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Smiseth OA, Rider O, Cvijic M, Valkovič L, Remme EW, Voigt JU. Myocardial Strain Imaging: Theory, Current Practice, and the Future. JACC Cardiovasc Imaging 2024:S1936-878X(24)00301-2. [PMID: 39269417 DOI: 10.1016/j.jcmg.2024.07.011] [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] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 09/15/2024]
Abstract
Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.
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Affiliation(s)
- Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Espen W Remme
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway; The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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English EJ, Samolyk BL, Gaudette GR, Pins GD. Micropatterned fibrin scaffolds increase cardiomyocyte alignment and contractility for the fabrication of engineered myocardial tissue. J Biomed Mater Res A 2023; 111:1309-1321. [PMID: 36932841 PMCID: PMC11128133 DOI: 10.1002/jbm.a.37530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/09/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
Cardiovascular disease is the leading cause of death in the United States, which can result in blockage of a coronary artery, triggering a myocardial infarction (MI), scar tissue formation in the myocardium, and ultimately heart failure. Currently, the gold-standard solution for total heart failure is a heart transplantation. An alternative to total-organ transplantation is surgically remodeling the ventricle with the implantation of a cardiac patch. Acellular cardiac patches have previously been investigated using synthetic or decellularized native materials to improve cardiac function. However, a limitation of this strategy is that acellular cardiac patches only reshape the ventricle and do not increase cardiac contractile function. Toward the development of a cardiac patch, our laboratory previously developed a cell-populated composite fibrin scaffold and aligned microthreads to recapitulate the mechanical properties of native myocardium. In this study, we explore micropatterning the surfaces of fibrin gels to mimic anisotropic native tissue architecture and promote cellular alignment of human induced pluripotent stem cell cardiomyocytes (hiPS-CM), which is crucial for increasing scaffold contractile properties. hiPS-CMs seeded on micropatterned surfaces exhibit cellular elongation, distinct sarcomere alignment, and circumferential connexin-43 staining at 14 days of culture, which are necessary for mature contractile properties. Constructs were also subject to electrical stimulation during culture to promote increased contractile properties. After 7 days of stimulation, contractile strains of micropatterned constructs were significantly higher than unpatterned controls. These results suggest that the use of micropatterned topographic cues on fibrin scaffolds may be a promising strategy for creating engineered cardiac tissue.
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Affiliation(s)
- Elizabeth J. English
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
- Tessera Therapeutics, Somerville, Massachusetts, USA
| | - Bryanna L. Samolyk
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Glenn R. Gaudette
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
- Department of Engineering, Boston College, Newton, Massachusetts, USA
| | - George D. Pins
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
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Amzulescu MS, De Craene M, Langet H, Pasquet A, Vancraeynest D, Pouleur AC, Vanoverschelde JL, Gerber BL. Myocardial strain imaging: review of general principles, validation, and sources of discrepancies. Eur Heart J Cardiovasc Imaging 2020; 20:605-619. [PMID: 30903139 PMCID: PMC6529912 DOI: 10.1093/ehjci/jez041] [Citation(s) in RCA: 294] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/07/2019] [Indexed: 01/01/2023] Open
Abstract
Myocardial tissue tracking imaging techniques have been developed for a more accurate evaluation of myocardial deformation (i.e. strain), with the potential to overcome the limitations of ejection fraction (EF) and to contribute, incremental to EF, to the diagnosis and prognosis in cardiac diseases. While most of the deformation imaging techniques are based on the similar principles of detecting and tracking specific patterns within an image, there are intra- and inter-imaging modality inconsistencies limiting the wide clinical applicability of strain. In this review, we aimed to describe the particularities of the echocardiographic and cardiac magnetic resonance deformation techniques, in order to understand the discrepancies in strain measurement, focusing on the potential sources of variation: related to the software used to analyse the data, to the different physics of image acquisition and the different principles of 2D vs. 3D approaches. As strain measurements are not interchangeable, it is highly desirable to work with validated strain assessment tools, in order to derive information from evidence-based data. There is, however, a lack of solid validation of the current tissue tracking techniques, as only a few of the commercial deformation imaging softwares have been properly investigated. We have, therefore, addressed in this review the neglected issue of suboptimal validation of tissue tracking techniques, in order to advocate for this matter.
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Affiliation(s)
- M S Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - M De Craene
- Philips Research, Medical Imaging (Medisys), 33 rue de Verdun, CS60055, Suresnes Cedex, France
| | - H Langet
- Clinical Research Board, Philips Research, 33 rue de Verdun, CS60055, Suresnes Cedex, France
| | - A Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - D Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - A C Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - J L Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - B L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
- Corresponding author. Tel: +32 (2) 764 2803; Fax: +32 (2) 764 8980. E-mail:
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AbdelMassih AF, Salama KM, Ghobrial C, Haroun B, Rahman MA. Discrepancy in patterns of myocardial involvement in beta-thalassaemia vs. sickle cell anaemia. Acta Cardiol 2020; 75:442-449. [PMID: 31165673 DOI: 10.1080/00015385.2019.1610836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Different mechanisms contribute to myocardial dysfunction in sickle cell disease [SCD] and beta thalassaemia major [TM]. TM mainly involves the highly vascular subepicardium by iron load and SCD mainly operates by inducing ischaemia in the relatively ischaemic subendocardium. The aim of this article was to determine if pattern of left ventricular [LV] dysfunction differ among the two groups of patients.Methods: Forty TM and 40 SCD patients and 40 age- and surface area-matched controls were subjected to conventional echocardiography, 2D Speckle tracking myocardial layer strain discriminating echocardiography (MLSD-STE) which is able to discriminate if myocardial dysfunction is predominantly subepicardial or subendocardial and 3D echocardiography for ejection fraction assessment as well as haemoglobin, ferritin, and lactate dehydrogenase levels.Results: TM patients had a deeper subepicardial dysfunction while SCD had prevalent subendocardial dysfunction, epicardial GLS (TM: -10.9 ± 2 vs. SCD: 19.9 ± 1.7; p value < 0.01); endocardial GLS (TM: -19.9 ± 1.7 vs. SCD: -10.6 ± 1.6, p value < 0.01).Conclusion: This study points towards divergent microcirculatory mechanisms in the pathogenesis of myocardial dysfunction in haemoglobinopathies. It shows predominant subendocardial dysfunction with underlying ischaemia of SCD and prevalent subepicardial iron-induced injury in cases of TM.
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Affiliation(s)
- Antoine Fakhry AbdelMassih
- Pediatric Cardiology Unit, Pediatrics’ Department, Faculty of Medicine, Cairo University (Kasr Al Ainy), Cairo, Egypt
| | - Khaled M. Salama
- Pediatric Hematology Unit, Pediatrics’ Department, Faculty of Medicine, Cairo University (Kasr Al Ainy), Cairo, Egypt
| | - Carolyne Ghobrial
- Pediatrics’ Department, Faculty of Medicine, Cairo University (Kasr Al Ainy), Cairo, Egypt
| | - Basma Haroun
- Pediatrics’ Department, Faculty of Medicine, Cairo University (Kasr Al Ainy), Cairo, Egypt
| | - Mohamed Abdel Rahman
- Pediatric Cardiology Unit, Pediatrics’ Department, Faculty of Medicine, Cairo University (Kasr Al Ainy), Cairo, Egypt
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Sharma A, Sood A, Mittal BR, Vijayvergiya R. Assessment of myocardial viability using echocardiographic strain imaging in patients with ST-elevation myocardial infarction: comparison with cardiac PET imaging. J Echocardiogr 2020; 18:240-252. [PMID: 32458228 DOI: 10.1007/s12574-020-00476-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND A speckle tracking echocardiographic (STE) strain imaging can predict myocardial viability. The study compared the STE strain imaging using low-dose dobutamine stress with 18fluoro-deoxyglucose positron emission tomographic (18FDG-PET) imaging for the detection of myocardium viability. METHODS We studied 57 patients with ST-elevation myocardial infarction (STEMI) having angiographic evidence of total arterial cut off and akinetic myocardium. These patients underwent low-dose dobutamine echocardiography and 18FDG-PET imaging. The STE was used to measure the peak systolic longitudinal and circumferential strain and strain rate at rest and after low-dose dobutamine stress. RESULTS A total of 298 akinetic segments were evaluated. The viable myocardium showed an increased strain and strain rate values following the dobutamine stress in comparison to the nonviable myocardium. The peak longitudinal strain rate [AUC 0.83 (95% confidence interval (CI) 0.67-0.99], p = 0.001; optimal cutoff - 0.64 s-1 for sensitivity 0.87 and specificity 0.81), post-dobutamine peak longitudinal strain rate [AUC 0.94 (95% CI 0.87-1.00), p = 0.001; optimal cutoff - 0.85 s-1 for sensitivity 0.89 and specificity 0.77), change in peak longitudinal strain rate [AUC 0.93 (95% CI 0.86-1), p = 0.001; optimal cutoff - 0.2 s-1 for sensitivity 0.87 and specificity 0.87] predicted viability. The post-dobutamine peak circumferential strain rate [AUC 0.92 (95% CI 0.81-1.0), p = 0.001; optimal cutoff - 1.1 s-1 for sensitivity and specificity 0.86], were predictor of viability. Both resting and post-dobutamine longitudinal and circumferential strain rate had better accuracy for the prediction of viability. CONCLUSIONS The resting and post-dobutamine stress STE strain and strain rate parameters can assess the viability in akinetic segments.
