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Duarte VE, Yamamura K, Economy KE, Graf JA, Lu M, Assenza GE, Karur GR, Marenco A, Ishikita A, Duncan ME, Geva T, Wald RM, Valente AM. The effects of pregnancy in subjects with repaired tetralogy of Fallot. Am Heart J 2024; 274:95-101. [PMID: 38677503 DOI: 10.1016/j.ahj.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous reports reveal inconsistent findings of right ventricular (RV) changes following pregnancy in subjects with repaired tetralogy of Fallot (rTOF). METHODS A two-center, retrospective cohort study which included women with rTOF who completed pregnancy that were matched to nulliparous women with rTOF by age at the time of baseline cardiac magnetic resonance (CMR), RV ejection fraction (RVEF), and indexed RV end-diastolic volume (RVEDVi). Pre-pregnancy and postpartum cardiac magnetic resonance (CMR) were analyzed and compared to sequential CMR of nulliparous subjects with rTOF. RESULTS Thirty-six women with rTOF who completed pregnancy were matched to 72 nulliparous women with rTOF. Over a mean period of 3.1 years for the pregnancy group and 2.7 years for the comparison group, there was no significant change in the RVEDVi, RVEF, RV mass, pulmonary regurgitation severity, left ventricular (LV) volumes, LV ejection fraction (LVEF), or LV mass when comparing the baseline CMR and the follow-up CMR in either of the groups. There was a slight increase in RV indexed end-systolic volume (RVESVi) when comparing the baseline CMR and the follow-up CMR in the pregnancy group (68.93, SD 23.34 ml/m2 at baseline vs. 72.97, SD 25.24 mL/m2 at follow-up, P = .028). Using a mixed effects model for CMR parameters change over time; when adjusted for time between baseline and follow-up CMR there was no significant difference in rate of change between the pregnancy and comparison groups. CONCLUSIONS Most ventricular remodeling parameters measured by CMR did not significantly change in subjects with rTOF who completed pregnancy or in nulliparous subjects with rTOF. In the pregnancy group, RVESVi is larger in those individuals who have undergone pregnancy without a significant change in ventricular function. These patients should be followed longitudinally to determine the long-term ventricular and clinical effects of pregnancy.
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Affiliation(s)
- Valeria E Duarte
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA.
| | - Kenichiro Yamamura
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E Economy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Julia A Graf
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gabriele Egidy Assenza
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gauri R Karur
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Anais Marenco
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ayako Ishikita
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madeline E Duncan
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Rachel M Wald
- University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA
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Moreyra C, Moreyra E, Rozich JD. Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders. Cardiol Rev 2024; 32:371-377. [PMID: 36576375 DOI: 10.1097/crd.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography. The present effort asks whether this historically dominant role of echocardiography is now shifting slightly, becoming instead a shared if not complimentary test. Will there be a gradual increasing profile for cardiac magnetic resonance as the attempt to further refine our understanding, diagnostic accuracy, and outcomes for HFpEF is attempted?
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Affiliation(s)
- Camila Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
| | - Eduardo Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
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Andersen CF, Larsen JH, Jensen J, Omar M, Nouhravesh N, Kistorp C, Tuxen C, Gustafsson F, Knop FK, Forman JL, Davidovski FS, Jensen LT, Højlund K, Køber L, Antonsen L, Poulsen MK, Schou M, Møller JE. Empagliflozin to elderly and obese patients with increased risk of developing heart failure: Study protocol for the Empire Prevent trial program. Am Heart J 2024; 271:84-96. [PMID: 38365073 DOI: 10.1016/j.ahj.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Sodium-glucose cotransporter 2 (SGLT2) inhibitors have previously demonstrated cardioprotective properties in patients with type 2 diabetes, suggesting a preventive effect on heart failure (HF). The Empire Prevent trial program investigates the therapeutic potential for HF prevention by evaluating the cardiac, metabolic, and renal effects of the SGLT2 inhibitor empagliflozin in patients with increased risk of developing HF, but without diabetes or established HF. METHODS The Empire Prevent trial program is an investigator-initiated, double-blind, randomized clinical trial program including elderly and obese patients (60-84 years, body mass index >28 kg/m2) with at least one manifestation of hypertension, cardiovascular or chronic kidney disease, but no history of diabetes or HF. The aims are to investigate the effects of empagliflozin on 1) physical capacity and left ventricular and atrial structural changes with peak oxygen consumption and left ventricular mass as primary endpoints (Empire Prevent Cardiac), and 2) cardiac-adipose tissue interaction and volume homeostasis with primary endpoints of changes in epicardial adipose tissue and estimated extracellular volume (Empire Prevent Metabolic). At present, 138 of 204 patients have been randomized in the Empire Prevent trial program. Patients are randomized 1:1 to 180 days treatment with empagliflozin 10 mg daily or placebo, while undergoing a comprehensive examination program at baseline and follow-up. DISCUSSION The Empire Prevent trial program will mark the first step towards elucidating the potential of SGLT2 inhibition for HF prevention in an outpatient setting in elderly and obese patients with increased risk of developing HF, but with no history of diabetes or established HF. Furthermore, the Empire Prevent trial program will supplement the larger event-driven trials by providing mechanistic insights to the beneficial effects of SGLT2 inhibition. TRIAL REGISTRATION Both parts of the trial program have been registered on September 13th 2021 (Clinical Trial Registration numbers: NCT05084235 and NCT05042973) before enrollment of the first patient. All patients will provide oral and written informed consent. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Medicines Agency. Data will be disseminated through scientific meetings and peer-reviewed journals irrespective of outcome.
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Affiliation(s)
- Camilla Fuchs Andersen
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark.
| | - Julie Hempel Larsen
- Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Jesper Jensen
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Caroline Kistorp
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Tuxen
- Department of Cardiology, Frederiksberg-Bispebjerg University Hospital, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Filip Soeskov Davidovski
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Lars Thorbjørn Jensen
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark; Department of Clinical Physiology and Nuclear Medicine, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Kurt Højlund
- Steno Diabetes Center Odense, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Herlev-Gentofte University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
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Fukuie M, Yamabe T, Kimura R, Zhu DC, Ohyama-Byun K, Maeda S, Sugawara J, Tarumi T. Ascending aortic impedance in young endurance athletes: a time-resolved phase-contrast MRI study. J Appl Physiol (1985) 2024; 136:555-566. [PMID: 38234292 DOI: 10.1152/japplphysiol.00184.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Ventricular-vascular coupling in endurance athletes remains incompletely understood. The purpose of this study was to determine the ascending aortic impedance in endurance athletes and explore its associations with traditional cardiovascular measurements. In 15 young male endurance runners and 19 young healthy men, time-resolved (CINE) two-dimensional (2-D) phase-contrast MRI quantified the ascending aortic flow while the pressure waveform was simultaneously collected via a generalized transfer function. The aortic impedance modulus and phase were calculated in the frequency domain while characteristic impedance (ZcF) was calculated by averaging moduli between the 4th and 8th heart rate (HR) harmonics. Stroke volume (SV), left ventricular (LV) morphometry, double product, aortic compliance, and total peripheral resistance (TPR) were also measured. Endurance athletes had higher SV, slower HR, greater LV end-diastolic volume and mass, and lower double product than sedentary participants (all P < 0.05). ZcF was significantly lower in athletes than in sedentary participants (73.3 ± 19.2 vs. 93.4 ± 19.0 dyn·s/cm5, P = 0.005). Furthermore, ZcF was negatively correlated with SV (r = -0.691) and aortic compliance (r = -0.601) but was positively correlated with double product (r = 0.445) and TPR (r = 0.458; all P < 0.05). Multivariate analysis revealed that ZcF was the strongest predictor of SV followed by TPR and HR (adjusted R2 = 0.788, P < 0.001). Therefore, our findings collectively suggest that LV afterload quantified by aortic ZcF is significantly lower in endurance athletes than in sedentary adults. The lower pulsatile LV afterload may contribute to greater SV in endurance athletes.NEW & NOTEWORTHY This is the first study to investigate aortic impedance with the noninvasive, simultaneous recordings of aortic pressure using SphygmoCor XCEL and flow using phase-contrast MRI. We found that the characteristic impedance (Zc) is significantly lower in endurance athletes than sedentary adults, is the strongest predictor of stroke volume (SV), and is inversely associated with aortic compliance. These findings suggest that aortic impedance is a key determinant of the ventricular-vascular coupling adapted to long-term training in endurance athletes.
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Affiliation(s)
- Marina Fukuie
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Yamabe
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ryota Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, Michigan, United States
| | - Keigo Ohyama-Byun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Seiji Maeda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- Sports Physiology, School of Sport Sciences, The University of Waseda, Saitama, Japan
| | - Jun Sugawara
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
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Xu Z, Li W, Wang J, Wang F, Sun B, Xiang S, Luo X, Meng Y, Wang X, Wang X, Song J, Zhang M, Xu D, Zhou X, Ju Z, Sun J, Han Y, Chen Y. Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study. J Magn Reson Imaging 2024; 59:812-822. [PMID: 37530736 DOI: 10.1002/jmri.28903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) reference ranges for ventricular morphology and function in the Chinese population are lacking. PURPOSE To establish the MRI reference ranges of left and right ventricular (LV and RV) morphology and function based on a large multicenter cohort. STUDY TYPE Prospective. POPULATION One thousand and twelve healthy Chinese Han adults. FIELD STRENGTH/SEQUENCE Balanced steady-state free procession cine sequence at 3.0 T. ASSESSMENT Biventricular end-diastolic, end-systolic, stroke volume, and ejection fraction (EDV, ESV, SV, and EF), LV mass (LVM), end-diastolic and end-systolic dimension (LVEDD and LVESD), anteroseptal wall thickness (AS), and posterolateral wall thickness (PL) were measured. Body surface area (BSA) and height were used to index biventricular parameters. Parameters were compared between age groups and sex. STATISTICAL TESTS Independent-samples t-tests or Mann-Whitney U test to compare mean values between sexes; ANOVA or Kruskal-Wallis test to compare mean values among age groups; linear regression to assess the relationships between cardiac parameters and age (correlation coefficient, r). A P value <0.05 was considered statistically significant. RESULTS The biventricular volumes, LVM, LVEDD, RVEDV/LVEDV ratio, LVESD, AS, and PL were significantly greater in males than in females, even after indexing to BSA or height, while LVEF and RVEF were significantly lower in males than in females. For both sexes, age was significantly negatively correlated with biventricular volumes (male and female: LVEDV [r = -0.491; r = -0.373], LVESV [r = -0.194; r = -0.184], RVEDV [r = -0.639; r = -0.506], RVESV [r = -0.270; r = -0.223]), with similar correlations after BSA normalization. LVEF (r = 0.043) and RVEF (r = 0.033) showed a significant correlation with age in females, but not in males (P = 0.889; P = 0.282). DATA CONCLUSION MRI reference ranges for biventricular morphology and function in Chinese adults are presented and show significant associations with age and sex. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Wang
- Department of Radiology, Anqing Municipal Hospital, Anqing, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shifeng Xiang
- Department of Radiology, Handan Central Hospital, Handan, China
| | - Xiao Luo
- Department of Radiology, Maanshan People's Hospital, Maanshan, China
| | - Yanfeng Meng
- Department of Radiology, Taiyuan Central Hospital, Taiyuan, China
| | - Xiang Wang
- Department of Radiology, Wuhan Central Hospital, Wuhan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Jinan, China
| | - Jianxun Song
- Department of Radiology, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Min Zhang
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Dinghu Xu
- Department of Radiology, Nanjing Jiangning Hospital, Nanjing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Grebur K, Mester B, Fekete BA, Kiss AR, Gregor Z, Horváth M, Farkas-Sütő K, Csonka K, Bödör C, Merkely B, Vágó H, Szűcs A. Genetic, clinical and imaging implications of a noncompaction phenotype population with preserved ejection fraction. Front Cardiovasc Med 2024; 11:1337378. [PMID: 38380180 PMCID: PMC10876896 DOI: 10.3389/fcvm.2024.1337378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction The genotype of symptomatic left ventricular noncompaction phenotype (LVNC) subjects with preserved left ventricular ejection fraction (LVEF) and its effect on clinical presentation are less well studied. We aimed to characterize the genetic, cardiac magnetic resonance (CMR) and clinical background, and genotype-phenotype relationship in LVNC with preserved LVEF. Methods We included 54 symptomatic LVNC individuals (LVEF: 65 ± 5%) whose samples were analyzed with a 174-gene next-generation sequencing panel and 54 control (C) subjects. The results were evaluated using the criteria of the American College of Medical Genetics and Genomics. Medical data suggesting a higher risk of cardiovascular complications were considered "red flags". Results Of the LVNC population, 24% carried pathogenic or likely pathogenic (P) mutations; 56% carried variants of uncertain significance (VUS); and 20% were free from cardiomyopathy-related mutations. Regarding the CMR parameters, the LVNC and C groups differed significantly, while the three genetic subgroups were comparable. We found a significant relationship between red flags and genotype; furthermore, the number of red flags in a single subject differed significantly among the genetic subgroups (p = 0.002) and correlated with the genotype (r = 0.457, p = 0.01). In 6 out of 7 LVNC subjects diagnosed in childhood, P or VUS mutations were found. Discussion The large number of P mutations and the association between red flags and genotype underline the importance of genetic-assisted risk stratification in symptomatic LVNC with preserved LVEF.
