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Fan L, Choy JS, Lee S, Campbell KS, Wenk JF, Kassab GS, Burkhoff D, Lee LC. An in silico study of the effects of left ventricular assist device on right ventricular function and inter-ventricular interaction. Artif Organs 2023; 47:1831-1847. [PMID: 37746896 PMCID: PMC10964177 DOI: 10.1111/aor.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Left ventricular assist device (LVAD) is associated with a high incidence of right ventricular (RV) failure, which is hypothesized to be caused by the occurring inter-ventricular interactions when the LV is unloaded. Factors contributing to these interactions are unknown. METHODS We used computer modeling to investigate the impact of the HeartMate 3 LVAD on RV functions. The model was first calibrated against pressure-volume (PV) loops associated with a heart failure (HF) patient and validated against measurements of inter-ventricular interactions in animal experiments. The model was then applied to investigate the effects of LVAD on (1) RV chamber contractility indexed byV 60 derived from its end-systolic PV relationship, and (2) RV diastolic function indexed byV 20 derived from its end-diastolic PV relationship. We also investigated how septal wall thickness and regional contractility affect the impact of LVAD on RV function. RESULTS The impact of LVAD on RV chamber contractility is small at a pump speed lower than 4k rpm. At a higher pump speed between 4k and 9k rpm, however, RV chamber contractility is reduced (by ~3% at 6k rpm and ~10% at 9k rpm). The reduction of RV chamber contractility is greater with a thinner septal wall or with a lower myocardial contractility at the LV free wall, septum, or RV free wall. CONCLUSION RV chamber contractility is reduced at a pump speed higher than 4k rpm, and this reduction is greater with a thinner septal wall or lower regional myocardial contractility. Findings here may have clinical implications in identifying LVAD patients who may suffer from RV failure.
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Affiliation(s)
- Lei Fan
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenny S. Choy
- California Medical Innovations Institute, San Diego, California, USA
| | - Sangjin Lee
- Division of Medicine, Advanced Heart Failure and Transplantation, Spectrum Health Meijer Heart & Vascular Institute, Grand Rapids, Michigan, USA
| | - Kenneth S. Campbell
- Physiology and Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jonathan F. Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Ghassan S. Kassab
- California Medical Innovations Institute, San Diego, California, USA
| | | | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
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2
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Kou M, Hishida M, Mathews L, Kitzman DW, Shah AM, Coresh J, Solomon S, Matsushita K, Ishigami J. Echocardiography-Based Cardiac Structure Parameters for the Long-term Risk of End-Stage Kidney Disease in Black Individuals: The Atherosclerosis Risk in Communities Study. Mayo Clin Proc 2022; 97:1794-1807. [PMID: 36202493 DOI: 10.1016/j.mayocp.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess whether echocardiographic parameters of left ventricular (LV) structure and function relate to the long-term risk of incident end-stage kidney disease (ESKD). PATIENTS AND METHODS We conducted a prospective cohort study analyzing 2137 Black participants from the Jackson site of the Atherosclerosis Risk in Communities Study from January 1, 1993, through July 31, 2017. Echocardiographic parameters of LV structure and function were obtained from 1993 to 1995. The primary outcome incident ESKD was identified through the linkage to the United States Renal Data System. Cox proportional hazards models were used to estimate the hazard ratios (HRs) according to each echocardiographic parameter. RESULTS There were 117 incident ESKD cases during a median follow-up of 22.2 (interquartile range, 15.0-23.3) years. Multivariable Cox models revealed that a higher LV mass index was significantly associated with the risk of ESKD (HR, 2.38; 95% CI, 1.21 to 4.68 for highest vs lowest quartile, P = 0.012). The HRs were significant and even higher for LV posterior wall thickness, with slightly higher HRs when their measures in end-systole (HR for highest vs lowest quartile, 4.38; 95% CI, 1.94 to 9.92, P < 0.001) vs end-diastole (HR, 3.50; 95% CI, 1.53 to 8.01, P = 0.003) were used. The associations were not significant for LV function parameters. CONCLUSION In Black individuals residing in the community, echocardiographic parameters of LV structure, including LV wall thickness, were robustly associated with the risk of subsequently incident ESKD. These results have potential implications for novel prevention and management strategies for persons with abnormal LV structure.
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Affiliation(s)
- Minghao Kou
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Manabu Hishida
- Department of Nephrology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Lena Mathews
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amil M Shah
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Scott Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
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3
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Meng Q, Qin C, Bai W, Liu T, de Marvao A, O’Regan DP, Rueckert D. MulViMotion: Shape-Aware 3D Myocardial Motion Tracking From Multi-View Cardiac MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:1961-1974. [PMID: 35201985 PMCID: PMC7613225 DOI: 10.1109/tmi.2022.3154599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Recovering the 3D motion of the heart from cine cardiac magnetic resonance (CMR) imaging enables the assessment of regional myocardial function and is important for understanding and analyzing cardiovascular disease. However, 3D cardiac motion estimation is challenging because the acquired cine CMR images are usually 2D slices which limit the accurate estimation of through-plane motion. To address this problem, we propose a novel multi-view motion estimation network (MulViMotion), which integrates 2D cine CMR images acquired in short-axis and long-axis planes to learn a consistent 3D motion field of the heart. In the proposed method, a hybrid 2D/3D network is built to generate dense 3D motion fields by learning fused representations from multi-view images. To ensure that the motion estimation is consistent in 3D, a shape regularization module is introduced during training, where shape information from multi-view images is exploited to provide weak supervision to 3D motion estimation. We extensively evaluate the proposed method on 2D cine CMR images from 580 subjects of the UK Biobank study for 3D motion tracking of the left ventricular myocardium. Experimental results show that the proposed method quantitatively and qualitatively outperforms competing methods.
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Affiliation(s)
- Qingjie Meng
- Biomedical Image Analysis GroupDepartment of ComputingImperial College LondonLondonSW7 2AZU.K.
| | - Chen Qin
- School of EngineeringInstitute for Digital Communications, The University of EdinburghEdinburghEH9 9JLU.K.
| | - Wenjia Bai
- Biomedical Image Analysis GroupDepartment of ComputingImperial College LondonLondonSW7 2AZU.K.
- Department of Brain SciencesImperial College LondonLondonSW7 2AZU.K.
| | - Tianrui Liu
- Biomedical Image Analysis GroupDepartment of ComputingImperial College LondonLondonSW7 2AZU.K.
| | - Antonio de Marvao
- MRC London Institute of Medical SciencesImperial College LondonLondonW12 0HSU.K.
| | - Declan P O’Regan
- MRC London Institute of Medical SciencesImperial College LondonLondonW12 0HSU.K.
| | - Daniel Rueckert
- Biomedical Image Analysis GroupDepartment of ComputingImperial College LondonLondonSW7 2AZU.K.
