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Detterich J, Taylor MD, Slesnick TC, DiLorenzo M, Hlavacek A, Lam CZ, Sachdeva S, Lang SM, Campbell MJ, Gerardin J, Whitehead KK, Rathod RH, Cartoski M, Menon S, Trachtenberg F, Gongwer R, Newburger J, Goldberg C, Dorfman AL. Cardiac Magnetic Resonance Imaging to Determine Single Ventricle Function in a Pediatric Population is Feasible in a Large Trial Setting: Experience from the Single Ventricle Reconstruction Trial Longitudinal Follow up. Pediatr Cardiol 2023; 44:1454-1461. [PMID: 37405456 PMCID: PMC10435402 DOI: 10.1007/s00246-023-03216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
The Single Ventricle Reconstruction (SVR) Trial was a randomized prospective trial designed to determine survival advantage of the modified Blalock-Taussig-Thomas shunt (BTTS) vs the right ventricle to pulmonary artery conduit (RVPAS) for patients with hypoplastic left heart syndrome. The primary aim of the long-term follow-up (SVRIII) was to determine the impact of shunt type on RV function. In this work, we describe the use of CMR in a large cohort follow up from the SVR Trial as a focused study of single ventricle function. The SVRIII protocol included short axis steady-state free precession imaging to assess single ventricle systolic function and flow quantification. There were 313 eligible SVRIII participants and 237 enrolled, ages ranging from 10 to 12.5 years. 177/237 (75%) participants underwent CMR. The most common reasons for not undergoing CMR exam were requirement for anesthesia (n = 14) or ICD/pacemaker (n = 11). A total of 168/177 (94%) CMR studies were diagnostic for RVEF. Median exam time was 54 [IQR 40-74] minutes, cine function exam time 20 [IQR 14-27] minutes, and flow quantification time 18 [IQR 12-25] minutes. There were 69/177 (39%) studies noted to have intra-thoracic artifacts, most common being susceptibility artifact from intra-thoracic metal. Not all artifacts resulted in non-diagnostic exams. These data describe the use and limitations of CMR for the assessment of cardiac function in a prospective trial setting in a grade-school-aged pediatric population with congenital heart disease. Many of the limitations are expected to decrease with the continued advancement of CMR technology.
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Affiliation(s)
- Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles and the University of Southern California, 4650 Sunset Blvd MS34, Los Angeles, CA, 90027, USA.
| | - Michael D Taylor
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy C Slesnick
- Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, GA, USA
| | - Michael DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anthony Hlavacek
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Pediatric Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Sean M Lang
- Department of Pediatrics, Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Gerardin
- Departments of Internal Medicine and Pediatrics, Children's Hospital Wisconsin-Herma Heart Institute, Medical College of Wiscosin, Milwaukee, WI, USA
| | - Kevin K Whitehead
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Cartoski
- Division of Pediatric Cardiology, Nemours Cardiac Center, Nemours Children's Hospital, Wilmington, DE,, USA
| | - Shaji Menon
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jane Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caren Goldberg
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Adam L Dorfman
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Cordeiro L, Ishikawa WY, Andreoli MCC, Canziani MEF, Araujo LKRP, Pereira BJ, Abensur H, Moysés RMA, Elias RM. A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis. Sci Rep 2022; 12:15776. [PMID: 36138087 PMCID: PMC9500040 DOI: 10.1038/s41598-022-20157-z] [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: 01/14/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo—Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (ΔLVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N = 12 and ICO, N = 10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p = 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p = 0.044). During follow-up, ΔLVMI was 3.9 g/m (− 10.7, 2.2) in GLU and 5.2 (− 26.8, 16.8) in ICO group (p = 0.651). ΔLVMI correlated with change in brain natriuretic peptide (r = 0.566, p = 0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population. Trial registration: this study has been registered at ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification #RBR-2mzhmj2, available at: https://ensaiosclinicos.gov.br/pesquisador.
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Affiliation(s)
- Lilian Cordeiro
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil.
| | | | | | | | - Luiza Karla R P Araujo
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil
| | - Benedito J Pereira
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil.,Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Hugo Abensur
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil
| | - Rosa M A Moysés
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil
| | - Rosilene M Elias
- Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, 05403-000, Brazil.,Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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3
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Kristensen CB, Myhr KA, Grund FF, Vejlstrup N, Hassager C, Mattu R, Mogelvang R. A new method to quantify left ventricular mass by 2D echocardiography. Sci Rep 2022; 12:9980. [PMID: 35705586 PMCID: PMC9200734 DOI: 10.1038/s41598-022-13677-1] [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: 12/29/2021] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Increased left ventricular mass (LVM) is a strong independent predictor for adverse cardiovascular events, but conventional echocardiographic methods are limited by poor reproducibility and accuracy. We developed a novel method based on adding the mean wall thickness from the parasternal short axis view, to the left ventricular end-diastolic volume acquired using the biplane model of discs. The participants (n = 85) had various left ventricular geometries and were assessed using echocardiography followed immediately by cardiac magnetic resonance, as reference. We compared our novel two-dimensional (2D) method to various conventional one-dimensional (1D) and other 2D methods as well as the three-dimensional (3D) method. Our novel method had better reproducibility in intra-examiner [coefficients of variation (CV) 9% vs. 11–14%] and inter-examiner analysis (CV 9% vs. 10–20%). Accuracy was similar to the 3D method (mean difference ± 95% limits of agreement, CV): Novel: 2 ± 50 g, 15% vs. 3D: 2 ± 51 g, 16%; and better than the “linear” 1D method by Devereux (7 ± 76 g, 23%). Our novel method is simple, has considerable better reproducibility and accuracy than conventional “linear” 1D methods, and similar accuracy as the 3D-method. As the biplane model forms part of the standard echocardiographic protocol, it does not require specific training and provides a supplement to the modern echocardiographic report.
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Affiliation(s)
- Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Katrine Aagaard Myhr
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Frederik Fasth Grund
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Raj Mattu
- Kettering General Hospital NHS Foundation Trust, Kettering, NN16 8UZ, Northants, UK.,University College London, Gower St, London, WC1E 6BT, UK
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.,Cardiovascular Research Unit, University of Southern Denmark, Baagoees allé 15, 5700, Svendborg, Denmark
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Sanchez F, Weitz C, Gutierrez JM, Mestroni L, Hanneman K, Vargas D. Cardiac MR Imaging of Muscular Dystrophies. Curr Probl Diagn Radiol 2021; 51:225-234. [PMID: 33551194 DOI: 10.1067/j.cpradiol.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
Muscular dystrophies (MDs) are a group of inherited disorders caused by mutations that interfere with muscular structure, contraction, or relaxation. As the cardiac sarcomeric unit shares multiple proteins with the skeletal muscle unit, the heart is affected in several MDs, sometimes without apparent musculoskeletal involvement. Early detection of MD-related cardiomyopathy is crucial as timely initiation of cardioprotective therapy can slow adverse cardiac remodeling. Although transthoracic echocardiography is widely used for the evaluation of cardiac morphology and function, it has limitations in terms of reproducibility and image quality. The need for an optimal acoustic window may be particularly challenging to obtain in patients with MDs given their body habitus and position. Cardiac magnetic resonance (CMR) imaging has emerged as a useful tool in the evaluation of patients with MDs. Its superb tissue characterization capability through late gadolinium enhancement, T1 mapping, extracellular volume fraction quantification, and edema imaging detects early cardiac involvement, even when echocardiography and electrocardiogram are unremarkable. MDs that frequently present with cardiac involvement include Duchenne MD, Becker MD, Emery Dreifuss MD, Limb-Girdle MDs, and myotonic dystrophy. The purpose of this review article is to briefly describe the pathophysiology of these entities, discuss their clinical presentation and expected evolution, explain the role of CMR in the diagnosis and follow-up of these patients, and portray the different CMR findings present in MD patients.
