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Brandt Y, Lubrecht JM, Adriaans BP, Aben JP, Gerretsen SC, Ghossein-Doha C, Spaanderman MEA, Prinzen FW, Kooi ME. Quantification of left ventricular myocardial strain: Comparison between MRI tagging, MRI feature tracking, and ultrasound speckle tracking. NMR IN BIOMEDICINE 2024; 37:e5164. [PMID: 38664924 DOI: 10.1002/nbm.5164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 08/07/2024]
Abstract
Ultrasound speckle tracking is frequently used to quantify myocardial strain, and magnetic resonance imaging (MRI) feature tracking is rapidly gaining interest. Our aim is to validate cardiac MRI feature tracking by comparing it with the gold standard method (i.e., MRI tagging) in healthy subjects and patients. Furthermore, we aim to perform an indirect validation by comparing ultrasound speckle tracking with MRI feature tracking. Forty-two subjects (17 formerly preeclamptic women, three healthy women, and 22 left bundle branch block patients of both sexes) received 3-T cardiac MRI and echocardiography. Cine and tagged MRI, and B-mode ultrasound images, were acquired. Intrapatient global and segmental left ventricular circumferential (MRI tagging vs. MRI feature tracking) and longitudinal (MRI feature tracking vs. ultrasound speckle tracking) peak strain and time to peak strain were compared between the three techniques. Intraclass correlation coefficient (ICC) (< 0.50 = poor, 0.50-0.75 = moderate, > 0.75-0.90 = good, > 0.90 = excellent) and Bland-Altman analysis were used to assess correlation and bias; p less than 0.05 indicates a significant ICC or bias. Global peak strain parameters showed moderate-to-good correlations between methods (ICC = 0.71-0.83, p < 0.01) with no significant biases. Global time to peak strain parameters showed moderate-to-good correlations (ICC = 0.56-0.82, p < 0.01) with no significant biases. Segmental peak strains showed significant biases in all parameters and moderate-to-good correlation (ICC = 0.62-0.77, p < 0.01), except for lateral longitudinal peak strain (ICC = 0.23, p = 0.22). Segmental time to peak strain parameters showed moderate-to-good correlation (ICC = 0.58-0.74, p < 0.01) with no significant biases. MRI feature tracking is a valid method to examine myocardial strain, but there is bias in absolute segmental strain values between imaging techniques. MRI feature tracking shows adequate comparability with ultrasound speckle tracking.
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Affiliation(s)
- Yentl Brandt
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jolijn M Lubrecht
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jean-Paul Aben
- Department of Research and Development, Pie Medical Imaging B.V., Maastricht, The Netherlands
| | - Suzanne C Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Santos MR, Silva MS, Guerreiro SL, Gomes DA, Rocha BM, Cunha GL, Freitas PN, Abecasis JM, Santos AC, Saraiva CC, Mendes M, Ferreira AM. Assessment of myocardial strain patterns in patients with left bundle branch block using cardiac magnetic resonance. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03049-3. [PMID: 38376720 DOI: 10.1007/s10554-024-03049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024]
Abstract
Recently, a classification with four types of septal longitudinal strain patterns was described using echocardiography, suggesting a pathophysiological continuum of left bundle branch block (LBBB)-induced left ventricle (LV) remodeling. The aim of this study was to assess the feasibility of classifying these strain patterns using cardiovascular magnetic resonance (CMR), and to evaluate their association with LV remodeling and myocardial scar. Single center registry included LBBB patients with septal flash (SF) referred to CMR to assess the cause of LV systolic dysfunction. Semi-automated feature-tracking cardiac resonance (FT-CMR) was used to quantify myocardial strain and detect the four strain patterns. A total of 115 patients were studied (age 66 ± 11 years, 57% men, 28% with ischemic heart disease). In longitudinal strain analysis, 23 patients (20%) were classified in stage LBBB-1, 37 (32.1%) in LBBB-2, 25 (21.7%) in LBBB-3, and 30 (26%) in LBBB-4. Patients at higher stages had more prominent septal flash, higher LV volumes, lower LV ejection fraction, and lower absolute strain values (p < 0.05 for all). Late gadolinium enhancement (LGE) was found in 55% of the patients (n = 63). No differences were found between the strain patterns regarding the presence, distribution or location of LGE. Among patients with LBBB, there was a good association between strain patterns assessed by FT-CMR analysis and the degree of LV remodeling and LV dysfunction. This association seems to be independent from the presence and distribution of LGE.
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Affiliation(s)
- Marina Raquel Santos
- Hospital Dr. Nélio Mendonça, Funchal, Portugal.
- CHLO - Hospital de Santa Cruz, Lisbon, Portugal.
| | - Mariana Santos Silva
- CHLO - Hospital de Santa Cruz, Lisbon, Portugal
- Centro Hospitalar Barreiro/Montijo, Setúbal, Portugal
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Lv H, Jiang Y, Tan X, Wang J, Liu Y. Global and regional myocardial function assessment in symptomatic patients with chronic coronary syndrome using longitudinal strain and noninvasive myocardial work. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2465-2474. [PMID: 37728801 DOI: 10.1007/s10554-023-02951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Speckle tracking echocardiography (STE) derived longitudinal strain (LS) and noninvasive pressure-strain loop (PSL) derived myocardial work (MW) are more sensitive than conventional echocardiographic parameters in quantitative assessment of early myocardial dysfunction. The aim of this study was to assess left ventricular (LV) global and regional myocardial function in symptomatic chronic coronary syndrome (CCS) patients using the two promising methods. Transthoracic echocardiography was performed on patients with angina or equivalent symptoms before coronary angiography. STE-based LS and PSL-based MW analysis were carried out on each patient for global and regional myocardial function assessment. A total of 102 patients were classified into significant and nonsignificant coronary artery stenosis (CAS) groups. Among global myocardial function parameters, LS had the biggest area under the curve (AUC) of 0.735, with cutoff value of 18.4% (sensitivity, 79.6%; specificity, 72.9%), but remained statistically alike with all MW indices in predicting significant CAS (P>0.05 for all). Among regional myocardial function parameters, both LS and MW indices had predictive value for significant left anterior descending artery (LAD) or left circumflex artery (LCX) stenosis, while only myocardial work efficiency (MWE) for right coronary artery (RCA) stenosis. Both global and regional LS and MW have predictive value for significant CAS, but their value of regionalized assessment varies with specific coronary artery involvement.
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Affiliation(s)
- HanLu Lv
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yuan Jiang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Xin Tan
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - JingFeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - YingMei Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Bjerregaard CL, Skaarup KG, Lassen MCH, Biering-Sørensen T, Olsen FJ. Strain Imaging and Ventricular Arrhythmia. Diagnostics (Basel) 2023; 13:diagnostics13101778. [PMID: 37238262 DOI: 10.3390/diagnostics13101778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Anastasius M, Thavendiranathan P, Kini A, Argulian E, Sharma S, Narula J, Lerakis S. Part 1: The Clinical Applications of Left Ventricular Myocardial Strain. Cardiol Rev 2023:00045415-990000000-00105. [PMID: 37126439 DOI: 10.1097/crd.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
There is an increasing prevalence of cardiovascular disease and heart failure. Indices of left ventricular (LV) systolic function such as LV ejection fraction used to identify those at risk of adverse cardiac events such as heart failure may not be truly representative of LV systolic function in certain cardiac diseases. Given that LV ejection fraction reduction may represent more advanced irreversible stages of disease, measures of myocardial strain have emerged as a feasible and robust instrument for the early identification of heart disease and subtle LV systolic dysfunction. The purpose of this review was to provide an overview of myocardial strain concepts and emerging clinical applications of global longitudinal strain in cardio-oncology.