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Affiliation(s)
- Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Mester
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint András Fekete
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Katalin Csonka
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Sciatti E, Coccia MG, Magnano R, Aakash G, Limonta R, Diep B, Balestrieri G, D'Isa S, Abramov D, Parwani P, D'Elia E. Heart Failure Preserved Ejection Fraction in Women: Insights Learned from Imaging. Heart Fail Clin 2023; 19:461-473. [PMID: 37714587 DOI: 10.1016/j.hfc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
While the prevalence of heart failure, in general, is similar in men and women, women experience a higher rate of HFpEF compared to HFrEF. Cardiovascular risk factors, parity, estrogen levels, cardiac physiology, and altered response to the immune system may be at the root of this difference. Studies have found that in response to increasing age and hypertension, women experience more concentric left ventricle remodeling, more ventricular and arterial stiffness, and less ventricular dilation compared to men, which predisposes women to developing more diastolic dysfunction. A multi-modality imaging approach is recommended to identify patients with HFpEF. Particularly, appreciation of sex-based differences as described in this review is important in optimizing the evaluation and care of women with HFpEF.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Gupta Aakash
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Raul Limonta
- School of Medicine and Surgery, Milano Bicocca University, Milano, Italy
| | - Brian Diep
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Salvatore D'Isa
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
| | - Emilia D'Elia
- Cardiology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy.
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8
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Gregor Z, Kiss AR, Grebur K, Dohy Z, Kovács A, Merkely B, Vágó H, Szűcs A. Characteristics of the right ventricle in left ventricular noncompaction with reduced ejection fraction in the light of dilated cardiomyopathy. PLoS One 2023; 18:e0290981. [PMID: 37747903 PMCID: PMC10519585 DOI: 10.1371/journal.pone.0290981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Reports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N). METHODS Forty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was divided into two subgroups by the amount of RV trabeculation. RESULTS There was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. The hypertrabeculated RV subgroups showed significantly higher RV volumes and lower RV-EF only in the decreased-LV-function groups. The correlation of LV and RV trabeculation was observed only in the LVNC-N group, while LV trabeculation correlated with RV volumes in both noncompacted groups. Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group. CONCLUSIONS The presence and characteristics of RV hypertrabeculation and the correlations between LV trabeculation and RV parameters raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the early detection of RV function deterioration.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
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9
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Arata A, Ricci F, Khanji MY, Mantini C, Angeli F, Aquilani R, Di Baldassarre A, Renda G, Mattioli AV, Nodari S, Gallina S. Sex Differences in Heart Failure: What Do We Know? J Cardiovasc Dev Dis 2023; 10:277. [PMID: 37504533 PMCID: PMC10380698 DOI: 10.3390/jcdd10070277] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Heart failure (HF) remains an important global health issue, substantially contributing to morbidity and mortality. According to epidemiological studies, men and women face nearly equivalent lifetime risks for HF. However, their experiences diverge significantly when it comes to HF subtypes: men tend to develop HF with reduced ejection fraction more frequently, whereas women are predominantly affected by HF with preserved ejection fraction. This divergence underlines the presence of numerous sex-based disparities across various facets of HF, encompassing aspects such as risk factors, clinical presentation, underlying pathophysiology, and response to therapy. Despite these apparent discrepancies, our understanding of them is far from complete, with key knowledge gaps still existing. Current guidelines from various professional societies acknowledge the existence of sex-based differences in HF management, yet they are lacking in providing explicit, actionable recommendations tailored to these differences. In this comprehensive review, we delve deeper into these sex-specific differences within the context of HF, critically examining associated definitions, risk factors, and therapeutic strategies. We provide a specific emphasis on aspects exclusive to women, such as the impact of pregnancy-induced hypertension and premature menopause, as these unique factors warrant greater attention in the broader HF discussion. Additionally, we aim to clarify ongoing controversies and knowledge gaps pertaining to the pharmacological treatment of HF and the sex-specific indications for cardiac implantable electronic devices. By shining a light on these issues, we hope to stimulate a more nuanced understanding and promote the development of more sex-responsive approaches in HF management.
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Affiliation(s)
- Allegra Arata
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
- Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Angeli
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33-40126 Bologna, Italy
| | - Roberta Aquilani
- Cardiac Surgery Intensive Care Unit, Heart Department, SS Annunziata University Hospital, Via dei Vestini 5, 66100 Chieti, Italy
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, and Reprogramming and Cell Differentiation Lab, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Anna Vittoria Mattioli
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST "Spedali Civili" Hospital, 25123 Brescia, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
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10
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Bokma JP, Geva T, Sleeper LA, Lee JH, Lu M, Sompolinsky T, Babu-Narayan SV, Wald RM, Mulder BJM, Valente AM. Improved Outcomes After Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. J Am Coll Cardiol 2023; 81:2075-2085. [PMID: 37225360 DOI: 10.1016/j.jacc.2023.02.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The impact of pulmonary valve replacement (PVR) on major adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF) is unknown. OBJECTIVES The purpose of this study was to determine whether PVR is associated with improved survival and freedom from sustained ventricular tachycardia (VT) in rTOF. METHODS A PVR propensity score was created to adjust for baseline differences between PVR and non-PVR patients enrolled in INDICATOR (International Multicenter TOF Registry). The primary outcome was time to the earliest occurrence of death or sustained VT. PVR and non-PVR patients were matched 1:1 on PVR propensity score (matched cohort) and in the full cohort, modeling was performed with propensity score as a covariate adjustment. RESULTS Among 1,143 patients with rTOF (age 27 ± 14 years, 47% PVR, follow-up 8.3 ± 5.2 years), the primary outcome occurred in 82. The adjusted HR for the primary outcome for PVR vs no-PVR (matched cohort n = 524) was 0.41 (95% CI: 0.21-0.81; multivariable model P = 0.010). Full cohort analysis revealed similar results. Subgroup analysis suggested beneficial effects in patients with advanced right ventricular (RV) dilatation (interaction P = 0.046; full cohort). In patients with RV end-systolic volume index >80 mL/m2, PVR was associated with a lower primary outcome risk (HR: 0.32; 95% CI: 0.16-0.62; P < 0.001). There was no association between PVR and the primary outcome in patients with RV end-systolic volume index ≤80 mL/m2 (HR: 0.86; 95% CI: 0.38-1.92; P = 0.70). CONCLUSIONS Compared with rTOF patients who did not receive PVR, propensity score-matched individuals receiving PVR had lower risk of a composite endpoint of death or sustained VT.
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Affiliation(s)
- Jouke P Bokma
- Department of Cardiology, Amsterdam University Medical Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ji Hae Lee
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tehila Sompolinsky
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, London, United Kingdom
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam University Medical Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Ferraro AM, Bonello K, Sleeper LA, Lu M, Shea M, Marx GR, Powell AJ, Geva T, Harrild DM. A comparison between the apical and subcostal view for three-dimensional echocardiographic assessment of right ventricular volumes in pediatric patients. Front Cardiovasc Med 2023; 10:1137814. [PMID: 37215544 PMCID: PMC10196107 DOI: 10.3389/fcvm.2023.1137814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Background Accurate measurement of ventricular volumes is an important clinical imaging goal. Three-dimensional echocardiography (3DEcho) is used increasingly as it is more available and less costly than cardiac magnetic resonance (CMR). For the right ventricle (RV), the current practice is to acquire 3DEcho volumes from the apical view. However, in some patients the RV may be better seen from the subcostal view. Therefore, this study compared RV volume measurements from the apical vs. the subcostal view, using CMR as a reference standard. Methods Patients <18 years old undergoing a clinical CMR examination were prospectively enrolled. 3DEcho was performed on the day of the CMR. 3DEcho images were acquired with Philips Epic 7 ultrasound system from apical and subcostal views. Offline analysis was performed with TomTec 4DRV Function for 3DEcho images and cvi42 for CMR ones. RV end-diastolic volume and end-systolic volume were collected. Agreement between 3DEcho and CMR was assessed with Bland-Altman analysis and the intraclass correlation coefficient (ICC). Percentage (%) error was calculated using CMR as the reference standard. Results Forty-seven patients were included in the analysis (age range 10 months to 16 years). The ICC was moderate to excellent for all volume comparisons to CMR (subcostal vs. CMR: end-diastolic volume 0.93, end-systolic volume 0.81; apical vs. CMR: end-diastolic volume 0.94, end-systolic volume 0.74).The 3DEcho mean % error vs. CMR for end-systolic volume was 25% for subcostal and 31% for apical; for end-diastolic volume it was 15% for subcostal and 16% for apical. The % error was not significantly different between apical vs. subcostal views for end-systolic and end-diastolic volume measurements. Conclusions For apical and subcostal views, 3DEcho-derived ventricular volumes agree well with CMR. Neither echo view has a consistently smaller error when compared to CMR volumes. Accordingly, the subcostal view can be used as an alternative to the apical view when acquiring 3DEcho volumes in pediatric patients, particularly when the image quality from this window is superior.
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Affiliation(s)
- Alessandra M. Ferraro
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- PhD Program in Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy
| | - Kristin Bonello
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
| | - Melinda Shea
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
| | - Gerald R. Marx
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Andrew J. Powell
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - David M. Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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12
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Grebur K, Gregor Z, Kiss AR, Horváth M, Mester B, Czimbalmos C, Tóth A, Szabó L, Dohy Z, Vágó H, Merkely B, Szűcs A. Different methods, different results? Threshold-based versus conventional contouring techniques in clinical practice. Int J Cardiol 2023; 381:128-134. [PMID: 36965638 DOI: 10.1016/j.ijcard.2023.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The quantitative differences of left and right ventricular (LV, RV) parameters of using different cardiac MRI (CMR) post-processing techniques and their clinical impact are less studied. We aimed to assess the differences and their clinical impact between the conventional contouring (CC) and the threshold-based (TB) methods using 70% and 50% thresholds in different hypertrabeculated conditions. METHODS This retrospective study included 30 dilated cardiomyopathy, 30 left ventricular non-compaction (LVNC), 30 arrhythmogenic cardiomyopathy patients, 30 healthy athletes and 30 healthy volunteers. All participants underwent CMR imaging on 1.5 T. Cine sequences were used to derive measures of the cardiac volumes, function, total muscle mass (TMi) and trabeculae and papillary muscle mass (TPMi) using CC and TB segmentation methods. RESULTS Comparing the CC and the 70% and 50% threshold TB methods, the LV and RV volumes were significantly lower, the ejection fraction (EF) and the TMi were significantly higher with the TB methods. Between the two threshold setups, only TPMi was significantly higher with the 70% threshold. Regarding the clinical benefits, the LVNC was the only group in whom all the diagnostic and therapeutic decisions and risk stratification were influenced using the TB method. Diagnostic changes occurred in three-quarters of the population, and all the cardiomyopathy groups were affected regarding the decision-making about pharmaco- and device therapy. CONCLUSIONS Using the TB method, only TPMi was significantly higher with the 70% threshold than the 50% setup, and both of them differed significantly from the CC technique, with relevant clinical impacts in all patient groups.
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Affiliation(s)
- Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Márton Horváth
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Balázs Mester
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Csilla Czimbalmos
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Attila Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary; Department of Sports Medicine, Semmelweis University, Budapest, Városmajor utca, 68., Budapest 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary; Department of Sports Medicine, Semmelweis University, Budapest, Városmajor utca, 68., Budapest 1122, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Városmajor utca 68., Budapest 1122, Hungary.
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13
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Normal Values of Left Ventricular Mass by Two-Dimensional and Three-Dimensional Echocardiography: Results from the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr 2022; 36:533-542.e1. [PMID: 36584904 DOI: 10.1016/j.echo.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although increased left ventricular (LV) mass is associated with adverse outcomes, measured values vary widely depending on the specific technique used. Moreover, the impact of sex, age, and race on LV mass remains controversial, further limiting the clinical use of this parameter. Accordingly, the authors studied LV mass using a variety of two-dimensional and three-dimensional echocardiographic techniques in a large population of normal subjects encompassing a wide range of ages. METHODS Transthoracic echocardiograms obtained from 1,854 healthy adult subjects (52% men) enrolled in the World Alliance Societies of Echocardiography (WASE) Normal Values Study, were divided into three age groups (young, 18-35 years; middle aged, 36-55 years; and old, >55 years). LV mass was obtained using five conventional techniques, including linear and two-dimensional methods, as well as direct three-dimensional measurement. All LV mass values were indexed to body surface area, and differences according to sex, age, and race were analyzed for each technique. RESULTS LV mass values differed significantly among the five techniques. Three-dimensional measurements were considerably smaller than those obtained using the other techniques and were closer to magnetic resonance imaging normal values reported in the literature. For all techniques, LV mass in men was significantly larger than in women, with and without body surface area indexing. These technique- and sex-related differences were larger than measurement variability. In women, age differences in LV mass were more pronounced and depicted significantly larger values in older age groups for all techniques, except three-dimensional echocardiography, which showed essentially no differences. LV mass was overall larger in black subjects than in white or Asian subjects. CONCLUSIONS Significant differences in LV mass values exist across echocardiographic techniques, which are therefore not interchangeable. Sex-, race-, and age-related differences underscore the need for separate population specific normal values.
