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Yin G, Cui C, An J, Zhao K, Yang K, Li S, Yang X, Wang J, Dong Z, Yu S, He J, Chen X, Lu M, Zhao S. Assessment of Left Ventricular Systolic Function by Cardiovascular Magnetic Resonance Compressed Sensing Real-Time Cine Imaging Combined With Area-Length Method in Normal Sinus Rhythm and Atrial Fibrillation. Front Cardiovasc Med 2022; 9:896816. [PMID: 35711346 PMCID: PMC9197321 DOI: 10.3389/fcvm.2022.896816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background The most-commonly used multi-slice Simpson's method employed with routine two-dimensional segmented cine images makes it difficult to evaluate left ventricular (LV) volume and function due to endocardial border blurring and beat-to-beat variation during atrial fibrillation (AF) status. Objectives To assess the feasibility of compressed sensing real-time (CSRT) cine imaging combined with an area-length method for quantification of LV systolic function in normal sinus rhythm (NSR) and AF. Methods The CSRT cine sequence and routine segmented balanced Steady-State-Free-Precession cine sequence were performed in 71 patients with NSR (n = 36) or AF (n = 35). Image quality and edge sharpness for both sequences were assessed. The LV functional measurements in patients with NSR included end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), cardiac index (CI), and LV mass (LVM); all were assessed using segmented cine with Simpson's rule in short axis (SegSA_Simpson, as a reference standard) and area-length (AL) method in the two chamber (Seg2CH_AL) or four chamber (Seg4CH_AL) and CSRT cine with AL method in the two chamber (CSRT2CH_AL) or four chamber (CSRT4CH_AL). Finally, the mean, maximum, and minimum values of each LV functional parameter [EDV/ESV/SV/EF/CO/CI/LVM/heart rate (HR)] from 4~5 consecutive heartbeats were measured using CSRT2CH_AL in patients with AF. Results In patients with NSR, measurements of EDV (p > 0.05), ESV (p > 0.05), SV (p > 0.05), EF (p > 0.05), and LVM (p > 0.05) assessed with CSRT2CH_AL did not differ significantly from those obtained with SegSA_Simpson. In patients with AF, CSRT image quality score (p < 0.001) and edge sharpness (p < 0.001) both were significantly higher than those obtained from segmented cine. The CSRT2CH_AL provided significantly different results among mean, maximum, and minimum values of each LV parameter from 4~5 consecutive heartbeats (all p < 0.001) with strong inter- and intra-observer agreement in AF. Conclusions The CSRT cine sequence combined with two chamber area-length analysis accurately assessed LV systolic function in NSR. This approach is expected to permit the assessment of multiple parameters in consecutive heartbeats with good inter- and intra-observer reproducibility for beat-to-beat analysis of LV function in AF.
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Affiliation(s)
- Gang Yin
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Chen Cui
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Siemens MRI Center, Shenzhen, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Kai Yang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shuang Li
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Xinling Yang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jiaxin Wang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Zhixiang Dong
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shiqin Yu
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jian He
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Xiuyu Chen
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Minjie Lu
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shihua Zhao
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
- *Correspondence: Shihua Zhao
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Liefke J, Steding-Ehrenborg K, Asgeirsson D, Nordlund D, Kopic S, Morsing E, Hedström E. Non-contrast-enhanced magnetic resonance imaging can be used to assess renal cortical and medullary volumes—A validation study. Acta Radiol Open 2022; 11:20584601211072281. [PMID: 35096415 PMCID: PMC8796087 DOI: 10.1177/20584601211072281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) biomarkers can diagnose and prognosticate kidney disease. Renal volume validation studies are however scarce, and measurements are limited by use of contrast agent or advanced post-processing. Purpose To validate a widely available non-contrast-enhanced MRI method for quantification of renal cortical and medullary volumes in pigs; investigate observer variability of cortical and medullary volumes in humans; and present reference values for renal cortical and medullary volumes in adolescents. Materials and Methods Cortical and medullary volumes were quantified from transaxial in-vivo water-excited MR images in six pigs and 15 healthy adolescents (13–16years). Pig kidneys were excised, and renal cortex and medulla were separately quantified by the water displacement method. Both limits of agreement by the Bland-Altman method and reference ranges are presented as 2.5–97.5 percentiles. Results Agreement between MRI and ex-vivo quantification were -7 mL (-10–0 mL) for total parenchyma, -4 mL (-9–3 mL) for cortex, and -2 mL (-7–2 mL) for medulla. Intraobserver variability for pig and human kidneys were <5% for total parenchyma, cortex, and medulla. Interobserver variability for both pig and human kidneys were ≤4% for total parenchyma and cortex, and 6% and 12% for medulla. Reference ranges indexed for body surface area and sex were 54–103 mL/m2 (boys) and 56–103 mL/m2 (girls) for total parenchyma, 39–62 mL/m2 and 36–68 mL/m2 for cortex, and 16–45 mL/m2 and 17–42 mL/m2 for medulla. Conclusion The proposed widely available non-contrast-enhanced MRI method can quantify cortical and medullary renal volumes and can be directly implemented clinically.
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Affiliation(s)
- Jonas Liefke
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | | | - David Nordlund
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sascha Kopic
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Morsing
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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3
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Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation. Magn Reson Imaging 2018; 54:109-118. [PMID: 30118827 DOI: 10.1016/j.mri.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality. OBJECTIVE The aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation. METHODS The proposed method uses a recent image processing tool called "monogenic signal" to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy). RESULTS The results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively. CONCLUSION Accuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.
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Benameur N, Caiani EG, Arous Y, Ben Abdallah N, Kraiem T. Parametric Imaging for the Assessment of Cardiac Motion: A Review. Cardiovasc Eng Technol 2018; 9:377-393. [PMID: 29761408 DOI: 10.1007/s13239-018-0362-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
Abstract
The assessment of wall motion abnormalities such as hypokinesia or dyskinesia and the identification of their extent as well as their degree of severity allow an accurate evaluation of several ischemic heart diseases and an early diagnosis of heart failure. These dysfunctions are usually revealed by a drop of contraction indicating a regional hypokinesia or a total absence of the wall motion in case of akinesia. The discrimination between these contraction abnormalities plays also a significant role in the therapeutic decision through the differentiation between the infarcted zones, which have lost their contractile function, and the stunned areas that still retain viable myocardial tissues. The lack of a reliable method for the evaluation of wall motion abnormalities in cardiac imaging presents a major limitation for a regional assessment of the left ventricular function. In the past years, several techniques were proposed as additional tools for the local detection of wall motion deformation. Among these approaches, the parametric imaging is likely to represent a promising technique for the analysis of a local contractile function. The aim of this paper is to review the most recent techniques of parametric imaging computation developed in cardiac imaging and their potential contributions in clinical practice.
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Affiliation(s)
- Narjes Benameur
- Laboratory of Biophysics and Medical Technology, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia.
