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Cao Y, Peng H, Zhang K, Huang M, Luo Q, Li H, Li Y, Wang L, Shi H. Cardiovascular MRI Reference Ranges for Heart, Aorta, and Pulmonary Artery in Healthy Chinese Children. J Magn Reson Imaging 2024. [PMID: 38651656 DOI: 10.1002/jmri.29394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (cardiac MR) reference ranges in Chinese children are lacking. PURPOSE To establish age- and sex-specific reference ranges for cardiac MR parameters in a cohort of healthy Chinese children. STUDY TYPE Retrospective. SUBJECTS One hundred ninety-six healthy children (mean age 9.5 ± 3.6 years, 111 boys). FIELD STRENGTH/SEQUENCE 1.5 T; balanced steady-state free precession. ASSESSMENT Biventricular volume and ejection fractions (EF), left atrial (LA) volume, right atrial (RA) area, left ventricular (LV) mass and thickness, aortic root (AR), and main pulmonary artery (MPA) dimensions were measured. Parameters were compared between age groups and sex. The relationships between parameters and age, body mass index (BMI) and body surface area (BSA) were investigated. STATISTICAL TESTS Independent-samples t tests; Pearson's correlation. A P value <0.05 was considered statistically significant. RESULTS Generally, boys exhibited greater absolute measurements of LV volume (end-diastolic: 94.4 ± 29.5 vs. 81.3 ± 31.0 mL), LA volume (end-diastolic: 42.6 ± 13.4 vs. 38.0 ± 13.3 mL), RA area (end-diastolic: 11.6 ± 2.5 vs. 10.8 ± 2.6 cm2), LV thickness (base: 4.4 ± 1.1 vs. 3.8 ± 0.9 mm), AR dimensions (annuls: 16.3 ± 2.7 vs. 15.0 ± 2.8 mm), and MPA dimensions (14.3 ± 2.3 vs. 13.1 ± 2.4 mm) than girls did. However, these differences were not observed when the measurements were normalized to BSA (LV volume: 75.3 ± 11.7 vs. 71.9 ± 12.3 mL/m2, P = 0.052; LA volume: 34.8 ± 8.9 vs. 34.5 ± 7.6 mL/m2, P = 0.783; RA area: 9.7 ± 2.3 vs. 10.2 ± 2.3 cm2/m2, P = 0.107; LV thickness: 3.6 ± 0.7 vs. 3.6 ± 0.9 mm/m2, P = 0.990; AR: 13.6 ± 2.7 vs. 14.3 ± 3.4 mm/m2, P = 0.108; MPA: 11.9 ± 2.3 vs. 12.4 ± 2.4 mm/m2, P = 0.118). Boys had greater RV volume (end-diastolic: 98.7 ± 33.5 vs. 82.7 ± 33.1 mL) and LV mass (52.6 ± 20.2 vs. 41.4 ± 16.0 g) compared to girls, irrespective of whether the values were indexed or not for BSA. Additionally, there were significant associations between age, BMI, and BSA with biventricular volume, LA volume, RA area, LV mass and thickness, AR and MPA dimensions in both boys and girls. DATA CONCLUSION This study suggests reference ranges at 1.5 T for Chinese children. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yukun Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Peng
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kailu Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengting Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinyue Luo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanting Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yumin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Wang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kamp AN, Kiper C, Russell J, Hor KN. Combined Atrial Volume is Associated with Significant Atrial Arrhythmias in Total Cavopulmonary Connection Fontan Patients. Pediatr Cardiol 2023; 44:1741-1745. [PMID: 37620579 DOI: 10.1007/s00246-023-03271-1] [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: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Atrial arrhythmias are a common late manifestation after Fontan palliation and are known to contribute to significant morbidity and mortality. Atrial volume by cardiac magnetic resonance imaging has been increasingly used in patients with congenital heart disease with no reports in those with Fontan palliation. In acquired heart disease, left atrial volume has been shown to be a strong predictor of outcomes of sustained atrial arrhythmias, including recurrence of atrial fibrillation. We hypothesized that combined atrial volume (CAV) in patients with total cavopulmonary connection (TCPC) Fontan palliation may be associated with increased risk of significant atrial arrhythmias (SAA). This is a single center retrospective case-control study. Cases were defined as patients with TCPC Fontan palliation ≥ 18 years of age, with SAA requiring intervention. Only those with advanced imaging for 3D rendering between 2013 and 2022 were included. CAV was analyzed from a 3-dimensional (3D) data set, including both the left and right atria, excluding the Fontan baffle. Seventeen TCPC Fontan case patients and 17 control patients were included. There was no difference in age between the two groups. There was no difference between gender, type of Fontan palliation, atrio-ventricular valve regurgitation, or combined ventricular function between the two groups. CAV was higher in SAA group compared to controls, and all control patients had indexed CAV ≤ 80 mL/kg. This is the first data suggesting CAV is associated with SAA in TCPC Fontan patients. Indexed CAV ≥ 80 mL/kg may be a valuable marker for SAA risk.
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Affiliation(s)
- Anna N Kamp
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | - Carmen Kiper
- Department of Pediatrics, Brenner Children's, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jennifer Russell
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Tower Building, Suite T3234, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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Henderson CC, George-Durrett K, Kikano S, Slaughter JC, Chew JD, Parra D, Weiner J, Soslow J. Reference data for left ventricular filling and atrial function in children using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:30. [PMID: 37308942 PMCID: PMC10258747 DOI: 10.1186/s12968-023-00936-x] [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: 11/02/2022] [Accepted: 05/11/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Diastolic dysfunction is associated with morbidity and mortality in multiple pediatric disease processes. Cardiovascular magnetic resonance (CMR) provides a non-invasive method of studying left ventricular (LV) diastolic dysfunction through the assessment of LV filling curves and left atrial (LA) volume and function. However, there are no normative data for LV filling curves and the standard method is time-intensive. This study aims to compare an alternate, more rapid method of obtaining LV filling curves to standard methodology and report normative CMR diastolic function data for LV filling curves and LA volumes and function. METHODS Ninety-six healthy pediatric subjects (14.3 ± 3.4 years) with normal CMR defined by normal biventricular size and systolic function without late gadolinium enhancement were included. LV filling curves were generated by removing basal slices without myocardium present throughout the cardiac cycle and apical slices with poor endocardial delineation (compressed method), then re-generated including every phase of myocardium from apex to base (standard method). Indices of diastolic function included peak filling rate and time to peak filling. Systolic metrics included peak ejection rate and time to peak ejection. Both peak ejection and peak filling rates were indexed to end-diastolic volume. LA maximum, minimum and pre-contraction volumes were calculated using a biplane method. Inter-and intra-observer variability were assessed with intraclass correlation coefficient. Multivariable linear regression was used to assess the effects of body surface area (BSA), gender and age on metrics of diastolic function. RESULTS BSA had the largest effect on LV filling curves. Normal LV filling data are reported for both compressed and standard methods. The time to perform the compressed method was significantly shorter than the standard method (median 6.1 min vs. 12.5 min, p < 0.001). Both methods had strong to moderate correlation for all metrics. Intra-observer reproducibility was moderate to high for all LV filling and LA metrics except for time to peak ejection and peak filling. CONCLUSIONS We report reference values for LV filling metrics and LA volumes. The compressed method is more rapid and produces similar results to standard methodology, which may facilitate the use of LV filling in clinical CMR reporting.
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Affiliation(s)
| | - Kristen George-Durrett
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandra Kikano
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua D Chew
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey Weiner
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Beroukhim RS, Merlocco A, Gerardin JF, Tham E, Patel JK, Siddiqui S, Goot B, Farooqi K, Soslow J, Grotenhuis H, Hor K, Muthurangu V, Raimondi F. Multicenter research priorities in pediatric CMR: results of a collaborative wiki survey. Sci Rep 2023; 13:9022. [PMID: 37270629 DOI: 10.1038/s41598-023-34720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/06/2023] [Indexed: 06/05/2023] Open
Abstract
Multicenter studies in pediatric cardiovascular magnetic resonance (CMR) improve statistical power and generalizability. However, a structured process for identifying important research topics has not been developed. We aimed to (1) develop a list of high priority knowledge gaps, and (2) pilot the use of a wiki survey to collect a large group of responses. Knowledge gaps were defined as areas that have been either unexplored or under-explored in the research literature. High priority goals were: (1) feasible and answerable from a multicenter research study, and (2) had potential for high impact on the field of pediatric CMR. Seed ideas were contributed by a working group and imported into a pairwise wiki survey format which allows for new ideas to be uploaded and voted upon ( https://allourideas.org ). Knowledge gaps were classified into 2 categories: 'Clinical CMR Practice' (16 ideas) and 'Disease Specific Research' (22 ideas). Over a 2-month period, 3,658 votes were cast by 96 users, and 2 new ideas were introduced. The 3 highest scoring sub-topics were myocardial disorders (9 ideas), translating new technology & techniques into clinical practice (7 ideas), and normal reference values (5 ideas). The highest priority gaps reflected strengths of CMR (e.g., myocardial tissue characterization; implementation of technologic advances into clinical practice), and deficiencies in pediatrics (e.g., data on normal reference values). The wiki survey format was effective and easy to implement, and could be used for future surveys.
