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Ghonim S, Babu-Narayan SV. Use of Cardiovascular Magnetic Resonance for Risk Stratification in Repaired Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:393-403. [PMID: 38161667 PMCID: PMC10755838 DOI: 10.1016/j.cjcpc.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/30/2023] [Indexed: 01/03/2024]
Abstract
The risk of premature death in adult patients with repaired tetralogy of Fallot is real and not inconsiderable. From the third decade of life, the incidence of malignant ventricular arrhythmia (VA) is known to exponentially rise. Progressive adverse mechanoelectrical modelling because of years of volume and/or pressure overload from residual pulmonary valve dysfunction and ventricular scar creates the perfect catalyst for VA. Although potentially lifesaving, implantable cardiac defibrillators are associated with substantial psychological and physical morbidity. Better selection of patients most at risk of VA, so that implantable cardiac defibrillators are not inflicted on patients who will never need them, is therefore crucial and has inspired research on this topic for several decades. Cardiovascular magnetic resonance (CMR) enables noninvasive, radiation-free clinical assessment of anatomy and function, making it ideal for the lifelong surveillance of patients with congenital heart disease. Gold standard measurements of ventricular volumes and systolic function can be derived from CMR. Tissue characterization using CMR can identify a VA substrate and provides insight into myocardial disease. We detail risk factors for VA identified using currently available CMR techniques. We also discuss emerging and advanced CMR techniques that have not all yet translated into routine clinical practice. We review how CMR-defined predictors of VA in repaired tetralogy of Fallot can be incorporated into risk scores with other clinical factors to improve the accuracy of risk prediction and to allow for pragmatic clinical application. Finally, we discuss what the future may hold.
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Affiliation(s)
- Sarah Ghonim
- Adult Congenital Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
- National Heart Lung Institute, Imperial College London, London, United Kingdom
| | - Sonya V. Babu-Narayan
- Adult Congenital Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
- National Heart Lung Institute, Imperial College London, London, United Kingdom
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Analysis of Reasonable Respiratory Efficiency in Tennis Competition and Training Environment Based on Cloud Computing. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4289667. [PMID: 35480156 PMCID: PMC9038377 DOI: 10.1155/2022/4289667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
Competitive tennis is developing in the direction of quantification. How to use and give full play to all positive factors, in order to attack actively and give full play to the limits of body and psychology, breathing, as the basic metabolic function of human body, also plays a vital role in tennis. This paper studies that it plays an important role in the rationality and explosiveness of sports and the psychological and physiological regulation in competition. The characteristics of tennis events determine the importance of scientific and rational breathing. Reasonable breathing during exercise is conducive to maintaining the basic stability of the internal environment, improving the training effect, and giving full play to the functional ability of the human body, so as to create excellent sports results. First, reduce respiratory resistance. Second, there are two methods to improve alveolar ventilation efficiency and pulmonary ventilation: increasing respiratory rate and increasing respiratory depth. When the inhalation volume is constant, the alveolar gas freshness rate depends on the functional residual volume in the alveolar cavity at the end of expiratory or before inhalation. The less functional the residual air, the more fresh air inhaled, and the higher the oxygen partial pressure in alveolar gas. An effective way to reduce the functional residual volume in the alveolar cavity is to exhale as deeply as possible, so as to ensure that more oxygen enters the body. Reasonable breathing methods can not only accelerate the excitation of the body, increase movement strength, reduce fatigue, and promote recovery but also play a vital role in the rational allocation of physical fitness and the improvement of sports performance. The purpose of this study is to provide a theoretical basis for scientific tennis training by analyzing the characteristics of tennis events, the form of breathing in tennis and the efficiency of reasonable breathing in tennis.
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Chen J, Zhang H, Mohiaddin R, Wong T, Firmin D, Keegan J, Yang G. Adaptive Hierarchical Dual Consistency for Semi-Supervised Left Atrium Segmentation on Cross-Domain Data. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:420-433. [PMID: 34534077 DOI: 10.1109/tmi.2021.3113678] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Semi-supervised learning provides great significance in left atrium (LA) segmentation model learning with insufficient labelled data. Generalising semi-supervised learning to cross-domain data is of high importance to further improve model robustness. However, the widely existing distribution difference and sample mismatch between different data domains hinder the generalisation of semi-supervised learning. In this study, we alleviate these problems by proposing an Adaptive Hierarchical Dual Consistency (AHDC) for the semi-supervised LA segmentation on cross-domain data. The AHDC mainly consists of a Bidirectional Adversarial Inference module (BAI) and a Hierarchical Dual Consistency learning module (HDC). The BAI overcomes the difference of distributions and the sample mismatch between two different domains. It mainly learns two mapping networks adversarially to obtain two matched domains through mutual adaptation. The HDC investigates a hierarchical dual learning paradigm for cross-domain semi-supervised segmentation based on the obtained matched domains. It mainly builds two dual-modelling networks for mining the complementary information in both intra-domain and inter-domain. For the intra-domain learning, a consistency constraint is applied to the dual-modelling targets to exploit the complementary modelling information. For the inter-domain learning, a consistency constraint is applied to the LAs modelled by two dual-modelling networks to exploit the complementary knowledge among different data domains. We demonstrated the performance of our proposed AHDC on four 3D late gadolinium enhancement cardiac MR (LGE-CMR) datasets from different centres and a 3D CT dataset. Compared to other state-of-the-art methods, our proposed AHDC achieved higher segmentation accuracy, which indicated its capability in the cross-domain semi-supervised LA segmentation.
