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Dong JX, Wei L, Jin LX, He J, Zhao CX, Ding S, Kong LC, Yang F, An DAL, Wu CW, Chen BH, Wang HW, Yang YN, Ge H, Pu J. MR Uniformity Ratio Estimates to Evaluate Ventricular Mechanical Dyssynchrony and Prognosis After ST-Segment Elevation Myocardial Infarction. J Magn Reson Imaging 2024; 59:1820-1831. [PMID: 37830268 DOI: 10.1002/jmri.28998] [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: 05/16/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The impact of left ventricular mechanical dyssynchrony (LVMD) on the long-term prognosis of ST-segment elevation myocardial infarction (STEMI) is unclear. HYPOTHESIS MR uniformity ratio estimates (URE) can detect LVMD and assess STEMI prognosis. STUDY TYPE Retrospective analysis of a prospective multicenter registry (EARLY-MYO trial, NCT03768453). POPULATION Overall, 450 patients (50 females) with first-time STEMI were analyzed, as well as 40 participants without cardiovascular disease as controls. FIELD STRENGTH/SEQUENCE 3.0-T, balanced steady-state free precession cine and late gadolinium enhancement imaging. ASSESSMENT MRI data were acquired within 1 week of symptom onset. Major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal re-infarction, hospitalization for heart failure, and stroke, were the primary clinical outcomes. LVMD was represented by circumferential URE (CURE) and radial URE (RURE) calculated using strain measurements. The patients were grouped according to clinical outcomes or URE values. Patients' clinical characteristics and MR indicators were compared. STATISTICAL TESTS The Student's t-test, Mann-Whitney U test, chi-square test, Fisher's exact test, receiver operating characteristic curve analysis with area under the curve, Kaplan-Meier analysis, Cox regression, logistic regression, intraclass correlation coefficient, c-index, and integrated discrimination improvement were used. P < 0.05 was considered statistically significant. RESULTS CURE and RURE were significantly lower in patients with STEMI than in controls. The median follow-up was 60.5 months. Patients with both lower CURE and RURE values experienced a significantly higher incidence of MACEs by 3.525-fold. Both CURE and RURE were independent risk factors for MACEs. The addition of UREs improved diagnostic efficacy and risk stratification based on infarct size and left ventricular ejection fraction (LVEF). The indicators associated with LVMD included male sex, serum biomarkers (peak creatine phosphokinase and cardiac troponin I), infarct size, and LVEF. DATA CONCLUSION CURE and RURE may be useful to evaluate long-term prognosis after STEMI. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jian-Xun Dong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lai Wei
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Xing Jin
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen-Xu Zhao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Yang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Ao-Lei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hu-Wen Wang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi-Ning Yang
- People's Hospital of Xinjiang Uygur Autonomous Region, Wulumuqi, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Pisesky A, Reichert MJE, de Lange C, Seed M, Yoo SJ, Lam CZ, Grosse-Wortmann L. Adverse fibrosis remodeling and aortopulmonary collateral flow are associated with poor Fontan outcomes. J Cardiovasc Magn Reson 2021; 23:134. [PMID: 34781968 PMCID: PMC8591885 DOI: 10.1186/s12968-021-00782-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The extent and significance in of cardiac remodeling in Fontan patients are unclear and were the subject of this study. METHODS This retrospective cohort study compared cardiovascular magnetic resonance (CMR) imaging markers of cardiac function, myocardial fibrosis, and hemodynamics in young Fontan patients to controls. RESULTS Fifty-five Fontan patients and 44 healthy controls were included (median age 14 years (range 7-17 years) vs 13 years (range 4-14 years), p = 0.057). Fontan patients had a higher indexed end-diastolic ventricular volume (EDVI 129 ml/m2 vs 93 ml/m2, p < 0.001), and lower ejection fraction (EF 45% vs 58%, p < 0.001), circumferential (CS - 23.5% vs - 30.8%, p < 0.001), radial (6.4% vs 8.2%, p < 0.001), and longitudinal strain (- 13.3% vs - 24.8%, p < 0.001). Compared to healthy controls, Fontan patients had higher extracellular volume fraction (ECV) (26.3% vs 20.6%, p < 0.001) and native T1 (1041 ms vs 986 ms, p < 