- Faculty of Informatics and MedicineTechnical University of Munich85748MunichGermany
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4
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Levrero-Florencio F, Margara F, Zacur E, Bueno-Orovio A, Wang Z, Santiago A, Aguado-Sierra J, Houzeaux G, Grau V, Kay D, Vázquez M, Ruiz-Baier R, Rodriguez B. Sensitivity analysis of a strongly-coupled human-based electromechanical cardiac model: Effect of mechanical parameters on physiologically relevant biomarkers. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2020; 361:112762. [PMID: 32565583 PMCID: PMC7299076 DOI: 10.1016/j.cma.2019.112762] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The human heart beats as a result of multiscale nonlinear dynamics coupling subcellular to whole organ processes, achieving electrophysiologically-driven mechanical contraction. Computational cardiac modelling and simulation have achieved a great degree of maturity, both in terms of mathematical models of underlying biophysical processes and the development of simulation software. In this study, we present the detailed description of a human-based physiologically-based, and fully-coupled ventricular electromechanical modelling and simulation framework, and a sensitivity analysis focused on its mechanical properties. The biophysical detail of the model, from ionic to whole-organ, is crucial to enable future simulations of disease and drug action. Key novelties include the coupling of state-of-the-art human-based electrophysiology membrane kinetics, excitation-contraction and active contraction models, and the incorporation of a pre-stress model to allow for pre-stressing and pre-loading the ventricles in a dynamical regime. Through high performance computing simulations, we demonstrate that 50% to 200% - 1000% variations in key parameters result in changes in clinically-relevant mechanical biomarkers ranging from diseased to healthy values in clinical studies. Furthermore mechanical biomarkers are primarily affected by only one or two parameters. Specifically, ejection fraction is dominated by the scaling parameter of the active tension model and its scaling parameter in the normal direction ( k ort 2 ); the end systolic pressure is dominated by the pressure at which the ejection phase is triggered ( P ej ) and the compliance of the Windkessel fluid model ( C ); and the longitudinal fractional shortening is dominated by the fibre angle ( ϕ ) and k ort 2 . The wall thickening does not seem to be clearly dominated by any of the considered input parameters. In summary, this study presents in detail the description and implementation of a human-based coupled electromechanical modelling and simulation framework, and a high performance computing study on the sensitivity of mechanical biomarkers to key model parameters. The tools and knowledge generated enable future investigations into disease and drug action on human ventricles.
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Affiliation(s)
- F. Levrero-Florencio
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
- Corresponding authors.
| | - F. Margara
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
| | - E. Zacur
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - A. Bueno-Orovio
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
| | - Z.J. Wang
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
| | - A. Santiago
- Barcelona Supercomputing Center – Centro Nacional de Supercomputación, Barcelona 08034, Spain
| | - J. Aguado-Sierra
- Barcelona Supercomputing Center – Centro Nacional de Supercomputación, Barcelona 08034, Spain
| | - G. Houzeaux
- Barcelona Supercomputing Center – Centro Nacional de Supercomputación, Barcelona 08034, Spain
| | - V. Grau
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - D. Kay
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
| | - M. Vázquez
- Barcelona Supercomputing Center – Centro Nacional de Supercomputación, Barcelona 08034, Spain
- ELEM Biotech, Spain
| | - R. Ruiz-Baier
- Mathematical Institute, University of Oxford, Oxford OX2 6GG, United Kingdom
- Universidad Adventista de Chile, Casilla 7-D, Chillan, Chile
| | - B. Rodriguez
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, United Kingdom
- Corresponding authors.
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5
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Verzhbinsky IA, Perotti LE, Moulin K, Cork TE, Loecher M, Ennis DB. Estimating Aggregate Cardiomyocyte Strain Using In Vivo Diffusion and Displacement Encoded MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:656-667. [PMID: 31398112 PMCID: PMC7325525 DOI: 10.1109/tmi.2019.2933813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Changes in left ventricular (LV) aggregate cardiomyocyte orientation and deformation underlie cardiac function and dysfunction. As such, in vivo aggregate cardiomyocyte "myofiber" strain ( [Formula: see text]) has mechanistic significance, but currently there exists no established technique to measure in vivo [Formula: see text]. The objective of this work is to describe and validate a pipeline to compute in vivo [Formula: see text] from magnetic resonance imaging (MRI) data. Our pipeline integrates LV motion from multi-slice Displacement ENcoding with Stimulated Echoes (DENSE) MRI with in vivo LV microstructure from cardiac Diffusion Tensor Imaging (cDTI) data. The proposed pipeline is validated using an analytical deforming heart-like phantom. The phantom is used to evaluate 3D cardiac strains computed from a widely available, open-source DENSE Image Analysis Tool. Phantom evaluation showed that a DENSE MRI signal-to-noise ratio (SNR) ≥20 is required to compute [Formula: see text] with near-zero median strain bias and within a strain tolerance of 0.06. Circumferential and longitudinal strains are also accurately measured under the same SNR requirements, however, radial strain exhibits a median epicardial bias of -0.10 even in noise-free DENSE data. The validated framework is applied to experimental DENSE MRI and cDTI data acquired in eight ( N=8 ) healthy swine. The experimental study demonstrated that [Formula: see text] has decreased transmural variability compared to radial and circumferential strains. The spatial uniformity and mechanistic significance of in vivo [Formula: see text] make it a compelling candidate for characterization and early detection of cardiac dysfunction.
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Zhou Y, Li D, Tang H, Xu Y, Wang C, Jiang Z, Xu F, Zhao Z, Li C, Tang S, Tang L, Zhou W. Development and validation of a new method to diagnose apical hypertrophic cardiomyopathy by gated single-photon emission computed tomography myocardial perfusion imaging. Nucl Med Commun 2019; 40:206-211. [PMID: 30570518 PMCID: PMC10961109 DOI: 10.1097/mnm.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM The aim of this study is to develop and validate a new method to diagnose apical hypertrophic cardiomyopathy (AHCM) by the integral quantitative analysis of myocardial perfusion and wall thickening from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). PATIENTS AND METHODS Twenty-two consecutive patients, who showed T wave inversion of at least 3 mm in precordial leads and sinus rhythm in ECG, were enrolled. All the patients underwent cardiac magnetic resonance (CMR), gated rest SPECT MPI and echocardiography. According to CMR diagnostic results, 13 patients were categorized as in the AHCM group and the remaining nine patients were categorized as in the non-AHCM group. Operators who were blinded to the CMR diagnosis independently performed the diagnosis by gated SPECT MPI. The regions of interest inside the apical hotspots on the perfusion polar map were drawn and the mean values of wall thickening in the drawn region of interests were calculated. Using MRI diagnosis as the gold standard, AHCM was diagnosed based on receiver operating characteristic analysis of the mean wall thickening in the apical perfusion hotspot. The area under curve, sensitivity, specificity, and accuracy of our method were 0.97, 100%, 89%, and 95%, respectively. CONCLUSION Our new method has high sensitivity, specificity, and accuracy against CMR diagnosis. It has great promise to become a clinical tool in the diagnosis of AHCM.
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Affiliation(s)
- Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Cheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Zhixin Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Zhongqiang Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Chunxiang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Shaojie Tang
- School of Automation, Xi’an University of Posts and Telecommunications, Xi’an, China
| | - Lijun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
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7
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Affiliation(s)
| | | | - Elizabeth M. McNally
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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8
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Yang KC, Breitbart A, De Lange WJ, Hofsteen P, Futakuchi-Tsuchida A, Xu J, Schopf C, Razumova MV, Jiao A, Boucek R, Pabon L, Reinecke H, Kim DH, Ralphe JC, Regnier M, Murry CE. Novel Adult-Onset Systolic Cardiomyopathy Due to MYH7 E848G Mutation in Patient-Derived Induced Pluripotent Stem Cells. JACC Basic Transl Sci 2018; 3:728-740. [PMID: 30623132 PMCID: PMC6314962 DOI: 10.1016/j.jacbts.2018.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 12/15/2022]
Abstract
A novel myosin heavy chain 7 mutation (E848G) identified in a familial cardiomyopathy was studied in patient-specific induced pluripotent stem cell-derived cardiomyocytes. The cardiomyopathic human induced pluripotent stem cell-derived cardiomyocytes exhibited reduced contractile function as single cells and engineered heart tissues, and genome-edited isogenic cells confirmed the pathogenic nature of the E848G mutation. Reduced contractility may result from impaired interaction between myosin heavy chain 7 and cardiac myosin binding protein C.
