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Zhan Y, Friedrich MG, Dendukuri N, Lu Y, Chetrit M, Schiller I, Joseph L, Shaw JL, Chuang ML, Riffel JH, Manning WJ, Afilalo J. Meta-Analysis of Normal Reference Values for Right and Left Ventricular Quantification by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2024; 17:e016090. [PMID: 38377242 DOI: 10.1161/circimaging.123.016090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/12/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) reference values are relied upon to accurately diagnose left ventricular (LV) and right ventricular (RV) pathologies. To date, reference values have been derived from modest sample sizes with limited patient diversity and attention to 1 but not both commonly used tracing techniques for papillary muscles and trabeculations. We sought to overcome these limitations by meta-analyzing normal reference values for CMR parameters stemming from multiple countries, vendors, analysts, and patient populations. METHODS We comprehensively extracted published and unpublished data from studies reporting CMR parameters in healthy adults. A steady-state free-precession short-axis stack at 1.5T or 3T was used to trace either counting the papillary muscles and trabeculations in the LV volume or mass. We used a novel Bayesian hierarchical meta-analysis model to derive the pooled lower and upper reference values for each CMR parameter. Our model accounted for the expected differences between tracing techniques by including informative prior distributions from a large external data set. RESULTS A total of 254 studies from 25 different countries were systematically reviewed, representing 12 812 healthy adults, of which 52 were meta-analyzed. For LV parameters counting papillary muscles and trabeculations in the LV volume, pooled normative reference ranges in men and women, respectively, were as follows: LV ejection fraction of 52% to 73% and 54% to 75%, LV end-diastolic volume index of 60 to 109 and 56 to 96 mL/m2, LV end-systolic volume index of 18 to 45 and 16 to 38 mL/m2, and LV mass index of 41 to 76 and 33 to 57 g/m2. For LV parameters counting papillary muscles and trabeculations in the LV mass, pooled normative reference ranges in men and women, respectively, were as follows: LV ejection fraction of 57% to 74% and 57% to 75%, LV end-diastolic volume index of 60 to 97 and 55 to 88 mL/m2, LV end-systolic volume index of 18 to 37 and 15 to 34 mL/m2, and LV mass index of 50 to 83 and 38 to 65 g/m2. For RV parameters, pooled normative reference ranges in men and women, respectively, were as follows: RV ejection fraction of 47% to 68% and 49% to 71%, RV end-diastolic volume index of 64 to 115 and 57 to 99 mL/m2, RV end-systolic volume index of 23 to 52 and 18 to 42 mL/m2, and RV mass index of 14 to 29 and 13 to 25 g/m2. CONCLUSIONS Our Bayesian hierarchical meta-analysis provides normative reference values for CMR parameters of LV and RV size, systolic function, and mass, encompassing both tracing techniques across a diverse multinational sample of healthy men and women.
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Affiliation(s)
- Yang Zhan
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC (Y.Z., J.A.)
- Division of Cardiology, Regina General Hospital, University of Saskatchewan, MB (Y.Z.)
| | - Matthias G Friedrich
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Germany (M.G.F., J.H.R.)
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | - Yang Lu
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | | | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre - Research Institute, Montreal, QC (N.D., Y.L., I.S.)
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics, and Occupational Health (L.J., J.A.), McGill University, Montreal, QC
| | - Jaime L Shaw
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.L.S.)
| | - Michael L Chuang
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.L.C., W.J.M.)
| | - Johannes H Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Germany (M.G.F., J.H.R.)
| | - Warren J Manning
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (M.L.C., W.J.M.)
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC (Y.Z., J.A.)
- Division of Cardiology, McGill University Health Center (M.G.F., M.L.C., J.A.), McGill University, Montreal, QC
- Department of Epidemiology, Biostatistics, and Occupational Health (L.J., J.A.), McGill University, Montreal, QC
- Division of Cardiology, Jewish General Hospital (J.A.), McGill University, Montreal, QC
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Goo HW, Park SH. Partial voxel interpolation to reduce partial volume error of cardiac computed tomography ventricular volumetry in patients with congenital heart disease. Pediatr Radiol 2023; 53:2528-2538. [PMID: 37603066 DOI: 10.1007/s00247-023-05734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Varying degrees of partial volume error depending on the complexity of the endocardial borders are inevitable in threshold-based cardiac computed tomography (CT) ventricular volumetry. These errors can potentially be reduced by using a partial voxel interpolation (PVI) method, but this has not been tested for cardiac CT ventricular volumetry. OBJECTIVE To evaluate the partial volume error-reducing effects of the PVI method in cardiac CT ventricular volumetry among patients with congenital heart disease (CHD). MATERIALS AND METHODS The cardiac CT ventricular volumetry data were obtained from 55 patients (median age 12.0 years) with CHD. The ventricular and myocardial volumes, ejection fraction and ventricular mass-volume ratio were quantified and compared before and after the PVI method. The correlation between the myocardial volumes in the end-systolic and end-diastolic phases was tested. The effect of the PVI method on the classification of ventricular hypertrophy was evaluated. RESULTS The indexed ventricular volumes after PVI were significantly smaller (7.4-11.5%) than those before PVI (P<0.001). In contrast, the indexed myocardial volumes were significantly larger (6.2-27.7%) after PVI (P<0.001). The ejection fractions and mass-volume ratios were significantly larger (1.6-2.2% and 19.7-42.5%, respectively) after PVI (P<0.001 and P<0.001, respectively). The indexed myocardial masses showed prominently high correlation between the end-systolic and end-diastolic phases (R, 0.961-0.990; P<0.001). The proportions of no and severe hypertrophy were significantly decreased (P<0.002) and increased (P<0.032), respectively, after the application of the PVI method. CONCLUSION The PVI method can reduce partial volume error in cardiac CT ventricular volumetry among patients with CHD.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Sang Hyub Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Kagan RD, Palumbo MC, Weinsaft JW, Kim J, Gaudino MFL, Girardi LN, Lau C. Impact of advanced imaging techniques on cardiac surgery-New insights provided by cardiac magnetic resonance. J Card Surg 2022; 37:4138-4143. [PMID: 36321961 DOI: 10.1111/jocs.17095] [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: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
Abstract
This dialog between a cardiac surgeon (C.L.) and cardiac imager (J.W.W.) provides an overview of cardiac MRI (CMR) methods relevant to cardiac surgery. Major areas of focus include logistics of performing a CMR exam, as well as established and emerging methods for assessment of cardiac structure, function, valvular performance, and tissue characterization. Regarding tissue characterization, a major area of focus concerns CMR assessment of viability, for which this modality has been shown to provide incremental utility to conventional techniques for detection of presence and transmural extent of infarction, as well as powerful predictive utility of recovery of left ventricular systolic function as well as long term clinical prognosis in patients with an array of clinical conditions, including coronary artery disease and valvular heart disease both before and following cardiac surgery.
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Affiliation(s)
- Ruth D Kagan
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Maria Chiara Palumbo
- Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Cardiac Hypertrophy and Related Dysfunctions in Cushing Syndrome Patients-Literature Review. J Clin Med 2022; 11:jcm11237035. [PMID: 36498610 PMCID: PMC9739690 DOI: 10.3390/jcm11237035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
The survival rate of adrenal Cushing syndrome patients has been greatly increased because of the availability of appropriate surgical and pharmacological treatments. Nevertheless, increased possibility of a heart attack induced by a cardiovascular event remains a major risk factor for the survival of affected patients. In experimental studies, hypercortisolemia has been found to cause cardiomyocyte hypertrophy via glucocorticoid receptor activation, including the possibility of cross talk among several hypertrophy signals related to cardiomyocytes and tissue-dependent regulation of 11β-hydroxysteroid dehydrogenase type 1. However, the factors are more complex in clinical cases, as both geometric and functional impairments leading to heart failure have been revealed, and their associations with a wide range of factors such as hypertension are crucial. In addition, knowledge regarding such alterations in autonomous cortisol secretion, which has a high risk of leading to heart attack as well as overt Cushing syndrome, is quite limited. When considering the effects of treatment, partial improvement of structural alterations is expected, while functional disorders are controversial. Therefore, whether the normalization of excess cortisol attenuates the risk related to cardiac hypertrophy has yet to be fully elucidated.
