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Shibata S, Wakeham DJ, Thomas JD, Abdullah SM, Platts S, Bungo MW, Levine BD. Cardiac Effects of Long-Duration Space Flight. J Am Coll Cardiol 2023; 82:674-684. [PMID: 37587578 DOI: 10.1016/j.jacc.2023.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Ventricular mass responds to changes in physical activity and loading, with cardiac hypertrophy after exercise training, and cardiac atrophy after sustained inactivity. Ventricular wall stress (ie, loading) decreases during microgravity. Cardiac atrophy does not plateau during 12 weeks of simulated microgravity but is mitigated by concurrent exercise training. OBJECTIVES The goal of this study was to determine whether the current exercise countermeasures on the International Space Station (ISS) offset cardiac atrophy during prolonged space flight. METHODS We measured left ventricular (LV) and right ventricular (RV) mass and volumes (via magnetic resonance imaging) in 13 astronauts (4 females; age 49 ± 4 years), between 75 and 60 days before and 3 days after 155 ± 31 days aboard the ISS. Furthermore, we assessed total cardiac work between 21 and 7 days before space flight and 15 days before the end of the mission. Data were compared via paired-samples t-tests. RESULTS Total cardiac work was lower during space flight (P = 0.008); however, we observed no meaningful difference in LV mass postflight (pre: 115 ± 30 g vs post: 118 ± 29 g; P = 0.053), with marginally higher LV stroke volume (P = 0.074) and ejection fraction postflight (P = 0.075). RV mass (P = 0.999), RV ejection fraction (P = 0.147), and ventricular end-diastolic (P = 0.934) and end-systolic volumes (P = 0.145) were not different postflight. There were strong positive correlations between the relative change in LV mass with the relative changes in total cardiac output (r = 0.73; P = 0.015) and total cardiac work (r = 0.53; P = 0.112). CONCLUSIONS The current exercise countermeasures used on the ISS appear effective in offsetting reductions in cardiac mass and volume, despite overall reductions in total cardiac work, during prolonged space flight.
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Affiliation(s)
- Shigeki Shibata
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | - Michael W Bungo
- University of Texas Health Science Center, Houston, Texas, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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2
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Rabbat MG, Kwong RY, Heitner JF, Young AA, Shanbhag SM, Petersen SE, Selvanayagam JB, Berry C, Nagel E, Heydari B, Maceira AM, Shenoy C, Dyke C, Bilchick KC. The Future of Cardiac Magnetic Resonance Clinical Trials. JACC Cardiovasc Imaging 2022; 15:2127-2138. [PMID: 34922874 DOI: 10.1016/j.jcmg.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 05/17/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023]
Abstract
Over the past 2 decades, cardiac magnetic resonance (CMR) has become an essential component of cardiovascular clinical care and contributed to imaging-guided diagnosis and management of coronary artery disease, cardiomyopathy, congenital heart disease, cardio-oncology, valvular, and vascular disease, amongst others. The widespread availability, safety, and capability of CMR to provide corresponding anatomical, physiological, and functional data in 1 imaging session can improve the design and conduct of clinical trials through both a reduction of sample size and provision of important mechanistic data that may augment clinical trial findings. Moreover, prospective imaging-guided strategies using CMR can enhance safety, efficacy, and cost-effectiveness of cardiovascular pathways in clinical practice around the world. As the future of large-scale clinical trial design evolves to integrate personalized medicine, cost-effectiveness, and mechanistic insights of novel therapies, the integration of CMR will continue to play a critical role. In this document, the attributes, limitations, and challenges of CMR's integration into the future design and conduct of clinical trials will also be covered, and recommendations for trialists will be explored. Several prominent examples of clinical trials that test the efficacy of CMR-imaging guided pathways will also be discussed.
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Affiliation(s)
- Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, Illinois, USA; Division of Cardiology, Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - John F Heitner
- Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Sujata M Shanbhag
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; National Institute for Health Research Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University of South Australia, Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, and Cardiac Imaging Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, and British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, United Kingdom
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Bobak Heydari
- Stephenson Cardiac Imaging Centre and Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, and Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alicia M Maceira
- Cardiovascular Unit, Ascires Biomedical Group, and Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Christopher Dyke
- Division of Cardiology, National Jewish Health, Denver, Colorado, USA
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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Fischer C, Wetzl J, Schaeffter T, Giese D. Fully automated background phase correction using M-estimate SAmple consensus (MSAC)-Application to 2D and 4D flow. Magn Reson Med 2022; 88:2709-2717. [PMID: 35916368 DOI: 10.1002/mrm.29363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Flow quantification by phase-contrast MRI is hampered by spatially varying background phase offsets. Correction performance by polynomial regression on stationary tissue may be affected by outliers such as wrap-around or constant flow. Therefore, we propose an alternative, M-estimate SAmple Consensus (MSAC) to reject outliers, and improve and fully automate background phase correction. METHODS The MSAC technique fits polynomials to randomly drawn small samples from the image. Over several trials, it aims to find the best consensus set of valid pixels by rejecting outliers to the fit and minimizing the residuals of the remaining pixels. The robustness of MSAC to its few parameters was investigated and verified using third-order polynomial correction fits on a total of 118 2D flow (97 with wrap-around) and 18 4D flow data sets (14 with wrap-around), acquired at 1.5 T and 3 T. Background phase was compared with standard stationary correction and phantom correction. Pulmonary/systemic flow ratios in 2D flow were derived, and exemplary 4D flow analysis was performed. RESULTS The MSAC technique is robust over a range of parameter choices, and a unique set of parameters is suitable for both 2D and 4D flow. In 2D flow, phase errors were significantly reduced by MSAC compared with stationary correction (p = 0.005), and stationary correction shows larger errors in pulmonary/systemic flow ratios compared with MSAC. In 4D flow, MSAC shows similar performance as stationary correction. CONCLUSIONS The MSAC method provides fully automated background phase correction to 2D and 4D flow data and shows improved robustness over stationary correction, especially with outliers present.