| | - Enrico Gianluca Caiani
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Younes Arous
- Military Hospital of Instruction of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nejmeddine Ben Abdallah
- Military Hospital of Instruction of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tarek Kraiem
- Laboratory of Biophysics and Medical Technology, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Odille F, Bustin A, Liu S, Chen B, Vuissoz P, Felblinger J, Bonnemains L. Isotropic 3
D
cardiac cine
MRI
allows efficient sparse segmentation strategies based on 3
D
surface reconstruction. Magn Reson Med 2017; 79:2665-2675. [DOI: 10.1002/mrm.26923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/04/2017] [Accepted: 08/28/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Freddy Odille
- IADI, INSERM U947 and Université de LorraineNancy France
- CIC‐IT 1433, INSERM, CHRU de Nancy and Université de LorraineNancy France
| | - Aurélien Bustin
- IADI, INSERM U947 and Université de LorraineNancy France
- Technische Universität München, Department of Computer ScienceMunich Germany
- GE Global Research Center, General ElectricMunich Germany
| | - Shufang Liu
- IADI, INSERM U947 and Université de LorraineNancy France
- Technische Universität München, Department of Computer ScienceMunich Germany
- GE Global Research Center, General ElectricMunich Germany
| | - Bailiang Chen
- CIC‐IT 1433, INSERM, CHRU de Nancy and Université de LorraineNancy France
| | | | - Jacques Felblinger
- IADI, INSERM U947 and Université de LorraineNancy France
- CIC‐IT 1433, INSERM, CHRU de Nancy and Université de LorraineNancy France
| | - Laurent Bonnemains
- IADI, INSERM U947 and Université de LorraineNancy France
- Department of Cardiothoracic SurgeryCHU Strasbourg and University of StrasbourgStrasbourg France
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6
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Fully-automatic left ventricular segmentation from long-axis cardiac cine MR scans. Med Image Anal 2017; 39:44-55. [DOI: 10.1016/j.media.2017.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 11/23/2022]
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Chaturvedi A, Whitnah J, Maki JH, Baran T, Mitsumori LM. Horizontal Long Axis Imaging Plane for Evaluation of Right Ventricular Function on Cardiac Magnetic Resonance Imaging. J Clin Imaging Sci 2017; 6:52. [PMID: 28123842 PMCID: PMC5209858 DOI: 10.4103/2156-7514.197076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate a horizontal long axis (HLA) magnetic resonance imaging (MRI) plane aligned to the long axis of the right ventricular (RV) cavity for functional analysis by comparing the measurement variability and time required for the analysis with that using a short-axis (SAX) image orientation. Materials and Methods: Thirty-four cardiac MRI exams with cine balanced steady-state free precession image stacks in both the SAX and the HLA of the RV (RHLA) were evaluated. Two reviewers independently traced RV endocardial borders on each image of the cine stacks. The time required to complete each set of traces was recorded, and the RV end-diastolic volume, end-systolic volume, and ejection fraction were calculated. Analysis times and RV measurements were compared between the two orientations. Results: Analysis time for each reviewer was significantly shorter for the RHLA stack (reviewer 1 = 6.4 ± 1.8 min, reviewer 2 = 6.0 ± 3.3 min) than for the SAX stack (7.5 ± 2.1 and 6.9 ± 3.6 min, respectively; P < 0.002). Bland–Altman analysis revealed lower mean differences, limits of agreement, and coefficients of variation for RV measurements obtained with the RHLA stack. Conclusions: RV functional analysis using a RHLA stack resulted in shorter analysis times and lower measurement variability than for a SAX stack orientation.
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Affiliation(s)
- Abhishek Chaturvedi
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA; Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, USA
| | - Joseph Whitnah
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA
| | - Jeffrey H Maki
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA
| | - Timothy Baran
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, USA
| | - Lee M Mitsumori
- Department of Radiology, University of Washington School of Medicine, 1959 Pacific Street, Seattle, WA, USA; Department of Radiology, Straub Clinic and Hospital, Honolulu, HI, NY, USA
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8
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Nyns ECA, Dragulescu A, Yoo SJ, Grosse-Wortmann L. Evaluation of knowledge-based reconstruction for magnetic resonance volumetry of the right ventricle in tetralogy of Fallot. Pediatr Radiol 2014; 44:1532-40. [PMID: 24986364 DOI: 10.1007/s00247-014-3042-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/20/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance using the Simpson method is the gold standard for right ventricular volumetry. However, this method is time-consuming and not without sources of error. Knowledge-based reconstruction is a novel post-processing approach that reconstructs the right ventricular endocardial shape based on anatomical landmarks and a database of various right ventricular configurations. OBJECTIVE To assess the feasibility, accuracy and labor intensity of knowledge-based reconstruction in repaired tetralogy of Fallot (TOF). MATERIALS AND METHODS The short-axis cine cardiac MR datasets of 35 children and young adults (mean age 14.4 ± 2.5 years) after TOF repair were studied using both knowledge-based reconstruction and the Simpson method. Intraobserver, interobserver and inter-method variability were assessed using Bland-Altman analyses. RESULTS Knowledge-based reconstruction was feasible and highly accurate as compared to the Simpson method. Intra- and inter-method variability for knowledge-based reconstruction measurements showed good agreement. Volumetric assessment using knowledge-based reconstruction was faster when compared with the Simpson method (10.9 ± 2.0 vs. 7.1 ± 2.4 min, P < 0.001). CONCLUSION In patients with repaired tetralogy of Fallot, knowledge-based reconstruction is a feasible, accurate and reproducible method for measuring right ventricular volumes and ejection fraction. The post-processing time of right ventricular volumetry using knowledge-based reconstruction was significantly shorter when compared with the routine Simpson method.
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Affiliation(s)
- Emile Christian Arie Nyns
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, Canada
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Mesubi O, Ego-Osuala K, Jeudy J, Purtilo J, Synowski S, Abutaleb A, Niekoop M, Abdulghani M, Asoglu R, See V, Saliaris A, Shorofsky S, Dickfeld T. Differences in quantitative assessment of myocardial scar and gray zone by LGE-CMR imaging using established gray zone protocols. Int J Cardiovasc Imaging 2014; 31:359-68. [PMID: 25352244 DOI: 10.1007/s10554-014-0555-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/15/2014] [Indexed: 11/25/2022]
Abstract
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard for myocardial scar evaluation. Heterogeneous areas of scar ('gray zone'), may serve as arrhythmogenic substrate. Various gray zone protocols have been correlated to clinical outcomes and ventricular tachycardia channels. This study assessed the quantitative differences in gray zone and scar core sizes as defined by previously validated signal intensity (SI) threshold algorithms. High quality LGE-CMR images performed in 41 cardiomyopathy patients [ischemic (33) or non-ischemic (8)] were analyzed using previously validated SI threshold methods [Full Width at Half Maximum (FWHM), n-standard deviation (NSD) and modified-FWHM]. Myocardial scar was defined as scar core and gray zone using SI thresholds based on these methods. Scar core, gray zone and total scar sizes were then computed and compared among these models. The median gray zone mass was 2-3 times larger with FWHM (15 g, IQR: 8-26 g) compared to NSD or modified-FWHM (5 g, IQR: 3-9 g; and 8 g. IQR: 6-12 g respectively, p < 0.001). Conversely, infarct core mass was 2.3 times larger with NSD (30 g, IQR: 17-53 g) versus FWHM and modified-FWHM (13 g, IQR: 7-23 g, p < 0.001). The gray zone extent (percentage of total scar that was gray zone) also varied significantly among the three methods, 51 % (IQR: 42-61 %), 17 % (IQR: 11-21 %) versus 38 % (IQR: 33-43 %) for FWHM, NSD and modified-FWHM respectively (p < 0.001). Considerable variability exists among the current methods for MRI defined gray zone and scar core. Infarct core and total myocardial scar mass also differ using these methods. Further evaluation of the most accurate quantification method is needed.
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Affiliation(s)
- Olurotimi Mesubi
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG), University of Maryland, Baltimore, MD, USA
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10
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Pöyhönen P, Kivistö S, Holmström M, Hänninen H. Quantifying late gadolinium enhancement on CMR provides additional prognostic information in early risk-stratification of nonischemic cardiomyopathy: a cohort study. BMC Cardiovasc Disord 2014; 14:110. [PMID: 25160650 PMCID: PMC4153898 DOI: 10.1186/1471-2261-14-110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/19/2014] [Indexed: 01/04/2023] Open
Abstract
Background Suspected nonischemic cardiomyopathy (NICM) is a common clinical setting with highly variable prognosis. Early noninvasive risk-stratification is important for justification of invasive examinations, specific treatment and patient surveillance. We studied the additional prognostic value of late gadolinium enhancement (LGE) and segmental wall motion abnormality (SWMA) extent on cardiovascular magnetic resonance (CMR) compared to traditional risk factors in suspected NICM. Methods In this observational cohort study, we enrolled 86 consecutive patients referred for CMR due to suspected NICM. Patients with ischemic cardiomyopathy were excluded. CMR images were analysed for left ventricular LGE and SWMA extents and patients were followed-up for major adverse cardiac events (MACE), including cardiovascular death, aborted sudden death and cardiac transplantation. Results Of 86 patients (median age: 53 years, 45% female), mainly presenting with ventricular arrhythmias (40%) and congestive heart failure (44%), 76% were finally diagnosed with NICM, 17% with left ventricle hypertrophy and 7% with idiopathic arrhythmia. On CMR, 61 patients (71%) had LGE and 56 (65%) SWMA. During median follow-up of 835 days, 15 patients (17%) reached MACE. In univariant analysis, LGE volume (hazard ratio [HR] 1.028 per 1% increase in LGE, p < 0.001), left ventricular ejection fraction (LVEF) (HR 0.959, p = 0.009) and SWMA score (HR 1.067, p = 0.012) had strongest associations with MACE. In multivariate analysis, the best overall model for event prediction included LGE volume (HR 1.027, p = 0.003), sustained ventricular tachycardia (HR 4.7, p = 0.011) and LVEF (HR 0.962, p = 0.034). Among patients with LGE, there was an event rate of 26% (14 of 61) versus 4% (1 of 25) in patients without LGE (p = 0.041, Log-rank). The highest event rate was observed in patients with LGE volume of ≥17%. Patients without SWMA did not experience MACE (p = 0.002, Log-rank), giving additional information in the subgroup of patients with preserved LVEF (≥50%). Conclusions In suspected NICM, presenting with ventricular arrhythmias or heart failure, LGE extent gives additional prognostic information compared to traditional risk factors, while the absence of SWMA may give prognostic information beyond normal LVEF. Even though the final diagnosis is uncertain in NICM, extensive amount of LGE should be considered as a sign of poor prognosis.