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Affiliation(s)
- Felipe Sanchez
- Department of Medical Imaging, University of Toronto - University Health Network, Toronto General Hospital, Toronto, ON, Canada.
| | - Carolina Weitz
- Department of Medical Imaging, Hospital Clinico Felix Bulnes Cerda, Santiago, Chile
| | - Jose M Gutierrez
- Department of Medical Imaging, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Luisa Mestroni
- University of Colorado - Anschutz Medical Campus, Molecular Genetics, Cardiovascular Institute, Aurora, CO
| | - Kate Hanneman
- Department of Medical Imaging, University of Toronto - University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Daniel Vargas
- Department of Radiology, University of Colorado - Anschutz Medical Campus, Aurora, CO
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5
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Calandri E, Guana F, Pultrone M, Leuzzi S, Chiorino G, Soligo E, Frantellizzi V, Gallina S, Liberatore M, De Vincentis G. Evaluation of Left Ventricular Volumes and Ejection Fraction from Gated Myocardial Perfusion SPECT Processed with "Myovation Evolution": Comparison of Three Automated Software Packages using Cardiac Magnetic Resonance as Reference. Curr Radiopharm 2020; 14:112-120. [PMID: 32933466 DOI: 10.2174/1874471013666200915130100] [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: 04/28/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The development of resolution recovery (RR) algorithms has made it possible to preserve the good quality of cardiac images despite a reduced number of counts during study acquisition. OBJECTIVE Our purpose was to evaluate the performance of three different software packages in the quantification of left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) from gated perfusion SPECT, applying a resolution recovery (RR) algorithm (GE Myovation Evolution), with respect to cardiac MRI (cMRI) as a gold standard. METHODS We retrospectively enrolled 21 patients, with suspected or known coronary heart disease. Images at rest were reconstructed by filtered back projection (FBP) and by an iterative protocol with the RR algorithm. EDV, ESV, and LVEF were automatically computed employing Quantitative Gated SPECT (QGS), Myometrix (MX), and Corridor 4DM (4DM). Any difference in EDV, ESV, and LVEF calculation between cMRI and the three packages (with FBP and iterative reconstruction with RR) was tested using Wilcoxon or paired t-test, with the assumption of normality assessed using the Shapiro-Wilk test. Agreement between imaging reconstruction algorithms and between gated-SPECT software packages and cMRI was studied with Pearson's (r) or Spearman's (R) correlation coefficients and Lin's concordance correlation coefficient (LCC). RESULTS Intra-software evaluation always revealed very strong correlation coefficients (R, r ≥ 0.8) and excellent LCC coefficients (LCC > 0.95), except for the LCC coefficient between MX-FBP and MX-RR in EDV evaluation, nevertheless considered very good (LCC = 0.94). EDV and ESV had significantly lower value when calculated with the RR algorithm with respect to FBP reconstruction in QGS and MX. LVEF estimation did not show significant differences for QGS-FBP, QGS-RR, MX, and 4DM-RR with respect to cMRI. CONCLUSION All reconstruction methods systematically underestimate EDV and ESV, with higher underestimation applying only the RR. No significant differences were observed between 4DM - RR and 4DM-FBP, for each parameter, when the 4DM package was used.
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Affiliation(s)
- Enrico Calandri
- Department of Medicine and Urgency, Nuclear Medicine Unit, Ospedale degli Infermi, Ponderano (BI), Italy
| | - Francesca Guana
- Laboratory of Cancer Genomics, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Mirco Pultrone
- Department of Medicine and Urgency, Nuclear Medicine Unit, Ospedale degli Infermi, Ponderano (BI), Italy
| | - Stefano Leuzzi
- Department of Medicine and Urgency, Unit of Cardiology, Ospedale degli Infermi, Ponderano (BI), Italy
| | - Giovanna Chiorino
- Laboratory of Cancer Genomics, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Eleonora Soligo
- Department of Medicine and Urgency, Radiology Unit, Ospedale degli Infermi, Ponderano (BI), Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Nuclear Medicine Unit, "Sapienza" University, Rome, Italy
| | - Sonya Gallina
- Department of Medicine and Urgency, Nuclear Medicine Unit, Ospedale degli Infermi, Ponderano (BI), Italy
| | - Mauro Liberatore
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Nuclear Medicine Unit, "Sapienza" University, Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Nuclear Medicine Unit, "Sapienza" University, Rome, Italy
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Lamacie MM, Warman-Chardon J, Crean AM, Florian A, Wahbi K. The Added Value of Cardiac Magnetic Resonance in Muscular Dystrophies. J Neuromuscul Dis 2019; 6:389-399. [PMID: 31561382 PMCID: PMC6918915 DOI: 10.3233/jnd-190415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Muscular dystrophies (MD) represent a heterogeneous group of rare genetic diseases that often lead to significant weakness due to progressive muscle degeneration. In many forms of MD, cardiac manifestations including heart failure, atrial and ventricular arrhythmias and conduction abnormalities can occur and may be a predominant feature of the disease. Cardiac magnetic resonance (CMR) can assess cardiac anatomy, global and regional ventricular function, volumes and mass as well as presence of myocardial inflammation, infiltration or fibrosis. The role for cardiac MRI has been well-established in a wide range of muscular dystrophies related cardiomyopathies. CMR is a more sensitive technique than echocardiography for early diagnosis of cardiac involvement. It has also great potential to improve the prediction of long-term outcome, particularly the development of heart failure and arrhythmic events; however it still has to be validated by longitudinal studies including large populations. This review will outline the utility of CMR in patients with muscular dystrophies for assessment of myocardial involvement, risk stratification, and in guiding therapeutic management.
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Affiliation(s)
- Mariana M Lamacie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Andrew M Crean
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada
| | - Anca Florian
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - Karim Wahbi
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Centre de Référence de Pathologie Neuromusculaire Nord/Est/Ile de France, Paris-Descartes, Sorbonne Paris Cité University, Paris, France; INSERM Unit, Paris Cardiovascular Research Centre (PARCC), Paris, France
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7
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Quantification of myocardial deformation by deformable registration–based analysis of cine MRI: validation with tagged CMR. Eur Radiol 2019; 29:3658-3668. [DOI: 10.1007/s00330-019-06019-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/05/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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8
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Influence of large hiatus hernia on cardiac volumes. A prospective observational cohort study by cardiovascular magnetic resonance. Int J Cardiol 2018; 268:241-244. [DOI: 10.1016/j.ijcard.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 11/24/2022]
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9
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Motion-Corrected Real-Time Cine Magnetic Resonance Imaging of the Heart: Initial Clinical Experience. Invest Radiol 2018; 53:35-44. [PMID: 28857861 DOI: 10.1097/rli.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Free-breathing real-time (RT) imaging can be used in patients with difficulty in breath-holding; however, RT cine imaging typically experiences poor image quality compared with segmented cine imaging because of low resolution. Here, we validate a novel unsupervised motion-corrected (MOCO) reconstruction technique for free-breathing RT cardiac images, called MOCO-RT. Motion-corrected RT uses elastic image registration to generate a single heartbeat of high-quality data from a free-breathing RT acquisition. MATERIALS AND METHODS Segmented balanced steady-state free precession (bSSFP) cine images and free-breathing RT images (Cartesian, TGRAPPA factor 4) were acquired with the same spatial/temporal resolution in 40 patients using clinical 1.5 T magnetic resonance scanners. The respiratory cycle was estimated using the reconstructed RT images, and nonrigid unsupervised motion correction was applied to eliminate breathing motion. Conventional segmented RT and MOCO-RT single-heartbeat cine images were analyzed to evaluate left ventricular (LV) function and volume measurements. Two radiologists scored images for overall image quality, artifact, noise, and wall motion abnormalities. Intraclass correlation coefficient was used to assess the reliability of MOCO-RT measurement. RESULTS Intraclass correlation coefficient showed excellent reliability (intraclass correlation coefficient ≥ 0.95) of MOCO-RT with segmented cine in measuring LV function, mass, and volume. Comparison of the qualitative ratings indicated comparable image quality for MOCO-RT (4.80 ± 0.35) with segmented cine (4.45 ± 0.88, P = 0.215) and significantly higher than conventional RT techniques (3.51 ± 0.41, P < 0.001). Artifact and noise ratings for MOCO-RT (1.11 ± 0.26 and 1.08 ± 0.19) and segmented cine (1.51 ± 0.90, P = 0.088 and 1.23 ± 0.45, P = 0.182) were not different. Wall motion abnormality ratings were comparable among different techniques (P = 0.96). CONCLUSIONS The MOCO-RT technique can be used to process conventional free-breathing RT cine images and provides comparable quantitative assessment of LV function and volume measurements to conventional segmented cine imaging while providing improved image quality and less artifact and noise. The free-breathing MOCO-RT reconstruction method may have considerable clinical utility in cardiac magnetic resonance imaging for patients with difficulty breath-holding.