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Lin M, Jiang M, Zhao M, Ukwatta E, White J, Chiu B. Cascaded triplanar autoencoder M-Net for fully automatic segmentation of left ventricle myocardial scar from three-dimensional late gadolinium-enhanced MR images. IEEE J Biomed Health Inform 2022; 26:2582-2593. [DOI: 10.1109/jbhi.2022.3146013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chen J, Yang G, Khan H, Zhang H, Zhang Y, Zhao S, Mohiaddin R, Wong T, Firmin D, Keegan J. JAS-GAN: Generative Adversarial Network Based Joint Atrium and Scar Segmentations on Unbalanced Atrial Targets. IEEE J Biomed Health Inform 2022; 26:103-114. [PMID: 33945491 DOI: 10.1109/jbhi.2021.3077469] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Automated and accurate segmentations of left atrium (LA) and atrial scars from late gadolinium-enhanced cardiac magnetic resonance (LGE CMR) images are in high demand for quantifying atrial scars. The previous quantification of atrial scars relies on a two-phase segmentation for LA and atrial scars due to their large volume difference (unbalanced atrial targets). In this paper, we propose an inter-cascade generative adversarial network, namely JAS-GAN, to segment the unbalanced atrial targets from LGE CMR images automatically and accurately in an end-to-end way. Firstly, JAS-GAN investigates an adaptive attention cascade to automatically correlate the segmentation tasks of the unbalanced atrial targets. The adaptive attention cascade mainly models the inclusion relationship of the two unbalanced atrial targets, where the estimated LA acts as the attention map to adaptively focus on the small atrial scars roughly. Then, an adversarial regularization is applied to the segmentation tasks of the unbalanced atrial targets for making a consistent optimization. It mainly forces the estimated joint distribution of LA and atrial scars to match the real ones. We evaluated the performance of our JAS-GAN on a 3D LGE CMR dataset with 192 scans. Compared with the state-of-the-art methods, our proposed approach yielded better segmentation performance (Average Dice Similarity Coefficient (DSC) values of 0.946 and 0.821 for LA and atrial scars, respectively), which indicated the effectiveness of our proposed approach for segmenting unbalanced atrial targets.
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Ghonim S, Gatzoulis MA, Ernst S, Li W, Moon JC, Smith GC, Heng EL, Keegan J, Ho SY, McCarthy KP, Shore DF, Uebing A, Kempny A, Alpendurada F, Diller GP, Dimopoulos K, Pennell DJ, Babu-Narayan SV. Predicting Survival in Repaired Tetralogy of Fallot: A Lesion-Specific and Personalized Approach. JACC Cardiovasc Imaging 2021; 15:257-268. [PMID: 34656466 PMCID: PMC8821017 DOI: 10.1016/j.jcmg.2021.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
Objectives This study sought to identify patients with repaired tetralogy of Fallot (rTOF) at high risk of death and malignant ventricular arrhythmia (VA). Background To date there is no robust risk stratification scheme to predict outcomes in adults with rTOF. Methods Consecutive patients were prospectively recruited for late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) to define right and left ventricular (RV, LV) fibrosis in addition to proven risk markers. Results The primary endpoint was all-cause mortality. Of the 550 patients (median age 32 years, 56% male), 27 died (mean follow-up 6.4 ± 5.8; total 3,512 years). Mortality was independently predicted by RVLGE extent, presence of LVLGE, RV ejection fraction ≤47%, LV ejection fraction ≤55%, B-type natriuretic peptide ≥127 ng/L, peak exercise oxygen uptake (V02) ≤17 mL/kg/min, prior sustained atrial arrhythmia, and age ≥50 years. The weighted scores for each of the preceding independent predictors differentiated a high-risk subgroup of patients with a 4.4%, annual risk of mortality (area under the curve [AUC]: 0.87; P < 0.001). The secondary endpoint (VA), a composite of life-threatening sustained ventricular tachycardia/resuscitated ventricular fibrillation/sudden cardiac death occurred in 29. Weighted scores that included several predictors of mortality and RV outflow tract akinetic length ≥55 mm and RV systolic pressure ≥47 mm Hg identified high-risk patients with a 3.7% annual risk of VA (AUC: 0.79; P < 0.001) RVLGE was heavily weighted in both risk scores caused by its strong relative prognostic value. Conclusions We present a score integrating multiple appropriately weighted risk factors to identify the subgroup of patients with rTOF who are at high annual risk of death who may benefit from targeted therapy.
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Affiliation(s)
- Sarah Ghonim
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Sabine Ernst
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Wei Li
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - James C Moon
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Gillian C Smith
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Ee Ling Heng
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Jennifer Keegan
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Siew Yen Ho
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Karen P McCarthy
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Darryl F Shore
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Anselm Uebing
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Aleksander Kempny
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Francisco Alpendurada
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Gerhard P Diller
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom
| | - Konstantinos Dimopoulos
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Dudley J Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust London, United Kingdom; National Heart Lung Institute, Imperial College London, United Kingdom.
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Hajhosseiny R, Munoz C, Cruz G, Khamis R, Kim WY, Prieto C, Botnar RM. Coronary Magnetic Resonance Angiography in Chronic Coronary Syndromes. Front Cardiovasc Med 2021; 8:682924. [PMID: 34485397 PMCID: PMC8416045 DOI: 10.3389/fcvm.2021.682924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/23/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is the leading cause of mortality worldwide, with atherosclerotic coronary artery disease (CAD) accounting for the majority of cases. X-ray coronary angiography and computed tomography coronary angiography (CCTA) are the imaging modalities of choice for the assessment of CAD. However, the use of ionising radiation and iodinated contrast agents remain drawbacks. There is therefore a clinical need for an alternative modality for the early identification and longitudinal monitoring of CAD without these associated drawbacks. Coronary magnetic resonance angiography (CMRA) could be a potential alternative for the detection and monitoring of coronary arterial stenosis, without exposing patients to ionising radiation or iodinated contrast agents. Further advantages include its versatility, excellent soft tissue characterisation and suitability for repeat imaging. Despite the early promise of CMRA, widespread clinical utilisation remains limited due to long and unpredictable scan times, onerous scan planning, lower spatial resolution, as well as motion related image quality degradation. The past decade has brought about a resurgence in CMRA technology, with significant leaps in image acceleration, respiratory and cardiac motion estimation and advanced motion corrected or motion-resolved image reconstruction. With the advent of artificial intelligence, great advances are also seen in deep learning-based motion estimation, undersampled and super-resolution reconstruction promising further improvements of CMRA. This has enabled high spatial resolution (1 mm isotropic), 3D whole heart CMRA in a clinically feasible and reliable acquisition time of under 10 min. Furthermore, latest super-resolution image reconstruction approaches which are currently under evaluation promise acquisitions as short as 1 min. In this review, we will explore the recent technological advances that are designed to bring CMRA closer to clinical reality.
