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Cojocaru C, Deaconu S, Gondos V, Onciul S, Petre I, Gheorghe-Fronea O, Vătășescu R. Complex Substrate Leading to PVC-Mediated Systolic Dysfunction in addition to Sustained Monomorphic VT in Repaired Tetralogy of Fallot. Diagnostics (Basel) 2024; 14:158. [PMID: 38248035 PMCID: PMC10814140 DOI: 10.3390/diagnostics14020158] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Frequent premature ventricular complexes (PVCs) are associated with deleterious effects on left ventricular (LV) function in various clinical scenarios. Repaired tetralogy of Fallot (rTOF) is frequently affected by sustained ventricular arrhythmias dependent on complex post-surgical substrates. However, there is limited data regarding the potential of arrhythmogenic isthmuses to generate frequent PVCs and PVC-mediated LV systolic dysfunction development in rTOF. We present a case of rTOF experiencing relatively infrequent episodes of internal shocks for episodes of sustained monomorphic ventricular tachycardia and a high burden of PVCs associated with left ventricular systolic function deterioration, in which the successful substrate ablation of the anatomical VT isthmuses also led to PVC abolition and consequently to LV systolic function normalization. In such cases, understanding the pathogenic mechanisms that lead to LV dysfunction is only possible by rigorous clinical reasoning, which leads to a tailored specific treatment.
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Affiliation(s)
- Cosmin Cojocaru
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (S.O.); (I.P.); (O.G.-F.)
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | | | - Viviana Gondos
- Department of Medical Electronics and Informatics, Polytechnic University, 060042 Bucharest, Romania;
| | - Sebastian Onciul
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (S.O.); (I.P.); (O.G.-F.)
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioana Petre
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (S.O.); (I.P.); (O.G.-F.)
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Oana Gheorghe-Fronea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (S.O.); (I.P.); (O.G.-F.)
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Radu Vătășescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (S.O.); (I.P.); (O.G.-F.)
- Cardiology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
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2
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Govil S, Mauger C, Hegde S, Occleshaw CJ, Yu X, Perry JC, Young AA, Omens JH, McCulloch AD. Biventricular shape modes discriminate pulmonary valve replacement in tetralogy of Fallot better than imaging indices. Sci Rep 2023; 13:2335. [PMID: 36759522 PMCID: PMC9911768 DOI: 10.1038/s41598-023-28358-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Current indications for pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF) rely on cardiovascular magnetic resonance (CMR) image-based indices but are inconsistently applied, lead to mixed outcomes, and remain debated. This study aimed to test the hypothesis that specific markers of biventricular shape may discriminate differences between rTOF patients who did and did not require subsequent PVR better than standard imaging indices. In this cross-sectional retrospective study, biventricular shape models were customized to CMR images from 84 rTOF patients. A statistical atlas of end-diastolic shape was constructed using principal component analysis. Multivariate regression was used to quantify shape mode and imaging index associations with subsequent intervention status (PVR, n = 48 vs. No-PVR, n = 36), while accounting for confounders. Clustering analysis was used to test the ability of the most significant shape modes and imaging indices to discriminate PVR status as evaluated by a Matthews correlation coefficient (MCC). Geometric strain analysis was also conducted to assess shape mode associations with systolic function. PVR status correlated significantly with shape modes associated with right ventricular (RV) apical dilation and left ventricular (LV) dilation (p < 0.01), RV basal bulging and LV conicity (p < 0.05), and pulmonary valve dilation (p < 0.01). PVR status also correlated significantly with RV ejection fraction (p < 0.05) and correlated marginally with LV end-systolic volume index (p < 0.07). Shape modes discriminated subsequent PVR better than standard imaging indices (MCC = 0.49 and MCC = 0.28, respectively) and were significantly associated with RV and LV radial systolic strain. Biventricular shape modes discriminated differences between patients who did and did not require subsequent PVR better than standard imaging indices in current use. These regional features of cardiac morphology may provide insight into adaptive vs. maladaptive types of structural remodeling and point toward an improved quantitative, patient-specific assessment tool for clinical use.
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Affiliation(s)
- Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Charlène Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | | | - Xiaoyang Yu
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - James C Perry
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Department of Biomedical Engineering, King's College London, London, UK
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA.
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Carruth ED, Fielden SW, Nevius CD, Fornwalt BK, Haggerty CM. 3D-Encoded DENSE MRI with Zonal Excitation for Quantifying Biventricular Myocardial Strain During a Breath-Hold. Cardiovasc Eng Technol 2021; 12:589-597. [PMID: 34244904 DOI: 10.1007/s13239-021-00561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Right ventricular (RV) function is increasingly recognized for its prognostic value in many disease states. As with the left ventricle (LV), strain-based measurements may have better prognostic value than typical chamber volumes or ejection fraction. Complete functional characterization of the RV requires high-resolution, 3D displacement tracking methods, which have been prohibitively challenging to implement. Zonal excitation during Displacement ENcoding with Stimulated Echoes (DENSE) magnetic resonance imaging (MRI) has helped reduce scan time for 2D LV strain quantification. We hypothesized that zonal excitation could alternatively be used to reproducibly acquire higher resolution, 3D-encoded DENSE images for quantification of bi-ventricular strain within a single breath-hold. METHODS We modified sequence parameters for a 3D zonal excitation DENSE sequence to achieve in-plane resolution < 2 mm and acquired two sets of images in eight healthy adult male volunteers with median (IQR) age 32.5 (32.0-33.8) years. We assessed the inter-test reproducibility of this technique, and compared computed strains and torsion with previously published data. RESULTS Data for one subject was excluded based on image artifacts. Reproducibility for LV (CoV: 6.1-9.0%) and RV normal strains (CoV: 6.3-8.2%) and LV torsion (CoV = 7.1%) were all very good. Reproducibility of RV torsion was lower (CoV = 16.7%), but still within acceptable limits. Computed global strains and torsion were within reasonable agreement with published data, but further studies in larger cohorts are needed to confirm. CONCLUSION Reproducible acquisition of 3D-encoded biventricular myocardial strain data in a breath-hold is feasible using DENSE with zonal excitation.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Samuel W Fielden
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Medical and Health Physics, Geisinger, Danville, PA, USA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,The Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA. .,The Heart Institute, Geisinger, Danville, PA, USA.
