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Halfmann MC, Hopman LHGA, Körperich H, Blaszczyk E, Gröschel J, Schulz-Menger J, Salatzki J, André F, Friedrich S, Emrich T. Reproducibility assessment of rapid strains in cardiac MRI: Insights and recommendations for clinical application. Eur J Radiol 2024; 174:111386. [PMID: 38447431 DOI: 10.1016/j.ejrad.2024.111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Studies have shown the incremental value of strain imaging in various cardiac diseases. However, reproducibility and generalizability has remained an issue of concern. To overcome this, simplified algorithms such as rapid atrioventricular strains have been proposed. This multicenter study aimed to assess the reproducibility of rapid strains in a real-world setting and identify potential predictors for higher interobserver variation. METHODS A total of 4 sites retrospectively identified 80 patients and 80 healthy controls who had undergone cardiac magnetic resonance imaging (CMR) at their respective centers using locally available scanners with respective field strengths and imaging protocols. Strain and volumetric parameters were measured at each site and then independently re-evaluated by a blinded core lab. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to assess inter-observer agreement. In addition, backward multiple linear regression analysis was performed to identify predictors for higher inter-observer variation. RESULTS There was excellent agreement between sites in feature-tracking and rapid strain values (ICC ≥ 0.96). Bland-Altman plots showed no significant bias. Bi-atrial feature-tracking and rapid strains showed equally excellent agreement (ICC ≥ 0.96) but broader limits of agreement (≤18.0 % vs. ≤3.5 %). Regression analysis showed that higher field strength and lower temporal resolution (>30 ms) independently predicted reduced interobserver agreement for bi-atrial strain parameters (ß = 0.38, p = 0.02 for field strength and ß = 0.34, p = 0.02 for temporal resolution). CONCLUSION Simplified rapid left ventricular and bi-atrial strain parameters can be reliably applied in a real-world multicenter setting. Due to the results of the regression analysis, a minimum temporal resolution of 30 ms is recommended when assessing atrial deformation.
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Affiliation(s)
- Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, the Netherlands.
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany.
| | - Edyta Blaszczyk
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Jan Gröschel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Janek Salatzki
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Germany.
| | - Florian André
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Germany.
| | | | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany.
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Grützediek K, Fischer R, Kurio G, Böckelmann L, Bleeke M, Hagar RW, Tahir E, Grosse R, Weyhmiller M, Adam G, Bannas P, Schoennagel BP. Rapid MRI Assessment of Long-Axis Strain to Indicate Systolic Dysfunction in Patients With Sickle Cell Disease. J Magn Reson Imaging 2023; 58:1499-1506. [PMID: 36789724 DOI: 10.1002/jmri.28623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Patients with sickle cell disease (SCD) have a unique form of cardiomyopathy. However, left ventricular ejection fraction (LVEF) is often preserved. Monoplanar long-axis strain (LAS) can be assessed from MRI four-chamber views and may be better at detecting mild systolic dysfunction in these patients. PURPOSE To compare LAS (monoplanar and biplanar) with LVEF as a marker of systolic dysfunction in SCD patients. STUDY TYPE Retrospective. SUBJECTS A total of 20 patients with genetically proven SCD (35 MRI examinations), 39 healthy controls, and 124 patients with systemic iron overload (for validation purposes). FIELD STRENGTH/SEQUENCE 1.5 T/3 T. Cine balanced steady-state free-precession. ASSESSMENT Rapidly assessed biplanar LAS from four- and two-chamber views was correlated with age and compared to LVEF by two operators. For validation, biplanar LAS was compared to global longitudinal strain (GLS) using MRI feature-tracking in 124 patients with systemic iron overload. STATISTICAL TESTS Bland-Altman analysis. Wilcoxon-Mann-Whitney test and Spearman-rank correlation (correlation coefficient, rS ). Receiver-operating-characteristic (ROC) curve analysis (area under the curve, AUC). Bivariate discriminant analysis. Significance level: P < 0.01. RESULTS There was strong correlation between biplanar LAS and GLS using feature tracking (rS = 0.73). Interoperator agreement showed nonsignificant bias for biplanar LAS (-0.02%; ±95%-agreement interval -2.2%/2.2%, P = 0.9). Biplanar LAS increased significantly with age in controls (rS = 0.70). In SCD patients, biplanar LAS was better correlated with age than monoplanar LAS (r2 = 0.53, standard error of estimate, SEE = 1.4% vs. r2 = 0.37;SEE = 2.0%). ROC analysis of LVEF, biplanar LAS, and age-adjusted Z-scores Z (LAS(age)) showed AUCs of 0.69, 0.75, and 0.86 for differentiation between SCD patients and controls. Bivariate discriminant analysis of biplanar Z (LAS(age)) and LVEF revealed a sensitivity of 63% and a specificity of 95%. DATA CONCLUSION Rapidly assessed biplanar LAS demonstrated high diagnostic accuracy and was an indicator of mild systolic dysfunction in patients with SCD. Biplanar LAS provided more precise measurements than monoplanar, and normalization to age increased diagnostic accuracy. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Katharina Grützediek
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Roland Fischer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
- UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Gregory Kurio
- UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Lukas Böckelmann
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Matthias Bleeke
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Regine Grosse
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany
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Hopman LHGA, van der Lingen ACJ, van Pouderoijen N, Krabbenborg J, Mulder MJ, Rijnierse MT, Bhagirath P, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MW, Allaart CP. Cardiac Magnetic Resonance Imaging-Derived Left Atrial Characteristics in Relation to Atrial Fibrillation Detection in Patients With an Implantable Cardioverter-Defibrillator. J Am Heart Assoc 2023; 12:e028014. [PMID: 37489727 PMCID: PMC10492968 DOI: 10.1161/jaha.122.028014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/24/2023] [Indexed: 07/26/2023]
Abstract
Background Among patients with an implantable cardioverter-defibrillator, a high prevalence of atrial fibrillation (AF) is present. Identification of AF predictors in this patient group is of clinical importance to initiate appropriate preventive therapeutic measures to reduce the risk of AF-related complications. This study assesses whether cardiac magnetic resonance imaging-derived atrial characteristics are associated with AF development in patients with a dual-chamber implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator, as detected by the cardiac implantable electronic device. Methods and Results This single-center retrospective study included 233 patients without documented AF history at the moment of device implantation (dual-chamber implantable cardioverter-defibrillator [63.5%] or cardiac resynchronization therapy defibrillator [36.5%]). All patients underwent cardiac magnetic resonance imaging before device implantation. Cardiac magnetic resonance-derived features of left atrial (LA) remodeling were evaluated in all patients. Detection of AF episodes was based on cardiac implantable electronic device interrogation. During a median follow-up of 6.1 years, a newly diagnosed AF episode was detected in 88 of the 233 (37.8%) patients with an ICD. In these patients, increased LA volumes and impaired LA function (LA emptying fraction and LA strain) were found as compared with patients without AF during follow-up. However, a significant association was only found in patients with dilated cardiomyopathy and not in patients with ischemic cardiomyopathy. Conclusions LA remodeling characteristics were associated with development of AF in patients with dilated cardiomyopathy but not patients with ischemic cardiomyopathy, suggesting different mechanisms of AF development in ischemic cardiomyopathy and dilated cardiomyopathy. Assessment of LA remodeling before device implantation might identify high-risk patients for AF.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Anne‐Lotte C. J. van der Lingen
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Nikki van Pouderoijen
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Judith Krabbenborg
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Mischa T. Rijnierse
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Lourens F. H. J. Robbers
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Vokko P. van Halm
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