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14
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Kawakubo M, Nagao M, Yamamoto A, Nakao R, Matsuo Y, Fukushim K, Watanabe E, Sakai A, Sasaki M, Sakai S. 13N-ammonia positron emission tomography-derived endocardial strain for the assessment of ischemia using feature-tracking in high-resolution cine imaging. J Nucl Cardiol 2022; 29:2103-2114. [PMID: 34117615 DOI: 10.1007/s12350-021-02677-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Assessing endocardial strain using a single 13N-ammonia positron emission tomography (PET) scan would be clinically useful, given the association between ischemia and myocardial deformation. However, no software has been developed for strain analysis using PET. We evaluated the clinical potential of feature tracking-derived strain values measured using PET, based on associations with the myocardial flow reserve (MFR). METHODS AND RESULTS This retrospective study included 95 coronary artery disease patients who underwent myocardial 13N-ammonia PET. Semi-automatic measurements were made using a feature-tracking technique during myocardial cine imaging, and values were calculated using a 16-segment model. Adenosine-stressed global circumferential strain (CS) and global longitudinal strain (LS) values were compared with global MFR values. Stressed and resting global strain values were also compared. Global strain values were significantly lower in 39 patients with abnormal MFRs [< 2.0] than in 56 patients with normal MFRs [≥ 2.0]. The global CS values in the stressed state were significantly decreased than the resting state values in patients with abnormal MFRs. CONCLUSIONS This study applied endocardial feature-tracking to 13N-ammonia PET, and the results suggested that blood flow and myocardial motility could be clinically assessed in ischemic patients using a single PET scan.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kenji Fukushim
- Department of Nuclear Medicine, Saitama Medical University, Saitama, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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15
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Tossas-Betancourt C, Li NY, Shavik SM, Afton K, Beckman B, Whiteside W, Olive MK, Lim HM, Lu JC, Phelps CM, Gajarski RJ, Lee S, Nordsletten DA, Grifka RG, Dorfman AL, Baek S, Lee LC, Figueroa CA. Data-driven computational models of ventricular-arterial hemodynamics in pediatric pulmonary arterial hypertension. Front Physiol 2022; 13:958734. [PMID: 36160862 PMCID: PMC9490558 DOI: 10.3389/fphys.2022.958734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a complex disease involving increased resistance in the pulmonary arteries and subsequent right ventricular (RV) remodeling. Ventricular-arterial interactions are fundamental to PAH pathophysiology but are rarely captured in computational models. It is important to identify metrics that capture and quantify these interactions to inform our understanding of this disease as well as potentially facilitate patient stratification. Towards this end, we developed and calibrated two multi-scale high-resolution closed-loop computational models using open-source software: a high-resolution arterial model implemented using CRIMSON, and a high-resolution ventricular model implemented using FEniCS. Models were constructed with clinical data including non-invasive imaging and invasive hemodynamic measurements from a cohort of pediatric PAH patients. A contribution of this work is the discussion of inconsistencies in anatomical and hemodynamic data routinely acquired in PAH patients. We proposed and implemented strategies to mitigate these inconsistencies, and subsequently use this data to inform and calibrate computational models of the ventricles and large arteries. Computational models based on adjusted clinical data were calibrated until the simulated results for the high-resolution arterial models matched within 10% of adjusted data consisting of pressure and flow, whereas the high-resolution ventricular models were calibrated until simulation results matched adjusted data of volume and pressure waveforms within 10%. A statistical analysis was performed to correlate numerous data-derived and model-derived metrics with clinically assessed disease severity. Several model-derived metrics were strongly correlated with clinically assessed disease severity, suggesting that computational models may aid in assessing PAH severity.
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Affiliation(s)
| | - Nathan Y. Li
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Sheikh M. Shavik
- Department of Mechanical Engineering, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | - Katherine Afton
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Brian Beckman
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Wendy Whiteside
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Mary K. Olive
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Heang M. Lim
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Jimmy C. Lu
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Christina M. Phelps
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Robert J. Gajarski
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Simon Lee
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - David A. Nordsletten
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronald G. Grifka
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Adam L. Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - C. Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States
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16
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Alfarih M, Augusto JB, Knott KD, Fatih N, Kumar MP, Boubertakh R, Hughes AD, Moon JC, Weingärtner S, Captur G. Saturation-pulse prepared heart-rate independent inversion-recovery (SAPPHIRE) biventricular T1 mapping: inter-field strength, head-to-head comparison of diastolic, systolic and dark-blood measurements. BMC Med Imaging 2022; 22:122. [PMID: 35799139 PMCID: PMC9264718 DOI: 10.1186/s12880-022-00843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background To assess the feasibility of biventricular SAPPHIRE T1 mapping in vivo across field strengths using diastolic, systolic and dark-blood (DB) approaches. Methods 10 healthy volunteers underwent same-day non-contrast cardiovascular magnetic resonance at 1.5 Tesla (T) and 3 T. Left and right ventricular (LV, RV) T1 mapping was performed in the basal, mid and apical short axis using 4-variants of SAPPHIRE: diastolic, systolic, 0th and 2nd order motion-sensitized DB and conventional modified Look-Locker inversion recovery (MOLLI). Results LV global myocardial T1 times (1.5 T then 3 T results) were significantly longer by diastolic SAPPHIRE (1283 ± 11|1600 ± 17 ms) than any of the other SAPPHIRE variants: systolic (1239 ± 9|1595 ± 13 ms), 0th order DB (1241 ± 10|1596 ± 12) and 2nd order DB (1251 ± 11|1560 ± 20 ms, all p < 0.05). In the mid septum MOLLI and diastolic SAPPHIRE exhibited significant T1 signal contamination (longer T1) at the blood-myocardial interface not seen with the other 3 SAPPHIRE variants (all p < 0.025). Additionally, systolic, 0th order and 2nd order DB SAPPHIRE showed narrower dispersion of myocardial T1 times across the mid septum when compared to diastolic SAPPHIRE (interquartile ranges respectively: 25 ms, 71 ms, 73 ms vs 143 ms, all p < 0.05). RV T1 mapping was achievable using systolic, 0th and 2nd order DB SAPPHIRE but not with MOLLI or diastolic SAPPHIRE. All 4 SAPPHIRE variants showed excellent re-read reproducibility (intraclass correlation coefficients 0.953 to 0.996). Conclusion These small-scale preliminary healthy volunteer data suggest that DB SAPPHIRE has the potential to reduce partial volume effects at the blood-myocardial interface, and that systolic SAPPHIRE could be a feasible solution for right ventricular T1 mapping. Further work is needed to understand the robustness of these sequences and their potential clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00843-0.
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Affiliation(s)
- Mashael Alfarih
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.,Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - João B Augusto
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nasri Fatih
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - M Praveen Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Redha Boubertakh
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.,UCL MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, UK
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sebastian Weingärtner
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Gabriella Captur
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. .,Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK. .,UCL MRC Unit for Lifelong Health and Ageing, 33 Bedford Place, London, WC1B 5JU, UK. .,Cardiology Department, Royal Free Hospital NHS Trust, Pond St, Hampstead, London, NW3 2QG, UK.
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17
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Okhovatian S, Mohammadi MH, Rafatian N, Radisic M. Engineering Models of the Heart Left Ventricle. ACS Biomater Sci Eng 2022; 8:2144-2160. [PMID: 35523206 DOI: 10.1021/acsbiomaterials.1c00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite capturing the imagination of scientists for decades, the goal of creating an artificial heart for transplantation proved to be significantly more challenging than initially anticipated. Toward this goal, recent ground-breaking studies demonstrate the development of functional left ventricular (LV) models. LV models are artificially constructed 3D chambers that are capable of containing liquid within the engineered cavity and exhibit the functionality of native LV including contraction, ejection of fluid, and electrical impulse propagation. Various hydrogels and polymers have been used in manufacturing of LV models, relying on techniques such as electrospinning, bioprinting, casting, and molding. Most studies scaled down the models based on the dimensions of the human or rat ventricle. Initially, neonatal rat cardiomyocytes were the cell type of choice for construction the LV models. Yet, as the stem cell biology field advanced, recent studies focused on the use of cardiomyocytes derived from human induced pluripotent stem cells. In this review, we first describe the physiological characteristics of the human heart, to establish the parameter space for modeling. We then elaborate on current advances in the field and compare recently developed LV models among themselves and with the native human left ventricle. Fabrication methods, cell types, biomaterials, functional properties, and disease modeling capability are some of the major parameters that have distinguished these models. We also highlight some of the current challenges in this field, such as vascularization, cell composition and fidelity, and discuss potential solutions to overcome them.
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Affiliation(s)
- Sargol Okhovatian
- Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Mohammad Hossein Mohammadi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Naimeh Rafatian
- Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Milica Radisic
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada.,Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada.,Toronto General Research Institute, Toronto, Ontario M5G 2C4, Canada
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18
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Karvonen V, Harjama L, Heliö K, Kettunen K, Elomaa O, Koskenvuo JW, Kere J, Weckström S, Holmström M, Saarela J, Ranki A, Heliö T, Hannula-Jouppi K. A novel desmoplakin mutation causes dilated cardiomyopathy with palmoplantar keratoderma as an early clinical sign. J Eur Acad Dermatol Venereol 2022; 36:1349-1358. [PMID: 35445468 PMCID: PMC9545885 DOI: 10.1111/jdv.18164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Background PPKs represent a heterogeneous group of disorders with hyperkeratosis of palmar and/or plantar skin. PPK, hair shaft abnormalities, cardiomyopathy and arrhythmias can be caused by mutations in desmosomal genes, e.g. desmoplakin (DSP). PPK should trigger genetic testing to reveal mutations with possible related cardiac disease. Objectives To report a large multigenerational family with a novel DSP mutation associated with early‐onset PPK and adult‐onset cardiomyopathy and arrhythmias. Methods A custom‐designed in‐house panel of 35 PPK related genes was used to screen mutations in the index patient with focal PPK. The identified DSP mutation was verified by Sanger sequencing. DNA samples from 20 members of the large multigenerational family were sequenced for the DSP mutation. Medical records were reviewed. Clinical dermatological evaluation was performed, including light microscopy of hair samples. Cardiac evaluation included clinical examination, echocardiography, cardiac magnetic resonance imaging (CMR), electrocardiogram (ECG), Holter monitoring and laboratory tests. Results We identified a novel autosomal dominant truncating DSP c.2493delA p.(Glu831Aspfs*33) mutation associated with dilated cardiomyopathy (DCM) with arrhythmia susceptibility and focal PPK as an early cutaneous sign. The mutation was found in nine affected family members, but not in any unaffected members. Onset of dermatological findings preceded cardiac symptoms which were variable and occurred at adult age. Conclusions We report a novel truncating DSP mutation causing focal PPK with varying severity and left ventricular dilatation and ventricular extrasystoles. This finding emphasizes the importance of genetic diagnosis in patients with PPK for clinical counselling and management of cardiomyopathies and arrhythmias.
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Affiliation(s)
- V Karvonen
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Harjama
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Heliö
- Department of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - K Kettunen
- HUS Diagnostic Center, Division of Genetics and Clinical Pharmacology, Laboratory of Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - O Elomaa
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Finland
| | | | - J Kere
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Finland.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - S Weckström
- Department of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Saarela
- HUS Diagnostic Center, Division of Genetics and Clinical Pharmacology, Laboratory of Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Centre for Molecular Medicine Norway (NCMM), University of Oslo, Oslo, Norway
| | - A Ranki
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T Heliö
- Department of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - K Hannula-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Finland
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19
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State of the Art on the Role of Postmortem Computed Tomography Angiography and Magnetic Resonance Imaging in the Diagnosis of Cardiac Causes of Death: A Narrative Review. Tomography 2022; 8:961-973. [PMID: 35448711 PMCID: PMC9025017 DOI: 10.3390/tomography8020077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
The need of a minimally invasive approach, especially in cases of cultural or religious oppositions to the internal examination of the body, has led over the years to the introduction of postmortem CT (PMCT) methodologies within forensic investigations for the comprehension of the cause of death in selected cases (e.g., traumatic deaths, acute hemorrhages, etc.), as well as for personal identification. The impossibility to yield clear information concerning the coronary arteries due to the lack of an active circulation to adequately distribute contrast agents has been subsequently overcome by the introduction of coronary-targeted PMCT Angiography (PMCTA), which has revealed useful in the detection of stenoses related to calcifications and/or atherosclerotic plaques, as well as in the suspicion of thrombosis. In parallel, due to the best ability to study the soft tissues, cardiac postmortem MR (PMMR) methodologies have been further implemented, which proved suitable for the detection and aging of infarcted areas, and for cardiomyopathies. Hence, the purpose of the present work to shed light on the state of the art concerning the value of both coronary-targeted PMCTA and PMMR in the diagnosis of coronary artery disease and/or myocardial infarction as causes of death, further evaluating their suitability as alternatives or complementary approaches to standard autopsy and histologic investigations.
