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Lange T, Backhaus SJ, Schulz A, Evertz R, Kowallick JT, Bigalke B, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Cardiovascular magnetic resonance-derived left atrioventricular coupling index and major adverse cardiac events in patients following acute myocardial infarction. J Cardiovasc Magn Reson 2023; 25:24. [PMID: 37046343 PMCID: PMC10099819 DOI: 10.1186/s12968-023-00929-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Recently, a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scarce, we aimed to assess the diagnostic and prognostic implications of LACI in a large AMI patient cohort. METHODS In total, 1046 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular (LV) end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or heart failure within 12 months after the index event were defined as primary clinical endpoint. RESULTS LACI was significantly higher in patients with MACE compared to those without MACE (p < 0.001). Youden Index identified an optimal LACI cut-off at 34.7% to classify patients at high-risk (p < 0.001 on log-rank testing). Greater LACI was associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4-14.9, p < 0.001) and after adjusting for baseline confounders and LV ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0-9, p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients with impaired LV systolic function (LVEF ≤ 35%; p < 0.001 on log-rank testing). CONCLUSION Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond LVEF especially in high-risk patients following AMI. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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2
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Zhao X, Leng S, Tan RS, Chai P, Yeo TJ, Bryant JA, Teo LLS, Fortier MV, Ruan W, Low TT, Ong CC, Zhang S, van der Geest RJ, Allen JC, Hughes M, Garg P, Tan TH, Yip JW, Tan JL, Zhong L. Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension. J Cardiovasc Magn Reson 2022; 24:61. [PMID: 36451198 PMCID: PMC9714144 DOI: 10.1186/s12968-022-00896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 10/19/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) offers comprehensive right ventricular (RV) evaluation in pulmonary arterial hypertension (PAH). Emerging four-dimensional (4D) flow CMR allows visualization and quantification of intracardiac flow components and calculation of phasic blood kinetic energy (KE) parameters but it is unknown whether these parameters are associated with cardiopulmonary exercise test (CPET)-assessed exercise capacity, which is a surrogate measure of survival in PAH. We compared 4D flow CMR parameters in PAH with healthy controls, and investigated the association of these parameters with RV remodelling, RV functional and CPET outcomes. METHODS PAH patients and healthy controls from two centers were prospectively enrolled to undergo on-site cine and 4D flow CMR, and CPET within one week. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes (EDV). Phasic (peak systolic, average systolic, and peak E-wave) LV and RV blood flow KE indexed to EDV (KEIEDV) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO2), carbon dioxide production (VCO2) and minute ventilation (VE) were measured and recorded. RESULTS 45 PAH patients (46 ± 11 years; 7 M) and 51 healthy subjects (46 ± 14 years; 17 M) with no significant differences in age and gender were analyzed. Compared with healthy controls, PAH had significantly lower median RV direct flow, RV delayed ejection flow, RV peak E-wave KEIEDV, peak VO2, and percentage (%) predicted peak VO2, while significantly higher median RV residual volume and VE/VCO2 slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO2, % predicted peak VO2 and VE/VCO2 slope (all P < 0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity. CONCLUSION In this 4D flow CMR and CPET study, RV direct flow provided incremental value over RVEF for discriminating adverse RV remodelling, impaired exercise capacity, and PAH with intermediate and high risk based on risk score. These data suggest that CMR with 4D flow CMR can provide comprehensive assessment of PAH severity, and may be used to monitor disease progression and therapeutic response. TRIAL REGISTRATION NUMBER https://www. CLINICALTRIALS gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Wen Ruan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
| | - Ting Ting Low
- National University Hospital Singapore, Singapore, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, National Heart Research Institute Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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3
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Zhao X, Hu L, Leng S, Tan RS, Chai P, Bryant JA, Teo LLS, Fortier MV, Yeo TJ, Ouyang RZ, Allen JC, Hughes M, Garg P, Zhang S, van der Geest RJ, Yip JW, Tan TH, Tan JL, Zhong Y, Zhong L. Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:4. [PMID: 34980199 PMCID: PMC8722058 DOI: 10.1186/s12968-021-00832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows quantification of biventricular blood flow by flow components and kinetic energy (KE) analyses. However, it remains unclear whether 4D flow parameters can predict cardiopulmonary exercise testing (CPET) as a clinical outcome in repaired tetralogy of Fallot (rTOF). Current study aimed to (1) compare 4D flow CMR parameters in rTOF with age- and gender-matched healthy controls, (2) investigate associations of 4D flow parameters with functional and volumetric right ventricular (RV) remodelling markers, and CPET outcome. METHODS Sixty-three rTOF patients (14 paediatric, 49 adult; 30 ± 15 years; 29 M) and 63 age- and gender-matched healthy controls (14 paediatric, 49 adult; 31 ± 15 years) were prospectively recruited at four centers. All underwent cine and 4D flow CMR, and all adults performed standardized CPET same day or within one week of CMR. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes. Four flow components were analyzed: direct flow, retained inflow, delayed ejection flow and residual volume. Additionally, three phasic KE parameters normalized to end-diastolic volume (KEiEDV), were analyzed for both LV and RV: peak systolic, average systolic and peak E-wave. RESULTS In comparisons of rTOF vs. healthy controls, median LV retained inflow (18% vs. 16%, P = 0.005) and median peak E-wave KEiEDV (34.9 µJ/ml vs. 29.2 µJ/ml, P = 0.006) were higher in rTOF; median RV direct flow was lower in rTOF (25% vs. 35%, P < 0.001); median RV delayed ejection flow (21% vs. 17%, P < 0.001) and residual volume (39% vs. 31%, P < 0.001) were both greater in rTOF. RV KEiEDV parameters were all higher in rTOF than healthy controls (all P < 0.001). On multivariate analysis, RV direct flow was an independent predictor of RV function and CPET outcome. RV direct flow and RV peak E-wave KEiEDV were independent predictors of RV remodelling index. CONCLUSIONS In this multi-scanner multicenter 4D flow CMR study, reduced RV direct flow was independently associated with RV dysfunction, remodelling and, to a lesser extent, exercise intolerance in rTOF patients. This supports its utility as an imaging parameter for monitoring disease progression and therapeutic response in rTOF. Clinical Trial Registration https://www.clinicaltrials.gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