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Affiliation(s)
- Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Won Yong Kim
- Department of Cardiology and Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Instituto de Ingeniería Biologica y Medica, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Greyling A, Vlachou C, Ailoaei S, Buchholz T, Toth B, Ernst S. Catheter mapping and ablation during pregnancy. Herzschrittmacherther Elektrophysiol 2021; 32:164-173. [PMID: 33782753 DOI: 10.1007/s00399-021-00756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
A substantial number of pregnant women at some point experience cardiac arrhythmia, which is mostly treated by antiarrhythmic medication. In some instances, arrhythmias can be drug-resistant and pose a relevant risk to both mother and unborn child as they can result in hemodynamic compromise. In recent years, invasive electrophysiology procedures have been carried out with ever reducing exposure to ionising radiation, and multiple techniques have been established to achieve ZERO exposure. Of course, these techniques should all be applied when contemplating an invasive mapping and ablation procedure during pregnancy. The role of the cardio-obstetrics team in planning and performing such procedures is paramount. Careful assessment of the pregnant mother and her unborn child is mandatory. Only with good preparation is a complete understanding of both cardiac anatomy and physiology achievable, which is a pre-requisite of a successful ablation outcome. Various aspects of the ablation procedure itself are discussed and evaluated from the perspective of all team members involved, including the obstetrician, the anaesthetist and the electrophysiologist. This review aims to inform the reader about the techniques available and reports on the published outcomes for ablations during pregnancy in the last decade.
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Affiliation(s)
- Adele Greyling
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK
- Department of Paediatric Cardiology, University of Stellenbosch, Cape Town, South Africa
| | - Caterina Vlachou
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stefan Ailoaei
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Bettina Toth
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Department Frauenheilkunde, Medizinische Universitaet Innsbruck, Innsbruck, Austria
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton and Harefield Hospital, Sydney Street, SW3 6NP, London, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
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Hajhosseiny R, Bustin A, Munoz C, Rashid I, Cruz G, Manning WJ, Prieto C, Botnar RM. Coronary Magnetic Resonance Angiography: Technical Innovations Leading Us to the Promised Land? JACC Cardiovasc Imaging 2020; 13:2653-2672. [PMID: 32199836 DOI: 10.1016/j.jcmg.2020.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality. Invasive X-ray angiography and coronary computed tomography angiography are established gold standards for coronary luminography. However, they expose patients to invasive complications, ionizing radiation, and iodinated contrast agents. Among a number of imaging modalities, coronary cardiovascular magnetic resonance (CMR) angiography may be used in some cases as an alternative for the detection and monitoring of coronary arterial stenosis, with advantages including its versatility, excellent soft tissue characterization, and avoidance of ionizing radiation and iodinated contrast agents. In this review, we explore the recent advances in motion correction, image acceleration, and reconstruction technologies that are bringing coronary CMR angiography closer to widespread clinical implementation.
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Affiliation(s)
- Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Aurelien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Imran Rashid
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gastao Cruz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Ghonim S, Ernst S, Keegan J, Giannakidis A, Spadotto V, Voges I, Smith GC, Boutsikou M, Montanaro C, Wong T, Ho SY, McCarthy KP, Shore DF, Dimopoulos K, Uebing A, Swan L, Li W, Pennell DJ, Gatzoulis MA, Babu-Narayan SV. Three-Dimensional Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Inducibility of Ventricular Tachycardia in Adults With Repaired Tetralogy of Fallot. Circ Arrhythm Electrophysiol 2020; 13:e008321. [PMID: 33022183 DOI: 10.1161/circep.119.008321] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adults with repaired tetralogy of Fallot die prematurely from ventricular tachycardia (VT) and sudden cardiac death. Inducible VT predicts mortality. Ventricular scar, the key substrate for VT, can be noninvasively defined with late gadolinium enhancement (LGE) cardiovascular magnetic resonance but whether this relates to inducible VT is unknown. METHODS Sixty-nine consecutive repaired tetralogy of Fallot patients (43 male, mean 40±15 years) clinically scheduled for invasive programmed VT-stimulation were prospectively recruited for prior 3-dimensional LGE cardiovascular magnetic resonance. Ventricular LGE was segmented and merged with reconstructed cardiac chambers and LGE volume measured. RESULTS VT was induced in 22 (31%) patients. Univariable predictors of inducible VT included increased RV LGE (odds ratio [OR], 1.15; P=0.001 per cm3), increased nonapical vent LV LGE (OR, 1.09; P=0.008 per cm3), older age (OR, 1.6; P=0.01 per decile), QRS duration ≥180 ms (OR, 3.5; P=0.02), history of nonsustained VT (OR, 3.5; P=0.02), and previous clinical sustained VT (OR, 12.8; P=0.003); only prior sustained VT (OR, 8.02; P=0.02) remained independent in bivariable analyses after controlling for RV LGE volume (OR, 1.14; P=0.003). An RV LGE volume of 25 cm3 had 72% sensitivity and 81% specificity for predicting inducible VT (area under the curve, 0.81; P<0.001). At the extreme cutoffs for ruling-out and ruling-in inducible VT, RV LGE >10 cm3 was 100% sensitive and >36 cm3 was 100% specific for predicting inducible VT. CONCLUSIONS Three-dimensional LGE cardiovascular magnetic resonance-defined scar burden is independently associated with inducible VT and may help refine patient selection for programmed VT-stimulation when applied to an at least intermediate clinical risk cohort.
