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Khanna S, Li C, Amarasekera AT, Bhat A, Chen HHL, Gan GCH, Tan TC. Echocardiographic parameters of cardiac structure and function in the diagnosis of acute myocarditis in adult patients: A systematic review and meta-analysis. Echocardiography 2024; 41:e15760. [PMID: 38345413 DOI: 10.1111/echo.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 01/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) plays a key role in the initial work-up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. METHODS A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta-analyzed using a random-effects model for effect size, and assessed through standardized mean difference (SMD). RESULTS Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end-diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) (p ≤ .01 for all). LV-GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46-1.98|). Two studies also demonstrated that impairment in LV-GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. CONCLUSIONS LV-GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. HIGHTLIGHTS What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies. Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end-diastolic diameter can differentiate between myocarditis patients and healthy controls. LV-GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls. Routine assessment of LV-GLS may serve as an important diagnostic tool in the acute care setting.
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Affiliation(s)
- Shaun Khanna
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Cindy Li
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Anjalee T Amarasekera
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia
- Westmead Hospital, Faculty of Cardiology, University of Sydney, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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2
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Pittman LA, Whittaker P, Milne ML, Chung CS. Collagenase treatment reduces the anisotropy of ultrasonic backscatter in rat myocardium by reducing collagen crosslinks. Physiol Rep 2023; 11:e15849. [PMID: 37960992 PMCID: PMC10643982 DOI: 10.14814/phy2.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Dysregulation of collagen deposition, degradation, and crosslinking in the heart occur in response to increased physiological stress. Collagen content has been associated with ultrasonic backscatter (brightness), and we have shown that the anisotropy of backscatter can be used to measure myofiber alignment, that is, variation in the brightness of a left ventricular short-axis ultrasound. This study investigated collagen's role in anisotropy of ultrasonic backscatter; female Sprague-Dawley rat hearts were treated with a collagenase-containing solution, for either 10 or 30 min, or control solution for 30 min. Serial ultrasound images were acquired at 2.5-min intervals throughout collagenase treatment. Ultrasonic backscatter was assessed from anterior and posterior walls, where collagen fibrils are predominately aligned perpendicular to the angle of insonification, and the lateral and septal walls, where collagen is predominately aligned parallel to the angle of insonification. Collagenase digestion reduced backscatter anisotropy within the myocardium. Collagen remains present in the myocardium throughout collagenase treatment, but crosslinking is altered within 10 min. These data suggest that crosslinking of collagen modulates the anisotropy of ultrasonic backscatter. An Anisotropy Index, derived from differences in backscatter from parallel and perpendicularly aligned fibers, may provide a noninvasive index to monitor the progression and state of myocardial fibrosis.
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Affiliation(s)
| | | | - Michelle L. Milne
- Department of PhysicsSt Mary's College of MarylandSt Mary's CityMarylandUSA
| | - Charles S. Chung
- Department of PhysiologyWayne State UniversityDetroitMichiganUSA
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3
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Chin SH, Allen E, Brack KE, Ng GA. Autonomic neuro-cardiac profile of electrical, structural and neuronal remodeling in myocardial infarction-induced heart failure. JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY PLUS 2023; 5:100044. [PMID: 37745157 PMCID: PMC10512199 DOI: 10.1016/j.jmccpl.2023.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Aims Heart failure is a clinical syndrome typified by abnormal autonomic tone, impaired ventricular function, and increased arrhythmic vulnerability. This study aims to examine electrophysiological, structural and neuronal remodeling following myocardial infarction in a rabbit heart failure model to establish its neuro-cardiac profile. Methods and results Weight-matched adult male New Zealand White rabbits (3.2 ± 0.1 kg, n = 25) were randomized to have coronary ligation surgeries (HF group, n = 13) or sham procedures (SHM group, n = 12). Transthoracic echocardiography was performed six weeks post-operatively. On week 8, dual-innervated Langendorff-perfused heart preparations were set up for terminal experiments. Seventeen hearts (HF group, n = 10) underwent ex-vivo cardiac MRI. Twenty-two hearts (HF group, n = 7) were examined histologically. Electrical remodeling and abnormal autonomic profile were evident in HF rabbits with exaggerated sympathetic and attenuated vagal effect on ventricular fibrillation threshold, ventricular refractoriness and restitution curves, in addition to increased spatial restitution dispersion. Histologically, there was significant neuronal enlargement at the heart hila and conus arteriosus in HF. Structural remodeling was characterized by quantifiable myocardial scarring, enlarged left ventricles, altered ventricular geometry and impaired contractility. Conclusion In an infarct-induced rabbit heart failure model, extensive structural, neuronal and electrophysiological remodeling in conjunction with abnormal autonomic profile provide substrates for ventricular arrhythmias.
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Affiliation(s)
- Shui Hao Chin
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Emily Allen
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
| | - Kieran E. Brack
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
| | - G. André Ng
- Cardiology group, Department of Cardiovascular Sciences, University of Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK
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4
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Lima MSM, Dalçóquio TF, Abduch MCD, Tsutsui JM, Mathias W, Nicolau JC. Influence of Physical Training after a Myocardial Infarction on Left Ventricular Contraction Mechanics. Arq Bras Cardiol 2023; 120:e20220185. [PMID: 37098984 PMCID: PMC10263431 DOI: 10.36660/abc.20220185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/22/2022] [Accepted: 01/11/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Exercise plays a positive role in the course of the ischemic heart disease, enhancing functional capacity and preventing ventricular remodeling. OBJECTIVE To investigate the impact of exercise on left ventricular (LV) contraction mechanics after an uncomplicated acute myocardial infarction (AMI). METHODS A total of 53 patients was included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual recommendations on physical exercise after AMI. All patients underwent cardiopulmonary stress testing and a speckle tracking echocardiography to measure several parameters of LV contraction mechanics at one month and five months after AMI. A p value < 0.05 was considered statistically significant for the comparisons of the variables. RESULTS No significant difference were found in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation in the TRAINING group in comparison to the CONTROL group (5.9±2.3 vs. 7.5±2.9o; p=0.03), and in the basal rotational velocity (53.6±18.4 vs.68.8±22.1 º/s; p=0.01), twist velocity (127.4±32.2 vs. 149.9±35.9 º/s; p=0.02) and torsion (2.4±0.4 vs. 2.8±0.8 º/cm; p=0.02). CONCLUSIONS Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, consisting of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular "torsion reserve" in this population.
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Affiliation(s)
- Márcio Silva Miguel Lima
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Talia Falcão Dalçóquio
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Maria Cristina Donadio Abduch
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Jeane Mike Tsutsui
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Wilson Mathias
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Carlos Nicolau
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
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Wilson AJ, Sands GB, LeGrice IJ, Young AA, Ennis DB. Myocardial mesostructure and mesofunction. Am J Physiol Heart Circ Physiol 2022; 323:H257-H275. [PMID: 35657613 PMCID: PMC9273275 DOI: 10.1152/ajpheart.00059.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
The complex and highly organized structural arrangement of some five billion cardiomyocytes directs the coordinated electrical activity and mechanical contraction of the human heart. The characteristic transmural change in cardiomyocyte orientation underlies base-to-apex shortening, circumferential shortening, and left ventricular torsion during contraction. Individual cardiomyocytes shorten ∼15% and increase in diameter ∼8%. Remarkably, however, the left ventricular wall thickens by up to 30-40%. To accommodate this, the myocardium must undergo significant structural rearrangement during contraction. At the mesoscale, collections of cardiomyocytes are organized into sheetlets, and sheetlet shear is the fundamental mechanism of rearrangement that produces wall thickening. Herein, we review the histological and physiological studies of myocardial mesostructure that have established the sheetlet shear model of wall thickening. Recent developments in tissue clearing techniques allow for imaging of whole hearts at the cellular scale, whereas magnetic resonance imaging (MRI) and computed tomography (CT) can image the myocardium at the mesoscale (100 µm to 1 mm) to resolve cardiomyocyte orientation and organization. Through histology, cardiac diffusion tensor imaging (DTI), and other modalities, mesostructural sheetlets have been confirmed in both animal and human hearts. Recent in vivo cardiac DTI methods have measured reorientation of sheetlets during the cardiac cycle. We also examine the role of pathological cardiac remodeling on sheetlet organization and reorientation, and the impact this has on ventricular function and dysfunction. We also review the unresolved mesostructural questions and challenges that may direct future work in the field.