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Hopman LHGA, Mulder MJ, van der Laan AM, Bhagirath P, Demirkiran A, von Bartheld MB, Kemme MJB, van Rossum AC, Allaart CP, Götte MJW. Left atrial strain is associated with arrhythmia recurrence after atrial fibrillation ablation: Cardiac magnetic resonance rapid strain vs. feature tracking strain. Int J Cardiol 2023; 378:23-31. [PMID: 36804765 DOI: 10.1016/j.ijcard.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients. METHODS This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring. RESULTS Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70). CONCLUSION Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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Ayton SL, Alfuhied A, Gulsin GS, Parke KS, Wormleighton JV, Arnold JR, Moss AJ, Singh A, Xue H, Kellman P, Graham‐Brown MPM, McCann GP. The Interfield Strength Agreement of Left Ventricular Strain Measurements at 1.5 T and 3 T Using Cardiac MRI Feature Tracking. J Magn Reson Imaging 2023; 57:1250-1261. [PMID: 35767224 PMCID: PMC10947203 DOI: 10.1002/jmri.28328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Left ventricular (LV) strain measurements can be derived using cardiac MRI from routinely acquired balanced steady-state free precession (bSSFP) cine images. PURPOSE To compare the interfield strength agreement of global systolic strain, peak strain rates and artificial intelligence (AI) landmark-based global longitudinal shortening at 1.5 T and 3 T. STUDY TYPE Prospective. SUBJECTS A total of 22 healthy individuals (mean age 36 ± 12 years; 45% male) completed two cardiac MRI scans at 1.5 T and 3 T in a randomized order within 30 minutes. FIELD STRENGTH/SEQUENCE: bSSFP cine images at 1.5 T and 3 T. ASSESSMENT Two software packages, Tissue Tracking (cvi42, Circle Cardiovascular Imaging) and QStrain (Medis Suite, Medis Medical Imaging Systems), were used to derive LV global systolic strain in the longitudinal, circumferential and radial directions and peak (systolic, early diastolic, and late diastolic) strain rates. Global longitudinal shortening and mitral annular plane systolic excursion (MAPSE) were measured using an AI deep neural network model. STATISTICAL TESTS Comparisons between field strengths were performed using Wilcoxon signed-rank test (P value < 0.05 considered statistically significant). Agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots. RESULTS Minimal bias was seen in all strain and strain rate measurements between field strengths. Using Tissue Tracking, strain and strain rate values derived from long-axis images showed poor to fair agreement (ICC range 0.39-0.71), whereas global longitudinal shortening and MAPSE showed good agreement (ICC = 0.81 and 0.80, respectively). Measures derived from short-axis images showed good to excellent agreement (ICC range 0.78-0.91). Similar results for the agreement of strain and strain rate measurements were observed with QStrain. CONCLUSION The interfield strength agreement of short-axis derived LV strain and strain rate measurements at 1.5 T and 3 T was better than those derived from long-axis images; however, the agreement of global longitudinal shortening and MAPSE was good. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Sarah L. Ayton
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Aseel Alfuhied
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Gaurav S. Gulsin
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Kelly S. Parke
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Joanne V. Wormleighton
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - J. Ranjit Arnold
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Alastair J. Moss
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Anvesha Singh
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Matthew P. M. Graham‐Brown
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Gerry P. McCann
- Department of Cardiovascular SciencesUniversity of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield HospitalLeicesterUK
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Cardiac Magnetic Resonance Imaging in Appraising Myocardial Strain and Biomechanics: A Current Overview. Diagnostics (Basel) 2023; 13:diagnostics13030553. [PMID: 36766658 PMCID: PMC9914753 DOI: 10.3390/diagnostics13030553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics.
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Lazar M, Olma A, Streb W. ECHOCARDIOGRAPHIC METHODS FOR ASSESSING LEFT VENTRICULAR SYSTOLIC FUNCTION. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:144-150. [PMID: 37254762 DOI: 10.36740/merkur202302107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Transthoracic echocardiography (TTE) is the recommended primary method of assessing cardiac function. The measurement of LVEF determines the strategy for treatment of patients, as well as influences their prognosis. 3D echocardiography has higher accuracy and reproducibility than 2D echocardiography; hence it is currently recommended for volume and LVEF measurements. New echocardiographic techniques: global longitudinal strain measured by speckle tracking and myocardial work allow earlier detection of myocardial abnormalities. In addition, they have greater sensitivity in detecting ischemia, fibrosis and left ven¬tricular systolic dyssynchrony. In some myocardial pathologies, such as amyloidosis, hypertrophic cardiomyopathy or Chagas disease, we observe characteristic patterns of myocardial deformation (strain), which are their hallmarks. Myocardial work, on the other hand, allows assessment of contractility independent of the effect of afterload. The new echocardiographic techniques provide additional diagnostic tools for assessing left ventricular systolic function and informa¬tion on prognosis, and hence their use can be expected to become more widespread in daily clinical practice.
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Affiliation(s)
- Monika Lazar
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND
| | - Anna Olma
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND
| | - Witold Streb
- DEPARTMENT OF CARDIOLOGY AND ANGIOLOGY, SILESIAN CENTRE FOR HEART DISEASES IN ZABRZE, ZABRZE, POLAND; DEPARTMENT OF CARDIOLOGY, CONGENITAL HEART DISEASES AND ELECTROTHERAPY, FACULTY OF MEDICAL SCIENCES IN ZABRZE, MEDICAL UNIVERSITY OF SILESIA, KATOWICE, POLAND
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Wang F, Deng Y, Li S, Cheng Q, Wang Q, Yu D, Wang Q. CMR left ventricular strains beyond global longitudinal strain in differentiating light-chain cardiac amyloidosis from hypertrophic cardiomyopathy. Front Cardiovasc Med 2023; 10:1108408. [PMID: 37206101 PMCID: PMC10188937 DOI: 10.3389/fcvm.2023.1108408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background The clinical value of left ventricular (LV) global longitudinal strain (GLS) in the differential diagnosis of light-chain cardiac amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM) has been previously reported. In this study, we analyzed the potential clinical value of the LV long-axis strain (LAS) to discriminate AL-CA from HCM. Furthermore, we analyzed the association between all the LV global strain parameters derived from cardiac magnetic resonance (CMR) feature tracking and LAS in both the AL-CA and HCM patients to assess the differential diagnostic efficacies of these global peak systolic strains. Materials and methods Thus, this study enrolled 89 participants who underwent cardiac MRI (CMRI), consisting of 30 AL-CA patients, 30 HCM patients, and 29 healthy controls. The intra- and inter-observer reproducibility of the LV strain parameters including GLS, global circumferential strain (GCS), global radial strain (GRS), and LAS were assessed in all the groups and compared. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performances of the CMR strain parameters in discriminating AL-CA from HCM. Results The intra- and inter-observer reproducibility of the LV global strains and LAS were excellent (range of interclass correlation coefficients: 0.907-0.965). ROC curve analyses showed that the differential diagnostic performances of the global strains in discriminating AL-CA from HCM were good to excellent (GRS, AUC = 0.921; GCS, AUC = 0.914; GLS, AUC = 0.832). Furthermore, among all the strain parameters analyzed, LAS showed the highest diagnostic efficacy in differentiating between AL-CA and HCM (AUC = 0.962). Conclusion CMRI-derived strain parameters such as GLS, LAS, GRS, and GCS are promising diagnostic indicators that distinguish AL-CA from HCM with high accuracy. LAS showed the highest diagnostic accuracy among all the strain parameters.
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Affiliation(s)
- Fangqing Wang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan Deng
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Shunjia Li
- Department of Radiation Oncology, Qilu Hospital, Shandong University, Jinan, China
| | - Qichao Cheng
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, China
- Correspondence: Qian Wang
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Li Y, Guo J, Li W, Xu Y, Wan K, Xu Z, Zhu Y, Han Y, Sun J, Chen Y. Prognostic value of right atrial strain derived from cardiovascular magnetic resonance in non-ischemic dilated cardiomyopathy. J Cardiovasc Magn Reson 2022; 24:54. [PMID: 36352424 PMCID: PMC9648034 DOI: 10.1186/s12968-022-00894-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The value of right atrial (RA) function in cardiovascular diseases is currently limited. This study was to explore the prognostic value of RA strain derived from fast long axis method by cardiovascular magnetic resonance (CMR) in patients with non-ischemic dilated cardiomyopathy (DCM). METHODS We prospectively enrolled patients with DCM who underwent CMR from June 2012 to March 2019 and 120 age- and sex-matched healthy subjects. Fast long-axis strain method was performed to assess the RA phasic function including RA reservoir strain, conduit strain, and booster strain. The predefined primary endpoint was all-cause mortality. The composite heart failure (HF) endpoint included HF death, HF readmission, and heart transplantation. Cox regression analysis and Kaplan-Meier survival curve were performed to describe the association between RA strain and outcomes. RESULTS A total of 624 patients (444 men, mean 48 years) were studied. After a median follow-up of 32.5 months, 116 patients (18.6%) experienced all-cause mortality and 205 patients (32.9%) reached composite HF endpoint. RA function was impaired in DCM patients compared with healthy subjects (all P < 0.001). After adjustment for covariates, RA reservoir strain [hazard ratio (HR) (per 5% decrease) 1.19, 95% confidence interval (CI) 1.03-1.37, P = 0.022] and conduit strain [HR (per 5% decrease) 1.37, 95% CI 1.03-1.84, P = 0.033] were independent predictors of all-cause mortality. Moreover, RA strain added incremental prognostic value for the prediction of adverse cardiac events over baseline clinical and CMR predictors (all P < 0.05). CONCLUSION RA strain by fast long-axis analysis is independently associated with adverse clinical outcomes in patients with DCM. TRIAL REGISTRATION Trial registration number: ChiCTR1800017058; Date of registration: 2018-07-10 (Retrospective registration); URL: https://www. CLINICALTRIALS gov.