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Affiliation(s)
- Sarah Ghonim
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Sabine Ernst
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Jenny Keegan
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Archontis Giannakidis
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Veronica Spadotto
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Inga Voges
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Gillian C Smith
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Maria Boutsikou
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Claudia Montanaro
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Tom Wong
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Siew Yen Ho
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Karen P McCarthy
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Darryl F Shore
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Anselm Uebing
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Lorna Swan
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Wei Li
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Dudley J Pennell
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital (S.G., S.E., J.K., A.G., V.S., I.V., G.C.S., M.B., C.M., T.W., S.Y.H., K.P.M., D.F.S., K.D., A.U., L.S., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom.,National Heart & Lung Institute, Imperial College (S.G., S.E., J.K., A.G., T.W., S.Y.H., K.D., W.L., D.J.P., M.A.G., S.V.B.-N.), London, United Kingdom
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11
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Guarguagli S, Cazzoli I, Kempny A, Gatzoulis MA, Ernst S. Initial Experience Using the Radiofrequency Needle Visualization on the Electroanatomical Mapping System for Transseptal Puncture. Cardiol Res Pract 2020; 2020:5420909. [PMID: 32655947 PMCID: PMC7322610 DOI: 10.1155/2020/5420909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Transseptal puncture (TSP) is a routine access route in patients with left-sided ablation substrates and is performed safely on fluoroscopy (+/- echocardiographic guidance). We report on our experience using a radiofrequency (RF) needle in an unselected group of patients to demonstrate safety and usefulness of direct tip visualization on the 3D electroanatomical mapping (EAM) system with specific emphasis on total radiation exposure. METHODS AND RESULTS We retrospectively reviewed 42 consecutive left-sided ablation procedures with TSP performed using an RF needle guided by fluoroscopy and/or EAM visualization by a single operator. The procedures included atrial fibrillation (n = 33), atrial tachycardia (n = 8), and ventricular tachycardia (n = 1) ablations. Fourteen of 41 patients had congenital heart disease, including 9 patients with previous septal closure. Twenty-two patients had at least one previous TSP. All TSPs were performed successfully and without complications. The overall median fluoroscopy time amounted to 3.2 min and median exposure of 199.5 µGy ∗ m2. In a subgroup of patients (n = 27), the RF needle was visualized on the EAM system: median radiation time was 0.88 (interquartile range: 0-3.4) min and median exposure 33.5 [0-324.8] µGy ∗ m2. CONCLUSIONS TSP using an RF needle is an effective technique, also in congenital patients with artificial patch material and in normal patients with multiple previous TSPs. Moreover, the RF needle tip visualization on EAM allows a low (or even zero) fluoroscopy approach.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, School of Cardiovascular Disease, University of Pavia, Pavia, Italy
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
| | - Aleksander Kempny
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
| | - Michael A. Gatzoulis
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, London, UK
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12
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Yang G, Chen J, Gao Z, Li S, Ni H, Angelini E, Wong T, Mohiaddin R, Nyktari E, Wage R, Xu L, Zhang Y, Du X, Zhang H, Firmin D, Keegan J. Simultaneous left atrium anatomy and scar segmentations via deep learning in multiview information with attention. FUTURE GENERATIONS COMPUTER SYSTEMS : FGCS 2020; 107:215-228. [PMID: 32494091 PMCID: PMC7134530 DOI: 10.1016/j.future.2020.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/03/2020] [Accepted: 02/02/2020] [Indexed: 05/20/2023]
Abstract
Three-dimensional late gadolinium enhanced (LGE) cardiac MR (CMR) of left atrial scar in patients with atrial fibrillation (AF) has recently emerged as a promising technique to stratify patients, to guide ablation therapy and to predict treatment success. This requires a segmentation of the high intensity scar tissue and also a segmentation of the left atrium (LA) anatomy, the latter usually being derived from a separate bright-blood acquisition. Performing both segmentations automatically from a single 3D LGE CMR acquisition would eliminate the need for an additional acquisition and avoid subsequent registration issues. In this paper, we propose a joint segmentation method based on multiview two-task (MVTT) recursive attention model working directly on 3D LGE CMR images to segment the LA (and proximal pulmonary veins) and to delineate the scar on the same dataset. Using our MVTT recursive attention model, both the LA anatomy and scar can be segmented accurately (mean Dice score of 93% for the LA anatomy and 87% for the scar segmentations) and efficiently ( ∼ 0.27 s to simultaneously segment the LA anatomy and scars directly from the 3D LGE CMR dataset with 60-68 2D slices). Compared to conventional unsupervised learning and other state-of-the-art deep learning based methods, the proposed MVTT model achieved excellent results, leading to an automatic generation of a patient-specific anatomical model combined with scar segmentation for patients in AF.
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Affiliation(s)
- Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
- Corresponding author at: Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK.
| | - Jun Chen
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, 510006, China
| | - Zhifan Gao
- Department of Medical Imaging, Western University, London, ON, N6A 3K7, Canada
| | - Shuo Li
- Department of Medical Imaging, Western University, London, ON, N6A 3K7, Canada
| | - Hao Ni
- Department of Mathematics, University College London, London, WC1E 6BT, UK
- Alan Turing Institute, London, NW1 2DB, UK
| | - Elsa Angelini
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College London, London, SW7 2AZ, UK
| | - Tom Wong
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Raad Mohiaddin
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Eva Nyktari
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
| | - Ricardo Wage
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | - Heye Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, 510006, China
- Corresponding author.
| | - David Firmin
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
| | - Jennifer Keegan
- Cardiovascular Research Centre, Royal Brompton Hospital, SW3 6NP, London, UK
- National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, UK
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13
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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14
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Cazzoli I, Gunturiz-Beltran C, Guarguagli S, Alonso-Gonzalez R, Babu-Narayan SV, Dimopoulos K, Swan L, Uebing A, Gatzoulis MA, Ernst S. Catheter ablation for patients with end-stage complex congenital heart disease or cardiomyopathy considered for transplantation: Trials and tribulations. Int J Cardiol 2020; 301:127-134. [PMID: 31604655 DOI: 10.1016/j.ijcard.2019.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Arrhythmia contributes significantly to morbidity and mortality of patients with congenital heart disease (CHD) or cardiomyopathy (CMP). It also has the potential to worsen symptoms and is particularly detrimental to patients with advanced heart failure awaiting cardiac transplantation. We report our experience using catheter ablation to treat recurrent arrhythmia in patients with CHD or CMP considered for transplantation. METHODS Five consecutive patients (3 female, mean age 47.8 ± 12.8 years) with complex CHD or CMP (tricuspid atresia, mitral atresia, double inlet left ventricle, arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction) presented with either atrial (n = 3) or ventricular (n = 2) arrhythmias. All ablations were guided by three-dimensional (3D) electro-anatomical mapping, plus remote magnetic navigation in 3 patients. RESULTS Patients underwent a median of 2 ablation procedures for a total number of 26 tachycardias. None of the 5 patients experienced further arrhythmia at a median of 939 days (range 4-1375) from their last ablation. During a median follow up of 31 months (range 1-70), three patients underwent successful transplantation at 1375, 1062 and 321 days following their last ablation. One patient with a Fontan circulation died from hepatic cancer and one from end-stage heart failure despite urgent transplant listing. CONCLUSIONS Catheter ablation is feasible in complex cardiac patients considered for heart transplantation and should be offered for rhythm management and patient optimization until a suitable donor is found.
