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Li Q, Liao H, Ren Y, Yang D, Yun Q, Wang Z, Zhou Z, Li S, Lian J, Wang H, Zhang L, Sun Z, Pan L, Xu L. Right Ventricular Function in Takayasu's Arteritis Patients With Pulmonary Artery Involvement Using MRI Feature Tracking. J Magn Reson Imaging 2024; 60:1013-1024. [PMID: 38038356 DOI: 10.1002/jmri.29143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Pulmonary artery involvement (PAI) is not rare in Takayasu arteritis (TA). Persistently elevated pulmonary arterial pressure in TA-PAI patients leads to pulmonary hypertension (PH), and eventually cardiac death. Thus, the early detection of right ventricular dysfunction before the onset of PH is important. PURPOSE To explore the potential of right ventricular global peak longitudinal and circumferential strain (RVGLS and RVGCS, respectively) in detecting right ventricular myocardial damage in TA-PAI patients without PH. STUDY TYPE Retrospective. POPULATION One hundred and six TA patients (39.6 ± 13.9 years), of whom 52 were non-PAI and 54 were PAI patients (36 without PH and 18 with PH), along with 58 sex- and age-matched healthy volunteers (HVs) (36.7 ± 13.2 years). The involved arteries were validated by aorta magnetic resonance (MR) angiography and pulmonary artery computed tomography angiography. FIELD STRENGTH/SEQUENCE 3 T/Cine imaging sequence with a steady-state free precession readout. ASSESSMENT Cardiac MRI-derived parameters measured by two radiologists independently were compared among HVs, and TA patients with and without PAI. In addition, these indices were further compared among HVs, and TA-PAI patients with and without PH. STATISTICAL TESTS Student's t test, one-way ANOVA analysis, Pearson and Spearman correlation analysis, and reproducibility analysis. A P-value of <0.05 was considered statistically significant. RESULTS Although the TA-PAI patients without PH had a similar RV ejection fraction (RVEF) with HV (P = 0.348), RVGLS (non-PH 20.6 ± 3.7% vs. HV 24.0 ± 3.1%) was significantly lower and RVGCS (non-PH 14.8 ± 3.9% vs. HV 13.0 ± 2.7%) higher. The TA-PAI patients with PH had significantly poorer RVGLS (PH 13.5 ± 3.8% vs. non-PH 20.6 ± 3.7%) and RVGCS (PH 10.9 ± 3.2% vs. non-PH 14.8 ± 3.9%) than those without PH. DATA CONCLUSION Right ventricular dysfunction was detected in the TA-PAI patients without PH. MR-feature tracking may be an effective method for detecting early cardiac damage in the TA-PAI patients without PH. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Qing Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hua Liao
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Ren
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dan Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qingping Yun
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhiyan Wang
- Department of Cardiovascular Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianxiu Lian
- Clinical & Technical Support, Philips Healthcare, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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O'Donnell C, Sanchez PA, Celestin B, McConnell MV, Haddad F. The Echocardiographic Evaluation of the Right Heart: Current and Future Advances. Curr Cardiol Rep 2023; 25:1883-1896. [PMID: 38041726 DOI: 10.1007/s11886-023-02001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW To discuss physiologic and methodologic advances in the echocardiographic assessment of right heart (RH) function, including the emergence of artificial intelligence (AI) and point-of-care ultrasound. RECENT FINDINGS Recent studies have highlighted the prognostic value of right ventricular (RV) longitudinal strain, RV end-systolic dimensions, and right atrial (RA) size and function in pulmonary hypertension and heart failure. While RA pressure is a central marker of right heart diastolic function, the recent emphasis on venous excess imaging (VExUS) has provided granularity to the systemic consequences of RH failure. Several methodological advances are also changing the landscape of RH imaging including post-processing 3D software to delineate the non-longitudinal (radial, anteroposterior, and circumferential) components of RV function, as well as AI segmentation- and non-segmentation-based quantification. Together with recent guidelines and advances in AI technology, the field is shifting from specific RV functional metrics to integrated RH disease-specific phenotypes. A modern echocardiographic evaluation of RH function should focus on the entire cardiopulmonary venous unit-from the venous to the pulmonary arterial system. Together, a multi-parametric approach, guided by physiology and AI algorithms, will help define novel integrated RH profiles for improved disease detection and monitoring.