| | - Rong Zhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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4
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Gonzales RA, Seemann F, Lamy J, Mojibian H, Atar D, Erlinge D, Steding-Ehrenborg K, Arheden H, Hu C, Onofrey JA, Peters DC, Heiberg E. MVnet: automated time-resolved tracking of the mitral valve plane in CMR long-axis cine images with residual neural networks: a multi-center, multi-vendor study. J Cardiovasc Magn Reson 2021; 23:137. [PMID: 34857009 PMCID: PMC8638514 DOI: 10.1186/s12968-021-00824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mitral annular plane systolic excursion (MAPSE) and left ventricular (LV) early diastolic velocity (e') are key metrics of systolic and diastolic function, but not often measured by cardiovascular magnetic resonance (CMR). Its derivation is possible with manual, precise annotation of the mitral valve (MV) insertion points along the cardiac cycle in both two and four-chamber long-axis cines, but this process is highly time-consuming, laborious, and prone to errors. A fully automated, consistent, fast, and accurate method for MV plane tracking is lacking. In this study, we propose MVnet, a deep learning approach for MV point localization and tracking capable of deriving such clinical metrics comparable to human expert-level performance, and validated it in a multi-vendor, multi-center clinical population. METHODS The proposed pipeline first performs a coarse MV point annotation in a given cine accurately enough to apply an automated linear transformation task, which standardizes the size, cropping, resolution, and heart orientation, and second, tracks the MV points with high accuracy. The model was trained and evaluated on 38,854 cine images from 703 patients with diverse cardiovascular conditions, scanned on equipment from 3 main vendors, 16 centers, and 7 countries, and manually annotated by 10 observers. Agreement was assessed by the intra-class correlation coefficient (ICC) for both clinical metrics and by the distance error in the MV plane displacement. For inter-observer variability analysis, an additional pair of observers performed manual annotations in a randomly chosen set of 50 patients. RESULTS MVnet achieved a fast segmentation (<1 s/cine) with excellent ICCs of 0.94 (MAPSE) and 0.93 (LV e') and a MV plane tracking error of -0.10 ± 0.97 mm. In a similar manner, the inter-observer variability analysis yielded ICCs of 0.95 and 0.89 and a tracking error of -0.15 ± 1.18 mm, respectively. CONCLUSION A dual-stage deep learning approach for automated annotation of MV points for systolic and diastolic evaluation in CMR long-axis cine images was developed. The method is able to carefully track these points with high accuracy and in a timely manner. This will improve the feasibility of CMR methods which rely on valve tracking and increase their utility in a clinical setting.
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Affiliation(s)
- Ricardo A. Gonzales
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
| | - Felicia Seemann
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Chenxi Hu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - John A. Onofrey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Urology, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut United States of America
| | - Dana C. Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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5
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Bojer AS, Soerensen MH, Gaede P, Myerson S, Madsen PL. Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function. Diagnostics (Basel) 2021; 11:diagnostics11071282. [PMID: 34359363 PMCID: PMC8305340 DOI: 10.3390/diagnostics11071282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
- Correspondence:
| | - Martin Heyn Soerensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, 4200 Slagelse, Denmark; (M.H.S.); (P.G.)
- Institute of Regional Health Research, University of Sothern Denmark, 5230 Odense, Denmark
| | - Saul Myerson
- Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX1 2JD, UK;
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, 2730 Herlev, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Leng S, Guo J, Tan RS, Chai P, Teo L, Fortier MV, Gong C, Zhao X, Ong CC, Allen JC, Ruan W, Koh AS, Tan TH, Yip JW, Tan JL, Chen Y, Zhong L. Age- and Sex-Specific Changes in CMR Feature Tracking-Based Right Atrial and Ventricular Functional Parameters in Healthy Asians. Front Cardiovasc Med 2021; 8:664431. [PMID: 34150866 PMCID: PMC8213369 DOI: 10.3389/fcvm.2021.664431] [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] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) is the reference standard for non-invasive assessment of right-sided heart function. Recent advances in CMR post-processing facilitate quantification of tricuspid annular (TA) dynamics and longitudinal strains of the right ventricle (RV) and right atrium (RA). We aimed to determine age- and sex-specific changes in CMR-derived TA dynamics, and RV and RA functional parameters in healthy Asian adults. We studied 360 healthy subjects aged 21-79 years, with 30 men and 30 women in each of the six age groups. Functional parameters of RV and RA were measured on standard four-chamber cine CMR using fast feature tracking: (1) TA peak velocities (systolic velocity S', early diastolic velocity E', late diastolic velocity A') and TA plane systolic excursion (TAPSE); (2) RV global longitudinal strain (GLS) and strain rates; and (3) RA phasic longitudinal strains and strain rates. S' and TAPSE exhibited negative correlations with age. RV GLS was significantly higher in females than in males but not associated with age in both sexes. Females had similar E', lower A', and higher E'/A' ratios compared to males. Positive associations of E' and E'/A', and negative association of A' with age were observed in both sexes. Females had higher RA reservoir and conduit strains compared to males. There were significantly negative and positive associations between RA conduit and booster strains, respectively, with age. Age- and sex-specific reference ranges were established, and associations revealed, for fast CMR feature tracking parameters of right heart function in a large normal Asian population.
