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Guo C, Jiang Z, He J, Ma H, Wang Y, Tan J, Ou Q, Tian Y, Tian L, Liu Q, Huang J, Yang L. Impact of left atrial appendage thrombus location on diagnostic accuracy of cardiac CT: a single-centre case-control study. BMJ Open 2024; 14:e079876. [PMID: 38296275 PMCID: PMC10831467 DOI: 10.1136/bmjopen-2023-079876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Cardiac CT (CCT) is an emerging non-invasive modality for assessing left atrial appendage (LAA) thrombus, but the results were conflicting. Our study aims to evaluate the accuracy of CCT for detecting LAA thrombus in patients undergoing catheter ablation of atrial fibrillation, using trans-oesophageal echocardiography (TEE) as the reference standard. DESIGN Case-control study. SETTING Patient data were collected from a tertiary hospital in China between 2017 and 2022. PARTICIPANTS The study enrolled 726 patients (male: 60.2%, age: 61±11 years) who had both TEE and CCT before catheter ablation of atrial fibrillation. MEASURES The CCT protocol consisted of one angiographic phase and one delayed scan 30 s later. LAA thrombi were defined as solid masses on TEE or persistent defects on CCT. The thrombus dimension and location, the LAA filling and emptying flow velocity were assessed by TEE. RESULTS Of the 57 (7.9%) patients with LAA thrombi identified by TEE, 29 (50.9%) were located at the LAA ostium, and 28 (49.1%) were in the LAA. The former showed higher motility following blood flow and heartbeats than the latter. The CCT detected 14 (48.3%) of the LAA-ostium thrombi but 25 (89.3%) of those in the LAA (p=0.001). The LAA-ostium thrombi with the LAA mean flow velocity >0.35 m/s and maximum diameters <10 mm were more prone to have CCT false-negative results. CONCLUSION For patients undergoing catheter ablation for atrial fibrillation, CCT with a 30 s delay scan is less sensitive to LAA thrombi than TEE, especially for LAA-ostium thrombi with smaller sizes and higher LAA flow velocity.
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Affiliation(s)
- Chuxian Guo
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jionghong He
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Echocardiography Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Haiyan Ma
- Radiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yuquan Wang
- Radiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jing Tan
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Echocardiography Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Qiaoqiao Ou
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Ye Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Qifang Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jing Huang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Long Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
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Niu T, Zhi Y, Wei L, Liu W, Ju X, Pi W, Fu Z, Tong H, Hu H, Dong J. Sirtuin 3 controls cardiac energetics and protects against oxidative stress in electromagnetic radiation-induced cardiomyopathy. Free Radic Biol Med 2023; 205:1-12. [PMID: 37268048 DOI: 10.1016/j.freeradbiomed.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023]
Abstract
Electromagnetic radiation can cause injuries to both the structures and functions of the heart. No therapy is currently available to inhibit these untoward effects. Mitochondrial energetic damage and oxidative stress are drivers of electromagnetic radiation-induced cardiomyopathy (eRIC); however, the pathways that mediate these events are poorly defined. Sirtuin 3 (SIRT3) has been emerged as a key target for maintaining mitochondrial redox potential and metabolism, but its role in eRIC remains unknown. Here, Sirt3-KO mice and cardiac-specific SIRT3 transgenic mice were subjected to the investigation of eRIC. We found that Sirt3 protein expression level was down-regulated in eRIC mice model. Sirt3-KO markedly exaggerated decreases in cardiac energetics and increases in oxidative stress in microwave irradiation (MWI)-stressed mice. Conversely, cardiac-specific SIRT3 overexpression protected the hearts from these effects and rescued cardiac malfunction. Mechanistically, Sirt3 maintained AMP-activated protein kinase (AMPK) signaling pathway in MWI-stressed hearts in vivo. In conclusion, electromagnetic radiation repressed SIRT3 expression and disturbed cardiac energetics and redox homeostasis. The increased SIRT3 expression and AMPK activation in vivo prevented eRIC, indicating that SIRT3 will be a potential therapeutic target for curative interventions in eRIC.
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Affiliation(s)
- Tianhui Niu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Air Force Medical Center, PLA, Beijing, China
| | - Yan Zhi
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Lizhao Wei
- Department of Clinical Laboratory, Air Force Medical Center, PLA, Beijing, China
| | - Wenjun Liu
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Xiaoxiao Ju
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Weiping Pi
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Zhaojun Fu
- Department of Medical Appraisal, Air Force Medical Center, PLA, Beijing, China
| | - Hao Tong
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China
| | - Haixiang Hu
- Department of Andrology, Air Force Medical Center, PLA, Beijing, China.
| | - Jing Dong
- Department of Traditional Chinese Medicine, Air Force Medical Center, PLA, Beijing, China.
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Dawood T, Chen C, Sidhu BS, Ruijsink B, Gould J, Porter B, Elliott MK, Mehta V, Rinaldi CA, Puyol-Antón E, Razavi R, King AP. Uncertainty aware training to improve deep learning model calibration for classification of cardiac MR images. Med Image Anal 2023; 88:102861. [PMID: 37327613 PMCID: PMC10788705 DOI: 10.1016/j.media.2023.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
Quantifying uncertainty of predictions has been identified as one way to develop more trustworthy artificial intelligence (AI) models beyond conventional reporting of performance metrics. When considering their role in a clinical decision support setting, AI classification models should ideally avoid confident wrong predictions and maximise the confidence of correct predictions. Models that do this are said to be well calibrated with regard to confidence. However, relatively little attention has been paid to how to improve calibration when training these models, i.e. to make the training strategy uncertainty-aware. In this work we: (i) evaluate three novel uncertainty-aware training strategies with regard to a range of accuracy and calibration performance measures, comparing against two state-of-the-art approaches, (ii) quantify the data (aleatoric) and model (epistemic) uncertainty of all models and (iii) evaluate the impact of using a model calibration measure for model selection in uncertainty-aware training, in contrast to the normal accuracy-based measures. We perform our analysis using two different clinical applications: cardiac resynchronisation therapy (CRT) response prediction and coronary artery disease (CAD) diagnosis from cardiac magnetic resonance (CMR) images. The best-performing model in terms of both classification accuracy and the most common calibration measure, expected calibration error (ECE) was the Confidence Weight method, a novel approach that weights the loss of samples to explicitly penalise confident incorrect predictions. The method reduced the ECE by 17% for CRT response prediction and by 22% for CAD diagnosis when compared to a baseline classifier in which no uncertainty-aware strategy was included. In both applications, as well as reducing the ECE there was a slight increase in accuracy from 69% to 70% and 70% to 72% for CRT response prediction and CAD diagnosis respectively. However, our analysis showed a lack of consistency in terms of optimal models when using different calibration measures. This indicates the need for careful consideration of performance metrics when training and selecting models for complex high risk applications in healthcare.
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Affiliation(s)
- Tareen Dawood
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Chen Chen
- BioMedIA Group, Department of Computing, Imperial College London, UK
| | - Baldeep S Sidhu
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Bram Ruijsink
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Bradley Porter
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Guy's and St Thomas' Hospital, London, UK
| | - Esther Puyol-Antón
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Andrew P King
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
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Zhang TY, An DA, Zhou H, Ni Z, Wang Q, Chen B, Lu R, Huang J, Zhou Y, Kim DH, Wilson M, Wu LM, Mou S. Texture analysis of native T1 images as a novel method for non-invasive assessment of heart failure with preserved ejection fraction in end-stage renal disease patients. Eur Radiol 2023; 33:2027-2038. [PMID: 36260118 DOI: 10.1007/s00330-022-09177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore the diagnostic potential of texture analysis applied to native T1 maps obtained from cardiac magnetic resonance (CMR) images for the assessment of heart failure with preserved ejection fraction (HFpEF) among patients with end-stage renal disease (ESRD). METHODS This study, conducted from June 2018 to November 2020, included 119 patients (35 on hemodialysis, 55 on peritoneal dialysis, and 29 with kidney transplants) in Renji Hospital. Native T1 maps were assessed with texture analysis, using a freely available software package, in participants who underwent cardiac MRI at 3.0 T. Four texture features, selected by dimension reduction specific to the diagnosis of HFpEF, were analyzed. Multivariate logistic regression was performed to examine the independent association between the selected features and HFpEF in ESRD patients. RESULTS Seventy-six of 119 patients were diagnosed with HFpEF. Demographic, laboratory, cardiac MRI, and echocardiogram characteristics were compared between HFpEF and non-HFpEF groups. The four texture features that were analyzed showed statistically significant differences between groups. In multivariate analysis, age, left atrial volume index (LAVI), and sum average 4 (SA4) turned out to be independent predictors for HFpEF in ESRD patients. Combining the texture feature, SA4, with typical predictive factors resulted in higher C-index (0.923 vs. 0.898, p = 0.045) and a sensitivity and specificity of 79.2% and 95.2%, respectively. CONCLUSIONS Texture analysis of T1 maps adds diagnostic value to typical clinical parameters for the assessment of heart failure with preserved ejection fraction in patients with end-stage renal disease. KEY POINTS • Non-invasive assessment of HFpEF can help predict prognosis in ESRD patients and help them take timely preventative measures. • Texture analysis of native T1 maps adds diagnostic value to the typical clinical parameters for the assessment of HFpEF in patients with ESRD.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Hang Zhou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Qin Wang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Renhua Lu
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Jiaying Huang
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Yin Zhou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Doo Hee Kim
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Molly Wilson
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
| | - Shan Mou
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
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5
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Li Y(Y, Craft J, Cheng Y(J, Gliganic K, Schapiro W, Cao J(J. Left Ventricle Wall Motion Analysis with Real-Time MRI Feature Tracking in Heart Failure Patients: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12122946. [PMID: 36552955 PMCID: PMC9776889 DOI: 10.3390/diagnostics12122946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Volumetric measurements with cardiac magnetic resonance imaging (MRI) are effective for evaluating heart failure (HF) with systolic dysfunction that typically induces a lower ejection fraction (EF) than normal (<50%) while they are not sensitive to diastolic dysfunction in HF patients with preserved EF (≥50%). This work is to investigate whether HF evaluation with cardiac MRI can be improved with real-time MRI feature tracking. In a cardiac MRI study, we recruited 16 healthy volunteers, 8 HF patients with EF < 50% and 10 HF patients with preserved EF. Using real-time feature tracking, a cardiac MRI index, torsion correlation, was calculated which evaluated the correlation of torsional and radial wall motion in the left ventricle (LV) over a series of sequential cardiac cycles. The HF patients with preserved EF and the healthy volunteers presented significant difference in torsion correlation (one-way ANOVA, p < 0.001). In the scatter plots of EF against torsion correlation, the HF patients with EF < 50%, the HF patients with preserved EF and the healthy volunteers were well differentiated, indicating that real-time MRI feature tracking provided LV function assessment complementary to volumetric measurements. This study demonstrated the potential of cardiac MRI for evaluating both systolic and diastolic dysfunction in HF patients.
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Affiliation(s)
- Yu (Yulee) Li
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
- Biomedical Engineering, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
- Correspondence: ; Tel.: +1-516-629-2191
| | - Jason Craft
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
| | - Yang (Josh) Cheng
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
| | - Kathleen Gliganic
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
| | - William Schapiro
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
| | - Jie (Jane) Cao
- Cardiac Imaging, DeMatteis Center for Cardiac Research and Education, St. Fracis Hospital & Heart Center, Greenvale, NY 11548, USA
- Clinical Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
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Shen D, Pathrose A, Sarnari R, Blake A, Berhane H, Baraboo JJ, Carr JC, Markl M, Kim D. Automated segmentation of biventricular contours in tissue phase mapping using deep learning. NMR IN BIOMEDICINE 2021; 34:e4606. [PMID: 34476863 PMCID: PMC8795858 DOI: 10.1002/nbm.4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
Tissue phase mapping (TPM) is an MRI technique for quantification of regional biventricular myocardial velocities. Despite its potential, clinical use is limited due to the requisite labor-intensive manual segmentation of cardiac contours for all time frames. The purpose of this study was to develop a deep learning (DL) network for automated segmentation of TPM images, without significant loss in segmentation and myocardial velocity quantification accuracy compared with manual segmentation. We implemented a multi-channel 3D (three dimensional; 2D + time) dense U-Net that trained on magnitude and phase images and combined cross-entropy, Dice, and Hausdorff distance loss terms to improve the segmentation accuracy and suppress unnatural boundaries. The dense U-Net was trained and tested with 150 multi-slice, multi-phase TPM scans (114 scans for training, 36 for testing) from 99 heart transplant patients (44 females, 1-4 scans/patient), where the magnitude and velocity-encoded (Vx , Vy , Vz ) images were used as input and the corresponding manual segmentation masks were used as reference. The accuracy of DL segmentation was evaluated using quantitative metrics (Dice scores, Hausdorff distance) and linear regression and Bland-Altman analyses on the resulting peak radial and longitudinal velocities (Vr and Vz ). The mean segmentation time was about 2 h per patient for manual and 1.9 ± 0.3 s for DL. Our network produced good accuracy (median Dice = 0.85 for left ventricle (LV), 0.64 for right ventricle (RV), Hausdorff distance = 3.17 pixels) compared with manual segmentation. Peak Vr and Vz measured from manual and DL segmentations were strongly correlated (R ≥ 0.88) and in good agreement with manual analysis (mean difference and limits of agreement for Vz and Vr were -0.05 ± 0.98 cm/s and -0.06 ± 1.18 cm/s for LV, and -0.21 ± 2.33 cm/s and 0.46 ± 4.00 cm/s for RV, respectively). The proposed multi-channel 3D dense U-Net was capable of reducing the segmentation time by 3,600-fold, without significant loss in accuracy in tissue velocity measurements.
