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Cai Q, Zhao Z, Gao J, Liu J, Li J, Peng X, Chen H. Normal Values for Atrial Deformation Measured by Feature-Tracking Cardiac MRI: A Meta-Analysis. J Magn Reson Imaging 2024. [PMID: 38807354 DOI: 10.1002/jmri.29465] [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: 02/25/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND A consensus on normal atrial deformation measurements by feature-tracking cardiac MRI remained absent. PURPOSE Provide reference ranges for atrial strain parameters in normal subjects, evaluating the influence of field strength and analysis software on the measurements. STUDY TYPE Meta-analysis. POPULATION 2708 subjects from 42 studies undergoing cardiac MRI. ASSESSMENT A systematic search was conducted from database (PubMed, Web of Science, ScienceDirect, and EMBASE) inception through August 2023. The random-effects model was used to pool the means of biatrial strain parameters. Heterogeneity and clinical variable effects were assessed. Strain measurements among different field strengths and analysis software were compared. STATISTICAL TESTS The inverse-variance method, Cochrane Q statistic, and I2 value, meta-regression analysis, and ANOVA were used; P < 0.05 was considered statistically significant. RESULTS The pooled means of left atrial (LA) total strain (εs), passive strain (εe), and active strain (εa) were 37.46%, 22.73%, and 16.24%, respectively, and the pooled means of LA total strain rate (SRs), passive strain rate (SRe), and active strain rate (SRa) were 1.66, -1.95, and -1.83, indicating significant heterogeneity. The pooled means of right atrial (RA) εs, εe, and εa were 44.87%, 26.05%, and 18.83%. RA SRs, SRe, and SRa were 1.66, -1.95, and -1.83, respectively. The meta-regression identified age as significantly associated with LA εs, εe and SRe, field strength was associated with LA SRa (all P < 0.05). ANOVA revealed differences in LA εa and SRa among different analysis software and in LA εs and all LA strain rates (all P < 0.05) among field strengths. No significant differences were identified in RA strain across analysis software (RA strain: P = 0.145-0.749; RA strain rates: P = 0.073-0.744) and field strengths (RA strain: P = 0.641-0.794; RA strain rates: P = 0.204-0.458). DATA CONCLUSION This study demonstrated the pooled reference values of biatrial strain. Age, analysis software, and field strength were attributed to differences in LA strain, whereas RA strain showed consistency across different field strengths and analysis software. Limited study subjects may account for the absence of influence on RA strain. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY Stage 5.
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Affiliation(s)
- Qiuyi Cai
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zhengkai Zhao
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jin Gao
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jian Liu
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jianlin Li
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xin Peng
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Hang Chen
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
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Nizhnikava V, Reiter U, Kovacs G, Reiter C, Kräuter C, Olschewski H, Fuchsjäger M, Reiter G. Myocardial strain parameters in pulmonary hypertension are determined by changes in volumetric function rather than by hemodynamic alterations. Eur J Radiol 2024; 170:111187. [PMID: 37995513 DOI: 10.1016/j.ejrad.2023.111187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To investigate associations of cardiac magnetic resonance feature-tracking-derived left (LV) and right ventricular (RV) global myocardial peak strains and strain rates with volumetric function and hemodynamic parameters to identify the major determinants of myocardial strain alterations in pulmonary hypertension (PH). METHODS Sixty-seven patients with PH or at risk of developing PH underwent right heart catheterization (RHC) and cine realtime imaging at 3 T. RHC parameters included mean pulmonary arterial pressure (mPAP), which was used for the diagnosis of PH. LV and RV volumetric function and feature-tracking-derived global radial, circumferential, and longitudinal (GLS) peak strains, together with their strain rates, were evaluated from cine images using routine software. Furthermore, myocardial strain parameters of 24 healthy subjects were evaluated as controls. Means were compared by t-test; relationships between parameters were investigated by correlation and regression analysis. RESULTS Compared to controls, RV-GLS, all RV systolic strain rates and the LV systolic longitudinal strain rate showed lower magnitudes in PH (RV-GLS: -21 ± 4% vs. -16 ± 5%, p < 0.0001); the strongest univariate correlate to mPAP was the RV-GLS (r = 0.59). All LV and RV strain parameters yielded stronger correlations with their respective ejection fractions. In bi-linear models using mPAP and ejection fraction as predictors, mPAP remained significant only for diastolic LV radial and circumferential strain rates. CONCLUSION Impairment of myocardial strains is more strongly associated with alterations in LV and RV volumetric function parameters than elevated mPAP, therefore limiting diagnostic information of myocardial strain parameters in PH.
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Affiliation(s)
- Volha Nizhnikava
- Department of Radiology, Medical University of Graz, Austria; Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland.
| | - Ursula Reiter
- Department of Radiology, Medical University of Graz, Austria.
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria & LBI for Lung Vascular Research Graz, Austria.
| | - Clemens Reiter
- Department of Radiology, Medical University of Graz, Austria.
| | - Corina Kräuter
- Department of Radiology, Medical University of Graz, Austria.
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria & LBI for Lung Vascular Research Graz, Austria.
| | | | - Gert Reiter
- Department of Radiology, Medical University of Graz, Austria; Research & Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
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3
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Chew JD, George-Durrett K, Acheampong B, Weiner JG, Slaughter JC, Parra DA, Soslow JH. Comparison of Strain-Encoding and Feature-Tracking Derived Myocardial Deformation Assessment of Left Ventricular Function in a Pediatric and Adult Congenital Heart Disease Cohort. Pediatr Cardiol 2022; 43:1338-1348. [PMID: 35238958 DOI: 10.1007/s00246-022-02856-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) strain can be assessed with feature-tracking (FT), which utilizes a post-processing algorithm to quantify myocardial deformation on routine cine images, and strain-encoding magnetic resonance imaging (SENC), which uses parallel magnetization tags combined with out-of-plane phase-encoding gradients to quantify deformation. Assessing agreement is critical to determine whether results can be translated between methods. We compared SENC to FT in the assessment of left ventricle (LV) global longitudinal strain (GLS) and global circumferential strain (GCS) in a cohort of pediatric and adult congenital heart disease (ACHD) patients. METHODS Pediatric subjects and ACHD patients underwent CMR on 1.5 T Siemens scanners, including balanced steady-state-free precession (bSSFP) cine imaging and SENC acquisitions in apical two and four chamber, left ventricular outflow tract, and short axis views. bSSFP cine imaging FT analysis was completed with Medis QStrain. Myocardial Solutions MyoStrain was used to analyze SENC. Correlation was assessed by Spearman's rank correlation coefficient. Agreement between techniques was assessed with concordance correlation coefficient (CCC) and Bland-Altman. RESULTS The cohort included 134 patients, 75 with congenital heart disease (56%). The median age was 16.3 years (IQR 13.7, 19.5). Median LV ejection fraction was 57% (IQR 54.4, 61.6). SENC and FT were in poor agreement for GLS (Spearman's ρ = 0.58, p < 0.001; CCC 0.24) and GCS (Spearman's ρ = 0.29, p < 0.001; CCC 0.03). CONCLUSION There was poor agreement between SENC and FT derived GLS and GCS in a cohort of pediatric and ACHD patients, suggesting that SENC and FT cannot be used interchangeably.