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Affiliation(s)
- Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - Jiajun Guo
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Singapore Institute for Clinical Sciences, ASTAR, Singapore, Singapore
| | - Chao Gong
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Ching Ching Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Wen Ruan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yucheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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7
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Leng S, Tan RS, Guo J, Chai P, Zhang G, Teo L, Ruan W, Yeo TJ, Zhao X, Allen JC, Tan JL, Yip JW, Chen Y, Zhong L. Cardiovascular magnetic resonance-assessed fast global longitudinal strain parameters add diagnostic and prognostic insights in right ventricular volume and pressure loading disease conditions. J Cardiovasc Magn Reson 2021; 23:38. [PMID: 33789701 PMCID: PMC8015087 DOI: 10.1186/s12968-021-00724-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Parameters of myocardial deformation may provide improved insights into right ventricular (RV) dysfunction. We quantified RV longitudinal myocardial function using a fast, semi-automated method and investigated its diagnostic and prognostic values in patients with repaired tetralogy of Fallot (rTOF) and pulmonary arterial hypertension (PAH), who respectively exemplify patients with RV volume and pressure overload conditions. METHODS The study enrolled 150 patients (rTOF, n = 75; PAH, n = 75) and 75 healthy controls. RV parameters of interest were fast global longitudinal strain (GLS) and strain rates during systole (GLSRs), early diastole (GLSRe) and late diastole (GLSRa), obtained by tracking the distance from the medial and lateral tricuspid valve insertions to the RV epicardial apex on cine cardiovascular magnetic resonance (CMR). RESULTS The RV fast GLS exhibited good agreement with strain values obtained by conventional feature tracking approach (bias - 4.9%, error limits (± 2·standard deviation) ± 4.3%) with fast GLS achieving greater reproducibility and requiring reduced analysis time. Mean RV fast GLS was reduced in PAH and rTOF groups compared to healthy controls (PAH < rTOF < healthy controls: 15.1 ± 4.9 < 19.3 ± 2.4 < 24.4 ± 3.0%, all P < 0.001 in pairwise comparisons). In rTOF patients, RV fast GLS was significantly associated with metabolic equivalents, peak oxygen consumption (PVO2) and percentage of predicted PVO2 achieved during cardiopulmonary exercise testing. Lower RV fast GLS was associated with subnormal exercise capacity in rTOF (area under the curve (AUC) = 0.822, sensitivity = 72%, specificity = 91%, cut-off = 19.3%). In PAH patients, reduced RV fast GLS was associated with RV decompensated hemodynamics (AUC = 0.717, sensitivity = 75%, specificity = 58%, cut-off = 14.6%) and higher risk of clinical worsening (AUC = 0.808, sensitivity = 79%, specificity = 70 %, cut-off = 16.0%). CONCLUSIONS Quantitative RV fast strain and strain rate parameters assessed from CMR identify abnormalities of RV function in rTOF and PAH and are predictive of exercise capacity, RV decompensation and clinical risks in these patients. Trial registry Clinicaltrials.gov: NCT03217240.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jiajun Guo
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan, People's Republic of China
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gangcheng Zhang
- Wuhan Asia Heart Hospital, Wuhan City, Hubei, People's Republic of China
| | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Wen Ruan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
| | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - James W Yip
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yucheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan, People's Republic of China.
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore, Singapore.
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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Detection of persistent systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot patients with preserved ejection fraction: a CMR feature tracking study. Eur Radiol 2021; 31:6156-6168. [PMID: 33492469 DOI: 10.1007/s00330-020-07643-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES A fast cardiovascular magnetic resonance (CMR) feature tracking was applied to assess ventricular systolic and diastolic function. This study sought to detect right ventricular (RV) systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients with preserved RV ejection fraction (EF). METHODS One hundred asymptomatic pediatric rTOF patients with preserved RVEF ≥ 45% and 52 control subjects underwent cine CMR examinations. Tricuspid annular plane systolic excursion (TAPSE); peak tricuspid annular systolic (Sm), early diastolic (Em), and late diastolic (Am) velocities; and biventricular global radial (GRS), circumferential (GCS), and longitudinal strains (GLS) were analyzed using CMR feature tracking. RESULTS TAPSE, Sm, Em, Am, and RV GLS were significantly lower in rTOF patients compared with controls (all p < 0.01). The lower limits (mean-2·standard deviations) of TAPSE, Sm, Em, and Am among controls were 10.9 mm, 6.3 cm/s, 8.9 cm/s, and 2.4 cm/s, respectively, and 78%, 75%, 75%, and 19% of rTOF patients had corresponding measurements below these thresholds. Among rTOF patients, RV GLS was significantly lower in females than in males (p < 0.05). CONCLUSIONS Despite preserved RVEF, there was a high prevalence of RV systolic and diastolic dysfunction among pediatric rTOF patients, which was detected using fast CMR feature tracking. KEY POINTS • There was high prevalence of systolic and diastolic dysfunction in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients despite preserved right ventricular (RV) ejection fraction (EF). • Significant correlations were observed between right ventricular (RV) measurements (strains, tricuspid annular plane systolic excursion (TAPSE), peak tricuspid annular early diastolic velocity (Em), peak tricuspid annular late diastolic velocity (Am)), and left ventricular (LV) strain measurements, which indicates ventricular-ventricular interactions at systolic and diastolic function level. • Right ventricular (RV) global longitudinal strain (GLS) was lower in female repaired tetralogy of Fallot (rTOF) patients than in males, suggesting females with rTOF may be at a higher risk of developing RV systolic dysfunction than males.
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Leng S, Ge H, He J, Kong L, Yang Y, Yan F, Xiu J, Shan P, Zhao S, Tan RS, Zhao X, Koh AS, Allen JC, Hausenloy DJ, Mintz GS, Zhong L, Pu J. Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction. Radiology 2020; 296:299-309. [PMID: 32544032 DOI: 10.1148/radiol.2020200176] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Left atrial (LA) dysfunction is associated with morbidity and mortality. To the knowledge of the authors, the relationship of LA strain to long-term prognosis in participants with ST-segment elevation myocardial infarction (STEMI) is unknown. Purpose To evaluate LA strain as a long-term outcome predictor in STEMI in a prospective, multicenter cardiac MRI cohort. Materials and Methods Participants with STEMI who underwent primary percutaneous coronary intervention and cardiac MRI from 10 sites (EARLY-MYO-CMR registry, clinical trial number NCT03768453) were included. The parent study took place between August 2013 and December 2018. LA longitudinal strain and strain rate parameters were derived from cine cardiac MRI by using an in-house semiautomated method. Major adverse cardiac events (MACEs) were defined as cardiovascular death, myocardial reinfarction, hospitalization for heart failure, and stroke. The association between LA performance and MACE was evaluated by using time-dependent receiver operating characteristic analysis, Kaplan-Meier analysis, and multivariable Cox regression analysis. Results A total of 321 participants (median age, 59 years; age range, 27-75 years; 90% men) were included in this study. During median follow-up of 3.7 years, MACE occurred in 76 participants (23.7%). Participants with impaired reservoir (≤22%) and conduit strain (≤10%) had a higher risk of MACE than those with reservoir strain greater than 22% and conduit strain greater than 10% (P < .001). Reservoir strain (hazard ratio, 0.84; 95% confidence interval: 0.77, 0.91; P < .001) and conduit strain (hazard ratio, 0.81; 95% confidence interval: 0.73, 0.89; P < .001) were independent predictors for MACE after adjustment for known risk factors. Finally, LA reservoir and conduit strains provided incremental prognostic value over traditional outcome predictors (Uno C statistic comparing models, 0.75 vs 0.68; P = .04). Conclusion Assessment of left atrial strain, as a measure of left atrial function, provided incremental prognostic information to established predictors in ST-segment elevation myocardial infarction. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kawel-Boehm and Bremerich in this issue.