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Kristensen CB, Sattler SM, Lubberding AF, Tfelt-Hansen J, Jespersen T, Hassager C, Mogelvang R. Necropsy Validation of a Novel Method for Left Ventricular Mass Quantification in Porcine Transthoracic and Transdiaphragmal Echocardiography. Front Cardiovasc Med 2022; 9:868603. [PMID: 35592401 PMCID: PMC9110773 DOI: 10.3389/fcvm.2022.868603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Increased left ventricular mass (LVM) is one of the most powerful predictors of adverse cardiovascular events. Clinical evaluation requires reliable, accurate and reproducible echocardiographic LVM-quantification to manage patients. For this purpose, we have developed a novel two-dimensional (2D) method based on adding the mean wall thickness to the left ventricular volume acquired by the biplane method of disks, which has recently been validated in humans using cardiac magnetic resonance as reference value. We assessed the hypothesis that the novel method has better accuracy than conventional one-dimensional (1D) methods, when compared to necropsy LVM in pigs. Materials and Methods Echocardiography was performed during anesthesia in 34 Danish Landrace pigs, weight 47–59 kg. All pigs were euthanized, cardiac necropsy was performed and the left ventricle was trimmed and weighed for necropsy LVM. Trans-thoracic echocardiography was applied for parasternal images. Transdiaphragmal echocardiography was applied for the apical images, which are otherwise difficult to obtain in pigs. We compared the conventional 1D- and 2D-methods and the novel 2D-method to the LVM from cardiac necropsy. Results Necropsy LVM was 132 ± 11 g (mean ± SD). The novel method had better accuracy than other methods (mean difference ± 95% limits of agreement; coefficients of variation; standard error of the estimate, Pearson's correlation). Novel (−1 ± 20 g; 8%; 11 g; r = 0.70), Devereux (+26 ± 37 g; 15%; 33 g; r = 0.52), Area-Length (+27 ± 34 g; 13 %; 33 g; r = 0.63), Truncated Ellipsoid (+10 ± 30 g; 12%; 19 g; r = 0.63), biplane endo-/epicardial tracing (−3 ± 2 g; 10%; 14 g; r = 0.57). No proportional bias in linear regression was detected for any method, when compared to necropsy LVM. Conclusion We confirm high accuracy of the novel 2D-based method compared to conventional 1D/2D-methods.
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Affiliation(s)
- Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- *Correspondence: Charlotte Burup Kristensen
| | - Stefan Michael Sattler
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Svendborg, Denmark
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Palumbo MC, Redaelli A, Wingo M, Tak KA, Leonard JR, Kim J, Rong LQ, Park C, Mitlak HW, Devereux RB, Roman MJ, RoyChoudury A, Lau C, Gaudino MFL, Girardi LN, Weinsaft JW. Impact of ascending aortic prosthetic grafts on early postoperative descending aortic biomechanics on cardiac magnetic resonance imaging. Eur J Cardiothorac Surg 2022; 61:860-868. [PMID: 34849679 PMCID: PMC8947796 DOI: 10.1093/ejcts/ezab501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Among patients with ascending thoracic aortic aneurysms, prosthetic graft replacement yields major benefits but risk for recurrent aortic events persists for which mechanism is poorly understood. This pilot study employed cardiac magnetic resonance to test the impact of proximal prosthetic grafts on downstream aortic flow and vascular biomechanics. METHODS Cardiac magnetic resonance imaging was prospectively performed in patients with thoracic aortic aneurysms undergoing surgical (Dacron) prosthetic graft implantation. Imaging included time resolved (4-dimensional) phase velocity encoded cardiac magnetic resonance for flow quantification and cine-cardiac magnetic resonance for aortic wall distensibility/strain. RESULTS Twenty-nine patients with thoracic aortic aneurysms undergoing proximal aortic graft replacement were studied; cardiac magnetic resonance was performed pre- [12 (4, 21) days] and postoperatively [6.4 (6.2, 7.2) months]. Postoperatively, flow velocity and wall shear stress increased in the arch and descending aorta (P < 0.05); increases were greatest in hereditary aneurysm patients. Global circumferential strain correlated with wall shear stress (r = 0.60-0.72, P < 0.001); strain increased postoperatively in the native descending and thoraco-abdominal aorta (P < 0.001). Graft-induced changes in biomechanical properties of the distal native ascending aorta were associated with post-surgical changes in descending aortic wall shear stress, as evidenced by correlations (r = -0.39-0.52; P ≤ 0.05) between graft-induced reduction of ascending aortic distensibility and increased distal native aortic wall shear stress following grafting. CONCLUSIONS Prosthetic graft replacement of the ascending aorta increases downstream aortic wall shear stress and strain. Postoperative increments in descending aortic wall shear stress correlate with reduced ascending aortic distensibility, suggesting that grafts provide a nidus for high energy flow and adverse distal aortic remodelling.
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Affiliation(s)
- Maria C Palumbo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Alberto Redaelli
- Department of Bioengineering, Polytecnico University, Milan, Italy
| | - Matthew Wingo
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katherine A Tak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Christine Park
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Hannah W Mitlak
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Richard B Devereux
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Mary J Roman
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Arindam RoyChoudury
- Division of Biostatistics, Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Cardiology), Weill Cornell Medicine, New York, NY, USA
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Li C, Romano D, Wang SJ, Zhang H, Prince MR, Wang Y. IRIS—Intelligent Rapid Interactive Segmentation for Measuring Liver Cyst Volumes in Autosomal Dominant Polycystic Kidney Disease. Tomography 2022; 8:447-456. [PMID: 35202202 PMCID: PMC8877996 DOI: 10.3390/tomography8010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To develop and integrate interactive features with automatic methods for accurate liver cyst segmentation in patients with autosomal dominant polycystic kidney and liver disease (ADPKD). Methods: SmartClick and antiSmartClick were developed using iterative region growth guided by spatial and intensity connections and were integrated with automated level set (LS) segmentation and graphical user interface, forming an intelligent rapid interactive segmentation (IRIS) tool. IRIS and LS segmentations of liver cysts on T2
weighted images of patients with ADPKD (n = 17) were compared with manual segmentation as ground truth (GT). Results: Compared to manual GT, IRIS reduced the segmentation time by more than 10-fold. Compared to automated LS, IRIS reduced the mean liver cyst volume error from 42.22% to 13.44% (p < 0.001). IRIS segmentation agreed well with manual GT (79% dice score and 99% intraclass correlation coefficient). Conclusion: IRIS is feasible for fast, accurate liver cyst segmentation in patients with ADPKD.
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Affiliation(s)
| | | | | | | | | | - Yi Wang
- Correspondence: ; Tel.: +1-646-962-2631
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Legrand L, Weinsaft JW, Pousset F, Ewenczyk C, Charles P, Hatem S, Heinzmann A, Biet M, Durr A, Redheuil A. Characterizing cardiac phenotype in Friedreich's ataxia: The CARFA study. Arch Cardiovasc Dis 2021; 115:17-28. [PMID: 34920960 DOI: 10.1016/j.acvd.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Friedreich's ataxia is an autosomal recessive mitochondrial disease caused by a triplet repeat expansion in the frataxin gene (FXN), exhibiting cerebellar sensory ataxia, diabetes and cardiomyopathy. Cardiac complications are the major cause of early death. AIMS To characterize the cardiac phenotype associated with Friedreich's ataxia, and to assess the evolution of the associated cardiopathy over 1 year. METHODS This observational single-centre open label study consisted of two groups: 20 subjects with Friedreich's ataxia and 20 healthy controls studied over two visits over 1 year. All subjects had transthoracic echocardiography, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, quantification of serum cardiac biomarkers and neurological assessment. RESULTS Patients with Friedreich's ataxia had left ventricular hypertrophy, with significantly smaller left ventricular diastolic diameters and volumes and increased wall thicknesses. Cardiac magnetic resonance imaging demonstrated significant concentric left ventricular remodelling, according to the mass/volume ratio, and focal myocardial fibrosis in 50% of patients with Friedreich's ataxia. Cardiopulmonary exercise testing showed alteration of left ventricular diastolic filling in patients with Friedreich's ataxia, with an elevated VE/VCO2 slope (ventilatory flow/exhaled volume of carbon dioxide). High-sensitivity troponin T plasma concentrations were higher in subjects with Friedreich's ataxia. None of the previous variables changed at 1 year. Neurological assessments remained stable for both groups, except for the nine-hole pegboard test, which was altered over 1 year. CONCLUSIONS The multivariable characterization of the cardiac phenotype of patients with Friedreich's ataxia was significantly different from controls at baseline. Over 1 year there were no clinically significant changes in patients with Friedreich's ataxia compared with healthy controls, whereas the neurological severity score increased modestly.
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Affiliation(s)
- Lise Legrand
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France
| | | | - Francoise Pousset
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France
| | - Claire Ewenczyk
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Perrine Charles
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Stéphane Hatem
- Cardiology Department, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75013 Paris, France; ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France; ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital (AP-HP), Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Inserm, CNRS, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - Anna Heinzmann
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Marie Biet
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Alexandra Durr
- Paris Brain Institute (ICM), INSERM, CNRS, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université, 75646 Paris cedex 13, France
| | - Alban Redheuil
- ICAN Institute of Cardiometabolism and Nutrition, 75013 Paris, France; ICT Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital (AP-HP), Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Inserm, CNRS, 47-83, boulevard de l'hôpital, 75013 Paris, France.