0.001). Patients with a dominant right ventricle demonstrated larger ventricles (EDVI 146 ml/m2 vs 120 ml/m2, p = 0.03), lower EF (41% vs 47%, p = 0.008), worse CS (- 20.1% vs - 25.6%, p = 0.003), and a trend towards higher ECV (28.3% versus 24.1%, p = 0.09). Worse EF and CS correlated with longer cumulative bypass (R = - 0.36, p = 0.003 and R = 0.46, p < 0.001), cross-clamp (R = - 0.41, p = 0.001 and R = 0.40, p = 0.003) and circulatory arrest times (R = - 0.42, p < 0.001 and R = 0.27, p = 0.03). T1 correlated with aortopulmonary collateral (APC) flow (R = 0.36, p = 0.009) which, in the linear regression model, was independent of ventricular morphology (p = 0.9) and EDVI (p = 0.2). The composite outcome (cardiac readmission, cardiac reintervention, Fontan failure or any clinically significant arrhythmia) was associated with increased native T1 (1063 ms vs 1026 ms, p = 0.029) and EDVI (146 ml/m2 vs 118 ml/m2, p = 0.013), as well as decreased EF (42% vs 46%, p = 0.045) and worse CS (- 22% vs - 25%, p = 0.029). APC flow (HR 5.5 CI 1.9-16.2, p = 0.002) was independently associated with the composite outcome, independent of ventricular morphology (HR 0.71 CI 0.30-1.69 p = 0.44) and T1 (HR1.006 CI 1.0-1.13, p = 0.07). CONCLUSIONS Pediatric Fontan patients have ventricular dysfunction, altered myocardial mechanics and increased fibrotic remodeling. Cumulative exposure to cardiopulmonary bypass and increased aortopulmonary collateral flow are associated with myocardial dysfunction and fibrosis. Cardiac dysfunction, fibrosis, and collateral flow are associated with adverse outcomes.
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Affiliation(s)
- Andrea Pisesky
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Marjolein J E Reichert
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Pediatric section, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Seed
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shi-Joon Yoo
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Labatt Family Heart Center, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA
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Li Y, Liu X, Xu Y, Li W, Tang S, Zhou X, Sun J, Zhang Q, Han Y, Chen Y. The Prognostic Value of Left Ventricular Mechanical Dyssynchrony Derived from Cardiac MRI in Patients with Idiopathic Dilated Cardiomyopathy. Radiol Cardiothorac Imaging 2021; 3:e200536. [PMID: 34498001 DOI: 10.1148/ryct.2021200536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
Purpose To investigate the prognostic value of mechanical dyssynchrony evaluated by deformable registration algorithm (DRA) analysis of cardiac MRI (CMR) in patients with idiopathic dilated cardiomyopathy (DCM). Materials and Methods This secondary analysis of a prospective study (clinical trial no. ChiCTR1800017058) enrolled 409 patients (mean age, 48 years ± 14:300 men) with idiopathic DCM who underwent CMR between June 2012 and September 2018. Mechanical dyssynchrony was measured as standard deviation of time-to-peak (sdTTP) and uniformity ratio estimate (URE) indexes by DRA strain analysis. The primary endpoint included all-cause mortality and heart transplantation. The secondary endpoint included primary endpoint, aborted sudden cardiac death, and heart failure readmission. Cox regression analyses and Kaplan-Meier survival analysis were performed to identify the association between variables and outcomes. Results During a median follow-up of 25.1 months, 57 and 132 patients reached primary and secondary endpoints, respectively. Most URE indexes were significantly lower in patients reaching primary endpoint. In multivariable analysis, circumferential URE (CURE) at apical level was independently associated with primary endpoints (hazard ratio, 0.307 [95% CI: 0.106, 0.883]; P = .03) and secondary endpoints (hazard ratio, 0.452 [95% CI: 0.209, 0.979]; P = .04), whereas most sdTTP measures were not. Furthermore, among patients with left ventricular ejection fraction of less than 35% or presence of late gadolinium enhancement, those with CURE at apical level of less than 0.917 had a significantly higher rate of adverse outcomes. Conclusion URE indexes were more predictive of prognostic outcomes compared with sdTTP measurements; the CURE at apical level was an independent predictor of adverse cardiac events in patients with DCM.Keywords: Heart, Outcomes Analysis, MR-ImagingClinical trial registration no. ChiCTR1800017058 Supplemental material is available for this article. See also commentary by Rajiah and François in this issue.© RSNA, 2021.