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Affiliation(s)
- Shuang Leng
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Heng Ge
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Jie He
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Lingcong Kong
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Yining Yang
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Fuhua Yan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Jiancheng Xiu
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Peiren Shan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Shihua Zhao
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Ru-San Tan
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Xiaodan Zhao
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Angela S Koh
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - John C Allen
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Derek J Hausenloy
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Gary S Mintz
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Liang Zhong
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
| | - Jun Pu
- From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.)
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10
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Zou H, Leng S, Xi C, Zhao X, Koh AS, Gao F, Tan JL, Tan RS, Allen JC, Lee LC, Genet M, Zhong L. Three-dimensional biventricular strains in pulmonary arterial hypertension patients using hyperelastic warping. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105345. [PMID: 31982668 PMCID: PMC7198336 DOI: 10.1016/j.cmpb.2020.105345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Evaluation of biventricular function is an essential component of clinical management in pulmonary arterial hypertension (PAH). This study aims to examine the utility of biventricular strains derived from a model-to-image registration technique in PAH patients in comparison to age- and gender-matched normal controls. METHODS A three-dimensional (3D) model was reconstructed from cine short- and long-axis cardiac magnetic resonance (CMR) images and subsequently partitioned into right ventricle (RV), left ventricle (LV) and septum. The hyperelastic warping method was used to register the meshed biventricular finite element model throughout the cardiac cycle and obtain the corresponding biventricular circumferential, longitudinal and radial strains. RESULTS Intra- and inter-observer reproducibility of biventricular strains was excellent with all intra-class correlation coefficients > 0.84. 3D biventricular longitudinal, circumferential and radial strains for RV, LV and septum were significantly decreased in PAH patients compared with controls. Receiver operating characteristic (ROC) analysis showed that the 3D biventricular strains were better early markers (Area under the ROC curve = 0.96 for RV longitudinal strain) of ventricular dysfunction than conventional parameters such as two-dimensional strains and ejection fraction. CONCLUSIONS Our highly reproducible methodology holds potential for extending CMR imaging to characterize 3D biventricular strains, eventually leading to deeper understanding of biventricular mechanics in PAH.
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Affiliation(s)
- Hua Zou
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Ce Xi
- Department of Mechanical Engineering, Michigan State University, MI, United States
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Fei Gao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, MI, United States
| | - Martin Genet
- Mechanics Department & Solid Mechanics Laboratory, École Polytechnique (Paris-Saclay University), Palaiseau, France; M3DISIM research team, INRIA (Paris-Saclay University), Palaiseau, France
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
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11
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 2020; 30:3672-3683. [PMID: 32107604 DOI: 10.1007/s00330-020-06744-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. METHODS The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. RESULTS FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). CONCLUSIONS The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. KEY POINTS • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
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12
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Leng S, Dong Y, Wu Y, Zhao X, Ruan W, Zhang G, Allen JC, Koh AS, Tan RS, Yip JW, Tan JL, Chen Y, Zhong L. Impaired Cardiovascular Magnetic Resonance–Derived Rapid Semiautomated Right Atrial Longitudinal Strain Is Associated With Decompensated Hemodynamics in Pulmonary Arterial Hypertension. Circ Cardiovasc Imaging 2019; 12:e008582. [PMID: 31088152 DOI: 10.1161/circimaging.118.008582] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Yang Dong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu City, Sichuan, People’s Republic of China (Y.D., Y.C.C.)
| | - Yang Wu
- WuHan Asia Heart Hospital, Wuhan City, Hubei, People’s Republic of China (Y.W., G.C.Z.)
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Wen Ruan
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Gangcheng Zhang
- WuHan Asia Heart Hospital, Wuhan City, Hubei, People’s Republic of China (Y.W., G.C.Z.)
| | - John C. Allen
- Duke-NUS Medical School, Singapore (J.C.A., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Angela S. Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
- Duke-NUS Medical School, Singapore (J.C.A., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
- Duke-NUS Medical School, Singapore (J.C.A., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - James W. Yip
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore (J.W.Y.)
- Yong Loo Lin School of Medicine, National University of Singapore (J.W.Y.)
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
- Duke-NUS Medical School, Singapore (J.C.A., A.S.K., R.-S.T., J.L.T., L.Z.)
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu City, Sichuan, People’s Republic of China (Y.D., Y.C.C.)
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore (S.L., X.D.Z., W.R., A.S.K., R.-S.T., J.L.T., L.Z.)
- Duke-NUS Medical School, Singapore (J.C.A., A.S.K., R.-S.T., J.L.T., L.Z.)
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13
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Koh AS, Gao F, Tan RS, Zhong L, Leng S, Zhao X, Fridianto KT, Ching J, Lee SY, Keng BMH, Yeo TJ, Tan SY, Tan HC, Lim CT, Koh WP, Kovalik JP. Metabolomic correlates of aerobic capacity among elderly adults. Clin Cardiol 2018; 41:1300-1307. [PMID: 30350416 DOI: 10.1002/clc.23016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Aerobic capacity is a powerful predictor of cardiovascular disease and all-cause mortality, and it declines with advancing age. HYPOTHESIS Since physical activity alters body metabolism, metabolism markers will likely differ between subjects with high vs low aerobic capacities. METHODS Community-based participants without physician-diagnosed heart disease, stroke or cancer underwent same-day multimodal assessment of cardiovascular function (by echocardiography and magnetic resonance feature tracking of left atrium) and aerobic capacity by peak oxygen uptake (VO2 ) metrics. Associations between VO2 and cardiovascular and metabolomics profiles were studied in adjusted models including standard covariates. RESULTS We studied 141 participants, of whom 82 (58.2%) had low VO2 , while 59 (41.8%) had high VO2 . Compared to participants with high VO2 , participants with low VO2 had more adverse cardiovascular parameters, such as lower ratio of peak velocity flow in early diastole to peak velocity flow in late diastole by atrial contraction of >0.8 (76% vs 35%, adjusted odd ratio [OR] = 4.1, 95% confidence interval [CI] [1.7-9.5], P = 0.001) and lower left atrial conduit strain (11.3 ± 4.0 vs 15.6 ± 6.1%, adjusted OR = 1.1, 95% CI [1.002-1.3], P = 0.045). High VO2 was associated with lower accumulation of wide-spectrum acyl-carnitines (OR = 0.6, 95% CI [0.4-0.9], P = 0.013), alanine (OR = 0.1, 95% CI [0.01-0.9], P = 0.044) and glutamine /glutamate (OR = 0.1, 95% CI [0.01-0.5], P = 0.007), compared to low VO2. CONCLUSION: Elderly adults with low VO2 have adverse cardiovascular and metabolic parameters compared to their counterparts with high VO2 . Combined cardiac and metabolomics phenotyping may be a promising tool to provide insights into physiological states, useful for tracking future interventions related to physical activity among community cohorts.
