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Gu ZY, Chen BH, Zhao L, An DA, Wu CW, Xue S, Chen WB, Huang S, Wang YY, Wu LM. Fractal analysis of left ventricular trabeculae in heart failure with preserved ejection fraction patients with multivessel coronary artery disease. Insights Imaging 2024; 15:148. [PMID: 38886266 PMCID: PMC11183012 DOI: 10.1186/s13244-024-01730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Endocardial trabeculae undergo varicose changes and hyperplasia in response to hemodynamic influences and are a variable phenotype reflecting changes in disease. Fractal analysis has been used to analyze the complexity of endocardial trabeculae in a variety of cardiomyopathies. The aim of this paper was to quantify the myocardial trabecular complexity through fractal analysis and to investigate its predictive value for the diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with multivessel coronary artery disease (CAD). METHODS The retrospective study population consisted of 97 patients with multivessel CAD, 39 of them were diagnosed with HFpEF, while 46 healthy volunteers were recruited as controls. Fractal dimension (FD) was obtained through fractal analysis of endocardial trabeculae on LV short-axis cine images. Logistic regression analyses were used to confirm the predictors and compare different prediction models. RESULTS Mean basal FD was significantly higher in patients with HFpEF than in patients without HFpEF or in the healthy group (median: 1.289; IQR: 0.078; p < 0.05). Mean basal FD was also a significant independent predictor in univariate and multivariate logistic regression (OR: 1.107 and 1.043, p < 0.05). Furthermore, adding FD to the prediction model improved the calibration and accuracy of the model (c-index: 0.806). CONCLUSION The left ventricular FD obtained with fractal analysis can reflect the complexity of myocardial trabeculae and has an independent predictive value for the diagnosis of HFpEF in patients with multivessel CAD. Including FD into the diagnostic model can help improve the diagnosis. CRITICAL RELEVANCE STATEMENT Differences show in the complexity of endocardial trabeculae in multivessel coronary artery disease patients, and obtaining fractal dimensions (FD) by fractal analysis can help identify heart failure with preserved ejection fraction (HFpEF) patients. KEY POINTS The complexity of myocardial trabeculae differs among patients with multivessel coronary artery disease. Left ventricular fractal dimensions can reflect the complexity of the myocardial trabecular. Fractal dimensions have predictive value for the diagnosis of heart failure with preserved ejection fraction.
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Affiliation(s)
- Zi-Yi Gu
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Lei Zhao
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Song Xue
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | | | - Shan Huang
- Philips Healthcare, Shanghai, 201103, China
| | - Yong-Yi Wang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Li S, Wang Z, Fu W, Li F, Gu H, Cui N, Lin Y, Xie M, Yang Y. Left Ventricular Papillary Muscle: Anatomy, Pathophysiology, and Multimodal Evaluation. Diagnostics (Basel) 2024; 14:1270. [PMID: 38928685 PMCID: PMC11202998 DOI: 10.3390/diagnostics14121270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
As an integral part of the mitral valve apparatus, the left ventricle papillary muscle (PM) controls mitral valve closure during systole and participates in the ejection process during left ventricular systole. Mitral regurgitation (MR) is the most immediate and predominant result when the PM is structurally or functionally abnormal. However, dysfunction of the PM is easily underestimated or overlooked in clinical interventions for MR-related diseases. Therefore, adequate recognition of PM dysfunction and PM-derived MR is critical. In this review, we systematically describe the normal anatomical variations in the PM and the pathophysiology of PM dysfunction-related diseases and summarize the commonly used parameters and the advantages and disadvantages of various noninvasive imaging modalities for the structural and functional assessment of the PM.
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Affiliation(s)
- Shiying Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhen Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenpei Fu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fangya Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Hui Gu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Nan Cui
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yali Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (S.L.); (Z.W.); (W.F.); (F.L.); (H.G.); (N.C.); (Y.L.); (M.X.)
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Xu Z, Li W, Wang J, Wang F, Sun B, Xiang S, Luo X, Meng Y, Wang X, Wang X, Song J, Zhang M, Xu D, Zhou X, Ju Z, Sun J, Han Y, Chen Y. Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study. J Magn Reson Imaging 2024; 59:812-822. [PMID: 37530736 DOI: 10.1002/jmri.28903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) reference ranges for ventricular morphology and function in the Chinese population are lacking. PURPOSE To establish the MRI reference ranges of left and right ventricular (LV and RV) morphology and function based on a large multicenter cohort. STUDY TYPE Prospective. POPULATION One thousand and twelve healthy Chinese Han adults. FIELD STRENGTH/SEQUENCE Balanced steady-state free procession cine sequence at 3.0 T. ASSESSMENT Biventricular end-diastolic, end-systolic, stroke volume, and ejection fraction (EDV, ESV, SV, and EF), LV mass (LVM), end-diastolic and end-systolic dimension (LVEDD and LVESD), anteroseptal wall thickness (AS), and posterolateral wall thickness (PL) were measured. Body surface area (BSA) and height were used to index biventricular parameters. Parameters were compared between age groups and sex. STATISTICAL TESTS Independent-samples t-tests or Mann-Whitney U test to compare mean values between sexes; ANOVA or Kruskal-Wallis test to compare mean values among age groups; linear regression to assess the relationships between cardiac parameters and age (correlation coefficient, r). A P value <0.05 was considered statistically significant. RESULTS The biventricular volumes, LVM, LVEDD, RVEDV/LVEDV ratio, LVESD, AS, and PL were significantly greater in males than in females, even after indexing to BSA or height, while LVEF and RVEF were significantly lower in males than in females. For both sexes, age was significantly negatively correlated with biventricular volumes (male and female: LVEDV [r = -0.491; r = -0.373], LVESV [r = -0.194; r = -0.184], RVEDV [r = -0.639; r = -0.506], RVESV [r = -0.270; r = -0.223]), with similar correlations after BSA normalization. LVEF (r = 0.043) and RVEF (r = 0.033) showed a significant correlation with age in females, but not in males (P = 0.889; P = 0.282). DATA CONCLUSION MRI reference ranges for biventricular morphology and function in Chinese adults are presented and show significant associations with age and sex. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Wang
- Department of Radiology, Anqing Municipal Hospital, Anqing, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shifeng Xiang
- Department of Radiology, Handan Central Hospital, Handan, China
| | - Xiao Luo
- Department of Radiology, Maanshan People's Hospital, Maanshan, China
| | - Yanfeng Meng
- Department of Radiology, Taiyuan Central Hospital, Taiyuan, China
| | - Xiang Wang
- Department of Radiology, Wuhan Central Hospital, Wuhan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Jinan, China
| | - Jianxun Song
- Department of Radiology, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Min Zhang
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Dinghu Xu
- Department of Radiology, Nanjing Jiangning Hospital, Nanjing, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Zhiguo Ju
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Zheng JY, Chen BH, Wu R, An DA, Shi RY, Wu CW, Xie JY, Jiang SS, Jia V, Zhao L, Wu LM. 3D Fractal Dimension Analysis: Prognostic Value of Right Ventricular Trabecular Complexity in Participants with Arrhythmogenic Cardiomyopathy. J Magn Reson Imaging 2024. [PMID: 38258534 DOI: 10.1002/jmri.29237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is characterized by progressive myocardial fibro-fatty infiltration accompanied by trabecular disarray. Traditionally, two-dimensional (2D) instead of 3D fractal dimension (FD) analysis has been used to evaluate trabecular disarray. However, the prognostic value of trabecular disorder assessed by 3D FD measurement remains unclear. PURPOSE To investigate the prognostic value of right ventricular trabecular complexity in ACM patients using 3D FD analysis based on cardiac MR cine images. STUDY TYPE Retrospective. POPULATION 85 ACM patients (mean age: 45 ± 17 years, 52 male). FIELD STRENGTH/SEQUENCE 3.0T/cine imaging, T2-short tau inversion recovery (T2-STIR), and late gadolinium enhancement (LGE). ASSESSMENT Using cine images, RV (right ventricular) volumetric and functional parameters were obtained. RV trabecular complexity was measured with 3D fractal analysis by box-counting method to calculate 3D-FD. Cox and logistic regression models were established to evaluate the prognostic value of 3D-FD for major adverse cardiac events (MACE). STATISTICAL TESTS Cox regression and logistic regression to explore the prognostic value of 3D-FD. C-index, time-dependent receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) to evaluate the incremental value of 3D-FD. Intraclass correlation coefficient for interobserver variability. P < 0.05 indicated statistical significance. RESULTS 26 MACE were recorded during the 60 month follow-up (interquartile range: 48-67 months). RV 3D-FD significantly differed between ACM patients with MACE (2.67, interquartile range: 2.51 ~ 2.81) and without (2.52, interquartile range: 2.40 ~ 2.67) and was a significant independent risk factor for MACE (hazard ratio, 1.02; 95% confidence interval: 1.01, 1.04). In addition, prognostic model fitness was significantly improved after adding 3D-FD to RV global longitudinal strain, LV involvement, and 5-year risk score separately. DATA CONCLUSION The myocardial trabecular complexity assessed through 3D FD analysis was found associated with MACE and provided incremental prognostic value beyond conventional ACM risk factors. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Jin-Yu Zheng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruo-Yang Shi
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Wen Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | | | - Victor Jia
- University of Michigan, Ann Arbor, Michigan, USA
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhang TY, An DA, Zhou H, Ni Z, Wang Q, Chen B, Lu R, Huang J, Zhou Y, Hu J, Kim DH, Wilson M, Mou S, Wu LM. Fractal analysis: Left ventricular trabecular complexity cardiac MRI adds independent risks for heart failure with preserved ejection fraction in participants with end-stage renal disease. Int J Cardiol 2023; 391:131334. [PMID: 37696365 DOI: 10.1016/j.ijcard.2023.131334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To measure left ventricular (LV) trabecular complexity by fractal dimension (FD) in patients with end-stage renal disease (ESRD), and assess whether FD was an independent risk factor for heart failure with preserved ejection fraction (HFpEF), or a significant predictor for adverse outcome in this population. METHODS The study retrospectively enrolled 104 participants with ESRD who underwent 3.0 T cardiac magnetic resonance imaging (MRI) from June 2018 to November 2020. LV trabeculation was quantified with fractal analysis of short-axis cine slices to estimate the FD. Logistic regression analyses were used to evaluate FD and cardiac MRI parameters and to find independent risk predictors. Cox proportional hazard regression was used to investigate the association between FD and MACE. RESULTS LV FD was higher in in the HFpEF group than those in the non-HFpEF group, with the greatest difference near the base of the ventricle. Age, minimum left atrial volume index, and LV mean basal FD were independent predictors for HFpEF in patients with ESRD. Combining the mean basal FD with typical predictive factors resulted in a C-index (0.902 vs 0.921), which was not significantly higher. Same improvements were found for net reclassification improvement [0.642; 95% confidence interval (CI), 0.254-1.029] and integrated discrimination index (0.026; 95% CI, 0.008-0.061). Participants with a LV global FD above the cutoff value (1.278) had higher risks of MACE in ESRD patients. CONCLUSIONS LV trabecular complexity measured by FD was an independent risk factor for HFpEF, and a significant predictor for MACE among patients with ESRD.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Hang Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Zhaohui Ni
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Qin Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Renhua Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiaying Huang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yin Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Doo Hee Kim
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Molly Wilson
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center,Ren Ji Hospital, Uremia Diagnosis and Treatment Center,Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Alkassar M, Engelhardt S, Abu-Tair T, Ojeda E, Treffer PC, Weyand M, Rompel O. Comparative Study of 2D-Cine and 3D-wh Volumetry: Revealing Systemic Error of 2D-Cine Volumetry. Diagnostics (Basel) 2023; 13:3162. [PMID: 37891983 PMCID: PMC10605840 DOI: 10.3390/diagnostics13203162] [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: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the crucial factors influencing the end-systolic and end-diastolic volumes in MRI volumetry and their direct effects on the derived functional parameters. Through the simultaneous acquisition of 2D-cine and 3D whole-heart slices in end-diastole and end-systole, we present a novel direct comparison of the volumetric measurements from both methods. A prospective study was conducted with 18 healthy participants. Both 2D-cine and 3D whole-heart sequences were obtained. Despite the differences in the creation of 3D volumes and trigger points, the impact on the LV volume was minimal (134.9 mL ± 16.9 mL vs. 136.6 mL ± 16.6 mL, p < 0.01 for end-diastole; 50.6 mL ± 11.0 mL vs. 51.6 mL ± 11.2 mL, p = 0.03 for end-systole). In our healthy patient cohort, a systematic underestimation of the end-systolic volume resulted in a significant overestimation of the SV (5.6 mL ± 2.6 mL, p < 0.01). The functional calculations from the 3D whole-heart method proved to be highly accurate and correlated well with function measurements from the phase-contrast sequences. Our study is the first to demonstrate the superiority of 3D whole-heart volumetry over 2D-cine volumetry and sheds light on the systematic error inherent in 2D-cine measurements.