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Affiliation(s)
- Daming Shen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Allison Blake
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, USA
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Naresh NK, Misener S, Zhang Z, Yang C, Ruh A, Bertolino N, Epstein FH, Collins JD, Markl M, Procissi D, Carr JC, Allen BA. Cardiac MRI Myocardial Functional and Tissue Characterization Detects Early Cardiac Dysfunction in a Mouse Model of Chemotherapy-Induced Cardiotoxicity. NMR IN BIOMEDICINE 2020; 33:e4327. [PMID: 32567177 DOI: 10.1002/nbm.4327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Doxorubicin and doxorubicin-trastuzumab combination chemotherapy have been associated with cardiotoxicity that eventually leads to heart failure and may limit dose-effective cancer treatment. Current diagnostic strategies rely on decreased ejection fraction (EF) to diagnose cardiotoxicity. PURPOSE The aim of this study is to explore the potential of cardiac MR (CMR) imaging to identify imaging biomarkers in a mouse model of chemotherapy-induced cardiotoxicity. METHODS A cumulative dose of 25 mg/kg doxorubicin was administered over three weeks using subcutaneous pellets (n = 9, Dox). Another group (n = 9) received same dose of Dox and a total of 10 mg/kg trastuzumab (DT). Mice were imaged at baseline, 5/6 weeks and 10 weeks post-treatment on a 7T MRI system. The protocol included short-axis cine MRI covering the left ventricle (LV) and mid-ventricular short-axis tissue phase mapping (TPM), pre- and post-contrast T1 mapping, T2 mapping and Displacement Encoding with Stimulated Echoes (DENSE) strain encoded MRI. EF, peak myocardial velocities, native T1, T2, extracellular volume (ECV), and myocardial strain were quantified. N = 7 mice were sacrificed for histopathologic assessment of apoptosis at 5/6 weeks. RESULTS Global peak systolic longitudinal velocity was reduced at 5/6 weeks in Dox (0.6 ± 0.3 vs 0.9 ± 0.3, p = 0.02). In the Dox group, native T1 was reduced at 5/6 weeks (1.3 ± 0.2 ms vs 1.6 ± 0.2 ms, p = 0.02), and relatively normalized at week 10 (1.4 ± 0.1 ms vs 1.6 ± 0.2 ms, p > 0.99). There was no change in EF and other MRI parameters and histopathologic results demonstrated minimal apoptosis in all mice (~1-2 apoptotic cell/high power field), suggesting early-stage cardiotoxicity. CONCLUSIONS In a mouse model of chemotherapy-induced cardiotoxicity using doxorubicin and trastuzumab, advanced CMR shows promise in identifying treatment-related decrease in myocardial velocity and native T1 prior to the onset of cardiomyocyte apoptosis and reduction of EF.
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Affiliation(s)
- Nivedita K Naresh
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Sol Misener
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Zhouli Zhang
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Cynthia Yang
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Alexander Ruh
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Nicola Bertolino
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
- McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Daniele Procissi
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
| | - Bradley A Allen
- Department of Radiology, Northwestern University, 737 N. Michigan Ave, Chicago, IL, USA
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Kermer J, Traber J, Utz W, Hennig P, Menza M, Jung B, Greiser A, Barckow P, von Knobelsdorff-Brenkenhoff F, Töpper A, Blaszczyk E, Schulz-Menger J. Assessment of diastolic dysfunction: comparison of different cardiovascular magnetic resonance techniques. ESC Heart Fail 2020; 7:2637-2649. [PMID: 32686332 PMCID: PMC7524101 DOI: 10.1002/ehf2.12846] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023] Open
Abstract
Aims Heart failure with preserved ejection fraction is still a diagnostic and therapeutic challenge, and accurate non‐invasive diagnosis of left ventricular (LV) diastolic dysfunction (DD) remains difficult. The current study aimed at identifying the most informative cardiovascular magnetic resonance (CMR) parameters for the assessment of LVDD. Methods and results We prospectively included 50 patients and classified them into three groups: with DD (DD+, n = 15), without (DD−, n = 26), and uncertain (DD±, n = 9). Diagnosis of DD was based on echocardiographic E/E′, invasive LV end‐diastolic pressure, and N‐terminal pro‐brain natriuretic peptide. CMR was performed at 1.5 T to assess LV and left atrial (LA) morphology, LV diastolic strain rate (SR) by tissue tracking and tagging, myocardial peak velocities by tissue phase mapping, and transmitral inflow profile using phase contrast techniques. Statistics were performed only on definitive DD+ and DD− (total number 41). DD+ showed enlarged LA with LA end‐diastolic volume/height performing best to identify DD+ with a cut‐off value of ≥0.52 mL/cm (sensitivity = 0.71, specificity = 0.84, and area under the receiver operating characteristic curve = 0.75). DD+ showed significantly reduced radial (inferolateral E peak: DD−: −14.5 ± 6.5%/s vs. DD+: −10.9 ± 5.9%/s, P = 0.04; anterolateral A peak: DD−: −4.2 ± 1.6%/s vs. DD+: −3.1 ± 1.4%/s, P = 0.04) and circumferential (inferolateral A peak: DD−: 3.8 ± 1.2%/s vs. DD+: 2.8 ± 0.8%/s, P = 0.007; anterolateral A peak: DD−: 3.5 ± 1.2%/s vs. DD+: 2.5 ± 0.8%/s, P = 0.048) SR in the basal lateral wall assessed by tissue tracking. In the same segments, DD+ showed lower peak myocardial velocity by tissue phase mapping (inferolateral radial peak: DD−: −3.6 ± 0.7 ms vs. DD+: −2.8 ± 1.0 ms, P = 0.017; anterolateral longitudinal peak: DD−: −5.0 ± 1.8 ms vs. DD+: −3.4 ± 1.4 ms, P = 0.006). Tagging revealed reduced global longitudinal SR in DD+ (DD−: 45.8 ± 12.0%/s vs. DD+: 34.8 ± 9.2%/s, P = 0.022). Global circumferential and radial SR by tissue tracking and tagging, LV morphology, and transmitral flow did not differ between DD+ and DD−. Conclusions Left atrial size and regional quantitative myocardial deformation applying CMR identified best patients with DD.
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Affiliation(s)
- Josephine Kermer
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Julius Traber
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Wolfgang Utz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Pierre Hennig
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany
| | - Marius Menza
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Jung
- Institute of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, Bern, Switzerland
| | | | - Philipp Barckow
- Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada
| | - Florian von Knobelsdorff-Brenkenhoff
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany.,Department of Cardiology, Clinic Agatharied, Academic Teaching Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Agnieszka Töpper
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany.,Zentrum für Innere Medizin, Kardiologie, Angiologie und Notfallambulanz, Johanniter-Krankenhaus Genthin-Stendal, Akut- und Schwerpunktkrankenhaus, Akademisches Lehrkrankenhaus Otto-von-Guericke-Universität Magdeburg, Stendal, Germany
| | - Edyta Blaszczyk
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin, 13125, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology and Nephrology, HELIOS-Kliniken Berlin-Buch, Schwanebecker Chaussee 50, Berlin, 13125, Germany
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9
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Ferrazzi G, Bassenge JP, Mayer J, Ruh A, Roujol S, Ittermann B, Schaeffter T, Cordero-Grande L, Schmitter S. Autocalibrated cardiac tissue phase mapping with multiband imaging and k-t acceleration. Magn Reson Med 2020; 84:2429-2441. [PMID: 32306471 DOI: 10.1002/mrm.28288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/05/2020] [Accepted: 03/28/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop an autocalibrated multiband (MB) CAIPIRINHA acquisition scheme with in-plane k-t acceleration enabling multislice three-directional tissue phase mapping in one breath-hold. METHODS A k-t undersampling scheme was integrated into a time-resolved electrocardiographic-triggered autocalibrated MB gradient-echo sequence. The sequence was used to acquire data on 4 healthy volunteers with MB factors of two (MB2) and three (MB3), which were reconstructed using a joint reconstruction algorithm that tackles both k-t and MB acceleration. Forward simulations of the imaging process were used to tune the reconstruction model hyperparameters. Direct comparisons between MB and single-band tissue phase-mapping measurements were performed. RESULTS Simulations showed that the velocities could be accurately reproduced with MB2 k-t (average ± twice the SD of the RMS error of 0.08 ± 0.22 cm/s and velocity peak reduction of 1.03% ± 6.47% compared with fully sampled velocities), whereas acceptable results were obtained with MB3 k-t (RMS error of 0.13 ± 0.58 cm/s and peak reduction of 2.21% ± 13.45%). When applied to tissue phase-mapping data, the proposed technique allowed three-directional velocity encoding to be simultaneously acquired at two/three slices in a single breath-hold of 18 heartbeats. No statistically significant differences were detected between MB2/MB3 k-t and single-band k-t motion traces averaged over the myocardium. Regional differences were found, however, when using the American Heart Association model for segmentation. CONCLUSION An autocalibrated MB k-t acquisition/reconstruction framework is presented that allows three-directional velocity encoding of the myocardial velocities at multiple slices in one breath-hold.
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Affiliation(s)
- Giulio Ferrazzi
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Jean Pierre Bassenge
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Johannes Mayer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Alexander Ruh
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- FG Medizintechnik, Technische Universität Berlin, Berlin, Germany
| | - Lucilio Cordero-Grande
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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10
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Sarnari R, Blake AM, Ruh A, Abbasi MA, Pathrose A, Blaisdell J, Dolan RS, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Anderson AS, Yancy CW, Carr JC, Markl M. Evaluating Biventricular Myocardial Velocity and Interventricular Dyssynchrony in Adult Patients During the First Year After Heart Transplantation. J Magn Reson Imaging 2020; 52:920-929. [PMID: 32061045 DOI: 10.1002/jmri.27091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Magnetic resonance tissue phase mapping (TPM) measures three-directional myocardial velocities of the left and right ventricle (LV, RV). This noninvasive technique may supplement endomyocardial biopsy (EMB) in monitoring grafts post-heart transplantation (HTx). PURPOSE To assess biventricular myocardial velocity alterations in grafts and investigate the relationship between velocities and acute cellular rejection (ACR) episodes. STUDY TYPE Prospective. SUBJECTS Twenty-seven patients within 1 year post-HTx (49 ± 13 years, 19 M) and 18 age-matched controls (49 ± 15 years, 12 M). FIELD STRENGTH/SEQUENCE 1.5T, 2D balanced steady-state free precession, and TPM. ASSESSMENT Ventricular function: end-diastolic and end-systolic volumes, stroke volumes, ejection fraction (EF), and myocardial mass. TPM velocities: peak-systolic and peak-diastolic velocities, cardiac twist, and interventricular dyssynchrony. ACR rejection episodes: International Society for Heart and Lung Transplantation grading of EMB specimens. STATISTICAL TESTS The Lilliefors test for normality, unpaired t-tests, and Wilcoxon rank-sum tests for normally and nonnormally distributed data, respectively, were used, as well as multivariate regression for confounding variables and Pearson's correlation for associations between TPM velocities and global function. RESULTS Compared to controls, HTx patients demonstrated reduced biventricular systolic longitudinal velocities (LV: 5.2 ± 2.1 vs. 4.0 ± 1.5 cm/s, P < 0.05; RV: 4.2 ± 1.3 vs. 3.1 ± 1.2 cm/s, P < 0.01). Correlation analysis revealed significant positive relationships for biventricular EF with radial peak velocities of the same ventricle in both systole and diastole (LV systole: r = 0.48, P < 0.01; LV diastole: r = 0.28, P < 0.05; RV systole: r = 0.35, P < 0.01; RV diastole: r = 0.36, P < 0.01). Segmentally, longitudinal velocities were impaired in 7/16 LV segments and 5/10 RV segments in systole and 7/10 RV segments in diastole. TPM analysis in studies with >4 preceding ACR episodes showed globally reduced RV and LV systolic radial velocity, and segmentally reduced radial and longitudinal systolic velocities. DATA CONCLUSION Biventricular global and segmental velocities were reduced in HTx patients. Patients with >4 rejection episodes showed reduced myocardial velocities. The TPM sequence may add functional information for monitoring graft dysfunction. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:920-929.