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Affiliation(s)
- Angela S Koh
- Department of Cardiology, National Heart Centre Singapore, Duke-NUS Medical School, Singapore
| | - Fei Gao
- Department of Cardiology, National Heart Centre Singapore, Singapore, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Ru S Tan
- Department of Cardiology, National Heart Centre Singapore, Duke-NUS Medical School, Singapore
| | - Liang Zhong
- Department of Cardiology, National Heart Centre Singapore, Duke-NUS Medical School, Singapore
| | - Shuang Leng
- Department of Cardiology, National Heart Centre, Singapore
| | - Xiaodan Zhao
- Department of Cardiology, National Heart Centre, Singapore
| | - Kevin T Fridianto
- Cardiovascular and Metabolic Diseases Programme, Duke-NUS Medical School, Singapore
| | - Jianhong Ching
- Cardiovascular and Metabolic Diseases Programme, Duke-NUS Medical School, Singapore
| | - Si Y Lee
- Department of Cardiology, National Heart Centre, Singapore
| | - Bryan M H Keng
- Department of Cardiology, National Heart Centre, Singapore
| | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre Singapore
| | - Shu Y Tan
- Department of Family Medicine and Continuing Care, General Hospital, Singapore
| | - Hong C Tan
- Department of Endocrinology, General Hospital, Singapore
| | - Chin T Lim
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Jean-Paul Kovalik
- Cardiovascular and Metabolic Diseases Programme, Duke-NUS Medical School, Singapore.,Department of Endocrinology, General Hospital, Singapore
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14
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Leng S, Zhao X, Koh AS, Zhao L, Allen JC, Tan RS, Ma X, Zhong L. Age-related changes in four-dimensional CMR-derived atrioventricular junction velocities and displacements: Implications for the identification of altered annular dynamics for ventricular function assessment. IJC HEART & VASCULATURE 2018; 22:6-12. [PMID: 30480084 PMCID: PMC6240643 DOI: 10.1016/j.ijcha.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
Abstract
Background We determined the age-related changes in atrioventricular junction (AVJ) velocities and displacements by feature tracking cardiovascular magnetic resonance (FT-CMR) in a healthy community-based population. We also investigated the importance of age-matching for the identification of altered AVJ dynamics. Methods FT-CMR was performed in 230 controls (18-78 years) and in two patient groups each consisting of 40 subjects (group 1: 23-55 years, group 2: 56-80 years). AVJ dynamic parameters, including systolic velocity Sm, early diastolic velocity Em, late diastolic velocity Am, maximal systolic excursion MAPSE and the new parameter sweep surface area velocity SSAV were measured. Results Increasing age in the control group was significantly associated with reductions in Sm, Em, MAPSE (r = -0.40, -0.76, -0.34, all P < 0.001) and an increase in Am (r = 0.45, P < 0.001). For patient group 1, the selection of an age-unmatched control group (56-76 years) underestimated the number of patients with abnormal AVJ dynamics during systole and early diastole (38% vs. 70% for Sm; 20% vs. 60% for Em; 35% vs. 50% for MAPSE). In contrast, for patient group 2, the number of patients with systolic and early diastolic AVJ dynamic abnormalities was overestimated (88% vs. 63% for Sm; 90% vs. 68% for Em; 73% vs. 58% for MAPSE) when compared with age-unmatched controls (24-55 years). Fifty-percent (20/40) of the sub-group of patients with normal left ventricular ejection fraction exhibited abnormal systolic Sm or MAPSE measurements. Conclusions Significant correlations exist between age and AVJ dynamics. Age matching is important for evaluating AVJ long-axis function.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Lei Zhao
- Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - John C Allen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Xiaohai Ma
- Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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15
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2018; 20:71. [PMID: 30396356 PMCID: PMC6219067 DOI: 10.1186/s12968-018-0496-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Abnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain. METHODS We studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain εs and strain rate SRs), conduit function (conduit strain εe and strain rate SRe) and booster pump function (booster strain εa and strain rate SRa). RESULTS There was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for εs, 18.1 ± 4.3% for εe, 17.2 ± 3.5% for εa, and 1.8 ± 0.4, - 2.0 ± 0.5, - 2.3 ± 0.6 s- 1 for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller εs, SRs, εe and SRe than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS). CONCLUSIONS Novel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - John C. Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Angela S. Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
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16
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Zou H, Xi C, Zhao X, Koh AS, Gao F, Su Y, Tan RS, Allen J, Lee LC, Genet M, Zhong L. Quantification of Biventricular Strains in Heart Failure With Preserved Ejection Fraction Patient Using Hyperelastic Warping Method. Front Physiol 2018; 9:1295. [PMID: 30283352 PMCID: PMC6156386 DOI: 10.3389/fphys.2018.01295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) imposes a major global health care burden on society and suffering on the individual. About 50% of HF patients have preserved ejection fraction (HFpEF). More intricate and comprehensive measurement-focused imaging of multiple strain components may aid in the diagnosis and elucidation of this disease. Here, we describe the development of a semi-automated hyperelastic warping method for rapid comprehensive assessment of biventricular circumferential, longitudinal, and radial strains that is physiological meaningful and reproducible. We recruited and performed cardiac magnetic resonance (CMR) imaging on 30 subjects [10 HFpEF, 10 HF with reduced ejection fraction patients (HFrEF) and 10 healthy controls]. In each subject, a three-dimensional heart model including left ventricle (LV), right ventricle (RV), and septum was reconstructed from CMR images. The hyperelastic warping method was used to reference the segmented model with the target images and biventricular circumferential, longitudinal, and radial strain-time curves were obtained. The peak systolic strains are then measured and analyzed in this study. Intra- and inter-observer reproducibility of the biventricular peak systolic strains was excellent with all ICCs > 0.92. LV peak systolic circumferential, longitudinal, and radial strain, respectively, exhibited a progressive decrease in magnitude from healthy control→HFpEF→HFrEF: control (-15.5 ± 1.90, -15.6 ± 2.06, 41.4 ± 12.2%); HFpEF (-9.37 ± 3.23, -11.3 ± 1.76, 22.8 ± 13.1%); HFrEF (-4.75 ± 2.74, -7.55 ± 1.75, 10.8 ± 4.61%). A similar progressive decrease in magnitude was observed for RV peak systolic circumferential, longitudinal and radial strain: control (-9.91 ± 2.25, -14.5 ± 2.63, 26.8 ± 7.16%); HFpEF (-7.38 ± 3.17, -12.0 ± 2.45, 21.5 ± 10.0%); HFrEF (-5.92 ± 3.13, -8.63 ± 2.79, 15.2 ± 6.33%). Furthermore, septum peak systolic circumferential, longitudinal, and radial strain magnitude decreased gradually from healthy control to HFrEF: control (-7.11 ± 1.81, 16.3 ± 3.23, 18.5 ± 8.64%); HFpEF (-6.11 ± 3.98, -13.4 ± 3.02, 12.5 ± 6.38%); HFrEF (-1.42 ± 1.36, -8.99 ± 2.96, 3.35 ± 2.95%). The ROC analysis indicated LV peak systolic circumferential strain to be the most sensitive marker for differentiating HFpEF from healthy controls. Our results suggest that the hyperelastic warping method with the CMR-derived strains may reveal subtle impairment in HF biventricular mechanics, in particular despite a "normal" ventricular ejection fraction in HFpEF.