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Affiliation(s)
- Joshua D Chew
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA.
| | - Kristen George-Durrett
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Benjamin Acheampong
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Jeffrey G Weiner
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Doctor's Office Tower, Nashville, TN, 37232, USA
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Dorfman AL, Geva T, Samyn MM, Greil G, Krishnamurthy R, Messroghli D, Festa P, Secinaro A, Soriano B, Taylor A, Taylor MD, Botnar RM, Lai WW. SCMR expert consensus statement for cardiovascular magnetic resonance of acquired and non-structural pediatric heart disease. J Cardiovasc Magn Reson 2022; 24:44. [PMID: 35864534 PMCID: PMC9302232 DOI: 10.1186/s12968-022-00873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is widely used for diagnostic imaging in the pediatric population. In addition to structural congenital heart disease (CHD), for which published guidelines are available, CMR is also performed for non-structural pediatric heart disease, for which guidelines are not available. This article provides guidelines for the performance and reporting of CMR in the pediatric population for non-structural ("non-congenital") heart disease, including cardiomyopathies, myocarditis, Kawasaki disease and systemic vasculitides, cardiac tumors, pericardial disease, pulmonary hypertension, heart transplant, and aortopathies. Given important differences in disease pathophysiology and clinical manifestations as well as unique technical challenges related to body size, heart rate, and sedation needs, these guidelines focus on optimization of the CMR examination in infants and children compared to adults. Disease states are discussed, including the goals of CMR examination, disease-specific protocols, and limitations and pitfalls, as well as newer techniques that remain under development.
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Affiliation(s)
- Adam L. Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan C.S. Mott Children’s Hospital, 1540 E. Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Margaret M. Samyn
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin/Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226 USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235 USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr. E4A, Columbus, OH 43205 USA
| | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-University Medicine Berlin, Berlin, Germany
| | - Pierluigi Festa
- Department of Cardiology, Fondazione Toscana G. Monasterio, Massa, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Brian Soriano
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Andrew Taylor
- Department of Cardiovascular Imaging, Great Ormond Street Hospital for Sick Children, University College London, London, UK
| | - Michael D. Taylor
- Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children’s Hospital, 3333 Burnet Ave #2129, Cincinnati, OH 45229 USA
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Wyman W. Lai
- CHOC Children’s, 1201 W. La Veta Avenue, Orange, CA 92868 USA
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Alenezi F, Covington TA, Mukherjee M, Mathai SC, Yu PB, Rajagopal S. Novel Approaches to Imaging the Pulmonary Vasculature and Right Heart. Circ Res 2022; 130:1445-1465. [PMID: 35482838 PMCID: PMC9060389 DOI: 10.1161/circresaha.121.319990] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is an increased appreciation for the importance of the right heart and pulmonary circulation in several disease states across the spectrum of pulmonary hypertension and left heart failure. However, assessment of the structure and function of the right heart and pulmonary circulation can be challenging, due to the complex geometry of the right ventricle, comorbid pulmonary airways and parenchymal disease, and the overlap of hemodynamic abnormalities with left heart failure. Several new and evolving imaging modalities interrogate the right heart and pulmonary circulation with greater diagnostic precision. Echocardiographic approaches such as speckle-tracking and 3-dimensional imaging provide detailed assessments of regional systolic and diastolic function and volumetric assessments. Magnetic resonance approaches can provide high-resolution views of cardiac structure/function, tissue characterization, and perfusion through the pulmonary vasculature. Molecular imaging with positron emission tomography allows an assessment of specific pathobiologically relevant targets in the right heart and pulmonary circulation. Machine learning analysis of high-resolution computed tomographic lung scans permits quantitative morphometry of the lung circulation without intravenous contrast. Inhaled magnetic resonance imaging probes, such as hyperpolarized 129Xe magnetic resonance imaging, report on pulmonary gas exchange and pulmonary capillary hemodynamics. These approaches provide important information on right ventricular structure and function along with perfusion through the pulmonary circulation. At this time, the majority of these developing technologies have yet to be clinically validated, with few studies demonstrating the utility of these imaging biomarkers for diagnosis or monitoring disease. These technologies hold promise for earlier diagnosis and noninvasive monitoring of right heart failure and pulmonary hypertension that will aid in preclinical studies, enhance patient selection and provide surrogate end points in clinical trials, and ultimately improve bedside care.
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Affiliation(s)
- Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | | | | | - Steve C. Mathai
- Johns Hopkins Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - Paul B. Yu
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
| | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
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6
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Valentin S, Maurac A, Mandry D, Selton-Suty C, Huttin O, Cherifi A, Guillaumot A, Gomez E, Chabot F, Chaouat A. Place de l’IRM cardiaque dans l’hypertension artérielle pulmonaire et l’hypertension pulmonaire thrombo-embolique chronique. Rev Mal Respir 2022; 39:486-497. [DOI: 10.1016/j.rmr.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/14/2022] [Indexed: 01/26/2023]
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7
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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8
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Lee J. Magnetic Resonance Imaging-based Right Ventricular Strain Evaluation. J Cardiovasc Imaging 2022; 30:59-61. [PMID: 35086171 PMCID: PMC8792712 DOI: 10.4250/jcvi.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jongmin Lee
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, Korea.