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Affiliation(s)
- Yangjie Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiajun Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yanjie Zhu
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Guangdong, 518055, China
| | - Yuchi Han
- Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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10
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Golukhova EZ, Alexandrova SA, Bulaeva NI, Mrikaev DV, Gromova OI, Berdibekov BS. Prognostic value of myocardial strain by magnetic resonance imaging in nonischemic dilated cardiomyopathy: a systematic review and meta-analysis. KARDIOLOGIIA 2022; 62:35-41. [DOI: 10.18087/cardio.2022.10.n2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022]
Abstract
Aim This study was aimed at performing a systematic review and meta-analysis to investigate the prognostic role of left ventricular (LV) myocardial strain variables as determined by magnetic-resonance imaging in non-ischemic dilated cardiomyopathy.Material and methods A search was performed in PubMed (MEDLINE), Google Scholar, and EMBASE databases for studies on the prognostic role of LV myocardial strain based on MR feature-tracking in non-ischemic dilated cardiomyopathy. Uncorrected odds ratio (OR) values reported by the studies where similar evaluation criteria of myocardial strain were available, were combined for a meta-analysis.Results Nine studies were selected from 351 publications for this systematic review and meta-analysis. The analysis included a totality of 2139 patients (mean age, 52.3 years; mean follow-up duration, 42.5 months). The meta-analysis showed that the worsening of the LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) was associated with increased risk of major adverse cardiovascular events (MACE): OR, 1.13 per each % of GLS; 95 % CI: 1.050–1.225; p=0.001; OR, 1.16 per each % of GCS; 95 % CI: 1.107–1.213; p<0.0001; OR, 0.95 per each % of GRS; 95 % CI: 0.92–0.97; p<0.0001.Conclusion The LV GLS, GCS, and GRS variables by MR feature-tracking data are powerful predictors for the development of MACE. Evaluation of myocardial strain can be used as an effective instrument for risk stratification in patients with non-ischemic dilated cardiomyopathy.
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Affiliation(s)
| | | | - N. I. Bulaeva
- Bakulev Scientific Center for Cardiovascular Surgery
| | - D. V. Mrikaev
- Bakulev Scientific Center for Cardiovascular Surgery
| | - O. I. Gromova
- Bakulev Scientific Center for Cardiovascular Surgery
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11
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Siry D, Riffel J, Salatzki J, André F, Weberling LD, Ochs M, Atia NA, Hillier E, Albert D, Katus HA, Giannitsis E, Frey N, Friedrich MG. A head-to-head comparison of fast-SENC and feature tracking to LV long axis strain for assessment of myocardial deformation in chest pain patients. BMC Med Imaging 2022; 22:159. [PMID: 36064332 PMCID: PMC9442977 DOI: 10.1186/s12880-022-00886-3] [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: 06/08/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial strain imaging has gained importance in cardiac magnetic resonance (CMR) imaging in recent years as an even more sensitive marker of early left ventricular dysfunction than left-ventricular ejection fraction (LVEF). fSENC (fast strain encoded imaging) and FT (feature tracking) both allow for reproducible assessment of myocardial strain. However, left-ventricular long axis strain (LVLAS) might enable an equally sensitive measurement of myocardial deformation as global longitudinal or circumferential strain in a more rapid and simple fashion. METHODS In this study we compared the diagnostic performance of fSENC, FT and LVLAS for identification of cardiac pathology (ACS, cardiac-non-ACS) in patients presenting with chest pain (initial hscTnT 5-52 ng/l). Patients were prospectively recruited from the chest pain unit in Heidelberg. The CMR scan was performed within 1 h after patient presentation. Analysis of LVLAS was compared to the GLS and GCS as measured by fSENC and FT. RESULTS In total 40 patients were recruited (ACS n = 6, cardiac-non-ACS n = 6, non-cardiac n = 28). LVLAS was comparable to fSENC for differentiation between healthy myocardium and myocardial dysfunction (GLS-fSENC AUC: 0.882; GCS-fSENC AUC: 0.899; LVLAS AUC: 0.771; GLS-FT AUC: 0.740; GCS-FT: 0.688), while FT-derived strain did not allow for differentiation between ACS and non-cardiac patients. There was significant variability between the three techniques. Intra- and inter-observer variability (OV) was excellent for fSENC and FT, while for LVLAS the agreement was lower and levels of variability higher (intra-OV: Pearson > 0.7, ICC > 0.8; inter-OV: Pearson > 0.65, ICC > 0.8; CoV > 25%). CONCLUSIONS While reproducibility was excellent for both FT and fSENC, it was only fSENC and the LVLAS which allowed for significant identification of myocardial dysfunction, even before LVEF, and therefore might be used as rapid supporting parameters for assessment of left-ventricular function.
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Affiliation(s)
- Deborah Siry
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany.
| | - Johannes Riffel
- Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Lukas Damian Weberling
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Marco Ochs
- Department of Cardiology, Angiology and Internal Intensive Care, Theresien-Hospital, Mannheim, Germany
| | - Noura A Atia
- Diagnostic Radiology and Medical Imaging Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elizabeth Hillier
- Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
| | - David Albert
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
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Pu L, Diao Y, Wang J, Fang T, Xu Z, Sun J, Chen Y. The predictive value of fast semi-automated left atrial long-axis strain analysis for atrial fibrillation in hypertrophic cardiomyopathy. Eur Radiol 2022; 33:312-320. [PMID: 35907026 DOI: 10.1007/s00330-022-09020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/28/2022] [Accepted: 07/04/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) patients are closely related to LA functional impairment. Left atrial (LA) strain provides more insight into LA function. The study aimed to investigate the left atrial dysfunction of HCM patients by rapid semi-automatic method and determine the predictive value of left atrial long-axis strain (LAS) for atrial fibrillation (AF). METHODS We enrolled 372 HCM patients and 100 healthy participants to assess the LA functional parameters. LAS was obtained by semi-automated tracking of the distance between the mid-posterior point of LA wall which is defined as the intersection of the LA long axis and the posterior wall, and the origins of the mitral valve. The inferior and anterior mitral valve annular insertion points on the 2-chamber view and the lateral and septal insertion points on the 4-chamber view were chosen as the origins of the mitral valve. The clinical outcome was defined as detecting the onset of AF. RESULTS The LA strain values were analyzed as 20.8 ± 7.48% for εs, 9.81 ± 5.09% for εe, and 10.91 ± 4.24% for εa in HCM patients, which decreased significantly compared with normal controls. Significant correlations were detected between LV functional parameters and LA strain. During a median follow-up of 61 months, 44 (11.8%) patients developed AF. In the Cox regression analysis, LA strain was identified as a significant predictor of the onset of AF. CONCLUSIONS HCM patients had impairment of LA strain before LA enlargement and reduced EF. LA-LAS can be used as a predictive value for predicting the occurrence of AF in HCM patients. KEY POINTS • Fast semi-automated long-axis strain analysis by CMR is feasible and effective for evaluating the LA longitudinal function. • Hypertrophic cardiomyopathy patients show significant impairment of left atrial strain before LA enlargement. • The left atrial long-axis strain was an independent predictor of atrial fibrillation in hypertrophic cardiomyopathy.
