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Chan AT, Maya TR, Park C, Tak K, Liberman N, Jain RH, Park MJ, Park RY, Grizzard J, Kim G, Tap WD, Jessurun J, Liu J, Kim J, Steingart RM, Weinsaft JW. Incremental Utility of First-Pass Perfusion CMR for Prognostic Risk Stratification of Cancer-Associated Cardiac Masses. JACC Cardiovasc Imaging 2024; 17:128-145. [PMID: 37410010 DOI: 10.1016/j.jcmg.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) differentiates cardiac metastasis (CMET) and cardiac thrombus (CTHR) based on tissue characteristics stemming from vascularity on late gadolinium enhancement (LGE). Perfusion CMR can assess magnitude of vascularity; utility for cardiac masses (CMASS) is unknown. OBJECTIVES This study sought to determine if perfusion CMR provides diagnostic and prognostic utility for CMASS beyond binary differentiation of CMET and CTHR. METHODS The population comprised adult cancer patients with CMASS on CMR; CMET and CTHR were defined using LGE-CMR: CMASS+ patients were matched to CMASS- control subjects for cancer type/stage. First-pass perfusion CMR was interpreted visually and semiquantitatively for CMASS vascularity, including contrast enhancement ratio (CER) (plateau vs baseline) and contrast uptake rate (CUR) (slope). Follow-up was performed for all-cause mortality. RESULTS A total of 462 cancer patients were studied, including patients with (CMET = 173, CTHR = 69) and without CMASS on LGE-CMR. On perfusion CMR, CER and CUR were higher within CMET vs CTHR (P < 0.001); CUR yielded better performance (AUC: 0.89-0.93) than CER (AUC: 0.66-0.72) (both P < 0.001) to differentiate LGE-CMR-evidenced CMET and CTHR, although both CUR (P = 0.10) and CER (P = 0.01) typically misclassified CMET with minimal enhancement. During follow-up, mortality among CMET patients was high but variable; 47% of patients were alive 1 year post-CMR. Patients with semiquantitative perfusion CMR-evidenced CMET had higher mortality than control subjects (HR: 1.42 [95% CI: 1.06-1.90]; P = 0.02), paralleling visual perfusion CMR (HR: 1.47 [95% CI: 1.12-1.94]; P = 0.006) and LGE-CMR (HR: 1.52 [95% CI: 1.16-2.00]; P = 0.003). Among patients with CMET on LGE-CMR, mortality was highest among patients (P = 0.002) with lesions in the bottom perfusion (CER) tertile, corresponding to low vascularity. Among CMET and cancer-matched control subjects, mortality was equivalent (P = NS) among patients with lesions in the upper CER tertile (corresponding to higher lesion vascularity). Conversely, patients with CMET in the middle (P = 0.03) and lowest (lowest vascularity) (P = 0.001) CER tertiles had increased mortality. CONCLUSIONS Perfusion CMR yields prognostic utility that complements LGE-CMR: Among cancer patients with LGE-CMR defined CMET, mortality increases in proportion to magnitude of lesion hypoperfusion.
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Affiliation(s)
- Angel T Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
| | - Tania Ruiz Maya
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christine Park
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Katherine Tak
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Nicole Liberman
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Raina H Jain
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michael J Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Y Park
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - John Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gene Kim
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jose Jessurun
- Department of Pathology, Weill Cornell Medical College, New York, New York, USA
| | - Jennifer Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Richard M Steingart
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan W Weinsaft
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Department of Radiology, Weill Cornell Medical College, New York, New York, USA.
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Thut T, Valsangiacomo Büchel E, Geiger J, Kellenberger CJ, Rücker B, Burkhardt BEU. Signal Thresholding Segmentation of Ventricular Volumes in Young Patients with Various Diseases-Can We Trust the Numbers? Diagnostics (Basel) 2023; 13:diagnostics13020180. [PMID: 36672990 PMCID: PMC9857934 DOI: 10.3390/diagnostics13020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/14/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
In many cardiac diseases, right and left ventricular volumes in systole and diastole are diagnostically and prognostically relevant. Measurements are made by segmentation of the myocardial borders on cardiac magnetic resonance (CMR) images. Automatic detection of myocardial contours is possible by signal thresholding techniques, but must be validated before use in clinical settings. Biventricular volumes were measured in end-diastole (EDVi) and in end-systole (ESVi) both manually and with the MassK application, with signal thresholds at 30%, 50%, and 70%. Stroke volumes (SV) and cardiac indices (CI) were calculated from volumetric measurements and from flow measured in the ascending aorta and the main pulmonary artery, and both methods were compared. Reproducibility of volumetric measurements was tested in 20 patients. Measurements were acquired in 94 patients aged 15 ± 9 years referred for various conditions. EDVi and ESVi of both ventricles were largest with manual segmentation and inversely proportional to the MassK threshold. Manual and k30 SV and CI corresponded best to flow measurements. Interobserver variability was low for all volumes manually and with MassK. In conclusion, manual and 30% threshold-based biventricular volume segmentation agree best with two-dimensional, phantom-corrected phase contrast flow measurements in a young cardiac referral population and are well reproducible.
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Affiliation(s)
- Titus Thut
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Emanuela Valsangiacomo Büchel
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Julia Geiger
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Christian Johannes Kellenberger
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Beate Rücker
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
| | - Barbara Elisabeth Ursula Burkhardt
- Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, 3032 Zurich, Switzerland
- Correspondence:
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Kagan RD, Palumbo MC, Weinsaft JW, Kim J, Gaudino MFL, Girardi LN, Lau C. Impact of advanced imaging techniques on cardiac surgery-New insights provided by cardiac magnetic resonance. J Card Surg 2022; 37:4138-4143. [PMID: 36321961 DOI: 10.1111/jocs.17095] [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: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
This dialog between a cardiac surgeon (C.L.) and cardiac imager (J.W.W.) provides an overview of cardiac MRI (CMR) methods relevant to cardiac surgery. Major areas of focus include logistics of performing a CMR exam, as well as established and emerging methods for assessment of cardiac structure, function, valvular performance, and tissue characterization. Regarding tissue characterization, a major area of focus concerns CMR assessment of viability, for which this modality has been shown to provide incremental utility to conventional techniques for detection of presence and transmural extent of infarction, as well as powerful predictive utility of recovery of left ventricular systolic function as well as long term clinical prognosis in patients with an array of clinical conditions, including coronary artery disease and valvular heart disease both before and following cardiac surgery.
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Affiliation(s)
- Ruth D Kagan
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Maria Chiara Palumbo
- Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Yang C, Xu H, Qiao S, Jia R, Jin Z, Yuan J. Papillary and Trabecular Muscles Have Substantial Impact on Quantification of Left Ventricle in Patients with Hypertrophic Obstructive Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12082029. [PMID: 36010378 PMCID: PMC9407152 DOI: 10.3390/diagnostics12082029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Patients with obstructive hypertrophic cardiomyopathy (HOCM) have large papillary and trabecular muscles (PTMs), which are myocardial tissue. PTMs are usually excluded from the myocardium and included in the left ventricular (LV) cavity when determining LV mass (LVM) and volumes using cardiac magnetic resonance (CMR). This conventional method may result in large distortion of LVM and other indices. We investigated 74 patients with HOCM undergoing CMR imaging. LV short-axis cine images were obtained. LV contours were drawn using two different methods: (1) the conventional method, where PTMs were included in the LV cavity; and (2) the mask method, which includes the TPMs in the LV myocardium. The LV end-diastolic volume (LV-EDV), LV end-systolic volume (LV-ESV), LV ejection fraction (LVEF), and the LVM were then calculated. Fasting NT-proBNP and CK-MB levels were measured with ELISA. In patients with HOCM, mass of PTMs (MOPTM) was 47.9 ± 18.7 g, which represented 26.9% of total LVM. Inclusion of PTMs with the mask method resulted in significantly greater LVM and LVM index (both p < 0.0001) in comparison with those measured with the conventional method. In addition, the mask method produced a significant decrease in LV-EDV and LV-ESV. LVEF was significantly increased with the mask method (64.3 ± 7.9% vs. 77.2 ± 7.1%, p < 0.0001). MOPTM was positively correlated with BMI, septal wall thickness, LVM, LV-EDV, and LV-ESV. LVEF was inversely correlated with MOPTM. In addition, MOPTM correlated positively with NT-proBNP (r = 0.265, p = 0.039) and CK-MB (r = 0.356, p = 0.002). In conclusion, inclusion of PTMs in the myocardium has a substantial impact on quantification of the LVM, LV-EDV, LV-ESV, and LVEF in patients with HOCM. The effects of the PTMs in women was greater than that in men. Furthermore, the MOPTM was positively associated with NT-proBNP and CK-MB. The PTMs might be included in the myocardium when measuring the LV volumes and mass of patients with HOCM. At present, the clinical and prognostic meaning and relevance of the PTMs is not clear and should be further studied.
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Affiliation(s)
- Chengzhi Yang
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Haobo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ruofei Jia
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
- Correspondence: (Z.J.); (J.Y.)
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Z.J.); (J.Y.)
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Palumbo MC, Redaelli A, Wingo M, Tak KA, Leonard JR, Kim J, Rong LQ, Park C, Mitlak HW, Devereux RB, Roman MJ, RoyChoudury A, Lau C, Gaudino MFL, Girardi LN, Weinsaft JW. Impact of ascending aortic prosthetic grafts on early postoperative descending aortic biomechanics on cardiac magnetic resonance imaging. Eur J Cardiothorac Surg 2022; 61:860-868. [PMID: 34849679 PMCID: PMC8947796 DOI: 10.1093/ejcts/ezab501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Among patients with ascending thoracic aortic aneurysms, prosthetic graft replacement yields major benefits but risk for recurrent aortic events persists for which mechanism is poorly understood. This pilot study employed cardiac magnetic resonance to test the impact of proximal prosthetic grafts on downstream aortic flow and vascular biomechanics. METHODS Cardiac magnetic resonance imaging was prospectively performed in patients with thoracic aortic aneurysms undergoing surgical (Dacron) prosthetic graft implantation. Imaging included time resolved (4-dimensional) phase velocity encoded cardiac magnetic resonance for flow quantification and cine-cardiac magnetic resonance for aortic wall distensibility/strain. RESULTS Twenty-nine patients with thoracic aortic aneurysms undergoing proximal aortic graft replacement were studied; cardiac magnetic resonance was performed pre- [12 (4, 21) days] and postoperatively [6.4 (6.2, 7.2) months]. Postoperatively, flow velocity and wall shear stress increased in the arch and descending aorta (P < 0.05); increases were greatest in hereditary aneurysm patients. Global circumferential strain correlated with wall shear stress (r = 0.60-0.72, P < 0.001); strain increased postoperatively in the native descending and thoraco-abdominal aorta (P < 0.001). Graft-induced changes in biomechanical properties of the distal native ascending aorta were associated with post-surgical changes in descending aortic wall shear stress, as evidenced by correlations (r = -0.39-0.52; P ≤ 0.05) between graft-induced reduction of ascending aortic distensibility and increased distal native aortic wall shear stress following grafting. CONCLUSIONS Prosthetic graft replacement of the ascending aorta increases downstream aortic wall shear stress and strain. Postoperative increments in descending aortic wall shear stress correlate with reduced ascending aortic distensibility, suggesting that grafts provide a nidus for high energy flow and adverse distal aortic remodelling.
