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Del Torto A, Guaricci AI, Pomarico F, Guglielmo M, Fusini L, Monitillo F, Santoro D, Vannini M, Rossi A, Muscogiuri G, Baggiano A, Pontone G. Advances in Multimodality Cardiovascular Imaging in the Diagnosis of Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2022; 9:758975. [PMID: 35355965 PMCID: PMC8959466 DOI: 10.3389/fcvm.2022.758975] [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: 08/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome defined by the presence of heart failure symptoms and increased levels of circulating natriuretic peptide (NP) in patients with preserved left ventricular ejection fraction and various degrees of diastolic dysfunction (DD). HFpEF is a complex condition that encompasses a wide range of different etiologies. Cardiovascular imaging plays a pivotal role in diagnosing HFpEF, in identifying specific underlying etiologies, in prognostic stratification, and in therapeutic individualization. Echocardiography is the first line imaging modality with its wide availability; it has high spatial and temporal resolution and can reliably assess systolic and diastolic function. Cardiovascular magnetic resonance (CMR) is the gold standard for cardiac morphology and function assessment, and has superior contrast resolution to look in depth into tissue changes and help to identify specific HFpEF etiologies. Differently, the most important role of nuclear imaging [i.e., planar scintigraphy and/or single photon emission CT (SPECT)] consists in the screening and diagnosis of cardiac transthyretin amyloidosis (ATTR) in patients with HFpEF. Cardiac CT can accurately evaluate coronary artery disease both from an anatomical and functional point of view, but tissue characterization methods have also been developed. The aim of this review is to critically summarize the current uses and future perspectives of echocardiography, nuclear imaging, CT, and CMR in patients with HFpEF.
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Affiliation(s)
- Alberico Del Torto
- Department of Emergency and Acute Cardiac Care, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Daniela Santoro
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Monica Vannini
- University Cardiology Unit, Policlinic University Hospital, Bari, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
- University Milano Bicocca, Milan, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- *Correspondence: Gianluca Pontone
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Dzhioeva O, Belyavskiy E. Diagnosis and Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): Current Perspectives and Recommendations. Ther Clin Risk Manag 2020; 16:769-785. [PMID: 32904123 PMCID: PMC7450524 DOI: 10.2147/tcrm.s207117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major global public health problem. Diagnosis of HFpEF is still challenging and built based on the comprehensive echocardiographic analysis. Currently, there are no universally accepted therapies that alter the clinical course of HFpEF. This review attempts to summarize the current advances in the diagnosis of HFpEF and provide future directions of the patients´ management with this very widespread, heterogeneous clinical syndrome.
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Affiliation(s)
- Olga Dzhioeva
- Department of Fundamental and Applied Aspects of Obesity, National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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A new non-invasive index for prognosis evaluation in patients with aortic stenosis. Sci Rep 2020; 10:7333. [PMID: 32355310 PMCID: PMC7193646 DOI: 10.1038/s41598-020-63777-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: 11/30/2019] [Accepted: 03/31/2020] [Indexed: 11/09/2022] Open
Abstract
The global left ventricular (LV) contractility index, dσ*/dtmax measures the maximal rate of change in pressure-normalized LV wall stress. We aim to describe the trend of dσ*/dtmax in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) and the association of dσ*/dtmax with clinical outcomes in moderate AS and severe AS. We retrospectively studied a total of 1738 patients with AS (550 mild AS, 738 moderate AS, 450 severe AS) and preserved LVEF ≥ 50% diagnosed from 1st January 2001 to 31st December 2015. dσ*/dtmax worsened with increasing severity of AS despite preserved LVEF (mild AS: 3.69 ± 1.28 s-1, moderate AS: 3.17 ± 1.09 s-1, severe AS: 2.58 ± 0.83 s-1, p < 0.001). Low dσ*/dtmax < 2.8 s-1 was independently associated with a higher composite outcome of aortic valve replacement, congestive cardiac failure admissions and all-cause mortality (adjusted hazard ratio 1.48, 95% CI: 1.25-1.77, p < 0.001). In conclusion, dσ*/dtmax declined with worsening AS despite preserved LVEF. Low dσ*/dtmax < 2.8 s-1 was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF.