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9
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Sato T, Ambale-Venkatesh B, Zimmerman SL, Tedford RJ, Hsu S, Chamera E, Fujii T, Mullin CJ, Mercurio V, Khair R, Corona-Villalobos CP, Simpson CE, Damico RL, Kolb TM, Mathai SC, Lima JA, Kass DA, Tsujino I, Hassoun PM. Right ventricular function as assessed by cardiac magnetic resonance imaging-derived strain parameters compared to high-fidelity micromanometer catheter measurements. Pulm Circ 2021; 11:20458940211032529. [PMID: 34603686 PMCID: PMC8481729 DOI: 10.1177/20458940211032529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Right ventricular function has prognostic significance in patients with pulmonary hypertension. We evaluated whether cardiac magnetic resonance-derived strain and strain rate parameters could reliably reflect right ventricular systolic and diastolic function in precapillary pulmonary hypertension. End-systolic elastance and the time constant of right ventricular relaxation tau, both derived from invasive high-fidelity micromanometer catheter measurements, were used as gold standards for assessing systolic and diastolic right ventricular function, respectively. Nineteen consecutive precapillary pulmonary hypertension patients underwent cardiac magnetic resonance and right heart catheterization prospectively. Cardiac magnetic resonance data were compared with those of 19 control subjects. In pulmonary hypertension patients, associations between strain- and strain rate-related parameters and invasive hemodynamic parameters were evaluated. Longitudinal peak systolic strain, strain rate, and early diastolic strain rate were lower in PAH patients than in controls; peak atrial-diastolic strain rate was higher in pulmonary hypertension patients. Similarly, circumferential peak systolic strain rate was lower and peak atrial-diastolic strain rate was higher in pulmonary hypertension. In pulmonary hypertension, no correlations existed between cardiac magnetic resonance-derived and hemodynamically derived measures of systolic right ventricular function. Regarding diastolic parameters, tau was significantly correlated with peak longitudinal atrial-diastolic strain rate (r = -0.61), deceleration time (r = 0.75), longitudinal systolic to diastolic time ratio (r = 0.59), early diastolic strain rate (r = -0.5), circumferential peak atrial-diastolic strain rate (r = -0.52), and deceleration time (r = 0.62). Strain analysis of the right ventricular diastolic phase is a reliable non-invasive method for detecting right ventricular diastolic dysfunction in PAH.
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Affiliation(s)
- Takahiro Sato
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefan L. Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ela Chamera
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomoki Fujii
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rubina Khair
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Celia P. Corona-Villalobos
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L. Damico
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M. Kolb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Kass
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Song J, Chen Y, Cui Y, Kong X, Liu J, Cao Y, Zhou X, Wetzl J, Shi H. Evaluation and Comparison of Quantitative Right Ventricular Strain Assessment by Cardiac Magnetic Resonance in Pulmonary Hypertension Using Feature Tracking and Deformable Registration Algorithms. Acad Radiol 2021; 28:e306-e313. [PMID: 32624401 DOI: 10.1016/j.acra.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVE Deformable registration algorithms (DRA) has been used to detect left ventricular myocardial changes, however, its clinical utility in right ventricular (RV) function has not been evaluated. In this study, we aim to evaluate and compare quantitative RV strain assessment by cardiac magnetic resonance in pulmonary hypertension (PH) using feature tracking (FT) and DRA. MATERIALS AND METHODS Thirty patients were confirmed to have PH using right heart catheterization, and 16 healthy controls were evaluated with cardiac magnetic resonance. Global and segmental RV strain was measured by DRA and FT methods. Intraclass correlation coefficients (ICCs), coefficient of variation, and Bland-Altman analysis were used to assess and compare the interobserver and intraobserver variability of the DRA and FT methods. RESULTS DRA was more sensitive than FT in the detection of RV circumferential and septal dysfunction. The global longitudinal strain (GLS) obtained by the two methods was reduced in mild-moderate PH patients (mean pulmonary artery pressure≤45 mm Hg), and the GLS and global circumferential strain (GCS) were reduced in severe PH patients (mean pulmonary artery pressure >45 mm Hg). DRA and FT methods demonstrate similar observer agreement in global strain using ICC (ICC greater than 0.90), but RV strain derived from DRA had lower variability using COV ([8%-14%] for DRA versus [11%-39%] for FT).For segmental longitudinal strain, DRA showed higher ICC and lower COV compared with that of the FT method. Correlations between RVEF and RV global strain parameters were strong (p < 0.01):GLS-DRA, r = -0.696; GLS-FT, r = -0.832; GCS-DRA, r = -0.745; and GCS-FT, r = -0.817. GLS-DRA was weakly correlated with mPAP (r = 0.385, p < 0.05).In multiple linear regression analysis, RVEF and mPAP were independent predictors of GLS-DRA (R2 = 0.57, p < 0.01). CONCLUSIONS The DRA method is more sensitive and robust for RV myocardial strain measurements than FT method.
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Affiliation(s)
- Jing Song
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yousan Chen
- Department of Radiology, Wuhan General Hospital of Chinese People's Liberation Army, Wuhan, China
| | - Yue Cui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Yukun Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | | | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China.
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11
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Ostovaneh MR, Makkar RR, Ambale-Venkatesh B, Ascheim D, Chakravarty T, Henry TD, Kowalchuk G, Aguirre FV, Kereiakes DJ, Povsic TJ, Schatz R, Traverse JH, Pogoda J, Smith RD, Marbán L, Marbán E, Lima JAC. Effect of cardiosphere-derived cells on segmental myocardial function after myocardial infarction: ALLSTAR randomised clinical trial. Open Heart 2021; 8:e001614. [PMID: 34233913 PMCID: PMC8264869 DOI: 10.1136/openhrt-2021-001614] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most cell therapy trials failed to show an improvement in global left ventricular (LV) function measures after myocardial infarction (MI). Myocardial segments are heterogeneously impacted by MI. Global LV function indices are not able to detect the small treatment effects on segmental myocardial function which may have prognostic implications for cardiac events. We aimed to test the efficacy of allogeneic cardiosphere-derived cells (CDCs) for improving regional myocardial function and contractility. METHODS In this exploratory analysis of a randomised clinical trial, 142 patients with post-MI with LVEF <45% and 15% or greater LV scar size were randomised in 2:1 ratio to receive intracoronary infusion of allogenic CDCs or placebo, respectively. Change in segmental myocardial circumferential strain (Ecc) by MRI from baseline to 6 months was compared between CDCs and placebo groups. RESULTS In total, 124 patients completed the 6-month follow-up (mean (SD) age 54.3 (10.8) and 108 (87.1%) men). Segmental Ecc improvement was significantly greater in patients receiving CDC (-0.5% (4.0)) compared with placebo (0.2% (3.7), p=0.05). The greatest benefit for improvement in segmental Ecc was observed in segments containing scar tissue (change in segmental Ecc of -0.7% (3.5) in patients receiving CDC vs 0.04% (3.7) in the placebo group, p=0.04). CONCLUSIONS In patients with post-MI LV dysfunction, CDC administration resulted in improved segmental myocardial function. Our findings highlight the importance of segmental myocardial function indices as an endpoint in future clinical trials of patients with post-MI. TRIAL REGISTRATION NUMBER NCT01458405.