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Affiliation(s)
- Pauli Pöyhönen
- Heart and Lung Center, Division of Cardiology, Helsinki University Central Hospital, Po BOX 340, 00029 HUCH Helsinki, Finland.
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11
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Burgmaier M, Frick M, Liberman A, Battermann S, Hellmich M, Lehmacher W, Jaskolka A, Marx N, Reith S. Plaque vulnerability of coronary artery lesions is related to left ventricular dilatation as determined by optical coherence tomography and cardiac magnetic resonance imaging in patients with type 2 diabetes. Cardiovasc Diabetol 2013; 12:102. [PMID: 23844855 PMCID: PMC3716884 DOI: 10.1186/1475-2840-12-102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/06/2013] [Indexed: 01/24/2023] Open
Abstract
Background Patients with type 2 diabetes are at increased risk for both, left ventricular (LV)-dilatation and myocardial infarction (MI) following the rupture of a vulnerable plaque. This study investigated the to date incompletely understood relationship between plaque vulnerability and LV-dilatation using optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) in patients with type 2 diabetes and stable coronary artery disease. Methods CMR was performed in 58 patients with type 2 diabetes, in which 81 coronary lesions were investigated using OCT. Results A decreased minimal fibrous cap thickness (FCT) of coronary lesions was associated with an increase of several CMR-derived parameters including LV-end diastolic volume (LVEDV, r = 0.521, p < 0.001), LV-end diastolic diameter (r = 0.502, p < 0.001) and LV-end systolic volume (r = 0.467, p = 0.001). Similar results were obtained for mean FCT. Furthermore, patients with dilated versus non-dilated LV differed significantly in several cardiovascular risk factors including previous MI (47.1% vs. 14.6%, p = 0.009), HDL-cholesterol (40.35 ± 5.57 mg/dl vs. 45.20 ± 10.79 mg/dl, p = 0.029) and smoking (82.4% vs. 51.2%, p = 0.027). However, minimal FCT is associated to LV-dilatation independent of previous MIs (odds ratio 0.679, p = 0.022). Receiver-operating curve analysis demonstrated that CMR-derived LVEDV predicts plaque vulnerability with low-moderate diagnostic efficiency (area under the curve 0.699) and considerate specificity (83.3%) at the optimal cut-off value (159.0 ml). Conclusion These data suggest that vulnerability of coronary lesions is associated with LV-dilatation in high risk patients with type 2 diabetes. CMR may be a useful adjunct to the risk-stratification in this population. Future studies are warranted to investigate potential mechanisms linking plaque vulnerability and LV-dilatation.
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Macedo R, Fernandes JL, Andrade SS, Rochitte CE, Lima KC, Maciel ACC, Maciel FC, Alves GSP, Coelho OR, Diniz RVZ. Morphological and functional measurements of the heart obtained by magnetic resonance imaging in Brazilians. Arq Bras Cardiol 2013; 101:68-77. [PMID: 23752338 PMCID: PMC3998183 DOI: 10.5935/abc.20130113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/16/2012] [Accepted: 03/20/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Still today, measurements used as a reference in the cardiac magnetic resonance imaging have been obtained mainly from studies carried out in North-American and European populations. OBJECTIVE To obtain measurements of the diastolic diameter, systolic diameter, end diastolic volume, end systolic volume, ejection fraction, and myocardial mass of the left and right ventricles in Brazilians. METHODS 54 men and 53 women, with mean age of 43.4 ± 13.1 years, asymptomatic, with no cardiomyopathies, have been subjected to the cardiac magnetic resonance imaging, using a balanced steady state free precession technique. RESULTS The averages and the standard deviations of the parameters for the left ventricle have been: diastolic diameter = 4.8 ± 0.5 cm; systolic diameter = 3.0 ± 0.6 cm; end diastolic volume = 128.4 ± 29.6 mL; end systolic volume = 45.2 ± 16.6 mL; ejection fraction = 65.5 ± 6.3%; mass = 95.2 ± 30.8 g. For the right ventricle, they have been: diastolic diameter = 3.9 ± 1.3 cm; systolic diameter = 2.5 ± 0.5 cm; end diastolic volume = 126.5 ± 30.7 mL; end systolic volume = 53.6 ± 18.4 mL; ejection fraction = 58.3 ± 8.0%, and mass = 26.1 ± 6.1 g. The masses and the volumes were significantly greater in the men, except for the end systolic volume of the left ventricle. The ejection fraction of the right ventricle has been significantly greater in the women. There has been a significant and inverted correlation of the systolic volume of the right volume with the progression of the age. CONCLUSION This study has described, for the first time, cardiac measurements obtained through the cardiac magnetic resonance imaging in Brazilians, asymptomatic, with no cardiomyopathies, showing differences in accordance with gender and age.
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Affiliation(s)
- Robson Macedo
- Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
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RV Dysfunction In Pulmonary Hypertension Is Independently Related To Pulmonary Artery Stiffness. JACC Cardiovasc Imaging 2012; 5:378-87. [DOI: 10.1016/j.jcmg.2011.11.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/03/2011] [Accepted: 11/01/2011] [Indexed: 11/24/2022]
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Nakamori S, Matsuoka K, Onishi K, Kurita T, Ichikawa Y, Nakajima H, Ishida M, Kitagawa K, Tanigawa T, Nakamura T, Ito M, Sakuma H. Prevalence and signal characteristics of late gadolinium enhancement on contrast-enhanced magnetic resonance imaging in patients with takotsubo cardiomyopathy. Circ J 2012; 76:914-21. [PMID: 22293447 DOI: 10.1253/circj.cj-11-1043] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND To determine the prevalence and signal intensity (SI) characteristics of late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI) in takotsubo cardiomyopathy (TC). METHODS AND RESULTS Cine, black-blood T2-weighted and LGE MR images were acquired in 23 patients with TC within 72 h of onset. Wall motion abnormality (WMA), edema and LGE were evaluated with a 16-segment model. The SI characteristics of LGE were analyzed using SI distribution in remote normal segments as reference. Follow-up MRI was performed 3 months later. Retrospective analysis of LGE MRI was also performed in 10 patients with acute myocardial infarction (AMI) to compare the SI characteristics between TC and AMI. In acute phase, WMA and edema were observed in 236 (64%) and 205 (56%) of 368 segments. LGE was observed in 10 (2.7%) of 368 segments and in 5 (22%) of 23 patients. All LGE lesions in TC exhibited transmural enhancement. The contrast-to-noise ratio (CNR) in TC was significantly lower than that of AMI (3.1±0.3 standard deviations (SD) vs. 6.1±1.2 SD, P<0.01), and CNR value of 4 was useful for distinguishing TC from AMI. Both LGE and WMA disappeared within 12 months. CONCLUSIONS Grey myocardial signal on LGE MRI may be observed in patients with TC. However, the extent of LGE is substantially less than that of WMA and edema, and disappears within 12 months.
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Affiliation(s)
- Shiro Nakamori
- Department of Cardiology, Matsusaka Central Hospital, Matsusaka, Japan
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Cardiomyopathies (hypertrophy and failure): what can offer cardiac magnetic resonance imaging? Presse Med 2011; 40:e425-36. [PMID: 21795013 DOI: 10.1016/j.lpm.2010.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/21/2010] [Indexed: 11/21/2022] Open
Abstract
In routine, cardiomyopathy, confirmed or not, is a frequent reason for cardiac MRI evaluation. Step by step, by using a wide panel of sequences, cardiac MRI is able to characterize cardiomyopathies by their morphologic and functional phenotype as well as by tissue characterization. Cardiac-MRI is also considered as the most appropriate technique for the follow-up of this disease. The purpose of this article is to browse an overview of the main MRI features of cardiomyopathy, focusing the purpose on hypertrophic forms and myocardial diseases leading to cardiac failure.
