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Goo HW, Park SH. Complimentary Cardiac Computed Tomography Ventricular Volumetry-Derived Metrics of Severity in Patients with Ebstein Anomaly: Comparison with Echocardiography-Based Severity Indices. Pediatr Cardiol 2024; 45:24-31. [PMID: 38012401 DOI: 10.1007/s00246-023-03342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
Detailed three-dimensional cardiac segmentations using cardiac computed tomography (CT) data is technically feasible in patients with Ebstein anomaly, but its complementary role has not been evaluated. This single-center, retrospective study was aimed to evaluate the complementary role of cardiac CT ventricular volumetry in evaluating the severity of Ebstein anomaly. Preoperative cardiac CT ventricular volumetry was performed in 21 children with Ebstein anomaly. CT-based ventricular functional measures were compared between Carpentier types, and between definitive surgical repair types. The Celermajer severity index measured with echocardiography was correlated with CT-based functional parameters. Total right ventricle (RV) and functional RV (fRV) volumes, fRV fraction, fRV/left ventricle (LV) volume ratio, and end-diastolic CT severity index demonstrated statistically significant differences between Carpentier type A/B and Carpentier type C/D (p < 0.05). The Celermajer severity index measured with echocardiography showed a high positive correlation with the end-diastolic CT severity index (R = 0.720, p < 0.002). There were no statistically significant differences in both echocardiography- and CT-based functional measures between patients with biventricular repair and patients with one-and-a-half or univentricular repair (p > 0.05). Compared with echocardiography, cardiac CT ventricular volumetry can provide the severity of Ebstein anomaly objectively and may be used in select patients when echocardiographic results are inconclusive or inconsistent.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Sang Hyub Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Monteagudo-Vela M, Tindale A, Monguió-Santín E, Reyes-Copa G, Panoulas V. Right ventricular failure: Current strategies and future development. Front Cardiovasc Med 2023; 10:998382. [PMID: 37187786 PMCID: PMC10175590 DOI: 10.3389/fcvm.2023.998382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Right heart failure can be defined as a clinical syndrome consisting of signs and symptoms of heart failure resulting from right ventricular dysfunction. Function is normally altered due to three mechanisms: (1) pressure overload (2) volume overload, or (3) a decrease in contractility due to ischaemia, cardiomyopathy or arrythmias. Diagnosis is based upon a combination of clinical assessment plus echocardiographic, laboratory and haemodynamic parameters, and clinical risk assessment. Treatment includes medical management, mechanical assist devices and transplantation if recovery is not observed. Distinct attention to special circumstances such as left ventricular assist device implantation should be sought. The future is moving towards new therapies, both pharmacological and device centered. Immediate diagnosis and management of RV failure, including mechanical circulatory support where needed, alongside a protocolized approach to weaning is important in successfully managing right ventricular failure.
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Affiliation(s)
- María Monteagudo-Vela
- Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Correspondence: María Monteagudo-Vela
| | - Alexander Tindale
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Emilio Monguió-Santín
- Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Reyes-Copa
- Cardiothoracic Surgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Zhang X, Xie G, Lu N, Zhu Y, Wei Z, Su S, Shi C, Yan F, Liu X, Qiu B, Fan Z. 3D self-gated cardiac cine imaging at 3 Tesla using stack-of-stars bSSFP with tiny golden angles and compressed sensing. Magn Reson Med 2018; 81:3234-3244. [PMID: 30474151 DOI: 10.1002/mrm.27612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop and evaluate an accelerated 3D self-gated cardiac cine imaging technique at 3 Tesla without the use of external electrocardiogram triggering or respiratory gating. METHODS A 3D stack-of-stars balanced steady-state free precession sequence with a tiny golden angle sampling scheme was developed to reduced eddy current effect-related artefacts at 3 Tesla. Respiratory and cardiac motion were derived from a central 5-point self-gating signal extraction approach. The data acquired around the end-expiration phases were then sorted into individual cardiac bins and used for reconstruction with compressed sensing. To evaluate the performance of the proposed method, image quality (1: the best; 4: the worst) was quantitatively compared using both the proposed method and the conventional 3D golden-angle self-gated method. Linear regression and Bland-Altman analysis were used to assess the functional measurements agreement between the proposed method and the routine 2D breath-hold multi-slice technique. RESULTS Compared to the conventional 3D golden-angle self-gated method, the proposed method yielded images with much less streaking artifact and higher myocardium edge sharpness (0.50 ± 0.06 vs. 0.45 ± 0.05, P = 0.004). The proposed method provided an inferior image quality score to the routine 2D technique (2.13 ± 0.35 vs. 1.38 ± 0.52, P = 0.063) but a superior one to the conventional self-gated method (2.13 ± 0.35 vs. 3.13 ± 0.64, P = 0.031). Left ventricular functional measurements between the proposed method and routine 2D technique were all well in agreement. CONCLUSION This study presents a novel self-gating approach to realize rapid 3D cardiac cine imaging at 3 Tesla.
