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Berberat J, Pircher A, Remonda L, Killer HE. Age related cerebrospinal fluid flow dynamics in the subarachnoid space of the optic nerve in patients with normal tension glaucoma, measured by diffusion weighted MRI. Eye (Lond) 2024; 38:2575-2580. [PMID: 38664515 PMCID: PMC11384767 DOI: 10.1038/s41433-024-03084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND/OBJECTIVES We aimed to measure cerebrospinal fluid (CSF) flow rates in the subarachnoid space (SAS) of the optic nerve (ON) by applying non-invasive diffusion-weighted MRI in patients with normal tension glaucoma (NTG) compared to age-matched controls. SUBJECTS/METHODS In this prospective study, an analysis of diffusion-weighted images of 26 patients with NTG (49ONs) and age-matched volunteers (52ONs) was conducted. Subjects were classified into 4 groups: group I (50-59 y., n = 12 eyes), group II (60-69 y., n = 16 eyes), group III (70-79 y., n = 18 eyes) and group IV ( > 80 y., n = 6 eyes) for NTGs and healthy volunteers, respectively. The flow-range ratio (FRR) between the frontal lobe SAS and the SAS of the ON was calculated for each age category group and then compared between age-categories as well as between NTGs and controls. RESULTS The mean FRR for age groups were (I) 0.54 ± 0.06 and 0.62 ± 0.03 (p < 0.05), (II) 0.56 ± 0.08 and 0.63 ± 0.03 (p < 0.05), (III) 0.54 ± 0.06 and 0.62 ± 0.02 (p < 0.001) as well as (IV) 0.61 ± 0.03 and 0.61 ± 0.04, for NTGs and controls, respectively. Using pooled data, the difference between the FRR in NTGs and controls was statistically significant (p < 0.0001). There were no statistically significant differences within the age categories of the control group. When comparing the FRR of NTGs by age categories, no statistically significant difference was found between the subgroups. CONCLUSIONS FRR was significantly reduced in NTGs compared to age-matched controls without any significant differences within the age groups themselves. Given the physiological importance of CSF for the integrity of neurons, axons and glial cells, reduced CSF flow dynamics might be part of the underlying neurodegenerative process of NTG.
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Affiliation(s)
- Jatta Berberat
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
| | - Achmed Pircher
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Luca Remonda
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Hanspeter E Killer
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Augenärzte Zentrum Aarau, Aarau, Switzerland
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Pype LL, Domenech-Ximenos B, Paelinck BP, Sturkenboom N, Van De Heyning CM. Assessment of Tricuspid Regurgitation by Cardiac Magnetic Resonance Imaging: Current Role and Future Applications. J Clin Med 2024; 13:4481. [PMID: 39124748 PMCID: PMC11312898 DOI: 10.3390/jcm13154481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Tricuspid regurgitation (TR) is a prevalent valvular disease with a significant mortality rate. The evaluation of TR severity and associated right heart remodeling and dysfunction is crucial to determine the optimal therapeutic strategy and to improve prognosis. While echocardiography remains the first-line imaging technique to evaluate TR, it has many limitations, both operator- and patient-related. Cardiovascular magnetic resonance imaging (CMR) has emerged as an innovative and comprehensive non-invasive cardiac imaging technique with additional value beyond routine echocardiographic assessment. Besides its established role as the gold standard for the evaluation of cardiac volumes, CMR can add important insights with regard to valvular anatomy and function. Accurate quantification of TR severity, including calculation of regurgitant volume and fraction, can be performed using either the well-known indirect volumetric method or novel 4D flow imaging. In addition, CMR can be used to assess the impact on the right heart, including right heart remodeling, function and tissue characterization. Several CMR-derived parameters have been associated with outcome, highlighting the importance of multi-modality imaging in patients with TR. The aim of this review is to provide an overview of the current role of CMR in the assessment and management of patients with TR and its future applications.
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Affiliation(s)
- Lobke L. Pype
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
| | - Blanca Domenech-Ximenos
- Department of Radiology, Hospital Clínic Barcelona, 08036 Barcelona, Spain
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK
| | - Bernard P. Paelinck
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiac Surgery, University Hospital Antwerp, 2650 Edegem, Belgium
| | - Nicole Sturkenboom
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
| | - Caroline M. Van De Heyning
- Department of Cardiology, University Hospital Antwerp, 2650 Edegem, Belgium; (L.L.P.)
- GENCOR Research Group, University of Antwerp, 2000 Antwerp, Belgium
- Department of Cardiovascular Imaging, School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK
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Malahfji M, Crudo V, Kaolawanich Y, Nguyen DT, Telmesani A, Saeed M, Reardon MJ, Zoghbi WA, Polsani V, Elliott M, Bonow RO, Graviss EA, Kim R, Shah DJ. Influence of Cardiac Remodeling on Clinical Outcomes in Patients With Aortic Regurgitation. J Am Coll Cardiol 2023; 81:1885-1898. [PMID: 36882135 DOI: 10.1016/j.jacc.2023.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Quantitative cardiac magnetic resonance (CMR) outcome studies in aortic regurgitation (AR) are few. It is unclear if volume measurements are beneficial over diameters. OBJECTIVES This study sought to evaluate the association of CMR quantitative thresholds and outcomes in AR patients. METHODS In a multicenter study, asymptomatic patients with moderate or severe AR on CMR with preserved left ventricular ejection fraction (LVEF) were evaluated. Primary outcome was development of symptoms or decrease in LVEF to <50%, development of guideline indications for surgery based on LV dimensions, or death under medical management. Secondary outcome was the same as the primary outcome, excluding surgery for remodeling indications. We excluded patients who underwent surgery within 30 days of CMR. Receiver-operating characteristic analyses for the association with outcomes were performed. RESULTS We studied 458 patients (median age: 60 years; IQR: 46-70 years). During a median follow-up of 2.4 years (IQR: 0.9-5.3 years), 133 events occurred. Optimal thresholds were regurgitant volume of 47 mL and regurgitant fraction of 43%, indexed LV end-systolic (iLVES) volume of 43 mL/m2, indexed LV end-diastolic volume of 109 mL/m2, and iLVES diameter of 2 cm/m2. In multivariable regression analysis, iLVES volume of ≥43 mL/m2 (HR: 2.53; 95% CI: 1.75-3.66; P < 0.001) and indexed LV end-diastolic volume of ≥109 mL/m2 were independently associated with the outcomes and provided additional discrimination improvement over iLVES diameter, whereas iLVES diameter was independently associated with the primary outcome but not the secondary outcome. CONCLUSIONS In asymptomatic AR patients with preserved LVEF, CMR findings can be used to guide management. CMR-based LVES volume assessment performed favorably compared to LV diameters.