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Key Words
- Ad-GFP, green fluorescent protein–encoding adenovirus
- DCM, dilated cardiomyopathy
- EHT, engineered heart tissue
- FCM, familial cardiomyopathy
- HCM, hypertrophic cardiomyopathy
- KO, knockout
- MOI, multiplicity of infections
- MYH, myosin heavy chain
- WT, wild-type
- cMyBP-C, cardiac myosin-binding protein C
- disease-modeling
- engineered heart tissue
- genetic cardiomyopathy
- hiPSC-CM, human induced pluripotent stem cell–derived cardiomyocyte
- iPSC-CM, induced pluripotent stem cell–derived cardiomyocyte
- induced pluripotent stem cells
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Affiliation(s)
- Kai-Chun Yang
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Astrid Breitbart
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Willem J. De Lange
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter Hofsteen
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Akiko Futakuchi-Tsuchida
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Joy Xu
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Cody Schopf
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Maria V. Razumova
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Alex Jiao
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Robert Boucek
- Department of Pediatrics, Seattle’s Children’s Hospital and the University of Washington, Seattle, Washington
| | - Lil Pabon
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Hans Reinecke
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
| | - Deok-Ho Kim
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - J. Carter Ralphe
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Regnier
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Charles E. Murry
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington
- Department of Bioengineering, University of Washington, Seattle, Washington
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9
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Wehner GJ, Suever JD, Fielden SW, Powell DK, Hamlet SM, Vandsburger MH, Haggerty CM, Zhong X, Fornwalt BK. Typical readout durations in spiral cine DENSE yield blurred images and underestimate cardiac strains at both 3.0 T and 1.5 T. Magn Reson Imaging 2018; 54:90-100. [PMID: 30099059 DOI: 10.1016/j.mri.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Displacement encoding with stimulated echoes (DENSE) is a phase contrast technique that encodes tissue displacement into phase images, which are typically processed into measures of cardiac function such as strains. For improved signal to noise ratio and spatiotemporal resolution, DENSE is often acquired with a spiral readout using an 11.1 ms readout duration. However, long spiral readout durations are prone to blurring due to common phenomena such as off-resonance and T2* decay, which may alter the resulting quantifications of strain. We hypothesized that longer readout durations would reduce image quality and underestimate cardiac strains at both 3.0 T and 1.5 T and that using short readout durations could overcome these limitations. MATERIAL AND METHODS Computational simulations were performed to investigate the relationship between off-resonance and T2* decay, the spiral cine DENSE readout duration, and measured radial and circumferential strain. Five healthy participants subsequently underwent 2D spiral cine DENSE at both 3.0 T and 1.5 T with several different readout durations 11.1 ms and shorter. Pearson correlations were used to assess the relationship between cardiac strains and the spiral readout duration. RESULTS Simulations demonstrated that long readout durations combined with off-resonance and T2* decay yield blurred images and underestimate strains. With the typical 11.1 ms DENSE readout, blurring was present in the anterior and lateral left ventricular segments of participants and was markedly improved with shorter readout durations. Radial and circumferential strains from those segments were significantly correlated with the readout duration. Compared to the 1.9 ms readout, the 11.1 ms readout underestimated radial and circumferential strains in those segments at both field strengths by up to 19.6% and 1.5% (absolute), or 42% and 7% (relative), respectively. CONCLUSIONS Blurring is present in spiral cine DENSE images acquired at both 3.0 T and 1.5 T using the typical 11.1 ms readout duration, which yielded substantially reduced radial strains and mildly reduced circumferential strains. Clinical studies using spiral cine DENSE should consider these limitations, while future technical advances may need to leverage accelerated techniques to improve the robustness and accuracy of the DENSE acquisition rather than focusing solely on reduced acquisition time.
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Affiliation(s)
- Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Jonathan D Suever
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States.
| | - Samuel W Fielden
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Medical & Health Physics, Geisinger, Danville, PA, United States.
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Sean M Hamlet
- Department of Electrical Engineering, University of Kentucky, Lexington, KY, United States.
| | - Moriel H Vandsburger
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States; Department of Physiology, University of Kentucky, Lexington, KY, United States.
| | | | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, United States.
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Geisinger, Danville, PA, United States; Department of Radiology, Geisinger, Danville, PA, United States.
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10
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Sanz-Estébanez S, Cordero-Grande L, Sevilla T, Revilla-Orodea A, de Luis-García R, Martín-Fernández M, Alberola-López C. Vortical features for myocardial rotation assessment in hypertrophic cardiomyopathy using cardiac tagged magnetic resonance. Med Image Anal 2018; 47:191-202. [PMID: 29753999 DOI: 10.1016/j.media.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/10/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Left ventricular rotational motion is a feature of normal and diseased cardiac function. However, classical torsion and twist measures rely on the definition of a rotational axis which may not exist. This paper reviews global and local rotation descriptors of myocardial motion and introduces new curl-based (vortical) features built from tensorial magnitudes, intended to provide better comprehension about fibrotic tissue characteristics mechanical properties. Fifty-six cardiomyopathy patients and twenty-two healthy volunteers have been studied using tagged magnetic resonance by means of harmonic phase analysis. Rotation descriptors are built, with no assumption about a regular geometrical model, from different approaches. The extracted vortical features have been tested by means of a sequential cardiomyopathy classification procedure; they have proven useful for the regional characterization of the left ventricular function by showing great separability not only between pathologic and healthy patients but also, and specifically, between heterogeneous phenotypes within cardiomyopathies.
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Affiliation(s)
- Santiago Sanz-Estébanez
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain. http://www.lpi.tel.uva.es/ssanest
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain and Department of Biomedical Engineering, Division of Imaging Science and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, U.K.
| | - Teresa Sevilla
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Ana Revilla-Orodea
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Rodrigo de Luis-García
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Marcos Martín-Fernández
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Carlos Alberola-López
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
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11
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Menza M, Föll D, Hennig J, Jung B. Segmental biventricular analysis of myocardial function using high temporal and spatial resolution tissue phase mapping. MAGMA (NEW YORK, N.Y.) 2017; 31:61-73. [PMID: 29143137 DOI: 10.1007/s10334-017-0661-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Myocardial dysfunction of the right ventricle (RV) is an important indicator of RV diseases, e.g. RV infarction or pulmonary hypertension. Tissue phase mapping (TPM) has been widely used to determine function of the left ventricle (LV) by analyzing myocardial velocities. The analysis of RV motion is more complicated due to the different geometry and smaller wall thickness. The aim of this work was to adapt and optimize TPM to the demands of the RV. MATERIALS AND METHODS TPM measurements were acquired in 25 healthy volunteers using a velocity-encoded phase-contrast sequence and kt-accelerated parallel imaging in combination with optimized navigator strategy and blood saturation. Post processing was extended by a 10-segment RV model and a detailed biventricular analysis of myocardial velocities was performed. RESULTS High spatio-temporal resolution (1.0 × 1.0 × 6 mm3, 21.3 ms) and the optimized blood saturation enabled good delineation of the RV and its velocities. Global and segmental velocities, as well as time to peak velocities showed significant differences between the LV and RV. Furthermore, complex timing of the RV could be demonstrated by segmental time to peak analysis. CONCLUSION High spatio-temporal resolution TPM enables a detailed biventricular analysis of myocardial motion and might provide a reliable tool for description and detection of diseases affecting left and right ventricular function.