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Affiliation(s)
- Rebecca S Beroukhim
- Department of Cardiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Anthony Merlocco
- Department of Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Jennifer F Gerardin
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Edythe Tham
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jyoti K Patel
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Saira Siddiqui
- Division of Pediatric Cardiology, Atlantic Health System, Morristown, NJ, USA
| | - Benjamin Goot
- Division of Pediatric Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Kanwal Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Heynric Grotenhuis
- Department of Pediatric Cardiology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Kan Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Vivek Muthurangu
- Department of Cardiology, UCL Center for Translational Cardiovascular Imaging, University College London, London, UK
| | - Francesca Raimondi
- Department of Cardiology, Meyer Children's Hospital, University of Florence, Florence, Italy
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Real C, Párraga R, Pizarro G, García-Lunar I, González-Calvo E, Martínez-Gómez J, Sánchez-González J, Sampedro P, Sanmamed I, De Miguel M, De Cos-Gandoy A, Bodega P, Ibanez B, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Magnetic resonance imaging reference values for cardiac morphology, function and tissue composition in adolescents. EClinicalMedicine 2023; 57:101885. [PMID: 37064511 PMCID: PMC10102894 DOI: 10.1016/j.eclinm.2023.101885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Background Cardiovascular magnetic resonance (CMR) is a precise tool for the assessment of cardiac anatomy, function, and tissue composition. However, studies providing CMR reference values in adolescence are scarce. We aim to provide sex-specific CMR reference values for biventricular and atrial dimensions and function and myocardial relaxation times in this population. Methods Adolescents aged 15-18 years with no known cardiovascular disease underwent a non-contrast 3-T CMR scan between March 2021 and October 2021. The imaging protocol included a cine steady-state free-precession sequence for the analysis of chamber size and function, as well as T2-GraSE and native MOLLI T1-mapping for the characterization of myocardial tissue. Findings CMR scans were performed in 123 adolescents (mean age 16 ± 0.5 years, 52% girls). Mean left and right ventricular end-diastolic indexed volumes were higher in boys than in girls (91.7 ± 11.6 vs 78.1 ± 8.3 ml/m2, p < 0.001; and 101.3 ± 14.1 vs 84.1 ± 10.5 ml/m2, p < 0.001), as was the indexed left ventricular mass (48.5 ± 9.6 vs 36.6 ± 6.0 g/m2, p < 0.001). Left ventricular ejection fraction showed no significant difference by sex (62.2 ± 4.1 vs 62.8 ± 4.2%, p = 0.412), whereas right ventricular ejection fraction trended slightly lower in boys (55.4 ± 4.7 vs. 56.8 ± 4.4%, p = 0.085). Indexed atrial size and function parameters did not differ significantly between sexes. Global myocardial native T1 relaxation time was lower in boys than in girls (1215 ± 23 vs 1252 ± 28 ms, p < 0.001), whereas global myocardial T2 relaxation time did not differ by sex (44.4 ± 2.0 vs 44.1 ± 2.4 ms, p = 0.384). Sex-stratified comprehensive percentile tables are provided for most relevant cardiac parameters. Interpretation This cross-sectional study provides overall and sex-stratified CMR reference values for cardiac dimensions and function, and myocardial tissue properties, in adolescents. This information is useful for clinical practice and may help in the differential diagnosis of cardiac diseases, such as cardiomyopathies and myocarditis, in this population. Funding Instituto de Salud Carlos III (PI19/01704).
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Affiliation(s)
- Carlos Real
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Rocío Párraga
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Ruber Juan Bravo Quironsalud UEM, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Cardiology Department, University Hospital La Moraleja, Madrid, Spain
| | - Ernesto González-Calvo
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | - Irene Sanmamed
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mercedes De Miguel
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Amaya De Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
- CIBER de enfermedades cardiovasculares (CIBER-CV), Madrid, Spain
- Corresponding author. Centro Nacional de Investigaciones Cardiovasculares (CNIC). Calle Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
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Voges I, Caliebe A, Hinz S, Boroni Grazioli S, Gabbert DD, Wegner P, Uebing AS, Daubeney PEF, Pennell DJ, Krupickova S. Reference Values for Pediatric Atrial Volumes Assessed by Steady-State Free-Precession Magnetic Resonance Imaging Using Monoplane and Biplane Area-Length Methods. J Magn Reson Imaging 2023; 57:532-542. [PMID: 35535720 DOI: 10.1002/jmri.28230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Measurement of atrial volumes by MRI is becoming increasingly important in pediatric cardiac disorders. However, MRI normal values for atrial volumes in children are lacking. PURPOSE To establish pediatric reference values for atrial volumes. STUDY TYPE Retrospective. SUBJECTS A total of 155 healthy children from two large institutions (103 male, age 13.9 ± 2.8 years, range 4-18 years). FIELD STRENGTH/SEQUENCE A 1.5 T; balanced steady-state free precession (bSSFP) sequence. ASSESSMENT The monoplane and biplane area-length methods were used to measure minimal and maximal left and right atrial volumes (LAmin , LAmax , RAmin , and RAmax ) from four-chamber (4ch) and two-chamber (2ch) MR cine images. Centile charts and tables for atrial volumes were created. STATISTICAL TESTS Descriptive statistics, lambda-mu-sigma (LMS)-method of Cole and Green, univariable and multivariable linear regression models. A P value < 0.05 was considered to be statistically significant. RESULTS In the multivariable linear model, body surface area was significantly associated with all atrial volumes and sex was significantly associated with RA volumes, LA volumes measured in the 2ch-view as well as biplane LAmax. Average atrial volumes measured: monoplane 4ch: LAmin 13.1 ± 4.8 mL/m2 , LAmax 33.4 ± 8.8 mL/m2 , RAmin 18.5 ± 6.8 mL/m2 , RAmax 33.2 ± 9.6 mL/m2 ; monoplane 2ch: LAmin 12.7 ± 4.9 mL/m2 , LAmax 30.5 ± 9.5 mL/m2 ; biplane: LAmin 12.3 ± 4.5 mL/m2 , LAmax 30.9 ± 8.7 mL/m2 . DATA CONCLUSION Pediatric MRI reference values for atrial volumes have been provided. TECHNICAL EFFICACY 2 EVIDENCE LEVEL: 4.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Sophia Hinz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Daniel Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
| | - Dudley J Pennell
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
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7
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Puder L, Roth S, Krabusch P, Wiegand S, Opitz R, Bald M, Flück C, Schulz E, Voss E, Markó L, Linz P, Berger F, Müller DN, Kuehne T, Litt MJ, Cone RD, Kühnen P, Kelm M. Cardiac Phenotype and Tissue Sodium Content in Adolescents With Defects in the Melanocortin System. J Clin Endocrinol Metab 2021; 106:2606-2616. [PMID: 34036349 PMCID: PMC8372645 DOI: 10.1210/clinem/dgab368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Pro-opiomelanocortin (POMC) and the melanocortin-4 receptor (MC4R) play a pivotal role in the leptin-melanocortin pathway. Mutations in these genes lead to monogenic types of obesity due to severe hyperphagia. In addition to dietary-induced obesity, a cardiac phenotype without hypertrophy has been identified in MC4R knockout mice. OBJECTIVE We aimed to characterize cardiac morphology and function as well as tissue Na+ content in humans with mutations in POMC and MC4R genes. METHODS A cohort of 42 patients (5 patients with bi-allelic POMC mutations, 6 heterozygous MC4R mutation carriers, 19 obese controls without known monogenic cause, and 12 normal weight controls) underwent cardiac magnetic resonance (CMR) imaging and 23Na-MRI. RESULTS Monogenic obese patients with POMC or MC4R mutation respectively had a significantly lower left ventricular mass/body surface area (BSA) than nonmonogenic obese patients. Left ventricular end-diastolic volume/BSA was significantly lower in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. Subcutaneous fat and skin Na+ content was significantly higher in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. In these compartments, the water content was significantly higher in patients with POMC and MC4R mutation than in control groups. CONCLUSION Patients with POMC or MC4R mutations carriers had a lack of transition to hypertrophy, significantly lower cardiac muscle mass/BSA, and stored more Na+ within the subcutaneous fat tissue than nonmonogenic obese patients. The results point towards the role of the melanocortin pathway for cardiac function and tissue Na+ storage and the importance of including cardiologic assessments into the diagnostic work-up of these patients.