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Preda A, Liberale L, Montecucco F. Imaging techniques for the assessment of adverse cardiac remodeling in metabolic syndrome. Heart Fail Rev 2021; 27:1883-1897. [PMID: 34796433 DOI: 10.1007/s10741-021-10195-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
Metabolic syndrome (MetS) includes different metabolic conditions (i.e. abdominal obesity, impaired glucose tolerance, hypertriglyceridemia, decreased HDL cholesterol, and/or hypertension) that concour in the development of cardiovascular disease and diabetes. MetS individuals often show adverse cardiac remodeling and myocardial dysfunction even in the absence of overt coronary artery disease or valvular affliction. Diastolic impairment and hypertrophy are hallmarks of MetS-related cardiac remodeling and represent the leading cause of heart failure with preserved ejection fraction (HFpEF). Altered cardiomyocyte function, increased neurohormonal tone, interstitial fibrosis, coronary microvascular dysfunction, and a myriad of metabolic abnormalities have all been implicated in the development and progression of adverse cardiac remodeling related to MetS. However, despite the enormous amount of literature produced on this argument, HF remains a leading cause of morbidity and mortality in such population. The early detection of initial adverse cardiac remodeling would enable the optimal implementation of effective therapies aiming at preventing the progression of the disease to the symptomatic phase. Beyond conventional imaging techniques, such as echocardiography, cardiac tomography, and magnetic resonance, novel post-processing tools and techniques provide information on the biological processes that underlie metabolic heart disease. In this review, we summarize the pathophysiology of MetS-related cardiac remodeling and illustrate the relevance of state-of-the-art multimodality cardiac imaging to identify and quantify the degree of myocardial involvement, prognosticate long-term clinical outcome, and potentially guide therapeutic strategies.
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Affiliation(s)
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland.,IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy. .,IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, Genoa, Italy.
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Espe EKS, Bendiksen BA, Zhang L, Sjaastad I. Analysis of right ventricular mass from magnetic resonance imaging data: a simple post-processing algorithm for correction of partial-volume effects. Am J Physiol Heart Circ Physiol 2021; 320:H912-H922. [PMID: 33337965 DOI: 10.1152/ajpheart.00494.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
Magnetic resonance imaging (MRI) of the right ventricle (RV) offers important diagnostic information, but the accuracy of this information is hampered by the complex geometry of the RV. Here, we propose a novel postprocessing algorithm that corrects for partial-volume effects in the analysis of standard MRI cine images of RV mass (RVm) and evaluate the method in clinical and preclinical data. Self-corrected RVm measurement was compared with conventionally measured RVm in 16 patients who showed different clinical indications for cardiac MRI and in 17 Wistar rats with different degrees of pulmonary congestion. The rats were studied under isoflurane anaesthesia. To evaluate the reliability of the proposed method, the measured end-systolic and end-diastolic RVm were compared. Accuracy was evaluated by comparing preclinical RVm to ex vivo RV weight (RVw). We found that use of the self-correcting algorithm improved reliability compared with conventional segmentation. For clinical data, the limits of agreement (LOAs) were -1.8 ± 8.6g (self-correcting) vs. 5.8 ± 7.8g (conventional), and coefficients of variation (CoVs) were 7.0% (self-correcting) vs. 14.3% (conventional). For preclinical data, LOAs were 21 ± 46 mg (self-correcting) vs. 64 ± 89 mg (conventional), and CoVs were 9.0% (self-correcting) and 17.4% (conventional). Self-corrected RVm also showed better correspondence with the ex vivo RVw: LOAs were -5 ± 80 mg (self-correcting) vs. 94 ± 116 mg (conventional) in end-diastole and -26 ± 74 mg (self-correcting) vs. 31 ± 98 mg (conventional) in end-systole. The new self-correcting algorithm improves the reliability and accuracy of RVm measurements in both clinical and preclinical MRI. It is simple and easy to implement and does not require any additional MRI data.NEW & NOTEWORTHY Magnetic resonance imaging (MRI) of the right ventricle (RV) offers important diagnostic information, but the accuracy of this information is hampered by the complex geometry of the RV. In particular, the crescent shape of the RV renders it particularly vulnerable to partial-volume effects. We present a new, simple, self-correcting algorithm that can be applied to correct partial-volume effects in MRI-based RV mass estimation. The self-correcting algorithm offers improved reliability and accuracy compared with the conventional approach.
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Affiliation(s)
- Emil K S Espe
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Nydalen, Oslo, Norway
- K. G. Jebsen Centre for Cardiac Research, University of Oslo, Nydalen, Oslo, Norway
| | - Bård A Bendiksen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Nydalen, Oslo, Norway
- K. G. Jebsen Centre for Cardiac Research, University of Oslo, Nydalen, Oslo, Norway
- Bjørknes University College, Oslo, Norway
| | - Lili Zhang
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Nydalen, Oslo, Norway
- K. G. Jebsen Centre for Cardiac Research, University of Oslo, Nydalen, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Nydalen, Oslo, Norway
- K. G. Jebsen Centre for Cardiac Research, University of Oslo, Nydalen, Oslo, Norway
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Quantification of left ventricular mass by echocardiography compared to cardiac magnet resonance imaging in hemodialysis patients. Cardiovasc Ultrasound 2020; 18:39. [PMID: 32938484 PMCID: PMC7495823 DOI: 10.1186/s12947-020-00217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/07/2020] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricular hypertrophy (LVH), defined by the left ventricular mass index (LVMI), is highly prevalent in hemodialysis patients and a strong independent predictor of cardiovascular events. Compared to cardiac magnetic resonance imaging (CMR), echocardiography tends to overestimate the LVMI. Here, we evaluate the diagnostic performance of transthoracic echocardiography (TTE) compared to CMR regarding the assessment of LVMI in hemodialysis patients. Methods TTR and CMR data for 95 hemodialysis patients who participated in the MiREnDa trial were analyzed. The LVMI was calculated by two-dimensional (2D) TTE-guided M-mode measurements employing the American Society of Echocardiography (ASE) and Teichholz (Th) formulas, which were compared to the reference method, CMR. Results LVH was present in 44% of patients based on LVMI measured by CMR. LVMI measured by echocardiography correlated moderately with CMR, ASE: r = 0.44 (0.34–0.62); Th: r = 0.44 (0.32–0.62). Compared to CMR, both echocardiographic formulas overestimated LVMI (mean ∆LVMI (ASE-CMR): 19.5 ± 19.48 g/m2, p < 0.001; mean ∆LVMI (Th-CMR): 15.9 ± 15.89 g/m2, p < 0.001). We found greater LVMI overestimation in patients with LVH using the ASE formula compared to the Th formula. Stratification of patients into CMR LVMI quartiles showed a continuous decrease in ∆LVMI with increasing CMR LVMI quartiles for the Th formula (p < 0.001) but not for the ASE formula (p = 0.772). Bland-Altman analysis showed that the Th formula had a constant bias independent of LVMI. Both methods had good discrimination ability for the detection of LVH (ROC-AUC: 0.819 (0.737–0.901) and 0.808 (0.723–0.892) for Th and ASE, respectively). Conclusions The ASE and Th formulas overestimate LVMI in hemodialysis patients. However, the overestimation is less with the Th formula, particularly with increasing LVMI. The results suggest that the Th formula should be preferred for measurement of LVMI in chronic hemodialysis patients. Trial registration The data was derived from the following clinical trial: NCT01691053, registered on 19 September 2012 before enrollment of the first participant.
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Zhang Y, Wang VY, Morgan AE, Kim J, Ge L, Guccione JM, Weinsaft JW, Ratcliffe MB. A Novel MRI-Based Finite Element Modeling Method for Calculation of Myocardial Ischemia Effect in Patients With Functional Mitral Regurgitation. Front Physiol 2020; 11:158. [PMID: 32231584 PMCID: PMC7082816 DOI: 10.3389/fphys.2020.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Functional Mitral Regurgitation (FMR) associated with coronary artery disease affects nearly 3 million patients in the United States. Both myocardial infarction (MI) and ischemia contribute to FMR development but uncertainty as to which patients will respond to revascularization (REVASC) of ischemia alone prevents rational decision making about FMR therapy. The aim of this study was to create patient-specific cardiac MRI (CMR) informed finite element (FE) models of the left ventricle (LV), calculate regional LV systolic contractility and then use optimized systolic material properties to simulate the effect of revascularization (virtual REVASC). METHODS We describe a novel FE method able to predict the effect of myocardial ischemia on regional LV function. CMR was obtained in five patients with multi-vessel coronary disease and FMR before and 3 months after percutaneous REVASC and a single healthy volunteer. Patient-specific FE models were created and divided into 17 sectors where the systolic contractility parameter, T m a x of each sector was a function of regional stress perfusion (SP-CMR) and myocardial infarction (LGE-CMR) scores. Sector-specific circumferential and longitudinal end-systolic strain and LV volume from CSPAMM were used in a formal optimization to determine the sector based myocardial contractility, T m a x and ischemia effect, α. Virtual REVASC was simulated by setting α to zero. RESULTS The FE optimization successfully converged with good agreement between calculated and experimental end-systolic strain and LV volumes. Specifically, the optimized T max for the healthy myocardium for five patients and the volunteer was 495.1, 336.8, 173.5, 227.9, 401.4, and 218.9 kPa. The optimized α was found to be 1.0, 0.44, and 0.08 for Patients 1, 2, and 3, and 0 for Patients 4 and 5. The calculated average of radial strain for Patients 1, 2, and 3 at baseline and after virtual REVASC was 0.23 and 0.25, respectively. CONCLUSION We developed a novel computational method able to predict the effect of myocardial ischemia in patients with FMR. This method can be used to predict the effect of ischemia on the regional myocardium and promises to facilitate better understanding of FMR response to REVASC.