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Affiliation(s)
- Xiaoyong Zhang
- Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, People's Republic of China.,MR Collaborations NE Asia, Siemens Healthcare, Shenzhen, People's Republic of China
| | - Guoxi Xie
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China.,Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Na Lu
- Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yanchun Zhu
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Zijun Wei
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Shi Su
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Caiyun Shi
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Fei Yan
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Xin Liu
- Paul C. Lauterber Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, People's Republic of China
| | - Bensheng Qiu
- Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, People's Republic of China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Departments of Medicine and Bioengineering, University of California, Los Angeles, California
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Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e578-e622. [DOI: 10.1161/cir.0000000000000560] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose:
The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
Methods:
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
Results:
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
Conclusions:
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
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Dynamic magnetic resonance imaging method based on golden-ratio cartesian sampling and compressed sensing. PLoS One 2018; 13:e0191569. [PMID: 29381709 PMCID: PMC5790254 DOI: 10.1371/journal.pone.0191569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022] Open
Abstract
Dynamic magnetic resonance imaging (DMRI) is used to noninvasively trace the movements of organs and the process of drug delivery. The results can provide quantitative or semiquantitative pathology-related parameters, thus giving DMRI great potential for clinical applications. However, conventional DMRI techniques suffer from low temporal resolution and long scan time owing to the limitations of the k-space sampling scheme and image reconstruction algorithm. In this paper, we propose a novel DMRI sampling scheme based on a golden-ratio Cartesian trajectory in combination with a compressed sensing reconstruction algorithm. The results of two simulation experiments, designed according to the two major DMRI techniques, showed that the proposed method can improve the temporal resolution and shorten the scan time and provide high-quality reconstructed images.
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Kawaji K, Patel MB, Cantrell CG, Tanaka A, Marino M, Tamura S, Wang H, Wang Y, Carroll TJ, Ota T, Patel AR. A fast, noniterative approach for accelerated high-temporal resolution cine-CMR using dynamically interleaved streak removal in the power-spectral encoded domain with low-pass filtering (DISPEL) and modulo-prime spokes (MoPS). Med Phys 2017; 44:3450-3463. [PMID: 28339110 DOI: 10.1002/mp.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To introduce a pair of accelerated non-Cartesian acquisition principles that when combined, exploit the periodicity of k-space acquisition, and thereby enable acquisition of high-temporal cine Cardiac Magnetic Resonance (CMR). METHODS The mathematical formulation of a noniterative, undersampled non-Cartesian cine acquisition and reconstruction is presented. First, a low-pass filtering step that exploits streaking artifact redundancy is provided (i.e., Dynamically Interleaved Streak removal in the Power-spectrum Encoded domain with Low-pass filtering [DISPEL]). Next, an effective radial acquisition for the DISPEL approach that exploits the property of prime numbers is described (i.e., Modulo-Prime Spoke [MoPS]). Both DISPEL and MoPS are examined using numerical simulation of a digital heart phantom to show that high-temporal cine-CMR is feasible without removing physiologic motion vs aperiodic interleaving using Golden Angles. The combined high-temporal cine approach is next examined in 11 healthy subjects for a time-volume curve assessment of left ventricular systolic and diastolic performance vs conventional Cartesian cine-CMR reference. RESULTS The DISPEL method was first shown using simulation under different streak cycles to allow separation of undersampled radial streaking artifacts from physiologic motion with a sufficiently frequent streak-cycle interval. Radial interleaving with MoPS is next shown to allow interleaves with pseudo-Golden-Angle variants, and be more compatible with DISPEL against irrational and nonperiodic rotation angles, including the Golden-Angle-derived rotations. In the in vivo data, the proposed method showed no statistical difference in the systolic performance, while diastolic parameters sensitive to the cine's temporal resolution were statistically significant (P < 0.05 vs Cartesian cine). CONCLUSIONS We demonstrate a high-temporal resolution cine-CMR using DISPEL and MoPS, whose streaking artifact was separated from physiologic motion.