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4
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Ellenberger K, Negishi K. Subclinical myocardial dysfunction and dyssynchrony after Ross or Ross-Konno procedure. Transl Pediatr 2020; 9:191-194. [PMID: 32477921 PMCID: PMC7237965 DOI: 10.21037/tp.2020.03.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Katherine Ellenberger
- Department of Cardiology, Nepean Hospital, New South Wales, Australia.,Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Australia
| | - Kazuaki Negishi
- Department of Cardiology, Nepean Hospital, New South Wales, Australia.,Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Australia
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5
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Abnormal left ventricular flow organization following repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2019; 160:1008-1015. [PMID: 31924354 DOI: 10.1016/j.jtcvs.2019.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/13/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left ventricular intracavitary flow (LVICF) characteristics reflect diastolic function. Right ventricular (RV) volume overload due to pulmonary regurgitation (PR) adversely impacts interventricular interactions and left ventricular (LV) function. This aimed to determine whether patients with PR and mild to moderate RV dilation after repair of tetralogy of Fallot (TOF) repair have abnormal LVICF, and to determine whether RV dilation and biventricular function correlate with LVICF abnormalities. METHODS Patients with repaired TOF with PR (n = 11) and controls (n = 11) underwent LVICF analysis. LV end-diastolic volume was partitioned into 4 flow components: direct flow, retained inflow, delayed ejection flow, and residual volume. Flow components were correlated with indexed biventricular size, function, and LV strain. RESULTS The TOF patients had reduced direct flow (35% vs 25%; P = .004) and increased residual volume (15% vs 24%; P = .026) compared with controls. Retained inflow and delayed ejection flow did not differ. Reduced direct flow correlated with increased RV end-diastolic volume index (R = 0.44; P = .042), RV end-systolic volume index (R = -0.46; P = .032), reduced RV ejection fraction (R = 0.45; P = .036), and reduced LV circumferential strain (R = 0.52; P = .014). Increased residual volume correlated with increased RV end-systolic volume index (R = 0.52; P = .013), reduced LV ejection fraction (R = -0.54; P = .010), and reduced LV circumferential strain (R = -0.44; P = .040). CONCLUSIONS Patients with repaired TOF with mild to moderate RV dilation have abnormal LV diastolic direct flow and increased recirculating residual volume. These changes correlate with the degree of RV dilation and impaired LV function.
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6
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Yim D, Hui W, Larios G, Dragulescu A, Grosse-Wortmann L, Bijnens B, Mertens L, Friedberg MK. Quantification of Right Ventricular Electromechanical Dyssynchrony in Relation to Right Ventricular Function and Clinical Outcomes in Children with Repaired Tetralogy of Fallot. J Am Soc Echocardiogr 2019; 31:822-830. [PMID: 29976349 DOI: 10.1016/j.echo.2018.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Electromechanical dyssynchrony occurs ubiquitously following tetralogy of Fallot (TOF) repair, manifesting electrically as a wide QRS duration and mechanically as a right-sided septal/apical flash. Early septal activation and prestretch of the right ventricular (RV) basal lateral wall followed by its postsystolic shortening contributes to inefficient RV mechanics. However, a right-sided septal flash is a dichotomous finding, and the severity of RV dyssynchrony as a continuous spectrum in relationship to RV dysfunction and clinical outcomes in patients with repaired TOF has not been studied. The aim of this study was to quantify the severity of electromechanical dyssynchrony in relation to RV remodeling and clinical outcomes in a pediatric cohort following TOF repair. METHODS A retrospective analysis was performed in 81 children with RV volume loading after TOF repair, aged 13.6 ± 2.9 years, and compared with 50 matched control subjects. RESULTS Patients had higher RV basal-lateral prestretch and postsystolic strain amplitude and duration, RV mechanical dispersion, and basal lateral-septal wall delay compared with control subjects (P < .001 for all). All intra-RV dyssynchrony timing parameters were associated with reduced cardiac magnetic resonance-derived RV ejection fraction and/or echocardiography-derived RV longitudinal strain. Prestretch duration as a percentage of total shortening time and RV basal lateral-to-midseptal delay were independently associated with RV dysfunction. Postsystolic strain amplitude was higher in patients with ventricular arrhythmias compared with arrhythmia-free patients (7.8% [4.2%-13%] vs 2.0% [0%-12.5%], P = .03). CONCLUSION RV prestretch duration, postsystolic strain, and RV lateral-septal delay quantify RV electromechanical dyssynchrony severity and reflect the underlying pathophysiology. The prestretch duration percentage and RV basal lateral-to-midseptal delay were independently associated with RV dysfunction, potentially providing a clinical tool to quantify RV electromechanical dyssynchrony.
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Affiliation(s)
- Deane Yim
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wei Hui
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Guillermo Larios
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Dragulescu
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Bart Bijnens
- ICREA, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Luc Mertens
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark K Friedberg
- The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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7
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Ylitalo P, Lehmonen L, Lauerma K, Holmström M, Pitkänen-Argillander O, Jokinen E. Severe pulmonary regurgitation in adolescents with tetralogy of Fallot leads to increased longitudinal strain. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:309-316. [PMID: 31583488 PMCID: PMC7109171 DOI: 10.1007/s10334-019-00780-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
Objectives Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic pulmonary regurgitation and chronic right ventricular volume load. We sought to determine whether pulmonary regurgitation (PR) would affect right and left ventricle (RV and LV) strain. Materials and methods This cross-sectional analysis included 40 patients who had TOF with surgical repair, with an average follow-up period of 11.8 ± 3.0 years. Altogether, 44 healthy volunteers with similar age and gender distribution were recruited. A cardiovascular magnetic resonance imaging study with feature tracking analysis was performed on all patients and controls. Results RV peak longitudinal strain was increased in TOF patients with PR > 30 ml/m2 when compared to those with PR < 30 ml/m2 (− 22.5% ± 2.7% vs − 19.7% ± 3.5%, p = 0.018) and controls (p = 0.007). PR volume correlated with peak RV longitudinal strain (R = − 0.37, p = 0.030) and peak RV longitudinal strain rate (systolic: R = 0.37, p = 0.03; diastolic: R = 0.39, p = 0.021). The peak RV circumferential strain, from base to apex, increased more than in healthy controls (apex-base difference 7.6% ± 4.2% vs 3.3% ± 2.4%, p < 0.0001). Conclusions Pediatric patients with TOF and a severe pulmonary regurgitation show an enhanced longitudinal strain when compared to patients with milder regurgitation or to control subjects. In addition, mean RV circumferential strain of the patients is significantly enhanced compared to healthy individuals.
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Affiliation(s)
- Pekka Ylitalo
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Lehmonen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Kirsi Lauerma
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Eero Jokinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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8
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Boucek KA, DeCampli WM. Commentary: Who doesn't have abnormal myocardial strain? J Thorac Cardiovasc Surg 2019; 158:520-522. [DOI: 10.1016/j.jtcvs.2019.03.022] [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: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
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9
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Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations. J Thorac Cardiovasc Surg 2019; 158:509-517. [DOI: 10.1016/j.jtcvs.2019.02.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
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10
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Impact of age and cardiac disease on regional left and right ventricular myocardial motion in healthy controls and patients with repaired tetralogy of fallot. Int J Cardiovasc Imaging 2019; 35:1119-1132. [PMID: 30715669 DOI: 10.1007/s10554-019-01544-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022]
Abstract
The assessment of both left (LV) and right ventricular (RV) motion is important to understand the impact of heart disease on cardiac function. The MRI technique of tissue phase mapping (TPM) allows for the quantification of regional biventricular three-directional myocardial velocities. The goal of this study was to establish normal LV and RV velocity parameters across a wide range of pediatric to adult ages and to investigate the feasibility of TPM for detecting impaired regional biventricular function in patients with repaired tetralogy of Fallot (TOF). Thirty-six healthy controls (age = 1-75 years) and 12 TOF patients (age = 5-23 years) underwent cardiac MRI including TPM in short-axis locations (base, mid, apex). For ten adults, a second TPM scan was used to assess test-retest reproducibility. Data analysis included the calculation of biventricular radial, circumferential, and long-axis velocity components, quantification of systolic and diastolic peak velocities in an extended 16 + 10 LV + RV segment model, and assessment of inter-ventricular dyssynchrony. Biventricular velocities showed good test-retest reproducibility (mean bias ≤ 0.23 cm/s). Diastolic radial and long-axis peak velocities for LV and RV were significantly reduced in adults compared to children (19-61%, p < 0.001-0.02). In TOF patients, TPM identified significantly reduced systolic and diastolic LV and RV long-axis peak velocities (20-50%, p < 0.001-0.05) compared to age-matched controls. In conclusion, tissue phase mapping enables comprehensive analysis of global and regional biventricular myocardial motion. Changes in myocardial velocities associated with age underline the importance of age-matched controls. This pilot study in TOF patients shows the feasibility to detect regionally abnormal LV and RV motion.