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Affiliation(s)
- Maria C Palumbo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Alberto Redaelli
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Matthew Wingo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katherine A Tak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Christine Park
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Hannah W Mitlak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Richard B Devereux
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Mary J Roman
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudury
- Division of Biostatistics, Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
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Legrand L, Weinsaft JW, Pousset F, Ewenczyk C, Charles P, Hatem S, Heinzmann A, Biet M, Durr A, Redheuil A. Characterizing cardiac phenotype in Friedreich's ataxia: The CARFA study. Arch Cardiovasc Dis 2021; 115:17-28. [PMID: 34920960 DOI: 10.1016/j.acvd.2021.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Friedreich's ataxia is an autosomal recessive mitochondrial disease caused by a triplet repeat expansion in the frataxin gene (FXN), exhibiting cerebellar sensory ataxia, diabetes and cardiomyopathy. Cardiac complications are the major cause of early death. AIMS To characterize the cardiac phenotype associated with Friedreich's ataxia, and to assess the evolution of the associated cardiopathy over 1 year. METHODS This observational single-centre open label study consisted of two groups: 20 subjects with Friedreich's ataxia and 20 healthy controls studied over two visits over 1 year. All subjects had transthoracic echocardiography, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, quantification of serum cardiac biomarkers and neurological assessment. RESULTS Patients with Friedreich's ataxia had left ventricular hypertrophy, with significantly smaller left ventricular diastolic diameters and volumes and increased wall thicknesses. Cardiac magnetic resonance imaging demonstrated significant concentric left ventricular remodelling, according to the mass/volume ratio, and focal myocardial fibrosis in 50% of patients with Friedreich's ataxia. Cardiopulmonary exercise testing showed alteration of left ventricular diastolic filling in patients with Friedreich's ataxia, with an elevated VE/VCO2 slope (ventilatory flow/exhaled volume of carbon dioxide). High-sensitivity troponin T plasma concentrations were higher in subjects with Friedreich's ataxia. None of the previous variables changed at 1 year. Neurological assessments remained stable for both groups, except for the nine-hole pegboard test, which was altered over 1 year. CONCLUSIONS The multivariable characterization of the cardiac phenotype of patients with Friedreich's ataxia was significantly different from controls at baseline. Over 1 year there were no clinically significant changes in patients with Friedreich's ataxia compared with healthy controls, whereas the neurological severity score increased modestly.
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Affiliation(s)
- Lise Legrand
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France
| | | | - Francoise Pousset
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France
| | - Claire Ewenczyk
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Perrine Charles
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Stéphane Hatem
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France; ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital (AP-HP), Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Inserm, CNRS, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - Anna Heinzmann
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Marie Biet
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Alexandra Durr
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Alban Redheuil
- ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France; ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital (AP-HP), Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Inserm, CNRS, 47-83, boulevard de l'hôpital, 75013 Paris, France.
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Gregor Z, Kiss AR, Szabó LE, Tóth A, Grebur K, Horváth M, Dohy Z, Merkely B, Vágó H, Szűcs A. Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification. PLoS One 2021; 16:e0258362. [PMID: 34637474 PMCID: PMC8509873 DOI: 10.1371/journal.pone.0258362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Methods Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18–29, Group B: 30–39, Group C: 40–49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). Results The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Conclusions Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.
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Affiliation(s)
- Zsófia Gregor
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Anna Réka Kiss
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center of Semmelweis University, Budapest, Hungary
- * E-mail:
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Naumova AV, Kicska G, Pimentel K, Neidig LE, Tsuchida H, Nakamura K, Murry CE. Quantitative Analyses of the Left Ventricle Volume and Cardiac Function in Normal and Infarcted Yucatan Minipigs. J Imaging 2021; 7:107. [PMID: 39080895 PMCID: PMC8321358 DOI: 10.3390/jimaging7070107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The accuracy of the left ventricular volume (LVV) and contractility measurements with cardiac magnetic resonance imaging (CMRI) is decreased if the papillary muscles are abnormally enlarged, such as in hypertrophic cardiomyopathy in human patients or in pig models of human diseases. The purpose of this work was to establish the best method of LVV quantification with CMRI in pigs. (2) Methods: The LVV in 29 Yucatan minipig hearts was measured using two different techniques: the "standard method", which uses smooth contouring along the endocardial surface and adds the papillary volume to the ventricular cavity volume, and the "detailed method", which traces the papillary muscles and trabeculations and adds them to the ventricular mass. (3) Results: Papillary muscles add 21% to the LV mass in normal and infarcted hearts of Yucatan minipigs. The inclusion or exclusion of these from the CMRI analysis significantly affected the study results. In the normal pig hearts, the biggest differences were found in measurements of the LVV, ejection fraction (EF), LV mass and indices derived from the LV mass (p < 0.001). The EF measurement in the normal pig heart was 11% higher with the detailed method, and 19% higher in the infarcted pig hearts (p < 0.0001). The detailed method of endocardium tracing with CMRI closely represented the LV mass measured ex vivo. (4) Conclusions: The detailed method, which accounts for the large volume of the papillary muscles in the pig heart, provides better accuracy and interobserver consistency in the assessment of LV mass and ejection fraction, and might therefore be preferable for these analyses.
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Affiliation(s)
- Anna V. Naumova
- Department of Radiology, University of Washington, Seattle, WA 98109, USA; (G.K.); (K.P.)
- Institute for Stem Cells and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA; (L.E.N.); (H.T.); (K.N.); (C.E.M.)
| | - Gregory Kicska
- Department of Radiology, University of Washington, Seattle, WA 98109, USA; (G.K.); (K.P.)
| | - Kiana Pimentel
- Department of Radiology, University of Washington, Seattle, WA 98109, USA; (G.K.); (K.P.)
| | - Lauren E. Neidig
- Institute for Stem Cells and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA; (L.E.N.); (H.T.); (K.N.); (C.E.M.)
- Department of Pathology, University of Washington, Seattle, WA 98109, USA
- Department of Comparative Medicine, University of Washington, Seattle, WA 98109, USA
| | - Hiroshi Tsuchida
- Institute for Stem Cells and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA; (L.E.N.); (H.T.); (K.N.); (C.E.M.)
- Department of Pathology, University of Washington, Seattle, WA 98109, USA
| | - Kenta Nakamura
- Institute for Stem Cells and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA; (L.E.N.); (H.T.); (K.N.); (C.E.M.)
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Charles E. Murry
- Institute for Stem Cells and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA; (L.E.N.); (H.T.); (K.N.); (C.E.M.)
- Department of Pathology, University of Washington, Seattle, WA 98109, USA
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9
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Quantification of left ventricular mass by echocardiography compared to cardiac magnet resonance imaging in hemodialysis patients. Cardiovasc Ultrasound 2020; 18:39. [PMID: 32938484 PMCID: PMC7495823 DOI: 10.1186/s12947-020-00217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/07/2020] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH), defined by the left ventricular mass index (LVMI), is highly prevalent in hemodialysis patients and a strong independent predictor of cardiovascular events. Compared to cardiac magnetic resonance imaging (CMR), echocardiography tends to overestimate the LVMI. Here, we evaluate the diagnostic performance of transthoracic echocardiography (TTE) compared to CMR regarding the assessment of LVMI in hemodialysis patients. Methods TTR and CMR data for 95 hemodialysis patients who participated in the MiREnDa trial were analyzed. The LVMI was calculated by two-dimensional (2D) TTE-guided M-mode measurements employing the American Society of Echocardiography (ASE) and Teichholz (Th) formulas, which were compared to the reference method, CMR. Results LVH was present in 44% of patients based on LVMI measured by CMR. LVMI measured by echocardiography correlated moderately with CMR, ASE: r = 0.44 (0.34–0.62); Th: r = 0.44 (0.32–0.62). Compared to CMR, both echocardiographic formulas overestimated LVMI (mean ∆LVMI (ASE-CMR): 19.5 ± 19.48 g/m2, p < 0.001; mean ∆LVMI (Th-CMR): 15.9 ± 15.89 g/m2, p < 0.001). We found greater LVMI overestimation in patients with LVH using the ASE formula compared to the Th formula. Stratification of patients into CMR LVMI quartiles showed a continuous decrease in ∆LVMI with increasing CMR LVMI quartiles for the Th formula (p < 0.001) but not for the ASE formula (p = 0.772). Bland-Altman analysis showed that the Th formula had a constant bias independent of LVMI. Both methods had good discrimination ability for the detection of LVH (ROC-AUC: 0.819 (0.737–0.901) and 0.808 (0.723–0.892) for Th and ASE, respectively). Conclusions The ASE and Th formulas overestimate LVMI in hemodialysis patients. However, the overestimation is less with the Th formula, particularly with increasing LVMI. The results suggest that the Th formula should be preferred for measurement of LVMI in chronic hemodialysis patients. Trial registration The data was derived from the following clinical trial: NCT01691053, registered on 19 September 2012 before enrollment of the first participant.
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10
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Rong LQ, Palumbo MC, Rahouma M, Lopes AJ, Devereux RB, Kim J, Girardi LN, Gaudino M, Weinsaft JW. Descending aortic strain quantification by intra-operative transesophageal echocardiography: Multimodality validation via cardiovascular magnetic resonance. Echocardiography 2020; 37:1820-1827. [PMID: 32909633 DOI: 10.1111/echo.14851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Whereas cardiac magnetic resonance (CMR) imaging provides high temporal resolution imaging of aortic distensibility (strain), transesophageal echocardiography (TEE) is widely used for intra-operative aortic imaging and provides a clinical alternative for aortic assessment. We tested intra-operative global circumferential aortic strain (GCS) measured on TEE in relation to the reference of CMR-derived strain among patients undergoing surgical graft repair of ascending aortic aneurysms. METHODS CMR (3T) was prospectively performed in patients scheduled for aortic repair. TEE was performed intra-operatively; images were co-localized with MRI. GCS on CMR and TEE was quantified independently, blinded to results of the other modality. RESULTS 25 patients (54 ± 10 year-old, 88% male) were studied, inclusive of 13 genetically mediated and 12 degenerative aneurysms: CMR and TEE were performed within 12 ± 9 days. Pulse pressure (PP)-adjusted descending aortic TEE-derived GCS strongly correlated with cine-CMR-derived GCS (r = .75, P = .002) though absolute GCS and PP-adjusted values were slightly lower (5.40 ± 1.11 vs 6.49 ± 1.43% and 11.55 ± 3.04 vs 13.99 ± 4.53%, respectively). Similarly, TEE yielded slightly lower end-diastolic area (EDA [5.1 ± 1.7 cm2 vs 5.8 ± 1.3 cm2 , P = .004]) and end-systolic area (ESA [6.1 ± 1.9 cm2 vs 6.5 ± 1.7 cm2 , P = .10]), with significant correlations between the two modalities (r = .73, .76, P < .05 for all). CONCLUSIONS This exploratory study supports feasibility of TEE for assessing aortic GCS in a surgical at-risk population, as well as magnitude of agreement between intra-operative TEE and preoperative CMR. We found that there is a significant correlation between GCS and EDA and ESA aortic areas, but that TEE-derived parameters underestimated CMR values by a small but significant amount.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Maria C Palumbo
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mohammed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Alexandra J Lopes
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Richard B Devereux
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jiwon Kim
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA
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11
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Zhang Y, Wang VY, Morgan AE, Kim J, Ge L, Guccione JM, Weinsaft JW, Ratcliffe MB. A Novel MRI-Based Finite Element Modeling Method for Calculation of Myocardial Ischemia Effect in Patients With Functional Mitral Regurgitation. Front Physiol 2020; 11:158. [PMID: 32231584 PMCID: PMC7082816 DOI: 10.3389/fphys.2020.00158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Functional Mitral Regurgitation (FMR) associated with coronary artery disease affects nearly 3 million patients in the United States. Both myocardial infarction (MI) and ischemia contribute to FMR development but uncertainty as to which patients will respond to revascularization (REVASC) of ischemia alone prevents rational decision making about FMR therapy. The aim of this study was to create patient-specific cardiac MRI (CMR) informed finite element (FE) models of the left ventricle (LV), calculate regional LV systolic contractility and then use optimized systolic material properties to simulate the effect of revascularization (virtual REVASC). METHODS We describe a novel FE method able to predict the effect of myocardial ischemia on regional LV function. CMR was obtained in five patients with multi-vessel coronary disease and FMR before and 3 months after percutaneous REVASC and a single healthy volunteer. Patient-specific FE models were created and divided into 17 sectors where the systolic contractility parameter, T m a x of each sector was a function of regional stress perfusion (SP-CMR) and myocardial infarction (LGE-CMR) scores. Sector-specific circumferential and longitudinal end-systolic strain and LV volume from CSPAMM were used in a formal optimization to determine the sector based myocardial contractility, T m a x and ischemia effect, α. Virtual REVASC was simulated by setting α to zero. RESULTS The FE optimization successfully converged with good agreement between calculated and experimental end-systolic strain and LV volumes. Specifically, the optimized T max for the healthy myocardium for five patients and the volunteer was 495.1, 336.8, 173.5, 227.9, 401.4, and 218.9 kPa. The optimized α was found to be 1.0, 0.44, and 0.08 for Patients 1, 2, and 3, and 0 for Patients 4 and 5. The calculated average of radial strain for Patients 1, 2, and 3 at baseline and after virtual REVASC was 0.23 and 0.25, respectively. CONCLUSION We developed a novel computational method able to predict the effect of myocardial ischemia in patients with FMR. This method can be used to predict the effect of ischemia on the regional myocardium and promises to facilitate better understanding of FMR response to REVASC.
