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Fulati Z, Liu Y, Sun N, Kang Y, Su Y, Chen H, Shu X. Speckle tracking echocardiography analyses of myocardial contraction efficiency predict response for cardiac resynchronization therapy. Cardiovasc Ultrasound 2018; 16:30. [PMID: 30453975 PMCID: PMC6245808 DOI: 10.1186/s12947-018-0148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with left ventricular (LV) dysssynchrony, contraction that doesn't fall into ejection period (LVEj) results in a waste of energy due to inappropriate contraction timing, which was now widely treated by cardiac resynchronization therapy(CRT). Myocardial Contraction Efficiency was defined as the ratio of Efficient Contraction Time (ECTR) and amplitude of efficient contraction (ECR) during LVEj against that in the entire cardiac cycle. This study prospectively investigated whether efficiency indexes could predict CRT outcome. METHODS Our prospective pilot study including 70 CRT candidates, parameters of myocardial contraction timing and contractility were measured by speckle tracking echocardiography (STE) and efficiency indexes were calculated accordingly at baseline and at 6-month follow-up. Primary outcome events were predefined as death or HF hospitalization, and secondary outcome events were defined as all-cause death during the follow-up. 16-segement Standard deviation of time to onset strain (TTO-16SD) and time to peak strain (TTP-16SD) were included as the dyssynchrony indexes. RESULTS According to LV end systolic volume (LVESV) and LV eject fraction(LVEF) values at 6-month follow-up, subjects were classified into responder and non-responder groups, ECR (OR 0.87, 95%CI 0.78-0.97, P < 0.05) and maximum longitudinal strain (MLS) (OR 2.22, 95%CI 1.36-3.61, P < 0.01) were the two independent predictors for CRT response, Both TTO-16SD and TTP-16SD failed to predict outcome. Patients with poorer myocardial contraction efficiency and better contractility are more likely to benefit from CRT. CONCLUSIONS STE can evaluate left ventricular contraction efficiency and contractility to predict CRT response. When analyzing myocardial strain by STE, contraction during LVEj should be highlighted.
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Affiliation(s)
- Zibire Fulati
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yang Liu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ning Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yangang Su
- Department of Cardiology; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Zweerink A, van Everdingen WM, Nijveldt R, Salden OAE, Meine M, Maass AH, Vernooy K, de Lange FJ, Vos MA, Croisille P, Clarysse P, Geelhoed B, Rienstra M, van Gelder IC, van Rossum AC, Cramer MJ, Allaart CP. Strain imaging to predict response to cardiac resynchronization therapy: a systematic comparison of strain parameters using multiple imaging techniques. ESC Heart Fail 2018; 5:1130-1140. [PMID: 30051598 PMCID: PMC6300826 DOI: 10.1002/ehf2.12335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Various strain parameters and multiple imaging techniques are presently available including cardiovascular magnetic resonance (CMR) tagging (CMR‐TAG), CMR feature tracking (CMR‐FT), and speckle tracking echocardiography (STE). This study aims to compare predictive performance of different strain parameters and evaluate results per imaging technique to predict cardiac resynchronization therapy (CRT) response. Methods and results Twenty‐seven patients were prospectively enrolled and underwent CMR and echocardiographic examination before CRT implantation. Strain analysis was performed in circumferential (CMR‐TAG, CMR‐FT, and STE‐circ) and longitudinal (STE‐long) orientations. Regional strain values, parameters of dyssynchrony, and discoordination were calculated. After 12 months, CRT response was measured by the echocardiographic change in left ventricular (LV) end‐systolic volume (LVESV). Twenty‐six patients completed follow‐up; mean LVESV change was −29 ± 27% with 17 (65%) patients showing ≥15% LVESV reduction. Measures of dyssynchrony (SD‐TTPLV) and discoordination (ISFLV) were strongly related to CRT response when using CMR‐TAG (R2 0.61 and R2 0.57, respectively), but showed poor correlations for CMR‐FT and STE (all R2 ≤ 0.32). In contrast, the end‐systolic septal strain (ESSsep) parameter showed a consistent high correlation with LVESV change for all techniques (CMR‐TAG R2 0.60; CMR‐FT R2 0.50; STE‐circ R2 0.43; and STE‐long R2 0.43). After adjustment for QRS duration and QRS morphology, ESSsep remained an independent predictor of response per technique. Conclusions End‐systolic septal strain was the only parameter with a consistent good relation to reverse remodelling after CRT, irrespective of assessment technique. In clinical practice, this measure can be obtained by any available strain imaging technique and provides predictive value on top of current guideline criteria.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Odette A E Salden
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik J de Lange
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Patrick Clarysse
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France
| | - Bastiaan Geelhoed
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, Thorax Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center, Amsterdam, The Netherlands
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3