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Affiliation(s)
- Lutong Pu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yike Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Tingting Fang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Ziqian Xu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People's Republic of China. .,Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China. .,Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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13
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Aquino GJ, Decker JA, Schoepf UJ, Carson L, Paladugu N, Yacoub B, Brandt V, Emrich AL, Schwarz F, Burt JR, Bayer R, Varga-Szemes A, Emrich T. Feasibility of Coronary CT Angiography-derived Left Ventricular Long-Axis Shortening as an Early Marker of Ventricular Dysfunction in Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2022; 4:e210205. [PMID: 35833168 DOI: 10.1148/ryct.210205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/18/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023]
Abstract
Purpose To evaluate the value of using left ventricular (LV) long-axis shortening (LAS) derived from coronary CT angiography (CCTA) to predict mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods Patients with severe AS who underwent CCTA for preprocedural TAVR planning between September 2014 and December 2019 were included in this retrospective study. CCTA covered the whole cardiac cycle in 10% increments. Image series reconstructed at end systole and end diastole were used to measure LV-LAS. All-cause mortality within 24 months of follow-up after TAVR was recorded. Cox regression analysis was performed, and hazard ratios (HRs) are presented with 95% CIs. The C index was used to evaluate model performance, and the likelihood ratio χ2 test was performed to compare nested models. Results The study included 175 patients (median age, 79 years [IQR, 73-85 years]; 92 men). The mortality rate was 22% (38 of 175). When adjusting for predictive clinical confounders, it was found that LV-LAS could be used independently to predict mortality (adjusted HR, 2.83 [95% CI: 1.13, 7.07]; P = .03). In another model using the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), LV-LAS remained significant (adjusted HR, 3.38 [95 CI: 1.48, 7.72]; P = .004), and its use improved the predictive value of the STS-PROM, increasing the STS-PROM C index from 0.64 to 0.71 (χ2 = 29.9 vs 19.7, P = .001). In a subanalysis of patients with a normal LV ejection fraction (LVEF), the significance of LV-LAS persisted (adjusted HR, 3.98 [95 CI: 1.56, 10.17]; P = .004). Conclusion LV-LAS can be used independently to predict mortality in patients undergoing TAVR, including those with a normal LVEF.Keywords: CT Angiography, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Outcomes Analysis, Cardiomyopathies, Left Ventricle, Aortic Valve Supplemental material is available for this article. © RSNA, 2022See also the commentary by Everett and Leipsic in this issue.
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Affiliation(s)
- Gilberto J Aquino
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Josua A Decker
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Landin Carson
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Namrata Paladugu
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Basel Yacoub
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Verena Brandt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Anna Lena Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Florian Schwarz
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Jeremy R Burt
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Richard Bayer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (G.J.A., J.A.D., U.J.S., L.C., N.P., B.Y., V.B., J.R.B., R.B., A.V.S., T.E.), Division of Cardiothoracic Surgery, Department of Surgery (A.L.E.), and Division of Cardiology, Department of Medicine (R.B.), Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260; Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany (J.A.D., F.S.); Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Mainz, Mainz, Germany (A.L.E.); Department of Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (T.E.); and German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Rhine Main, Mainz, Germany (T.E.)
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Shang Y, Zhang Y, Leng W, Lei X, Chen L, Zhou X, Liang Z, Wang J. Assessment of right ventricular function using cardiovascular magnetic resonance in patients with type 2 diabetes mellitus. Quant Imaging Med Surg 2022; 12:1539-1548. [PMID: 35111646 DOI: 10.21037/qims-21-376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022]
Abstract
Background Accurate evaluation of right ventricular (RV) function is always difficult due to its irregular shape and movement. Many indices have been proposed to assess RV function, but none have been universally accepted. This study evaluated RV function in type 2 diabetes mellitus (T2DM) patients using long-axis strain (LAS) and other traditional indices. Methods Fifty-seven patients with T2DM and 39 healthy controls were prospectively enrolled. Four-chamber cardiovascular magnetic resonance (CMR) and RV short-axis cine images were obtained from all participants to measure the tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (EF), peak longitudinal strain (PLS) and four LAS indices. The inter-and intraobserver variabilities were also calculated. Results Compared with healthy controls, T2DM was associated with a decreased LAS (apex/lateral wall) (-17.4%±4.2% vs. control, -19.7%±3.7%, P=0.008) and LAS (apex/middle point) (-17.5%±4.5% vs. control, -19.5%±3.9%, P=0.026), but both groups had a similar LAS (RV/lateral wall) and LAS (RV/middle point) (all P>0.05). After adjustments for age and body mass index, a significant difference was observed only for LAS (apex/lateral wall) (P=0.028). There were no significant differences in the TAPSE, RVEF and PLS (all P>0.05). LAS (apex/lateral wall) correlated with the TAPSE (r=-0.723, P<0.001), RVEF (r=-0.270, P=0.008) and PLS (r=0.210, P=0.040). The inter- and intraobserver variability of the LAS (apex/lateral wall) were lower than the other three LAS indices. Conclusions Compared with traditional RV function indices, such as the TAPSE, RVEF and PLS, LAS is easy to obtain and shows high repeatability. LAS (apex/lateral wall) may provide a more sensitive T2DM-related RV dysfunction index.
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Affiliation(s)
- Yongning Shang
- Department of Ultrasound, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yulin Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weiling Leng
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaotian Lei
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Liu Chen
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | | | - Ziwen Liang
- Department of Endocrinology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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15
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O'Brien AC, MacDermott R, Keane S, Ryan D, McVeigh N, Durand R, Ferre M, Murphy DJ, Teekakirikul P, Keane D, McDonald K, Ledwidge M, Dodd JD. Cardiac MRI e-prime Predicts Myocardial Late Gadolinium Enhancement and Diastolic Dysfunction in Hypertrophic Cardiomyopathy. Eur J Radiol 2022; 149:110192. [DOI: 10.1016/j.ejrad.2022.110192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
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16
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Holzknecht M, Reindl M, Tiller C, Reinstadler SJ, Lechner I, Pamminger M, Schwaiger JP, Klug G, Bauer A, Metzler B, Mayr A. Global longitudinal strain improves risk assessment after ST-segment elevation myocardial infarction: a comparative prognostic evaluation of left ventricular functional parameters. Clin Res Cardiol 2021; 110:1599-1611. [PMID: 33884479 PMCID: PMC8484167 DOI: 10.1007/s00392-021-01855-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIM We aimed to investigate the comparative prognostic value of left ventricular ejection fraction (LVEF), mitral annular plane systolic excursion (MAPSE), fast manual long-axis strain (LAS) and global longitudinal strain (GLS) determined by cardiac magnetic resonance (CMR) in patients after ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS This observational cohort study included 445 acute STEMI patients treated with primary percutaneous coronary intervention (pPCI). Comprehensive CMR examinations were performed 3 [interquartile range (IQR): 2-4] days after pPCI for the determination of left ventricular (LV) functional parameters and infarct characteristics. Primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as composite of death, re-infarction and congestive heart failure. During a follow-up of 16 [IQR: 12-49] months, 48 (11%) patients experienced a MACE. LVEF (p = 0.023), MAPSE (p < 0.001), LAS (p < 0.001) and GLS (p < 0.001) were significantly related to MACE. According to receiver operating characteristic analyses, only the area under the curve (AUC) of GLS was significantly higher compared to LVEF (0.69, 95% confidence interval (CI) 0.64-0.73; p < 0.001 vs. 0.60, 95% CI 0.55-0.65; p = 0.031. AUC difference: 0.09, p = 0.020). After multivariable analysis, GLS emerged as independent predictor of MACE even after adjustment for LV function, infarct size and microvascular obstruction (hazard ratio (HR): 1.13, 95% CI 1.01-1.27; p = 0.030), as well as angiographical (HR: 1.13, 95% CI 1.01-1.28; p = 0.037) and clinical parameters (HR: 1.16, 95% CI 1.05-1.29; p = 0.003). CONCLUSION GLS emerged as independent predictor of MACE after adjustment for parameters of LV function and myocardial damage as well as angiographical and clinical characteristics with superior prognostic validity compared to LVEF.
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Affiliation(s)
- Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Johannes P Schwaiger
- Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milser Strasse 10, 6060, Hall in Tirol, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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17
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CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter-Defibrillator in Non-Ischemic Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22137115. [PMID: 34281168 PMCID: PMC8268120 DOI: 10.3390/ijms22137115] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.
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18
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Sobh M, Freitag-Wolf S, Scheewe J, Kanngiesser LM, Uebing AS, Gabbert DD, Voges I. Serial right ventricular assessment in patients with hypoplastic left heart syndrome: a multiparametric cardiovascular magnetic resonance study. Eur J Cardiothorac Surg 2021; 61:36-42. [PMID: 34050651 DOI: 10.1093/ejcts/ezab232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess single right ventricular (RV) function in a large cohort of hypoplastic left heart syndrome (HLHS) patients after the completion of total cavopulmonary connection by analysing serial cardiovascular magnetic resonance (CMR) studies. METHODS CMR studies from 95 HLHS patients were analysed. RV end-diastolic and end-systolic volumes (RVEDV, RVESV), ejection fraction (RVEF) and long-axis strain (LAS) were measured from cine images. RESULTS All 95 patients had at least 2 CMR scans and 35 patients had 3 CMR scans. The median age (first quartile-third quartile) at the 3 examinations was 4.2 (3.3-6.1), 9.4 (6.1-11.4) and 14.6 (11.8-16.8) years. RV indexed volumes (RVEDVi and RVESVi) increased from first to the second and from the first and second examination to the third examination in patients with >10 years of age (P < 0.05). There was a slight decrease in RVEF and LAS throughout the examinations, but this was not statistically significant. Correlations were found between RVEF and LAS (r = -0.23; P < 0.01). Both RVEF and LAS correlated with RVEDVi and RVESVi (r = -0.17 to 0.43; P < 0.05). CONCLUSIONS Serial assessment of CMR studies in HLHS patients after total cavopulmonary connection completion demonstrate an increase in indexed RV volumes in older HLHS patients but only mild reduction in RVEF and LAS. The correlation of indexed RV volumes with RVEF and LAS together with the significant increase in RV volumes over time suggests that indexed RV volumes might be superior to RV functional markers to monitor the RV in HLHS patients.