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Affiliation(s)
- Ambudhar Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Barton GP, Vildberg L, Goss K, Aggarwal N, Eldridge M, McMillan AB. Simultaneous determination of dynamic cardiac metabolism and function using PET/MRI. J Nucl Cardiol 2019; 26:1946-1957. [PMID: 29717407 PMCID: PMC7851880 DOI: 10.1007/s12350-018-1287-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac metabolic changes in heart disease precede overt contractile dysfunction. However, metabolism and function are not typically assessed together in clinical practice. The purpose of this study was to develop a cardiac positron emission tomography/magnetic resonance (PET/MR) stress test to assess the dynamic relationship between contractile function and metabolism in a preclinical model. METHODS Following an overnight fast, healthy pigs (45-50 kg) were anesthetized and mechanically ventilated. 18F-fluorodeoxyglucose (18F-FDG) solution was administered intravenously at a constant rate of 0.01 mL/s for 60 minutes. A cardiac PET/MR stress test was performed using normoxic gas (FIO2 = .209) and hypoxic gas (FIO2 = .12). Simultaneous cardiac imaging was performed on an integrated 3T PET/MR scanner. RESULTS Hypoxic stress induced a significant increase in heart rate, cardiac output, left ventricular (LV) ejection fraction (EF), and peak torsion. There was a significant decline in arterial SpO2, LV end-diastolic and end-systolic volumes in hypoxia. Increased LV systolic function was coupled with an increase in myocardial FDG uptake (Ki) during hypoxic stress. CONCLUSION PET/MR with continuous FDG infusion captures dynamic changes in both cardiac metabolism and contractile function. This technique warrants evaluation in human cardiac disease for assessment of subtle functional and metabolic abnormalities.
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Affiliation(s)
- Gregory P Barton
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA.
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA.
| | - Lauren Vildberg
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Kara Goss
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Niti Aggarwal
- Division of Cardiovascular Disease Department of Medicine, University of Wisconsin-Madison, Madison, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Marlowe Eldridge
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Alan B McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
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Affiliation(s)
- Nathaniel Reichek
- From the Cardiac Imaging Program and Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY; and Division of Cardiology, Department of Medicine and Department of Biomedical Engineering, School of Engineering and Applied Mathematics, Stony Brook University, SUNY, NY.
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8
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Regional Myocardial Strain and Function: From Novel Techniques to Clinical Applications. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-1-4939-8841-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Morphologically normalized left ventricular motion indicators from MRI feature tracking characterize myocardial infarction. Sci Rep 2017; 7:12259. [PMID: 28947754 PMCID: PMC5612925 DOI: 10.1038/s41598-017-12539-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/08/2017] [Indexed: 01/12/2023] Open
Abstract
We characterized motion attributes arising from LV spatio-temporal analysis of motion distributions in myocardial infarction. Time-varying 3D finite element shape models were obtained in 300 Controls and 300 patients with myocardial infarction. Inter-individual left ventricular shape differences were eliminated using parallel transport to the grand mean of all cases. The first three principal component (PC) scores were used to characterize trajectory attributes. Scores were tested with ANOVA/MANOVA using patient disease status (Infarcts vs. Controls) as a factor. Infarcted patients had significantly different magnitude, orientation and shape of left ventricular trajectories in comparison to Controls. Significant differences were found for the angle between PC scores 1 and 2 in the endocardium, and PC scores 1 and 3 in the epicardium. The largest differences were found in the magnitude of endocardial motion. Endocardial PC scores in shape space showed the highest classification power using support vector machine, with higher total accuracy in comparison to previous methods. Shape space performed better than size-and-shape space for both epicardial and endocardial features. In conclusion, LV spatio-temporal motion attributes accurately characterize the presence of infarction. This approach is easily generalizable to different pathologies, enabling more precise study of the pathophysiological consequences of a wide spectrum of cardiac diseases.
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Mavrogeni S, Katsi V, Vartela V, Noutsias M, Markousis-Mavrogenis G, Kolovou G, Manolis A. The emerging role of Cardiovascular Magnetic Resonance in the evaluation of hypertensive heart disease. BMC Cardiovasc Disord 2017; 17:132. [PMID: 28535761 PMCID: PMC5442666 DOI: 10.1186/s12872-017-0556-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Arterial hypertension is the commonest cause of cardiovascular death. It may lead to hypertensive heart disease (HHD), including heart failure (HF), ischemic heart disease (IHD) and left ventricular hypertrophy (LVH). MAIN BODY According to the 2007 ESH/ESC guidelines, the recommended imaging technique is echocardiography (echo), when a more sensitive detection of LVH than that provided by ECG, is needed. Cardiovascular Magnetic Resonance (CMR), a non-invasive, non-radiating technique, offers the following advantages, beyond echo: a) more reliable and reproducible measurements of cardiac parameters such as volumes, ejection fraction and cardiac mass b) more accurate differentiation of LVH etiology by providing information about tissue characterisation c) more accurate evaluation of myocardial ischemia, specifically if small vessels disease is present d) technique of choice for diagnosis of renovascular, aortic tree/branches lesions and quantification of aortic valve regurgitation e) technique of choice for treatment evaluation in clinical trials. The superiority of CMR against echocardiography in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterization makes the technique ideal for evaluation of heart, quantification of aortic valve regurgitation, aorta and aortic branches. CONCLUSIONS CMR has a great potential in early diagnosis, risk stratification and treatment follow up of HHD. However, an international consensus about CMR in HHD, taking under consideration the cost-benefit ratio, expertise and availability, is still warranted.
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Affiliation(s)
- Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
| | | | - Vasiliki Vartela
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
| | - Michel Noutsias
- Department of Cardiology, Pneumonology and Intensive Care Medicine, Clinic for Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | | | - Genovefa Kolovou
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175 61 P.Faliro, Athens, Greece
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Jacob A, Krishnamurthi G, Mathur M. Estimation of myocardial deformation using correlation image velocimetry. BMC Med Imaging 2017; 17:25. [PMID: 28381245 PMCID: PMC5382518 DOI: 10.1186/s12880-017-0195-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/02/2017] [Indexed: 11/24/2022] Open
Abstract
Background Tagged Magnetic Resonance (tMR) imaging is a powerful technique for determining cardiovascular abnormalities. One of the reasons for tMR not being used in routine clinical practice is the lack of easy-to-use tools for image analysis and strain mapping. In this paper, we introduce a novel interdisciplinary method based on correlation image velocimetry (CIV) to estimate cardiac deformation and strain maps from tMR images. Methods CIV, a cross-correlation based pattern matching algorithm, analyses a pair of images to obtain the displacement field at sub-pixel accuracy with any desired spatial resolution. This first time application of CIV to tMR image analysis is implemented using an existing open source Matlab-based software called UVMAT. The method, which requires two main input parameters namely correlation box size (CB) and search box size (SB), is first validated using a synthetic grid image with grid sizes representative of typical tMR images. Phantom and patient images obtained from a Medical Imaging grand challenge dataset (http://stacom.cardiacatlas.org/motion-tracking-challenge/) were then analysed to obtain cardiac displacement fields and strain maps. The results were then compared with estimates from Harmonic Phase analysis (HARP) technique. Results For a known displacement field imposed on both the synthetic grid image and the phantom image, CIV is accurate for 3-pixel and larger displacements on a 512 × 512 image with (CB,SB)=(25,55) pixels. Further validation of our method is achieved by showing that our estimated landmark positions on patient images fall within the inter-observer variability in the ground truth. The effectiveness of our approach to analyse patient images is then established by calculating dense displacement fields throughout a cardiac cycle, and were found to be physiologically consistent. Circumferential strains were estimated at the apical, mid and basal slices of the heart, and were shown to compare favorably with those of HARP over the entire cardiac cycle, except in a few (∼4) of the segments in the 17-segment AHA model. The radial strains, however, are underestimated by our method in most segments when compared with HARP. Conclusions In summary, we have demonstrated the capability of CIV to accurately and efficiently quantify cardiac deformation from tMR images. Furthermore, physiologically consistent displacement fields and circumferential strain curves in most regions of the heart indicate that our approach, upon automating some pre-processing steps and testing in clinical trials, can potentially be implemented in a clinical setting. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0195-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Athira Jacob
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, 21218, USA
| | - Ganapathy Krishnamurthi
- Department of Engineering Design, Indian Institute of Technology Madras, Chennai, 600036, India.
| | - Manikandan Mathur
- Department of Aerospace Engineering, Indian Institute of Technology Madras, Chennai, 600036, India
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Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers. Sci Rep 2017; 7:45314. [PMID: 28349989 PMCID: PMC5368608 DOI: 10.1038/srep45314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023] Open
Abstract
The cine magnetic resonance imaging based technique feature tracking-cardiac magnetic resonance (FT-CMR) is emerging as a novel, simple and robust method to evaluate myocardial strain. We investigated the distribution characteristics of left-ventricular myocardial strain using a novel cine MRI based deformation registration algorithm (DRA) in a cohort of healthy Chinese subjects. A total of 130 healthy Chinese subjects were enrolled. Three components of orthogonal strain (radial, circumferential, longitudinal) of the left ventricle were analyzed using DRA on steady-state free precession cine sequence images. A distinct transmural circumferential strain gradient was observed in the left ventricle that showed universal increment from the epicardial to endocardial myocardial wall (epiwall: -15.4 ± 1.9%; midwall: -18.8 ± 2.0%; endowall: -22.3 ± 2.3%, P < 0.001). Longitudinal strain showed a similar trend from epicardial to endocardial layers (epiwall: -16.0 ± 2.9%; midwall: -15.6 ± 2.7%; endowall: -14.8 ± 2.4%, P < 0.001), but radial strain had a very heterogeneous distribution and variation. In the longitudinal direction from the base to the apex of the left ventricle, there was a trend of decreasing peak systolic longitudinal strain (basal: -23.3 ± 4.6%; mid: -13.7 ± 7.3%; apical: -13.2 ± 5.5%; P < 0.001). In conclusion, there are distinct distribution patterns of circumferential and longitudinal strain within the left ventricle in healthy Chinese subjects. These distribution patterns of strain may provide unique profiles for further study in different types of myocardial disease.