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Affiliation(s)
- Yue Zhang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Vicky Y. Wang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Ashley E. Morgan
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Liang Ge
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Julius M. Guccione
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | | | - Mark B. Ratcliffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
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12
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Oglesby M, Escobedo D, Escobar GP, Fatemifar F, Sako EY, Bailey SR, Han HC, Feldman MD. Trabecular cutting: a novel surgical therapy to increase diastolic compliance. J Appl Physiol (1985) 2019; 127:457-463. [PMID: 31219774 DOI: 10.1152/japplphysiol.00087.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common cause of hospital admission in patients over 65 yr old and has high mortality. HFpEF is characterized by left ventricular (LV) hypertrophy that reduces compliance. Current HFpEF therapies control symptoms, but no existing medications or therapies can sustainably increase LV compliance. LV trabeculae develop hypertrophy and fibrosis that contribute to reduced LV compliance. This study expands our previous results in ex vivo human hearts to show that severing LV trabeculae increases diastolic compliance in an ex vivo working rabbit heart model. Trabecular cutting was performed in ex vivo rabbit hearts set up in a working heart perfusion system perfused with oxygenated Krebs-Henseleit buffer. A hook was inserted in the LV to cut trabeculae. End-systolic and end-diastolic pressure-volume relationships during transient preload reduction were recorded using an admittance catheter in the following three groups: control (no cutting; n = 9), mild cutting (15 cuts; n = 5), and aggressive cutting (30 cuts; n = 5). In a second experiment, each heart served as its own control. Hemodynamic data were recorded before and after trabecular cutting (n = 10) or sham cutting (n = 5) within the same heart. In the first experiments, trabecular cutting did not affect systolic function (P > 0.05) but significantly increased overall diastolic compliance (P = 0.009). Greater compliance was seen as trabecular cutting increased (P = 0.002, r2 = 0.435). In the second experiment, significant increases in systolic function (P = 0.048) and diastolic compliance (P = 0.002) were seen after trabecular cutting compared with baseline. In conclusion, trabecular cutting significantly increases diastolic compliance without reducing systolic function.NEW & NOTEWORTHY We postulate that, in mammalian hearts, free-running trabeculae carneae exist to provide tensile support to the left ventricle and minimize diastolic wall stress. Because of hypertrophy and fibrosis of trabeculae in patients with left ventricular hypertrophy, this supportive role can become pathologic, worsening diastolic compliance. We demonstrate a novel operation involving cutting trabeculae as a method to acutely increase diastolic compliance in patients presenting with heart failure and diastolic dysfunction to improve their left ventricle compliance.
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Affiliation(s)
- Meagan Oglesby
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Danny Escobedo
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Gladys Patricia Escobar
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Fatemeh Fatemifar
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Edward Y Sako
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Steven R Bailey
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hai-Chao Han
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas
| | - Marc D Feldman
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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13
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Fatemifar F, Feldman M, Clarke G, Finol EA, Han HC. Computational modeling of human left ventricle to assess the role of trabeculae carneae on the diastolic and systolic functions. J Biomech Eng 2019; 141:2734766. [PMID: 31116359 DOI: 10.1115/1.4043831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 12/12/2022]
Abstract
Trabeculae carneae are irregular structures that cover the endocardial surfaces of both ventricles and account for a significant portion of human ventricular mass. The role of trabeculae carneae in diastolic and systolic functions of the left ventricle (LV) is not well understood. Thus, the objective of this study was to investigate the functional role of trabeculae carneae in the LV. Finite element analyses of ventricular functions were conducted for three different models of human LV derived from high-resolution magnetic resonance imaging (MRI). The first model comprised trabeculae carneae and papillary muscles, while the second model had papillary muscles and partial trabeculae carneae, and the third model had a smooth endocardial surface. We customized these patient-specific models with myofiber architecture generated with a rule-based algorithm, diastolic material parameters using Fung strain energy function derived from bi-axial tests and adjusted with the empirical Klotz relationship, and myocardial contractility constants optimized for average normal ejection fraction of the human LV. Results showed that the partial trabeculae cutting model had enlarged end-diastolic volume, reduced wall stiffness and even increased end-systolic function, indicating that the absence of trabeculae carneae increased the compliance of the LV during diastole, while maintaining systolic function.
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Affiliation(s)
- Fatemeh Fatemifar
- Department of Mechanical Engineering, University of Texas at San Antonio, USA
| | - Marc Feldman
- Department of Medicine, University of Texas Health Science Center at San Antonio, USA; Biomedical Engineering Joint Graduate Program, UTSA-UTHSCSA, USA
| | - Geoffrey Clarke
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, USA; Biomedical Engineering Joint Graduate Program, UTSA-UTHSCSA, USA
| | - Ender A Finol
- Department of Mechanical Engineering, University of Texas at San Antonio, USA; Biomedical Engineering Joint Graduate Program, UTSA-UTHSCSA, USA
| | - Hai-Chao Han
- Fellow of ASME, Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249; Biomedical Engineering Joint Graduate Program, UTSA-UTHSCSA, USA
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14
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Szűcs A, Kiss AR, Suhai FI, Tóth A, Gregor Z, Horváth M, Czimbalmos C, Csécs I, Dohy Z, Szabó LE, Merkely B, Vágó H. The effect of contrast agents on left ventricular parameters calculated by a threshold-based software module: does it truly matter? Int J Cardiovasc Imaging 2019; 35:1683-1689. [PMID: 31037474 PMCID: PMC6700040 DOI: 10.1007/s10554-019-01587-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/23/2019] [Indexed: 11/30/2022]
Abstract
The acquisition of short-axis (SA) cine magnetic resonance (MR) images after the administration of contrast agent (CA) is a common, time-saving technique, but a decreased difference in the blood-myocardium contrast on these steady-state free precession (SSFP) cine scans could change the calculated parameters when using threshold-based papillary and trabecular muscle (PTM) quantification. We studied the effect of CA on the parameters calculated from pre- and post-CA SA cine images in noncompaction cardiomyopathy (NC-CMP) and healthy (H) participants using a threshold-based module. A total of 39 individuals (20 patients and 19 healthy) were included prospectively in this study. After the pre-CA SA images were acquired, i.v. gadobutrol (GA) or gadobenate dimeglumine (GD) (GA vs. GD: NC-CMP = 12 vs. 8; C = 12 vs. 7) was administered, and SA scans were repeated after two minutes. A threshold-based PTM software was used for postprocessing. Pre-CA and post-CA SA images were analyzed, and the parameters were compared in both the NC-CMP and H groups. The left ventricular volumes were significantly larger, while the left ventricular myocardial (LVmass) and trabecular mass (LVtrab) values were significantly smaller on the post-CA scans (NC-CMP: pre-CA vs. post-CA, EDV: 74.0 ± 13.6 vs. 81.1 ± 16.3 ml/m2, ESV: 25.3 ± 7.3 vs. 30.1 ± 11.2 ml/m2, LVmass-ED: 82.5 ± 17.5 vs. 75.7 ± 15.9 g/m2, LVtrab-ED: 25.0 ± 6.6 vs. 18.9 ± 4.7 g/m2; Healthy: preCA vs. post-CA, EDV: 69.7 ± 11.9 vs. 72.2 ± 10.7 ml/m2, ESV: 22.6 ± 5.7 vs. 23.9 ± 6.3 ml/m2, LVmass-ED: 71.3 ± 13.6 vs. 68.7 ± 13.9 g/m2, LVtrab-ED: 19.4 ± 2.6 vs. 16.2 ± 3.0 g/m2; p < 0.05). The decreased blood-myocardium contrast difference on post-CA SSFP SA cine images leads to altered cardiac parameters when using threshold-based software for evaluation.
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Affiliation(s)
- Andrea Szűcs
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary.
| | - Anna Réka Kiss
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary.
| | - Ferenc Imre Suhai
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Attila Tóth
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Zsófia Gregor
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Márton Horváth
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Csilla Czimbalmos
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Ibolya Csécs
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University of Budapest, Budapest, Hungary
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15
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Fatemifar F, Feldman MD, Oglesby M, Han HC. Comparison of Biomechanical Properties and Microstructure of Trabeculae Carneae, Papillary Muscles, and Myocardium in the Human Heart. J Biomech Eng 2019; 141:021007. [PMID: 30418486 PMCID: PMC6298537 DOI: 10.1115/1.4041966] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 10/28/2018] [Indexed: 12/13/2022]
Abstract
Trabeculae carneae account for a significant portion of human ventricular mass, despite being considered embryologic remnants. Recent studies have found trabeculae hypertrophy and fibrosis in hypertrophied left ventricles with various pathological conditions. The objective of this study was to investigate the passive mechanical properties and microstructural characteristics of trabeculae carneae and papillary muscles compared to the myocardium in human hearts. Uniaxial tensile tests were performed on samples of trabeculae carneae and myocardium strips, while biaxial tensile tests were performed on samples of papillary muscles and myocardium sheets. The experimental data were fitted with a Fung-type strain energy function and material coefficients were determined. The secant moduli at given diastolic stress and strain levels were determined and compared among the tissues. Following the mechanical testing, histology examinations were performed to investigate the microstructural characteristics of the tissues. Our results demonstrated that the trabeculae carneae were significantly stiffer (Secant modulus SM2 = 80.06 ± 10.04 KPa) and had higher collagen content (16.10 ± 3.80%) than the myocardium (SM2 = 55.14 ± 20.49 KPa, collagen content = 10.06 ± 4.15%) in the left ventricle. The results of this study improve our understanding of the contribution of trabeculae carneae to left ventricular compliance and will be useful for building accurate computational models of the human heart.
