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Teixeira-Fonseca JL, Joviano-Santos JV, Machado FS, da Silva PL, Conceição MRL, Roman-Campos D. Isolated Left Atrium Morphofunctional Study of an Experimental Pulmonary Hypertension Model in Rats. Arq Bras Cardiol 2023; 120:e20230188. [PMID: 37878960 PMCID: PMC10548886 DOI: 10.36660/abc.20230188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The high incidence of atrial arrhythmias in pulmonary hypertension (PH) might be associated with poor prognosis, and the left atrium (LA) may play a role in this. An important finding in PH studies is that LA remodeling is underestimated. OBJECTIVE This study investigated LA morphology and mechanical function, as well as the susceptibility to develop arrhythmias in a monocrotaline-induced PH (MCT-PH) model. METHODS Wistar rats aged 4 weeks received 50 mg/kg of MCT. Electrocardiography and histology analysis were performed to evaluate the establishment of the MCT-PH model. The tissue was mounted in an isolated organ bath to characterize the LA mechanical function. RESULTS Compared with the control group (CTRL), the MCT-PH model presented LA hypertrophy and changes in cardiac electrical activity, as evidenced by increased P wave duration, PR and QT interval in MCT-PH rats. In LA isolated from MCT-PH rats, no alteration in inotropism was observed; however, the time to peak contraction was delayed in the experimental MCT-PH group. Finally, there was no difference in arrhythmia susceptibility of LA from MCT-PH animals after the burst pacing protocol. CONCLUSION The morphofunctional remodeling of the LA did not lead to increased susceptibility to ex vivo arrhythmia after application of the burst pacing protocol.
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Affiliation(s)
| | - Julliane Vasconcelos Joviano-Santos
- Faculdade de Ciências Médicas de Minas GeraisBelo HorizonteMGBrasil Faculdade de Ciências Médicas de Minas Gerais , Belo Horizonte , MG – Brasil
| | - Fabiana Silva Machado
- Universidade Federal de São PauloSão PauloSPBrasil Universidade Federal de São Paulo , São Paulo , SP – Brasil
| | - Polyana Leal da Silva
- Universidade Federal de São PauloSão PauloSPBrasil Universidade Federal de São Paulo , São Paulo , SP – Brasil
| | | | - Danilo Roman-Campos
- Universidade Federal de São PauloSão PauloSPBrasil Universidade Federal de São Paulo , São Paulo , SP – Brasil
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Kitchin SS, Lakshmanan S, Kinninger A, Mao SS, Rabbat MG, Bhatt DL, Budoff MJ. The effect of icosapent ethyl on left atrial and left ventricular morphology. THE BRITISH JOURNAL OF CARDIOLOGY 2023; 30:22. [PMID: 39144091 PMCID: PMC11321466 DOI: 10.5837/bjc.2023.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Atrial fibrillation (AF) is a common arrhythmia associated with poor outcomes. N-3 fatty acids have been shown to provide significant cardiovascular risk reduction, but they may exacerbate the risk of AF. The pathway by which N-3 fatty acids may be arrhythmogenic is unknown. One possible mechanism involves cardiac chamber morphology alteration. The purpose of this study was to investigate the effect of icosapent ethyl (IPE) on left atrial (LA) size and left ventricular (LV) mass. This study used coronary computed tomographic angiography images gathered from the Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis (EVAPORATE) trial. EVAPORATE was a randomised, double-blind, placebo-controlled study finding a significant reduction in coronary atherosclerosis progression in patients with residually elevated triglycerides despite statin therapy on 4 g IPE daily versus 4 g placebo daily. Computed tomography images were used to measure LA size and LV mass at 0 and 18 months. Of 80 enrolled patients, 68 were included in the final analysis. Baseline demographics and risk factors were similar between IPE and placebo cohorts. LA anterior- posterior diameter measured on axial (p=0.51) and sagittal (p=0.52) orientations were not different over time. Also, there was no difference between groups in the change in LA volume (p=0.84). Change in LV mass was similar between groups (p=0.13). In conclusion, this study did not detect differences in LA size or LV mass over 18 months between patients on 4 g daily IPE versus placebo.