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Affiliation(s)
- Carola Fischer
- Department of Medical Imaging, Technical University of Berlin, Berlin, Germany.,Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
| | - Jens Wetzl
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
| | - Tobias Schaeffter
- Department of Medical Imaging, Technical University of Berlin, Berlin, Germany.,Biomedical Imaging, Physikalisch-Technische Bundesanstalt, Braunschweig and Berlin, Berlin, Germany.,School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany.,Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
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Bertelsen L, Vejlstrup N, Andreasen L, Olesen MS, Svendsen JH. Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method. Open Heart 2020; 7:openhrt-2020-001323. [PMID: 32675299 PMCID: PMC7368492 DOI: 10.1136/openhrt-2020-001323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Cardiac MRI is quickly emerging as the gold standard for assessment of mitral regurgitation, most commonly with the indirect method subtracting forward flow in aorta from volumetric segmentation of the left ventricle. We aimed to investigate how aortic flow measurements with increasing distance from the aortic valve affect calculated mitral regurgitations and whether measurements were influenced by breath-hold regimen. Methods Free-breathing and breath-hold phase contrast flows were measured in aorta at valve level, sinotubular (ST) junction, mid-ascending aorta and in the pulmonary trunk. Flow measurements were pairwise compared, and subsequently, after exclusion of patients with visible mitral and tricuspid regurgitations for left-sided and right-sided comparisons, respectively, flow-measured stroke volumes were compared with ventricular volumetric segmentations. Results Thirty-nine participants without arrhythmias or structural abnormalities of the large vessels were included. Stroke volumes measured with free-breathing and breath-hold flow decreased equally with increasing distance to the aortic valves (breath-hold flow: aortic valve 105.6±20.8 mL, ST junction 101.5±20.7 mL, mid-ascending aorta 98.1±21.5 mL). After exclusion of atrioventricular regurgitations, stroke volumes determined by volumetric measurements were higher compared with values determined by flow measurements, corresponding to ‘false’ atrioventricular regurgitations of 8.0%±5.8% with flow measured at valve level, 11.6%±5.2% at the ST junction and 15.3%±5.0% at the mid-ascending aorta. Conclusions Stroke volumes determined by flow decrease throughout the proximal aorta and are systematically lower than volumetrically measured stroke volumes. The indirect method systematically overestimates mitral regurgitations, especially with increasing distance from the aortic valves.
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Affiliation(s)
- Litten Bertelsen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Andreasen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Salling Olesen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Yousef HA, Hamdan AES, Elminshawy A, Mohammed NAA, Ibrahim AS. Corrected calculation of the overestimated ejection fraction in valvular heart disease by phase-contrast cardiac magnetic resonance imaging for better prediction of patient morbidity. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To establish a more accurate technique for the assessment of the left ventricular function correlated with patients’ clinical condition avoiding the miscalculation of the ejection fraction in valvular regurgitation. A prospective study carried out between July 2018 and June 2019. The studied group included 35 subjects, 25 patients with valvular regurgitation, and 10 healthy control subjects. All subjects underwent cardiovascular magnetic resonance examination to evaluate the ejection fraction by two methods: the volumetric method which assesses stroke volume via subtraction of the end-systolic volume from the end-diastolic volume, and phase-contrast method which assesses the aortic stroke volume via a through-plane phase contrast across the aortic valve. The sensitivity, specificity, P value and the area under the curve of both methods were calculated.
Results
In the healthy group, using the volumetric method, the calculated mean ejection fraction was 62.44 ± 6.61, while that calculated by the phase-contrast method was 64.34 ± 5.33, with a non-significant difference (P = 0.62) showing the validity of the phase-contrast method. In the patients’ group, by using the volumetric method, the calculated mean ejection fraction was 47.17 ± 14.31%, which was significantly higher than that calculated by the phase-contrast method (29.39 ± 7.98%) (P = 0.02). According to the results of the calculation of the ejection fraction by the volumetric method, there were 18 patients (72%) having impaired cardiac function and 7 (28%) patients of normal function; while according to the phase-contrast method, all the 25 patients had impaired cardiac function. The current study shows that the phase-contrast cardiac magnetic resonance had 89.29% sensitivity and 85.7% specificity in diagnosing impaired cardiac function with the area under the curve of 0.87 (P = 0.00).
Conclusion
The phase-contrast cardiac magnetic resonance can provide a better assessment of the ejection fraction in valvular regurgitation.
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Abstract
PURPOSE OF REVIEW Degenerative mitral regurgitation (DMR) continues to be an important cause of morbidity and mortality with surgical mitral valve repair remaining the gold standard for the treatment of severe disease. The purpose of this review is to summarize recent advances in the understanding of DMR as well as the progress made in its assessment with a focus on imaging techniques. RECENT FINDINGS Recent insights into the anatomy and physiology of DMR challenge the assumption that fibroelastic deficiency and Barlow disease are part of a single DMR spectrum. Advances in echocardiography and cardiovascular MRI have the potential to improve quantification of mitral regurgitation, provide unique information on prognosis and impact of DMR, further the association between DMR and arrhythmic risk and aide in decision-making for DMR treatment. SUMMARY With growing interest in the use of noninvasive transcatheter therapies in the mitral valve space, comprehensive assessment of the mitral valve is critical to instruct decision-making and guide therapeutic strategy.
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2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation. J Am Coll Cardiol 2020; 75:2236-2270. [DOI: 10.1016/j.jacc.2020.02.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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8
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Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography. J Am Soc Echocardiogr 2020; 33:342-354. [DOI: 10.1016/j.echo.2019.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/27/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022]
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9
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Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P, Hahn R, Han Y, Hung J, Lang R, Little S, Shah D, Shernan S, Thavendiranathan P, Thomas J, Weissman N. Recommendations for noninvasive evaluation of native valvular regurgitation
A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Abstract
Mitral regurgitation (MR) is a common valvular heart disease and is the second most frequent indication for heart valve surgery in Western countries. Echocardiography is the recommended first-line test for the assessment of valvular heart disease, but cardiovascular magnetic resonance imaging (CMR) provides complementary information, especially for assessing MR severity and to plan the timing of intervention. As new CMR techniques for the assessment of MR have arisen, standardizing CMR protocols for research and clinical studies has become important in order to optimize diagnostic utility and support the wider use of CMR for the clinical assessment of MR. In this Consensus Statement, we provide a detailed description of the current evidence on the use of CMR for MR assessment, highlight its current clinical utility, and recommend a standardized CMR protocol and report for MR assessment. In this Consensus Statement, Garg and colleagues describe the current evidence on the use of cardiovascular magnetic resonance imaging for the assessment of mitral regurgitation, highlight its current clinical utility, and recommend a standardized imaging protocol and report.