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Affiliation(s)
- Malcolm Anastasius
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Annapoorna Kini
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edgar Argulian
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samin Sharma
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jagat Narula
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stamatios Lerakis
- From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY
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6
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Kar J, Cohen MV, McQuiston SA, Malozzi CM. Can global longitudinal strain (GLS) with magnetic resonance prognosticate early cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer patients, a prospective study? Magn Reson Imaging 2023; 97:68-81. [PMID: 36581216 PMCID: PMC10292191 DOI: 10.1016/j.mri.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine if Artificial Intelligence-based computation of global longitudinal strain (GLS) from left ventricular (LV) MRI is an early prognostic factor of cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer patients. The main hypothesis based on the patients receiving antineoplastic chemotherapy treatment was CTRCD risk analysis with GLS that was independent of LV ejection fraction (LVEF). METHODS Displacement Encoding with Stimulated Echoes (DENSE) MRI was acquired on 32 breast cancer patients at baseline and 3- and 6-month follow-ups after chemotherapy. Two DeepLabV3+ Fully Convolutional Networks (FCNs) were deployed to automate image segmentation for LV chamber quantification and phase-unwrapping for 3D strains, computed with the Radial Point Interpolation Method. CTRCD risk (cardiotoxicity and adverse cardiac events) was analyzed with Cox Proportional Hazards (PH) models with clinical and contractile prognostic factors. RESULTS GLS worsened from baseline to the 3- and 6-month follow-ups (-19.1 ± 2.1%, -16.0 ± 3.1%, -16.1 ± 3.0%; P < 0.001). Univariable Cox regression showed the 3-month GLS significantly associated as an agonist (hazard ratio [HR]-per-SD: 2.1; 95% CI: 1.4-3.1; P < 0.001) and LVEF as a protector (HR-per-SD: 0.8; 95% CI: 0.7-0.9; P = 0.001) for CTRCD occurrence. Bivariable regression showed the 3-month GLS (HR-per-SD: 2.0; 95% CI: 1.2-3.4; P = 0.01) as a CTRCD prognostic factor independent of other covariates, including LVEF (HR-per-SD: 1.0; 95% CI: 0.9-1.2; P = 0.9). CONCLUSIONS The end-point analyses proved the hypothesis that GLS is an early, independent prognosticator of incident CTRCD risk. This novel GLS-guided approach to CTRCD risk analysis could improve antineoplastic treatment with further validation in a larger clinical trial.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, 150 Jaguar Drive, Mobile, AL 36688, USA.
| | - Michael V Cohen
- Division of Cardiology, Department of Medicine, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA; Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, 5851 USA Dr N, Mobile, AL 36688, USA
| | - Samuel A McQuiston
- Department of Radiology, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA
| | - Christopher M Malozzi
- Division of Cardiology, Department of Medicine, University Hospital, 2451 USA Medical Center Drive, Mobile, AL 36617, USA
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7
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Rademakers FE. Seeing, even quantified, is not always believing. Eur Heart J Cardiovasc Imaging 2022; 23:1445-1446. [PMID: 35815683 DOI: 10.1093/ehjci/jeac132] [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: 11/14/2022] Open
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8
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Rajiah PS, Kalisz K, Broncano J, Goerne H, Collins JD, François CJ, Ibrahim ES, Agarwal PP. Myocardial Strain Evaluation with Cardiovascular MRI: Physics, Principles, and Clinical Applications. Radiographics 2022; 42:968-990. [PMID: 35622493 DOI: 10.1148/rg.210174] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial strain is a measure of myocardial deformation, which is a more sensitive imaging biomarker of myocardial disease than the commonly used ventricular ejection fraction. Although myocardial strain is commonly evaluated by using speckle-tracking echocardiography, cardiovascular MRI (CMR) is increasingly performed for this purpose. The most common CMR technique is feature tracking (FT), which involves postprocessing of routinely acquired cine MR images. Other CMR strain techniques require dedicated sequences, including myocardial tagging, strain-encoded imaging, displacement encoding with stimulated echoes, and tissue phase mapping. The complex systolic motion of the heart can be resolved into longitudinal strain, circumferential strain, radial strain, and torsion. Myocardial strain metrics include strain, strain rate, displacement, velocity, torsion, and torsion rate. Wide variability exists in the reference ranges for strain dependent on the imaging technique, analysis software, operator, patient demographics, and hemodynamic factors. In anticancer therapy cardiotoxicity, CMR myocardial strain can help identify left ventricular dysfunction before the decline of ejection fraction. CMR myocardial strain is also valuable for identifying patients with left ventricle dyssynchrony who will benefit from cardiac resynchronization therapy. CMR myocardial strain is also useful in ischemic heart disease, cardiomyopathies, pulmonary hypertension, and congenital heart disease. The authors review the physics, principles, and clinical applications of CMR strain techniques. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Kevin Kalisz
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Jordi Broncano
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Harold Goerne
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Jeremy D Collins
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Christopher J François
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - El-Sayed Ibrahim
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
| | - Prachi P Agarwal
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., J.D.C., C.J.F.); Department of Radiology, Duke University Medical Center, Durham, NC (K.K.); Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, HT-RESALTA, HT Médica, Córdoba, Spain (J.B.); Department of Radiology, Division of Cardiac Imaging, Imaging and Diagnostic Center CID, Guadalajara, Mexico (H.G.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (E.S.I.); and Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.)
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Gambril JA, Chum A, Goyal A, Ruz P, Mikrut K, Simonetti O, Dholiya H, Patel B, Addison D. Cardiovascular Imaging in Cardio-Oncology: The Role of Echocardiography and Cardiac MRI in Modern Cardio-Oncology. Heart Fail Clin 2022; 18:455-478. [PMID: 35718419 PMCID: PMC9280694 DOI: 10.1016/j.hfc.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cardiovascular (CV) events are an increasingly common limitation of effective anticancer therapy. Over the last decade imaging has become essential to patients receiving contemporary cancer therapy. Herein we discuss the current state of CV imaging in cardio-oncology. We also provide a practical apparatus for the use of imaging in everyday cardiovascular care of oncology patients to improve outcomes for those at risk for cardiotoxicity, or with established cardiovascular disease. Finally, we consider future directions in the field given the wave of new anticancer therapies.
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Affiliation(s)
- John Alan Gambril
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA; Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA. https://twitter.com/GambrilAlan
| | - Aaron Chum
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Akash Goyal
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA. https://twitter.com/agoyalMD
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Katarzyna Mikrut
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA. https://twitter.com/KatieMikrut
| | - Orlando Simonetti
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA; Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA; Department of Radiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Hardeep Dholiya
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA. https://twitter.com/Hardeep_10
| | - Brijesh Patel
- Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA; Cardio-Oncology Program, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
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10
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A method for direct estimation of left ventricular global longitudinal strain rate from echocardiograms. Sci Rep 2022; 12:4008. [PMID: 35256638 PMCID: PMC8901690 DOI: 10.1038/s41598-022-06878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/31/2022] [Indexed: 11/08/2022] Open
Abstract
We present a new method for measuring global longitudinal strain and global longitudinal strain rate from 2D echocardiograms using a logarithmic-transform correlation (LTC) method. Traditional echocardiography strain analysis depends on user inputs and chamber segmentation, which yield increased measurement variability. In contrast, our approach is automated and does not require cardiac chamber segmentation and regularization, thus eliminating these issues. The algorithm was benchmarked against two conventional strain analysis methods using synthetic left ventricle ultrasound images. Measurement error was assessed as a function of contrast-to-noise ratio (CNR) using mean absolute error and root-mean-square error. LTC showed better agreement to the ground truth strain \documentclass[12pt]{minimal}
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\begin{document}$${({\varvec{R}}}^{2}=0.91)$$\end{document}(R2=0.91) and ground truth strain rate \documentclass[12pt]{minimal}
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\begin{document}$${({\varvec{R}}}^{2}=0.85)$$\end{document}(R2=0.85) compared with agreement to ground truth for two block-matching speckle tracking algorithms (one based on sum of square difference and the other on Fourier transform correlation; strain \documentclass[12pt]{minimal}
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\begin{document}$${({\varvec{R}}}^{2}=0.70)$$\end{document}(R2=0.70), strain rate \documentclass[12pt]{minimal}
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\begin{document}$${({\varvec{R}}}^{2}=0.70)$$\end{document}(R2=0.70)). A 200% increase in strain measurement accuracy was observed compared to the conventional algorithms. Subsequently, we tested the method using a 53-subject clinical cohort (20 subjects diseased with cardiomyopathy, 33 healthy controls). Our method distinguished between normal and abnormal left ventricular function with an AUC = 0.89, a 5% improvement over the conventional GLS algorithms.