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Affiliation(s)
- Maan Malahfji
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Valentina Crudo
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Texas, USA
| | - Amr Telmesani
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Mujtaba Saeed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | - Michael Elliott
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Robert O Bonow
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, Texas, USA
| | - Raymond Kim
- Division of Cardiology, Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
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Choi E, Mathews LM, Paik J, Corretti MC, Wu KC, Michos ED, Hays AG, Mukherjee M. Multimodality Evaluation of Aortic Insufficiency and Aortitis in Rheumatologic Diseases. Front Cardiovasc Med 2022; 9:874242. [PMID: 35497991 PMCID: PMC9039512 DOI: 10.3389/fcvm.2022.874242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Aortic insufficiency is commonly observed in rheumatologic diseases such as ankylosing spondylitis, systemic lupus erythematosus, antiphospholipid syndrome, Behçet's disease, granulomatosis with polyangiitis, and Takayasu arteritis. Aortic insufficiency with an underlying rheumatologic disease may be caused by a primary valve pathology (leaflet destruction, prolapse or restriction), annular dilatation due to associated aortitis or a combination of both. Early recognition of characteristic valve and aorta morphology on cardiac imaging has both diagnostic and prognostic importance. Currently, echocardiography remains the primary diagnostic tool for aortic insufficiency. Complementary use of computed tomography, cardiac magnetic resonance imaging and positron emission tomography in these systemic conditions may augment the assessment of underlying mechanism, disease severity and identification of relevant non-valvular/extracardiac pathology. We aim to review common rheumatologic diseases associated with aortic insufficiency and describe their imaging findings that have been reported in the literature.
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Affiliation(s)
- Eunjung Choi
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH, United States
| | - Lena M. Mathews
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Julie Paik
- Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine C. Wu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Monica Mukherjee
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Hlubocká Z, Kočková R, Línková H, Pravečková A, Hlubocký J, Dostálová G, Bláha M, Pěnička M, Linhart A. Assessment of Asymptomatic Severe Aortic Regurgitation by Doppler-Derived Echo Indices: Comparison with Magnetic Resonance Quantification. J Clin Med 2021; 11:jcm11010152. [PMID: 35011893 PMCID: PMC8745471 DOI: 10.3390/jcm11010152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Reliable quantification of aortic regurgitation (AR) severity is essential for clinical management. We aimed to compare quantitative and indirect echo-Doppler indices to quantitative cardiac magnetic resonance (CMR) parameters in asymptomatic chronic severe AR. Methods and Results: We evaluated 104 consecutive patients using echocardiography and CMR. A comprehensive 2D, 3D, and Doppler echocardiography was performed. The CMR was used to quantify regurgitation fraction (RF) and volume (RV) using the phase-contrast velocity mapping technique. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. Correlation between RV and RF as assessed by echocardiography and CMR was relatively good (rs = 0.50 for RV, rs = 0.40 for RF, p < 0.0001). The best correlation between indirect echo-Doppler and CMR parameters was found for diastolic flow reversal (DFR) velocity in descending aorta (rs = 0.62 for RV, rs = 0.50 for RF, p < 0.0001) and 3D vena contracta area (VCA) (rs = 0.48 for RV, rs = 0.38 for RF, p < 0.0001). Using receiver operating characteristic analysis, the largest area under curve (AUC) to predict severe AR by CMR RV was observed for DFR velocity (AUC = 0.79). DFR velocity of 19.5 cm/s provided 78% sensitivity and 80% specificity. The AUC for 3D VCA to predict severe AR by CMR RV was 0.73, with optimal cut-off of 26 mm2 (sensitivity 80% and specificity 66%). Conclusions: Out of the indirect echo-Doppler indices of AR severity, DFR velocity in descending aorta and 3D vena contracta area showed the best correlation with CMR-derived RV and RF in patients with chronic severe AR.
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Affiliation(s)
- Zuzana Hlubocká
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
- Correspondence: ; Tel.: +420-224-962-635
| | - Radka Kočková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Hana Línková
- Department of Cardiology, Royal Vinohrady University Hospital, 10034 Prague, Czech Republic;
| | - Alena Pravečková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Jaroslav Hlubocký
- Department of Cardiovascular Surgery, General University Hospital, 12808 Prague, Czech Republic;
| | - Gabriela Dostálová
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
| | - Martin Bláha
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Martin Pěnička
- Onze-Lieve-Vrouwziekenhuis Aalst Clinic, Cardiovascular Centre Aalst, 9300 Aalst, Belgium;
| | - Aleš Linhart
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
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Abstract
PURPOSE OF REVIEW The rapid search for suitable tricuspid transcatheter devices has ignited renewed enthusiasm in accurate characterization of tricuspid valve disease. Cardiovascular magnetic resonance (CMR), traditionally used as the gold standard in assessment for right ventricular size and function, has recently seen its use expanded to assess both the structure and function of the tricuspid apparatus. This review will highlight the role of CMR in tricuspid valve disease and compare it with other commonly used imaging modalities. RECENT FINDINGS Dynamic anatomical assessment of the tricuspid apparatus, in combination with accurate leaflet identification, is possible with CMR. Tricuspid regurgitation volume and fraction are derived through an indirect volumetric method, and therefore, able to overcome many traditional hurdles involved with valve regurgitation quantitation. Adverse right heart prognostic factors in tricuspid valve disease, such as right heart volumes, function, and tissue characterization, are optimally assessed using CMR. SUMMARY Cardiovascular magnetic resonance is a powerful modality that should be harnessed in order to obtain a multifaceted assessment of tricuspid valve structure, function, and the effects of valve disease on right heart remodeling.
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Hemodynamic performance of the balloon-expandable SAPIEN 3 valve as assessed by cardiac magnetic resonance. Int J Cardiol 2020; 320:128-132. [PMID: 32702409 DOI: 10.1016/j.ijcard.2020.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/13/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Scarce data exist on transcatheter heart valve (THV) performance evaluated by cardiac magnetic resonance (CMR) in newer generation THV patients. Furthermore, it has been suggested that echocardiographic evaluation after TAVR may inaccurately assess residual AR in some patients. This study aimed to determine the incidence and severity of aortic regurgitation (AR) assessed by CMR in patients undergoing TAVR with the SAPIEN 3 valve, and evaluate the agreement between CMR and transthoracic echocardiography (TTE) on the assessment of AR severity in such patients. METHODS This multicentric observational study included 146 SAPIEN 3 patients with TTE and CMR within the month following their procedure. According to the CMR regurgitation fraction (RF), AR was considered mild and moderate-severe if the RF was 15-<30% and ≥ 30%, respectively. TTE exams followed VARC-2 recommendations. RESULTS By CMR, SAPIEN 3 recipients displayed a mean RF of 5.0 ± 6.1%, and mild and moderate-severe AR rates of 3.4% and 0.7%, respectively. The agreement between CMR-TTE was modest (weighted κ = 0.2640, p<0.001), due to an overestimation of AR severity by TTE. A historical cohort of 139 SAPIEN XT patients with a post-procedure CMR, displayed a mean RF of 9.6 ± 10.7% and mild and moderate-severe AR rates of 18.7% and 3.6%, respectively (p < .001 vs. SAPIEN 3 group). CONCLUSIONS SAPIEN 3 recipients exhibited very low rates of residual AR by CMR, suggesting a surgical-like performance regarding AR with this newer generation THV. TTE tended to overestimate the severity of AR, particularly among mild AR patients.