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Affiliation(s)
- Spencer S Kitchin
- Resident Physician Department of Internal Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Box #400, Torrance, CA 90502, USA
| | - Suvasini Lakshmanan
- Cardiovascular Disease Fellow Department of Internal Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242-1009, USA
| | | | | | - Mark G Rabbat
- Associate Professor Loyola University of Chicago, 2160 S 1 Ave, Maywood, IL 60153, USA
| | - Deepak L Bhatt
- Director of Mount Sinai Heart Icahn School of Medicine at Mount Sinai Health System, One Gustave L. Levy Place, New York, NY 10029-6574, USA
| | - Matthew J Budoff
- Program Director and Director of Cardiac CT Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson St, Torrance, CA 90502, USA
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Gopalan D, Riley J, Leong K, Alsanjari S, Ariff B, Auger W, Lindholm P. Biatrial Volumetric Assessment by Non-ECG-Gated CT Pulmonary Angiography Correlated with Transthoracic Echocardiography in Patients with Normal Diastology. Tomography 2022; 8:2761-2771. [PMID: 36412689 PMCID: PMC9680340 DOI: 10.3390/tomography8060230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
Atrial size is a predictor of cardiovascular mortality. Non-ECG-gated computed tomography pulmonary angiography (CTPA) is a common test for cardiopulmonary evaluation but normative values for biatrial volumes are lacking. We derived normal CT biatrial volumes using manual and semiautomated segmentation with contemporaneous transthoracic echocardiography (TTE) to confirm normal diastology. Thirty-five consecutive cases in sinus rhythm with no history of cardio-vascular, renal, or pulmonary disease and normal diastolic function were selected. Planimetric CTPA measurements were compared to TTE volumes measured using area length method. TTE and CTPA derived normal LAVi and RAVi were 27 + 5 and 20 + 6 mL/m2, and 30 + 8 and 29 + 9 mL/m2, respectively. Bland-Altman analysis revealed an underestimation of biatrial volumes by TTE. TTE-CT mean biases for LAV and RAV were -5.7 + 12.0 mL and -16.2 + 14.8 mL, respectively. The CT intraclass correlation coefficients (ICC 95% CI) for LA and RA volumes were 0.99 (0.96-1.00) and 0.96 (0.76-0.99), respectively. There was excellent correlation (p < 0.001) between the semiautomated and manual measurements for LA (r 0.99, 95% CI 0.98-0.99) and RA (r 0.99, 95% CI 0.99-1.00). Atrial volumetric assessment on CTPA is easy and reproducible and can provide additional metric in cardiopulmonary assessment.
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Affiliation(s)
- Deepa Gopalan
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
- Correspondence:
| | - Jan Riley
- Department of Radiology, Monash Health, Melbourne 3168, Australia
| | - Kai’En Leong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3052, Australia
| | - Senan Alsanjari
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Ben Ariff
- Department of Radiology, Imperial College Healthcare, London W12 0HS, UK
| | - Willam Auger
- Department of Pulmonary Medicine, University of California, San Diego, CA 92037, USA
| | - Peter Lindholm
- Department of Physiology & Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Emergency Medicine, University of California, San Diego, CA 92103, USA
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Diagnosis of acute heart failure in CT pulmonary angiography: feasibility and accuracy. Eur Radiol 2022; 32:5287-5296. [PMID: 35294585 PMCID: PMC8924734 DOI: 10.1007/s00330-022-08676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients. METHODS In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HUratio) and difference (HUdiff) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis. RESULTS Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980-0.991). NT-pro BNP exhibited moderate correlations with HUratio (r = 0.50, p < 0.001) and HUdiff (r = 0.50, p < 0.001). In the training cohort, HUratio (AUC: 0.89, 95%CI: 0.82-0.95) and HUdiff (AUC: 0.88, 95%CI: 0.81-0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HUratio (sensitivity 93%; specificity 75%) and 113 for HUdiff (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HUratio and HUdiff, respectively. CONCLUSION In emergency department patients undergoing CTPA and showing no PE, both HUratio and HUdiff have a high sensitivity for diagnosing acute HF. KEY POINTS • Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.