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Kotby AA, Ebrahim SOS, Al-Fahham MM. Reference centiles for left ventricular longitudinal global and regional systolic strain by automated functional imaging in healthy Egyptian children. Cardiol Young 2022; 33:1-9. [PMID: 35241202 DOI: 10.1017/s1047951122000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Two-dimensional speckle tracking echocardiography-derived left ventricular longitudinal systolic strain is an important myocardial deformation parameter for assessing the systolic function of the left ventricle. Strain values differ according to the vendor machine and software. This study aimed to provide normal reference values for global and regional left ventricular longitudinal systolic strain in Egyptian children using automated functional imaging software integrated into the General Electric healthcare machine and to study the correlation between the global longitudinal left ventricular systolic strain and age, body size, vital data, and some echocardiographic parameters. METHODS Healthy children (250) aged from 1 to 16 years were included. Conventional echocardiography was done to measure the left ventricular dimensions and function. Automated functional imaging was performed to measure the global and regional peak longitudinal systolic strain. RESULTS The global longitudinal strain was -21.224 ± 1.862%. The regional strain was -20.68 ± 2.11%, -21.06 ± 1.84%, and -21.86 ± 2.71% at the basal, mid, and apical segments, respectively. The mean values of the systolic longitudinal strain become significantly more negative from base to apex. Age differences were found as regard to global and regional longitudinal strain parameters but no gender differences. The global peak longitudinal systolic strain correlated positively with age. No correlations were found with either the anthropometric parameters or the vital data. CONCLUSIONS Age-specific normal values for two-dimensional speckle tracking-derived left ventricular longitudinal regional and global systolic strain are established using automated functional imaging.
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Affiliation(s)
- Alyaa A Kotby
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Sahar O S Ebrahim
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Marwa M Al-Fahham
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
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Taha MB, Jeng EI, Salerno M, Moguillansky D, Keeley EC, Al-Ani MA. Left Ventricular Strain Is Associated With Myocardial Recovery Following ST-Elevation Myocardial Infarction, a Prospective Longitudinal CMR Study. Front Cardiovasc Med 2022; 9:842619. [PMID: 35282338 PMCID: PMC8907654 DOI: 10.3389/fcvm.2022.842619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/02/2022] [Indexed: 01/27/2023] Open
Abstract
Background Infarct size following ST-elevation myocardial infarction (STEMI) is an important determinate of left ventricular (LV) dysfunction and cardiovascular morbidity and mortality. Cardiac magnetic resonance feature tracking (CMR-FT) is a technique that allows for the assessment of myocardial function via quantification of longitudinal, radial, and circumferential strain. We investigated the association between CMR-FT-derived myocardial global strain and myocardial recovery. Methods A prospective study on patients presenting with STEMI treated with primary percutaneous coronary intervention (PCI) was conducted. CMR imaging was obtained at two interval time points, the baseline within 2 weeks of hospital discharge and follow-up at 6 months. Strain analysis was performed via FT-CMR, and recovery was quantified by the area of late gadolinium enhancement (LGE). Results A total of n = 14 patients met inclusion and exclusion criteria and were analyzed. There was a significant reduction in the infarct size, as measured by LGE mass percentage of the left ventricular muscle mass, between the initial and follow-up CMR (19.7%, IQR 12.2-23.9 vs. 17.1%, IQR 8.3-22.5, p = 0.04). Initial strain parameters were inversely correlated with the initial edema mass and the decrease in LGE mass between the initial and follow-up CMR. All LV global strains had high accuracy for the prediction of a reduction in LGE mass by 50% or more. Conclusions LV global strains measured after primary PCI can predict the extent of myocardial recovery.
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Affiliation(s)
- Mohamad B. Taha
- Department of Cardiovascular Medicine, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States
| | - Eric I. Jeng
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Michael Salerno
- Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, United States
| | - Diego Moguillansky
- Department of Medicine, Division of Cardiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Ellen C. Keeley
- Department of Medicine, Division of Cardiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mohammad A. Al-Ani
- Department of Medicine, Division of Cardiology, College of Medicine, University of Florida, Gainesville, FL, United States,*Correspondence: Mohammad A. Al-Ani
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Influence of Heart Rate on Left and Right Ventricular Longitudinal Strain in Patients with Chronic Heart Failure. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the past years, a number of studies have demonstrated the relevance of strain assessed by two-dimensional speckle tracking echocardiography (STE) in evaluating ventricular function. The aim of this study was to analyze changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of heart rate (HR) in participants with and without chronic heart failure (CHF). We enrolled 45 patients, 38 of these diagnosed with CHF and carrying an implantable cardioverter defibrillator, and seven patients with pacemakers and without CHF. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR. When analyzed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed. Patients with a worsening of LVGLS (76% overall) were more likely to present lower baseline LV function. Only a few patients (18% for RVGLS and 16% for RVfwLS) exhibited HR-related deteriorations of RV strain measures, which was associated with lower levels of baseline RV function and higher pulmonary systolic pressures. Finally, 21 (47%) and 25 (56%) participants responded with improvements in RVGLS and RVfwLS, respectively. Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality in patients diagnosed with CHF.
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2D-echocardiography vs cardiac MRI strain: a prospective cohort study in patients with HER2-positive breast cancer undergoing trastuzumab. Cardiovasc Ultrasound 2021; 19:35. [PMID: 34753503 PMCID: PMC8576921 DOI: 10.1186/s12947-021-00266-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to study the predictive value of early two-dimensional echocardiography (2DE) speckle tracking (ST) for left ventricular ejection fraction (LVEF) changes during trastuzumab treatment for HER2-positive breast cancer. METHODS HER2-positive breast cancer patients receiving trastuzumab, with or without anthracycline, underwent 2DE-ST at baseline and after 3 and 6 months (m) trastuzumab. Cardiac magnetic resonance (CMR) imaging (with ST) was performed at baseline and 6 m. We studied the correlation between 2DE-ST- and CMR-derived global longitudinal strain (GLS) and global radial strain (GRS) measured at the same time. Additionally, we associated baseline and 3 m 2DE-ST measurements with later CMR-LVEF, and with cardiotoxicity, defined as CMR-LVEF < 45% and/or absolute decline > 10% during trastuzumab. RESULTS Forty-seven patients were included. Median baseline LVEF was 60.4%. GLS measurements based on 2DE-ST and CMR showed weak correlation (Pearson's r = 0.33; p = 0.041); GRS measurements were uncorrelated (r = 0.09; p = 0.979). 2DE-LVEF at baseline and 3 m, and 2DE-ST-GLS at 3 m were predictive of CMR-LVEF at 6 m. In contrast, the change in 2DE-ST-GLS at 3 m was predictive of the change in CMR-LVEF at 6 m, whereas the change in 2DE-LVEF was not. Importantly, the 11 patients who developed cardiotoxicity (28%) had larger 2DE-ST-GLS change at 3 m than those who did not (median 5.2%-points versus 1.7%-points; odds ratio for 1% difference change 1.81, 95% confidence interval 1.11-2.93; p = 0.016; explained variance 0.34). CONCLUSIONS Correlations between 2DE-ST and CMR-derived measurements are weak. Nevertheless, ST-measurements appeared useful to improve the performance of 2DE in predicting LVEF changes after 6 m of trastuzumab treatment.
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Zhang Y, Mui D, Chirinos JA, Zamani P, Ferrari VA, Chen Y, Han Y. Comparing cardiovascular magnetic resonance strain software packages by their abilities to discriminate outcomes in patients with heart failure with preserved ejection fraction. J Cardiovasc Magn Reson 2021; 23:55. [PMID: 34011382 PMCID: PMC8136221 DOI: 10.1186/s12968-021-00747-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) myocardial strain analysis using feature tracking (FT) is an increasingly popular method to assess cardiac function. However, different software packages produce different strain values from the same images and there is little guidance regarding which software package would be the best to use. We explored a framework under which different software packages could be compared and used based on their abilities to differentiate disease from health and differentiate disease severity based on outcome. METHOD To illustrate this concept, we compared 4-chamber left ventricular (LV) peak longitudinal strain (GLS) analyzed from retrospective electrocardiogram gated cine imaging performed on 1.5 T CMR scanners using three CMR post-processing software packages in their abilities to discriminate a group of 45 patients with heart failure with preserved ejection fraction (HFpEF) from 26 controls without cardiovascular disease and to discriminate disease severity based on outcomes. The three different post-processing software used were SuiteHeart, cvi42, and DRA-Trufistrain. RESULTS All three software packages were able to distinguish HFpEF patients from controls. 4-chamber peak GLS by SuiteHeart was shown to be a better discriminator of adverse outcomes in HFpEF patients than 4-chamber GLS derived from cvi42 or DRA-Trufistrain. CONCLUSION We illustrated a framework to compare feature tracking GLS derived from different post-processing software packages. Publicly available imaging data sets with outcomes would be important to validate the growing number of CMR-FT software packages.