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Berganza FM, de Alba CG, Özcelik N, Adebo D. Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children. Pediatr Cardiol 2017; 38:566-574. [PMID: 28058478 DOI: 10.1007/s00246-016-1549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Abstract
Cardiac magnetic resonance imaging is an important tool to evaluate cardiac anatomy and ventricular size and function after repaired tetralogy of Fallot. Magnetic resonance tissue tagging is the gold standard for evaluation of myocardial strain. However, myocardial tagging strain requires tagged images to be obtained prospectively, during the scan and with limited temporal resolution. Cardiac magnetic resonance feature tracking is a new tool that allows the retrospective analysis of cine images. There is limited experience with cardiac magnetic resonance feature tracking strain analysis in children. The medical records of patients with repaired tetralogy of Fallot that had a cardiac magnetic resonance (CMR) study from December 2013 to June 2015 were reviewed. The control group included patients who underwent a CMR with normal cardiac anatomy and ventricular function. Global longitudinal, circumferential and radial strain parameters (2D and 3D) were obtained by retrospectively contouring cine images from ventricular short axis, two chamber and four chamber views using post-processing software (Circle CVi42, Calgary, Canada). The correlation between conventional ventricular function parameters and ventricular strain was performed using Pearson's correlation. The mean age of tetralogy of Fallot and control subjects was 12.4 and 14.1 years, respectively. In patients after repaired tetralogy of Fallot, the mean left ventricular global 2D and 3D circumferential strains were -17.4 ± 2.9 and -10.1 ± 3, respectively. The mean indexed right ventricular end-diastolic volume was 135.4 cc m2 ± 46 compared to 75.7 cc m2 ± 17 in control subjects (P = 0.0001, CI 95%). Left ventricular global circumferential 3D strain showed a statistically significant difference in patients after TOF repair compared to normal subjects (-10.1 ± 3 vs. -14.71 ± 1.9, P = 0.00001). A strong correlation between left ventricular global circumferential 3D strain and right ventricular end-diastolic volume (P ≤ 0.0001) was noted. We found a strong correlation between left ventricular circumferential 3D strain and indexed right ventricular end-diastolic volume, as well as a strong correlation between left ventricular longitudinal 2D strain and right ventricular ejection fraction. Circumferential 3D strain may be a suitable tool to detect early abnormalities of ventricular myocardium even before the ejection fraction becomes compromised. Large-scale prospective studies are recommended.
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Affiliation(s)
- Fernando M Berganza
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | | | - Nazire Özcelik
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Dilachew Adebo
- Division of Pediatric Cardiology, Memorial Hermann Children's Hospital, University of Texas Medical School at Houston, Houston, TX, USA.
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14
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Romito E, Shazly T, Spinale FG. In vivo assessment of regional mechanics post-myocardial infarction: A focus on the road ahead. J Appl Physiol (1985) 2017; 123:728-745. [PMID: 28235858 DOI: 10.1152/japplphysiol.00589.2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 01/13/2017] [Accepted: 02/18/2017] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular disease, particularly the occurrence of myocardial infarction (MI), remains a leading cause of morbidity and mortality (Go et al., Circulation 127: e6-e245, 2013; Go et al. Circulation 129: e28-e292, 2014). There is growing recognition that a key factor for post-MI outcomes is adverse remodeling and changes in the regional structure, composition, and mechanical properties of the MI region itself. However, in vivo assessment of regional mechanics post-MI can be confounded by the species, temporal aspects of MI healing, as well as size, location, and extent of infarction across myocardial wall. Moreover, MI regional mechanics have been assessed over varying phases of the cardiac cycle, and thus, uniform conclusions regarding the material properties of the MI region can be difficult. This review assesses past studies that have performed in vivo measures of MI mechanics and attempts to provide coalescence on key points from these studies, as well as offer potential recommendations for unifying approaches in terms of regional post-MI mechanics. A uniform approach to biophysical measures of import will allow comparisons across studies, as well as provide a basis for potential therapeutic markers.
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Affiliation(s)
- Eva Romito
- University of South Carolina School of Engineering and Computing, Columbia, South Carolina; .,Cardiovascular Translational Research Center, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Tarek Shazly
- University of South Carolina School of Engineering and Computing, Columbia, South Carolina
| | - Francis G Spinale
- University of South Carolina School of Engineering and Computing, Columbia, South Carolina.,Cardiovascular Translational Research Center, University of South Carolina School of Medicine, Columbia, South Carolina.,Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina; and.,William Jennings Bryan Dorn Veteran Affairs Medical Center, Columbia, South Carolina
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15
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Shetye AM, Nazir SA, Razvi NA, Price N, Khan JN, Lai FY, Squire IB, McCann GP, Arnold JR. Comparison of global myocardial strain assessed by cardiovascular magnetic resonance tagging and feature tracking to infarct size at predicting remodelling following STEMI. BMC Cardiovasc Disord 2017; 17:7. [PMID: 28056808 PMCID: PMC5217595 DOI: 10.1186/s12872-016-0461-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023] Open
Abstract
Background To determine if global strain parameters measured by cardiovascular magnetic resonance (CMR) acutely following ST-segment Elevation Myocardial Infarction (STEMI) predict adverse left ventricular (LV) remodelling independent of infarct size (IS). Methods Sixty-five patients with acute STEMI (mean age 60 ± 11 years) underwent CMR at 1–3 days post-reperfusion (baseline) and at 4 months. Global peak systolic circumferential strain (GCS), measured by tagging and Feature Tracking (FT), and global peak systolic longitudinal strain (GLS), measured by FT, were calculated at baseline, along with IS. On follow up scans, volumetric analysis was performed to determine the development of adverse remodelling – a composite score based on development of either end-diastolic volume index [EDVI] ≥20% or end-systolic volume index [ESVI] ≥15% at follow-up compared to baseline. Results The magnitude of GCS was higher when measured using FT (−21.1 ± 6.3%) than with tagging (−12.1 ± 4.3; p < 0.001 for difference). There was good correlation of strain with baseline LVEF (r 0.64–to 0.71) and IS (ρ -0.62 to–0.72). Baseline strain parameters were unable to predict development of adverse LV remodelling. Only baseline IS predicted adverse remodelling – Odds Ratio 1.05 (95% CI 1.01–1.10, p = 0.03), area under the ROC curve 0.70 (95% CI 0.52–0.87, p = 0.04). Conclusion Baseline global strain by CMR does not predict the development of adverse LV remodelling following STEMI.
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Affiliation(s)
- Abhishek M Shetye
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Sheraz A Nazir
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Naveed A Razvi
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Ipswich Hospital NHS trust, Ipswich, IP4 5PD, UK
| | - Nathan Price
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, LS2 9JT, UK
| | - Jamal N Khan
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Gerald P McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QF, UK.
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16
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Carruth ED, McCulloch AD, Omens JH. Transmural gradients of myocardial structure and mechanics: Implications for fiber stress and strain in pressure overload. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 122:215-226. [PMID: 27845176 DOI: 10.1016/j.pbiomolbio.2016.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although a truly complete understanding of whole heart activation, contraction, and deformation is well beyond our current reach, a significant amount of effort has been devoted to discovering and understanding the mechanisms by which myocardial structure determines cardiac function to better treat patients with cardiac disease. Several experimental studies have shown that transmural fiber strain is relatively uniform in both diastole and systole, in contrast to predictions from traditional mechanical theory. Similarly, mathematical models have largely predicted uniform fiber stress across the wall. The development of this uniform pattern of fiber stress and strain during filling and ejection is due to heterogeneous transmural distributions of several myocardial structures. This review summarizes these transmural gradients, their contributions to fiber mechanics, and the potential functional effects of their remodeling during pressure overload hypertrophy.
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Affiliation(s)
- Eric D Carruth
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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17
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Capulli AK, MacQueen LA, Sheehy SP, Parker KK. Fibrous scaffolds for building hearts and heart parts. Adv Drug Deliv Rev 2016; 96:83-102. [PMID: 26656602 PMCID: PMC4807693 DOI: 10.1016/j.addr.2015.11.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 12/14/2022]
Abstract
Extracellular matrix (ECM) structure and biochemistry provide cell-instructive cues that promote and regulate tissue growth, function, and repair. From a structural perspective, the ECM is a scaffold that guides the self-assembly of cells into distinct functional tissues. The ECM promotes the interaction between individual cells and between different cell types, and increases the strength and resilience of the tissue in mechanically dynamic environments. From a biochemical perspective, factors regulating cell-ECM adhesion have been described and diverse aspects of cell-ECM interactions in health and disease continue to be clarified. Natural ECMs therefore provide excellent design rules for tissue engineering scaffolds. The design of regenerative three-dimensional (3D) engineered scaffolds is informed by the target ECM structure, chemistry, and mechanics, to encourage cell infiltration and tissue genesis. This can be achieved using nanofibrous scaffolds composed of polymers that simultaneously recapitulate 3D ECM architecture, high-fidelity nanoscale topography, and bio-activity. Their high porosity, structural anisotropy, and bio-activity present unique advantages for engineering 3D anisotropic tissues. Here, we use the heart as a case study and examine the potential of ECM-inspired nanofibrous scaffolds for cardiac tissue engineering. We asked: Do we know enough to build a heart? To answer this question, we tabulated structural and functional properties of myocardial and valvular tissues for use as design criteria, reviewed nanofiber manufacturing platforms and assessed their capabilities to produce scaffolds that meet our design criteria. Our knowledge of the anatomy and physiology of the heart, as well as our ability to create synthetic ECM scaffolds have advanced to the point that valve replacement with nanofibrous scaffolds may be achieved in the short term, while myocardial repair requires further study in vitro and in vivo.