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Affiliation(s)
- Yue Zhang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Vicky Y. Wang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Ashley E. Morgan
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Liang Ge
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | - Julius M. Guccione
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
| | | | - Mark B. Ratcliffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Bioengineering, University of California, San Francisco, San Francisco, CA, United States
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Lecoq AL, Brandi ML, Linglart A, Kamenický P. Management of X-linked hypophosphatemia in adults. Metabolism 2020; 103S:154049. [PMID: 31863781 DOI: 10.1016/j.metabol.2019.154049] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/27/2022]
Abstract
X-linked hypophosphatemia (XLH) is caused by mutations in the PHEX gene which result in Fibroblast Growth Factor-23 (FG-F23) excess and phosphate wasting. Clinically, XLH children present with rickets, bone deformities and short stature. In adulthood, patients may still be symptomatic with bone and joint pain, osteomalacia-related fractures or pseudofractures, precocious osteoarthrosis, enthesopathy, muscle weakness and severe dental anomalies. Besides these musculoskeletal and dental manifestations, adult XLH patients are also prone to secondary and tertiary hyperparathyroidism, cardiovascular and metabolic disorders. Pathophysiology of hyperparathyroidism is only partially understood but FGF23 excess and deficient production of calcitriol likely contributes to its development. Similarly, the pathophysiological mechanisms of potential cardiovascular and metabolic involvements are not clear, but FGF-23 excess may play an essential role. Treatment should be considered in symptomatic patients, patients undergoing orthopedic or dental surgery and women during pregnancy and lactation. Treatment with oral phosphate salts and active vitamin D analogs has incomplete efficacy and potential risks. Burosumab, a recombinant human monoclonal antibody against FGF-23, has proven its efficacy in phase 2 and phase 3 clinical trials in adult patients with XLH, but currently its position as first line or second line treatment differ among the countries.
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Affiliation(s)
- Anne-Lise Lecoq
- AP-HP, Department of Endocrinology and Reproductive Diseases, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, filière OSCAR, and Platform of Expertise for Rare Disorders, Bicêtre Paris Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, University Hospital of Florence, Florence, Italy
| | - Agnès Linglart
- AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, filière OSCAR, and Platform of Expertise for Rare Disorders, Bicêtre Paris Saclay Hospital, Le Kremlin-Bicêtre, France; Université Paris-Saclay, INSERM, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France
| | - Peter Kamenický
- AP-HP, Department of Endocrinology and Reproductive Diseases, Reference Center for Rare Disorders of Calcium and Phosphate Metabolism, filière OSCAR, and Platform of Expertise for Rare Disorders, Bicêtre Paris Saclay Hospital, Le Kremlin-Bicêtre, France; Université Paris-Saclay, INSERM, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicêtre, France.
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Abstract
Heart failure (HF) with either reduced or preserved ejection fraction is an increasingly prevalent condition. Cardiac imaging plays a central role in trying to identify the underlying cause of the underlying systolic and diastolic dysfunction, as the imaging findings have implications for patient's management and individualised treatment. The imaging modalities used more frequently in patients with heart failure in clinical routine are echocardiography and cardiac magnetic resonance. Both techniques keep some strengths and weakness due to their spatial and temporal resolution. Notably, several features in the diagnostic algorithm of heart failure with preserved systolic function (HFpEF) may be improved by an integrated approach. This review focuses on the role of each modality in characterising cardiac anatomy, systolic and diastolic function as well as myocardial tissue characterisation in the most common phenotypes of dilated and hypertrophied hearts.
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Bisciglia A, Pasceri V, Irini D, Varveri A, Speciale G. Risk Factors for Ischemic Heart Disease. Rev Recent Clin Trials 2019; 14:86-94. [PMID: 30919783 DOI: 10.2174/1574887114666190328125153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/11/2017] [Accepted: 05/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several risk factors have been empirically linked to an increased risk of cardiovascular disease. Some of them are therapeutically amenable to modification; while others are not. Modifiable risk factors include physical inactivity, tobacco use, diet, "bad fats" in the blood, hypertension, and being overweight; while non-modifiable risk factors include the patient's family history, the presence versus absence of diabetes mellitus, and demographic characteristics like age, gender, ethnicity, and socio-economic status. METHODS In this article, we review those risk factors that are both clinically important and amenable to change. CONCLUSION To prevent cardiovascular disease, it is important to minimize modifiable risk factors, like LDL cholesterol.
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Affiliation(s)
- Andrea Bisciglia
- San Filippo Neri Hospital, Via Giovanni Martinotti, 20, 00135 Rome, Italy
| | - Vincenzo Pasceri
- San Filippo Neri Hospital, Via Giovanni Martinotti, 20, 00135 Rome, Italy
| | - Diego Irini
- San Filippo Neri Hospital, Via Giovanni Martinotti, 20, 00135 Rome, Italy
| | - Antonio Varveri
- San Filippo Neri Hospital, Via Giovanni Martinotti, 20, 00135 Rome, Italy
| | - Giulio Speciale
- San Filippo Neri Hospital, Via Giovanni Martinotti, 20, 00135 Rome, Italy
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16
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Goo HW. Technical feasibility of semiautomatic three-dimensional threshold-based cardiac computed tomography quantification of left ventricular mass. Pediatr Radiol 2019; 49:318-326. [PMID: 30470863 DOI: 10.1007/s00247-018-4303-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/17/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Semiautomatic three-dimensional (3-D) threshold-based cardiac computed tomography (CT) quantification has not been attempted for left ventricular mass. OBJECTIVE To evaluate the technical feasibility of semiautomatic 3-D threshold-based cardiac CT quantification of left ventricular mass in patients with various degrees of left ventricular hypertrophy. MATERIALS AND METHODS In 99 patients, cardiac CT was utilized to quantify ventricular volume and mass by using a semiautomatic 3-D threshold-based method. Left ventricular mass values were compared between the end-systole and the end-diastole. Volumetric parameters were compared among three left ventricular hypertrophy groups (definite, borderline, none). The reproducibility was assessed. The t-test, one-way analysis of variance and Pearson correlation were used. RESULTS There were no technical failures. The left ventricular mass between the two sessions exhibited a small mean difference of 2.3±1.1% (mean±standard deviation). The indexed mass values were significantly higher at the end-systole than at the end-diastole (71.4±42.9 g/m2 vs. 65.9±43.3 g/m2, P<0.001), with significant correlation (R=0.99, P<0.001). The definite group (83.5±41.3 g/m2) showed statistically significantly higher indexed mass values than the borderline and none groups (64.7±26.9 and 55.6±23.9 g/m2, respectively; P<0.03), while demonstrating no statistically significant difference between the latter two groups (P>0.05). Left ventricular volume-mass and mass-volume ratios could be calculated in all three groups. CONCLUSION CT quantification of left ventricular mass using semiautomatic 3-D threshold-based segmentation is feasible with high reproducibility and the mass values and its ratios with ventricular volumes may be used in patients with various degrees of left ventricular hypertrophy.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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17
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Bratt A, Kim J, Pollie M, Beecy AN, Tehrani NH, Codella N, Perez-Johnston R, Palumbo MC, Alakbarli J, Colizza W, Drexler IR, Azevedo CF, Kim RJ, Devereux RB, Weinsaft JW. Machine learning derived segmentation of phase velocity encoded cardiovascular magnetic resonance for fully automated aortic flow quantification. J Cardiovasc Magn Reson 2019; 21:1. [PMID: 30612574 PMCID: PMC6322266 DOI: 10.1186/s12968-018-0509-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Phase contrast (PC) cardiovascular magnetic resonance (CMR) is widely employed for flow quantification, but analysis typically requires time consuming manual segmentation which can require human correction. Advances in machine learning have markedly improved automated processing, but have yet to be applied to PC-CMR. This study tested a novel machine learning model for fully automated analysis of PC-CMR aortic flow. METHODS A machine learning model was designed to track aortic valve borders based on neural network approaches. The model was trained in a derivation cohort encompassing 150 patients who underwent clinical PC-CMR then compared to manual and commercially-available automated segmentation in a prospective validation cohort. Further validation testing was performed in an external cohort acquired from a different site/CMR vendor. RESULTS Among 190 coronary artery disease patients prospectively undergoing CMR on commercial scanners (84% 1.5T, 16% 3T), machine learning segmentation was uniformly successful, requiring no human intervention: Segmentation time was < 0.01 min/case (1.2 min for entire dataset); manual segmentation required 3.96 ± 0.36 min/case (12.5 h for entire dataset). Correlations between machine learning and manual segmentation-derived flow approached unity (r = 0.99, p < 0.001). Machine learning yielded smaller absolute differences with manual segmentation than did commercial automation (1.85 ± 1.80 vs. 3.33 ± 3.18 mL, p < 0.01): Nearly all (98%) of cases differed by ≤5 mL between machine learning and manual methods. Among patients without advanced mitral regurgitation, machine learning correlated well (r = 0.63, p < 0.001) and yielded small differences with cine-CMR stroke volume (∆ 1.3 ± 17.7 mL, p = 0.36). Among advanced mitral regurgitation patients, machine learning yielded lower stroke volume than did volumetric cine-CMR (∆ 12.6 ± 20.9 mL, p = 0.005), further supporting validity of this method. Among the external validation cohort (n = 80) acquired using a different CMR vendor, the algorithm yielded equivalently small differences (∆ 1.39 ± 1.77 mL, p = 0.4) and high correlations (r = 0.99, p < 0.001) with manual segmentation, including similar results in 20 patients with bicuspid or stenotic aortic valve pathology (∆ 1.71 ± 2.25 mL, p = 0.25). CONCLUSION Fully automated machine learning PC-CMR segmentation performs robustly for aortic flow quantification - yielding rapid segmentation, small differences with manual segmentation, and identification of differential forward/left ventricular volumetric stroke volume in context of concomitant mitral regurgitation. Findings support use of machine learning for analysis of large scale CMR datasets.