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CMR in Evaluating Valvular Heart Disease: Diagnosis, Severity, and Outcomes. JACC Cardiovasc Imaging 2020; 14:2020-2032. [PMID: 33248967 DOI: 10.1016/j.jcmg.2020.09.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 01/20/2023]
Abstract
Cardiac magnetic resonance (CMR) is a versatile imaging tool that brings much to the assessment of valvular heart disease. Although it is best known for myocardial imaging (even in valve disease), it provides excellent assessment of all 4 heart valves, with some distinct advantages, including a free choice of image planes and accurate flow and volumetric quantification. These allow the severity of each valve lesion to be characterized, in addition to optimal visualization of the surrounding outflow tracts and vessels, to deliver a comprehensive package. It can assess each valve lesion separately (in multiple valve disease) and is not affected by hemodynamic status. The accurate quantitation of regurgitant lesions and the ability to characterize myocardial changes also provides an ability to predict future clinical outcomes in asymptomatic patients. This review outlines how CMR can be used in cardiac valve disease to compliment echocardiography and enhance the patient assessment. It covers the main CMR methods used, their strengths and limitations, and the optimal way to apply them to evaluate valve disease.
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Stationary tissue background correction increases the precision of clinical evaluation of intra-cardiac shunts by cardiovascular magnetic resonance. Sci Rep 2020; 10:5053. [PMID: 32193468 PMCID: PMC7081189 DOI: 10.1038/s41598-020-61812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
We aimed to evaluate the clinical utility of stationary tissue background phase correction for affecting precision in the measurement of Qp/Qs by cardiovascular magnetic resonance (CMR). We enrolled consecutive patients (n = 91) referred for CMR at 1.5T without suspicion of cardiac shunt, and patients (n = 10) with verified cardiac shunts in this retrospective study. All patients underwent phase contrast flow quantification in the ascending aorta and pulmonary trunk. Flow was quantified using two semi-automatic software platforms (SyngoVia VA30, Vendor 1; Segment 2.0R4534, Vendor 2). Measurements were performed both uncorrected and corrected for linear (Vendor 1 and Vendor 2) or quadratic (Vendor 2) background phase. The proportion of patients outside the normal range of Qp/Qs was compared using the McNemar’s test. Compared to uncorrected measurements, there were fewer patients with a Qp/Qs outside the normal range following linear correction using Vendor 1 (10% vs 18%, p < 0.001), and Vendor 2 (10% vs 18%, p < 0.001), and following quadratic correction using Vendor 2 (7% vs 18%, p < 0.001). No patient with known shunt was reclassified as normal following stationary background correction. Therefore, we conclude that stationary tissue background correction reduces the number of patients with a Qp/Qs ratio outside the normal range in a consecutive clinical population, while simultaneously not reclassifying any patient with known cardiac shunts as having a normal Qp/Qs. Stationary tissue background correction may be used in clinical patients to increase diagnostic precision.
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Multimodality Imaging of the Tricuspid Valve and Right Heart Anatomy. JACC Cardiovasc Imaging 2020; 12:516-531. [PMID: 30846125 DOI: 10.1016/j.jcmg.2019.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
The characterization of tricuspid valve and right-heart anatomy has been gaining significant interest in the setting of new percutaneous transcatheter interventions for tricuspid regurgitation. Multimodality cardiac imaging provides a wealth of information about the anatomy and function of the tricuspid valve apparatus, right ventricle, and right atrium, which is pivotal for diagnosis and prognosis and for planning of percutaneous interventions. The present review describes the role of echocardiography, cardiac magnetic resonance, and multidetector row cardiac computed tomography for right heart and tricuspid valve assessment.
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Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P, Hahn R, Han Y, Hung J, Lang R, Little S, Shah D, Shernan S, Thavendiranathan P, Thomas J, Weissman N. Recommendations for noninvasive evaluation of native valvular regurgitation
A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Kooistra NHM, Nijhoff F, Abawi M, Agostoni P, Araya Roos DM, van Tuijl S, Blanken N, Voskuil M, Doevendans PAFM, Stella PR, Leiner T. Ex Vivo Pilot Study of Cardiac Magnetic Resonance Velocity Mapping for Quantification of Aortic Regurgitation in a Porcine Model in the Presence of a Transcatheter Heart Valve. J Cardiovasc Transl Res 2019; 12:310-320. [PMID: 30877562 PMCID: PMC6708050 DOI: 10.1007/s12265-019-09878-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/22/2019] [Indexed: 11/02/2022]
Abstract
Accuracy of aortic regurgitation (AR) quantification by magnetic resonance (MR) imaging in the presence of a transcatheter heart valve (THV) remains to be established. We evaluated the accuracy of cardiac MR velocity mapping for quantification of antegrade flow (AF) and retrograde flow (RF) across a THV and the optimal slice position to use in cardiac MR imaging. In a systematic and fully controlled laboratory ex vivo setting, two THVs (Edwards SAPIEN XT, Medtronic CoreValve) were tested in a porcine model (n = 1) under steady flow conditions. Results showed a high level of accuracy and precision. For both THVs, AF was best measured at left ventricular outflow tract level, and RF at ascending aorta level. At these levels, MR had an excellent repeatability (ICC > 0.99), with a tendency to overestimate (4.6 ± 2.4% to 9.4 ± 7.0%). Quantification of AR by MR velocity mapping in the presence of a THV was accurate, precise, and repeatable in this pilot study, when corrected for the systematic error and when the best MR slice position was used. Confirmation of these results in future clinical studies would be a step forward in increasing the accuracy of the assessment of paravalvular AR severity.
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Affiliation(s)
- Nynke H M Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Masieh Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,Department of Cardiology, Hartcentrum ZNA Middelheim, Antwerp, Belgium
| | - Daniël M Araya Roos
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Niels Blanken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pieter A F M Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Kan CD, Wang JN, Lin CH, Chen WL, Lu PJ, Chan MY, Wu JT. Handmade trileaflet valve design and validation for patch-valved conduit reconstruction using generalized regression machine learning model. Technol Health Care 2018; 26:605-620. [PMID: 30040769 DOI: 10.3233/thc-171064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary valve diseases include the different degrees of aortic stenosis or congenital defects in children or adults. Valve repair or replacement surgery is commonly performed to relieve valvular dysfunction and improve the significant flow regurgitation in the aortic valve and the pulmonary valve. However, commercial valve stents and valved conduits are sometimes not available for children or patients with special conditions. The handmade trileaflet valve design has been used with different range of diameters for patch-valved conduit reconstruction. Thus, we propose a multiple regression model, as a generalized regression neural network (GRNN), to determine the optimal trileaflet parameters, including the width, length, and upper lower curved structure. Through computed tomography pulmonary angiography, while the diameter of the main pulmonary artery is determined, a leaflet template can be rapidly sketched and made. Using an experimental pulmonary circulation loop system, the efficacy of the valved conduit can be validated using the regurgitation fraction method. In contrast to commercial valve stents, experimental results indicate that the handmade trileaflet valve can also improve severe pulmonary regurgitations.