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Affiliation(s)
- Roberto Sarnari
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison M Blake
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexander Ruh
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhannad A Abbasi
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan S Dolan
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane E Wilcox
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther E Vorovich
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan D Rich
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allen S Anderson
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Cardiovascular Imaging, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, USA
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11
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Altered regional myocardial velocities by tissue phase mapping and feature tracking in pediatric patients with hypertrophic cardiomyopathy. Pediatr Radiol 2020; 50:168-179. [PMID: 31659403 PMCID: PMC6982608 DOI: 10.1007/s00247-019-04549-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is associated with heart failure, atrial fibrillation and sudden death. Reduced myocardial function has been reported in HCM despite normal left ventricular (LV) ejection fraction. Additionally, LV fibrosis is associated with elevated T1 and might be an outcome predictor. OBJECTIVE To systematically compare tissue phase mapping and feature tracking for assessing regional LV function in children and young adults with HCM and pediatric controls, and to evaluate structure-function relationships among myocardial velocities, LV wall thickness and myocardial T1. MATERIALS AND METHODS Seventeen pediatric patients with HCM and 21 age-matched controls underwent cardiac MRI including standard cine imaging, tissue phase mapping (two-dimensional cine phase contrast with three-directional velocity encoding), and modified Look-Locker inversion recovery to calculate native global LV T1. Maximum LV wall thickness was measured on cine images. LV radial, circumferential and long-axis myocardial velocity time courses, as well as global and segmental systolic and diastolic peak velocities, were quantified from tissue phase mapping and feature tracking. RESULTS Both tissue phase mapping and feature tracking detected significantly decreased global and segmental diastolic radial and long-axis peak velocities (by 12-51%, P<0.001-0.05) in pediatric patients with HCM vs. controls. Feature tracking peak velocities were lower than directly measured tissue phase mapping velocities (mean bias = 0.3-2.9 cm/s). Diastolic global peak velocities correlated moderately with global T1 (r = -0.57 to -0.72, P<0.01) and maximum wall thickness (r = -0.37 to -0.61, P<0.05). CONCLUSION Both tissue phase mapping and feature tracking detected myocardial velocity changes in children and young adults with HCM vs. controls. Associations between impaired diastolic LV velocities and elevated T1 indicate structure-function relationships in HCM.
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12
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Abstract
OBJECTIVE. A spectrum of pathophysiologic mechanisms can lead to the development of myocardial disorders including ischemia, genetic abnormalities, and systemic disorders. Cardiac MRI identifies different myocardial disorders, provides prognostic information, and directs therapy. In comparison with other imaging modalities, cardiac MRI has the advantage of allowing both functional assessment and tissues characterization in a single examination without the use of ionizing radiation. Newer cardiac MRI techniques including mapping can provide additional information about myocardial disease that may not be detected using conventional techniques. Emerging techniques including MR spectroscopy and finger printing will likely change the way we understand the pathophysiology mechanisms of the wide array of myocardial disorders. CONCLUSION. Imaging of myocardial disorders encompasses a large variety of conditions including both ischemic and nonischemic diseases. Cardiac MRI sequences, such as balanced steady-state free precession and late gadolinium enhancement, play a critical role in establishing diagnosis, determining prognosis, and guiding therapeutic management. Additional sequences-including perfusion imaging, T2*, real-time cine, and T2-weighted sequences-should be performed in specific clinical scenarios. There is emerging evidence for the use of mapping in imaging of myocardial disease. Multiple other new techniques are currently being studied. These novel techniques will likely change the way myocardial disorders are understood and diagnosed in the near future.
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13
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Dolan RS, Rahsepar AA, Blaisdell J, Sarnari R, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Yancy CW, Anderson AS, Carr JC, Markl M. Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function. Radiol Cardiothorac Imaging 2019; 1:e190009. [PMID: 32076670 PMCID: PMC6939741 DOI: 10.1148/ryct.2019190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To use structure-function cardiac MRI in the evaluation of relationships between donor and heart transplantation (HTx) recipient characteristics and changes in cardiac tissue structure and function. HTx candidates and donor hearts are evaluated for donor-recipient matches to improve survival, but the impact of donor and recipient characteristics on changes in myocardial tissue and function in the transplanted heart is not fully understood. MATERIALS AND METHODS Cardiac MRI at 1.5 T was performed from August 2014 to June 2017 in 58 HTx recipients (mean age, 51.1 years ± 12.6 [standard deviation], 26 female patients) and included T2 mapping (to evaluate edematous and/or inflammatory changes), precontrast and postcontrast T1 mapping (allowing the calculation of extracellular volume fraction [ECV] to estimate interstitial expansion), and tissue phase mapping (allowing the calculation of myocardial velocities and twist). Donor and recipient demographics (age, sex, height, weight, and body mass index [BMI]) and comorbidities (hypertension, diabetes, and smoking history) were evaluated for relationships with cardiac MRI measures. RESULTS Sex-influenced cardiac MRI measures of myocardial tissue and function are as follows: Female HTx recipients demonstrated increased precontrast T1 (P = .002) and reduced systolic peak long-axis velocities (P = .015). Increased age of the donor heart was associated with elevated T2 (r = 0.32; P < .05) and ECV (r = 0.47; P < .01), indicating increased edema and interstitial expansion, as well as impaired diastolic peak long-axis velocities (r = 0.41; P < .01). Recipient-donor differences in age, weight, and BMI were significantly associated with elevated ECV (r = 0.36-0.48; P < .05). Hypertension in donors resulted in increased ECV (31.0% ± 4.2 vs 26.0% ± 3.3; P = .001). CONCLUSION Donor and HTx recipient characteristics were significantly associated with cardiac MRI-derived measures of myocardial tissue structure and function.© RSNA, 2019.
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Affiliation(s)
- Ryan S. Dolan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Amir A. Rahsepar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Julie Blaisdell
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Roberto Sarnari
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Kambiz Ghafourian
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jane E. Wilcox
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Sadiya S. Khan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Esther E. Vorovich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jonathan D. Rich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Clyde W. Yancy
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Allen S. Anderson
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - James C. Carr
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Michael Markl
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
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14
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Jeong D, Gladish G, Chitiboi T, Fradley MG, Gage KL, Schiebler ML. MRI in cardio-oncology: A review of cardiac complications in oncologic care. J Magn Reson Imaging 2019; 50:1349-1366. [PMID: 31448472 DOI: 10.1002/jmri.26895] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/17/2019] [Indexed: 12/23/2022] Open
Abstract
From detailed characterization of cardiac abnormalities to the assessment of cancer treatment-related cardiac dysfunction, cardiac MRI is playing a growing role in the evaluation of cardiac pathology in oncology patients. Current guidelines are now incorporating the use of MRI for the comprehensive multidisciplinary approach to cancer management, and innovative applications of MRI in research are expanding its potential to provide a powerful noninvasive tool in the arsenal against cancer. This review focuses on the application of cardiac MRI to diagnose and manage cardiovascular complications related to cancer and its treatment. Following an introduction to current cardiac MRI methods and principles, this review is divided into two sections: functional cardiovascular analysis and anatomical or tissue characterization related to cancer and cancer therapeutics. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;50:1349-1366.
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Affiliation(s)
- Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Gregory Gladish
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teodora Chitiboi
- Medical Imaging Technologies, Siemens Healthineers, Princeton, New Jersey, USA
| | - Michael G Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, Florida, USA
| | - Kenneth L Gage
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
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15
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Impact of age and cardiac disease on regional left and right ventricular myocardial motion in healthy controls and patients with repaired tetralogy of fallot. Int J Cardiovasc Imaging 2019; 35:1119-1132. [PMID: 30715669 DOI: 10.1007/s10554-019-01544-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022]
Abstract
The assessment of both left (LV) and right ventricular (RV) motion is important to understand the impact of heart disease on cardiac function. The MRI technique of tissue phase mapping (TPM) allows for the quantification of regional biventricular three-directional myocardial velocities. The goal of this study was to establish normal LV and RV velocity parameters across a wide range of pediatric to adult ages and to investigate the feasibility of TPM for detecting impaired regional biventricular function in patients with repaired tetralogy of Fallot (TOF). Thirty-six healthy controls (age = 1-75 years) and 12 TOF patients (age = 5-23 years) underwent cardiac MRI including TPM in short-axis locations (base, mid, apex). For ten adults, a second TPM scan was used to assess test-retest reproducibility. Data analysis included the calculation of biventricular radial, circumferential, and long-axis velocity components, quantification of systolic and diastolic peak velocities in an extended 16 + 10 LV + RV segment model, and assessment of inter-ventricular dyssynchrony. Biventricular velocities showed good test-retest reproducibility (mean bias ≤ 0.23 cm/s). Diastolic radial and long-axis peak velocities for LV and RV were significantly reduced in adults compared to children (19-61%, p < 0.001-0.02). In TOF patients, TPM identified significantly reduced systolic and diastolic LV and RV long-axis peak velocities (20-50%, p < 0.001-0.05) compared to age-matched controls. In conclusion, tissue phase mapping enables comprehensive analysis of global and regional biventricular myocardial motion. Changes in myocardial velocities associated with age underline the importance of age-matched controls. This pilot study in TOF patients shows the feasibility to detect regionally abnormal LV and RV motion.
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16
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Magrath P, Maforo N, Renella P, Nelson SF, Halnon N, Ennis DB. Cardiac MRI biomarkers for Duchenne muscular dystrophy. Biomark Med 2018; 12:1271-1289. [PMID: 30499689 PMCID: PMC6462870 DOI: 10.2217/bmm-2018-0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a fatal inherited genetic disorder that results in progressive muscle weakness and ultimately loss of ambulation, respiratory failure and heart failure. Cardiac MRI (MRI) plays an increasingly important role in the diagnosis and clinical care of boys with DMD and associated cardiomyopathies. Conventional cardiac MRI biomarkers permit measurements of global cardiac function and presence of fibrosis, but changes in these measures are late manifestations. Emerging MRI biomarkers of myocardial function and structure include the estimation of rotational mechanics and regional strain using MRI tagging; T1-mapping; and T2-mapping, a marker of inflammation, edema and fat. These emerging biomarkers provide earlier insights into cardiac involvement in DMD, improving patient care and aiding the evaluation of emerging therapies.
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Affiliation(s)
- Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Nyasha Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, Department of Human Genetics, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, University of California, Los Angeles, CA 90024, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
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17
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Ferrazzi G, Bassenge JP, Wink C, Ruh A, Markl M, Moeller S, Metzger GJ, Ittermann B, Schmitter S. Autocalibrated multiband CAIPIRINHA with through‐time encoding: Proof of principle and application to cardiac tissue phase mapping. Magn Reson Med 2018; 81:1016-1030. [DOI: 10.1002/mrm.27460] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Giulio Ferrazzi
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
| | - Jean Pierre Bassenge
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max‐Delbrueck Center for Molecular Medicine
| | - Clarissa Wink
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
| | - Alexander Ruh
- Department of Radiology, Feinberg School of Medicine Northwestern University Chicago Illinois
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine Northwestern University Chicago Illinois
- Department of Biomedical Engineering, McCormick School of Engineering Northwestern University Chicago Illinois
| | - Steen Moeller
- University of Minnesota, Center for Magnetic Resonance Research (CMRR) Minneapolis Minnesota
| | - Gregory J. Metzger
- University of Minnesota, Center for Magnetic Resonance Research (CMRR) Minneapolis Minnesota
| | - Bernd Ittermann
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
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18
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Dolan RS, Rahsepar AA, Blaisdell J, Lin K, Suwa K, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Anderson AS, Yancy CW, Collins JD, Markl M, Carr JC. Cardiac Structure-Function MRI in Patients After Heart Transplantation. J Magn Reson Imaging 2018; 49:678-687. [PMID: 30142237 DOI: 10.1002/jmri.26275] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. PURPOSE To test the feasibility of comprehensive structure-function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. STUDY TYPE Prospective. SUBJECTS MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). FIELD STRENGTH/SEQUENCE 1.5T; 2D CINE steady state free precession (SSF)P imaging, T2 -mapping, pre- and postgadolinium contrast T1 -mapping, and tissue-phase mapping (TPM). ASSESSMENT Quantification of myocardial T2 (as a measure of edema), pre- and post-Gd T1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. STATISTICAL TESTS Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T2 , T1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. RESULTS T2 and T1 were significantly elevated in transplant recipients compared to controls (global T2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T2 (global r = -0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T2 and peak T1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). DATA CONCLUSION MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T2 , T1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure-function relationship of cardiac abnormalities following heart transplant. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:678-687.
