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Ahmed MI, Andrikopoulou E, Zheng J, Ulasova E, Pat B, Kelley EE, Powell PC, Denney TS, Lewis C, Davies JE, Darley-Usmar V, Dell’Italia LJ. Interstitial Collagen Loss, Myocardial Remodeling, and Function in Primary Mitral Regurgitation. JACC Basic Transl Sci 2022; 7:973-981. [PMID: 36337921 PMCID: PMC9626893 DOI: 10.1016/j.jacbts.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022]
Abstract
The stretch of volume overload in PMR initiates interstitial collagen loss and decrease in LV sphericity index. LV chamber diastolic function is normal whereas LA function, LV twist/volume slope, early LV untwist, and myocardial circumferential strain are impaired. There is increased oxidative stress in the cardiomyocyte with cytoskeletal breakdown and myofibrillar loss in PMR.
Interstitial collagen loss and cardiomyocyte ultrastructural damage accounts for left ventricular (LV) sphericity and decrease in LV twist and circumferential strain. Normal LV diastolic function belies significantly abnormal left atrial (LA) function and early LV diastolic untwist rate. This underscores the complex interplay of LV and LA myocardial remodeling and function in the pathophysiology of primary mitral regurgitation. In this study, we connect LA function with LV systolic and diastolic myocardial remodeling and function using cardiac magnetic resonance tissue tagging in primary mitral regurgitation.
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Hasin T, Mann D, Welt M, Barrett O, Shalev A, Godfrey M, Kovacs A, Bogot N, Carasso S, Glikson M, Wolak A. Loss of left ventricular rotation is a significant determinant of functional mitral regurgitation. Int J Cardiol 2021; 345:143-149. [PMID: 34626742 DOI: 10.1016/j.ijcard.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
AIM To evaluate insufficient rotational movement of the left ventricle (LV) as a potential novel mechanism for functional regurgitation of the mitral valve (FMR). METHODS AND RESULTS We compared reference subjects and patients with LV dysfunction (LVD, ejection fraction EF < 50%) with and without FMR (regurgitant volume RVol>10 ml). Subjects without structural mitral valve pathology undergoing cardiac MRI were evaluated. Delayed enhancement, global LV remodeling parameters, systolic twist and torsion were measured (using manual and novel automated cardiac MRI tissue-tracking). The study included 117 subjects with mean ± SD age 50.4 ± 17.8 years, of which 30.8% were female. Compared to subjects with LVD without FMR (n = 31), those with FMR (n = 37) had similar clinical characteristics, diagnoses, delayed enhancement, EF, and longitudinal strain. Subjects with FMR had significantly larger left ventricles (EDVi:136.6 ± 41.8 vs 97.5 ± 26.2 ml/m, p < 0.0001) with wider separation between papillary muscles (21.1 ± 7.6 vs 17.2 ± 5.7 mm, p = 0.023). Notably, they had lower apical (p < 0.0001) but not basal rotation and lower peak systolic twist (3.1 ± 2.4° vs 5.5 ± 2.5°, p < 0.0001) and torsion (0.56 ± 0.38°/cm vs 0.88 ± 0.52°/cm, p = 0.004). In a multivariate model for RVol including age, gender, twist, LV end-diastolic volume, sphericity index and separation between papillary muscles, only gender, volume and twist were significant. Twist was the most powerful correlate (beta -2.23, CI -3.26 to -1.23 p < 0.001). In patients with FMR, peak systolic twist negatively correlates with RVol (r = -0.73, p < 0.0001). CONCLUSION Reduced rotational systolic LV motion is significantly and independently associated with RVol among patients with FMR, suggesting a novel pathophysiological mechanism and a potential therapeutic target.