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Latypova GM, Bychenkova MA, Katayev VA, Perfilova VN, Tyurenkov IN, Mokrousov IS, Prokofiev II, Salikhov SM, Iksanova GR. Composition and cardioprotective effects of Primula veris L. solid herbal extract in experimental chronic heart failure. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 54:17-26. [PMID: 30668367 DOI: 10.1016/j.phymed.2018.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND High interest in chronic heart failure (CHF) is accounted for by its high incidence, poor prognosis, growing number of hospital admissions due to the heart failure relapse, and inadequate treatment. These facts necessitate a search for new pharmacological agents for the CHF correction. Herbal medicinal products appear to be very promising as they have a noticeable therapeutic effect and tend to be more harmless in comparison to the most of synthesized medications. PURPOSE Our aim was to study the composition of the Primula veris L. solid herbal extract (PVSHE) and its effects on the myocardial contractile function in animals with experimental CHF. STUDY DESIGN The study design involved the identification of the raw material composition of the P. veris L. extract. For the experimental part of our research, we used the model of CHF to elucidate the cardioprotective properties of PVSHE. METHODS The active extract constituents were isolated by thin-layer chromatography and column chromatography; the extract components were identified by high-performance liquid chromatography, ultraviolet spectroscopy (UVS), and nuclear magnetic resonance spectroscopy (NMRS). To model CHF, L-isoproterenol at a dose of 2.5 mg/kg was intraperitoneally injected to the experimental rats twice a day for 21 days. Cardiac output was assessed with the loading test, adrenoreactivity test, and maximum isometric loading test; CHF markers adrenomedullin and copeptin were detected in blood plasma with ELISA kit for adrenomedullin and copeptin (Coud-Clone Corp., USA). RESULTS P. veris L. solid herbal extract contains flavonoid aglycons (apigenin, quercetine, kaemferol), flavonoid glycosides (cinarozid, rutin, hyperozid), as well as polymethoxylated flavonoids acting as chemotaxonomic markers for the genus Primula (8-methoxy-flavone; 3',4'methylenedioxy-5'-methoxyflavone). The substance 3',4'methylenedioxy-5'-methoxyflavone has been isolated from the primrose herb for the first time. We showed that the PVSHE has a cardioprotective effect when it was administered at a dose of 30 mg/kg in the experimental CHF, as evidenced by a lower number of animal death, lower level of CHF markers in the blood plasma of the experimental animals, the higher increase in rate of myocardial contraction and relaxation, the higher level of left ventricular pressure (LVP) and of maximum intensity of structural performance (MISP), as compared to the control group. CONCLUSION P. veris L. solid herbal extract contains flavonoid aglycons, flavonoid glycosides, and polymethoxylated flavonoids. The herbal agent increases the myocardial contractility in experimental CHF.
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Affiliation(s)
- G M Latypova
- FSBEE HE Bashkirsky State Medical University, Lenina st., 8, Ufa 540008, Russia
| | - M A Bychenkova
- FSBEE HE Bashkirsky State Medical University, Lenina st., 8, Ufa 540008, Russia
| | - V A Katayev
- FSBEE HE Bashkirsky State Medical University, Lenina st., 8, Ufa 540008, Russia
| | - V N Perfilova
- FSBEE HE Volgograd State Medical University, Pavshikh Bortsov sq., 1, Volgograd 400131, Russia.