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Affiliation(s)
- Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Sophie Roth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin 13353, Germany
| | - Robert Opitz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
| | - Martin Bald
- Pediatric Endocrinology, Olgahospital, Klinikum Stuttgart, Stuttgart 70174, Germany
| | - Christa Flück
- Department of Paediatrics and Department of BioMedical Research, Pediatric Endocrinology, Diabetology and Metabolism, Bern University Hospital Inselspital and University of Bern, Bern 3010, Switzerland
| | - Esther Schulz
- Pediatric Endocrinology, AKK Altonaer Kinderkrankenhaus GmbH, Hamburg 22763, Germany
| | - Egbert Voss
- Cnopfsche Kinderklinik, Nürnberg 90419, Germany
| | - Lajos Markó
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Dominik N Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Michael J Litt
- Brigham and Women’s Hospital, Harvard University, Boston, MA 02115, USA
| | - Roger D Cone
- Life Sciences Institute, and Department of Molecular and Integrative Physiology, School of Medicine, University of Michigan, Ann Arbor, MI 48109-5624, USA
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Correspondence: Peter Kühnen, MD, Institute for Experimental Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marcus Kelm
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
- Marcus Kelm, MD, Department of Congenital Heart Disease, German Heart Centre Berlin, Augustenburger Platz 1, 13353 Berlin, Germany,
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8
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Kiran M, Misra S, Pr S, Babu S, Anand A, Koshy T. Quantification of Right Atrial-Indexed End-Systolic Volumes and Emptying Fraction in Children Undergoing Cardiac Surgery With Two-Dimensional Transesophageal Echocardiography: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2021; 36:202-207. [PMID: 34006468 DOI: 10.1053/j.jvca.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/17/2021] [Accepted: 04/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary objective of this study was to establish "normal" right atrial (RA)-indexed end-systolic volumes (ESVs) and emptying fraction (EF) in children undergoing ventricular septal defect (VSD) repair using two-dimensional (2D) transesophageal echocardiography (TEE). Secondary objectives were to obtain RA-indexed ESV and EF in children with RA/right ventricular (RV) volume overload (atrial septal defect [ASD]) and RV pressure overload (tetralogy of Fallot [TOF]) and to determine whether baseline differences existed in these indices among the three lesions. DESIGN A prospective observational study. SETTING Tertiary referral center and a university level teaching hospital. PARTICIPANTS The study comprised 90 children (30 in each cohort) >3 kg and <14 years old admitted for elective repair of either VSD, TOF, or ASD. MEASUREMENTS AND MAIN RESULTS RA ESV and EF were measured in the midesophageal four-chamber view using the area-length and the modified Simpson's methods with 2D TEE in the prebypass period. Mean RA- indexed ESV (area-length method) in the VSD cohort was 24.2 ± 6.7 mL/m2, whereas it was significantly greater in the TOF (31.9 ± 9.8 mL/m2; p = 0.0008) and ASD (52 ± 12.9 mL/m2; p < 0.0001) cohorts. RA EF in the TOF cohort was 48.4% ± 7.6%, which was significantly more than in the VSD (41.5% ± 11.8%; p = 0.0093) and ASD (39.1% ± 12.3%; p = 0.0008) cohorts. CONCLUSIONS This was the first study using 2D TEE to measure RA indices in children with and without right-sided heart dilation undergoing cardiac surgery. In this study, RA, ESV, and EF were considerably different in children with congenital heart disease causing RV pressure or volume overload. Additional studies can examine how these values can be used for risk stratification in this cohort of patients or how they correlate with measures of ventricular performances.
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Affiliation(s)
- Molli Kiran
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Satyajeet Misra
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Suneel Pr
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Asha Anand
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
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9
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Clarke GD, Li J, Kuo AH, Moody AJ, Nathanielsz PW. Cardiac magnetic resonance imaging: insights into developmental programming and its consequences for aging. J Dev Orig Health Dis 2021; 12:203-219. [PMID: 33349289 PMCID: PMC7987688 DOI: 10.1017/s2040174420001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cardiovascular diseases (CVD) are important consequences of adverse perinatal conditions such as fetal hypoxia and maternal malnutrition. Cardiac magnetic resonance imaging (CMR) can produce a wealth of physiological information related to the development of the heart. This review outlines the current state of CMR technologies and describes the physiological biomarkers that can be measured. These phenotypes include impaired ventricular and atrial function, maladaptive ventricular remodeling, and the proliferation of myocardial steatosis and fibrosis. The discussion outlines the applications of CMR to understanding the developmental pathways leading to impaired cardiac function. The use of CMR, both in animal models of developmental programming and in human studies, is described. Specific examples are given in a baboon model of intrauterine growth restriction (IUGR). CMR offers great potential as a tool for understanding the sequence of dysfunctional adaptations of developmental origin that can affect the human cardiovascular system.
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Affiliation(s)
- G D Clarke
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - J Li
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - A H Kuo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - A J Moody
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - P W Nathanielsz
- Department of Animal Science, University of Wyoming, Laramie, WY, USA
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10
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Alis D, Asmakutlu O, Topel C, Karaarslan E. Diagnostic value of left atrial strain in pediatric hypertrophic cardiomyopathy with normal maximum left atrial volume index: preliminary cardiac magnetic resonance study. Pediatr Radiol 2021; 51:594-604. [PMID: 33474633 DOI: 10.1007/s00247-020-04884-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The maximum left atrial volume index is the most widely used metric for assessing the left atrium in hypertrophic cardiomyopathy; however, it may be normal in the early phases of the disease. OBJECTIVE To assess whether pediatric hypertrophic cardiomyopathy patients with normal maximum left atrial volume index have impaired atrial functions on cardiac magnetic resonance imaging (MRI). MATERIALS AND METHOD A total of 26 pediatric hypertrophic cardiomyopathy patients and 24 age-matched children, as controls, were enrolled in the study. The left atrial reservoir, conduit and booster strain were calculated from two orthogonal planes and the left atrial volumes were calculated using the biplanar method. The extent of left ventricular late gadolinium enhancement (LGE-%) was calculated using the thresholding method. The left ventricular early diastolic longitudinal strain rate was calculated to assess diastolic dysfunction. RESULTS The maximum left atrial volume index of the children with hypertrophic cardiomyopathy and the controls were not significantly different (P>0.05). Most of the left atrial functional indices were worse in children with hypertrophic cardiomyopathy (P<0.05), yet no difference was observed between the left atrial booster strains of the two groups (P>0.05). The left atrial conduit strain showed moderate to good negative correlations with left ventricular LGE-% and diastolic dysfunction. CONCLUSION Left atrial conduit and reservoir strains are impaired in pediatric hypertrophic cardiomyopathy patients with normal maximum left atrial volumetric indices. Most left atrial strain parameters are closely linked to left ventricular LGE-% and diastolic dysfunction. Left atrial strain analysis may reveal subtle functional changes in the atrium before the increase in the maximum volume index.
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Affiliation(s)
- Deniz Alis
- Department of Radiology, Maslak Acibadem Hospital, Darussafaka Buyukdere St., No. 40, 34457, Sarıyer, Istanbul, Turkey.
| | - Ozan Asmakutlu
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Maslak Acibadem Hospital, Darussafaka Buyukdere St., No. 40, 34457, Sarıyer, Istanbul, Turkey
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11
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Novljan G, Kolar M, Kastelec L, Battelino N. Citrate-induced local ionized calcium decrease in pediatric hemodialysis settings: An in-vitro study. J Vasc Access 2021; 23:543-549. [PMID: 33752479 DOI: 10.1177/11297298211002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Citrate is instilled into the dialysis catheter to prevent clotting and to maintain patency between dialysis sessions. A significant amount of citrate leaks from the catheter at the injection time, which decreases the blood ionized calcium concentration (Ca2+) due to chelation. We aimed to evaluate the local impact of concentrated (i.e. 30%) citrate spilling on Ca2+ at the catheter tip in real-time pediatric conditions. METHODS An in-vitro model was constructed, involving an ion-selective electrode (Ca-ISE). A pre-curved catheter and the Ca-ISE were submerged in a glass vessel with the tips positioned adjacent to each other. The vessel was filled with 30 and 80 ml of normal saline with added calcium to simulate normal right atrium size in children and adults, respectively, and normal blood Ca2+. The amount of instilled citrate matched the filling volume of the catheter. Measurements were performed with 4% and 30% citrate solutions. RESULTS The mean Ca2+ measured at the tip of the catheter was 0.457 and 0.058 mmol/l when using 4% and 30% citrate, respectively (p < 0.001). The mean Ca2+ recorded in 30 and 80 ml after instilling 30 % citrate was 0.058 and 0.055 mmol/l, respectively (p = 0.878). CONCLUSIONS The spilling of 30% citrate caused a strikingly greater decrease of Ca2+ at the catheter tip than the standard 4% citrate. The atrial volume did not influence the test results implying similar safety concerns for pediatric and adult patients. The used static experimental setting might have overestimated the spilling effect.