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Affiliation(s)
- A K Capulli
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - L A MacQueen
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Sean P Sheehy
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - K K Parker
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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18
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Witzenburg CM, Dhume RY, Lake SP, Barocas VH. Automatic Segmentation of Mechanically Inhomogeneous Tissues Based on Deformation Gradient Jump. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:29-41. [PMID: 26168433 PMCID: PMC4739827 DOI: 10.1109/tmi.2015.2453316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Variations in properties, active behavior, injury, scarring, and/or disease can all cause a tissue's mechanical behavior to be heterogeneous. Advances in imaging technology allow for accurate full-field displacement tracking of both in vitro and in vivo deformation from an applied load. While detailed strain fields provide some insight into tissue behavior, material properties are usually determined by fitting stress-strain behavior with a constitutive equation. However, the determination of the mechanical behavior of heterogeneous soft tissue requires a spatially varying constitutive equation (i.e., one in which the material parameters vary with position). We present an approach that computationally dissects the sample domain into many homogeneous subdomains, wherein subdomain boundaries are formed by applying a betweenness based graphical analysis to the deformation gradient field to identify locations with large discontinuities. This novel partitioning technique successfully determined the shape, size and location of regions with locally similar material properties for: (1) a series of simulated soft tissue samples prescribed with both abrupt and gradual changes in anisotropy strength, prescribed fiber alignment, stiffness, and nonlinearity, (2) tissue analogs (PDMS and collagen gels) which were tested biaxially and speckle tracked (3) and soft tissues which exhibited a natural variation in properties (cadaveric supraspinatus tendon), a pathologic variation in properties (thoracic aorta containing transmural plaque), and active behavior (contracting cardiac sheet). The routine enables the dissection of samples computationally rather than physically, allowing for the study of small tissues specimens with unknown and irregular inhomogeneity.
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Affiliation(s)
- Colleen M. Witzenburg
- University of Minnesota, Minneapolis, MN 55455 USA and is now with the University of Virginia, Charlottesville, VA 22908 USA
| | | | - Spencer P. Lake
- University of Minnesota, Minneapolis, MN 55455 USA as is now with Washington University, St. Louis, MO 63130 USA
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19
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3D harmonic phase tracking with anatomical regularization. Med Image Anal 2015; 26:70-81. [PMID: 26363844 DOI: 10.1016/j.media.2015.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/23/2022]
Abstract
This paper presents a novel algorithm that extends HARP to handle 3D tagged MRI images. HARP results were regularized by an original regularization framework defined in an anatomical space of coordinates. In the meantime, myocardium incompressibility was integrated in order to correct the radial strain which is reported to be more challenging to recover. Both the tracking and regularization of LV displacements were done on a volumetric mesh to be computationally efficient. Also, a window-weighted regression method was extended to cardiac motion tracking which helps maintain a low complexity even at finer scales. On healthy volunteers, the tracking accuracy was found to be as accurate as the best candidates of a recent benchmark. Strain accuracy was evaluated on synthetic data, showing low bias and strain errors under 5% (excluding outliers) for longitudinal and circumferential strains, while the second and third quartiles of the radial strain errors are in the (-5%,5%) range. In clinical data, strain dispersion was shown to correlate with the extent of transmural fibrosis. Also, reduced deformation values were found inside infarcted segments.
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20
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Biederman RWW, Young AA, Doyle M, Devereux RB, Kortright E, Perry G, Bella JN, Oparil S, Calhoun D, Pohost GM, Dell’Italia LJ. Regional Heterogeneity in 3D Myocardial Shortening in Hypertensive Left Ventricular Hypertrophy: A Cardiovascular CMR Tagging Substudy to the Life Study. JOURNAL OF BIOMEDICAL SCIENCE AND ENGINEERING 2015; 8:213-225. [PMID: 27011783 PMCID: PMC4800488 DOI: 10.4236/jbise.2015.83021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increased relative wall thickness in hypertensive left ventricular hypertrophy (LVH) has been shown by echocardiography to allow preserved shortening at the endocardium despite depressed LV midwall circumferential shortening (MWCS). Depressed MWCS is an adverse prognostic indicator, but whether this finding reflects reduced global or regional LV myocardial function, as assessed by three-dimensional (3D) myocardial strain, is unknown. METHODS AND RESULTS Cardiac Magnetic Resonance (CMR) tissue tagging permits direct evaluation of regional 3D intramyocardial strain, independent of LV geometry. We evaluated 21 hypertensive patients with electrocardiographic LVH in the LIFE study and 8 normal controls using 3D MR tagging and echocardiography. Patients had higher MR LV mass than normals (116 ± 40 versus 63 ± 6 g/m2, P = 0.002). Neither echocardiographic fractional shortening (32 ± 6 versus 33% ± 3%), LVEF (63% versus 64%) or mean end-systolic stress (175 ± 27 versus 146 ± 28 g/cm2) were significantly different, yet global MWCS was decreased by both echocardiography (13.4 ± 2.8 versus 18.2% ± 1.5%, P < 0.001) and MR (16.8 ± 3.6 versus 21.6% ± 3.0%, P < 0.005). 3D MR MWCS was lower at the base versus apex (P = 0.002) in LVH and greater in lateral and anterior regions versus septal and posterior regions (P < 0.001), contributing to the higher mean global MWCS by MR than echo. MR longitudinal strain was severely depressed in LVH patients (11.0 ± 3.3 versus 16.5% ± 2.5%, P < 0.001) and apical twist was increased (17.5 ± 4.3 versus 13.7 ± 3.7, P < 0.05). Importantly, both circumferential and longitudinal shortening correlated with LV relative wall thickness (R > 0.60, P = 0.001 for both). CONCLUSIONS In patients with hypertensive LVH, despite normal LV function via echocardiography or CMR, CMR intramyocardial tagging show depressed global MWCS while 3D MR strain revealed marked underlying regional heterogeneity of LV dysfunction.
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Affiliation(s)
- Robert W. W. Biederman
- Division of Cardiology, Department of Cardiovascular CMR, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, USA
| | | | - Mark Doyle
- Division of Cardiology, Department of Cardiovascular CMR, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, USA
| | | | | | - Gilbert Perry
- University of Auckland, Auckland, New Zealand
- University of Alabama at Birmingham, Birmingham, USA
| | | | | | - David Calhoun
- University of Alabama at Birmingham, Birmingham, USA
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21
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Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Influence of comorbid cardiovascular risk factors on left atrial-left ventricular interaction in asymptomatic patients: clinical application of two-dimensional speckle-tracking echocardiography. Int Heart J 2014; 55:138-45. [PMID: 24632964 DOI: 10.1536/ihj.13-220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies have examined the negative impacts of individual cardiovascular risk (CVR) factors on left atrial (LA)-left ventricular (LV) interaction, whereas the combined effects of these risk factors are insufficiently elucidated. We studied 176 asymptomatic patients with CVR factors and age-matched 50 healthy individuals by conventional and 2-dimensional speckle-tracking echocardiography. The patients were classified into 2 groups according to the number of CVR factors: one risk factor (single) group (n = 79) and 2 or more risk factors (comorbid) group (n = 97). The peak early diastolic transmitral flow velocity (E)/peak early diastolic mitral annular motion velocity (e')/peak systolic LA strain (S-LAs) was used as a surrogate for LA stiffness during ventricular systole. The E/e'/S-LAs was greatest in the comorbid group. The peak systolic LV circumferential and radial strains, peak early diastolic LV radial strain rate, and peak early diastolic LA strain and strain rate were lower in the comorbid group than in the single group. Multivariate regression analysis identified age, body mass index, systolic blood pressure, end-systolic LV diameter, peak systolic mitral annular motion velocity (s'), and peak systolic LV radial strain in the comorbid group, and peak atrial systolic transmitral fl ow velocity and s' in the single group, as independent predictors of E/e'/S-LAs. Subtle LA and LV dysfunction with individual CVR factors were more aggravated with the comorbid conditions in asymptomatic patients.