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Affiliation(s)
- Alexander J Wilson
- Department of Radiology, Stanford University, Stanford, California
- Stanford Cardiovascular Institute, Stanford University, Stanford, California
| | - Gregory B Sands
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ian J LeGrice
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, California
- Veterans Administration Palo Alto Health Care System, Palo Alto, California
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Impact of atrial septal defect device size on biventricular global and regional function: a two-dimensional strain echocardiographic study. Cardiol Young 2022; 32:746-754. [PMID: 34348814 DOI: 10.1017/s1047951121002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In this study, we assessed the acute changes in biventricular longitudinal strain after atrial septal defect transcatheter closure and its relation to the device size. METHODS Hundred atrial septal defect patients and 40 age-matched controls were included. Echocardiography and strain study were performed at baseline and 24 hours and 1 month after the intervention. The study group was divided into two subgroups; group 1: smaller devices were used (mean device size = 1.61 ± 0.05 cm, n = 74) and group 2: larger devices were used (mean device size = 2.95 ± 0.07 cm, n = 26). RESULTS At baseline, there was a significant difference between the study group and controls as regards right ventricular global longitudinal strain with significant hyperkinetic apex (p = 0.033, p = 0.020, respectively). There was a significant immediate reduction in right ventricular global longitudinal strain (from -24.43 ± 0.49% to -21.62 ± 0.47%, p < 0.001), which showed insignificant improvement after 1-month follow-up. While only left ventricular global longitudinal strain increased after 1 month. Within 24 hours of device closure, all the basal- and mid-lateral segments strains and apical right ventricular strains showed a significant reduction. There was a significant negative correlation between the indexed large device size and an immediate change in the right ventricular global longitudinal strain (r = -0.425, p = 0.034). CONCLUSION Significant right ventricular global longitudinal strain reduction starts as early as 24 hours after transcatheter closure, irrespective of the device size used. The rapid impact of closure was mainly on the biventricular basal and lateral segments and right ventricular apical ones, especially with the large sized atrial septal defect.
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7
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Lee S, Lee M, Hor KN. The role of imaging in characterizing the cardiac natural history of Duchenne muscular dystrophy. Pediatr Pulmonol 2021; 56:766-781. [PMID: 33651923 DOI: 10.1002/ppul.25227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 01/11/2023]
Abstract
Duchene muscular dystrophy (DMD) is a rare but devastating disease resulting in progressive loss of ambulation, respiratory failure, DMD-associated cardiomyopathy (DMD-CM), and premature death. The use of corticosteroids and supportive respiratory care has improved outcomes, such that DMD-CM is now the leading cause of death. Historically, most programs have focused on skeletal myopathy with less attention to the cardiac phenotype. This omission is rather astonishing since patients with DMD possess an absolute genetic risk of developing cardiomyopathy. Unfortunately, heart failure signs and symptoms are vague due to skeletal muscle myopathy leading to limited ambulation. Traditional assessment of cardiac symptoms by the New York Heart Association American College of Cardiology/American Heart Association Staging (ACC/AHA) classification is of limited utility, even in advanced stages. Echocardiographic assessment can detect cardiac dysfunction late in the disease course, but this has proven to be a poor surrogate marker of early cardiovascular disease and an inadequate predictor of DMD-CM. Indeed, one explanation for the paucity of cardiac therapeutic trials for DMD-CM has been the lack of a suitable end-point. Improved outcomes require a better proactive treatment strategy; however, the barrier to treatment is the lack of a sensitive and specific tool to assess the efficacy of treatment. The use of cardiac imaging has evolved from echocardiography to cardiac magnetic resonance imaging to assess cardiac performance. The purpose of this article is to review the role of cardiac imaging in characterizing the cardiac natural history of DMD-CM, highlighting the prognostic implications and an outlook on how this field might evolve in the future.
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Affiliation(s)
- Simon Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Marc Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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Alkhateeb A, Roushdy A, Hasan-Ali H, Kishk YT, Hassan AK. Immediate and short-term biventricular function assessment post-atrial septal defect surgical versus device closure: A comparative two-dimensional speckle tracking study. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Alkhateeb A, Roushdy A, Hasan-Ali H, Kishk YT, Hassan AKM. The changes in biventricular remodelling and function after atrial septal defect device closure and its relation to age of closure. Egypt Heart J 2020; 72:85. [PMID: 33296065 PMCID: PMC7726070 DOI: 10.1186/s43044-020-00120-x] [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: 08/11/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background The trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions. Whether the transcatheter closure of ASD at early childhood or at adulthood age would affect the improvement in biventricular dimensions and functions remains an area of active research. Results This prospective observational study enrolled 70 subjects (50 ASD cases and 20 control subjects). Tissue Doppler imaging (TDI) and strain (S) were performed for the control group and ASD patients at baseline and at 24 h and 1 month after ASD device closure. The total ASD group was subdivided into two subgroups: group-1—children and adolescent with ASD, who underwent transcatheter closure at age ≤ 19 years; group-2—adult who underwent ASD device closure at age > 19 years old. The right and left ventricular global longitudinal systolic strain (RV/LV-GLS) and RV free wall longitudinal strain (RV free wall LS) showed a significant decline after 24 h of device closure (RVGLS-P = 0.001, LVGLS-P = 0.048, RV free wall LS-P < 0.001). However, after a 1-month follow-up, the LVGLS increased in comparison with 24 h changes after device closure (P = 0.038). The baseline mean value of RV free wall LS of G2 was significantly lower than G1 value (P < 0.001). There was no statistically significant difference between the 2 age subgroups regarding biventricular GLS and RV free wall LS changes after device closure. The changes in LV diastolic function immediately and after 1 month of device closure showed a statistically significant change in e′ and its delta change value in group-2 in comparison with its baseline values and to group-1 delta changes (P = 0.002, P = 0.011, P = 0.019, respectively). Conclusion The ASD transcatheter closure reduced biventricular global and RV free wall longitudinal systolic strain within 1 day of intervention and was associated with a short-term improvement in the LV-GLSS after a 1-month duration. The progressive increase in LV preload results in its strain growth and reduction in diastolic function after transcatheter ASD closure. The older age at the time of ASD device closure was associated with a significant decrease in the RV free wall LS and septal e′ velocity towards abnormality.
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Affiliation(s)
- Areej Alkhateeb
- Cardiology Division of Internal Medicine Department, South Valley University Hospital, Qena, 83523, Egypt. .,King's College London, London, UK. .,Congenital and Structural Heart Disease Unit, Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
| | - Alaa Roushdy
- Congenital and Structural Heart Disease Unit, Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt
| | - Hosam Hasan-Ali
- Department of Cardiology, Assiut University Hospitals, Assiut, Egypt
| | - Yehia Taha Kishk
- Department of Cardiology, Assiut University Hospitals, Assiut, Egypt
| | - Ayman K M Hassan
- Department of Cardiology, Assiut University Hospitals, Assiut, Egypt
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Beyhoff N, Lohr D, Thiele A, Foryst-Ludwig A, Klopfleisch R, Schreiber LM, Kintscher U. Myocardial Infarction After High-Dose Catecholamine Application-A Case Report From an Experimental Imaging Study. Front Cardiovasc Med 2020; 7:580296. [PMID: 33330644 PMCID: PMC7717942 DOI: 10.3389/fcvm.2020.580296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
Although heart failure following myocardial infarction (MI) represents a major health burden, underlying microstructural and functional changes remain incompletely understood. Here, we report on a case of unexpected MI after treatment with the catecholamine isoproterenol in an experimental imaging study in mice using different state-of-the-art imaging modalities. The decline in cardiac function was documented by ultrahigh-frequency echocardiography and speckle-tracking analyses. Myocardial microstructure was studied ex vivo at a spatial resolution of 100 × 100 × 100 μm3 using diffusion tensor magnetic resonance imaging (DT-MRI) and histopathologic analyses. Two weeks after ISO treatment, the animal showed an apical aneurysm accompanied by reduced radial strain in corresponding segments and impaired global systolic function. DT-MRI revealed a loss of contractile fiber tracts together with a disarray of remaining fibers as corresponding microstructural correlates. This preclinical case report provides valuable insights into pathophysiology and morphologic–functional relations of heart failure following MI using emerging imaging technologies.