| | - I N Tyurenkov
- FSBEE HE Volgograd State Medical University, Pavshikh Bortsov sq., 1, Volgograd 400131, Russia
| | - I S Mokrousov
- FSBEE HE Volgograd State Medical University, Pavshikh Bortsov sq., 1, Volgograd 400131, Russia
| | - I I Prokofiev
- FSBEE HE Volgograd State Medical University, Pavshikh Bortsov sq., 1, Volgograd 400131, Russia
| | - Sh M Salikhov
- Ufa Institute of the Chemistry of the Russian Academy of Sciences, Oktyabrya av., 71, Ufa 450054, Russia
| | - G R Iksanova
- FSBEE HE Bashkirsky State Medical University, Lenina st., 8, Ufa 540008, Russia
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Zou H, Xi C, Zhao X, Koh AS, Gao F, Su Y, Tan RS, Allen J, Lee LC, Genet M, Zhong L. Quantification of Biventricular Strains in Heart Failure With Preserved Ejection Fraction Patient Using Hyperelastic Warping Method. Front Physiol 2018; 9:1295. [PMID: 30283352 PMCID: PMC6156386 DOI: 10.3389/fphys.2018.01295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) imposes a major global health care burden on society and suffering on the individual. About 50% of HF patients have preserved ejection fraction (HFpEF). More intricate and comprehensive measurement-focused imaging of multiple strain components may aid in the diagnosis and elucidation of this disease. Here, we describe the development of a semi-automated hyperelastic warping method for rapid comprehensive assessment of biventricular circumferential, longitudinal, and radial strains that is physiological meaningful and reproducible. We recruited and performed cardiac magnetic resonance (CMR) imaging on 30 subjects [10 HFpEF, 10 HF with reduced ejection fraction patients (HFrEF) and 10 healthy controls]. In each subject, a three-dimensional heart model including left ventricle (LV), right ventricle (RV), and septum was reconstructed from CMR images. The hyperelastic warping method was used to reference the segmented model with the target images and biventricular circumferential, longitudinal, and radial strain-time curves were obtained. The peak systolic strains are then measured and analyzed in this study. Intra- and inter-observer reproducibility of the biventricular peak systolic strains was excellent with all ICCs > 0.92. LV peak systolic circumferential, longitudinal, and radial strain, respectively, exhibited a progressive decrease in magnitude from healthy control→HFpEF→HFrEF: control (-15.5 ± 1.90, -15.6 ± 2.06, 41.4 ± 12.2%); HFpEF (-9.37 ± 3.23, -11.3 ± 1.76, 22.8 ± 13.1%); HFrEF (-4.75 ± 2.74, -7.55 ± 1.75, 10.8 ± 4.61%). A similar progressive decrease in magnitude was observed for RV peak systolic circumferential, longitudinal and radial strain: control (-9.91 ± 2.25, -14.5 ± 2.63, 26.8 ± 7.16%); HFpEF (-7.38 ± 3.17, -12.0 ± 2.45, 21.5 ± 10.0%); HFrEF (-5.92 ± 3.13, -8.63 ± 2.79, 15.2 ± 6.33%). Furthermore, septum peak systolic circumferential, longitudinal, and radial strain magnitude decreased gradually from healthy control to HFrEF: control (-7.11 ± 1.81, 16.3 ± 3.23, 18.5 ± 8.64%); HFpEF (-6.11 ± 3.98, -13.4 ± 3.02, 12.5 ± 6.38%); HFrEF (-1.42 ± 1.36, -8.99 ± 2.96, 3.35 ± 2.95%). The ROC analysis indicated LV peak systolic circumferential strain to be the most sensitive marker for differentiating HFpEF from healthy controls. Our results suggest that the hyperelastic warping method with the CMR-derived strains may reveal subtle impairment in HF biventricular mechanics, in particular despite a "normal" ventricular ejection fraction in HFpEF.
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Affiliation(s)
- Hua Zou
- National Heart Centre Singapore, Singapore, Singapore
| | - Ce Xi
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore
| | - Yi Su
- Institute of High Performance Computing, A∗STAR, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Martin Genet
- Mechanics Department and Solid Mechanics Laboratory, École Polytechnique, C.N.R.S., Université Paris-Saclay, Palaiseau, France.,M3DISIM Team, I.N.R.I.A, Université Paris-Saclay, Palaiseau, France
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Peng J, Zhao X, Zhao L, Fan Z, Wang Z, Chen H, Leng S, Allen J, Tan RS, Koh AS, Ma X, Lou M, Zhong L. Normal Values of Myocardial Deformation Assessed by Cardiovascular Magnetic Resonance Feature Tracking in a Healthy Chinese Population: A Multicenter Study. Front Physiol 2018; 9:1181. [PMID: 30233388 PMCID: PMC6129778 DOI: 10.3389/fphys.2018.01181] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/06/2018] [Indexed: 01/15/2023] Open
Abstract
Reference values on atrial and ventricular strain from cardiovascular magnetic resonance (CMR) are essential in identifying patients with impaired atrial and ventricular function. However, reference values have not been established for Chinese subjects. One hundred and fifty healthy volunteers (75 Males/75 Females; 18–82 years) were recruited. All underwent CMR scans with images acceptable for further strain analysis. Subjects were stratified by age: Group 1, 18–44 years; Group 2, 45–59 years; Group 3, ≥60 years. Feature tracking of CMR cine imaging was used to obtain left atrial global longitudinal (LA Ell) and circumferential strains (LA Ecc) and respective systolic strain rates, left ventricular longitudinal (LV Ell), circumferential (LV Ecc) and radial strains (LV Err) and their respective strain rates, and right ventricular longitudinal strain (RV Ell) and strain rate. LA Ell and LA Ecc were 32.8 ± 9.2% and 40.3 ± 13.4%, respectively, and RV Ell was −29.3 ± 6.0%. LV Ell, LV Ecc and LV Err were −22.4 ± 2.9%, −24.3 ± 3.1%, and 79.0 ± 19.4%, respectively. LV Ell and LV Ecc were higher in females than males (P < 0.05). LA Ell, LA Ecc, and LV Ecc decreased, while LV Err increased with age (P < 0.05). LV Ell and RV Ell were not shown to be associated with age. Normal ranges for atrial and ventricular strain and strain rates are provided using CMR feature tracking in Chinese subjects.