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Affiliation(s)
- Mohamed Sobh
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Luca M Kanngiesser
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anselm S Uebing
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dominik D Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
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19
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Backhaus SJ, Lange T, George EF, Hellenkamp K, Gertz RJ, Billing M, Wachter R, Steinmetz M, Kutty S, Raaz U, Lotz J, Friede T, Uecker M, Hasenfuß G, Seidler T, Schuster A. Exercise Stress Real-Time Cardiac Magnetic Resonance Imaging for Noninvasive Characterization of Heart Failure With Preserved Ejection Fraction: The HFpEF-Stress Trial. Circulation 2021; 143:1484-1498. [PMID: 33472397 DOI: 10.1161/circulationaha.120.051542] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Right heart catheterization using exercise stress is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF) but carries the risk of the invasive procedure. We hypothesized that real-time cardiac magnetic resonance (RT-CMR) exercise imaging with pathophysiologic data at excellent temporal and spatial resolution may represent a contemporary noninvasive alternative for diagnosing HFpEF. METHODS The HFpEF-Stress trial (CMR Exercise Stress Testing in HFpEF; URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621. URL: https://dzhk.de/; Unique identifier: DZHK-17) prospectively recruited 75 patients with echocardiographic signs of diastolic dysfunction and dyspnea on exertion (E/e'>8, New York Heart Association class ≥II) to undergo echocardiography, right heart catheterization, and RT-CMR at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure (≥15 mm Hg at rest or ≥25 mm Hg during exercise stress). RT-CMR functional assessments included time-volume curves for total and early (1/3) diastolic left ventricular filling, left atrial (LA) emptying, and left ventricular/LA long axis strain. RESULTS Patients with HFpEF (n=34; median pulmonary capillary wedge pressure at rest, 13 mm Hg; at stress, 27 mm Hg) had higher E/e' (12.5 versus 9.15), NT-proBNP (N-terminal pro-B-type natriuretic peptide; 255 versus 75 ng/L), and LA volume index (43.8 versus 36.2 mL/m2) compared with patients with noncardiac dyspnea (n=34; rest, 8 mm Hg; stress, 18 mm Hg; P≤0.001 for all). Seven patients were excluded because of the presence of non-HFpEF cardiac disease causing dyspnea on imaging. There were no differences in RT-CMR left ventricular total and early diastolic filling at rest and during exercise stress (P≥0.164) between patients with HFpEF and noncardiac dyspnea. RT-CMR revealed significantly impaired LA total and early (P<0.001) diastolic emptying in patients with HFpEF during exercise stress. RT-CMR exercise stress LA long axis strain was independently associated with HFpEF (adjusted odds ratio, 0.657 [95% CI, 0.516-0.838]; P=0.001) after adjustment for clinical and imaging measures and emerged as the best predictor for HFpEF (area under the curve at rest 0.82 versus exercise stress 0.93; P=0.029). CONCLUSIONS RT-CMR allows highly accurate identification of HFpEF during physiologic exercise and qualifies as a suitable noninvasive diagnostic alternative. These results will need to be confirmed in multicenter prospective research studies to establish widespread routine clinical use. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621. URL: https://dzhk.de/; Unique identifier: DZHK-17.
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Affiliation(s)
- Sören J Backhaus
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Torben Lange
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Elisabeth F George
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Kristian Hellenkamp
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Roman J Gertz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany (R.J.G.)
| | - Marcus Billing
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
| | - Rolf Wachter
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Germany (R.W.)
| | - Michael Steinmetz
- Departments of Pediatric Cardiology and Intensive Care Medicine (M.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD (S.K.)
| | - Uwe Raaz
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Joachim Lotz
- Diagnostic and Interventional Radiology (J.L., M.U.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Tim Friede
- Medical Statistics (T.F.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Martin Uecker
- Diagnostic and Interventional Radiology (J.L., M.U.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany (M.U., G.H.)
| | - Gerd Hasenfuß
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany (M.U., G.H.)
| | - Tim Seidler
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Andreas Schuster
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
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20
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Schuster A, Backhaus SJ, Stiermaier T, Kowallick JT, Stulle A, Koschalka A, Lotz J, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Eitel I. Fast manual long-axis strain assessment provides optimized cardiovascular event prediction following myocardial infarction. Eur Heart J Cardiovasc Imaging 2020; 20:1262-1270. [PMID: 31329854 DOI: 10.1093/ehjci/jez077] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/12/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental prognostic value following acute myocardial infarction (AMI) but requires substantial post-processing. Alternatively, manual global long-axis strain (LAS) can be easily assessed from standard steady state free precession images. We aimed to define the prognostic value of LAS in a large multicentre study in patients following AMI. METHODS AND RESULTS A total of 1235 patients with myocardial infarction [n = 795 with ST-elevation myocardial infarction (STEMI) and 440 with non-ST-elevation myocardial infarction (NSTEMI)] underwent cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention in eight centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) including death, reinfarction, and congestive heart failure within 1 year after AMI. During 1-year follow-up, 76 patients suffered from MACE. Impaired LAS was associated with higher MACE occurrence both in STEMI (P < 0.001) and NSTEMI (P = 0.001) patients. Association of LAS remained significant (P = 0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of additional LAS assessment for optimized event prediction compared with left ventricular ejection fraction (MACE P = 0.044; mortality P = 0.013) and a combination of established clinical and imaging parameters (MACE P = 0.084; mortality P = 0.027), but not CMR-FT GLS (MACE P = 0.075; mortality P = 0.380). CONCLUSION LAS provides software independent, widely available, easy and fast approximation of longitudinal left ventricular shortening early after reperfused AMI with incremental prognostic value beyond established risk stratification parameters. CLINICAL TRIALS.GOV NCT00712101 and NCT01612312.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, 5th Floor, Acute Services Building, Reserve Road, St Leonard's, Sydney, NSW, Australia
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Thomas Stiermaier
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Alina Stulle
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Children's Center, M 2303, 1800 Orleans Street, Baltimore, Maryland, USA
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Matthias Gutberlet
- Institute for Diagnostic and Interventional Radiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
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21
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Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome. J Clin Med 2020; 9:jcm9123882. [PMID: 33260461 PMCID: PMC7759874 DOI: 10.3390/jcm9123882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/14/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.
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22
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Defining the Reference Range for Left Ventricular Strain in Healthy Patients by Cardiac MRI Measurement Techniques: Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 217:569-583. [PMID: 33084383 DOI: 10.2214/ajr.20.24264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND. Echocardiography is the primary noninvasive technique for left ventricular (LV) strain measurement. MRI has potential advantages, although reference ranges and thresholds to differentiate normal from abnormal left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular global radial strain (LVGRS) are not yet established. OBJECTIVE. The purpose of our study was to determine the mean and lower limit of normal (LLN) of MRI-derived LV strain measurements in healthy patients and explore factors potentially influencing these measurements. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Library databases were searched for studies published through January 1, 2020, that reported MRI-derived LV strain measurements in at least 30 healthy individuals. Mean and LLN measurements of LV strain were pooled using random-effects models overall and for studies stratified by measurement method (feature tracking [FT] or tagging). Additional subgroup and meta-regression analyses were performed. EVIDENCE SYNTHESIS. Twenty-three studies with a total of 1782 healthy subjects were included. Pooled means and LLNs for all studies were -18.6% (95% CI, -19.5% to -17.6%) and -13.3% (-13.9% to 12.7%) for LVGLS, -21.0% (-22.4% to -19.6%) and -15.6% (-17.0% to -14.3%) for LVGCS, and 38.7% (30.5-46.9%) and 20.6% (15.1-26.1%) for LVGRS. Pooled means and LLNs for LVGLS by strain measurement method were -19.4% (95% CI, -20.6% to -18.1%) and -13.1% (-14.2% to -12.0%) for FT and -15.6% (-16.2% to -15.1%) and -13.1% (-14.1% to -12.2%) for tagging. A later year of study publication, increasing patient age, and increasing body mass index were associated with more negative mean LVGLS values. An increasing LV end-diastolic volume index was associated with less negative mean LVGLS values. No factor was associated with LLN of LVGLS. CONCLUSION. We determined the pooled means and LLNs, with associated 95% CIs, for LV strain by cardiac MRI to define thresholds for normal, abnormal, and borderline strain in healthy patients. The method of strain measurement by MRI affected the mean LVGLS. No factor affected the LLN of LVGLS. CLINICAL IMPACT. This meta-analysis lays a foundation for clinical adoption of MRI-derived LV strain measurements, with management implications in both healthy patients and patients with various disease states.