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Affiliation(s)
- Mohammad R Ostovaneh
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angles, California, USA
| | | | | | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angles, California, USA
| | | | - Glen Kowalchuk
- Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | | | | | - Thomas J Povsic
- Duke Clinical Research Institute and Duke Medicine, Durham, North Carolina, USA
| | | | - Jay H Traverse
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Janice Pogoda
- Cipher Biostatistics and Reporting, Reno, Nevada, USA
| | | | - Linda Marbán
- Capricor Therapeutics Inc, Los Angles, California, USA
| | - Eduardo Marbán
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angles, California, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Walsh TP, Baird GL, Atalay MK, Agarwal S, Arcuri D, Klinger JR, Mullin CJ, Morreo H, Normandin B, Shiva S, Whittenhall M, Ventetuolo CE. Experimental design of the Effects of Dehydroepiandrosterone in Pulmonary Hypertension (EDIPHY) trial. Pulm Circ 2021; 11:2045894021989554. [PMID: 34094503 PMCID: PMC8142004 DOI: 10.1177/2045894021989554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/15/2020] [Indexed: 12/02/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) remains life-limiting despite numerous approved vasodilator therapies. Right ventricular (RV) function determines outcome in PAH but no treatments directly target RV adaptation. PAH is more common in women, yet women have better RV function and survival as compared to men with PAH. Lower levels of the adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate ester are associated with more severe pulmonary vascular disease, worse RV function, and mortality independent of other sex hormones in men and women with PAH. DHEA has direct effects on nitric oxide (NO) and endothelin-1 (ET-1) synthesis and signaling, direct antihypertrophic effects on cardiomyocytes, and mitigates oxidative stress. Effects of Dehydroepiandrosterone in Pulmonary Hypertension (EDIPHY) is an on-going randomized double-blind placebo-controlled crossover trial of DHEA in men (n = 13) and pre- and post-menopausal women (n = 13) with Group 1 PAH funded by the National Heart, Lung and Blood Institute. We will determine whether orally administered DHEA 50 mg daily for 18 weeks affects RV longitudinal strain measured by cardiac magnetic resonance imaging, markers of RV remodeling and oxidative stress, NO and ET-1 signaling, sex hormone levels, other PAH intermediate end points, side effects, and safety. The crossover design will elucidate sex-based phenotypes in PAH and whether active treatment with DHEA impacts NO and ET-1 biosynthesis. EDIPHY is the first clinical trial of an endogenous sex hormone in PAH. Herein we present the study’s rationale and experimental design.
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Affiliation(s)
| | - Grayson L Baird
- Lifespan Health System, Providence, RI, USA.,Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael K Atalay
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - Saurabh Agarwal
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel Arcuri
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA
| | - James R Klinger
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christopher J Mullin
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Sruti Shiva
- Department of Pharmacology and Chemical Biology, Vascular Medicine Institute, NO Metabolomics Core Facility, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Whittenhall
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Corey E Ventetuolo
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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Militaru S, Panovsky R, Hanet V, Amzulescu MS, Langet H, Pisciotti MM, Pouleur AC, Vanoverschelde JLJ, Gerber BL. Multivendor comparison of global and regional 2D cardiovascular magnetic resonance feature tracking strains vs tissue tagging at 3T. J Cardiovasc Magn Reson 2021; 23:54. [PMID: 33980259 PMCID: PMC8117295 DOI: 10.1186/s12968-021-00742-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/16/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) 2D feature tracking (FT) left ventricular (LV) myocardial strain has seen widespread use to characterize myocardial deformation. Yet, validation of CMR FT measurements remains scarce, particularly for regional strain. Therefore, we aimed to perform intervendor comparison of 3 different FT software against tagging. METHODS In 61 subjects (18 healthy subjects, 18 patients with chronic myocardial infarction, 15 with dilated cardiomyopathy, and 10 with LV hypertrophy due to hypertrophic cardiomyopathy or aortic stenosis) were prospectively compared global (G) and regional transmural peak-systolic Lagrangian longitudinal (LS), circumferential (CS) and radial strains (RS) by 3 FT software (cvi42, Segment, and Tomtec) among each other and with tagging at 3T. We also evaluated the ability of regional LS, CS, and RS by different FT software vs tagging to identify late gadolinium enhancement (LGE) in the 18 infarct patients. RESULTS GLS and GCS by all 3 software had an excellent agreement among each other (ICC = 0.94-0.98 for GLS and ICC = 0.96-0.98 for GCS respectively) and against tagging (ICC = 0.92-0.94 for GLS and ICC = 0.88-0.91 for GCS respectively), while GRS showed inconsistent agreement between vendors (ICC 0.10-0.81). For regional LS, the agreement was good (ICC = 0.68) between 2 vendors but less vs the 3rd (ICC 0.50-0.59) and moderate to poor (ICC 0.44-0.47) between all three FT software and tagging. Also, for regional CS agreement between 2 software was higher (ICC = 0.80) than against the 3rd (ICC = 0.58-0.60), and both better agreed with tagging (ICC = 0.70-0.72) than the 3rd (ICC = 0.57). Regional RS had more variation in the agreement between methods ranging from good (ICC = 0.75) to poor (ICC = 0.05). Finally, the accuracy of scar detection by regional strains differed among the 3 FT software. While the accuracy of regional LS was similar, CS by one software was less accurate (AUC 0.68) than tagging (AUC 0.80, p < 0.006) and RS less accurate (AUC 0.578) than the other two (AUC 0.76 and 0.73, p < 0.02) to discriminate segments with LGE. CONCLUSIONS We confirm good agreement of CMR FT and little intervendor difference for GLS and GCS evaluation, with variable agreement for GRS. For regional strain evaluation, intervendor difference was larger, especially for RS, and the diagnostic performance varied more substantially among different vendors for regional strain analysis.
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Affiliation(s)
- Sebastian Militaru
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Roman Panovsky
- International Clinical Research Center, St. Anne´S Faculty Hospital, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne´S Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Vincent Hanet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Mihaela Silvia Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Mary Mojica Pisciotti
- International Clinical Research Center, St. Anne´S Faculty Hospital, Brno, Czech Republic
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis J. Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
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Defining the Reference Range for Left Ventricular Strain in Healthy Patients by Cardiac MRI Measurement Techniques: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 217:569-583. [PMID: 33084383 DOI: 10.2214/ajr.20.24264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND. Echocardiography is the primary noninvasive technique for left ventricular (LV) strain measurement. MRI has potential advantages, although reference ranges and thresholds to differentiate normal from abnormal left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular global radial strain (LVGRS) are not yet established. OBJECTIVE. The purpose of our study was to determine the mean and lower limit of normal (LLN) of MRI-derived LV strain measurements in healthy patients and explore factors potentially influencing these measurements. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Library databases were searched for studies published through January 1, 2020, that reported MRI-derived LV strain measurements in at least 30 healthy individuals. Mean and LLN measurements of LV strain were pooled using random-effects models overall and for studies stratified by measurement method (feature tracking [FT] or tagging). Additional subgroup and meta-regression analyses were performed. EVIDENCE SYNTHESIS. Twenty-three studies with a total of 1782 healthy subjects were included. Pooled means and LLNs for all studies were -18.6% (95% CI, -19.5% to -17.6%) and -13.3% (-13.9% to 12.7%) for LVGLS, -21.0% (-22.4% to -19.6%) and -15.6% (-17.0% to -14.3%) for LVGCS, and 38.7% (30.5-46.9%) and 20.6% (15.1-26.1%) for LVGRS. Pooled means and LLNs for LVGLS by strain measurement method were -19.4% (95% CI, -20.6% to -18.1%) and -13.1% (-14.2% to -12.0%) for FT and -15.6% (-16.2% to -15.1%) and -13.1% (-14.1% to -12.2%) for tagging. A later year of study publication, increasing patient age, and increasing body mass index were associated with more negative mean LVGLS values. An increasing LV end-diastolic volume index was associated with less negative mean LVGLS values. No factor was associated with LLN of LVGLS. CONCLUSION. We determined the pooled means and LLNs, with associated 95% CIs, for LV strain by cardiac MRI to define thresholds for normal, abnormal, and borderline strain in healthy patients. The method of strain measurement by MRI affected the mean LVGLS. No factor affected the LLN of LVGLS. CLINICAL IMPACT. This meta-analysis lays a foundation for clinical adoption of MRI-derived LV strain measurements, with management implications in both healthy patients and patients with various disease states.