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Affiliation(s)
- Gregor Novljan
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Kolar
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Kastelec
- Faculty of Chemistry and Chemical Technology, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Battelino
- Pediatric Nephrology Department, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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12
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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13
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Ta HT, Alsaied T, Steele JM, Truong VT, Mazur W, Nagueh SF, Kutty S, Tretter JT. Atrial Function and Its Role in the Non-invasive Evaluation of Diastolic Function in Congenital Heart Disease. Pediatr Cardiol 2020; 41:654-668. [PMID: 32342149 DOI: 10.1007/s00246-020-02351-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/17/2020] [Indexed: 01/19/2023]
Abstract
Diastolic dysfunction has correlated with adverse outcomes in various forms of unrepaired and repaired or palliated congenital heart disease (CHD). The non-invasive assessment of diastolic function in pediatric and adult patients with CHD remains challenging. Atrial size has a pivotal role in the evaluation of diastolic function; however, a growing body of evidence supports the additional role of atrial function as a more sensitive parameter of ventricular diastolic dysfunction. While the importance of atrial function is becoming clearer in adult acquired heart disease, it remains ambiguous in those with CHD. In this review we set the stage with the current understanding of diastolic function assessment in CHD, followed by insight into atrial form and function including its non-invasive assessment, and conclude with the current knowledge of atrial function in CHD. A general pattern of decrease in reservoir and conduit function with compensatory increase followed by decompensatory decrease in contractile function seems to be the common pathway of atrial dysfunction in most forms of CHD.
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Affiliation(s)
- Hieu T Ta
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Tarek Alsaied
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeremy M Steele
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Vien T Truong
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Wojciech Mazur
- Department of Cardiology, The Christ Hospital, Cincinnati, OH, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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14
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Linden K, Goldschmidt F, Laser KT, Winkler C, Körperich H, Dalla-Pozza R, Breuer J, Herberg U. Left Atrial Volumes and Phasic Function in Healthy Children: Reference Values Using Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2019; 32:1036-1045.e9. [DOI: 10.1016/j.echo.2019.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
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15
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Voges I, Giordano R, Koestenberg M, Marchese P, Scalese M, Ait-Ali L, Santoro G, Iervasi G, Valverde I, Kutty S, Cantinotti M. Nomograms for Cardiovascular Magnetic Resonance Measurements in the Pediatric Age Group: To Define the Normal and the Expected Abnormal Values in Corrected/Palliated Congenital Heart Disease: A Systematic Review. J Magn Reson Imaging 2019; 49:1222-1235. [DOI: 10.1002/jmri.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Inga Voges
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Deparment of Advanced Biomedical Sciences, University of Naples "Federico II"; Italy
| | - Martin Koestenberg
- Division of Pediatric Cardiology, Department of Pediatrics; Medical University Graz; Austria
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
| | | | | | - Giuseppe Santoro
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | | | - Israel Valverde
- Hospital Virgen del Rocio & Institute of Biomedicine of Seville (IBIS); Seville Spain
- Guy's and St. Thomas' Hospital/Evelina Children's Hospital; London UK
| | - Shelby Kutty
- Division of Pediatric Cardiology; Johns Hopkins School of Medicine Bloomberg Children's Center; Baltimore Maryland USA
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
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16
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Rajagopal H, Uppu SC, Weigand J, Lee S, Karnik R, Ko H, Bhatla P, Nielsen J, Doucette J, Parness I, Srivastava S. Validation of Right Atrial Area as a Measure of Right Atrial Size and Normal Values of in Healthy Pediatric Population by Two-Dimensional Echocardiography. Pediatr Cardiol 2018. [PMID: 29523923 DOI: 10.1007/s00246-018-1838-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Right atrial (RA) size is a prognostic indicator for heart failure and cardiovascular death in adults. Data regarding use of RA area (RAA) by two-dimensional echocardiography as a surrogate for RA size and allometric modeling to define appropriate indexing of the RAA are lacking. Our objective was to validate RAA as a reliable measure of RA size and to define normal reference values by transthoracic echocardiography (TTE) in a large population of healthy children and develop Z-scores using a validated allometric model for indexing RAA independent of age, sex, and body size. Agreement between RAA and volume by 2D, 3D TTE, and MRI was assessed. RAA not volume by 2D TTE is an excellent surrogate for RA size. RAA/BSA1 has an inverse correlation with BSA with a residual relationship to BSA (r = - 0.54, p < 0.0001). The allometric exponent (AE) derived for the entire cohort (0.85) also fails to eliminate the residual relationship. The entire cohort divided into two groups with a BSA cut-off of 1 m2 to provide the best-fit allometric model (r = 0). The AE by least square regression analysis for each group is 0.95 and 0.88 for BSA < 1 m2 and > 1 m2, respectively, and was validated against an independent sample. The mean indexed RAA ± SD for BSA ≤ 1 m2 and > 1 m2 is 9.7 ± 1.3 cm2 and 8.7 ± 1.3 cm2, respectively, and was used to derive Z-scores. RAA by 2D TTE is superior to 2D or 3D echocardiography-derived RA volume as a measure of RA size using CMR as the reference standard. RAA when indexed to BSA1, decreases as body size increases. The best-fit allometric modeling is used to create Z scores. RAA/BSA0.95 for BSA < 1 m2 and RAA/BSA0.88 for those with BSA > 1 m2 can be used to derive Z scores.
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Affiliation(s)
- Hari Rajagopal
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Santosh C Uppu
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Justin Weigand
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Simon Lee
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Ruchika Karnik
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Helen Ko
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Puneet Bhatla
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - James Nielsen
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - John Doucette
- Biostatistics, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA
| | - Ira Parness
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA
| | - Shubhika Srivastava
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1030, New York, NY, USA.
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17
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Kutty S, Shang Q, Joseph N, Kowallick JT, Schuster A, Steinmetz M, Danford DA, Beerbaum P, Sarikouch S. Abnormal right atrial performance in repaired tetralogy of Fallot: A CMR feature tracking analysis. Int J Cardiol 2017; 248:136-142. [PMID: 28712562 DOI: 10.1016/j.ijcard.2017.06.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND We hypothesized that right atrial (RA) performance is abnormal in repaired tetralogy of Fallot (TOF). METHODS TOF patients were prospectively enrolled for cardiovascular magnetic resonance (CMR), echocardiography and exercise stress following a standardized 14-center protocol. Peak RA longitudinal strain (RALS) and right ventricular longitudinal strain (RVLS) were measured using CMR feature tracking (FT) and correlated to RA and RV end diastolic volumes (EDVi) and ejection fraction (EF). RESULTS The cohort had 311 subjects: 171 TOF (94 male, age 18.2±8years) and 140 healthy controls (69 male, 16.4±11years). RAEDVi, RALS, RVEDVi, RVLS, RAEF, and RVEF in TOF were 60.8±17.1ml/m2, 13.6±5.7%, 120.3±30.3ml/m2, 12.3±4.2%, 32.5±9.9% and 51.2±8.4% and differed from respective indices in controls: 51.7±15.7ml/m2, 27±10.1%, 74±19.0ml/m2, 18.5±5.3%, 54±8% and 62.5±5.5% (p<0.001). RAEDVi and RALS correlated with RVLS (p=0.004, <0.001, r=0.2,0.3). RAEDVi was higher in older TOF, while RALS did not increase with age. RAEDVi but not RALS correlated with RV systolic pressure(r=0.2, 0). Neither RAEDVi nor RALS was associated with tricuspid regurgitation grade or peak oxygen uptake (r=0.1, 0). Positive correlation was observed for RVEDVi with RAEDVi (p=0.035, r=0.2) and a trend toward negative correlation with RALS (p=0.09, r=0.1). CONCLUSION RALS, RAEDVi and RAEF are abnormal in TOF. Reduced RALS indicates decreased RA reservoir function. Because they correlate with other functional RV indices, these abnormalities may represent RA diastolic burden from chronic RV dysfunction in TOF. The young cohort age might explain the absence of RALS correlation to tricuspid regurgitation and peak oxygen uptake.