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Affiliation(s)
- Niklas Beyhoff
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - David Lohr
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Arne Thiele
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Anna Foryst-Ludwig
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Department of Veterinary Pathology, College of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Laura M Schreiber
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Kintscher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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11
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Nagata Y, Iwataki M, Nabeshima Y, Hei S, Onoue T, Hayashi A, Otani K, Tsuda Y, Araki M, Kim DH, Song JK, Hayashida A, Toki M, Yuasa T, Mizukami N, Nishimura Y, Levine RA, Otsuji Y. Potential mechanism of left ventricular spherical remodeling: association of mitral valve complex-myocardium longitudinal tissue remodeling mismatch. Am J Physiol Heart Circ Physiol 2020; 319:H694-H704. [PMID: 32795182 DOI: 10.1152/ajpheart.00279.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since mitral valve (MV) complex (MVC) longitudinally bridges left ventricular (LV) base end and its middle, insufficient MVC longitudinal tissue length (TL) elongation relative to whole LV myocardial longitudinal TL elongation could limit LV-base-longitudinal-TL elongation, leading to predominant LV-base-transverse-TL elongation, constituting LV spherical remodeling. In 30 patients with dilated cardiomyopathy (DCM), 30 with aortic regurgitation (AR), and 30 controls, LV sphericity, LV-apex- or base-transverse- and longitudinal-TL, MVC-longitudinal-TL, and whole-LV-longitudinal-TL were measured by three-dimensional (3D) echocardiography. Ratio of each measure versus mean normal value (i.e., LV-apex-transverse-TL ratio) was considered to express the directional and regional tissue elongation. [LV-base-longitudinal-TL ratio/global-LV-TL ratio] and [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] were obtained as the degree of LV-base-longitudinal-TL or MVC-longitudinal-TL elongation relative to the whole LV elongation. LV-apex-transverse-, LV-apex-longitudinal-, and LV-base-transverse-TL ratios were significantly increased (1.27 to 1.42, P < 0.01) in both DCM and AR, while the LV-base-longitudinal-TL ratio was not increased in DCM [1.04 ± 0.19, not significant (ns)] and only modestly increased in AR (1.12 ± 0.21, P < 0.01). Whole-LV-longitudinal-TL ratio was significantly increased in both DCM and AR (1.22 ± 0.18 and 1.20 ± 0.16, P < 0.01), while MVC-longitudinal-TL ratio was not or only modestly increased in both groups (1.07 ± 0.15, ns, and 1.12 ± 0.17, P = 0.02, respectively). Multivariable analysis revealed that LV sphericity was independently related to a reduced [LV-base-longitudinal-TL ratio/global-LV-TL ratio] (standard β = -0.42, P < 0.01), which was further related to a reduced [MVC-longitudinal-TL ratio/whole-LV-longitudinal-TL ratio] (standard β = 0.72, P < 0.01). These are consistent with the hypothesis that relatively less MVC-longitudinal-TL elongation in the process of primary LV myocardial tissue elongation may limit LV-base-longitudinal-TL elongation, contributing to LV spherical remodeling.NEW & NOTEWORTHY Left ventricular (LV) spherical remodeling is associated with poor prognosis and less-effective cardiac performance, which commonly develops in dilated cardiomyopathy. However, its mechanism remains unclear. We hypothesized and subsequently clarified that less mitral valve complex (MVC) tissue longitudinal elongation relative to whole LV myocardial tissue longitudinal elongation is related to disproportionately less LV base longitudinal versus transverse myocardial tissue elongation, constituting spherical remodeling. This study suggests modification of MVC tissue elongation could be potential therapeutic targets.
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Affiliation(s)
- Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.,Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Soshi Hei
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Atsushi Hayashi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Kyoko Otani
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yuki Tsuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaru Araki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Dae-Hee Kim
- Department of Echocardiography, Asan Medical Center, Seoul, Korea
| | - Jae-Kwan Song
- Department of Echocardiography, Asan Medical Center, Seoul, Korea
| | - Akihiro Hayashida
- Department of Cardiology, the Sakakibara Heart Institution of Okayama, Okayama, Japan
| | - Misako Toki
- Department of Clinical Laboratory, the Sakakibara Heart Institution of Okayama, Okayama, Japan
| | - Toshinori Yuasa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medicine and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Naoko Mizukami
- Department of Clinical Laboratory, Graduate School of Medicine and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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12
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Niu P, Li L, Yin Z, Du J, Tan W, Huo Y. Speckle tracking echocardiography could detect the difference of pressure overload-induced myocardial remodelling between young and adult rats. J R Soc Interface 2020; 17:20190808. [PMID: 32093537 DOI: 10.1098/rsif.2019.0808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The assessment by speckle tracking echocardiography (STE) provides useful information on regional and global left ventricular (LV) functions. The aim of the study is to investigate if STE-based strain analysis could detect the difference of pressure overload-induced myocardial remodelling between young and adult rats. Physiological, haemodynamic, histological measurements were performed post-operatively in young and adult rats with transverse aortic constriction (TAC) as well as the age-matched shams. Two-way ANOVA was used to detect the statistical difference of various measured parameters. Pressure overload decreased the ejection fraction, fractional shortening, dp/dtmax and |dp/dtmin|, but increased the LV end-diastolic (ED) pressure in adult rat hearts for nine weeks after TAC operation than those in young rat hearts. Pressure overload also resulted in different changes of peak strain and strain rate in the free wall, but similar changes in the interventricular septum of young and adult rat hearts. The changes in myocardial remodelling were confirmed by the histological analysis including the increased apoptosis rate of myocytes and collagen area ratio in the free wall of adult rat hearts of LV hypertrophy when compared with the young. Pressure overload alters myocardial components in different degrees between young and adult animals. STE-based strain analysis could detect the subtle difference of pressure overload-induced myocardial remodelling between young and adult rats.
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Affiliation(s)
- Pei Niu
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Li Li
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Zhongjie Yin
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China
| | - Jie Du
- Beijing Anzhen Hospital Capital Medical University, Beijing, People's Republic of China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, People's Republic of China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, People's Republic of China.,Shenzhen Graduate School, Peking University, Shenzhen, Guangdong, People's Republic of China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, People's Republic of China.,Institute of Mechanobiology and Medical Engineering, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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13
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Milne ML, Schick BM, Alkhazal T, Chung CS. Myocardial Fiber Mapping of Rat Hearts, Using Apparent Backscatter, with Histologic Validation. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2075-2085. [PMID: 31155403 PMCID: PMC6615029 DOI: 10.1016/j.ultrasmedbio.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 06/09/2023]
Abstract
Myocardial fiber architecture is a physiologically important regulator of ejection fraction, strain and pressure development. Apparent ultrasonic backscatter has been shown to be a useful method for recreating the myocardial fiber architecture in human-sized sheep hearts because of the dependence of its amplitude on the relative orientation of a myofiber to the angle of ultrasonic insonification. Thus, the anisotropy of the backscatter signal is linked to and provides information about the fiber orientation. In this study, we sought to determine whether apparent backscatter could be used to measure myofiber orientation in rodent hearts. Fixed adult-rat hearts were imaged intact, and both a transmural cylindrical core and transmural wedge of the left ventricular free wall were imaged. Cylindrical core samples confirmed that backscatter anisotropy could be measured in rat hearts. Ultrasound and histologic analysis of transmural myocardial wedge samples confirmed that the apparent backscatter could be reproducibly mapped to fiber orientation (angle of the fiber relative to the direction of insonification). These data provided a quantitative relationship between the apparent backscatter and fiber angle that was applied to whole-heart images. Myocardial fiber architecture was successfully measured in rat hearts. Quantifying myocardial fiber architecture, using apparent backscatter, provides a number of advantages, including its scalable use from rodents to man, its rapid low-cost acquisition and minimal contraindications. The method outlined in this study provides a method for investigators to begin detailed assessments of how the myocardial fiber architecture changes in preclinical disease models, which can be immediately translated into the clinic.
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Affiliation(s)
- Michelle L Milne
- Department of Physics, St. Mary's College of Maryland, St. Mary's City, MD, USA
| | - Brianna M Schick
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - Thamer Alkhazal
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - Charles S Chung
- Department of Physiology, Wayne State University, Detroit, MI, USA.
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14
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Beyhoff N, Lohr D, Foryst-Ludwig A, Klopfleisch R, Brix S, Grune J, Thiele A, Erfinanda L, Tabuchi A, Kuebler WM, Pieske B, Schreiber LM, Kintscher U. Characterization of Myocardial Microstructure and Function in an Experimental Model of Isolated Subendocardial Damage. Hypertension 2019; 74:295-304. [PMID: 31291149 PMCID: PMC6635061 DOI: 10.1161/hypertensionaha.119.12956] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Subendocardial damage is among the first cardiac manifestations of hypertension and is already present in asymptomatic disease states. Accordingly, markers of subendocardial impairment may facilitate early detection of cardiac damages and risk stratification under these conditions. This study aimed to investigate the impact of subendocardial damage on myocardial microstructure and function to elucidate early pathophysiologic processes and to identify corresponding diagnostic measures. Mice (n=38) were injected with isoproterenol to induce isolated subendocardial scarring or saline as corresponding control. Cardiac function and myocardial deformation were determined by high-frequency echocardiography. The cardiac stress response was assessed in a graded exercise test and during dobutamine stress echocardiography. Myocardial microstructure was studied ex vivo by 7 T diffusion tensor magnetic resonance imaging at a spatial resolution of 100×100×100 µm 3 . Results were correlated with histology and biomarker expression. Subendocardial fibrosis was accompanied by diastolic dysfunction, impaired longitudinal deformation (global peak longitudinal strain [LS]: -12.5±0.5% versus -15.6±0.5%; P<0.001) and elevated biomarker expression (ANP [atrial natriuretic peptide], Galectin-3, and ST2). Systolic function and cardiac stress response remained preserved. Diffusion tensor magnetic resonance imaging revealed a left-shift in helix angle towards lower values in isoproterenol-treated animals, which was mainly determined by subepicardial myofibers (mean helix angle: 2.2±0.8° versus 5.9±1.0°; P<0.01). Longitudinal strain and subepicardial helix angle were highly predictive for subendocardial fibrosis (sensitivity, 82%-92% and specificity, 89%-90%). The results indicate that circumscribed subendocardial damage alone can cause several hallmarks observed in cardiovascular high-risk patients. Microstructural remodeling under these conditions involves also remote regions, and corresponding changes in longitudinal strain and helix angle might serve as diagnostic markers.