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10
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Shetye AM, Nazir SA, Razvi NA, Price N, Khan JN, Lai FY, Squire IB, McCann GP, Arnold JR. Comparison of global myocardial strain assessed by cardiovascular magnetic resonance tagging and feature tracking to infarct size at predicting remodelling following STEMI. BMC Cardiovasc Disord 2017; 17:7. [PMID: 28056808 PMCID: PMC5217595 DOI: 10.1186/s12872-016-0461-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023] Open
Abstract
Background To determine if global strain parameters measured by cardiovascular magnetic resonance (CMR) acutely following ST-segment Elevation Myocardial Infarction (STEMI) predict adverse left ventricular (LV) remodelling independent of infarct size (IS). Methods Sixty-five patients with acute STEMI (mean age 60 ± 11 years) underwent CMR at 1–3 days post-reperfusion (baseline) and at 4 months. Global peak systolic circumferential strain (GCS), measured by tagging and Feature Tracking (FT), and global peak systolic longitudinal strain (GLS), measured by FT, were calculated at baseline, along with IS. On follow up scans, volumetric analysis was performed to determine the development of adverse remodelling – a composite score based on development of either end-diastolic volume index [EDVI] ≥20% or end-systolic volume index [ESVI] ≥15% at follow-up compared to baseline. Results The magnitude of GCS was higher when measured using FT (−21.1 ± 6.3%) than with tagging (−12.1 ± 4.3; p < 0.001 for difference). There was good correlation of strain with baseline LVEF (r 0.64–to 0.71) and IS (ρ -0.62 to–0.72). Baseline strain parameters were unable to predict development of adverse LV remodelling. Only baseline IS predicted adverse remodelling – Odds Ratio 1.05 (95% CI 1.01–1.10, p = 0.03), area under the ROC curve 0.70 (95% CI 0.52–0.87, p = 0.04). Conclusion Baseline global strain by CMR does not predict the development of adverse LV remodelling following STEMI.
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Affiliation(s)
- Abhishek M Shetye
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Sheraz A Nazir
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Naveed A Razvi
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Ipswich Hospital NHS trust, Ipswich, IP4 5PD, UK
| | - Nathan Price
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Jamal N Khan
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Gerald P McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.
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11
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Wan M, Huang W, Zhang JM, Zhao X, Allen JC, Tan RS, Wan X, Zhong L. Correcting motion in multiplanar cardiac magnetic resonance images. Biomed Eng Online 2016; 15:93. [PMID: 27503101 PMCID: PMC4977636 DOI: 10.1186/s12938-016-0216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 07/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Misalignment in cardiac magnetic resonance (CMR) images can adversely affect three-dimensional left ventricle modelling and downstream quantitative analysis. Currently, there are two types of approaches for dealing with realignment and motion distortion problems, one image based and the other geometry based. Image-based approaches are limited by the inherent non-homogeneity and anisotropy of CMR images. Geometry-based approaches rely on idealized models and over-simplified assumptions. This study was motivated by the need for a robust and effective approach for correcting motion related distortions due to misalignment in CMR images. METHODS A cine cardiac magnetic resonance image sequence was acquired using our routine clinical imaging protocol. The left ventricular endocardium was delineated manually with software assistance on all long and short-axis images. Long and short-axis contours were projected onto a patient-based coordinate system and then realigned using iterative registration. The realigned contour points were used to reconstruct the shape of the left ventricle for quantitative validation. RESULTS The method was tested on five myocardial infarction patients whose images showed substantial misalignment. Realignment time was about 16 seconds per case, using a 2.5 GHz CPU desktop with obvious elimination of the distortion in the reconstructed model. Using the long-axis contour as a reference in evaluating the reconstructed models, it was apparent that the models with realigned contours had better accuracy than the non-realigned ones. CONCLUSION This study presents a novel, geometry-based method for correcting motion distortions in CMR images. The method incorporates (1) manual delineation, (2) registration based on a generalized, iterative closest point algorithm, and (3) reconstruction of the shape of the left ventricle for quantitative validation. The effectiveness of our approach is corroborated both visually and by quantitative assessment. We envision the use of our method in current clinical practice as a means of improving accuracy in the evaluation of cardiac function.
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Affiliation(s)
- Min Wan
- Nanchang University, No. 999, Xuefu Dadao, Nanchang, People’s Republic of China
| | - Wei Huang
- Nanchang University, No. 999, Xuefu Dadao, Nanchang, People’s Republic of China
| | - Jun-Mei Zhang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Xiaodan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - John Carson Allen
- Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Ru San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Xiaofeng Wan
- Nanchang University, No. 999, Xuefu Dadao, Nanchang, People’s Republic of China
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
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Lamacie MM, Thavendiranathan P, Hanneman K, Greiser A, Jolly MP, Ward R, Wintersperger BJ. Quantification of global myocardial function by cine MRI deformable registration-based analysis: Comparison with MR feature tracking and speckle-tracking echocardiography. Eur Radiol 2016; 27:1404-1415. [DOI: 10.1007/s00330-016-4514-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 07/12/2016] [Accepted: 07/19/2016] [Indexed: 12/01/2022]
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Widya RL, de Mutsert R, den Heijer M, le Cessie S, Rosendaal FR, Jukema JW, Smit JWA, de Roos A, Lamb HJ. Association between Hepatic Triglyceride Content and Left Ventricular Diastolic Function in a Population-based Cohort: The Netherlands Epidemiology of Obesity Study. Radiology 2016; 279:443-50. [DOI: 10.1148/radiol.2015150035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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Segmentation of the left ventricular endocardium from magnetic resonance images by using different statistical shape models. J Electrocardiol 2016; 49:383-91. [PMID: 27046100 DOI: 10.1016/j.jelectrocard.2016.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 11/20/2022]
Abstract
We evaluate in this paper different strategies for the construction of a statistical shape model (SSM) of the left ventricle (LV) to be used for segmentation in cardiac magnetic resonance (CMR) images. From a large database of LV surfaces obtained throughout the cardiac cycle from 3D echocardiographic (3DE) LV images, different LV shape models were built by varying the considered phase in the cardiac cycle and the registration procedure employed for surface alignment. Principal component analysis was computed to describe the statistical variability of the SSMs, which were then deformed by applying an active shape model (ASM) approach to segment the LV endocardium in CMR images of 45 patients. Segmentation performance was evaluated by comparing LV volumes derived by ASM segmentation with different SSMs and those obtained by manual tracing, considered as a reference. A high correlation (r(2)>0.92) was found in all cases, with better results when using the SSM models comprising more than one frame of the cardiac cycle.
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Evaluation of ventricular dysfunction using semi-automatic longitudinal strain analysis of four-chamber cine MR imaging. Int J Cardiovasc Imaging 2015; 32:283-289. [DOI: 10.1007/s10554-015-0771-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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16
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Suinesiaputra A, Bluemke DA, Cowan BR, Friedrich MG, Kramer CM, Kwong R, Plein S, Schulz-Menger J, Westenberg JJM, Young AA, Nagel E. Quantification of LV function and mass by cardiovascular magnetic resonance: multi-center variability and consensus contours. J Cardiovasc Magn Reson 2015; 17:63. [PMID: 26215273 PMCID: PMC4517503 DOI: 10.1186/s12968-015-0170-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND High reproducibility of LV mass and volume measurement from cine cardiovascular magnetic resonance (CMR) has been shown within single centers. However, the extent to which contours may vary from center to center, due to different training protocols, is unknown. We aimed to quantify sources of variation between many centers, and provide a multi-center consensus ground truth dataset for benchmarking automated processing tools and facilitating training for new readers in CMR analysis. METHODS Seven independent expert readers, representing seven experienced CMR core laboratories, analyzed fifteen cine CMR data sets in accordance with their standard operating protocols and SCMR guidelines. Consensus contours were generated for each image according to a statistical optimization scheme that maximized contour placement agreement between readers. RESULTS Reader-consensus agreement was better than inter-reader agreement (end-diastolic volume 14.7 ml vs 15.2-28.4 ml; end-systolic volume 13.2 ml vs 14.0-21.5 ml; LV mass 17.5 g vs 20.2-34.5 g; ejection fraction 4.2 % vs 4.6-7.5 %). Compared with consensus contours, readers were very consistent (small variability across cases within each reader), but bias varied between readers due to differences in contouring protocols at each center. Although larger contour differences were found at the apex and base, the main effect on volume was due to small but consistent differences in the position of the contours in all regions of the LV. CONCLUSIONS A multi-center consensus dataset was established for the purposes of benchmarking and training. Achieving consensus on contour drawing protocol between centers before analysis, or bias correction after analysis, is required when collating multi-center results.
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Affiliation(s)
- Avan Suinesiaputra
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand.
| | - David A Bluemke
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA.
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand.
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Canada.
| | | | | | | | | | | | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand.
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt/Main, Frankfurt, Germany.
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Bugdol MN, Pietka E. Mathematical model in left ventricle segmentation. Comput Biol Med 2015; 57:187-200. [PMID: 25575185 DOI: 10.1016/j.compbiomed.2014.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 11/17/2022]
Abstract
In this paper a parametric model of the left ventricle is presented. Its task is to estimate the myocardium shape on those slices, on which the segmentation algorithm has outlined the structure incorrectly. The aim of using the model on improperly segmented slices is to improve the accuracy of computing cardiac hemodynamic parameters and the heart mass. The proposed model works with any segmentation algorithm. The usefulness of the model is the largest while determining the myocardium at end-systole and calculating the heart mass. In case of the segmentation algorithm applied in this study, the error decreased from clinically unacceptable to acceptable after using the presented model.