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Affiliation(s)
- Hua Zou
- National Heart Centre Singapore, Singapore, Singapore
| | - Ce Xi
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore
| | - Yi Su
- Institute of High Performance Computing, A∗STAR, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Martin Genet
- Mechanics Department and Solid Mechanics Laboratory, École Polytechnique, C.N.R.S., Université Paris-Saclay, Palaiseau, France.,M3DISIM Team, I.N.R.I.A, Université Paris-Saclay, Palaiseau, France
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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17
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Peng J, Zhao X, Zhao L, Fan Z, Wang Z, Chen H, Leng S, Allen J, Tan RS, Koh AS, Ma X, Lou M, Zhong L. Normal Values of Myocardial Deformation Assessed by Cardiovascular Magnetic Resonance Feature Tracking in a Healthy Chinese Population: A Multicenter Study. Front Physiol 2018; 9:1181. [PMID: 30233388 PMCID: PMC6129778 DOI: 10.3389/fphys.2018.01181] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/06/2018] [Indexed: 01/15/2023] Open
Abstract
Reference values on atrial and ventricular strain from cardiovascular magnetic resonance (CMR) are essential in identifying patients with impaired atrial and ventricular function. However, reference values have not been established for Chinese subjects. One hundred and fifty healthy volunteers (75 Males/75 Females; 18–82 years) were recruited. All underwent CMR scans with images acceptable for further strain analysis. Subjects were stratified by age: Group 1, 18–44 years; Group 2, 45–59 years; Group 3, ≥60 years. Feature tracking of CMR cine imaging was used to obtain left atrial global longitudinal (LA Ell) and circumferential strains (LA Ecc) and respective systolic strain rates, left ventricular longitudinal (LV Ell), circumferential (LV Ecc) and radial strains (LV Err) and their respective strain rates, and right ventricular longitudinal strain (RV Ell) and strain rate. LA Ell and LA Ecc were 32.8 ± 9.2% and 40.3 ± 13.4%, respectively, and RV Ell was −29.3 ± 6.0%. LV Ell, LV Ecc and LV Err were −22.4 ± 2.9%, −24.3 ± 3.1%, and 79.0 ± 19.4%, respectively. LV Ell and LV Ecc were higher in females than males (P < 0.05). LA Ell, LA Ecc, and LV Ecc decreased, while LV Err increased with age (P < 0.05). LV Ell and RV Ell were not shown to be associated with age. Normal ranges for atrial and ventricular strain and strain rates are provided using CMR feature tracking in Chinese subjects.
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Affiliation(s)
- Junping Peng
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Post-Doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Xiaohai Ma
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingwu Lou
- Post-Doctoral Research Center, Department of Radiology, Longgang Central Hospital, Shenzhen Clinical Medical Institute, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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18
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Seemann F, Baldassarre LA, Llanos‐Chea F, Gonzales RA, Grunseich K, Hu C, Sugeng L, Meadows J, Heiberg E, Peters DC. Assessment of diastolic function and atrial remodeling by MRI - validation and correlation with echocardiography and filling pressure. Physiol Rep 2018; 6:e13828. [PMID: 30187654 PMCID: PMC6125607 DOI: 10.14814/phy2.13828] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrosis can be estimated noninvasively by magnetic resonance imaging (MRI) using late gadolinium enhancement (LGE), but diastolic dysfunction is clinically assessed by transthoracic echocardiography (TTE), and rarely by MRI. This study aimed to evaluate well-established diastolic parameters using MRI, and validate them with TTE and left ventricular (LV) filling pressures, and to study the relationship between left atrial (LA) remodeling and parameters of diastolic function. The study retrospectively included 105 patients (53 ± 16 years, 39 females) who underwent 3D LGE MRI between 2012 and 2016. Medical charts were reviewed for the echocardiographic diastolic parameters E, A, and e' by TTE, and pressure catheterizations. E and A were measured from in-plane phase-contrast cardiac MRI images, and e' by feature-tracking, and validated with TTE. Interobserver and intraobserver variability was examined. Furthermore, LA volumes, function, and atrial LGE was correlated with diastolic parameters. Evaluation of e' in MRI had strong agreement with TTE (r = 0.75, P < 0.0001), and low interobserver and intraobserver variability. E and A by TTE showed strong agreement to MRI (r = 0.77, P = 0.001; r = 0.73, P = 0.003, for E and A, respectively). Agreement between E/e' by TTE and MRI was strong (r = 0.85, P = 0.0004), and E/e' by TTE correlated moderately to invasive pressures (r = 0.59, P = 0.03). There was a strong relationship between LA LGE and pulmonary capillary wedge pressure (r = 0.81, P = 0.01). In conclusion, diastolic parameters can be measured with good reproducibility by cardiovascular MRI. LA LGE exhibited a strong relationship with pulmonary capillary wedge pressure, an indicator of diastolic function.