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23
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Wan K, Lin J, Guo X, Song R, Wang J, Xu Y, Li W, Cheng W, Sun J, Zhang Q, Han Y, Chen Y. Prognostic Value of Right Ventricular Dysfunction in Patients With AL Amyloidosis: Comparison of Different Techniques by Cardiac Magnetic Resonance. J Magn Reson Imaging 2020; 52:1441-1448. [PMID: 32691470 DOI: 10.1002/jmri.27200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is common in patients with amyloid light-chain (AL) amyloidosis. While cardiac MRI is the reference standard tool for RV assessment, there are a number of measures of RV function that can be evaluated and it is yet unknown which of these results in the highest prognostic performance in AL amyloidosis. PURPOSE To examine the prognostic value of various measures of RV function in a bid to find which best predicts outcome in AL amyloidosis. STUDY TYPE Single-center, prospective. SUBJECTS In all, 129 patients (mean age, 58 ± 11 years; 61.2% men) with biopsy-proven AL amyloidosis. FIELD STRENGTH/SEQUENCE 3.0T / balanced steady-state free-precession cine. ASSESSMENT RV ejection fraction (EF), RV fractional area change (FAC), RV long axis strain (LAS), RV free wall longitudinal strain (FWS), RV global longitudinal strain (GLS), and tricuspid annular plane systolic excursion (TAPSE). STATISTICAL TESTS Mann-Whitney U-tests, Student's t-tests, receiver-operating characteristic curves, Kaplan-Meier curves, Cox proportional hazards regression models, and C-statistics. RESULTS During the median follow-up period of 38.0 months (interquartile range, 18.5-58.0 months), all-cause mortality occurred in 95 patients (73.6%). The RVEF, RVGLS, TAPSE, RVFAC, and RVFWS were significant predictors of outcome in univariate Cox regression (all P < 0.001). After adjusting for New York Heart Association (NYHA) class, Mayo staging 2004, left ventricular (LV) EF, and LV mass index, RVFWS (HR [hazard ratio] =1.074; 95% CI [confidence interval]: 1.041-1.108; P < 0.001) was an independent predictor of all-cause mortality and had a higher C-statistic (0.753) compared to the model including RVEF (C-statistic = 0.724, P = 0.034), the model including RVFAC (C-statistic = 0.723, P = 0.033), and the model including RVGLS (C-statistic =0.733, P = 0.011). DATA CONCLUSION RV dysfunction appears to be an independent determinant of outcome in patients with AL amyloidosis. RVFWS is a better predictor of all-cause mortality than RVEF, RVFAC, or RVGLS. EVIDENCE LEVEL 2 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Ke Wan
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayi Lin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinli Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rizhen Song
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.,Center of Rare diseases, West China Hospital, Sichuan University, Chengdu, China
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24
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 2020; 30:3672-3683. [PMID: 32107604 DOI: 10.1007/s00330-020-06744-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES In some cardiac pathologies, impairment of left ventricular (LV) longitudinal function may precede reduction in LV ejection fraction. This study investigates the effectiveness of a fast method to quantify long-axis LV function compared to conventional feature tracking and manual approaches. METHODS The study consisted of 50 normal controls and 100 heart failure (HF) patients including 40 with reduced ejection fraction (HFrEF), 30 with mid-range ejection fraction (HFmrEF), and 30 with preserved ejection fraction (HFpEF). Parameters including fast long-axis strain (FLAS) at end-systole and peak strain rates during systole (FLASRs), early diastole (FLASRe), and atrial contraction (FLASRa) were derived by a fast semi-automated approach on cine cardiovascular magnetic resonance. RESULTS FLAS exhibited good agreement with strain values obtained using conventional feature tracking (bias - 2.9%, limits of agreement ± 3.0%) and the manual approach (bias 0.6%, limits of agreement ± 2.1%), where FLAS was more reproducible and required shorter measurement time. The mean FLAS (HFrEF < HFmrEF < HFpEF < controls; 6.1 ± 2.4 < 9.9 ± 2.4 < 11.0 ± 2.5 < 16.9 ± 2.3%, all p < 0.0001) was decreased in all the HF patient groups. A FLAS of 12.3% (mean-2SD of controls) predicted the presence of systolic dysfunction in 67% of patients with HFpEF, and 87% with HFmrEF. Strain parameters using the fast approach were superior to those obtained by conventional feature tracking and manual approaches for discriminating HFpEF from controls. Notable examples are area under the curve, sensitivity, and specificity for FLAS (0.94, 93%, and 86%) and FLASRe (0.96, 90%, and 94%). CONCLUSIONS The fast approach-derived LV strain and strain rate parameters facilitate reproducible, reliable, and effective LV longitudinal function analysis. KEY POINTS • Left ventricular long-axis strain can be rapidly derived from cine CMR with shorter measurement time and higher reproducibility compared to conventional feature tracking and the manual approach. • Progressive reductions in left ventricular long-axis strain and strain rate measurements were observed from HFpEF, HFmrEF, to HFrEF group. • Based on long-axis strain, systolic abnormalities were evident in HFmrEF and HFpEF indicating common coexistence of systolic and diastolic dysfunction in the HF phenotypes.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John C Allen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
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25
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Arenja N, Andre F, Riffel JH, Siepen FAD, Hegenbart U, Schönland S, Kristen AV, Katus HA, Buss SJ. Prognostic value of novel imaging parameters derived from standard cardiovascular magnetic resonance in high risk patients with systemic light chain amyloidosis. J Cardiovasc Magn Reson 2019; 21:53. [PMID: 31434577 PMCID: PMC6704553 DOI: 10.1186/s12968-019-0564-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/23/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The differentiated assessment of functional parameters besides morphological changes is essential for the evaluation of prognosis in systemic immunoglobulin light chain (AL) amyloidosis. METHODS Seventy-four subjects with AL amyloidosis and presence of late gadolinium enhancement (LGE) pattern typical for cardiac amyloidosis were analyzed. Long axis strain (LAS) and myocardial contraction fraction (MCF), as well as morphological and functional markers, were measured. The primary endpoint was death, while death and heart transplantation served as a composite secondary endpoint. RESULTS After a median follow-up of 41 months, 29 out of 74 patients died and 10 received a heart transplant. Left ventricular (LV) functional parameters were reduced in patients, who met the composite endpoint (LV ejection fraction 51% vs. 61%, LAS - 6.9% vs - 10%, GLS - 12% vs - 15% and MCF 42% vs. 69%; p < 0.001 for all). In unadjusted univariate analysis, LAS (HR = 1.05, p < 0.001) and MCF (HR = 0.96, p < 0.001) were associated with reduced transplant-free survival. Kaplan-Meier analyses showed a significantly lower event-free survival in patients with reduced MCF. MCF and LAS performed best to identify high risk patients for secondary endpoint (Log-rank test p < 0.001) in a combined model. Using sequential Cox regression analysis, the addition of LAS and MCF to LV ejection fraction led to a significant increase in the predictive power of the model (χ2 (df = 1) = 28.2, p < 0.001). CONCLUSIONS LAS and MCF as routinely available and robust CMR-derived parameters predict outcome in LGE positive AL amyloidosis. Patients with impaired LV function in combination with reduced LAS and MCF are at the highest risk for death and heart transplantation.