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Holmström M, Kivistö S, Heliö T, Jurkko R, Kaartinen M, Antila M, Reissell E, Kuusisto J, Kärkkäinen S, Peuhkurinen K, Koikkalainen J, Lötjönen J, Lauerma K. Late gadolinium enhanced cardiovascular magnetic resonance of lamin A/C gene mutation related dilated cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:30. [PMID: 21689390 PMCID: PMC3135551 DOI: 10.1186/1532-429x-13-30] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/20/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify early features of lamin A/C gene mutation related dilated cardiomyopathy (DCM) with cardiovascular magnetic resonance (CMR). We characterise myocardial and functional findings in carriers of lamin A/C mutation to facilitate the recognition of these patients using this method. We also investigated the connection between myocardial fibrosis and conduction abnormalities. METHODS Seventeen lamin A/C mutation carriers underwent CMR. Late gadolinium enhancement (LGE) and cine images were performed to evaluate myocardial fibrosis, regional wall motion, longitudinal myocardial function, global function and volumetry of both ventricles. The location, pattern and extent of enhancement in the left ventricle (LV) myocardium were visually estimated. RESULTS Patients had LV myocardial fibrosis in 88% of cases. Segmental wall motion abnormalities correlated strongly with the degree of enhancement. Myocardial enhancement was associated with conduction abnormalities. Sixty-nine percent of our asymptomatic or mildly symptomatic patients showed mild ventricular dilatation, systolic failure or both in global ventricular analysis. Decreased longitudinal systolic LV function was observed in 53% of patients. CONCLUSIONS Cardiac conduction abnormalities, mildly dilated LV and depressed systolic dysfunction are common in DCM caused by a lamin A/C gene mutation. However, other cardiac diseases may produce similar symptoms. CMR is an accurate tool to determine the typical cardiac involvement in lamin A/C cardiomyopathy and may help to initiate early treatment in this malignant familiar form of DCM.
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MESH Headings
- Adolescent
- Adult
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/physiopathology
- Chi-Square Distribution
- Contrast Media
- Electrocardiography
- Female
- Fibrosis
- Finland
- Genetic Predisposition to Disease
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/genetics
- Lamin Type A/genetics
- Magnetic Resonance Imaging, Cine
- Male
- Meglumine
- Middle Aged
- Mutation
- Myocardium/pathology
- Organometallic Compounds
- Phenotype
- Predictive Value of Tests
- Severity of Illness Index
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/genetics
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Miia Holmström
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Sari Kivistö
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Tiina Heliö
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Raija Jurkko
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Maija Kaartinen
- Department of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland
| | - Margareta Antila
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
| | - Eeva Reissell
- Boehringer Ingelheim Finland Ky Tammasaarenkatu 5, FI-00180 Helsinki, Finland
| | - Johanna Kuusisto
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Satu Kärkkäinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Keijo Peuhkurinen
- Heart Center, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland
| | - Juha Koikkalainen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Jyrki Lötjönen
- VTT Technical Research Centre of Finland, P.O. Box 1300, FI-33101 Tampere, Finland
| | - Kirsi Lauerma
- Department of Radiology, University of Helsinki and HUS Radiology (Medical Imaging Center) P.O. Box 340, FI-00029 HUS, Finland
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Hof IE, Velthuis BK, Van Driel VJ, Wittkampf FH, Hauer RN, Loh P. Left atrial volume and function assessment by magnetic resonance imaging. J Cardiovasc Electrophysiol 2011; 21:1247-50. [PMID: 20487121 DOI: 10.1111/j.1540-8167.2010.01805.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Left Atrial Volume and Function Assessment. INTRODUCTION In patients with atrial fibrillation undergoing catheter ablation, magnetic resonance imaging (MRI) can determine left atrial (LA) volume and function before and after ablation. The most accurate, but time consuming, method to determine LA volume is the multiple slice method (MSM), which involves manual tracing of LA area on each slice. The area length method (ALM) offers a simplified, but unvalidated, alternative for LA volume assessment by MRI. The aim of this study was to compare LA volume and function assessment by ALM with MSM. METHODS AND RESULTS MRI was performed before and after catheter ablation in 40 patients with atrial fibrillation (30 male, mean age 57 years). All patients had sinus rhythm during imaging. In total, 72 MRI scans were available. LA end-diastolic and end-systolic volumes (EDV, respectively ESV) were measured by both methods. LA function was determined by calculating LA ejection fraction (EF = (EDV-ESV)/EDV). Measured by ALM, mean LA EDV and ESV were significantly lower than using MSM (102 mL and 49 mL vs 111 mL and 65 mL, respectively, P < 0.001) with a larger difference in mean ESV than EDV (16 mL vs 9 mL). This resulted in an overestimation of LA EF by ALM with a mean of 11% (54% by ALM and 42% by MSM, P < 0.001). ALM correlated well with MSM for LA EDV and ESV (r = 0.77, respectively 0.85), and showed no significant difference in intraobserver and interobserver variability. CONCLUSION ALM significantly underestimates LA volumes and overestimates LA function, but correlates well with the more accurate MSM.
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Affiliation(s)
- Irene E Hof
- Department of Cardiology Department of Radiology, University Medical Center, Utrecht, The Netherlands
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Krishnamurthy R, Pednekar A, Cheong B, Muthupillai R. High temporal resolution SSFP cine MRI for estimation of left ventricular diastolic parameters. J Magn Reson Imaging 2010; 31:872-80. [PMID: 20373431 DOI: 10.1002/jmri.22123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To obtain high temporal resolution (HTR) magnetic resonance (MR) steady-state free-precession (SSFP) cine cardiac images by using multichannel radiofrequency (RF) hardware and parallel imaging techniques; to study the effect of temporal resolution; and to compare the derived left ventricular (LV) diastolic filling parameters with echocardiographic results. MATERIALS AND METHODS HTR images were acquired in 13 healthy volunteers using a 1.5 T scanner with 32 RF channels and sensitivity encoding (SENSE) and k-t broad-use linear-acquisition speedup technique (k-t BLAST) imaging techniques. LV diastolic parameters were calculated and compared to conventional echocardiographic indices such as the isovolumic relaxation time (IVRT) and E/A ratio. The need for HTR was assessed and the MR results were compared with echocardiographic results. RESULTS The HTR (approximately 6-ms) images yielded higher peak filling rates, peak ejection rates, and peak atrial filling rates. A progressive decline in filling and ejection rates was observed with worsening temporal resolution. The IVRTs and E/A ratios measured with MR versus echocardiography were in broad agreement. Also, SENSE and k-t BLAST yielded similar diastolic functional parameters. CONCLUSION With SENSE or k-t BLAST and modern hardware, HTR cine images can be obtained. The lower temporal resolutions (30-50 ms) used in clinical practice reduce LV filling rates by <or=30% and may hinder characterization of transient phenomena such as the IVRT.
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Ozgun M, Kirchhof P, Bunck AC, Heindel W, Eckardt L, Maintz D. MRI of right atrial function after catheter ablation of atrial flutter. Acad Radiol 2010; 17:856-61. [PMID: 20471870 DOI: 10.1016/j.acra.2010.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Revised: 03/15/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES Catheter ablation of the cavotricuspid isthmus (CTI) is an effective treatment of right atrial flutter. The objective of this study was to evaluate the changes in CTI length and right atrial (RA) function after radiofrequency ablation of isthmus-dependent atrial flutter (isthmus ablation). MATERIALS AND METHODS Magnetic resonance imaging was obtained in 14 patients (2 female, mean age 59 +/- 9) before and after isthmus ablation (mean delay 80 +/- 175 days) using steady-state free precession cine magnetic resonance imaging in right anterior oblique view orientation. Right atrial function (maximum/minimum right atrial volumes, stroke volume, ejection fraction) and maximum/minimum length of the CTI were measured. RESULTS After isthmus ablation, maximum RA volume decreased by 13% (P = .02) and minimum RA volume by 22% (P = .01), whereas stroke volume and ejection fraction did not increase significantly (P = .4 and .2, respectively). After ablation, the maximum length of the CTI showed a significant decrease of 19% (P < .001) and the minimum length a decrease of 24% (P < .001). A linear correlation between change in CTI length and number of energy applications during ablation could not be observed (r = .605, P = .22 for minimum length; r = .384, P = .18 for maximum length). After eliminating the outliers in the number of energy applications, a significant correlation between energy applications and change in CTI systolic length was found (r = .808, P = .008). CONCLUSION Magnetic resonance imaging to visualize right atrial size and function in right anterior oblique orientation was successfully performed and easy to evaluate for volumetric analysis and determination of CTI length. Scarring of the CTI with the use of catheter ablation leads to a significant and linear decrease in its length and to a subsequent reduction of right atrial volumes, whereas functional parameters such as stroke volume/ejection fraction did not change significantly.