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Affiliation(s)
- Yangjie Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiumin Liu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuanwei Xu
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Weihao Li
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Siqi Tang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Xiaoyue Zhou
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jiayu Sun
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Qing Zhang
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuchi Han
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yucheng Chen
- Departments of Cardiology (Y.L., Y.X., W.L., S.T., Q.Z., Y.C.) and Radiology (X.L., J.S.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Siemens Healthcare, Shanghai, China (X.Z.); and Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa (Y.H.)
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Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction. Int J Cardiol 2021; 331:124-130. [PMID: 33577906 DOI: 10.1016/j.ijcard.2021.01.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a lack of cardiac MRI information on left ventricular (LV) strain and rotational parameters of left ventricular noncompaction (LVNC) patients with reduced ejection fraction (EF). Thus, we sought to use feature tracking (FT) to describe these changes at different levels of EF deterioration. METHODS We included 31 adult LVNC patients with reduced LV EF (Group B, EF < 50%) without any comorbidities or concomitant cardiac diseases, 31 age- and sex-matched LVNC patients with good EF (Group A, EF > 50%) and 31 healthy controls. Group B was divided according to LV EF into two subgroups (Group B-1: EF 35-50%, Group B-2: EF < 35%). Their global longitudinal, circumferential (GCS), and radial (GRS) strains; LV segmental strains; LV apical and basal rotation values; and patterns and degree of LV dyssynchrony were measured. RESULTS All of the global and mean segmental strain parameters were significantly worse in Groups B, B-1 and B-2 than in Group A and in the controls. The LV mechanical dispersion increased as LV EF decreased. The degree of apical rotation was the highest in the control group, almost the same in Group A and the lowest and in the reverse direction in Group B-2. A rotational pattern, clockwise-directed rigid body rotation (RBR), was found in 39% of the Group B patients, and a counterclockwise-directed RBR was found in 26% of the Group A patients. CONCLUSIONS The strain values and rotational parameters changed as the EF decreased. These changes affected the global LV, and we did not identify an LVNC-specific strain pattern.
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Quantitative mechanical dyssynchrony in dilated cardiomyopathy measured by deformable registration algorithm. Eur Radiol 2020; 30:2010-2020. [PMID: 31953665 DOI: 10.1007/s00330-019-06578-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the diagnostic value and reproducibility of deformable registration algorithm (DRA)-derived mechanical dyssynchrony parameters in dilated cardiomyopathy (DCM) patients. METHODS The present study included 80 DCM patients (40 with normal QRS duration (NQRS-DCM); 40 with left bundle branch block (LBBB-DCM)) and 20 healthy volunteers. The balanced steady-state free-precession (bSSFP) cine images were acquired using a 3.0T scanner. Mechanical dyssynchrony parameters were calculated based on DRA-derived segmental strain, including uniformity ratio estimate (URE) and standard derivation of time-to-peak (T2Psd) parameters in circumferential, radial, and longitudinal orientations. RESULTS DCM patients showed significant mechanical dyssynchrony reflected by both URE and T2Psd parameters compared with controls. Among DCM patients, LBBB-DCM showed decreased CURE (0.78 ± 0.21 vs. 0.93 ± 0.05, p < 0.001) and RURE (0.69 ± 0.14 vs. 0.83 ± 0.15, p = 0.001), and increased T2Psd-Ecc (median with interquartile range, 94.1 (54.4-123.2) ms vs. 63.7 (44.9-80.4) ms, p = 0.003) and T2Psd-Err (91.1 (61.1-103.2) ms vs. 62.3 (46.3-104.5) ms, p = 0.041) compared with NQRS-DCM patients. CURE showed a strong correlation with QRS duration (r = - 0.54, p < 0.001), with maximum AUC (0.791) to differentiate LBBB-DCM from NQRS-DCM patients. Improved intra- and inter-observer reproducibility was found using URE indices (coefficient of variation (CoV), 1.20-3.17%) than T2Psd parameters (CoV, 15.28-41.18%). CONCLUSIONS The DRA-based CURE showed significant correlation with QRS duration and the highest discriminatory value between LBBB-DCM and NQRS-DCM patients. URE indices showed greater reproducibility compared with T2Psd parameters for assessing myocardial dyssynchrony in DCM patients. KEY POINTS • The strain analyses based on DRA suggested that DCM patients have varying degrees of mechanical dyssynchrony and there is a significant difference from normal controls. • CURE showed the strongest correlation with QRS duration and was the best parameter for differentiating DCM patients with normal QRS duration from patients with LBBB, and with normal controls. • URE indices showed improved reproducibility compared with T2Psd parameters in all three orientations (circumferential, radial, and longitudinal).
