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Sillanmäki S, Vainio HL, Ylä-Herttuala E, Husso M, Hedman M. Measuring Cardiac Dyssynchrony with DENSE (Displacement Encoding with Stimulated Echoes)-A Systematic Review. Rev Cardiovasc Med 2023; 24:261. [PMID: 39076380 PMCID: PMC11270089 DOI: 10.31083/j.rcm2409261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2024] Open
Abstract
Background In this review, we introduce the displacement encoding with stimulated echoes (DENSE) method for measuring myocardial dyssynchrony using cardiovascular magnetic resonance (CMR) imaging. We provide an overview of research findings related to DENSE from the past two decades and discuss other techniques used for dyssynchrony evaluation. Additionally, the review discusses the potential uses of DENSE in clinical practice. Methods A search was conducted to identify relevant articles published from January 2000 through January 2023 using the Scopus, Web of Science, PubMed and Cochrane databases. The following search term was used: (DENSE OR 'displacement encoding with stimulated echoes' OR CURE) AND (dyssynchrony* OR asynchron* OR synchron*) AND (MRI OR 'magnetic resonance' OR CMR). Results After removing duplicates, researchers screened a total of 174 papers. Papers that were not related to the topic, reviews, general overview articles and case reports were excluded, leaving 35 articles for further analysis. Of these, 14 studies focused on cardiac dyssynchrony estimation with DENSE, while the remaining 21 studies served as background material. The studies used various methods for presenting synchronicity, such as circumferential uniformity ratio estimate (CURE), CURE-singular value decomposition (SVD), radial uniformity ratio estimate (RURE), longitudinal uniformity ratio estimate (LURE), time to onset of shortening (TOS) and dyssynchrony index (DI). Most of the dyssynchrony studies concentrated on human heart failure, but congenital heart diseases and obesity were also evaluated. The researchers found that DENSE demonstrated high reproducibility and was found useful for detecting cardiac resynchronisation therapy (CRT) responders, optimising CRT device settings and assessing right ventricle synchronicity. In addition, studies showed a correlation between cardiac fibrosis and mechanical dyssynchrony in humans, as well as a decrease in the synchrony of contraction in the left ventricle in obese mice. Conclusions DENSE shows promise as a tool for quantifying myocardial function and dyssynchrony, with advantages over other cardiac dyssynchrony evaluation methods. However, there remain challenges related to DENSE due to the relatively time-consuming imaging and analysis process. Improvements in imaging and analysing technology, as well as possible artificial intelligence solutions, may help overcome these challenges and lead to more widespread clinical use of DENSE.
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Affiliation(s)
- Saara Sillanmäki
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Hanna-Liina Vainio
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
| | - Elias Ylä-Herttuala
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
- A.I. Virtanen Institute, University of Eastern Finland, 70210 Kuopio, Finland
| | - Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Marja Hedman
- Institute of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, 70029 Kuopio, Finland
- Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
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Auger DA, Ghadimi S, Cai X, Reagan CE, Sun C, Abdi M, Cao JJ, Cheng JY, Ngai N, Scott AD, Ferreira PF, Oshinski JN, Emamifar N, Ennis DB, Loecher M, Liu ZQ, Croisille P, Viallon M, Bilchick KC, Epstein FH. Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease. J Cardiovasc Magn Reson 2022. [PMID: 35369885 DOI: 10.1186/s12968-022-00851-7/figures/6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (Ecc), longitudinal (Ell) and radial (Err) strain, torsion, and segmental Ecc at multiple centers. METHODS Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global Ecc, Ell and Err, torsion, and segmental Ecc were quantified using Bland-Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10% < CV ≤ 20%, fair for 20% < CV ≤ 40%, and poor for CV > 40. ICC values were considered excellent for ICC > 0.74, good for ICC 0.6 < ICC ≤ 0.74, fair for ICC 0.4 < ICC ≤ 0.59, poor for ICC < 0.4. RESULTS Based on CV and ICC, segmental Ecc provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good-excellent inter-scan reproducibility. Whole-slice Ecc and global Ell provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good-excellent for all comparisons. For whole-slice Err, CV was in the fair-good range, and ICC was in the good-excellent range. CONCLUSIONS Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental Ecc, global Ell, and torsion measurements in healthy subjects and heart disease patients.
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Affiliation(s)
- Daniel A Auger
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Sona Ghadimi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Xiaoying Cai
- Siemens Healthineers, Boston, Massachusetts, USA
| | - Claire E Reagan
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Jie Jane Cao
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Joshua Y Cheng
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Nora Ngai
- St. Francis Hospital, The Heart Center, Long Island, NY, USA
| | - Andrew D Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Pedro F Ferreira
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John N Oshinski
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Nick Emamifar
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Zhan-Qiu Liu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Pierre Croisille
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
- Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Kenneth C Bilchick
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA.