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Affiliation(s)
- Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization
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22
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Swoboda PP, Larghat A, Zaman A, Fairbairn TA, Motwani M, Greenwood JP, Plein S. Reproducibility of myocardial strain and left ventricular twist measured using complementary spatial modulation of magnetization. J Magn Reson Imaging 2013; 39:887-94. [PMID: 24006100 DOI: 10.1002/jmri.24223] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/18/2013] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To establish the reproducibility of complementary spatial modulation of magnetization (CSPAMM) tagged cardiovascular MR (CMR) data in normal volunteers. MATERIALS AND METHODS Twelve healthy volunteers underwent CMR studies on two separate occasions using an identical CSPAMM pulse sequence with images acquired in three short axis slices. Data were analyzed by two independent observers using harmonic phase analysis (HARP). Lagrangian circumferential and radial strain, rotation, and left ventricular twist were calculated. RESULTS The intraobserver reproducibility of circumferential strain (CoV [coefficient of variation] 1.5-4.3%) and LV twist (CoV 1.2-4.4%) was better than radial strain (CoV 10.6-14.8%). For interobserver reproducibility, circumferential strain (CoV 3.5-6.2%) and LV twist (CoV 3.5-7.2%) were more reproducible than radial strain (CoV 11.8-21.8%). Interstudy reproducibility of circumferential strain (CoV 3.7-5.5%) and LV twist (CoV 9.8-12.2%) were good but radial strain (CoV 13.8-23.4%) but showed poorer interstudy reproducibility. Sample size calculations suggested 20 or fewer subjects are needed to detect a 10% change in circumferential strain (power 90%; α error 0.05), whereas for twist, 66 subjects would be required. CONCLUSION In normal volunteers, the intraobserver, interobserver, and interstudy reproducibility of circumferential strain and LV twist measured from CSPAMM tagged CMR data are good, but are less so for radial strain.
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23
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Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension. ACTA ACUST UNITED AC 2013; 7:206-15. [DOI: 10.1016/j.jash.2013.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/12/2022]
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24
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Thomas D, Xie F, Smith LM, O'Leary E, Smith K, Olson J, Nalty K, Hess R, Graham M, Therrien S, Porter TR. Prospective randomized comparison of conventional stress echocardiography and real-time perfusion stress echocardiography in detecting significant coronary artery disease. J Am Soc Echocardiogr 2012; 25:1207-14. [PMID: 22998856 DOI: 10.1016/j.echo.2012.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although retrospective studies have suggested that myocardial perfusion and wall motion analysis with real-time myocardial contrast echocardiography (RTMCE) improves the detection of coronary artery disease (CAD) during dobutamine or exercise stress echocardiography, a prospective randomized comparison with conventional stress echocardiography that did not use RTMCE has not been performed. METHODS A total of 1,776 patients with preserved resting left ventricular wall motion undergoing dobutamine or exercise stress echocardiography for suspicion of CAD were randomized to either non-RTMCE, for which contrast was used only for the approved indication of enhancing left ventricular opacification, or RTMCE, for which contrast infusion was used in all cases to examine both wall motion and myocardial perfusion. Comparisons in test positivity, and positive predictive value in those subsequently referred for quantitative coronary angiography, were performed. RESULTS Patients randomized to RTMCE had significantly higher test positivity (22% for RTMCE vs 15% with non-RTMCE, P = .0002). The increased test positivity occurred without a difference in positive predictive value in predicting >50% diameter stenoses by quantitative coronary angiography (67% for non-RTMCE, 73% for RTMCE). The mechanism for increased detection of CAD with RTMCE was mostly due to the detection of subendocardial wall thickening abnormalities that would have gone undetected when examining transmural wall thickening. CONCLUSIONS RTMCE improves the detection of CAD during dobutamine and exercise stress echocardiography, mainly by the detection of subendocardial ischemia.
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Affiliation(s)
- Deepak Thomas
- Department of Cardiology, Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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25
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Zurbuchen A, Pfenniger A, Stahel A, Stoeck CT, Vandenberghe S, Koch VM, Vogel R. Energy harvesting from the beating heart by a mass imbalance oscillation generator. Ann Biomed Eng 2012; 41:131-41. [PMID: 22805983 DOI: 10.1007/s10439-012-0623-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
Abstract
Energy-harvesting devices attract wide interest as power supplies of today's medical implants. Their long lifetime will spare patients from repeated surgical interventions. They also offer the opportunity to further miniaturize existing implants such as pacemakers, defibrillators or recorders of bio signals. A mass imbalance oscillation generator, which consists of a clockwork from a commercially available automatic wrist watch, was used as energy harvesting device to convert the kinetic energy from the cardiac wall motion to electrical energy. An MRI-based motion analysis of the left ventricle revealed basal regions to be energetically most favorable for the rotating unbalance of our harvester. A mathematical model was developed as a tool for optimizing the device's configuration. The model was validated by an in vitro experiment where an arm robot accelerated the harvesting device by reproducing the cardiac motion. Furthermore, in an in vivo experiment, the device was affixed onto a sheep heart for 1 h. The generated power in both experiments-in vitro (30 μW) and in vivo (16.7 μW)-is sufficient to power modern pacemakers.
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Affiliation(s)
- A Zurbuchen
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3010, Bern, Switzerland
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26
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Bachner-Hinenzon N, Ertracht O, Malka A, Leitman M, Vered Z, Binah O, Adam D. Layer-specific strain analysis: investigation of regional deformations in a rat model of acute versus chronic myocardial infarction. Am J Physiol Heart Circ Physiol 2012; 303:H549-58. [PMID: 22777422 DOI: 10.1152/ajpheart.00294.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Myocardial infarction (MI) injury extends from the endocardium toward the epicardium. This phenomenon should be taken into consideration in the detection of MI. To study the extent of damage at different stages of MI, we hypothesized that measurement of layer-specific strain will allow better delineation of the MI extent than total wall thickness strain at acute stages but not at chronic stages, when fibrosis and remodeling have already occurred. After baseline echocardiography scans had been obtained, 24 rats underwent occlusion of the left anterior descending coronary artery for 30 min followed by reperfusion. Thirteen rats were rescanned at 24 h post-MI and eleven rats at 2 wk post-MI. Next, rats were euthanized, and histological analysis for MI size was performed. Echocardiographic scans were postprocessed by a layer-specific speckle tracking program to measure the peak circumferential strain (S(C)(peak)) at the endocardium, midlayer, and epicardium as well as total wall thickness S(C)(peak). Linear regression for MI size versus S(C)(peak) showed that the slope was steeper for the endocardium compared with the other layers (P < 0.001), meaning that the endocardium was more sensitive to MI size than the other layers. Moreover, receiver operating characteristics analysis yielded better sensitivity and specificity in the detection of MI using endocardial S(C)(peak) instead of total wall thickness S(C)(peak) at 24 h post-MI (P < 0.05) but not 2 wk later. In conclusion, at acute stages of MI, before collagen deposition, scar tissue formation, and remodeling have occurred, damage may be nontransmural, and thus the use of endocardial S(C)(peak) is advantageous over total wall thickness S(C)(peak).
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Affiliation(s)
- Noa Bachner-Hinenzon
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel.
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Distinguishing focal fibrotic lesions and non-fibrotic lesions in hypertrophic cardiomyopathy by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography: Comparison with multislice CT. Int J Cardiol 2012; 158:423-32. [DOI: 10.1016/j.ijcard.2011.01.096] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/23/2011] [Accepted: 01/29/2011] [Indexed: 11/30/2022]
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Hodt A, Stugaard M, Hisdal J, Stranden E, Atar D, Steine K. Regional LV deformation in healthy individuals during isovolumetric contraction and ejection phases assessed by 2D speckle tracking echocardiography. Clin Physiol Funct Imaging 2012; 32:372-9. [DOI: 10.1111/j.1475-097x.2012.01139.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 03/15/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Anders Hodt
- Department of Cardiology; Oslo University Hospital HF and Faculty of Medicine; University of Oslo; Oslo; Norway
| | - Marie Stugaard
- Department of Cardiology; Hospital in Lillehammer; Lillehammer; Norway
| | - Jonny Hisdal
- Section of Vascular Investigations; Oslo University Hospital HF; Oslo; Norway
| | - Einar Stranden
- Section of Vascular Investigations; Oslo University Hospital HF; Oslo; Norway
| | - Dan Atar
- Department of Cardiology; Oslo University Hospital HF and Faculty of Medicine; University of Oslo; Oslo; Norway
| | - Kjetil Steine
- Department of Cardiology; Akershus University Hospital; Lørenskog; Norway
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Temporal changes of strain parameters in the progress of chronic ischemia: with comparison to transmural infarction. Int J Cardiovasc Imaging 2012; 28:1671-81. [PMID: 22231467 DOI: 10.1007/s10554-012-0010-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 01/02/2012] [Indexed: 12/12/2022]
Abstract
The aim of this study was to reveal the temporal and spatial changes of strain parameters during the progression of chronic coronary ischemia. Fourteen pigs received occluder implantation to create gradual ischemia (CI), while six pigs underwent a sham surgery (Control). Six pigs after myocardial infarction were also studied (MI). Strain analysis was performed using a speckle-tracking algorithm. Eleven of the 14 animals with occluder implantation had total occlusion of the left anterior descending artery with collaterals at 1 month (early occlusion group), whereas three pigs had occlusion at 3 months (late occlusion group). Both radial strain (RS) and circumferential strain (CS) of ischemic area deteriorated at 1 month in the early occlusion group and remained at the same level throughout the remaining 2 months of the experiment. In the late occlusion group, RS gradually declined, while CS took the same course as Control until the 2 month time point. Thereafter, both metrics reached the same level as the early occlusion group at the time of occlusion. Interestingly, RS in the remote area decreased moderately, whereas CS remained normal in CI pigs. The comparison between CI and MI revealed preserved CS at the ischemic area in CI pigs. Both RS and CS deteriorate by the time total coronary occlusion was established and remain at the same level thereafter. Altered RS in the remote area may be an indicator of remodeling in the non-ischemic area, whereas CS may be useful for distinguishing between transmural and non-transmural scar.
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Ibrahim ESH. Myocardial tagging by cardiovascular magnetic resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications. J Cardiovasc Magn Reson 2011; 13:36. [PMID: 21798021 PMCID: PMC3166900 DOI: 10.1186/1532-429x-13-36] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/28/2011] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging.