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Affiliation(s)
- Chung-Dann Kan
- Division of Cardiovascular Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital Tainan, Tainan, Taiwan
| | - Chia-Hung Lin
- Department of Electrical Engineering, Kao-Yuan University, Kaohsiung, Taiwan
| | - Wei-Ling Chen
- Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pong-Jeu Lu
- Heart Science and Medical Devices Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Yao Chan
- Heart Science and Medical Devices Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Te Wu
- Department of Veterinary Medicine, National Chiayi University, Chiayi, Taiwan
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14
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Chen WL, Lin CH, Wang JN, Lu PJ, Chan MY, Wu JT, Kan CD. Assistive technology using regurgitation fraction and fractional-order integration to assess pulmonary valve insufficiency for pre-surgery decision making and post-surgery outcome evaluation. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Penicka M, Vecera J, Mirica DC, Kotrc M, Kockova R, Van Camp G. Prognostic Implications of Magnetic Resonance-Derived Quantification in Asymptomatic Patients With Organic Mitral Regurgitation: Comparison With Doppler Echocardiography-Derived Integrative Approach. Circulation 2018; 137:1349-1360. [PMID: 29269390 DOI: 10.1161/circulationaha.117.029332] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is an accurate method for the quantitative assessment of organic mitral regurgitation (OMR). The aim of the present study was to compare the discriminative power of MRI quantification and the recommended Doppler echocardiography (ECHO)-derived integrative approach to identify asymptomatic patients with OMR and adverse outcome. METHODS The study population consisted of 258 asymptomatic patients (63±14 years, 60% men) with preserved left ventricular ejection fraction (>60%) and chronic moderate and severe OMR (flail 25%, prolapse 75%) defined by using the ECHO-derived integrative approach. All patients underwent MRI to quantify regurgitant volume (RV) of OMR by subtracting the aortic forward flow volume from the total left ventricular stroke volume. Severe OMR was defined as RV≥60 mL. RESULTS Mean ECHO-derived RV was on average 17.1 mL larger than the MRI-derived RV (P<0.05). Concordant grading of OMR severity with both techniques was observed in 197 (76%) individuals with 62 (31%) patients having severe OMR (MRI SEV-ECHO SEV) and 135 (69%) patients having moderate OMR (MRI MOD-ECHO MOD). The remaining 61 (24%) individuals had discordant findings (MRI SEV-ECHO MOD or MRI MOD-ECHO SEV) between the 2 techniques. The majority of these differences in OMR classification were observed in patients with late systolic or multiple jets (both κ<0.2). Patients with eccentric jets showed moderate agreement (κ=0.53; 95% confidence interval, 0.41-0.64). In contrast, a very good agreement (κ=0.90; 95% confidence interval, 0.82-0.98) was observed in a combination of holosystolic, central, and single jet. During a median follow-up of 5.0 years (interquartile range, 3.5-6.0 years), 38 (15%) patients died and 106 (41%) either died or developed indication for mitral valve surgery. In separate Cox regression analyses, the MRI-derived left ventricular end-systolic volume index, RV, and OMR category (severe versus moderate), and the ECHO-derived OMR category were independent predictors of all-cause mortality (all P<0.05). The MRI-derived RV showed the largest area under the curve to predict mortality (0.72) or its combination with the development of indication for mitral valve surgery (0.83). CONCLUSIONS The findings of the present study suggest that the MRI-derived assessment of OMR can better identify patients with severe OMR and adverse outcome than ECHO-derived integrative approach warranting close follow-up and perhaps, early mitral valve surgery.
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Affiliation(s)
- Martin Penicka
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (M.P., J.V., D.C.M., G.V.C.)
| | - Jan Vecera
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (M.P., J.V., D.C.M., G.V.C.)
| | - Daniela C Mirica
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (M.P., J.V., D.C.M., G.V.C.)
| | - Martin Kotrc
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.K., R.K.)
| | - Radka Kockova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic (M.K., R.K.)
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (M.P., J.V., D.C.M., G.V.C.)
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Bech-Hanssen O, Polte CL, Svensson F, Johnsson ÅA, Lagerstrand KM, Cederbom U, Gao SA. Pulsed-Wave Doppler Recordings in the Proximal Descending Aorta in Patients with Chronic Aortic Regurgitation: Insights from Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2018; 31:304-313.e3. [PMID: 29290484 DOI: 10.1016/j.echo.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The pulsed-wave Doppler recording in the descending aorta (PWDDAO) is one of the parameters used in grading aortic regurgitation (AR) severity. The aim of the present study was to investigate the assessment of chronic AR by PWDDAO with insights from cardiovascular magnetic resonance (CMR). METHODS This prospective study comprised 40 patients investigated with echocardiography and CMR within 4 hours either prior to valve surgery (n = 23) or as part of their follow-up (n = 17) due to moderate or severe AR. End-diastolic flow velocity (EDFV) and the diastolic velocity time integral (dVTI) were measured. The appearance of diastolic forward flow (DFF) was noted. Phase-contrast flow rate curves were obtained in the DAO. RESULTS Twenty-five patients had severe and eight had moderate AR by echocardiography (seven were indeterminate). The EDFV was below the recommended threshold (>20 cm/sec) in 13 patients (52%) with severe AR. Lowering the EDFV threshold (>13 cm/sec) and with a dVTI threshold >13 cm showed negative likelihood ratios of 0.27 and 0.09, respectively. Detection of DFF with PWDDAO identified a nonuniform velocity profile by CMR with positive and negative likelihood ratios of 7.0 and 0.19, respectively. The relation between EDFV and DAO regurgitant volume (DAO-RVolCMR) was strong in patients without (R = 0.88) and weak in patients with DFF (R = 0.49). The DAO-RVolCMR as a percent of the total RVolCMR decreased with increasing ascending aorta (AAO) size and increased with increasing AR severity. CONCLUSIONS Our findings suggest that PWDDAO provides semiquantitative parameters useful to assess chronic AR severity. The limitations are related to nonuniform velocity contour and variable degree of lower body contribution, which depends on AR severity but also on the AAO size.
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christian L Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Svensson
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Cederbom
- Department of Clinical Physiology, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | - Sinsia A Gao
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Boye D, Montali M, Miller NR, Pircher A, Gruber P, Killer HE, Remonda L, Berberat J. Flow dynamics of cerebrospinal fluid between the intracranial cavity and the subarachnoid space of the optic nerve measured with a diffusion magnetic resonance imaging sequence in patients with normal tension glaucoma. Clin Exp Ophthalmol 2017; 46:511-518. [DOI: 10.1111/ceo.13116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Dirk Boye
- Department of Neuroradiology; Cantonal Hospital; Aarau Switzerland
| | | | - Neil R Miller
- Wilmer Ophthalmological Institute; Johns Hopkins Hospital; Baltimore Maryland USA
| | - Achmed Pircher
- Department of Ophthalmology; Cantonal Hospital; Aarau Switzerland
| | - Philipp Gruber
- Department of Neuroradiology; Cantonal Hospital; Aarau Switzerland
| | | | - Luca Remonda
- Department of Neuroradiology; Cantonal Hospital; Aarau Switzerland
| | - Jatta Berberat
- Department of Neuroradiology; Cantonal Hospital; Aarau Switzerland
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19
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Frick M, Meyer CG, Kirschfink A, Altiok E, Lehrke M, Brehmer K, Lotfi S, Hoffmann R. Evaluation of aortic regurgitation after transcatheter aortic valve implantation: aortic root angiography in comparison to cardiac magnetic resonance. EUROINTERVENTION 2016; 11:1419-27. [PMID: 25772902 DOI: 10.4244/eijy15m03_06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Aortic regurgitation (AR) is common after transcatheter aortic valve implantation (TAVI). Intraprocedural assessment of AR relies on aortic root angiography. Cardiac magnetic resonance (CMR) phase-contrast mapping of the ascending aorta provides accurate AR quantification. This study evaluated the accuracy of AR grading by aortic root angiography after TAVI in comparison to CMR phase-contrast velocity mapping. METHODS AND RESULTS In 69 patients with TAVI for severe aortic stenosis, post-procedural AR was determined by aortic root angiography with visual assessment according to the Sellers classification and by CMR using phase-contrast velocity mapping for analysis of AR volume and fraction. Spearman's correlation coefficient showed a moderate correlation between angiographic analysis of AR grade and CMR-derived AR volume (r=0.41; p<0.01) as well as AR fraction (r=0.42; p<0.01). There was significant overlap between the angiographic Sellers classes compared to CMR-derived AR fractions. Aortic root angiography with cut-off Sellers grade ≥2 had a sensitivity of 71% and a specificity of 98% to detect AR graded as moderate to severe or severe as defined by CMR. CONCLUSIONS There is only a moderate correlation between aortic root angiography and CMR in the classification of AR severity after TAVI. Alternative imaging including multimodality imaging as well as haemodynamic analysis should therefore be considered for intraprocedural AR assessment and guidance of TAVI procedure in cases of uncertainty in AR grading.