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20
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Majeed A, Geva T, Sleeper LA, Graf JA, Lu M, Babu-Narayan SV, Wald RM, Mulder BJM, Valente AM. Cardiac MRI predictors of good long-term outcomes in patients with repaired TOF. Am Heart J 2022; 245:70-77. [PMID: 34875276 DOI: 10.1016/j.ahj.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk stratification in patients with repaired tetralogy of Fallot (rTOF) have focused on poor clinical outcomes while predictors of a benign clinical course have not been characterized. OBJECTIVE The goal of this study was to Identify cardiac magnetic resonance (CMR) markers of a good clinical course late after TOF repair. METHODS Clinical and CMR data from the International Multicenter TOF Registry (INDICATOR) were analyzed. The primary outcome was time to the earliest occurrence of a composite of death, aborted sudden death, and sustained ventricular tachycardia (VT). The secondary outcome was time to the earliest occurrence of atrial arrhythmia, nonsustained VT, and NYHA class >II. Multinomial regression was used to identify predictors of the 3-category outcome: (a) good outcome, defined as freedom from the primary AND secondary outcomes at age 50 years; (b) poor outcome, defined as presence of the primary outcome before age 50 years; and (c) intermediate outcome, defined as not fulfilling criteria for good or poor outcomes. RESULTS Among 1088 eligible patients, 96 had good outcome, 60 experienced poor outcome, and 932 had intermediate outcome. Patients were age 25.8±10.8 years at the time of the index CMR. Median follow-up was 5.8 years (IQR 3.0, 9.9) after CMR in event-free patients. By univariate analysis, smaller right ventricular (RV) end-systolic and end-diastolic volume index, smaller left ventricular end-systolic volume index, higher right and left ventricular ejection fraction, lower right and left ventricular mass index, and lower left ventricular mass/volume ratio were associated with good outcome. Multivariable modeling identified higher RV ejection fraction (OR 2.38 per 10% increase, P = .002) and lower RV mass index (OR 1.72, per 10 g/m2 decrease, P = .002) as independently associated with good outcome after adjusting for age at CMR. Classification and regression tree analysis identified important thresholds associated with good outcome that were specific to patients age ≥37 years at the time of CMR; these were RV ejection fraction ≥42% and RV mass index <39 g/m2. CONCLUSIONS Adults with rTOF and no more than mild RV dysfunction combined with no significant RV hypertrophy are likely to be free from serious adverse clinical events into their sixth decade of life and may require less frequent cardiac testing.
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Affiliation(s)
- Amara Majeed
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Julia A Graf
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; and National Heart Lung Institute, Imperial College London, United Kingdom
| | - Rachel M Wald
- University of Toronto, Toronto, ON, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto ON, Canada
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, NH, The Netherlands; Academic Medical Center, Amsterdam, NH, The Netherlands
| | - Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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21
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Greutmann M, Ruperti J, Schwitz F, Haag N, Santos Lopes B, Meier L, Babic D, Valsangiacomo Buechel E, Kellenberger C, Bonassin F, Attenhofer Jost C, Schwerzmann M, Wustmann K, Tobler D. High Variability of Right Ventricular Volumes and Function in Adults with Severe Pulmonary Regurgitation Late After Tetralogy of Fallot Repair. Am J Cardiol 2022; 166:88-96. [PMID: 34949470 DOI: 10.1016/j.amjcard.2021.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 01/20/2023]
Abstract
Our aim was to assess changes of right ventricular end-diastolic volumes (RVEDVi) and right ventricular ejection fraction (RVEF) in asymptomatic adults with repaired tetralogy of Fallot, with native right ventricular outflow tract and severe pulmonary regurgitation by serial cardiac magnetic resonance imaging (CMR). The study included 23 asymptomatic adults who underwent ≥3 CMR studies (total of 88 CMR studies). We compared changes in RVEDVi and RVEF between first and last study (median follow-up: 8.8 years, interquartile range: 6.3 to 13.1 years) and between all study pairs. Variability of measurements between study pairs (65 consecutive and 139 nonconsecutive CMR study pairs) were assessed using Bland-Altman analysis and intraclass correlation coefficients. On average, there were no significant changes of RVEDVi or RVEF over the study period (change in RVEDVi: +0.4 ± 17.8 ml/m2, change in RVEF: -1.0 ± 5.5%). Assessment of variability of measurements between study pairs demonstrated no systematic change in RVEDVi and RVEF between study pairs with limits of agreement within the range of previously published studies (RVEDVi -29.1 to +27.2 ml/m2; RVEF -11.5% to 10.2%). High intraclass correlation coefficients for RVEDVi (0.943, 95% CI 0.906 to 0.965, p <0.001) and RVEF (0.815, 95% CI 0.697 to 0.887, p <0.0001) indicate high reliability of reported measurements. In conclusion, in asymptomatic adults with repaired tetralogy of Fallot with native right ventricular outflow tracts and severe pulmonary regurgitation, CMR measurements of RV volumes and RVEF remain stable during follow-up with variability between CMR studies in individual patients, as expected for interobserver and interstudy variability. Measurements derived from a single CMR study or changes occurring between 2 CMR studies should be used with caution for clinical decision-making.
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Affiliation(s)
- Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Javier Ruperti
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Nora Haag
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Santos Lopes
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela Babic
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Christian Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Francesca Bonassin
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Attenhofer Jost
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Schwerzmann
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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22
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Luu JM, Gebhard C, Ramasundarahettige C, Desai D, Schulze K, Marcotte F, Awadalla P, Broet P, Dummer T, Hicks J, Larose E, Moody A, Smith EE, Tardif JC, Teixeira T, Teo KK, Vena J, Lee DS, Anand SS, Friedrich MG. Normal sex and age-specific parameters in a multi-ethnic population: a cardiovascular magnetic resonance study of the Canadian Alliance for Healthy Hearts and Minds cohort. J Cardiovasc Magn Reson 2022; 24:2. [PMID: 34980185 PMCID: PMC8722350 DOI: 10.1186/s12968-021-00819-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the growing utility of cardiovascular magnetic resonance (CMR) for cardiac morphology and function, sex and age-specific normal reference values derived from large, multi-ethnic data sets are lacking. Furthermore, most available studies use a simplified tracing methodology. Using a large cohort of participants without history of cardiovascular disease (CVD) or risk factors from the Canadian Alliance for Healthy Heart and Minds, we sought to establish a robust set of reference values for ventricular and atrial parameters using an anatomically correct contouring method, and to determine the influence of age and sex on ventricular parameters. METHODS AND RESULTS Participants (n = 3206, 65% females; age 55.2 ± 8.4 years for females and 55.1 ± 8.8 years for men) underwent CMR using standard methods for quantitative measurements of cardiac parameters. Normal ventricular and atrial reference values are provided: (1) for males and females, (2) stratified by four age categories, and (3) for different races/ethnicities. Values are reported as absolute, indexed to body surface area, or height. Ventricular volumes and mass were significantly larger for males than females (p < 0.001). Ventricular ejection fraction was significantly diminished in males as compared to females (p < 0.001). Indexed left ventricular (LV) end-systolic, end-diastolic volumes, mass and right ventricular (RV) parameters significantly decreased as age increased for both sexes (p < 0.001). For females, but not men, mean LV and RVEF significantly increased with age (p < 0.001). CONCLUSION Using anatomically correct contouring methodology, we provide accurate sex and age-specific normal reference values for CMR parameters derived from the largest, multi-ethnic population free of CVD to date. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02220582. Registered 20 August 2014-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02220582 .
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Affiliation(s)
- Judy M Luu
- Division of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Francois Marcotte
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, 661 University Avenue Suite 510, Toronto, ON, M5G 0A3, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, École de Santé Publique, Université de Montréal, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Research Centre, CHU Sainte Justine, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Trevor Dummer
- School of Population and Public Health, Cancer Control Research, BC Cancer, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Jason Hicks
- Atlantic PATH, Dalhousie University, 1494 Carlton Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Quebec, G1V 4G5, Canada
| | - Alan Moody
- Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Tiago Teixeira
- Cardiology Department, Entre Douro e Vouga Hospital Centre, Santa Maria Feira, Portugal
| | - Koon K Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Suite 1500 Sun Life Place, 10123 99th Street NW, Edmonton, AB, T5J 3H1, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Peter Munk Cardiac Centre University Health Network University of Toronto, Toronto, ON, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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23
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Alshammari QT, Almutairi W, Alshammari E, Alrashidi O, Alshammari MT, Alyahyawi. AR, Alzamil Y, Shahanawaz SD, Shashi CGK. Cardiac Magnetic Resonance Imaging Feature Tracking for Quantifying Left Ventricle Deformation in Type 2 Diabetic Patients. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2022. [DOI: 10.51847/dgpw4yl4ox] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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He F, Feng Z, Yuan J, Ma K, Yang K, Lu M, Zhang S, Li S. Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: Midterm Impact on Biventricular Response and Adverse Clinical Outcomes. Front Pediatr 2022; 10:864455. [PMID: 35601413 PMCID: PMC9120843 DOI: 10.3389/fped.2022.864455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Pulmonary regurgitation (PR), though well tolerated for short term in patients with repaired tetralogy of Fallot (rTOF), could lead to right ventricular (RV) dysfunction, arrhythmias, and sudden cardiac death. Pulmonary valve replacement (PVR), considered as the gold-standard treatment for PR, is performed to mitigate these late effects. In this study, we aimed to evaluate the midterm outcomes and predictors of adverse clinical outcomes (ACO). METHODS From May 2014 to December 2017, 42 patients with rTOF undergoing surgical or transcatheter PVR in our department were retrospectively included. Cardiovascular magnetic resonance was performed before PVR (pre-PVR), early after PVR (early post-PVR), and midterm after PVR (midterm post-PVR). Medical history and individual data were collected from medical records. ACO included all-cause death, new-onset arrhythmia, prosthetic valve failure, and repeat PVR. RESULTS The median follow-up duration was 4.7 years. PVR was performed at a median age of 21.6 years. There was no early or late death. Freedom from ACO at 3 and 5 years was 88.1 ± 5% and 58.2 ± 9%, respectively. RV end-diastolic volume index (RVEDVI) and end-systolic volume index (RVESVI) significantly reduced early after PVR and further decreased by midterm follow-up (pre-PVR vs. early post-PVR vs. midterm post-PVR: RVEDVI, 155.2 ± 34.7 vs. 103.8 ± 31.2 vs. 95.1 ± 28.6 ml/m2, p < 0.001; RVESVI, 102.9 ± 28.5 vs. 65.4 ± 28.2 vs. 57.7 ± 23.4 ml/m2, p < 0.001). Multivariable analysis revealed that the occurrence of ACO was significantly increased in patients with lower left ventricular end-systolic volume index. CONCLUSIONS A significant reduction of RV volume occurred early after PVR, followed by a further improvement of biventricular function by midterm follow-up. The midterm freedom from ACO was favorable.
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Affiliation(s)
- Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.,Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zicong Feng
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianhui Yuan
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kai Ma
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Keming Yang
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, National Centre for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Sen Zhang
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shoujun Li
- Paediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, Peking Union Medical College, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhou D, Li S, Sirajuddin A, Wu W, Huang J, Sun X, Zhao S, Pu J, Lu M. CMR Characteristics, gene variants and long-term outcome in patients with left ventricular non-compaction cardiomyopathy. Insights Imaging 2021; 12:184. [PMID: 34894296 PMCID: PMC8665949 DOI: 10.1186/s13244-021-01130-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background As the paucity of data focusing on evaluating cardiac structure and function in patients with or without gene mutation, this study was sought to investigate the correlation between genotype and cardiac magnetic resonance (CMR) phenotype in patients with left ventricular non-compaction cardiomyopathy (LVNC) and to explore prognostic relevance in this cohort if possible. Methods Patients with LVNC who underwent CMR and targeted gene sequencing between 2006 and 2016 were retrospectively evaluated. Demographic data, clinical presentation, genetic analysis, CMR data and follow-up data of all participants were collected. Results Compared to negative genotype (G−) group, patients with positive genotype (G+) had larger left atrial volume (LAV), and carriers of multiple variants had lower left ventricular (LV) ejection fraction and cardiac index, increased LV fibrosis, larger LA volume, reduced LV global circumferential strain, LA reservoir strain and booster pump strain (all p < 0.05). LA volume was able to discriminate patients with G + (all p < 0.05), as well as those with multiple genetic mutation (all p < 0.01). During a median follow-up of 5.1 years, Kaplan–Meier survival analysis revealed worse primary endpoint-free survival among carriers of multiple variants compared to G− group. Conclusions CMR feature tracking is a remarkable tool to evaluate implication, genetics cascade screen and predict outcome in LVNC population. LA volume is a sensitive and robust indicator for genetic mutational condition, of which facilities to guide clinical management and intensity of follow-up for patients and their relatives. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01130-2.