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Affiliation(s)
- Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Clara Gunturiz-Beltran
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Rafael Alonso-Gonzalez
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Cardiovascular Research Center, Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Lorna Swan
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Anselm Uebing
- Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Department of Paediatric Cardiology, University of Muenster, Muenster, Germany
| | - Michael A Gatzoulis
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom.
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15
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Li L, Wu F, Yang G, Xu L, Wong T, Mohiaddin R, Firmin D, Keegan J, Zhuang X. Atrial scar quantification via multi-scale CNN in the graph-cuts framework. Med Image Anal 2019; 60:101595. [PMID: 31811981 PMCID: PMC6988106 DOI: 10.1016/j.media.2019.101595] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/05/2019] [Accepted: 10/26/2019] [Indexed: 11/06/2022]
Abstract
Propose a fully automatic method for left atrial scar quantification, with promising performance. Formulate a new framework of scar quantification based on surface projection and graph-cuts framework. Propose the multi-scale learning CNN, combined with the random shift training strategy, to learn and predict the graph potentials, which significantly improves the performance of the proposed method, and enables the full automation of the framework. Provide thorough validation and parameter studies for the proposed techniques using fifty-eight clinical images.
Late gadolinium enhancement magnetic resonance imaging (LGE MRI) appears to be a promising alternative for scar assessment in patients with atrial fibrillation (AF). Automating the quantification and analysis of atrial scars can be challenging due to the low image quality. In this work, we propose a fully automated method based on the graph-cuts framework, where the potentials of the graph are learned on a surface mesh of the left atrium (LA) using a multi-scale convolutional neural network (MS-CNN). For validation, we have included fifty-eight images with manual delineations. MS-CNN, which can efficiently incorporate both the local and global texture information of the images, has been shown to evidently improve the segmentation accuracy of the proposed graph-cuts based method. The segmentation could be further improved when the contribution between the t-link and n-link weights of the graph is balanced. The proposed method achieves a mean accuracy of 0.856 ± 0.033 and mean Dice score of 0.702 ± 0.071 for LA scar quantification. Compared to the conventional methods, which are based on the manual delineation of LA for initialization, our method is fully automatic and has demonstrated significantly better Dice score and accuracy (p < 0.01). The method is promising and can be potentially useful in diagnosis and prognosis of AF.
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Affiliation(s)
- Lei Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Data Science, Fudan University, Shanghai, China
| | - Fuping Wu
- School of Data Science, Fudan University, Shanghai, China; Dept of Statistics, School of Management, Fudan University, Shanghai, China
| | - Guang Yang
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Lingchao Xu
- School of NAOCE, Shanghai Jiao Tong University, Shanghai, China
| | - Tom Wong
- Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Raad Mohiaddin
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - David Firmin
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- National Heart and Lung Institute, Imperial College London, London, UK; Cardiovascular Research Center, Royal Brompton Hospital, London, UK
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China; Fudan-Xinzailing Joint Research Center for Big Data, Fudan University, Shanghai, China.
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16
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Yang G, Chen J, Gao Z, Zhang H, Ni H, Angelini E, Mohiaddin R, Wong T, Keegan J, Firmin D. Multiview Sequential Learning and Dilated Residual Learning for a Fully Automatic Delineation of the Left Atrium and Pulmonary Veins from Late Gadolinium-Enhanced Cardiac MRI Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:1123-1127. [PMID: 30440587 DOI: 10.1109/embc.2018.8512550] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate delineation of heart substructures is a prerequisite for abnormality detection, for making quantitative and functional measurements, and for computer-aided diagnosis and treatment planning. Late Gadolinium-Enhanced Cardiac MRI (LGE-CMRI) is an emerging imaging technology for myocardial infarction or scar detection based on the differences in the volume of residual gadolinium distribution between scar and healthy tissues. While LGE-CMRI is a well-established non-invasive tool for detecting myocardial scar tissues in the ventricles, its application to left atrium (LA) imaging is more challenging due to its very thin wall of the LA and poor quality images, which may be produced because of motion artefacts and low signal-to-noise ratio. As the LGE-CMRI scan is designed to highlight scar tissues by altering the gadolinium kinetics, the anatomy among different heart substructures has less distinguishable boundaries. An accurate, robust and reproducible method for LA segmentation is highly in demand because it can not only provide valuable information of the heart function but also be helpful for the further delineation of scar tissue and measuring the scar percentage. In this study, we proposed a novel deep learning framework working on LGE-CMRI images directly by combining sequential learning and dilated residual learning to delineate LA and pulmonary veins fully automatically. The achieved results showed accurate segmentation results compared to the state-of-the-art methods. The proposed framework leads to an automatic generation of a patient-specific model that can potentially enable an objective atrial scarring assessment for the atrial fibrillation patients.
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17
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Guarguagli S, Kempny A, Cazzoli I, Barracano R, Gatzoulis MA, Dimopoulos K, Ernst S. Efficacy of catheter ablation for atrial fibrillation in patients with congenital heart disease. Europace 2019; 21:1334-1344. [DOI: 10.1093/europace/euz157] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/04/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
Advances in surgical techniques allow an increasing number of children with congenital heart disease (CHD) to reach adulthood. As patients grow older, atrial fibrillation (AF) is evolving into a major clinical concern and can be difficult to manage medically. Primary AF catheter ablation may, therefore, have a role in this setting but few reports have evaluated its efficacy in CHD patients.