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Affiliation(s)
- Ying Zhang
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
- PLA General Hospital, Beijing, China
| | - David Mui
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Julio A. Chirinos
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Payman Zamani
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Chengdu, China
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
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Militaru S, Panovsky R, Hanet V, Amzulescu MS, Langet H, Pisciotti MM, Pouleur AC, Vanoverschelde JLJ, Gerber BL. Multivendor comparison of global and regional 2D cardiovascular magnetic resonance feature tracking strains vs tissue tagging at 3T. J Cardiovasc Magn Reson 2021; 23:54. [PMID: 33980259 PMCID: PMC8117295 DOI: 10.1186/s12968-021-00742-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/16/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) 2D feature tracking (FT) left ventricular (LV) myocardial strain has seen widespread use to characterize myocardial deformation. Yet, validation of CMR FT measurements remains scarce, particularly for regional strain. Therefore, we aimed to perform intervendor comparison of 3 different FT software against tagging. METHODS In 61 subjects (18 healthy subjects, 18 patients with chronic myocardial infarction, 15 with dilated cardiomyopathy, and 10 with LV hypertrophy due to hypertrophic cardiomyopathy or aortic stenosis) were prospectively compared global (G) and regional transmural peak-systolic Lagrangian longitudinal (LS), circumferential (CS) and radial strains (RS) by 3 FT software (cvi42, Segment, and Tomtec) among each other and with tagging at 3T. We also evaluated the ability of regional LS, CS, and RS by different FT software vs tagging to identify late gadolinium enhancement (LGE) in the 18 infarct patients. RESULTS GLS and GCS by all 3 software had an excellent agreement among each other (ICC = 0.94-0.98 for GLS and ICC = 0.96-0.98 for GCS respectively) and against tagging (ICC = 0.92-0.94 for GLS and ICC = 0.88-0.91 for GCS respectively), while GRS showed inconsistent agreement between vendors (ICC 0.10-0.81). For regional LS, the agreement was good (ICC = 0.68) between 2 vendors but less vs the 3rd (ICC 0.50-0.59) and moderate to poor (ICC 0.44-0.47) between all three FT software and tagging. Also, for regional CS agreement between 2 software was higher (ICC = 0.80) than against the 3rd (ICC = 0.58-0.60), and both better agreed with tagging (ICC = 0.70-0.72) than the 3rd (ICC = 0.57). Regional RS had more variation in the agreement between methods ranging from good (ICC = 0.75) to poor (ICC = 0.05). Finally, the accuracy of scar detection by regional strains differed among the 3 FT software. While the accuracy of regional LS was similar, CS by one software was less accurate (AUC 0.68) than tagging (AUC 0.80, p < 0.006) and RS less accurate (AUC 0.578) than the other two (AUC 0.76 and 0.73, p < 0.02) to discriminate segments with LGE. CONCLUSIONS We confirm good agreement of CMR FT and little intervendor difference for GLS and GCS evaluation, with variable agreement for GRS. For regional strain evaluation, intervendor difference was larger, especially for RS, and the diagnostic performance varied more substantially among different vendors for regional strain analysis.
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Affiliation(s)
- Sebastian Militaru
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Roman Panovsky
- International Clinical Research Center, St. Anne´S Faculty Hospital, Brno, Czech Republic
- 1st Department of Internal Medicine/Cardioangiology, St. Anne´S Faculty Hospital, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Vincent Hanet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Mihaela Silvia Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Mary Mojica Pisciotti
- International Clinical Research Center, St. Anne´S Faculty Hospital, Brno, Czech Republic
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis J. Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc UCL, Av Hippocrate 10/2806, 1200 Woluwe St. Lambert, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
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Finite-element based optimization of left ventricular passive stiffness in normal volunteers and patients after myocardial infarction: Utility of an inverse deformation gradient calculation of regional diastolic strain. J Mech Behav Biomed Mater 2021; 119:104431. [PMID: 33930653 DOI: 10.1016/j.jmbbm.2021.104431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Left ventricular (LV) diastolic dysfunction (DD) is common after myocardial infarction (MI). Whereas current clinical assessment of DD relies on indirect markers including LV filling, finite element (FE) -based computational modeling directly measures regional diastolic stiffness. We hypothesized that an inverse deformation gradient (DG) method calculation of diastolic strain (IDGDS) allows the FE model-based calculation of regional diastolic stiffness (material parameters; MP) in post-MI patients with DD. METHODS Cardiac magnetic resonance (CMR) with tags (CSPAMM) and late gadolinium enhancement (LGE) was performed in 10 patients with post-MI DD and 10 healthy volunteers. The 3-dimensional (3D) LV DG from end-diastole (ED) to early diastolic filling (EDF; DGED→EDF) was calculated from CSPAMM. Diastolic strain was calculated from DGEDF→ED by inverting the DGED→EDF. FE models were created with MI and non-MI (remote; RM) regions determined by LGE. Guccione MPs C, and exponential fiber, bf, and transverse, bt , terms were optimized with IDGDS strain. RESULTS 3D circumferential and longitudinal diastolic strain (Ecc;Ell) calculated using IDGDS in CSPAMM obtained in volunteers and MI patients were [Formula: see text] = 0.27 ± 0.01, [Formula: see text] = 0.24 ± 0.03 and [Formula: see text] = 0.21 ± 0.02, and [Formula: see text] = 0.15 ± 0.02, respectively. MPs in the volunteer group were CH = 0.013 [0.001, 0.235] kPa, [Formula: see text] = 20.280 ± 4.994, and [Formula: see text] = 7.460 ± 2.171 and CRM = 0.0105 [0.010, 0.011] kPa, [Formula: see text] = 50.786 ± 13.511 (p = 0.0846), and [Formula: see text] = 17.355 ± 2.743 (p = 0.0208) in the remote myocardium of post-MI patients. CONCLUSION Diastolic strain, calculated from CSPAMM with IDGDS, enables calculation of FE model-based regional diastolic material parameters. Transverse stiffness of the remote myocardium, , may be a valuable new metric for determination of DD in patients after MI.
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Pathan F, Zainal Abidin HA, Vo QH, Zhou H, D'Angelo T, Elen E, Negishi K, Puntmann VO, Marwick TH, Nagel E. Left atrial strain: a multi-modality, multi-vendor comparison study. Eur Heart J Cardiovasc Imaging 2021; 22:102-110. [PMID: 31848575 DOI: 10.1093/ehjci/jez303] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/08/2019] [Accepted: 11/17/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities. METHODS AND RESULTS We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ƐR), conduit strain (ƐCD), and contractile strain (ƐCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ƐR [intraclass correlation coefficient (ICC 0.64-0.90)], ƐCD (ICC 0.62-0.89), and ƐCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ƐR, ƐCD (1.6-8.6%), and ƐCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%. CONCLUSION Vendor derived ƐR, ƐCD, and ƐCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility.
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Affiliation(s)
- Faraz Pathan
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, University of Sydney, Nepean Clinical School, Sydney, Australia
| | - Hafisyatul Aiza Zainal Abidin
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, Faculty of Medicine, Universiti Teknologi MARA, Kuala Lampur, Malaysia
| | - Quang Ha Vo
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia
| | - Hui Zhou
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Radiology, XiangYa Hospital, Central South University, Hunan, China
| | - Tommaso D'Angelo
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital, Messina, Italy
| | - Elen Elen
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, National Cardiovascular Center Harapan Kita, Universitas, Jakarta, Indonesia
| | - Kazuaki Negishi
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, University of Sydney, Nepean Clinical School, Sydney, Australia
| | - Valentina O Puntmann
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas H Marwick
- Department of Cardiovascular Imaging, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Australia.,Department of Cardiovascular Imaging, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Eike Nagel
- Department of Cardiovascular Imaging, Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt am Main, Germany
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Pamukcu HE, Felekoğlu MA, Algül E, Şahan HF, Aydinyilmaz F, Guliyev İ, İnci SD, Özbeyaz NB, Nallbani A. Copeptin levels predict left ventricular systolic function in STEMI patients: A 2D speckle tracking echocardiography-based prospective observational study. Medicine (Baltimore) 2020; 99:e23514. [PMID: 33327294 PMCID: PMC7738094 DOI: 10.1097/md.0000000000023514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the present study, we aimed to investigate whether copeptin values on admission are related to left ventricle (LV) systolic function and its improvement at 6 months in ST-segment elevation myocardial infarction (STEMI) patients.In this single-center, prospective observational study, we included 122 STEMI patients from January 2016 to November 2016. LV systolic functions in the form of global longitudinal strain (GLS) in addition to conventional echocardiography parameters were evaluated on admission and at 6-month. Serum copeptin levels were determined using an ultrasensitive immunofluorescence assay.The study population was divided into 2 groups according to median values of copeptin. GLS was significantly lower in patients with high copeptin levels compared to those with low copeptin levels at early stage and 6-month (-16% (16-16.5) vs -15% (15-15.5), P < .001 and -18% (18-19) vs -16% (16-16.25), P < .001, respectively). Copeptin values were negatively correlated with an early and 6-month GLS (r = -0.459 at early stage and r = -0.662 at 6-month). In addition, we observed that copeptin values were negatively correlated with the improvement of GLS at 6-month follow-up (r = -0.458, P < .001 and r = -0.357, P = .005, respectively).Serum copeptin levels in STEMI patients at the time of admission may predict early and 6-month LV systolic function assessed by two-dimensional GLS. To the best of our knowledge, this study is the first to specifically address the relationship between copeptin values and GLS in STEMI patients.