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Werys K, Petryka-Mazurkiewicz J, Błaszczyk Ł, Miśko J, Śpiewak M, Małek ŁA, Mazurkiewicz Ł, Miłosz-Wieczorek B, Marczak M, Kubik A, Dąbrowska A, Piątkowska-Janko E, Sawionek B, Wijesurendra R, Piechnik SK, Bogorodzki P. Cine dyscontractility index: A novel marker of mechanical dyssynchrony that predicts response to cardiac resynchronization therapy. J Magn Reson Imaging 2016; 44:1483-1492. [PMID: 27131044 DOI: 10.1002/jmri.25295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate whether magnetic resonance imaging (MRI) cine-derived dyssynchrony indices provide additional information compared to conventional tagged MRI (tMRI) acquisitions in heart failure patients undergoing cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Patients scheduled for CRT (n = 52) underwent preprocedure MRI including cine and tMRI acquisitions. Segmental strain curves were calculated for both cine and tMRI to produce a range of standard indices for direct comparison between modalities. We also proposed and evaluated a novel index of "dyscontractility," which detects the presence of focal areas with paradoxically positive circumferential strain. RESULTS Across conventional strain indices, there was only moderate-to-poor (R = 0.3-0.6) correlation between modalities; eight cine-derived indices showed statistically significant (P < 0.05) relations to CRT outcome compared to just two tMRI-based counterparts. The novel dyscontractility index calculated on basal slice cine images (cine dyscontractility index, "CDI") was the single best predictor of clinical response to CRT (area under the curve AUC = 0.81, P < 0.001). While poorly correlated to its tMRI counterpart (R = 0.33), CDI performed significantly better in predicting response to CRT (P < 0.005), and was also numerically better than all other tMRI indices (AUC 0.53-0.76, all P for AUC comparisons <0.17). CONCLUSION Cine-derived strain indices offer potentially new information compared to tMRI. Specifically, the novel CDI is most strongly linked to response to cardiac resynchronization therapy in a contemporary patient cohort. It utilizes readily available MRI data, is relatively straightforward to process, and compares favorably with any conventional tagging index. J. Magn. Reson. Imaging 2016;44:1483-1492.