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Affiliation(s)
- Muhnnad Alkassar
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
- Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, 90419 Nuremberg, Germany
| | - Sophia Engelhardt
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany;
| | - Efren Ojeda
- Siemens Healtineers, 91052 Erlangen, Germany; (E.O.); (P.C.T.)
| | | | - Michael Weyand
- Department of Cardiac Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.E.); (M.W.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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Ponsiglione A, De Giorgi M, Ascione R, Nappi C, Sanduzzi L, Pisani A, Dell'Aversana S, Cuocolo A, Imbriaco M. Advanced CMR Techniques in Anderson-Fabry Disease: State of the Art. Diagnostics (Basel) 2023; 13:2598. [PMID: 37568960 PMCID: PMC10417643 DOI: 10.3390/diagnostics13152598] [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: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Anderson-Fabry disease (AFD) is a rare multisystem X-linked lysosomal storage disorder caused by α-galactosidase A enzyme deficiency. Long-term cardiac involvement in AFD results in left ventricular hypertrophy and myocardial fibrosis, inducing several complications, mainly arrhythmias, valvular dysfunction, and coronary artery disease. Cardiac magnetic resonance (CMR) represents the predominant noninvasive imaging modality for the assessment of cardiac involvement in the AFD, being able to comprehensively assess cardiac regional anatomy, ventricular function as well as to provide tissue characterization. This review aims to explore the role of the most advanced CMR techniques, such as myocardial strain, T1 and T2 mapping, perfusion and hybrid imaging, as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Ascione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luca Sanduzzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Serena Dell'Aversana
- Department of Radiology, Santa Maria delle Grazie Hospital, ASL Napoli 2 Nord, 80078 Pozzuoli, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Varga-Szemes A, Emrich T. Editorial for "Pediatric Cardiac Magnetic Resonance Reference Values for Biventricular Volumes Derived From Different Contouring Techniques". J Magn Reson Imaging 2023; 57:1287-1288. [PMID: 35818989 DOI: 10.1002/jmri.28348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,German Centre for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
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Voges I, Caliebe A, Hinz S, Boroni Grazioli S, Gabbert DD, Daubeney PEF, Uebing AS, Pennell DJ, Krupickova S. Pediatric Cardiac Magnetic Resonance Reference Values for Biventricular Volumes Derived From Different Contouring Techniques. J Magn Reson Imaging 2023; 57:774-788. [PMID: 35713958 DOI: 10.1002/jmri.28299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measurement of ventricular volumes and function using MRI is an important tool in pediatric congenital heart disease. However, normal values for children are sparce and analysis methods are inconsistent. PURPOSE To propose biventricular reference values in children for two MRI postprocessing (contouring) techniques. STUDY TYPE Retrospective. SUBJECTS A total of 154 children from two institutions (13.9 ± 2.8 years; 101 male) that were referred for a clinical MRI study. FIELD STRENGTH/SEQUENCE 1.5 T; balanced steady-state free precession (bSSFP) sequence. ASSESSMENT Left ventricular (LV) and right ventricular (RV) end-diastolic and end-systolic volumes (LVEDV, LVESV, RVEDV, RVESV) and end-diastolic and end-systolic myocardial mass (LVEDMM, LVESMM, RVEDMM, RVESMM) were measured from short-axis images using two contouring techniques: 1) papillary muscles, trabeculations and the moderator band were included in the ventricular blood volume and excluded from the myocardial mass, 2) papillary muscles, trabeculations and the moderator band were excluded from the ventricular volume and included in the ventricular mass. STATISTICAL TESTS Univariable and multivariable linear regression models were used to evaluate relationships between sex, weight, height, body surface area (BSA) and age and volumetric results. Reference graphs and tables were created with the LMS-method. Contouring techniques were compared by intraclass correlation, regression analysis and Bland-Altman plots. A P value < 0.05 was considered statistically significant. RESULTS Height and BSA were significantly associated with LVESV (method 1) and with LVEDV and RVEDV (method 2). LVESV (method 2), RVESV (both methods), RVEDV (method 1), and LVEDMM and RVEDMM (both methods), showed significant associations with height and weight. LVSV and RVSV (both methods) were significantly associated with BSA and weight. RVESV (method 1) was significantly associated with age. Gender showed significant associations for all parameters. DATA CONCLUSION The proposed pediatric reference values can be used in the diagnosis and follow-up of congenital or acquired heart disease and for research purposes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Amke Caliebe
- Medical Faculty, Kiel University, Germany
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sophia Hinz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
| | - Anselm S Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Dudley J Pennell
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
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10
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Thut T, Valsangiacomo Büchel E, Geiger J, Kellenberger CJ, Rücker B, Burkhardt BEU. Signal Thresholding Segmentation of Ventricular Volumes in Young Patients with Various Diseases-Can We Trust the Numbers? Diagnostics (Basel) 2023; 13:diagnostics13020180. [PMID: 36672990 PMCID: PMC9857934 DOI: 10.3390/diagnostics13020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/14/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
In many cardiac diseases, right and left ventricular volumes in systole and diastole are diagnostically and prognostically relevant. Measurements are made by segmentation of the myocardial borders on cardiac magnetic resonance (CMR) images. Automatic detection of myocardial contours is possible by signal thresholding techniques, but must be validated before use in clinical settings. Biventricular volumes were measured in end-diastole (EDVi) and in end-systole (ESVi) both manually and with the MassK application, with signal thresholds at 30%, 50%, and 70%. Stroke volumes (SV) and cardiac indices (CI) were calculated from volumetric measurements and from flow measured in the ascending aorta and the main pulmonary artery, and both methods were compared. Reproducibility of volumetric measurements was tested in 20 patients. Measurements were acquired in 94 patients aged 15 ± 9 years referred for various conditions. EDVi and ESVi of both ventricles were largest with manual segmentation and inversely proportional to the MassK threshold. Manual and k30 SV and CI corresponded best to flow measurements. Interobserver variability was low for all volumes manually and with MassK. In conclusion, manual and 30% threshold-based biventricular volume segmentation agree best with two-dimensional, phantom-corrected phase contrast flow measurements in a young cardiac referral population and are well reproducible.