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Affiliation(s)
- Michael Frick
- Medical Clinic I, University RWTH Aachen, Aachen, Germany
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Ribeiro HB, Orwat S, Hayek SS, Larose É, Babaliaros V, Dahou A, Le Ven F, Pasian S, Puri R, Abdul-Jawad Altisent O, Campelo-Parada F, Clavel MA, Pibarot P, Lerakis S, Baumgartner H, Rodés-Cabau J. Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:577-585. [DOI: 10.1016/j.jacc.2016.05.059] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/23/2016] [Accepted: 05/07/2016] [Indexed: 11/27/2022]
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21
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Myerson SG, d’Arcy J, Christiansen JP, Dobson LE, Mohiaddin R, Francis JM, Prendergast B, Greenwood JP, Karamitsos TD, Neubauer S. Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification. Circulation 2016; 133:2287-96. [DOI: 10.1161/circulationaha.115.017888] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 04/08/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Saul G. Myerson
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Joanna d’Arcy
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Jonathan P. Christiansen
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Laura E. Dobson
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Raad Mohiaddin
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Jane M. Francis
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Bernard Prendergast
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - John P. Greenwood
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Theodoros D. Karamitsos
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
| | - Stefan Neubauer
- From Departments of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, UK (S.G.M., J.d’A., J.M.F., B.P., T.D.K., S.N.); Waitemata Health and the University of Auckland, New Zealand (J.P.C.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (L.E.D., J.P.G.); and CMR Unit, Royal Brompton Hospital and the National Heart and
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Everett RJ, Newby DE, Jabbour A, Fayad ZA, Dweck MR. The Role of Imaging in Aortic Valve Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016; 9:21. [PMID: 27375833 PMCID: PMC4896976 DOI: 10.1007/s12410-016-9383-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Aortic valve disease is the most common form of heart valve disease in developed countries. Imaging remains central to the diagnosis and risk stratification of patients with both aortic stenosis and regurgitation and has traditionally been performed with echocardiography. Indeed, echocardiography remains the cornerstone of aortic valve imaging as it is cheap, widely available and provides critical information concerning valve hemodynamics and ventricular function. RECENT FINDINGS Whilst diagnostic in the vast majority of patients, echocardiography has certain limitations including operator variability, potential for measurement errors and internal inconsistencies in severity grading. In particular, low-gradient severe aortic stenosis is common and challenging to diagnose. Aortic valve imaging may therefore be improved with alternative and complimentary multimodality approaches. SUMMARY This review investigates established and novel techniques for imaging both the aortic valve and the myocardial remodelling response including echocardiography, computed tomography, cardiovascular magnetic resonance and positron emission tomography. Moreover, we examine how the complementary information provided by each modality may be used in both future clinical practice and the research arena.
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Affiliation(s)
- Russell J. Everett
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - David E. Newby
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | | | - Zahi A. Fayad
- />Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marc R. Dweck
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
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Looi JL, Kerr AJ, Gabriel R. Morphology of congenital and acquired aortic valve disease by cardiovascular magnetic resonance imaging. Eur J Radiol 2015; 84:2144-54. [DOI: 10.1016/j.ejrad.2015.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 06/14/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
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Boye D, Springer O, Wassmer F, Scheidegger S, Remonda L, Berberat J. Effects of contour propagation and background corrections in different MRI flow software packages. Acta Radiol Open 2015; 4:2058460115589124. [PMID: 26346318 PMCID: PMC4548733 DOI: 10.1177/2058460115589124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background Velocity-encoded magnetic resonance imaging (VENC-MRI) is a commonly used technique in cardiac examinations. This technique utilizes the phase shift properties of protons moving along a magnetic field gradient. VENC-MRI offers a unique way of measuring the severity of valve regurgitation by directly quantifying the regurgitation flow volume. Purpose To compare flow analysis results of different software programs and to assess the effect of background correction in sample patient cases. Material and Methods A phantom was built out of Polymethyl methacrylate (PMMA) which provides tubes of different diameters. These tubes can be connected to an external water circuit to generate a water flow inside the tubes. Expected absolute flow quantities inside the tubes were determined from preset tube- and flow-parameters. Different flow conditions were measured with a VENC-MRI sequence and the images evaluated using different software packages. In a second step six randomly selected patients showing different degrees of aortic insufficiency were evaluated in clinical terms. Results The contour propagation algorithms used in the software packages performed differently even on static phantom geometry. In terms of clinical evaluation the software packages performed similarly. Enabling background correction or leaving out manual correction of propagated contours changed results for severity of aortic insufficiency. Conclusion Turning on background correction and manual correction of propagated contours in MRI flow volume measurements is strongly recommended.