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15
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Azuma M, Kato S, Kodama S, Hayakawa K, Kagimoto M, Iguchi K, Fukuoka M, Fukui K, Iwasawa T, Utsunomiya D, Kimura K, Tamura K. Relationship between the cardiac magnetic resonance derived extracellular volume fraction and feature tracking myocardial strain in patients with non-ischemic dilated cardiomyopathy. Magn Reson Imaging 2020; 74:14-20. [PMID: 32898651 DOI: 10.1016/j.mri.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Feature tracking (FT) has emerged as a promising method to quantify myocardial strain using conventional cine magnetic resonance imaging (MRI). Extracellular volume fraction (ECV) by T1 mapping enables quantification of myocardial fibrosis. To date, the correlation between FT-derived left ventricular strain and ECV has not been elucidated yet. The aim of this study was to evaluate the relationship between myocardial strain by FT and ECV by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM). METHODS A total of 57 patients with NIDCM (61 ± 12 years; 46 (81%) male)) and 15 controls (62 ± 11 years; 11 (73%) male)) were studied. Using a 1.5 T magnetic resonance scanner, pre- and post- T1 mapping images of the LV wall at the mid-ventricular level were acquired to calculate the ECV by a modified Look-Locker inversion recovery (MOLLI) sequence. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) were assessed by the FT technique. The ECV and myocardial strain were compared using a 6-segment model at the mid-ventricular level. RESULTS The ECV and myocardial strain were evaluable in all 432 segments in 72 subjects. On a patient-based analysis, NIDCM patients had a significantly higher ECV (0.30 ± 0.07 vs. 0.28 ± 0.06, p = .007) and impaired myocardial strain than the control subjects (RS, 22.7 ± 10.3 vs. 30.3 ± 18.2, p < .01; CS, -6.47 ± 1.89 vs. -9.52 ± 5.15, p < .001; LS -10.2 ± 3.78 vs. -19.8 ± 4.30, p < .001, respectively). A significant linear correlation was found between the RS and ECV (r = -0.38, p < .001) and CS and ECV, (r = 0.38, p < .001). LS and ECV also correlated (r = 0.31, p < 0.001). On a segment-based analysis, there was a significant correlation between the ECV and RS and ECV and CS (all p values < .05). The intraclass correlation coefficient was good for the strain measurement (>0.80). CONCLUSIONS In patients with NIDCM, significant correlation was found between myocardial strain and ECV, suggesting the FT-derived myocardial strain might be useful as a non-invasive imaging marker for the detection of myocardial fibrosis without any contrast media.
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Affiliation(s)
- Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Keigo Hayakawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Minako Kagimoto
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kohei Iguchi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Masahiro Fukuoka
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Broncano J, Bhalla S, Gutierrez FR, Vargas D, Williamson EE, Makan M, Luna A. Cardiac MRI in Pulmonary Hypertension: From Magnet to Bedside. Radiographics 2020; 40:982-1002. [PMID: 32609599 DOI: 10.1148/rg.2020190179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pulmonary hypertension (PH) is a disease characterized by progressive rise of pulmonary artery (PA) pressure, which can lead to right ventricular (RV) failure. It is usually diagnosed late because of the nonspecificity of its symptoms. RV performance and adaptation to an increased afterload, reflecting the interaction of the PA and RV as a morphofunctional unit, constitute a critical determinant of morbidity and mortality in these patients. Therefore, early detection of dysfunction may prevent treatment failure. Cardiac MRI constitutes one of the most complete diagnostic modalities for diagnosing PH. It allows evaluation of the morphology and hemodynamics of the PA and RV. Several cine steady-state free-precession (SSFP)-derived parameters (indexed RV end-diastolic volume or RV systolic volume) and phase-contrast regional area change have been suggested as powerful biomarkers for prognosis and treatment. Recently, new cardiac MRI sequences have been added to clinical protocols for PH evaluation, providing brand-new information. Strain analysis with myocardial feature tracking can help detect early RV dysfunction, even with preserved ejection fraction. Four-dimensional flow cardiac MRI can enhance assessment of advanced RV and PA hemodynamics. Late gadolinium enhancement (LGE) imaging may allow detection of replacement fibrosis in PH patients, which is associated with poor outcome. T1 mapping may help detect interstitial fibrosis, even with normal LGE imaging results. The authors analyze the imaging workup of PH with a focus on the role of morphologic and functional cardiac MRI in diagnosis and management of PH, including some of the newer techniques. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Fernando R Gutierrez
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Eric E Williamson
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Majesh Makan
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA HT Médica, Avenida el Brillante 36, 14012 Córdoba, Spain (J.B.); Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., F.R.G.); Department of Radiology, University of Colorado-Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Mayo Clinic, Rochester, Minn (E.E.W.); Cardiovascular Division, Barnes Jewish Heart and Vascular Center, St Louis, Mo (M.M.); and MRI Section, Department of Radiology, Clínica Las Nieves, SERCOSA HT Médica, Jaén, Spain (A.L.)