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11
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Krupickova S, Li W, Cheang MH, Rigby ML, Uebing A, Davlouros P, Dimopoulos K, Di Salvo G, Fraisse A, Swan L, Alonso-Gonzalez R, Kempny A, Pennell DJ, Senior R, Gatzoulis MA, Babu-Narayan SV. Ramipril and left ventricular diastolic function in stable patients with pulmonary regurgitation after repair of tetralogy of Fallot. Int J Cardiol 2018; 272:64-69. [DOI: 10.1016/j.ijcard.2018.07.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 01/15/2023]
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12
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Stromp TA, Spear TJ, Holtkamp RM, Andres KN, Kaine JC, Alghuraibawi WH, Leung SW, Fornwalt BK, Vandsburger MH. Quantitative Gadolinium-Free Cardiac Fibrosis Imaging in End Stage Renal Disease Patients Reveals A Longitudinal Correlation with Structural and Functional Decline. Sci Rep 2018; 8:16972. [PMID: 30451960 PMCID: PMC6242893 DOI: 10.1038/s41598-018-35394-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/05/2018] [Indexed: 01/19/2023] Open
Abstract
Patients with end stage renal disease (ESRD) suffer high mortality from arrhythmias linked to fibrosis, but are contraindicated to late gadolinium enhancement magnetic resonance imaging (MRI). We present a quantitative method for gadolinium-free cardiac fibrosis imaging using magnetization transfer (MT) weighted MRI, and probe correlations with widely used surrogate markers including cardiac structure and contractile function in patients with ESRD. In a sub-group of patients who returned for follow-up imaging after one year, we examine the correlation between changes in fibrosis and ventricular structure/function. Quantification of changes in MT revealed significantly greater fibrotic burden in patients with ESRD compared to a healthy age matched control cohort. Ventricular mechanics, including circumferential strain and diastolic strain rate were unchanged in patients with ESRD. No correlation was observed between fibrotic burden and concomitant measures of either circumferential or longitudinal strains or strain rates. However, among patients who returned for follow up examination a strong correlation existed between initial fibrotic burden and subsequent loss of contractile function. Gadolinium-free myocardial fibrosis imaging in patients with ESRD revealed a complex and longitudinal, not contemporary, association between fibrosis and ventricular contractile function.
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Affiliation(s)
- Tori A Stromp
- Department of Physiology, University of Kentucky, Lexington, KY, USA
- Glaxo Smith Kline Research and Development, Philadelphia, PA, USA
| | - Tyler J Spear
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
| | - Rebecca M Holtkamp
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
| | | | - Joshua C Kaine
- College of Medicine, University of Kentucky, Lexington, KY, USA
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | | | - Steve W Leung
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, USA
| | - Moriel H Vandsburger
- Department of Bioengineering, University of California Berkeley, Berkeley, CA, USA.
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13
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Voges I, Al-Mallah MH, Scognamiglio G, Di Salvo G. Right Heart-Pulmonary Circulation Unit in Congenital Heart Diseases. Heart Fail Clin 2018; 14:283-295. [PMID: 29966627 DOI: 10.1016/j.hfc.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The right ventricle plays a major role in congenital heart disease. This article describes the right ventricular mechanics in some selected congenital heart diseases affecting the right ventricle in different ways: tetralogy of Fallot, Ebstein anomaly, and the systemic right ventricle.
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Affiliation(s)
- Inga Voges
- Royal Brompton and Harefield Trust, London, UK
| | - Mouaz H Al-Mallah
- National Guard Health Affairs, Riyadh King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
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14
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Wehner GJ, Jing L, Haggerty CM, Suever JD, Chen J, Hamlet SM, Feindt JA, Dimitri Mojsejenko W, Fogel MA, Fornwalt BK. Comparison of left ventricular strains and torsion derived from feature tracking and DENSE CMR. J Cardiovasc Magn Reson 2018; 20:63. [PMID: 30208894 PMCID: PMC6136226 DOI: 10.1186/s12968-018-0485-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/20/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) feature tracking is increasingly used to quantify cardiac mechanics from cine CMR imaging, although validation against reference standard techniques has been limited. Furthermore, studies have suggested that commonly-derived metrics, such as peak global strain (reported in 63% of feature tracking studies), can be quantified using contours from just two frames - end-diastole (ED) and end-systole (ES) - without requiring tracking software. We hypothesized that mechanics derived from feature tracking would not agree with those derived from a reference standard (displacement-encoding with stimulated echoes (DENSE) imaging), and that peak strain from feature tracking would agree with that derived using simple processing of only ED and ES contours. METHODS We retrospectively identified 88 participants with 186 pairs of DENSE and balanced steady state free precession (bSSFP) image slices acquired at the same locations across two institutions. Left ventricular (LV) strains, torsion, and dyssynchrony were quantified from both feature tracking (TomTec Imaging Systems, Circle Cardiovascular Imaging) and DENSE. Contour-based strains from bSSFP images were derived from ED and ES contours. Agreement was assessed with Bland-Altman analyses and coefficients of variation (CoV). All biases are reported in absolute percentage. RESULTS Comparison results were similar for both vendor packages (TomTec and Circle), and thus only TomTec Imaging System data are reported in the abstract for simplicity. Compared to DENSE, mid-ventricular circumferential strain (Ecc) from feature tracking had acceptable agreement (bias: - 0.4%, p = 0.36, CoV: 11%). However, feature tracking significantly overestimated the magnitude of Ecc at the base (bias: - 4.0% absolute, p < 0.001, CoV: 18%) and apex (bias: - 2.4% absolute, p = 0.01, CoV: 15%), underestimated torsion (bias: - 1.4 deg/cm, p < 0.001, CoV: 41%), and overestimated dyssynchrony (bias: 26 ms, p < 0.001, CoV: 76%). Longitudinal strain (Ell) had borderline-acceptable agreement (bias: - 0.2%, p = 0.77, CoV: 19%). Contour-based strains had excellent agreement with feature tracking (biases: - 1.3-0.2%, CoVs: 3-7%). CONCLUSION Compared to DENSE as a reference standard, feature tracking was inaccurate for quantification of apical and basal LV circumferential strains, longitudinal strain, torsion, and dyssynchrony. Feature tracking was only accurate for quantification of mid LV circumferential strain. Moreover, feature tracking is unnecessary for quantification of whole-slice strains (e.g. base, apex), since simplified processing of only ED and ES contours yields very similar results to those derived from feature tracking. Current feature tracking technology therefore has limited utility for quantification of cardiac mechanics.