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Affiliation(s)
- Christian O'Donnell
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Pablo Amador Sanchez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bettia Celestin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
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Gopalan D, Riley JYJ, Leong K, Alsanjari S, Auger W, Lindholm P. Computed Tomography Pulmonary Angiography Prediction of Adverse Long-Term Outcomes in Chronic Thromboembolic Pulmonary Hypertension: Correlation with Hemodynamic Measurements Pre- and Post-Pulmonary Endarterectomy. Tomography 2023; 9:1787-1798. [PMID: 37888734 PMCID: PMC10611069 DOI: 10.3390/tomography9050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
CT pulmonary angiography is commonly used in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). This work was conducted to determine if cardiac chamber size on CTPA may also be useful for predicting the outcome of CTEPH treatment. A retrospective analysis of paired CTPA and right heart hemodynamics in 33 consecutive CTEPH cases before and after pulmonary thromboendarterectomy (PTE) was performed. Semiautomated and manual CT biatrial and biventricular size quantifications were correlated with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and cardiac output. The baseline indexed right atrioventricular volumes were twice the left atrioventricular volumes, with significant (p < 0.001) augmentation of left heart filling following PTE. Except for the left atrial volume to cardiac index, all other chamber ratios significantly correlated with hemodynamics. Left to right ventricular ratio cut point <0.82 has high sensitivity (91% and 97%) and specificity (88% and 85%) for identifying significant elevations of mPAP and PVR, respectively (AUC 0.90 and 0.95), outperforming atrial ratios (sensitivity 78% and 79%, specificity 82% and 92%, and AUC 0.86 and 0.91). Manual LV:RV basal dimension ratio correlates strongly with semiautomated volume ratio (r 0.77, 95% CI 0.64-0.85) and is an expeditious alternative with comparable prognostic utility (AUC 0.90 and 0.95). LV:RV dimension ratio of <1.03 and ≤0.99 (alternatively expressed as RV:LV ratio of >0.97 and ≥1.01) is a simple metric that can be used for CTEPH outcome prediction.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden;
- Department of Radiology, Imperial College Hospital NHS Trust, London W12 0HS, UK;
| | - Jan Y. J. Riley
- Department of Diagnostic Imaging, Monash Health, Melbourne 3168, Australia;
| | - Kai’en Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia;
| | - Senan Alsanjari
- Department of Radiology, Imperial College Hospital NHS Trust, London W12 0HS, UK;
| | - William Auger
- Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA;
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden;
- Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
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Leong K, Howard L, Giudice FL, Davies R, Haji G, Gibbs S, Gopalan D. Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status. Pulm Circ 2023; 13:e12116. [PMID: 36843875 PMCID: PMC9947220 DOI: 10.1002/pul2.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/10/2022] [Indexed: 11/05/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension may be cured by pulmonary endarterectomy (PEA). Thromboembolic disease distribution/PEA success primarily determines prognosis but risk scoring criteria may be adjunctive. Right ventriculoarterial (RV-PA) and ventriculoatrial (RV-right atrium [RA]) coupling may be evaluated by cardiac MRI (CMR) feature tracking deformation/strain assessment. We characterized biatrial and biventricular CMR feature tracking (FT) strain parameters following PEA and tested the ability of CMR FT to identify REVEAL 2.0 high-risk status. We undertook a retrospective single-center cross-sectional study of patients (n = 57) who underwent PEA (2015-2020). All underwent pre and postoperative catheterization and CMR. Pulmonary arterial hypertension validated risk scores were calculated. Significant postoperative improvements were observed in mean pulmonary artery pressure (mPAP) (pre-op 45 ± 11 mmHg vs. post-op 26 ± 11 mmHg; p < 0.001) and PVR however a large proportion had residual pulmonary hypertension (45%; mPAP ≥25 mmHg). PEA augmented left heart filling with left ventricular end diastolic volume index and left atrial volume index increment. Left ventricular ejection fraction was unchanged postoperatively but LV global longitudinal strain improved (pre-op median -14.2% vs. post-op -16.0%; p < 0.001). Right ventricular (RV) geometry and function also improved with reduction in RV mass. Most had uncoupled RV-PA relationships which recovered (pre-op right ventricular free wall longitudinal strain -13.2 ± 4.8%, RV stroke volume/right ventricular end systolic volume ratio 0.78 ± 0.53 vs. post-op -16.8 ± 4.2%, 1.32 ± 0.55; both p < 0.001). Postoperatively, there were six REVEAL 2.0 high-risk patients, best predicted by impaired RA strain which was superior to traditional volumetric parameters (area under the curve [AUC] 0.99 vs. RVEF AUC 0.88). CMR deformation/strain evaluation can offer insights into coupling recovery; RA strain may be an expeditious surrogate for the more laborious REVEAL 2.0 score.