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Affiliation(s)
- Junping Peng
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Post-Doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Xiaohai Ma
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingwu Lou
- Post-Doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Mathew AV, Seymour EM, Byun J, Pennathur S, Hummel SL. Altered Metabolic Profile With Sodium-Restricted Dietary Approaches to Stop Hypertension Diet in Hypertensive Heart Failure With Preserved Ejection Fraction. J Card Fail 2015; 21:963-7. [PMID: 26497755 PMCID: PMC4720261 DOI: 10.1016/j.cardfail.2015.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a distinct entity with unique pathophysiology. In the Dietary Approaches to Stop Hypertension in Diastolic Heart Failure (DASH-DHF) study, the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) was associated with improved blood pressure and cardiovascular function in 13 hypertensive patients with HFpEF. With the use of targeted metabolomics, we explored metabolite changes and their relationship with energy-dependent measures of cardiac function in DASH-DHF. METHODS AND RESULTS With the use of chromatography and mass spectrometry, 152 metabolites including amino acids, free fatty acids, phospholipids, diglycerides, triglycerides, cholesterol esters, and acyl carnitines were measured. Comparison of baseline and post-DASH/SRD samples revealed increases in short-chain acetyl, butryl, and propionyl carnitines (P values .02, .03, .03, respectively). Increases in propionyl carnitine correlated with ventricular-arterial coupling ratio (Ees:Ea; r = 0.78; P = .005) and ventricular contractility (maximum rate of change of pressure-normalized stress [dσ*/dtmax]; r = 0.66; P = .03). Changes in L-carnitine also correlated with Ees:Ea (r = 0.62; P = .04) and dσ*/dtmax (r = 0.60; P = .05) and inversely with ventricular stiffness (r = -0.63; P = .03). CONCLUSIONS Metabolite profile changes of patients with HFpEF during dietary modification with the use of DASH/SRD suggest improved energy substrate utilization. Additional studies are needed to clarify connections between diet, metabolic changes, and myocardial function in HFpEF.
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Affiliation(s)
- Anna V Mathew
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - E Mitchell Seymour
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jaeman Byun
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Subramaniam Pennathur
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Scott L Hummel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
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Teo SK, Vos FJA, Tan RS, Zhong L, Su Y. Regional ejection fraction and regional area strain for left ventricular function assessment in male patients after first-time myocardial infarction. J R Soc Interface 2015; 12:rsif.2015.0006. [PMID: 25694545 DOI: 10.1098/rsif.2015.0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this work, we present a method to assess left ventricle (LV) regional function from cardiac magnetic resonance (CMR) imaging based on the regional ejection fraction (REF) and regional area strain (RAS). CMR scans were performed for 30 patients after first-time myocardial infarction (MI) and nine age- and sex-matched healthy volunteers. The CMR images were processed to reconstruct three-dimensional LV geometry, and the REF and RAS in a 16-segment model were computed using our proposed methodology. The method of computing the REF was tested and shown to be robust against variation in user input. Furthermore, analysis of data was feasible in all patients and healthy volunteers without any exclusions. The REF correlated well with the RAS in a nonlinear manner (quadratic fit-R(2) = 0.88). In patients after first-time MI, the REF and RAS were significantly reduced across all 16 segments (REF: p < 0.05; RAS: p < 0.01). Moreover, the REF and RAS significantly decreased with the extent of transmural scar obtained from late gadolinium-enhanced CMR images. In addition, we show that the REF and RAS can be used to identify regions with compromised function in the patients with preserved global ejection fraction with reasonable accuracy (more than 78%). These preliminary results confirmed the validity of our approach for accurate analysis of LV regional function. Our approach potentially offers physicians new insights into the local characteristics of the myocardial mechanics after a MI.