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Affiliation(s)
- Konrad Werys
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Błaszczyk
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Jolanta Miśko
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Łukasz A Małek
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Ewa Piątkowska-Janko
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Błażej Sawionek
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Rohan Wijesurendra
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Piotr Bogorodzki
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
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Saporito S, van Assen HC, Houthuizen P, Aben JPMM, Strik M, van Middendorp LB, Prinzen FW, Mischi M. Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI. J Magn Reson Imaging 2016; 44:956-63. [PMID: 26973138 DOI: 10.1002/jmri.25225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/23/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare cine and tagged magnetic resonance imaging (MRI) for left ventricular dyssynchrony assessment in left bundle branch block (LBBB), using the time-to-peak contraction timing, and a novel approach based on cross-correlation. MATERIALS AND METHODS We evaluated a canine model dataset (n = 10) before (pre-LBBB) and after induction of isolated LBBB (post-LBBB). Multislice short-axis tagged and cine MRI images were acquired using a 1.5 T scanner. We computed contraction time maps by cross-correlation, based on the timing of radial wall motion and of circumferential strain. Finally, we estimated dyssynchrony as the standard deviation of the contraction time over the different regions of the myocardium. RESULTS Induction of LBBB resulted in a significant increase in dyssynchrony (cine: 13.0 ± 3.9 msec for pre-LBBB, and 26.4 ± 5.0 msec for post-LBBB, P = 0.005; tagged: 17.1 ± 5.0 msec at for pre-LBBB, and 27.9 ± 9.8 msec for post-LBBB, P = 0.007). Dyssynchrony assessed by cine and tagged MRI were in agreement (r = 0.73, P = 0.0003); differences were in the order of time difference between successive frames of 20 msec (bias: -2.9 msec; limit of agreement: 10.1 msec). Contraction time maps were derived; agreement was found in the contraction patterns derived from cine and tagged MRI (mean difference in contraction time per segment: 3.6 ± 13.7 msec). CONCLUSION This study shows that the proposed method is able to quantify dyssynchrony after induced LBBB in an animal model. Cine-assessed dyssynchrony agreed with tagged-derived dyssynchrony, in terms of magnitude and spatial direction. J. MAGN. RESON. IMAGING 2016;44:956-963.
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Affiliation(s)
- Salvatore Saporito
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Hans C van Assen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Marc Strik
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Characterisation of cardiomyopathy by cardiac and aortic magnetic resonance in patients new to hemodialysis. Eur Radiol 2015; 26:2749-61. [PMID: 26679178 PMCID: PMC4927657 DOI: 10.1007/s00330-015-4096-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/12/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022]
Abstract
Objectives Cardiomyopathy is a key factor in accelerated cardiovascular mortality in haemodialysis (HD) patients. We aimed to phenotype cardiac and vascular dysfunction by tagged cardiovascular magnetic resonance (CMR) imaging in patients recently commencing HD. Methods Fifty-four HD patients and 29 age and sex-matched controls without kidney disease were studied. Left ventricular (LV) mass, volumes, ejection fraction (EF), concentric remodelling, peak-systolic circumferential strain (PSS), peak diastolic strain rate (PDSR), LV dyssynchrony, aortic distensibility and aortic pulse wave velocity were determined. Results Global systolic function was reduced (EF 51 ± 10%, HD versus 59 ± 5%, controls, p < 0.001; PSS 15.9 ± 3.7% versus 19.5 ± 3.3%, p < 0.001). Diastolic function was decreased (PDSR 1.07 ± 0.33s-1 versus 1.31 ± 0.38s-1, p = 0.003). LV mass index was increased (63[54,79]g/m2 versus 46[42,53]g/m2, p < 0.001). Anteroseptal reductions in PSS were apparent. These abnormalities remained prevalent in the subset of HD patients with preserved EF >50% (n = 35) and the subset of HD patients without diabetes (n = 40). LV dyssynchrony was inversely correlated to diastolic function, EF and aortic distensibility. Diastolic function was inversely correlated to LV dyssynchrony, concentric remodelling, age and aortic pulse wave velocity. Conclusion Patients new to HD have multiple cardiac and aortic abnormalities as characterised by tagged CMR. Cardio-protective interventions are required from initiation of therapy. Key Points • First characterisation of cardiomyopathy by tagged CMR in haemodialysis patients. • Diastolic function was correlated to LV dyssynchrony, concentric remodelling and aortic PWV. • Reductions in strain localised to the septal and anterior wall. • Bioimpedance measures were unrelated to LV strain, suggesting volume-independent pathogenetic mechanisms. • Multiple abnormalities persisted in the HD patient subset with preserved EF or without diabetes. Electronic supplementary material The online version of this article (doi:10.1007/s00330-015-4096-2) contains supplementary material, which is available to authorized users.
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