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Lang N, Staffa SJ, Zurakowski D, Sperotto F, Shea M, Baird CW, Emani S, del Nido PJ, Marx GR. Clinical and 2D/3D-Echo Cardiography Determinants of Mitral Valve Reoperation in Children With Congenital Mitral Valve Disease. JACC. ADVANCES 2024; 3:101081. [PMID: 39113914 PMCID: PMC11304883 DOI: 10.1016/j.jacadv.2024.101081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 02/12/2024] [Accepted: 03/25/2024] [Indexed: 08/10/2024]
Abstract
Background Congenital mitral valve disease (CMVD) presents major challenges in its medical and surgical management. Objectives The purpose of this study was to investigate the value of 3-dimensional echocardiography (3DE) and identify associations with MV reoperation in this setting. Methods All children <18 years of age who underwent MV reconstruction for CMVD in 2002 to 2018 were included. Preoperative and postoperative 2-dimensional echocardiography (2DE) and 3DE data were collected. Competing risks and Cox regression analysis were used to identify independent associations with MV reoperation. Receiver operating characteristic and decision-tree analysis were implemented for comparison of 3DE vs 2DE. Results A total of 206 children underwent MV reconstruction for CMVD (mitral stenosis, n = 105, mitral regurgitation [MR], n = 75; mixed disease, n = 26); 64 (31%) required MV reoperation. Variables independently associated with MV reoperation were age <1 year (HR: 2.65; 95% CI: 1.13-6.21), tethered leaflets (HR: 2.00; 95% CI: 1.05-3.82), ≥ moderate 2DE postoperative MR (HR: 4.26; 95% CI: 2.45-7.40), changes in 3D-effective orifice area (3D-EOA) and in 3D-vena contracta regurgitant area (3D-VCRA). Changes in 3D-EOA and 3D-VCRA were more strongly associated with MV reoperation than changes in mean gradients (area under the curve [AUC]: 0.847 vs AUC: 0.676, P = 0.006) and 2D-VCRA (AUC: 0.969 vs AUC: 0.720, P = 0.012), respectively. Decision-tree analysis found that a <30% increase in 3D-EOA had 80% accuracy (HR = 8.50; 95% CI: 2.9-25.1) and a <40% decrease in 3D-VCRA had 93% accuracy (HR: 22.50; 95% CI: 2.9-175) in discriminating MV reoperation for stenotic and regurgitant MV, respectively. Conclusions Age <1 year, tethered leaflets, 2DE postoperative MR, changes in 3D-EOA and 3D-VCRA were all independently associated with MV reoperation. 3DE parameters showed a stronger association than 2DE. 3DE-based decision-tree algorithms may help prognostication and serve as a support tool for clinical decision-making.
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Affiliation(s)
- Nora Lang
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steven J. Staffa
- Department of Surgery, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Surgery, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melinda Shea
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher W. Baird
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sitaram Emani
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J. del Nido
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald R. Marx
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hagendorff A, Kandels J, Metze M, Tayal B, Stöbe S. Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking? Diagnostics (Basel) 2023; 13:1359. [PMID: 37046577 PMCID: PMC10093440 DOI: 10.3390/diagnostics13071359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Bhupendar Tayal
- Harrington Heart and Vascular Center, Department of Cardiology, University Hospitals, Cleveland, OH 44106, USA;
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
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Zhao D, Ferdian E, Maso Talou GD, Quill GM, Gilbert K, Wang VY, Babarenda Gamage TP, Pedrosa J, D’hooge J, Sutton TM, Lowe BS, Legget ME, Ruygrok PN, Doughty RN, Camara O, Young AA, Nash MP. MITEA: A dataset for machine learning segmentation of the left ventricle in 3D echocardiography using subject-specific labels from cardiac magnetic resonance imaging. Front Cardiovasc Med 2023; 9:1016703. [PMID: 36704465 PMCID: PMC9871929 DOI: 10.3389/fcvm.2022.1016703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Segmentation of the left ventricle (LV) in echocardiography is an important task for the quantification of volume and mass in heart disease. Continuing advances in echocardiography have extended imaging capabilities into the 3D domain, subsequently overcoming the geometric assumptions associated with conventional 2D acquisitions. Nevertheless, the analysis of 3D echocardiography (3DE) poses several challenges associated with limited spatial resolution, poor contrast-to-noise ratio, complex noise characteristics, and image anisotropy. To develop automated methods for 3DE analysis, a sufficiently large, labeled dataset is typically required. However, ground truth segmentations have historically been difficult to obtain due to the high inter-observer variability associated with manual analysis. We address this lack of expert consensus by registering labels derived from higher-resolution subject-specific cardiac magnetic resonance (CMR) images, producing 536 annotated 3DE images from 143 human subjects (10 of which were excluded). This heterogeneous population consists of healthy controls and patients with cardiac disease, across a range of demographics. To demonstrate the utility of such a dataset, a state-of-the-art, self-configuring deep learning network for semantic segmentation was employed for automated 3DE analysis. Using the proposed dataset for training, the network produced measurement biases of -9 ± 16 ml, -1 ± 10 ml, -2 ± 5 %, and 5 ± 23 g, for end-diastolic volume, end-systolic volume, ejection fraction, and mass, respectively, outperforming an expert human observer in terms of accuracy as well as scan-rescan reproducibility. As part of the Cardiac Atlas Project, we present here a large, publicly available 3DE dataset with ground truth labels that leverage the higher resolution and contrast of CMR, to provide a new benchmark for automated 3DE analysis. Such an approach not only reduces the effect of observer-specific bias present in manual 3DE annotations, but also enables the development of analysis techniques which exhibit better agreement with CMR compared to conventional methods. This represents an important step for enabling more efficient and accurate diagnostic and prognostic information to be obtained from echocardiography.