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Lahm T, Douglas IS, Archer SL, Bogaard HJ, Chesler NC, Haddad F, Hemnes AR, Kawut SM, Kline JA, Kolb TM, Mathai SC, Mercier O, Michelakis ED, Naeije R, Tuder RM, Ventetuolo CE, Vieillard-Baron A, Voelkel NF, Vonk-Noordegraaf A, Hassoun PM. Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2019; 198:e15-e43. [PMID: 30109950 DOI: 10.1164/rccm.201806-1160st] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Right ventricular (RV) adaptation to acute and chronic pulmonary hypertensive syndromes is a significant determinant of short- and long-term outcomes. Although remarkable progress has been made in the understanding of RV function and failure since the meeting of the NIH Working Group on Cellular and Molecular Mechanisms of Right Heart Failure in 2005, significant gaps remain at many levels in the understanding of cellular and molecular mechanisms of RV responses to pressure and volume overload, in the validation of diagnostic modalities, and in the development of evidence-based therapies. METHODS A multidisciplinary working group of 20 international experts from the American Thoracic Society Assemblies on Pulmonary Circulation and Critical Care, as well as external content experts, reviewed the literature, identified important knowledge gaps, and provided recommendations. RESULTS This document reviews the knowledge in the field of RV failure, identifies and prioritizes the most pertinent research gaps, and provides a prioritized pathway for addressing these preclinical and clinical questions. The group identified knowledge gaps and research opportunities in three major topic areas: 1) optimizing the methodology to assess RV function in acute and chronic conditions in preclinical models, human studies, and clinical trials; 2) analyzing advanced RV hemodynamic parameters at rest and in response to exercise; and 3) deciphering the underlying molecular and pathogenic mechanisms of RV function and failure in diverse pulmonary hypertension syndromes. CONCLUSIONS This statement provides a roadmap to further advance the state of knowledge, with the ultimate goal of developing RV-targeted therapies for patients with RV failure of any etiology.
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Korosoglou G, Giusca S, Hofmann NP, Patel AR, Lapinskas T, Pieske B, Steen H, Katus HA, Kelle S. Strain-encoded magnetic resonance: a method for the assessment of myocardial deformation. ESC Heart Fail 2019; 6:584-602. [PMID: 31021534 PMCID: PMC6676282 DOI: 10.1002/ehf2.12442] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
This study aims to assess the usefulness of strain‐encoded magnetic resonance (SENC) for the quantification of myocardial deformation (‘strain’) in healthy volunteers and for the diagnostic workup of patients with different cardiovascular pathologies. SENC was initially described in the year 2001. Since then, the SENC sequence has undergone several technical developments, aiming at the detection of strain during single‐heartbeat acquisitions (fast‐SENC). Experimental and clinical studies that used SENC and fast‐SENC or compared SENC with conventional cine or tagged magnetic resonance in phantoms, animals, healthy volunteers, or patients were systematically searched for in PubMed. Using ‘strain‐encoded magnetic resonance and SENC’ as keywords, three phantom and three animal studies were identified, along with 27 further clinical studies, involving 185 healthy subjects and 904 patients. SENC (i) enabled reproducible assessment of myocardial deformation in vitro, in animals and in healthy volunteers, (ii) showed high reproducibility and substantially lower time spent compared with conventional tagging, (iii) exhibited incremental value to standard cine imaging for the detection of inducible ischaemia and for the risk stratification of patients with ischaemic heart disease, and (iv) enabled the diagnostic classification of patients with transplant vasculopathy, cardiomyopathies, pulmonary hypertension, and diabetic heart disease. SENC has the potential to detect a wide range of myocardial diseases early, accurately, and without the need of contrast agent injection, possibly enabling the initiation of specific cardiac therapies during earlier disease stages. Its one‐heartbeat acquisition mode during free breathing results in shorter cardiovascular magnetic resonance protocols, making its implementation in the clinical realm promising.
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Affiliation(s)
- Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina P Hofmann
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Hugo A Katus
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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19
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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20
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Vazquez Alvarez MDC, Grosse-Wortmann L. Form Follows Function? Circ Cardiovasc Imaging 2018; 11:e008271. [DOI: 10.1161/circimaging.118.008271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria del Carmen Vazquez Alvarez
- The Labatt Family Heart Centre, Department of Paediatrics (M.d.C.V.A., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre, Department of Paediatrics (M.d.C.V.A., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Department of Diagnostic Imaging (L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
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21
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Sato T, Ambale-Venkatesh B, Lima JAC, Zimmerman SL, Tedford RJ, Fujii T, Hulme OL, Pullins EH, Corona-Villalobos CP, Zamanian RT, Minai OA, Girgis RE, Chin K, Khair R, Damico RL, Kolb TM, Mathai SC, Hassoun PM. The impact of ambrisentan and tadalafil upfront combination therapy on cardiac function in scleroderma associated pulmonary arterial hypertension patients: cardiac magnetic resonance feature tracking study. Pulm Circ 2017; 8:2045893217748307. [PMID: 29251556 PMCID: PMC6018906 DOI: 10.1177/2045893217748307] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to evaluate the effect of upfront combination therapy with ambrisentan and tadalafil on left ventricular (LV) and right ventricular (RV) function in patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH). LV and RV peak longitudinal and circumferential strain and strain rate (SR), which consisted of peak systolic SR (SRs), peak early diastolic SR (SRe), and peak atrial-diastolic SR (SRa) were analyzed using cardiac magnetic resonance imaging (CMRI) data from the recently published ATPAHSS-O trial (ambrisentan and tadalafil upfront combination therapy in SSc-PAH). Twenty-one patients completed the study protocol. Measures of RV systolic function (RV free wall [RVFW] peak longitudinal strain [pLS], RVFW peak longitudinal SRs [pLSRs]) and RV diastolic function (RVFW peak longitudinal SRa [pLSRa], RVFW peak circumferential SRe) were improved after treatment. LV systolic function (LV peak global longitudinal strain [pGLS]) and diastolic function (LV peak global longitudinal SRe [pGLSRe]) were also significantly improved at follow-up. Increased 6-min walk distance was significantly correlated with RVFW pLS and pLSRs, while the decrease in N-terminal pro-brain natriuretic peptide was correlated with LV pGLS. Increased cardiac index was associated with improved LV pGLSRe, and reduction in mean right atrial pressure was correlated with improved RVFW pLS and pLSRa. Combination therapy was associated with a significant improvement in both RV and LV function as assessed by CMR-derived strain and SR. Importantly, the improvement in RV and LV strain and SR correlated with improvements in known prognostic markers of PAH. (Approved by clinicaltrials.gov [NCT01042158] before patient recruitment.)