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Affiliation(s)
- Ryan S Dolan
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amir A Rahsepar
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kai Lin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kenichiro Suwa
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jane E Wilcox
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Sadiya S Khan
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Esther E Vorovich
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jonathan D Rich
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Allen S Anderson
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Clyde W Yancy
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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19
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Tong X, Poon J, Li A, Kit C, Yamada A, Shiino K, Ling LF, Choe YH, Chan J, Lau YK, Ng MY. Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RV function: a comparative study to echocardiography. Clin Radiol 2017; 73:324.e9-324.e18. [PMID: 29195659 DOI: 10.1016/j.crad.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
AIM To investigate the accuracy of cardiac magnetic resonance (CMR) tissue tracking (CMR-TT) and speckle tracking echocardiography (STE) against CMR determined right ventricular (RV) ejection fraction (RVEF) and to identify an optimal cut-off value for STE and CMR-TT to determine RVEF <45% and compare this to other conventional methods for estimating RVEF in dilated cardiomyopathy (DCM) patients. MATERIALS AND METHODS Twenty-nine DCM patients were recruited prospectively. CMR and echocardiography were performed within 48 hours and four-chamber views were used for strain analysis. Contoured CMR short axis images provided RVEF. Intraclass correlation coefficient (ICC), bias, levels of agreement, and receiver operating characteristic (ROC) curve analyses were performed. RESULTS CMR-TT RV free-wall longitudinal strain (FLS) and STE RV global longitudinal strain (GLS) showed the best correlation with RVEF (r=-0.68, r=-0.82, p<0.001 respectively). There was moderate correlation between echocardiography RV GLS and CMR RV FLS (r=0.64, p<0.001). CMR-TT FLS showed excellent intra-observer and interobserver reliability (ICC=0.980; ICC=0.968 respectively). STE GLS correlated better with RVEF than with peak systolic annular velocity (S'; r=0.45), tricuspid annular plane systolic excursion (TAPSE; r=0.56), and fractional area change (FAC; r=0.78). CMR-TT RV FLS had better correlation with RVEF than CMR TAPSE (r=0.69 versus 0.40). ROC analysis demonstrated the optimal cut-off value for CMR-TT RV FLS and STE GLS in detection of RVEF <45% was ≥-24.4% (area under the curve=0.87, 100% sensitivity, 66.7% specificity) and ≥-20.9% (area under the curve=0.88, 100% sensitivity, 60% specificity) respectively. CONCLUSION CMR-TT FLS and STE GLS showed potential to provide rapid assessment of RV function and had superior correlation with RVEF compared to conventional parameters.
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Affiliation(s)
- X Tong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | - J Poon
- Department of Medicine and Cardiology, Ruttonjee and Tang Siu Kin Hospitals, Hong Kong
| | - A Li
- Department of Medicine, United Christian Hospital, Hong Kong
| | - C Kit
- Department of Medicine and Cardiology, Ruttonjee and Tang Siu Kin Hospitals, Hong Kong
| | - A Yamada
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - K Shiino
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - L F Ling
- Department of Cardiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
| | - Y H Choe
- Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J Chan
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Y-K Lau
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - M-Y Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong.
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20
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Menza M, Föll D, Hennig J, Jung B. Segmental biventricular analysis of myocardial function using high temporal and spatial resolution tissue phase mapping. MAGMA (NEW YORK, N.Y.) 2017; 31:61-73. [PMID: 29143137 DOI: 10.1007/s10334-017-0661-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Myocardial dysfunction of the right ventricle (RV) is an important indicator of RV diseases, e.g. RV infarction or pulmonary hypertension. Tissue phase mapping (TPM) has been widely used to determine function of the left ventricle (LV) by analyzing myocardial velocities. The analysis of RV motion is more complicated due to the different geometry and smaller wall thickness. The aim of this work was to adapt and optimize TPM to the demands of the RV. MATERIALS AND METHODS TPM measurements were acquired in 25 healthy volunteers using a velocity-encoded phase-contrast sequence and kt-accelerated parallel imaging in combination with optimized navigator strategy and blood saturation. Post processing was extended by a 10-segment RV model and a detailed biventricular analysis of myocardial velocities was performed. RESULTS High spatio-temporal resolution (1.0 × 1.0 × 6 mm3, 21.3 ms) and the optimized blood saturation enabled good delineation of the RV and its velocities. Global and segmental velocities, as well as time to peak velocities showed significant differences between the LV and RV. Furthermore, complex timing of the RV could be demonstrated by segmental time to peak analysis. CONCLUSION High spatio-temporal resolution TPM enables a detailed biventricular analysis of myocardial motion and might provide a reliable tool for description and detection of diseases affecting left and right ventricular function.
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Affiliation(s)
- Marius Menza
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 60a, 79106, Freiburg, Germany.
| | - Daniela Föll
- Department of Cardiology and Angiology I, Heart Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 60a, 79106, Freiburg, Germany
| | - Bernd Jung
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland
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21
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Roberts TA, Price AN, Jackson LH, Taylor V, David AL, Lythgoe MF, Stuckey DJ. Direct comparison of high-temporal-resolution CINE MRI with Doppler ultrasound for assessment of diastolic dysfunction in mice. NMR IN BIOMEDICINE 2017; 30:e3763. [PMID: 28643891 PMCID: PMC5638074 DOI: 10.1002/nbm.3763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 08/24/2023]
Abstract
Diastolic dysfunction is a sensitive early indicator of heart failure and can provide additional data to conventional measures of systolic function. Transmitral Doppler ultrasound, which measures the one-dimensional flow of blood through the mitral valve, is currently the preferred method for the measurement of diastolic function, but the measurement of the left ventricular volume changes using high-temporal-resolution cinematic magnetic resonance imaging (CINE MRI) is an alternative approach which is emerging as a potentially more robust and user-independent technique. Here, we investigated the performance of high-temporal-resolution CINE MRI and compared it with ultrasound for the detection of diastolic dysfunction in a mouse model of myocardial infarction. An in-house, high-temporal-resolution, retrospectively gated CINE sequence was developed with a temporal resolution of 1 ms. Diastolic function in mice was assessed using a custom-made, open-source reconstruction package. Early (E) and late (A) left ventricular filling phases were easily identifiable, and these measurements were compared directly with high-frequency, pulsed-wave, Doppler ultrasound measurements of mitral valve inflow. A repeatability study established that high-temporal-resolution CINE MRI and Doppler ultrasound showed comparable accuracy when measuring E/A in normal control mice. However, when applied in a mouse model of myocardial infarction, high-temporal-resolution CINE MRI indicated diastolic heart failure (E/A = 0.94 ± 0.11), whereas ultrasound falsely detected normal cardiac function (E/A = 1.21 ± 0.11). The addition of high-temporal-resolution CINE MRI to preclinical imaging studies enhances the library of sequences available to cardiac researchers and potentially identifies diastolic heart failure early in disease progression.
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Affiliation(s)
- Thomas A. Roberts
- Centre for Advanced Biomedical ImagingUniversity College LondonLondonUK
| | - Anthony N. Price
- Division of Imaging Sciences and Biomedical EngineeringKing's College LondonLondonUK
| | | | - Valerie Taylor
- Centre for Advanced Biomedical ImagingUniversity College LondonLondonUK
| | - Anna L. David
- Institute for Women's HealthUniversity College LondonLondonUK
| | - Mark F. Lythgoe
- Centre for Advanced Biomedical ImagingUniversity College LondonLondonUK
| | - Daniel J. Stuckey
- Centre for Advanced Biomedical ImagingUniversity College LondonLondonUK
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22
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Chang MC, Wu MT, Weng KP, Su MY, Menza M, Huang HC, Peng HH. Left ventricular regional myocardial motion and twist function in repaired tetralogy of Fallot evaluated by magnetic resonance tissue phase mapping. Eur Radiol 2017; 28:104-114. [PMID: 28677054 DOI: 10.1007/s00330-017-4908-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/20/2017] [Accepted: 05/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to characterise regional myocardial motion and twist function in the left ventricles (LV) in patients with repaired tetralogy of Fallot (rTOF) and preserved LV global function. METHODS We recruited 47 rTOF patients and 38 age-matched normal volunteers. Tissue phase mapping (TPM) was performed for evaluating the LV myocardial velocity in longitudinal, radial, and circumferential (Vz, Vr, and VØ) directions in basal, middle, and apical slices. The VØ peak-to-peak (PTP) during systolic phases, the rotation angle of each slice, and VØ inconsistency were computed for evaluating LV twist function and VØ dyssynchrony. RESULTS As compared to the controls, the rTOF patients presented decreased RV ejection fraction (RVEF) (p = 0.002) and preserved global LV ejection fraction (LVEF). They also demonstrated decreased systolic and diastolic Vz in several LV segments and higher diastolic Vr in the septum (all p < 0.05). A lower VØ PTP, higher VØ inconsistency, and reduced peak net rotation angle (all p < 0.05) were observed. The aforementioned indices demonstrated an altered LV twist function in rTOF patients in an early disease stage. CONCLUSIONS MR TPM could provide information about early abnormalities of LV regional motion and twist function in rTOF patients with preserved LV global function. KEY POINTS • Patients with rTOF presented significantly reduced systolic and diastolic Vz in the LV. • rTOF patients demonstrated significantly increased diastolic Vr in the septum. • Abnormal characteristics of the segmental dynamic velocity evolution were shown in rTOF. • rTOF patients presented altered circumferential rotation and velocity inconsistency in early stage.
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Affiliation(s)
- Meng-Chu Chang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No.101, Sec. 2, Kuang-Fu Rd., BMES Building, R415, Hsinchu, 300, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ken-Pen Weng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Marius Menza
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hung-Chieh Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No.101, Sec. 2, Kuang-Fu Rd., BMES Building, R415, Hsinchu, 300, Taiwan.
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23
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Dressler FF, Bodi I, Menza M, Moss R, Bugger H, Bode C, Behrends JC, Seemann G, Odening KE. Interregional electro-mechanical heterogeneity in the rabbit myocardium. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:344-355. [PMID: 28655649 DOI: 10.1016/j.pbiomolbio.2017.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increased electrical heterogeneity has been causatively linked to arrhythmic disorders, yet the knowledge about physiological heterogeneity remains incomplete. This study investigates regional electro-mechanical heterogeneities in rabbits, one of the key animal models for arrhythmic disorders. METHODS AND FINDINGS 7 wild-type rabbits were examined by phase-contrast magnetic resonance imaging in vivo to assess cardiac wall movement velocities. Using a novel data-processing algorithm regional contraction-like profiles were calculated. Contraction started earlier and was longer in left ventricular (LV) apex than base. Patch clamp recordings showed longer action potentials (AP) in LV apex compared to the base of LV, septum, and right ventricle. Western blots of cardiac ion channels and calcium handling proteins showed lower expression of Cav1.2, KvLQT1, Kv1.4, NCX and Phospholamban in LV apex vs. base. A single-cell in silico model integrating the quantitative regional differences in ion channels reproduced a longer contraction and longer AP in apex vs. base. CONCLUSIONS Apico-basal electro-mechanical heterogeneity is physiologically present in the healthy rabbit heart. An apico-basal electro-mechanical gradient exists with longer APD and contraction duration in the apex and associated regionally heterogeneous expression of five key proteins. This pattern of apical mechanical dominance probably serves to increase pumping efficiency.
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Affiliation(s)
- Franz F Dressler
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Ilona Bodi
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Marius Menza
- Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Department of Medical Physics, Medical Center - University of Freiburg, Breisacher Straße 60a, 79106 Freiburg, Germany
| | - Robin Moss
- Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Kaiserstrasse 12, 76128 Karlsruhe, Germany; Institute for Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Medical Center - University of Freiburg, Elsaesserstrasse 2q, 79110 Freiburg, Germany
| | - Heiko Bugger
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Jan C Behrends
- Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Department of Physiology, Laboratory for Membrane Physiology and -Technology, University of Freiburg, Hermann-Herder-Strasse 7, 79104 Freiburg, Germany
| | - Gunnar Seemann
- Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Kaiserstrasse 12, 76128 Karlsruhe, Germany; Institute for Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Medical Center - University of Freiburg, Elsaesserstrasse 2q, 79110 Freiburg, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany; Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany; Institute for Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Medical Center - University of Freiburg, Elsaesserstrasse 2q, 79110 Freiburg, Germany.
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24
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Meyer C, Felblinger J, Vuissoz PA, Bonnemains L. Accuracy of subject-specific prediction of end-systolic time in MRI across a range of RR intervals. PLoS One 2017; 12:e0179011. [PMID: 28598980 PMCID: PMC5466307 DOI: 10.1371/journal.pone.0179011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/23/2017] [Indexed: 11/18/2022] Open
Abstract
Background Prediction of End-Systole time is of utmost importance for cardiac MRI to correctly associate acquired k-space lines during reconstruction of cine acquisitions. This prediction is usually based on the patient’s heart rate using Weissler’s formula, which was calibrated by linear regression within a population and cannot account for individual variability. Objective We propose an automatic method to build a personalized model that better predicts end-systole. Methods A phase contrast sequence was modified to acquire only central k-space line with 6.6ms temporal resolution, in a slice passing through the aorta during 128 heartbeats in 35 subjects. Segmentation of aorta and detection of end of systolic ejection was automatic. Duration of electromechanical systole duration as function of heart rate was determined for each subject separately. Results In comparison with the global models, the adapted cardiac model predicted significantly better both echocardiographic end-systolic reference (bias = 0ms vs 17ms, p<0.001) and MRI measurements (bias = 6.8ms vs 17ms). Favorable impact was shown on the cine reconstruction of the 5 subjects with the higher cardiac variability (p = 0.02). Conclusions Personalization of cardiac model to the subject is feasible in MRI and reduces the error of prediction of systole.