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Saporito S, Houthuizen P, Aben JPMM, Westenberg JJM, van Den Bosch HCM, van Assen HC, Mischi M. Endocardial center motion for quantification of left ventricular discoordination in heart failure using cine MRI. Physiol Meas 2018; 39:025009. [PMID: 29369050 DOI: 10.1088/1361-6579/aaaaa0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare a novel cardiovascular magnetic resonance technique for the assessment of left ventricular (LV) mechanical discoordination by characterizing the endocardial center motion (ECM) in short-axis cine MRI in healthy volunteers and heart failure patients with left bundle branch block (HF-LBBB). APPROACH To evaluate ECM analysis as mechanical discoordination measure, we retrospectively compared spatial and temporal features of the ECM between a group of healthy volunteers (n = 14) and conduction defect patients (HF-LBBB, n = 31). We tracked the center of the endocardial borders on short-axis view MRI cine loops during the cardiac cycle. From the ECM trajectory we calculated the overall traveled distance, the enclosed area, the eccentricity of the trajectory, and the maximum traveled distance. The ECM can be visualized in spatial coordinates as well as by its temporal behavior. We evaluated the classification performance of these measures for LBBB detection. We also quantified the coherence of the ECM on the longitudinal direction by considering the variability of the ECM measures between different short-axis slices. MAIN RESULTS Patients with LBBB showed significantly higher traveled distance (p < 0.0001), enclosed area (p < 0.002), eccentricity (p < 0.02), and peak displacement (p < 0.02) of the endocardial center. Patients with positive late gadolinium enhancement showed a higher variability of ECM measures across different slices (p < 0.05). SIGNIFICANCE ECM analysis is feasible and it allows the assessment of left ventricular mechanical discoordination. Differences in ECM measures permit one to distinguish between LBBB and healthy volunteers.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ Eindhoven, Netherlands
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4
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de Roest GJ, Wu L, de Cock CC, Delnoy PPH, Hendriks ML, van Rossum AC, Allaart CP. Bifocal left ventricular stimulation or the optimal left ventricular stimulation site in cardiac resynchronization therapy: a pressure–volume loop study. Europace 2015; 18:1030-7. [DOI: 10.1093/europace/euv280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/23/2015] [Indexed: 12/14/2022] Open
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El Ghannudi S, Germain P, Jeung MY, Breton E, Croisille P, Durand E, Roy C, Gangi A. Quantification of left ventricular dyssynchrony in patients with systolic dysfunction: A comparison of circumferential strain MR-tagging metrics. J Magn Reson Imaging 2013; 40:1238-46. [DOI: 10.1002/jmri.24447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 09/10/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
- Soraya El Ghannudi
- Department of Radiology; University Hospital; Strasbourg France
- Department of Nuclear Medicine; University Hospital; Strasbourg France
| | - Philippe Germain
- Department of Radiology; University Hospital; Strasbourg France
- Department of Cardiology; University Hospital; Strasbourg France
| | - Mi-Young Jeung
- Department of Radiology; University Hospital; Strasbourg France
| | - Elodie Breton
- ICube; Université de Strasbourg, CNRS; Strasbourg France
| | - Pierre Croisille
- Department of Radiology; University Jean Monnet Saint-Etienne; CREATIS, UMR CNRS 5220-INSERM U1044 Lyon France
| | - Emmanuel Durand
- Department of Nuclear Medicine; University Hospital; Strasbourg France
| | - Catherine Roy
- Department of Radiology; University Hospital; Strasbourg France
| | - Afshin Gangi
- Department of Radiology; University Hospital; Strasbourg France
- ICube; Université de Strasbourg, CNRS; Strasbourg France
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6
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Suever JD, Fornwalt BK, Neuman LR, Delfino JG, Lloyd MS, Oshinski JN. Method to create regional mechanical dyssynchrony maps from short-axis cine steady-state free-precession images. J Magn Reson Imaging 2013; 39:958-65. [PMID: 24123528 DOI: 10.1002/jmri.24257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/15/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop a robust method to assess regional mechanical dyssynchrony from cine short-axis MR images. Cardiac resynchronization therapy (CRT) is an effective treatment for patients with heart failure and evidence of left-ventricular (LV) dyssynchrony. Patient response to CRT is greatest when the LV pacing lead is placed in the most dyssynchronous segment. Existing techniques for assessing regional dyssynchrony require difficult acquisition and/or postprocessing. Our goal was to develop a widely applicable and robust method to assess regional mechanical dyssynchrony. MATERIALS AND METHODS Using the endocardial boundary, radial displacement curves (RDCs) were generated throughout the LV. Cross-correlation was used to determine the delay time between each RDC and a patient-specific reference. Delay times were projected onto the American Heart Association 17-segment model creating a regional dyssynchrony map. Our method was tested in 10 normal individuals and 10 patients enrolled for CRT (QRS > 120 ms, NYHA III-IV, EF < 35%). RESULTS Delay times over the LV were 23.9 ± 33.8 ms and 93.1 ± 99.9 ms (P < 0.001) in normal subjects and patients, respectively. Interobserver reproducibility for segment averages was 6.8 ± 39.3 ms and there was 70% agreement in identifying the latest contracting segment. CONCLUSION We have developed a method that can reliably calculate regional delay times from cine steady-state free-precession (SSFP) images. Maps of regional dyssynchrony could be used to identify the latest-contracting segment to assist in CRT lead implantation.