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Affiliation(s)
- Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Jing Chen
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Sean M. Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
| | - Jared A. Feindt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | | | - Mark A. Fogel
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Brandon K. Fornwalt
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Electrical Engineering, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger, Danville, PA USA
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15
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Samad MD, Wehner GJ, Arbabshirani MR, Jing L, Powell AJ, Geva T, Haggerty CM, Fornwalt BK. Predicting deterioration of ventricular function in patients with repaired tetralogy of Fallot using machine learning. Eur Heart J Cardiovasc Imaging 2018; 19:730-738. [PMID: 29538684 PMCID: PMC6012881 DOI: 10.1093/ehjci/jey003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 12/23/2022] Open
Abstract
Aims Previous studies using regression analyses have failed to identify which patients with repaired tetralogy of Fallot (rTOF) are at risk for deterioration in ventricular size and function despite using common clinical and cardiac function parameters as well as cardiac mechanics (strain and dyssynchrony). This study used a machine learning pipeline to comprehensively investigate the predictive value of the baseline variables derived from cardiac magnetic resonance (CMR) imaging and provide models for identifying patients at risk for deterioration. Methods and results Longitudinal deterioration for 153 patients with rTOF was categorized as 'none', 'minor', or 'major' based on changes in ventricular size and ejection fraction between two CMR scans at least 6 months apart (median 2.7 years). Baseline variables were measured at the time of the first CMR. An exhaustive variable search with a support vector machine classifier and five-fold cross-validation was used to predict deterioration and identify the most useful variables. For predicting any deterioration (minor or major) vs. no deterioration, the mean area under the curve (AUC) was 0.82 ± 0.06. For predicting major deterioration vs. minor or no deterioration, the AUC was 0.77 ± 0.07. Baseline left ventricular (LV) ejection fraction, LV circumferential strain, and pulmonary regurgitation were most useful for achieving accurate predictions. Conclusion For the prediction of deterioration in patients with rTOF, a machine learning pipeline uncovered the utility of baseline variables that was previously lost to regression analyses. The predictive models may be useful for planning early interventions in patients with high risk.
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Affiliation(s)
- Manar D Samad
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, 522 Robotics and Manufacturing Building, Lexington, 40506-0108 KY, USA
| | - Mohammad R Arbabshirani
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
- Department of Radiology, Geisinger, 100 North Academy Ave, Danville, 17822 PA, USA
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16
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Balasubramanian S, Harrild DM, Kerur B, Marcus E, del Nido P, Geva T, Powell AJ. Impact of surgical pulmonary valve replacement on ventricular strain and synchrony in patients with repaired tetralogy of Fallot: a cardiovascular magnetic resonance feature tracking study. J Cardiovasc Magn Reson 2018; 20:37. [PMID: 29909772 PMCID: PMC6004693 DOI: 10.1186/s12968-018-0460-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/22/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients with repaired tetralogy of Fallot (TOF), a better understanding of the impact of surgical pulmonary valve replacement (PVR) on ventricular mechanics may lead to improved indications and outcomes. Therefore, we used cardiovascular magnetic resonance (CMR) feature tracking analysis to quantify ventricular strain and synchrony in repaired TOF patients before and after PVR. METHODS Thirty-six repaired TOF patients (median age 22.4 years) prospectively underwent CMR a mean of 4.5 ± 3.8 months before PVR surgery and 7.3 ± 2.1 months after PVR surgery. Feature tracking analysis on cine steady-state free precession images was used to measure right ventricular (RV) and left ventricular (LV) circumferential strain from short-axis views at basal, mid-ventricular, and apical levels; and longitudinal strain from 4-chamber views. Intraventricular synchrony was quantified using the maximum difference in time-to-peak strain, the standard deviation of the time-to-peak, and cross correlation delay (CCD) metrics; interventricular synchrony was assessed using the CCD metric. RESULTS Following PVR, RV end-diastolic volume, end-systolic volume, and ejection fraction declined, and LV end-diastolic volume and end-systolic volume both increased with no significant change in the LV ejection fraction. LV global basal and apical circumferential strains, and basal synchrony improved. RV global circumferential and longitudinal strains were unchanged, and there was a varied impact on synchrony across the locations. Interventricular synchrony worsened at the midventricular level but was unchanged at the base and apex, and on 4-chamber views. CONCLUSIONS Surgical PVR in repaired TOF patients led to improved LV global strain and no change in RV global strain. LV and RV synchrony parameters improved or were unchanged, and interventricular synchrony worsened at the midventricular level.
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MESH Headings
- Adolescent
- Adult
- Cardiac Surgical Procedures/adverse effects
- Child
- Databases, Factual
- Female
- Heart Valve Prosthesis Implantation/adverse effects
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardial Contraction
- Observer Variation
- Predictive Value of Tests
- Pulmonary Valve/diagnostic imaging
- Pulmonary Valve/physiopathology
- Pulmonary Valve/surgery
- Pulmonary Valve Insufficiency/diagnostic imaging
- Pulmonary Valve Insufficiency/etiology
- Pulmonary Valve Insufficiency/physiopathology
- Pulmonary Valve Insufficiency/surgery
- Randomized Controlled Trials as Topic
- Recovery of Function
- Reproducibility of Results
- Stroke Volume
- Tetralogy of Fallot/complications
- Tetralogy of Fallot/diagnostic imaging
- Tetralogy of Fallot/physiopathology
- Tetralogy of Fallot/surgery
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Sowmya Balasubramanian
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - David M. Harrild
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Basavaraj Kerur
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
| | - Edward Marcus
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Pedro del Nido
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, USA
- Department of Surgery, Boston Children’s Hospital, Boston, USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
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17
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Beroukhim RS, Jing L, Harrild DM, Fornwalt BK, Mejia-Spiegeler A, Rhodes J, Emani S, Powell AJ. Impact of the cone operation on left ventricular size, function, and dyssynchrony in Ebstein anomaly: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2018; 20:32. [PMID: 29783986 PMCID: PMC5963144 DOI: 10.1186/s12968-018-0452-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/10/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In addition to tricuspid regurgitation (TR) and right ventricular (RV) enlargement, patients with Ebstein anomaly are at risk for left ventricular (LV) dysfunction and dyssynchrony. We studied the impact of the cone tricuspid valve reconstruction operation on LV size, function, and dyssynchrony. METHODS All Ebstein anomaly patients who had both pre- and postoperative cardiovascular magnetic resonance (CMR) studies were retrospectively identified. From cine images, RV and LV volumes and ejection fractions (EF) were calculated, and LV circumferential and longitudinal strain were measured by feature tracking. To quantify LV dyssynchrony, temporal offsets (TOs) were computed among segmental circumferential strain versus time curves using cross-correlation analysis and patient-specific reference curves. An LV dyssynchrony index was calculated as the standard deviation of the TOs. RESULTS Twenty patients (65% female) were included with a median age at cone operation of 16 years, and a median time between pre- and postoperative CMR of 2.8 years. Postoperatively, there was a decline in the TR fraction (56 ± 19% vs. 5 ± 4%, p < 0.001), RV end-diastolic volume (EDV) (242 ± 110 ml/m2 vs. 137 ± 82 ml/m2, p < 0.001), and RV stroke volume (SV) (101 ± 35 vs. 51 ± 7 ml/m2, p < 0.001). RV EF was unchanged. Conversely, there was an increase in both LV EDV (68 ± 13 vs. 85 ± 13 ml/m2, p < 0.001) and LV stroke volume (37 ± 8 vs. 48 ± 6 ml/m2, p < 0.001). There was no change in LV EF, or global circumferential and longitudinal strain but basal septal circumferential strain improved (16 ± 7% vs. 22 ± 5%, p = 0.04). LV contraction become more synchronous (dyssynchrony index: 32 ± 17 vs. 21 ± 9 msec, p = 0.02), and the extent correlated with the reduction in RV EDV and TR. CONCLUSIONS In patients with the Ebstein anomaly, the cone operation led to reduced TR and RV stroke volume, increased LV stroke volume, improved LV basal septal strain, and improved LV synchrony. Our data demonstrates that the detrimental effect of the RV on LV function can be mitigated by the cone operation.