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11
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Functional Mitral Valve Regurgitation. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Moersdorf R, Treutlein M, Kroeger JR, Ruijsink B, Wong J, Maintz D, Weiss K, Bunck AC, Baeßler B, Giese D. Precision, reproducibility and applicability of an undersampled multi-venc 4D flow MRI sequence for the assessment of cardiac hemodynamics. Magn Reson Imaging 2019; 61:73-82. [PMID: 31100318 DOI: 10.1016/j.mri.2019.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/05/2019] [Accepted: 05/06/2019] [Indexed: 11/25/2022]
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Liu B, Edwards NC, Pennell D, Steeds RP. The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time? Eur Heart J Cardiovasc Imaging 2019; 20:123-130. [PMID: 30364971 PMCID: PMC6343082 DOI: 10.1093/ehjci/jey147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
A fifth of patients with primary degenerative mitral regurgitation continue to present with de novo ventricular dysfunction following surgery and higher rates of heart failure, morbidity, and mortality. This raises questions as to why the left ventricle (LV) might fail to recover and has led to support for better LV characterization; cardiac magnetic resonance (CMR) may play a role in this regard, pending further research and outcome data. CMR has widely acknowledged advantages, particularly in repeatability of measurements of volume and ejection fraction, yet recent guidelines relegate its use to cases where there is discordant information or poor-quality imaging from echocardiography because of the lack of data regarding the CMR-based ejection fraction threshold for surgery and CMR-based outcome data. This article reviews the current evidence regarding the role of CMR in an integrated surveillance and surgical timing programme.
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Affiliation(s)
- Boyang Liu
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nicola C Edwards
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Dudley Pennell
- CMR Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - Richard P Steeds
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
PURPOSE OF REVIEW This article will review the current techniques in cardiac magnetic resonance imaging (CMR) for diagnosing and assessing primary valvular heart disease. RECENT FINDINGS The recent advancements in CMR have led to an increased role of this modality for qualifying and quantifying various native valve diseases. Phase-contrast velocity encoded imaging is a well-established technique that can be used to quantify aortic and pulmonic flow. This technique, combined with the improved ability for CMR to obtain accurate left and right ventricular volumetrics, has allowed for increased accuracy and reproducibility in assessing valvular dysfunction. Advancements in CMR technology also allows for improved spatial and temporal resolution imaging of various valves and their regurgitant or stenotic jets. Therefore, CMR can be a powerful tool in evaluation of native valvular heart disease. The role of CMR in assessing valvular heart disease is growing and being recognized in recent guidelines. CMR has the ability to assess valve morphology along with qualifying and quantifying valvular disease. In addition, the ability to obtain accurate volumetric measurements may improve more precise management strategies and may lead to improvements in mortality and morbidity.
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A Comparative Assessment of Echocardiographic Parameters for Determining Primary Mitral Regurgitation Severity Using Magnetic Resonance Imaging as a Reference Standard. J Am Soc Echocardiogr 2018; 31:992-999. [PMID: 29921479 DOI: 10.1016/j.echo.2018.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The American Society of Echocardiography (ASE) guidelines suggest the use of several echocardiographic methods to assess mitral regurgitation severity using an integrated approach, without guidance as to the weighting of each parameter. The purpose of this multicenter prospective study was to evaluate the recommended echocardiographic parameters against a reference modality and develop and validate a weighting for each echocardiographic measure of mitral regurgitation severity. METHODS This study included 112 patients who underwent evaluation with echocardiography and magnetic resonance imaging (MRI). Echocardiographic parameters recommended by the ASE were included and compared with MRI-derived regurgitant volume (MRI-RV). RESULTS Echocardiographic parameters that correlated best with MRI-RV were proximal isovelocity surface area (PISA) radius (r = 0.65, P < .0001), PISA-derived effective regurgitant orifice area (r = 0.65, P < .0001), left ventricular end-diastolic volume (r = 0.56, P < .0001), and PISA-derived regurgitant volume (r = 0.52, P < .0001). In the linear regression models PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet independently predicted MRI-RV. CONCLUSION Echocardiographic parameters of mitral regurgitation as recommended by the ASE had moderate correlations with MRI-RV. The best predictors of MRI-RV were PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet, suggesting that these parameters should be weighted more heavily than other echocardiographic parameters in the application of the ASE-recommended integrated approach.
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17
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Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
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Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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Jeong D, Patel A, Francois CJ, Gage KL, Fradley MG. Cardiac Magnetic Resonance Imaging in Oncology. Cancer Control 2018; 24:147-160. [PMID: 28441369 DOI: 10.1177/107327481702400207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. METHODS An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment. RESULTS Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. CONCLUSIONS Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
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Affiliation(s)
- Daniel Jeong
- Department of Radiology, Moffitt Cancer Center, Tampa, FL.
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Uretsky S, Argulian E, Narula J, Wolff SD. Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation. J Am Coll Cardiol 2018; 71:547-563. [DOI: 10.1016/j.jacc.2017.12.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 02/04/2023]
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O'Gara PT, Grayburn PA, Badhwar V, Afonso LC, Carroll JD, Elmariah S, Kithcart AP, Nishimura RA, Ryan TJ, Schwartz A, Stevenson LW. 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70:2421-2449. [PMID: 29055505 DOI: 10.1016/j.jacc.2017.09.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mitral regurgitation (MR) is a complex valve lesion that can pose significant management challenges for the cardiovascular clinician. This Expert Consensus Document emphasizes that recognition of MR should prompt an assessment of its etiology, mechanism, and severity, as well as indications for treatment. A structured approach to evaluation based on clinical findings, precise echocardiographic imaging, and when necessary, adjunctive testing, can help clarify decision making. Treatment goals include timely intervention by an experienced heart team to prevent left ventricular dysfunction, heart failure, reduced quality of life, and premature death.
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Vincenti G, Masci PG, Rutz T, De Blois J, Prša M, Jeanrenaud X, Schwitter J, Monney P. Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study. J Cardiovasc Magn Reson 2017; 19:56. [PMID: 28750632 PMCID: PMC5530914 DOI: 10.1186/s12968-017-0362-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson's method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson's method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR. METHODS In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSVuncorr was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESVcorr was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5-29% regurgitant fraction (RF)), moderate (30-49% RF), or severe (≥50% RF). RESULTS In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p < 0.001). In the subgroup without MR, LVSVcorr was not significantly different from RVSV (difference: 2.5 ± 4.7 ml, p = 0.11 vs 0) while a systematic overestimation was observed with LVSVuncorr (difference: 16.9 ± 9.1 ml, p = 0.0007 vs 0). Also, RVSV was highly correlated with aortic forward flow (n = 24, R 2 = 0.97, p < 0.001). CONCLUSION For patients with severe bileaflet prolapse, the correction of the LVSV for the prolapse volume is suggested as it modified the assessment of MR severity by one grade in a large portion of patients.