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Affiliation(s)
- Debbie Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Gina M. Quill
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Vicky Y. Wang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - João Pedrosa
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - Jan D’hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Timothy M. Sutton
- Counties Manukau Health Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Boris S. Lowe
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Malcolm E. Legget
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Peter N. Ruygrok
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Robert N. Doughty
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Oscar Camara
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Martyn P. Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
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Muraru D, Baldea SM, Genovese D, Tomaselli M, Heilbron F, Gavazzoni M, Radu N, Sergio C, Baratto C, Perelli F, Curti E, Parati G, Badano LP. Association of outcome with left ventricular volumes and ejection fraction measured with two- and three-dimensional echocardiography in patients referred for routine, clinically indicated studies. Front Cardiovasc Med 2022; 9:1065131. [PMID: 36620642 PMCID: PMC9815115 DOI: 10.3389/fcvm.2022.1065131] [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: 10/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives We sought to analyze if left ventricular (LV) volumes and ejection fraction (EF) measured by three-dimensional echocardiography (3DE) have incremental prognostic value over measurements obtained from two-dimensional echocardiography (2DE) in patients referred to a high-volume echocardiography laboratory for routine, clinically-indicated studies. Methods We measured LV volumes and EF using both 2DE and 3DE in 725 consecutive patients (67% men; 59 ± 18 years) with various clinical indications referred for a routine clinical study. Results LV volumes were significantly larger, and EF was lower when measured by 3DE than 2DE. During follow-up (3.6 ± 1.2 years), 111 (15.3%) all-cause deaths and 248 (34.2%) cardiac hospitalizations occurred. Larger LV volumes and lower EF were associated with worse outcome independent of age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart diseases). In stepwise Cox regression analyses, the associations of both death and cardiac hospitalization with clinical data (CD: age, creatinine, hemoglobin, atrial fibrillation, and ischemic heart disease) whose Harrel's C-index (HC) was 0.775, were augmented more by the LV volumes and EF obtained by 3DE than by 2DE parameters. The association of CD with death was not affected by LV end-diastolic volume (EDV) either measured by 2DE or 3DE. Conversely, it was incremented by 3DE LVEF (HC = 0.84, p < 0.001) more than 2DE LVEF (HC = 0.814, p < 0.001). The association of CD with the composite endpoint (HC = 0.64, p = 0.002) was augmented more by 3DE LV EDV (HC = 0.786, p < 0.001), end-systolic volume (HC = 0.801, p < 0.001), and EF (HC = 0.84, p < 0.001) than by the correspondent 2DE parameters (HC = 0.786, HC = 0.796, and 0.84, all p < 0.001) In addition, partition values for mild, moderate and severe reduction of the LVEF measured by 3DE showed a higher discriminative power than those measured by 2DE for cardiac death (Log-Rank: χ2 = 98.3 vs. χ2 = 77.1; p < 0.001). Finally, LV dilation defined according to the 3DE threshold values showed higher discriminatory power and prognostic value for death than when using 2DE reference values (3DE LVEDV: χ2 = 15.9, p < 0.001 vs. χ2 = 10.8, p = 0.001; 3DE LVESV: χ2 = 24.4, p < 0.001 vs. χ2 = 17.4, p = 0.001). Conclusion In patients who underwent routine, clinically-indicated echocardiography, 3DE LVEF and ESV showed stronger association with outcome than the corresponding 2DE parameters.
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Affiliation(s)
- Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sorina Mihaila Baldea
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Davide Genovese
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Francesca Heilbron
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Noela Radu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Caravita Sergio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Claudia Baratto
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Francesco Perelli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuele Curti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy,*Correspondence: Luigi P. Badano,
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Velcea AE, Mihaila Baldea S, Nicula AI, Vinereanu D. The role of multimodality imaging in the selection for implantable cardioverter-defibrillators in heart failure: A narrative review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1066-1072. [PMID: 35899916 DOI: 10.1002/jcu.23281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Advanced pharmacologic and interventional therapies have improved survival in heart failure. Implantable cardioverter-defibrillators (ICD) have been shown to reduce mortality in patients with heart failure, but the benefit appears to be uneven in this population. We reviewed the evidence showing the benefit of ICD therapy in heart failure patients, the main issues arising from these studies, and the possible answers for a better risk stratification. In addition, we showed that multimodality imaging could improve patient selection for the implantation of ICDs, in both primary and secondary prevention, beyond the selection using only the left ventricular ejection fraction, by concentrating on arrhythmic substrate.
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Affiliation(s)
- Andreea Elena Velcea
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Sorina Mihaila Baldea
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
| | - Alina Ioana Nicula
- Radiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Dragos Vinereanu
- Cardiology Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology and Cardiovascular Surgery Department, Emergency and University Hospital, Bucharest, Romania
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