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Affiliation(s)
- Shelby Kutty
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States.
| | - Quanliang Shang
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States; Department of Radiology, Central South University, China
| | - Navya Joseph
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States
| | - Johannes T Kowallick
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Cardiology, Pneumology, and the Institute for Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - David A Danford
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States
| | - Phillip Beerbaum
- Department of Pediatric Cardiology and Intensive Care, Hanover Medical School, Hanover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic Surgery, Hanover Medical School, Hanover, Germany
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Zemrak F, Ambale-Venkatesh B, Captur G, Chrispin J, Chamera E, Habibi M, Nazarian S, Mohiddin SA, Moon JC, Petersen SE, Lima JAC, Bluemke DA. Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging 2017; 10:e005379. [PMID: 28196797 PMCID: PMC5319802 DOI: 10.1161/circimaging.116.005379] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left atrial (LA) size is a marker of diastolic function and is associated with atrial fibrillation and cardiovascular outcomes. However, there are no large population studies measuring LA structure. The relationship of demographics and cardiovascular risk factors to LA size is largely unknown. This study aimed to determine associations of LA size with demographic factors, cardiac structure and function, and cardiovascular risk factors. METHODS AND RESULTS LA volume indexed to body surface area was measured by cardiovascular magnetic resonance steady-state free precession and fast gradient echo cine long- and short-axis images in 2576 asymptomatic participants of MESA ([Multi-Ethnic Study of Atherosclerosis] 68.7 years, 53.0% women, white 42.2%, Chinese American 12.0%, black 24.5%, and Hispanic 21.2%) using biplane and short-axis images. The mean LA volume index was 36.5±11.4 mL/m2 in the entire cohort and 35.5±10.1 mL/m2 in subjects free of cardiovascular risk factors (n=283). Multivariable analysis included adjustment for demographics, ethnicity, cardiovascular risk factors, serological studies, socioeconomic status, left ventricular structure, and medications. In the adjusted analysis, age (β=0.2 mL/m2 per year, P<0.0001), male sex (β=-4.2 mL/m2, P<0.0001), obesity (β=1.3 mL/m2, P<0.01), end-diastolic volume index (β=0.4 mL/m2, P<0.0001), Chinese American (β=-2.6 mL/m2, P<0.0001), and Hispanic (β=1.1 mL/m2, P<0.05) ethnicities were associated with LA volume index. Diabetes mellitus and smoking were not associated with LA volume index. LA volumes measured by steady-state free precession were 3% larger than by fast gradient echo cine cardiovascular magnetic resonance (P<0.001). CONCLUSIONS Age, sex, ethnicity and left ventricular structural parameters were associated with LA size. Importantly, the study provides reference values of normal LA volume index.
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Affiliation(s)
- Filip Zemrak
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Bharath Ambale-Venkatesh
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Gabriella Captur
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Jonathan Chrispin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Ela Chamera
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Mohammadali Habibi
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saman Nazarian
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Saidi A Mohiddin
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - James C Moon
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - Steffen E Petersen
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - João A C Lima
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.)
| | - David A Bluemke
- From the Centre for Advanced Cardiovascular Imaging, Queen Mary University of London, Barts Heart Centre, United Kingdom (F.Z., S.A.M., S.E.P.); Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD (B.A.-V., J.C., E.C., M.H., S.N., J.A.C.L.); Institute of Cardiovascular Science, University College London, United Kingdom (G.C., J.C.M.); and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD (D.A.B.).
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Gandy SJ, Matthew S, Rekhraj S, Szwejkowski B, Crowe E, Struthers AD, Houston JG. MRI of the left atrium at 3T: evaluation of measurement reproducibility in healthy volunteers and patients with cardiovascular disease. Acta Radiol 2016; 57:1468-1475. [PMID: 26861203 DOI: 10.1177/0284185115627386] [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] [Indexed: 11/16/2022]
Abstract
Background Left ventricular (LV) function has traditionally been the focus for cardiac magnetic resonance imaging (MRI) investigations, but similar methods can also be applied to the left atrium (LA). Previous studies elsewhere have almost entirely involved the use of 1.5T systems, but 3T MRI can provide faster data acquisition with thinner image slices, and may be more suitable for quantifying the structure and function of the LA. Purpose To evaluate 3T-MRI for LA volume assessments in: (i) healthy volunteers (HV); (ii) patients with LV-hypertrophy and ischemia (LVHI); and (iii) patients with LV-hypertrophy and diabetes (LVHD). Material and Methods Participants were imaged using a balanced steady-state free precession sequence. Healthy volunteers were scanned twice and patients were scanned on one occasion. Volumes were segmented by two observers, and coefficients of repeatability (CoR) were derived. Results For LA volumes (indexed to body surface area), CoRs were in the range of 1.3-4.6 mL/m2. The LVHI patients had enlarged LA volumes (diastolic, 46.4 mL/m2; systolic, 25.9 mL/m2) and reduced ejection fraction (EF) (44.9%) relative to the HV (diastolic, 39.0 mL/m2; systolic, 17.8 mL/m2; EF, 54.5%) and LVHD groups (diastolic, 41.4 mL/m2; systolic, 20.2 mL/m2; EF, 50.7%). LA volumes were moderately correlated with LV mass in the HV group (R2 = 0.59 for LA end-systolic volume), but became weaker (R2 ≤ 0.17) for patient groups. Conclusion 3T-MRI derived LA volume measurements are simple and repeatable, and can elicit clear differences between LVHI patients and HVs. These MRI endpoints provide scope for improved radiological interpretation of LA structure and function, and the high degree of repeatability validates their use for longitudinal investigations where precision work is essential.
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Affiliation(s)
- Stephen J Gandy
- NHS Tayside Medical Physics, Ninewells Hospital, Dundee, UK
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
| | - Shona Matthew
- University of Dundee, Ninewells Hospital, Dundee, UK
| | | | | | - Elena Crowe
- NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, UK
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Voges I, Kees J, Jerosch-Herold M, Gottschalk H, Trentmann J, Hart C, Gabbert DD, Pardun E, Pham M, Andrade AC, Wegner P, Kristo I, Jansen O, Kramer HH, Rickers C. Aortic stiffening and its impact on left atrial volumes and function in patients after successful coarctation repair: a multiparametric cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:56. [PMID: 27618813 PMCID: PMC5020476 DOI: 10.1186/s12968-016-0278-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/26/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The increased cardiovascular morbidity of adults with late repair of aortic coarctation (CoA) has been well documented. In contrast, successful CoA repair in early childhood has a generally good prognosis, though adverse vascular and ventricular characteristics may be abnormal, which could increase long-term risk. This study sought to perform a comprehensive analysis of aortic elasticity and left ventricular (LV) function in patients with aortic coarctation (CoA) using cardiovascular magnetic resonance (CMR). In a subgroup of patients, we assessed structure and function of the common carotid arteries to probe for signs of systemic vascular remodeling. METHODS Fifty-one patients (median age 17.3 years), 13.9 ± 7.5 years after CoA repair, and 54 controls (median age 19.8 years) underwent CMR. We determined distensibility and pulse wave velocity (PWV) at different aortic locations. In a subgroup, common carotid artery distensibility, PWV, wall thickness and wall area were measured. LV ejection fraction (EF), volumes, and mass were measured from short axis views. Left atrial (LA) volumes and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir) were assessed from axial cine images. RESULTS In patients distensibility of the whole thoracic aorta was reduced (p < 0.05) while PWV was only significantly higher in the aortic arch (p < 0.01). Distensibility of the descending aorta at the level of the pulmonary arteries and PWV in the descending aorta, both correlated negatively with age at CoA repair. LA volume before atrial contraction and minimal LA volume were higher in patients (p < 0.05). LAEFPassive and LAEFReservoir were reduced (p < 0.05), and LAEFReservoir correlated negatively with aortic arch PWV (p < 0.05). LVEF, volumes and mass were not different from controls. Carotid wall thickness and PWV were higher in patients compared to controls (p < 0.05). CONCLUSIONS Patients after CoA repair have impaired bioelastic properties of the thoracic aorta with impact on LV diastolic function. Reduced descending aortic elasticity is associated with older age at time of CoA repair. The remodeling of the common carotid artery in our sub-study suggests systemic vessel wall changes.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Julian Kees
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham & Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hannes Gottschalk
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens Trentmann
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Christopher Hart
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Dominik D. Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Eileen Pardun
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Minh Pham
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Ana C. Andrade
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Philip Wegner
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Ines Kristo
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Olav Jansen
- Department of Diagnostic Radiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
| | - Carsten Rickers
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany
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21
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Evaluation of single right atrial volume and function with magnetic resonance imaging in children with hypoplastic left heart. Pediatr Radiol 2016; 46:991-1002. [PMID: 27003135 DOI: 10.1007/s00247-015-3534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Standardized methods to evaluate atrial properties in single ventricles are lacking. OBJECTIVE To determine the feasibility of quantifying right atrial volumes and function in hypoplastic left heart using MRI. MATERIALS AND METHODS We studied 15 infants with hypoplastic left heart prior to Glenn surgery (mean age 4.2 months [standard deviation 0.3]) who underwent cardiac MRI with evaluation of atrial volumes and emptying fraction using monoplane two-chamber, monoplane four-chamber, and biplane methods, all of which were compared to the atrial short-axial oblique stack method. We compared atrial end-diastolic volume, end-systolic volume and emptying fraction among these methods. We analyzed reproducibility of the methods using Bland‒Altman plots. RESULTS Both four-chamber and biplane methods showed high correlations for atrial end-diastolic volume (r = 0.7 and r = 0.8, respectively; P < 0.01) and end-systolic volume (r = 0.8 and r = 0.9, respectively; P < 0.01) with small mean differences (-0.2 ± 2.9 standard deviation [SD] ml and -0.8 ± 1.6 ml, respectively, for atrial end-diastolic volume and -0.8 ± 1.5 ml and -0.9 ± 0.9 ml, respectively, for atrial end-systolic volume). The short-axial oblique method was the most reproducible, followed by the four-chamber method. CONCLUSION MRI assessment of atrial volume and function is feasible in hypoplastic left heart and might provide further insight into single-ventricle mechanics.