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Affiliation(s)
- Gabriella Vincenti
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pier Giorgio Masci
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Tobias Rutz
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Jonathan De Blois
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Milan Prša
- Pediatric Cardiology unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Xavier Jeanrenaud
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Juerg Schwitter
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Pierre Monney
- Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
- Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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Polte CL, Gao SA, Johnsson ÅA, Lagerstrand KM, Bech-Hanssen O. Characterization of Chronic Aortic and Mitral Regurgitation Undergoing Valve Surgery Using Cardiovascular Magnetic Resonance. Am J Cardiol 2017; 119:2061-2068. [PMID: 28450039 DOI: 10.1016/j.amjcard.2017.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
Grading of chronic aortic regurgitation (AR) and mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR) is currently based on thresholds, which are neither modality nor quantification method specific. Accordingly, this study sought to identify CMR-specific and quantification method-specific thresholds for regurgitant volumes (RVols), RVol indexes, and regurgitant fractions (RFs), which denote severe chronic AR or MR with an indication for surgery. The study comprised patients with moderate and severe chronic AR (n = 38) and MR (n = 40). Echocardiography and CMR was performed at baseline and in all operated AR/MR patients (n = 23/25) 10 ± 1 months after surgery. CMR quantification of AR: direct (aortic flow) and indirect method (left ventricular stroke volume [LVSV] - pulmonary stroke volume [PuSV]); MR: 2 indirect methods (LVSV - aortic forward flow [AoFF]; mitral inflow [MiIF] - AoFF). All operated patients had severe regurgitation and benefited from surgery, indicated by a significant postsurgical reduction in end-diastolic volume index and improvement or relief of symptoms. The discriminatory ability between moderate and severe AR was strong for RVol >40 ml, RVol index >20 ml/m2, and RF >30% (direct method) and RVol >62 ml, RVol index >31 ml/m2, and RF >36% (LVSV-PuSV) with a negative likelihood ratio ≤ 0.2. In MR, the discriminatory ability was very strong for RVol >64 ml, RVol index >32 ml/m2, and RF >41% (LVSV-AoFF) and RVol >40 ml, RVol index >20 ml/m2, and RF >30% (MiIF-AoFF) with a negative likelihood ratio < 0.1. In conclusion, CMR grading of chronic AR and MR should be based on modality-specific and quantification method-specific thresholds, as they differ largely from recognized guideline criteria, to assure appropriate clinical decision-making and timing of surgery.
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Jackson TR, Kim HY, Balakrishnan UL, Stuckenholz C, Davidson LA. Spatiotemporally Controlled Mechanical Cues Drive Progenitor Mesenchymal-to-Epithelial Transition Enabling Proper Heart Formation and Function. Curr Biol 2017; 27:1326-1335. [PMID: 28434863 DOI: 10.1016/j.cub.2017.03.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/14/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
During early cardiogenesis, bilateral fields of mesenchymal heart progenitor cells (HPCs) move from the anterior lateral plate mesoderm to the ventral midline, undergoing a mesenchymal-to-epithelial transition (MET) en route to forming a single epithelial sheet. Through tracking of tissue-level deformations in the heart-forming region (HFR) as well as movement trajectories and traction generation of individual HPCs, we find that the onset of MET correlates with a peak in mechanical stress within the HFR and changes in HPC migratory behaviors. Small-molecule inhibitors targeting actomyosin contractility reveal a temporally specific requirement of bulk tissue compliance to regulate heart development and MET. Targeting mutant constructs to modulate contractility and compliance in the underlying endoderm, we find that MET in HPCs can be accelerated in response to microenvironmental stiffening and can be inhibited by softening. To test whether MET in HPCs was responsive to purely physical mechanical cues, we mimicked a high-stress state by injecting an inert oil droplet to generate high strain in the HFR, demonstrating that exogenously applied stress was sufficient to drive MET. MET-induced defects in anatomy result in defined functional lesions in the larval heart, implicating mechanical signaling and MET in the etiology of congenital heart defects. From this integrated analysis of HPC polarity and mechanics, we propose that normal heart development requires bilateral HPCs to undergo a critical behavioral and phenotypic transition on their way to the ventral midline, and that this transition is driven in response to the changing mechanical properties of their endoderm substrate.
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Affiliation(s)
- Timothy R Jackson
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Hye Young Kim
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Uma L Balakrishnan
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Carsten Stuckenholz
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lance A Davidson
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA; Department of Developmental Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Heo R, Son JW, ó Hartaigh B, Chang HJ, Kim YJ, Datta S, Cho IJ, Shim CY, Hong GR, Ha JW, Chung N. Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic Echocardiography in Quantifying Mitral Regurgitation: A Comparison with Conventional Two-Dimensional Methods. J Am Soc Echocardiogr 2017; 30:393-403.e7. [DOI: 10.1016/j.echo.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 10/20/2022]
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Mehta NK, Kim J, Siden JY, Rodriguez-Diego S, Alakbarli J, Di Franco A, Weinsaft JW. Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery. J Thorac Dis 2017; 9:S246-S256. [PMID: 28540067 DOI: 10.21037/jtd.2017.03.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR. Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR.
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Affiliation(s)
- Neil K Mehta
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Y Siden
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Javid Alakbarli
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Antonino Di Franco
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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28
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Functional mitral regurgitation in patients with heart failure and depressed ejection fraction. Curr Opin Cardiol 2016; 31:483-92. [DOI: 10.1097/hco.0000000000000325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Hall ME, Rocco MV, Morgan TM, Hamilton CA, Jordan JH, Edwards MS, Hall JE, Hundley WG. Beta-Blocker Use Is Associated with Higher Renal Tissue Oxygenation in Hypertensive Patients Suspected of Renal Artery Stenosis. Cardiorenal Med 2016; 6:261-8. [PMID: 27648007 DOI: 10.1159/000445302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic renal hypoxia influences the progression of chronic kidney disease (CKD). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) is a noninvasive tool for the assessment of renal oxygenation. The impact of beta-blockers on renal hemodynamics and oxygenation is not completely understood. We sought to determine the association between beta-blocker use, renal cortical and medullary oxygenation, and renal blood flow in patients suspected of renal artery stenosis. METHODS We measured renal cortical and medullary oxygenation using BOLD MR and renal artery blood flow using MR phase contrast techniques in 38 participants suspected of renal artery stenosis. RESULTS Chronic beta-blocker therapy was associated with improved renal cortical (p < 0.001) and medullary (p = 0.03) oxygenation, while the use of calcium channel blockers or diuretics showed no association with either cortical or medullary oxygenation. Receipt of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with reduced medullary oxygenation (p = 0.01). In a multivariable model, chronic receipt of beta-blockers was the only significant predictor of renal tissue oxygenation (β = 8.4, p = 0.008). Beta-blocker therapy was not associated with significant changes in renal artery blood flow, suggesting that improved renal oxygenation may be related to reduced renal oxygen consumption. CONCLUSIONS In addition to known benefits to reduce cardiovascular mortality in patients with renal disease, beta-blockers may reduce or prevent the progression of renal dysfunction in patients with hypertension, diabetes, and renovascular disease, partly by reducing renal oxygen consumption. These observations may have important implications for the treatment of patients with CKD.