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Affiliation(s)
- Titus Thut
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Emanuela Valsangiacomo Büchel
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Julia Geiger
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Christian Johannes Kellenberger
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Beate Rücker
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Barbara Elisabeth Ursula Burkhardt
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Correspondence:
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11
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Barbieri A, Albini A, Chiusolo S, Forzati N, Laus V, Maisano A, Muto F, Passiatore M, Stuani M, Torlai Triglia L, Vitolo M, Ziveri V, Boriani G. Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases. J Clin Med 2022; 11:jcm11247363. [PMID: 36555980 PMCID: PMC9782505 DOI: 10.3390/jcm11247363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background. Three-dimensional transthoracic echocardiography (3DE) powered by artificial intelligence provides accurate left chamber quantification in good accordance with cardiac magnetic resonance and has the potential to revolutionize our clinical practice. Aims. To evaluate the association and the independent value of dynamic heart model (DHM)-derived left atrial (LA) and left ventricular (LV) metrics with prevalent vascular risk factors (VRFs) and cardiovascular diseases (CVDs) in a large, unselected population. Materials and Methods. We estimated the association of DHM metrics with VRFs (hypertension, diabetes) and CVDs (atrial fibrillation, stroke, ischemic heart disease, cardiomyopathies, >moderate valvular heart disease/prosthesis), stratified by prevalent disease status: participants without VRFs or CVDs (healthy), with at least one VRFs but without CVDs, and with at least one CVDs. Results. We retrospectively included 1069 subjects (median age 62 [IQR 49−74]; 50.6% women). When comparing VRFs with the healthy, significant difference in maximum and minimum indexed atrial volume (LAVi max and LAVi min), left atrial ejection fraction (LAEF), left ventricular mass/left ventricular end-diastolic volume ratio, and left ventricular global function index (LVGFI) were recorded (p < 0.05). In the adjusted logistic regression, LAVi min, LAEF, LV ejection fraction, and LVGFI showed the most robust association (OR 3.03 [95% CI 2.48−3.70], 0.45 [95% CI 0.39−0.51], 0.28 [95% CI 0.22−0.35], and 0.22 [95% CI 0.16−0.28], respectively, with CVDs. Conclusions. The present data suggested that novel 3DE left heart chamber metrics by DHM such as LAEF, LAVi min, and LVGFI can refine our echocardiographic disease discrimination capacity.
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Affiliation(s)
- Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Correspondence:
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Simona Chiusolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Nicola Forzati
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Vera Laus
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Anna Maisano
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Federico Muto
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Matteo Passiatore
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marco Stuani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Laura Torlai Triglia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- 2 Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Valentina Ziveri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
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12
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Faber JW, Wüst RCI, Dierx I, Hummelink JA, Kuster DWD, Nollet E, Moorman AFM, Sánchez-Quintana D, van der Wal AC, Christoffels VM, Jensen B. Equal force generation potential of trabecular and compact wall ventricular cardiomyocytes. iScience 2022; 25:105393. [PMID: 36345331 PMCID: PMC9636041 DOI: 10.1016/j.isci.2022.105393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/20/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
Trabecular myocardium makes up most of the ventricular wall of the human embryo. A process of compaction in the fetal period presumably changes ventricular wall morphology by converting ostensibly weaker trabecular myocardium into stronger compact myocardium. Using developmental series of embryonic and fetal humans, mice and chickens, we show ventricular morphogenesis is driven by differential rates of growth of trabecular and compact layers rather than a process of compaction. In mouse, fetal cardiomyocytes are relatively weak but adult cardiomyocytes from the trabecular and compact layer show an equally large force generating capacity. In fetal and adult humans, trabecular and compact myocardium are not different in abundance of immunohistochemically detected vascular, mitochondrial and sarcomeric proteins. Similar findings are made in human excessive trabeculation, a congenital malformation. In conclusion, trabecular and compact myocardium is equally equipped for force production and their proportions are determined by differential growth rates rather than by compaction.
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Affiliation(s)
- Jaeike W Faber
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Rob C I Wüst
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Inge Dierx
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Janneke A Hummelink
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Diederik W D Kuster
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Edgar Nollet
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Antoon F M Moorman
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Allard C van der Wal
- Department of Pathology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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13
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Yogev D, Tejman-Yarden S, Feinberg O, Parmet Y, Goldberg T, Illouz S, Nagar N, Freidin D, Vazgovsky O, Chatterji S, Salem Y, Katz U, Goitein O. Proof of concept: Comparative accuracy of semiautomated VR modeling for volumetric analysis of the heart ventricles. Heliyon 2022; 8:e11250. [PMID: 36387466 PMCID: PMC9641195 DOI: 10.1016/j.heliyon.2022.e11250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Simpson's rule is generally used to estimate cardiac volumes. By contrast, modern methods such as Virtual Reality (VR) utilize mesh modeling to present the object's surface spatial structure, thus enabling intricate volumetric calculations. In this study, two types of semiautomated VR models for cardiac volumetric analysis were compared to the standard Philips dedicated cardiac imaging platform (PDP) which is based on Simpson's rule calculations. Methods This retrospective report examined the cardiac computed tomography angiography (CCTA) of twenty patients with atrial fibrillation obtained prior to a left atrial appendage occlusion procedure. We employed two VR models to evaluate each CCTA and compared them to the PDP: a VR model with Philips-similar segmentations (VR-PS) that included the trabeculae and the papillary muscles within the luminal volume, and a VR model that only included the inner blood pool (VR-IBP). Results Comparison of the VR-PS and the PDP left ventricle (LV) volumes demonstrated excellent correlation with a ρc of 0.983 (95% CI 0.96, 0.99), and a small mean difference and range. The calculated volumes of the right ventricle (RV) had a somewhat lower correlation of 0.89 (95% CI 0.781, 0.95), a small mean difference, and a broader range. The VR-IBP chamber size estimations were significantly smaller than the estimates based on the PDP. Discussion Simpson's rule and polygon summation algorithms produce similar results in normal morphological LVs. However, this correlation failed to emerge when applied to RVs and irregular chambers. Conclusions The findings suggest that the polygon summation method is preferable for RV and irregular LV volume and function calculations.
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Affiliation(s)
- David Yogev
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Tejman-Yarden
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- Corresponding author.
| | - Omer Feinberg
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel
| | - Tomer Goldberg
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shay Illouz
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Netanel Nagar
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- Industrial Design Department, Bezalel Academy of Art and Design, Jerusalem, Israel
| | - Dor Freidin
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Oliana Vazgovsky
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
| | - Sumit Chatterji
- The Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel
- Interventional Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yishay Salem
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Uriel Katz
- The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel
- The Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Goitein
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
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14
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Yang C, Xu H, Qiao S, Jia R, Jin Z, Yuan J. Papillary and Trabecular Muscles Have Substantial Impact on Quantification of Left Ventricle in Patients with Hypertrophic Obstructive Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12082029. [PMID: 36010378 PMCID: PMC9407152 DOI: 10.3390/diagnostics12082029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Patients with obstructive hypertrophic cardiomyopathy (HOCM) have large papillary and trabecular muscles (PTMs), which are myocardial tissue. PTMs are usually excluded from the myocardium and included in the left ventricular (LV) cavity when determining LV mass (LVM) and volumes using cardiac magnetic resonance (CMR). This conventional method may result in large distortion of LVM and other indices. We investigated 74 patients with HOCM undergoing CMR imaging. LV short-axis cine images were obtained. LV contours were drawn using two different methods: (1) the conventional method, where PTMs were included in the LV cavity; and (2) the mask method, which includes the TPMs in the LV myocardium. The LV end-diastolic volume (LV-EDV), LV end-systolic volume (LV-ESV), LV ejection fraction (LVEF), and the LVM were then calculated. Fasting NT-proBNP and CK-MB levels were measured with ELISA. In patients with HOCM, mass of PTMs (MOPTM) was 47.9 ± 18.7 g, which represented 26.9% of total LVM. Inclusion of PTMs with the mask method resulted in significantly greater LVM and LVM index (both p < 0.0001) in comparison with those measured with the conventional method. In addition, the mask method produced a significant decrease in LV-EDV and LV-ESV. LVEF was significantly increased with the mask method (64.3 ± 7.9% vs. 77.2 ± 7.1%, p < 0.0001). MOPTM was positively correlated with BMI, septal wall thickness, LVM, LV-EDV, and LV-ESV. LVEF was inversely correlated with MOPTM. In addition, MOPTM correlated positively with NT-proBNP (r = 0.265, p = 0.039) and CK-MB (r = 0.356, p = 0.002). In conclusion, inclusion of PTMs in the myocardium has a substantial impact on quantification of the LVM, LV-EDV, LV-ESV, and LVEF in patients with HOCM. The effects of the PTMs in women was greater than that in men. Furthermore, the MOPTM was positively associated with NT-proBNP and CK-MB. The PTMs might be included in the myocardium when measuring the LV volumes and mass of patients with HOCM. At present, the clinical and prognostic meaning and relevance of the PTMs is not clear and should be further studied.
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Affiliation(s)
- Chengzhi Yang
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Haobo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ruofei Jia
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
- Correspondence: (Z.J.); (J.Y.)
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Z.J.); (J.Y.)
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15
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Barbieri A, Pepi M. Three-Dimensional Echocardiography Based on Automation and Machine Learning Principles and the Renaissance of Cardiac Morphometry. J Clin Med 2022; 11:jcm11154357. [PMID: 35955974 PMCID: PMC9369091 DOI: 10.3390/jcm11154357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Correspondence:
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
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16
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Camoni L, Cerudelli E. First-pass cardiac PET: Potentiality and limitations. J Nucl Cardiol 2022; 29:1018-1020. [PMID: 33604788 DOI: 10.1007/s12350-020-02476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Luca Camoni
- Nuclear Medicine, University of Brescia, Brescia, Italy.
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17
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MR -specific characteristics of left ventricular noncompaction and dilated cardiomyopathy. Int J Cardiol 2022; 359:69-75. [DOI: 10.1016/j.ijcard.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/05/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
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18
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Schoennagel BP, Müllerleile K, Tahir E, Starekova J, Grosse R, Yamamura J, Bannas P, Adam G, Fischer R. Insights into diastolic function analyses using cardiac magnetic resonance imaging: impact of trabeculae and papillary muscles. Insights Imaging 2021; 12:159. [PMID: 34731305 PMCID: PMC8566627 DOI: 10.1186/s13244-021-01104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background This cardiovascular magnetic resonance (CMR) study investigates the impact of trabeculae and papillary muscles (TPM) on diastolic function parameters by differentiation of the time-volume curve. Differentiation causes additional problems, which is overcome by standardization. Methods Cine steady-state free-precession imaging at 1.5 T was performed in 40 healthy volunteers stratified for age (age range 7–78y). LV time-volume curves were assessed by software-assisted delineation of endocardial contours from short axis slices applying two different methods: (1) inclusion of TPM into the myocardium and (2) inclusion of TPM into the LV cavity blood volume. Diastolic function was assessed from the differentiated time-volume curves defining the early and atrial peaks, their filling rates, filling volumes, and further dedicated diastolic measures, respectively. Results Only inclusion of TPM into the myocardium allowed precise assessment of early and atrial peak filling rates (EPFR, APFR) with clear distinction of EPFR and APFR expressed by the minimum between the early and atrial peak (EAmin) (100% vs. 36% for EAmin < 0.8). Prediction of peak filling rate ratios (PFRR) and filling volume ratios (FVR) by age was superior with inclusion of TPM into the myocardium compared to inclusion into the blood pool (r2 = 0.85 vs. r2 = 0.56 and r2 = 0.89 vs. r2 = 0.66). Standardization problems were overcome by the introduction of a third phase (mid-diastole, apart from diastole and systole) and fitting of the early and atrial peaks in the differentiated time-volume curve. Conclusions Only LV volumetry with inclusion of TPM into the myocardium allows precise determination of diastolic measures and prevents methodological artifacts.