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Affiliation(s)
- Di Zhou
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Shijie Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National, Institutes of Health (NIH), Bethesda, USA
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jinghan Huang
- The Heart-Lung Testing Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Department of Nuclear Medicine, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China
| | - Jielin Pu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China. .,Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China.
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China. .,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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Overhoff D, Ansari U, Hohneck A, Tülümen E, Rudic B, Kuschyk J, Lossnitzer D, Baumann S, Froelich MF, Waldeck S, Akin I, Borggrefe M, Schoenberg SO, Papavassiliu T. Prediction of cardiac events with non-contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy. ESC Heart Fail 2021; 9:574-584. [PMID: 34818694 PMCID: PMC8788051 DOI: 10.1002/ehf2.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/24/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.
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Affiliation(s)
- Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Uzair Ansari
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Anna Hohneck
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Boris Rudic
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan Baumann
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Stephan Waldeck
- Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Ibrahim Akin
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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Jain SS, Steele JM, Fonseca B, Huang S, Shah S, Maskatia SA, Buddhe S, Misra N, Ramachandran P, Gaur L, Eshtehardi P, Anwar S, Kaushik N, Han F, Chaudhuri NR, Grosse-Wortmann L. COVID-19 Vaccination-Associated Myocarditis in Adolescents. Pediatrics 2021; 148:peds.2021-053427. [PMID: 34389692 DOI: 10.1542/peds.2021-053427] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In this study, we aimed to characterize the clinical presentation, short-term prognosis, and myocardial tissue changes as noted on cardiovascular magnetic resonance (CMR) or cardiac MRI in pediatric patients with coronavirus disease 2019 vaccination-associated myocarditis (C-VAM). METHODS In this retrospective multicenter study across 16 US hospitals, patients <21 years of age with a diagnosis of C-VAM were included and compared with a cohort with multisystem inflammatory syndrome in children. Younger children with C-VAM were compared with older adolescents. RESULTS Sixty-three patients with a mean age of 15.6 years were included; 92% were male. All had received a messenger RNA vaccine and, except for one, presented after the second dose. Four patients had significant dysrhythmia; 14% had mild left ventricular dysfunction on echocardiography, which resolved on discharge; 88% met the diagnostic CMR Lake Louise criteria for myocarditis. Myocardial injury as evidenced by late gadolinium enhancement on CMR was more prevalent in comparison with multisystem inflammatory syndrome in children. None of the patients required inotropic, mechanical, or circulatory support. There were no deaths. Follow-up data obtained in 86% of patients at a mean of 35 days revealed resolution of symptoms, arrhythmias, and ventricular dysfunction. CONCLUSIONS Clinical characteristics and early outcomes are similar between the different pediatric age groups in C-VAM. The hospital course is mild, with quick clinical recovery and excellent short-term outcomes. Myocardial injury and edema are noted on CMR. Close follow-up and further studies are needed to understand the long-term implications and mechanism of these myocardial tissue changes.
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Affiliation(s)
- Supriya S Jain
- New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | | | | | - Sihong Huang
- College of Human Medicine, Michigan State University and Helen DeVos Children's Hospital, Spectrum Health, Grand Rapids, Michigan
| | - Sanket Shah
- Children's Mercy Hospital, Kansas City, Missouri
| | - Shiraz A Maskatia
- School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California
| | - Sujatha Buddhe
- Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Nilanjana Misra
- Cohen Children's Medical Center of New York, Northwell Health, Queens, New York
| | | | - Lasya Gaur
- School of Medicine, John Hopkins University, Baltimore, Maryland
| | - Parham Eshtehardi
- Northside Heart and Vascular Institute, Northside Hospital, Atlanta, Georgia
| | - Shafkat Anwar
- University of California, San Francisco, San Francisco, California
| | - Neeru Kaushik
- University of California, San Francisco Benioff Children's Hospitals, Oakland, California
| | - Frank Han
- College of Medicine, University of Illinois, Peoria, Illinois
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Gregor Z, Kiss AR, Szabó LE, Tóth A, Grebur K, Horváth M, Dohy Z, Merkely B, Vágó H, Szűcs A. Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification. PLoS One 2021; 16:e0258362. [PMID: 34637474 PMCID: PMC8509873 DOI: 10.1371/journal.pone.0258362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Methods Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18–29, Group B: 30–39, Group C: 40–49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). Results The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Conclusions Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- * E-mail:
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29
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Balancing Speed and Accuracy in Cardiac Magnetic Resonance Function Post-Processing: Comparing 2 Levels of Automation in 3 Vendors to Manual Assessment. Diagnostics (Basel) 2021; 11:diagnostics11101758. [PMID: 34679457 PMCID: PMC8534796 DOI: 10.3390/diagnostics11101758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Automating cardiac function assessment on cardiac magnetic resonance short-axis cines is faster and more reproducible than manual contour-tracing; however, accurately tracing basal contours remains challenging. Three automated post-processing software packages (Level 1) were compared to manual assessment. Subsequently, automated basal tracings were manually adjusted using a standardized protocol combined with software package-specific relative-to-manual standard error correction (Level 2). All post-processing was performed in 65 healthy subjects. Manual contour-tracing was performed separately from Level 1 and 2 automated analysis. Automated measurements were considered accurate when the difference was equal or less than the maximum manual inter-observer disagreement percentage. Level 1 (2.1 ± 1.0 min) and Level 2 automated (5.2 ± 1.3 min) were faster and more reproducible than manual (21.1 ± 2.9 min) post-processing, the maximum inter-observer disagreement was 6%. Compared to manual, Level 1 automation had wide limits of agreement. The most reliable software package obtained more accurate measurements in Level 2 compared to Level 1 automation: left ventricular end-diastolic volume, 98% and 53%; ejection fraction, 98% and 60%; mass, 70% and 3%; right ventricular end-diastolic volume, 98% and 28%; ejection fraction, 80% and 40%, respectively. Level 1 automated cardiac function post-processing is fast and highly reproducible with varying accuracy. Level 2 automation balances speed and accuracy.
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Butters A, Lakdawala NK, Ingles J. Sex Differences in Hypertrophic Cardiomyopathy: Interaction With Genetics and Environment. Curr Heart Fail Rep 2021; 18:264-273. [PMID: 34478112 PMCID: PMC8484093 DOI: 10.1007/s11897-021-00526-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review We explore the sex-specific interaction of genetics and the environment on the clinical course and outcomes of hypertrophic cardiomyopathy (HCM). Recent Findings Women account for approximately one-third of patients in specialist HCM centres and reported in observational studies. As a result, evidence informing clinical guideline recommendations is based predominantly on risk factors and outcomes seen in men. However, disease progression appears to be different between the sexes. Women present at a more advanced stage of disease, are older at diagnosis, have higher symptom burden, carry greater risk for heart failure and are at greater risk of mortality compared to men. Women are more likely to be gene-positive, while men are more likely to be gene-negative. The risk of sudden cardiac death and access to specialised care do not differ between the sexes. Summary Reporting sex-disaggregated results is essential to identify the mechanisms leading to sex differences in HCM.
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Affiliation(s)
- Alexandra Butters
- Centre for Population, Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia.,Centenary Institute and Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neal K Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jodie Ingles
- Centre for Population, Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, Australia. .,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia. .,Centenary Institute and Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
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31
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Pednekar AS, Cheong BYC, Muthupillai R. Ultrafast Computation of Left Ventricular Ejection Fraction by Using Temporal Intensity Variation in Cine Cardiac Magnetic Resonance. Tex Heart Inst J 2021; 48:471806. [PMID: 34643734 DOI: 10.14503/thij-20-7238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac magnetic resonance enables comprehensive cardiac evaluation; however, intense time and labor requirements for data acquisition and processing have discouraged many clinicians from using it. We have developed an alternative image-processing algorithm that requires minimal user interaction: an ultrafast algorithm that computes left ventricular ejection fraction (LVEF) by using temporal intensity variation in cine balanced steady-state free precession (bSSFP) short-axis images, with or without contrast medium. We evaluated the algorithm's performance against an expert observer's analysis for segmenting the LV cavity in 65 study participants (LVEF range, 12%-70%). In 12 instances, contrast medium was administered before cine imaging. Bland-Altman analysis revealed quantitative effects of LV basal, midcavity, and apical morphologic variation on the algorithm's accuracy. Total computation time for the LV stack was <2.5 seconds. The algorithm accurately delineated endocardial boundaries in 1,132 of 1,216 slices (93%). When contours in the extreme basal and apical slices were not adequate, they were replaced with manually drawn contours. The Bland-Altman mean differences were <1.2 mL (0.8%) for end-diastolic volume, <5 mL (6%) for end-systolic volume, and <3% for LVEF. Standard deviation of the difference was ≤4.1% of LV volume for all sections except the midcavity in end-systole (8.3% of end-systolic volume). We conclude that temporal intensity variation-based ultrafast LVEF computation is clinically accurate across a range of LV shapes and wall motions and is suitable for postcontrast cine SSFP imaging. Our algorithm enables real-time processing of cine bSSFP images on a commercial scanner console within 3 seconds in an unobtrusive automated process.
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Affiliation(s)
| | - Benjamin Y C Cheong
- Department of Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas.,Department of Cardiology, Texas Heart Institute, Houston, Texas
| | - Raja Muthupillai
- Department of Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas.,Department of Cardiology, Texas Heart Institute, Houston, Texas
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Stagnaro N, Trocchio G, Torre M, Rizzo F, Martucciello G, Marasini M. Cardiovascular MRI assessment of pectus excavatum in pediatric patients and postoperative simulation using vacuum bell. J Pediatr Surg 2021; 56:1600-1605. [PMID: 33256973 DOI: 10.1016/j.jpedsurg.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The sternal lift by Vacuum Bell (VB) is effective, as largely demonstrated by its intraoperative use during surgical procedure to elevate the sternum during the Nuss procedure routinely. Indeed, the thoracic remodelling during VB application is comparable to post-surgical scenario, and suitable to compare cardiovascular parameters of the two different thoracic configurations immediately. OBJECTIVE We would quantify and correlate preoperative parameters which determine the severity of the pectus excavatum (PE), and the cardiovascular effects at the baseline. Than we would assess the cardiovascular changes during VB positioning, mimicking the immediate, temporary effect of Pectus-correction. MATERIALS AND METHODS We included 26 consecutive patients (mean age is 13,3 +/- 2,2 years) symptomatic and non, with a previous clinical diagnosis of PE. CMR was performed before and during application of VB, using the same imaging protocol. In both conditions, we measured thoracic indexes, and cardiac function as well as flow through main vessels. RESULTS Mean expiratory Haller Index (HI) was 5,4 (+/-1,4 SD; normal <3). During VB application, all patients showed improvement in the main morphologic parameters of the thorax (mean expiratory HI = 4,7 (+/-1,6 SD, delta -13%, P = 0,01). During VB application, a minimal but not significant increase of Right Ventricle End Diastolic Volume (RVEDVi) (delta +4,6%, P = 0,12), and Right Ventricle Ejection Fraction (RVEF) (delta +1,2%, P = 0,2) was observed. CONCLUSION In adolescents affected by PE, cardiacMRI (CMR) demonstrates normal values of biventricular volume and systolic function. During VB application, beside significative improvements in chest wall anatomy, CMR shows a minimal positive variation in right ventricle volume and function. A minority of patients showed some degree of diastolic dysfunction at baseline, unchanged after VB application, with possible correlation between valve inflow and sternal impingement.
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Affiliation(s)
- Nicola Stagnaro
- UOC Radiologia, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147 Genova, Italy.
| | | | - Michele Torre
- Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Francesca Rizzo
- UOC Radiologia, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147 Genova, Italy
| | - Giuseppe Martucciello
- DiNOGMI, Università degli Studi di Genova, Genova, Italy; Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Kiss AR, Gregor Z, Furak A, Tóth A, Horváth M, Szabo L, Czimbalmos C, Dohy Z, Merkely B, Vago H, Szucs A. Left ventricular characteristics of noncompaction phenotype patients with good ejection fraction measured with cardiac magnetic resonance. Anatol J Cardiol 2021; 25:565-571. [PMID: 34369884 DOI: 10.5152/anatoljcardiol.2021.25905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We describe left ventricular (LV) volumes, myocardial and trabeculated muscle mass and strains with Cardiac magnetic resonance of a large cohort (n=81) who fulfilled the morphologic criteria of left ventricular noncompaction (LVNC) and had good ejection fraction (EF >55%) and compare them with healthy controls (n=81). Male and female patients were compared to matched controls and to each other. We also investigated the LV trabeculated muscle mass cutoff in male and female patients with LVNC. METHODS 81 participants with LVNC and 81 healthy controls were included. Male and female patients were compared to matched controls and to each other. We also investigated the left ventricular trabeculated muscle mass cut-off in male and female LVNC patients. RESULTS The LV parameters of the LVNC population were normal, but they had significantly higher volumes, myocardial and trabeculated muscle mass, and a significantly smaller EF than the controls. Similar differences were observed after stratifying by sex. The optimal LV trabeculated muscle mass cutoffs were 25.8 g/m2 in men (area under the curve: 0.81) and 19.0 g/m2 in women (area under the curve: 0.87). The patients had normal global strains but a significantly worse global circumferential strain (patients vs controls: -29.9±4.9 vs. -35.8±4.7%, p<0.05) and significantly higher circumferential mechanical dispersion than the controls (patients vs. controls: 7.6±4.2 vs. 6.1±2.8%; p<0.05). No disease-related strain differences were noted between men and women. CONCLUSION The LV functional and strain characteristics of the LVNC cohort differed significantly from those of healthy participants; this might be caused by increased LV trabeculation, and its clinical relevance might be questionable. The LV trabeculated muscle mass was very different between men and women; thus, the use of sex-specific morphologic diagnostic criteria should be considered.