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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Auger DA, Ghadimi S, Cai X, Reagan CE, Sun C, Abdi M, Cao JJ, Cheng JY, Ngai N, Scott AD, Ferreira PF, Oshinski JN, Emamifar N, Ennis DB, Loecher M, Liu ZQ, Croisille P, Viallon M, Bilchick KC, Epstein FH. Reproducibility of global and segmental myocardial strain using cine DENSE at 3 T: a multicenter cardiovascular magnetic resonance study in healthy subjects and patients with heart disease. J Cardiovasc Magn Reson 2022; 24:23. [PMID: 35369885 PMCID: PMC8978361 DOI: 10.1186/s12968-022-00851-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While multiple cardiovascular magnetic resonance (CMR) methods provide excellent reproducibility of global circumferential and global longitudinal strain, achieving highly reproducible segmental strain is more challenging. Previous single-center studies have demonstrated excellent reproducibility of displacement encoding with stimulated echoes (DENSE) segmental circumferential strain. The present study evaluated the reproducibility of DENSE for measurement of whole-slice or global circumferential (Ecc), longitudinal (Ell) and radial (Err) strain, torsion, and segmental Ecc at multiple centers. METHODS Six centers participated and a total of 81 subjects were studied, including 60 healthy subjects and 21 patients with various types of heart disease. CMR utilized 3 T scanners, and cine DENSE images were acquired in three short-axis planes and in the four-chamber long-axis view. During one imaging session, each subject underwent two separate DENSE scans to assess inter-scan reproducibility. Each subject was taken out of the scanner and repositioned between the scans. Intra-user, inter-user-same-site, inter-user-different-site, and inter-user-Human-Deep-Learning (DL) comparisons assessed the reproducibility of different users analyzing the same data. Inter-scan comparisons assessed the reproducibility of DENSE from scan to scan. The reproducibility of whole-slice or global Ecc, Ell and Err, torsion, and segmental Ecc were quantified using Bland-Altman analysis, the coefficient of variation (CV), and the intraclass correlation coefficient (ICC). CV was considered excellent for CV ≤ 10%, good for 10% < CV ≤ 20%, fair for 20% < CV ≤ 40%, and poor for CV > 40. ICC values were considered excellent for ICC > 0.74, good for ICC 0.6 < ICC ≤ 0.74, fair for ICC 0.4 < ICC ≤ 0.59, poor for ICC < 0.4. RESULTS Based on CV and ICC, segmental Ecc provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL reproducibility and good-excellent inter-scan reproducibility. Whole-slice Ecc and global Ell provided excellent intra-user, inter-user-same-site, inter-user-different-site, inter-user-Human-DL and inter-scan reproducibility. The reproducibility of torsion was good-excellent for all comparisons. For whole-slice Err, CV was in the fair-good range, and ICC was in the good-excellent range. CONCLUSIONS Multicenter data show that 3 T CMR DENSE provides highly reproducible whole-slice and segmental Ecc, global Ell, and torsion measurements in healthy subjects and heart disease patients.
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Affiliation(s)
- Daniel A. Auger
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Sona. Ghadimi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | | | - Claire E. Reagan
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
| | - Jie Jane Cao
- St. Francis Hospital, The Heart Center, Long Island, NY USA
| | | | - Nora Ngai
- St. Francis Hospital, The Heart Center, Long Island, NY USA
| | - Andrew D. Scott
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Pedro F. Ferreira
- Cardiovascular Magnetic Resonance Unit, The Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John N. Oshinski
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Nick Emamifar
- Department of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, Georgia
| | - Daniel B. Ennis
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Zhan-Qiu Liu
- Department of Radiology, Stanford University, Stanford, CA USA
| | - Pierre Croisille
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
- Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Magalie Viallon
- University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, Saint-Etienne, France
| | - Kenneth C. Bilchick
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA 22908 USA
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA USA
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Moss R, Wülfers EM, Schuler S, Loewe A, Seemann G. A Fully-Coupled Electro-Mechanical Whole-Heart Computational Model: Influence of Cardiac Contraction on the ECG. Front Physiol 2022; 12:778872. [PMID: 34975532 PMCID: PMC8716847 DOI: 10.3389/fphys.2021.778872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 01/12/2023] Open
Abstract
The ECG is one of the most commonly used non-invasive tools to gain insights into the electrical functioning of the heart. It has been crucial as a foundation in the creation and validation of in silico models describing the underlying electrophysiological processes. However, so far, the contraction of the heart and its influences on the ECG have mainly been overlooked in in silico models. As the heart contracts and moves, so do the electrical sources within the heart responsible for the signal on the body surface, thus potentially altering the ECG. To illuminate these aspects, we developed a human 4-chamber electro-mechanically coupled whole heart in silico model and embedded it within a torso model. Our model faithfully reproduces measured 12-lead ECG traces, circulatory characteristics, as well as physiological ventricular rotation and atrioventricular valve plane displacement. We compare our dynamic model to three non-deforming ones in terms of standard clinically used ECG leads (Einthoven and Wilson) and body surface potential maps (BSPM). The non-deforming models consider the heart at its ventricular end-diastatic, end-diastolic and end-systolic states. The standard leads show negligible differences during P-Wave and QRS-Complex, yet during T-Wave the leads closest to the heart show prominent differences in amplitude. When looking at the BSPM, there are no notable differences during the P-Wave, but effects of cardiac motion can be observed already during the QRS-Complex, increasing further during the T-Wave. We conclude that for the modeling of activation (P-Wave/QRS-Complex), the associated effort of simulating a complete electro-mechanical approach is not worth the computational cost. But when looking at ventricular repolarization (T-Wave) in standard leads as well as BSPM, there are areas where the signal can be influenced by cardiac motion of the heart to an extent that should not be ignored.
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Affiliation(s)
- Robin Moss
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eike Moritz Wülfers
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen Schuler
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Pekkan K, Oshinski JN. Shaping the field of Cardiovascular Fluid Mechanics: The 40th Anniversary of Ajit Yoganathan's Research Laboratory. Cardiovasc Eng Technol 2021; 12:557-558. [PMID: 34625905 DOI: 10.1007/s13239-021-00576-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Kerem Pekkan
- Department of Mechanical Engineering, Koc University, Istanbul, Turkey
| | - John N Oshinski
- Departments of Radiology & Imaging Sciences and Biomedical Engineering, Emory University, Atlanta, GA, 30322, USA.
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