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Affiliation(s)
- Jonathan D Suever
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology / Emory University, Atlanta, Georgia, USA
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7
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New insights in LV torsion for the selection of cardiac resynchronisation therapy candidates. Neth Heart J 2013; 19:386-91. [PMID: 21562790 DOI: 10.1007/s12471-011-0136-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Recent literature indicates that torsion of the left ventricle (LV) is a promising predictor for response to cardiac resynchronisation therapy (CRT). Among patients with severe heart failure, 45 to 75% of patients show rigid body rotation, where the base and apex rotate in the same direction, instead of normal, opposite rotation. The occurrence of this phenomenon seems to be a good indicator for response to CRT. From this review, it can be concluded that LV torsion might be a welcome addition to current selection criteria.
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Lutz A, Paul J, Bornstedt A, Nienhaus GU, Etyngier P, Bernhardt P, Rottbauer W, Rasche V. Volumetric motion quantification by 3D tissue phase mapped CMR. J Cardiovasc Magn Reson 2012; 14:74. [PMID: 23101880 PMCID: PMC3514160 DOI: 10.1186/1532-429x-14-74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study was the quantification of myocardial motion from 3D tissue phase mapped (TPM) CMR. Recent work on myocardial motion quantification by TPM has been focussed on multi-slice 2D acquisitions thus excluding motion information from large regions of the left ventricle. Volumetric motion assessment appears an important next step towards the understanding of the volumetric myocardial motion and hence may further improve diagnosis and treatments in patients with myocardial motion abnormalities. METHODS Volumetric motion quantification of the complete left ventricle was performed in 12 healthy volunteers and two patients applying a black-blood 3D TPM sequence. The resulting motion field was analysed regarding motion pattern differences between apical and basal locations as well as for asynchronous motion pattern between different myocardial segments in one or more slices. Motion quantification included velocity, torsion, rotation angle and strain derived parameters. RESULTS All investigated motion quantification parameters could be calculated from the 3D-TPM data. Parameters quantifying hypokinetic or asynchronous motion demonstrated differences between motion impaired and healthy myocardium. CONCLUSIONS 3D-TPM enables the gapless volumetric quantification of motion abnormalities of the left ventricle, which can be applied in future application as additional information to provide a more detailed analysis of the left ventricular function.
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Affiliation(s)
- Anja Lutz
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Dusseldorf, Germany
| | - Jan Paul
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Axel Bornstedt
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - G Ulrich Nienhaus
- Institute of Applied Physics and Center for Functional Nanostructures (CFN), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | | | - Peter Bernhardt
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
| | - Volker Rasche
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany
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Strik M, Regoli F, Auricchio A, Prinzen F. Electrical and mechanical ventricular activation during left bundle branch block and resynchronization. J Cardiovasc Transl Res 2012; 5:117-26. [PMID: 22311563 PMCID: PMC3294208 DOI: 10.1007/s12265-012-9351-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/21/2012] [Indexed: 11/27/2022]
Abstract
Cardiac resynchronization therapy (CRT) aims to treat selected heart failure patients suffering from conduction abnormalities with left bundle branch block (LBBB) as the culprit disease. LBBB remained largely underinvestigated until it became apparent that the amount of response to CRT was heterogeneous and that the therapy and underlying pathology were thus incompletely understood. In this review, current knowledge concerning activation in LBBB and during biventricular pacing will be explored and applied to current CRT practice, highlighting novel ways to better measure and treat the electrical substrate.