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Affiliation(s)
- Niklas Beyhoff
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.)
| | - David Lohr
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Germany (D.L., L.M.S.)
| | - Anna Foryst-Ludwig
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.)
| | - Robert Klopfleisch
- Department of Veterinary Pathology, College of Veterinary Medicine, Freie Universität Berlin, Germany (R.K.)
| | - Sarah Brix
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.)
| | - Jana Grune
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.).,Charité-Universitaätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany (J.G., L.E., Arata Tabuchi, W.M.K.)
| | - Arne Thiele
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.)
| | - Lasti Erfinanda
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.).,Charité-Universitaätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany (J.G., L.E., Arata Tabuchi, W.M.K.)
| | - Arata Tabuchi
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.).,Charité-Universitaätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany (J.G., L.E., Arata Tabuchi, W.M.K.)
| | - Wolfgang M Kuebler
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.).,Charité-Universitaätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Physiology, Berlin, Germany (J.G., L.E., Arata Tabuchi, W.M.K.)
| | - Burkert Pieske
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.).,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin and Deutsches Herzzentrum Berlin (DHZB), Department of Cardiology, Berlin, Germany (B.P.)
| | - Laura M Schreiber
- Chair of Cellular and Molecular Imaging, Comprehensive Heart Failure Center (CHFC), University Hospital Wuerzburg, Germany (D.L., L.M.S.)
| | - Ulrich Kintscher
- From the Charité-Universitätsmedizin Berlin, corporate member of Freie Universitaät Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Institute of Pharmacology, Center for Cardiovascular Research, Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, U.K.).,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany (N.B., A.F.-L., S.B., J.G., Arne Thiele, L.E., Arata Tabuchi, W.M.K., B.P., U.K.)
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15
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How myofilament strain and strain rate lead the dance of the cardiac cycle. Arch Biochem Biophys 2019; 664:62-67. [PMID: 30710504 PMCID: PMC6589344 DOI: 10.1016/j.abb.2019.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Movement of the myocardium can modify organ-level cardiac function and its molecular (crossbridge) mechanisms. This motion, which is defined by myocardial strain and strain rate (muscle shortening, lengthening, and the speed of these movements), occurs throughout the cardiac cycle, including during isovolumic periods. This review highlights how the left ventricular myocardium moves throughout the cardiac cycle, how muscle mechanics experiments provide insight into the regulation of forces used to move blood in and out of the left ventricle, and its impact on (and regulation by) crossbridge and sarcomere kinetics. We specifically highlight how muscle mechanics experiments explain how myocardial relaxation is accelerated by lengthening (strain rate) during late systole and isovolumic relaxation, a lengthening which has been measured in human hearts. Advancing and refining both in vivo measurement and ex vivo protocols with physiologic strain and strain rates could reveal important insights into molecular (crossbridge) kinetics. These advances could provide an improvement in both diagnosis and precise treatment of cardiac dysfunction.
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16
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Razak A, Said Mohd M, Hajri A, Shetty KR, Nayak K. Left Ventricular Torsion Deformation in Atrial Septal Defect Patients Undergoing Transcatheter Device Closure. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Gianturco L, Bodini B, Gianturco V, Lippo G, Solbiati A, Turiel M. Left ventricular longitudinal strain in soccer referees. Oncotarget 2018; 8:39766-39773. [PMID: 28199991 PMCID: PMC5503651 DOI: 10.18632/oncotarget.15242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/31/2016] [Indexed: 01/20/2023] Open
Abstract
Along the years, the analysis of soccer referees perfomance has interested the experts and we can find several types of studies in literature using in particular cardiac imaging. The aim of this retrospective study was to observe relationship between VO2max uptake and some conventional and not-conventional echocardiographic parameters. In order to perform this evaluation, we have enrolled 20 referees, belonging to Italian Soccer Referees' Association and we have investigated cardiovascular profile of them. We found a strong direct relationship between VO2max and global longitudinal strain of left ventricle assessed by means of speckle tracking echocardiographic analysis (R2=0.8464). The most common classic echocardiographic indexes have showed mild relations (respectively, VO2max vs EF: R2=0.4444; VO2max vs LV indexed mass: R2=0.2268). Therefore, our study suggests that longitudinal strain could be proposed as a specific echocardiographic parameter to evaluate the soccer referees performance.
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Affiliation(s)
- Luigi Gianturco
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Bruno Bodini
- IRCCS Galeazzi Orthopedic Institute, Rehabilitation Unit, Milan, Italy
| | | | - Giuseppina Lippo
- Department of Occupational and Environmental Health University of Milan, IRCCS Fondazione Policlinico Mangiagalli Regina Elena, Milan, Italy
| | - Agnese Solbiati
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Maurizio Turiel
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
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18
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Salem JE, Nguyen LS, Hammoudi N, Preud'homme G, Hulot JS, Leban M, Funck-Brentano C, Touraine P, Isnard R, Bachelot A. Complex Association of Sex Hormones on Left Ventricular Systolic Function: Insight into Sexual Dimorphism. J Am Soc Echocardiogr 2017; 31:231-240.e1. [PMID: 29246515 DOI: 10.1016/j.echo.2017.10.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Normal values of left ventricular ejection fraction (LVEF) and absolute values of global longitudinal strain (GLS) are lower in men than in women. Data concerning the association of sex hormone levels on these left ventricular systolic function surrogates are scarce. The aim of this study was to determine the association of sex hormones with systolic left ventricular function in healthy subjects and patients with congenital adrenal hyperplasia (CAH) as a model of testosterone dysregulation. METHODS Eighty-four adult patients with CAH (58 women; median age, 27 years; interquartile range, 23-36 years) and 84 healthy subjects matched for sex and age were prospectively included. Circulating concentrations of sex hormones were measured within 48 hours of echocardiography with assessment of LVEF and left ventricular longitudinal, radial, and circumferential strain. RESULTS LVEF and GLS were higher in healthy women than in healthy men (63.9 ± 4.2% vs 60.9 ± 5.1% [P < .05] and 20.0 ± 1.9% vs 17.9 ± 2.4% [P < .001], respectively), while there was no difference in LVEF or GLS between women and men with CAH (63.9 ± 4.5% vs 63.0 ± 4.6% [P = NS] and 19.4 ± 2.2% vs 18.3 ± 1.8% [P = NS], respectively). Bioavailable testosterone levels were higher in women with CAH than in female control subjects (0.08 ng/mL [interquartile range, 0.04-0.14 ng/mL] vs 0.16 ng/mL [interquartile range, 0.04-0.3 ng/mL], P < .001) and lower in men with CAH than in male control subjects (2.3 ng/mL [interquartile range, 1.3-3 ng/mL] vs 2.9 ng/mL [interquartile range, 2.5-3.4 ng/mL], P < .05). In men, LVEF and GLS were negatively correlated with bioavailable testosterone levels (r = -0.3, P ≤ .05, and r = -0.45, P < .01, respectively), while midventricular radial strain was positively correlated with bioavailable testosterone level (r = 0.38, P < .05). The absolute value of circumferential strain was positively correlated with follicle-stimulating hormone (r = 0.65, P < .0001). CONCLUSIONS These data support that the existence of sex dimorphism concerning left ventricular systolic cardiac function is significantly associated with testosterone levels.
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Affiliation(s)
- Joe-Elie Salem
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France.
| | - Lee S Nguyen
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
| | - Nadjib Hammoudi
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
| | - Gisèle Preud'homme
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
| | - Jean-Sebastien Hulot
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
| | - Monique Leban
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, Department of Endocrinology and Reproductive Medecine, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance et Centre des Pathologies Gynécologiques Rares, and CIC-1421, Paris, France
| | - Christian Funck-Brentano
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and CIC-1421; INSERM, CIC-1421 and UMR ICAN 1166; Sorbonne Universités, Paris, France; UPMC Univ Paris 06, Faculty of Medicine
| | - Philippe Touraine
- AP-HP, Pitié-Salpêtrière Hospital, IE3M, Department of Endocrinology and Reproductive Medecine, and Centre de Référence des Maladies Endocriniennes Rares de la Croissance et Centre des Pathologies Gynécologiques Rares, and CIC-1421, Paris, France
| | - Richard Isnard
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
| | - Anne Bachelot
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Pitié-Salpêtrière Hospital, Department of Cardiology, Echocardiography Unit, Paris, France; UMR ICAN 1166, Paris, France
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Jouk PS, Truong BL, Michalowicz G, Usson Y. Postnatal myocardium remodelling generates inhomogeneity in the architecture of the ventricular mass. Surg Radiol Anat 2017; 40:75-83. [PMID: 29181565 PMCID: PMC5820407 DOI: 10.1007/s00276-017-1945-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
Background The 3D architecture of the ventricular mass is poorly known, although in vivo imaging techniques show the physiological inhomogeneity of ventricular walls mechanics. Polarized light imaging makes it possible to quantitatively analyse the myosin filament orientation. Aims In this paper, we focus on the study the 3D architecture and regional isotropy of myocardial cells. Methods Twenty normal human hearts, 10 from the perinatal period and 10 from the post-neonatal period were studied by polarized light microscopy. In each voxel of the ventricular mass (90 × 90 × 500 µm) the principal orientation segment was automatically and unambiguously extracted as well as a regional isotropy index (regional orientation tensor of the voxel neighbourhood). Results During the first months of postnatal age, the median regional isotropy values decreased in the ventricular mesh. This global decrease was not homogeneous across the ventricular walls. From the perinatal to the neonatal period, this decrease was more marked in the inner two-third of the lateral left ventricular wall and in the right part of the interventricular septum. There was a progressive post-neonatal appearance of a particularly inhomogeneous secondary arrangement of myocardial cells with alternation of thick low-RI and thin high-RI areas. Conclusions This study has shown a postnatal change in ventricular myocardial architecture, which became more inhomogeneous. The cell rearrangements responsible for the inhomogeneity in ventricular myocardial architecture are revealed by a variation of the regional isotropy index. These major changes are probably an adaptive consequence of the major haemodynamic changes occurring after birth during the neonatal period that generates major parietal stress variations and parietal remodelling. Electronic supplementary material The online version of this article (10.1007/s00276-017-1945-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre-Simon Jouk
- Equipe DyCTim, Laboratoire TIMC-IMAG, 38706, La Tronche cedex, France. .,Service de génétique - CHU Grenoble Alpes, 38043, Grenoble cedex 9, France.