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Affiliation(s)
- Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany.
| | - Kai Müllerleile
- Department of Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Regine Grosse
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Roland Fischer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany.,UCSF Benioff Children's Hospital, Oakland, USA
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19
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Gregor Z, Kiss AR, Szabó LE, Tóth A, Grebur K, Horváth M, Dohy Z, Merkely B, Vágó H, Szűcs A. Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification. PLoS One 2021; 16:e0258362. [PMID: 34637474 PMCID: PMC8509873 DOI: 10.1371/journal.pone.0258362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Methods Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18–29, Group B: 30–39, Group C: 40–49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). Results The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Conclusions Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- * E-mail:
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20
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Zhang Z, Ma Q, Gao Y, Cao L, Zhu C, Zhao Z, Zhao J, Zeng L, Lou M, Pohost GM, Li K. Biventricular Morphology and Function Reference Values Derived From a Large Sample of Healthy Chinese Adults by Magnetic Resonance Imaging. Front Cardiovasc Med 2021; 8:697481. [PMID: 34350219 PMCID: PMC8326328 DOI: 10.3389/fcvm.2021.697481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Quantification of cardiac structure and function is essential for diagnostic interpretation and clinical decision making. We sought to establish cardiovascular magnetic resonance (CMR) reference values of left and right ventricular (LV and RV) morphology and function based on a large sample of healthy Chinese adults. Methods: Five hundred fifty validated healthy Chinese adults (aged 21-70 years; 323 men) free of hypertension, diabetes, and obesity were included in this study. All the subjects were stratified by gender (men and women) and age decades. On cine CMR, measurements of biventricular end-diastolic, end-systolic, and stroke volumes (EDV, ESV, and SV), ejection fraction (EF), and end-diastolic LV wall thickness (LVWT) and mass (LVM) were obtained. Results: Men had greater LVEDV (111.6 ± 19.8 vs. 94.6 ± 15.6 ml), LVESV (36.5 ± 9.8 vs. 28.2 ± 7.9 ml), LVM (121.1 ± 19.9 vs. 86.1 ± 14.5 g), global end-diastolic LVWT (8.1 ± 1.1 vs. 6.7 ± 1.0 mm), RVEDV (128.0 ± 23.6 vs. 101.7 ± 17.0 ml), and RVESV (53.5 ± 13.7 vs. 36.8 ± 8.9 ml), while women had greater LVEF (67.5 ± 5.4 vs. 70.4 ± 5.7%) and RVEF (58.5 ± 5.2 vs. 64.0 ± 5.3%) (all p < 0.001). For both men and women, age was negatively correlated with LVEDV (r = -0.31 and r = -0.32), LVESV (r = -0.37 and r = -0.47), RVEDV (r = -0.31 and r = -0.29), and RVESV (r = -0.33 and r = -0.44), while it was positively correlated with LVEF (r = 0.28 and r = 0.43) and RVEF (r = 0.28 and r = 0.41) (all p < 0.001). Aging was associated with increasing global end-diastolic LVWT and LVM/LVEDV in both sexes (all p < 0.001). Older age was associated with increasing LVM only in women (r = 0.36, p < 0.001), not in men (r = 0.05, p = 0.359). Conclusions: We systematically provide age-, sex-, and body size-specific CMR reference values for biventricular morphology and function based on a large sample of healthy Chinese adults. Biventricular structure and function are significantly associated with age and sex.
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Affiliation(s)
- Zhen Zhang
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qiaozhi Ma
- Department of Radiology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yiyuan Gao
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lizhen Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Zhiwei Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Jun Zhao
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Linan Zeng
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
| | - Mingwu Lou
- Post-doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Gerald M Pohost
- Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Zhouxin Medical Imaging and Health Screening Centre, Xiamen, China
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21
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Urzua Fresno CM, Folador L, Shalmon T, Hamad FMD, Singh SM, Karur GR, Tan NS, Mangat I, Kirpalani A, Chacko BR, Jimenez-Juan L, Yan AT, Deva DP. Prognostic value of cardiovascular magnetic resonance left ventricular volumetry and geometry in patients receiving an implantable cardioverter defibrillator. J Cardiovasc Magn Reson 2021; 23:72. [PMID: 34108003 PMCID: PMC8191093 DOI: 10.1186/s12968-021-00768-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/28/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Current indications for implantable cardioverter defibrillator (ICD) implantation for sudden cardiac death prevention rely primarily on left ventricular (LV) ejection fraction (LVEF). Currently, two different contouring methods by cardiovascular magnetic resonance (CMR) are used for LVEF calculation. We evaluated the comparative prognostic value of these two methods in the ICD population, and if measures of LV geometry added predictive value. METHODS In this retrospective, 2-center observational cohort study, patients underwent CMR prior to ICD implantation for primary or secondary prevention from January 2005 to December 2018. Two readers, blinded to all clinical and outcome data assessed CMR studies by: (a) including the LV trabeculae and papillary muscles (TPM) (trabeculated endocardial contours), and (b) excluding LV TPM (rounded endocardial contours) from the total LV mass for calculation of LVEF, LV volumes and mass. LV sphericity and sphere-volume indices were also calculated. The primary outcome was a composite of appropriate ICD shocks or death. RESULTS Of the 372 consecutive eligible patients, 129 patients (34.7%) had appropriate ICD shock, and 65 (17.5%) died over a median duration follow-up of 61 months (IQR 38-103). LVEF was higher when including TPM versus excluding TPM (36% vs. 31%, p < 0.001). The rate of appropriate ICD shock or all-cause death was higher among patients with lower LVEF both including and excluding TPM (p for trend = 0.019 and 0.004, respectively). In multivariable models adjusting for age, primary prevention, ischemic heart disease and late gadolinium enhancement, both LVEF (HR per 10% including TPM 0.814 [95%CI 0.688-0.962] p = 0.016, vs. HR per 10% excluding TPM 0.780 [95%CI 0.639-0.951] p = 0.014) and LV mass index (HR per 10 g/m2 including TPM 1.099 [95%CI 1.027-1.175] p = 0.006; HR per 10 g/m2 excluding TPM 1.126 [95%CI 1.032-1.228] p = 0.008) had independent prognostic value. Higher LV end-systolic volumes and LV sphericity were significantly associated with increased mortality but showed no added prognostic value. CONCLUSION Both CMR post-processing methods showed similar prognostic value and can be used for LVEF assessment. LVEF and indexed LV mass are independent predictors for appropriate ICD shocks and all-cause mortality in the ICD population.
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Affiliation(s)
- Camila M. Urzua Fresno
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Luciano Folador
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Radiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS Brazil
| | - Tamar Shalmon
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Faisal Mhd. Dib Hamad
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Sheldon M. Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Gauri R. Karur
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Nigel S. Tan
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Iqwal Mangat
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Binita Riya Chacko
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Andrew T. Yan
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Division of Cardiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
| | - Djeven P. Deva
- Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- St. Michael’s Hospital, 30 Bond Street, Toronto, M5B 1W8 Canada
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22
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Bartoli A, Fournel J, Bentatou Z, Habib G, Lalande A, Bernard M, Boussel L, Pontana F, Dacher JN, Ghattas B, Jacquier A. Deep Learning-based Automated Segmentation of Left Ventricular Trabeculations and Myocardium on Cardiac MR Images: A Feasibility Study. Radiol Artif Intell 2021; 3:e200021. [PMID: 33937851 DOI: 10.1148/ryai.2020200021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 01/25/2023]
Abstract
Purpose To develop and evaluate a complete deep learning pipeline that allows fully automated end-diastolic left ventricle (LV) cardiac MRI segmentation, including trabeculations and automatic quality control of the predicted segmentation. Materials and Methods This multicenter retrospective study includes training, validation, and testing datasets of 272, 27, and 150 cardiac MR images, respectively, collected between 2012 and 2018. The reference standard was the manual segmentation of four LV anatomic structures performed on end-diastolic short-axis cine cardiac MRI: LV trabeculations, LV myocardium, LV papillary muscles, and the LV blood cavity. The automatic pipeline was composed of five steps with a DenseNet architecture. Intraobserver agreement, interobserver agreement, and interaction time were recorded. The analysis includes the correlation between the manual and automated segmentation, a reproducibility comparison, and Bland-Altman plots. Results The automated method achieved mean Dice coefficients of 0.96 ± 0.01 (standard deviation) for LV blood cavity, 0.89 ± 0.03 for LV myocardium, and 0.62 ± 0.08 for LV trabeculation (mean absolute error, 3.63 g ± 3.4). Automatic quantification of LV end-diastolic volume, LV myocardium mass, LV trabeculation, and trabeculation mass-to-total myocardial mass (TMM) ratio showed a significant correlation with the manual measures (r = 0.99, 0.99, 0.90, and 0.83, respectively; all P < .01). On a subset of 48 patients, the mean Dice value for LV trabeculation was 0.63 ± 0.10 or higher compared with the human interobserver (0.44 ± 0.09; P < .01) and intraobserver measures (0.58 ± 0.09; P < .01). Automatic quantification of the trabeculation mass-to-TMM ratio had a higher correlation (0.92) compared with the intra- and interobserver measures (0.74 and 0.39, respectively; both P < .01). Conclusion Automated deep learning framework can achieve reproducible and quality-controlled segmentation of cardiac trabeculations, outperforming inter- and intraobserver analyses.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Axel Bartoli
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Joris Fournel
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Zakarya Bentatou
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Gilbert Habib
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Alain Lalande
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Monique Bernard
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Loïc Boussel
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - François Pontana
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Jean-Nicolas Dacher
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Badih Ghattas
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
| | - Alexis Jacquier
- Departments of Radiology (A.B., A.J.) and Cardiology (G.H.), Hôpital de la Timone Adultes, AP-HM, 264, rue Saint-Pierre 13385 Marseille Cedex 05, France; CRMBM-UMR CNRS 7339, Medical Faculty, Aix-Marseille University, Marseille, France (A.B., J.F., Z.B., M.B., A.J.); I2M-UMR CNRS 7373, Aix-Marseille University, Centrale Marseille, Marseille, France (J.F., B.G.); ImVia Laboratory and University Hospital of Dijon, Bourgogne-Franche Comté University, Dijon, France (A.L.); Department of Radiology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (L.B.); Department of Cardiovascular Imaging, Lille University Hospital, Lille, France (F.P.); and Department of Diagnostic Imaging, Rouen University Hospital, Rouen, France (J.N.D.)