Methods and results
We retrospectively reviewed 58 consecutive patients [median age 51, interquartile range (IQR) 44–63 years, 57% male] with AF (45% paroxysmal) who underwent 122 ablation procedures in our tertiary centre in the last decade. The majority had CHD of moderate or severe complexity (57%, Bethesda Class 2 or 3) with a dilated left atrium (LA) (81%) and/or right atrium (86%). At 1-year from the first ablation, 32.8% of patients remained in sinus rhythm. Multiple procedures were required in 35 (60%) patients. Freedom from AF at 1-year after the 2nd and 3rd ablation was 40.9% and 36.5%, respectively. Multivariable predictors of AF recurrence were underlying anatomic complexity [hazard ratio (HR) in Bethesda 3 1.98, P = 0.006], type of AF (HR for persistent 1.87, P = 0.004), and indexed LA dimensions (HR for cm2/m2 1.06, P = 0.03).
Conclusion
While ablation may be a valid option for the treatment of AF in CHD patients, multiple procedures are likely to be required. Early referral and careful patient selection are essential to optimize the results of AF ablation, achieving a low rate of recurrence. Further studies are needed to validate our prognostic model and guide clinical practice.
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Affiliation(s)
- Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; School of Cardiovascular Disease, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aleksander Kempny
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Rosaria Barracano
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Center and Centre of Pulmonary Hypertension, Royal Brompton and Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital and Imperial College London, Sydney St, Chelsea, London, UK
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Yang G, Zhuang X, Khan H, Haldar S, Nyktari E, Li L, Wage R, Ye X, Slabaugh G, Mohiaddin R, Wong T, Keegan J, Firmin D. Fully automatic segmentation and objective assessment of atrial scars for long-standing persistent atrial fibrillation patients using late gadolinium-enhanced MRI. Med Phys 2018; 45:1562-1576. [PMID: 29480931 PMCID: PMC5969251 DOI: 10.1002/mp.12832] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Atrial fibrillation (AF) is the most common heart rhythm disorder and causes considerable morbidity and mortality, resulting in a large public health burden that is increasing as the population ages. It is associated with atrial fibrosis, the amount and distribution of which can be used to stratify patients and to guide subsequent electrophysiology ablation treatment. Atrial fibrosis may be assessed noninvasively using late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) where scar tissue is visualized as a region of signal enhancement. However, manual segmentation of the heart chambers and of the atrial scar tissue is time consuming and subject to interoperator variability, particularly as image quality in AF is often poor. In this study, we propose a novel fully automatic pipeline to achieve accurate and objective segmentation of the heart (from MRI Roadmap data) and of scar tissue within the heart (from LGE MRI data) acquired in patients with AF. METHODS Our fully automatic pipeline uniquely combines: (a) a multiatlas-based whole heart segmentation (MA-WHS) to determine the cardiac anatomy from an MRI Roadmap acquisition which is then mapped to LGE MRI, and (b) a super-pixel and supervised learning based approach to delineate the distribution and extent of atrial scarring in LGE MRI. We compared the accuracy of the automatic analysis to manual ground truth segmentations in 37 patients with persistent long-standing AF. RESULTS Both our MA-WHS and atrial scarring segmentations showed accurate delineations of cardiac anatomy (mean Dice = 89%) and atrial scarring (mean Dice = 79%), respectively, compared to the established ground truth from manual segmentation. In addition, compared to the ground truth, we obtained 88% segmentation accuracy, with 90% sensitivity and 79% specificity. Receiver operating characteristic analysis achieved an average area under the curve of 0.91. CONCLUSION Compared with previously studied methods with manual interventions, our innovative pipeline demonstrated comparable results, but was computed fully automatically. The proposed segmentation methods allow LGE MRI to be used as an objective assessment tool for localization, visualization, and quantitation of atrial scarring and to guide ablation treatment.
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Affiliation(s)
- Guang Yang
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonSW7 2AZUK
| | - Xiahai Zhuang
- School of Data ScienceFudan UniversityShanghai201203China
| | - Habib Khan
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
| | - Shouvik Haldar
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
| | - Eva Nyktari
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
| | - Lei Li
- Department of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200240China
| | - Ricardo Wage
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
| | - Xujiong Ye
- School of Computer ScienceUniversity of LincolnLincolnLN6 7TSUK
| | - Greg Slabaugh
- Department of Computer ScienceCity University LondonLondonEC1V 0HBUK
| | - Raad Mohiaddin
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonSW7 2AZUK
| | - Tom Wong
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
| | - Jennifer Keegan
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonSW7 2AZUK
| | - David Firmin
- Cardiovascular Research CentreRoyal Brompton HospitalLondonSW3 6NPUK
- National Heart and Lung InstituteImperial College LondonLondonSW7 2AZUK
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19
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Duong P, Coats L, O'Sullivan J, Crossland D, Haugk B, Babu‐Narayan SV, Keegan J, Hudson M, Parry G, Manas D, Hasan A. Combined heart-liver transplantation for failing Fontan circulation in a late survivor with single-ventricle physiology. ESC Heart Fail 2017; 4:675-678. [PMID: 28941165 PMCID: PMC5695182 DOI: 10.1002/ehf2.12202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 12/27/2022] Open
Abstract
Management of adults with failing Fontan physiology poses many challenges, especially as transplantation offers the only realistic alternative to palliative care. We present the first combined heart and liver transplant performed in Europe, for a late survivor of single ventricle palliation with the Fontan circulation. In addition to the conventional medical and surgical challenges posed, we highlight the management of the associated multi-organ failure with focus on the liver and novel strategies for assessment and optimization.