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Affiliation(s)
- Michael E Hall
- Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson, Miss, N.C., USA; Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Miss, N.C., USA
| | - Michael V Rocco
- Division of Nephrology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
| | - Timothy M Morgan
- Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
| | - Craig A Hamilton
- Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
| | - Jennifer H Jordan
- Division of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
| | - Matthew S Edwards
- Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
| | - John E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Miss, N.C., USA
| | - William G Hundley
- Division of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, N.C., USA; Radiology, Wake Forest University School of Medicine, Winston-Salem, N.C., USA
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Aplin M, Kyhl K, Bjerre J, Ihlemann N, Greenwood JP, Plein S, Uddin A, Tønder N, Høst NB, Ahlström MG, Hove J, Hassager C, Iversen K, Vejlstrup NG, Lav Madsen P. Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2016; 17:863-70. [DOI: 10.1093/ehjci/jev321] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
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Nayak KS, Nielsen JF, Bernstein MA, Markl M, D Gatehouse P, M Botnar R, Saloner D, Lorenz C, Wen H, S Hu B, Epstein FH, N Oshinski J, Raman SV. Cardiovascular magnetic resonance phase contrast imaging. J Cardiovasc Magn Reson 2015; 17:71. [PMID: 26254979 PMCID: PMC4529988 DOI: 10.1186/s12968-015-0172-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/16/2015] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) phase contrast imaging has undergone a wide range of changes with the development and availability of improved calibration procedures, visualization tools, and analysis methods. This article provides a comprehensive review of the current state-of-the-art in CMR phase contrast imaging methodology, clinical applications including summaries of past clinical performance, and emerging research and clinical applications that utilize today's latest technology.
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Affiliation(s)
- Krishna S Nayak
- Ming Hsieh Department of Electrical Engineering, University of Southern California, 3740 McClintock Ave, EEB 406, Los Angeles, California, 90089-2564, USA.
| | - Jon-Fredrik Nielsen
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Peter D Gatehouse
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Rene M Botnar
- Cardiovascular Imaging, Imaging Sciences Division, Kings's College London, London, UK.
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Christine Lorenz
- Center for Applied Medical Imaging, Siemens Corporation, Baltimore, MD, USA.
| | - Han Wen
- Imaging Physics Laboratory, National Heart Lung and Blood Institute, Bethesda, MD, USA.
| | - Bob S Hu
- Palo Alto Medical Foundation, Palo Alto, CA, USA.
| | - Frederick H Epstein
- Departments of Radiology and Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
| | - John N Oshinski
- Departments of Radiology and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA.
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
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Choi J, Hong GR, Kim M, Cho IJ, Shim CY, Chang HJ, Mancina J, Ha JW, Chung N. Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography: a validation study with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2015; 31:1379-89. [PMID: 26164059 DOI: 10.1007/s10554-015-0707-x] [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: 05/25/2015] [Accepted: 07/06/2015] [Indexed: 12/26/2022]
Abstract
Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging (PC-CMR) as the reference method. Automated AR quantification using 3D-FVCDE was feasible in 30 of the 32 patients. 2D-PISA underestimated the AR volume compared to 3D-FVCDE and PC-CMR (38.6 ± 9.9 mL by 2D-PISA; 49.5 ± 10.2 mL by 3D-FVCDE; 52.3 ± 12.6 mL by PC-CMR). The AR volume assessed by 3D-FVCDE showed better correlation and agreement with PC-CMR (r = 0.93, p < 0.001, 2SD: 9.5 mL) than did 2D-PISA (r = 0.76, p < 0.001, 2SD: 15.7 mL). When used to classify AR severity, 3D-FVCDE agreed better with PC-CMR (k = 0.94) than did 2D-PISA (k = 0.53). In patients with eccentric jets, only 30% were correctly graded by 2D-PISA. Conversely, almost all patients with eccentric jets (86.7%) were correctly graded by 3D-FVCDE. In patients with multiple jets, only 3 out of 10 were correctly graded by 2D-PISA, while 3D-FVCDE correctly graded 9 out of 10 of these patients. Automated quantification of AR using the 3D-FVCDE method is clinically feasible and more accurate than the current 2D-based method. AR quantification by 2D-PISA significantly misclassified AR grade in patients with eccentric or multiple jets. This study demonstrates that 3D-FVCDE is a valuable tool to accurately measure AR volume regardless of AR characteristics.
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Affiliation(s)
- Jaehuk Choi
- Division of Cardiology, College of Medicine, Hangang Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Minji Kim
- School of Medicine, University of Queensland, Herston, QLD, Australia
| | - In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Joel Mancina
- Ultrasound Division, Siemens Medical Solutions USA Inc., Mountain View, CA, USA
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Polte CL, Bech-Hanssen O, Johnsson ÅA, Gao SA, Lagerstrand KM. Mitral regurgitation quantification by cardiovascular magnetic resonance: a comparison of indirect quantification methods. Int J Cardiovasc Imaging 2015; 31:1223-31. [DOI: 10.1007/s10554-015-0681-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/13/2015] [Indexed: 11/30/2022]
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Assessment of Mitral Valve Disease: A Review of Imaging Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:390. [DOI: 10.1007/s11936-015-0390-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Imaging Evaluation of Tricuspid Valve: Analysis of Morphology and Function With CT and MRI. AJR Am J Roentgenol 2015; 204:W531-42. [DOI: 10.2214/ajr.14.13551] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Andersen MM, Kritchevsky SB, Morgan TM, Hire DG, Vasu S, Brinkley TE, Kitzman DW, Hamilton CA, Soots S, Hundley WG. Increased cardiovascular stiffness and impaired age-related functional status. J Gerontol A Biol Sci Med Sci 2015; 70:545-53. [PMID: 24963155 PMCID: PMC4400394 DOI: 10.1093/gerona/glu085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/06/2014] [Indexed: 11/14/2022] Open
Abstract
Our objective was to determine if increased cardiovascular (CV) stiffness is associated with disability in middle-aged and older adults at risk for congestive heart failure. CV stiffness (brachial pulse pressure/left ventricular stroke volume indexed to body surface area) and total disability (the summed assessment of activities of daily living, mobility, and instrumental activities of daily living) were measured in 445 individuals. A subset of 109 randomly selected individuals also underwent physical function testing. Total disability was associated with CV stiffness (p = .01), driven by an association with mobility (p = .005), but not activities of daily living (p = .13) or instrumental activities of daily living (p = .61). After accounting for age, these correlations remained significant for men (p = .04), but not for women. CV stiffness was also associated with increased 400-m walk time (p = .02). In middle-aged and elderly men at risk for congestive heart failure, CV stiffness is associated with decreased mobility and physical function, and increased overall disability.