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23
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Kawel-Boehm N, Hetzel SJ, Ambale-Venkatesh B, Captur G, Francois CJ, Jerosch-Herold M, Salerno M, Teague SD, Valsangiacomo-Buechel E, van der Geest RJ, Bluemke DA. Reference ranges ("normal values") for cardiovascular magnetic resonance (CMR) in adults and children: 2020 update. J Cardiovasc Magn Reson 2020; 22:87. [PMID: 33308262 PMCID: PMC7734766 DOI: 10.1186/s12968-020-00683-3] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland
- Institute for Diagnostic, Interventional and Pediatric Radiology (DIPR), Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, InselspitalBern, Switzerland
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, 610 Walnut St, Madison, WI, 53726, USA
| | - Bharath Ambale-Venkatesh
- Department of Radiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Gabriella Captur
- MRC Unit of Lifelong Health and Ageing At UCL, 5-19 Torrington Place, Fitzrovia, London, WC1E 7HB, UK
- Inherited Heart Muscle Conditions Clinic, Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK
| | - Christopher J Francois
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael Salerno
- Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Shawn D Teague
- Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO, 80206, USA
| | - Emanuela Valsangiacomo-Buechel
- Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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Perry R, Shah R, Saiedi M, Patil S, Ganesan A, Linhart A, Selvanayagam JB. The Role of Cardiac Imaging in the Diagnosis and Management of Anderson-Fabry Disease. JACC Cardiovasc Imaging 2020; 12:1230-1242. [PMID: 31272606 DOI: 10.1016/j.jcmg.2018.11.039] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/19/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022]
Abstract
Anderson-Fabry disease (AFD) is a rare X-linked inherited metabolic disorder which results in a deficiency or absence of the enzyme α-galactosidase A, leading to the accumulation of glycosphingolipids in various cells and organs including the heart. Cardiac involvement is common and results in increased myocardial inflammation, left ventricular hypertrophy (LVH), and myocardial fibrosis. Echocardiography and cardiovascular magnetic resonance (CMR) offer distinctive and often complementary use to assist in the diagnosis and monitoring pharmacologic therapy in AFD, including detection of the AFD cardiac phenotype, differentiation from other forms of LVH, and patient selection for therapeutic intervention. Advanced cardiac imaging holds promise in subclinical detection of AFD-related abnormalities as well as disease staging and prognostication.
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Affiliation(s)
- Rebecca Perry
- College of Medicine, Flinders University of South Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Ranjit Shah
- College of Medicine, Flinders University of South Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Madiha Saiedi
- College of Medicine, Flinders University of South Australia; Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Sanjana Patil
- College of Medicine, Flinders University of South Australia
| | - Anand Ganesan
- College of Medicine, Flinders University of South Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Ales Linhart
- Second Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University of South Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network; Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia.
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25
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Lee JW, Nam KJ, Kim JY, Jeong YJ, Lee G, Park SM, Lim SJ, Choo KS. Simultaneous Assessment of Left Ventricular Function and Coronary Artery Anatomy by Third-generation Dual-source Computed Tomography Using a Low Radiation Dose. J Cardiovasc Imaging 2019; 28:21-32. [PMID: 31805621 PMCID: PMC6992922 DOI: 10.4250/jcvi.2019.0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To assess left ventricular function and coronary artery simultaneously by third-generation dual-source computed tomography (CT) using a low radiation dose. METHODS A total of 48 patients (36 men, 12 women; mean age 57.0 ± 9.5 years) who underwent both electrocardiography-gated cardiac CT angiography (CCTA) using 70–90 kVp and echocardiography were included in this retrospective study. The correlation between left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) measured using CCTA and echocardiography was determined. The quality of coronary artery images was analyzed using a 4-point scale (1, excellent; 4, poor). The effective radiation dose of CCTA was calculated. RESULTS Mean heart rate during the CT examination was 59.9 ± 9.9 bpm (range 38–79) and the body mass index of 48 patients was 24.5 ± 2.6 kg/m2 (range 17.0–29.4). LVEDV, LVESV, and LVEF measured using CCTA and echocardiography demonstrated a fair to moderate correlation (Pearson correlation coefficient: r = 0.395, p = 0.005 for LVEDV; r = 0.509. p < 0.001 for LVESV; r = 0.551, p < 0.001 for LVEF). Average image quality score of coronary arteries was 1.0 ± 0.1 (range 1–2). A total of 99.0% (783 of 791) of segments had an excellent image quality score, and 1.0% (8 of 791) of segments had a good score. Mean effective radiation dose was 2.2 ± 0.7 mSv. CONCLUSIONS Third-generation dual-source CT using a low tube voltage simultaneously provides information regarding LV function and coronary artery disease at a low radiation dose. It can serve as an alternative option for functional assessment, particularly when other imaging modalities are inadequate.
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Affiliation(s)
- Ji Won Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kyung Jin Nam
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin You Kim
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yeon Joo Jeong
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geewon Lee
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Min Park
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo Jin Lim
- Department of Cardiology, Kim Hae Kangil Hospital, Gimhae, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
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26
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Biederman RWW, Doyle M, Correa-Jaque P, Rayarao G, Benza RL. Integrated use of cardiac MRI and the CardioMEMS™ HF system in PAH: the utility of coincident pressure and volume in RV failure-the NHLBI-VITA trial. Cardiovasc Diagn Ther 2019; 9:492-501. [PMID: 31737520 DOI: 10.21037/cdt.2019.09.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to study the feasibility and safety of measuring volumetric and pressure parameters noninvasively using simultaneous cardiovascular magnetic resonance (cMR) volumetric data and time-resolved pressure waveforms from previously implanted CardioMEMS devices in pulmonary arterial hypertension (PAH) patients. Opportunities to intervene during clinically occult phases in PAH promise to herald a key transformation in our current practice for treating this complex population. Currently, it is possible and convenient to monitor daily pulmonary arterial (PA) pressures in PAH patients using the CardioMEMS device to determine clinically silent progression. Supplementation of these pressures with other prognostic measurements of right ventricular (RV) contractility, PA resistance and RV/PA coupling could add further predictive capabilities. Methods PAH patients (n=17) with New York Hospital Association (NYHA) class III or IV heart failure (HF) and recent HF related hospitalizations were implanted with the CardioMEMS device as part of a NHLBI sponsored Trial. Implanted patients were then assessed using cMR imaging of the right ventricle (RV) along with measurement of pulmonary artery flow. Patients were imaged at one-month post implant (baseline) and at 4-month follow-up time (n=12). At baseline, patients were studied at rest and then under three different physiologic conditions: inhaled nitric oxide (INO), dobutamine (Dob) stress and volumetric stress (Vol), using a multiple slice short-axis imaging and a rapid imaging protocol. Results All patients were safely imaged, with no artifacts obscuring the cMR images. RV volumes were measured successfully at rest and under each stress condition using a reduced scan approach that required calibration for each patient which achieved a correlation r2 of 0.98. Variables measured included the maximal pulmonary artery elastance (Ea), maximal RV myocardial elastance (Emax) and ventricular-vascular coupling ratio (VVC). The response to stressors was determined on a patient basis. No complications occurred during the cMRI examination. Conclusions It is safe and feasible to perform cMR imaging with simultaneous pulmonary artery pressure readings from the CardioMEMS device. A reduced scan approach was developed to allowed measurement of RV volumes during stress conditions. Volumetric and pressure measurements can be combined to assess fundamental myocardial properties (e.g., Emax, Ea and VVC) in PAH patients serially over time. In the future, these parameters can be tested as serial predictors of outcome and response to therapies in PAH.
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Affiliation(s)
| | - Mark Doyle
- Allegheny General Hospital, Pittsburgh, PA, USA
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Kawamura T, Yasuda M, Okune M, Kakehi K, Kagioka Y, Nakamura T, Miyazaki S, Iwanaga Y. Increased Left Ventricular Trabeculation Is Associated With Increased B-Type Natriuretic Peptide Levels and Impaired Outcomes in Nonischemic Cardiomyopathy. Can J Cardiol 2019; 36:518-526. [PMID: 32007348 DOI: 10.1016/j.cjca.2019.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The clinical significance of left ventricular (LV) trabeculation remains unknown in cardiomyopathies. B-Type natriuretic peptide (BNP) strongly reflects LV end-diastolic wall stress and is a useful prognostic marker of cardiovascular diseases. The enhanced identification of LV trabeculae (T) with the use of cardiac magnetic resonance and the evaluation of its relationship with BNP may elucidate the biologic significance and clinical impact of trabeculation in patients with nonischemic cardiomyopathy (NICM). METHODS The LV volume and mass of 515 patients with NICM and 36 control subjects were analyzed with the use of a steady-state free precession sequence, and individual T mass was planimetred. Major adverse cardiac events (MACE) were assessed. RESULTS T mass index correlated with LV end-diastolic volume index (EDVI), LV mass index, and papillary muscle mass index (all P < 0.001). Also, T mass index was positively correlated with BNP level (R = 0.381; P < 0.001) and was an independent determinant of BNP after adjusting for age, sex, body mass index (BMI), etiology, LV ejection fraction, and LV EDVI (P < 0.001). Kaplan-Meier analysis during a median follow-up of 17.3 months showed that higher T mass index and increased BNP level correlated with MACE. On multivariate analysis, T mass index (P = 0.031) and BNP (P < 0.001) remained associated with poor outcomes when combined with age, sex, BMI, and etiology. CONCLUSIONS Increased LV trabeculation was associated with LV dysfunction/remodelling and impaired outcomes in NICM of various etiologies. This may support the biologic significance of LV trabeculation and could be attributed to its association with BNP through LV wall stress.