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Franzoso FD, Wohlmuth C, Greutmann M, Kellenberger CJ, Oxenius A, Voser EM, Valsangiacomo Buechel ER. Atrial Function after the Atrial Switch Operation for Transposition of the Great Arteries: Comparison with Arterial Switch and Normals by Cardiovascular Magnetic Resonance. CONGENIT HEART DIS 2015; 11:426-436. [DOI: 10.1111/chd.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca D. Franzoso
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
| | - Christoph Wohlmuth
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Gynecology and Obstetrics; Paracelsus Medical University Salzburg; Salzburg Austria
| | - Matthias Greutmann
- Department of Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Christian J. Kellenberger
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Diagnostic Imaging; University Children's Hospital Zurich; Zurich Switzerland
| | - Angela Oxenius
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
- Department of Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Eva M. Voser
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- Division of Cardiology; Pediatric Heart Center, University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Center, University Children's Hospital Zurich; Zurich Switzerland
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Le Ven F, Bibeau K, De Larochellière É, Tizón-Marcos H, Deneault-Bissonnette S, Pibarot P, Deschepper CF, Larose É. Cardiac morphology and function reference values derived from a large subset of healthy young Caucasian adults by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2015; 17:981-90. [PMID: 26354980 DOI: 10.1093/ehjci/jev217] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/09/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Assessment of cardiac anatomy and function by cardiovascular magnetic resonance (CMR) is accurate and reproducible and is commonly performed to clarify borderline results obtained by other techniques. Normal reference values are lacking in a large sample of young healthy adults. As CMR is increasingly solicited to discriminate normality from equivocal disease in this population, we sought to determine reliable reference values. METHODS AND RESULTS A sample of 434 Caucasian adults aged 26 ± 4 years (45% male) without cardiovascular disease or risk factors (including obesity and smoking) underwent CMR. Blood pressure, electrocardiogram, and plasma markers (lipid profile, fasting glucose, troponin, and Nt-pro-BNP) were within normal limits and typical of a low-cardiometabolic-risk profile. End-diastolic (ED), end-systolic (ES), and stroke volumes were greater in men for left and right atria and ventricles. Left ventricular (LV) mass was higher in men. ED wall thickness of all segments was greater in men, whereas ES wall thickening (segmental function) was similar in both genders. After normalization to body surface area, all gender differences remained. Left and right ventricular volumes were lower, and left atrial volumes were higher in older individuals. In contrast, LV mass was not associated with age. CONCLUSION This is the first large database of reference ranges for ventricular and atrial functions, volumes, and mass in young Caucasian men and women devoid of cardiovascular disease and risk factors. These data will contribute to improving the accuracy of CMR interpretation for clinical and research applications.
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Affiliation(s)
- Florent Le Ven
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | - Karine Bibeau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | - Élianne De Larochellière
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | - Helena Tizón-Marcos
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | - Stéphanie Deneault-Bissonnette
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
| | | | - Éric Larose
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec (CRIUCPQ), and Faculté de Médecine, Université Laval, 2725 Chemin Ste-Foy, Québec City, QC, Canada G1V 4G5
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Right Atrial Volume is Increased in Corrected Tetralogy of Fallot and Correlates with the Incidence of Supraventricular Arrhythmia: A CMR Study. Pediatr Cardiol 2015; 36:1239-47. [PMID: 25862665 DOI: 10.1007/s00246-015-1152-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/24/2015] [Indexed: 12/22/2022]
Abstract
The aim of this study was to evaluate right atrial (RA) volume in corrected Tetralogy of Fallot (cTOF) and assess its correlation with the occurrence of supraventricular (SV) arrhythmia. Cardiac magnetic resonance imaging (CMR) and 24-h Holter were performed in n = 67 consecutive cTOF patients (age 30 ± 11.3 years). The CMR protocol included standard HASTE, SSFP cine, and blood flow measurements. Correlations between arrhythmia in ECG, heart volume, and functional parameters were investigated by negative binominal regression. Patients' characteristics (mean ± SD) included mean RA volume of 49 ± 19 ml/m(2) (HASTE sequence), mean right ventricular (RV) end-diastolic volume of 98 ± 27 ml/m(2), mean pulmonary valve regurgitation fraction (PR) of 21 ± 19 %, BMI of 25 kg/m(2), and heart rate of 75/min. Twenty-eight out of 67 patients experienced SV arrhythmia including SV couplets or bigeminus or longer non-sustained SV tachycardia (SVT) episodes. RA volume index was identified as an independent risk factor for different degrees of SV arrhythmia (SV couplets/bigeminus p < 0.001, SVT p < 0.001). Further risk factors for SV arrhythmia were male gender (p = 0.023) and decreased left ventricular (LV) ejection fraction (EF) (LV EF p < 0.001). RA volume is increased in adult patients with cTOF with larger RA volumes relating to higher incidence of SV arrhythmia. SV arrhythmia also appeared more often in male patients and those with decreased LV EF. Risk stratification according to these parameters could help to optimize early prevention and adjusted individual therapy to improve patient outcome and quality of life.
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Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Cardiol Young 2015; 25:819-38. [PMID: 25739865 DOI: 10.1017/s1047951115000025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, Plein S, Tee M, Eng J, Bluemke DA. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 2015; 17:29. [PMID: 25928314 PMCID: PMC4403942 DOI: 10.1186/s12968-015-0111-7] [Citation(s) in RCA: 521] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/06/2015] [Indexed: 01/17/2023] Open
Abstract
Morphological and functional parameters such as chamber size and function, aortic diameters and distensibility, flow and T1 and T2* relaxation time can be assessed and quantified by cardiovascular magnetic resonance (CMR). Knowledge of normal values for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. In this review, we present normal reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques and sequences.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland.
| | - Alicia Maceira
- Cardiac Imaging Unit, Eresa Medical Center, C/Marqués de San Juan s/n, 46015, Valencia, Spain.
| | | | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str 1, 30625, Hannover, Germany.
| | - Evrim B Turkbey
- Radiology and Imaging Sciences/ Clinical Image Processing Service, Clinical Center, NIH, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Rupert Williams
- The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT, UK.
| | - Michael Tee
- Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, 10 Center Drive, Bethesda, MD, 20892-1074, USA.
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, 10 Center Drive, Bethesda, MD, 20892-1074, USA.