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Affiliation(s)
- Soo-Kng Teo
- Department of Computing Science, Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - F J A Vos
- Department of Computing Science, Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore Technical Medicine, University of Twente, Maarn, The Netherlands
| | - Ru-San Tan
- National Heart Centre Singapore, Republic of Singapore Duke-NUS Graduate Medical School Singapore, Republic of Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Republic of Singapore Duke-NUS Graduate Medical School Singapore, Republic of Singapore
| | - Yi Su
- Department of Computing Science, Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
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9
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Leng S, Zhao XD, Huang FQ, Wong JI, Su BY, Allen JC, Kassab GS, Tan RS, Zhong L. Automated quantitative assessment of cardiovascular magnetic resonance-derived atrioventricular junction velocities. Am J Physiol Heart Circ Physiol 2015; 309:H1923-35. [PMID: 26408537 DOI: 10.1152/ajpheart.00284.2015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/23/2015] [Indexed: 11/22/2022]
Abstract
The assessment of atrioventricular junction (AVJ) deformation plays an important role in evaluating left ventricular systolic and diastolic function in clinical practice. This study aims to demonstrate the effectiveness and consistency of cardiovascular magnetic resonance (CMR) for quantitative assessment of AVJ velocity compared with tissue Doppler echocardiography (TDE). A group of 145 human subjects comprising 21 healthy volunteers, 8 patients with heart failure, 17 patients with hypertrophic cardiomyopathy, 52 patients with myocardial infarction, and 47 patients with repaired Tetralogy of Fallot were prospectively enrolled and underwent TDE and CMR scan. Six AVJ points were tracked with three CMR views. The peak systolic velocity (Sm1), diastolic velocity during early diastolic filling (Em), and late diastolic velocity during atrial contraction (Am) were extracted and analyzed. All CMR-derived septal and lateral AVJ velocities correlated well with TDE measurements (Sm1: r = 0.736; Em: r = 0.835; Am: r = 0.701; Em/Am: r = 0.691; all p < 0.001) and demonstrated excellent reproducibility [intrastudy: r = 0.921-0.991, intraclass correlation coefficient (ICC): 0.918-0.991; interstudy: r = 0.900-0.970, ICC: 0.887-0.957; all p < 0.001]. The evaluation of three-dimensional AVJ motion incorporating measurements from all views better differentiated normal and diseased states [area under the curve (AUC) = 0.918] and provided further insights into mechanical dyssynchrony diagnosis in HF patients (AUC = 0.987). These findings suggest that the CMR-based method is feasible, accurate, and consistent in quantifying the AVJ deformation, and subsequently in diagnosing systolic and diastolic cardiac dysfunction.