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Affiliation(s)
- Takahiro Sato
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A C Lima
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stefan L Zimmerman
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan J Tedford
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomoki Fujii
- 3 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olivia L Hulme
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erica H Pullins
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Celia P Corona-Villalobos
- 2 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roham T Zamanian
- 4 Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Omar A Minai
- 5 Division of Pulmonary and Critical Care Medicine, The Cleveland Clinic, Cleveland, OH, USA
| | - Reda E Girgis
- 6 Division of Pulmonary Medicine, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Kelly Chin
- 7 Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rubina Khair
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel L Damico
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd M Kolb
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Hassoun
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Tong X, Poon J, Li A, Kit C, Yamada A, Shiino K, Ling LF, Choe YH, Chan J, Lau YK, Ng MY. Validation of cardiac magnetic resonance tissue tracking in the rapid assessment of RV function: a comparative study to echocardiography. Clin Radiol 2017; 73:324.e9-324.e18. [PMID: 29195659 DOI: 10.1016/j.crad.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
AIM To investigate the accuracy of cardiac magnetic resonance (CMR) tissue tracking (CMR-TT) and speckle tracking echocardiography (STE) against CMR determined right ventricular (RV) ejection fraction (RVEF) and to identify an optimal cut-off value for STE and CMR-TT to determine RVEF <45% and compare this to other conventional methods for estimating RVEF in dilated cardiomyopathy (DCM) patients. MATERIALS AND METHODS Twenty-nine DCM patients were recruited prospectively. CMR and echocardiography were performed within 48 hours and four-chamber views were used for strain analysis. Contoured CMR short axis images provided RVEF. Intraclass correlation coefficient (ICC), bias, levels of agreement, and receiver operating characteristic (ROC) curve analyses were performed. RESULTS CMR-TT RV free-wall longitudinal strain (FLS) and STE RV global longitudinal strain (GLS) showed the best correlation with RVEF (r=-0.68, r=-0.82, p<0.001 respectively). There was moderate correlation between echocardiography RV GLS and CMR RV FLS (r=0.64, p<0.001). CMR-TT FLS showed excellent intra-observer and interobserver reliability (ICC=0.980; ICC=0.968 respectively). STE GLS correlated better with RVEF than with peak systolic annular velocity (S'; r=0.45), tricuspid annular plane systolic excursion (TAPSE; r=0.56), and fractional area change (FAC; r=0.78). CMR-TT RV FLS had better correlation with RVEF than CMR TAPSE (r=0.69 versus 0.40). ROC analysis demonstrated the optimal cut-off value for CMR-TT RV FLS and STE GLS in detection of RVEF <45% was ≥-24.4% (area under the curve=0.87, 100% sensitivity, 66.7% specificity) and ≥-20.9% (area under the curve=0.88, 100% sensitivity, 60% specificity) respectively. CONCLUSION CMR-TT FLS and STE GLS showed potential to provide rapid assessment of RV function and had superior correlation with RVEF compared to conventional parameters.
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Affiliation(s)
- X Tong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong
| | - J Poon
- Department of Medicine and Cardiology, Ruttonjee and Tang Siu Kin Hospitals, Hong Kong
| | - A Li
- Department of Medicine, United Christian Hospital, Hong Kong
| | - C Kit
- Department of Medicine and Cardiology, Ruttonjee and Tang Siu Kin Hospitals, Hong Kong
| | - A Yamada
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - K Shiino
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - L F Ling
- Department of Cardiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore
| | - Y H Choe
- Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J Chan
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Y-K Lau
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - M-Y Ng
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong.
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23
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Bourfiss M, Vigneault DM, Aliyari Ghasebeh M, Murray B, James CA, Tichnell C, Mohamed Hoesein FA, Zimmerman SL, Kamel IR, Calkins H, Tandri H, Velthuis BK, Bluemke DA, te Riele ASJM. Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study. J Cardiovasc Magn Reson 2017; 19:66. [PMID: 28863780 PMCID: PMC5581480 DOI: 10.1186/s12968-017-0380-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regional right ventricular (RV) dysfunction is the hallmark of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), but is currently only qualitatively evaluated in the clinical setting. Feature Tracking Cardiovascular Magnetic Resonance (FT-CMR) is a novel quantitative method that uses cine CMR to calculate strain values. However, most prior FT-CMR studies in ARVD/C have focused on global RV strain using different software methods, complicating implementation of FT-CMR in clinical practice. We aimed to assess the clinical value of global and regional strain using FT-CMR in ARVD/C and to determine differences between commercially available FT-CMR software packages. METHODS We analyzed cine CMR images of 110 subjects (39 overt ARVD/C [mutation+/phenotype+], 40 preclinical ARVD/C [mutation+/phenotype-] and 31 control) for global and regional (subtricuspid, anterior, apical) RV strain in the horizontal longitudinal axis using four FT-CMR software methods (Multimodality Tissue Tracking, TomTec, Medis and Circle Cardiovascular Imaging). Intersoftware agreement was assessed using Bland Altman plots. RESULTS For global strain, all methods showed reduced strain in overt ARVD/C patients compared to control subjects (p < 0.041), whereas none distinguished preclinical from control subjects (p > 0.275). For regional strain, overt ARVD/C patients showed reduced strain compared to control subjects in all segments which reached statistical significance in the subtricuspid region for all software methods (p < 0.037), in the anterior wall for two methods (p < 0.005) and in the apex for one method (p = 0.012). Preclinical subjects showed abnormal subtricuspid strain compared to control subjects using one of the software methods (p = 0.009). Agreement between software methods for absolute strain values was low (Intraclass Correlation Coefficient = 0.373). CONCLUSIONS Despite large intersoftware variability of FT-CMR derived strain values, all four software methods distinguished overt ARVD/C patients from control subjects by both global and subtricuspid strain values. In the subtricuspid region, one software package distinguished preclinical from control subjects, suggesting the potential to identify early ARVD/C prior to overt disease expression.
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Affiliation(s)
- Mimount Bourfiss
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Davis M. Vigneault
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, UK
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA USA
| | | | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Cynthia A. James
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | | | | | - Ihab R. Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
| | - Anneline S. J. M. te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
- Netherlands Heart Institute, Utrecht, the Netherlands
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24
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Vo HQ, Marwick TH, Negishi K. MRI-Derived Myocardial Strain Measures in Normal Subjects. JACC Cardiovasc Imaging 2017; 11:196-205. [PMID: 28528164 DOI: 10.1016/j.jcmg.2016.12.025] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to perform a systematic review and meta-analysis to estimate the normal ranges of magnetic resonance imaging (MRI)-based feature tracking (FT) and to identify sources of variations. Similar analyses were also performed for strain encoding, displacement encoding with stimulated echoes, and myocardial tagging. BACKGROUND MRI-FT is a novel technique for quantification of myocardial deformation using MRI cine images. However, the reported 95% confidence intervals (CIs) from the 2 largest studies have no overlaps. METHODS Four databases (EMBASE, SCOPUS, PUBMED, and Web of Science) were systematically searched for MRI strains of the left (LV) and right (RV) ventricles. The key terms for MRI-FT were "tissue tracking," "feature tracking," "cardiac magnetic resonance," "cardiac MRI," "CMR," and "strain." A random effects model was used to pool LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and RVGLS. Meta-regressions were used to identify the sources of variations. RESULTS 659 healthy subjects were included from 18 papers for MRI-FT. Pooled mean of LVGLS was -20.1% (95% CI: -20.9% to -19.3%), LVGCS -23% (95% CI: -24.3% to -21.7%), LVGRS 34.1% (95% CI: 28.5% to 39.7%), and RVGLS -21.8% (95% CI: -23.3% to -20.2%). Although there were no publication biases except for LVGCS, significant heterogeneities were found. Meta-regression showed that variation of LVGCS was associated with field strength (β = 3.2; p = 0.041). Variations of LVGLS, LVGRS, and RVGLS were not associated with any of age, sex, software, field strength, sequence, LV ejection fraction, or LV size. LVGCS seems the most robust in MRI-FT. Among the MRI-derived strain techniques, the normal ranges were mostly concordant in LVGLS and LVGCS but varied substantially in LVGRS and RVGLS. CONCLUSIONS The pooled means of 4 MRI-derived myocardial strain methods in normal subjects are demonstrated. Differences in field strength were attributed to variations of LVGCS.