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Affiliation(s)
- Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Mana Okune
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yoshinori Kagioka
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takashi Nakamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.
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Gimelli A, Liga R, Magro S, Novo S, Pedrinelli R, Petronio AS, Marzullo P, Pepe A. Evaluation of left ventricular mass on cadmium-zinc-telluride imaging: Validation against cardiac magnetic resonance. J Nucl Cardiol 2019; 26:899-905. [PMID: 29043554 DOI: 10.1007/s12350-017-1086-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Single-photon emission computed tomography has shown relevant limitations in the quantification of left ventricular (LV) mass. We sought to compare the estimates of LV mass on Cadmium-Zinc-Telluride (CZT) myocardial perfusion imaging (MPI) as compared to cardiac magnetic resonance (CMR). METHODS AND RESULTS Twenty-five patients underwent MPI on a CZT camera and CMR on a 1.5 T scanner within 12 ± 3 weeks. LV mass was quantified on CZT images using two softwares: 4D-MSPECT (4DM) and Emory Cardiac Toolbox (ECTb). LV mass by CMR was quantified using MASS software (Medis, Leiden, The Netherlands). LV mass values obtained with 4DM and ECTb were highly reproducible [intraclass correlation coefficients .98 (95% CI .97-.99), and .98 (95% CI 0.97-.99), respectively]. The mean LVM mass values were 151 ± 44 g on CMR, 151 ± 43 g with 4DM (P = NS vs CMR), and 157 ± 42 g with ECTb (P < .001 vs CMR; P = .007 vs 4DM) CZT images. There was an excellent correlation between LV mass values between CMR and both 4DM (R2 = .95; P < .001) and ECTb (R2 = .98; P < .001) with narrow limits of agreement (- 13.6% to + 13.4% for 4DM, and - 5.6% to + 14.1% for ECTb). CONCLUSIONS The evaluation of LV mass is feasible on CZT images, showing excellent agreement with CMR.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy.
| | - Serena Magro
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Salvatore Novo
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
| | - Anna Sonia Petronio
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Alessia Pepe
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
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Packard RRS, Maddahi J. Assessment of left ventricular mass by SPECT MPI. J Nucl Cardiol 2019; 26:906-908. [PMID: 29243071 DOI: 10.1007/s12350-017-1146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- René R Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jamshid Maddahi
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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30
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Seraphim A, Knott KD, Augusto J, Bhuva AN, Manisty C, Moon JC. Quantitative cardiac MRI. J Magn Reson Imaging 2019; 51:693-711. [PMID: 31111616 DOI: 10.1002/jmri.26789] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Cardiac MRI has become an indispensable imaging modality in the investigation of patients with suspected heart disease. It has emerged as the gold standard test for cardiac function, volumes, and mass and allows noninvasive tissue characterization and the assessment of myocardial perfusion. Quantitative MRI already has a key role in the development and incorporation of machine learning in clinical imaging, potentially offering major improvements in both workflow efficiency and diagnostic accuracy. As the clinical applications of a wide range of quantitative cardiac MRI techniques are being explored and validated, we are expanding our capabilities for earlier detection, monitoring, and risk stratification of disease, potentially guiding personalized management decisions in various cardiac disease models. In this article we review established and emerging quantitative techniques, their clinical applications, highlight novel advances, and appraise their clinical diagnostic potential. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:693-711.
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Affiliation(s)
- Andreas Seraphim
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kristopher D Knott
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Joao Augusto
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anish N Bhuva
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Charlotte Manisty
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - James C Moon
- University College London, Institute of Cardiovascular Science, London, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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Goo HW. Technical feasibility of semiautomatic three-dimensional threshold-based cardiac computed tomography quantification of left ventricular mass. Pediatr Radiol 2019; 49:318-326. [PMID: 30470863 DOI: 10.1007/s00247-018-4303-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/17/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Semiautomatic three-dimensional (3-D) threshold-based cardiac computed tomography (CT) quantification has not been attempted for left ventricular mass. OBJECTIVE To evaluate the technical feasibility of semiautomatic 3-D threshold-based cardiac CT quantification of left ventricular mass in patients with various degrees of left ventricular hypertrophy. MATERIALS AND METHODS In 99 patients, cardiac CT was utilized to quantify ventricular volume and mass by using a semiautomatic 3-D threshold-based method. Left ventricular mass values were compared between the end-systole and the end-diastole. Volumetric parameters were compared among three left ventricular hypertrophy groups (definite, borderline, none). The reproducibility was assessed. The t-test, one-way analysis of variance and Pearson correlation were used. RESULTS There were no technical failures. The left ventricular mass between the two sessions exhibited a small mean difference of 2.3±1.1% (mean±standard deviation). The indexed mass values were significantly higher at the end-systole than at the end-diastole (71.4±42.9 g/m2 vs. 65.9±43.3 g/m2, P<0.001), with significant correlation (R=0.99, P<0.001). The definite group (83.5±41.3 g/m2) showed statistically significantly higher indexed mass values than the borderline and none groups (64.7±26.9 and 55.6±23.9 g/m2, respectively; P<0.03), while demonstrating no statistically significant difference between the latter two groups (P>0.05). Left ventricular volume-mass and mass-volume ratios could be calculated in all three groups. CONCLUSION CT quantification of left ventricular mass using semiautomatic 3-D threshold-based segmentation is feasible with high reproducibility and the mass values and its ratios with ventricular volumes may be used in patients with various degrees of left ventricular hypertrophy.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Pencina KM, Travison TG, Bhasin S, Li Z, Nigam N, Manning WJ, Vasan RS, Hoffmann U, O'Donnell CJ, Basaria S. Endogenous circulating testosterone and sex hormone-binding globulin levels and measures of myocardial structure and function: the Framingham Heart Study. Andrology 2019; 7:307-314. [PMID: 30761772 DOI: 10.1111/andr.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/14/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. OBJECTIVES To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. METHODS A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean = 59.6 years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). RESULTS Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p = 0.009), left ventricular mass index (p = 0.006), cardiac output (p = 0.001), and main pulmonary artery diameter (p = 0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p = 0.002), left ventricular mass index (p = 0.004), cardiac output (p = 0.003), left ventricular ejection fraction (p = 0.039), and main pulmonary artery diameter (p = 0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. CONCLUSIONS Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.
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Affiliation(s)
- K M Pencina
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T G Travison
- Program on Aging, Hebrew Senior Life, Roslindale, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Z Li
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - N Nigam
- St. Mary's Medical Center, San Francisco, CA, USA
| | - W J Manning
- Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R S Vasan
- Framingham Heart Study, Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - U Hoffmann
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | | | - S Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Czimbalmos C, Csecs I, Toth A, Kiss O, Suhai FI, Sydo N, Dohy Z, Apor A, Merkely B, Vago H. The demanding grey zone: Sport indices by cardiac magnetic resonance imaging differentiate hypertrophic cardiomyopathy from athlete's heart. PLoS One 2019; 14:e0211624. [PMID: 30763323 PMCID: PMC6375568 DOI: 10.1371/journal.pone.0211624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We aimed to characterize gender specific left ventricular hypertrophy using a novel, accurate and less time demanding cardiac magnetic resonance (CMR) quantification method to differentiate physiological hypertrophy and hypertrophic cardiomyopathy based on a large population of highly trained athletes and hypertrophic cardiomyopathy patients. METHODS Elite athletes (n = 150,>18 training hours/week), HCM patients (n = 194) and athletes with hypertrophic cardiomyopathy (n = 10) were examined by CMR. CMR based sport indices such as maximal end-diastolic wall thickness to left ventricular end-diastolic volume index ratio (EDWT/LVEDVi) and left ventricular mass to left ventricular end-diastolic volume ratio (LVM/LVEDV) were calculated, established using both conventional and threshold-based quantification method. RESULTS Whereas 47.5% of male athletes, only 4.1% of female athletes were in the grey zone of hypertrophy (EDWT 13-16mm). EDWT/LVEDVi discriminated between physiological and pathological left ventricular hypertrophy with excellent diagnostic accuracy (AUCCQ:0.998, AUCTQ:0.999). Cut-off value for LVM/LVEDVCQ<0.82 mm×m2/ml and for EDWT/LVEDViTQ<1.27 discriminated between physiological and pathological left ventricular hypertrophy with a sensitivity of 77.8% and 89.2%, a specificity of 86.7% and 91.3%, respectively. LVM/LVEDV evaluated using threshold-based quantification performed significantly better than conventional quantification even in the male subgroup with EDWT between 13-16mm (p<0.001). CONCLUSIONS Almost 50% of male highly trained athletes can reach EDWT of 13 mm. CMR based sport indices provide an important tool to distinguish hypertrophic cardiomyopathy from athlete's heart, especially in highly trained athletes in the grey zone of hypertrophy.