| | - Ba Luu Truong
- Equipe DyCTim, Laboratoire TIMC-IMAG, 38706, La Tronche cedex, France.,Cardiovascular Unit, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Gabrielle Michalowicz
- Equipe DyCTim, Laboratoire TIMC-IMAG, 38706, La Tronche cedex, France.,Service de génétique - CHU Grenoble Alpes, 38043, Grenoble cedex 9, France
| | - Yves Usson
- Equipe DyCTim, Laboratoire TIMC-IMAG, 38706, La Tronche cedex, France
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20
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Sims JA, Giorgi MC, Oliveira MA, Meneghetti JC, Gutierrez MA. Directional analysis of cardiac motion field from gated fluorodeoxyglucose PET images using the Discrete Helmholtz Hodge Decomposition. Comput Med Imaging Graph 2017; 65:69-78. [PMID: 28688629 DOI: 10.1016/j.compmedimag.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/31/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Extract directional information related to left ventricular (LV) rotation and torsion from a 4D PET motion field using the Discrete Helmholtz Hodge Decomposition (DHHD). MATERIALS AND METHODS Synthetic motion fields were created using superposition of rotational and radial field components and cardiac fields produced using optical flow from a control and patient image. These were decomposed into curl-free (CF) and divergence-free (DF) components using the DHHD. RESULTS Synthetic radial components were present in the CF field and synthetic rotational components in the DF field, with each retaining its center position, direction of motion and diameter after decomposition. Direction of rotation at apex and base for the control field were in opposite directions during systole, reversing during diastole. The patient DF field had little overall rotation with several small rotators. CONCLUSIONS The decomposition of the LV motion field into directional components could assist quantification of LV torsion, but further processing stages seem necessary.
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Affiliation(s)
- J A Sims
- Laboratory of Biomedical Engineering, Polytechnic School, University of São Paulo, São Paulo, Brazil.
| | - M C Giorgi
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - M A Oliveira
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - J C Meneghetti
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - M A Gutierrez
- Laboratory of Biomedical Engineering, Polytechnic School, University of São Paulo, São Paulo, Brazil; Informatics Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
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21
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Kim CS, Park S, Eun LY. Myocardial Rotation and Torsion in Child Growth. J Cardiovasc Ultrasound 2016; 24:223-228. [PMID: 27721953 PMCID: PMC5050311 DOI: 10.4250/jcu.2016.24.3.223] [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: 05/03/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 12/05/2022] Open
Abstract
Background The speckle tracking echocardiography can benefit to assess the regional myocardial deformations. Although, previous reports suggested no significant change in left ventricular (LV) torsion with aging, there are certain differences in LV rotation at the base and apex. The purpose of this study was to evaluate the change and relationship of LV rotation for torsion with aging in children. Methods Forty healthy children were recruited and divided into two groups of twenty based on whether the children were preschool-age (2–6 years of age) or school-age (7–12 years of age). After obtaining conventional echocardiographic data, apical and basal short axis rotation were assessed with speckle tracking echocardiography. LV rotation in the basal and apical short axis planes was determined using six myocardial segments along the central axis. Results Apical and basal LV rotation did not show the statistical difference with increased age between preschool- and school-age children. Apical radial strain showed significant higher values in preschool-age children, especially at the anterior (52.8 ± 17.4% vs. 34.7 ± 23.2%, p < 0.02), lateral (55.8 ± 20.4% vs. 36.1 ± 22.7%, p < 0.02), and posterior segments (57.1 ± 17.6% vs. 38.5 ± 21.7%, p < 0.01). The torsion values did not demonstrate the statistical difference between two groups. Conclusion This study revealed the tendency of higher rotation values in preschool-age children than in school-age children. The lesser values of rotation and torsion with increased age during childhood warrant further investigation.
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Affiliation(s)
- Chang Sin Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sora Park
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Lucy Youngmin Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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22
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Kim BJ, Moon KP, Yoon JH, Lee EJ, Lee JY, Kim SK, Lee JW, Chung NG, Cho B, Kim HK. Subclinical left ventricular dysfunction in children after hematopoietic stem cell transplantation for severe aplastic anemia: a case control study using speckle tracking echocardiography. KOREAN JOURNAL OF PEDIATRICS 2016; 59:190-5. [PMID: 27186230 PMCID: PMC4865643 DOI: 10.3345/kjp.2016.59.4.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 11/27/2022]
Abstract
Purpose Severe aplastic anemia (SAA), a fatal disease, requires multiple transfusion, immunosuppressive therapy, and finally, hematopoietic stem cell transplantation (HSCT) as the definitive treatment. We hypothesized that iron overloading associated with multiple transfusions and HSCTrelated complications may adversely affect cardiac function. Left ventricular (LV) function was assessed in children after HSCT for SAA. Methods Forty-six consecutive patients with a median age of 9.8 years (range, 1.5-18 years), who received HSCT for SAA and who underwent comprehensive echocardiography before and after HSCT, were included in this study. The data of LV functional parameters obtained using conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were collected from pre- and post-HSCT echocardiography. These data were compared to those of 40 age-matched normal controls. Results In patients, the LV ejection fraction, shortening fraction, end-diastolic dimension, mitral early diastolic E velocity, TDI mitral septal E' velocity, and STE LV longitudinal systolic strain rate (SSR) decreased significantly after HSCT. Compared to normal controls, patients had significantly lower post-HSCT early diastolic E velocity and E/A ratio. On STE, patients had significantly decreased LV deformational parameters including LV longitudinal systolic strain (SS), SSR, and diastolic SR (DSR), and circumferential SS and DSR. Serum ferritin levels showed weak but significant correlations (P<0.05) with LV longitudinal SS and SSR and circumferential SS and DSR. Conclusion Subclinical LV dysfunction is evident in patients after HSCT for SAA, and was associated with increased iron load. Serial monitoring of cardiac function is mandatory in this population.
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Affiliation(s)
- Beom Joon Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Pil Moon
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hong Yoon
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Young Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Koo Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack Gyun Chung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hack Ki Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mazumder R, Choi S, Clymer BD, White RD, Kolipaka A. Diffusion Tensor Imaging of Healthy and Infarcted Porcine Hearts: Study on the Impact of Formalin Fixation. J Med Imaging Radiat Sci 2016; 47:74-85. [PMID: 26989451 PMCID: PMC4790101 DOI: 10.1016/j.jmir.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Due to complexities of in-vivo cardiac diffusion tensor imaging (DTI), ex-vivo formalin-fixed specimens are used to investigate cardiac remodeling in diseases, and reported results have shown conflicting trends. This study investigates the impact of formalin-fixation on diffusion properties and optimizes tracking parameters based on controls to understand remodeling in myocardial-infarction (MI). METHODS DTI was performed on 4 healthy (controls) and 4 MI induced formalin-fixed (PoMI) ex-vivo porcine hearts. Controls were scanned pre-fixation (PrCtrl) and re-scanned (PoCtrl) after formalin-fixation. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were estimated in all hearts. Tracking parameters (FA, tract termination angle (TTA), fiber-length) were optimized in controls and then used to investigate structural remodeling in PoMI hearts. RESULTS Fixation increased ADC and decreased FA. PoMI showed increased ADC but decreased FA in infarcted zone compared to remote zone. TTA showed sharp increase in slope from 5°-10°, which flattened after 25° in all groups. Mean fiber-length for different tracking length range showed that PoCtrl had shorter fibers compared to PrCtrl. Fibers around infarction were shorter in length and disarrayed compared to PoCtrl group. CONCLUSION Formalin-fixation affects diffusion properties and hence DTI parametric trends observed in pathology may be influenced by the fixation process which can cause contradictory findings.