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Prasad M, Ramesh A, Kavanagh P, Tamarappoo BK, Nakazato R, Gerlach J, Cheng V, Thomson LEJ, Berman DS, Germano G, Slomka PJ. Quantification of 3D regional myocardial wall thickening from gated magnetic resonance images. J Magn Reson Imaging 2010; 31:317-27. [PMID: 20099344 DOI: 10.1002/jmri.22033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To develop 3D quantitative measures of regional myocardial wall motion and thickening using cardiac magnetic resonance imaging (MRI) and to validate them by comparison to standard visual scoring assessment. MATERIALS AND METHODS In all, 53 consecutive subjects with short-axis slices and mid-ventricular 2-chamber/4-chamber views were analyzed. After correction for breath-hold-related misregistration, 3D myocardial boundaries were fitted to images and edited by an imaging cardiologist. Myocardial thickness was quantified at end-diastole and end-systole by computing the 3D distances using Laplace's equation. 3D thickening was represented using the standard 17-segment polar coordinates. 3D thickening was compared with 3D wall motion and with expert visual scores (6-point visual scoring of wall motion and wall thickening; 0 = normal; 5 = greatest abnormality) assigned by imaging cardiologists. RESULTS Correlation between ejection fraction and thickening measurements was (r = 0.84; P < 0.001) compared to correlation between ejection fraction and motion measurements (r = 0.86; P < 0.001). Good negative correlation between summed visual scores and global wall thickening and motion measurements were also obtained (r(thick) = -0.79; r(motion) = -0.74). Additionally, overall good correlation between individual segmental visual scores with thickening/wall motion (r(thick) = -0.69; r(motion) = -0.65) was observed (P < 0.0001). CONCLUSION 3D quantitative regional thickening and wall motion measures obtained from MRI correlate strongly with expert clinical scoring.
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Affiliation(s)
- Mithun Prasad
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Strugnell WE, Hamilton-Craig CR, Parry TA, Bartlett HJG, Slaughter RE. Cardiac MRI is superior to gated blood pool imaging in the assessment of left ventricular function in patients post-cardiac transplantation. Heart Lung Circ 2010; 19:400-5. [PMID: 20356786 DOI: 10.1016/j.hlc.2010.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 12/11/2009] [Accepted: 02/09/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gated Blood Pool Imaging (GBPI) has low inter-test variability compared to echocardiography, and is often used when accurate repeated measurements of left ventricular ejection fraction are required such as in the surveillance of post-transplant patients. The aim of this study was to determine if cardiac MRI (CMR) could replace Gated Blood Pool Imaging for annual assessment of left ventricular (LV) function in the surveillance of patients post-cardiac transplantation. METHODS Forty-nine patients at various stages of post-cardiac transplantation presenting for annual review underwent LV functional assessment with GBPI and CMR. LV ejection fractions (EF) obtained from the two methods were compared and limits of agreement determined. RESULTS The mean EF (plus and minus two standard deviations) was 58.3+/-18% for GBPI and 57.6+/-18% for CMR. The two methods were found to provide clinically equivalent results. CONCLUSIONS Assessment of LVEF with CMR offers comparable values to GBPI in post-heart transplant patients. However, CMR also allows quantitative volumetric analysis of ventricular volumes and assessment of wall motion and valvular function. As is now accepted in native heart assessment, CMR should be considered the "gold standard" for post-transplant volumetric and functional evaluation. CMR offers information over-and-above traditional imaging modalities.
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Affiliation(s)
- Wendy E Strugnell
- Queensland Centre of Excellence in Cardiovascular MRI, Department of Medical Imaging, The Prince Charles Hospital, Rode Road, Chermside, Queensland 4032, Australia.
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Peri-infarct dysfunction in post-myocardial infarction: assessment of 3-T tagged and late enhancement MRI. Eur Radiol 2009; 20:1139-48. [PMID: 19915846 DOI: 10.1007/s00330-009-1657-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 09/14/2009] [Accepted: 10/02/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine LV function at different distances from myocardial infarction (MI) by using 3-T tagged MRI and late gadolinium enhancement (LGE). METHODS Cardiac MR images were acquired from 21 patients with previous MI. The harmonic phase (HARP) method was used to calculate radial and circumferential strain (RS, CS). The two strains were synchronised by subtracting the CS from the RS at the same time, and this was defined as the efficient strain (ES). Peak strain (P-RS, P-CS, P-ES) and time to peak strain (T-RS, T-CS, T-ES) were used as estimates of contractile function. Based on the presence of LGE, myocardium was classified into infarct, border zone, adjacent and remote areas. RESULTS P-RS and P-ES were significantly greater for remote than for adjacent and infarct areas. P-CS values were significantly greater for remote and border zone than for infarct areas. T-RS and T-ES were significantly shorter for remote and border zone than for infarct areas. T-CS was significantly shorter for border zone than for infarct areas. CONCLUSION Contractile dysfunction demonstrated by peak strain was correlated with location at different distances from the infarct. In the border zone, contractile deformation was characterised as earlier T-RS, T-CS and T-ES and greater P-CS than in the infarct area.
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Jeneson JAL, Schmitz JPJ, Hilbers PAJ, Nicolay K. An MR-compatible bicycle ergometer for in-magnet whole-body human exercise testing. Magn Reson Med 2009; 63:257-61. [DOI: 10.1002/mrm.22179] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Stevens GR, Lala A, Sanz J, Garcia MJ, Fuster V, Pinney S. Exercise Performance in Patients With Pulmonary Hypertension Linked to Cardiac Magnetic Resonance Measures. J Heart Lung Transplant 2009; 28:899-905. [DOI: 10.1016/j.healun.2009.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/23/2009] [Accepted: 05/02/2009] [Indexed: 10/20/2022] Open
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Weber OM, Speier P, Scheffler K, Bieri O. Assessment of magnetization transfer effects in myocardial tissue using balanced steady-state free precession (bSSFP) cine MRI. Magn Reson Med 2009; 62:699-705. [DOI: 10.1002/mrm.22053] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sixty-four-slice multidetector computed tomography for preoperative evaluation of left ventricular function and mass in patients with mitral regurgitation: comparison with magnetic resonance imaging and echocardiography. Eur Radiol 2009; 19:2107-16. [DOI: 10.1007/s00330-009-1392-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
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Anderson DJ, Dendy JM, Paschal CB. Simulation study of susceptibility gradients leading to focal myocardial signal loss. J Magn Reson Imaging 2009; 28:1402-8. [PMID: 19025948 DOI: 10.1002/jmri.21619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess the cause of a "bite"-shaped signal void artifact often seen in 1.5 Tesla (T) and 3T gradient echo MR images in myocardium along the infero-apical border of the heart, MRI simulation was used to conduct experiments impossible in reality. Two previous studies attempting to explain the origin of this artifact came to different conclusions. One suggested deoxygenated blood in the posterior vein of the left ventricle (PVLV) leads to a susceptibility gradient that causes the artifact. The other suggested the difference in susceptibility between lung tissue and myocardium was responsible. This study assessed the relative effect of each possible cause. MATERIALS AND METHODS Anthropometric phantoms were developed for use with a previously reported MRI simulator. The images were simulated at 3T with gradient echo scans using TE = 4 ms, TR = 25 ms, and theta = 25 degrees . RESULTS The simulations indicate that both susceptibility differences can lead to signal losses in the area of the artifact with contributions from the PVLV being more localized while lung tissue effects are stronger but more spatially distributed. CONCLUSION The data support the conclusion that both differences together, rather than one or the other, are responsible for the artifact.