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Affiliation(s)
- Hilal Erken Pamukcu
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
| | - Mehmet Ali Felekoğlu
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
| | - Engin Algül
- Department of Cardiology, Bitlis State Hospital, Bitlis
| | - Haluk Furkan Şahan
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
| | | | - İlkin Guliyev
- Department of Cardiology, Tokat Medical Park Hospital, Tokat, Turkey
| | - Saadet Demirtaş İnci
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
| | - Nail Burak Özbeyaz
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
| | - Ali Nallbani
- Department of Cardiology, University of Health Sciences Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara
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20
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Impairment of right ventricular strain evaluated by cardiovascular magnetic resonance feature tracking in patients with interstitial lung disease. Int J Cardiovasc Imaging 2020; 37:1073-1083. [PMID: 33113068 DOI: 10.1007/s10554-020-02079-x] [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: 09/21/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the relationship between pulmonary hypertension (PH) and right ventricular (RV) strain, and to evaluate the prognostic value of RV strain by cardiac magnetic resonance (CMR) feature tracking for patients with interstitial lung disease (ILD). METHODS A total of seventy ILD patients (mean age: 71 ± 8 years, 39 [56%] males) who underwent CMR and right heart catheterization (RHC) were studied. Using a 1.5T magnetic resonance (MR) scanner, steady-state free precession cine MR images encompassing the RV were acquired in all patients and 20 control subjects. RV longitudinal strain were calculated with a feature tracking algorithm. PH was defined as a mean pulmonary artery pressure of more than 20 mmHg at rest and a pulmonary vascular resistance ≥3 Woods unit. RESULTS The RV longitudinal strain was significantly impaired in the ILD patients with PH (n=18) than ILD patients without PH (n=52) (-13.3 ± 5.4% vs. -16.9±5.4%, p=0.048). The RV longitudinal strain differed significantly between the ILD patients without PH and the controls (n=20) (-16.9 ± 5.4% vs. -20.8 ± 6.2%, p=0.002). Five of 70 (7%) patients died within one-year after CMR scan. Area under receiver operating characteristics curve for predicting death was 0.900 (95%CI: 0.800 to 1.000) for RV strain, 0.643 (95%CI: 0.454 to 0.832) for RVEF. CONCLUSIONS Presence of PH was associated with impairment of RV strain, and RV strain could predict short-term mortality in patients with ILD. RV strain by feature tracking might be useful as a non-invasive prognostic marker for patients with ILD.
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21
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Amzulescu MS, De Craene M, Langet H, Pasquet A, Vancraeynest D, Pouleur AC, Vanoverschelde JL, Gerber BL. Myocardial strain imaging: review of general principles, validation, and sources of discrepancies. Eur Heart J Cardiovasc Imaging 2020; 20:605-619. [PMID: 30903139 PMCID: PMC6529912 DOI: 10.1093/ehjci/jez041] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/07/2019] [Indexed: 01/01/2023] Open
Abstract
Myocardial tissue tracking imaging techniques have been developed for a more accurate evaluation of myocardial deformation (i.e. strain), with the potential to overcome the limitations of ejection fraction (EF) and to contribute, incremental to EF, to the diagnosis and prognosis in cardiac diseases. While most of the deformation imaging techniques are based on the similar principles of detecting and tracking specific patterns within an image, there are intra- and inter-imaging modality inconsistencies limiting the wide clinical applicability of strain. In this review, we aimed to describe the particularities of the echocardiographic and cardiac magnetic resonance deformation techniques, in order to understand the discrepancies in strain measurement, focusing on the potential sources of variation: related to the software used to analyse the data, to the different physics of image acquisition and the different principles of 2D vs. 3D approaches. As strain measurements are not interchangeable, it is highly desirable to work with validated strain assessment tools, in order to derive information from evidence-based data. There is, however, a lack of solid validation of the current tissue tracking techniques, as only a few of the commercial deformation imaging softwares have been properly investigated. We have, therefore, addressed in this review the neglected issue of suboptimal validation of tissue tracking techniques, in order to advocate for this matter.
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Affiliation(s)
- M S Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - M De Craene
- Philips Research, Medical Imaging (Medisys), 33 rue de Verdun, CS60055, Suresnes Cedex, France
| | - H Langet
- Clinical Research Board, Philips Research, 33 rue de Verdun, CS60055, Suresnes Cedex, France
| | - A Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - D Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - A C Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - J L Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
| | - B L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, B Brussels, Belgium
- Corresponding author. Tel: +32 (2) 764 2803; Fax: +32 (2) 764 8980. E-mail:
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22
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Azuma M, Kato S, Kodama S, Hayakawa K, Kagimoto M, Iguchi K, Fukuoka M, Fukui K, Iwasawa T, Utsunomiya D, Kimura K, Tamura K. Relationship between the cardiac magnetic resonance derived extracellular volume fraction and feature tracking myocardial strain in patients with non-ischemic dilated cardiomyopathy. Magn Reson Imaging 2020; 74:14-20. [PMID: 32898651 DOI: 10.1016/j.mri.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Feature tracking (FT) has emerged as a promising method to quantify myocardial strain using conventional cine magnetic resonance imaging (MRI). Extracellular volume fraction (ECV) by T1 mapping enables quantification of myocardial fibrosis. To date, the correlation between FT-derived left ventricular strain and ECV has not been elucidated yet. The aim of this study was to evaluate the relationship between myocardial strain by FT and ECV by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM). METHODS A total of 57 patients with NIDCM (61 ± 12 years; 46 (81%) male)) and 15 controls (62 ± 11 years; 11 (73%) male)) were studied. Using a 1.5 T magnetic resonance scanner, pre- and post- T1 mapping images of the LV wall at the mid-ventricular level were acquired to calculate the ECV by a modified Look-Locker inversion recovery (MOLLI) sequence. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) were assessed by the FT technique. The ECV and myocardial strain were compared using a 6-segment model at the mid-ventricular level. RESULTS The ECV and myocardial strain were evaluable in all 432 segments in 72 subjects. On a patient-based analysis, NIDCM patients had a significantly higher ECV (0.30 ± 0.07 vs. 0.28 ± 0.06, p = .007) and impaired myocardial strain than the control subjects (RS, 22.7 ± 10.3 vs. 30.3 ± 18.2, p < .01; CS, -6.47 ± 1.89 vs. -9.52 ± 5.15, p < .001; LS -10.2 ± 3.78 vs. -19.8 ± 4.30, p < .001, respectively). A significant linear correlation was found between the RS and ECV (r = -0.38, p < .001) and CS and ECV, (r = 0.38, p < .001). LS and ECV also correlated (r = 0.31, p < 0.001). On a segment-based analysis, there was a significant correlation between the ECV and RS and ECV and CS (all p values < .05). The intraclass correlation coefficient was good for the strain measurement (>0.80). CONCLUSIONS In patients with NIDCM, significant correlation was found between myocardial strain and ECV, suggesting the FT-derived myocardial strain might be useful as a non-invasive imaging marker for the detection of myocardial fibrosis without any contrast media.