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Bollensdorff C, Lookin O, Kohl P. Assessment of contractility in intact ventricular cardiomyocytes using the dimensionless 'Frank-Starling Gain' index. Pflugers Arch 2011; 462:39-48. [PMID: 21494804 PMCID: PMC3114067 DOI: 10.1007/s00424-011-0964-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
Abstract
This paper briefly recapitulates the Frank-Starling law of the heart, reviews approaches to establishing diastolic and systolic force-length behaviour in intact isolated cardiomyocytes, and introduces a dimensionless index called 'Frank-Starling Gain', calculated as the ratio of slopes of end-systolic and end-diastolic force-length relations. The benefits and limitations of this index are illustrated on the example of regional differences in Guinea pig intact ventricular cardiomyocyte mechanics. Potential applicability of the Frank-Starling Gain for the comparison of cell contractility changes upon stretch will be discussed in the context of intra- and inter-individual variability of cardiomyocyte properties.
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Affiliation(s)
- Christian Bollensdorff
- Cardiac Biophysics and Systems Biology, The National Heart and Lung Institute, Imperial College, London, UK.
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Abstract
Hypertensive heart disease is the target organ response to arterial hypertension. Left ventricular hypertrophy represents an important predictor for cardiovascular events. Myocardial fibrosis, a common end point in hypertensive heart disease, has been linked to the development of left ventricular hypertrophy and diastolic dysfunction. Echocardiography is clinically useful in the detection of left ventricular hypertrophy and the assessment of diastolic function. Although echocardiography is more widely available, cardiac magnetic resonance has been demonstrated to be more reproducible for the estimation of left ventricular mass. Future developments in cardiac magnetic resonance techniques may facilitate the quantification of diffuse fibrosis that occurs in hypertensive heart disease. Thus, advances in cardiac imaging provide comprehensive, noninvasive tools for imaging left ventricular hypertrophy, diastolic dysfunction, myocardial fibrosis and ischemia observed in hypertensive heart disease. The objective of this article is to summarize the state-of-the-art and the future of multimodality imaging of hypertensive heart disease.
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Affiliation(s)
- Rajesh Janardhanan
- Department of Medicine (Cardiology), Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee St., Box 800170, Charlottesville, VA 22908, USA
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Hodt A, Hisdal J, Stugaard M, Stranden E, Atar D, Steine K. Reduced preload elicits increased LV twist in healthy humans. Clin Physiol Funct Imaging 2011; 31:382-9. [DOI: 10.1111/j.1475-097x.2011.01029.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hung CL, Verma A, Uno H, Shin SH, Bourgoun M, Hassanein AH, McMurray JJ, Velazquez EJ, Kober L, Pfeffer MA, Solomon SD. Longitudinal and circumferential strain rate, left ventricular remodeling, and prognosis after myocardial infarction. J Am Coll Cardiol 2011; 56:1812-22. [PMID: 21087709 DOI: 10.1016/j.jacc.2010.06.044] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to investigate the clinical prognostic value of longitudinal and circumferential strain (S) and strain rate (SR) in patients after high-risk myocardial infarction (MI). BACKGROUND Left ventricular (LV) contractile performance after MI is an important predictor of long-term outcome. Tissue deformation imaging might more closely reflect myocardial contractility than traditional measures of systolic functions. METHODS The VALIANT (Valsartan in Acute Myocardial Infarction Trial) Echo study enrolled 603 patients with LV dysfunction, heart failure, or both 5 days after MI. We measured global peak longitudinal S and systolic SR (SRs) from apical 4- and 2-chamber views and global circumferential S and SRs from parasternal short-axis view with speckle tracking software (Velocity Vector Imaging, Siemens, Inc., Mountain View, California). We related global S and SRs to LV remodeling at 20-month follow-up and to clinical outcomes. RESULTS Both longitudinal (mean: -5.1 ± 1.6 100/ms) and circumferential SRs (mean: -8.0 ± 2.8 100/ms) were predictive of death or hospital stay for heart failure (hazard ratio: 2.4, 95% confidence interval [CI]: 2.0 to 3.1, p < 0.001; hazard ratio: 1.3, 95% CI: 1.2 to 1.4, p < 0.001, respectively) after adjustment for clinical covariates by Cox proportional hazards, and longitudinal SRs further improved in predicting 18-month survivor on a model based on clinical and standard echocardiographic measures (increase in area under the receiver-operator characteristic curve: 0.13, p = 0.009). With multivariable logistic regression, circumferential SRs, but not longitudinal SRs, was strongly predictive of remodeling (odds ratio: 1.3, 95% CI: 1.1 to 1.4, p < 0.001). CONCLUSIONS Both longitudinal and circumferential SRs were independent predictors of outcomes after MI, whereas only circumferential SRs was predictive of remodeling, suggesting that preserved circumferential function might serve to restrain ventricular enlargement after MI.
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Affiliation(s)
- Chung-Lieh Hung
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Hayashi H, Izumi C, Takahashi S, Uchikoshi M, Yamazaki R, Asanuma T, Ishikura F, Beppu S, Nakatani S. Evaluation of left ventricular rotation by two-dimensional speckle tracking method and real-time three-dimensional echocardiography: comparison with MRI tagging method. J Echocardiogr 2010; 9:83-9. [PMID: 27277174 DOI: 10.1007/s12574-010-0077-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/09/2010] [Accepted: 11/16/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, it has become possible to evaluate left ventricular (LV) torsion by two-dimensional (2D) speckle tracking images. However, LV torsion is a three-dimensional (3D) performance, which per se cannot be assessed by the 2D speckle tracking method. The present study investigated the accuracy of the 2D speckle tracking method and real-time 3D echocardiography in measuring LV rotation, comparing with the MRI tagging method. METHODS We assessed LV apical rotation using the 2D speckle tracking method, real-time 3D echocardiography, and MRI tagging method in 26 normal subjects, and compared the results of these three methods. LV apical rotation was measured just before the level in which the posterior papillary muscle was absorbed into the free wall. RESULTS The degree of LV apical rotation evaluated by the 2D speckle tracking method (Δθ 2D) was significantly smaller than that evaluated by 3D echocardiography (Δθ 3D) and the MRI tagging method (Δθ MRI) (Δθ 2D 7.3 ± 2.8°; Δθ 3D 8.8 ± 3.4°; Δθ MRI 9.0 ± 3.4°; Δθ 2D vs. Δθ 3D, p = 0.0001; Δθ 2D vs. Δθ MRI, p < 0.0001). There were good correlations among Δθ 2D, Δθ 3D, and Δθ MRI, but agreement between Δθ 3D and Δθ MRI (mean difference 0.14 ± 1.43°) was better than that between Δθ 2D and Δθ MRI (mean difference 1.68 ± 1.89°). CONCLUSION The degree of LV apical rotation was underestimated with the 2D speckle tracking method compared with the MRI tagging method, whereas it could be precisely measured by 3D echocardiography.
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Affiliation(s)
- Hidetaka Hayashi
- Department of Radiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | - Masato Uchikoshi
- Department of Radiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Ryou Yamazaki
- Department of Radiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Toshihiko Asanuma
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fuminobu Ishikura
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shintaro Beppu
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Layer-specific assessment of left ventricular function by utilizing wavelet de-noising: a validation study. Med Biol Eng Comput 2010; 49:3-13. [DOI: 10.1007/s11517-010-0662-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 06/29/2010] [Indexed: 11/26/2022]
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Bansal M, Jeffriess L, Leano R, Mundy J, Marwick TH. Assessment of myocardial viability at dobutamine echocardiography by deformation analysis using tissue velocity and speckle-tracking. JACC Cardiovasc Imaging 2010; 3:121-31. [PMID: 20159637 DOI: 10.1016/j.jcmg.2009.09.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 09/16/2009] [Accepted: 09/23/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Comparison of myocardial tissue-velocity imaging (TVI) and speckle-tracking echocardiography (STE) for prediction of viability at dobutamine echocardiography (DbE). BACKGROUND Use of TVI-based strain imaging during DbE may facilitate the prediction of myocardial viability but has technical limitations. STE overcomes these but requires evaluation for prediction of viability. METHODS We studied 55 patients with ischemic heart disease and left ventricular systolic dysfunction (left ventricular ejection fraction <0.45) who were undergoing DbE for assessment of myocardial viability and who subsequently underwent myocardial revascularization. TVI was used to measure longitudinal end-systolic strain (longS) and peak systolic strain rate (SR) at rest and at low-dose dobutamine (LDD). Longitudinal, radial, and circumferential strain and strain rate were measured with STE. Segmental functional recovery was defined by improved wall-motion score on side-by-side comparison of echocardiographic images before and 9 months after revascularization and areas under the receiver operator characteristic curves were used to compare methods. RESULTS Of the 375 segments with abnormal resting function, 154 (41%) showed functional recovery. Only circumferential resting and low-dose STE strain and low-dose longitudinal strain and SR predicted functional recovery independent of wall-motion analysis. Among different strain parameters, only TVI-based longitudinal end-systolic strain and peak systolic SR at LDD had incremental value over wall-motion analysis (areas under the receiver operator characteristic curves of 0.79, 0.79, and 0.74, respectively). STE measurements of strain and SR identified viability only in the anterior circulation, whereas TVI strain and SR accurately identified viability in both anterior and posterior circulations. CONCLUSIONS Combination of TVI or STE methods with DbE can predict viability, with TVI strain and SR at LDD being the most accurate. TVI measures can predict viability in both anterior and posterior circulations, but STE measurements predict viability only in the anterior circulation.