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Affiliation(s)
- Alex Bratt
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Jiwon Kim
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Meridith Pollie
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Ashley N. Beecy
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Nathan H. Tehrani
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Noel Codella
- IBM TJ Watson Research Center, 1101 Kitchawan Rd, Yorktown Heights, NY 10598 USA
| | | | - Maria Chiara Palumbo
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Javid Alakbarli
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Wayne Colizza
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Ian R. Drexler
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Clerio F. Azevedo
- Duke Cardiovascular Magnetic Resonance Center, 10 Duke Medicine Circle, Durham, NC 27710 USA
| | - Raymond J. Kim
- Duke Cardiovascular Magnetic Resonance Center, 10 Duke Medicine Circle, Durham, NC 27710 USA
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
| | - Jonathan W. Weinsaft
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
- Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 USA
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
- Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021 USA
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Volpato V, Mor-Avi V, Narang A, Prater D, Gonçalves A, Tamborini G, Fusini L, Pepi M, Patel AR, Lang RM. Automated, machine learning-based, 3D echocardiographic quantification of left ventricular mass. Echocardiography 2018; 36:312-319. [PMID: 30592791 DOI: 10.1111/echo.14234] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although 3D echocardiography (3DE) circumvents many limitations of 2D echocardiography by allowing direct measurements of left ventricular (LV) mass, it is seldom used in clinical practice due to time-consuming analysis. A recently developed 3DE machine learning (ML) approach allows automated determination of LV mass. We aimed to evaluate the accuracy of this new approach by comparing it to cardiac magnetic resonance (CMR) reference and to conventional 3DE volumetric analysis. METHODS We prospectively studied 23 patients who underwent 3DE (Philips EPIQ) and CMR imaging on the same day. Single-beat wide-angle 3D datasets of the left ventricle were acquired. LV mass was quantified using the new automated software (Philips HeartModel) with manual corrections when necessary and using conventional volumetric analysis (TomTec). CMR analysis was performed by manual slice-by-slice tracing of LV endo- and epicardial boundaries. Reproducibility of the ML approach was assessed using repeated measurements and quantified by intra-class correlation (ICC) and coefficients of variation (CoV). RESULTS Automated LV mass measurements were feasible in 20 patients (87%). The results were similar to CMR-derived values (Bland-Altman bias 5 g, limits of agreement ±37 g) and also to the conventional 3DE analysis (bias 7 g, ±27 g). Processing time was considerably shorter: 1.02 ± 0.24 minutes (CMR: 2.20 ± 0.13 minutes; TomTec: 2.36 ± 0.09 minutes), although manual corrections were performed in most patients. Repeated measurements showed high reproducibility: ICC = 0.99; CoV = 4 ± 5%. CONCLUSIONS 3D Echocardiography analysis of LV mass using novel ML-based algorithm is feasible, fast, and accurate and may thus facilitate the incorporation of 3DE measurements of LV mass into clinical practice.
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Affiliation(s)
- Valentina Volpato
- Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois.,Department of Cardiovascular Sciences, Centro Cardiologico Monzino, Milan, Italy
| | - Victor Mor-Avi
- Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois
| | - Akhil Narang
- Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois
| | | | | | - Gloria Tamborini
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, Milan, Italy
| | - Amit R Patel
- Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Cardiac Imaging Center, University of Chicago Medical Center, Chicago, Illinois
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Goo HW. Semiautomatic Three-Dimensional Threshold-Based Cardiac Computed Tomography Ventricular Volumetry in Repaired Tetralogy of Fallot: Comparison with Cardiac Magnetic Resonance Imaging. Korean J Radiol 2018; 20:102-113. [PMID: 30627026 PMCID: PMC6315063 DOI: 10.3348/kjr.2018.0237] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023] Open
Abstract
Objective To assess the accuracy and potential bias of computed tomography (CT) ventricular volumetry using semiautomatic three-dimensional (3D) threshold-based segmentation in repaired tetralogy of Fallot, and to compare them to those of two-dimensional (2D) magnetic resonance imaging (MRI). Materials and Methods This retrospective study evaluated 32 patients with repaired tetralogy of Fallot who had undergone both cardiac CT and MRI within 3 years. For ventricular volumetry, semiautomatic 3D threshold-based segmentation was used in CT, while a manual simplified contouring 2D method was used in MRI. The indexed ventricular volumes were compared between CT and MRI. The indexed ventricular stroke volumes were compared with the indexed arterial stroke volumes measured using phase-contrast MRI. The mean differences and degrees of agreement in the indexed ventricular and stroke volumes were evaluated using Bland-Altman analysis. Results The indexed end-systolic (ES) volumes showed no significant difference between CT and MRI (p > 0.05), while the indexed end-diastolic (ED) volumes were significantly larger on CT than on MRI (93.6 ± 17.5 mL/m2 vs. 87.3 ± 15.5 mL/m2 for the left ventricle [p < 0.001] and 177.2 ± 39.5 mL/m2 vs. 161.7 ± 33.1 mL/m2 for the right ventricle [p < 0.001], respectively). The mean differences between CT and MRI were smaller for the indexed ES volumes (2.0–2.5 mL/m2) than for the indexed ED volumes (6.3–15.5 mL/m2). CT overestimated the stroke volumes by 14–16%. With phase-contrast MRI as a reference, CT (7.2–14.3 mL/m2) showed greater mean differences in the indexed stroke volumes than did MRI (0.8–3.3 mL/m2; p < 0.005). Conclusion Compared to 2D MRI, CT ventricular volumetry using semiautomatic 3D threshold-based segmentation provides comparable ES volumes, but overestimates the ED and stroke volumes in patients with repaired tetralogy of Fallot.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1806] [Impact Index Per Article: 301.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Riffel JH, Schmucker K, Andre F, Ochs M, Hirschberg K, Schaub E, Fritz T, Mueller-Hennessen M, Giannitsis E, Katus HA, Friedrich MG. Cardiovascular magnetic resonance of cardiac morphology and function: impact of different strategies of contour drawing and indexing. Clin Res Cardiol 2018; 108:411-429. [DOI: 10.1007/s00392-018-1371-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5622] [Impact Index Per Article: 937.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Goo HW. Comparison between Three-Dimensional Navigator-Gated Whole-Heart MRI and Two-Dimensional Cine MRI in Quantifying Ventricular Volumes. Korean J Radiol 2018; 19:704-714. [PMID: 29962876 PMCID: PMC6005949 DOI: 10.3348/kjr.2018.19.4.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 01/19/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To test whether the method utilizing three-dimensional (3D) whole-heart MRI has an additional benefit over that utilizing conventional two-dimensional (2D) cine MRI in quantifying ventricular volumes. Materials and Methods In 110 patients with congenital heart disease, a navigator-gated, 3D whole-heart MRI during end-systole (ES) and end-diastole (ED), 2D short-axis cine MRI, and phase contrast MRI of the great arteries were acquired. Ventricular volumes were measured by using a 3D threshold-based segmentation for 3D whole-heart MRI and by using a simplified contouring for 2D cine MRI. The cardiac trigger delays of 3D whole-heart MRI were compared with those of a 2D cine MRI. The stroke volumes calculated from the ventricular volumes were compared with the arterial flow volumes, measured by phase contrast MRI. Results The ES and ED trigger delays of whole-heart MRI were significantly less than cine MRI for both the left ventricle (−16.8 ± 35.9 ms for ES, −59.0 ± 90.4 ms for ED; p < 0.001) and the right ventricle (−58.8 ± 30.6 ms for ES, −104.9 ± 92.7 ms for ED; p < 0.001). Compared with the arterial flow volumes, 2D cine MRI significantly overestimated the left ventricular stroke volumes (8.7 ± 8.9 mL, p < 0.001) and the 3D whole-heart MRI significantly underestimated the right ventricular stroke volumes (−22.7 ± 22.9 mL, p < 0.001). Conclusion Three-dimensional whole-heart MRI is often subject to early timing of the ED phase, potentially leading to the underestimation of the right ventricular stroke volumes.