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Affiliation(s)
- Rebecca S. Beroukhim
- Department of Pediatrics, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA 02114 USA
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, Danville, PA USA
| | - David M. Harrild
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | | | - Jonathan Rhodes
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Surgery, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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18
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Gao Y, Yang ZG, Shi K, Diao KY, Xu HY, Guo YK. Computed tomography for evaluating right ventricle and pulmonary artery in pediatric tetralogy of Fallot: correlation with post-operative pulmonary regurgitation. Sci Rep 2018; 8:7515. [PMID: 29760475 PMCID: PMC5951817 DOI: 10.1038/s41598-018-25868-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/14/2018] [Indexed: 02/05/2023] Open
Abstract
Pulmonary regurgitation (PR) is the most common complication after tetralogy of Fallot (TOF) surgical repair, and long-term PR might result in cardiovascular events. The aim of this study was to assess the influence of pre-operative right ventricle (RV) and pulmonary artery (PA) parameters assessed by dual-source computed tomography on post-operative PR. A total of 41 TOF patients who underwent trans-valve surgical repair were retrospectively recruited. The RV and PA parameters evaluated by pre-operative DSCT were compared between the PR and non-PR groups. Our result revealed that the PA parameters (McGoon ratio, Nakata index, and LPA diameter) and RV parameters (RV length diameter and RV short diameter) all showed significant differences between the two groups (all p < 0.05). There was a significant correlation between PR and LPA diameter (r = 0.361), McGoon ratio (r = 0.413), and Nakata index (r = 0.482). Receiver operating characteristic analysis also revealed a moderate sensitivity and specificity of LPA (66.33%; 82.60%), McGoon ratio (83.33%, 56.52%), and Nakata index (83.33%; 60.87%) for predicting the occurrence of PR. This study indicated that these pre-operative indices calculated by DSCT are associated with post-operative PR and that these pre-operative PA and RV parameters may serve as novel predictors of the risk of PR.
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Affiliation(s)
- Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan, 610041, China.
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19
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Kalaitzidis P, Orwat S, Kempny A, Robert R, Peters B, Sarikouch S, Beerbaum P, Baumgartner H, Diller GP. Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot. Int J Cardiol 2018; 264:53-57. [PMID: 29673853 DOI: 10.1016/j.ijcard.2018.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/09/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrical dyssynchrony and prolonged QRS duration are common in patients with repaired tetralogy of Fallot (ToF). It has been linked to increased risk of sudden cardiac death and right ventricular (RV) dysfunction. We investigated myocardial dyssynchrony using cardiac magnetic resonance imaging (CMR) and feature tracking analysis (FT) in this setting and compared it to myocardial deformation, conventional parameters of ventricular dysfunction and clinical parameters. METHODS AND RESULTS Patients underwent standardized CMR investigations as part of a nationwide study. We prospectively assessed myocardial deformation and analysed regional wall motion abnormalities of the RV and the left ventricle (LV) using CMR-FT. The main measure of dyssynchrony was the maximal time difference (wall motion delay) of the regional strain as a parameter of mechanical biventricular dyssynchrony. In addition, clinical parameters and measures of cardiopulmonary exercise capacity were available. Overall 345 patients were included. Parameters of biventricular wall motion delay correlated significantly with global FT-strain parameters (p < 0.0001 for all imaging planes assessed). Furthermore, we found a significant correlation between circumferential RV motion delay and QRS duration (p = 0.006). Higher LV and RV wall motion delay parameters were also associated with lower peak oxygen consumption (p < 0.05) and a worse LV and RV ejection fraction (p < 0.02). CONCLUSIONS Assessment of mechanical dyssynchrony is feasible using CMR-FT in ToF patients. Parameters of mechanical dyssynchrony correlate with electrical dyssynchrony, biventricular function and objective exercise capacity in this setting. Due to the weak degree of correlation, however, the clinical significance of these findings remains to be clarified by further studies.
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Affiliation(s)
- Pantelis Kalaitzidis
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Radke Robert
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Brigitte Peters
- Institute for Biometry and Medical Informatics, University of Magdeburg, Germany
| | - Samir Sarikouch
- Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Germany
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
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20
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Advanced Cardiovascular Magnetic Resonance Techniques in Grown-Up Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Haggerty CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Wehner GJ, Jing L, Charnigo RJ, Fornwalt BK, Fogel MA. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19:100. [PMID: 29228952 PMCID: PMC5724335 DOI: 10.1186/s12968-017-0410-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
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Affiliation(s)
- Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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22
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Spear TJ, Stromp TA, Leung SW, Vandsburger MH. Influence of longitudinal position on the evolution of steady-state signal in cardiac cine balanced steady-state free precession imaging. Acta Radiol Open 2017; 6:2058460117729186. [PMID: 29201434 PMCID: PMC5700791 DOI: 10.1177/2058460117729186] [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: 07/28/2017] [Accepted: 08/08/2017] [Indexed: 11/18/2022] Open
Abstract
Background Emerging quantitative cardiac magnetic resonance imaging (CMRI) techniques use cine balanced steady-state free precession (bSSFP) to measure myocardial signal intensity and probe underlying physiological parameters. This correlation assumes that steady-state is maintained uniformly throughout the heart in space and time. Purpose To determine the effects of longitudinal cardiac motion and initial slice position on signal deviation in cine bSSFP imaging by comparing two-dimensional (2D) and three-dimensional (3D) acquisitions. Material and Methods Nine healthy volunteers completed cardiac MRI on a 1.5-T scanner. Short axis images were taken at six slice locations using both 2D and 3D cine bSSFP. 3D acquisitions spanned two slices above and below selected slice locations. Changes in myocardial signal intensity were measured across the cardiac cycle and compared to longitudinal shortening. Results For 2D cine bSSFP, 46% ± 9% of all frames and 84% ± 13% of end-diastolic frames remained within 10% of initial signal intensity. For 3D cine bSSFP the proportions increased to 87% ± 8% and 97% ± 5%. There was no correlation between longitudinal shortening and peak changes in myocardial signal. The initial slice position significantly impacted peak changes in signal intensity for 2D sequences (P < 0.001). Conclusion The initial longitudinal slice location significantly impacts the magnitude of deviation from steady-state in 2D cine bSSFP that is only restored at the center of a 3D excitation volume. During diastole, a transient steady-state is established similar to that achieved with 3D cine bSSFP regardless of slice location.