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Affiliation(s)
- Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Daniel Mann
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Welt
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Cardiology, The Edith Wolfson Medical Center, Holon, Israel
| | - Orit Barrett
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Aryeh Shalev
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Max Godfrey
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andras Kovacs
- Department of Cardiology, Hungarian Defense Forces Medical Center, Budapest, Hungary
| | - Naama Bogot
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shemy Carasso
- Department of Cardiology, Padeh Poria Medical Center, Poria, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
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Wang ZJ, Santiago A, Zhou X, Wang L, Margara F, Levrero-Florencio F, Das A, Kelly C, Dall'Armellina E, Vazquez M, Rodriguez B. Human biventricular electromechanical simulations on the progression of electrocardiographic and mechanical abnormalities in post-myocardial infarction. Europace 2021; 23:i143-i152. [PMID: 33751088 PMCID: PMC7943362 DOI: 10.1093/europace/euaa405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023] Open
Abstract
AIMS Develop, calibrate and evaluate with clinical data a human electromechanical modelling and simulation framework for multiscale, mechanistic investigations in healthy and post-myocardial infarction (MI) conditions, from ionic to clinical biomarkers. METHODS AND RESULTS Human healthy and post-MI electromechanical simulations were conducted with a novel biventricular model, calibrated and evaluated with experimental and clinical data, including torso/biventricular anatomy from clinical magnetic resonance, state-of-the-art human-based membrane kinetics, excitation-contraction and active tension models, and orthotropic electromechanical coupling. Electromechanical remodelling of the infarct/ischaemic region and the border zone were simulated for ischaemic, acute, and chronic states in a fully transmural anterior infarct and a subendocardial anterior infarct. The results were compared with clinical electrocardiogram and left ventricular ejection fraction (LVEF) data at similar states. Healthy model simulations show LVEF 63%, with 11% peak systolic wall thickening, QRS duration and QT interval of 100 ms and 330 ms. LVEF in ischaemic, acute, and chronic post-MI states were 56%, 51%, and 52%, respectively. In linking the three post-MI simulations, it was apparent that elevated resting potential due to hyperkalaemia in the infarcted region led to ST-segment elevation, while a large repolarization gradient corresponded to T-wave inversion. Mechanically, the chronic stiffening of the infarct region had the benefit of improving systolic function by reducing infarct bulging at the expense of reducing diastolic function by inhibiting inflation. CONCLUSION Our human-based multiscale modelling and simulation framework enables mechanistic investigations into patho-physiological electrophysiological and mechanical behaviour and can serve as testbed to guide the optimization of pharmacological and electrical therapies.
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Affiliation(s)
- Zhinuo J Wang
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Alfonso Santiago
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Centre (BSC), Barcelona, Spain
- ELEM Biotech, Barcelona, Spain
| | - Xin Zhou
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Lei Wang
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | - Francesca Margara
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
| | | | - Arka Das
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Kelly
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Erica Dall'Armellina
- Department of Biomedical Imaging Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Mariano Vazquez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Centre (BSC), Barcelona, Spain
- ELEM Biotech, Barcelona, Spain
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Wolfson Building, Parks Road, Oxford OX1 3QD, UK
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M H BT, H Z, H P, Sh N, A E, A G. Sex-related Left Ventricle Rotational and Torsional Mechanics by Block Matching Algorithm. J Biomed Phys Eng 2019; 9:541-550. [PMID: 31750268 PMCID: PMC6820028 DOI: 10.31661/jbpe.v0i0.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
Background: The aim of the present study was to evaluate how left ventricular twist and torsion are associated with sex between sex groups of the same age.
Materials and Methods: In this analytical study, twenty one healthy subjects were scanned in left ventricle basal and apical short axis views to run the block matching algorithm; instantaneous changes in the base and apex rotation angels were estimated by this algorithm and then instantaneous changes of the twist and torsion were calculated over the cardiac cycle.
Results: The rotation amount between the consecutive frames in basal and apical levels was extracted from short axis views by tracking the speckle pattern of images. The maximum basal rotation angle for men and women were -6.94°±1.84 and 9.85°±2.36 degrees (p-value = 0.054), respectively. Apex maximum rotation for men was -8.89°±2.04 and for women was 12.18°±2.33 (p-value < 0.05). The peak of twist angle for men and women was 16.78 ± 1.83 and 20.95± 2.09 degrees (p-value < 0.05), respectively. In men and women groups, the peak of calculated torsion angle was 5.49°±1.04 and 7.12± 1.38 degrees (p-value < 0.05), respectively.
Conclusion: The conclusion is that although torsion is an efficient parameter for left ventricle function assessment, because it can take in account the heart diameter and length,
statistic evaluation of the results shows that among men and women LV mechanical parameters are significantly different. This study was mainly ascribed to the dependency of the torsion and twist on patient sex.