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Affiliation(s)
- Monika N Bugdol
- Faculty of Biomedical Engineering, Silesian University of Technology, Akademicka 16, Gliwice, Poland.
| | - Ewa Pietka
- Faculty of Biomedical Engineering, Silesian University of Technology, Akademicka 16, Gliwice, Poland.
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Caiani EG, Colombo A, Pepi M, Piazzese C, Maffessanti F, Lang RM, Carminati MC. Three-dimensional left ventricular segmentation from magnetic resonance imaging for patient-specific modelling purposes. Europace 2014; 16 Suppl 4:iv96-iv101. [PMID: 25362176 DOI: 10.1093/europace/euu232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To propose a nearly automated left ventricular (LV) three-dimensional (3D) surface segmentation procedure, based on active shape modelling (ASM) and built on a database of 3D echocardiographic (3DE) LV surfaces, for cardiac magnetic resonance (CMR) images, and to test its accuracy for LV volumes computation compared with 'gold standard' manual tracings and discs-summation method. METHODS AND RESULTS The ASM was created based on segmented LV surfaces (4D LV analysis, Tomtec) from 3DE datasets of 205 patients. Then, it was applied to the cardiac magnetic resonance imaging short-axis (SAX) images stack of 12 consecutive patients. After proper realignment using two- and four-chambers CMR long-axis views both as reference and for initializing LV apex and base (six points in total), the ASM was iteratively and automatically updated to match the information of all the SAX planes contemporaneously, resulting in an endocardial LV 3D mesh from which volume was directly derived. The same CMR images were analysed by an experienced cardiologist to derive end-diastolic and end-systolic volumes. Linear correlation and Bland-Altman analyses were applied vs. the manual 'gold standard'. Active shape modelling results showed high correlations with manual values both for LV volumes (r(2) > 0.98) and ejection fraction (EF) (r(2) > 0.90), non-significant biases and narrow limits of agreement. CONCLUSION The proposed method resulted in accurate detection of 3D LV endocardial surfaces, which lead to fast and reliable measurements of LV volumes and EF when compared with manual tracing of CMR SAX images. The segmented 3D mesh, including a realistic LV apex and base, could constitute a novel starting point for more realistic patient-specific finite element modelling.
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Affiliation(s)
- Enrico G Caiani
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. da Vinci, 32, 20133 Milan, Italy
| | - Andrea Colombo
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. da Vinci, 32, 20133 Milan, Italy
| | - Mauro Pepi
- IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy
| | - Concetta Piazzese
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. da Vinci, 32, 20133 Milan, Italy Center for Computational Medicine in Cardiology, Universitá della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Francesco Maffessanti
- Noninvasive imaging Laboratories, University of Chicago Medical Center, 60637 Chicago, USA
| | - Roberto M Lang
- Noninvasive imaging Laboratories, University of Chicago Medical Center, 60637 Chicago, USA
| | - Maria Chiara Carminati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Piazza L. da Vinci, 32, 20133 Milan, Italy IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy
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Gottlieb I, Camargo G. Is cardiac magnetic resonance one of cardiology's magic crystal balls? J Am Coll Cardiol 2014; 63:1046-7. [PMID: 24486279 DOI: 10.1016/j.jacc.2013.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Ilan Gottlieb
- National Institute of Cardiology, Rio de Janeiro, Brazil; Clínica de Diagnostico por Imagem (CDPI), Rio de Janeiro, Brazil.
| | - Gabriel Camargo
- National Institute of Cardiology, Rio de Janeiro, Brazil; Clínica de Diagnostico por Imagem (CDPI), Rio de Janeiro, Brazil
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Abstract
Imaging evaluation of the heart encompasses structural evaluation of the chambers, valves and coronary arteries, and functional evaluation, including assessment of perfusion, wall motion and myocardial viability. Magnetic resonance imaging is well established for the structural and functional evaluation of the heart, and benefits from direct multiplanar image acquisition and a lack of ionizing radiation. Magnetic resonance imaging assessment of myocardial viability after myocardial infarction appears to be helpful in predicting benefit from revascularization procedures. Magnetic resonance imaging continues to hold promise as the least invasive method of coronary artery evaluation, and continuing developments are improving image quality and decreasing examination time. The development of cardiac-gating techniques for multidetector computed tomography has the potential to provide widespread availability of cardiac computed tomography. Short examination times and straightforward scanning procedures promise a convenient method for the examination of cardiac structure and function. However, this convenience must be balanced against radiation dose and contrast-media requirements when determining the appropriate use of cardiac computed tomography. Computed tomography coronary-calcium scoring can aid in the prediction of significant coronary events in all but the lowest-risk patients. The high negative-predictive value of computed tomography coronary angiography may allow some patients to avoid cardiac catheterization, but its role in the assessment of patients with moderate coronary atherosclerosis remains unclear. New software tools can assist in the complex and tedious analysis of the large volumes of data produced by these examinations.
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Affiliation(s)
- Gregory W Gladish
- Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Box 57, Houston, TX 77030, USA.
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21
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Adenaw N, Salerno M. PET/MRI: current state of the art and future potential for cardiovascular applications. J Nucl Cardiol 2013; 20:976-89. [PMID: 23996656 DOI: 10.1007/s12350-013-9780-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Positron emission tomography-magnetic resonance imaging (PET/MRI) is emerging as a novel diagnostic modality with exciting potential for a role in multiple cardiovascular applications. The combination of the high sensitivity of PET tracers with the excellent spatial resolution and tissue characterization of cardiac MRI will provide complementary information in a variety of cardiac pathologies. While initial efforts have focused on the combination of MRI and PET for assessment of coronary artery disease, cardiomyopathy, viability, and inflammation, this new technology holds enormous potential for molecular cardiovascular imaging. This article will review the development of PET/MRI, review the current research, and discuss potential future applications.
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Affiliation(s)
- Nebiyu Adenaw
- Departments of Medicine and Cardiology, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA
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Schwartz T, Sanner H, Gjesdal O, Flatø B, Sjaastad I. In juvenile dermatomyositis, cardiac systolic dysfunction is present after long-term follow-up and is predicted by sustained early skin activity. Ann Rheum Dis 2013; 73:1805-10. [DOI: 10.1136/annrheumdis-2013-203279] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Young AA, Prince JL. Cardiovascular magnetic resonance: deeper insights through bioengineering. Annu Rev Biomed Eng 2013; 15:433-61. [PMID: 23662778 DOI: 10.1146/annurev-bioeng-071812-152346] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Heart disease is the main cause of morbidity and mortality worldwide, with coronary artery disease, diabetes, and obesity being major contributing factors. Cardiovascular magnetic resonance (CMR) can provide a wealth of quantitative information on the performance of the heart, without risk to the patient. Quantitative analyses of these data can substantially augment the diagnostic quality of CMR examinations and can lead to more effective characterization of disease and quantification of treatment benefit. This review provides an overview of the current state of the art in CMR with particular regard to the quantification of motion, both microscopic and macroscopic, and the application of bioengineering analysis for the evaluation of cardiac mechanics. We discuss the current clinical practice and the likely advances in the next 5-10 years, as well as the ways in which clinical examinations can be augmented by bioengineering analysis of strain, compliance, and stress.
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Affiliation(s)
- A A Young
- Department of Anatomy with Radiology, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand.
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25
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Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: A magnetic resonance imaging study. Int J Cardiol 2011; 153:42-6. [DOI: 10.1016/j.ijcard.2010.08.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/18/2010] [Accepted: 08/07/2010] [Indexed: 11/20/2022]
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Lin A, Stewart R. Medical treatment of asymptomatic chronic aortic regurgitation. Expert Rev Cardiovasc Ther 2011; 9:1249-54. [PMID: 21932966 DOI: 10.1586/erc.11.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chronic aortic regurgitation results in left ventricular (LV) dilation, increased LV work and, eventually, a decline in LV function and heart failure. An important question is whether pharmacological therapy could preserve LV function and delay the need for aortic valve replacement. Vasodilators have a number of theoretical advantages. By lowering blood pressure, they reduce the regurgitant volume and decrease LV afterload. This article summarizes the clinical studies that have evaluated vasodilators in asymptomatic patients with chronic aortic regurgitation. Some studies suggest favorable effects on LV function and clinical outcomes, but results are inconsistent, making it difficult to draw definite conclusions. In general, studies have been too small to reliably evaluate the overall benefits and risks of this treatment, and in several studies there was no significant difference in measured blood pressure by treatment allocation. For these reasons, decisions on whether vasodilators are indicated in individual patients must currently be based on clinical judgment alone.