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Affiliation(s)
- Kai'En Leong
- Department of RadiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK
- Department of CardiologyThe Royal Melbourne HospitalVictoriaAustralia
| | - Luke Howard
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Francesco Lo Giudice
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
- Department of CardiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK
| | - Rachel Davies
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
| | - Gulammehdi Haji
- National Pulmonary Hypertension ServiceImperial College Healthcare NHS TrustLondonUK
| | - Simon Gibbs
- National Heart & Lung InstituteImperial College LondonLondonUK
- Imperial College LondonLondonUK
| | - Deepa Gopalan
- Department of RadiologyImperial College Healthcare NHS Trust/Hammersmith HospitalLondonUK
- Imperial College LondonLondonUK
- Department of RadiologyCambridge University Hospitals NHS TrustCambridgeUK
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Leong K, Howard L, Lo Giudice F, Pavey H, Davies R, Haji G, Gibbs S, Gopalan D. MRI Feature Tracking Strain in Pulmonary Hypertension: Utility of Combined Left Atrial Volumetric and Deformation Assessment in Distinguishing Post- From Pre-capillary Physiology. Front Cardiovasc Med 2022; 9:787656. [PMID: 35369294 PMCID: PMC8968034 DOI: 10.3389/fcvm.2022.787656] [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: 10/01/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
AimsPulmonary hypertension (PH) is dichotomized into pre- and post-capillary physiology by invasive catheterization. Imaging, particularly strain assessment, may aid in classification and be helpful with ambiguous hemodynamics. We sought to define cardiac MRI (CMR) feature tracking biatrial peak reservoir and biventricular peak systolic strain in pre- and post-capillary PH and examine the performance of peak left atrial strain in distinguishing the 2 groups compared to TTE.Methods and ResultsRetrospective cross-sectional study from 1 Jan 2015 to 31 Dec 2020; 48 patients (22 pre- and 26 post-capillary) were included with contemporaneous TTE, CMR and catheterization. Mean pulmonary artery pressures were higher in the pre-capillary cohort (55 ± 14 vs. 42 ± 9 mmHg; p < 0.001) as was pulmonary vascular resistance (median 11.7 vs. 3.7 WU; p < 0.001). Post-capillary patients had significantly larger left atria (60 ± 22 vs. 25 ± 9 ml/m2; p < 0.001). There was no difference in right atrial volumes between groups (60 ± 21 vs. 61 ± 29 ml/m2; p = 0.694), however peak RA strain was lower in post-capillary PH patients (8.9 ± 5.5 vs. 18.8 ± 7.0%; p < 0.001). In the post-capillary group, there was commensurately severe peak strain impairment in both atria (LA strain 9.0 ± 5.8%, RA strain 8.9 ± 5.5%). CMR LAVi and peak LA strain had a multivariate AUC of 0.98 (95% CI 0.89–1.00; p < 0.001) for post-capillary PH diagnosis which was superior to TTE.ConclusionCMR volumetric and deformation assessment of the left atrium can highly accurately distinguish post- from pre-capillary PH.
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Affiliation(s)
- Kai'En Leong
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Luke Howard
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
- Department of Cardiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
| | - Holly Pavey
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Davies
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Gulammehdi Haji
- National Pulmonary Hypertension Service, Imperial College National Health Service Trust, London, United Kingdom
| | - Simon Gibbs
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Imperial College National Health Service Trust/Hammersmith Hospital, London, United Kingdom
- Department of Radiology, Cambridge University Hospitals National Health Service Trust, Cambridge, United Kingdom
- *Correspondence: Deepa Gopalan
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