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Affiliation(s)
- Anna Reka Kiss
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Zsófia Gregor
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Adam Furak
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Attila Tóth
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Márton Horváth
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Liliana Szabo
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | | | - Zsofia Dohy
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Hajnalka Vago
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
| | - Andrea Szucs
- Semmelweis University Heart and Vascular Center; Budapest-Hungary
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Solheim TÅ, Fornander F, Raja AA, Møgelvang R, Poulsen NS, Dunø M, Bundgaard H, Vissing J. Cardiac Involvement in Women With Pathogenic Dystrophin Gene Variants. Front Neurol 2021; 12:707838. [PMID: 34385974 PMCID: PMC8353322 DOI: 10.3389/fneur.2021.707838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: To determine the frequency and extent of cardiac involvement in female carriers of pathogenic variants in DMD, 53 women were examined through an observational, cross-sectional study. Methods: Genetically verified female carriers of pathogenic DMD variants were examined by cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement, echocardiography, 24-h Holter monitoring, ECG, and blood concentrations of skeletal and cardiac muscle biomarkers. Results: Fifty-three female carriers of pathogenic DMD variants (mean age 49.6 years, 33 associated with DMD, and 20 with BMD) were included in the study. Sixty-two percent had cardiac dysfunction on echocardiography. On CMR, 49% had myocardial fibrosis, 35% had dilated left ventricles, and 10% had left ventricular hypertrophy. ECGs were abnormal in 72%, and abnormal Holter monitoring was found in 43%. Age did not correlate with myocardial fibrosis or cardiac dysfunction. Myocardial fibrosis was more frequent in carriers of pathogenic variants associated with DMD vs. BMD (61 vs. 28%, p = 0.02). Conclusion: This study shows that cardiac involvement, affecting both structure and function of the heart, is found in over 2/3 of women with a pathogenic DMD variant. The study supports early cardiac screening, including ECG, Holter, and cardiac imaging, in this group of carriers, so that symptoms related to pathogenic variants in DMD can be recognized, and relevant treatment can be initiated. Longitudinal studies are needed to assess morbidity and mortality related to single, pathogenic DMD variants in women.
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Affiliation(s)
- Tuva Å Solheim
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Freja Fornander
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna A Raja
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nanna S Poulsen
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Dunø
- Department of Clinical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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van der Ven JPG, Sadighy Z, Valsangiacomo Buechel ER, Sarikouch S, Robbers-Visser D, Kellenberger CJ, Kaiser T, Beerbaum P, Boersma E, Helbing WA. Multicentre reference values for cardiac magnetic resonance imaging derived ventricular size and function for children aged 0-18 years. Eur Heart J Cardiovasc Imaging 2021; 21:102-113. [PMID: 31280290 PMCID: PMC6923680 DOI: 10.1093/ehjci/jez164] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/25/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (CMR) imaging is an important tool in the assessment of paediatric cardiac disease. Reported reference values of ventricular volumes and masses in the paediatric population are based on small cohorts and several methodologic differences between studies exist. We sought to create steady-state free precession (SSFP) CMR reference values for biventricular volumes and mass by combining data of previously published studies and re-analysing these data in a standardized manner. Methods and results A total of 141 healthy children (68 boys) from three European centres underwent cine-SSFP CMR imaging. Cardiac structures were manually contoured for end-diastolic and end-systolic phases in the short-axis orientation according to current standardized CMR post-processing guidelines. Volumes and masses were derived from these contours. Age-related reference curves were constructed using the lambda mu sigma method. Median age was 12.7 years (range 0.6–18.5). We report biventricular volumes and masses, unindexed and indexed for body surface area, stratified by age groups. In general, boys had approximately 15% higher biventricular volumes and masses compared with girls. Only in children aged <6 years old no gender differences could be observed. Left ventricle ejection fraction was slightly higher in boys in this study population (median 67% vs. 65%, P = 0.016). Age-related reference curves showed non-linear relations between age and cardiac parameters. Conclusion We report volumetric SSFP CMR imaging reference values for children aged 0–18 years old in a relatively large multi-centre cohort. These references can be used in the follow-up of paediatric cardiac disease and for research purposes.
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Affiliation(s)
- J P G van der Ven
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Netherlands Heart Institute, Moreelsepark 1, EP, Utrecht, The Netherlands
| | - Z Sadighy
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
| | | | - S Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - D Robbers-Visser
- Department of Cardiology, Amsterdam Medical Center, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
| | - C J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - T Kaiser
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, Zurich, Switzerland
| | - P Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hannover Medical School, Carl Neuberg-Strasse 1, Hannover, Germany
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus University Medical Center-Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Center, Sophia Children's Hospital, Doctor Molewaterplein 40, GD, Rotterdam, The Netherlands
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Petersen SE, Khanji MY, Plein S, Lancellotti P, Bucciarelli-Ducci C. European Association of Cardiovascular Imaging expert consensus paper: a comprehensive review of cardiovascular magnetic resonance normal values of cardiac chamber size and aortic root in adults and recommendations for grading severity. Eur Heart J Cardiovasc Imaging 2021; 20:1321-1331. [PMID: 31544926 DOI: 10.1093/ehjci/jez232] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/02/2019] [Indexed: 01/16/2023] Open
Abstract
This consensus paper provides a framework for grading of severity of cardiovascular magnetic resonance (CMR) imaging-based assessment of chamber size, function, and aortic measurements. This does not currently exist for CMR measures. Differences exist in the normal reference values between echocardiography and CMR along with differences in methods used to derive these. We feel that this document will significantly complement the current literature and provide a practical guide for clinicians in daily reporting and interpretation of CMR scans. This manuscript aims to complement a recent comprehensive review of CMR normal value publications to recommend cut-off values required for severity grading. Standardization of severity grading for clinically useful CMR parameters is encouraged to lead to clearer and easier communication with referring clinicians and may contribute to better patient care. To this end, the European Association of Cardiovascular Imaging (EACVI) has formed this expert panel that has critically reviewed the literature and has come to a consensus on approaches to severity grading for commonly quantified CMR parameters.
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Affiliation(s)
- Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Mohammed Y Khanji
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Via Camillo Rosalba, 35, 70124 Bari BA, Italy
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Upper Maudlin Street, Bristol, BS2 8HW, UK
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Miskulin DC, Jiang H, Gul A, Pankratz VS, Paine SS, Gassman JJ, Jhamb M, Kwong RY, Negrea L, Ploth DW, Shaffi SK, Harford AM, Zager PG. Comparison of Dialysis Unit and Home Blood Pressures: An Observational Cohort Study. Am J Kidney Dis 2021; 78:640-648. [PMID: 34144104 DOI: 10.1053/j.ajkd.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/16/2021] [Indexed: 01/28/2023]
Abstract
RATIONALE & OBJECTIVE Prior studies of patients receiving maintenance hemodialysis have shown that, on average, blood pressure (BP) measured predialysis is higher than BP measured at home. We hypothesized that a subset of hemodialysis patients has BP that is higher when measured at home than when measured predialysis and this subgroup of patients has a higher prevalence of left ventricular hypertrophy. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 97 hypertensive hemodialysis patients enrolled in the Blood Pressure in Dialysis Study (BID), a randomized trial of comparing target predialysis BP ≤140/90 to 155-165/90 mm Hg. EXPOSURE Differences between predialysis and next-day home systolic BP measured ≥6 times over 1 year. OUTCOME Left ventricular mass index (LVMI) by cardiac magnetic resonance imaging. ANALYTICAL APPROACH A hierarchical clustering analysis divided patients into 3 clusters based on the average and variability of differences in systolic predialysis and home BP. Clusters were compared with respect to clinical factors and LVMI. RESULTS Mean differences between predialysis and home systolic BP were 19.1 (95% CI, 17.0 to 21.1) mm Hg for cluster 1 ("home lower"), 3.7 (95% CI, 1.6 to 5.8) mm Hg for cluster 2 ("home and predialysis similar"), and -9.7 (95% CI, -12.0 to -7.4) mm Hg for cluster 3 ("home higher"). Systolic BP declined during dialysis in clusters 1 and 2 but increased in cluster 3. Interdialytic weight gains did not differ. After adjusting for sex and treatment arm, LVMI was higher in cluster 3 than in clusters 1 and 2: differences in means of 10.6 ± 4.96 (SE) g/m2 (P = 0.04) and 12.0 ± 5.08 g/m2 (P = 0.02), respectively. LIMITATIONS Limited statistical power. CONCLUSIONS Nearly one-third of participants had home BPs higher than predialysis BPs. These patients had LVMI higher than those with similar or lower BPs at home, indicating that their BP may have been undertreated.
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Affiliation(s)
- Dana C Miskulin
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
| | - Huan Jiang
- Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico
| | - Ambreen Gul
- Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico
| | - V Shane Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Susan S Paine
- Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico
| | - Jennifer J Gassman
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Manisha Jhamb
- Renal-Electrolyte Division, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond Y Kwong
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lavinia Negrea
- Division of Nephrology and Hypertension, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David W Ploth
- Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina
| | - Saeed Kamran Shaffi
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Antonia M Harford
- Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico
| | - Philip G Zager
- Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico
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Li J, Zhang L, Wang Y, Zuo H, Huang R, Yang X, Han Y, He Y, Song X. Agreement in Left Ventricular Function Measured by Echocardiography and Cardiac Magnetic Resonance in Patients With Chronic Coronary Total Occlusion. Front Cardiovasc Med 2021; 8:675087. [PMID: 34212013 PMCID: PMC8239151 DOI: 10.3389/fcvm.2021.675087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/04/2021] [Indexed: 11/27/2022] Open
Abstract
Aims: To determine the agreement between two-dimensional transthoracic echocardiography (2DTTE) and cardiovascular magnetic resonance (CMR) in left ventricular (LV) function [including end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF)] in chronic total occlusion (CTO) patients. Methods: Eighty-eight CTO patients were enrolled in this study. All patients underwent 2DTTE and CMR within 1 week. The correlation and agreement of LVEF, LVESV, and LVEDV as measured by 2DTTE and CMR were assessed using Pearson correlation, Kappa analysis, and Bland–Altman method. Results: The mean age of patients enrolled was 57 ± 10 years. There was a strong correlation (r = 0.71, 0.90, and 0.80, respectively, all P < 0.001) and a moderately strong agreement (Kappa = 0.62, P < 0.001) between the two modalities in measurement of LV function. The agreement in patients with EF ≧50% was better than in those with an EF <50%. CTO patients without echocardiographic wall motion abnormality (WMA) had stronger intermodality correlations (r = 0.84, 0.96, and 0.87, respectively) and smaller biases in LV function measurement. Conclusions: The difference in measurement between 2DTTE and CMR should be noticed in CTO patients with EF <50% or abnormal ventricular motion. CMR should be considered in these conditions.