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Affiliation(s)
- Christophe Meyer
- U947, INSERM, Nancy, France
- IADI, University of Loraine, Nancy, France
| | - Jacques Felblinger
- U947, INSERM, Nancy, France
- IADI, University of Loraine, Nancy, France
- Clinical Investigation Center (CIC-IT 1433), CHU Nancy, Nancy, France
| | | | - Laurent Bonnemains
- U947, INSERM, Nancy, France
- Department of Cardiac Surgery, CHU Strasbourg, Strasbourg, France
- University of Strasbourg, Strasbourg, France
- * E-mail:
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25
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Carlsson Å, Sohlin MC, Lagerstrand KM, Aronsson EF, Ljungberg M. The influence of cardiac triggering time and an optimization strategy for improved cardiac MR spectroscopy. Z Med Phys 2017; 27:310-317. [PMID: 28554547 DOI: 10.1016/j.zemedi.2017.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE To study how cardiac motion affects the spectral quality in cardiac MR spectroscopy and to establish an optimization strategy for the cardiac triggering time for improved quality and success rate of cardiac MRS. METHOD Water spectra were acquired while the cardiac triggering time was varied over the cardiac cycle, and five different spectral quality parameters were studied (frequency, phase, linewidth, amplitude and noise). Furthermore, three different optimization strategies for the cardiac triggering time were tested, and finally, a comparison was made between water suppressed lipid spectra acquired in systole and diastole. RESULTS The cardiac triggering time had a high impact on the spectral quality, especially on the mean signal amplitude and the standard deviation of the signal amplitude, phase and linewidth. Generally, the highest spectral quality was observed for spectra acquired in mid to end systole, at approximately 23% of the cardiac cycle. The exact optimal triggering time differed between subjects and needed to be individually optimized. To optimize the triggering time with our proposed MRS-method gave in average 13% higher signal than when the triggering time was determined through imaging. Lipid spectra acquired in systole demonstrated higher quality with improved SNR compared with acquisitions made in diastole. CONCLUSION This study shows that the spectral quality in cardiac MRS is strongly dependent on the cardiac triggering time, and that the spectral quality as well as the repeatability between acquisitions is greatly improved when the cardiac triggering time is individually optimized in mid to end systole using MRS.
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Affiliation(s)
- Åsa Carlsson
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiation Physics, Gothenburg University, Gothenburg, Sweden.
| | - Maja C Sohlin
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiation Physics, Gothenburg University, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiation Physics, Gothenburg University, Gothenburg, Sweden
| | - Eva Forsell Aronsson
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiation Physics, Gothenburg University, Gothenburg, Sweden
| | - Maria Ljungberg
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiation Physics, Gothenburg University, Gothenburg, Sweden
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Brado J, Dechant MJ, Menza M, Komancsek A, Lang CN, Bugger H, Foell D, Jung BA, Stiller B, Bode C, Odening KE. Phase-contrast magnet resonance imaging reveals regional, transmural, and base-to-apex dispersion of mechanical dysfunction in patients with long QT syndrome. Heart Rhythm 2017; 14:1388-1397. [PMID: 28479515 DOI: 10.1016/j.hrthm.2017.04.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Regional dispersion of prolonged repolarization is a hallmark of long QT syndrome (LQTS). We have also revealed regional heterogeneities in mechanical dysfunction in transgenic rabbit models of LQTS. OBJECTIVE In this clinical pilot study, we investigated whether patients with LQTS exhibit dispersion of mechanical/diastolic dysfunction. METHODS Nine pediatric patients with genotyped LQTS (12.2 ± 3.3 years) and 9 age- and sex-matched healthy controls (10.6 ± 1.5 years) were subjected to phase-contrast magnetic resonance imaging to analyze radial (Vr) and longitudinal (Vz) myocardial velocities during systole and diastole in the left ventricle (LV) base, mid, and apex. Twelve-lead electrocardiograms were recorded to assess the heart rate-corrected QT (QTc) interval. RESULTS The QTc interval was longer in patients with LQTS than in controls (469.1 ± 39.4 ms vs 417.8 ± 24.4 ms; P < .01). Patients with LQTS demonstrated prolonged radial and longitudinal time-to-diastolic peak velocities (TTP), a marker for prolonged contraction duration, in the LV base, mid, and apex. The longer QTc interval positively correlated with longer time-to-diastolic peak velocities (correlation coefficient 0.63; P < .01). Peak diastolic velocities were reduced in LQTS in the LV mid and apex, indicating impaired diastolic relaxation. In patients with LQTS, regional (TTPmax-min) and transmural (TTPVz-Vr) dispersion of contraction duration was increased in the LV apex (TTPVz_max-min: 38.9 ± 25.5 ms vs 20.2 ± 14.7 ms; P = .07; TTPVz-Vr: -21.7 ± 14.5 ms vs -8.7 ± 11.3 ms; P < .05). The base-to-apex longitudinal relaxation sequence was reversed in patients with LQTS compared with controls (TTPVz_base-apex: 14.4 ± 14.9 ms vs -10.1 ± 12.7 ms; P < .01). CONCLUSION Patients with LQTS exhibit diastolic dysfunction with reduced diastolic velocities and prolonged contraction duration. Mechanical dispersion is increased in LQTS with an increased regional and transmural dispersion of contraction duration and altered apicobasal longitudinal relaxation sequence. LQTS is an electromechanical disorder, and phase-contrast magnetic resonance imaging Heterogeneity in mechanical dysfunction enables a detailed assessment of mechanical consequences of LQTS.
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Affiliation(s)
- Johannes Brado
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus J Dechant
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Marius Menza
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Adriana Komancsek
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Medical Physics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Corinna N Lang
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Bugger
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Foell
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd A Jung
- Department of Diagnostic and Pediatric Radiology, University Hospital of Bern, Bern, Switzerland
| | - Brigitte Stiller
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Cardiology, Heart Center, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for Experimental Cardiovascular Medicine, Heart Center, University of Freiburg, Freiburg, Germany.
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Chitiboi T, Axel L. Magnetic resonance imaging of myocardial strain: A review of current approaches. J Magn Reson Imaging 2017; 46:1263-1280. [PMID: 28471530 DOI: 10.1002/jmri.25718] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/14/2017] [Indexed: 11/07/2022] Open
Abstract
Contraction of the heart is central to its purpose of pumping blood around the body. While simple global function measures (such as the ejection fraction) are most commonly used in the clinical assessment of cardiac function, MRI also provides a range of approaches for quantitatively characterizing regional cardiac function, including the local deformation (or strain) within the heart wall. While they have been around for some years, these methods are still undergoing further technical development, and they have had relatively little clinical evaluation. However, they can provide potentially useful new ways to assess cardiac function, which may be able to contribute to better classification and treatment of heart disease. This article provides some basic background on the physical and physiological factors that determine the motion of the heart, in health and disease and then reviews some of the ways that MRI methods are being developed to image and quantify strain within the myocardium. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1263-1280.
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Affiliation(s)
- Teodora Chitiboi
- NYU School of Medicine, Department of Radiology, New York, New York, USA
| | - Leon Axel
- NYU School of Medicine, Department of Radiology, New York, New York, USA
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Reproducibility and observer variability of tissue phase mapping for the quantification of regional myocardial velocities. Int J Cardiovasc Imaging 2016; 32:1227-34. [PMID: 27116238 DOI: 10.1007/s10554-016-0894-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
To systematically investigate the reproducibility of global and segmental left ventricular (LV) velocities derived from tissue phase mapping (TPM). Breath held and ECG synchronized TPM data (spatial/temporal resolution = 2 × 2 mm(2)/20.8 ms) were acquired in 18 healthy volunteers. To analyze scan-rescan variability, TPM was repeated in all subjects during a second visit separated by 16 ± 5 days. Data analysis included LV segmentation, and quantification of global and regional (AHA 16-segment modal) metrics of LV function [velocity-time curves, systolic and diastolic peak and time-to-peak (TTP) velocities] for radial (Vr), long-axis (Vz) and circumferential (VΦ) LV velocities. Mean velocity time curves in basal, mid-ventricular, and apical locations showed highly similar LV motion patterns for all three velocity components (Vr, VΦ, Vz) for scan and rescan. No significant differences for both systolic and diastolic peak and TTP myocardial velocities were observed. Segmental analysis revealed similar regional peak Vr and Vz during both systole and diastole except for three LV segments (p = 0.045, p = 0.033, and p = 0.009). Excellent (p < 0.001) correlations between scans and rescan for peak Vr (R(2) = 0.92), peak Vz (R(2) = 0.90), radial TTP (R(2) = 0.91) and long-axis TTP (R(2) = 0.88) confirmed good agreement. Bland-Altman analysis demonstrated excellent intra-observer and good inter-observer analysis agreement but increased variability for long axis peak velocities. TPM based analysis of global and regional myocardial velocities can be performed with good reproducibility. Robustness of regional quantification of long-axis velocities was limited but spatial velocity distributions across the LV could reliably be replicated.
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Chitiboi T, Schnell S, Collins J, Carr J, Chowdhary V, Honarmand AR, Hennemuth A, Linsen L, Hahn HK, Markl M. Analyzing myocardial torsion based on tissue phase mapping cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2016; 18:15. [PMID: 27062364 PMCID: PMC4826723 DOI: 10.1186/s12968-016-0234-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this work is to analyze differences in left ventricular torsion between volunteers and patients with non-ischemic cardiomyopathy based on tissue phase mapping (TPM) cardiovascular magnetic resonance (CMR). METHODS TPM was performed on 27 patients with non-ischemic cardiomyopathy and 14 normal volunteers. Patients underwent a standard CMR including late gadolinium enhancement (LGE) for the assessment of myocardial scar and ECG-gated cine CMR for global cardiac function. TPM was acquired in short-axis orientation at base, mid, and apex for all subjects. After evaluation by experienced observers, the patients were divided in subgroups according to the presence or absence of LGE (LGE+/LGE-), local wall motion abnormalities (WM+/WM-), and having a preserved (≥50%) or reduced (<50%) ejection fraction (EF+/EF-). TPM data was semi-automatically segmented and global LV torsion was computed for each cardiac time frame for endocardial and epicardial layers, and for the entire myocardium. RESULTS Maximum myocardial torsion was significantly lower for patients with reduced EF compared to controls (0.21 ± 0.15°/mm vs. 0.36 ± 0.11°/mm, p = 0.018), but also for patients with wall motion abnormalities (0.21 ± 0.13°/mm vs. 0.36 ± 0.11°/mm, p = 0.004). Global myocardial torsion showed a positive correlation (r = 0.54, p < 0.001) with EF. Moreover, endocardial torsion was significantly higher than epicardial torsion for EF+ subjects (0.56 ± 0.33°/mm vs. 0.34 ± 0.18°/mm, p = 0.039) and for volunteers (0.46 ± 0.16°/mm vs. 0.30 ± 0.09°/mm, p = 0.004). The difference in maximum torsion between endo- and epicardial layers was positively correlated with EF (r = 0.47, p = 0.002) and age (r = 0.37, p = 0.016) for all subjects. CONCLUSIONS TPM can be used to detect significant differences in LV torsion in patients with reduced EF and in the presence of local wall motion abnormalities. We were able to quantify torsion differences between the endocardium and epicardium, which vary between patient subgroups and are correlated to age and EF.
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Affiliation(s)
- Teodora Chitiboi
- />Jacobs University Bremen, Bremen, Germany
- />Fraunhofer MEVIS, Bremen, Germany
| | - Susanne Schnell
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - Jeremy Collins
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - James Carr
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | - Varun Chowdhary
- />Department of Radiology, Northwestern University, Chicago, IL USA
| | | | | | | | - Horst K. Hahn
- />Jacobs University Bremen, Bremen, Germany
- />Fraunhofer MEVIS, Bremen, Germany
| | - Michael Markl
- />Department of Radiology, Northwestern University, Chicago, IL USA
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Knight DS, Steeden JA, Moledina S, Jones A, Coghlan JG, Muthurangu V. Left ventricular diastolic dysfunction in pulmonary hypertension predicts functional capacity and clinical worsening: a tissue phase mapping study. J Cardiovasc Magn Reson 2015; 17:116. [PMID: 26715551 PMCID: PMC4696235 DOI: 10.1186/s12968-015-0220-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The function of the right and left ventricles is intimately related through a shared septum and pericardium. Therefore, right ventricular (RV) disease in pulmonary hypertension (PH) can result in abnormal left ventricular (LV) myocardial mechanics. To assess this, we implemented novel cardiovascular magnetic resonance (CMR) tissue phase mapping (TPM) to assess radial, longitudinal and tangential LV myocardial velocities in patients with PH. METHODS Respiratory self-gated TPM was performed using a rotating golden-angle spiral acquisition with retrospective cardiac gating. TPM of a mid ventricular slice was acquired in 40 PH patients and 20 age- and sex-matched healthy controls. Endocardial and epicardial LV borders were manually defined, and myocardial velocities calculated using in-house software. Patients without proximal CTEPH (chronic thromboembolic PH) and not receiving intravenous prostacyclin therapy (n = 34) were followed up until the primary outcome of disease progression (death, transplantation, or progression to intravenous therapy) or the end of the study. Physicians who determined disease progression were blinded to CMR data. Conventional ventricular volumetric indices and novel TPM metrics were analyzed for prediction of 6-min walk distance (6MWD) and disease progression. RESULTS Peak longitudinal (p < 0.0001) and radial (p = 0.001) early diastolic (E) wave velocities were significantly lower in PH patients compared with healthy volunteers. Reversal of tangential E waves was observed in all patients and was highly discriminative for the presence of PH (p < 0.0001). The global radial E wave (β = 0.41, p = 0.017) and lateral wall radial systolic (S) wave velocities (β = 0.33, p = 0.028) were the only independent predictors of 6MWD in a model including RV ejection fraction (RVEF) and LV stroke volume. Over a median follow-up period of 20 months (IQR 7.9 months), 8 patients commenced intravenous therapy and 1 died. Global longitudinal E wave was the only independent predictor of clinical worsening (6.3× increased risk, p = 0.009) in a model including RVEF and septal curvature. CONCLUSIONS TPM metrics of LV diastolic function are significantly abnormal in PH. More importantly, abnormal LV E wave velocities are the only independent predictors of functional capacity and clinical worsening in a model that includes conventional metrics of biventricular function.