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Affiliation(s)
| | | | | | | | - Sujethra Vasu
- Section of Cardiology, Department of Internal Medicine
| | | | | | | | - Sandra Soots
- Section of Cardiology, Department of Internal Medicine
| | - William G Hundley
- Section of Cardiology, Department of Internal Medicine, Section of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Howden EJ, Perhonen M, Peshock RM, Zhang R, Arbab-Zadeh A, Adams-Huet B, Levine BD. Females have a blunted cardiovascular response to one year of intensive supervised endurance training. J Appl Physiol (1985) 2015; 119:37-46. [PMID: 25930024 DOI: 10.1152/japplphysiol.00092.2015] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/23/2015] [Indexed: 12/22/2022] Open
Abstract
Cross-sectional studies in athletes suggest that endurance training augments cardiovascular structure and function with apparently different phenotypes in athletic males and females. It is unclear whether the longitudinal response to endurance training leads to similar cardiovascular adaptations between sexes. We sought to determine whether males and females demonstrate similar cardiovascular adaptations to 1 yr of endurance training, matched for training volume and intensity. Twelve previously sedentary males (26 ± 7, n = 7) and females (31 ± 6, n = 5) completed 1 yr of progressive endurance training. All participants underwent a battery of tests every 3 mo to determine maximal oxygen uptake (V̇o2max) and left ventricle (LV) function and morphology (cardiac magnetic resonance imaging). Pulmonary artery catheterization was performed before and after 1 yr of training, and pressure-volume and Starling curves were constructed during decreases (lower-body negative pressure) and increases (saline infusion) in cardiac volume. Males progressively increased V̇o2max, LV mass, and mean wall thickness, before reaching a plateau from month 9 to 12 of training. In contrast, despite exactly the same training, the response in females was markedly blunted, with V̇o2max, LV mass, and mean wall thickness plateauing after only 3 mo of training. The response of LV end-diastolic volume was not influenced by sex (males +20% and females +18%). After training Starling curves were shifted upward and left, but the effect was greatest in males (interaction P = 0.06). We demonstrate for the first time clear sex differences in response to 1 yr of matched endurance training, such that the development of ventricular hypertrophy and increase in V̇o2max in females is markedly blunted compared with males.
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Affiliation(s)
- Erin J Howden
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Merja Perhonen
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and
| | | | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Armin Arbab-Zadeh
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and
| | | | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Dallas, Texas; and University of Texas Southwestern Medical Center, Dallas, Texas
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Chotenimitkhun R, D'Agostino R, Lawrence JA, Hamilton CA, Jordan JH, Vasu S, Lash TL, Yeboah J, Herrington DM, Hundley WG. Chronic statin administration may attenuate early anthracycline-associated declines in left ventricular ejection function. Can J Cardiol 2015; 31:302-7. [PMID: 25662284 PMCID: PMC4410009 DOI: 10.1016/j.cjca.2014.11.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/21/2014] [Accepted: 11/22/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Recent studies have shown an association between statin therapy and a reduced risk of heart failure among breast cancer survivors. Our goal was to evaluate whether statin therapy for prevention of cardiovascular (CV) disease would ameliorate declines in the left ventricular ejection fraction (LVEF) that is often observed during anthracycline-based chemotherapy (Anth-bC). METHODS There were 51 participants (33 women and 18 men, aged 48 ± 2 years). We obtained cardiovascular magnetic resonance imaging (CMRI) measurements of LVEF before and 6 months after initiation of Anth-bC for patients with breast cancer, leukemia, or lymphoma. Fourteen individuals received statin therapy, and 37 patients received no statins. MR image analysts were blinded to participant identifiers. RESULTS Individuals receiving statins were older and often had diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HLD). For those receiving statins, LVEF was 56.6% ± 1.4% at baseline and 54.1% ± 1.3% 6 months after initiating anthracycline treatment (P = 0.15). For those not receiving statins, LVEF was 57.5% ± 1.4% at baseline and decreased to 52.4% ± 1.2% over a similar 6-month interval (P = 0.0003). In a multivariable model accounting for age, sex, DM, HTN, HLD, and cumulative amount of anthracycline received, LVEF remained unchanged in participants receiving a statin (+1.1% ± 2.6%) vs a -6.5% ± 1.5% decline among those not receiving a statin (P = 0.03). CONCLUSIONS These data highlight the finding that individuals receiving statin therapy for prevention of cardiovascular disease may experience less deterioration in LVEF with early receipt of Anth-bC than individuals not receiving statins. Further studies with large numbers of participants are warranted to determine if statins protect against LVEF decline in patients receiving Anth-bC.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ralph D'Agostino
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Julia A Lawrence
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Craig A Hamilton
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer H Jordan
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sujethra Vasu
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joseph Yeboah
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David M Herrington
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - W Gregory Hundley
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity. J Am Coll Cardiol 2015; 65:1078-88. [DOI: 10.1016/j.jacc.2014.12.047] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/21/2014] [Accepted: 12/22/2014] [Indexed: 11/21/2022]
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Arbab-Zadeh A, Perhonen M, Howden E, Peshock RM, Zhang R, Adams-Huet B, Haykowsky MJ, Levine BD. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation 2014; 130:2152-61. [PMID: 25281664 DOI: 10.1161/circulationaha.114.010775] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether, and to what extent, the striking cardiac morphological manifestations of endurance athletes are a result of exercise training or a genetically determined characteristic of talented athletes. We hypothesized that prolonged and intensive endurance training in previously sedentary healthy young individuals could induce cardiac remodeling similar to that observed cross-sectionally in elite endurance athletes. METHODS AND RESULTS Twelve previously sedentary subjects (aged 29±6 years; 7 men and 5 women) trained progressively and intensively for 12 months such that they could compete in a marathon. Magnetic resonance images for assessment of right and left ventricular mass and volumes were obtained at baseline and after 3, 6, 9, and 12 months of training. Maximum oxygen uptake ( max) and cardiac output at rest and during exercise (C2H2 rebreathing) were measured at the same time periods. Pulmonary artery catheterization was performed before and after 1 year of training, and pressure-volume and Starling curves were constructed during decreases (lower body negative pressure) and increases (saline infusion) in cardiac volume. Mean max rose from 40.3±1.6 to 48.7±2.5 mL/kg per minute after 1 year (P<0.00001), associated with an increase in both maximal cardiac output and stroke volume. Left and right ventricular mass increased progressively with training duration and intensity and reached levels similar to those observed in elite endurance athletes. In contrast, left ventricular volume did not change significantly until 6 months of training, although right ventricular volume increased progressively from the outset; Starling and pressure-volume curves approached but did not match those of elite athletes. CONCLUSIONS One year of prolonged and intensive endurance training leads to cardiac morphological adaptations in previously sedentary young subjects similar to those observed in elite endurance athletes; however, it is not sufficient to achieve similar levels of cardiac compliance and performance. Contrary to conventional thinking, the left ventricle responds to exercise with initial concentric but not eccentric remodeling during the first 6 to 9 months after commencement of endurance training depending on the duration and intensity of exercise. Thereafter, the left ventricle dilates and restores the baseline mass-to-volume ratio. In contrast, the right ventricle responds to endurance training with eccentric remodeling at all levels of training.