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Affiliation(s)
- Mai Azuma
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Shingo Kato
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
| | - Sho Kodama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Keigo Hayakawa
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Minako Kagimoto
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kohei Iguchi
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Masahiro Fukuoka
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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23
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Backhaus SJ, Metschies G, Zieschang V, Erley J, Mahsa Zamani S, Kowallick JT, Lapinskas T, Pieske B, Lotz J, Kutty S, Hasenfuß G, Kelle S, Schuster A. Head-to-head comparison of cardiovascular MR feature tracking cine versus acquisition-based deformation strain imaging using myocardial tagging and strain encoding. Magn Reson Med 2020; 85:357-368. [PMID: 32851707 DOI: 10.1002/mrm.28437] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Myocardial feature-tracking (FT) deformation imaging is superior for risk stratification compared with volumetric approaches. Because there is no clear recommendation regarding FT postprocessing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain-encoded (SENC) MRI. METHODS Feature-tracking software from four different vendors (TomTec, Medis, Circle [CVI], and Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential strains (GCS) and longitudinal strains (GLS) in 12 healthy volunteers and 12 patients with heart failure. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as Pearson correlation coefficients. RESULTS For FT-GCS, consistency was excellent comparing different FT vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and in comparison to fast SENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared with tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements among FT vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared with both tagging and fast SENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64), and lowest for TomTec (ICCa = 0.41 and 0.47). For FT-GLS, consistency was excellent (ICCc ≥ 0.86, r ≥ 0.76). Absolute agreements among FT vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared with tagging, but excellent compared with fast SENC (ICCa = 0.77-0.90). CONCLUSION Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high regardless of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Victoria Zieschang
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Jennifer Erley
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Seyedeh Mahsa Zamani
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
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24
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Houard L, Militaru S, Tanaka K, Pasquet A, Vancraeynest D, Vanoverschelde JL, Pouleur AC, Gerber BL. Test–retest reliability of left and right ventricular systolic function by new and conventional echocardiographic and cardiac magnetic resonance parameters. Eur Heart J Cardiovasc Imaging 2020; 22:1157-1167. [DOI: 10.1093/ehjci/jeaa206] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/01/2020] [Indexed: 02/05/2023] Open
Abstract
Abstract
Aims
Reproducible evaluation of left (LV) and right ventricular (RV) function is crucial for clinical decision-making and risk stratification. We evaluated whether speckle-tracking echocardiography (STE) and cardiac magnetic resonance feature-tracking (cMR-FT) global longitudinal (GLS) and circumferential strains allow better test–retest reproducibility of LV and RV systolic function than conventional cMR and echocardiographic parameters.
Methods and results
Thirty healthy volunteers and 20 chronic heart failure patients underwent cMR and STE twice on separate days to evaluate test–retest coefficient of variation (CV), intraclass correlation coefficient (ICC) and estimated sample sizes for significant changes in LV and RV function. Among LV parameters, cMR-left ventricular ejection fraction (LVEF) had the highest reproducibility (CV = 6.7%, ICC = 0.98), significantly better than cMR-FT-GLS (CV = 15.1%, ICC = 0.84), global circumferential strains (CV = 11.5%, ICC = 0.94) and echocardiographic LVEF (CV = 11.3%, ICC = 0.93). STE-LV-GLS (CV = 8.9%, ICC = 0.94) had significantly better reproducibility than cMR-FT-LV-GLS. Among RV parameters, STE-RV-GLS (CV = 7.3%, ICC = 0.93) had significantly better CV than cMR-right ventricular ejection fraction (RVEF) (CV = 13%, ICC = 0.82). cMR-FT-RV-GLS (CV = 43%, ICC = 0.39) performed poorly with significantly lower reproducibility than all other RV parameters. Owing to their superior interstudy reproducibility, cMR-LVEF (n = 12), cMR-RVEF (n = 41), STE-LV-GLS and STE-RV-GLS (both n = 14) were the parameters allowing the lowest calculated sample sizes to detect 10% change in LV or RV systolic function.
Conclusion
STE-LV-GLS and STE-RV-GLS showed higher test–retest reliability than other echocardiographic measurements of LV and RV function. They also allowed smaller calculated sample sizes, supporting the use of STE-LV and RV-GLS for longitudinal follow-up of LV and RV function.
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Affiliation(s)
- Laura Houard
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - Sebastian Militaru
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - Kaoru Tanaka
- Afdeling Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Avenue du Laerbeek 101, B-1090 Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. LucPôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Av Hippocrate 10/2806, B-1200 Woluwe St. Lambert, Brussels, Belgium
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25
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Feature tracking computed tomography-derived left ventricular global longitudinal strain in patients with aortic stenosis: a comparative analysis with echocardiographic measurements. J Cardiovasc Comput Tomogr 2020; 14:240-245. [DOI: 10.1016/j.jcct.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/09/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022]
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26
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Erley J, Zieschang V, Lapinskas T, Demir A, Wiesemann S, Haass M, Osman NF, Simonetti OP, Liu Y, Patel AR, Mor-Avi V, Unal O, Johnson KM, Pieske B, Hansmann J, Schulz-Menger J, Kelle S. A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2020; 36:899-911. [PMID: 32056087 PMCID: PMC7174273 DOI: 10.1007/s10554-020-01775-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/11/2020] [Indexed: 01/23/2023]
Abstract
Myocardial strain is a convenient parameter to quantify left ventricular (LV) function. Fast strain-encoding (fSENC) enables the acquisition of cardiovascular magnetic resonance images for strain-measurement within a few heartbeats during free-breathing. It is necessary to analyze inter-vendor agreement of techniques to determine strain, such as fSENC, in order to compare existing studies and plan multi-center studies. Therefore, the aim of this study was to investigate inter-vendor agreement and test-retest reproducibility of fSENC for three major MRI-vendors. fSENC-images were acquired three times in the same group of 15 healthy volunteers using 3 Tesla scanners from three different vendors: at the German Heart Institute Berlin, the Charité University Medicine Berlin-Campus Buch and the Theresien-Hospital Mannheim. Volunteers were scanned using the same imaging protocol composed of two fSENC-acquisitions, a 15-min break and another two fSENC-acquisitions. LV global longitudinal and circumferential strain (GLS, GCS) were analyzed by a trained observer (Myostrain 5.0, Myocardial Solutions) and for nine volunteers repeatedly by another observer. Inter-vendor agreement was determined using Bland-Altman analysis. Test-retest reproducibility and intra- and inter-observer reproducibility were analyzed using intraclass correlation coefficient (ICC) and coefficients of variation (CoV). Inter-vendor agreement between all three sites was good for GLS and GCS, with biases of 0.01–1.88%. Test-retest reproducibility of scans before and after the break was high, shown by ICC- and CoV values of 0.63–0.97 and 3–9% for GLS and 0.69–0.82 and 4–7% for GCS, respectively. Intra- and inter-observer reproducibility were excellent for both parameters (ICC of 0.77–0.99, CoV of 2–5%). This trial demonstrates good inter-vendor agreement and test–retest reproducibility of GLS and GCS measurements, acquired at three different scanners from three different vendors using fSENC. The results indicate that it is necessary to account for a possible bias (< 2%) when comparing strain measurements of different scanners. Technical differences between scanners, which impact inter-vendor agreement, should be further analyzed and minimized. DRKS Registration Number: 00013253. Universal Trial Number (UTN): U1111-1207-5874.
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Affiliation(s)
- Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aylin Demir
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Markus Haass
- Department of Internal Medicine/Cardiology/Angiology, Theresienkrankenhaus Und St. Hedwig-Klinik, Mannheim, Germany
| | - Nael F Osman
- Department of Radiology and Radiological Science, School of Medicine, John Hopkins University, Baltimore, MD, USA.,Myocardial Solutions, Inc, Morrisville, NC, USA
| | - Orlando P Simonetti
- Departments of Internal Medicine and Radiology, The Ohio State University, Columbus, OH, USA
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amit R Patel
- Department of Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Victor Mor-Avi
- Department of Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Orhan Unal
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin M Johnson
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jochen Hansmann
- Department of Radiology, Theresienkrankenhaus Und St. Hedwig-Klinik, Mannheim, Germany
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Max-Delbrueck Center for Molecular Medicine, Department of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis. Pediatr Cardiol 2020; 41:1-11. [PMID: 31673733 DOI: 10.1007/s00246-019-02219-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6-22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0-21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6-24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.