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Affiliation(s)
- Douglas J Anderson
- Department of Biomedical Engineering, Vanderbilt University School of Engineering, Nashville, Tennessee 37232-2310, USA
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Woodard PK, Bhalla S, Javidan-Nejad C, Bierhals A, Gutierrez FR, Singh GK. Cardiac MRI in the management of congenital heart disease in children, adolescents, and young adults. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 10:419-24. [DOI: 10.1007/s11936-008-0033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Guo YK, Gao HL, Zhang XC, Wang QL, Yang ZG, Ma ES. Accuracy and reproducibility of assessing right ventricular function with 64-section multi-detector row CT: comparison with magnetic resonance imaging. Int J Cardiol 2008; 139:254-62. [PMID: 19028401 DOI: 10.1016/j.ijcard.2008.10.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 08/24/2008] [Accepted: 10/12/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND Right ventricular (RV) function is very important for those patients with respiratory and cardiovascular disorders that can result in RV impairments. Because of complex geometry of the chamber, it is difficult to accurately measure the RV volumetric parameters with conventional imaging modalities. The purpose of this study was to evaluate whether the 64-MDCT can assess RV function with high accuracy and reproducibility when compared to the results with those of MRI. METHODS Forty-seven consecutive subjects underwent retrospectively ECG-gated 64-MDCT and MRI for assessing the ventricular function. Right ventricular end diastolic and end-systolic volume, stroke volume, and ejection fraction were measured with dedicated cardiac analysis software on 64-MDCT and compared with values measured on MRI which served as the reference standard. Agreement between two modalities was assessed with Bland and Altman analysis and linear regression analysis. Repeated measurements were performed to determine intraobserver and interobserver variability. RESULTS No significant differences were revealed in calculated RV volumes and EF between the two modalities. Agreement and correlation were similar for RV-EDV (0.4 ± 8.2 ml; r=0.95), RV-ESV (-0.6 ± 4.8; r=0.95), RV-SV (1.1 ± 6.7 ml; r=0.93), and RV-EF (0.9 ± 4.4; r=0.88). The difference of SV of right and left ventricle with 64-MDCT was not statistically significant (p=0.40) and good correlation was obtained (r=0.96). The variability in 64-MDCT measurements was lower than those in MRI. CONCLUSIONS ECG-gated 64-MDCT can assess the RV function with high accuracy and reproducibility without geometric assumptions about right ventricle.
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Affiliation(s)
- Ying-kun Guo
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
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Koikkalainen JR, Antila M, Lötjönen JMP, Heliö T, Lauerma K, Kivistö SM, Sipola P, Kaartinen MA, Kärkkäinen STJ, Reissell E, Kuusisto J, Laakso M, Orešič M, Nieminen MS, Peuhkurinen KJ. Early Familial Dilated Cardiomyopathy: Identification with Determination of Disease State Parameter from Cine MR Image Data. Radiology 2008; 249:88-96. [DOI: 10.1148/radiol.2491071584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Hergan K, Schuster A, Frühwald J, Mair M, Burger R, Töpker M. Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method. Eur J Radiol 2008; 65:270-8. [PMID: 17498903 DOI: 10.1016/j.ejrad.2007.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 03/14/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). MATERIALS AND METHODS Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. RESULTS A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%. CONCLUSION In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.
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Affiliation(s)
- Klaus Hergan
- Department of Radiology, Paracelsus Medical University Salzburg, Austria.
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33
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Abstract
Coronary artery disease and other acquired and congenital cardiac diseases are major medical and socio-economic problems. Historically, imaging has had a critical role in the diagnosis and evaluation of acquired and congenital cardiac disease. Advances in computed tomography (CT), with multidetector CT and electron beam CT technology, and magnetic resonance (MR) imaging, now make it possible to noninvasively image the coronary arteries, cardiac chambers, valves, myocardium, and pericardium and assess cardiac function, and CT and MR imaging are becoming increasingly important in the evaluation of cardiac disease. Radiologists, because of their extensive experience in CT and MR imaging, have an important role in imaging cardiac patients using these modalities. This clinical statement of the ACR discusses various technical and patient safety issues related to cardiac CT and MR imaging, and it suggests appropriate qualifications for radiologists until such time as ACR practice guidelines for the performance of cardiac CT and cardiac MR imaging are written and approved through the usual ACR process. It stresses that the interpreting physician is responsible for examining not only the cardiac structures of interest but also all the visualized noncardiac structures and must report any clinically relevant abnormalities of these adjacent structures.
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Melby SJ, Gaynor SL, Lubahn JG, Lee AM, Rahgozar P, Caruthers SD, Williams TA, Schuessler RB, Damiano RJ. Efficacy and safety of right and left atrial ablations on the beating heart with irrigated bipolar radiofrequency energy: a long-term animal study. J Thorac Cardiovasc Surg 2006; 132:853-60. [PMID: 17000297 DOI: 10.1016/j.jtcvs.2006.05.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 02/07/2006] [Accepted: 05/17/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Cox maze procedure is the most effective surgical treatment for atrial fibrillation; however, its complexity has limited its clinical utility. The purpose of this study was to simplify the procedure by using an irrigated bipolar radiofrequency ablation device on the beating heart without cardiopulmonary bypass. METHODS Six domestic pigs underwent median sternotomy. The pulmonary veins were circumferentially ablated. Electrical isolation was confirmed by pacing. Eight lesions were performed epicardially, and three lesions were performed through purse-string sutures with one of the jaws of the device introduced into the right atrium. After 30 days, magnetic resonance imaging was performed to assess atrial function, pulmonary vein anatomy, and coronary artery patency. Cholinergic stimulation and burst pacing were administered to induce atrial fibrillation. Histologic assessment of the heart was performed after the animal was killed. RESULTS A modified Cox maze procedure was successfully performed with the irrigated bipolar radiofrequency device with no deaths. In every instance, the pulmonary veins were electrically isolated. Cholinergic stimulation with burst pacing failed to produce atrial fibrillation. Imaging studies revealed tricuspid regurgitation without evidence of pulmonary vein stenosis, coronary artery stenosis, or intra-atrial thrombus. Total atrial ejection fraction was 16.9% +/- 7.5%, a significant reduction. Histologically, 99% of the lesions were transmural, and there was no evidence of coronary sinus injury. CONCLUSION Lesions on both the right and left atria can be created successfully on the beating heart with irrigated bipolar radiofrequency. The great majority of lesions with this device were transmural. This device should not be used on valvular tissue.
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Affiliation(s)
- Spencer J Melby
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo 63110, USA
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35
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Husmann L, Leschka S, Desbiolles L, Schepis T, Koepfli P, Gaemperli O, Seifert B, Flohr TG, Frauenfelder T, Marincek B, Kaufmann PA, Alkadhi H. Thick Maximum Intensity Projections for the Assessment of Left Ventricular Function With 64-Slice Computed Tomography. Invest Radiol 2006; 41:746-52. [PMID: 16971798 DOI: 10.1097/01.rli.0000236906.05265.4f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the accuracy of thick maximum intensity projections (MIP) from computed tomography (CT) data sets mimicking projection images from biplane ventriculography for evaluation of left ventricular (LV) parameters. MATERIALS AND METHODS Fifty-eight patients underwent 64-slice CT. Multiphase images were reconstructed in 10% steps of the RR interval. MIP images (70-mm thickness) of the contrast-enhanced LV in fixed 30 degrees right anterior oblique (RAO)/60 degrees left anterior oblique (LAO) and in adapted short-/long-axis planes were reconstructed. LV parameters were calculated using the area-length method formula. Three-dimensional assessment with semiautomated software served as reference standard. RESULTS Use of thick MIP reconstructions had a high intermethod reliability (86-94%) compared with the 3-dimensional approach. Smaller measurement errors were found for thick MIP reconstructions in adapted short-/long-axis planes. A significant projection error (3.0%, P < 0.001) of thick MIP reconstructions was found using fixed 30 degrees RAO/60 degrees LAO compared with adapted short-/long-axis reconstructions. CONCLUSION Thick MIP reconstructions with adapted short-/long-axis planes allow an accurate assessment of LV parameters compared with the established 3-dimensional method.