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Affiliation(s)
- Aaron Lin
- Green Lane Cardiovascular Unit, Auckland City Hospital, Park Road, Auckland, New Zealand
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Accuracy and variability of right ventricular volumes and mass assessed by dual-source computed tomography: influence of slice orientation in comparison to magnetic resonance imaging. Eur Radiol 2011; 21:2492-502. [DOI: 10.1007/s00330-011-2207-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/07/2011] [Accepted: 07/02/2011] [Indexed: 10/18/2022]
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Tang J, Hsieh J, Chen GH. Temporal resolution improvement in cardiac CT using PICCS (TRI-PICCS): Performance studies. Med Phys 2010; 37:4377-88. [DOI: 10.1118/1.3460318] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mendes AA, Roncal CGP, da Costa VLV, Japyassu FAA, Oliveira FRA, Sepúlveda DL, da Silva CA, Albuquerque ES, de Melo RJV, Loureiro R, Muniz MTC. [Pulmonary hypertension associated with acquired immunodeficiency syndrome: presentation of five cases and review of the literature]. Rev Soc Bras Med Trop 2010; 42:452-7. [PMID: 19802485 DOI: 10.1590/s0037-86822009000400018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 07/20/2009] [Indexed: 11/21/2022] Open
Abstract
Several cardiorespiratory diseases may complicate the acquired immunodeficiency syndrome. Pulmonary hypertension is a rare clinical disorder with a poor prognosis. We describe this syndrome in five patients seen at our service who presented infection with the acquired immunodeficiency virus, and we review the literature.
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Jonnalagadda N, Jain A, Calkins H, Tandri H. Role of cardiac imaging evaluation of patients with documented or suspected ventricular arrhythmias. J Nucl Cardiol 2010; 17:145-52. [PMID: 19941094 DOI: 10.1007/s12350-009-9168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Naveen Jonnalagadda
- The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Carnegie 565D, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Cowan BR, Young AA, Anderson C, Doughty RN, Krittayaphong R, Lonn E, Marwick TH, Reid CM, Sanderson JE, Schmieder RE, Teo K, Wadham AK, Worthley SG, Yu CM, Yusuf S, Jennings GL. Left ventricular mass and volume with telmisartan, ramipril, or combination in patients with previous atherosclerotic events or with diabetes mellitus (from the ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET]). Am J Cardiol 2009; 104:1484-9. [PMID: 19932779 DOI: 10.1016/j.amjcard.2009.07.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 01/20/2023]
Abstract
The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) showed that the angiotensin receptor blocker telmisartan 80 mg was not inferior to the angiotensin-converting enzyme inhibitor ramipril 10 mg, and the combination no more effective than ramipril alone, in decreasing morbidity and mortality in patients with cardiovascular disease or high-risk diabetes. Although therapy targeting angiotensin II is known to decrease left ventricular (LV) mass and volume, the relative influence of angiotensin-converting enzyme inhibitor inhibitors and angiotensin receptor blocker, and their combination, on the heart remains unclear in this population. Magnetic resonance imaging was performed in 287 patients enrolled in ONTARGET, across 8 centers in 6 countries, at randomization and after 2-year treatment (90, 100, and 97 patients in the ramipril, telmisartan, and combination therapy groups, respectively). Baseline patient characteristics showed higher frequencies of coronary artery disease, Asian ethnicity, and use of statins and beta blockers than the main ONTARGET trial. LV mass decreased in all groups (p <0.0001 for each), but there were no significant differences in change in LV mass or volume among groups, except that LV mass index decreased more on combination versus telmisartan (p = 0.04). Key determinants of LV mass decrease were a history of hypertension (p = 0.03), baseline mass (p <0.0001), and decrease in systolic blood pressure (p <0.0001). The best magnetic resonance imaging predictor of composite events was end-systolic volume (p <0.0001). In conclusion, telmisartan and ramipril had similar effects on LV mass and volume, and combination therapy was not more effective, in high-risk patients with cardiovascular disease. These results are consistent with the major outcome findings of the main ONTARGET study.
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Assessment of left ventricular function at rest using rubidium-82 myocardial perfusion PET: comparison of four software algorithms with simultaneous 64-slice coronary CT angiography. Nucl Med Commun 2009; 30:918-25. [DOI: 10.1097/mnm.0b013e328329fc34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cardiac image modeling tool for quantitative analysis of global and regional cardiac wall motion. Invest Radiol 2009; 44:271-8. [PMID: 19346964 DOI: 10.1097/rli.0b013e31819c96e3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the Cardiac Image Modeling (CIM 4.6; University of Auckland, Auckland, New Zealand) tool's ability to assess cardiac function via quantitative calculations of global and regional ejection fraction (EF) from magnetic resonance imaging in comparison with a current method of global analysis with Argus (Siemens Medical Solutions) and regional analysis with visual analysis. BACKGROUND Global cardiac function is commonly assessed quantitatively by post processing tools that calculate global EF. Currently, regional cardiac function is assessed by subjective visual analysis of wall motion, which can have significant interobserver variability. CIM is a tool that may reduce variability by generating a semi-automated 3-dimensional heart model to calculate quantitative global and regional EF. MATERIALS AND METHODS Thirty-one patients (22 men, 9 women; mean age 55.1 +/- 17.5 years) were selected based on global EFs calculated at the time of the clinical visit with the Argus postprocessing tool (Siemens Medical Solutions). Patients were then placed into 2 predetermined categories of normal: EF >or=50% and abnormal: EF <50%. Regional EF was calculated for each segment of a 16-segment cardiac model. Three blinded reviewers used the standard of care assessment of regional function, which was a qualitative grading of the 16 segments into categories of normal or abnormal regional wall motion by visual analysis. CIM quantitatively analyzed global EF and regional EF for each segment. These segments were then sorted into the predetermined categories of normal (EF >or=50%) and abnormal (EF <50%). Level of agreement was conducted via Pearson correlation coefficient and Bland-Altman analysis for global EF analysis and observed proportion of agreement (p(a)), sensitivity, and specificity for regional EF analysis. RESULTS Global EF analysis showed a high correlation (r2 = 0.85; y = 0.94x + 4.85, P < 0.001) between the Argus and CIM analyses. Sixteen-segment regional EF analysis showed p(a) averages >0.60. Regional wall motion by short axis slices showed pa averages >0.75, and combined analyses of all 3 reviewers' 16-segment regional data showed an overall total p(a) = 0.79 (sensitivity = 72%, specificity = 88%). Interobserver and intraobserver variability were low (p(a) > 0.65) in this study. CONCLUSIONS Global EF analysis of cardiac magnetic resonance imaging by CIM showed high agreement with the commonly used Argus postprocessing tool. Furthermore, CIM is capable of evaluating regional EF with good agreement in comparison with the current visual method. In addition to determining abnormal versus normal cardiac wall motion, CIM is able to add to the analysis a quantitative regional EF for each given segment. As a semi-automated tool, CIM has the potential to reduce reviewer variability and decrease the time required for analysis. In the future, CIM can potentially quantitatively track global and regional changes in patients with heart disease and aid the clinical management throughout the course of the disease.
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Farzaneh-Far R, Na B, Whooley MA, Schiller NB. Left-ventricular power-to-mass ratio at peak exercise predicts mortality, heart failure, and cardiovascular events in patients with stable coronary artery disease: data from the Heart and Soul Study. Cardiology 2009; 114:226-34. [PMID: 19672059 DOI: 10.1159/000231991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 04/30/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND Quantitative stress echocardiography enables calculation of left-ventricular power-to-mass ratio (LVPMR) at peak exercise, a novel measure of cardiac performance per unit mass of myocardial tissue. We hypothesized that LVPMR at peak exercise provides prognostic information beyond established echocardiographic indices such as left-ventricular ejection fraction (LVEF) and left-ventricular mass index (LVMI). METHODS LVPMR (watts/kilogram) at peak exercise was defined as (k x heart rate x mean arterial pressure x stroke volume)/LV mass. We measured LVPMR in 918 adults with stable ambulatory coronary artery disease recruited for the Heart and Soul Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, heart failure hospitalization, and combined adverse cardiovascular events. Multivariate adjustments were made for established risk factors including LVEF and LVMI. The prognostic value of LVPMR was also compared with established exercise parameters using receiver-operating characteristic curve analysis. RESULTS Compared with patients in the highest LVPMR quartile, those in the lowest quartile were at increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.1-3.3), heart failure hospitalization (adjusted HR 2.9; 95% CI 1.2-6.9), and combined adverse cardiovascular events (adjusted HR 1.9; 95% CI 1.1-3.4). In comparison with the rate-pressure product and the Duke treadmill score, LVPMR did not add significant prognostic value (p > 0.1 for c-statistic comparisons). CONCLUSIONS In patients with stable ambulatory coronary artery disease, LVPMR at peak exercise predicts mortality, heart failure hospitalization, and adverse cardiovascular events. However, LVPMR does not add significant prognostic information beyond established exercise test parameters.