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Affiliation(s)
- D Boye
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
| | - O Springer
- Cantonal Hospital Aarau, Department of Radiology, Aarau, Switzerland
| | - F Wassmer
- Zurich University of Applied Sciences, Institute of Applied Mathematics and Physics, Winterthur, Switzerland
| | - S Scheidegger
- Zurich University of Applied Sciences, Institute of Applied Mathematics and Physics, Winterthur, Switzerland
| | - L Remonda
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
| | - J Berberat
- Cantonal Hospital Aarau, Department of Neuroradiology, Aarau, Switzerland
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Salaun E, Jacquier A, Theron A, Giorgi R, Lambert M, Jaussaud N, Hubert S, Collart F, Bonnet J, Habib G, Cuisset T, Grisoli D. Value of CMR in quantification of paravalvular aortic regurgitation after TAVI. Eur Heart J Cardiovasc Imaging 2015; 17:41-50. [DOI: 10.1093/ehjci/jev177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 06/18/2015] [Indexed: 11/13/2022] Open
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Ko SM, Park JH, Shin JK, Kim JS. Assessment of the regurgitant orifice area in aortic regurgitation with dual-source CT: Comparison with cardiovascular magnetic resonance. J Cardiovasc Comput Tomogr 2015; 9:345-53. [DOI: 10.1016/j.jcct.2015.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/28/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
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Crouch G, Tully PJ, Bennetts J, Sinhal A, Bradbrook C, Penhall AL, De Pasquale CG, Baker RA, Selvanayagam JB. Quantitative assessment of paravalvular regurgitation following transcatheter aortic valve replacement. J Cardiovasc Magn Reson 2015; 17:32. [PMID: 25953135 PMCID: PMC4423485 DOI: 10.1186/s12968-015-0134-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/15/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Paravalvular aortic regurgitation (PAR) following transcatheter aortic valve implantation (TAVI) is well acknowledged. Despite improvements, echocardiographic measurement of PAR largely remains qualitative. Cardiovascular magnetic resonance (CMR) directly quantifies AR with accuracy and reproducibility. We compared CMR and transthoracic echocardiography (TTE) analysis of pre-operative and post-operative aortic regurgitation in patients undergoing both TAVI and surgical aortic valve replacement (AVR). METHODS Eighty-seven patients with severe aortic stenosis undergoing TAVI (56 patients) or AVR were recruited. CMR (1.5 T) and transthoracic echocardiography (TTE) were carried out pre-operatively and a median of 6 days post-operatively. The CMR protocol included regurgitant aortic flows using through-plane phase-contrast velocity. None/trivial, mild, moderate and severe AR by CMR was defined as ≤8%, 9-20%, 21-39%, >40% regurgitant fractions respectively. RESULTS Pre- and post-operative left ventricular ejection fraction (LVEF) was similar. Post-procedure aortic regurgitant fraction using CMR was higher in the TAVI group (TAVI 16 ± 13% vs. AVR 4 ± 4%, p < 0.01). Comparing CMR to TTE, 27 of 56 (48%) TAVI patients had PAR which was at least one grade more severe on CMR than TTE (Z = -4.56, p <0.001). Sensitivity analysis confirmed the difference in PAR grade between TTE and CMR in the TAVI group (Z = -4.49, p < 0.001). CONCLUSION When compared to CMR based quantitative analysis, TTE underestimated the degree of paravalvular aortic regurgitation. This underestimation may in part explain the findings of increased mortality associated with mild or greater AR by TTE in the PARTNER trial. Paravalvular aortic regurgitation post TAVI assessed as mild by TTE may in fact be more severe.
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Affiliation(s)
- Gareth Crouch
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
| | - Phillip J Tully
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
| | - Jayme Bennetts
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Craig Bradbrook
- South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Amy L Penhall
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Carmine G De Pasquale
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Robert A Baker
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
| | - Joseph B Selvanayagam
- South Australian Health and Medical Research Institute, Adelaide, Australia.
- Department of Cardiology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
- Flinders University of South Australia, Adelaide, SA, Australia.
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Direct measurement of aortic regurgitation with phase-contrast magnetic resonance is inaccurate: proposal of an alternative method of quantification. Pediatr Radiol 2014; 44:1358-69. [PMID: 24939669 DOI: 10.1007/s00247-014-3017-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/12/2014] [Accepted: 04/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Phase-contrast magnetic resonance (MR) has been widely used for quantification of aortic regurgitation. However there is significant practice variability regarding where and how the blood flow data are acquired. OBJECTIVE To compare the accuracy of flow quantification of aortic regurgitation at three levels: the ascending aorta at the level of the right pulmonary artery (level 1), the aortic valve hinge points at end-diastole (level 2) and the aortic valve hinge points at end-systole (level 3). MATERIALS AND METHODS We performed cardiovascular MR in 43 children with aortic regurgitation. By using phase-contrast MR, we measured the systolic forward, diastolic retrograde and net forward flow volume indices at three levels. At each level, the following comparisons were made: (1) systolic forward flow volume index (FFVI) versus left ventricular cardiac index (LVCI) measured by cine ventricular volumetry; (2) retrograde flow volume index (RFVI) versus estimated aortic regurgitation volume index (which equals LVCI minus pulmonary blood flow index [QPI]); (3) net forward flow volume index (NFVI) versus pulmonary blood flow index. RESULTS The forward flow volume index, retrograde flow volume index and net forward flow volume index measured at each of the three levels were significantly different except for the retrograde flow volume index measured at levels 1 and 3. There were good correlations between the forward flow volume index and the left ventricular cardiac index at all three levels, with measurement at level 2 showing the best correlation. Compared to the forward flow volume indices, the retrograde flow volume index had a lower correlation with the estimated aortic regurgitation volume indices and had widely dispersed data with larger prediction intervals. CONCLUSION Large variations in systolic forward, diastolic retrograde and net forward flow volumes were observed at different levels of the aortic valve and ascending aorta. Direct measurement of aortic regurgitation volume and fraction is inaccurate and should be abandoned. Instead, calculation of the aortic regurgitation volume from more reliable data is advised. We recommend subtracting pulmonary blood flow from systolic forward flow measured at the aortic valve hinge points at end-diastole as a more accurate and consistent method for calculating the volume of aortic regurgitation.
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Picard FA, Garçon P, Chaudeurge A, Simion C, Cador R. [Planimetric measurement of the regurgitant orifice area using tridimensional transoesophageal echocardiography for aortic regurgitation, reproducibility and feasibility]. Ann Cardiol Angeiol (Paris) 2014; 63:293-299. [PMID: 24953201 DOI: 10.1016/j.ancard.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/14/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Aortic regurgitation is mainly evaluated by trans-thoracic echocardiography using multi-parametric qualitative and semi quantitative tools. All those parameters can fail to meet expectations, resulting in an imperfect diagnostic reliability and assessment of aortic regurgitation severity can be challenging. OBJECTIVES We sought to evaluate feasibility and intra- and inter-observer reproducibility of aortic regurgitant orifice area measured by planimetry with tridimensional trans-esophageal echocardiography on patients with at least grade 2/4 aortic regurgitation. PATIENTS AND METHODS Consecutive patients with at least grade 2/4 aortic regurgitation measured by trans-thoracic echocardiography and referred for trans-esophageal echocardiography for any reason were included. Planimetric reconstructions of regurgitant orifice area were studied and reproducibility indexes between senior and junior observers were calculated. RESULTS Twenty-three patients were included in this study. Intra- and inter-observer reproducibility were excellent with an ICC of 0.95 [0.88-0.98], P<0.0001 and 0.91 [0.79-0.96], P<0.0001, respectively. Mean length of the measurement was 6.6±0.9min [CI95% 6.23-7.01]. CONCLUSION Planimetric measurement of the aortic regurgitant orifice using tridimensional trans-esophageal echocardiography seems to be feasible and has great intra- and inter-observer reproducibility. Reconstruction durations were compatible with a daily use. There is a need now to investigate the reliability of this measurement as compared with the reference technique.
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Affiliation(s)
- F-A Picard
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - P Garçon
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Chaudeurge
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - C Simion
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - R Cador
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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Lopez-Mattei JC, Shah DJ. The role of cardiac magnetic resonance in valvular heart disease. Methodist Debakey Cardiovasc J 2014; 9:142-8. [PMID: 24066197 DOI: 10.14797/mdcj-9-3-142] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion.