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Affiliation(s)
- Ria Mazumder
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Seongjin Choi
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Bradley D. Clymer
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Richard D. White
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
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Milne ML, Singh GK, Miller JG, Wallace KD, Holland MR. Toward 3-D Echocardiographic Determination of Regional Myofiber Structure. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:607-18. [PMID: 26589530 PMCID: PMC4711925 DOI: 10.1016/j.ultrasmedbio.2015.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/15/2015] [Accepted: 09/27/2015] [Indexed: 05/10/2023]
Abstract
As a step toward the goal of relating changes in underlying myocardial structure to observed altered cardiac function in the hearts of individual patients, this study addresses the feasibility of creating echocardiography-derived maps of regional myocardial fiber structure for entire, intact, excised sheep hearts. Backscatter data were obtained from apical echocardiographic images acquired with a clinical ultrasonic imaging system and used to determine local fiber orientations in each of seven hearts. Systematic acquisition across the entire heart volume provided information sufficient to give a complete map for each heart. Results from the echocardiography-derived fiber maps compare favorably with corresponding results derived from diffusion tensor magnetic resonance imaging. The results of this study provide evidence of the feasibility of using echocardiographic methods to generate individualized whole heart fiber maps for patients.
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Affiliation(s)
- Michelle L Milne
- Department of Physics, St. Mary's College of Maryland, St. Mary's City, Maryland, USA.
| | - Gautam K Singh
- Department of Pediatrics, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - James G Miller
- Department of Physics, Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | - Mark R Holland
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IUPUI, Indianapolis, Indiana, USA
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25
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Hayabuchi Y, Sakata M, Kagami S. Assessment of the Helical Ventricular Myocardial Band Using Standard Echocardiography. Echocardiography 2014; 32:310-8. [DOI: 10.1111/echo.12624] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Miho Sakata
- Department of Pediatrics; University of Tokushima; Tokushima Japan
| | - Shoji Kagami
- Department of Pediatrics; University of Tokushima; Tokushima Japan
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26
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Afshin M, Ben Ayed I, Punithakumar K, Law M, Islam A, Goela A, Peters T. Regional assessment of cardiac left ventricular myocardial function via MRI statistical features. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:481-494. [PMID: 24184708 DOI: 10.1109/tmi.2013.2287793] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Automating the detection and localization of segmental (regional) left ventricle (LV) abnormalities in magnetic resonance imaging (MRI) has recently sparked an impressive research effort, with promising performances and a breadth of techniques. However, despite such an effort, the problem is still acknowledged to be challenging, with much room for improvements in regard to accuracy. Furthermore, most of the existing techniques are labor intensive, requiring delineations of the endo- and/or epi-cardial boundaries in all frames of a cardiac sequence. The purpose of this study is to investigate a real-time machine-learning approach which uses some image features that can be easily computed, but that nevertheless correlate well with the segmental cardiac function. Starting from a minimum user input in only one frame in a subject dataset, we build for all the regional segments and all subsequent frames a set of statistical MRI features based on a measure of similarity between distributions. We demonstrate that, over a cardiac cycle, the statistical features are related to the proportion of blood within each segment. Therefore, they can characterize segmental contraction without the need for delineating the LV boundaries in all the frames. We first seek the optimal direction along which the proposed image features are most descriptive via a linear discriminant analysis. Then, using the results as inputs to a linear support vector machine classifier, we obtain an abnormality assessment of each of the standard cardiac segments in real-time. We report a comprehensive experimental evaluation of the proposed algorithm over 928 cardiac segments obtained from 58 subjects. Compared against ground-truth evaluations by experienced radiologists, the proposed algorithm performed competitively, with an overall classification accuracy of 86.09% and a kappa measure of 0.73.
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27
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Computational modeling of electromechanical propagation in the helical ventricular anatomy of the heart. Comput Biol Med 2013; 43:1698-703. [PMID: 24209915 DOI: 10.1016/j.compbiomed.2013.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 07/14/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022]
Abstract
The classical interpretation of myocardial activation assumes that the myocardium is homogeneous and that the electrical propagation is radial. However, anatomical studies have described a layered anatomical structure resulting from a continuous anatomical helical disposition of the myocardial fibers. To further investigate the sequence of electromechanical propagation based on the helical architecture of the heart, a simplified computational model was designed. This model was then used to test four activation patterns, which were generated by propagating the action potential along the myocardial band from different activation sites.
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28
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Pravdin SF, Berdyshev VI, Panfilov AV, Katsnelson LB, Solovyova O, Markhasin VS. Mathematical model of the anatomy and fibre orientation field of the left ventricle of the heart. Biomed Eng Online 2013; 12:54. [PMID: 23773421 PMCID: PMC3699427 DOI: 10.1186/1475-925x-12-54] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 06/05/2013] [Indexed: 11/10/2022] Open
Abstract
Background One of the main factors affecting propagation of electrical waves and contraction in ventricles of the heart is anisotropy of cardiac tissue. Anisotropy is determined by orientation of myocardial fibres. Determining fibre orientation field and shape of the heart is important for anatomically accurate modelling of electrical and mechanical function of the heart. The aim of this paper is to introduce a theoretical rule-based model for anatomy and fibre orientation of the left ventricle (LV) of the heart and to compare it with experimental data. We suggest explicit analytical formulae that allow us to obtain the left ventricle form and its fibre direction field. The ventricle band concept of cardiac architecture given by Torrent-Guasp is chosen as the model postulate. Methods In our approach, anisotropy of the heart is derived from some general principles. The LV is considered as a set of identical spiral surfaces, each of which can be produced from the other by rotation around one vertical axis. Each spiral surface is filled with non-intersecting curves which represent myocardial fibres. For model verification, we use experimental data on fibre orientation in human and canine hearts. Results LV shape and anisotropy are represented by explicit analytical expressions in a curvilinear 3-D coordinate system. The derived fibre orientation field shows good qualitative agreement with experimental data. The model reveals the most thorough quantitative simulation of fibre angles at the LV middle zone. Conclusions Our analysis shows that the band concept can generate realistic anisotropy of the LV. Our model shows good qualitative agreement between the simulated fibre orientation field and the experimental data on LV anisotropy, and the model can be used for various numerical simulations to study the effects of anisotropy on cardiac excitation and mechanical function.
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Affiliation(s)
- Sergey F Pravdin
- Function Approximation Theory Department, Institute of Mathematics and Mechanics, Ekaterinburg, Russia.
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29
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Dedobbeleer C, Hadefi A, Naeije R, Unger P. Left ventricular adaptation to acute hypoxia: a speckle-tracking echocardiography study. J Am Soc Echocardiogr 2013; 26:736-45. [PMID: 23706341 DOI: 10.1016/j.echo.2013.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypoxia depresses myocardial contractility in vitro but does not affect or may even improve indices of myocardial performance in vivo, possibly through associated changes in autonomic nervous system tone. The aim of this study was to explore the effects of hypoxic breathing on speckle-tracking echocardiographic indices of left ventricular function, with and without β1-adrenergic inhibition. METHODS Speckle-tracking echocardiography was performed in 21 healthy volunteers in normoxia and after 30 min of hypoxic breathing (fraction of inspired oxygen, 0.12). Measurements were also obtained after the administration of atropine in normoxia (n = 21) and after bisoprolol intake in normoxia (n = 6) and in hypoxia (n = 10). RESULTS Hypoxia increased heart rate (from 68 ± 11 to 74 ± 9 beats/min, P = .001), without changing mean blood pressure (P = NS), and decreased total peripheral resistance (P = .003). Myocardial deformation magnitude increased (circumferential strain, -19.6 ± 1.9% vs -21.2 ± 2.5%; radial strain, 19.2 ± 3.7% vs 22.6 ± 4.1%, P < .05; longitudinal and circumferential strain rate, -0.88 ± 0.11 vs -0.99 ± 0.15 sec(-1) and -1.03 ± 0.16 vs -1.18 ± 0.18 sec(-1), respectively, P < .05 for both; peak twist, 8.98 ± 3.2° vs 11.1 ± 2.9°, P < .05). Except for peak twist, these deformation parameters were correlated with total peripheral resistance (P < .05). Atropine increased only longitudinal strain rate magnitude (-0.88 ± 0.11 vs -0.97 ± 0.14 sec(-1), P < .05). The increased magnitude of myocardial deformation persisted in hypoxia under bisoprolol (P < .05). In normoxia, bisoprolol decreased heart rate (73 ± 10 vs 54 ± 7 beats/min, P = .0005), mean blood pressure (88 ± 7 vs 81 ± 4 mm Hg, P = .0027), without altering deformation. CONCLUSIONS Hypoxic breathing increases left ventricular deformation magnitude in normal subjects, and this effect may not be attributed to hypoxia-induced tachycardia or β1-adrenergic pathway changes but to hypoxia-induced systemic vasodilation.
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Affiliation(s)
- Chantal Dedobbeleer
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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30
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Wang HM, Gao H, Luo XY, Berry C, Griffith BE, Ogden RW, Wang TJ. Structure-based finite strain modelling of the human left ventricle in diastole. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:83-103. [PMID: 23293070 DOI: 10.1002/cnm.2497] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 05/25/2023]
Abstract
Finite strain analyses of the left ventricle provide important information on heart function and have the potential to provide insights into the biomechanics of myocardial contractility in health and disease. Systolic dysfunction is the most common cause of heart failure; however, abnormalities of diastolic function also contribute to heart failure, and are associated with conditions including left ventricular hypertrophy and diabetes. The clinical significance of diastolic abnormalities is less well understood than systolic dysfunction, and specific treatments are presently lacking. To obtain qualitative and quantitative information on heart function in diastole, we develop a three-dimensional computational model of the human left ventricle that is derived from noninvasive imaging data. This anatomically realistic model has a rule-based fibre structure and a structure-based constitutive model. We investigate the sensitivity of this comprehensive model to small changes in the constitutive parameters and to changes in the fibre distribution. We make extensive comparisons between this model and similar models that employ different constitutive models, and we demonstrate qualitative and quantitative differences in stress and strain distributions for the different constitutive models. We also provide an initial validation of our model through comparisons to experimental data on stress and strain distributions in the left ventricle.