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Affiliation(s)
- Jiahui Li
- Ward 1 of Coronary Heart Disease Center, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yueli Wang
- Department of Echocardiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huijuan Zuo
- Department of Community Health Research, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xueyao Yang
- Ward 1 of Coronary Heart Disease Center, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Han
- Department of Radiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Ward 1 of Coronary Heart Disease Center, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Mansour A, Gamal NM, Alaa Nady M, Demitry SR, Shams-Eddin H, El-Maghraby KM. Comparison of the early cardiac electromechanical remodeling following transcatheter and surgical secundum atrial septal defect closure in adults. Egypt Heart J 2021; 73:53. [PMID: 34114072 PMCID: PMC8192679 DOI: 10.1186/s43044-021-00174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background Secundum atrial septal defect (ASD) closure leads to electrical and mechanical remodeling that occurs early after shunt disappearance. The relationship between electromechanical remodeling using electrocardiogram (ECG) and cardiac magnetic resonance (CMR) after percutaneous and surgical closure has not yet been recorded in prospective studies. Objective We thought to study right atrium (RA) and right ventricle (RV) changes by CMR 3 months after transcatheter and surgical closure and their comparison with electrical remodeling by ECG. Results We prospectively evaluated 30 consecutive adult patients with isolated secundum ASD who were referred for (transcatheter and surgical) ASD closure. There was significant reduction in all of the electrical parameters within the same group as compared to the baseline values, except P wave dispersion (Pd). (P max was 97.33 ± 16.67 (pre closure) to 76 ± 15.49 (post closure) in the device group and 97.33 ± 12.79 (preclosure) to 73.33 ± 16.32 (post closure) in the surgical group, QRS complex was 104 ± 18.82 (preclosure) to 80 ± 18.51 (post closure) in the device group and 106.67 ± 14.47 (preclosure) to 86.67 ± 17.99 (post closure) in the surgical group. QTc maximum was 478.53 ± 36.79 (preclosure) to 412.53 ± 38.03 (post closure) in the device group and 470.53 ± 65.70 (preclosure) to 405.93 ± 63.08 (post closure) in the surgical group, and QTc dispersion was 70.33 ± 24.04 (preclosure) to 60.26 ± 28.56 (post closure) in the device group and 80.73 ± 30.38 (preclosure) to 60.27 ± 28.57 (post closure) in the surgical group).There was no significant difference between two groups indicating that transcatheter and surgical closure had led to equivalent value of electrical remodeling. In CMR study, we measured RA maximal volume and right ventricle end diastolic volume (RVEDV), RA maximal volume decreased significantly as compared to the base line values post closure in both groups (P value < 0.001). The reduction in RA max volume was more in the transcatheter closure group; however, this difference was not statistically significant when compared with the surgical arm (P value = 0.5).RVEDV decreased significantly in both groups as compared to the baseline values (P value < 0.001). Transcatheter closure resulted in more significant reduction in the RVEDV than the surgical closure (P value = 0.03). Conclusion Our study showed early significant electromechanical reverse remodeling in most of the study parameters from the baseline values after ASD closure. We found no significant differences in all of the electrical and RA mechanical remodeling parameters with significantly better mechanical remodeling of RV in the device group.
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Affiliation(s)
- Amr Mansour
- Cardiology Department, Congenital and Structural Heart Disease Unit, Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Noha M Gamal
- Cardiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - M Alaa Nady
- Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Salwa R Demitry
- Cardiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - H Shams-Eddin
- Cardiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Ali F, Bydder M, Han H, Wang D, Ghodrati V, Gao C, Prosper A, Nguyen KL, Finn JP, Hu P. Slice encoding for the reduction of outflow signal artifacts in cine balanced SSFP imaging. Magn Reson Med 2021; 86:2034-2048. [PMID: 34056755 PMCID: PMC10185493 DOI: 10.1002/mrm.28858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Standard balanced SSFP (bSSFP) cine MRI often suffers from blood outflow artifacts. We propose a method that spatially encodes these outflowing spins to reduce their effects in the intended slice. METHODS Bloch simulations were performed to characterize through-plane flow and to investigate how the use of phase encoding along the slice select's direction ("slice encoding") could alleviate its issues. Phantom scans and in vivo cines were acquired on a 3T system, comparing the standard 2D acquisition to the proposed slice-encoding method. Nineteen healthy volunteers were recruited for short-axis and horizontal long-axis oriented scans. An expert radiologist evaluated each slice-encoded/standard cine pairs in a rank comparison test and graded their quality on a 1-5 scale. The grades were used for a nonparametric paired evaluation for independent samples with a null hypothesis that there was no statistical difference between the two quality-grade distributions for α = 0.05 significance. RESULTS Bloch simulation results demonstrated this technique's feasibility, showing a fully resolved slice profile given a sufficient number of slice encodes. These results were confirmed with the phantom experiments. Each in vivo slice-encoded cine had a higher quality than its corresponding standard acquisition. The nonparametric paired evaluation came to 0.01 significance, encouraging us to reject the null hypothesis and conclude that slice-encoding effectively works in reducing outflow effects. CONCLUSION The slice-encoding balanced SSFP technique is helpful in mitigating outflow effects and is achievable within a single breath hold, being a useful alternative for cases in which the flow artifacts are significant.
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Affiliation(s)
- Fadil Ali
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Physics and Biology in Medicine Inter-Departmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
| | - Mark Bydder
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Hui Han
- Biomedical Imaging Research Center, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Da Wang
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
| | - Vahid Ghodrati
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Physics and Biology in Medicine Inter-Departmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
| | - Chang Gao
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Physics and Biology in Medicine Inter-Departmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
| | - Ashley Prosper
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Kim-Lien Nguyen
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Physics and Biology in Medicine Inter-Departmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA.,Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, USA.,Physics and Biology in Medicine Inter-Departmental Graduate Program, University of California Los Angeles, Los Angeles, California, USA
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Yu H, Del Nido PJ, Geva T, Yang C, Wu Z, Rathod RH, Huang X, Billiar KL, Tang D. A Novel Pulmonary Valve Replacement Surgery Strategy Using Contracting Band for Patients With Repaired Tetralogy of Fallot: An MRI-Based Multipatient Modeling Study. Front Bioeng Biotechnol 2021; 9:638934. [PMID: 34095094 PMCID: PMC8170134 DOI: 10.3389/fbioe.2021.638934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/08/2021] [Indexed: 11/21/2022] Open
Abstract
Patients with repaired Tetralogy of Fallot (ToF), a congenital heart defect which includes a ventricular septal defect and severe right ventricular outflow obstruction, account for the majority of cases with late-onset right ventricle (RV) failure. Current surgery procedures, including pulmonary valve replacement (PVR) with right ventricle remodeling, yield mixed results. PVR with active band insertion was hypothesized to be of clinical usage on improving RV function measured by ejection fraction (EF). In lieu of risky open-heart surgeries and experiments on animal and human, computational biomechanical models were adapted to study the impact of PVR with five band insertion options. Cardiac magnetic resonance (CMR) images were acquired from seven TOF patients before PVR surgery for model construction. For each patient, five different surgery plans combined with passive and active contraction band with contraction ratio of 20, 15, and 10% were studied. Those five plans include three single-band plans with different band locations; one plan with two bands, and one plan with three bands. Including the seven no-band models, 147 computational bi-ventricle models were constructed to simulate RV cardiac functions and identify optimal band plans. Patient variations with different band plans were investigated. Surgery plan with three active contraction bands and band active contraction ratio of 20% had the best performance on improving RV function. The mean ± SD RV ejection fraction value from the seven patients was 42.90 ± 5.68%, presenting a 4.19% absolute improvement or a 10.82% relative improvement, when compared with the baseline models (38.71 ± 5.73%, p = 0.016). The EF improvements from the seven patients varied from 2.87 to 6.01%. Surgical procedures using active contraction bands have great potential to improve RV function measured by ejection fraction for patients with repaired ToF. It is possible to have higher right ventricle ejection fraction improvement with more bands and higher band active contraction ratio. Our findings with computational models need to be further validated by animal experiments before clinical trial could become possible.
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Affiliation(s)
- Han Yu
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, United States.,Department of Surgery, Harvard Medical School, Boston, MA, United States
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Chun Yang
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Zheyang Wu
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, China
| | - Kristen L Billiar
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, United States
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.,Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA, United States
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Meyer SL, St Clair N, Powell AJ, Geva T, Rathod RH. Integrated Clinical and Magnetic Resonance Imaging Assessments Late After Fontan Operation. J Am Coll Cardiol 2021; 77:2480-2489. [PMID: 34016261 DOI: 10.1016/j.jacc.2021.03.312] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several clinical and cardiac magnetic resonance (CMR)-derived parameters have been shown to be associated with death or heart transplant late after the Fontan operation. OBJECTIVES The objective of this study was to identify the relative importance and interactions of clinical and CMR-based parameters for risk stratification after the Fontan operation. METHODS Fontan patients were retrospectively reviewed. Clinical and CMR parameters were analyzed using univariable Cox regression. The primary endpoint was time to death or (listing for) heart transplant. To identify the patients at highest risk for the endpoint, classification and regression tree survival analysis was performed, including all significant variables from Cox regression. RESULTS The cohort consisted of 416 patients (62% male) with a median age of 16 years (25th, 75th percentiles: 11, 23 years). Over a median follow-up of 5.4 years (25th, 75th percentiles: 2.4, 10.0 years) after CMR, 57 patients (14%) reached the endpoint (46 deaths, 7 heart transplants, 4 heart transplant listings). Lower total indexed end-diastolic volume (EDVi) was the strongest predictor of transplant-free survival. Among patients with dilated ventricles (EDVi ≥156 ml/BSA1.3), worse global circumferential strain (GCS) was the next most important predictor (73% vs. 44%). In patients with smaller ventricles (EDVi <156 ml/BSA1.3), New York Heart Association functional class ≥II was the next most important predictor (30% vs. 4%). CONCLUSIONS In this cohort of patients late after Fontan operation, increased ventricular dilation was the strongest independent predictor of death or transplant (listing). Patients with both ventricular dilation and worse GCS were at highest risk. These data highlight the value of integrating CMR and clinical parameters for risk stratification in this population.
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Affiliation(s)
- Sophie L Meyer
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Center for Congenital Heart Diseases, Department of Pediatric Cardiology, University Medical Center, Groningen, the Netherlands
| | - Nicole St Clair
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
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Raisi-Estabragh Z, Kenawy AAM, Aung N, Cooper J, Munroe PB, Harvey NC, Petersen SE, Khanji MY. Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2021; 22:494-504. [PMID: 32460308 PMCID: PMC8081427 DOI: 10.1093/ehjci/jeaa089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/09/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS To determine population-related and technical sources of variation in cardiac magnetic resonance (CMR) reference ranges for left ventricular (LV) quantification through a formal systematic review and meta-analysis. METHODS AND RESULTS This study is registered with the International Prospective Register of Systematic Reviews (CRD42019147161). Relevant studies were identified through electronic searches and assessed by two independent reviewers based on predefined criteria. Fifteen studies comprising 2132 women and 1890 men aged 20-91 years are included in the analysis. Pooled LV reference ranges calculated using random effects meta-analysis with inverse variance weighting revealed significant differences by age, sex, and ethnicity. Men had larger LV volumes and higher LV mass than women [LV end-diastolic volume (mean difference = 6.1 mL/m2, P-value = 0.014), LV end-systolic volume (MD = 4 mL/m2, P-value = 0.033), LV mass (mean difference = 12 g/m2, P-value = 7.8 × 10-9)]. Younger individuals had larger LV end-diastolic volumes than older ages (20-40 years vs. ≥65 years: women MD = 14.0 mL/m2, men MD = 14.7 mL/m2). East Asians (Chinese, Korean, Singaporean-Chinese, n = 514) had lower LV mass than Caucasians (women: MD = 6.4 g/m2, P-value = 0.016; men: MD = 9.8 g/m2, P-value = 6.7 × 10-5). Between-study heterogeneity was high for all LV parameters despite stratification by population-related factors. Sensitivity analyses identified differences in contouring methodology, magnet strength, and post-processing software as potential sources of heterogeneity. CONCLUSION There is significant variation between CMR normal reference ranges due to multiple population-related and technical factors. Whilst there is need for population-stratified reference ranges, limited sample sizes and technical heterogeneity precludes derivation of meaningful unified ranges from existing reports. Wider representation of different populations and standardization of image analysis is urgently needed to establish such reference distributions.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Asmaa A M Kenawy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit (MRCLEU), Tremona Rd, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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Cocomello L, Sinha S, Gonzalez Corcia MC, Baquedano M, Benedetto U, Caputo M. Determinants of QRS duration in patients with tetralogy of Fallot after pulmonary valve replacement. J Card Surg 2021; 36:1958-1968. [PMID: 33651426 DOI: 10.1111/jocs.15469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following the repair of TOF patients may be left with pulmonary regurgitation and a dilated right ventricle (RV), which in turn can lead to ventricular arrhythmias and sudden death. A prolonged QRS is a predictor of ventricular arrhythmias. However, whether subsequent pulmonary valve replacement (PVR) can reverse QRS-prolongation is controversial. We hypothesized that changes in QRS duration following PVR are determined by preoperative QRS-duration and RV volumes METHODS: A retrospective single-center cohort study was conducted on 142 post-TOF repair patients (mean age 25 ± 13 years) who underwent PVR between 1995 and 2019. Information on QRS duration and RV volumes measured by cardiac MRI (available in 83 patients) were collected. A linear mixed model was used to investigate the association between the preoperative QRS duration and RV volumes and the postoperative QRS duration. RESULTS The QRS-duration following PVR continued to increase in all subjects with a prolonged preoperative QRS-duration(>160 ms, rate of increase of 0.87 msec ± 0.33 per year; p = .01), markedly raised RV end-diastolic volume (RVEDV; ≥166 ml/m2, rate of increase of 2.0 msec ± 0.37 per year; p < .01) or RV end-systolic volume (RVESV; ≥89 ml/m2 , rate of increase of 1.25 msec ± 0.43 per year; p = .01). In contrast, in patients with preoperative QRS-duration <160 msec (p = .16), RVEDV <166 ml/m2 (p = .14), or RVESV < 89 ml/m2 (p = .37), the QRS-duration did not change significantly when compared to preoperative values. CONCLUSIONS In subjects with shorter QRS and smaller RV volumes, QRS duration did not show further prolongation following PVR. While markedly prolonged QRS and increased RV volumes were associated with a small but constant increase in QRS duration despite PVR.