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Myerson SG, d'Arcy J, Mohiaddin R, Greenwood JP, Karamitsos TD, Francis JM, Banning AP, Christiansen JP, Neubauer S. Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation 2012; 126:1452-60. [PMID: 22879371 DOI: 10.1161/circulationaha.111.083600] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current indications for surgery in patients with significant aortic regurgitation (AR) focus on symptoms and left ventricular dilation/dysfunction. However, prognosis is already reduced by this stage, and earlier identification of patients for surgery could be beneficial. Quantifying the regurgitation may help, but there are limited data on its link with outcome. Cardiovascular magnetic resonance (CMR) can accurately quantify AR, and we examined whether this was associated with the future need for surgery. METHODS AND RESULTS One hundred thirteen patients with echocardiographic moderate or severe AR were monitored for up to 9 years (mean 2.6 ± 2.1 years) following a CMR scan, and the progression to symptoms or other indications for surgery was monitored. AR quantification identified outcome with high accuracy: 85% of the 39 subjects with regurgitant fraction >33% progressed to surgery (mostly within 3 years) in comparison with 8% of 74 subjects with regurgitant fraction ≤ 33% (P<0.0001); the area under the curve on receiver operating characteristic analysis was 0.93 (P<0.0001). This ability remained strong on time-dependent Kaplan-Meier survival curves. CMR-derived left ventricular end-diastolic volume >246 mL had good, although lower, discriminatory ability (area under the curve 0.88), but the combination of this measure with regurgitant fraction provided the best discriminatory power. CONCLUSIONS High degrees of CMR-quantified AR were associated with the development of symptoms or other indications for surgery. Quantifying AR showed slightly better discriminatory ability than "gold standard" CMR ventricular volume assessment. This could provide a new paradigm for the timing of surgical intervention but requires confirmation in a clinical trial.
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Affiliation(s)
- Saul G Myerson
- Department of Cardiology and Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, United Kingdom.
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Sommer G, Bremerich J, Lund G. Magnetic resonance imaging in valvular heart disease: Clinical application and current role for patient management. J Magn Reson Imaging 2012; 35:1241-52. [DOI: 10.1002/jmri.23544] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Myerson SG. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:7. [PMID: 22260363 PMCID: PMC3305609 DOI: 10.1186/1532-429x-14-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/19/2012] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has become a valuable investigative tool in many areas of cardiac medicine. Its value in heart valve disease is less well appreciated however, particularly as echocardiography is a powerful and widely available technique in valve disease. This review highlights the added value that CMR can bring in valve disease, complementing echocardiography in many areas, but it has also become the first-line investigation in some, such as pulmonary valve disease and assessing the right ventricle. CMR has many advantages, including the ability to image in any plane, which allows full visualisation of valves and their inflow/outflow tracts, direct measurement of valve area (particularly for stenotic valves), and characterisation of the associated great vessel anatomy (e.g. the aortic root and arch in aortic valve disease). A particular strength is the ability to quantify flow, which allows accurate measurement of regurgitation, cardiac shunt volumes/ratios and differential flow volumes (e.g. left and right pulmonary arteries). Quantification of ventricular volumes and mass is vital for determining the impact of valve disease on the heart, and CMR is the 'Gold standard' for this. Limitations of the technique include partial volume effects due to image slice thickness, and a low ability to identify small, highly mobile objects (such as vegetations) due to the need to acquire images over several cardiac cycles. The review examines the advantages and disadvantages of each imaging aspect in detail, and considers how CMR can be used optimally for each valve lesion.
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Sherif MA, Abdel-Wahab M, Beurich HW, Stöcker B, Zachow D, Geist V, Tölg R, Richardt G. Haemodynamic evaluation of aortic regurgitation after transcatheter aortic valve implantation using cardiovascular magnetic resonance. EUROINTERVENTION 2011; 7:57-63. [PMID: 21550904 DOI: 10.4244/eijv7i8a12] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Echocardiography may underestimate the degree of paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve bioprosthesis due to inherent limitations of ultrasound imaging in the evaluation of implanted cardiac prostheses. We aimed to evaluate the accuracy and feasibility of cardiovascular magnetic resonance (CMR) in quantifying regurgitant volume (RV) and regurgitant fraction (RF) in patients treated with this bioprosthesis for severe calcific aortic stenosis, and to compare the results with echocardiography and aortography. METHODS AND RESULTS This study included 16 patients with a mean age of 78.7 years (eight women, eight men) who underwent successful TAVI using Medtronic CoreValve bioprosthesis. AR was evaluated by CMR, echocardiography, and aortography. Angiography was performed immediately after valve implantation. CMR and echocardiography were performed four weeks after valve implantation. There was a highly significant correlation between the CMR-derived and the angiographically-estimated degree of AR (r=0.86, p<0.001). On the other hand, there was only a limited correlation between CMR and echocardiography (r=0.374, p=0.15) as well as angiography and echocardiography (r=0.319, p=0.23) regarding the degree of AR. The weighted kappa for agreement between echocardiography and angiography was 0.14, for agreement between echocardiography and CMR 0.20, and for agreement between angiography and CMR 0.72. Echocardiography underestimated AR by one degree compared to CMR in five patients and 2 degrees in two patients; in six of these, the degree of AR obtained by CMR was similar to angiography. CONCLUSIONS In patients undergoing TAVI, comparisons between purely quantitative measurements of AR by CMR and qualitative assessment by angiography showed better correlations than those with echocardiography. This suggests that echocardiography may underestimate the degree of AR and CMR in these circumstances has a great potential in reliably measuring the severity of AR in a quantitative manner.
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Affiliation(s)
- Mohammad A Sherif
- Heart and Vascular Centre, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Thunberg P, Emilsson K, Rask P, Kähäri A. Flow and peak velocity measurements in patients with aortic valve stenosis using phase contrast MR accelerated with k-t BLAST. Eur J Radiol 2011; 81:2203-7. [PMID: 21724348 DOI: 10.1016/j.ejrad.2011.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/07/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the accuracy of velocity measurements in patients with aortic valve stenosis using phase contrast (PC) imaging accelerated with SENSE (Sensitivity Encoding) and k-t BLAST (Broad-use Linear Acquisition Speed-up Technique). METHODS Accelerated quantitative breath hold PC measurements, using SENSE and k-t BLAST, were performed in twelve patients whose aortic valve stenosis had been initially diagnosed using echocardiography. Stroke volume (SV) and peak velocity measurements were performed on each subject in three adjacent slices using both accelerating methods. RESULTS The peak velocities measured with PC MRI using SENSE were -8.0±9.5% lower (p<0.01) compared to the peak velocities measured with k-t BLAST and the correlation was r=0.83. The stroke volumes when using SENSE were slightly higher 0.4±17.1 ml compared to the SV obtained using k-t BLAST but the difference was not significant (p>0.05). CONCLUSIONS In this study higher peak velocities were measured in patients with aortic stenosis when combining k-t BLAST with PC MRI compared to PC MRI using SENSE. A probable explanation of this difference is the higher temporal resolution achieved in the k-t BLAST measurement. There was, however, no significant difference between calculated SV based on PC MRI using SENSE and k-t BLAST, respectively.
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Affiliation(s)
- Per Thunberg
- Department of Medical Physics, Örebro University Hospital, S-70185 Örebro, Sweden.