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Dobrovie M, Bėzy S, Ünlü S, Chakraborty B, Petrescu A, Duchenne J, Beela AS, Voigt JU. How Does Regional Hypertrophy Affect Strain Measurements With Different Speckle-Tracking Methods? J Am Soc Echocardiogr 2019; 32:1444-1450. [DOI: 10.1016/j.echo.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 01/14/2023]
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Automated 4-dimensional regional myocardial strain evaluation using cardiac computed tomography. Int J Cardiovasc Imaging 2019; 36:149-159. [PMID: 31538258 DOI: 10.1007/s10554-019-01696-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/08/2019] [Indexed: 01/12/2023]
Abstract
Evaluation of myocardial regional function is generally performed by visual "eyeballing" which is highly subjective. A robust quantifiable parameter of regional function is required to provide an objective, repeatable and comparable measure of myocardial performance. We aimed to evaluate the clinical utility of novel regional myocardial strain software from cardiac computed tomography (CT) datasets. 93 consecutive patients who had undergone retrospectively gated cardiac CT were evaluated by the software, which utilizes a finite element based tracking algorithm through the cardiac cycle. Circumferential (CS), longitudinal (LS) and radial (RS) strains were calculated for each of 16 myocardial segments and compared to a visual assessment, carried out by an experienced cardiologist on cine movies of standard "echo" views derived from the CT data. A subset of 37 cases was compared to speckle strain by echocardiography. The automated software performed successfully in 93/106 cases, with minimal human interaction. Peak CS, LS and RS all differentiated well between normal, hypokinetic and akinetic segments. Peak strains for akinetic segments were generally post-systolic, peaking at 50 ± 17% of the RR interval compared to 43 ± 9% for normokinetic segments. Using ROC analysis to test the ability to differentiate between normal and abnormal segments, the area under the curve was 0.84 ± 0.01 for CS, 0.80 ± 0.02 for RS and 0.68 ± 0.02 for LS. There was a moderate agreement with speckle strain. Automated 4D regional strain analysis of CT datasets shows a good correspondence to visual analysis and successfully differentiates between normal and abnormal segments, thus providing an objective quantifiable map of myocardial regional function.
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30
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Delgado V, Ajmone Marsan N. Global and Regional Longitudinal Strain Assessment in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2019; 12:e009586. [PMID: 31412721 DOI: 10.1161/circimaging.119.009586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victoria Delgado
- Department of Cardiology, Leiden University Medical Center; the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center; the Netherlands
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31
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Liu T, Wang C, Li S, Zhao Y, Li P. Age- and gender-related normal references of right ventricular strain values by tissue tracking cardiac magnetic resonance: results from a Chinese population. Quant Imaging Med Surg 2019; 9:1441-1450. [PMID: 31559173 DOI: 10.21037/qims.2019.08.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Myocardial deformation is a sensitive marker for sub-clinical myocardial dysfunction and carries independent prognostic significance across a broad range of cardiovascular diseases. Reproducible and repeatable assessment of right ventricular (RV) function is vital for monitoring congenital and acquired heart diseases. The purpose of this study was to determine the normal references of RV strain and strain rate values using tissue tracking cardiac magnetic resonance imaging (MRI). Methods A cohort of 120 normal human subjects from each decade of life between 20 and 70 without cardiac diseases were enrolled in this study. Retrospectively, electrocardiogram (ECG) gating cardiac MRI imaging was performed at 3.0T with balanced steady-state free precession (bSSFP) imaging. RV global and segmental myocardial strains were analyzed by tissue tracking by two experienced observers. Results The global peak longitudinal strain (GLS) and global peak radial strain (GRS) was -24.3±4.7 and 23.0±8.5 respectively. For the peak circumferential strains (GCS), the values for global, basal, mid-cavity, and apical segments were -13.3±4.1, -13.1±4.0, -12.5±4.7, and -15.9±5.8, respectively. There were significant gender differences in peak GRS (P=0.009) and at the base (P=0.017) and the mid-cavity (P=0.011) with greater deformation in females than in males. There were also significant age differences in GRS (P<0.001), GCS for basal (P<0.001), and mid-cavity segments (P=0.037). On Bland-Altman analysis, peak GLS and GRS had the best intra-observer agreement (mean bias, -0.13±0.51; 95% CI, -1.13-0.87) and inter-observer (mean bias, 0.054±0.31; 95% CI, -0.55-0.66) agreement, respectively. Conclusions Normal values of RV deformation for healthy individuals using tissue tracking cardiac magnetic resonance (CMR-TT) provided good RV peak strain reproducibility. There was a significant correlation between RV strain or strain rate parameters with either age or sex.
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Affiliation(s)
- Ting Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Congcong Wang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Shu Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yu Zhao
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Peiling Li
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
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Fixsen LS, de Lepper AGW, Strik M, van Middendorp LB, Prinzen FW, van de Vosse FN, Houthuizen P, Lopata RGP. Echocardiographic Assessment of Left Bundle Branch-Related Strain Dyssynchrony: A Comparison With Tagged MRI. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2063-2074. [PMID: 31060858 DOI: 10.1016/j.ultrasmedbio.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Recent studies have shown the efficacy of myocardial strain estimated using speckle tracking echocardiography (STE) in predicting response to cardiac resynchronisation therapy. This study focuses on circumferential strain patterns, comparing STE-acquired strains to tagged-magnetic resonance imaging (MRI-T). Second, the effect of regularisation was examined. Two-dimensional parasternal ultrasound (US) and MRI-T data were acquired in the left ventricular short-axis view of canines before (n = 8) and after (n = 9) left bunch branch block (LBBB) induction. US-based strain analysis was performed on Digital Imaging and Communications in Medicine data at the mid-level using three overall methods ("Commercial software," "Basic block-matching," "regularised block-matching"). Moreover, three regularisation approaches were implemented and compared. MRI-T analysis was performed using SinMod. Normalised regional circumferential strain curves, based on standard six or septal/lateral segments, were analysed and cross-correlated with MRI-T data. Systolic strain (SS) and septal rebound stretch (SRS) were calculated and compared. Overall agreement of normalised circumferential strain was good between all methods on a global and regional level. All STE methods showed a bias (≥4% strain) toward higher SS estimates. Pre-LBBB, septal and lateral segment correlation was excellent between the Basic (mean ρ = 0.96) and regularised (mean ρ = 0.97) methods and MRI-T. The Commercial method showed a significant discrepancy between the two walls (septal ρ = 0.94, lateral ρ = 0.68). Correlation with MRI-T reduced between pre- and post-LBBB (Commercial ρ = 0.79, Basic ρ = 0.82, mean regularised ρ = 0.86). Septal strain patterns and SRS varied with the STE software and type of regularisation, with all STE methods estimating non-zero SRS values pre-LBBB. Absolute values showed moderate agreement, with a bias for higher strain from STE. SRS varied with the type of software and extra regularisation applied. Open efforts are needed to understand the underlying causes of differences between STE methods before standardisation can be achieved. This is particularly important given the apparent clinical value of strain-based parameters such as SRS.
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Affiliation(s)
- Louis S Fixsen
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Lars B van Middendorp
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Mathur S, Dreisbach JG, Karur GR, Iwanochko RM, Morel CF, Wasim S, Nguyen ET, Wintersperger BJ, Hanneman K. Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy. J Cardiovasc Magn Reson 2019; 21:45. [PMID: 31366357 PMCID: PMC6670217 DOI: 10.1186/s12968-019-0557-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac involvement is common and is the leading cause of mortality in Fabry disease (FD). We explored the association between cardiovascular magnetic resonance (CMR) myocardial strain, T1 mapping, late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) in patients with FD. METHODS In this prospective study, 38 FD patients (45.0 ± 14.5 years, 37% male) and 8 healthy controls (40.1 ± 13.7 years, 63% male) underwent 3 T CMR including cine balanced steady-state free precession (bSSFP), LGE and modified Look-Locker Inversion recovery (MOLLI) T1 mapping. Global longitudinal (GLS) and circumferential (GCS) strain and base-to-apex longitudinal strain (LS) and circumferential strain (CS) gradients were derived from cine bSSFP images using feature tracking analysis. RESULTS Among FD patients, 8 had LVH (FD LVH+, 21%) and 17 had LGE (FD LGE+, 45%). Nineteen FD patients (50%) had neither LVH nor LGE (FD LVH- LGE-). None of the healthy controls had LVH or LGE. FD patients and healthy controls did not differ significantly with respect to GLS (- 15.3 ± 3.5% vs. - 16.3 ± 1.5%, p = 0.45), GCS (- 19.4 ± 3.0% vs. -19.5 ± 2.9%, p = 0.84) or base-to-apex LS gradient (7.5 ± 3.8% vs. 9.3 ± 3.5%, p = 0.24). FD patients had significantly lower base-to-apex CS gradient (2.1 ± 3.7% vs. 6.5 ± 2.2%, p = 0.002) and native T1 (1170.2 ± 37.5 ms vs. 1239.0 ± 18.0 ms, p < 0.001). Base-to-apex CS gradient differentiated FD LVH- LGE- patients from healthy controls (OR 0.42, 95% CI: 0.20 to 0.86, p = 0.019), even after controlling for native T1 (OR 0.24, 95% CI: 0.06 to 0.99, p = 0.049). In a nested logistic regression model with native T1, model fit was significantly improved by the addition of base-to-apex CS gradient (χ2(df = 1) = 11.04, p < 0.001). Intra- and inter-observer agreement were moderate to good for myocardial strain parameters: GLS (ICC 0.849 and 0.774, respectively), GCS (ICC 0.831 and 0.833, respectively), and base-to-apex CS gradient (ICC 0.737 and 0.613, respectively). CONCLUSIONS CMR reproducibly identifies myocardial strain abnormalities in FD. Loss of base-to-apex CS gradient may be an early marker of cardiac involvement in FD, with independent and incremental value beyond native T1.