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Affiliation(s)
- Marius Menza
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 60a, 79106, Freiburg, Germany.
| | - Daniela Föll
- Department of Cardiology and Angiology I, Heart Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 60a, 79106, Freiburg, Germany
| | - Bernd Jung
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Bern, Switzerland
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12
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Saito S, Masuda K, Mori Y, Nakatani S, Yoshioka Y, Murase K. Mapping of left ventricle wall thickness in mice using 11.7-T magnetic resonance imaging. Magn Reson Imaging 2017; 36:128-134. [DOI: 10.1016/j.mri.2016.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
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13
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Contractile Dysfunction in Sarcomeric Hypertrophic Cardiomyopathy. J Card Fail 2016; 22:731-7. [DOI: 10.1016/j.cardfail.2016.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/06/2016] [Accepted: 03/18/2016] [Indexed: 12/29/2022]
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14
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Trapped lung secondary to cardiomegaly in a 78 year-old male with congestive heart failure. Respir Med Case Rep 2016; 18:4-7. [PMID: 27054087 PMCID: PMC4802684 DOI: 10.1016/j.rmcr.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/04/2022] Open
Abstract
Although the etiologies of both trapped lung and cardiomegaly are well-established, co-presentation of the two conditions, and possible interactions between them, are much rarer. Here we describe the case of 78 year-old male found to have both cardiomegaly and trapped lung, with a cause of death of congestive heart failure and subsequent cardiac arrest. This case prompted consideration of possible interactions between the two conditions. Issues related to decision-making for imaging and clinical interventions are also discussed.
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Fast 3-Breath-Hold 3-Dimensional Tagging Cardiac Magnetic Resonance in Patients with Hypertrophic Myocardial Diseases: A Feasibility Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3749489. [PMID: 27022609 PMCID: PMC4789016 DOI: 10.1155/2016/3749489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
Tagging CMR has been established as the standard reference for measurement of myocardial strain. The current 2D tagging technique requires multiple breath-holds to cover the whole heart and cannot show the 3D motions of the left ventricle. We performed fast 3-breath-hold 3D tagging with localized tagging preparation and complementary spatial modulation of magnetization in 10 patients with hypertrophic myocardial diseases and 6 normal volunteers. The left wall motion was observed at any view angle, which allowed for the identification of regional and global hypokinesis using the fast 3D tagging. Although a decrease in the circumferential strain and LGE were observed at the basal septum in hypertrophic cardiomyopathy, they were not located together in each patient. In hypertensive heart disease, the decrease in circumferential strain was observed more widely than LGE, and the summed strain of all segments was significantly decreased. The decrease in strain and LGE were observed diffusely in cardiac amyloidosis. In conclusion, fast 3-breath-hold 3D tagging is feasible for the regional and global strain analysis. The location of reduced circumferential strain is not necessarily the same as that of LGE and is related to the global cardiac function in patients with hypertrophic myocardial diseases.
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16
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An electromechanical left ventricular wedge model to study the effects of deformation on repolarization during heart failure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:465014. [PMID: 26550570 PMCID: PMC4625222 DOI: 10.1155/2015/465014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/12/2015] [Accepted: 09/20/2015] [Indexed: 11/18/2022]
Abstract
Heart failure is a major and costly problem in public health, which, in certain cases, may lead to death. The failing heart undergo a series of electrical and structural changes that provide the underlying basis for disturbances like arrhythmias. Computer models of coupled electrical and mechanical activities of the heart can be used to advance our understanding of the complex feedback mechanisms involved. In this context, there is a lack of studies that consider heart failure remodeling using strongly coupled electromechanics. We present a strongly coupled electromechanical model to study the effects of deformation on a human left ventricle wedge considering normal and hypertrophic heart failure conditions. We demonstrate through a series of simulations that when a strongly coupled electromechanical model is used, deformation results in the thickening of the ventricular wall that in turn increases transmural dispersion of repolarization. These effects were analyzed in both normal and failing heart conditions. We also present transmural electrograms obtained from these simulations. Our results suggest that the waveform of electrograms, particularly the T-wave, is influenced by cardiac contraction on both normal and pathological conditions.
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17
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Bravo PE, Luo HC, Pozios I, Zimmerman SL, Corona-Villalobos CP, Sorensen L, Kamel IR, Bluemke DA, Wahl RL, Abraham MR, Abraham TP. Late gadolinium enhancement confined to the right ventricular insertion points in hypertrophic cardiomyopathy: an intermediate stage phenotype? Eur Heart J Cardiovasc Imaging 2015; 17:293-300. [PMID: 26077330 DOI: 10.1093/ehjci/jev154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/23/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS To investigate whether hypertrophic cardiomyopathy (HCM) patients with late gadolinium enhancement (LGE) confined to the right ventricular insertion points (RVIP) differ phenotypically from patients without LGE or intramural LGE in the left ventricle (LV). METHODS AND RESULTS Sixty-two HCM patients underwent cardiac magnetic resonance for quantification of LGE (% LV mass) and were classified as group (i) no-LGE (n = 18), group (ii) LGE-RVIP (n = 19), and group (iii) intramural LGE (n = 25). All patients also underwent vasodilator N-13 ammonia PET to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR), and echocardiography to measure longitudinal LV strain. LGE extent (17 ± 11% vs. 4 ± 4% vs. 0%; P < 0.001) and LV thickness (21.7 ± 3.4 vs. 18.8 ± 3.9 vs. 16.3 ± 2.8 mm; P < 0.001) were significantly greater in group 3, intermediate in group 2, and lower in group 1. In contrast, stress MBF (1.62 ± 0.44 vs. 1.90 ± 0.37 vs. 2.22 ± 0.48 mL/min/g; P < 0.001); MFR (1.92 ± 0.47 vs. 2.15 ± 0.52 vs. 2.71 ± 0.52; P < 0.001), and longitudinal LV strain (-11.4 ± 3.8 vs. -12.6 ± 3.2 vs. -14.4 ± 4.1%; P = 0.04) were lower in group 3, intermediate in group 2, and higher in group 1. CONCLUSIONS From an imaging viewpoint, patients with LGE confined to only the RVIP appear to represent an intermediate-stage phenotype between patients with no LGE and intramural LGE in the LV.
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Affiliation(s)
- Paco E Bravo
- Department of Cardiology, University of Washington, 1959 NE Pacific Street, PO Box 356422, Seattle, WA 98195, USA Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | | | | | - Lars Sorensen
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ihab R Kamel
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
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18
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Stöhr EJ, Stembridge M, Esformes JI. In vivohuman cardiac shortening and lengthening velocity is region dependent and not coupled with heart rate: ‘longitudinal’ strain rate markedly underestimates apical contribution. Exp Physiol 2015; 100:507-18. [DOI: 10.1113/ep085081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Eric J. Stöhr
- Cardiff School of Sport; , Cardiff Metropolitan University; Cardiff UK
| | - Mike Stembridge
- Cardiff School of Sport; , Cardiff Metropolitan University; Cardiff UK
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Zhong L, Zhao X, Wan M, Zhang JM, Su BY, Tang HC, Tan RS. Characterization and quantification of curvature using independent coordinates method in the human left ventricle by magnetic resonance imaging to identify the morphology subtype of hypertrophy cardiomyopathy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5619-22. [PMID: 25571269 DOI: 10.1109/embc.2014.6944901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The patterns of ventricular hypertrophy are critical determinants of blood flow and function, but are variable. Therefore, it is clinically relevant to assess the hypertrophic shape patterns to better characterize and identify the morphological subtypes. We proposed and developed an independent coordinates method (ICM) to quantify the regional shape of the left ventricle in terms of curvature. 19 normal subjects and 5 HCM (hypertrophic cardiomyopathy) patients with different morphological subtype (i.e., septal hypertrophy, mid-ventricular hypertrophy, reverse curvature septum hypertrophy and sigmoid septum hypertrophy) were recruited and underwent magnetic resonance scans. The curvature along the endocardial and epicardial surface was computed using ICM method and was compared in HCM patients against normal subjects. The results showed that curvature plots are variable in different morphological subtype. The curvature pattern demonstrated the utilities in delineating different subtype. In conclusion, ICM method to quantify regional curvature of the left ventricle from magnetic resonance imaging are feasible in normal subjects and those with hypertrophy cardiomyopathy, which may serve as a novel approach to depict local shape of the left ventricle and to assess the morphological subtype in clinical practice.