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Affiliation(s)
| | | | - Fei-Qiong Huang
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
| | | | - Bo-Yang Su
- National Heart Centre Singapore, Singapore
| | | | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
| | - Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
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10
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Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System. J Am Soc Echocardiogr 2015; 28:1070-82. [DOI: 10.1016/j.echo.2015.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/22/2022]
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11
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ZHONG LIANG, WANG YIJIA, HUANG FEIQIONG, GHISTA DHANJOO, TAN RUSAN. DECREASED LEFT VENTRICULAR CONTRACTILITY AND VENTRICULAR-ARTERIAL MATCHING INDEX CORRELATION WITH N-TERMINAL PRO B-TYPE NATRIURETIC PEPTIDE IN HEART FAILURE. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study is aimed to assess (1) Left ventricle (LV) contractile function and ventricular-arterial matching from echocardiography; (2) whether ventricular-arterial matching (VAM) is associated with N-terminal pro B-type natriuretic peptide (NT-proBNP), and stroke output in patients with heart failure. Normal subjects (n = 81) and heart failure patients (n = 80) underwent echocardiography, Doppler echocardiography and tissue Doppler imaging. Only heart failure patients underwent blood test for NT-proBNP. The LV contractility was calculated as dσ ⁎ /dt max = 3 × (dV/dt) max /2V m = 3 × V peak × (π × D2/4)/(2V m ), and the arterial elastance was calculated as Ea = SBP × 0.9/ SV , wherein V peak and D are peak velocity and diameter of LV outflow tract, Vm is myocardial volume, SBP is the systolic blood pressure and SV is stroke volume measured from LVOT. The VAM index was expressed as the ratio of LV contractility to arterial elastance (dσ ⁎ /dt max /Ea). We found that HF patients had (i) decreased dσ ⁎ /dt max (1.46 ± 0.73 versus 4.06 ± 1.06 s-1), (ii) increased Ea (2.90 ± 0.87 versus 1.81 ± 0.38 mmHg/mL), and (iii) attenuated ventricular-arterial matching index (0.66 ± 0.57 versus 2.38 ± 0.91 mL/mmHg⋅s) (all p < 0.001) compared with normal subjects. The VAM index was correlated inversely with NT-proBNP (r = -0.32, p < 0.05), but positively with the stroke volume (r = 0.85, p < 0.001). The VAM index of < 1.51 was able to clearly differentiate the failing heart from normal hearts (AUC = 0.959, Sensitivity = 0.911, Specificity = 0.905). Heart failure patients demonstrated impaired ventricular contractility, enhanced arterial stiffening, and attenuated ventricular-arterial matching index. The attenuated ventricular-arterial matching index value was associated with elevated NT-proBNP levels and lower cardiac output.
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Affiliation(s)
- LIANG ZHONG
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| | - YI-JIA WANG
- SIM University, 416 Clementi Road, Singapore 599491, Singapore
| | - FEI-QIONG HUANG
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | | | - RU-SAN TAN
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857, Singapore
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12
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Huang FQ, Tan RS, Sim D, Le TT, Zhong L. Left Ventricular Diastolic Function Assessment Using Time Differences Between Mitral Annular Velocities and Transmitral Inflow Velocities in Patients with Heart Failure. Heart Lung Circ 2015; 24:257-63. [DOI: 10.1016/j.hlc.2014.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
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13
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Abstract
Heart failure is defined as a clinical syndrome and is known to present with a number of different pathophysiological patterns. There is a remarkable degree of variation in measures of left ventricular systolic emptying and this has been used to categorise heart failure into two separate types: low ejection fraction (EF) heart failure or HF-REF and high EF heart failure or HF-PEF. Here we review the pathophysiology, epidemiology and management of HF-PEF and argue that sharp separation of heart failure into two forms is misguided and illogical, and the present scarcity of clinical trial evidence for effective treatment for HF-PEF is a problem of our own making; we should never have excluded patients from major trials on the basis of EF in the first place. Whilst as many heart failure patients have preserved EFs as reduced we have dramatically under-represented HF-PEF patients in trials. Only four trials have been performed in HF-PEF specifically, and another two trials that recruited both HF-PEF and HF-REF can be considered. When we consider the similarity in outcomes and neurohormonal activation between HF-REF and HF-REF, the vast corpus of trial data that we have to attest to the efficacy of various treatment (angiotensin-converting-enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], beta-blockers and aldosterone antagonists) in HF-REF, and the much more limited number of trials of similar agents showing near statistically significant benefits in HF-PEF the time has come rethink our management of HF-PEF, and in particular our selection of patients for trials.
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Affiliation(s)
- Andrew Js Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
| | - Louise G Shewan
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK.,Sydney Medical School, University of Sydney, Australia
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14
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Pang J, Zhang Z, Zheng T, Yang YJ, Li N, Bai M, Peng Y, Zhang J, Li Q, Zhang B. The clinical, angiographic and prognosis characteristics of elderly patients with acute ST-segment elevation myocardial infarction--the first elderly STEMI population study in northwest of China. Int J Cardiol 2014; 179:326-8. [PMID: 25464478 DOI: 10.1016/j.ijcard.2014.11.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jun Pang
- The First Clinical College of Lanzhou University, Lanzhou, China; Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zheng Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China.