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Affiliation(s)
- Nisha Arenja
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Department of Cardiology, Kantonsspital Olten, Solothurner Spitäler AG, Baslerstrasse 150, 4600 Olten, Switzerland
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johannes H. Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Fabian aus dem Siepen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Ute Hegenbart
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Stefan Schönland
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Arnt V. Kristen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Das Radiologische Zentrum, Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Alte Waibstadter Str. 2a, 74889 Sinsheim, Germany
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26
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Mayr A, Pamminger M, Reindl M, Greulich S, Reinstadler SJ, Tiller C, Holzknecht M, Nalbach T, Plappert D, Kranewitter C, Klug G, Metzler B. Mitral annular plane systolic excursion by cardiac MR is an easy tool for optimized prognosis assessment in ST-elevation myocardial infarction. Eur Radiol 2019; 30:620-629. [PMID: 31392477 PMCID: PMC6890588 DOI: 10.1007/s00330-019-06393-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the comparative prognostic value of mitral annular plane systolic excursion (MAPSE) versus left ventricular ejection fraction (LVEF), measured by cardiac magnetic resonance (CMR) imaging in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS CMR was performed in 255 STEMI patients within 2 days (interquartile range (IQR) 2-4 days) after infarction. CMR included MAPSE measurement on CINE 4-chamber view. Patients were followed for major adverse cardiovascular events (MACE)-death, non-fatal myocardial re-infarction, stroke, and new congestive heart failure. RESULTS Patients with MACE (n = 35, 14%, median follow-up 3 years [IQR 1-4 years]) showed significantly lower MAPSE (8 mm [7-8.8] vs. 9.6 mm [8.1-11.5], p < 0.001). The association between decreased MAPSE (< 9 mm, optimal cut-off value by c-statistics) remained significant after adjustment for independent clinical and CMR predictors of MACE. The AUC of MAPSE for the prediction of MACE was 0.74 (CI 95% 0.65-0.82), significantly higher than that of LVEF (0.61 [CI 95% 0.50-0.71]; p < 0.001). CONCLUSIONS Reduced long-axis function assessed with MAPSE measurement using CINE CMR independently predicts long-term prognosis following STEMI. Moreover, MAPSE provided significantly higher prognostic implication in comparison with conventional LVEF measurement. KEY POINTS • MAPSE determined by CMR independently predicts long-term prognosis following STEMI. • MACE-free survival is significantly higher in patients with MAPSE ≥ 9 mm than < 9 mm. • MAPSE provides significantly higher prognostic implication than conventional LVEF.
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Affiliation(s)
- Agnes Mayr
- University Clinic of Radiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Simon Greulich
- Department of Cardiology and Cardiovascular Diseases, University Hospital Tübingen, Otfried Müller-Straße 10, 72076, Tübingen, Germany
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Timo Nalbach
- University Clinic of Radiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - David Plappert
- University Clinic of Radiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christof Kranewitter
- University Clinic of Radiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
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27
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Yang F, Wang J, Li Y, Li W, Xu Y, Wan K, Sun J, Han Y, Chen Y. The prognostic value of biventricular long axis strain using standard cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Int J Cardiol 2019; 294:43-49. [PMID: 31405582 DOI: 10.1016/j.ijcard.2019.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Long axis strain (LAS) is a parameter derived from standard cardiovascular magnetic resonance imaging. However, the prognostic value of biventricular LAS in hypertrophic cardiomyopathy (HCM) is unknown. METHODS Patients with HCM (n = 384) and healthy volunteers (n = 150) were included in the study. Left ventricular (LV)-LAS was defined as the percentage change in the length measured from the epicardial border of the LV apex to the midpoint of a line connecting the mitral annulus at end-systole and end-diastole. Right ventricular (RV)-LAS represented the percentage change of length between epicardial border of the LV apex to the midpoint of a line connecting the tricuspid annulus at end-systole and end-diastole. The primary endpoint was a combination of all-cause death and sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge and cardiopulmonary resuscitation after syncope. The secondary endpoint was a combination of the primary endpoint and hospitalization for congestive heart failure. RESULTS Twenty-nine patients (7.6%) achieved the primary endpoint, and the secondary endpoint occurred in 66 (17.2%) patients. In multivariate Cox regression analysis, RV-LAS was an independent prognostic factor for the primary (hazard ratio (HR), 1.13) and secondary (HR, 1.11) endpoints. In the subgroup of patients with a normal RV ejection fraction (EF) (>45.0%, n = 345), impaired RV-LAS was associated with adverse outcomes and might add incremental prognostic value to RVEF and tricuspid annular plane systolic excursion (TAPSE) (p < 0.01). CONCLUSIONS RV-LAS is an independent predictor of adverse prognosis in HCM in addition to RVEF and TAPSE.
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Affiliation(s)
- Fuyao Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuancheng Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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28
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Merlocco A, Cross RR, Kellman P, Xue H, Olivieri L. Validation of cardiac magnetic-resonance-derived left ventricular strain measurements from free-breathing motion-corrected cine imaging. Pediatr Radiol 2019; 49:68-75. [PMID: 30244412 PMCID: PMC8432251 DOI: 10.1007/s00247-018-4251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/18/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Myocardial strain is an important measure of cardiac function and can be assessed on cardiac magnetic resonance (MR) through the current gold standard of breath-held segmented steady-state free precession (SSFP) cine imaging. Novel free-breathing techniques have been validated for volumetry and systolic function, allowing for evaluation of sicker and younger children who cannot reliably hold their breath. It is unclear whether strain measurements can be reliably performed on free-breathing, motion-corrected, re-binning cine images. OBJECTIVE To compare strain analysis from motion-corrected retrospective re-binning images to the breath-held SSFP cine images to explore their validity. MATERIALS AND METHODS Twenty-five children and young adults, ages (2.1-18.6 years) underwent breath-held and motion-corrected retrospective re-binning cine techniques during the same MR examination on a 1.5-tesla magnet. We measured endocardial end-systolic global circumferential strain and endocardial averaged segmental strain using commercial software (MEDIS QStrain 2.1). We used Pearson correlation coefficients to test agreement across techniques. RESULTS Analysis was possible in all 25 breath-held and motion-corrected retrospective re-binning studies. Global circumferential strain and endocardial averaged segmental strain obtained by motion-corrected retrospective re-binning compared favorably to breath-held studies. Global circumferential strain linear regression models demonstrated acceptable agreement, with coefficients of determination of 0.75 for breath-held compared to motion-corrected retrospective re-binning (P<0.001) and for endocardial averaged segmental strain comparisons yielded 0.77 for breath-held vs. motion-corrected retrospective re-binning (P<0.001). Bland-Altman assessment demonstrated minimal bias for breath-held compared to motion-corrected retrospective re-binning (mean 2.4 and 1.9, respectively, for global circumferential strain and endocardial averaged segmental strain). CONCLUSION Free-breathing imaging by motion-corrected retrospective re-binning cine imaging provides adequate spatial and temporal resolution to measure myocardial deformation when compared to the gold-standard breath-held SSFP cine imaging in children with normal or borderline systolic function.
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Affiliation(s)
- Anthony Merlocco
- Division of Cardiology, Children's National Health System, Department of Pediatrics, George Washington Medical School, Washington, DC, USA.
- Division of Cardiology, Le Bonheur Children's Hospital, Department of Pediatrics, University of Tennessee Health Science Center, 49 North Dunlap St., Faculty Office Building, 3rd floor, Memphis, TN, 38105, USA.
| | - Russell R Cross
- Division of Cardiology, Children's National Health System, Department of Pediatrics, George Washington Medical School, Washington, DC, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura Olivieri
- Division of Cardiology, Children's National Health System, Department of Pediatrics, George Washington Medical School, Washington, DC, USA
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Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L. Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2018; 20:71. [PMID: 30396356 PMCID: PMC6219067 DOI: 10.1186/s12968-018-0496-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Abnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain. METHODS We studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain εs and strain rate SRs), conduit function (conduit strain εe and strain rate SRe) and booster pump function (booster strain εa and strain rate SRa). RESULTS There was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for εs, 18.1 ± 4.3% for εe, 17.2 ± 3.5% for εa, and 1.8 ± 0.4, - 2.0 ± 0.5, - 2.3 ± 0.6 s- 1 for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller εs, SRs, εe and SRe than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS). CONCLUSIONS Novel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - John C. Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Angela S. Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
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Pahlm U, Seemann F, Engblom H, Gyllenhammar T, Halvorsen S, Hansen HS, Erlinge D, Atar D, Heiberg E, Arheden H, Carlsson M. Longitudinal left ventricular function is globally depressed within a week of STEMI. Clin Physiol Funct Imaging 2018; 38:1029-1037. [PMID: 29701310 DOI: 10.1111/cpf.12521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
Sixty percent of stroke volume (SV) is generated by atrioventricular plane displacement (AVPD) in a healthy left ventricle (LV). The aims were to determine the effect of ST-elevation myocardial infarction (STEMI) on AVPD and contribution of AVPD to SV and to study the relationship between AVPD and infarct size (IS) and location. Patients from CHILL-MI and MITOCARE studies with cardiovascular magnetic resonance within a week of STEMI (n = 177, 59 ± 11 years) and healthy controls (n = 20, 62 ± 11 years) were included. Left ventricular volumes were quantified in short-axis images. AVPD was measured in six locations in long-axis images. Longitudinal contribution to SV was calculated as AVPD multiplied by the short-axis epicardial area. Patients (IS 17 ± 10% of LV) had decreased ejection fraction (48 ± 8%) compared to controls (60 ± 5%, P<0·001). Global AVPD was decreased in patients (11 ± 2 mm versus 15 ± 2 mm in controls, P<0·001) and this held true for both infarcted and remote segments. AVPD contribution to SV was lower in patients (58 ± 9%) than in controls (64 ± 8%) (P<0·001). There was a weak negative correlation between IS and AVPD (r2 =0·06) but no differences in global AVPD linked to infarct location. Decrease in global and regional AVPD occur even in remote myocardium within 1 week of STEMI. Global AVPD decrease is independent of MI location, and MI size has only minor effect. Longitudinal pumping is slightly lower compared to controls but remains to be the main component to SV even after STEMI. These results highlight the difficulty in determining infarct location and size from longitudinal measures of LV function.