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Affiliation(s)
- Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht 6200 MD, The Netherlands.
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10
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Aljaroudi W, Koneru J, Iqbal F, Aggarwal H, Heo J, Iskandrian AE. Left ventricular mechanical dyssynchrony by phase analysis of gated single photon emission computed tomography in end-stage renal disease. Am J Cardiol 2010; 106:1042-7. [PMID: 20854972 DOI: 10.1016/j.amjcard.2010.05.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 11/17/2022]
Abstract
The presence and degree of left ventricular (LV) dyssynchrony in patients with end-stage renal disease (ESRD) has not been well studied. We hypothesized that these patients would be more likely to have mechanical dyssynchrony than a control cohort. The indexes of LV mechanical dyssynchrony were measured by automated analysis of gated single photon emission computed tomography myocardial perfusion imaging in 290 patients with ESRD and 109 control patients. Only patients with normal myocardial perfusion imaging findings and a narrow QRS duration were included. The following variables were derived: LV ejection fraction (EF), volume, mass, and 2 indexes of dyssynchrony, the standard deviation and bandwidth. The standard deviation and bandwidth were significantly greater in those with ESRD (23° ± 13° vs 15° ± 6° and 65° ± 40° vs 42° ± 14°, respectively, p <0.001 for each). The LV volumes and LV mass were significantly lower and LVEF significantly greater in the control group than in the patients with ESRD (p <0.001 for each). The subgroup of 217 patients with ESRD and normal LVEF also had a significantly greater standard deviation and bandwidth than did the control group (21° ± 12° and 57° ± 35°, p <0.001 for each). However, their values were lower than those of the 73 patients with ESRD and a LVEF <50% (30° ± 13° and 90° ± 45°, p <0.001 for each). Finally, 25 patients (9%) with ESRD and none of the control group had a standard deviation >43° (p = 0.01). In conclusion, patients with ESRD had significantly more mechanical dyssynchrony than did the control group, even in absence of electrical dyssynchrony and abnormal LV perfusion or function.
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Affiliation(s)
- Wael Aljaroudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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11
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Manzke R, Binner L, Bornstedt A, Merkle N, Lutz A, Gradinger R, Rasche V. Assessment of the coronary venous system in heart failure patients by blood pool agent enhanced whole-heart MRI. Eur Radiol 2010; 21:799-806. [PMID: 20872222 DOI: 10.1007/s00330-010-1961-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/05/2010] [Accepted: 08/03/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the feasibility of MRI for non-invasive assessment of the coronary sinus (CS) and the number and course of its major tributaries in heart failure patients. METHODS Fourteen non-ischaemic heart failure patients scheduled for cardiac resynchronisation therapy (CRT) underwent additional whole-heart coronary venography. MRI was performed 1 day before device implantation. The visibility, location and dimensions of the CS and its major tributaries were assessed and the number of potential implantation sites identified. The MRI results were validated by X-ray venography conventionally acquired during the device implantation procedure. RESULTS The right atrium (RA), CS and mid-cardiac vein (MCV) could be visualised in all patients. 36% of the identified candidate branches were located posterolaterally, 48% laterally and 16% anterolaterally. The average diameter of the CS was quantified as 9.8 mm, the posterior interventricular vein (PIV) 4.6 mm, posterolateral segments 3.3 mm, lateral 2.9 mm and anterolateral 2.9 mm. Concordance with X-ray in terms of number and location of candidate branches was given in most cases. CONCLUSION Contrast-enhanced MRI venography appears feasible for non-invasive pre-interventional assessment of the course of the CS and its major tributaries.
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Affiliation(s)
- Robert Manzke
- Department of Internal Medicine II, University Hospital of Ulm, Ulm, Germany.
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12
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Kumar A, Patton DJ, Friedrich MG. The emerging clinical role of cardiovascular magnetic resonance imaging. Can J Cardiol 2010; 26:313-22. [PMID: 20548977 DOI: 10.1016/s0828-282x(10)70396-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Starting as a research method little more than a decade ago, cardiovascular magnetic resonance (CMR) imaging has rapidly evolved to become a powerful diagnostic tool used in routine clinical cardiology. The contrast in CMR images is generated from protons in different chemical environments and, therefore, enables high-resolution imaging and specific tissue characterization in vivo, without the use of potentially harmful ionizing radiation.CMR imaging is used for the assessment of regional and global ventricular function, and to answer questions regarding anatomy. State-of-the-art CMR sequences allow for a wide range of tissue characterization approaches, including the identification and quantification of nonviable, edematous, inflamed, infiltrated or hypoperfused myocardium. These tissue changes are not only used to help identify the etiology of cardiomyopathies, but also allow for a better understanding of tissue pathology in vivo. CMR tissue characterization may also be used to stage a disease process; for example, elevated T2 signal is consistent with edema and helps differentiate acute from chronic myocardial injury, and the extent of myocardial fibrosis as imaged by contrast-enhanced CMR correlates with adverse patient outcome in ischemic and nonischemic cardiomyopathies.The current role of CMR imaging in clinical cardiology is reviewed, including coronary artery disease, congenital heart disease, nonischemic cardiomyopathies and valvular disease.