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Assessment of Valvular Heart Disease by Cardiovascular Magnetic Resonance Imaging: A Review. Heart Lung Circ 2011; 20:73-82. [DOI: 10.1016/j.hlc.2010.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/16/2010] [Accepted: 08/31/2010] [Indexed: 12/17/2022]
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Direct and indirect quantification of mitral regurgitation with cardiovascular magnetic resonance, and the effect of heart rate variability. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2010; 23:243-9. [DOI: 10.1007/s10334-010-0222-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/21/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
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Kumar A, Patton DJ, Friedrich MG. The emerging clinical role of cardiovascular magnetic resonance imaging. Can J Cardiol 2010; 26:313-22. [PMID: 20548977 DOI: 10.1016/s0828-282x(10)70396-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Starting as a research method little more than a decade ago, cardiovascular magnetic resonance (CMR) imaging has rapidly evolved to become a powerful diagnostic tool used in routine clinical cardiology. The contrast in CMR images is generated from protons in different chemical environments and, therefore, enables high-resolution imaging and specific tissue characterization in vivo, without the use of potentially harmful ionizing radiation.CMR imaging is used for the assessment of regional and global ventricular function, and to answer questions regarding anatomy. State-of-the-art CMR sequences allow for a wide range of tissue characterization approaches, including the identification and quantification of nonviable, edematous, inflamed, infiltrated or hypoperfused myocardium. These tissue changes are not only used to help identify the etiology of cardiomyopathies, but also allow for a better understanding of tissue pathology in vivo. CMR tissue characterization may also be used to stage a disease process; for example, elevated T2 signal is consistent with edema and helps differentiate acute from chronic myocardial injury, and the extent of myocardial fibrosis as imaged by contrast-enhanced CMR correlates with adverse patient outcome in ischemic and nonischemic cardiomyopathies.The current role of CMR imaging in clinical cardiology is reviewed, including coronary artery disease, congenital heart disease, nonischemic cardiomyopathies and valvular disease.
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Affiliation(s)
- Andreas Kumar
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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41
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Uretsky S, Supariwala A, Nidadovolu P, Khokhar SS, Comeau C, Shubayev O, Campanile F, Wolff SD. Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation. J Cardiovasc Magn Reson 2010; 12:32. [PMID: 20497540 PMCID: PMC2893171 DOI: 10.1186/1532-429x-12-32] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/24/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The treatment of patients with aortic regurgitation (AR) or mitral regurgitation (MR) relies on the accurate assessment of the severity of the regurgitation as well as its effect on left ventricular (LV) size and function. Cardiovascular Magnetic Resonance (CMR) is an excellent tool for quantifying regurgitant volumes as well as LV size and function. The 2008 AHA/ACC management guidelines for the therapy of patients with AR or MR only describe LV size in terms of linear dimensions (i.e. end-diastolic and end-systolic dimension). LV volumes that correspond to these linear dimensions have not been published in the peer-reviewed literature. The purpose of this study is to determine the effect of regurgitant volume on LV volumes and chamber dimensions in patients with isolated AR or MR and preserved LV function. METHODS Regurgitant volume, LV volume, mass, linear dimensions, and ejection fraction, were determined in 34 consecutive patients with isolated AR and 23 consecutive patients with MR and no other known cardiac disease. RESULTS There is a strong, linear relationship between regurgitant volume and LV end-diastolic volume index (aortic regurgitation r2 = 0.8, mitral regurgitation r2 = 0.8). Bland-Altman analysis of regurgitant volume shows little interobserver variation (AR: 0.6 +/- 4 ml; MR 4 +/- 6 ml). The correlation is much poorer between regurgitant volume and commonly used clinical linear measures such as end-systolic dimension (mitral regurgitation r2 = 0.3, aortic regurgitation r2 = 0.5). For a given regurgitant volume, AR causes greater LV enlargement and hypertrophy than MR. CONCLUSION CMR is an accurate and robust technique for quantifying regurgitant volume in patients with AR or MR. Ventricular volumes show a stronger correlation with regurgitant volume than linear dimensions, suggesting LV volumes better reflect ventricular remodeling in patients with isolated mitral or aortic regurgitation. Ventricular volumes that correspond to published recommended linear dimensions are determined to guide the timing of surgical intervention.
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Affiliation(s)
- Seth Uretsky
- Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Azhar Supariwala
- Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Puspalatha Nidadovolu
- Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Surinder S Khokhar
- Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Cindy Comeau
- Advanced Cardiovascular Imaging, New York, NY, USA
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Affiliation(s)
- Joanna D'Arcy
- Department of Cardiology, John Radcliffe Hospital, Oxford
| | - Saul G Myerson
- Department of Cardiology, John Radcliffe Hospital, Oxford
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To ACY, Stewart RA. Novel methods to assess heart valve disease. Future Cardiol 2009; 4:583-92. [PMID: 19804352 DOI: 10.2217/14796678.4.6.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Optimal timing of surgery for heart valve disease relies on the accurate assessment of symptoms, lesion severity, cardiac function and the risks of disease progression. Recent studies suggest potential roles for new echocardiographic techniques, including tissue Doppler and strain imaging at rest or after exercise stress, cardiac magnetic resonance imaging and biomarkers such as B-type natriuretic peptide. These techniques may identify patients at higher risk of symptomatic deterioration or adverse clinical events, and improve the cost-effectiveness and reliability of follow-up.
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Affiliation(s)
- Andrew C Y To
- Green Lane Cardiovascular Service, Auckland City Hospital, Level 3, Building 32, Private Bag 92 189 Auckland 1030, New Zealand
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Abstract
Cardiovascular magnetic resonance is able to provide a comprehensive assessment of valvular and hemodynamic function, including quantification of valve regurgitation and other flows, and accurate cardiac volumes and mass for assessing the effect on both ventricles. Combined with the ability to image all areas of the heart (including difficult areas, such as the right ventricle and pulmonary veins), it is an ideal technique for investigating patients who have heart failure in whom these areas need to be examined.
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Affiliation(s)
- Saul G Myerson
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
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Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Eur Radiol 2009; 20:326-36. [DOI: 10.1007/s00330-009-1544-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
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Hellgren L, Landelius J, Stridsberg M, Kvidal P, Ståhle E, Bjerner T. Severe mitral regurgitation--relations between magnetic resonance imaging, echocardiography and natriuretic peptides. SCAND CARDIOVASC J 2009; 42:48-55. [DOI: 10.1080/14017430701678691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Koskenvuo JW, Järvinen V, Pärkkä JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging 2009; 29:229-40. [DOI: 10.1111/j.1475-097x.2009.00865.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Peter J. Cawley
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
| | - Jeffrey H. Maki
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
| | - Catherine M. Otto
- From the Division of Cardiology (P.J.C., C.M.O.), Department of Medicine, and Department of Radiology (J.H.M.), University of Washington, Seattle, Wash
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Garcia MJ. Evaluation of Valvular Heart Disease by Cardiac Magnetic Resonance and Computed Tomography. VALVULAR HEART DISEASE: A COMPANION TO BRAUNWALD'S HEART DISEASE 2009:101-112. [DOI: 10.1016/b978-1-4160-5892-2.00007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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