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MESH Headings
- Adult
- Biomechanical Phenomena
- Case-Control Studies
- Diastole
- Disease Progression
- Feasibility Studies
- Female
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Image Interpretation, Computer-Assisted/methods
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Daniel S Knight
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | | | - Shahin Moledina
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - Alexander Jones
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
| | - J Gerry Coghlan
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK.
| | - Vivek Muthurangu
- UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK.
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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von Knobelsdorff-Brenkenhoff F, Hennig P, Menza M, Dieringer MA, Foell D, Jung B, Schulz-Menger J. Myocardial dysfunction in patients with aortic stenosis and hypertensive heart disease assessed by MR tissue phase mapping. J Magn Reson Imaging 2015; 44:168-77. [PMID: 26687082 DOI: 10.1002/jmri.25125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/01/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To identify abnormalities of myocardial velocities in patients with left ventricular pressure overload using magnetic resonance tissue phase mapping (TPM). MATERIAL AND METHODS Thirty-three patients (nine with hypertensive heart disease [HYP], 24 with aortic stenosis [AS]) and 41 healthy controls were enrolled. To assess left ventricular motion, a basal, midventricular, and apical slice were acquired using three-directional velocity-encoded phase-contrast MR with a 3T system. Target parameters were peak longitudinal (Vz ) and radial (Vr ) velocity in systole and diastole (Peaksys , Peakdias ). Analysis was done on each myocardial segment. In a subgroup (n = 7 HYP, n = 12 AS, n = 24 controls), measurement was repeated during handgrip exercise. RESULTS AS had significantly lower Vz -Peaksys in the inferolateral and inferoseptal wall (P = 0.003-0.029) and Vr -Peaksys in the septum and anterior wall (P = 0.001-0.013) than controls. Vz -Peakdias and Vr -Peakdias were lower in AS than in controls in almost all segments (P < 0.001-0.028). HYP showed reduced Vz -Peakdias compared to controls in all basal segments as well as in the lateral midventricular wall (P < 0.001-0.045), and reduced Vr -Peakdias compared to controls predominantly in the midventricular and apical segments (P = 0.004-0.042). AS patients with focal fibrosis had significantly reduced myocardial velocities (P = 0.001-0.047) in segments without late enhancement. During exercise, Vz -Peaksys , Vr -Peaksys , and Vz -Peakdias remained unchanged in AS and HYP, but decreased in the lateral wall in controls (P < 0.001-0.043). CONCLUSION Even with preserved left ventricle (LV) ejection fraction, peak longitudinal and radial velocities of the LV are reduced in AS and HYP, indicating early functional impairment. J. Magn. Reson. Imaging 2016;44:168-177.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Pierre Hennig
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Marius Menza
- Department of Radiology, Medical Physics, University Medical Center, Freiburg, Germany
| | - Matthias A Dieringer
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Daniela Foell
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Freiburg, Germany
| | - Bernd Jung
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Switzerland
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
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Electro-mechanical dysfunction in long QT syndrome: Role for arrhythmogenic risk prediction and modulation by sex and sex hormones. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 120:255-69. [PMID: 26718598 DOI: 10.1016/j.pbiomolbio.2015.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/26/2015] [Accepted: 12/15/2015] [Indexed: 12/24/2022]
Abstract
Long QT syndrome (LQTS) is a congenital arrhythmogenic channelopathy characterized by impaired cardiac repolarization. Increasing evidence supports the notion that LQTS is not purely an "electrical" disease but rather an "electro-mechanical" disease with regionally heterogeneously impaired electrical and mechanical cardiac function. In the first part, this article reviews current knowledge on electro-mechanical (dys)function in LQTS, clinical consequences of the observed electro-mechanical dysfunction, and potential underlying mechanisms. Since several novel imaging techniques - Strain Echocardiography (SE) and Magnetic Resonance Tissue Phase Mapping (TPM) - are applied in clinical and experimental settings to assess the (regional) mechanical function, advantages of these non-invasive techniques and their feasibility in the clinical routine are particularly highlighted. The second part provides novel insights into sex differences and sex hormone effects on electro-mechanical cardiac function in a transgenic LQT2 rabbit model. Here we demonstrate that female LQT2 rabbits exhibit a prolonged time to diastolic peak - as marker for contraction duration and early relaxation - compared to males. Chronic estradiol-treatment enhances these differences in time to diastolic peak even more and additionally increases the risk for ventricular arrhythmia. Importantly, time to diastolic peak is particularly prolonged in rabbits exhibiting ventricular arrhythmia - regardless of hormone treatment - contrasting with a lack of differences in QT duration between symptomatic and asymptomatic LQT2 rabbits. This indicates the potential added value of the assessment of mechanical dysfunction in future risk stratification of LQTS patients.
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Collins J, Sommerville C, Magrath P, Spottiswoode B, Freed BH, Benzuly KH, Gordon R, Vidula H, Lee DC, Yancy C, Carr J, Markl M. Extracellular volume fraction is more closely associated with altered regional left ventricular velocities than left ventricular ejection fraction in nonischemic cardiomyopathy. Circ Cardiovasc Imaging 2014; 8:CIRCIMAGING.114.001998. [PMID: 25552491 DOI: 10.1161/circimaging.114.001998] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nonischemic cardiomyopathy is a common cause of left ventricular (LV) dysfunction and myocardial fibrosis. The purpose of this study was to noninvasively evaluate changes in segmental LV extracellular volume (ECV) fraction, LV velocities, myocardial scar, and wall motion in nonischemic cardiomyopathy patients. METHODS AND RESULTS Cardiac MRI including pre- and postcontrast myocardial T1 mapping and velocity quantification (tissue phase mapping) of the LV (basal, midventricular, and apical short axis) was applied in 31 patients with nonischemic cardiomyopathy (50±18 years). Analysis based on the 16-segment American Heart Association model was used to evaluate the segmental distribution of ECV, peak systolic and diastolic myocardial velocities, scar determined by late gadolinium enhancement, and wall motion abnormalities. LV segments with scar or impaired wall motion were significantly associated with elevated ECV (rs =0.26; P<0.001) and reduced peak systolic radial velocities (r=-0.43; P<0.001). Regional myocardial velocities and ECV were similar for patients with reduced (n=12; ECV=0.28±0.06) and preserved left ventricular ejection fraction (n=19; ECV=0.30±0.09). Patients with preserved left ventricular ejection fraction showed significant relationships between increasing ECV and reduced systolic (r=-0.19; r=-0.30) and diastolic (r=0.34; r=0.26) radial and long-axis peak velocities (P<0.001). Even after excluding myocardial segments with late gadolinium enhancement, significant relationships between ECV and segmental LV velocities were maintained indicating the potential of elevated ECV to identify regional diffuse fibrosis not visible by late gadolinium enhancement, which was associated with impaired regional LV function. CONCLUSIONS Regionally elevated ECV negatively affected myocardial velocities. The association of elevated regional ECV with reduced myocardial velocities independent of left ventricular ejection fraction suggests a structure-function relationship between altered ECV and segmental myocardial function in nonischemic cardiomyopathy.
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Affiliation(s)
- Jeremy Collins
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Cort Sommerville
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Patrick Magrath
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Bruce Spottiswoode
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Benjamin H Freed
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Keith H Benzuly
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Robert Gordon
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Himabindu Vidula
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Dan C Lee
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Clyde Yancy
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - James Carr
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.)
| | - Michael Markl
- From the Departments of Radiology (J. Collins, C.S., J. Carr, M.M.) and Biomedical Engineering (P.M., M.M.) and Division of Cardiology, Department of Medicine (B.H.F., K.H.B., R.G., H.V., D.C.L., C.Y.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Siemens Medical Solutions USA, Chicago, IL (B.S.).
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Simpson R, Keegan J, Gatehouse P, Hansen M, Firmin D. Spiral tissue phase velocity mapping in a breath-hold with non-cartesian SENSE. Magn Reson Med 2014; 72:659-68. [PMID: 24123135 PMCID: PMC3979503 DOI: 10.1002/mrm.24971] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/23/2013] [Accepted: 09/05/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE Tissue phase velocity mapping (TPVM) is capable of reproducibly measuring regional myocardial velocities. However acquisition durations of navigator gated techniques are long and unpredictable while current breath-hold techniques have low temporal resolution. This study presents a spiral TPVM technique which acquires high resolution data within a clinically acceptable breath-hold duration. METHODS Ten healthy volunteers are scanned using a spiral sequence with temporal resolution of 24 ms and spatial resolution of 1.7 × 1.7 mm. Retrospective cardiac gating is used to acquire data over the entire cardiac cycle. The acquisition is accelerated by factors of 2 and 3 by use of non-Cartesian SENSE implemented on the Gadgetron GPU system resulting in breath-holds of 17 and 13 heartbeats, respectively. Systolic, early diastolic, and atrial systolic global and regional longitudinal, circumferential, and radial velocities are determined. RESULTS Global and regional velocities agree well with those previously reported. The two acceleration factors show no significant differences for any quantitative parameter and the results also closely match previously acquired higher spatial resolution navigator-gated data in the same subjects. CONCLUSION By using spiral trajectories and non-Cartesian SENSE high resolution, TPVM data can be acquired within a clinically acceptable breath-hold.
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Affiliation(s)
- R. Simpson
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London
| | - J. Keegan
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London
| | - P. Gatehouse
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
| | - M. Hansen
- National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - D. Firmin
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London
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Codreanu I, Robson MD, Rider OJ, Pegg TJ, Dasanu CA, Jung BA, Rotaru N, Clarke K, Holloway CJ. Details of left ventricular radial wall motion supporting the ventricular theory of the third heart sound obtained by cardiac MR. Br J Radiol 2014; 87:20130780. [PMID: 24641347 DOI: 10.1259/bjr.20130780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. METHODS Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquired using a black blood segmented κ-space spoiled gradient echo sequence with a temporal resolution of 13.8 ms. Peak systolic and diastolic radial velocities as well as radial velocity curves were obtained for 16 ventricular segments. RESULTS Significant differences among peak radial velocities of basal and mid-ventricular segments have been recorded. Particular patterns of segmental radial velocity curves were also noted. An additional wave of outward radial movement during the phase of rapid ventricular filling, corresponding to the expected timing of the third heart sound, appeared of particular interest. CONCLUSION The technique has allowed visualization of new details of LV radial wall motion. In particular, higher peak systolic radial velocities of anterior and inferior segments are suggestive of a relatively higher dynamics of anteroposterior vs lateral radial motion in systole. Specific patterns of radial motion of other LV segments may provide additional insights into LV mechanics. ADVANCES IN KNOWLEDGE The outward radial movement of LV segments impacted by the blood flow during rapid ventricular filling provides a potential substrate for the third heart sound. A biphasic radial expansion of the basal anteroseptal segment in early diastole is likely to be related to the simultaneous longitudinal LV displacement by the stretched great vessels following repolarization and their close apposition to this segment.
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Affiliation(s)
- I Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Codreanu I, Robson MD, Rider OJ, Pegg TJ, Dasanu CA, Jung BA, Clarke K, Holloway CJ. Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR. Br J Radiol 2014; 86:20130326. [PMID: 24133098 DOI: 10.1259/bjr.20130326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Obtaining new details for rotational motion of left ventricular (LV) segments using velocity encoding cardiac MR and correlating the regional motion patterns to LV insertion sites. METHODS Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Peak rotational velocities and circumferential velocity curves were obtained for 16 ventricular segments. RESULTS Reduced peak clockwise velocities of anteroseptal segments (i.e. Segments 2 and 8) and peak counterclockwise velocities of inferoseptal segments (i.e. Segments 3 and 9) were the most prominent findings. The observations can be attributed to the LV insertion sites into the right ventricle, limiting the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments as viewed from the apex. Relatively lower clockwise velocities of Segment 5 and counterclockwise velocities of Segment 6 were also noted, suggesting a cardiac fixation point between these two segments, which is in close proximity to the lateral LV wall. CONCLUSION Apart from showing different rotational patterns of LV base, mid ventricle and apex, the study showed significant differences in the rotational velocities of individual LV segments. Correlating regional wall motion with known orientation of myocardial aggregates has also provided new insights into the mechanisms of LV rotational motions during a cardiac cycle. ADVANCES IN KNOWLEDGE LV insertion into the right ventricle limits the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments adjacent to the ventricular insertion sites. The pattern should be differentiated from wall motion abnormalities in cardiac pathology.