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Affiliation(s)
- Lars Husmann
- Institute of Diagnostic Radiology, University of Zurich, Zurich, Switzerland
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36
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Woodard PK, Bluemke DA, Cascade PN, Finn JP, Stillman AE, Higgins CB, White RD, Yucel EK. ACR Practice Guideline for the Performance and Interpretation of Cardiac Magnetic Resonance Imaging (MRI). J Am Coll Radiol 2006; 3:665-76. [PMID: 17412147 DOI: 10.1016/j.jacr.2006.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) is an established imaging modality, recognized for its value in the assessment and monitoring of a wide range of cardiac pathology. It can provide physiologic as well as anatomic information. Image interpretation requires both well-developed MRI skills and knowledge of cardiac pathology. Radiologists, because of their extensive experience in MRI, have an important role in its application in the heart. The guidelines presented here are an educational tool designed to assist practitioners in providing the best possible patient care via the diagnostic methods of cardiac MRI. American College of Radiology requirements for physicians and personnel performing and interpreting cardiac MRI, which will become applicable by July 1, 2008, are also presented.
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Affiliation(s)
- Pamela K Woodard
- Mallinckrodt Institute of Radiology, Saint Louis, MO 63110, USA.
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37
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Rocco M, Carbone I, Morelli A, Palantonio P, Rossi S, Spadetta G, Passariello R, Pietropaoli P. The calcium sensitizer levosimendan improves carbon monoxide poisoning related stunned myocardium: a cardiac magnetic resonance study. Acta Anaesthesiol Scand 2006; 50:897-8. [PMID: 16879479 DOI: 10.1111/j.1399-6576.2006.01052.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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38
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Montet-Abou K, Daire JL, Ivancevic MK, Hyacinthe JN, Nguyen D, Jorge-Costa M, Morel DR, Vallée JP. Optimization of cardiac cine in the rat on a clinical 1.5-T MR system. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2006; 19:144-51. [PMID: 16865385 DOI: 10.1007/s10334-006-0037-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 06/09/2006] [Accepted: 06/12/2006] [Indexed: 11/30/2022]
Abstract
OBJECT The overall goal was to study cardiovascular function in small animals using a clinical 1.5-T MR scanner optimizing a fast gradient-echo cine sequence to obtain high spatial and temporal resolution. MATERIALS AND METHODS Normal rat hearts (n = 9) were imaged using a 1.5-T MR scanner with a spiral fast gradient-echo (fast field echo for Philips scanners) sequence, three Cartesian fast gradient-echo (turbo field echo for Philips scanners) sequences with different in-plane resolution, and with and without flow compensation and half-Fourier acquisition. The hearts of four rats were then excised and left-ventricle mass was weighed. Inter- and intra-observer variability analysis was performed for magnetic resonance imaging (MRI) measurements. RESULTS Half-Fourier acquisition with flow compensation gave the best sequence in terms of image quality, spatial as well as temporal resolution, and suppression of flow artifact. Ejection fraction was 71 +/- 4% with less than 5% inter- and intra-observer variability. A good correlation was found between MRI-calculated left-ventricular mass and wet weight. CONCLUSIONS Using optimized sequences on a clinical 1.5-T MR scanner can provide accurate quantification of cardiac function in small animals and can promote cardiovascular research on small animals at 1.5-T.
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Affiliation(s)
- K Montet-Abou
- Radiology and Medical Informatics Department, Digital Imaging Unit (UIN), Geneva University Hospital, 1211 Geneva 14, Switzerland.
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39
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Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM, Di Carli MF, Reynolds HG, Stevenson WG, Kwong RY. Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post–Myocardial Infarction Mortality. Circulation 2006; 114:32-9. [PMID: 16801462 DOI: 10.1161/circulationaha.106.613414] [Citation(s) in RCA: 545] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background—
Accurate risk stratification is crucial for effective treatment planning after myocardial infarction (MI). Previous studies suggest that the peri-infarct border zone may be an important arrhythmogenic substrate. In this pilot study, we tested the hypothesis that the extent of the peri-infarct zone quantified by contrast-enhanced cardiac magnetic resonance (CMR) is an independent predictor of post-MI mortality.
Methods and Results—
We studied 144 patients with documented coronary artery disease and abnormal myocardial delayed enhancement (MDE) consistent with MI. A computer-assisted, semiautomatic algorithm quantified the total infarct size and divided it into the core and peri-infarct regions based on signal-intensity thresholds (>3 SDs and 2 to 3 SDs above remote normal myocardium, respectively). The peri-infarct zone was normalized as a percentage of the total infarct size (%MDE
periphery
). After a median follow-up of 2.4 years, 29 (20%) patients died. Patients with an above-median %MDE
periphery
were at higher risk for death compared with those with a below-median %MDE
periphery
(28% versus 13%, log-rank
P
<0.01). Multivariable analysis showed that left ventricular systolic volume index and %MDE
periphery
were the strongest predictors of all-cause mortality (adjusted hazard ratio [HR] for %MDE
periphery
, 1.45 per 10% increase;
P
=0.002) and cardiovascular mortality (adjusted HR, 1.51 per 10% increase;
P
=0.009). Similarly, after adjusting for age and left ventricular ejection fraction, %MDE
periphery
maintained strong and independent associations with all-cause mortality (adjusted HR, 1.42;
P
=0.005) and cardiovascular mortality (adjusted HR, 1.49;
P
=0.01).
Conclusions—
In patients with a prior MI, the extent of the peri-infarct zone characterized by CMR provides incremental prognostic value beyond left ventricular systolic volume index or ejection fraction. Infarct characteristics by CMR may prove to be a unique and valuable noninvasive predictor of post-MI mortality.
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Affiliation(s)
- Andrew T Yan
- Cardiovascular Magnetic Resonance Imaging Program, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115, USA
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40
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Strugnell WE, Slaughter LRE, Riley RA, Trotter AJ, Bartlett H. Modified RV short axis series--a new method for cardiac MRI measurement of right ventricular volumes. J Cardiovasc Magn Reson 2006; 7:769-74. [PMID: 16353437 DOI: 10.1080/10976640500295433] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The current standard image orientation employed in the MRI assessment of right ventricular volumes uses a series of short axis cine acquisitions located with respect to a horizontal long axis view with the first slice placed across the atrio-ventricular valve plane at end diastole. Inherent inaccuracies are encountered with the use of this image orientation due to difficulty in defining the tricuspid valve and the border between atrium and ventricle on the resultant images. Our experience indicates that because the tricuspid valve is usually not in-plane in the slice the atrio-ventricular margin is difficult to distinguish. This leads to inaccuracies in measurements at the base of the RV and miscalculation of the RV volume. The purpose of this study was to assess an alternative method of image orientation aimed at increasing the accuracy of RV volume measurements using current commercially available CMRI sequences. This technique, the modified RV short axis series, is oriented to the outflow tract of the right ventricle. METHOD We undertook a prospective study of 50 post cardiac transplant patients. A series of LV short axis multi-slice cine acquisition FIESTA images was acquired using the current standard technique. From this data set, LV and RV stroke volumes were derived on an Advantage Windows workstation using planimetry of the endocardial and epicardial borders in end systole and end diastole. Our new technique involved obtaining a set of multi-slice cine acquisition FIESTA images in a plane perpendicular to a line from the centre of the pulmonary valve to the apex of the RV. Planimetry of the RV was then performed and a stroke volume calculated using the same method of analysis. RV stroke volumes obtained from both techniques were compared with LV stroke volumes. Three operators independently derived RV data sets. RESULTS On the images acquired with the new technique, the tricuspid valve was easier to define leading to more accurate and reproducible planimetry of ventricular borders. RV stroke volumes calculated from the new method showed better agreement with LV stroke volumes than with the current method. These results were consistent across the three operators. CONCLUSIONS This new method improves visualisation of the tricuspid valve and makes analysis easier and less prone to operator error than the current standard technique for MRI assessment of RV volumes.
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Affiliation(s)
- Wendy E Strugnell
- Cardiovascular MRI Research Centre, The Prince Charles Hospital, Rode Rd., Chermside, Queensland 4032, Australia.
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41
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Sparrow P, Reid S, Sivananthan M. Magnetic resonance imaging of a coronary fistula manifesting as a pericardial effusion. J Comput Assist Tomogr 2006; 30:250-3. [PMID: 16628041 DOI: 10.1097/00004728-200603000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of a congenital fistulous communication between the left circumflex coronary artery and coronary sinus that presented as a pericardial effusion and was diagnosed using a comprehensive cardiac magnetic resonance imaging (MRI) evaluation is presented. This is an unusual presentation of an uncommon condition, and the MRI features have not been described previously. Noninvasive cardiac assessment via MRI allows for identification of the anatomic basis and functional consequences of an unusual anomaly such as a coronary artery fistula.