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Luo G, Dong S, Wang K, Zuo W, Cao S, Zhang H. Multi-Views Fusion CNN for Left Ventricular Volumes Estimation on Cardiac MR Images. IEEE Trans Biomed Eng 2017; 65:1924-1934. [PMID: 29035205 DOI: 10.1109/tbme.2017.2762762] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Left ventricular (LV) volume estimation is a critical procedure for cardiac disease diagnosis. The objective of this paper is to address a direct LV volume prediction task. METHODS In this paper, we propose a direct volume prediction method based on the end-to-end deep convolutional neural networks. We study the end-to-end LV volume prediction method in items of the data preprocessing, network structure, and multiview fusion strategy. The main contributions of this paper are the following aspects. First, we propose a new data preprocessing method on cardiac magnetic resonance (CMR). Second, we propose a new network structure for end-to-end LV volume estimation. Third, we explore the representational capacity of different slices and propose a fusion strategy to improve the prediction accuracy. RESULTS The evaluation results show that the proposed method outperforms other state-of-the-art LV volume estimation methods on the open accessible benchmark datasets. The clinical indexes derived from the predicted volumes agree well with the ground truth ( ${\rm{EDV:R}}^{{\rm 2}}={\text{0.974}}$, ${\rm{RMSE\,}}= {\text{9.6}}{\rm{\,ml}}$; ${\rm{ESV:R}}^{{\rm 2}}={\text{0.976}}$, ${\rm{RMSE}}= {\text{7.1}}\,{\text{ml}}$; ${\rm{EF:R}}^{{\rm 2}} ={\text{0.828}}$, ${\rm{RMSE}}= {\text{4.71}}\% $). CONCLUSION Experimental results prove that the proposed method may be useful for the LV volume prediction task. SIGNIFICANCE The proposed method not only has application potential for cardiac diseases screening for large-scale CMR data, but also can be extended to other medical image research fields.
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Singh P, Almarzooq Z, Codell NCF, Wang Y, Roman MJ, Devereux RB, Weinsaft JW. Cine-CMR partial voxel segmentation demonstrates increased aortic stiffness among patients with Marfan syndrome. J Thorac Dis 2017; 9:S239-S245. [PMID: 28540066 DOI: 10.21037/jtd.2017.04.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Standard cine-cardiac magnetic resonance (CMR) imaging is commonly used to evaluate cardiac structure, geometry and function. Prior studies have shown that automated segmentation via partial voxel interpolation (PVI) accurately quantifies phantom-based cardiac chamber volumes and necropsy left ventricular myocardial mass. Despite this, the applicability and usefulness of PVI in the determination of physiologic parameters of the aorta such as aortic stiffness has yet to be investigated. METHODS Routine CMR was conducted with a 1.5T (GE) scanner with pulse sequences similar to that of standard CMR (parameters: TR 3.4 msec, TE 1.14 msec, flip angle 60°, temporal resolution ~30-40 msec). Views were obtained in standard cardiac-oriented longitudinal or axial views (2, 3 and 4 chambers). Within non-dilated regions of the descending thoracic aorta, aortic area was quantified via a novel PVI automated process (LV-METRIC), which discerns relative amounts of blood pool in each voxel. Aortic stiffness, as calculated from brachial artery pulse pressure and aortic area at maximal and minimal dimensions, was evaluated in 60 total segments (one segment per patient). All segments were in the descending aorta and were not aneurysmal. RESULTS Sixty patients in total were studied, including 50 that had genetically-related aortic disorder [35 bicuspid aortic valve (BAV), 15 Marfan syndrome (MFS)]. Ten normal controls without aortic disease were included for comparison purposes. All patients (n=60) had evaluable CMR images for assessment of the descending aorta with use of automated segmentation. Patients with BAV and MFS were similar to controls in age, systolic blood pressure, brachial artery pulse pressure, smoking status or hypercholesterolemia (all P=NS). There were more women (P<0.001), lower body mass index (P=0.008), and greater height (P<0.001) in the MFS cohort compared to BAV and controls. Descending aortic area in either systole (maximal) or diastole (minimal) was similar among all three cohorts. However, change in aortic area (ΔArea) throughout the cardiac cycle was substantially lower in MFS than control subjects (P<0.001). In contrast, change in aortic area throughout the cardiac cycle was not significantly different between BAV vs. controls (P=0.62). Aortic stiffness was increased among MFS patients versus control subjects (P=0.014). When comparing MFS to BAV subjects, a comparable trend was observed (P=0.09). No statistical difference was evident in aortic stiffness in patients with BAV versus control subjects (P=0.29). CONCLUSIONS The application of PVI to standard CMR imaging can assess abnormal descending aorta functional indices in normal caliber segments in MFS subjects. Future prospective studies with larger subject populations are warranted to further determine the overall utility of automated aortic segmentation as a possible early biomarker of aortic dysfunction before overt dilatation.
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Affiliation(s)
- Parmanand Singh
- Department of Cardiology, Weill Cornell Medical College, NYC, NY, USA
| | - Zaid Almarzooq
- Department of Cardiology, Weill Cornell Medical College, NYC, NY, USA
| | | | - Yi Wang
- Department of Cardiology, Weill Cornell Medical College, NYC, NY, USA
| | - Mary J Roman
- Department of Cardiology, Weill Cornell Medical College, NYC, NY, USA
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Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14:915-26. [DOI: 10.1080/14779072.2016.1186542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Narotsky DL, Castano A, Weinsaft JW, Bokhari S, Maurer MS. Wild-Type Transthyretin Cardiac Amyloidosis: Novel Insights From Advanced Imaging. Can J Cardiol 2016; 32:1166.e1-1166.e10. [PMID: 27568874 DOI: 10.1016/j.cjca.2016.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 12/24/2022] Open
Abstract
Amyloidosis is caused by extracellular deposition of abnormal protein fibrils, resulting in destruction of tissue architecture and impairment of organ function. The most common forms of systemic amyloidosis are light-chain and transthyretin-related (ATTR). ATTR can result from an autosomal dominant hereditary transmission of mutated genes in the transthyretin or from a wild-type form of disease (ATTRwt), previously known as senile cardiac amyloidosis. With the aging of the worldwide population, ATTRwt will emerge as the most common type of cardiac amyloidosis that clinicians encounter. Diagnosis of systemic amyloidosis is often delayed, either because of the false assumption that it is a rare disease, or because of misdiagnosis as a result of mistaking it with other conditions. Clinicians must integrate clinical clues from history, physical examination, and common diagnostic tests to raise suspicion for ATTRwt. The historical gold standard for diagnosis of cardiac amyloid is endomyocardial biopsy analysis with pathological distinction of precursor protein type, but this method often results in delayed diagnosis because of the limited availability of expertise to perform and interpret the endomyocardial biopsy specimen. Emerging noninvasive imaging modalities provide easier, accurate screening for ATTRwt. These modalities include advanced echocardiography, using strain imaging and the myocardial contraction fraction; nuclear scintigraphy, which can differentiate between ATTR and light-chain cardiac amyloid; and cardiac magnetic resonance imaging, using extracellular volume measurement, late gadolinium enhancement, and distinct T1 mapping. These novel approaches reveal insights into the prevalence, clinical course, morphological effects, and prognosis of ATTRwt.