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Affiliation(s)
- Tyler J Spear
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA
| | - Tori A Stromp
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.,Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Steve W Leung
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.,Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Moriel H Vandsburger
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, USA.,Department of Physiology, University of Kentucky, Lexington, KY, USA.,Department of Bioengineering, University of California, Berkeley, CA, USA
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23
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Bourfiss M, Vigneault DM, Aliyari Ghasebeh M, Murray B, James CA, Tichnell C, Mohamed Hoesein FA, Zimmerman SL, Kamel IR, Calkins H, Tandri H, Velthuis BK, Bluemke DA, te Riele ASJM. Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study. J Cardiovasc Magn Reson 2017; 19:66. [PMID: 28863780 PMCID: PMC5581480 DOI: 10.1186/s12968-017-0380-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regional right ventricular (RV) dysfunction is the hallmark of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), but is currently only qualitatively evaluated in the clinical setting. Feature Tracking Cardiovascular Magnetic Resonance (FT-CMR) is a novel quantitative method that uses cine CMR to calculate strain values. However, most prior FT-CMR studies in ARVD/C have focused on global RV strain using different software methods, complicating implementation of FT-CMR in clinical practice. We aimed to assess the clinical value of global and regional strain using FT-CMR in ARVD/C and to determine differences between commercially available FT-CMR software packages. METHODS We analyzed cine CMR images of 110 subjects (39 overt ARVD/C [mutation+/phenotype+], 40 preclinical ARVD/C [mutation+/phenotype-] and 31 control) for global and regional (subtricuspid, anterior, apical) RV strain in the horizontal longitudinal axis using four FT-CMR software methods (Multimodality Tissue Tracking, TomTec, Medis and Circle Cardiovascular Imaging). Intersoftware agreement was assessed using Bland Altman plots. RESULTS For global strain, all methods showed reduced strain in overt ARVD/C patients compared to control subjects (p < 0.041), whereas none distinguished preclinical from control subjects (p > 0.275). For regional strain, overt ARVD/C patients showed reduced strain compared to control subjects in all segments which reached statistical significance in the subtricuspid region for all software methods (p < 0.037), in the anterior wall for two methods (p < 0.005) and in the apex for one method (p = 0.012). Preclinical subjects showed abnormal subtricuspid strain compared to control subjects using one of the software methods (p = 0.009). Agreement between software methods for absolute strain values was low (Intraclass Correlation Coefficient = 0.373). CONCLUSIONS Despite large intersoftware variability of FT-CMR derived strain values, all four software methods distinguished overt ARVD/C patients from control subjects by both global and subtricuspid strain values. In the subtricuspid region, one software package distinguished preclinical from control subjects, suggesting the potential to identify early ARVD/C prior to overt disease expression.
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Affiliation(s)
- Mimount Bourfiss
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Davis M. Vigneault
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Headington, Oxford, UK
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA USA
| | | | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Cynthia A. James
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | | | | | - Ihab R. Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD USA
| | - Anneline S. J. M. te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD USA
- Netherlands Heart Institute, Utrecht, the Netherlands
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24
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25
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Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Hasenfuß G, Lotz J, Chiribiri A, Nagel E, Schuster A. Quantitative assessment of left ventricular mechanical dyssynchrony using cine cardiovascular magnetic resonance imaging: Inter-study reproducibility. JRSM Cardiovasc Dis 2017; 6:2048004017710142. [PMID: 28567282 PMCID: PMC5438106 DOI: 10.1177/2048004017710142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/13/2017] [Accepted: 04/23/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the inter-study reproducibility of left ventricular (LV) mechanical dyssynchrony measures based on standard cardiovascular magnetic resonance (CMR) cine images. DESIGN Steady-state free precession (SSFP) LV short-axis stacks and three long-axes were acquired on the same day at three time points. Circumferential strain systolic dyssynchrony indexes (SDI), area-SDI as well as circumferential and radial uniformity ratio estimates (CURE and RURE, respectively) were derived from CMR myocardial feature-tracking (CMR-FT) based on the tracking of three SSFP short-axis planes. Furthermore, 4D-LV-analysis based on SSFP short-axis stacks and longitudinal planes was performed to quantify 4D-volume-SDI. SETTING A single-centre London teaching hospital. PARTICIPANTS 16 healthy volunteers. MAIN OUTCOME MEASURES Inter-study reproducibility between the repeated exams. RESULTS CURE and RURE as well as 4D-volume-SDI showed good inter-study reproducibility (coefficient of variation [CoV] 6.4%-12.9%). Circumferential strain and area-SDI showed higher variability between the repeated measurements (CoV 24.9%-37.5%). Uniformity ratio estimates showed the lowest inter-study variability (CoV 6.4%-8.5%). CONCLUSIONS Derivation of LV mechanical dyssynchrony measures from standard cine images is feasible using CMR-FT and 4D-LV-analysis tools. Uniformity ratio estimates and 4D-volume-SDI showed good inter-study reproducibility. Their clinical value should next be explored in patients who potentially benefit from cardiac resynchronization therapy.
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Affiliation(s)
- Johannes T Kowallick
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | | | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Roy Jogiya
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Gerd Hasenfuß
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,Division of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research (DZHK, partner site Rhine-Main), Frankfurt, Germany
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St Thomas' Hospital, London, UK.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
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26
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Affiliation(s)
- Anne Marie Valente
- From the Department of Cardiology, Boston Children’s Hospital, MA (A.M.V., T.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (A.M.V., T.G.); and Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Boston, MA (A.M.V.)
| | - Tal Geva
- From the Department of Cardiology, Boston Children’s Hospital, MA (A.M.V., T.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (A.M.V., T.G.); and Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Boston, MA (A.M.V.)
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27
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Suever JD, Wehner GJ, Jing L, Powell DK, Hamlet SM, Grabau JD, Mojsejenko D, Andres KN, Haggerty CM, Fornwalt BK. Right Ventricular Strain, Torsion, and Dyssynchrony in Healthy Subjects Using 3D Spiral Cine DENSE Magnetic Resonance Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1076-1085. [PMID: 28055859 PMCID: PMC5711416 DOI: 10.1109/tmi.2016.2646321] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mechanics of the left ventricle (LV) are important indicators of cardiac function. The role of right ventricular (RV) mechanics is largely unknown due to the technical limitations of imaging its thin wall and complex geometry and motion. By combining 3D Displacement Encoding with Stimulated Echoes (DENSE) with a post-processing pipeline that includes a local coordinate system, it is possible to quantify RV strain, torsion, and synchrony. In this study, we sought to characterize RV mechanics in 50 healthy individuals and compare these values to their LV counterparts. For each cardiac frame, 3D displacements were fit to continuous and differentiable radial basis functions, allowing for the computation of the 3D Cartesian Lagrangian strain tensor at any myocardial point. The geometry of the RV was extracted via a surface fit to manually delineated endocardial contours. Throughout the RV, a local coordinate system was used to transform from a Cartesian strain tensor to a polar strain tensor. It was then possible to compute peak RV torsion as well as peak longitudinal and circumferential strain. A comparable analysis was performed for the LV. Dyssynchrony was computed from the standard deviation of regional activation times. Global circumferential strain was comparable between the RV and LV (-18.0% for both) while longitudinal strain was greater in the RV (-18.1% vs. -15.7%). RV torsion was comparable to LV torsion (6.2 vs. 7.1 degrees, respectively). Regional activation times indicated that the RV contracted later but more synchronously than the LV. 3D spiral cine DENSE combined with a post-processing pipeline that includes a local coordinate system can resolve both the complex geometry and 3D motion of the RV.