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Affiliation(s)
- Ha Q Vo
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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25
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Assessment of left ventricular deformation in patients with Ebstein’s anomaly by cardiac magnetic resonance tissue tracking. Eur J Radiol 2017; 89:20-26. [DOI: 10.1016/j.ejrad.2017.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/14/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
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26
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Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson 2016; 18:51. [PMID: 27561421 PMCID: PMC5000424 DOI: 10.1186/s12968-016-0269-7] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/27/2016] [Indexed: 01/29/2023] Open
Abstract
Tissue tracking technology of routinely acquired cardiovascular magnetic resonance (CMR) cine acquisitions has increased the apparent ease and availability of non-invasive assessments of myocardial deformation in clinical research and practice. Its widespread availability thanks to the fact that this technology can in principle be applied on images that are part of every CMR or echocardiographic protocol. However, the two modalities are based on very different methods of image acquisition and reconstruction, each with their respective strengths and limitations. The image tracking methods applied are not necessarily directly comparable between the modalities, or with those based on dedicated CMR acquisitions for strain measurement such as tagging or displacement encoding. Here we describe the principles underlying the image tracking methods for CMR and echocardiography, and the translation of the resulting tracking estimates into parameters suited to describe myocardial mechanics. Technical limitations are presented with the objective of suggesting potential solutions that may allow informed and appropriate use in clinical applications.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Piet Claus
- Department of Cardiovascular Diseases, Laboratory for Cardiovascular Imaging and Dynamics, KU Leuven, Leuven, Belgium
| | - Philip J Kilner
- CMR Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Interdisciplinary Cardiovascular Imaging, Internal Medicine III and Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Main, Germany.
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27
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Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S. Cardiovascular Magnetic Resonance Myocardial Feature Tracking: Concepts and Clinical Applications. Circ Cardiovasc Imaging 2016; 9:e004077. [PMID: 27009468 DOI: 10.1161/circimaging.115.004077] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/29/2016] [Indexed: 12/14/2022]
Abstract
Heart failure-induced cardiovascular morbidity and mortality constitute a major health problem worldwide and result from diverse pathogeneses, including coronary artery disease, nonischemic cardiomyopathies, and arrhythmias. Assessment of cardiovascular performance is important for early diagnosis and accurate management of patients at risk of heart failure. During the past decade, cardiovascular magnetic resonance myocardial feature tracking has emerged as a useful tool for the quantitative evaluation of cardiovascular function. The method allows quantification of biatrial and biventricular mechanics from measures of deformation: strain, torsion, and dyssynchrony. The purpose of this article is to review the basic principles, clinical applications, accuracy, and reproducibility of cardiovascular magnetic resonance myocardial feature tracking, highlighting the prognostic implications. It will also provide an outlook on how this field might evolve in the future.
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Affiliation(s)
- Andreas Schuster
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.).
| | - Kan N Hor
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Johannes T Kowallick
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Philipp Beerbaum
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Shelby Kutty
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
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de Siqueira MEM, Pozo E, Fernandes VR, Sengupta PP, Modesto K, Gupta SS, Barbeito-Caamaño C, Narula J, Fuster V, Caixeta A, Sanz J. Characterization and clinical significance of right ventricular mechanics in pulmonary hypertension evaluated with cardiovascular magnetic resonance feature tracking. J Cardiovasc Magn Reson 2016; 18:39. [PMID: 27306901 PMCID: PMC4910232 DOI: 10.1186/s12968-016-0258-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prognosis in pulmonary hypertension (PH) is related to right ventricular (RV) function. Quantification of RV mechanics may offer additive value. The objective of our study is to determine the feasibility and clinical and prognostic value of RV strain analysis by cardiovascular magnetic resonance (CMR) based feature tracking (FT) in PH. METHODS We retrospectively enrolled 116 patients (age 52.2 ± 12 years, 73.6 % women) referred to CMR for PH evaluation who underwent right heart catheterization within 1 month. Using dedicated FT software, peak global longitudinal and circumferential RV strain and strain rates (GLS, GCS, GLSR, and GCSR, respectively) were quantified from standard cine images. Using multivariate regression analysis, we evaluated the associations of strain with a composite endpoint of death, lung transplantation, or functional class deterioration. RESULTS RV strain analysis was feasible in 110 (95 %) patients. Patients were classified into: Group A (no PH, normal right ventricular ejection fraction [RVEF]; n = 17), Group B (PH, normal RVEF; n = 26), or Group C (PH, abnormal RVEF; n = 67). All strain and strain rate values were reduced in Group C. Furthermore, GCSR was significantly reduced in Group B (-0.92 [-1.0/-0.7]; p < 0.001) compared to Group A (-1.12 [-1.3/-0.9]; p < 0.001). After adjustment for six clinically meaningful covariates, GLS (hazard ratio 1.06; p = 0.026), GLSR (hazard ratio 2.52; p = 0.04), and GCSR (hazard ratio 4.5; p = 0.01) were independently associated with the composite endpoint. GCSR successfully discriminated patients with and without events (p = 0.01). CONCLUSIONS Quantification of RV strain with CMR-FT is feasible in the majority of patients, correlates with disease severity, and is independently associated with poor outcomes in PH.
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MESH Headings
- Adult
- Biomechanical Phenomena
- Chi-Square Distribution
- Disease Progression
- Feasibility Studies
- Female
- Humans
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/surgery
- Image Interpretation, Computer-Assisted
- Kaplan-Meier Estimate
- Lung Transplantation
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Multivariate Analysis
- Myocardial Contraction
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Stress, Mechanical
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/mortality
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Maria Eduarda Menezes de Siqueira
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Eduardo Pozo
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Veronica R Fernandes
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Partho P Sengupta
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karen Modesto
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sushilkumar Satish Gupta
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cayetana Barbeito-Caamaño
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña, A Coruña, Spain
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriano Caixeta
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Javier Sanz
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Mount Sinai Medical Center, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA.
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Ballo P, Nistri S, Bocelli A, Mele D, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. A new method to estimate left ventricular circumferential midwall systolic function by standard echocardiography: Concordance between models and validation by speckle tracking. Int J Cardiol 2016; 203:947-58. [DOI: 10.1016/j.ijcard.2015.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/27/2022]
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