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Affiliation(s)
- David L Narotsky
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Adam Castano
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - Sabahat Bokhari
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
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Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction. Int J Cardiovasc Imaging 2015; 31 Suppl 2:223-32. [DOI: 10.1007/s10554-015-0751-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 01/12/2023]
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Varga-Szemes A, Muscogiuri G, Schoepf UJ, Wichmann JL, Suranyi P, De Cecco CN, Cannaò PM, Renker M, Mangold S, Fox MA, Ruzsics B. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method. Eur Radiol 2015; 26:1503-11. [PMID: 26267520 DOI: 10.1007/s00330-015-3952-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. METHODS Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. RESULTS Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17%; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM mesurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. CONCLUSIONS Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. KEY POINTS • Threshold-based left ventricular segmentation provides time-efficient assessment of left ventricular parameters • The threshold-based method can discriminate between blood and papillary muscles • This method provides improved accuracy compared to aortic flow measurements as a reference.
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Affiliation(s)
- Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Giuseppe Muscogiuri
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Medical-Surgical Sciences and Translational Medicine, University of Rome "Sapienza", Rome, Italy
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Carlo N De Cecco
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Paola M Cannaò
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Scuola di Specializzazione in Radiodiagnostica, University of Milan, Milan, Italy
| | - Matthias Renker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Stefanie Mangold
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA.,Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen, Germany
| | - Mary A Fox
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA
| | - Balazs Ruzsics
- Department of Cardiology, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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Seo HY, Lee SP, Park JB, Lee JM, Park EA, Chang SA, Kim HK, Park SJ, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Choe YH. Discrepancies in Left Ventricular Mass Calculation Based on Echocardiography and Cardiovascular Magnetic Resonance Measurements in Patients with Left Ventricular Hypertrophy. J Am Soc Echocardiogr 2015; 28:1194-1203, e2. [PMID: 26194306 DOI: 10.1016/j.echo.2015.06.009] [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: 05/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increased left ventricular (LV) mass is associated with adverse cardiovascular outcomes, and its accurate assessment is important. The aim of this study was to analyze the degree of difference among various methods of LV mass calculation based on transthoracic echocardiographic (TTE) measurements and cardiovascular magnetic resonance (CMR) measurements, especially in patients with aortic stenosis with varying degrees of LV hypertrophy (LVH). The mechanism underlying this disagreement was also investigated. METHODS Ninety-nine patients with moderate to severe aortic stenosis and 33 control subjects matched for age, sex, body weight, and height were enrolled in this prospective observational cohort study. All patients underwent TTE and CMR imaging. LV mass index (LVMI) was calculated using three formulas on the basis of TTE measurements (the Penn-cube, American Society of Echocardiography [ASE], and Teichholz methods) and compared with measurements obtained using CMR, the reference method. RESULTS Although all methods calculated using TTE measurements showed good correlations with CMR measurements, LVMI measured using the Penn-cube and ASE methods tended to be larger than LVMI measured using CMR (difference in LVMI by the Penn-cube and ASE methods, 59.3 ± 29.7 and 30.6 ± 22.3 g/m², respectively). This tendency decreased with the Teichholz method (difference in LVMI by the Teichholz method, 22.9 ± 19.1 g/m²). The degree of LVMI overestimation was significantly different among the three methods (P < .001 by one-way analysis of variance), which was more significant in patients with LVH, especially with the Penn-cube method (differences between CMR and TTE measurements in patients with aortic stenosis and LVH, 66.3 ± 34.8 vs 31.2 ± 26.6 vs 15.5 ± 20.9 g/m² for the Penn-cube, ASE, and Teichholz methods, respectively; P < .001 with post hoc Tukey analysis). There was a good correlation between LVMI and LV diameter-to-length ratio (r = 0.468, P < .001), which suggested that the left ventricle takes on a more globular shape with the increase of LVMI, resulting in a significant deviation from the basic assumptions on which the Penn-cube and ASE methods were built. CONCLUSIONS Current methods of calculating LVMI from echocardiographic measurements carry a tendency to measure LVMI larger than methods based on CMR measurements, which was more significant in patients with LVH. The change of the left ventricle's shape with LVH may be a plausible explanation for this, and a correction method may be needed when calculating LVMI from echocardiographic measurements, especially in patients with LVH and smaller body size.
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Affiliation(s)
- Hee-Young Seo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jun-Bean Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-A Chang
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ji Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Chol Lee
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Validation and Development of a New Automatic Algorithm for Time-Resolved Segmentation of the Left Ventricle in Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2015; 2015:970357. [PMID: 26180818 PMCID: PMC4491381 DOI: 10.1155/2015/970357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022]
Abstract
Introduction. Manual delineation of the left ventricle is clinical standard for quantification of cardiovascular magnetic resonance images despite being time consuming and observer dependent. Previous automatic methods generally do not account for one major contributor to stroke volume, the long-axis motion. Therefore, the aim of this study was to develop and validate an automatic algorithm for time-resolved segmentation covering the whole left ventricle, including basal slices affected by long-axis motion. Methods. Ninety subjects imaged with a cine balanced steady state free precession sequence were included in the study (training set n = 40, test set n = 50). Manual delineation was reference standard and second observer analysis was performed in a subset (n = 25). The automatic algorithm uses deformable model with expectation-maximization, followed by automatic removal of papillary muscles and detection of the outflow tract. Results. The mean differences between automatic segmentation and manual delineation were EDV −11 mL, ESV 1 mL, EF −3%, and LVM 4 g in the test set. Conclusions. The automatic LV segmentation algorithm reached accuracy comparable to interobserver for manual delineation, thereby bringing automatic segmentation one step closer to clinical routine. The algorithm and all images with manual delineations are available for benchmarking.
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Gomez AD, Zou H, Shiu YT, Hsu EW. Characterization of regional deformation and material properties of the intact explanted vein by microCT and computational analysis. Cardiovasc Eng Technol 2014; 5:359-370. [PMID: 25541587 DOI: 10.1007/s13239-014-0190-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Detailed mechanical information of the vein is important to better understand remodeling of the vessel in disease states, but has been difficult to obtain due to its thinness, unique geometry, and limitations of mechanical testing. This study presents a novel method for characterizing deformation of the intact explanted vein under physiological loads and determining its material properties by combining high-resolution imaging and computational analysis. METHODS High-resolution CT (microCT) was used to image an iodine-stained, excised porcine internal jugular vein sample under extension to 100% and 120% of in situ length, and inflation and 2, 10, 20 mmHg of pressure, inside a microCT-compatible hydrostatic loading chamber. Regional strains were measured with the finite element (FE) image registration method known as Hyperelastic Warping. Material properties were approximated with inverse FE characterization by optimizing stiffness-related coefficients so to match simulated strains to the experimental measurements. RESULTS The observed morphology and regional strain of the vein were found to be relatively heterogeneous. The regional variability in the measured strain was primarily driven by geometry. Although iodine treatment may result in tissue stiffening, which requires additional investigation, it is effective in allowing detailed detection of vein geometry. CONCLUSIONS The feasibility and utility of using microCT and computational analysis to characterize mechanical responses and material properties of the vein were demonstrated. The presented method is a promising alternative or addition to mechanical testing for characterizing veins or other similarly delicate vessels in their native anatomical configuration under a wide range of realistic or simulated environmental and loading conditions.
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Affiliation(s)
- Arnold David Gomez
- Bioengineering Department, University of Utah ; Cardiothoracic Surgery Division, Department of Surgery, University of Utah
| | - Huashan Zou
- Bioengineering Department, University of Utah
| | - Yan-Ting Shiu
- Nephrology Division, Department of Medicine, University of Utah
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Kamenický P, Redheuil A, Roux C, Salenave S, Kachenoura N, Raissouni Z, Macron L, Guignat L, Jublanc C, Azarine A, Brailly S, Young J, Mousseaux E, Chanson P. Cardiac structure and function in Cushing's syndrome: a cardiac magnetic resonance imaging study. J Clin Endocrinol Metab 2014; 99:E2144-53. [PMID: 25093618 PMCID: PMC4223435 DOI: 10.1210/jc.2014-1783] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with Cushing's syndrome have left ventricular (LV) hypertrophy and dysfunction on echocardiography, but echo-based measurements may have limited accuracy in obese patients. No data are available on right ventricular (RV) and left atrial (LA) size and function in these patients. OBJECTIVES The objective of the study was to evaluate LV, RV, and LA structure and function in patients with Cushing's syndrome by means of cardiac magnetic resonance, currently the reference modality in assessment of cardiac geometry and function. METHODS Eighteen patients with active Cushing's syndrome and 18 volunteers matched for age, sex, and body mass index were studied by cardiac magnetic resonance. The imaging was repeated in the patients 6 months (range 2-12 mo) after the treatment of hypercortisolism. RESULTS Compared with controls, patients with Cushing's syndrome had lower LV, RV, and LA ejection fractions (P < .001 for all) and increased end-diastolic LV segmental thickness (P < .001). Treatment of hypercortisolism was associated with an improvement in ventricular and atrial systolic performance, as reflected by a 15% increase in the LV ejection fraction (P = .029), a 45% increase in the LA ejection fraction (P < .001), and an 11% increase in the RV ejection fraction (P = NS). After treatment, the LV mass index and end-diastolic LV mass to volume ratio decreased by 17% (P < .001) and 10% (P = .002), respectively. None of the patients had late gadolinium myocardial enhancement. CONCLUSION Cushing's syndrome is associated with subclinical biventricular and LA systolic dysfunctions that are reversible after treatment. Despite skeletal muscle atrophy, Cushing's syndrome patients have an increased LV mass, reversible upon correction of hypercortisolism.