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Affiliation(s)
- Andreas Kumar
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, Iskandrian AE. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010; 17:398-404. [PMID: 20300907 DOI: 10.1007/s12350-009-9169-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 11/05/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Left-ventricular (LV) dyssynchrony could be measured by gated SPECT myocardial perfusion imaging (MPI). This study examined the relation between the degree of dyssynchrony and outcome in patients with implantable cardiac defibrillators (ICDs). METHODS AND RESULTS We studied 70 patients with ICD and LV ejection fraction (EF) <.40 by gated MPI (performed within 6 weeks of the device implantation). The images were re-processed using phase analysis to derive phase standard deviation (SD) and histogram bandwidth. All-cause mortality and appropriate ICD shocks were identified as the primary endpoint. There were 87% men, aged 62 +/- 11 years. The EF was 26 +/- 8% (range 12%-39%). The phase SD was 51 degrees +/- 20 degrees (range 12 degrees -99 degrees ) and the histogram bandwidth was 157 degrees +/- 72 degrees (range 21 degrees -327 degrees ). The SD and bandwidth were significantly greater than corresponding values in patients with normal EF (15.8 +/- 11.8 degrees and 42.0 +/- 28.4 degrees , respectively, P < .0001, each). At 1 year, 8 patients (11%) died or had shocks. The patients with events had higher phase SD than those without events (60 +/- 5 degrees vs 50 +/- 21 degrees , P = .002). The histogram bandwidth was also higher in those with events (185 +/- 37 vs 154 +/- 75, P = .07). All patients with event had a phase SD >or= 50 degrees , while none of the patients with a phase SD < 50 degrees (N = 26) had an event (P = .02). CONCLUSIONS The severity of LV dyssynchrony by phase analysis in patients with LV dysfunction, and ICD is associated with increased risk of death and appropriate ICD shock; a phase SD < 50 degrees was associated with no events at 1 year.
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Affiliation(s)
- Wael A Aljaroudi
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 318 LHRB, 1900 University BLVD, Birmingham, AL 35294-0006, USA.
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14
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Eggen MD, Bateman MG, Rolfes CD, Howard SA, Swingen CM, Iaizzo PA. MRI assessment of pacing induced ventricular dyssynchrony in an isolated human heart. J Magn Reson Imaging 2010; 31:466-9. [PMID: 20099368 DOI: 10.1002/jmri.22050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study demonstrates the capabilities of MRI in the assessment of cardiac pacing induced ventricular dyssynchrony, and the findings support the need for employing more physiological pacing. A human donor heart deemed non-viable for transplantation, was reanimated using an MR compatible, four-chamber working perfusion system. The heart was imaged using a 1.5T MR scanner while being paced from the right ventricular apex (RVA) via an epicardial placed lead. Four-chamber, short-axis, and tagged short-axis cines were acquired in order to track wall motion and intramyocardial strain during pacing. The results of this study revealed that the activation patterns of the left ventricle (LV) during RVA pacing demonstrated intraventricular dyssynchrony; as the left ventricular mechanical activation proceeded from the septum and anterior wall to the lateral wall, with the posterior wall being activated last. As such, the time difference to peak contraction between the septum and lateral wall was approximately 125 msec. Likewise, interventricular dyssynchrony was demonstrated from the four-chamber cine as the time difference between the peak LV and RV free wall motion was 180 msec. With the ongoing development of MR safe and MR compatible pacing systems, we can expect MRI to be added to the list of imaging modalities used to optimize cardiac resynchronization therapy (CRT) and/or alternate site pacing.