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Affiliation(s)
| | - Ibolya Csecs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Nora Sydo
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsofia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Astrid Apor
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- * E-mail:
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Goo HW. Semiautomatic Three-Dimensional Threshold-Based Cardiac Computed Tomography Ventricular Volumetry in Repaired Tetralogy of Fallot: Comparison with Cardiac Magnetic Resonance Imaging. Korean J Radiol 2018; 20:102-113. [PMID: 30627026 PMCID: PMC6315063 DOI: 10.3348/kjr.2018.0237] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To assess the accuracy and potential bias of computed tomography (CT) ventricular volumetry using semiautomatic three-dimensional (3D) threshold-based segmentation in repaired tetralogy of Fallot, and to compare them to those of two-dimensional (2D) magnetic resonance imaging (MRI). Materials and Methods This retrospective study evaluated 32 patients with repaired tetralogy of Fallot who had undergone both cardiac CT and MRI within 3 years. For ventricular volumetry, semiautomatic 3D threshold-based segmentation was used in CT, while a manual simplified contouring 2D method was used in MRI. The indexed ventricular volumes were compared between CT and MRI. The indexed ventricular stroke volumes were compared with the indexed arterial stroke volumes measured using phase-contrast MRI. The mean differences and degrees of agreement in the indexed ventricular and stroke volumes were evaluated using Bland-Altman analysis. Results The indexed end-systolic (ES) volumes showed no significant difference between CT and MRI (p > 0.05), while the indexed end-diastolic (ED) volumes were significantly larger on CT than on MRI (93.6 ± 17.5 mL/m2 vs. 87.3 ± 15.5 mL/m2 for the left ventricle [p < 0.001] and 177.2 ± 39.5 mL/m2 vs. 161.7 ± 33.1 mL/m2 for the right ventricle [p < 0.001], respectively). The mean differences between CT and MRI were smaller for the indexed ES volumes (2.0–2.5 mL/m2) than for the indexed ED volumes (6.3–15.5 mL/m2). CT overestimated the stroke volumes by 14–16%. With phase-contrast MRI as a reference, CT (7.2–14.3 mL/m2) showed greater mean differences in the indexed stroke volumes than did MRI (0.8–3.3 mL/m2; p < 0.005). Conclusion Compared to 2D MRI, CT ventricular volumetry using semiautomatic 3D threshold-based segmentation provides comparable ES volumes, but overestimates the ED and stroke volumes in patients with repaired tetralogy of Fallot.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Śpiewak M. Letter by Śpiewak Regarding Article, "Prognostic Implications of Magnetic Resonance-Derived Quantification in Asymptomatic Patients With Organic Mitral Regurgitation: Comparison With Doppler Echocardiography-Derived Integrative Approach". Circulation 2018; 138:1608-1609. [PMID: 30354515 DOI: 10.1161/circulationaha.118.033684] [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)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
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Goo HW. Comparison between Three-Dimensional Navigator-Gated Whole-Heart MRI and Two-Dimensional Cine MRI in Quantifying Ventricular Volumes. Korean J Radiol 2018; 19:704-714. [PMID: 29962876 PMCID: PMC6005949 DOI: 10.3348/kjr.2018.19.4.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/19/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To test whether the method utilizing three-dimensional (3D) whole-heart MRI has an additional benefit over that utilizing conventional two-dimensional (2D) cine MRI in quantifying ventricular volumes. Materials and Methods In 110 patients with congenital heart disease, a navigator-gated, 3D whole-heart MRI during end-systole (ES) and end-diastole (ED), 2D short-axis cine MRI, and phase contrast MRI of the great arteries were acquired. Ventricular volumes were measured by using a 3D threshold-based segmentation for 3D whole-heart MRI and by using a simplified contouring for 2D cine MRI. The cardiac trigger delays of 3D whole-heart MRI were compared with those of a 2D cine MRI. The stroke volumes calculated from the ventricular volumes were compared with the arterial flow volumes, measured by phase contrast MRI. Results The ES and ED trigger delays of whole-heart MRI were significantly less than cine MRI for both the left ventricle (−16.8 ± 35.9 ms for ES, −59.0 ± 90.4 ms for ED; p < 0.001) and the right ventricle (−58.8 ± 30.6 ms for ES, −104.9 ± 92.7 ms for ED; p < 0.001). Compared with the arterial flow volumes, 2D cine MRI significantly overestimated the left ventricular stroke volumes (8.7 ± 8.9 mL, p < 0.001) and the 3D whole-heart MRI significantly underestimated the right ventricular stroke volumes (−22.7 ± 22.9 mL, p < 0.001). Conclusion Three-dimensional whole-heart MRI is often subject to early timing of the ED phase, potentially leading to the underestimation of the right ventricular stroke volumes.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Jagsi R, Griffith KA, Moran JM, Ficaro E, Marsh R, Dess RT, Chung E, Liss AL, Hayman JA, Mayo CS, Flaherty K, Corbett J, Pierce L. A Randomized Comparison of Radiation Therapy Techniques in the Management of Node-Positive Breast Cancer: Primary Outcomes Analysis. Int J Radiat Oncol Biol Phys 2018; 101:1149-1158. [PMID: 30012527 DOI: 10.1016/j.ijrobp.2018.04.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Edward Ficaro
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Eugene Chung
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Adam L Liss
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kevin Flaherty
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - James Corbett
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Qazi S, Gona PN, Salton CJ, Bajaj NS, Larson MG, O’Donnell CJ, Manning WJ, Chuang ML. Impact of Left Ventricular Trabeculations and Papillary Muscles on Mass, Geometry, and Association With Incident Adverse Cardiovascular Events. JACC Cardiovasc Imaging 2018; 11:653-654. [DOI: 10.1016/j.jcmg.2017.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022]
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Non-compact myocardium assessment by cardiac magnetic resonance: dependence on image analysis method. Int J Cardiovasc Imaging 2018. [DOI: 10.1007/s10554-018-1331-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Left and right ventricular parameters corrected with threshold-based quantification method in a normal cohort analyzed by three independent observers with various training-degree. Int J Cardiovasc Imaging 2018; 34:1127-1133. [DOI: 10.1007/s10554-018-1322-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
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Rayarao G, Biederman RWW, Williams RB, Yamrozik JA, Lombardi R, Doyle M. Improved approach to quantitative cardiac volumetrics using automatic thresholding and manual trimming: a cardiovascular MRI study. J Med Imaging (Bellingham) 2018; 5:014004. [DOI: 10.1117/1.jmi.5.1.014004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Geetha Rayarao
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Robert W. W Biederman
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Ronald B. Williams
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - June A. Yamrozik
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Richard Lombardi
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Mark Doyle
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Gaasch WH, Meyer TE. Secondary mitral regurgitation (part 2): deliberations on mitral surgery and transcatheter repair. Heart 2018; 104:639-643. [DOI: 10.1136/heartjnl-2017-312002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/21/2017] [Indexed: 02/01/2023] Open
Abstract
Secondary mitral regurgitation (MR) develops as a consequence of postinfarction remodelling of the ventricle or other causes of left ventricular (LV) dilatation and dysfunction. The presence of MR amplifies the poor prognosis of the failing ventricle, but it has not been established whether the adverse outcomes stem from the MR or whether the MR is simply a marker of progressive LV dysfunction. In this article, an attempt will be made to clarify the clinical impact of mitral surgery and transcatheter repair in patients with secondary MR. Observational studies indicate symptomatic improvement, but the results of randomised trials are mixed. Furthermore, neither mitral surgery nor transcatheter repair consistently leads to reversal of the adverse LV remodelling. There is, however, general agreement that these procedures do not have a salutary effect on survival. Certainly mitral surgery and transcatheter repair can substantially reduce the mitral regurgitant flow, but inconsistencies and uncertainties regarding clinical outcomes persist in the published literature. Some such problems could be resolved by utilisation of more accurate and reproducible imaging modalities in randomised studies of patients who are most likely to benefit from a reduction in the regurgitant volume—namely those with the most severe MR.
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Blood-threshold CMR volume analysis of functional univentricular heart. Radiol Med 2018; 123:331-337. [PMID: 29357037 DOI: 10.1007/s11547-017-0851-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To validate a blood-threshold (BT) segmentation software for cardiac magnetic resonance (CMR) cine images in patients with functional univentricular heart (FUH). MATERIALS AND METHODS We evaluated retrospectively 44 FUH patients aged 25 ± 8 years (mean ± standard deviation). For each patient, the epicardial contour of the single ventricle was manually segmented on cine images by two readers and an automated BT algorithm was independently applied to calculate end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and cardiac mass (CM). Aortic flow analysis (AFA) was performed on through-plane images to obtain forward volumes and used as a benchmark. Reproducibility was tested in a subgroup of 24 randomly selected patients. Wilcoxon, Spearman, and Bland-Altman statistics were used. RESULTS No significant difference was found between SV (median 57.7 ml; interquartile range 47.9-75.6) and aortic forward flow (57.4 ml; 48.9-80.4) (p = 0.123), with a high correlation (r = 0.789, p < 0.001). Intra-reader reproducibility was 86% for SV segmentation, and 96% for AFA. Inter-reader reproducibility was 85 and 96%, respectively. CONCLUSION The BT segmentation provided an accurate and reproducible assessment of heart function in FUH patients.