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Rapid MR assessment of left ventricular systolic function after acute myocardial infarction using single breath-hold cine imaging with the temporal parallel acquisition technique (TPAT) and 4D guide-point modelling analysis of left ventricular function. Eur Radiol 2009; 20:73-80. [DOI: 10.1007/s00330-009-1522-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/02/2009] [Accepted: 06/22/2009] [Indexed: 11/25/2022]
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Cowan BR, Young AA, Anderson C, Doughty RN, Krittayaphong R, Lonn E, Marwick TH, Reid CM, Sanderson JE, Schmieder RE, Teo K, Wadham AK, Worthley SG, Yu CM, Yusuf S, Jennings GL. The cardiac MRI substudy to ongoing telmisartan alone and in combination with ramipril global endpoint trial/telmisartan randomized assessment study in ACE-intolerant subjects with cardiovascular disease: analysis protocol and baseline characteristics. Clin Res Cardiol 2009; 98:421-33. [DOI: 10.1007/s00392-009-0014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/17/2009] [Indexed: 01/20/2023]
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Lungen- und Atemwegserkrankungen. INNERE MEDIZIN 2009. [PMCID: PMC7152426 DOI: 10.1016/b978-3-437-42831-9.10010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Integrative models of cardiac physiology are important for understanding disease and planning intervention. Multimodal cardiovascular imaging plays an important role in defining the computational domain, the boundary/initial conditions, and tissue function and properties. Computational models can then be personalized through information derived from in vivo and, when possible, non-invasive images. Efforts are now established to provide Web-accessible structural and functional atlases of the normal and pathological heart for clinical, research and educational purposes. Efficient and robust statistical representations of cardiac morphology and morphodynamics can thereby be obtained, enabling quantitative analysis of images based on such representations. Statistical models of shape and appearance can be built automatically from large populations of image datasets by minimizing manual intervention and data collection. These methods facilitate statistical analysis of regional heart shape and wall motion characteristics across population groups, via the application of parametric mathematical modelling tools. These parametric modelling tools and associated ontological schema also facilitate data fusion between different imaging protocols and modalities as well as other data sources. Statistical priors can also be used to support cardiac image analysis with applications to advanced quantification and subject-specific simulations of computational physiology.
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Affiliation(s)
- Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland Mail Centre, Private Bag, Auckland, New Zealand.
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Mizuno N, Funabashi N, Nakamura K, Uehara M, Suzuki K, Terao M, Okubo K, Mita Y, Maeda F, Komuro I. Utility of multislice computed tomography with a 64-data acquisition system for four-dimensional volumetric analysis using a pulsating phantom and considering pulsation rate and reconstruction methods. Int J Cardiol 2008; 130:477-80. [PMID: 17707932 DOI: 10.1016/j.ijcard.2007.05.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 05/11/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate 64-data acquisition system (DAS) MSCT (Light Speed VCT, GE) at 0.625 mm slice thickness, 0.35 s/rotation, tube 120 kV at 400 mA, ECG-gated for 4-D volumetric analysis, we used pulsating phantoms to measure end-diastolic (EDV) and end-systolic (ESV) volume and ejection fraction (EF) to assess reconstruction methods especially for higher pulsation rates. MATERIALS AND METHODS A pulsating device (AZ-631N, Anzai Medical) with contrast material (300 mgI/dl) diluted 10x with saline was moved at 40-110 to-and-fro movements/min. ECG-gated MSCT was performed x5 per pulsation rate. The EDV and ESV were measured using workstation (Virtual Place Advance Plus, Aze). RESULTS The mean EDV and ESV were 98, 97, 97 96, 95, 94, and 101% and 145, 143, 142, 144, 145, 149, 156 and 160%, respectively, compared to the static state. EF was 80, 81, 81, 80, 79, 77, 73, and 76% at 40-110 pulsations/min, when reconstructed by the segmented method, but was improved to 82, 83, 85, and 84% at 80-110 beat/min when reconstructed by the burst method. The latter is therefore more appropriate for higher rates. CONCLUSION This 64-DAS MSCT can measure EDV even at high beat rates (up to 110 beats per minute) compared to the static state. Because ESV tended to be overestimated by approximately 140-160% compared with the static state, EF tended to be underestimated by approximately 73-81% compared with the static state. However, at higher beat rates of >70 beat/min, an appropriate reconstruction method (the burst method) may further improve the accuracy of EF measurement.
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Nakamura K, Funabashi N, Uehara M, Suzuki K, Terao M, Okubo K, Mita Y, Maeda F, Komuro I. Quantitative 4-dimensional volumetric analysis of left ventricle in ischemic heart disease by 64-slice computed tomography: a comparative study with invasive left ventriculogram. Int J Cardiol 2008; 129:42-52. [PMID: 17707526 DOI: 10.1016/j.ijcard.2007.06.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 06/30/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To elucidate the usefulness of CT in evaluating left ventricular (LV) volumes and ejection fraction (EF) in ischemic heart disease (IHD), we compared 64-slice CT with conventional left ventriculography (CLVG). MATERIALS AND METHODS 71 subjects with suspected or confirmed IHD underwent ECG-gated enhanced CT before or after cardiac catheterization. End-diastolic volume (EDV) and end-systolic volume (ESV) of LV were selected in 20 phases of R-R interval of ECG, and data sets were reconstructed to determine EDV, ESV, SV, and EF of LV using a multislice area summation method; in CLVG these parameters were calculated from the right anterior oblique 30-degree projection. RESULTS Correlation coefficients between CT and CLVG for EDV, ESV, SV, and EF were 0.759, 0.895, 0.550, and 0.836, respectively (P<0.01). In 35 subjects without apical asynergy of LV wall motion, correlation coefficients between CT and CLVG were 0.77, 0.91, 0.63, and 0.87 respectively (P<0.01); in 36 subjects, with apical asynergy, the correlation coefficients were 0.751, 0.875, 0.503, and 0.738, respectively (P<0.01). The limits of agreement of all parameters were wider in the subjects with apical asynergy of LV wall motion than the subjects without. CONCLUSION There was good correlation between EDV, ESV, SV, and EF estimated by CT and those by CLVG, but CT tended to overestimate EDV and ESV and underestimate EF. In subjects with apical asynergy of LV wall motion, estimates of EF were less correlated between CT and CLVG and the limits of agreement of all parameters were wider than in those without. These discrepancies may come from the capability of CT to estimate LV wall asynergy 3-dimensionally and more accurately.
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Affiliation(s)
- Koki Nakamura
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
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DOĞAN H, VELDKAMP WJH, DIBBETS-SCHNEIDER P, SPIJKERBOER AM, MERTENS BJA, KROFT LJM, DE ROOS A, GELEIJNS J. Effects of heart rate, filling and slice thickness on the accuracy of left ventricular volume measurements in a dynamic cardiac phantom using ECG-gated MDCT. Br J Radiol 2008; 81:577-82. [DOI: 10.1259/bjr/92798700] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Alter P, Rupp H, Rominger MB, Vollrath A, Czerny F, Figiel JH, Adams P, Stoll F, Klose KJ, Maisch B. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem 2008; 314:179-91. [PMID: 18461428 DOI: 10.1007/s11010-008-9779-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/22/2008] [Indexed: 01/20/2023]
Abstract
Background Although B-type natriuretic peptide (BNP) is used as complimentary diagnostic tool in patients with unknown thoracic disorders, many other factors appear to trigger its release. In particular, it remains unresolved to what extent cellular stretch or wall stress of the whole heart contributes to enhanced serum BNP concentration. Wall stress cannot be determined directly, but has to be calculated from wall volume, cavity volume and intraventricular pressure of the heart. The hypothesis was, therefore, addressed that wall stress as determined by cardiac magnetic resonance imaging (CMR) is the major determinant of serum BNP in patients with a varying degree of left ventricular dilatation or dysfunction (LVD). Methods A thick-walled sphere model based on volumetric analysis of the LV using CMR was compared with an echocardiography-based approach to calculate LV wall stress in 39 patients with LVD and 21 controls. Serum BNP was used as in vivo marker of a putatively raised wall stress. Nomograms of isostress lines were established to assess the extent of load reduction that is necessary to restore normal wall stress and related biochemical events. Results Both enddiastolic and endsystolic LV wall stress were correlated with the enddiastolic LV volume (r = 0.54, P < 0.001; r = 0.81, P < 0.001). LV enddiastolic wall stress was related to pulmonary pressure (capillary: r = 0.69, P < 0.001; artery: r = 0.67, P < 0.001). Although LV growth was correlated with the enddiastolic and endsystolic volume (r = 0.73, P < 0.001; r = 0.70, P < 0.001), patients with LVD exhibited increased LV wall stress indicating an inadequately enhanced LV growth. Both enddiastolic (P < 0.05) and endsystolic (P < 0.01) wall stress were increased in patients with increased BNP. In turn, BNP concentration was elevated in individuals with increased enddiastolic wall stress (>8 kPa: 587 +/- 648 pg/ml, P < 0.05; >12 kPa: 715 +/- 661 pg/ml, P < 0.001; normal < or =4 kPa: 124 +/- 203 pg/ml). Analysis of variance revealed LV enddiastolic wall stress as the only independent hemodynamic parameter influencing BNP (P < 0.01). Using nomograms with "isostress" curves, the extent of load reduction required for restoring normal LV wall stress was assessed. Compared with the CMR-based volumetric analysis for wall stress calculation, the echocardiography based approach underestimated LV wall stress particularly of dilated hearts. Conclusions In patients with LVD, serum BNP was increased over the whole range of stress values which were the only hemodynamic predictors. Cellular stretch appears to be a major trigger for BNP release. Biochemical mechanisms need to be explored which appear to operate over this wide range of wall stress values. It is concluded that the diagnostic use of BNP should primarily be directed to assess ventricular wall stress rather than the extent of functional ventricular impairment in LVD.