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Melzig C, Do TD, Egenlauf B, Partovi S, Grünig E, Kauczor HU, Heussel CP, Rengier F. Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease. Eur Radiol 2022; 32:5222-5232. [PMID: 35267088 PMCID: PMC9279230 DOI: 10.1007/s00330-022-08663-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/07/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess diagnostic accuracy of automated 3D volumetry of cardiac chambers based on computed tomography pulmonary angiography (CTPA) for the differentiation of pulmonary hypertension due to left heart disease (group 2 PH) from non-group 2 PH compared to manual diameter measurements. METHODS Patients with confirmed PH undergoing right heart catheterisation and CTPA within 100 days for diagnostic workup of PH between August 2013 and February 2016 were included in this retrospective, single-centre study. Automated 3D segmentation of left atrium, left ventricle, right atrium and right ventricle (LA/LV/RA/RV) was performed by two independent and blinded radiologists using commercial software. For comparison, axial diameters were manually measured. The ability to differentiate group 2 PH from non-group 2 PH was assessed by means of logistic regression. RESULTS Ninety-one patients (median 67.5 years, 44 women) were included, thereof 19 patients (20.9%) classified as group 2 PH. After adjustment for age, sex and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger LA volume (p < 0.001), larger LV volume (p = 0.001), lower RV/LV volume ratio (p = 0.04) and lower RV/LA volume ratio (p = 0.003). LA volume demonstrated the highest discriminatory ability to identify group 2 PH (AUC, 0.908; 95% confidence interval, 0.835-0.981) and was significantly superior to LA diameter (p = 0.009). Intraobserver and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients 0.926-0.999, all p < 0.001). CONCLUSIONS LA volume quantified by automated, CTPA-based 3D volumetry can differentiate group 2 PH from other PH groups with good diagnostic accuracy and yields significantly higher diagnostic accuracy than left atrial diameter. KEY POINTS • Automated cardiac chamber volumetry using non-gated CT pulmonary angiography can differentiate pulmonary hypertension due to left heart disease from other causes with good diagnostic accuracy. • Left atrial volume yields significantly higher diagnostic accuracy than left atrial axial diameter for identification of pulmonary hypertension due to left heart disease without time-consuming manual processing.
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Affiliation(s)
- Claudius Melzig
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Thuy Duong Do
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Benjamin Egenlauf
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Sasan Partovi
- Department of Interventional Radiology, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ekkehard Grünig
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Claus Peter Heussel
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,Department of Radiology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Fabian Rengier
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Utility of Automated Cardiac Chamber Volumetry by Non-Gated CT Pulmonary Angiography for Detection of Pulmonary Hypertension Using the 2018 Updated Hemodynamic Definition. AJR Am J Roentgenol 2022; 219:66-75. [PMID: 35080457 DOI: 10.2214/ajr.21.27147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND: Noninvasive tests for pulmonary hypertension (PH) are needed to help select patients for diagnostic right heart catheterization (RHC). CT pulmonary angiography (CTPA) is commonly performed for suspected PH. OBJECTIVE: To assess the utility of CTPA-based cardiac chamber volumetric measurements for diagnosis of PH in comparison with echocardiographic and conventional CTPA parameters, using as reference the 2018 updated hemodynamic definition. METHODS: This retrospective study included 109 patients (median age, 68 years; 72 women, 37 men) who underwent non-gated CTPA, echocardiography, and RHC for workup of suspected PH between August 2013 and February 2016. Two radiologists independently used automated 3D segmentation software to determine volumes of the right ventricle (RV), right atrium (RA), left ventricle (LV), and left atrium (LA), and measured axial diameters of cardiac chambers, main pulmonary artery, and ascending aorta. Interobserver agreement was assessed, and mean values were obtained; one observer repeated volumetric measurements to assess intraobserver agreement. ROC analysis was used to assess diagnostic performance for detection of PH. A multivariable binary logistic regression model was established. RESULTS: A total of 60/109 patients had PH. Intra- and interobserver agreement were excellent for all volume measurements (intraclass correlation coefficients, 0.935-0.999). In patients with, versus without, PH, RV volume was 172.6 versus 118.1 ml, and RA volume was 130.2 versus 77.0 ml (both p<.05). Cardiac chamber measurements with highest AUC for PH were RV/LV volume ratio and RA volume (both 0.791). Significant predictors of PH after adjustment for age, sex, and body surface area included RV volume per 10 ml [odds ratio (OR)=1.21], RA volume per 10 ml (OR=1.27), RV/LV volume ratio (OR=2.91), and RA/LA volume ratio (OR=11.22). Regression analysis yielded a predictive model for PH containing two independent predictors, echocardiographic pulmonary arterial systolic pressure and CTPA-based RA volume; the model had AUC 0.898, sensitivity 83.3%, and specificity 85.7%. CONCLUSION: Automated cardiac chamber volumetry using non-gated CTPA, particularly of the RA, provides incremental utility relative to echocardiographic and conventional CTPA parameters for diagnosis of PH. CLINICAL IMPACT: Automated cardiac chamber volumetry on CTPA may facilitate early nonvinvasive detection of PH, identifying patients warranting further evaluation by RHC.
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Nguyen TC, Ohyama Y, Taketomi-Takahashi A, Nguyen HT, Sugimoto A, Sato M, Sumiyoshi H, Nakamura T, Kurabayashi M, Tsushima Y. Impact of left atrial enlargement on image quality in coronary computed tomography angiography. Clin Imaging 2022; 84:87-92. [DOI: 10.1016/j.clinimag.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
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