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Affiliation(s)
- Manish Bansal
- Department of Medicine, University of Queensland, Brisbane, Australia
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Deng YB, Liu R, Wu YH, Xiong L, Liu YN. Evaluation of short-axis and long-axis myocardial function with two-dimensional strain echocardiography in patients with different degrees of coronary artery stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:227-233. [PMID: 20045591 DOI: 10.1016/j.ultrasmedbio.2009.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 07/15/2009] [Accepted: 09/27/2009] [Indexed: 05/28/2023]
Abstract
This study was designed to characterize the changes in the peak systolic longitudinal, circumferential and radial strains by using 2-D strain echocardiography in patients with coronary artery stenosis without segmental wall motion abnormalities on conventional 2-D echocardiography. 2D strain echocardiography was performed in 44 patients with different degrees of coronary artery stenosis. Myocardial longitudinal, circumferential and radial strain profiles were obtained and peak systolic strain values were measured. The peak systolic longitudinal strain was significantly reduced in myocardial segments subtended by coronary arteries with greater than 75% stenosis when compared with those subtended by coronary artery with less than 75% stenosis and those in control. Sensitivity and specificity were 74% and 72%, respectively, for peak systolic longitudinal strain to predict segments subtended by coronary arteries with greater than 75% stenosis (cutoff value--17.7%; area under the receiver operating characteristic curve, 0.825). There were no significant differences in circumferential and radial strains among myocardial segments subtended by coronary arteries with greater than 75% stenosis and those with less than 75% stenosis and in control. In conclusion, our study suggests that analysis of long-axis cardiac function by using the 2-D strain echocardiography may help to identify the myocardial segments subtended by coronary arteries with severe stenosis.
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Affiliation(s)
- You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
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Hamdan A, Thouet T, Kelle S, Wellnhofer E, Paetsch I, Gebker R, Schnackenburg B, Fahmy AS, Osman NF, Bornstedt A, Fleck E. Strain-encoded MRI to evaluate normal left ventricular function and timing of contraction at 3.0 Tesla. J Magn Reson Imaging 2009; 29:799-808. [PMID: 19306402 DOI: 10.1002/jmri.21684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To define the reproducibility of strain-encoded (SENC) magnetic resonance imaging (MRI) for assessment of regional left ventricular myocardial strain and timing of contraction in a 3T MRI system. MATERIALS AND METHODS The study population consisted of 16 healthy subjects. SENC measurements were performed in three short-axis (SA) slices (apical, mid, and basal) and three long-axis (LA) views (two-, three-, and four-chamber) for assessment of maximal transmural systolic strain and time to peak strain. To assess the interobserver and interstudy reproducibility, analysis of SENC MRI was performed by two independent observers who were blinded to each other's results and four studies were repeated on a different day. RESULTS Maximal longitudinal strain was highest at the apex, as was maximal circumferential strain. Peak longitudinal strain occurred earliest at the base, as did peak circumferential strain. Interclass correlation coefficient between observers and repeated studies ranged from 0.92 to 0.98 (P < 0.001 for all). CONCLUSION The present study demonstrates the ability of SENC MRI to define regional left ventricular strain and the time sequence of regional strain. SENC MRI may represent a highly objective method for quantifying regional left ventricular function.
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Affiliation(s)
- Ashraf Hamdan
- Department of Internal Medicine/Cardiology, Deutsche Herzzentrum Berlin, Berlin, Germany
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Xie F, Dodla S, O'Leary E, Porter TR. Detection of subendocardial ischemia in the left anterior descending coronary artery territory with real-time myocardial contrast echocardiography during dobutamine stress echocardiography. JACC Cardiovasc Imaging 2009; 1:271-8. [PMID: 19356438 DOI: 10.1016/j.jcmg.2008.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/20/2008] [Accepted: 02/28/2008] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The purpose of this study was to test whether the transmural delineation of myocardial perfusion during dobutamine stress imaging with real-time myocardial contrast echocardiography (RTMCE) might permit visualization of dobutamine-induced subendocardial ischemia. BACKGROUND Significant coronary artery disease can be present despite normal transmural wall thickening (WT) responses during dobutamine stress echocardiography (DSE). One potential reason is dobutamine-induced recruitment of epicardial WT in the presence of subendocardial ischemia. METHODS Myocardial perfusion and WT were examined with RTMCE during DSE with a continuous infusion of ultrasound contrast in 94 patients with normal resting WT. Fifty-five of the patients had a >50% diameter stenosis in the left anterior descending coronary artery (LAD). The WT was visually assessed by a blinded reviewer at 2 time periods: initially after a high mechanical index impulse before myocardial contrast replenishment (MCR), and again during MCR. Subendocardial %WT was measured during MCR, if a subendocardial perfusion defect was visually evident, whereas transmural WT was quantified on the pre-MCR images. RESULTS Fifty patients (91%) with LAD stenoses exhibited a myocardial contrast defect at peak stress, with 45 defects being subendocardial. Transmural WT pre-MCR appeared normal in 35 of the 45 patients with subendocardial perfusion defects (78%). However, a subendocardial WT abnormality was apparent during MCR in 18 of these 35 patients, even though transmural WT was not different from the 17 patients with normal subendocardial WT (33 +/- 15% vs. 36 +/- 14%). Quantitative measurements of WT within the subendocardium were significantly less in the patients with visually evident subendocardial WT abnormalities, when compared with those who seemed to have normal WT during MCR (17 +/- 8% vs. 25 +/- 10%, p < 0.01). CONCLUSIONS In patients with significant LAD disease, RTMCE during DSE detects subendocardial ischemia even when transmural WT appears normal. Real-time myocardial contrast echocardiography should be the preferred ultrasound imaging method when using contrast to detect coronary artery disease during DSE.
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Affiliation(s)
- Feng Xie
- Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Crosby J, Amundsen BH, Hergum T, Remme EW, Langeland S, Torp H. 3-D speckle tracking for assessment of regional left ventricular function. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:458-471. [PMID: 19056164 DOI: 10.1016/j.ultrasmedbio.2008.09.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 08/22/2008] [Accepted: 09/15/2008] [Indexed: 05/27/2023]
Abstract
Speckle tracking in 2-D ultrasound images has become an established tool for assessment of left ventricular function. The recent development of ultrasound systems with capability to acquire real-time full volume data of the left ventricle makes it possible to perform speckle tracking in three dimensions, and thereby track the real motion of the myocardium. This paper presents a method for assessing local strain and rotation from 3-D speckle tracking in apical full-volume datasets. The method has been tested on simulated ultrasound data based on a computer model of the left ventricle, and on patients with myocardial infarction. When applied on simulated ultrasound data, the method showed good agreement with strain and rotation traces calculated from the reference motion, and the method was able to capture segmental differences in the deformation pattern, although the magnitudes of strains were systematically lower than the reference strains. When applied on patients, the method demonstrated reduced strain in the infarcted areas. Bulls-eye plots of regional strains showed good correspondence with wall motion scoring based on 2-D apical images, although the dyskinetic and hypokinetic regions were not apparent in all strain components.
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Affiliation(s)
- Jonas Crosby
- Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
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Adamu U, Schmitz F, Becker M, Kelm M, Hoffmann R. Advanced speckle tracking echocardiography allowing a three-myocardial layer-specific analysis of deformation parameters. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 10:303-8. [PMID: 18801725 DOI: 10.1093/ejechocard/jen238] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Different layers of myocardium may contribute differently to myocardial deformation. Speckle tracking based on high resolution two-dimensional (2D) echocardiography has been used to define myocardial deformation parameters of whole left ventricular (LV) segments. This study evaluated with a Novell analysis modality allowing layer-specific analysis of deformation if there are differences in myocardial deformation between different layers of myocardium. METHODS AND RESULTS In 30 normal subjects and 20 patients with impaired myocardial function 2D parasternal short-axis echocardiographic views of the LV were acquired at the basal, mid-papillary, and apical levels. Using a Novell automatic frame-to-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound, Haifa, Israel), circumferential strain (CS) and strain rate of the endocardial, mid-myocardial and epicardial layer was calculated for each LV segment in an 18-segment model. Wall motion for each segment was defined as normokinetic, hypokinetic, and akinetic based on 2D echocardiographic images. Peak systolic CS could be analysed in 837 segments (93%). In the normal subjects peak systolic CS was greatest in the endocardial layer, lower in the mid-myocardial layer, and lowest in the epicardial layer (38.1+/-9.0%, 28.9+/-9.3%, and 24.0+/-9.4%, respectively, P<0.001). In the patients with impaired LV function 151 segments were hypokinetic and 92 segments akinetic by visual analysis. In all myocardial layers peak systolic CS and strain rate decreased with decreasing segmental function. CONCLUSION Decreasing myocardial deformation from endocardial to epicardial layers can be demonstrated with the use of an advanced analysis system allowing definition of deformation parameters for three myocardial layers. Myocardial deformation is reduced in all layers of segments with impaired wall motion.