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Affiliation(s)
- Lucia Cocomello
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Department of Translational Health Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Mai Baquedano
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
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Kim M, Kim B, Choi YJ, Lee HJ, Lee H, Park JB, Lee SP, Han KD, Kim YJ, Kim HK. Sex differences in the prognosis of patients with hypertrophic cardiomyopathy. Sci Rep 2021; 11:4854. [PMID: 33649405 PMCID: PMC7921653 DOI: 10.1038/s41598-021-84335-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
We investigated sex-related differences in the prognosis of patients with hypertrophic cardiomyopathy (HCM) using the Korea National Health Insurance Service database. From 2010 to 2016, 9524 patients diagnosed with HCM and had more than 1-year follow-up period were analyzed. The primary endpoint was the composite of cardiovascular death or new-onset heart failure (HF) admission. Propensity score-matching analysis was performed to adjust for different baseline characteristics. With a 4.4-years’ median follow-up interval (range 2.0–6.6 years) and male predominance (77.6%), women with HCM were older (52.6 ± 9.7 vs. 51.4 ± 9.1, p < 0.001), had lower incomes, more comorbidities based on Charlson comorbidity index. Women with HCM had a higher incidence of the primary endpoint than men (incidence rate: 34.15 vs. 22.83 per 1000 person-years, log-rank p < 0.001). Multivariable Cox analysis showed that female sex was a poor prognostic factor for the primary endpoint (HR 1.43, 95% CI 1.24–1.64, p < 0.001). This was mainly driven by a higher incidence of new-onset HF admission (HR 1.55, 95% CI 1.34–1.80). However, there was no difference in the incidence of cardiovascular death between the sexes. This result was concordant in the propensity score-matched cohort. In conclusion, women with HCM have worse prognosis, which was mainly driven by a higher new-onset HF admission.
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Affiliation(s)
- Minkwan Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, The Soongsil University, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Tarumi T, Yamabe T, Fukuie M, Kimura R, Zhu DC, Ohyama-Byun K, Maeda S, Sugawara J. Proximal Aortic Compliance in Young Male Endurance Athletes: An MRI Study. Med Sci Sports Exerc 2021; 53:543-550. [PMID: 32881770 DOI: 10.1249/mss.0000000000002508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION High-intensity endurance training can elicit profound cardiac adaptations; however, the current evidence as to its impact on the proximal aorta is limited. The purpose of this study was to investigate the morphological and functional characteristics of the proximal aorta in endurance athletes. METHODS Fifteen young male middle- and long-distance runners were compared with 19 age- and sex-matched sedentary control participants. CINE phase-contrast magnetic resonance imaging was used to measure blood flow velocities and cross-sectional areas of the ascending and proximal descending aorta. Aortic blood pressure was measured simultaneously during the phase-contrast magnetic resonance imaging scan using a generalized transfer function. Maximal oxygen uptake (V˙O2max) was measured in the athletes. Left ventricular morphology was assessed in a subgroup of participants (n = 16) with cardiac magnetic resonance imaging. RESULTS The athlete group exhibited an average V˙O2max of 69.5 ± 3.1 mL·kg-1⋅min-1, which is above the 90th percentile of men with similar age according to the American College of Sports Medicine guideline. The athletes had significantly higher stroke volume and slower heart rate at rest and greater left ventricular end-diastolic volume and mass than the sedentary participants. Significantly larger cross-sectional areas and higher compliance of the ascending and proximal descending aorta were also found in the athletes, independently of body surface area. Moreover, higher compliance of the ascending aorta was associated with greater stroke volume (r = 0.382, P = 0.026) and slower heart rate (r = -0.442, P = 0.009) across all participants. CONCLUSIONS The proximal aorta of young male endurance athletes undergoes morphological and functional adaptations that may be resulting from the significant hemodynamic alterations associated with their cardiac function.
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Affiliation(s)
- Takashi Tarumi
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, JAPAN
| | | | | | - Ryota Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, JAPAN
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI
| | - Keigo Ohyama-Byun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, JAPAN
| | - Seiji Maeda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, JAPAN
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Kido T, Hirai K, Ogawa R, Tanabe Y, Nakamura M, Kawaguchi N, Kurata A, Watanabe K, Schmidt M, Forman C, Mochizuki T, Kido T. Comparison between conventional and compressed sensing cine cardiovascular magnetic resonance for feature tracking global circumferential strain assessment. J Cardiovasc Magn Reson 2021; 23:10. [PMID: 33618722 PMCID: PMC7898736 DOI: 10.1186/s12968-021-00708-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feature tracking (FT) has become an established tool for cardiovascular magnetic resonance (CMR)-based strain analysis. Recently, the compressed sensing (CS) technique has been applied to cine CMR, which has drastically reduced its acquisition time. However, the effects of CS imaging on FT strain analysis need to be carefully studied. This study aimed to investigate the use of CS cine CMR for FT strain analysis compared to conventional cine CMR. METHODS Sixty-five patients with different left ventricular (LV) pathologies underwent both retrospective conventional cine CMR and prospective CS cine CMR using a prototype sequence with the comparable temporal and spatial resolution at 3 T. Eight short-axis cine images covering the entire LV were obtained and used for LV volume assessment and FT strain analysis. Prospective CS cine CMR data over 1.5 heartbeats were acquired to capture the complete end-diastolic data between the first and second heartbeats. LV volume assessment and FT strain analysis were performed using a dedicated software (ci42; Circle Cardiovasacular Imaging, Calgary, Canada), and the global circumferential strain (GCS) and GCS rate were calculated from both cine CMR sequences. RESULTS There were no significant differences in the GCS (- 17.1% [- 11.7, - 19.5] vs. - 16.1% [- 11.9, - 19.3; p = 0.508) and GCS rate (- 0.8 [- 0.6, - 1.0] vs. - 0.8 [- 0.7, - 1.0]; p = 0.587) obtained using conventional and CS cine CMR. The GCS obtained using both methods showed excellent agreement (y = 0.99x - 0.24; r = 0.95; p < 0.001). The Bland-Altman analysis revealed that the mean difference in the GCS between the conventional and CS cine CMR was 0.1% with limits of agreement between -2.8% and 3.0%. No significant differences were found in all LV volume assessment between both types of cine CMR. CONCLUSION CS cine CMR could be used for GCS assessment by CMR-FT as well as conventional cine CMR. This finding further enhances the clinical utility of high-speed CS cine CMR imaging.
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Affiliation(s)
- Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kuniaki Hirai
- Department of Radiology, Uwajima City Hospital, Uwajima, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masashi Nakamura
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kouki Watanabe
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | | | - Teruhito Mochizuki
- Department of Radiology, Yoshino Hospital, Imabari, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
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Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction. Int J Cardiol 2021; 331:124-130. [PMID: 33577906 DOI: 10.1016/j.ijcard.2021.01.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a lack of cardiac MRI information on left ventricular (LV) strain and rotational parameters of left ventricular noncompaction (LVNC) patients with reduced ejection fraction (EF). Thus, we sought to use feature tracking (FT) to describe these changes at different levels of EF deterioration. METHODS We included 31 adult LVNC patients with reduced LV EF (Group B, EF < 50%) without any comorbidities or concomitant cardiac diseases, 31 age- and sex-matched LVNC patients with good EF (Group A, EF > 50%) and 31 healthy controls. Group B was divided according to LV EF into two subgroups (Group B-1: EF 35-50%, Group B-2: EF < 35%). Their global longitudinal, circumferential (GCS), and radial (GRS) strains; LV segmental strains; LV apical and basal rotation values; and patterns and degree of LV dyssynchrony were measured. RESULTS All of the global and mean segmental strain parameters were significantly worse in Groups B, B-1 and B-2 than in Group A and in the controls. The LV mechanical dispersion increased as LV EF decreased. The degree of apical rotation was the highest in the control group, almost the same in Group A and the lowest and in the reverse direction in Group B-2. A rotational pattern, clockwise-directed rigid body rotation (RBR), was found in 39% of the Group B patients, and a counterclockwise-directed RBR was found in 26% of the Group A patients. CONCLUSIONS The strain values and rotational parameters changed as the EF decreased. These changes affected the global LV, and we did not identify an LVNC-specific strain pattern.
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Krupickova S, Risch J, Gati S, Caliebe A, Sarikouch S, Beerbaum P, Puricelli F, Daubeney PEF, Barth C, Wage R, Boroni Grazioli S, Uebing A, Pennell DJ, Voges I. Cardiovascular magnetic resonance normal values in children for biventricular wall thickness and mass. J Cardiovasc Magn Reson 2021; 23:1. [PMID: 33390185 PMCID: PMC7780624 DOI: 10.1186/s12968-020-00692-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pediatric patients are becoming increasingly referred for cardiovascular magnetic resonance (CMR). Measurement of ventricular wall thickness is typically part of the assessment and can be of diagnostic importance, e.g. in arterial hypertension. However, normal values for left ventricular (LV) and right ventricular (RV) wall thickness in pediatric patients are lacking. The aim of this study was to establish pediatric centile charts for segmental LV and RV myocardial thickness in a retrospective multicenter CMR study. METHODS CMR was performed in 161 healthy children and adolescents with an age range between 6 and 18 years from two centers in the UK and Germany as well as from a previously published CMR project of the German Competence Network for Congenital Heart Defects. LV myocardial thickness of 16 segments was measured on the short axis stack using the American Heart Association segmentation model. In addition, the thickness of the RV inferior and anterior free wall as well as biventricular mass was measured. RESULTS The mean age (standard deviation) of the subjects was 13.6 (2.9) years, 64 (39.7%) were female. Myocardial thickness of the basal septum (basal antero- and inferoseptal wall) was 5.2 (1.1) mm, and the basal lateral wall (basal antero- and inferolateral) measured 5.1 (1.2) mm. Mid-ventricular septum (antero- and inferoseptal wall) measured 5.5 (1.2) mm, and mid-ventricular lateral wall (antero- and inferolateral wall) was 4.7 (1.2) mm. Separate centile charts for boys and girls for all myocardial segments and myocardial mass were created because gender was significantly correlated with LV myocardial thickness (p < 0.001 at basal level, p = 0.001 at midventricular level and p = 0.005 at the apex) and biventricular mass (LV, p < 0.001; RV, p < 0.001). CONCLUSION We established CMR normal values of segmental myocardial thickness and biventricular mass in children and adolescents. Our data are of use for the detection of abnormal myocardial properties and can serve as a reference in future studies and clinical practice.
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Affiliation(s)
- Sylvia Krupickova
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Julian Risch
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Sabiha Gati
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Samir Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine At the Hannover Medical School, Hannover, Germany
| | | | - Piers E F Daubeney
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Rick Wage
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Dudley J Pennell
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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Van den Eynde J, Sá MPBO, Vervoort D, Roever L, Meyns B, Budts W, Gewillig M, Ruhparwar A, Zhigalov K, Weymann A. Pulmonary Valve Replacement in Tetralogy of Fallot: An Updated Meta-Analysis. Ann Thorac Surg 2020; 113:1036-1046. [PMID: 33378694 DOI: 10.1016/j.athoracsur.2020.11.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/23/2020] [Accepted: 11/16/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND The benefits of pulmonary valve replacement (PVR) for pulmonary insufficiency in patients with repaired tetralogy of Fallot are still incompletely understood, and optimal timing remains challenging. METHODS We systematically reviewed databases (PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials /Cochrane Controlled Trials Register, ClinicalTrials.gov, Scientific Electronic Library Online, Literatura Latino Americana em Ciências da Saúde, and Google Scholar) and reference lists of relevant articles for studies about PVR in repaired tetralogy of Fallot patients that reported any of the following outcomes: mortality and redo PVR rates, right ventricular (RV) and left ventricular measures, QRS duration, cardiopulmonary exercise test results, or brain natriuretic peptide. In addition to calculating the pooled treatment effects using a random-effects meta-analysis, we evaluated the effect of preoperative measures on PVR outcomes using meta-regressions. RESULTS Eighty-four studies involving 7544 patients met the eligibility criteria. Pooled mortality at 30 days, 5 years, and 10 years after PVR was 0.87% (63 of 7253 patients, 80 studies), 2.7% (132 of 4952 patients, 37 studies), and 6.2% (510 of 2765 patients, 15 studies), respectively. Pooled 5- and 10-year redo PVR rates were 3.7% (141 of 3755 patients, 23 studies) and 16.8% (172 of 3035 patients, 16 studies), respectively. The results of the previous meta-analysis could be confirmed. In addition, we demonstrated that after PVR (1) QRS duration, cardiopulmonary exercise test results, and RV and left ventricular measures longitudinal strain do not significantly change; (2) brain natriuretic peptide decreases; and (3) greater indexed RV end-diastolic and end-systolic volumes are associated with lower chances of RV volume normalization after PVR. CONCLUSIONS This updated meta-analysis provides evidence about the benefits of PVR.
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Affiliation(s)
- Jef Van den Eynde
- Unit of Cardiac Surgery, Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Uberlândia, Brazil
| | - Bart Meyns
- Unit of Cardiac Surgery, Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology University Hospitals Leuven and Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Marc Gewillig
- Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
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