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Affiliation(s)
- Felicia Seemann
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of Clinical PhysiologySkane University HospitalLund UniversityLundSweden
- Department of Biomedical EngineeringFaculty of EngineeringLund UniversityLundSweden
| | - Lauren A. Baldassarre
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of CardiologyYale UniversityNew HavenConnecticut
| | | | - Ricardo A. Gonzales
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- Department of Electrical EngineeringUniversidad de Ingenieria y Tecnologia ‐ UTECLimaPeru
| | - Karl Grunseich
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Chenxi Hu
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
| | - Lissa Sugeng
- Section of Cardiovascular MedicineDepartment of MedicineYale UniversityNew HavenConnecticut
| | - Judith Meadows
- Section of Cardiovascular MedicineDepartment of MedicineYale UniversityNew HavenConnecticut
| | - Einar Heiberg
- Department of Clinical PhysiologySkane University HospitalLund UniversityLundSweden
- Department of Biomedical EngineeringFaculty of EngineeringLund UniversityLundSweden
- Wallenberg Center for Molecular MedicineLund UniversityLundSweden
| | - Dana C. Peters
- Department of Radiology and Biomedical ImagingYale UniversityNew HavenConnecticut
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19
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Leng S, Zhang S, Jiang M, Zhao X, Wu R, Allen J, He B, Tan RS, Zhong L. Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking. Sci Rep 2018; 8:81. [PMID: 29311562 PMCID: PMC5758818 DOI: 10.1038/s41598-017-18354-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022] Open
Abstract
Feature tracking in cine cardiac magnetic resonance (CMR) is a quantitative technique to assess heart structure and function. We investigated 4-dimensional (4D) dynamics and morphology of the mitral annulus (MA) using a novel tracking system based on radially rotational long-axis cine CMR series. A total of 30 normal controls and patients with mitral regurgitation were enrolled. The spatiotemporal changes of the MA were characterized by an in-house developed program. Dynamic and morphological parameters extracted from all 18 radial slices were used as references and were compared with those from subsequently generated sub-datasets with different degrees of sparsity. An excellent agreement was found among all datasets including routine 2-, 3- and 4-chamber views for MA dynamics such as peak systolic velocity (Sm) and mitral annular plane systolic excursion (MAPSE). MA morphology for size and shape was addressed adequately by as few as 6 radial slices, but poorly by only three routine views. Patients with regurgitation showed significantly reduced mitral dynamics and mild annular deformation, which was consistent between three routine views and 18 reference slices. In conclusion, feature tracking cine CMR provided a comprehensive and distinctive profile for 4D MA dynamics and morphology, which may help in studying different cardiac diseases.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Shuo Zhang
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Philips Healthcare, 622 Lorong 1, Toa Payoh, 319763, Singapore, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Rui Wu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - John Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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20
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Xiao P, Zhao X, Leng S, Tan RS, Wong P, Zhong L. A Software Tool for Heart AVJ Motion Tracking Using Cine Cardiovascular Magnetic Resonance Images. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:1900412. [PMID: 29018633 PMCID: PMC5630007 DOI: 10.1109/jtehm.2017.2738623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/05/2017] [Accepted: 08/02/2017] [Indexed: 11/30/2022]
Abstract
One important index to assess left ventricular diastolic function is the quantitative measurement of atrioventricular junction (AVJ) motion in one cardiac cycle including systole and diastole. The best way to perform the measurement is to use a software tool that can conduct AVJ motion tracking from cine cardiovascular magnetic resonance (CMR) images. In this paper, a software tool for this purpose is presented by using the insight segmentation and registration toolkit (ITK), the visualization toolkit (VTK), and Qt. We propose a surface area-based tracking approach in the software tool. In the tracking approach to obtain the surface area swept by six points being tracked, we manually select six points from four-, three- and two-chamber views of CMR images. After that, we reconstruct the 3-D coordinates of the six points from image acquisition parameters extracted from DICOM files. We perform interpolation by using parametric cubic curve fitting techniques. From the curve fitting results, we finally obtain the surface areas for all time points in one cardiac cycle. The software tool has been successfully implemented. The functionality include single point-based tracking, surface area-based tracking by using 6 tracked points, generation of displacement, sweep surface area and velocity, and generation of tracking movies. From the software engineering practice, it is concluded that ITK, VTK, and Qt are very handy software systems to implement automatic image analysis functions for CMR images, such as quantitative measure of motion by visual tracking. The software tool provides a convenient and efficient way to measure AVJ motion and extends the scope of methods for ventricular function assessment.
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Affiliation(s)
- Pengdong Xiao
- National Heart Research Institute Singapore, National Heart Center Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Center Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Center Singapore
| | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Center Singapore
| | - Philip Wong
- National Heart Research Institute Singapore, National Heart Center Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Center Singapore
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21
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Asgeirsson D, Hedström E, Jögi J, Pahlm U, Steding-Ehrenborg K, Engblom H, Arheden H, Carlsson M. Longitudinal shortening remains the principal component of left ventricular pumping in patients with chronic myocardial infarction even when the absolute atrioventricular plane displacement is decreased. BMC Cardiovasc Disord 2017; 17:208. [PMID: 28754098 PMCID: PMC5534092 DOI: 10.1186/s12872-017-0641-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background The majority (60%) of left ventricular (LV) stroke volume (SV) is generated by longitudinal shortening causing apical atrioventricular plane displacement (AVPD) in systole. The remaining SV is caused by radial inward motion of the epicardium both in the septal and the lateral wall. We aimed to determine if these longitudinal, septal and lateral contributions to LVSV are changed in patients with chronic myocardial infarction (MI). Methods Patients with a chronic (>3 months) ST-elevation MI in the left anterior descending (LAD, n = 20) or right coronary artery (RCA, n = 16) and healthy controls (n = 20) were examined with cardiovascular magnetic resonance (CMR). AVPD was quantified in long axis cine CMR images and LV volumes and dimensions in short axis cine images. Results AVPD was decreased both in patients with LAD-MI (11 ± 1 mm, p < 0.001) and RCA-MI (13 ± 1 mm, p < 0.05) compared to controls (15 ± 0 mm). However, the longitudinal contribution to SV was unchanged for both LAD-MI (58 ± 3%, p = 0.08) and RCA-MI (59 ± 3%, p = 0.09) compared to controls (64 ± 2%). The preserved longitudinal contribution despite decreased absolute AVPD was a results of increased epicardial dimensions (p < 0.01 for LAD-MI and p = 0.06 for RCA-MI). In LAD-MI the septal contribution to LVSV was decreased (5 ± 1%) compared to both controls (10 ± 1%, p < 0.01) and patients with RCA-MIs (10 ± 1%, p < 0.01). The lateral contribution was increased in LAD-MI patients (44 ± 3%) compared to both RCA-MI (35 ± 2%, p < 0.05) and controls (29 ± 2%, p < 0.001). Conclusion Longitudinal shortening remains the principal component of left ventricular pumping in patients with chronic MI even when the absolute AVPD is decreased.
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Affiliation(s)
- Daniel Asgeirsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Erik Hedström
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.