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Affiliation(s)
- Armin Arbab-Zadeh
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Merja Perhonen
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Erin Howden
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Ronald M Peshock
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Rong Zhang
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Beverly Adams-Huet
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Mark J Haykowsky
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.)
| | - Benjamin D Levine
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (A.A.-Z., M.P., E.H., R.Z.); University of Texas Southwestern Medical Center, Dallas (R.M.P., R.Z., B.A.-H., B.D.L.); and Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada (M.H.).
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Sordelli C, Severino S, Ascione L, Coppolino P, Caso P. Echocardiographic Assessment of Heart Valve Prostheses. J Cardiovasc Echogr 2014; 24:103-113. [PMID: 28465917 PMCID: PMC5353566 DOI: 10.4103/2211-4122.147201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape.
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Affiliation(s)
- Chiara Sordelli
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Sergio Severino
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | - Luigi Ascione
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
| | | | - Pio Caso
- Unit of Cardiology, Vincenzo Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale, Ospedali dei Colli, Naples, Italy
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Matsuo T, Saotome K, Seino S, Shimojo N, Matsushita A, Iemitsu M, Ohshima H, Tanaka K, Mukai C. Effects of a low-volume aerobic-type interval exercise on VO2max and cardiac mass. Med Sci Sports Exerc 2014; 46:42-50. [PMID: 23846165 DOI: 10.1249/mss.0b013e3182a38da8] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to compare the effects of time-efficient, low-volume interval exercises on cardiorespiratory capacity and left ventricular (LV) mass with traditional continuous exercise in sedentary adults. METHODS Forty-two healthy but sedentary male subjects (age 26.5 ± 6.2 yr) participated in an 8-wk, five times per week, supervised exercise intervention. They were randomly assigned to one of three exercise protocols: sprint interval training (SIT, 5 min, 100 kcal), high-intensity interval aerobic training (HIAT, 13 min, 180 kcal), and continuous aerobic training (CAT, 40 min, 360 kcal). Cardiorespiratory capacity (V˙O2max) and LV mass (3T-MRI) were measured preintervention and postintervention. RESULTS We observed significant (P < 0.01) increases in V˙O2max in all three groups, and the effect of the HIAT was the greatest of the three (SIT, 16.7% ± 11.6%; HIAT, 22.5% ± 12.2%; CAT, 10.0% ± 8.9%; P = 0.01). There were significant changes in LV mass, stroke volume (SV), and resting HR in both the SIT (LV mass, 6.5% ± 8.3%; SV, 5.3% ± 8.3%; HR, -7.3% ± 11.1%; all P < 0.05) and HIAT (LV mass, 8.0% ± 8.3%; SV, 12.1% ± 9.8%; HR, -12.7% ± 12.2%; all P < 0.01) but not in the CAT (LV mass, 2.5% ± 10.1%; SV, 3.6% ± 6.6%; HR, -2.2% ± 13.3%; all P > 0.05). CONCLUSIONS Our study revealed that V˙O2max improvement with the HIAT was greater than with the CAT despite the HIAT being performed with a far lower volume and in far less time than the CAT. This suggests that the HIAT has potential as a time-efficient training mode to improve V˙O2max in sedentary adults.
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Affiliation(s)
- Tomoaki Matsuo
- 1Space Biomedical Research Office, Japan Aerospace Exploration Agency, Tokyo, JAPAN; 2Hazard Evaluation and Epidemiology Research Group, National Institute of Occupational Safety and Health, Kawasaki, JAPAN; 3Center for Cybernics Research, University of Tsukuba, Tsukuba, JAPAN; 4Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, JAPAN; and 5Faculty of Sport and Health Science, Ritsumeikan University, Kyoto, JAPAN
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Benjamin MM, Smith RL, Grayburn PA. Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment. Curr Cardiol Rep 2014; 16:517. [DOI: 10.1007/s11886-014-0517-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lopez-Mattei JC, Shah DJ. The role of cardiac magnetic resonance in valvular heart disease. Methodist Debakey Cardiovasc J 2014; 9:142-8. [PMID: 24066197 DOI: 10.14797/mdcj-9-3-142] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion.
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Hall ME, Rocco MV, Morgan TM, Hamilton CA, Edwards MS, Jordan JH, Hurie JB, Hundley WG. Chronic diuretic therapy attenuates renal BOLD magnetic resonance response to an acute furosemide stimulus. J Cardiovasc Magn Reson 2014; 16:17. [PMID: 24490671 PMCID: PMC3914363 DOI: 10.1186/1532-429x-16-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/29/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Blood Oxygen Level Dependent (BOLD) magnetic resonance (MR) is a novel imaging tool that detects changes in tissue oxygenation. Increases in renal oxygenation in response to a standard 20 mg intravenous furosemide stimulus have been evaluated to assess kidney viability in patients with renal artery stenosis (RAS). The effect of prior exposure to furosemide on the ability of BOLD MR techniques to evaluate renal function is unknown.This study tested the hypothesis that chronic loop diuretic therapy is associated with attenuated responses in renal tissue oxygenation as measured by BOLD MR with an acute 20 mg intravenous furosemide stimulus in participants undergoing evaluation for RAS. METHODS Thirty-eight participants referred for evaluation of RAS were recruited for this study. We examined renal cortical and medullary BOLD signal (T2*) intensities before and after a 20 mg intravenous furosemide stimulus. Additionally, we measured changes in renal artery blood flow using phase contrast techniques. RESULTS After controlling for covariates age, race, gender, diabetes, glomerular filtration rate, body mass index, and stenosis severity, daily oral furosemide dose was an independent, negative predictor of renal medullary T2* response (p=0.01) to a standard 20 mg intravenous furosemide stimulus. Stenosis severity and ethnicity were also significant independent predictors of changes in T2* signal intensity in response to an acute furosemide challenge. Changes in renal blood flow in response to acute furosemide administration were correlated with changes in T2* in the renal cortex (r=0.29, p=0.03) but not the medulla suggesting changes in renal medullary oxygenation were not due to reduced renal medullary blood flow. CONCLUSIONS Chronic furosemide therapy attenuates BOLD MR responses to an acute furosemide stimulus in patients with RAS being evaluated for renal artery revascularization procedures. Thus, patients who are chronically administered loop diuretics may need a different dosing strategy to accurately detect changes in renal oxygenation with BOLD MR in response to a furosemide stimulus.