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Affiliation(s)
- Phuoc Duong
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
| | - Louise Coats
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
- Institute of Genetic MedicineNewcastle UniversityNewcastle upon TyneUK
| | - John O'Sullivan
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
| | - David Crossland
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
| | - Beate Haugk
- Department of PathologyRoyal Victoria InfirmaryNewcastle upon TyneUK
| | | | - Jennifer Keegan
- National Heart and Lung InstituteRoyal Brompton HospitalLondonUK
| | - Mark Hudson
- Department of Hepatology and Hepatobiliary SurgeryFreeman HospitalNewcastle upon TyneUK
| | - Gareth Parry
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
| | - Derek Manas
- Department of Hepatology and Hepatobiliary SurgeryFreeman HospitalNewcastle upon TyneUK
| | - Asif Hasan
- Department of Congenital CardiologyFreeman HospitalNewcastle upon TyneUK
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20
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Abstract
Besides antiarrhythmic medication, there are now very good options for a potentially curative therapy by catheter ablation targeting the origin of the underlying arrhythmias in patients with complex congenital heart disease. Three-dimensional (3D) reconstruction of tomographic imaging (MRI or computed tomography) is helpful to understand the underlying cardiac anatomy, identify the most likely target chamber, and help with planning access. Use of the available 3D mapping systems (sequential or simultaneous acquisition) and (if available) more advanced navigation systems, such as remote magnetic navigation, can improve the acute and long-term outcomes of catheter ablation in congenital heart disease.
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Affiliation(s)
- Sabine Ernst
- Cardiology Department, National Heart and Lung Institute, Royal Brompton and Harefield Hospital, Imperial College, Sydney Street, London SW3 6NP, UK.
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21
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Ernst S, Yen Ho S, McCarthy K. [Arrhythmia in adults with congenital heart defects : Atrial tachycardia]. Herzschrittmacherther Elektrophysiol 2016; 27:122-30. [PMID: 27250726 DOI: 10.1007/s00399-016-0432-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/12/2016] [Indexed: 11/25/2022]
Abstract
Atrial arrhythmias are frequently encountered in patients with congenital heart disease (CHD) with or without corrective surgery and respond to pharmacological therapies with only limited success. This review describes the technologies currently available for performing successful ablation procedures in this very complex patient cohort. In addition to an understanding of the underlying anatomy, which can be supplemented by 3D imaging with the aid of magnetic resonance imaging (MRI) or computed tomography (CT), the choice between the different 3D mapping systems (sequential versus simultaneous) is presented. Finally, conventional manual navigation is compared with magnetic navigation and then discussed with regard to the respective arrhythmias encountered with the different forms of CHD.
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Affiliation(s)
- Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, SW3 6NP, London, UK.
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK.
| | - Siew Yen Ho
- Brompton Cardiac Morphology Unit, Imperial College London, London, UK
| | - Karen McCarthy
- Brompton Cardiac Morphology Unit, Imperial College London, London, UK
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22
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Giannakidis A, Nyktari E, Keegan J, Pierce I, Suman Horduna I, Haldar S, Pennell DJ, Mohiaddin R, Wong T, Firmin DN. Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation. Biomed Eng Online 2015; 14:88. [PMID: 26445883 PMCID: PMC4596471 DOI: 10.1186/s12938-015-0083-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/21/2015] [Indexed: 01/11/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR’s diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre. Methods Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels. Results Global normalized intensity threshold levels TPRE = 1 1/4 and TPOST = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustrated that the cut-off levels employed by other centres may not be usable for clinical studies performed in our centre. Conclusions The proposed technique has great potential for successful employment in the AF management within our centre. It provides a highly desirable validation of the LGE CMR technique for AF studies. Inter-centre differences in the CMR acquisition protocol and image analysis strategy inevitably impede the selection of a universally optimal algorithm for segmentation of enhancement in AF studies.
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Affiliation(s)
- Archontis Giannakidis
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Eva Nyktari
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Iain Pierce
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Irina Suman Horduna
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Shouvik Haldar
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Dudley J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Raad Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Tom Wong
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
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23
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Advances in cardiac magnetic resonance imaging of congenital heart disease. Pediatr Radiol 2015; 45:5-19. [PMID: 25552386 DOI: 10.1007/s00247-014-3067-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/21/2014] [Indexed: 01/09/2023]
Abstract
Due to advances in cardiac surgery, survival of patients with congenital heart disease has increased considerably during the past decades. Many of these patients require repeated cardiovascular magnetic resonance imaging to assess cardiac anatomy and function. In the past decade, technological advances have enabled faster and more robust cardiovascular magnetic resonance with improved image quality and spatial as well as temporal resolution. This review aims to provide an overview of advances in cardiovascular magnetic resonance hardware and acquisition techniques relevant to both pediatric and adult patients with congenital heart disease and discusses the techniques used to assess function, anatomy, flow and tissue characterization.
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Rajchl M, Stirrat J, Goubran M, Yu J, Scholl D, Peters TM, White JA. Comparison of semi-automated scar quantification techniques using high-resolution, 3-dimensional late-gadolinium-enhancement magnetic resonance imaging. Int J Cardiovasc Imaging 2014; 31:349-57. [PMID: 25307896 DOI: 10.1007/s10554-014-0553-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/08/2014] [Indexed: 01/01/2023]
Abstract
The quantification and modeling of myocardial scar is of expanding interest for image-guided therapy, particularly in the field of arrhythmia management. Migration towards high-resolution, three-dimensional (3D) MRI techniques for spatial mapping of myocardial scar provides superior spatial registration. However, to date no systematic comparison of available approaches to 3D scar quantification have been performed. In this study we compare the reproducibility of six 3D scar segmentation algorithms for determination of left ventricular scar volume. Additionally, comparison to two-dimensional (2D) scar quantification and 3D manual segmentation is performed. Thirty-five consecutive patients with ischemic cardiomyopathy were recruited and underwent conventional 2D late gadolinium enhancement (LGE) and 3D isotropic LGE imaging (voxel size 1.3 mm(3)) using a 3 T scanner. 3D LGE datasets were analyzed using six semi-automated segmentation techniques, including the signal threshold versus reference mean (STRM) technique at >2, >3, >5 and >6 standard deviations (SD) above reference myocardium, the full width at half maximum (FWHM) technique, and an optimization-based technique called hierarchical max flow (HMF). The mean ejection fraction was 32.1 ± 12.7 %. Reproducibility was greatest for HMF and FWHM techniques with intra-class correlation coefficient values ≥0.95. 3D scar quantification and modeling is clinically feasible in patients with ischemic cardiomyopathy. While several approaches show acceptable reproducibility, HMF appears superior due to maintenance of accuracy towards manual segmentations.
