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Hou Y, Zhou H, Li Y, Mao T, Luo J, Yang J. Hemodynamic Force Based on Cardiac Magnetic Resonance Imaging: State of the Art and Perspective. J Magn Reson Imaging 2024. [PMID: 38958118 DOI: 10.1002/jmri.29483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024] Open
Abstract
Intracardiac blood flow has long been proposed to play a significant role in cardiac morphology and function. However, absolute blood pressure within the heart has mainly been measured by invasive catheterization, which limits its application. Hemodynamic force (HDF) is the global force of intracavitary blood flow acquired by integrating the intraventricular pressure gradient over the entire ventricle and thus may be a promising tool for accurately characterizing cardiac function. Recent advances in magnetic resonance imaging technology allow for a noninvasive measurement of HDF through both 4D flow cardiac MRI and cine cardiac MRI. The HDF time curve provides comprehensive data for both qualitative and quantitative analysis. In this review, a series of HDF parameters is introduced and a summary of the current literature regarding HDF in clinical practice is presented. Additionally, the current dilemmas and future prospects are discussed in order to contribute to the future research. LEVEL OF EVIDENCE: 5. TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yangzhen Hou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yajuan Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ting Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Luo
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ji Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Schulz A, Mittelmeier H, Wagenhofer L, Backhaus SJ, Lange T, Evertz R, Kutty S, Kowallick JT, Hasenfuß G, Schuster A. Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients. Int J Cardiovasc Imaging 2024; 40:853-862. [PMID: 38236362 PMCID: PMC11052864 DOI: 10.1007/s10554-024-03054-6] [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: 11/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Hannah Mittelmeier
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Lukas Wagenhofer
- Institute of Biomedical Imaging, University of Technology Graz, Graz, Austria
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, 21287, USA
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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Yang W, Wang Y, Zhu L, Xu J, Wu W, Zhou D, Sirajuddin A, Arai AE, Zhao S, Lu M. Unravelling the intricacies of left ventricular haemodynamic forces: age and gender-specific normative values assessed by cardiac MRI in healthy adults. Eur Heart J Cardiovasc Imaging 2024; 25:229-239. [PMID: 37724746 PMCID: PMC11046054 DOI: 10.1093/ehjci/jead234] [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: 06/18/2023] [Revised: 08/05/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS Haemodynamic forces (HDFs) provided a feasible method to early detect cardiac mechanical abnormalities by estimating the intraventricular pressure gradients. The novel advances in assessment of HDFs using routine cardiac magnetic resonance (CMR) cines shed new light on detection of preclinical dysfunction. However, definition of normal values for this new technique is the prerequisite for application in the clinic. METHODS AND RESULTS A total of 218 healthy volunteers [38.1 years ± 11.1; 111 male (50.9%)] were recruited and underwent CMR examinations with a 3.0T scanner. Balanced steady state free precession breath hold cine images were acquired, and HDF assessments were performed based on strain analysis. The normal values of longitudinal and transversal HDF strength [root mean square (RMS)] and ratio of transversal to longitudinal HDF were all evaluated in overall population as well as in both genders and in age-specific groups. The longitudinal RMS values (%) of HDFs were significantly higher in women (P < 0.05). Moreover, the HDF amplitudes significantly decreased with ageing in entire heartbeat, systole, diastole, systolic/diastolic transition, and diastolic deceleration, while increased in atrial thrust. In multivariable linear regression analysis, age, heart rate, and global longitudinal strain emerged as independent predictors of the amplitudes of longitudinal HDFs in entire heartbeat and systole, while left ventricular end-diastole volume index was also independently associated with longitudinal HDFs in diastole and diastolic deceleration (P < 0.05 for all). CONCLUSION Our study provided comprehensive normal values of HDF assessments using CMR as well as presented with specific age and sex stratification. HDF analyses can be performed with excellent intra- and inter-observer reproducibility.