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28
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Daraban AM, Jurcuţ R, Bădilă E, Bartoş D, Dan GA. Following up adult patients with tetralogy of fallot: The role of echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:79-95. [PMID: 27861982 DOI: 10.1002/jcu.22411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/14/2016] [Accepted: 08/22/2016] [Indexed: 06/06/2023]
Abstract
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. With surgical repair and the advances in postoperative care, contemporary mortality has dramatically improved and an increasing number of patients survive into adulthood, leading to a growing number of adult TOF. However, residual anatomic and hemodynamic abnormalities are encountered in nearly all patients, making follow-up mandatory. Furthermore, mortality starts to increase 25 years after surgery, emphasizing that, in adult TOF, closer monitoring is necessary. We review here the role of echocardiography in the follow-up of the TOF patients, emphasizing the role of multiple echocardiographic techniques. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:79-95, 2017.
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Affiliation(s)
- Ana Maria Daraban
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Ruxandra Jurcuţ
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- 'C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Elisabeta Bădilă
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Daniela Bartoş
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Emergency Hospital, Bucharest, Romania
| | - Gheorghe Andrei Dan
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Colentina Clinical Hospital, Bucharest, Romania
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29
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Soto Iglesias D, Duchateau N, Kostantyn Butakov CB, Andreu D, Fernandez-Armenta J, Bijnens B, Berruezo A, Sitges M, Camara O. Quantitative Analysis of Electro-Anatomical Maps: Application to an Experimental Model of Left Bundle Branch Block/Cardiac Resynchronization Therapy. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 5:1900215. [PMID: 29164019 PMCID: PMC5477765 DOI: 10.1109/jtehm.2016.2634006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/08/2016] [Accepted: 11/14/2016] [Indexed: 01/02/2023]
Abstract
Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding
ablation therapies. They provide voltage and activation time information on a 3-D
anatomical mesh representation, making them useful for analyzing the electrical
activation patterns in specific pathologies. However, the variability between the
different acquisitions and anatomies hampers the comparison between different maps.
This paper presents two contributions for the analysis of electrical patterns in EAM
data from biventricular surfaces of cardiac chambers. The first contribution is an
integrated automatic 2-D disk representation (2-D bull’s eye plot) of the left
ventricle (LV) and right ventricle (RV) obtained with a quasi-conformal mapping from
the 3-D EAM meshes, that allows an analysis of cardiac resynchronization therapy
(CRT) lead positioning, interpretation of global (total activation time), and local
indices (local activation time (LAT), surrogates of conduction velocity,
inter-ventricular, and transmural delays) that characterize changes in the electrical
activation pattern. The second contribution is a set of indices derived from the
electrical activation: speed maps, computed from LAT values, to study the electrical
wave propagation, and histograms of isochrones to analyze regional electrical
heterogeneities in the ventricles. We have applied the proposed methods to look for
the underlying physiological mechanisms of left bundle branch block (LBBB) and CRT,
with the goal of optimizing the therapy by improving CRT response. To better
illustrate the benefits of the proposed tools, we created a set of synthetically
generated and fully controlled activation patterns, where the proposed representation
and indices were validated. Then, the proposed analysis tools are used to analyze EAM
data from an experimental swine model of induced LBBB with an implanted CRT device.
We have analyzed and compared the electrical activation patterns at baseline, LBBB,
and CRT stages in four animals: two without any structural disease and two with an
induced infarction. By relating the CRT lead location with electrical dyssynchrony,
we evaluated current hypotheses about lead placement in CRT and showed that optimal
pacing sites should target the RV lead close to the apex and the LV one distant from
it.
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Affiliation(s)
- David Soto Iglesias
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | | | - David Andreu
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | | | - Bart Bijnens
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra.,Catalan Institution for Research and Advanced Studies
| | | | - Marta Sitges
- Cardiology DepartmentThorax Institute, Hospital Clinic
| | - Oscar Camara
- PhySense, Information and Communication Technologies DepartmentUniversitat Pompeu Fabra
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30
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Jing L, Wehner GJ, Suever JD, Charnigo RJ, Alhadad S, Stearns E, Mojsejenko D, Haggerty CM, Hickey K, Valente AM, Geva T, Powell AJ, Fornwalt BK. Left and right ventricular dyssynchrony and strains from cardiovascular magnetic resonance feature tracking do not predict deterioration of ventricular function in patients with repaired tetralogy of Fallot. J Cardiovasc Magn Reson 2016; 18:49. [PMID: 27549809 PMCID: PMC4993000 DOI: 10.1186/s12968-016-0268-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/22/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (rTOF) suffer from progressive ventricular dysfunction decades after their surgical repair. We hypothesized that measures of ventricular strain and dyssynchrony would predict deterioration of ventricular function in patients with rTOF. METHODS A database search identified all patients at a single institution with rTOF who underwent cardiovascular magnetic resonance (CMR) at least twice, >6 months apart, without intervening surgical or catheter procedures. Seven primary predictors were derived from the first CMR using a custom feature tracking algorithm: left (LV), right (RV) and inter-ventricular dyssynchrony, LV and RV peak global circumferential strains, and LV and RV peak global longitudinal strains. Three outcomes were defined, whose changes were assessed over time: RV end-diastolic volume, and RV and LV ejection fraction. Multivariate linear mixed models were fit to investigate relationships of outcomes to predictors and ten potential baseline confounders. RESULTS One hundred fifty-three patients with rTOF (23 ± 14 years, 50 % male) were included. The mean follow-up duration between the first and last CMR was 2.9 ± 1.3 years. After adjustment for confounders, none of the 7 primary predictors were significantly associated with change over time in the 3 outcome variables. Only 1-17 % of the variability in the change over time in the outcome variables was explained by the baseline predictors and potential confounders. CONCLUSIONS In patients with repaired tetralogy of Fallot, ventricular dyssynchrony and global strain derived from cine CMR were not significantly related to changes in ventricular size and function over time. The ability to predict deterioration in ventricular function in patients with rTOF using current methods is limited.