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Hösch O, Ngyuen TT, Lauerer P, Schuster A, Kutty S, Staab W, Unterberg-Buchwald C, Sohns JM, Paul T, Lotz J, Steinmetz M. BNP and haematological parameters are markers of severity of Ebstein's anomaly: correlation with CMR and cardiopulmonary exercise testing. Eur Heart J Cardiovasc Imaging 2015; 16:670-5. [PMID: 25736309 DOI: 10.1093/ehjci/jeu312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/13/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS Ebstein's anomaly (EA) involves a displaced and dysplastic tricuspid valve resulting in an atrialized portion of the right ventricle and an enlargement of the functional right ventricle and right atrium. Biomarkers targeting heart failure such as brain natriuretic peptide (BNP) or haematological parameters [haemoglobin (Hb) and haematocrit (Hct)] are upregulated in states of pulmonary hypoperfusion. We hypothesized that decreased pulmonary perfusion dependent on the stage of right heart failure is a possible mechanism in EA, and that it can be correlated with cardiac magnetic resonance (CMR) parameters. The aim of this study was to investigate the relationship between BNP and haematological parameters with functional parameters from CMR and exercise testing in patients with EA. METHODS AND RESULTS Twenty-five patients with non-corrected EA were studied prospectively (mean age 26 ± 14 years). BNP level was increased (74 ± 127 ng/L), and in 16% markedly above the heart failure cut-off level of 100 ng/L. Hb and Hct were increased above normal levels in 20 and 24% of patients, respectively. BNP and Hct/Hb correlated with CMR [total right/left (R/L)-Volume-Index, right atrium-end-diastolic volume index (EDVi), functional right ventricle (fRV)-EDVi, fRV-ejection fraction (EF), tricuspid regurgitation, pulmonary artery flow, and left ventricular EF] and exercise testing [workload/kg, oxygen uptake (VO2), ventilatory response to carbon dioxide production (VE/VCO2), oxygen (O2) pulse, and heart rate reserve]. The higher BNP and haematological parameters, the higher was the disease severity and the more limited was the physical exercise capacity. CONCLUSION In this EA cohort, BNP levels and haematological parameters correlated well with functional data from CMR and exercise testing. The total R/L-Volume-Index and BNP, and to some extent hematological parameters, may be useful as prognostic markers in patients with EA.
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Affiliation(s)
- Olga Hösch
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Thuy-Trang Ngyuen
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Peter Lauerer
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University Göttingen, Göttingen, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA
| | - Wieland Staab
- Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | | | - Jan M Sohns
- DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
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Valsangiacomo Buechel ER, Grosse-Wortmann L, Fratz S, Eichhorn J, Sarikouch S, Greil GF, Beerbaum P, Bucciarelli-Ducci C, Bonello B, Sieverding L, Schwitter J, Helbing WA, Galderisi M, Miller O, Sicari R, Rosa J, Thaulow E, Edvardsen T, Brockmeier K, Qureshi S, Stein J. Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI. Eur Heart J Cardiovasc Imaging 2015; 16:281-97. [PMID: 25712078 DOI: 10.1093/ehjci/jeu129] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.
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Wohlmuth C, Kellenberger CJ, Voser EM, Burkhardt BE, Buechel ERV. Cardiac function after repair of tetralogy of fallot: how are the atria performing? pilot study by cardiac magnetic resonance imaging. Pediatr Cardiol 2015; 36:96-105. [PMID: 25087054 DOI: 10.1007/s00246-014-0970-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 07/16/2014] [Indexed: 11/24/2022]
Abstract
The atria of the heart function as reservoir, conduit, and active pump and are critical for ventricular filling and cardiac output. We sought to evaluate right (RA) and left atrial (LA) function in patients after tetralogy of Fallot (TOF) repair by using cardiovascular magnetic resonance. Twelve TOF patients, age 16.7 ± 6.1 years, weight 50.9 ± 14.9 kg, were compared to 10 healthy volunteers, age 18.8 ± 6.8 years, weight 52.3 ± 20.8 kg. Both atria and both ventricles were imaged in short-axis planes by Steady State Free Precession. Volume changes and all derived atrial functional parameters were calculated from the volume/time curves obtained after segmentation on the cine images. Blood flow across the AV valves was used to define ventricular diastolic dysfunction. TOF patients showed similar maximal RA volume compared to controls, but increased volumes at mid-diastole (p < 0.05), resulting in a decreased cyclic volume change and atrial filling fraction (p < 0.01), and a decreased passive emptying volume and fraction (p < 0.01). In patients with diastolic dysfunction, conduit volume was increased (p < 0.05), and active emptying volume and fraction tended to be increased, respectively. No significant changes were found in LA, except for a decreased passive emptying fraction (p < 0.05). RA function and particularly reservoir function are impaired in TOF patients. The RA conduit/reservoir ratio is increased and reflects the lost of the ability of the atrium to fill the ventricle by pulsatile flow.
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Affiliation(s)
- C Wohlmuth
- Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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Hösch O, Sohns JM, Nguyen TT, Lauerer P, Rosenberg C, Kowallick JT, Kutty S, Unterberg C, Schuster A, Faßhauer M, Staab W, Paul T, Lotz J, Steinmetz M. The total right/left-volume index: a new and simplified cardiac magnetic resonance measure to evaluate the severity of Ebstein anomaly of the tricuspid valve: a comparison with heart failure markers from various modalities. Circ Cardiovasc Imaging 2014; 7:601-9. [PMID: 24807407 DOI: 10.1161/circimaging.113.001467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The classification of clinical severity of Ebstein anomaly still remains a challenge. The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically-supposedly-normal left heart and to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of Ebstein anomaly. METHODS AND RESULTS Twenty-five patients at a mean age of 26±14 years with unrepaired Ebstein anomaly were examined in a prospective study. Disease severity was classified using CMR volumes and functional measurements in comparison with heart failure markers from clinical data, ECG, laboratory and cardiopulmonary exercise testing, and echocardiography. All examinations were completed within 24 hours. A total right/left-volume index was defined from end-diastolic volume measurements in CMR: total right/left-volume index=(RA+aRV+fRV)/(LA+LV). Mean total right/left-volume index was 2.6±1.7 (normal values: 1.1±0.1). This new total right/left-volume index correlated with almost all clinically used biomarkers of heart failure: brain natriuretic peptide (r=0.691; P=0.0003), QRS (r=0.432; P=0.039), peak oxygen consumption/kg (r=-0.479; P=0.024), ventilatory response to carbon dioxide production at anaerobic threshold (r=0.426; P=0.048), the severity of tricuspid regurgitation (r=0.692; P=0.009), tricuspid valve offset (r=0.583; P=0.004), and tricuspid annular plane systolic excursion (r=0.554; P=0.006). Previously described severity indices ([RA+aRV]/[fRV+LA+LV]) and fRV/LV end-diastolic volume corresponded only to some parameters. CONCLUSIONS In patients with Ebstein anomaly, the easily acquired index of right-sided to left-sided heart volumes from CMR correlated well with established heart failure markers. Our data suggest that the total right/left-volume index should be used as a new and simplified CMR measure, allowing more accurate assessment of disease severity than previously described scoring systems.
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Affiliation(s)
- Olga Hösch
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Jan Martin Sohns
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Thuy-Trang Nguyen
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Peter Lauerer
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Christina Rosenberg
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Johannes Tammo Kowallick
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Shelby Kutty
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Christina Unterberg
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Andreas Schuster
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Martin Faßhauer
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Wieland Staab
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Thomas Paul
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Joachim Lotz
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Michael Steinmetz
- From the Department of Pediatric Cardiology and Intensive Care Medicine (O.H., T.-T.N., P.L., T.P., M.S.), Institute for Diagnostic and Interventional Radiology (J.M.S., C.R., J.T.W., M.F., W.S., J.L.), and Department of Cardiology and Pneumology (C.U., A.S.), Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Germany (J.M.S., C.U., A.S., M.F., W.S., J.L., M.S.); and University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.).