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Śpiewak M, Kłopotowski M, Gawor M, Kubik A, Kowalik E, Miłosz-Wieczorek B, Dąbrowski M, Werys K, Mazurkiewicz Ł, Kożuch K, Polańska-Skrzypczyk M, Petryka-Mazurkiewicz J, Klisiewicz A, Bilińska ZT, Grzybowski J, Witkowski A, Marczak M. Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods. J Cardiovasc Magn Reson 2017; 19:105. [PMID: 29268761 PMCID: PMC5740710 DOI: 10.1186/s12968-017-0417-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM) enables the assessment of not only left ventricular (LV) hypertrophy and scarring but also the severity of mitral regurgitation. CMR assessment of mitral regurgitation is primarily based on the difference between LV stroke volume (LVSV) and aortic forward flow (Ao) measured using the phase-contrast (PC) technique. However, LV outflow tract (LVOT) obstruction causing turbulent, non-laminar flow in the ascending aorta may impact the accuracy of aortic flow quantification, leading to false conclusions regarding mitral regurgitation severity. Thus, we decided to quantify mitral regurgitation in patients with HCM using Ao or, alternatively, main pulmonary artery forward flow (MPA) for mitral regurgitation volume (MRvol) calculations. METHODS The analysis included 143 prospectively recruited subjects with HCM and 15 controls. MRvol was calculated as the difference between LVSV computed with either the inclusion (LVSVincl) or exclusion (LVSVexcl) of papillary muscles and trabeculations from the blood pool and either Ao (MRvolAoi or MRvolAoe) or MPA (MRvolMPAi or MRvolMPAe). The presence or absence of LVOT obstruction was determined based on Doppler echocardiography findings. RESULTS MRvolAoi was higher than MRvolMPAi in HCM patients with LVOT obstruction [47.0 ml, interquartile range (IQR) = 31.5-60.0 vs. 35.5 ml, IQR = 26.0-51.0; p < 0.0001] but not in non-obstructive HCM patients (23.0 ml, IQR = 16.0-32.0 vs. 24.0 ml, IQR = 15.3-32.0; p = 0.26) or controls (18.0 ml, IQR = 14.3-21.8 vs. 20.0 ml, IQR = 14.3-22.0; p = 0.89). In contrast to controls and HCM patients without LVOT obstruction, in HCM patients with LVOT obstruction, aortic flow-based MRvol (MRvolAoi) was higher than pulmonary-based findings (MRvolMPAi) (bias = 9.5 ml; limits of agreement: -11.7-30.7 with a difference of 47 ml in the extreme case). The differences between aortic-based and pulmonary-based MRvol values calculated using LVSVexcl mirrored those derived using LVSVincl. However, MRvol values calculated using LVSVexcl were lower in all the groups analyzed (HCM with LVOT obstruction, HCM without LVOT obstruction, and controls) and with all methods of MRvol quantification used (p ≤ 0.0001 for all comparisons). CONCLUSIONS In HCM patients, LVOT obstruction significantly affects the estimation of aortic flow, leading to its underestimation and, consequently, to higher MRvol values than those obtained with MPA-based MRvol calculations.
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Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kłopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Katarzyna Kożuch
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
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Gaasch WH, Meyer TE. Secondary mitral regurgitation (part 1): volumetric quantification and analysis. Heart 2017; 104:634-638. [DOI: 10.1136/heartjnl-2017-312001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/04/2022] Open
Abstract
Secondary mitral regurgitation (MR) develops as a consequence of left ventricular (LV) dilatation and dysfunction, which complicates its evaluation and management. The goal of this article is to review the assessment of secondary MR with special emphasis on quantification and analysis of LV volume data. At the present time, the optimal method for making these measurements appears to be cardiac MRI. In severe MR (both primary and secondary), the regurgitant fraction (RF) exceeds 50%, and as a result, the LV end diastolic volume (EDV) is increased. In secondary MR, the ejection fraction is depressed (generally <40%) and despite an RF >50%, the regurgitant volume (RegV) rarely meets the current published criteria for severe MR (>60 mL). The ratio of the RegV to EDV, which is very low in secondary MR, reflects the effect of the RegV on the ventricle and it may be predictive of the fractional change in LV size that can be expected after correction of MR. Accurate measurement of the volumetric parameters is essential to proper management of patients with secondary MR.
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Relationship between changes in blood pressure and left ventricular mass over 1 year in end-stage renal disease. J Hypertens 2017; 35:1709-1716. [DOI: 10.1097/hjh.0000000000001353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Left Ventricular Noncompaction: Anatomical Phenotype or Distinct Cardiomyopathy? J Am Coll Cardiol 2017; 68:2157-2165. [PMID: 27855805 PMCID: PMC5116443 DOI: 10.1016/j.jacc.2016.08.054] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/13/2016] [Accepted: 08/01/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is considerable overlap between left ventricular noncompaction (LVNC) and other cardiomyopathies. LVNC has been reported in up to 40% of the general population, raising questions about whether it is a distinct pathological entity, a remodeling epiphenomenon, or merely an anatomical phenotype. OBJECTIVES The authors determined the prevalence and predictors of LVNC in a healthy population using 4 cardiac magnetic resonance imaging diagnostic criteria. METHODS Volunteers >40 years of age (N = 1,651) with no history of cardiovascular disease (CVD), a 10-year risk of CVD < 20%, and a B-type natriuretic peptide level greater than their gender-specific median underwent magnetic resonance imaging scan as part of the TASCFORCE (Tayside Screening for Cardiac Events) study. LVNC ratios were measured on the horizontal and vertical long axis cine sequences. All individuals with a noncompaction ratio of ≥2 underwent short axis systolic and diastolic LVNC ratio measurements, and quantification of noncompacted and compacted myocardial mass ratios. Those who met all 4 criteria were considered to have LVNC. RESULTS Of 1,480 participants analyzed, 219 (14.8%) met ≥1 diagnostic criterion for LVNC, 117 (7.9%) met 2 criteria, 63 (4.3%) met 3 criteria, and 19 (1.3%) met all 4 diagnostic criteria. There was no difference in demographic or allometric measures between those with and without LVNC. Long axis noncompaction ratios were the least specific, with current diagnostic criteria positive in 219 (14.8%), whereas the noncompacted to compacted myocardial mass ratio was the most specific, only being met in 61 (4.4%). CONCLUSIONS A significant proportion of an asymptomatic population free from CVD satisfy all currently used cardiac magnetic resonance imaging diagnostic criteria for LVNC, suggesting that those criteria have poor specificity for LVNC, or that LVNC is an anatomical phenotype rather than a distinct cardiomyopathy.
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Harris AW, Krieger EV, Kim M, Cawley PJ, Owens DS, Hamilton-Craig C, Maki J, Otto CM. Cardiac Magnetic Resonance Imaging Versus Transthoracic Echocardiography for Prediction of Outcomes in Chronic Aortic or Mitral Regurgitation. Am J Cardiol 2017; 119:1074-1081. [PMID: 28153348 DOI: 10.1016/j.amjcard.2016.12.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
In subjects with aortic regurgitation (AR) or mitral regurgitation (MR), transthoracic echocardiography (TTE) is recommended for surveillance. Few prospective studies have directly compared the ability of TTE and cardiac magnetic resonance (CMR) to predict clinical outcomes in AR and MR. We hypothesized that, given its higher reproducibility, CMR would predict the need for valve surgery or heart failure (HF) hospitalization better than TTE. Quantitative TTE and CMR were performed on the same day for 51 subjects: 29 with chronic AR and 22 with chronic, primary MR for quantification of valve regurgitation. Baseline measurements of valve regurgitation were compared to the combined primary end point of new HF and valve surgery using receiver operating characteristics, simple logistic regression, and Kaplan-Meier survival analyses. The primary end point occurred in 5 AR subjects (all surgery) and 8 MR subjects (7 surgery, 1 HF) after a mean follow-up of 4.4 ± 1.5 years. For AR, CMR-derived regurgitant volume >50 ml identified those at high risk with 50% undergoing valve surgery versus 0% for those with regurgitant volume ≤50 ml and was more strongly associated with outcomes than regurgitant volume by TTE (p <0.05). For MR, 6.8% of those with regurgitant volume by TTE ≤30 ml developed the primary end point versus 70% in those with regurgitant volume >30 ml. Regurgitant volume by CMR showed no significant separation of survival curves for MR. In conclusion, regurgitant volume by CMR was more predictive of outcomes than by TTE in subjects with AR. In MR, the 2 methods performed similarly.
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Bulluck H, Go YY, Crimi G, Ludman AJ, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Pica S, Raineri C, Sirker A, Herrey AS, Manisty C, Groves A, Moon JC, Hausenloy DJ. Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:26. [PMID: 28285594 PMCID: PMC5346848 DOI: 10.1186/s12968-017-0343-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/16/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI. METHODS Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV. RESULTS The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened). CONCLUSIONS The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Gabriele Crimi
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Andrew J. Ludman
- Royal Devon and Exeter Hospital, NHS Foundation Trust, Exeter, UK
| | | | | | - Anish N. Bhuva
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | | | | | - Silvia Pica
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy
| | - Claudia Raineri
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Alex Sirker
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Royal Free Hospital, London, UK
| | - Charlotte Manisty
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Ashley Groves
- UCL Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - James C. Moon
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Halaney DL, Sanyal A, Nafissi NA, Escobedo D, Goros M, Michalek J, Acevedo PJ, Pérez W, Patricia Escobar G, Feldman MD, Han HC. The Effect of Trabeculae Carneae on Left Ventricular Diastolic Compliance: Improvement in Compliance With Trabecular Cutting. J Biomech Eng 2017; 139:2595441. [PMID: 28024161 PMCID: PMC7104769 DOI: 10.1115/1.4035585] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/13/2016] [Indexed: 12/25/2022]
Abstract
The role of trabeculae carneae in modulating left ventricular (LV) diastolic compliance remains unclear. The objective of this study was to determine the contribution of trabeculae carneae to the LV diastolic compliance. LV pressure-volume compliance curves were measured in six human heart explants from patients with LV hypertrophy at baseline and following trabecular cutting. The effect of trabecular cutting was also analyzed with finite-element model (FEM) simulations. Our results demonstrated that LV compliance improved after trabecular cutting (p < 0.001). Finite-element simulations further demonstrated that stiffer trabeculae reduce LV compliance further, and that the presence of trabeculae reduced the wall stress in the apex. In conclusion, we demonstrate that integrity of the LV and trabeculae is important to maintain LV stiffness and loss in trabeculae leads to more LV compliance.
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Affiliation(s)
- David L Halaney
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229
| | - Arnav Sanyal
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249
| | - Navid A Nafissi
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Daniel Escobedo
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229
| | - Martin Goros
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Joel Michalek
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Pedro J Acevedo
- Department of Anatomy, University of Environmental and Applied Sciences U.D.C.A., Bogotá, Cundinamarca, Colombia
| | - William Pérez
- Department of Anatomy, Faculty of Veterinary Medicine, University of the Republic, Montevideo 11200, Uruguay
| | - G Patricia Escobar
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Marc D Feldman
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229 e-mail:
| | - Hai-Chao Han
- Fellow ASME Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249
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