.5 ± 2.3 ms, respectively, p = NS). T2 mapping allowed for the detection of edematous myocardium in 26 of 27 patients; by comparison, segmented breath-hold T2-weighted short tau inversion recovery images were negative in 7 and uninterpretable in another 2 due to breathing artifacts. Within the infarct zone, areas of microvascular obstruction were characterized by a lower T2 value (59 ± 6 ms) compared with areas with no microvascular obstruction (71.6 ± 10 ms, p < 0.0001). T2 mapping provided consistent high-quality results in patients unable to breath-hold and in those with irregular heart rhythms, in whom short tau inversion recovery often yielded inadequate imaging. CONCLUSIONS Quantitative T2 mapping reliably identifies myocardial edema without the limitations encountered by T2-weighted short tau inversion recovery imaging, and may therefore be clinically more robust in showing acute ischemic injury.
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297
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Harrild DM, Han Y, Geva T, Zhou J, Marcus E, Powell AJ. Comparison of cardiac MRI tissue tracking and myocardial tagging for assessment of regional ventricular strain. Int J Cardiovasc Imaging 2012; 28:2009-18. [PMID: 22392105 DOI: 10.1007/s10554-012-0035-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/19/2012] [Indexed: 12/13/2022]
Abstract
This study sought to compare regional measures of ventricular strain by tissue tracking (TT) to those derived from myocardial tagging (MT) within cardiac MR (CMR), in normal subjects and patients with hypertrophic cardiomyopathy. CMR images from 13 normal subjects and 11 subjects with hypertrophic cardiomyopathy were retrospectively analyzed. For each subject, equivalent mid-papillary level short-axis cine steady-state free precession and MT slices from the same examination were evaluated. The time to peak circumferential strain and magnitude of the peak strain were calculated for 6 matched left ventricular segments. Data from 24 slices (n = 144 segments) were compared. The mean difference between techniques in magnitude of peak strain and time to peak strain was 1 ± 9% and 1 ± 58 ms, respectively. The mean difference in the standard deviation of time to peak strain within a slice was 0 ± 19 ms (mean cardiac cycle duration 1,013 ± 204 ms). Bland-Altman analysis showed closer agreement in time to peak strain than peak strain magnitude. Measurements of segmental time to peak strain by TT and MT were in close agreement; agreement for the magnitude of peak segmental strain was more modest. The TT approach does not add to CMR examination time and may be a useful tool for the assessment of ventricular synchrony.
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Affiliation(s)
- David M Harrild
- Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
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298
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Bish LT, Sleeper MM, Forbes SC, Wang B, Reynolds C, Singletary GE, Trafny D, Morine KJ, Sanmiguel J, Cecchini S, Virag T, Vulin A, Beley C, Bogan J, Wilson JM, Vandenborne K, Kornegay JN, Walter GA, Kotin RM, Garcia L, Sweeney HL. Long-term restoration of cardiac dystrophin expression in golden retriever muscular dystrophy following rAAV6-mediated exon skipping. Mol Ther 2012; 20:580-9. [PMID: 22146342 PMCID: PMC3293605 DOI: 10.1038/mt.2011.264] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 11/09/2011] [Indexed: 12/23/2022] Open
Abstract
Although restoration of dystrophin expression via exon skipping in both cardiac and skeletal muscle has been successfully demonstrated in the mdx mouse, restoration of cardiac dystrophin expression in large animal models of Duchenne muscular dystrophy (DMD) has proven to be a challenge. In large animals, investigators have focused on using intravenous injection of antisense oligonucleotides (AO) to mediate exon skipping. In this study, we sought to optimize restoration of cardiac dystrophin expression in the golden retriever muscular dystrophy (GRMD) model using percutaneous transendocardial delivery of recombinant AAV6 (rAAV6) to deliver a modified U7 small nuclear RNA (snRNA) carrying antisense sequence to target the exon splicing enhancers of exons 6 and 8 and correct the disrupted reading frame. We demonstrate restoration of cardiac dystrophin expression at 13 months confirmed by reverse transcription-PCR (RT-PCR) and immunoblot as well as membrane localization by immunohistochemistry. This was accompanied by improved cardiac function as assessed by cardiac magnetic resonance imaging (MRI). Percutaneous transendocardial delivery of rAAV6 expressing a modified U7 exon skipping construct is a safe, effective method for restoration of dystrophin expression and improvement of cardiac function in the GRMD canine and may be easily translatable to human DMD patients.
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Affiliation(s)
- Lawrence T Bish
- Department of Physiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Puntmann VO, Nagel E, Hughes AD, Gebker R, Gaddum N, Chowienczyk P, Jahnke C, Mirelis J, Schnackenburg B, Paetsch I, Fleck E. Gender-Specific Differences in Myocardial Deformation and Aortic Stiffness at Rest and Dobutamine Stress. Hypertension 2012; 59:712-8. [DOI: 10.1161/hypertensionaha.111.183335] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Valentina O. Puntmann
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Eike Nagel
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Alun D. Hughes
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Rolf Gebker
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Nicholas Gaddum
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Phil Chowienczyk
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Cosima Jahnke
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Jesus Mirelis
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Bernhard Schnackenburg
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Ingo Paetsch
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
| | - Eckart Fleck
- From the Department of Cardiology and Internal Medicine (V.O.P., R.G., C.J., J.M., I.P., E.F.), German Heart Institute Berlin, Berlin, Germany; Divisions of Imaging Sciences and Medical Engineering (V.O.P., E.N., N.G.) and Cardiovascular Sciences (P.C.), King's College London, London, United Kingdom; International Centre for Circulatory Health (A.D.H.), National Heart and Lung Institute Division, Imperial College London, London, United Kingdom; Philips Healthcare (B.S.), Clinical Science, Hamburg,
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Marcucci CE, Samad Z, Rivera J, Adams DB, Philips-Bute BG, Mahajan A, Douglas PS, Aronson S, Mackensen GB, Podgoreanu MV, Mathew JP, Swaminathan M. A Comparative Evaluation of Transesophageal and Transthoracic Echocardiography for Measurement of Left Ventricular Systolic Strain Using Speckle Tracking. J Cardiothorac Vasc Anesth 2012; 26:17-25. [PMID: 21835637 DOI: 10.1053/j.jvca.2011.06.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Indexed: 11/11/2022]
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