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Madueme PC, Mazur W, Hor KN, Germann JT, Jefferies JL, Taylor MD. Comparison of area-length method by echocardiography versus full-volume quantification by cardiac magnetic resonance imaging for the assessment of left atrial volumes in children, adolescents, and young adults. Pediatr Cardiol 2014; 35:645-51. [PMID: 24240782 DOI: 10.1007/s00246-013-0833-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/28/2013] [Indexed: 01/20/2023]
Abstract
Left atrial (LA) size is a known predictor of adverse cardiovascular events. Echocardiography is the modality of choice for the evaluation of atrial size; however, cardiac magnetic resonance imaging (cMRI) remains the "gold standard." We sought to calculate atrial volumes using the area-length method by both echocardiography and cMRI and compare them with area-volume quantification by cMRI. Thiry-eight patients (mean age 20 ± 12 years, 71% male) who underwent cMRI and echocardiography between September 2010 and June 2012 were retrospectively identified. The time interval between the two studies was ≤ 6 months. LA volumes by echocardiogram were estimated using the area-length method: LA volume = (0.85 × area(4ch) × area(2ch))/(shortest atrial length). The atrial length and area were measured in standard apical two-chamber and four-chamber planes. Measured values were indexed to body surface area (BSA). CMRI measurements were obtained from prospectively gated steady-state free precession cine stack images obtained in a standard four-chamber plane. LA volumes were calculated using Simpson's method: LA volume = LA area × (slice thickness + gap) per slice. Slice thickness ranged from 5 to 7 mm with contiguous slices of 5 to 7 mm. The values were indexed to BSA. Statistics were summarized using measures of central tendency. LA volumes by echocardiography were significantly less than those by full-volume cMRI quantification. The mean LA volume by echocardiography and full-volume cMRI were 35 ± 14.5 and 42.4 ± 17.2, respectively (p = 0.05). The mean difference between LA volumes obtained by the two methods was 7.4 ± 10.6. LA volume measured by cMRI using the area-length method closely approximated full-volume assessment by cMRI with mean values of 42.9 ± 17.4 versus 42.4 ± 17.2, respectively (p = 0.91). There were no significant differences in the patient characteristics between the two study modalities. LA volumes as measured by echocardiography using the area-length method consistently underestimated the true volume when compared with cMRI. LA volumes measured using the area-length method by cMRI is an alternative technique for accurately quantifying chamber size and can be useful in decreasing scan time or when full-volume data sets are incomplete.
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Affiliation(s)
- Peace C Madueme
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2003, Cincinnati, OH, 45229-3039, USA,
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Valente AM, Cook S, Festa P, Ko HH, Krishnamurthy R, Taylor AM, Warnes CA, Kreutzer J, Geva T. Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27:111-41. [DOI: 10.1016/j.echo.2013.11.009] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Riesenkampff E, Al-Wakeel N, Kropf S, Stamm C, Alexi-Meskishvili V, Berger F, Kuehne T. Surgery impacts right atrial function in tetralogy of Fallot. J Thorac Cardiovasc Surg 2013; 147:1306-11. [PMID: 23896323 DOI: 10.1016/j.jtcvs.2013.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/29/2013] [Accepted: 06/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the impact of surgery and pericardial integrity on right atrial function and total heart volume variation in the setting of pulmonary valve insufficiency. METHODS Right atrial function and total heart volume variation were analyzed in 2 subgroups of patients with pulmonary valve insufficiency compared with healthy controls: group 1 with surgically repaired tetralogy of Fallot (n = 20 patients) and group 2 after balloon angioplasty of pulmonary valve stenosis in patients with isolated valve disease without surgery (n = 7 patients). Volumetric analysis of magnetic resonance imaging data revealed parameters of atrial function (reservoir, conduit, and pump functions and cyclic volume change) and of total heart volume (end-diastolic and end-systolic total heart volume and the variation). Statistical analysis included uncorrected and corrected pairwise comparisons and the calculation of groupwise Pearson correlation coefficients. RESULTS In group 1 with a pulmonary regurgitation fraction of 31.0% ± 14.9%, right atrial function was clearly impaired, with reduced reservoir and elevated conduit function, and total heart volume variation was elevated to 13.9% ± 3.4%. In group 2 with a pulmonary regurgitation fraction of 22.8% ± 6.9%, the values were close to normal, with unaffected atrial function and a total heart volume variation of 9.9% ± 3.3%. CONCLUSIONS The hydrodynamic effect of pulmonary valve insufficiency alone is likely not the only reason for impaired right atrial function and elevated total heart volume variation in patients with tetralogy of Fallot; it is rather the scar in the right atrium, the injured pericardium, and the disease itself that are responsible for the energetically unfavorable alterations.
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Affiliation(s)
- Eugenie Riesenkampff
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Nadya Al-Wakeel
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Siegfried Kropf
- Institute of Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Felix Berger
- Department of Pediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Department of Pediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany.
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Voges I, Jerosch-Herold M, Hedderich J, Hart C, Petko C, Scheewe J, Andrade AC, Pham M, Gabbert D, Kramer HH, Rickers C. Implications of Early Aortic Stiffening in Patients With Transposition of the Great Arteries After Arterial Switch Operation. Circ Cardiovasc Imaging 2013; 6:245-53. [DOI: 10.1161/circimaging.112.000131] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Inga Voges
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Michael Jerosch-Herold
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Jürgen Hedderich
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Christopher Hart
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Colin Petko
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Jens Scheewe
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Ana Cristina Andrade
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Minh Pham
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Dominik Gabbert
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Hans-Heiner Kramer
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
| | - Carsten Rickers
- From the Department of Congenital Heart Disease and Pediatric Cardiology (I.V., C.H., C.P., A.C.A., M.P., D.G., H.-H.K., C.R.), Department of Cardiac and Vascular Surgery (J.S.), and Department for Medical Informatics and Statistics (J.H.), University Hospital of Schleswig-Holstein, Kiel, Germany; and Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA (M.J.-H.)
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Abstract
PURPOSE OF REVIEW The following review will focus on the current advances in both echocardiography and cardiovascular MRI (CMRI) in the assessment of cardiac function. RECENT FINDINGS The assessment of cardiac function in pediatric patients and in congenital heart disease (CHD) patients has dramatically improved over the last several years. The advancement of transthoracic echocardiography with tissue Doppler imaging, speckle tracking, and three-dimensional echocardiography has enabled strain assessment and the ability to estimate ventricular volumes in these complex patients. In the last few decades, CMRI has become an imaging modality that is now part of the standard tools used for cardiac assessment. With superb two-dimensional and three-dimensional resolution, CMRI allows clear delineation of cardiac and extracardiac structures as well as accurate and reproducible assessment of ventricular volume and function. The most recent and robust contributions of CMRI are its ability to provide characterization of the myocardium and the development of new measurements of global and regional myocardial mechanics and function. SUMMARY Recent advances in echocardiography and CMRI allow a better understanding of myocardial mechanics and composition as well as accurate assessment of ventricular volume and global and regional function in the complex and unique anatomy often found in CHD patients.
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Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Luijnenburg SE, Peters RE, van der Geest RJ, Moelker A, Roos-Hesselink JW, de Rijke YB, Mulder BJM, Vliegen HW, Helbing WA. Abnormal right atrial and right ventricular diastolic function relate to impaired clinical condition in patients operated for tetralogy of Fallot. Int J Cardiol 2012; 167:833-9. [PMID: 22390967 DOI: 10.1016/j.ijcard.2012.02.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/09/2012] [Accepted: 02/04/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Atrial enlargement may reflect ventricular diastolic dysfunction. Although patients with tetralogy of Fallot (TOF) have been studied extensively, little is known about atrial size and function. We assessed bi-atrial size and function in patients after TOF repair, and related them to biventricular systolic and diastolic function, and clinical parameters. METHODS 51 Patients (21 ± 8 years) and 30 healthy controls (31 ± 7 years) were included and underwent magnetic resonance imaging to assess bi-atrial and biventricular size, systolic and diastolic function. Patients also underwent exercise testing, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) assessment. RESULTS In patients, right atrial (RA) minimal volume (34 ± 8 ml/m(2) vs. 28 ± 8 ml/m(2), p=0.001) and late emptying fraction were increased; RA early emptying fraction was decreased. Patients had longer right ventricular (RV) deceleration time (0.24 ± 0.10 vs. 0.13 ± 0.04, p<0.001), reflecting impaired RV relaxation, and larger RV volumes. Patients with end-diastolic forward flow (EDFF) had larger RA and RV size, abnormal RA emptying, higher NT-proBNP levels, higher VE/VCO2 slope (ventilatory response to carbon dioxide production), and the most abnormal LV diastolic function (impaired compliance). Patients with abnormal RA emptying (reservoir function <30% and pump function >24%) had higher NT-proBNP levels and worse exercise capacity. RA minimal volume was associated with RV end-diastolic volume (r=0.35, p=0.013). CONCLUSIONS In TOF patients with moderate RV dilatation, abnormal bi-atrial function and biventricular diastolic dysfunction are common. Abnormal RA emptying was associated with signs of impaired clinical condition, as was the presence of EDFF. These parameters, together with RA enlargement, could serve as useful markers for clinically relevant RV diastolic dysfunction.
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Affiliation(s)
- Saskia E Luijnenburg
- Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
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