| | | | - Yue-Jin Yang
- Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China; Fu Wai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China
| | - Na Li
- Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China; Fu Wai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China
| | - Min Bai
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yu Peng
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jin Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Qiang Li
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Bo Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
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15
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Zhong L, Zhang JM, Zhao X, Tan RS, Wan M. Automatic localization of the left ventricle from cardiac cine magnetic resonance imaging: a new spectrum-based computer-aided tool. PLoS One 2014; 9:e92382. [PMID: 24722328 PMCID: PMC3982962 DOI: 10.1371/journal.pone.0092382] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 02/21/2014] [Indexed: 11/19/2022] Open
Abstract
Traditionally, cardiac image analysis is done manually. Automatic image processing can help with the repetitive tasks, and also deal with huge amounts of data, a task which would be humanly tedious. This study aims to develop a spectrum-based computer-aided tool to locate the left ventricle using images obtained via cardiac magnetic resonance imaging. Discrete Fourier Transform was conducted pixelwise on the image sequence. Harmonic images of all frequencies were analyzed visually and quantitatively to determine different patterns of the left and right ventricles on spectrum. The first and fifth harmonic images were selected to perform an anisotropic weighted circle Hough detection. This tool was then tested in ten volunteers. Our tool was able to locate the left ventricle in all cases and had a significantly higher cropping ratio of 0.165 than did earlier studies. In conclusion, a new spectrum-based computer aided tool has been proposed and developed for automatic left ventricle localization. The development of this technique, which will enable the automatic location and further segmentation of the left ventricle, will have a significant impact in research and in diagnostic settings. We envisage that this automated method could be used by radiographers and cardiologists to diagnose and assess ventricular function in patients with diverse heart diseases.
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Affiliation(s)
- Liang Zhong
- Bioengineering Department, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
| | - Jun-Mei Zhang
- Bioengineering Department, National Heart Centre Singapore, Singapore, Singapore
| | - Xiaodan Zhao
- Bioengineering Department, National Heart Centre Singapore, Singapore, Singapore
| | - Ru San Tan
- Bioengineering Department, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore
| | - Min Wan
- Bioengineering Department, National Heart Centre Singapore, Singapore, Singapore
- Geometrical Modelling, Institute of High Performance Computing, A*STAR, Singapore, Singapore
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16
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Schattke S, Xing Y, Lock J, Brechtel L, Schroeckh S, Spethmann S, Baumann G, Borges AC, Knebel F. Increased longitudinal contractility and diastolic function at rest in well-trained amateur Marathon runners: a speckle tracking echocardiography study. Cardiovasc Ultrasound 2014; 12:11. [PMID: 24571726 PMCID: PMC3975967 DOI: 10.1186/1476-7120-12-11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/09/2014] [Indexed: 12/21/2022] Open
Abstract
Background Regular physical activity reduces cardiovascular risk. There is concern that Marathon running might acutely damage the heart. It is unknown to what extent intensive physical endurance activity influences the cardiac mechanics at resting condition. Methods Eighty-four amateur marathon runners (43 women and 41 men) from Berlin-Brandenburg area who had completed at least one marathon previously underwent clinical examination and echocardiography at least 10 days before the Berlin Marathon at rest. Standard transthoracic echocardiography and 2D strain and strain rate analysis were performed. The 2D Strain and strain rate values were compared to previous published data of healthy untrained individuals. Results The average global longitudinal peak systolic strain of the left ventricle was -23 +/- 2% with peak systolic strain rate -1.39 +/- 0.21/s, early diastolic strain rate 2.0 +/- 0.40/s and late diastolic strain rate 1.21 +/- 0.31/s. These values are significantly higher compared to the previous published values of normal age-adjusted individuals. In addition, no age-related decline of longitudinal contractility in well-trained athletes was observed. Conclusions There is increased overall longitudinal myocardial contractility at rest in experienced endurance athletes compared to the published normal values in the literature indicating a preserved and even supra-normal contractility in the athletes. There is no age dependent decline of the longitudinal 2D Strain values. This underlines the beneficial effects of regular physical exercise even in advanced age.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Fabian Knebel
- Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité -Universitätsmedizin Berlin, Charitéplatz 1, D - 10117 Berlin, Germany.
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17
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Age and gender-specific changes in left ventricular systolic function in human volunteers. Int J Cardiol 2014; 172:e102-5. [PMID: 24438932 DOI: 10.1016/j.ijcard.2013.12.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/22/2013] [Indexed: 11/20/2022]
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