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Affiliation(s)
- Shobhit Mathur
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - John G. Dreisbach
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Gauri R. Karur
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Robert M. Iwanochko
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2 Canada
| | - Chantal F. Morel
- Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON M5T 3L9 Canada
| | - Syed Wasim
- Fred A. Litwin Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, University of Toronto, 60 Murray St, Toronto, ON M5T 3L9 Canada
| | - Elsie T. Nguyen
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Bernd J. Wintersperger
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Kate Hanneman
- Toronto Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, 1PMB-298, Toronto, ON M5G 2N2 Canada
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Ferreira de Souza T, Quinaglia T, Neilan TG, Coelho-Filho OR. Assessment of Cardiotoxicity of Cancer Chemotherapy: The Value of Cardiac MR Imaging. Magn Reson Imaging Clin N Am 2019; 27:533-544. [PMID: 31279455 PMCID: PMC6624085 DOI: 10.1016/j.mric.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chemotherapy is associated with cardiovascular injury, including the development of a cardiomyopathy and vascular remodeling. Cardiac magnetic resonance (CMR) is sensitive to detect not only established morphologic and functional abnormalities but also early, potentially reversible, signs of myocardial injury. It robustly detects and quantifies myocardial edema, inflammation, and focal fibrosis, as well as interstitial fibrosis and vascular remodeling. These capabilities support the role of CMR as an excellent tool for evaluating cardiotoxicity. Novel CMR markers may even enhance patient management by facilitating the early detection of reversible myocardial tissue remodeling before classic morphologic and functional changes appear.
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Affiliation(s)
- Thiago Ferreira de Souza
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil
| | - Thiago Quinaglia
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil
| | - Tomas G Neilan
- Cardio-Oncology Program and Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Otávio R Coelho-Filho
- Faculdade de Ciências Médicas - Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil; Division of Cardiology, Department of Medicine, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brasil.
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35
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Nolan MT, Thavendiranathan P. Automated Quantification in Echocardiography. JACC Cardiovasc Imaging 2019; 12:1073-1092. [DOI: 10.1016/j.jcmg.2018.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/25/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
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Affiliation(s)
- Anna B Catino
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City
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37
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Affiliation(s)
- Nathaniel Reichek
- From the Cardiac Imaging Program and Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY; and Division of Cardiology, Department of Medicine and Department of Biomedical Engineering, School of Engineering and Applied Mathematics, Stony Brook University, SUNY, NY.
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38
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Longitudinal strain by speckle tracking echocardiography: Is it useful in clinical practice for differentiating Takotsubo syndrome from anterior myocardial infarction? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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39
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Longitudinal strain by speckle tracking echocardiography: Is it useful in clinical practice for differentiating Takotsubo syndrome from anterior myocardial infarction? Rev Port Cardiol 2019; 38:267-268. [DOI: 10.1016/j.repc.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Giusca S, Korosoglou G, Zieschang V, Stoiber L, Schnackenburg B, Stehning C, Gebker R, Pieske B, Schuster A, Backhaus S, Pieske-Kraigher E, Patel A, Kawaji K, Steen H, Lapinskas T, Kelle S. Reproducibility study on myocardial strain assessment using fast-SENC cardiac magnetic resonance imaging. Sci Rep 2018; 8:14100. [PMID: 30237411 PMCID: PMC6147889 DOI: 10.1038/s41598-018-32226-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022] Open
Abstract
Myocardial strain is a well validated parameter for estimating left ventricular (LV) performance. The aim of our study was to evaluate the inter-study as well as intra- and interobserver reproducibility of fast-SENC derived myocardial strain. Eighteen subjects (11 healthy individuals and 7 patients with heart failure) underwent a cardiac MRI examination including fast-SENC acquisition for evaluating left ventricular global longitudinal (GLS) and circumferential strain (GCS) as well as left ventricular ejection fraction (LVEF). The examination was repeated after 63 [range 49‒87] days and analyzed by two experienced observers. Ten datasets were repeatedly assessed after 1 month by the same observer to test intraobserver variability. The reproducibility was measured using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Patients with heart failure demonstrated reduced GLS and GCS compared to healthy controls (−15.7 ± 3.7 vs. −20.1 ± 1.4; p = 0.002 for GLS and −15.3 ± 3.7 vs. −21.4 ± 1.1; p = 0.001 for GCS). The test-retest analysis showed excellent ICC for LVEF (0.92), GLS (0.94) and GCS (0.95). GLS exhibited excellent ICC (0.99) in both intra- and interobserver variability analysis with very narrow limits of agreement (−0.6 to 0.5 for intraobserver and −1.3 to 0.96 for interobserver agreement). Similarly, GCS showed excellent ICC (0.99) in both variability analyses with narrow limits of agreement (−1.1 to 1.2 for intraobserver and −1.7 to 1.3 for interobserver agreement), whereas LVEF showed larger limits of agreement (−14.4 to 10.1). The analysis of fast-SENC derived myocardial strain using cardiac MRI provides a highly reproducible method for assessing LV functional performance.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Lukas Stoiber
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | | | | | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, the Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Sören Backhaus
- Department of Cardiology and Pneumology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Amit Patel
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Keigo Kawaji
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Henning Steen
- Department of Internal Medicine/Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany. .,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.
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Amzulescu MS, Langet H, Saloux E, Manrique A, Slimani A, Allain P, Roy C, de Meester C, Pasquet A, Somphone O, De Craene M, Vancraeynest D, Pouleur AC, Vanoverschelde JL, Gerber BL. Improvements of Myocardial Deformation Assessment by Three-Dimensional Speckle-Tracking versus Two-Dimensional Speckle-Tracking Revealed by Cardiac Magnetic Resonance Tagging. J Am Soc Echocardiogr 2018; 31:1021-1033.e1. [DOI: 10.1016/j.echo.2018.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 01/15/2023]
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Khidir MJH, Abou R, Yilmaz D, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic value of global longitudinal strain in heart failure patients treated with cardiac resynchronization therapy. Heart Rhythm 2018; 15:1533-1539. [PMID: 29604420 DOI: 10.1016/j.hrthm.2018.03.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Myocardial fibrosis (macroscopic scar or diffuse reactive fibrosis) is one of the determinants of impaired left ventricular (LV) global longitudinal strain (GLS) in heart failure (HF) patients. OBJECTIVE The purpose of this study was to evaluate the prognostic value of LV GLS in HF patients treated with cardiac resynchronization therapy (CRT). METHODS The study included 829 HF patients (mean age 64.6 ± 10.4 years; 72% men) treated with CRT. Before CRT implantation, LV GLS was assessed using 2-dimensional speckle tracking echocardiography. The primary endpoint was the combination of all-cause mortality, heart transplantation, and LV assist device implantation. The secondary endpoint was the occurrence of ventricular arrhythmias or appropriate implantable defibrillator device therapies. RESULTS During follow-up, 332 patients reached the primary endpoint, and 233 presented with the secondary endpoint. Patients were divided according to LV GLS quartiles. Patients with the most impaired LV GLS quartile had a 2-fold higher risk of reaching the combined endpoint compared with patients in the best LV GLS quartile (hazard ratio [HR] 2.088; 95% confidence interval [CI] 1.555-2.804; P <.001). LV GLS was significantly associated with the combined endpoint (HR 1.075; 95% CI 1.020-1.133; P = .007) after adjusting for clinical, electrocardiographic, and echocardiographic characteristics. Although patients in the most impaired LV GLS quartile showed higher event rates for the secondary endpoint compared with the other groups, LV GLS was not independently associated with the secondary endpoint (HR 1.047; 95% CI 0.989-1.107; P = .115). CONCLUSION In this large cohort of CRT patients, baseline LV GLS was independently associated with the combined endpoint.
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Affiliation(s)
- Mand J H Khidir
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Rachid Abou
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Dilek Yilmaz
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
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