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Affiliation(s)
- Patrick Sparrow
- British Heart Foundation Cardiac MRI Unit, Leeds General Infirmary, Leeds, United Kingdom.
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42
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Abstract
Cardiac multidetector CT (MDCT) has moved from purely anatomic imaging, to assessment of cardiac function. Significant advances since the advent of multidetector CT now make it feasible to assess not only the coronary arteries, but also ejection fraction, ventricular volumes, myocardial mass and the presence of wall-motion abnormalities. Advances include improvements in EKG-gating, including improvements in temporal resolution, as well as the addition of delayed contrast-enhanced methods. Anatomic imaging has improved as well, with thinner collimation and better reconstruction methods. Three-dimensional software programs now permit excellent surface rendered displays and multiplanar reconstructions suitable as surgical and procedural "road maps."
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Affiliation(s)
- Pamela K Woodard
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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43
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Danilouchkine MG, van der Geest RJ, Westenberg JJM, Lelieveldt BPF, Reiber JHC. Influence of positional and angular variation of automatically planned short-axis stacks on quantification of left ventricular dimensions and function with cardiovascular magnetic resonance. J Magn Reson Imaging 2005; 22:754-64. [PMID: 16270293 DOI: 10.1002/jmri.20442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To theoretically and experimentally investigate the influence of the automated cardiovascular magnetic resonance (CMR) scan planning pitfalls, namely inaccurate positioning and tilting of short-axis (SA) imaging planes, on quantification of the left ventricular (LV) dimensions and function. MATERIALS AND METHODS Eleven healthy subjects and eight patients underwent CMR. Manually and automatically planned SA sets were acquired. To obtain the quantitative measurements of LV function, one observer performed image analysis twice. The agreement between planning methods, as well as the decomposition of the total variation into interstudy and intraobserver components was measured. RESULTS The decomposition of the total variation showed that the interstudy factor accounts for 70-85% of the total variation, while the rest is due to the intraobserver factor. Moreover, the relative contribution of the interstudy factor remains independent from errors in slice positioning and small angular deviation of SA stacks from the optimal orientation. Good agreement between the theoretical and measured variability factors was observed. CONCLUSION Global LV function derived from the automatically planned CMR acquisitions yield accurate quantification of the human cardiovascular system. Inaccurate positioning and tilting of SA images does not affect the quantitative measurements of LV function. The computer-aided system for automated CMR has proven clinical applicability.
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Affiliation(s)
- Mikhail G Danilouchkine
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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44
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Salm LP, Bax JJ, Jukema JW, Schuijf JD, Vliegen HW, Lamb HJ, van der Wall EE, de Roos A. Comprehensive assessment of patients after coronary artery bypass grafting by 16-detector-row computed tomography. Am Heart J 2005; 150:775-81. [PMID: 16209981 DOI: 10.1016/j.ahj.2004.11.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 11/21/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multidetector-row computed tomography (MDCT) is a versatile modality to evaluate stenoses in native coronary arteries and bypass grafts. Acquired MDCT data can additionally be used to assess left ventricular ejection fraction (LVEF). The purpose was to use MDCT for the assessment of bypass graft and coronary artery disease combined with evaluation of LVEF. METHODS Twenty-five patients underwent 16-detector-row CT examination and coronary angiography. Bypass grafts and nongrafted coronary artery segments at MDCT were evaluated on eligibility, patency, and > or = 50% stenosis. The MDCT data set was used to calculate LVEF and was divided into patients with no/subendocardial/transmural myocardial infarctions (MIs). RESULTS Ninety vessels were evaluated: 14 arterial grafts/53 vein grafts/23 nongrafted vessels. Of 225 segments, 17 were ineligible for evaluation because of metal clips. With MDCT, patency in segments of arterial grafts/vein grafts/nongrafted vessels could be evaluated with high accuracy in 100%/100%/97% of segments. In arterial grafts, stenoses > or = 50% did not occur at angiography, which was for all eligible segments correctly diagnosed at MDCT. Stenosis > or = 50% could be correctly detected by MDCT with a sensitivity/specificity of 100%/94% for vein grafts and 100%/89% for nongrafted vessels. Negative predictive value was 100% for vein grafts and nongrafted vessels. In patients with transmural MI, MDCT revealed a significant lower LVEF as compared with patients without or with subendocardial MI (P < .05). CONCLUSION Comprehensive assessment of bypass grafts, nongrafted vessels, and LVEF is feasible with MDCT. Owing to the high negative predictive value this noninvasive approach may be used as gatekeeper before coronary angiography.
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Affiliation(s)
- Liesbeth P Salm
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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45
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Affiliation(s)
- Pamela K Woodard
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
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46
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Weinreb JC, Larson PA, Woodard PK, Stanford W, Rubin GD, Stillman AE, Bluemke DA, Duerinckx AJ, Dunnick NR, Smith GG. American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging. Radiology 2005; 235:723-7. [PMID: 15845799 DOI: 10.1148/radiol.2353050358] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey C Weinreb
- Department of Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT, USA.
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47
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Ashley EA, Vagelos RH. Preoperative Cardiac Evaluation: Mechanisms, Assessment, and Reduction of Risk. Thorac Surg Clin 2005; 15:263-75. [PMID: 15999524 DOI: 10.1016/j.thorsurg.2005.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The changing paradigm in cardiovascular disease in which atherosclerotic lesions exist in a spectrum of stable to unstable, the lack of a perfect prediction tool, and the paucity of randomized controlled data on appropriate intervention make protection of cardiac patients undergoing thoracic surgery challenging. Nociception-related sympathetic drive combines with inflammatory stimuli and the cardiodepressant effects of anesthesia to create a window of maximum risk in the early postoperative period (8-24 hours), and although multivariate models have shown that a combination of surgery-specific risk, patient-specific cardiovascular history, and estimated functional capacity best determine the need for further investigation, the optimal choice of investigation is unclear. Exercise or dobutamine stress echocardiography provide the best validated investigations, and in the case of poor images, dobutamine MR imaging is increasingly used. When disease is found, medical and interventional options are available. PCI is often used, but the risk of converting a stable flow-limiting lesion into a less stable non-flow-limiting lesion must be considered, along with a delay for anti-platelet therapy and endothelialization of the stent. Alternatively, medical protection with acute beta-blockade or alpha2-agonists reduces risk (although beta-blockade often is avoided in chronic lung disease, even nonselective agents are safe in patients with non-airways reactive COPD). In addition, it is likely that statin use reduces risk, probably by stabilizing plaques, but patients with cardiac risk are increasingly likely to be taking this medication already. The assessment and management of cardiac risk in the perioperative thoracic surgery patient is challenging. With focused, rational, and individually tailored management; tight monitoring of postoperative pain; and a close working relationship between the surgeon, anesthesiologist, and cardiologist, patient care can be optimized, and risk can be effectively controlled.
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Affiliation(s)
- Euan A Ashley
- Division of Cardiology, Stanford University School of Medicine, Falk CVRB, 300 Pasteur Drive, Stanford, CA 94305, USA.
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48
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DiCarlo JC, Hargreaves BA, Nayak KS, Hu BS, Pauly JM, Nishimura DG. Variable-density one-shot fourier velocity encoding. Magn Reson Med 2005; 54:645-55. [PMID: 16088883 DOI: 10.1002/mrm.20594] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In areas of highly pulsatile and turbulent flow, real-time imaging with high temporal, spatial, and velocity resolution is essential. The use of 1D Fourier velocity encoding (FVE) was previously demonstrated for velocity measurement in real time, with fewer effects resulting from off-resonance. The application of variable-density sampling is proposed to improve velocity measurement without a significant increase in readout time or the addition of aliasing artifacts. Two sequence comparisons are presented to improve velocity resolution or increase the velocity field of view (FOV) to unambiguously measure velocities up to 5 m/s without aliasing. The results from a tube flow phantom, a stenosis phantom, and healthy volunteers are presented, along with a comparison of measurements using Doppler ultrasound (US). The studies confirm that variable-density acquisition of kz-kv space improves the velocity resolution and FOV of such data, with the greatest impact on the improvement of FOV to include velocities in stenotic ranges.
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Affiliation(s)
- Julie C DiCarlo
- Department of Electrical Engineering, Stanford University, Stanford, California 94305-9510, USA.
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