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Affiliation(s)
- H M Wang
- SV Lab, School of Aerospace Engineering, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
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Abstract
Multiple recent epidemiologic studies have highlighted the importance of diastolic heart failure (DHF) as a public health problem. Approximately half of patients presenting with symptomatic heart failure (HF) have DHF and they suffer from morbidity and mortality comparable to those with systolic HF. Our understanding of the pathophysiology of DHF has evolved rapidly over the last decade, and the associated echo-Doppler findings that assist with its diagnosis are greatly refined. Recently, there has been increased recognition of the role of diastolic dysfunction and DHF in the care of critically ill patients, including those admitted to noncardiac units. The purpose of this review is to provide an up-to-date summary of the concepts of the pathophysiology of DHF. In addition, we provide an overview of the diagnostic approaches, prognostic identifiers, and associated comorbidities that make DHF more resistant to manage with a focus of the patients admitted to the intensive care unit. The current approach to managing patients with DHF is also reviewed.
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Affiliation(s)
- Wassef Karrowni
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kanu Chatterjee
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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32
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Milne ML, Singh GK, Miller JG, Holland MR. Echocardiographic-based assessment of myocardial fiber structure in individual, excised hearts. ULTRASONIC IMAGING 2012; 34:129-141. [PMID: 22972911 DOI: 10.1177/0161734612455580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to assess the feasibility of using echocardiographic imaging as an approach for determining the myocardial fiber structure of intact, individual hearts. Seven formalin-fixed, ex vivo sheep hearts were imaged using a commercially available echocardiographic imaging system, and the intrinsic fiber structure for the reconstructed short-axis cross section was determined for a specific distance from the apex of each heart. Diffusion tensor magnetic resonance (DT-MR) images of each heart were acquired and fiber maps were created for comparison with the fiber structure obtained from the corresponding reconstructed echocardiographic images. These two methods of obtaining the fiber structure showed relatively good agreement, suggesting that measurements of fiber orientation for individual hearts can be derived from echocardiographic images. Further development of this method may provide a clinically useful approach for mapping the fiber orientation in individual patients over the heart cycle.
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Affiliation(s)
- Michelle L Milne
- Department of Physics, Washington University, St. Louis, MO, USA
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Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Aytekin S. Assessment of Right Ventricular Endocardial Dysfunction in Mild-to-Moderate Mitral Stenosis Patients Using Velocity Vector Imaging. Echocardiography 2011; 29:25-33. [DOI: 10.1111/j.1540-8175.2011.01529.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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34
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Iwasaki M, Masuda K, Asanuma T, Nakatani S. Effects of mechanical limitation of apical rotation on left ventricular relaxation and end-diastolic pressure. Am J Physiol Heart Circ Physiol 2011; 301:H1456-60. [DOI: 10.1152/ajpheart.00316.2011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) twist is thought to play an important role in cardiac function. However, how twist affects systolic or diastolic function is not understood in detail. We acquired apical and basal short-axis images of dogs undergoing open-chest procedures ( n = 15) using a GE Vivid 7 at baseline and during the use of an apical suction device (Starfish) to limit apical rotation. We measured LV pressure and stroke volume using a micromanometer-tipped catheter and an ultrasonic flow probe, respectively. Peak radial strain, peak rotation, peak twist, peak systolic twisting rate (TR), peak untwisting rate during isovolumic relaxation period (URIVR), and peak early diastolic untwisting rate after mitral valve opening (URE) were determined using speckle tracking echocardiography. Immobilizing the apex with gentle suction significantly decreased apical rotation (−50 ± 27%) and slightly increased basal rotation, resulting in a significant decrease in twist. The time constant of LV relaxation (τ) was prolonged, and LV end-diastolic pressure increased. TR and URIVR decreased. LV systolic pressure, peak positive and negative first derivative of LV pressure (±dP/d t), stroke volume, radial strain, and URE were not changed. The correlation between τ and URIVR ( r = 0.63, P = 0.0006) was stronger than that between peak +dP/d t and TR ( r = 0.46, P = 0.01). Diastolic function was impaired with reduced apical rotation and URIVR when the apex of the heart was immobilized using an apical suction device.
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Affiliation(s)
- Mariko Iwasaki
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kasumi Masuda
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Asanuma
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakatani
- Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Shudo Y, Matsumiya G, Sakaguchi T, Miyagawa S, Yamauchi T, Takeda K, Saito S, Taniguchi K, Sawa Y. Impact of surgical ventricular reconstruction for ischemic dilated cardiomyopathy on restrictive filling pattern. Gen Thorac Cardiovasc Surg 2010; 58:399-404. [DOI: 10.1007/s11748-010-0597-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Zhou Z, Ashraf M, Hu D, Dai X, Xu Y, Kenny B, Cameron B, Nguyen T, Xiong L, Sahn DJ. Three-dimensional speckle-tracking imaging for left ventricular rotation measurement: an in vitro validation study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:903-909. [PMID: 20498464 DOI: 10.7863/jum.2010.29.6.903] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Left ventricular (LV) twist is manifested in oppositely directed apical and basal rotation. We studied a new 3-dimensional (3D) echocardiography program (wall motion tracking; Toshiba America Medical Systems, Inc, Tustin, CA) for left ventricular rotation. METHODS We used a rotation model with a variable-speed motor to rotate hearts in a water bath. We studied 10 freshly harvested pig hearts, which were mounted on the rotary actuator of our twist phantom with the heart base rotating and the apex held fixed to avoid translational motion, at rotations of 0 degrees , 15 degrees , 20 degrees , and 25 degrees . Full-volume 3D image loops were acquired on a Toshiba Aplio Artida ultrasound system at a maximized frame rate. RESULTS As the actual heart rotation increased, computed segmental and global rotation also increased accordingly, with the measured rotations of the basal and middle segments greater than that of the apex (both P < .001). Segmental and global rotation at all 3 levels correlated well with the actual rotation (base: r = 0.93; middle: r = 0.92; apex: r = 0.82; global: r = 0.95; all P < .001). CONCLUSIONS The new 3D program tracked LV rotation accurately.
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Affiliation(s)
- Zhiwen Zhou
- Shanghai 10th People's Hospital, affiliated with Tongji University, Shanghai, China
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Di Bella G, Gaeta M, Pingitore A, Oreto G, Zito C, Minutoli F, Anfuso C, Dattilo G, Lamari A, Coglitore S, Carerj S. Myocardial deformation in acute myocarditis with normal left ventricular wall motion--a cardiac magnetic resonance and 2-dimensional strain echocardiographic study. Circ J 2010; 74:1205-13. [PMID: 20453384 DOI: 10.1253/circj.cj-10-0017] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of our study was to assess longitudinal (L), circumferential (C) and radial (R) strain (S) of the left ventricle (LV) in patients with acute myocarditis and preserved LV wall motion. METHODS AND RESULTS Of the 26 male patients that were enrolled, 13 patients (26+/-8 years) suffered from acute myocarditis and 13 (25+/-2 years) were healthy participants (controls). Both patients and controls underwent cardiac magnetic resonance (CMR) and 2-dimensional S imaging (2D-S) echocardiography on the same day. Myocardial strains (RS, LS and CS) were quantified by 2D-S. In patients with myocarditis, a delayed enhancement (DE) CMR study was performed to identify damaged myocardial segments. In the myocarditis group there was a significant LS reduction compared with controls (-25+/-7 vs -20+/-7, P<0.0001), whereas no difference was found between the 2 groups concerning CS and RS. Subepicardial DE areas were found in 12 of 13 patients. Segments with DE showed a significantly lower LS in comparison with segments without DE (-19+/-4 vs -23+/-6, P<0.0001). In contrast, no difference in CS and RS was found when comparing segments with DE vs segments without DE. CONCLUSIONS In patients with acute myocarditis, evidence of subepicardial damage and no wall motion abnormalities, longitudinal deformation is diffusely impaired, whereas circumferential impairment is regionally sited in the areas of subepicardial damage.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
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Garcia-Barnes J, Gil D, Badiella L, Hernandez-Sabate A, Carreras F, Pujades S, Marti E. A normalized framework for the design of feature spaces assessing the left ventricular function. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:733-745. [PMID: 20199911 DOI: 10.1109/tmi.2009.2034653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A through description of the left ventricle functionality requires combining complementary regional scores. A main limitation is the lack of multiparametric normality models oriented to the assessment of regional wall motion abnormalities (RWMA). This paper covers two main topics involved in RWMA assessment. We propose a general framework allowing the fusion and comparison across subjects of different regional scores. Our framework is used to explore which combination of regional scores (including 2-D motion and strains) is better suited for RWMA detection. Our statistical analysis indicates that for a proper (within interobserver variability) identification of RWMA, models should consider motion and extreme strains.