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Affiliation(s)
- P Alter
- Internal Medicine, Cardiology, Philipps University, Baldingerstrasse, Marburg, Germany.
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van der Vleuten PA, Rasoul S, Huurnink W, van der Horst IC, Slart RH, Reiffers S, Dierckx RA, Tio RA, Ottervanger JP, De Boer MJ, Zijlstra F. The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention. BMC Cardiovasc Disord 2008; 8:4. [PMID: 18294397 PMCID: PMC2278125 DOI: 10.1186/1471-2261-8-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 02/23/2008] [Indexed: 11/10/2022] Open
Abstract
Background In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF), assessed by planar radionuclide ventriculography (PRV), after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods In total 925 patients underwent PRV for LVEF assessment after PPCI for myocardial infarction before discharge from the hospital. PRV was performed with a standard dose of 500 Mbq of 99mTc-pertechnetate. Average follow-up time was 2.5 years. Results Mean (± SD) age was 60 ± 12 years. Mean (± SD) LVEF was 45.7 ± 12.2 %. 1 year survival was 97.3 % and 3 year survival was 94.2 %. Killip class, multi vessel-disease, previous cardiovascular events, peak creatin kinase and its MB fraction, age and LVEF proved to be univariate predictors of mortality. When entered in a forward conditional Cox regression model age and LVEF were independent predictors of 1 and 3 year mortality. Conclusion LVEF assessed by PRV is a powerful independent predictor of long term mortality after PPCI for STEMI.
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van der Heide J, Mannaerts H, Yang L, Sieswerda G, Visser† C, Kamp O. Contrast-enhanced versus non-enhanced three-dimensional echocardiography of left ventricular volumes. Neth Heart J 2008; 16:47-52. [PMID: 18335021 PMCID: PMC2245811 DOI: 10.1007/bf03086117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In three-dimensional echocardiography (3DE), individual endocardial trabeculae are not clearly visible necessitating left ventricular (LV) volumes to be measured by tracing the innermost endocardial contour. Ultrasound contrast agents aim to improve endocardial definition, but may delineate the outermost endocardial contour by filling up intertrabecular space. Although measurement reproducibility may benefit, there may be a significant influence on absolute LV volume measurements. METHODS Twenty patients with a recent myocardial infarction and good ultrasound image quality underwent 3DE using the TomTec Freehand method before and during continuous intravenous contrast infusion. LV volumes were measured offline using TomTec Echo-Scan software. RESULTS The use of contrast enhancement increased end-diastolic (110+/-35 vs. 144+/-53 ml; p<0.01) and end-systolic volume measurements (68+/-31 vs. 87+/-45 ml; p<0.01) significantly compared with non-contrast; the ejection fraction remained unchanged (40+/-13 vs. 41+/-14%, p=NS). Measurement reproducibility did not improve significantly, however. CONCLUSION Volumes measured by 3DE are significantly larger when ultrasound contrast is used. Possibly, intertrabecular space comprises a substantial part of the LV cavity. In the presence of an adequate apical acoustic window, ultrasound contrast does not improve LV volume measurement reproducibility. (Neth Heart J 2008;16:47-52.).
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Affiliation(s)
- J.A. van der Heide
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - H.F.J. Mannaerts
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - L. Yang
- Department of Cardiology, the Second Affiliated Hospital, Sun Yat-Sen University, Ghangzou, People’s Republic of China
| | - G.T. Sieswerda
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C.A. Visser†
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - O. Kamp
- Department of Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
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Hergan K, Schuster A, Frühwald J, Mair M, Burger R, Töpker M. Comparison of left and right ventricular volume measurement using the Simpson's method and the area length method. Eur J Radiol 2008; 65:270-8. [PMID: 17498903 DOI: 10.1016/j.ejrad.2007.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 03/14/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare ventricular volume measurement using a volumetric approach in the three standard cardiac planes and ventricular volume estimation by a geometrical model, the Area-Length method (ALM). MATERIALS AND METHODS Fifty-six healthy volunteers were examined (27 males, 29 females) on a 1.5T MR-unit with ECG-triggered steady state free precision (SSFP) Cine-MR sequences and parallel image acquisition. Multiple slices in standardized planes including the short-axis view (sa), 4-chamber view (4ch), left and right 2-chamber views (2ch) were used to cover the whole heart. End-systolic and end-diastolic ventricular volumes (EDV, ESV), stroke volume (SV), and ejection fraction (EF) were calculated with Simpson's rule in all planes and with ALM in the 2ch and 4ch planes. Global function parameters measured in the sa plane were compared with those obtained in the other imaging planes. RESULTS A very good correlation is observed when comparing functional parameters calculated with Simpson's rule in all imaging planes: for instance, the mean EDV/ESV of the left and right ventricle of the female population group measured in sa, 4ch, and 2ch: left ventricle EDV/ESV 114.3/44.4, 120.9/46.5, and 117.7/45.3 ml; right ventricle EDV/ESV 106.6/46.0, 101.2/41.1, and 103.5/43.0 ml. Functional parameters of the left ventricle calculated with ALM in 2ch and 4ch correlate to parameters obtained in sa with Simpson's rule in the range of 5-10%: for instance, the EDV/ESV of the left ventricle of the male population group measured in the sa, 4ch, and 2ch: 160.3/63.5, 163.1/59.0, and 167.0/65.7 ml. Functional parameters of the right ventricle measured with ALM in 4ch are 40-50% lower and calculated in 2ch almost double as high as compared with the parameters obtained in sa with Simpson's rule: for instance, male right ventricular EDV/ESV measured in sa, 4ch, and 2ch: 153.4/68.1, 97.5/34.5, and 280.2/123.2 ml. The EF correlates for all imaging planes measured with the Simpson's rule in both ventricles and using ALM in the left ventricle except for males with an overestimation of less than 6%. The EF of the right ventricle is calculated higher using ALM in 4ch and 2ch compared to the EF calculated in sa: female/male EF of the right ventricle measured in the sa, 4ch, and 2ch: 56.8/55.7, 66.0/65.0, and 60.0/57.0%. CONCLUSION In the setting of healthy volunteers the ALM method should not be used in 2ch and 4ch planes of the right ventricle because of lacking correlation of global functional parameters compared to those obtained in the sa plane. Using Simpson's rule functional parameters correlate well to each other in the different imaging planes.
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Affiliation(s)
- Klaus Hergan
- Department of Radiology, Paracelsus Medical University Salzburg, Austria.