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Affiliation(s)
- Fatemeh Fatemifar
- Department of Mechanical Engineering,
University of Texas at San Antonio,
San Antonio, TX 78249
| | - Marc D. Feldman
- Department of Medicine,
University of Texas Health Science
Center at San Antonio,
San Antonio, TX 78229
| | - Meagan Oglesby
- Department of Medicine,
University of Texas Health Science
Center at San Antonio,
San Antonio, TX 78229
| | - Hai-Chao Han
- Department of Mechanical Engineering,
University of Texas at San Antonio,
San Antonio, TX 78249
e-mail:
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16
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Riffel JH, Schmucker K, Andre F, Ochs M, Hirschberg K, Schaub E, Fritz T, Mueller-Hennessen M, Giannitsis E, Katus HA, Friedrich MG. Cardiovascular magnetic resonance of cardiac morphology and function: impact of different strategies of contour drawing and indexing. Clin Res Cardiol 2018; 108:411-429. [DOI: 10.1007/s00392-018-1371-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
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17
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Abdi-Ali A, Miller RJ, Southern D, Zhang M, Mikami Y, Knudtson M, Heydari B, Howarth AG, Lydell CP, James MT, Wilton SB, White JA. LV Mass Independently Predicts Mortality and Need for Future Revascularization in Patients Undergoing Diagnostic Coronary Angiography. JACC Cardiovasc Imaging 2018; 11:423-433. [DOI: 10.1016/j.jcmg.2017.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 01/19/2023]
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18
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Śpiewak M, Kłopotowski M, Gawor M, Kubik A, Kowalik E, Miłosz-Wieczorek B, Dąbrowski M, Werys K, Mazurkiewicz Ł, Kożuch K, Polańska-Skrzypczyk M, Petryka-Mazurkiewicz J, Klisiewicz A, Bilińska ZT, Grzybowski J, Witkowski A, Marczak M. Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods. J Cardiovasc Magn Reson 2017; 19:105. [PMID: 29268761 PMCID: PMC5740710 DOI: 10.1186/s12968-017-0417-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM) enables the assessment of not only left ventricular (LV) hypertrophy and scarring but also the severity of mitral regurgitation. CMR assessment of mitral regurgitation is primarily based on the difference between LV stroke volume (LVSV) and aortic forward flow (Ao) measured using the phase-contrast (PC) technique. However, LV outflow tract (LVOT) obstruction causing turbulent, non-laminar flow in the ascending aorta may impact the accuracy of aortic flow quantification, leading to false conclusions regarding mitral regurgitation severity. Thus, we decided to quantify mitral regurgitation in patients with HCM using Ao or, alternatively, main pulmonary artery forward flow (MPA) for mitral regurgitation volume (MRvol) calculations. METHODS The analysis included 143 prospectively recruited subjects with HCM and 15 controls. MRvol was calculated as the difference between LVSV computed with either the inclusion (LVSVincl) or exclusion (LVSVexcl) of papillary muscles and trabeculations from the blood pool and either Ao (MRvolAoi or MRvolAoe) or MPA (MRvolMPAi or MRvolMPAe). The presence or absence of LVOT obstruction was determined based on Doppler echocardiography findings. RESULTS MRvolAoi was higher than MRvolMPAi in HCM patients with LVOT obstruction [47.0 ml, interquartile range (IQR) = 31.5-60.0 vs. 35.5 ml, IQR = 26.0-51.0; p < 0.0001] but not in non-obstructive HCM patients (23.0 ml, IQR = 16.0-32.0 vs. 24.0 ml, IQR = 15.3-32.0; p = 0.26) or controls (18.0 ml, IQR = 14.3-21.8 vs. 20.0 ml, IQR = 14.3-22.0; p = 0.89). In contrast to controls and HCM patients without LVOT obstruction, in HCM patients with LVOT obstruction, aortic flow-based MRvol (MRvolAoi) was higher than pulmonary-based findings (MRvolMPAi) (bias = 9.5 ml; limits of agreement: -11.7-30.7 with a difference of 47 ml in the extreme case). The differences between aortic-based and pulmonary-based MRvol values calculated using LVSVexcl mirrored those derived using LVSVincl. However, MRvol values calculated using LVSVexcl were lower in all the groups analyzed (HCM with LVOT obstruction, HCM without LVOT obstruction, and controls) and with all methods of MRvol quantification used (p ≤ 0.0001 for all comparisons). CONCLUSIONS In HCM patients, LVOT obstruction significantly affects the estimation of aortic flow, leading to its underestimation and, consequently, to higher MRvol values than those obtained with MPA-based MRvol calculations.
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Affiliation(s)
- Mateusz Śpiewak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kłopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Gawor
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Dąbrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | | | - Katarzyna Kożuch
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | | | - Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Anna Klisiewicz
- Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Institute of Cardiology, Warsaw, Poland
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland
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19
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Kim J, Rodriguez-Diego S, Srinivasan A, Brown RM, Pollie MP, Di Franco A, Goldburg SR, Siden JY, Ratcliffe MB, Levine RA, Devereux RB, Weinsaft JW. Echocardiography-quantified myocardial strain-a marker of global and regional infarct size that stratifies likelihood of left ventricular thrombus. Echocardiography 2017; 34:1623-1632. [PMID: 28833519 DOI: 10.1111/echo.13668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Myocardial strain provides a novel means of quantifying subtle alterations in contractile function; incremental utility post-MI is unknown. OBJECTIVES To test longitudinal-quantified by postprocessing routine echo-for assessment of MI size measured by cardiac magnetic resonance (CMR) and conventional methods, and assess regional and global strain (GLS) as markers of LV thrombus. METHODS The population comprised of patients with anterior ST-segment MI who underwent echo and CMR prospectively. Preexisting echoes were retrieved, re-analyzed for strain, and compared to conventional MI markers as well as CMR-evidenced MI, function, and thrombus. RESULTS Seventy-four patients underwent echo and CMR 4 ± 1 weeks post-MI; 72% had abnormal GLS. CMR-quantified MI size was 2.5-fold larger and EF lower among patients with abnormal GLS, paralleling 2.6-3.1 fold differences in Q-wave size and CPK (all P ≤ .002). GLS correlated with CMR-quantified MI (r = .66), CPK (r = .52) and Q-wave area (r = .44; all P ≤ .001): Regional strain was lower in the base, mid, and apical LV among patients with CMR-defined transmural MI in each territory (P < .05) and correlated with cine-CMR regional EF (r = .53-.71; P < .001) and echo wall motion (r = .45-.71; P < .001). GLS and apical strain were ~2-fold lower among patients with LV thrombus (P ≤ .002): Apical strain yielded higher diagnostic performance for thrombus (AUC: 0.83 [0.72-0.93], P = .001) than wall motion (0.73 [0.58-0.88], P = .02), as did global strain (0.78 [0.65-0.90], P = .005) compared to LVEF (0.58 [0.45-0.72], P = .41). CONCLUSIONS Echo-quantified longitudinal strain provides a marker of MI size and improves stratification for post-MI LV thrombus beyond conventional indices.
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Affiliation(s)
- Jiwon Kim
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Sara Rodriguez-Diego
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Aparna Srinivasan
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Rachel-Maria Brown
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Meridith P Pollie
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Antonino Di Franco
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Samantha R Goldburg
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Jonathan Y Siden
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Mark B Ratcliffe
- Departments of Surgery and Bioengineering, University of California, San Francisco, CA, USA
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard B Devereux
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine Weill Cornell Medical College, Weill Medical College of Cornell University, New York, NY, USA
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20
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Impact of papillary muscles on ventricular function measurements in 3T cardiac magnetic resonance. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Halaney DL, Sanyal A, Nafissi NA, Escobedo D, Goros M, Michalek J, Acevedo PJ, Pérez W, Patricia Escobar G, Feldman MD, Han HC. The Effect of Trabeculae Carneae on Left Ventricular Diastolic Compliance: Improvement in Compliance With Trabecular Cutting. J Biomech Eng 2017; 139:2595441. [PMID: 28024161 PMCID: PMC7104769 DOI: 10.1115/1.4035585] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/13/2016] [Indexed: 12/25/2022]
Abstract
The role of trabeculae carneae in modulating left ventricular (LV) diastolic compliance remains unclear. The objective of this study was to determine the contribution of trabeculae carneae to the LV diastolic compliance. LV pressure-volume compliance curves were measured in six human heart explants from patients with LV hypertrophy at baseline and following trabecular cutting. The effect of trabecular cutting was also analyzed with finite-element model (FEM) simulations. Our results demonstrated that LV compliance improved after trabecular cutting (p < 0.001). Finite-element simulations further demonstrated that stiffer trabeculae reduce LV compliance further, and that the presence of trabeculae reduced the wall stress in the apex. In conclusion, we demonstrate that integrity of the LV and trabeculae is important to maintain LV stiffness and loss in trabeculae leads to more LV compliance.
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Affiliation(s)
- David L Halaney
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229
| | - Arnav Sanyal
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249
| | - Navid A Nafissi
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Daniel Escobedo
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229
| | - Martin Goros
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Joel Michalek
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Pedro J Acevedo
- Department of Anatomy, University of Environmental and Applied Sciences U.D.C.A., Bogotá, Cundinamarca, Colombia
| | - William Pérez
- Department of Anatomy, Faculty of Veterinary Medicine, University of the Republic, Montevideo 11200, Uruguay
| | - G Patricia Escobar
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229
| | - Marc D Feldman
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229;Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229 e-mail:
| | - Hai-Chao Han
- Fellow ASME Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249
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22
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Altmann U, Böger CA, Farkas S, Mack M, Luchner A, Hamer OW, Zeman F, Debl K, Fellner C, Jungbauer C, Banas B, Buchner S. Effects of Reduced Kidney Function Because of Living Kidney Donation on Left Ventricular Mass. Hypertension 2017; 69:297-303. [DOI: 10.1161/hypertensionaha.116.08175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/29/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
Living kidney donation is associated with a small but significant increase in cardiovascular mortality. In addition, mildly decreased kidney function is associated with an increase of left ventricular mass and with cardiovascular disease in patients with chronic kidney disease. To investigate this association, we evaluated the impact of mildly decreased kidney function after living kidney donation on subclinical cardiac structural and functional changes. In this prospective cohort study, cardiac and renal magnetic resonance imaging and laboratory analyses were performed in 23 living kidney donors (mean age 54±10 years, 52% male) before donation and at 4 and 12 months after nephrectomy. Mean estimated glomerular filtration rate was 102±15 mL min
−1
1.73 m
−2
before donation and 70±13 mL min
−1
1.73 m
−2
at 12 months (
P
<0.001). Left ventricular mass increased from 112±22 to 115±23 g (
P
<0.001). In addition, heart rate was significantly increased (65±7 to 74±14;
P
=0.04). Concurrently, kidney and adrenal gland volume increased from 163±33 to 195±34 mL (
P
<0.001) and from 7.6±2.2 to 8.4±2.4 mL (
P
=0.032), respectively, as did procollagen type III (Δ0.11 ng/mL,
P
<0.001) and not N-terminal probrain natriuretic peptide (Δ14 pg/mL,
P
=0.25). The mild decrease in kidney function after living kidney donation leads to a significant but clinically negligible increase in left ventricular mass 12 months after living kidney donation. This study of a longitudinal analysis of living kidney donors provides direct evidence of a kidney–heart link.