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MESH Headings
- Adolescent
- Algorithms
- Biomechanical Phenomena
- Cardiac Surgical Procedures/adverse effects
- Child
- Databases, Factual
- Disease Progression
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Kentucky
- Linear Models
- Magnetic Resonance Imaging, Cine
- Male
- Multivariate Analysis
- Predictive Value of Tests
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Stress, Mechanical
- Stroke Volume
- Tetralogy of Fallot/complications
- Tetralogy of Fallot/diagnostic imaging
- Tetralogy of Fallot/physiopathology
- Tetralogy of Fallot/surgery
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Linyuan Jing
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Gregory J. Wehner
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Jonathan D. Suever
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | | | - Sudad Alhadad
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Evan Stearns
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Dimitri Mojsejenko
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
| | - Kelsey Hickey
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, Boston, MA USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Brandon K. Fornwalt
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY USA
- Institute for Advanced Application, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
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31
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Leng S, Jiang M, Zhao XD, Allen JC, Kassab GS, Ouyang RZ, Tan JL, He B, Tan RS, Zhong L. Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking. Ann Biomed Eng 2016; 44:3522-3538. [PMID: 27436293 DOI: 10.1007/s10439-016-1695-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/07/2016] [Indexed: 02/04/2023]
Abstract
Right ventricular (RV) dysfunction is known to be highly correlated with mortality and morbidity; nevertheless, imaging-based assessment of RV anatomy and physiology lags far behind that of the left ventricle. In this study, we advance RV imaging using cardiac magnetic resonance (CMR) to accomplish the following aims: (i) track the motion of six tricuspid annular (TA) sites using a semi-automatic tracking system; (ii) extract clinically important TA measurements-systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), and TA plane systolic excursion (TAPSE)-for each TA site and compare these CMR-derived measurements in healthy subjects vs. patients with heart failure, repaired tetralogy of Fallot, pulmonary hypertension, and hypertrophic cardiomyopathy; (iii) investigate how the TA motion related measurements compare with information provided by invasive right heart catheterization (RHC); (iv) evaluate the rate of change in surface area swept out by the reconstructed tricuspid annulus over time and (v) assess the reproducibility of this CMR-based technique. Results indicate that TA motion parameter data obtained in three dimensions using the proposed CMR-based systematic methodology achieve superior diagnostic performance (Sm: AUC = 0.957; TAPSE: AUC = 0.981) compared to two-dimensional CMR imaging. Both Sm and TAPSE from CMR correlated positively with dP/dt max/IP from RHC (Sm: r = 0.621, p < 0.01; TAPSE: r = 0.648, p < 0.01). Our highly reproducible and robust methodology holds potential for extending CMR imaging to characterization of TA morphology and dynamic behaviour, eventually leading to deeper understanding of RV function and improved diagnostic capability.
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Affiliation(s)
- Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiao-Dan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, 92121, USA
| | - Rong-Zhen Ouyang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ju-Le Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China.
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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32
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Pradegan N, Vida VL, Geva T, Stellin G, White MT, Sanders SP, Padera RF. Myocardial histopathology in late-repaired and unrepaired adults with tetralogy of Fallot. Cardiovasc Pathol 2016; 25:225-231. [DOI: 10.1016/j.carpath.2016.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 11/26/2022] Open
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33
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Gilbert K, Lam HI, Pontré B, Cowan BR, Occleshaw CJ, Liu JY, Young AA. An interactive tool for rapid biventricular analysis of congenital heart disease. Clin Physiol Funct Imaging 2015; 37:413-420. [PMID: 26577068 PMCID: PMC5484291 DOI: 10.1111/cpf.12319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
Cardiac malformations are the most common birth defect. Better interventions in early life have improved mortality for children with congenital heart disease, but heart failure is a significant problem in adulthood. These patients require regular imaging and analysis of biventricular (left and right ventricular) function. In this study, we describe a rapid method to analyse left and right ventricular shape and function from cardiac MRI examinations. A 4D (3D+time) finite element model template is interactively customized to the anatomy and motion of the biventricular unit. The method was validated in 17 patients and 10 ex-vivo hearts. Interactive model updates were achieved through preconditioned conjugate gradient optimization on a multithread system, and by precomputing points predicted from a coarse mesh optimization.
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Affiliation(s)
- K Gilbert
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H-I Lam
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B Pontré
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - B R Cowan
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C J Occleshaw
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J Y Liu
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A A Young
- Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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34
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Gerber BL, Edvardsen T, Pierard LA, Saraste A, Knuuti J, Maurer G, Habib G, Lancellotti P. The year 2014 in the European Heart Journal--Cardiovascular Imaging: part II. Eur Heart J Cardiovasc Imaging 2015; 16:1180-4. [PMID: 26377903 DOI: 10.1093/ehjci/jev223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
The European Heart Journal-Cardiovascular Imaging, created in 2012, has become a reference for publishing multimodality cardiovascular imaging scientific and review papers. The impressive 2014 impact factor of 4.105 confirms the important position of our journal. In this part, we summarize the most important studies from the journal's third year, with specific emphasis on cardiomyopathies, congenital heart diseases, valvular heart diseases, and heart failure.
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Affiliation(s)
- Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway Centre of Cardiological Innovation, Oslo, Norway
| | - Luc A Pierard
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium
| | - Antti Saraste
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre and Heart Center, Turku University Hospital and University of Turku, Kiinmyllynkatu 4-8, 20520 Turku, Finland
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gilbert Habib
- Aix-Marseille Université, 13284 Marseille, France Department of Cardiology, La Timone Hospital, Bd Jean Moulin, 13005 Marseille, France
| | - Patrizio Lancellotti
- Avenue de l'hôpital, 1, Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, Imaging Cardiology, CHU Sart Tilman, 4000 Liege, Belgium GVM Care and Research, E.S. Health Science Foundation, Lugo, RA, Italy
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McLeod K, Sermesant M, Beerbaum P, Pennec X. Spatio-Temporal Tensor Decomposition of a Polyaffine Motion Model for a Better Analysis of Pathological Left Ventricular Dynamics. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:1562-1575. [PMID: 25706580 DOI: 10.1109/tmi.2015.2405579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given that heart disease can cause abnormal motion dynamics over the cardiac cycle, understanding and quantifying cardiac motion can provide insight for clinicians to aid with diagnosis, therapy planning, and determining prognosis. The goal of this paper is to extract population-specific motion patterns from 3D displacements in order to identify the mean motion in a population, and to describe pathology-specific motion patterns in terms of the spatial and temporal components. Since there are common motion patterns observed in patients with the same condition, extracting these can lead towards a better understanding of the disease. Quantifying cardiac motion at a population level is not a simple task since images can vary widely in terms of image quality, size, resolution, and pose. To overcome this, we analyze the parameters obtained from a cardiac-specific Polyaffine motion-tracking algorithm, which are aligned both spatially and temporally to a common reference space. Once all parameters are aligned, different subjects can be compared and analyzed in the space of Polyaffine transformations by projecting the transformations to a reduced order subspace in which dominant motion patterns in each population can be extracted. Using tensor decomposition, the spatial and temporal aspects can be decoupled in order to study the components individually. The proposed method was validated on healthy volunteers and Tetralogy of Fallot patients according to known spatial and temporal behavior for each population. A key advantage of this method is the ability to regenerate motion sequences from the models, which can be visualized in terms of the full motion.
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