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Affiliation(s)
- Michael D Eggen
- Department of Biomedical Engineering, Minneapolis, Minnesota, USA
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Abstract
Cardiac resynchronization has emerged as a highly effective therapy for heart failure. However, up to 40% of patients do not benefit from this treatment. In this Review, we discuss the potential role of MRI and nuclear molecular imaging in providing additional insights into the response to cardiac resynchronization therapy. Variables with potential prognostic and therapeutic values include the evaluation of cardiac dyssynchrony, scar, cardiac sympathetic function, myocardial blood flow, myocardial glucose and oxidative metabolism. Other molecular targets to characterize apoptosis, fatty acid metabolism, angiogenesis and angiotensin-converting enzyme activity will also be described. The potential use of these techniques in identifying and measuring responses to cardiac resynchronization therapy and future areas of research will be explored.
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Rutz AK, Manka R, Kozerke S, Roas S, Boesiger P, Schwitter J. Left ventricular dyssynchrony in patients with left bundle branch block and patients after myocardial infarction: integration of mechanics and viability by cardiac magnetic resonance. Eur Heart J 2009; 30:2117-27. [DOI: 10.1093/eurheartj/ehp212] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Korosoglou G, Futterer S, Humpert PM, Riedle N, Lossnitzer D, Hoerig B, Steen H, Giannitsis E, Osman NF, Katus HA. Strain-encoded cardiac MR during high-dose dobutamine stress testing: comparison to cine imaging and to myocardial tagging. J Magn Reson Imaging 2009; 29:1053-61. [PMID: 19388131 DOI: 10.1002/jmri.21759] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate regional strain response during high-dose dobutamine stress cardiac magnetic resonance imaging (DS-CMR) using myocardial tagging and Strain-Encoded MR (SENC). MATERIALS AND METHODS Stress induced ischemia was assessed by wall motion analysis, by tagged CMR and by SENC in 65 patients with suspected or known CAD who underwent DS-CMR in a clinical 1.5 Tesla scanner. Coronary angiography deemed as the standard reference for the presence or absence of CAD (> or =50% diameter stenosis) in all patients. RESULTS SENC and conventional tagging detected abnormal strain response in six and five additional patients, respectively, who were missed by cine images and proved to have CAD by angiography (P < 0.05 for SENC versus cine, P = 0.06 for tagging versus cine and p = NS for SENC versus tagging). On a per-vessel level, wall motion analysis on cine images showed high specificity (95%) but moderate sensitivity (70%) for the detection of CAD. Tagging and SENC yielded significantly higher sensitivity of 81% and 89%, respectively (P < 0.05 for tagging and P < 0.01 for SENC versus wall motion analysis, and p = NS for SENC versus tagging), while specificity was equally high (96% and 94%, respectively, P = NS for all). CONCLUSION Both the direct color-coded visualization of strain on CMR images and the generation of additional visual markers within the myocardium with tagged CMR represent useful adjuncts for DS-CMR, which may provide incremental value for the detection of CAD in humans. J. Magn. Reson.
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18
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Bilchick KC, Dimaano V, Wu KC, Helm RH, Weiss RG, Lima JA, Berger RD, Tomaselli GF, Bluemke DA, Halperin HR, Abraham T, Kass DA, Lardo AC. Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy. JACC Cardiovasc Imaging 2009; 1:561-8. [PMID: 19356481 DOI: 10.1016/j.jcmg.2008.04.013] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 04/21/2008] [Accepted: 04/28/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We tested a circumferential mechanical dyssynchrony index (circumferential uniformity ratio estimate [CURE]; 0 to 1, 1 = synchrony) derived from magnetic resonance-myocardial tagging (MR-MT) for predicting clinical function class improvement following cardiac resynchronization therapy (CRT). BACKGROUND There remains a significant nonresponse rate to CRT. MR-MT provides high quality mechanical activation data throughout the heart, and delayed enhancement cardiac magnetic resonance (DE-CMR) offers precise characterization of myocardial scar. METHODS MR-MT was performed in 2 cohorts of heart failure patients with: 1) a CRT heart failure cohort (n = 20; left ventricular ejection fraction of 0.23 +/- 0.057) to evaluate the role of MR-MT and DE-CMR prior to CRT; and 2) a multimodality cohort (n = 27; ejection fraction of 0.20 +/- 0.066) to compare MR-MT and tissue Doppler imaging septal-lateral delay for assessment of mechanical dyssynchrony. MR-MT was also performed in 9 healthy control subjects. RESULTS MR-MT showed that control subjects had highly synchronous contraction (CURE 0.96 +/- 0.01), but tissue Doppler imaging indicated dyssynchrony in 44%. Using a cutoff of <0.75 for CURE based on receiver-operator characteristic analysis (area under the curve: 0.889), 56% of patients tested positive for mechanical dyssynchrony, and the MR-MT CURE predicted improved function class with 90% accuracy (positive and predictive values: 87%, 100%); adding DE-CMR (% total scar <15%) data improved accuracy further to 95% (positive and negative predictive values: 93%, 100%). The correlation between CURE and QRS duration was modest in all cardiomyopathy subjects (r = 0.58, p < 0.001). The multimodality cohort showed a 30% discordance rate between CURE and tissue Doppler imaging septal-lateral delay. CONCLUSIONS The MR-MT assessment of circumferential mechanical dyssynchrony predicts improvement in function class after CRT. The addition of scar imaging by DE-CMR further improves this predictive value.