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Affiliation(s)
- Ursula Altmann
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Carsten A. Böger
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Stefan Farkas
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Matthias Mack
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Andreas Luchner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Okka W. Hamer
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Florian Zeman
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Kurt Debl
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Claudia Fellner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Carsten Jungbauer
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Bernhard Banas
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Stefan Buchner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
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23
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Morphine Does Not Affect Myocardial Salvage in ST-Segment Elevation Myocardial Infarction. PLoS One 2017; 12:e0170115. [PMID: 28081269 PMCID: PMC5231339 DOI: 10.1371/journal.pone.0170115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022] Open
Abstract
Recent studies have proposed intravenous (IV) morphine is associated with delayed action of antiplatelet agents in acute myocardial infarction. However, it is unknown whether morphine results in increased myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated myocardial salvage index (MSI) to determine whether IV morphine affects myocardial injury adversely in STEMI patients undergoing primary PCI. 299 STEMI patients underwent contrast-enhanced magnetic resonance imaging a median of 3 days after PCI. Infarct size was measured on delayed-enhancement imaging, and area at risk was quantified on T2-weighted imaging. MSI was calculated as ‘[area at risk–infarct size] X 100 / area at risk’. IV morphine was administrated in 32.1% of patients. Patients treated with morphine had shorter symptom to balloon time and higher prevalence of Thrombolysis in Myocardial Infarction flow grade 0 or 1. The morphine group showed a trend toward larger MSI and infarct size and significantly greater area at risk than the non-morphine group. After propensity score matching (90 pairs), MSI was similar between the morphine and non-morphine group (46.1% versus 43.5%, P = .11), and infarct size and area at risk showed no difference. In propensity score-matched analysis, IV morphine prior to primary PCI in STEMI patients did not cause adverse impacts on myocardial salvage.
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24
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Hajiaghayi M, Groves EM, Jafarkhani H, Kheradvar A. A 3-D Active Contour Method for Automated Segmentation of the Left Ventricle From Magnetic Resonance Images. IEEE Trans Biomed Eng 2017; 64:134-144. [DOI: 10.1109/tbme.2016.2542243] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Bravo PE, Tahari A, Pozios I, Luo HC, Bengel FM, Wahl RL, Abraham MR, Abraham TP. Apparent left ventricular cavity dilatation during PET/CT in hypertrophic cardiomyopathy: Clinical predictors and potential mechanisms. J Nucl Cardiol 2016; 23:1304-1314. [PMID: 25989730 DOI: 10.1007/s12350-015-0158-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/09/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Apparent left ventricular cavity dilatation (LVCD) in patients with hypertrophic cardiomyopathy (HCM) is an incompletely understood phenomenon. We aimed at investigating its clinical predictors and potential mechanisms. METHODS Sixty one HCM patients underwent N-13-ammonia PET for visual evaluation of LVCD, transient ischemic dilatation (TID) index, myocardial blood flow (MBF), coronary flow reserve (CFR), and regional myocardial perfusion (rMP). TID index was also derived at 2-4 and 15-20 minutes. RESULTS Visual LVCD and quantitative TID (>1.13 abnormal) agreement were excellent (k 0.91; P < .0001). LVCD-positive (n = 32) patients had greater LV thickness (2.26 ± 0.59 vs 1.92 ± 0.41 cm; P = .005), but lower stress MBF (1.66 ± 0.42 vs 2.07 ± 0.46 mL/minute/g; P < .0001), and CFR (1.90 ± 0.46 vs 2.46 ± 0.69; P < .0001) than LVCD-negative (n = 29) patients. Abnormal rMP was present in 31/32 LVCD-positive but only 12/29 (P < .0001) LVCD-negative. TID index was higher at 2-4 (1.30 ± 0.13) than at 15-20 minutes (1.27 ± 0.12; P = .001) in LVCD-positive, whereas it was the same (1.04 ± 0.07 vs 1.04 ± 0.07; P = .9) in LVCD-negative. In multivariate analysis, global peak MBF, abnormal rMP, and LV thickness were the best predictors of LVCD. CONCLUSION Apparent LVCD is a common finding in HCM, intimately related to abnormal myocardial perfusion, globally impaired vasodilator flow reserve, and degree of hypertrophy. In addition to regional and/or diffuse subendocardial ischemia, some degree of true LV chamber dilatation may also contribute to the occurrence of apparent LVCD in HCM.
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Affiliation(s)
- Paco E Bravo
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
- Division of Cardiology, University of Washington, 1959 NE Pacific St., HSB AA522, Seattle, WA, 98133, USA.
| | - Abdel Tahari
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Iraklis Pozios
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hong-Chang Luo
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Richard L Wahl
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - M Roselle Abraham
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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26
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Gommans DHF, Bakker J, Cramer GE, Verheugt FWA, Brouwer MA, Kofflard MJM. Impact of the papillary muscles on cardiac magnetic resonance image analysis of important left ventricular parameters in hypertrophic cardiomyopathy. Neth Heart J 2016; 24:326-31. [PMID: 26914916 PMCID: PMC4840113 DOI: 10.1007/s12471-016-0805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The use of cardiac magnetic resonance (CMR) analysis has increased in patients with hypertrophic cardiomyopathy (HCM). Quantification of left ventricular (LV) measures will be affected by the inclusion or exclusion of the papillary muscles as part of the LV mass, but the magnitude of effect and potential consequences are unknown. METHODS We performed Cine-CMR in (1) clinical HCM patients (n = 55) and (2) subclinical HCM mutation carriers without hypertrophy (n = 14). Absolute and relative differences in LV ejection fraction (EF) and mass were assessed between algorithms with and without inclusion of the papillary muscles. RESULTS Papillary muscle mass in group 1 was 6.6 ± 2.5 g/m(2) and inclusion of the papillary muscles resulted in significant relative increases in LVEF of 4.5 ± 1.8 % and in LV mass of 8.7 ± 2.6 %. For group 2 these figures were 4.0 ± 0.9 g/m(2), 3.8 ± 1.0 % and 9.5 ± 1.8 %, respectively. With a coefficient of variation of 4 %, this 9 % difference in LV mass during CMR follow-up will be considered a change, while in fact the exact same mass may have been assessed according to two different algorithms. CONCLUSIONS In clinical HCM patients, CMR quantification of important LV measures is significantly affected by inclusion or exclusion of the papillary muscles. In relative terms, the difference was similar in subjects without hypertrophy. This underscores a general need for a uniform approach in CMR image analysis.
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Affiliation(s)
- D H F Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - J Bakker
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - G E Cramer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F W A Verheugt
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M A Brouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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27
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Peng P, Lekadir K, Gooya A, Shao L, Petersen SE, Frangi AF. A review of heart chamber segmentation for structural and functional analysis using cardiac magnetic resonance imaging. MAGMA (NEW YORK, N.Y.) 2016; 29:155-95. [PMID: 26811173 PMCID: PMC4830888 DOI: 10.1007/s10334-015-0521-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 01/19/2023]
Abstract
Cardiovascular magnetic resonance (CMR) has become a key imaging modality in clinical cardiology practice due to its unique capabilities for non-invasive imaging of the cardiac chambers and great vessels. A wide range of CMR sequences have been developed to assess various aspects of cardiac structure and function, and significant advances have also been made in terms of imaging quality and acquisition times. A lot of research has been dedicated to the development of global and regional quantitative CMR indices that help the distinction between health and pathology. The goal of this review paper is to discuss the structural and functional CMR indices that have been proposed thus far for clinical assessment of the cardiac chambers. We include indices definitions, the requirements for the calculations, exemplar applications in cardiovascular diseases, and the corresponding normal ranges. Furthermore, we review the most recent state-of-the art techniques for the automatic segmentation of the cardiac boundaries, which are necessary for the calculation of the CMR indices. Finally, we provide a detailed discussion of the existing literature and of the future challenges that need to be addressed to enable a more robust and comprehensive assessment of the cardiac chambers in clinical practice.
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Affiliation(s)
- Peng Peng
- Department of Electronic and Electrical Engineering, The University of Sheffield, Sheffield, S1 3JD, UK
| | | | - Ali Gooya
- Department of Electronic and Electrical Engineering, The University of Sheffield, Sheffield, S1 3JD, UK
| | - Ling Shao
- Department of Computer Science and Digital Technologies, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Steffen E Petersen
- Centre Lead for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Alejandro F Frangi
- Department of Electronic and Electrical Engineering, The University of Sheffield, Sheffield, S1 3JD, UK.
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28
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D'Silva A, Sharma S. Exercise-Induced Cardiac Remodeling: Not a Case of One Size Fits All. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.004277. [PMID: 26666383 DOI: 10.1161/circimaging.115.004277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew D'Silva
- From the St George's University of London, St George's University Hospital NHS Foundation Trust, London
| | - Sanjay Sharma
- From the St George's University of London, St George's University Hospital NHS Foundation Trust, London.
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Kim EK, Chang SA, Choi JO, Glockner J, Shapiro B, Choe YH, Fine N, Jang SY, Kim SM, Miller W, Lee SC, Oh JK. Concordant and Discordant Cardiac Magnetic Resonance Imaging Delayed Hyperenhancement Patterns in Patients with Ischemic and Non-Ischemic Cardiomyopathy. Korean Circ J 2016; 46:41-7. [PMID: 26798384 PMCID: PMC4720848 DOI: 10.4070/kcj.2016.46.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/19/2015] [Accepted: 07/14/2015] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives The diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM. Subjects and Methods Patients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy. Results A total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern. Conclusion A subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.
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Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - James Glockner
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Brian Shapiro
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nowell Fine
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shin Yi Jang
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Mok Kim
- Department of Radiology, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wayne Miller
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Kim EK, Choi JH, Song YB, Hahn JY, Chang SA, Park SJ, Lee SC, Choi SH, Choe YH, Park SW, Gwon HC. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J 2016; 171:56-63. [PMID: 26699601 DOI: 10.1016/j.ahj.2015.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/17/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. METHODS In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. RESULTS Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). CONCLUSIONS In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity.