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Simprini LA, Goyal P, Codella N, Fieno DS, Afroz A, Mullally J, Cooper M, Wang Y, Finn JP, Devereux RB, Weinsaft JW. Geometry-independent inclusion of basal myocardium yields improved cardiac magnetic resonance agreement with echocardiography and necropsy quantified left-ventricular mass. J Hypertens 2014; 31:2069-76. [PMID: 24107735 DOI: 10.1097/hjh.0b013e328362d935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Left-ventricular mass (LVM) is widely used to guide clinical decision-making. Cardiac magnetic resonance (CMR) quantifies LVM by planimetry of contiguous short-axis images, an approach dependent on reader-selection of images to be contoured. Established methods have applied different binary cut-offs using circumferential extent of left-ventricular myocardium to define the basal left ventricle (LV), omitting images containing lesser fractions of left-ventricular myocardium. This study tested impact of basal slice variability on LVM quantification. METHODS CMR was performed in patients and laboratory animals. LVM was quantified with full inclusion of left-ventricular myocardium, and by established methods that use different cut-offs to define the left-ventricular basal-most slice: 50% circumferential myocardium at end diastole alone (ED50), 50% circumferential myocardium throughout both end diastole and end systole (EDS50). RESULTS One hundred and fifty patients and 10 lab animals were studied. Among patients, fully inclusive LVM (172.6±42.3g) was higher vs. ED50 (167.2±41.8g) and EDS50 (150.6±41.1g; both P<0.001). Methodological differences yielded discrepancies regarding proportion of patients meeting established criteria for left-ventricular hypertrophy and chamber dilation (P<0.05). Fully inclusive LVM yielded smaller differences with echocardiography (Δ=11.0±28.8g) than did ED50 (Δ=16.4±29.1g) and EDS50 (Δ=33.2±28.7g; both P<0.001). Among lab animals, ex-vivo left-ventricular weight (69.8±13.2g) was similar to LVM calculated using fully inclusive (70.1±13.5g, P=0.67) and ED50 (69.4±13.9g; P=0.70) methods, whereas EDS50 differed significantly (67.9±14.9g; P=0.04). CONCLUSION Established CMR methods that discordantly define the basal-most LV produce significant differences in calculated LVM. Fully inclusive quantification, rather than binary cut-offs that omit basal left-ventricular myocardium, yields smallest CMR discrepancy with echocardiography-measured LVM and non-significant differences with necropsy-measured left-ventricular weight.
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Affiliation(s)
- Lauren A Simprini
- aDepartment of Medicine (Cardiology) bDepartment of Radiology cDepartment of Biomedical Engineering, Weill Cornell Medical College dMemorial Sloan Kettering Cancer Center eIBM TJ Watson Research Center, Yorktown, New York fHeart South Cardiovascular Group, Alabaster, Alabama gUCLA Health System, Los Angeles, California, USA
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Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2014; 31:2060-8. [PMID: 23838656 DOI: 10.1097/hjh.0b013e328362bbd6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients. METHODS AND RESULTS Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05). CONCLUSION The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
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Britov AN, Platonova EM, Ryzova TV, Eliseeva NA. EARLY HEART DISORDERS IN HYPERTENSIVE PERSONS AS THE RESULTS OF PREVENTIVE EXAMINATION ON INDUSTRIAL ENTERPRISE. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2014. [DOI: 10.15829/1728-8800-2014-2-65-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The article is considered on the questions of pathogenesis, clinic and diagnosis of myocardial disorders, first of all in persons with high blood pressure. Preference of ultrasound cardiography (UC) for detection of concentric and eccentric hypertrophy of left heart ventricle as well as concentric remodeling is shown. Authors claim the principle possibility to use UC methods in the plant out-patient department; it has principal significance for economically active persons. 2557 industrial workers 20–60 years (1492 men and 1065 women) were investigated. Hypertension (140/90 mm Hg or antihypertensive treatment) was diagnosed in 20% — 514 persons. Voltage ECG LVH criteria were found in 142 pts (28%); UC signs of LVH were found in 389 pts (76%). Increase of related thickness of heart walls diagnosed in 412 pts (80%) and increase of Mass myocardial index — in 347 pts (67%), diastolic dysfunction was found in 402 pts (78%). So the exclusive value of modern diagnostic methods including UC is proven which gives the possibility of early diagnostic of prevalent heart disorders in hypertensive industrial workers.
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2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2014; 31:1281-357. [PMID: 23817082 DOI: 10.1097/01.hjh.0000431740.32696.cc] [Citation(s) in RCA: 3280] [Impact Index Per Article: 328.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Oghli MG, Dehlaghi V, Zadeh AM, Fallahi A, Pooyan M. Right ventricle functional parameters estimation in arrhythmogenic right ventricular dysplasia using a robust shape based deformable model. JOURNAL OF MEDICAL SIGNALS & SENSORS 2014; 4:211-22. [PMID: 25298930 PMCID: PMC4187356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 05/04/2014] [Indexed: 12/04/2022]
Abstract
Assessment of cardiac right-ventricle functions plays an essential role in diagnosis of arrhythmogenic right ventricular dysplasia (ARVD). Among clinical tests, cardiac magnetic resonance imaging (MRI) is now becoming the most valid imaging technique to diagnose ARVD. Fatty infiltration of the right ventricular free wall can be visible on cardiac MRI. Finding right-ventricle functional parameters from cardiac MRI images contains segmentation of right-ventricle in each slice of end diastole and end systole phases of cardiac cycle and calculation of end diastolic and end systolic volume and furthermore other functional parameters. The main problem of this task is the segmentation part. We used a robust method based on deformable model that uses shape information for segmentation of right-ventricle in short axis MRI images. After segmentation of right-ventricle from base to apex in end diastole and end systole phases of cardiac cycle, volume of right-ventricle in these phases calculated and then, ejection fraction calculated. We performed a quantitative evaluation of clinical cardiac parameters derived from the automatic segmentation by comparison against a manual delineation of the ventricles. The manually and automatically determined quantitative clinical parameters were statistically compared by means of linear regression. This fits a line to the data such that the root-mean-square error (RMSE) of the residuals is minimized. The results show low RMSE for Right Ventricle Ejection Fraction and Volume (≤ 0.06 for RV EF, and ≤ 10 mL for RV volume). Evaluation of segmentation results is also done by means of four statistical measures including sensitivity, specificity, similarity index and Jaccard index. The average value of similarity index is 86.87%. The Jaccard index mean value is 83.85% which shows a good accuracy of segmentation. The average of sensitivity is 93.9% and mean value of the specificity is 89.45%. These results show the reliability of proposed method in these cases that manual segmentation is inapplicable. Huge shape variety of right-ventricle led us to use a shape prior based method and this work can develop by four-dimensional processing for determining the first ventricular slices.
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Affiliation(s)
- Mostafa Ghelich Oghli
- Department of Biomedical Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahab Dehlaghi
- Department of Biomedical Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran,Address for correspondence: Dr. Vahab Dehlaghi, Department of Biomedical Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran. E-mail:
| | - Ali Mohammad Zadeh
- Department of Radiology, Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
| | - Alireza Fallahi
- Department of Biomedical Engineering, Hamedan University of Technology, Hamedan, Iran
| | - Mohammad Pooyan
- Department of Biomedical Engineering, Shahed University, Tehran, Iran
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Circulation: Cardiovascular Imaging
Editors’ Picks. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.113.001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Palmieri V, Manganelli F, Russo C, Gagliardi B, Pezzullo S, Gagliardi G, Rosato G, Lombardi C. Accuracy and Feasibility of Simplified Doppler-Based Left Ventricular Ejection Fraction. Am J Cardiol 2013; 112:889-94. [DOI: 10.1016/j.amjcard.2013.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 11/26/2022]
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Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159-219. [PMID: 23771844 DOI: 10.1093/eurheartj/eht151] [Citation(s) in RCA: 3168] [Impact Index Per Article: 288.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Giuseppe Mancia
- Centro di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Milano, Italy.
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Current world literature. Curr Opin Cardiol 2012; 27:556-64. [PMID: 22874129 DOI: 10.1097/hco.0b013e32835793f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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