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Affiliation(s)
- Keigo Kawaji
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Mita B Patel
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Akiko Tanaka
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Marco Marino
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Satoshi Tamura
- Department of Electrical, Electronic and Computer Engineering, Gifu University, Gifu City, Japan
| | | | - Yi Wang
- Departments of Biomedical Engineering and Radiology, Cornell University, New York, NY, USA
| | - Timothy J Carroll
- Department of Radiology, The University of Chicago, Chicago, IL, USA
| | - Takeyoshi Ota
- Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Amit R Patel
- Departments of Medicine and Radiology, The University of Chicago, Chicago, IL, USA
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Liu J, Feng L, Shen HW, Zhu C, Wang Y, Mukai K, Brooks GC, Ordovas K, Saloner D. Highly-accelerated self-gated free-breathing 3D cardiac cine MRI: validation in assessment of left ventricular function. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 30:337-346. [PMID: 28120280 DOI: 10.1007/s10334-017-0607-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This work presents a highly-accelerated, self-gated, free-breathing 3D cardiac cine MRI method for cardiac function assessment. MATERIALS AND METHODS A golden-ratio profile based variable-density, pseudo-random, Cartesian undersampling scheme was implemented for continuous 3D data acquisition. Respiratory self-gating was achieved by deriving motion signal from the acquired MRI data. A multi-coil compressed sensing technique was employed to reconstruct 4D images (3D+time). 3D cardiac cine imaging with self-gating was compared to bellows gating and the clinical standard breath-held 2D cine imaging for evaluation of self-gating accuracy, image quality, and cardiac function in eight volunteers. Reproducibility of 3D imaging was assessed. RESULTS Self-gated 3D imaging provided an image quality score of 3.4 ± 0.7 vs 4.0 ± 0 with the 2D method (p = 0.06). It determined left ventricular end-systolic volume as 42.4 ± 11.5 mL, end-diastolic volume as 111.1 ± 24.7 mL, and ejection fraction as 62.0 ± 3.1%, which were comparable to the 2D method, with bias ± 1.96 × SD of -0.8 ± 7.5 mL (p = 0.90), 2.6 ± 3.3 mL (p = 0.84) and 1.4 ± 6.4% (p = 0.45), respectively. CONCLUSION The proposed 3D cardiac cine imaging method enables reliable respiratory self-gating performance with good reproducibility, and provides comparable image quality and functional measurements to 2D imaging, suggesting that self-gated, free-breathing 3D cardiac cine MRI framework is promising for improved patient comfort and cardiac MRI scan efficiency.
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Affiliation(s)
- Jing Liu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.
| | - Li Feng
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Hsin-Wei Shen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Yan Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - Kanae Mukai
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gabriel C Brooks
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ordovas
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94107, USA.,Radiology Service, VA Medical Center, San Francisco, CA, USA
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