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Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Young Bin Song
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Division of Radiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Seo HY, Lee SP, Park JB, Lee JM, Park EA, Chang SA, Kim HK, Park SJ, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Choe YH. Discrepancies in Left Ventricular Mass Calculation Based on Echocardiography and Cardiovascular Magnetic Resonance Measurements in Patients with Left Ventricular Hypertrophy. J Am Soc Echocardiogr 2015; 28:1194-1203, e2. [PMID: 26194306 DOI: 10.1016/j.echo.2015.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increased left ventricular (LV) mass is associated with adverse cardiovascular outcomes, and its accurate assessment is important. The aim of this study was to analyze the degree of difference among various methods of LV mass calculation based on transthoracic echocardiographic (TTE) measurements and cardiovascular magnetic resonance (CMR) measurements, especially in patients with aortic stenosis with varying degrees of LV hypertrophy (LVH). The mechanism underlying this disagreement was also investigated. METHODS Ninety-nine patients with moderate to severe aortic stenosis and 33 control subjects matched for age, sex, body weight, and height were enrolled in this prospective observational cohort study. All patients underwent TTE and CMR imaging. LV mass index (LVMI) was calculated using three formulas on the basis of TTE measurements (the Penn-cube, American Society of Echocardiography [ASE], and Teichholz methods) and compared with measurements obtained using CMR, the reference method. RESULTS Although all methods calculated using TTE measurements showed good correlations with CMR measurements, LVMI measured using the Penn-cube and ASE methods tended to be larger than LVMI measured using CMR (difference in LVMI by the Penn-cube and ASE methods, 59.3 ± 29.7 and 30.6 ± 22.3 g/m², respectively). This tendency decreased with the Teichholz method (difference in LVMI by the Teichholz method, 22.9 ± 19.1 g/m²). The degree of LVMI overestimation was significantly different among the three methods (P < .001 by one-way analysis of variance), which was more significant in patients with LVH, especially with the Penn-cube method (differences between CMR and TTE measurements in patients with aortic stenosis and LVH, 66.3 ± 34.8 vs 31.2 ± 26.6 vs 15.5 ± 20.9 g/m² for the Penn-cube, ASE, and Teichholz methods, respectively; P < .001 with post hoc Tukey analysis). There was a good correlation between LVMI and LV diameter-to-length ratio (r = 0.468, P < .001), which suggested that the left ventricle takes on a more globular shape with the increase of LVMI, resulting in a significant deviation from the basic assumptions on which the Penn-cube and ASE methods were built. CONCLUSIONS Current methods of calculating LVMI from echocardiographic measurements carry a tendency to measure LVMI larger than methods based on CMR measurements, which was more significant in patients with LVH. The change of the left ventricle's shape with LVH may be a plausible explanation for this, and a correction method may be needed when calculating LVMI from echocardiographic measurements, especially in patients with LVH and smaller body size.
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Affiliation(s)
- Hee-Young Seo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jun-Bean Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-A Chang
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ji Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Chol Lee
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee JM, Park SJ, Lee SP, Park E, Chang SA, Kim HK, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Choe YH. Gender difference in ventricular response to aortic stenosis: insight from cardiovascular magnetic resonance. PLoS One 2015; 10:e0121684. [PMID: 25811358 PMCID: PMC4374835 DOI: 10.1371/journal.pone.0121684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/03/2015] [Indexed: 01/20/2023] Open
Abstract
Background Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients. Methods and Results A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1g/m2 vs. 86.1±29.2g/m2, p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively). Conclusion Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.
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Affiliation(s)
- Joo Myung Lee
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Eunah Park
- Department of Radiology, Seoul National University Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kozor R, Callaghan F, Tchan M, Hamilton-Craig C, Figtree GA, Grieve SM. A disproportionate contribution of papillary muscles and trabeculations to total left ventricular mass makes choice of cardiovascular magnetic resonance analysis technique critical in Fabry disease. J Cardiovasc Magn Reson 2015; 17:22. [PMID: 25890002 PMCID: PMC4335368 DOI: 10.1186/s12968-015-0114-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/08/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sphingolipid deposition in Fabry disease causes left ventricular (LV) hypertrophy, of which the accurate assessment is essential. Cardiovascular magnetic resonance (CMR) has been proposed as the gold standard. However, there is debate in the literature as to whether papillary muscles and trabeculations (P&T) should be included in LV mass (LVM). METHODS/RESULTS We examined the accuracy of 2 CMR methods of assessing LVM and LV volumes, including (M inc P&T) or excluding (M ex P&T) P&T, in a cohort of Fabry disease subjects (n = 20) compared to a matched control group (n = 20). Significant differences between the two measurement methods were observed for LV end-diastolic volume, LV end-systolic volume, LVM, and LV ejection fraction (LVEF) in both groups. These differences were significantly greater in the Fabry group compared to controls, except for LVEF. P&T contributed to a greater percentage of LVM in Fabry subjects than controls (20 ± 1% vs 13 ± 2%, p = 0.01). In the control group, both volume-derived methods (M inc P&T or MexP&T) provided accurate SV measurements compared with the internal reference of velocity-encoded aortic flow. In the Fabry group, inclusion of P&T (M inc P&T) resulted in good concordance with phase contrast flow imaging (difference between flow and volume techniques: 1 ± 3 ml, p = 0.7). CONCLUSION The volumetric contribution of P&T in Fabry disease is markedly increased relative to healthy controls. Failure to account for this results in significant underestimation of LVM and results in misclassification of a proportion of subjects.
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Affiliation(s)
- Rebecca Kozor
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
| | - Fraser Callaghan
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Michel Tchan
- Department of Genetic Medicine, Westmead Hospital, Sydney, Australia.
- Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Christian Hamilton-Craig
- Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia.
- University of Queensland, Brisbane, Australia.
| | - Gemma A Figtree
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
| | - Stuart M Grieve
- North Shore Heart Research Group, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia.
- Sydney Translational Imaging Laboratory, Sydney Medical School, University of Sydney, Sydney, Australia.
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Effect of ischemic postconditioning on myocardial salvage in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: cardiac magnetic resonance substudy of the POST randomized trial. Int J Cardiovasc Imaging 2015; 31:629-37. [PMID: 25589306 DOI: 10.1007/s10554-015-0589-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
In the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction (POST) trial, ischemic postconditioning did not improve myocardial reperfusion in 700 patients with STEMI undergoing primary PCI. However, the impact of postconditioning on myocardial salvage and infarct size still needs to be addressed. The aim of this study was to investigate the effect of ischemic postconditioning on myocardial salvage using cardiac magnetic resonance (CMR) in patients with STEMI undergoing primary PCI. For the CMR substudy, a total of 111 patients was analyzed, 56 in the postconditioning group and 55 undergoing conventional primary PCI in the control group. Postconditioning was performed immediately after restoration of coronary flow by four cycles of 1-min balloon occlusion separated by 1 min of deflation. The primary end point was myocardial salvage measured by CMR 3 days after the index event. The myocardial salvage index was not improved by ischemic postconditioning compared with conventional PCI (46.3 ± 18.5 vs. 45.7 ± 20.5%, p = 0.86). The infarct size was not significantly different between the two groups (18.8 ± 10.3 vs. 20.2 ± 11.0%, p = 0.52). Moreover, there was no significant difference in the rates of microvascular obstruction or hemorrhagic infarction between the groups. CMR study demonstrated that ischemic postconditioning during primary PCI in STEMI patients did not improve myocardial salvage or reduce infarct size. These findings further support the results of the POST trial which showed no benefit of ischemic postconditioning as an adjunctive treatment of primary PCI.
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Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2014; 30:1559-67. [PMID: 25008088 DOI: 10.1007/s10554-014-0487-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/02/2014] [Indexed: 01/28/2023]
Abstract
Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus ICM (3 %, p < 0.001). However, owing to higher prevalence of ICM, 15 % of patients with MW-LGE had ICM. LV wall stress was higher (p = 0.02) among patients with, versus those without, MW-LGE despite similar systolic blood pressure (p = 0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p = 0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR 1.13, CI 1.004-1.27 per 10 ml/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p < 0.001). While more common in NICM, MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.
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Simprini LA, Goyal P, Codella N, Fieno DS, Afroz A, Mullally J, Cooper M, Wang Y, Finn JP, Devereux RB, Weinsaft JW. Geometry-independent inclusion of basal myocardium yields improved cardiac magnetic resonance agreement with echocardiography and necropsy quantified left-ventricular mass. J Hypertens 2014; 31:2069-76. [PMID: 24107735 DOI: 10.1097/hjh.0b013e328362d935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Left-ventricular mass (LVM) is widely used to guide clinical decision-making. Cardiac magnetic resonance (CMR) quantifies LVM by planimetry of contiguous short-axis images, an approach dependent on reader-selection of images to be contoured. Established methods have applied different binary cut-offs using circumferential extent of left-ventricular myocardium to define the basal left ventricle (LV), omitting images containing lesser fractions of left-ventricular myocardium. This study tested impact of basal slice variability on LVM quantification. METHODS CMR was performed in patients and laboratory animals. LVM was quantified with full inclusion of left-ventricular myocardium, and by established methods that use different cut-offs to define the left-ventricular basal-most slice: 50% circumferential myocardium at end diastole alone (ED50), 50% circumferential myocardium throughout both end diastole and end systole (EDS50). RESULTS One hundred and fifty patients and 10 lab animals were studied. Among patients, fully inclusive LVM (172.6±42.3g) was higher vs. ED50 (167.2±41.8g) and EDS50 (150.6±41.1g; both P<0.001). Methodological differences yielded discrepancies regarding proportion of patients meeting established criteria for left-ventricular hypertrophy and chamber dilation (P<0.05). Fully inclusive LVM yielded smaller differences with echocardiography (Δ=11.0±28.8g) than did ED50 (Δ=16.4±29.1g) and EDS50 (Δ=33.2±28.7g; both P<0.001). Among lab animals, ex-vivo left-ventricular weight (69.8±13.2g) was similar to LVM calculated using fully inclusive (70.1±13.5g, P=0.67) and ED50 (69.4±13.9g; P=0.70) methods, whereas EDS50 differed significantly (67.9±14.9g; P=0.04). CONCLUSION Established CMR methods that discordantly define the basal-most LV produce significant differences in calculated LVM. Fully inclusive quantification, rather than binary cut-offs that omit basal left-ventricular myocardium, yields smallest CMR discrepancy with echocardiography-measured LVM and non-significant differences with necropsy-measured left-ventricular weight.
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Affiliation(s)
- Lauren A Simprini
- aDepartment of Medicine (Cardiology) bDepartment of Radiology cDepartment of Biomedical Engineering, Weill Cornell Medical College dMemorial Sloan Kettering Cancer Center eIBM TJ Watson Research Center, Yorktown, New York fHeart South Cardiovascular Group, Alabaster, Alabama gUCLA Health System, Los Angeles, California, USA
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Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2014; 31:2060-8. [PMID: 23838656 DOI: 10.1097/hjh.0b013e328362bbd6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients. METHODS AND RESULTS Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05). CONCLUSION The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
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Huang X, Dione DP, Compas CB, Papademetris X, Lin BA, Bregasi A, Sinusas AJ, Staib LH, Duncan JS. Contour tracking in echocardiographic sequences via sparse representation and dictionary learning. Med Image Anal 2014; 18:253-71. [PMID: 24292554 PMCID: PMC3946038 DOI: 10.1016/j.media.2013.10.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 10/22/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Abstract
This paper presents a dynamical appearance model based on sparse representation and dictionary learning for tracking both endocardial and epicardial contours of the left ventricle in echocardiographic sequences. Instead of learning offline spatiotemporal priors from databases, we exploit the inherent spatiotemporal coherence of individual data to constraint cardiac contour estimation. The contour tracker is initialized with a manual tracing of the first frame. It employs multiscale sparse representation of local image appearance and learns online multiscale appearance dictionaries in a boosting framework as the image sequence is segmented frame-by-frame sequentially. The weights of multiscale appearance dictionaries are optimized automatically. Our region-based level set segmentation integrates a spectrum of complementary multilevel information including intensity, multiscale local appearance, and dynamical shape prediction. The approach is validated on twenty-six 4D canine echocardiographic images acquired from both healthy and post-infarct canines. The segmentation results agree well with expert manual tracings. The ejection fraction estimates also show good agreement with manual results. Advantages of our approach are demonstrated by comparisons with a conventional pure intensity model, a registration-based contour tracker, and a state-of-the-art database-dependent offline dynamical shape model. We also demonstrate the feasibility of clinical application by applying the method to four 4D human data sets.