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Jahnke C, Nagel E, Gebker R, Bornstedt A, Schnackenburg B, Kozerke S, Fleck E, Paetsch I. Four-dimensional single breathhold magnetic resonance imaging using kt-BLAST enables reliable assessment of left- and right-ventricular volumes and mass. J Magn Reson Imaging 2007; 25:737-42. [PMID: 17347994 DOI: 10.1002/jmri.20877] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To prospectively determine the accuracy of four-dimensional (4D) kt-broad-use linear acquisition speed-up technique (BLAST) accelerated MRI (kt-BLAST) for the assessment of left-ventricular (LV) volumes and mass as well as right-ventricular (RV) volumes in comparison to standard multiple breathhold cine imaging. MATERIALS AND METHODS A total of 40 patients with suspected or known coronary artery disease (CAD) underwent cardiac MRI. In each patient a standard multislice cine steady-state free precession (SSFP) sequence was performed with complete ventricular coverage during multiple breathholds. Additionally, a kt-BLAST-accelerated 4D sequence with complete ventricular coverage was acquired during one single breathhold. For comparison of SSFP and kt-BLAST, the following LV parameters were determined: end-diastolic and end-systolic volumes, ejection fraction, end-diastolic diameter and mass. For comparison of RV dimensions, end-diastolic and end-systolic volumes and ejection fraction were assessed. RESULTS LV volumes, ejection fraction, diameter, and mass showed a strong correlation between SSFP and kt-BLAST (r=0.98-0.99; P<0.01). In addition, RV parameters demonstrated a high correlation (r=0.97-0.98; P<0.01). For all parameters, the calculated bias between both methods was found to be minimal (0.4-4%). CONCLUSION 4D kt-BLAST-accelerated MRI enabled the accurate assessment of LV and RV quantitative parameters during one single breathhold when compared to standard multislice, multiple breathhold SSFP imaging.
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Affiliation(s)
- Cosima Jahnke
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.
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Slomka PJ, Fieno D, Ramesh A, Goyal V, Nishina H, Thompson LEJ, Saouaf R, Berman DS, Germano G. Patient motion correction for multiplanar, multi-breath-hold cardiac cine MR imaging. J Magn Reson Imaging 2007; 25:965-73. [PMID: 17457798 DOI: 10.1002/jmri.20909] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To correct for spatial misregistration of multi-breath-hold short-axis (SA), two-chamber (2CH), and four-chamber (4CH) cine cardiac MR (CMR) images caused by respiratory and patient motion. MATERIALS AND METHODS Twenty CMR studies from consecutive patients with separate breath-hold 2CH, 4CH, and SA 20-phase cine images were considered. We automatically registered the 2CH, 4CH, and SA images in three dimensions by minimizing the cost function derived from plane intersections for all cine phases. The automatic alignment was compared with manual alignment by two observers. RESULTS The processing time for the proposed method was <20 seconds, compared to 14-24 minutes for the manual correction. The initial plane displacement identified by the observers was 2.8 +/- 1.8 mm (maximum = 14 mm). A displacement of >/=5 mm was identified in 15 of 20 studies. The registration accuracy (defined as the difference between the automatic parameters and those obtained by visual registration) was 1.0 +/- 0.9 mm, 1.1 +/- 1.0 mm, 1.1 +/- 1.2 mm, and 2.0 +/- 1.8 mm for 2CH-4CH alignment and SA alignment in the mid, basal, and apical regions, respectively. The algorithm variability was higher in the apex (2.0 +/- 1.9 mm) than in the mid (1.4 +/- 1.4 mm) or basal (1.2 +/- 1.2 mm) regions (ANOVA, P < 0.05). CONCLUSION An automated preprocessing algorithm can reduce spatial misregistration between multiple CMR images acquired at different breath-holds and plane orientations.
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Affiliation(s)
- Piotr J Slomka
- Department of Imaging, Cedars-Sinai Medical Center, #A047 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
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Inoue Y, Nomura Y, Nakaoka T, Watanabe M, Kiryu S, Okubo T, Ohtomo K. Effect of temporal resolution on the estimation of left ventricular function by cardiac MR imaging. Magn Reson Imaging 2006; 23:641-5. [PMID: 16051038 DOI: 10.1016/j.mri.2005.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Accepted: 04/11/2005] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate the effect of temporal resolution on the estimation of left ventricular (LV) function by cardiac magnetic resonance (MR) imaging using a steady-state free precession (SSFP) sequence. Left ventricular function was assessed by cine MR imaging using a segmented SSFP sequence in 10 healthy volunteers. Views per segment (VPS) were set at 8 and 20, resulting in high and low true temporal resolution, respectively. Irrespective of VPS, images were reconstructed at 40 cardiac phases, providing high apparent temporal resolution. Data were analyzed using 40, 20 and 10 phases to simulate different apparent temporal resolutions. Increasing the cardiac phases used for analysis slightly decreased mean end-systolic volume (ESV) and slightly increased mean ejection fraction (EF). No substantial difference in estimates of end-diastolic volume (EDV) was found between VPSs of 8 and 20. Imaging with a VPS of 20 yielded a larger ESV and smaller EF than imaging with a VPS of 8 when 40 phases were used. In conclusion, low true temporal resolution causes overestimation of ESV and underestimation of EF. Improvement of apparent temporal resolution mildly reduces but does not eliminate the errors caused by low true temporal resolution.
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Affiliation(s)
- Yusuke Inoue
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan.
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Nomura Y, Inoue Y, Yokoyama I, Nakaoka T, Itoh D, Okubo T, Ohtomo K. Evaluation of left ventricular function with cardiac magnetic resonance imaging using Fourier fitting. Magn Reson Imaging 2006; 24:1333-9. [PMID: 17145405 DOI: 10.1016/j.mri.2006.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Accepted: 07/30/2006] [Indexed: 11/29/2022]
Abstract
The aims of this study were to investigate the applicability of Fourier fitting in the magnetic resonance (MR) evaluation of left ventricular (LV) function and to determine the optimal number of harmonics for fitting. Cine cardiac MR imaging was performed in 10 subjects, and an LV time-volume curve was generated. Fourier fitting was applied to the original curve using 1-10 harmonics, and the qualities of the time-volume curve and first-derivative curve were evaluated. LV functional parameters were calculated from curves generated with and without fitting. The quality of the original time-volume curve was good, and Fourier fitting had no substantial effect on functional parameters obtained directly from the time-volume curve such as ejection fraction. The first-derivative curve generated without fitting showed substantial artificial fluctuation. The application of Fourier fitting depressed the fluctuation and tended to decrease estimates of peak ejection rate and peak filling rate. Five or six harmonics appeared to be appropriate for obtaining a high-quality first-derivative curve. In conclusion, Fourier fitting was indicated to aid in reducing the artificial fluctuation of the first-derivative curve generated from cine cardiac MR imaging and to contribute to the evaluation of functional parameters derived from the first-derivative curve.
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Affiliation(s)
- Yukihiro Nomura
- Department of Radiology, Institute of Medical Science, University of Tokyo, and Department of Cardiovascular Medicine, Sanno Hospital, Tokyo 108-8639, Japan
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Delhaye D, Remy-Jardin M, Teisseire A, Hossein-Foucher C, Leroy S, Duhamel A, Remy J. MDCT of Right Ventricular Function: Comparison of Right Ventricular Ejection Fraction Estimation and Equilibrium Radionuclide Ventriculography, Part 1. AJR Am J Roentgenol 2006; 187:1597-604. [PMID: 17114556 DOI: 10.2214/ajr.05.1193] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to calculate right ventricular ejection fraction by use of ECG-gated MDCT and to compare the results with those of equilibrium radionuclide ventriculography. SUBJECTS AND METHODS Forty-nine consecutively examined patients (30 men, 19 women; mean age, 59 years) with known or suspected right ventricular dysfunction secondary to bronchopulmonary (n = 30) or pulmonary vascular (n = 19) disease underwent ECG-gated 16-MDCT angiography of the heart (rotation time, 0.42 second; 120 kV; 300 mAs; collimation, 12 x 0.75 mm; pitch, 0.2) after CT angiographic examination of the entire thorax according to a standard protocol. Biphasic administration of a 30% contrast agent was systematically performed (phase 1, 90 mL at 3 mL/s; phase 2, 30 mL at 1.5 mL/s); no patient received additional medication. Right ventricular ejection fraction was calculated after two reviewers in consensus determined the reconstruction windows and segmentation of the right ventricular cavity on a series of diastolic and systolic short-axis images. The results were compared with those of equilibrium radionuclide ventriculography. RESULTS At data acquisition, the mean (+/- SD) heart rate of the study group was 82 +/- 13.87 beats per minute (BPM) (range, 51-115 BPM). ECG showed a sinus rhythm in 30 (61%) of the patients and irregular cardiac rhythm in 19 (39%) of the patients. Agreement between the two techniques was estimated by intraclass correlation coefficient (0.77), the method of Bland and Altman (limits of concordance, -14.9 and 13.7), and percentage of variability between two measurements expressed by mean absolute percentage error (12.1%). The estimated effective dose for heart examination was 7.48 mSv with CT and 5 mSv with scintigraphy. The mean effective dose for the chest and heart CT examinations was 11.64 mSv. CONCLUSION Right ventricular ejection fraction can be reliably estimated with 16-MDCT in unselected patients.
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Affiliation(s)
- Damien Delhaye
- Department of Thoracic Imaging, Hospital Calmette, University Center of Lille, Blvd. Jules Leclerc, 59037 Lille, France
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