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Affiliation(s)
- Wenjing Yang
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Yining Wang
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Leyi Zhu
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Jing Xu
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Weichun Wu
- Departments of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Di Zhou
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Arlene Sirajuddin
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Shihua Zhao
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
| | - Minjie Lu
- Departments of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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Lange T, Backhaus SJ, Schulz A, Evertz R, Schneider P, Kowallick JT, Hasenfuß G, Kelle S, Schuster A. Inter-study reproducibility of cardiovascular magnetic resonance-derived hemodynamic force assessments. Sci Rep 2024; 14:634. [PMID: 38182625 PMCID: PMC10770352 DOI: 10.1038/s41598-023-50405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR)-derived hemodynamic force (HDF) analyses have been introduced recently enabling more in-depth cardiac function evaluation. Inter-study reproducibility is important for a widespread clinical use but has not been quantified for this novel CMR post-processing tool yet. Serial CMR imaging was performed in 11 healthy participants in a median interval of 63 days (range 49-87). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, diastolic deceleration as well as atrial thrust acceleration forces. Inter-study reproducibility and study sample sizes required to demonstrate 10%, 15% or 20% relative changes of HDF measurements were calculated. In addition, intra- and inter-observer analyses were performed. Intra- and inter-observer reproducibility was excellent for all HDF parameters according to intraclass correlation coefficient (ICC) values (> 0.80 for all). Inter-study reproducibility of all HDF parameters was excellent (ICC ≥ 0.80 for all) with systolic parameters showing lower coeffients of variation (CoV) than diastolic measurements (CoV 15.2% for systolic impulse vs. CoV 30.9% for atrial thrust). Calculated sample sizes to detect relative changes ranged from n = 12 for the detection of a 20% relative change in systolic impulse to n = 200 for the detection of 10% relative change in atrial thrust. Overall inter-study reproducibility of CMR-derived HDF assessments was sufficient with systolic HDF measurements showing lower inter-study variation than diastolic HDF analyses.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Patrick Schneider
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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The DZHK research platform: maximisation of scientific value by enabling access to health data and biological samples collected in cardiovascular clinical studies. Clin Res Cardiol 2023:10.1007/s00392-023-02177-5. [PMID: 36884078 DOI: 10.1007/s00392-023-02177-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
The German Centre for Cardiovascular Research (DZHK) is one of the German Centres for Health Research and aims to conduct early and guideline-relevant studies to develop new therapies and diagnostics that impact the lives of people with cardiovascular disease. Therefore, DZHK members designed a collaboratively organised and integrated research platform connecting all sites and partners. The overarching objectives of the research platform are the standardisation of prospective data and biological sample collections among all studies and the development of a sustainable centrally standardised storage in compliance with general legal regulations and the FAIR principles. The main elements of the DZHK infrastructure are web-based and central units for data management, LIMS, IDMS, and transfer office, embedded in a framework consisting of the DZHK Use and Access Policy, and the Ethics and Data Protection Concept. This framework is characterised by a modular design allowing a high standardisation across all studies. For studies that require even tighter criteria additional quality levels are defined. In addition, the Public Open Data strategy is an important focus of DZHK. The DZHK operates as one legal entity holding all rights of data and biological sample usage, according to the DZHK Use and Access Policy. All DZHK studies collect a basic set of data and biosamples, accompanied by specific clinical and imaging data and biobanking. The DZHK infrastructure was constructed by scientists with the focus on the needs of scientists conducting clinical studies. Through this, the DZHK enables the interdisciplinary and multiple use of data and biological samples by scientists inside and outside the DZHK. So far, 27 DZHK studies recruited well over 11,200 participants suffering from major cardiovascular disorders such as myocardial infarction or heart failure. Currently, data and samples of five DZHK studies of the DZHK Heart Bank can be applied for.
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Schulz A, Schuster A. Visualizing diastolic failure: Non-invasive imaging-biomarkers in patients with heart failure with preserved ejection fraction. EBioMedicine 2022; 86:104369. [PMID: 36423377 PMCID: PMC9691917 DOI: 10.1016/j.ebiom.2022.104369] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction is an increasing challenge for modern day medicine and has been drawing more attention recently. Invasive right heart catheterization represents the mainstay for the diagnosis of diastolic dysfunction, however due to its attributable risk of an invasive procedure, other non-invasive clinical pathways are trying to approach this pathology in clinical practice. Diastolic failure is complex, and imaging is based on various parameters. In addition to transthoracic echocardiography, numerous novel imaging approaches, such as cardiac magnetic resonance imaging, computed tomography, positron emission (computed) tomography or single photon emission tomography techniques are being used to supplement deeper insights into causal pathology and might open targets for dedicated therapy options. This article provides insights into these sophisticated imaging techniques, their incremental value for the diagnosis of this poorly understood disease and recent promising results for an enhanced prognostication of outcome and therapy monitoring.
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Affiliation(s)
| | - Andreas Schuster
- Corresponding author. Department for Cardiology and Pneumology, University Medical Center, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
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