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Affiliation(s)
- Bahreini Toosi M H
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zarghani H
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Poorzand H
- MD, Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naseri Sh
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eshraghi A
- MD, Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Golabpour A
- PhD, Biomedical Informatics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Liu B, Edwards NC, Pennell D, Steeds RP. The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time? Eur Heart J Cardiovasc Imaging 2019; 20:123-130. [PMID: 30364971 PMCID: PMC6343082 DOI: 10.1093/ehjci/jey147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
A fifth of patients with primary degenerative mitral regurgitation continue to present with de novo ventricular dysfunction following surgery and higher rates of heart failure, morbidity, and mortality. This raises questions as to why the left ventricle (LV) might fail to recover and has led to support for better LV characterization; cardiac magnetic resonance (CMR) may play a role in this regard, pending further research and outcome data. CMR has widely acknowledged advantages, particularly in repeatability of measurements of volume and ejection fraction, yet recent guidelines relegate its use to cases where there is discordant information or poor-quality imaging from echocardiography because of the lack of data regarding the CMR-based ejection fraction threshold for surgery and CMR-based outcome data. This article reviews the current evidence regarding the role of CMR in an integrated surveillance and surgical timing programme.
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Affiliation(s)
- Boyang Liu
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nicola C Edwards
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Dudley Pennell
- CMR Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - Richard P Steeds
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
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Ponnaluri AVS, Verzhbinsky IA, Eldredge JD, Garfinkel A, Ennis DB, Perotti LE. Model of Left Ventricular Contraction: Validation Criteria and Boundary Conditions. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2019; 11504:294-303. [PMID: 31231721 DOI: 10.1007/978-3-030-21949-9_32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computational models of cardiac contraction can provide critical insight into cardiac function and dysfunction. A necessary step before employing these computational models is their validation. Here we propose a series of validation criteria based on left ventricular (LV) global (ejection fraction and twist) and local (strains in a cylindrical coordinate system, aggregate cardiomyocyte shortening, and low myocardial compressibility) MRI measures to characterize LV motion and deformation during contraction. These validation criteria are used to evaluate an LV finite element model built from subject-specific anatomy and aggregate cardiomyocyte orientations reconstructed from diffusion tensor MRI. We emphasize the key role of the simulation boundary conditions in approaching the physiologically correct motion and strains during contraction. We conclude by comparing the global and local validation criteria measures obtained using two different boundary conditions: the first constraining the LV base and the second taking into account the presence of the pericardium, which leads to greatly improved motion and deformation.
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Affiliation(s)
- Aditya V S Ponnaluri
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | | | - Jeff D Eldredge
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alan Garfinkel
- Departments of Medicine (Cardiology) and Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
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7
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Magrath P, Maforo N, Renella P, Nelson SF, Halnon N, Ennis DB. Cardiac MRI biomarkers for Duchenne muscular dystrophy. Biomark Med 2018; 12:1271-1289. [PMID: 30499689 PMCID: PMC6462870 DOI: 10.2217/bmm-2018-0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a fatal inherited genetic disorder that results in progressive muscle weakness and ultimately loss of ambulation, respiratory failure and heart failure. Cardiac MRI (MRI) plays an increasingly important role in the diagnosis and clinical care of boys with DMD and associated cardiomyopathies. Conventional cardiac MRI biomarkers permit measurements of global cardiac function and presence of fibrosis, but changes in these measures are late manifestations. Emerging MRI biomarkers of myocardial function and structure include the estimation of rotational mechanics and regional strain using MRI tagging; T1-mapping; and T2-mapping, a marker of inflammation, edema and fat. These emerging biomarkers provide earlier insights into cardiac involvement in DMD, improving patient care and aiding the evaluation of emerging therapies.
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Affiliation(s)
- Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Nyasha Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, Department of Human Genetics, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, University of California, Los Angeles, CA 90024, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
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8
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Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2016; 311:H633-44. [DOI: 10.1152/ajpheart.00104.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
Abstract
The anatomy of the adult human left ventricle (LV) is the result of its complex interaction with its environment. From the fetal to the neonatal to the adult form, the human LV undergoes an anatomical transformation that finally results in the most complex of the four cardiac chambers. In its adult form, the human LV consists of two muscular helixes that surround the midventricular circumferential layer of muscle fibers. Contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and is deemed relatively consistent and predictable. Conversely, the LV twist response in patient populations appears to be a little more variable and less predictable, yet it has revealed important insight into the effect of cardiovascular disease on LV mechanical function. This review discusses important methodological aspects of assessing LV twist and evaluates the LV twist responses to the main physiological and pathophysiological states. It is concluded that correct assessment of LV twist mechanics holds significant potential to advance our understanding of LV function in human health and cardiovascular disease.
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Affiliation(s)
- Eric J. Stöhr
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Rob E. Shave
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B. Weiner
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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