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Affiliation(s)
- Martin Rajchl
- Imaging Laboratories, Robarts Research Institute, Western University, London, ON, Canada
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25
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Keegan J, Gatehouse PD, Haldar S, Wage R, Babu-Narayan SV, Firmin DN. Dynamic inversion time for improved 3D late gadolinium enhancement imaging in patients with atrial fibrillation. Magn Reson Med 2014; 73:646-54. [PMID: 24604664 DOI: 10.1002/mrm.25190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 01/09/2014] [Accepted: 02/03/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE High resolution three-dimensional (3D) late gadolinium enhancement (LGE) imaging is performed with single R-wave gating to minimize lengthy acquisition durations. In patients with atrial fibrillation (AF), heart rate variability results in variable magnetization recovery between sequence repeats, and image quality is often poor. In this study, we implemented and tested a dynamic inversion time (dynamic-TI) scheme designed to reduce sequence sensitivity to heart rate variations. METHODS An inversion-prepared 3D segmented gradient echo sequence was modified so that the TI varied automatically from beat-to-beat (dynamic-TI) based on the time since the last sequence repeat. 3D LGE acquisitions were performed in 17 patients prior to radio frequency ablation of persistent AF both with and without dynamic-TI. Qualitative image quality scores, blood signal-to-ghosting ratios (SGRs). and blood-myocardium contrast-to-ghosting ratios (CGRs) were compared. RESULTS Image quality scores were higher with dynamic-TI than without dynamic-TI (2.2 ± 0.9 vs. 1.8 ± 1.1, P = 0.008), as were blood-myocardium CGRs (13.8 ± 7.6 vs. 8.3 ± 6.1, P = 0.003) and blood SGRs (19.6 ± 8.5 vs. 13.1 ± 8.0, P = 0.003). CONCLUSION The dynamic-TI algorithm improves image quality of 3D LGE imaging in this difficult patient population by reducing the sequence sensitivity to RR interval variations
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United Kingdom
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26
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Rajchl M, Yuan J, White JA, Ukwatta E, Stirrat J, Nambakhsh CMS, Li FP, Peters TM. Interactive Hierarchical-Flow Segmentation of Scar Tissue From Late-Enhancement Cardiac MR Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:159-172. [PMID: 24107924 DOI: 10.1109/tmi.2013.2282932] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We propose a novel multi-region image segmentation approach to extract myocardial scar tissue from 3-D whole-heart cardiac late-enhancement magnetic resonance images in an interactive manner. For this purpose, we developed a graphical user interface to initialize a fast max-flow-based segmentation algorithm and segment scar accurately with progressive interaction. We propose a partially-ordered Potts (POP) model to multi-region segmentation to properly encode the known spatial consistency of cardiac regions. Its generalization introduces a custom label/region order constraint to Potts model to multi-region segmentation. The combinatorial optimization problem associated with the proposed POP model is solved by means of convex relaxation, for which a novel multi-level continuous max-flow formulation, i.e., the hierarchical continuous max-flow (HMF) model, is proposed and studied. We demonstrate that the proposed HMF model is dual or equivalent to the convex relaxed POP model and introduces a new and efficient hierarchical continuous max-flow based algorithm by modern convex optimization theory. In practice, the introduced hierarchical continuous max-flow based algorithm can be implemented on the parallel GPU to achieve significant acceleration in numerics. Experiments are performed in 50 whole heart 3-D LE datasets, 35 with left-ventricular and 15 with right-ventricular scar. The experimental results are compared to full-width-at-half-maximum and Signal-threshold to reference-mean methods using manual expert myocardial segmentations and operator variabilities and the effect of user interaction are assessed. The results indicate a substantial reduction in image processing time with robust accuracy for detection of myocardial scar. This is achieved without the need for additional region constraints and using a single optimization procedure, substantially reducing the potential for error.
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Keegan J, Drivas P, Firmin DN. Navigator artifact reduction in three-dimensional late gadolinium enhancement imaging of the atria. Magn Reson Med 2013; 72:779-85. [PMID: 24151231 DOI: 10.1002/mrm.24967] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE Navigator-gated three-dimensional (3D) late gadolinium enhancement (LGE) imaging demonstrates scarring following ablation of atrial fibrillation. An artifact originating from the slice-selective navigator-restore pulse is frequently present in the right pulmonary veins (PVs), obscuring the walls and making quantification of enhancement difficult. We describe a simple sequence modification to greatly reduce or remove this artifact. METHODS A navigator-gated inversion-prepared gradient echo sequence was modified so that the slice-selective navigator-restore pulse was delayed in time from the nonselective preparation (NAV-restore-delayed). Both NAV-restore-delayed and conventional 3D LGE acquisitions were performed in 11 patients and the results compared. RESULTS One patient was excluded due to severe respiratory motion artifact in both NAV-restore-delayed and conventional acquisitions. Moderate to severe artifact was present in 9 of the remaining 10 patients using the conventional sequence and was considerably reduced when using the NAV-restore-delayed sequence (ostial PV to blood pool ratio, 1.7 ± 0.5 versus 1.1 ± 0.2, respectively [P < 0.0001]; qualitative artifact scores, 2.8 ± 1.1 versus 1.2 ± 0.4, respectively [P < 0.001]). While navigator signal-to-noise ratio was reduced with the NAV-restore-delayed sequence, respiratory motion compensation was unaffected. CONCLUSIONS Shifting the navigator-restore pulse significantly reduces or eliminates navigator artifact. This simple modification improves the quality of 3D LGE imaging and potentially aids late enhancement quantification in the atria.
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Affiliation(s)
- Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
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