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20
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Jiang K, Yu X. Quantification of regional myocardial wall motion by cardiovascular magnetic resonance. Quant Imaging Med Surg 2014; 4:345-57. [PMID: 25392821 DOI: 10.3978/j.issn.2223-4292.2014.09.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is a versatile tool that also allows comprehensive and accurate measurement of both global and regional myocardial contraction. Quantification of regional wall motion parameters, such as strain, strain rate, twist and torsion, has been shown to be more sensitive to early-stage functional alterations. Since the invention of CMR tagging by magnetization saturation in 1988, several CMR techniques have been developed to enable the measurement of regional myocardial wall motion, including myocardial tissue tagging, phase contrast mapping, displacement encoding with stimulated echoes (DENSE), and strain encoded (SENC) imaging. These techniques have been developed with their own advantages and limitations. In this review, two widely used and closely related CMR techniques, i.e., tissue tagging and DENSE, will be discussed from the perspective of pulse sequence development and image-processing techniques. The clinical and preclinical applications of tissue tagging and DENSE in assessing wall motion mechanics in both normal and diseased hearts, including coronary artery diseases, hypertrophic cardiomyopathy, aortic stenosis, and Duchenne muscular dystrophies, will be discussed.
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Affiliation(s)
- Kai Jiang
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xin Yu
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
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21
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Aly MFA, Brouwer WP, Kleijn SA, van Rossum AC, Kamp O. Three-dimensional speckle tracking echocardiography for the preclinical diagnosis of hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:523-33. [DOI: 10.1007/s10554-014-0364-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/07/2014] [Indexed: 11/28/2022]
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22
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Rangel I, Gonçalves A, de Sousa C, Correia AS, Pinho T, Madureira AJ, Martins E, Cardoso JS, Macedo F, Maciel MJ. Spirito-Maron echocardiographic score: a marker for morphological and physiological assessment of patients with hypertrophic cardiomyopathy. Echocardiography 2014; 31:708-15. [PMID: 24460546 DOI: 10.1111/echo.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The heterogeneous distribution of hypertrophy in hypertrophic cardiomyopathy (HCM) limits the echocardiographic conventional measurements accuracy in the evaluation of left ventricular hypertrophy (LVH). The aim of this study was to assess the correlation of the echocardiographic Spirito-Maron score (SMS) with left ventricle (LV) mass quantification by cardiac magnetic resonance (CMR) and with LV diastolic function. METHODS AND RESULTS Left ventricle diastolic function parameters, SMS, LV mass (American Society of Echocardiography formula), and maximal wall thickness (MWT) were evaluated by two-dimensional (2D) transthoracic echocardiography. The SMS was obtained by adding the MWT of 4 LV segments, at the mitral valve or papillary muscles short-axis views. Echocardiographic parameters of LVH, including SMS, were correlated with LV mass obtained by CMR and with E/e' ratio. We included 45 patients (60% male, mean age 48 ± 18 years), who underwent 2D echocardiography. Twenty-two of them performed a CMR study. A positive correlation was found between SMS and CMR LV mass (r = 0.80; P < 0.001), whereas MWT (r = 0.62; P = 0.002) and the 2D LV mass (r = 0.60; P = 0.011) presented a lower correlation with CMR LV mass. The SMS was significantly correlated with E/e' ratio (r = 0.60; P = 0.007), whereas a nonsignificant correlation was found with MWT (r = 0.41; P = 0.081) and 2D LV mass (r = 0.22; P = 0.400). CONCLUSION Spirito-Maron score presents a highly positive correlation with CMR LV mass and with diastolic dysfunction severity in HCM patients. SMS is a reliable quantitative LVH measurement method and seems to provide more comprehensive morphological and physiological information than 2D echocardiographic conventional parameters used to estimate LVH.
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Affiliation(s)
- Inês Rangel
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
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23
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Xu HY, Yang ZG, Sun JY, Wen LY, Zhang G, Zhang S, Guo YK. The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy patients with or without left ventricular outflow tract obstruction: assessment with first-pass perfusion imaging using 3.0-T cardiac magnetic resonance. Eur J Radiol 2014; 83:665-72. [PMID: 24521610 DOI: 10.1016/j.ejrad.2014.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 12/16/2013] [Accepted: 01/05/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction using 3.0-T cardiac magnetic resonance (CMR) first-pass perfusion imaging. MATERIALS AND METHODS Forty-two HCM patients, including 25 HCM patients with left ventricular outflow tract obstruction (HOCM), 17 HCM patients without left ventricular outflow tract obstruction (NOHCM), and 14 healthy subjects underwent CMR. The left ventricular (LV) function, left ventricular end-diastolic wall thickness (EDTH), and diameter of left ventricular outflow tract (LVOT) were measured and calculated. Based on the signal-time curve of the first-pass myocardium perfusion imaging, perfusion parameters including upslope, time to peak, and peak intensity, were assessed and compared by using one-way analysis of variance and independent t tests. RESULTS On the first-pass perfusion imaging, lower upslope and peak intensity and longer time to peak were found in HCM patients compared with normal subjects (all p<0.05). In contrast to the NOHCM group, the average time to peak of the HOCM group was increased (13.30 ± 4.82 s vs 16.28 ± 4.90 s, p<0.05), but first-pass perfusion upslope was reduced (4.96 ± 2.55 vs 2.58 ± 0.77, p<0.05). According to the bull's-eye model, the HOCM group's average thickness of basal segments was thicker than the NOHCM group, especially the anteroseptal, inferolateral, and anterior wall values, with a corresponding lower first-pass perfusion upslope than the NOHCM group (all p<0.05). A significant correlation was observed between first-pass perfusion upslope and LV EDTH (r=-0.551, p<0.001) and LVOT diameter (r=0.472, p<0.001). CONCLUSIONS The regional myocardial microvascular dysfunction differences in hypertrophic cardiomyopathy (HCM) patients with or without left ventricular outflow tract obstruction can be detected with first-pass perfusion CMR imaging.
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Affiliation(s)
- Hua-yan Xu
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Zhi-gang Yang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
| | - Jia-yu Sun
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ling-yi Wen
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ge Zhang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Shuai Zhang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ying-kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, China
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de Oliveira BL, Rocha BM, Barra LPS, Toledo EM, Sundnes J, Weber dos Santos R. Effects of deformation on transmural dispersion of repolarization using in silico models of human left ventricular wedge. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:1323-1337. [PMID: 23794390 DOI: 10.1002/cnm.2570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/08/2012] [Indexed: 06/02/2023]
Abstract
Mechanical deformation affects the electrical activity of the heart through multiple feedback loops. The purpose of this work is to study the effect of deformation on transmural dispersion of repolarization and on surface electrograms using an in silico human ventricular wedge. To achieve this purpose, we developed a strongly coupled electromechanical cell model by coupling a human left ventricle electrophysiology model and an active contraction model reparameterized for human cells. This model was then embedded in tissue simulations on the basis of bidomain equations and nonlinear solid mechanics. The coupled model was used to evaluate effects of mechanical deformation on important features of repolarization and electrograms. Our results indicate an increase in the T-wave amplitude of the surface electrograms in simulations that account for the effects of cardiac deformation. This increased T-wave amplitude can be explained by changes to the coupling between neighboring myocytes, also known as electrotonic effect. The thickening of the ventricular wall during repolarization contributes to the decoupling of cells in the transmural direction, enhancing action potential heterogeneity and increasing both transmural repolarization dispersion and T-wave amplitude of surface electrograms. The simulations suggest that a considerable percentage of the T-wave amplitude (15%) may be related to cardiac deformation.