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Affiliation(s)
- J Garcia-Barnes
- Computer Vision Center and the Department of Computer Sciences, Universitat Autonoma de Barcelona, 08193 Bellaterra, Spain.
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Mu Y, Qin C, Wang C, Huojiaabudula G. Two-Dimensional Ultrasound Speckle Tracking Imaging in Evaluation of Early Changes in Left Ventricular Diastolic Function in Patients with Essential Hypertension. Echocardiography 2010; 27:146-54. [DOI: 10.1111/j.1540-8175.2009.00984.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Heterogeneous contraction of the left ventricle demonstrated by 2-dimensional strain imaging. J Echocardiogr 2009; 8:33-9. [PMID: 27278658 DOI: 10.1007/s12574-009-0027-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/13/2009] [Accepted: 10/17/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) is useful in quantifying regional myocardial function, but has a significant limitation of Doppler angle dependency. The recently developed 2-dimensional strain imaging (2DS), based on speckle tracking imaging (STI) technology, enables us to evaluate myocardial function independent of ultrasound beam direction. The aim of this study was to assess the mode of contraction of the left ventricle. METHODS Circumferential, radial and longitudinal strains were measured in 18 segments (anteroseptal, anterior, anterolateral, inferolateral, inferior and inferoseptal walls at the base, mid-ventricle and apex) from apical and short-axis views using 2DS in 24 healthy subjects (mean age, 33 ± 5 years). We divided the left ventricle into 2 sites: septum (anterior, anteroseptal and inferoseptal walls) and free walls (anterolateral, inferolateral and inferior walls). We then compared the mode of contraction between the septum and free walls. RESULTS At the base and mid-ventricular levels, circumferential strain was larger in the septum (-22.6 ± 3.6 vs. -18.3 ± 4.1% and -24.1 ± 4.8 vs. -18.4 ± 5.7%, respectively; p < 0.0001 each), and radial strain was larger in the free walls (33.4 ± 12.4 vs. 38.7 ± 14.5% and 37.8 ± 12.6 vs. 43.0 ± 11.6%, respectively; p < 0.001 each) at the basal and mid-ventricular levels, whereas both were relatively homogeneous at the apex. The longitudinal strain did not differ among walls. CONCLUSIONS Heterogeneous contraction is seen in the left ventricle. The septum mainly contracts circumferentially, whereas the free walls contract radially. 2DS is helpful in understanding the mode of 3-dimensional myocardial contraction.
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Sosnovik DE, Wang R, Dai G, Reese TG, Wedeen VJ. Diffusion MR tractography of the heart. J Cardiovasc Magn Reson 2009; 11:47. [PMID: 19912654 PMCID: PMC2781805 DOI: 10.1186/1532-429x-11-47] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 11/13/2009] [Indexed: 12/17/2022] Open
Abstract
Histological studies have shown that the myocardium consists of an array of crossing helical fiber tracts. Changes in myocardial fiber architecture occur in ischemic heart disease and heart failure, and can be imaged non-destructively with diffusion-encoded MR. Several diffusion-encoding schemes have been developed, ranging from scalar measurements of mean diffusivity to a 6-dimensional imaging technique known as diffusion spectrum imaging or DSI. The properties of DSI make it particularly suited to the generation of 3-dimensional tractograms of myofiber architecture. In this article we review the physical basis of diffusion-tractography in the myocardium and the attributes of the available techniques, placing particular emphasis on DSI. The application of DSI in ischemic heart disease is reviewed, and the requisites for widespread clinical translation of diffusion MR tractography in the heart are discussed.
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Affiliation(s)
- David E Sosnovik
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
- Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge MA, USA
| | - Ruopeng Wang
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Guangping Dai
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Timothy G Reese
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Van J Wedeen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge MA, USA
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Kvitting JPE, Sigfridsson A, Wigström L, Bolger AF, Karlsson M. Analysis of human myocardial dynamics using virtual markers based on magnetic resonance imaging. Clin Physiol Funct Imaging 2009; 30:23-9. [PMID: 19780762 DOI: 10.1111/j.1475-097x.2009.00900.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY BACKGROUND Myocardial dynamics are three-dimensional (3D) and time-varying. Cineradiography of surgically implanted makers in animals or patients is accurate for assessing these events, but this invasive method potentially alters myocardial motion. The aim of the study was to quantify myocardial motion using magnetic resonance imaging (MRI) and hence to provide a non-invasive approach to characterize 3D myocardial dynamics. METHODS Myocardial motion was quantified in ten normal volunteers by tracking the Lagrangian motion of individual points (i.e. virtual markers), based on time-resolved 3D phase-contrast MRI data and Fourier tracking. Nine points in the myocardium were tracked over the entire cardiac cycle, allowing a wire frame model to be generated and systolic and diastolic events identified. RESULTS Radius of curvature of the left ventricular (LV) wall was calculated from the virtual markers; the ratio between the anterior-posterior (AP) and septal-lateral (SL) walls in the LV shows an oval shape of the apical short axis plane at end systole (ES) and more circular at end diastole (ED). The AP/SL ratio for the basal plane shows an oval shape at ES and ED. We found that the rotation of the basal plane in ES was less compared to the apical plane [-2.0 +/- 2.2 versus 4.1 +/- 2.6 degrees (P<0.005)]. The apical plane rotated counter clock wise as viewed from the apex. CONCLUSION This new non-invasive tool, despite current limitations in temporal and spatial resolution, may provide a comprehensive set of virtual myocardial markers throughout the entire LV without the confounding effects introduced by surgical implantation.
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Donal E, Bergerot C, Thibault H, Ernande L, Loufoua J, Augeul L, Ovize M, Derumeaux G. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:914-21. [DOI: 10.1093/ejechocard/jep095] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Congestive heart failure has become a major problem and the only surgical treatment for end-stage heart failure caused by dilated cardiomyopathy (DCM) had been heart transplantation. However, because of the shortage of donors, several procedures for non-transplant surgery have been developed. Published literature on left ventricular (LV) restoration was searched to review the new surgical procedures for treating patients with ischemic or non-ischemic DCM. LV restoration was initiated in the 1980s for repairing LV aneurysm. In the 1990s several surgical procedures were introduced for treating DCM, and the new evolving surgical treatment plays an important role in the management of DCM in the 21st century.
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Affiliation(s)
- Tadashi Isomura
- Cardiovascular Surgery, Hayama Heart Center, Hayama, Kanagawa 248-0116, Japan.
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Dong L, Zhang F, Shu X, Zhou D, Guan L, Pan C, Chen H. Left ventricular torsional deformation in patients undergoing transcatheter closure of secundum atrial septal defect. Int J Cardiovasc Imaging 2009; 25:479-86. [DOI: 10.1007/s10554-009-9458-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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van Dalen BM, Soliman OI, Vletter WB, ten Cate FJ, Geleijnse ML. Insights into Left Ventricular Function from the Time Course of Regional and Global Rotation by Speckle Tracking Echocardiography. Echocardiography 2009; 26:371-7. [DOI: 10.1111/j.1540-8175.2008.00834.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sosnovik DE, Wang R, Dai G, Wang T, Aikawa E, Novikov M, Rosenzweig A, Gilbert RJ, Wedeen VJ. Diffusion spectrum MRI tractography reveals the presence of a complex network of residual myofibers in infarcted myocardium. Circ Cardiovasc Imaging 2009; 2:206-12. [PMID: 19808594 DOI: 10.1161/circimaging.108.815050] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Changes in myocardial microstructure are important components of the tissue response to infarction but are difficult to resolve with current imaging techniques. A novel technique, diffusion spectrum MRI tractography (DSI tractography), was thus used to image myofiber architecture in normal and infarcted myocardium. Unlike diffusion tensor imaging, DSI tractography resolves multiple myofiber populations per voxel, thus generating accurate 3D tractograms, which we present in the myocardium for the first time. METHODS AND RESULTS DSI tractography was performed at 4.7 T in excised rat hearts 3 weeks after left coronary artery ligation (n=4) and in 4 age-matched controls. Fiber architecture in the control hearts varied smoothly from endocardium to epicardium, producing a symmetrical array of crossing helical structures in which orthogonal myofibers were separated by fibers with intermediate helix angles. Fiber architecture in the infarcted hearts was severely perturbed. The infarct boundary in all cases was highly irregular and punctuated repeatedly by residual myofibers extending from within the infarct to the border zones. In all infarcts, longitudinal myofibers extending toward the basal-anterior wall and transversely oriented myofibers extending toward the septum lay in direct contact with each other, forming nodes of orthogonal myofiber intersection or contact. CONCLUSIONS DSI tractography resolves 3D myofiber architecture and reveals a complex network of orthogonal myofibers within infarcted myocardium. Meshlike networks of orthogonal myofibers in infarcted myocardium may resist mechanical remodeling but also probably increase the risk for lethal reentrant arrhythmias. DSI tractography thus provides a new and important readout of tissue injury after myocardial infarction.
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Affiliation(s)
- David E Sosnovik
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass., USA.
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