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Affiliation(s)
- Xiaojie Huang
- Department of Electrical Engineering, Yale University, New Haven, CT 06520, USA.
| | - Donald P Dione
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Colin B Compas
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Xenophon Papademetris
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA; Department of Diagnostic Radiology, Yale University, New Haven, CT 06520, USA
| | - Ben A Lin
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Alda Bregasi
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Albert J Sinusas
- Department of Diagnostic Radiology, Yale University, New Haven, CT 06520, USA; Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Lawrence H Staib
- Department of Electrical Engineering, Yale University, New Haven, CT 06520, USA; Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA; Department of Diagnostic Radiology, Yale University, New Haven, CT 06520, USA
| | - James S Duncan
- Department of Electrical Engineering, Yale University, New Haven, CT 06520, USA; Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA; Department of Diagnostic Radiology, Yale University, New Haven, CT 06520, USA
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39
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The importance of trabecular hypertrophy in right ventricular adaptation to chronic pressure overload. Int J Cardiovasc Imaging 2013; 30:357-65. [PMID: 24306052 DOI: 10.1007/s10554-013-0338-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
Abstract
To assess the contribution of right ventricular (RV) trabeculae and papillary muscles (TPM) to RV mass and volumes in controls and patients with pulmonary arterial hypertension (PAH). Furthermore, to evaluate whether TPM shows a similar response as the RV free wall (RVFW) to changes in pulmonary artery pressure (PAP) during follow-up. 50 patients underwent cardiac magnetic resonance (CMR) and right heart catheterization at baseline and after one-year follow-up. Furthermore 20 controls underwent CMR. RV masses were assessed with and without TPM. TPM constituted a larger proportion of total RV mass and RV end-diastolic volume (RVEDV) in PAH than in controls (Mass: 35 ± 7 vs. 25 ± 5 %; p < 0.001; RVEDV: 17 ± 6 vs. 12 ± 6 %; p = 0.003). TPM mass was related to the RVFW mass in patients (baseline: R = 0.65; p < 0.001; follow-up: R = 0.80; p < 0.001) and controls (R = 0.76; p < 0.001). In PAH and controls, exclusion of TPM from the assessment resulted in altered RV mass, volumes and function than when included (all p < 0.01). Changes in RV TPM mass (β = 0.44; p = 0.004) but not the changes in RVFW mass (p = 0.095) were independently related to changes in PAP during follow-up. RV TPM showed a larger contribution to total RV mass in PAH (~35 %) compared to controls (~25 %). Inclusion of TPM in the analyses significantly influenced the magnitude of the RV volumes and mass. Furthermore, TPM mass was stronger related to changes in PAP than RVFW mass. Our results implicate that TPM are important contributors to RV adaptation during pressure overload and cannot be neglected from the RV assessment.
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Dreijer JF, Herbst BM, du Preez JA. Left ventricular segmentation from MRI datasets with edge modelling conditional random fields. BMC Med Imaging 2013; 13:24. [PMID: 23899437 PMCID: PMC3737053 DOI: 10.1186/1471-2342-13-24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 07/25/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This paper considers automatic segmentation of the left cardiac ventricle in short axis magnetic resonance images. Various aspects, such as the presence of papillary muscles near the endocardium border, makes simple threshold based segmentation difficult. METHODS The endo- and epicardium are modelled as two series of radii which are inter-related using features describing shape and motion. Image features are derived from edge information from human annotated images. The features are combined within a discriminatively trained Conditional Random Field (CRF). Loopy belief propagation is used to infer segmentations when an unsegmented video sequence is given. Powell's method is applied to find CRF parameters by minimizing the difference between ground truth annotations and the inferred contours. We also describe how the endocardium centre points are calculated from a single human-provided centre point in the first frame, through minimization of frame alignment error. RESULTS We present and analyse the results of segmentation. The algorithm exhibits robustness against inclusion of the papillary muscles by integrating shape and motion information. Possible future improvements are identified. CONCLUSIONS The presented model integrates shape and motion information to segment the inner and outer contours in the presence of papillary muscles. On the Sunnybrook dataset we find an average Dice metric of 0.91 ± 0.02 and 0.93 ± 0.02 for the inner and outer segmentations, respectively. Particularly problematic are patients with hypertrophy where the blood pool disappears from view at end-systole.
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Affiliation(s)
- Janto F Dreijer
- Department of Applied Mathematics, Stellenbosch University, Stellenbosch, South Africa
- Department of Electrical and Electronic Engineering, Stellenbosch University, Stellenbosch, South Africa
| | - Ben M Herbst
- Department of Applied Mathematics, Stellenbosch University, Stellenbosch, South Africa
| | - Johan A du Preez
- Department of Electrical and Electronic Engineering, Stellenbosch University, Stellenbosch, South Africa
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41
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Stacey RB, Andersen MM, St Clair M, Hundley WG, Thohan V. Comparison of systolic and diastolic criteria for isolated LV noncompaction in CMR. JACC Cardiovasc Imaging 2013; 6:931-40. [PMID: 23769489 DOI: 10.1016/j.jcmg.2013.01.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/16/2013] [Accepted: 01/22/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study used cardiac magnetic resonance (CMR) to compare standard criteria for left ventricular noncompaction (LVNC). BACKGROUND LVNC as a distinct cardiomyopathy is supported by a growing number of publications. Echocardiographic and CMR criteria have been established to diagnosis LVNC but have led to concerns of diagnostic accuracy. METHODS Trabeculation/possible LVNC by CMR was retrospectively observed in 122 consecutive cases. We compared the standard end-systolic noncompacted-to-compacted ratio (ESNCCR), end-diastolic noncompacted:compacted ratio (EDNCCR), and trabecular mass-to-total mass ratio (TMTMR) along with deaths, embolic events, congestive heart failure (CHF) readmissions, ventricular arrhythmias, myocardial thickening (MT), left ventricular ejection fraction (LVEF), 3-dimensional sphericity index (3DSi), and left ventricular end-diastolic volume index. Adjusting for age, race, sex, body surface area, diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, and CHF, logistic regression was used to compare combined events (death, CHF readmission, embolism, ventricular arrhythmia) between ESNCCR, EDNCCR, and TMTMR. Adjusting for same covariates except CHF, logistic regression was used to compare the odds of CHF for those who met criteria and those who did not. Using analysis of covariance, adjusted means for LVEF, MT, 3DSi, and left ventricular end-diastolic volume index were generated. RESULTS ES criteria had a higher odds ratio (8.6; 95% confidence interval [CI]: 2.5 to 33) for combined events than ED criteria (1.8; 95% CI: 0.6 to 5.8) or TMTMR criteria (3.14; 95% CI: 1.09 to 10.2). The odds ratio of CHF for those who met ESNCCR criteria was 29.4 (95% CI: 6.6 to 125), but the odds ratio of CHF for those who met EDNCCR criteria was 3.3 (95% CI: 1.1 to 9.2). After adjustment, those who met criteria for noncompaction by ESNCCR had a lower LVEF and less MT than those who did not (p = 0.01 and p = 0.003, respectively), but there was no difference between those who met criteria for EDNCCR or the TMTMR criteria and those who did not. CONCLUSIONS ES measures of LVNC have stronger associations with events, CHF, and systolic dysfunction than other measures.
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Affiliation(s)
- R Brandon Stacey
- Department of Internal Medicine, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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42
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Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Valsangiacomo Buechel ER, Yoo SJ, Powell AJ. Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 2013; 15:51. [PMID: 23763839 PMCID: PMC3686659 DOI: 10.1186/1532-429x-15-51] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.
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Affiliation(s)
- Sohrab Fratz
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München (German Heart Center Munich) of the Technical University Munich, Munich, Germany
| | - Taylor Chung
- Department of Diagnostic Imaging, Children’s Hospital & Research Center Oakland, Oakland, California, USA
| | - Gerald F Greil
- Department of Pediatric Cardiology, Evelina Children’s Hospital/Guy’s and St. Thomas’ Hospital NHS Foundation Trust; Division of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
| | - Margaret M Samyn
- The Herma Heart Center, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, & Great Ormond Street Hospital for Children, London, UK
| | | | - Shi-Joon Yoo
- Department of Diagnostic Imaging and Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Powell
- Department of Cardiology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Dele-Michael AO, Fujikura K, Devereux RB, Islam F, Hriljac I, Wilson SR, Lin F, Weinsaft JW. Left ventricular stroke volume quantification by contrast echocardiography - comparison of linear and flow-based methods to cardiac magnetic resonance. Echocardiography 2013; 30:880-8. [PMID: 23488864 DOI: 10.1111/echo.12155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Echocardiography (echo)-quantified LV stroke volume (SV) is widely used to assess systolic performance after acute myocardial infarction (AMI). This study compared 2 common echo approaches - predicated on flow (Doppler) and linear chamber dimensions (Teichholz) - to volumetric SV and global infarct parameters quantified by cardiac magnetic resonance (CMR). METHODS Multimodality imaging was performed as part of a post-AMI registry. For echo, SV was measured by Doppler and Teichholz methods. Cine-CMR was used for volumetric SV and LVEF quantification, and delayed-enhancement (DE) CMR for infarct size. RESULTS Overall, 142 patients underwent same day echo and CMR. On echo, mean SV by Teichholz (78 ± 17 mL) was slightly higher than Doppler (75 ± 16 mL; Δ = 3 ± 13 mL; P = 0.02). Compared to SV on CMR (78 ± 18 mL), mean difference by Teichholz (Δ = -0.2 ± 14; P = 0.89) was slightly smaller than Doppler (Δ = -3 ± 14; P = 0.02), but limits of agreement were similar between CMR and echo methods (Teichholz: -28, 27 mL, Doppler: -31, 24 mL). For Teichholz, differences with CMR SV were greatest among patients with anteroseptal or lateral wall hypokinesis (P < 0.05). For Doppler, differences were associated with aortic valve abnormalities or root dilation (P = 0.01). SV by both echo methods decreased stepwise in relation to global LV injury as assessed by CMR-quantified LVEF and infarct size (P < 0.01). CONCLUSIONS Teichholz and Doppler calculated SV yield similar magnitude of agreement with CMR. Teichholz differences with CMR increase with septal or lateral wall contractile dysfunction, whereas Doppler yields increased offsets in patients with aortic remodeling.