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Affiliation(s)
- Kenneth C Bilchick
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Mele D, Toselli T, Capasso F, Stabile G, Piacenti M, Piepoli M, Giatti S, Klersy C, Sallusti L, Ferrari R. Comparison of myocardial deformation and velocity dyssynchrony for identification of responders to cardiac resynchronization therapy. Eur J Heart Fail 2009; 11:391-9. [DOI: 10.1093/eurjhf/hfp032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Donato Mele
- Azienda Ospedaliero-Universitaria, Ferrara and Fondazione Salvatore Maugeri, Brescia; Corso Giovecca 203 44100 Ferrara Italy
| | - Tiziano Toselli
- Azienda Ospedaliero-Universitaria, Ferrara and Fondazione Salvatore Maugeri, Brescia; Corso Giovecca 203 44100 Ferrara Italy
| | - Fabio Capasso
- Cardiac Unit, Casa di Cura S. Michele; Maddaloni Italy
| | | | | | | | - Sara Giatti
- Azienda Ospedaliero-Universitaria, Ferrara and Fondazione Salvatore Maugeri, Brescia; Corso Giovecca 203 44100 Ferrara Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service; Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | | | - Roberto Ferrari
- Azienda Ospedaliero-Universitaria, Ferrara and Fondazione Salvatore Maugeri, Brescia; Corso Giovecca 203 44100 Ferrara Italy
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Neizel M, Lossnitzer D, Korosoglou G, Schäufele T, Lewien A, Steen H, Katus HA, Osman NF, Giannitsis E. Strain-encoded (SENC) magnetic resonance imaging to evaluate regional heterogeneity of myocardial strain in healthy volunteers: Comparison with conventional tagging. J Magn Reson Imaging 2009; 29:99-105. [PMID: 19097105 DOI: 10.1002/jmri.21612] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the ability of strain-encoded (SENC) magnetic resonance imaging (MRI) for regional systolic and diastolic strain analysis of the myocardium in healthy volunteers. MATERIALS AND METHODS Circumferential and longitudinal peak systolic strain values of 75 healthy volunteers (35 women and 40 men, mean age 44 +/- 12 years) were measured using SENC at 1.5T. MR tagging was used as the reference standard for measuring regional function. Diastolic function was assessed in the 10 youngest (24 +/- 8 years) and 10 oldest (62 +/- 5 years) subjects. RESULTS Peak strain values assessed with SENC were comparable to those obtained by MR tagging, showing narrow limits of agreement (limits of agreement -5.6% to 8.1%). Regional heterogeneity was observed between different segments of the left ventricle (LV) by both techniques (P < 0.001). Longitudinal strain obtained by SENC was also heterogenous (P < 0.001). Interestingly, no age- or gender-specific differences in peak systolic strain were observed, whereas the peak rate of relaxation of circumferential strain rate was decreased in the older group. CONCLUSION SENC is a reliable tool for accurate and objective quantification of regional myocardial systolic as well as diastolic function. In agreement with tagged MRI, SENC detected slightly heterogeneous myocardial strain within LV segments.