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Affiliation(s)
- Umar Adamu
- Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
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45
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Phatak NS, Maas SA, Veress AI, Pack NA, Di Bella EVR, Weiss JA. Strain measurement in the left ventricle during systole with deformable image registration. Med Image Anal 2008; 13:354-61. [PMID: 18948056 DOI: 10.1016/j.media.2008.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 07/16/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
Abstract
The objective of this study was to validate a deformable image registration technique, termed Hyperelastic Warping, for left ventricular strain measurement during systole using cine-gated, non-tagged MR images with strains measured from tagged MRI. The technique combines deformation from high resolution, non-tagged MR image data with a detailed computational model, including estimated myocardial material properties, fiber direction, and active fiber contraction, to provide a comprehensive description of myocardial contractile function. A normal volunteer (male, age 30) with no history of cardiac pathology was imaged with a 1.5 T Siemens Avanto clinical scanner using a TrueFISP imaging sequence and a 32-channel cardiac coil. Both tagged and non-tagged cine MR images were obtained. The Hyperelastic Warping solution was evolved using a series of non-tagged images in ten intermediate phases from end-diastole to end-systole. The solution may be considered as ten separate warping problems with multiple templates and targets. At each stage, an active contraction was initially applied to a finite element model, and then image-based warping penalty forces were utilized to generate the final registration. Warping results for circumferential strain (R(2)=0.75) and radial strain (R(2)=0.78) were strongly correlated with results obtained from tagged MR images analyzed with a Harmonic Phase (HARP) algorithm. Results for fiber stretch, LV twist, and transmural strain distributions were in good agreement with experimental values in the literature. In conclusion, Hyperelastic Warping provides a unique alternative for quantifying regional LV deformation during systole without the need for tags.
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Affiliation(s)
- Nikhil S Phatak
- Department of Bioengineering, University of Utah, 50 South Central Campus Drive, Salt Lake City, UT 84112-9202, USA
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Biederman RWW, Doyle M, Young AA, Devereux RB, Kortright E, Perry G, Bella JN, Oparil S, Calhoun D, Pohost GM, Dell'Italia LJ. Marked regional left ventricular heterogeneity in hypertensive left ventricular hypertrophy patients: a losartan intervention for endpoint reduction in hypertension (LIFE) cardiovascular magnetic resonance and echocardiographic substudy. Hypertension 2008; 52:279-86. [PMID: 18606908 DOI: 10.1161/hypertensionaha.108.109819] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Concentric hypertensive left ventricular (LV) hypertrophy is presumed to be a symmetrical process. Using MRI-derived intramyocardial strain, we sought to determine whether segmental deformation was also symmetrical, as suggested by echocardiography. High echocardiographic LV relative wall thickness in hypertensive LV hypertrophy allows preserved endocardial excursion despite depressed LV midwall shortening (MWS). Depressed MWS is an adverse prognostic indicator, but whether this is related to global or regional myocardial depression is unknown. We prospectively compared MWS derived from linear echocardiographic dimensions with MR strain(in) in septal and posterior locations in 27 subjects with ECG LV hypertrophy in the Losartan Intervention for Endpoint Reduction in Hypertension Study. Although MRI-derived mass was higher in patients than in normal control subjects (124.0+/-38.6 versus 60.5+/-13.2g/m(2); P<0.001), fractional shortening (30+/-5% versus 33+/-3%) and end-systolic stress (175+/-22 versus 146+/-28 g/cm(2)) did not differ between groups. However, mean MR(in) was decreased in patients versus normal control subjects (13.9+/-6.8% versus 22.4+/-3.5%), as was echo MWS (13.4+/-2.8% versus 18.2+/-1.4%; both P<0.001). For patients versus normal control subjects, posterior wall(in) was not different (17.8+/-7.1% versus 21.6+/-4.0%), whereas septal(in) was markedly depressed (10.1+/-6.6% versus 23.2+/-3.4%; P<0.001). Although global MWS by echocardiography or MRI is depressed in hypertensive LV hypertrophy, MRI tissue tagging demonstrates substantial regional intramyocardial strain(in) heterogeneity, with most severely depressed strain patterns in the septum. Although posterior wall 2D principal strain was inversely related to radius of curvature, septal strain was not, suggesting that factors other than afterload are responsible for pronounced myocardial strain heterogeneity in concentric hypertrophy.
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Affiliation(s)
- Robert W W Biederman
- Division of Cardiology, Department of Cardiovascular MRI, Gerald McGuiness Center, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212, USA.
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47
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Mizuguchi Y, Oishi Y, Tanaka H, Miyoshi H, Ishimoto T, Nagase N, Oki T. Arterial Stiffness Is Associated With Left Ventricular Diastolic Function in Patients With Cardiovascular Risk Factors: Early Detection With the Use of Cardio-Ankle Vascular Index and Ultrasonic Strain Imaging. J Card Fail 2007; 13:744-51. [DOI: 10.1016/j.cardfail.2007.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 05/23/2007] [Accepted: 05/25/2007] [Indexed: 10/22/2022]
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48
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Tanaka H, Oishi Y, Mizuguchi Y, Emi S, Ishimoto T, Nagase N, Tabata T, Yamada H, Oki T. Three-dimensional Evaluation of Dobutamine-induced Changes in Regional Myocardial Deformation in Ischemic Myocardium Using Ultrasonic Strain Measurements: The Role of Circumferential Myocardial Shortening. J Am Soc Echocardiogr 2007; 20:1294-9. [PMID: 17604959 DOI: 10.1016/j.echo.2007.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Indexed: 11/17/2022]
Abstract
Early identification of myocardial ischemia during high-dose dobutamine stress (DOB) has important clinical implications. Myocardial strain imaging can evaluate regional myocardial contractility in the radial, longitudinal, and circumferential directions. The aim of this study was to assess precisely the differences in deterioration of myocardial deformation among the 3 directions in patients with newly developed myocardial ischemia during high-dose (40 microg/kg/min) DOB infusion. Color Doppler tissue 2-dimensional images were recorded during DOB infusion in 20 patients without myocardial ischemia and 25 patients with scintigraphically diagnosed myocardial ischemia caused by left anterior descending coronary artery stenosis. In the offline analysis, systolic radial strain (Sr), longitudinal strain (Sl), and circumferential strain (Sc) were determined in the anteroseptal and anterolateral left ventricular walls. In 20 patients without myocardial ischemia, the peak systolic strains significantly increased in all 3 directions during DOB infusion at rates between 5 and 10 microg/kg/min (Sr 50%-69%, Sl 27%-36%, Sc 29%-38%, all P < .01) with a greater rate of change in the Sr (1.8 and 1.9 times, respectively, P < .001) than in the Sl and Sc. However, the peak systolic strains decreased significantly during DOB infusion at rates between 5 and 10 microg/kg/min in all 3 directions (Sr 56%-35%, Sl 27%-13%, both P < .01; Sc 29%-7%, P < .001) with the greatest rate of change in the Sc in 25 patients with newly developed myocardial ischemia. In conclusion, circumferential myocardial shortening deteriorated to a greater extent during DOB infusion in patients with coronary artery stenosis, and its measurement is a promising tool for detecting newly developed myocardial ischemia.
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Affiliation(s)
- Hideji Tanaka
- Higashi Tokushima National Hospital, National Hospital Organization, Tokushima, Japan
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49
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Mizuguchi Y, Tanaka H, Oishi Y, Miyoshi H, Emi S, Ishimoto T, Nagase N, Oki T. Predictive Value of Associations Between Carotid Arterial Sclerosis and Left Ventricular Diastolic Dysfunction in Patients with Cardiovascular Risk Factors. J Am Soc Echocardiogr 2007; 20:806-12. [PMID: 17617306 DOI: 10.1016/j.echo.2007.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Indexed: 10/23/2022]
Abstract
It is well known that arterial stiffness affects the morbidity and mortality associated with cardiovascular disease. However, there are limited data addressing the relationship between arterial stiffness and left ventricular (LV) diastolic function in patients with cardiovascular risk factors. Subclinical atherosclerosis was determined by measuring the intima-media thickness and stiffness (beta) of the left and right common carotid arteries using B- and M-mode ultrasonography in 30 patients with one or more cardiovascular risk factors. LV systolic and diastolic function were also determined by measuring transmitral flow velocity, mitral annular motion velocity, and myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. The carotid stiffness beta was greater and the peak early diastolic strain rates of the LV posterior and inferior walls were lower in these patients than in the age-matched control group. The carotid intima-media thickness correlated only with body mass index and LV wall thickness. The carotid stiffness beta correlated with age, peak early diastolic velocity and deceleration time of the transmitral flow, peak early diastolic mitral annular motion velocity, and peak early diastolic strain rates of the LV walls. Multiple linear regression analysis revealed that early diastolic strain rates of the LV walls are strongly related to carotid stiffness beta. In conclusion, LV relaxation is significantly associated with carotid arterial atherosclerosis, particularly sclerosis, in patients with cardiovascular risk factors. These results support the importance of screening using ultrasonic strain imaging and early intervention in this patient population.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, Tokushima, Japan.
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50
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Rocha KR, Yezzi AJ, Prince JL. A hybrid Eulerian-Lagrangian approach for thickness, correspondence, and gridding of annular tissues. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2007; 16:636-48. [PMID: 17357725 DOI: 10.1109/tip.2007.891072] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a novel approach to efficiently compute thickness, correspondence, and gridding of tissues between two simply connected boundaries. The solution of Laplace's equation within the tissue region provides a harmonic function whose gradient flow determines the correspondence trajectories going from one boundary to the other. The proposed method uses and expands upon two recently introduced techniques in order to compute thickness and correspondences based on these trajectories. Pairs of partial differential equations are efficiently computed within an Eulerian framework and combined with a Lagrangian approach so that correspondences trajectories are partially constructed when necessary. Examples are presented in order to compare the performance of this method with those of the pure Lagrangian and pure Eulerian approaches. Results show that the proposed technique takes advantage of both the speed of the Eulerian approach and the accuracy of the Lagrangian approach.
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Affiliation(s)
- Kelvin R Rocha
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332-1100, USA.
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