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22
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Zhao X, Tan RS, Tang HC, Leng S, Zhang JM, Zhong L. Analysis of three-dimensional endocardial and epicardial strains from cardiac magnetic resonance in healthy subjects and patients with hypertrophic cardiomyopathy. Med Biol Eng Comput 2017; 56:159-172. [PMID: 28674779 DOI: 10.1007/s11517-017-1674-2] [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] [Received: 01/16/2017] [Accepted: 06/10/2017] [Indexed: 11/29/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease that leads to left ventricle (LV) hypertrophy with or without the presence of LV outflow tract obstruction. The aim of this study was to find an easy and useful indicator based on cardiac magnetic resonance (CMR) images for control subjects and patients with and without obstruction. CMR scans were performed for 19 control subjects and 19 HCM patients. Endocardial strain was defined as [Formula: see text], with [Formula: see text] being the length of endocardium at end-diastole (end-systole); similarly for epicardial strain ([Formula: see text]). The strains were evaluated in cine CMR two-, three- and four-chamber views. Six atrioventricular junction (AVJ) points from three CMR views were semi-automatically tracked. The peak systolic velocity (Sm1), peak early diastolic velocity and late diastolic velocity (Em, Am) were extracted and analysed. Compared with control subjects, HCM patients had significantly smaller three-dimensional strains and AVJ motion incorporating measurements from three long-axis views (all P < 0.05). Moreover, ROC analysis found that three-dimensional global epicardial strain <17.2% had the best sensitivity 94.4% and specificity 94.7% to differentiate HCM from control (AUC = 0.97). Therefore, three-dimensional endocardial and epicardial strains provide an easy and effective approach to manage and triage hypertrophic cardiomyopathy patients.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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23
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Wong P. Atrioventricular junction (AVJ) motion tracking: a software tool with ITK/VTK/Qt. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4141-4144. [PMID: 28269194 DOI: 10.1109/embc.2016.7591638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The quantitative measurement of the Atrioventricular Junction (AVJ) motion is an important index for ventricular functions of one cardiac cycle including systole and diastole. In this paper, a software tool that can conduct AVJ motion tracking from cardiovascular magnetic resonance (CMR) images is presented by using Insight Segmentation and Registration Toolkit (ITK), The Visualization Toolkit (VTK) and Qt. The software tool is written in C++ by using Visual Studio Community 2013 integrated development environment (IDE) containing both an editor and a Microsoft complier. The software package has been successfully implemented. From the software engineering practice, it is concluded that ITK, VTK, and Qt are very handy software systems to implement automatic image analysis functions for CMR images such as quantitative measure of motion by visual tracking.
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24
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Genet M. Characterization of patient-specific biventricular mechanics in heart failure with preserved ejection fraction: Hyperelastic warping. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4149-4152. [PMID: 28269196 DOI: 10.1109/embc.2016.7591640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Heart failure with preserved ejection fraction (HFPEF) is considered as a major public health problem. Traditionally, HFPEF is diagnosed based on a "normal" EF, but the studies have explored the potential role of left ventricular mechanics. Furthermore, right ventricular mechanics and bi-ventricular interaction in HFPEF is currently not well understood. In this study, we aim to develop a framework using a hyperelastic warping approach to quantify bi-ventricular and septum strains from cardiac magnetic resonance (CMR) images. Whole heart models were reconstructed in HFPEF, HF with reduced EF (HFREF) and normal control patients, and a Laplace-Dirichlet Rule-Based (LDRB) algorithm was employed to assign circumferential orientation. The LV circumferential strain was 10.56% in normal control, and decreased to 5.90% in HFPEF and 1.66% in HFREF. Interestingly, the RV circumferential strain was 7.29% in normal control, but increased to 8.93% in HFPEF, and decreased to 2.16% in HFREF. The septum circumferential strain was comparable between HFPEF and normal control. Heart failure with preserved ejection fraction demonstrated augmented right ventricular strain and comparable septum strain to maintain its "normal" ejection fraction. This might unveil a new mechanism of bi-ventricular interaction and compensation in heart failure with preserved ejection fraction.
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25
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Seemann F, Pahlm U, Steding-Ehrenborg K, Ostenfeld E, Erlinge D, Dubois-Rande JL, Jensen SE, Atar D, Arheden H, Carlsson M, Heiberg E. Time-resolved tracking of the atrioventricular plane displacement in Cardiovascular Magnetic Resonance (CMR) images. BMC Med Imaging 2017; 17:19. [PMID: 28241751 PMCID: PMC5330030 DOI: 10.1186/s12880-017-0189-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Atrioventricular plane displacement (AVPD) is an indicator for systolic and diastolic function and accounts for 60% of the left ventricular, and 80% of the right ventricular stroke volume. AVPD is commonly measured clinically in echocardiography as mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE), but has not been applied widely in cardiovascular magnetic resonance (CMR). To date, there is no robust automatic algorithm available that allows the AVPD to be measured clinically in CMR with input in a single timeframe. This study aimed to develop, validate and provide a method that automatically tracks the left and right ventricular AVPD in CMR images, which can be used in the clinical setting or in applied cardiovascular research in multi-center studies. Methods The proposed algorithm is based on template tracking by normalized cross-correlation combined with a priori information by principal component analysis. The AVPD in each timeframe is calculated for the left and right ventricle separately using CMR long-axis cine images of the 2, 3, and 4-chamber views. The algorithm was developed using a training set (n = 40), and validated in a test set (n = 113) of healthy subjects, athletes, and patients after ST-elevation myocardial infarction from 10 centers. Validation was done using manual measurements in end diastole and end systole as reference standard. Additionally, AVPD, peak emptying velocity, peak filling velocity, and atrial contraction was validated in 20 subjects, where time-resolved manual measurements were used as reference standard. Inter-observer variability was analyzed in 20 subjects. Results In end systole, the difference between the algorithm and the reference standard in the left ventricle was (mean ± SD) -0.6 ± 1.9 mm (R = 0.79), and −0.8 ± 2.1 mm (R = 0.88) in the right ventricle. Inter-observer variability in end systole was −0.6 ± 0.7 mm (R = 0.95), and −0.5 ± 1.4 mm (R = 0.95) for the left and right ventricle, respectively. Validation of peak emptying velocity, peak filling velocity, and atrial contraction yielded lower accuracy than the displacement measures. Conclusions The proposed algorithm show good agreement and low bias with the reference standard, and with an agreement in parity with inter-observer variability. Thus, it can be used as an automatic method of tracking and measuring AVPD in CMR. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0189-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felicia Seemann
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Numerical Analysis, Faculty of Engineering, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
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