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Affiliation(s)
- Mirja Neizel
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
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21
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Trimble MA, Borges-Neto S, Velazquez EJ, Chen J, Shaw LK, Pagnanelli R, Garcia EV, Iskandrian AE. Emerging role of myocardial perfusion imaging to evaluate patients for cardiac resynchronization therapy. Am J Cardiol 2008; 102:211-7. [PMID: 18602524 DOI: 10.1016/j.amjcard.2008.03.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 03/02/2008] [Accepted: 03/02/2008] [Indexed: 10/22/2022]
Abstract
Left ventricular (LV) dyssynchrony is an increasingly important consideration in the evaluation and management of patients with LV systolic dysfunction. Improvements in clinical status, LV remodeling, and survival have been demonstrated with the use of cardiac resynchronization therapy (CRT). The current selection criteria for patients who undergo CRT include the presence of severe LV dysfunction, significant heart failure symptoms, and electrical dyssynchrony on surface electrocardiography (wide QRS interval). However, up to 40% of patients who undergo CRT do not experience reductions in symptoms or LV functional improvement. Because electrical dyssynchrony is not synonymous with contractile or mechanical dyssynchrony, efforts have been made to more accurately quantify mechanical dyssynchrony in the hope of improving the selection of patients for CRT. These efforts have focused largely on echocardiographic measures of mechanical dyssynchrony. A novel method to quantify LV mechanical dyssynchrony has been developed using phase analysis of gated single photon-emission computed tomographic myocardial perfusion imaging. In conclusion, this report describes potential advantages, compared with other methods, of using myocardial perfusion imaging to evaluate patients for CRT; reviews the method of the phase analysis technique to quantify dyssynchrony; reviews the available evidence of its utility; and describes future directions in research.
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Abraham J, Abraham TP. Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy? Circ Cardiovasc Imaging 2008; 1:79-84; discussion 84. [DOI: 10.1161/circimaging.108.792804] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob Abraham
- From the Translational Cardiovascular Ultrasound Laboratory, Division of Cardiology, Johns Hopkins University, Baltimore, Md
| | - Theodore P. Abraham
- From the Translational Cardiovascular Ultrasound Laboratory, Division of Cardiology, Johns Hopkins University, Baltimore, Md
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Prinzen FW, Auricchio A. Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy? Circ Cardiovasc Imaging 2008; 1:70-7; discussion 78. [DOI: 10.1161/circimaging.108.791772] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frits W. Prinzen
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (F.W.P.); and Cardiocentro Ticino, Lugano, Switzerland (A.A.)
| | - Angelo Auricchio
- From the Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (F.W.P.); and Cardiocentro Ticino, Lugano, Switzerland (A.A.)
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De Boeck BWL, Kirn B, Teske AJ, Hummeling RW, Doevendans PA, Cramer MJ, Prinzen FW. Three-dimensional mapping of mechanical activation patterns, contractile dyssynchrony and dyscoordination by two-dimensional strain echocardiography: rationale and design of a novel software toolbox. Cardiovasc Ultrasound 2008; 6:22. [PMID: 18513412 PMCID: PMC2429897 DOI: 10.1186/1476-7120-6-22] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 05/30/2008] [Indexed: 11/11/2022] Open
Abstract
Background Dyssynchrony of myocardial deformation is usually described in terms of variability only (e.g. standard deviations SD's). A description in terms of the spatio-temporal distribution pattern (vector-analysis) of dyssynchrony or by indices estimating its impact by expressing dyscoordination of shortening in relation to the global ventricular shortening may be preferential. Strain echocardiography by speckle tracking is a new non-invasive, albeit 2-D imaging modality to study myocardial deformation. Methods A post-processing toolbox was designed to incorporate local, speckle tracking-derived deformation data into a 36 segment 3-D model of the left ventricle. Global left ventricular shortening, standard deviations and vectors of timing of shortening were calculated. The impact of dyssynchrony was estimated by comparing the end-systolic values with either early peak values only (early shortening reserve ESR) or with all peak values (virtual shortening reserve VSR), and by the internal strain fraction (ISF) expressing dyscoordination as the fraction of deformation lost internally due to simultaneous shortening and stretching. These dyssynchrony parameters were compared in 8 volunteers (NL), 8 patients with Wolff-Parkinson-White syndrome (WPW), and 7 patients before (LBBB) and after cardiac resynchronization therapy (CRT). Results Dyssynchrony indices merely based on variability failed to detect differences between WPW and NL and failed to demonstrate the effect of CRT. Only the 3-D vector of onset of shortening could distinguish WPW from NL, while at peak shortening and by VSR, ESR and ISF no differences were found. All tested dyssynchrony parameters yielded higher values in LBBB compared to both NL and WPW. CRT reduced the spatial divergence of shortening (both vector magnitude and direction), and improved global ventricular shortening along with reductions in ESR and dyscoordination of shortening expressed by ISF. Conclusion Incorporation of local 2-D echocardiographic deformation data into a 3-D model by dedicated software allows a comprehensive analysis of spatio-temporal distribution patterns of myocardial dyssynchrony, of the global left ventricular deformation and of newer indices that may better reflect myocardial dyscoordination and/or impaired ventricular contractile efficiency. The potential value of such an analysis is highlighted in two dyssynchronous pathologies that impose particular challenges to deformation imaging.
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Affiliation(s)
- Bart W L De Boeck
- Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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