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Affiliation(s)
- I Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Codreanu I, Pegg TJ, Selvanayagam JB, Robson MD, Rider OJ, Dasanu CA, Jung BA, Taggart DP, Golding SJ, Clarke K, Holloway CJ. Normal values of regional and global myocardial wall motion in young and elderly individuals using navigator gated tissue phase mapping. AGE (DORDRECHT, NETHERLANDS) 2014; 36:231-241. [PMID: 23604860 PMCID: PMC3889897 DOI: 10.1007/s11357-013-9535-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/05/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate normal values for regional and global myocardial wall motion parameters in young and elderly individuals, as detected by navigator gated high temporal resolution tissue phase mapping. Radial, longitudinal and circumferential ventricular wall motion, as well as ventricular torsion and longitudinal strain rates, were assessed in two age groups of volunteers, 23 ± 3 (n = 14) and 66 ± 7 years old (n = 9), respectively. All subjects were healthy, non-smokers without known cardiac disease. An increased global left ventricular (LV) torsion rate (peak systolic torsion rate 20.6 ± 2.0 versus 14.5 ± 1.0°/s/cm, peak diastolic torsion rate -25.2 ± 1.8 versus -14.1 ± 1.3°/s/cm) and a decrease in longitudinal LV motion (peak systolic values at mid-ventricle 5.9 ± 0.5 versus 8.5 ± 0.8 cm/s, peak diastolic values -10.7 ± 0.7 versus -15.2 ± 0.9 cm/s) in the older age group were the most prominent findings. Lower peak diastolic radial velocities with a longer time-to-peak values, most pronounced at the apex, are consistent with reduced diastolic function with ageing. Lower peak clockwise and counter-clockwise velocities at all LV levels revealed limitations in resting LV rotational motions in the older group. Significant changes in the undulating pattern of the rotational motions of the left ventricle were also observed. The results demonstrate distinct changes in regional and global myocardial wall motion in elderly individuals. Increased LV torsion rate and reduced LV longitudinal motion were particularly prominent in the older group. These parameters may have a role in the assessment of global LV contractility and help differentiate age-related changes from cardiac disease.
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Affiliation(s)
- Ion Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX1 3PT, UK,
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Espe EKS, Aronsen JM, Skårdal K, Schneider JE, Zhang L, Sjaastad I. Novel insight into the detailed myocardial motion and deformation of the rodent heart using high-resolution phase contrast cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013; 15:82. [PMID: 24034168 PMCID: PMC3848852 DOI: 10.1186/1532-429x-15-82] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phase contrast velocimetry cardiovascular magnetic resonance (PC-CMR) is a powerful and versatile tool allowing assessment of in vivo motion of the myocardium. However, PC-CMR is sensitive to motion related artifacts causing errors that are geometrically systematic, rendering regional analysis of myocardial function challenging. The objective of this study was to establish an optimized PC-CMR method able to provide novel insight in the complex regional motion and strain of the rodent myocardium, and provide a proof-of-concept in normal and diseased rat hearts with higher temporal and spatial resolution than previously reported. METHODS A PC-CMR protocol optimized for assessing the motion and deformation of the myocardium in rats with high spatiotemporal resolution was established, and ten animals with different degree of cardiac dysfunction underwent examination and served as proof-of-concept. Global and regional myocardial velocities and circumferential strain were calculated, and the results were compared to five control animals. Furthermore, the global strain measurements were validated against speckle-tracking echocardiography, and inter- and intrastudy variability of the protocol were evaluated. RESULTS The presented method allows assessment of regional myocardial function in rats with high level of detail; temporal resolution was 3.2 ms, and analysis was done using 32 circumferential segments. In the dysfunctional hearts, global and regional function were distinctly altered, including reduced global peak values, increased regional heterogeneity and increased index of dyssynchrony. Strain derived from the PC-CMR data was in excellent agreement with echocardiography (r = 0.95, p < 0.001; limits-of-agreement -0.02 ± 3.92%strain), and intra- and interstudy variability were low for both velocity and strain (limits-of-agreement, radial motion: 0.01 ± 0.32 cm/s and -0.06 ± 0.75 cm/s; circumferential strain: -0.16 ± 0.89%strain and -0.71 ± 1.67%strain, for intra- and interstudy, respectively). CONCLUSION We demonstrate, for the first time, that PC-CMR enables high-resolution evaluation of in vivo circumferential strain in addition to myocardial motion of the rat heart. In combination with the superior geometric robustness of CMR, this ultimately provides a tool for longitudinal studies of regional function in rodents with high level of detail.
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Affiliation(s)
- Emil KS Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Jan Magnus Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
- Bjørknes College, Oslo, Norway
| | - Kristine Skårdal
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | | | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Kirkeveien 166, N-0407, Oslo, Norway
- KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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Föll D, Markl M, Menza M, Usman A, Wengenmayer T, Anjarwalla AL, Bode C, Carr J, Jung B. Cold ischaemic time and time after transplantation alter segmental myocardial velocities after heart transplantation. Eur J Cardiothorac Surg 2013; 45:502-8. [PMID: 24026855 DOI: 10.1093/ejcts/ezt448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate changes in segmental, three-directional left ventricular (LV) velocities in patients after heart transplantation (Tx). METHODS Magnetic resonance tissue phase mapping was used to assess myocardial velocities in patients after Tx (n = 27) with normal LV ejection fraction (63 ± 5%) and those without signs of rejection. Regional wall motion and dyssynchrony were analysed in relation to cold ischaemic time (150 ± 57 min, median = 154 min), age of the donor heart (35 ± 13 years, median = 29 years), time after transplantation (32 ± 26 months, median = 31 months) and global LV morphology and function. RESULTS Segmental myocardial velocities were significantly altered in patients with cold ischaemic times >155 min resulting in an increase in peak systolic radial velocities (2 of 16 segments, P = 0.03-0.04) and reduced segmental diastolic long-axis velocities (5 of 16 segments, P = 0.01-0.04). Time after transplantation (n = 8 patients <12 months after Tx vs n = 19 >12 months) had a significant influence on systolic radial velocities (increased in 2 of 16 segments, P = 0.01-0.04) and diastolic long-axis velocities (reduced in 5 of 16 segments, P = 0.02-0.04). Correlation analysis and multiple regression revealed significant relationships of cold ischaemic time (R = -0.384, P = 0.048), the donor heart's age (β= 0.9, P = 0.01) and time from transplantation (β= -0.36, P = 0.03) with long-axis diastolic dyssynchrony. CONCLUSIONS Time after transplantation and cold ischaemic time strongly affect segmental systolic and diastolic motion in patients after Tx. The understanding of alterations in regional LV motion in the transplanted heart under stable conditions is essential in order to utilize this methodology in the future as a potentially non-invasive means of diagnosing transplant rejection.
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Affiliation(s)
- Daniela Föll
- Department of Cardiology and Angiology I, University Heart Centre Freiburg, Freiburg, Germany
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Longitudinal myocardial peak velocities using high temporal resolution phase-contrast and simple averaging are comparable to tissue Doppler echocardiography. MAGMA (NEW YORK, N.Y.) 2013; 27:211-8. [PMID: 24013857 DOI: 10.1007/s10334-013-0405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 08/16/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECT Phase contrast imaging is widely used to measure blood velocity. However tissue Doppler imaging (TDI) echocardiography is the reference for myocardial velocity assessment. This study aims at validating the ability of phase contrast (PC) sequences to correctly assess myocardial velocities and to compare these velocities to TDI. The phase contrast sequence was performed with breath-hold parameters and with parameters tuned to increase temporal resolution in free breathing. MATERIALS AND METHODS Left and Right auriculo-ventricular annuluses longitudinal velocities were recorded on six healthy volunteers with different temporal resolutions (TDI: 5 ms, breath-hold PC: 94 ms and free-breathing PC: 19 ms). Free-breathing PC was obtained by averaging of three excitations. Amplitudes of four standard echocardiographic and clinically relevant myocardial longitudinal velocity waves were compared: Early filling and auricular, systolic and isovolumic contractions. RESULTS Isovolumic contraction waves were only visible with free-breathing PC and TDI. The differences with the reference TDI wave velocities were lower (p = 0.02) for free-breathing PC (19.2 ± 2.6%) than for breath-hold PC (28.1 ± 2.9%). These differences for free-breathing PC were close to (p = 0.21) the coefficient of variation of the measurements provided by TDI (14.8 ± 1.2%). CONCLUSION Myocardial longitudinal peak velocities can be assessed with a PC sequence tuned to optimize temporal resolution.
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Haggerty CM, Kramer SP, Binkley CM, Powell DK, Mattingly AC, Charnigo R, Epstein FH, Fornwalt BK. Reproducibility of cine displacement encoding with stimulated echoes (DENSE) cardiovascular magnetic resonance for measuring left ventricular strains, torsion, and synchrony in mice. J Cardiovasc Magn Reson 2013; 15:71. [PMID: 23981339 PMCID: PMC3765995 DOI: 10.1186/1532-429x-15-71] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/06/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Advanced measures of cardiac function are increasingly important to clinical assessment due to their superior diagnostic and predictive capabilities. Cine DENSE cardiovascular magnetic resonance (CMR) is ideal for quantifying advanced measures of cardiac function based on its high spatial resolution and streamlined post-processing. While many studies have utilized cine DENSE in both humans and small-animal models, the inter-test and inter-observer reproducibility for quantification of advanced cardiac function in mice has not been evaluated. This represents a critical knowledge gap for both understanding the capabilities of this technique and for the design of future experiments. We hypothesized that cine DENSE CMR would show excellent inter-test and inter-observer reproducibility for advanced measures of left ventricular (LV) function in mice. METHODS Five normal mice (C57BL/6) and four mice with depressed cardiac function (diet-induced obesity) were imaged twice, two days apart, on a 7T ClinScan MR system. Images were acquired with 15-20 frames per cardiac cycle in three short-axis (basal, mid, apical) and two long-axis orientations (4-chamber and 2-chamber). LV strain, twist, torsion, and measures of synchrony were quantified. Images from both days were analyzed by one observer to quantify inter-test reproducibility, while inter-observer reproducibility was assessed by a second observer's analysis of day-1 images. The coefficient of variation (CoV) was used to quantify reproducibility. RESULTS LV strains and torsion were highly reproducible on both inter-observer and inter-test bases with CoVs ≤ 15%, and inter-observer reproducibility was generally better than inter-test reproducibility. However, end-systolic twist angles showed much higher variance, likely due to the sensitivity of slice location within the sharp longitudinal gradient in twist angle. Measures of synchrony including the circumferential (CURE) and radial (RURE) uniformity of strain indices, showed excellent reproducibility with CoVs of 1% and 3%, respectively. Finally, peak measures (e.g., strains) were generally more reproducible than the corresponding rates of change (e.g., strain rate). CONCLUSIONS Cine DENSE CMR is a highly reproducible technique for quantification of advanced measures of left ventricular cardiac function in mice including strains, torsion and measures of synchrony. However, myocardial twist angles are not reproducible and future studies should instead report torsion.
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Affiliation(s)
- Christopher M Haggerty
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, Lexington, KY, USA
| | - Sage P Kramer
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, Lexington, KY, USA
| | - Cassi M Binkley
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Andrea C Mattingly
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, Lexington, KY, USA
| | - Richard Charnigo
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Frederick H Epstein
- Departments of Biomedical Engineering and Radiology, University of Virginia, Charlottesville, VA, USA
| | - Brandon K Fornwalt
- Departments of Pediatrics, Physiology and Medicine, University of Kentucky, Lexington, KY, USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Odening KE, Jung BA, Lang CN, Cabrera Lozoya R, Ziupa D, Menza M, Relan J, Franke G, Perez Feliz S, Koren G, Zehender M, Bode C, Brunner M, Sermesant M, Föll D. Spatial correlation of action potential duration and diastolic dysfunction in transgenic and drug-induced LQT2 rabbits. Heart Rhythm 2013; 10:1533-41. [PMID: 23892340 DOI: 10.1016/j.hrthm.2013.07.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Enhanced dispersion of action potential duration (APD) is a major contributor to long QT syndrome (LQTS)-related arrhythmias. OBJECTIVE To investigate spatial correlations of regional heterogeneities in cardiac repolarization and mechanical function in LQTS. METHODS Female transgenic LQTS type 2 (LQT2; n = 11) and wild-type littermate control (LMC) rabbits (n = 9 without E4031 and n = 10 with E4031) were subjected to phase contrast magnetic resonance imaging to assess regional myocardial velocities. In the same rabbits' hearts, monophasic APDs were assessed in corresponding segments. RESULTS In LQT2 and E4031-treated rabbits, APD was longer in all left ventricular segments (P < .01) and APD dispersion was greater than that in LMC rabbits (P < .01). In diastole, peak radial velocities (Vr) were reduced in LQT2 and E4031-treated compared to LMC rabbits in LV base and mid (LQT2: -3.36 ± 0.4 cm/s, P < .01; E4031-treated: -3.24 ± 0.6 cm/s, P < .0001; LMC: -4.42 ± 0.5 cm/s), indicating an impaired diastolic function. Regionally heterogeneous diastolic Vr correlated with APD (LQT2: correlation coefficient [CC] 0.38, P = .01; E4031-treated: CC 0.42, P < .05). Time-to-diastolic peak Vr were prolonged in LQT2 rabbits (LQT2: 196.8 ± 2.9 ms, P < .001; E4031-treated: 199.5 ± 2.2 ms, P < .0001, LMC 183.1 ± 1.5), indicating a prolonged contraction duration. Moreover, in transgenic LQT2 rabbits, diastolic time-to-diastolic peak Vr correlated with APD (CC 0.47, P = .001). In systole, peak Vr were reduced in LQT2 and E4031-treated rabbits (P < .01) but longitudinal velocities or ejection fraction did not differ. Finally, random forest machine learning algorithms enabled a differentiation between LQT2, E4031-treated, and LMC rabbits solely based on "mechanical" magnetic resonance imaging data. CONCLUSIONS The prolongation of APD led to impaired diastolic and systolic function in transgenic and drug-induced LQT2 rabbits. APD correlated with regional diastolic dysfunction, indicating that LQTS is not purely an electrical but an electromechanical disorder.