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Affiliation(s)
- B L de Oliveira
- Simula Research Laboratory, Lysaker, Norway; Graduate Program in Computational Modeling of the Federal University of Juiz de Fora, Brazil
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Eriksson TSE, Prassl AJ, Plank G, Holzapfel GA. Modeling the dispersion in electromechanically coupled myocardium. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2013; 29:1267-84. [PMID: 23868817 PMCID: PMC3970090 DOI: 10.1002/cnm.2575] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/08/2013] [Accepted: 06/06/2013] [Indexed: 05/05/2023]
Abstract
We present an approach to model the dispersion of fiber and sheet orientations in the myocardium. By utilizing structure parameters, an existing orthotropic and invariant-based constitutive model developed to describe the passive behavior of the myocardium is augmented. Two dispersion parameters are fitted to experimentally observed angular dispersion data of the myocardial tissue. Computations are performed on a unit myocardium tissue cube and on a slice of the left ventricle indicating that the dispersion parameter has an effect on the myocardial deformation and stress development. The use of fiber dispersions relating to a pathological myocardium had a rather big effect. The final example represents an ellipsoidal model of the left ventricle indicating the influence of fiber and sheet dispersions upon contraction over a cardiac cycle. Although only a minor shift in the pressure-volume (PV) loops between the cases with no dispersions and with fiber and sheet dispersions for a healthy myocardium was observed, a remarkably different behavior is obtained with a fiber dispersion relating to a diseased myocardium. In future simulations, this dispersion model for myocardial tissue may advantageously be used together with models of, for example, growth and remodeling of various cardiac diseases.
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Affiliation(s)
- Thomas S E Eriksson
- Institute of Biomechanics, Center of Biomedical Engineering, Graz University of Technology, 8010 Graz, Austria; Department of Biophysics, Medical University of Graz, 8010 Graz, Austria
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26
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Haggerty CM, Kramer SP, Skrinjar O, Binkley CM, Powell DK, Mattingly AC, Epstein FH, Fornwalt BK. Quantification of left ventricular volumes, mass, and ejection fraction using cine displacement encoding with stimulated echoes (DENSE) MRI. J Magn Reson Imaging 2013; 40:398-406. [PMID: 24923710 DOI: 10.1002/jmri.24350] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/25/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To test the hypothesis that magnitude images from cine displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI) can accurately quantify left ventricular (LV) volumes, mass, and ejection fraction (EF). MATERIALS AND METHODS Thirteen mice (C57BL/6J) were imaged using a 7T ClinScan MRI. A short-axis stack of cine T2-weighted black blood (BB) images was acquired for calculation of LV volumes, mass, and EF using the gold standard sum-of-slices methodology. DENSE images were acquired during the same imaging session in three short-axis (basal, mid, apical) and two long-axis orientations. A custom surface fitting algorithm was applied to epicardial and endocardial borders from the DENSE magnitude images to calculate volumes, mass, and EF. Agreement between the DENSE-derived measures and BB-derived measures was assessed via coefficient of variation (CoV). RESULTS 3D surface reconstruction was completed on the order of seconds from segmented images, and required fewer slices to be segmented. Volumes, mass, and EF from DENSE-derived surfaces matched well with BB data (CoVs ≤11%). CONCLUSION LV mass, volumes, and EF in mice can be quantified through sparse (five slices) sampling with DENSE. This consolidation significantly reduces the time required to assess both mass/volume-based measures of cardiac function and advanced cardiac mechanics.
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Affiliation(s)
- Christopher M Haggerty
- University of Kentucky, Departments of Pediatrics, Physiology and Medicine, Lexington, Kentucky, USA
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27
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Kumar P, Blackshear JL, Ibrahim ESH, Mergo P, Parikh P, Batton K, Shapiro B. Advances of cardiovascular MRI in hypertrophic cardiomyopathy. Future Cardiol 2013; 9:697-709. [PMID: 24020671 DOI: 10.2217/fca.13.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease characterized by abnormal myocardial hypertrophy, which can lead to a wide clinical spectrum, including sudden cardiac death and heart failure. Cardiac MRI has a significant role in establishing the diagnosis of HCM. In the three principal management issues related to HCM; testing of family members of affected individuals; assessing the risk of sudden cardiac death from lethal ventricular arrhythmias; and selection of appropriate treatments for left ventricular outflow obstruction, cardiac MRI has established or emerging roles.
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Affiliation(s)
- Preetham Kumar
- Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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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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29
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Predicting the Future in Hypertrophic Cardiomyopathy: From Histopathology To Flow To Function. J Am Soc Echocardiogr 2012; 25:190-3. [DOI: 10.1016/j.echo.2011.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2011; 4:1123-37. [DOI: 10.1016/j.jcmg.2011.06.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 05/27/2011] [Accepted: 06/29/2011] [Indexed: 01/19/2023]
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31
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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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Cardiomyopathies (hypertrophy and failure): what can offer cardiac magnetic resonance imaging? Presse Med 2011; 40:e425-36. [PMID: 21795013 DOI: 10.1016/j.lpm.2010.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/21/2010] [Indexed: 11/21/2022] Open
Abstract
In routine, cardiomyopathy, confirmed or not, is a frequent reason for cardiac MRI evaluation. Step by step, by using a wide panel of sequences, cardiac MRI is able to characterize cardiomyopathies by their morphologic and functional phenotype as well as by tissue characterization. Cardiac-MRI is also considered as the most appropriate technique for the follow-up of this disease. The purpose of this article is to browse an overview of the main MRI features of cardiomyopathy, focusing the purpose on hypertrophic forms and myocardial diseases leading to cardiac failure.
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33
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Relation of coronary microvascular dysfunction in hypertrophic cardiomyopathy to contractile dysfunction independent from myocardial injury. Am J Cardiol 2011; 107:1522-8. [PMID: 21377644 DOI: 10.1016/j.amjcard.2011.01.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 12/26/2022]
Abstract
We studied the spatial relations among hyperemic myocardial blood flow (hMBF), contractile function, and morphologic tissue alterations in 19 patients with hypertrophic cardiomyopathy (HC). All patients were studied with oxygen-15 water positron emission tomography during rest and adenosine administration to assess myocardial perfusion. Cardiovascular magnetic resonance was performed to derive delayed contrast-enhanced images and to calculate contractile function (E(cc)) with tissue tagging. Eleven healthy subjects underwent similar positron emission tomographic and cardiovascular magnetic resonance scanning protocols and served as a control group. In the HC group, hMBF averaged 2.46 ± 0.91 ml/min/g and mean E(cc) was -14.7 ± 3.4%, which were decreased compared to the control group (3.97 ± 1.48 ml/min/g and -17.7 ± 3.2%, respectively, p <0.001 for the 2 comparisons). Delayed contrast enhancement (DCE) was present only in patients with HC, averaging 6.2 ± 10.3% of left ventricular mass. In the HC group, E(cc) and DCE in the septum (-13.7 ± 3.6% and 10.2 ± 13.6%) significantly differed from the lateral wall (-16.0 ± 2.8% and 2.4 ± 5.9%, p <0.001 for the 2 comparisons). In general, hMBF and E(cc) were decreased in segments displaying DCE compared to nonenhanced segments (p <0.001 for the comparisons). In the HC group, univariate analysis revealed relations of hMBF to E(cc) (r = -0.45, p <0.001) and DCE (r = -0.31, p <0.001). Multivariate analysis revealed that E(cc) was independently related to hMBF (beta -0.37, p <0.001) and DCE (beta 0.28, p <0.001). In conclusion, in HC hMBF is impaired and related to contractile function independent from presence of DCE. When present, DCE reflected a progressed disease state as characterized by an increased perfusion deficit and contractile dysfunction.