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Affiliation(s)
- Abiola O Dele-Michael
- Departments of Medicine (Cardiology) and Radiology, Weill Cornell Medical College, New York, New York
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Friedrich MG, Larose E, Patton D, Dick A, Merchant N, Paterson I. Canadian Society for Cardiovascular Magnetic Resonance (CanSCMR) Recommendations for Cardiovascular Magnetic Resonance Image Analysis and Reporting. Can J Cardiol 2013; 29:260-5. [DOI: 10.1016/j.cjca.2012.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 01/07/2023] Open
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Assessment of left and right ventricular parameters in healthy Korean volunteers using cardiac magnetic resonance imaging: change in ventricular volume and function based on age, gender and body surface area. Int J Cardiovasc Imaging 2012; 28 Suppl 2:141-7. [PMID: 23139150 DOI: 10.1007/s10554-012-0150-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/31/2012] [Indexed: 01/01/2023]
Abstract
The clinical utility of cardiac magnetic resonance imaging (CMR) is growing and is being used predominantly as a means of measuring ventricular function. The normal reference range of ventricular function may vary based on age, sex and ethnicity. At present, most CMR reference values for healthy individuals have been reported from Western countries. The intent of this study was to investigate the normal CMR reference range for left ventricular (LV) and right ventricular (RV) parameters in healthy Koreans. Healthy volunteers between the ages of 20-70 years without any history of cardiovascular disease or associated risk factors were prospectively recruited to be a part of this study. A total of 124 patients were recruited for this study. Steady-state free precession pulse sequences were used to obtain the cine images for LV and RV volume analysis. All parameters were analyzed based on age and gender, and normalized to body surface area (BSA). LV volume, mass and cardiac output were significantly greater in males than in females. However, all of these parameters which are associated with BSA and gender differences disappeared when corrected for BSA. RV volume was less in females even after the data was normalized for BSA. LV and RV volumes normalized for BSA gradually decreased with greater age, whereas the ejection fraction increased with age, thus maintaining the stroke volume index and cardiac index. LV and RV volumes, mass and function values for a healthy population largely depend on BSA and should be evaluated after normalization by BSA. LV parameters show no difference based on gender, but RV volume is less in the female. Greater age is associated with less ventricular volume, suggesting the possibility of volume sensitivity in the elderly.
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46
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Effects of hypertrophy and fibrosis on regional and global functional heterogeneity in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2012; 28 Suppl 2:133-40. [DOI: 10.1007/s10554-012-0141-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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Improving the reproducibility of MR-derived left ventricular volume and function measurements with a semi-automatic threshold-based segmentation algorithm. Int J Cardiovasc Imaging 2012; 29:617-23. [PMID: 23053857 DOI: 10.1007/s10554-012-0130-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
To validate a novel semi-automatic segmentation algorithm for MR-derived volume and function measurements by comparing it with the standard method of manual contour tracing. The new algorithms excludes papillary muscles and trabeculae from the blood pool, while the manual approach includes these objects in the blood pool. An epicardial contour served as input for both methods. Multiphase 2D steady-state free precession short axis images were acquired in 12 subjects with normal heart function and in a dynamic anthropomorphic heart phantom on a 1.5 T MR system. In the heart phantom, manually and semi-automatically measured cardiac parameters were compared to the true end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF). In the subjects, the semi-automatic method was compared to manual contouring in terms of difference in measured EDV, ESV, EF and myocardial volume (MV). For all measures, intra- and inter-observer agreement was determined. In the heart phantom, EDV and ESV were underestimated for both the semi-automatic. As the papillary muscles were excluded from the blood pool with the semi-automatic method, EDV and ESV were approximately 20 ml lower in the patients, whereas EF was approximately 16 % higher. Intra- and inter-observer agreement was overall improved with the semi-automatic method compared to the manual method. Correlation between manual and semi-automatic measurements was high (EDV: R = 0.99, ESV: R = 0.96; EF: R = 0.80, MV: R = 0.99). The semi-automatic method could exclude endoluminal muscular structures from the blood volume with significantly improved intra- and inter-observer variabilities in cardiac function measurements compared to the conventional, manual method, which includes endoluminal structures in the blood volume.
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Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012; 5:837-48. [PMID: 22897998 PMCID: PMC3501209 DOI: 10.1016/j.jcmg.2012.06.003] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 01/16/2023]
Abstract
The authors investigated 3 important areas related to the clinical use of left ventricular mass (LVM): accuracy of assessments by echocardiography and cardiac magnetic resonance (CMR), the ability to predict cardiovascular outcomes, and the comparative value of different indexing methods. The recommended formula for echocardiographic estimation of LVM uses linear measurements and is based on the assumption of the left ventricle (LV) as a prolate ellipsoid of revolution. CMR permits a modeling of the LV free of cardiac geometric assumptions or acoustic window dependency, showing better accuracy and reproducibility. However, echocardiography has lower cost, easier availability, and better tolerability. From the MEDLINE database, 26 longitudinal echocardiographic studies and 5 CMR studies investigating LVM or LV hypertrophy as predictors of death or major cardiovascular outcomes were identified. LVM and LV hypertrophy were reliable cardiovascular risk predictors using both modalities. However, no study directly compared the methods for the ability to predict events, agreement in hypertrophy classification, or performance in cardiovascular risk reclassification. Indexing LVM to body surface area was the earliest normalization process used, but it seems to underestimate the prevalence of hypertrophy in obese and overweight subjects. Dividing LVM by height to the allometric power of 1.7 or 2.7 is the most promising normalization method in terms of practicality and usefulness from a clinical and scientific standpoint for scaling myocardial mass to body size. The measurement of LVM, calculation of LVM index, and classification for LV hypertrophy should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision making.
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Affiliation(s)
- Anderson C. Armstrong
- Johns Hopkins University/Division of Cardiology, Universidade Federal do Vale do São Francisco/School of Medicine, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
| | - Samuel Gidding
- Nemours Cardiac Center/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899
| | - Ola Gjesdal
- Johns Hopkins University/Division of Cardiology, Johns Hopkins University/Division of Cardiology, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
| | - Colin Wu
- National Heart, Lung, and Blood Institute, NIH / Office of Biostatistics Research, 6701 Rockledge Drive, MSC 7938, Bethesda, MD 20892-7938, USA
| | - David A Bluemke
- National Institute of Health/Radiology and Imaging Sciences, 10 Center Drive, MSC 1074, Bethesda, Maryland 20892-1074
| | - João A. Lima
- Johns Hopkins University/Division of Cardiology, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
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Bruder O, Jensen CJ, Bell M, Rummel R, Boehm G, Klebs S, Sieder C, Senges J. Effects of the combinations of amlodipine/valsartan versus losartan/hydrochlorothiazide on left ventricular hypertrophy as determined with magnetic resonance imaging in patients with hypertension. J Drug Assess 2011; 1:1-10. [PMID: 27536421 PMCID: PMC4980731 DOI: 10.3109/21556660.2011.639418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH), a marker of cardiac end-organ damage, is frequently found in patients with arterial hypertension and is associated with cardiovascular and cerebrovascular morbidity and mortality. Therefore, LVH regression is an important treatment goal. For amlodipine plus valsartan (A/V) no specific study on LVH has been reported to date. METHODS Prospective, open-label, randomized parallel-group study. Patients with essential hypertension and LVH were randomized to 52-week treatment with A/V 10/160 mg (n = 43) or the active comparator losartan/HCT 100/25 mg (L/H, n = 47). Add-on medication was allowed in case of inadequate blood pressure control. LV parameters were measured by cardiovascular magnetic resonance imaging (MRI), and adjudicated in a blinded manner. Study identifiers were NCT00446563 and EudraCT 2006-001977-17. RESULTS In addition to the study treatment, 35% of patients in the A/V group and 49% in the L/H group received additional antihypertensive medication. Compared to baseline, both treatments reduced measures of LVH significantly after 52 weeks (e.g. LV mass index in the A/V group from 64.7 g/m(2) by -3.5 g/m(2), in the L/H group from 69.1 g/m(2) by -4.4 g/m(2), p < 0.01 for both). LV ejection fraction and LV volumes were not significantly changed by any regimen. A/V and L/H treatments were well tolerated. CONCLUSIONS Both regimen were effective in reducing LV mass compared to baseline and were well tolerated.
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Key Words
- A/V, amlodipine plus valsartan
- Arterial hypertension
- Asc. aorta, ascending aorta
- BP, diastolic blood pressure
- CCB, calcium channel blockers
- IVS, interventricular septum thickness
- L/H, losartan/hydrochlorothiazide
- LA, left atrium
- LVEDV, left ventricular enddiastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular endsystolic volume
- LVH, left ventricular hypertrophy
- LVM, left ventricular mass
- LVMI, left ventricular mass index
- MRI, magnetic resonance imaging
- RAAS
- SBP, systolic blood pressure
- combination therapy
- end-organ damage
- left ventricular hypertrophy
- magnetic resonance imaging
- norm BSA, adjusted for body surface area
- treatment
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Affiliation(s)
- Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | | | - Michael Bell
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | | | | | - Sven Klebs
- Novartis Pharma GmbH, Clinical and Regulatory Affairs, Nürnberg, Germany
| | - Christian Sieder
- Novartis Pharma GmbH, Clinical and Regulatory Affairs, Nürnberg, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research, Ludwigshafen, Germany
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50
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Codella NCF, Lee HY, Fieno DS, Chen DW, Hurtado-Rua S, Kochar M, Finn JP, Judd R, Goyal P, Schenendorf J, Cham MD, Devereux RB, Prince M, Wang Y, Weinsaft JW. Improved left ventricular mass quantification with partial voxel interpolation: in vivo and necropsy validation of a novel cardiac MRI segmentation algorithm. Circ Cardiovasc Imaging 2011; 5:137-46. [PMID: 22104165 DOI: 10.1161/circimaging.111.966754] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) typically quantifies LV mass (LVM) by means of manual planimetry (MP), but this approach is time-consuming and does not account for partial voxel components--myocardium admixed with blood in a single voxel. Automated segmentation (AS) can account for partial voxels, but this has not been used for LVM quantification. This study used automated CMR segmentation to test the influence of partial voxels on quantification of LVM. METHODS AND RESULTS LVM was quantified by AS and MP in 126 consecutive patients and 10 laboratory animals undergoing CMR. AS yielded both partial voxel (AS(PV)) and full voxel (AS(FV)) measurements. Methods were independently compared with LVM quantified on echocardiography (echo) and an ex vivo standard of LVM at necropsy. AS quantified LVM in all patients, yielding a 12-fold decrease in processing time versus MP (0:21±0:04 versus 4:18±1:02 minutes; P<0.001). AS(FV) mass (136±35 g) was slightly lower than MP (139±35; Δ=3±9 g, P<0.001). Both methods yielded similar proportions of patients with LV remodeling (P=0.73) and hypertrophy (P=1.00). Regarding partial voxel segmentation, AS(PV) yielded higher LVM (159±38 g) than MP (Δ=20±10 g) and AS(FV) (Δ=23±6 g, both P<0.001), corresponding to relative increases of 14% and 17%. In multivariable analysis, magnitude of difference between AS(PV) and AS(FV) correlated with larger voxel size (partial r=0.37, P<0.001) even after controlling for LV chamber volume (r=0.28, P=0.002) and total LVM (r=0.19, P=0.03). Among patients, AS(PV) yielded better agreement with echo (Δ=20±25 g) than did AS(FV) (Δ=43±24 g) or MP (Δ=40±22 g, both P<0.001). Among laboratory animals, AS(PV) and ex vivo results were similar (Δ=1±3 g, P=0.3), whereas AS(FV) (6±3 g, P<0.001) and MP (4±5 g, P=0.02) yielded small but significant differences with LVM at necropsy. CONCLUSIONS Automated segmentation of myocardial partial voxels yields a 14-17% increase in LVM versus full voxel segmentation, with increased differences correlated with lower spatial resolution. Partial voxel segmentation yields improved CMR agreement with echo and necropsy-verified LVM.
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Affiliation(s)
- Noel C F Codella
- Department of Physiology/Biophysics, Weill Cornell Medical College, New York, NY 10021, USA
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