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Affiliation(s)
- Katja E Odening
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany.
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Simpson R, Keegan J, Firmin D. Efficient and reproducible high resolution spiral myocardial phase velocity mapping of the entire cardiac cycle. J Cardiovasc Magn Reson 2013; 15:34. [PMID: 23587250 PMCID: PMC3651364 DOI: 10.1186/1532-429x-15-34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/29/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Three-directional phase velocity mapping (PVM) is capable of measuring longitudinal, radial and circumferential regional myocardial velocities. Current techniques use Cartesian k-space coverage and navigator-gated high spatial and high temporal resolution acquisitions are long. In addition, prospective ECG-gating means that analysis of the full cardiac cycle is not possible. The aim of this study is to develop a high temporal and high spatial resolution PVM technique using efficient spiral k-space coverage and retrospective ECG-gating. Detailed analysis of regional motion over the entire cardiac cycle, including atrial systole for the first time using MR, is presented in 10 healthy volunteers together with a comprehensive assessment of reproducibility. METHODS A navigator-gated high temporal (21 ms) and spatial (1.4 × 1.4 mm) resolution spiral PVM sequence was developed, acquiring three-directional velocities in 53 heartbeats (100% respiratory-gating efficiency). Basal, mid and apical short-axis slices were acquired in 10 healthy volunteers on two occasions. Regional and transmural early systolic, early diastolic and atrial systolic peak longitudinal, radial and circumferential velocities were measured, together with the times to those peaks (TTPs). Reproducibilities were determined as mean ± SD of the signed differences between measurements made from acquisitions performed on the two days. RESULTS All slices were acquired in all volunteers on both occasions with good image quality. The high temporal resolution allowed consistent detection of fine features of motion, while the high spatial resolution allowed the detection of statistically significant regional and transmural differences in motion. Colour plots showing the regional variations in velocity over the entire cardiac cycle enable rapid interpretation of the regional motion within any given slice. The reproducibility of peak velocities was high with the reproducibility of early systolic, early diastolic and atrial systolic peak radial velocities in the mid slice (for example) being -0.01 ± 0.36, 0.20 ± 0.56 and 0.14 ± 0.42 cm/s respectively. Reproducibility of the corresponding TTP values, when normalised to a fixed systolic and diastolic length, was also high (-13.8 ± 27.4, 1.3 ± 21.3 and 3.0 ± 10.9 ms for early systolic, early diastolic and atrial systolic respectively). CONCLUSIONS Retrospectively gated spiral PVM is an efficient and reproducible method of acquiring 3-directional, high resolution velocity data throughout the entire cardiac cycle, including atrial systole.
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Affiliation(s)
- Robin Simpson
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Jennifer Keegan
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London, UK
| | - David Firmin
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, London, UK
- Imperial College, London, UK
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Steeden JA, Knight DS, Bali S, Atkinson D, Taylor AM, Muthurangu V. Self-navigated tissue phase mapping using a golden-angle spiral acquisition-proof of concept in patients with pulmonary hypertension. Magn Reson Med 2013; 71:145-55. [PMID: 23412927 DOI: 10.1002/mrm.24646] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/29/2012] [Accepted: 12/21/2012] [Indexed: 11/08/2022]
Abstract
PURPOSE To create a high temporal- and spatial-resolution retrospectively cardiac-gated, tissue phase mapping (TPM) sequence, using an image-based respiratory navigator calculated from the data itself. METHODS The sequence was based on a golden-angle spiral acquisition. Reconstruction of real-time images allowed creation of an image-based navigator. The expiratory spiral interleaves were then retrospectively cardiac-gated using data binning. TPM data were acquired in 20 healthy volunteers and 10 patients with pulmonary hypertension. Longitudinal and radial myocardial velocities were calculated in the left ventricle and right ventricle. RESULTS The image-based navigator was shown to correlate well with simultaneously acquired airflow data in 10 volunteers(r=0.93±0.04). The TPM navigated images had a significantly higher subjective image quality and edge sharpness (P<0.0001) than averaged spiral TPM. No significant differences in myocardial velocities were seen between conventional Cartesian TPM with navigator respiratory-gating and the proposed self-navigated TPM technique, in 10 volunteers. Significant differences in the velocities were seen between the volunteers and patients in the left ventricle at systole and end diastole and in the right ventricle at end diastole. CONCLUSION The feasibility of measuring myocardial motion using a golden-angle spiral TPM sequence was demonstrated, with an image-based respiratory navigator calculated from the TPM data itself.
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Affiliation(s)
- Jennifer A Steeden
- UCL Centre for Cardiovascular Imaging, UCL Institute for Cardiovascular Science, University College London, London, UK
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Jung B, Odening KE, Dall’Armellina E, Föll D, Menza M, Markl M, Schneider JE. A quantitative comparison of regional myocardial motion in mice, rabbits and humans using in-vivo phase contrast CMR. J Cardiovasc Magn Reson 2012; 14:87. [PMID: 23270566 PMCID: PMC3579745 DOI: 10.1186/1532-429x-14-87] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 12/06/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Genetically manipulated animals like mice or rabbits play an important role in the exploration of human cardiovascular diseases. It is therefore important to identify animal models that closely mimic physiological and pathological human cardiac function. METHODS In-vivo phase contrast cardiovascular magnetic resonance (CMR) was used to measure regional three-directional left ventricular myocardial motion with high temporal resolution in mice (N=18), rabbits (N=8), and humans (N=20). Radial, long-axis, and rotational myocardial velocities were acquired in left ventricular basal, mid-ventricular, and apical short-axis locations. RESULTS Regional analysis revealed different patterns of motion: 1) In humans and rabbits, the apex showed slower radial velocities compared to the base. 2) Significant differences within species were seen in the pattern of long-axis motion. Long-axis velocities during systole were fairly homogeneously distributed in mice, whereas humans showed a dominant component in the lateral wall and rabbits in the base. 3) Rotational velocities and twist showed the most distinct patterns in both temporal evolution and relative contribution of base, mid-ventricle and apex, respectively. Interestingly, a marked difference in rotational behavior during early-systole was found in mice, which exhibited clockwise rotation in all slice locations compared to counter-clockwise rotation in rabbits and humans. CONCLUSIONS Phase contrast CMR revealed subtle, but significantly different regional myocardial motion patterns in mice, rabbits and humans. This finding has to be considered when investigating myocardial motion pattern in small animal models of heart disease.
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Affiliation(s)
- Bernd Jung
- Department of Radiology, Medical Physics, University Medical Center, Freiburg, Germany
| | - Katja E Odening
- Department of Cardiology, University Medical Center, Freiburg, Germany
| | | | - Daniela Föll
- Department of Cardiology, University Medical Center, Freiburg, Germany
| | - Marius Menza
- Department of Radiology, Medical Physics, University Medical Center, Freiburg, Germany
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA
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Gatehouse PD, Rolf MP, Bloch KM, Graves MJ, Kilner PJ, Firmin DN, Hofman MBM. A multi-center inter-manufacturer study of the temporal stability of phase-contrast velocity mapping background offset errors. J Cardiovasc Magn Reson 2012; 14:72. [PMID: 23083397 PMCID: PMC3514147 DOI: 10.1186/1532-429x-14-72] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/01/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Phase-contrast velocity images often contain a background or baseline offset error, which adds an unknown offset to the measured velocities. For accurate flow measurements, this offset must be shown negligible or corrected. Some correction techniques depend on replicating the clinical flow acquisition using a uniform stationary phantom, in order to measure the baseline offset at the region of interest and subtract it from the clinical study. Such techniques assume that the background offset is stable over the time of a patient scan, or even longer if the phantom scans are acquired later, or derived from pre-stored background correction images. There is no published evidence regarding temporal stability of the background offset. METHODS This study assessed the temporal stability of the background offset on 3 different manufacturers' scanners over 8 weeks, using a retrospectively-gated phase-contrast cine acquisition with fixed parameters and at a fixed location, repeated 5 times in rapid succession each week. A significant offset was defined as 0.6 cm/s within 50 mm of isocenter, based upon an accuracy of 10% in a typical cardiac shunt measurement. RESULTS Over the 5 repeated cine acquisitions, temporal drift in the baseline offset was insignificant on two machines (0.3 cm/s, 0.2 cm/s), and marginally insignificant on the third machine (0.5 cm/s) due to an apparent heating effect. Over a longer timescale of 8 weeks, insignificant drift (0.4 cm/s) occurred on one, with larger drifts (0.9 cm/s, 0.6 cm/s) on the other machines. CONCLUSIONS During a typical patient study, background drift was insignificant. Extended high gradient power scanning with work requires care to avoid drift on some machines. Over the longer term of 8 weeks, significant drift is likely, preventing accurate correction by delayed phantom corrections or derivation from pre-stored background offset data.
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Affiliation(s)
| | - Marijn P Rolf
- VU University Medical Center, ICaR-VU, Amsterdam, Netherlands
| | | | | | | | | | - Mark BM Hofman
- VU University Medical Center, ICaR-VU, Amsterdam, Netherlands
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Markl M, Rustogi R, Galizia M, Goyal A, Collins J, Usman A, Jung B, Foell D, Carr J. Myocardial T2-mapping and velocity mapping: Changes in regional left ventricular structure and function after heart transplantation. Magn Reson Med 2012; 70:517-26. [DOI: 10.1002/mrm.24472] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/20/2012] [Accepted: 08/03/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Michael Markl
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
- Department of Biomedical Engineering; McCormick School of Engineering; Northwestern University; Chicago Illinois USA
| | - Rahul Rustogi
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | - Mauricio Galizia
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | - Amita Goyal
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | - Jeremy Collins
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | - Asad Usman
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | - Bernd Jung
- Department of Medical Physics; Freiburg University Medical Center; Freiburg Germany
| | - Daniela Foell
- Department of Cardiology; Freiburg University Medical Center; Freiburg Germany
| | - James Carr
- Department of Radiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
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Foell D, Jung BA, Germann E, Staehle F, Bode C, Hennig J, Markl M. Segmental myocardial velocities in dilated cardiomyopathy with and without left bundle branch block. J Magn Reson Imaging 2012; 37:119-26. [DOI: 10.1002/jmri.23803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/03/2012] [Indexed: 11/07/2022] Open
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Hypertensive heart disease: MR tissue phase mapping reveals altered left ventricular rotation and regional myocardial long-axis velocities. Eur Radiol 2012; 23:339-47. [DOI: 10.1007/s00330-012-2613-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 06/26/2012] [Accepted: 07/13/2012] [Indexed: 11/26/2022]
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Simpson RM, Keegan J, Firmin DN. MR assessment of regional myocardial mechanics. J Magn Reson Imaging 2012; 37:576-99. [PMID: 22826177 DOI: 10.1002/jmri.23756] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 06/15/2012] [Indexed: 12/30/2022] Open
Abstract
Regional myocardial function can be measured by several MR techniques including tissue tagging, phase velocity mapping, and more recently, displacement encoding with stimulated echoes (DENSE) and strain encoding (SENC). Each of these techniques was developed separately and has undergone significant change since its original implementation. As a result, in the current literature, the common features and the differences between the techniques and what they measure are often unclear and confusing. This review article delivers an extensively referenced introductory text which clarifies the current methodology from the starting point of the Bloch equations. By doing this in a consistent way for each method, the similarities and differences between them are highlighted. In addition, their capabilities and limitations are discussed, together with their relative advantages and disadvantages. While the focus is on sequence design and development, the principal parameters measured by each technique are also summarized, together with brief results, with the reader being directed to the extensive literature on data processing and clinical applications for more detail.
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Affiliation(s)
- Robin M Simpson
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Hospital Trust, London, United Kingdom.
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