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Rüssel IK, Brouwer WP, Germans T, Knaapen P, Marcus TJ, van der Velden J, Götte MJW, van Rossum AC. Increased left ventricular torsion in hypertrophic cardiomyopathy mutation carriers with normal wall thickness. J Cardiovasc Magn Reson 2011; 13:3. [PMID: 21219655 PMCID: PMC3025877 DOI: 10.1186/1532-429x-13-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 01/10/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increased left ventricular (LV) torsion has been observed in patients with manifest familial hypertrophic cardiomyopathy (HCM), and is thought to be caused by subendocardial dysfunction. We hypothesize that increased LV torsion is already present in healthy mutation carriers with normal wall thickness. METHODS Seventeen carriers with an LV wall thickness <10 mm, and seventeen age and gender matched controls had cardiovascular magnetic resonance (CMR) cine imaging and tissue tagging. LV volumes and mass were calculated from the cine images. LV torsion, torsion rate, endocardial circumferential strain and torsion-to-endocardial-circumferential-shortening (TECS) ratio, which reflects the transmural distribution in contractile function, were determined using tissue tagging. RESULTS LV volumes, mass and circumferential strain were comparable between groups, whereas LV ejection fraction, torsion and TECS-ratio were increased in carriers compared to controls (63 ± 3% vs. 60 ± 3%, p = 0.04, 10.1 ± 2.5° vs. 7.7 ± 1.2°, p = 0.001, and 0.52 ± 0.14°/% vs. 0.42 ± 0.10°/%, p = 0.02, respectively). CONCLUSIONS Carriers with normal wall thickness display increased LV torsion and TECS-ratio with respect to controls, which might be due to subendocardial myocardial dysfunction. As similar abnormalities are observed in patients with manifest HCM, the changes in healthy carriers may be target for clinical intervention to delay or prevent the onset of hypertrophy.
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MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Case-Control Studies
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mutation
- Myocardial Contraction/genetics
- Netherlands
- Torsion Abnormality/genetics
- Torsion Abnormality/pathology
- Torsion Abnormality/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/genetics
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Affiliation(s)
- Iris K Rüssel
- Department of Clinical Physics, Hagaziekenhuis, The Hague, The Netherlands
| | - Wessel P Brouwer
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim J Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Marco JW Götte
- Department of cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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35
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Arrigan MT, Killeen RP, Dodd JD, Torreggiani WC. Imaging spectrum of sudden athlete cardiac death. Clin Radiol 2011; 66:203-23. [PMID: 21295200 DOI: 10.1016/j.crad.2010.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/06/2010] [Accepted: 10/17/2010] [Indexed: 01/18/2023]
Abstract
Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.
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Affiliation(s)
- M T Arrigan
- Department of Radiology, Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland.
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36
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37
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Wess G, Sarkar R, Hartmann K. Assessment of Left Ventricular Systolic Function by Strain Imaging Echocardiography in Various Stages of Feline Hypertrophic Cardiomyopathy. J Vet Intern Med 2010; 24:1375-82. [DOI: 10.1111/j.1939-1676.2010.0586.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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38
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Dewey S, Xu Q, Gomes A. Static and dynamic properties of the HCM myocardium. J Mol Cell Cardiol 2010; 49:715-8. [PMID: 20705073 DOI: 10.1016/j.yjmcc.2010.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 07/25/2010] [Indexed: 01/02/2023]
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39
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Cikes M, Sutherland GR, Anderson LJ, Bijnens BH. The role of echocardiographic deformation imaging in hypertrophic myopathies. Nat Rev Cardiol 2010; 7:384-96. [DOI: 10.1038/nrcardio.2010.56] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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40
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Prasad M, Ramesh A, Kavanagh P, Tamarappoo BK, Nakazato R, Gerlach J, Cheng V, Thomson LEJ, Berman DS, Germano G, Slomka PJ. Quantification of 3D regional myocardial wall thickening from gated magnetic resonance images. J Magn Reson Imaging 2010; 31:317-27. [PMID: 20099344 DOI: 10.1002/jmri.22033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To develop 3D quantitative measures of regional myocardial wall motion and thickening using cardiac magnetic resonance imaging (MRI) and to validate them by comparison to standard visual scoring assessment. MATERIALS AND METHODS In all, 53 consecutive subjects with short-axis slices and mid-ventricular 2-chamber/4-chamber views were analyzed. After correction for breath-hold-related misregistration, 3D myocardial boundaries were fitted to images and edited by an imaging cardiologist. Myocardial thickness was quantified at end-diastole and end-systole by computing the 3D distances using Laplace's equation. 3D thickening was represented using the standard 17-segment polar coordinates. 3D thickening was compared with 3D wall motion and with expert visual scores (6-point visual scoring of wall motion and wall thickening; 0 = normal; 5 = greatest abnormality) assigned by imaging cardiologists. RESULTS Correlation between ejection fraction and thickening measurements was (r = 0.84; P < 0.001) compared to correlation between ejection fraction and motion measurements (r = 0.86; P < 0.001). Good negative correlation between summed visual scores and global wall thickening and motion measurements were also obtained (r(thick) = -0.79; r(motion) = -0.74). Additionally, overall good correlation between individual segmental visual scores with thickening/wall motion (r(thick) = -0.69; r(motion) = -0.65) was observed (P < 0.0001). CONCLUSION 3D quantitative regional thickening and wall motion measures obtained from MRI correlate strongly with expert clinical scoring.
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Affiliation(s)
- Mithun Prasad
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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41
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Kwon DH, Desai MY. Cardiac magnetic resonance in hypertrophic cardiomyopathy: current state of the art. Expert Rev Cardiovasc Ther 2010; 8:103-11. [PMID: 20014937 DOI: 10.1586/erc.09.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypertrophic cardiomyopathy is a complex disorder with significant heterogeneity in clinical characteristics and natural history. Traditionally, the diagnosis has been based on clinical assessment and echocardiography; however, persistent challenges in its noninvasive evaluation remain. Hence, improved diagnostic techniques could lead to better risk stratification of patients, which would potentially identify patients likely to benefit from effective therapies. Recent studies have demonstrated the increasing utility of cardiac magnetic resonance in the management of this disease. With the increasing utilization of genetics, cardiac magnetic resonance is likely to play an even more important role in discerning the subtle morphologic differences seen in such patients with similar genotypic profiles.
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Affiliation(s)
- Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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42
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Dillman JR, Mueller GC, Attili AK, Dorfman AL, Ensing GJ, Gordon D. Case 153: atypical tumefactive hypertrophic cardiomyopathy. Radiology 2009; 254:310-3. [PMID: 20032162 DOI: 10.1148/radiol.2541082143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Section of Pediatric Radiology, C. S. Mott Children's Hospital, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
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43
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Shehata ML, Cheng S, Osman NF, Bluemke DA, Lima JAC. Myocardial tissue tagging with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:55. [PMID: 20025732 PMCID: PMC2809051 DOI: 10.1186/1532-429x-11-55] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 12/21/2009] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is currently the gold standard for assessing both global and regional myocardial function. New tools for quantifying regional function have been recently developed to characterize early myocardial dysfunction in order to improve the identification and management of individuals at risk for heart failure. Of particular interest is CMR myocardial tagging, a non-invasive technique for assessing regional function that provides a detailed and comprehensive examination of intra-myocardial motion and deformation. Given the current advances in gradient technology, image reconstruction techniques, and data analysis algorithms, CMR myocardial tagging has become the reference modality for evaluating multidimensional strain evolution in the human heart. This review presents an in depth discussion on the current clinical applications of CMR myocardial tagging and the increasingly important role of this technique for assessing subclinical myocardial dysfunction in the setting of a wide variety of myocardial disease processes.