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Affiliation(s)
- Michael E Hall
- Department of Medicine, Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael V Rocco
- Department of Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Timothy M Morgan
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Craig A Hamilton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Matthew S Edwards
- Department of Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Jennifer H Jordan
- Department of Medicine, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - Justin B Hurie
- Department of Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
| | - W Gregory Hundley
- Department of Medicine, Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, USA
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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Maffessanti F, Tamborini G, Fusini L, Stevanella M, Sotaquira M, Caiani E, Pepi M. Advances in echocardiography: insights into the mitral valve and implications for surgical and percutaneous repair. Interv Cardiol 2013. [DOI: 10.2217/ica.13.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Exploratory Use of Cardiovascular Magnetic Resonance Imaging in Liver Transplantation. Transplantation 2013; 96:827-33. [DOI: 10.1097/tp.0b013e3182a078e9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Fujimoto N, Hastings JL, Carrick-Ranson G, Shafer KM, Shibata S, Bhella PS, Abdullah SM, Barkley KW, Adams-Huet B, Boyd KN, Livingston SA, Palmer D, Levine BD. Cardiovascular effects of 1 year of alagebrium and endurance exercise training in healthy older individuals. Circ Heart Fail 2013; 6:1155-64. [PMID: 24130005 DOI: 10.1161/circheartfailure.113.000440] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lifelong exercise training maintains a youthful compliance of the left ventricle (LV), whereas a year of exercise training started later in life fails to reverse LV stiffening, possibly because of accumulation of irreversible advanced glycation end products. Alagebrium breaks advanced glycation end product crosslinks and improves LV stiffness in aged animals. However, it is unclear whether a strategy of exercise combined with alagebrium would improve LV stiffness in sedentary older humans. METHODS AND RESULTS Sixty-two healthy subjects were randomized into 4 groups: sedentary+placebo; sedentary+alagebrium (200 mg/d); exercise+placebo; and exercise+alagebrium. Subjects underwent right heart catheterization to define LV pressure-volume curves; secondary functional outcomes included cardiopulmonary exercise testing and arterial compliance. A total of 57 of 62 subjects (67 ± 6 years; 37 f/20 m) completed 1 year of intervention followed by repeat measurements. Pulmonary capillary wedge pressure and LV end-diastolic volume were measured at baseline, during decreased and increased cardiac filling. LV stiffness was assessed by the slope of LV pressure-volume curve. After intervention, LV mass and end-diastolic volume increased and exercise capacity improved (by ≈8%) only in the exercise groups. Neither LV mass nor exercise capacity was affected by alagebrium. Exercise training had little impact on LV stiffness (training × time effect, P=0.46), whereas alagebrium showed a modest improvement in LV stiffness compared with placebo (medication × time effect, P=0.04). CONCLUSIONS Alagebrium had no effect on hemodynamics, LV geometry, or exercise capacity in healthy, previously sedentary seniors. However, it did show a modestly favorable effect on age-associated LV stiffening. CLINICAL TRIAL REGISTRATION- URL http://www.clinicaltrials.gov. Unique identifier: NCT01014572.
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Affiliation(s)
- Naoki Fujimoto
- University of Texas Southwestern Medical Center at Dallas
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Uretsky S, Chaudhry FA, Gillam L, Gurram S, Bonda SLK, Ponnam H, Bader E, Thota N, Cohen R, Supariwala A, Wolff SD. A novel technique to quantify the instantaneous mitral regurgitant rate. J Cardiovasc Magn Reson 2013; 15:74. [PMID: 24119924 PMCID: PMC3766041 DOI: 10.1186/1532-429x-15-74] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/22/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The systolic variation of mitral regurgitation (MR) is a pitfall in its quantification. Current recommendations advocate using quantitative echocardiographic techniques that account for this systolic variation. While prior studies have qualitatively described patterns of systolic variation no study has quantified this variation. METHODS This study includes 41 patients who underwent cardiovascular magnetic resonance (CMR) evaluation for the assessment of MR. Systole was divided into 3 equal parts: early, mid, and late. The MR jets were categorized as holosystolic, early, or late based on the portions of systole the jet was visible. The aortic flow and left ventricular stroke volume (LVSV) acquired by CMR were plotted against time. The instantaneous regurgitant rate was calculated for each third of systole as the difference between the LVSV and the aortic flow. RESULTS The regurgitant rate varied widely with a 1.9-fold, 3.4-fold, and 1.6-fold difference between the lowest and highest rate in patients with early, late, and holosystolic jets respectively. There was overlap of peak regurgitant rates among patients with mild, moderate and severe MR. The greatest variation of regurgitant rate was seen among patients with mild MR. CONCLUSION CMR can quantify the systolic temporal variation of MR. There is significant variation of the mitral regurgitant rate even among patients with holosystolic MR jets. These findings highlight the need to use quantitative measures of MR severity that take into consideration the temporal variation of MR.
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Affiliation(s)
- Seth Uretsky
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Farooq A Chaudhry
- Department of Cardiology, Mount Sinai School of Medicine, New York, NY USA
| | - Linda Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, NJ USA
| | - Srinivasa Gurram
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Sri Lakshmi Kala Bonda
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Harikrishna Ponnam
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Eric Bader
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Naganath Thota
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Randy Cohen
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
| | - Azhar Supariwala
- Department of Medicine, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, 1111 Amsterdam Ave, Cardiology 3rd Floor, New York, NY 10025, USA
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The Role of Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CCT) in Facilitating Heart Failure Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:373-86. [PMID: 23817725 DOI: 10.1007/s11936-013-0253-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OPINION STATEMENT Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) offer advantages for detecting left or right ventricular dysfunction in patients with or suspected of heart failure. CMR does not expose patients to ionizing radiation, and thus is well-suited for functional assessments and serial studies. CCT provides high spatial resolution, making it useful for the identification of coronary arteriosclerosis associated with ischemic cardiomyopathy. In this review, the clinical applications of CMR and CCT are individually discussed, with comparisons made between them to examine the strengths of each modality. The major techniques for each modality are outlined, as well as their uses for the evaluation of cardiomyopathy in heart failure patients with reduced left ventricular ejection fraction, preserved left ventricular ejection fraction, and valvular heart disease. Finally, we review the utility of CMR and CCT in determining which patients will benefit from cardiac resynchronization therapy.
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