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Affiliation(s)
- Monda L Shehata
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nael F Osman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, National Institutes of Health, Bethesda, MD, USA
| | - João AC Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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44
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Novel wall motion score-based method for estimating global left ventricular ejection fraction: validation by real-time 3D echocardiography and global longitudinal strain. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:125-30. [DOI: 10.1093/ejechocard/jep177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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45
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Ho CY, Carlsen C, Thune JJ, Havndrup O, Bundgaard H, Farrohi F, Rivero J, Cirino AL, Andersen PS, Christiansen M, Maron BJ, Orav EJ, Køber L. Echocardiographic strain imaging to assess early and late consequences of sarcomere mutations in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2009; 2:314-21. [PMID: 20031602 DOI: 10.1161/circgenetics.109.862128] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Genetic testing identifies sarcomere mutation carriers (G+) before clinical diagnosis of hypertrophic cardiomyopathy (HCM), allowing characterization of initial disease manifestations. Previous studies demonstrated that impaired relaxation develops before left ventricular hypertrophy (LVH). The precise impact of sarcomere mutations on systolic function in early and late disease is unclear. METHODS AND RESULTS Comprehensive echocardiography with strain imaging was performed on 146 genotyped individuals with mutations in 5 sarcomere genes. Contractile parameters were compared in 68 preclinical (G+/LVH-), 40 overt (G+/LVH+) subjects with HCM, and 38 mutation (-) normal control relatives. All subjects had normal left ventricular ejection fraction. In preclinical HCM, global and regional peak systolic strain (epsilon(sys)) and longitudinal systolic strain rate were not significantly different from controls, but early diastolic mitral annular velocity (Ea) was reduced by 13%. In overt HCM, there was a significant 27% and 14% decrease in global longitudinal epsilon(sys) and systolic strain rate, respectively, compared with both preclinical HCM and controls (P<0.013 for all comparisons), and a 33% reduction in Ea. CONCLUSIONS Sarcomere mutations have disparate initial effects on diastolic and systolic functions. Preclinical HCM is characterized by impaired relaxation but preserved systolic strain. In contrast, both diastolic and longitudinal systolic abnormalities are present in overt disease despite normal ejection fraction. We propose that diastolic dysfunction is an early consequence of sarcomere mutations, whereas systolic dysfunction results from mutations combined with subsequent pathological remodeling. Identifying mechanistic pathways triggered by these mutations may begin to reshape the clinical paradigm for treatment, based on early diagnosis and disease prevention.
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Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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46
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Turkbey EB, Dombroski DA. Cardiac Magnetic Resonance Imaging: Techniques and Clinical Applications. Semin Roentgenol 2009; 44:67-83. [PMID: 19233083 DOI: 10.1053/j.ro.2008.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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AJR Teaching File: Asymptomatic Man with Giant Negative T Waves on ECG. AJR Am J Roentgenol 2009; 192:S57-61. [DOI: 10.2214/ajr.07.7116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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48
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Prasad M, Ramesh A, Kavanagh P, Gerlach J, Germano G, Berman D, Slomka P. Myocardial wall thickening from gated Magnetic Resonance images using Laplace's equation. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2009; 7260. [PMID: 20835373 DOI: 10.1117/12.811411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The aim of our work is to present a robust 3D automated method for measuring regional myocardial thickening using cardiac magnetic resonance imaging (MRI) based on Laplace's equation. Multiple slices of the myocardium in short-axis orientation at end-diastolic and end-systolic phases were considered for this analysis. Automatically assigned 3D epicardial and endocardial boundaries were fitted to short-axis and long axis slices corrected for breathold related misregistration, and final boundaries were edited by a cardiologist if required. Myocardial thickness was quantified at the two cardiac phases by computing the distances between the myocardial boundaries over the entire volume using Laplace's equation. The distance between the surfaces was found by computing normalized gradients that form a vector field. The vector fields represent tangent vectors along field lines connecting both boundaries. 3D thickening measurements were transformed into polar map representation and 17-segment model (American Heart Association) regional thickening values were derived. The thickening results were then compared with standard 17-segment 6-point visual scoring of wall motion/wall thickening (0=normal; 5=greatest abnormality) performed by a consensus of two experienced imaging cardiologists. Preliminary results on eight subjects indicated a strong negative correlation (r=-0.8, p<0.0001) between the average thickening obtained using Laplace and the summed segmental visual scores. Additionally, quantitative ejection fraction measurements also correlated well with average thickening scores (r=0.72, p<0.0001). For segmental analysis, we obtained an overall correlation of -0.55 (p<0.0001) with higher agreement along the mid and apical regions (r=-0.6). In conclusion 3D Laplace transform can be used to quantify myocardial thickening in 3D.
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Affiliation(s)
- M Prasad
- Cedars-Sinai Medical Center, 8700 Beverly Blvd., Ste. A238, Los Angeles, CA 90048, USA
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49
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Zhong L, Su Y, Yeo SY, Tan RS, Ghista DN, Kassab G. Left ventricular regional wall curvedness and wall stress in patients with ischemic dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2009; 296:H573-84. [PMID: 19122166 DOI: 10.1152/ajpheart.00525.2008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Geometric remodeling of the left ventricle (LV) after myocardial infarction is associated with changes in myocardial wall stress. The objective of this study was to determine the regional curvatures and wall stress based on three-dimensional (3-D) reconstructions of the LV using MRI. Ten patients with ischemic dilated cardiomyopathy (IDCM) and 10 normal subjects underwent MRI scan. The IDCM patients also underwent delayed gadolinium-enhancement imaging to delineate the extent of myocardial infarct. Regional curvedness, local radii of curvature, and wall thickness were calculated. The percent curvedness change between end diastole and end systole was also calculated. In normal heart, a short- and long-axis two-dimensional analysis showed a 41 +/- 11% and 45 +/- 12% increase of the mean of peak systolic wall stress between basal and apical sections, respectively. However, 3-D analysis showed no significant difference in peak systolic wall stress from basal and apical sections (P = 0.298, ANOVA). LV shape differed between IDCM patients and normal subjects in several ways: LV shape was more spherical (sphericity index = 0.62 +/- 0.08 vs. 0.52 +/- 0.06, P < 0.05), curvedness at end diastole (mean for 16 segments = 0.034 +/- 0.0056 vs. 0.040 +/- 0.0071 mm(-1), P < 0.001) and end systole (mean for 16 segments = 0.037 +/- 0.0068 vs. 0.067 +/- 0.020 mm(-1), P < 0.001) was affected by infarction, and peak systolic wall stress was significantly increased at each segment in IDCM patients. The 3-D quantification of regional wall stress by cardiac MRI provides more precise evaluation of cardiac mechanics. Identification of regional curvedness and wall stresses helps delineate the mechanisms of LV remodeling in IDCM and may help guide therapeutic LV restoration.
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Affiliation(s)
- Liang Zhong
- Deparment of Cardiology, National Heart Centre, Singapore
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50
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Minoshima M, Noda A, Nishizawa T, Hara Y, Sugiura M, Iino S, Nagata K, Koike Y, Murohara T. Endomyocardial Radial Strain Imaging and Left Ventricular Relaxation Abnormalities in Patients With Hypertrophic Cardiomyopathy or Hypertensive Left Ventricular Hypertrophy. Circ J 2009; 73:2294-9. [DOI: 10.1253/circj.cj-08-0879] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Akiko Noda
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Takao Nishizawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yuki Hara
- Department of Pathophysiology Laboratory Sciences
| | - Mari Sugiura
- Department of Pathophysiology Laboratory Sciences
| | - Shigeo Iino
- Department of Clinical Laboratory, Nagoya University Hospital
| | - Kohzo Nagata
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Yasuo Koike
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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