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Affiliation(s)
- Ulrika Pahlm
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Emergency Medicine, Skåne University Hospital, Lund, Sweden
| | - Felicia Seemann
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Faculty of Engineering, Department of Biomedical Engineering, Lund University, Lund, Sweden
- Faculty of Engineering, Department of Numerical Analysis, Lund University, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Tom Gyllenhammar
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sigrun Halvorsen
- Div. of Medicine, and Faculty of Medicine, Dept. of Cardiology B, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - David Erlinge
- Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dan Atar
- Div. of Medicine, and Faculty of Medicine, Dept. of Cardiology B, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Faculty of Engineering, Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Romano S, Judd RM, Kim RJ, Kim HW, Klem I, Heitner JF, Shah DJ, Jue J, Farzaneh-Far A. Left Ventricular Long-Axis Function Assessed with Cardiac Cine MR Imaging Is an Independent Predictor of All-Cause Mortality in Patients with Reduced Ejection Fraction: A Multicenter Study. Radiology 2017; 286:452-460. [PMID: 28914601 DOI: 10.1148/radiol.2017170529] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To evaluate the prognostic value of a simple index of left ventricular (LV) long-axis function-lateral mitral annular plane systolic excursion (MAPSE)-in a large multicenter population of patients with reduced ejection fraction (EF) who were undergoing cardiac magnetic resonance (MR) imaging. Materials and Methods This retrospective study included 1040 consecutive patients (mean age, 59.5 years ± 15.8) at four U.S. medical centers who were undergoing cardiac MR imaging for assessment of LV dysfunction with EF less than 50%. Lateral MAPSE was measured in the four-chamber cine view. The primary end point was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models. Results During a median follow-up of 4.4 years, 132 patients died. With Kaplan-Meier analysis, the risk of death increased significantly with decreasing tertiles of lateral MAPSE (log-rank P = .0001). Patients with relatively preserved lateral MAPSE (>9 mm) had very few deaths, regardless of whether their EF was above or below 35%. Patients with late gadolinium enhancement (LGE) and low lateral MAPSE had significantly reduced survival compared to those with LGE and high lateral MAPSE (log-rank P < .0001). Lateral MAPSE was independently associated with risk of death after adjustment for clinical and imaging risk factors, which were univariate predictors (age, body mass index, diabetes, LV end-diastolic volume index, LGE, EF) (hazard ratio = 2.051 per mm decrease; 95% confidence interval [CI]: 1.520, 2.768; P < .001). Inclusion of lateral MAPSE in this model resulted in significant improvement in model fit (likelihood ratio test P < .0001) and C statistic (increasing from 0.675 to 0.844; P < .0001). Continuous net reclassification improvement was 1.036 (95% CI: 0.878, 1.194). Conclusion Lateral MAPSE measured during routine cine cardiac MR imaging is a significant independent predictor of mortality in patients with LV dysfunction, incremental to common clinical and cardiac MR risk factors-including EF and LGE. © RSNA, 2017.
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Affiliation(s)
- Simone Romano
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Robert M Judd
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Raymond J Kim
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Han W Kim
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Igor Klem
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - John F Heitner
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Dipan J Shah
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Jennifer Jue
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
| | - Afshin Farzaneh-Far
- From the Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St, M/C 715, Suite 920 S, Chicago, IL 60612 (S.R., J.J., A.F.F.); Department of Medicine, University of Verona, Verona, Italy (S.R.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (R.M.J., R.J.K., H.W.K., I.K., A.F.F.); Department of Cardiology, New York Methodist Hospital, Brooklyn, NY (J.F.H.); and Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex (D.J.S.)
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Assessment of Longitudinal Shortening in Cardiomyopathies with Cardiac Magnetic Resonance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berganza FM, de Alba CG, Özcelik N, Adebo D. Cardiac Magnetic Resonance Feature Tracking Biventricular Two-Dimensional and Three-Dimensional Strains to Evaluate Ventricular Function in Children After Repaired Tetralogy of Fallot as Compared with Healthy Children. Pediatr Cardiol 2017; 38:566-574. [PMID: 28058478 DOI: 10.1007/s00246-016-1549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Abstract
Cardiac magnetic resonance imaging is an important tool to evaluate cardiac anatomy and ventricular size and function after repaired tetralogy of Fallot. Magnetic resonance tissue tagging is the gold standard for evaluation of myocardial strain. However, myocardial tagging strain requires tagged images to be obtained prospectively, during the scan and with limited temporal resolution. Cardiac magnetic resonance feature tracking is a new tool that allows the retrospective analysis of cine images. There is limited experience with cardiac magnetic resonance feature tracking strain analysis in children. The medical records of patients with repaired tetralogy of Fallot that had a cardiac magnetic resonance (CMR) study from December 2013 to June 2015 were reviewed. The control group included patients who underwent a CMR with normal cardiac anatomy and ventricular function. Global longitudinal, circumferential and radial strain parameters (2D and 3D) were obtained by retrospectively contouring cine images from ventricular short axis, two chamber and four chamber views using post-processing software (Circle CVi42, Calgary, Canada). The correlation between conventional ventricular function parameters and ventricular strain was performed using Pearson's correlation. The mean age of tetralogy of Fallot and control subjects was 12.4 and 14.1 years, respectively. In patients after repaired tetralogy of Fallot, the mean left ventricular global 2D and 3D circumferential strains were -17.4 ± 2.9 and -10.1 ± 3, respectively. The mean indexed right ventricular end-diastolic volume was 135.4 cc m2 ± 46 compared to 75.7 cc m2 ± 17 in control subjects (P = 0.0001, CI 95%). Left ventricular global circumferential 3D strain showed a statistically significant difference in patients after TOF repair compared to normal subjects (-10.1 ± 3 vs. -14.71 ± 1.9, P = 0.00001). A strong correlation between left ventricular global circumferential 3D strain and right ventricular end-diastolic volume (P ≤ 0.0001) was noted. We found a strong correlation between left ventricular circumferential 3D strain and indexed right ventricular end-diastolic volume, as well as a strong correlation between left ventricular longitudinal 2D strain and right ventricular ejection fraction. Circumferential 3D strain may be a suitable tool to detect early abnormalities of ventricular myocardium even before the ejection fraction becomes compromised. Large-scale prospective studies are recommended.
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Affiliation(s)
- Fernando M Berganza
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | | | - Nazire Özcelik
- Division of Pediatric Cardiology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Dilachew Adebo
- Division of Pediatric Cardiology, Memorial Hermann Children's Hospital, University of Texas Medical School at Houston, Houston, TX, USA.
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Arenja N, Riffel JH, Halder M, Djiokou CN, Fritz T, Andre F, aus dem Siepen F, Zelniker T, Meder B, Kayvanpour E, Korosoglou G, Katus HA, Buss SJ. The prognostic value of right ventricular long axis strain in non-ischaemic dilated cardiomyopathies using standard cardiac magnetic resonance imaging. Eur Radiol 2017; 27:3913-3923. [DOI: 10.1007/s00330-016-4729-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/19/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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Arenja N, Riffel JH, Fritz T, André F, Aus dem Siepen F, Mueller-Hennessen M, Giannitsis E, Katus HA, Friedrich MG, Buss SJ. Diagnostic and Prognostic Value of Long-Axis Strain and Myocardial Contraction Fraction Using Standard Cardiovascular MR Imaging in Patients with Nonischemic Dilated Cardiomyopathies. Radiology 2017; 283:681-691. [PMID: 28156200 DOI: 10.1148/radiol.2016161184] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To assess the utility of established functional markers versus two additional functional markers derived from standard cardiovascular magnetic resonance (MR) images for their incremental diagnostic and prognostic information in patients with nonischemic dilated cardiomyopathy (NIDCM). Materials and Methods Approval was obtained from the local ethics committee. MR images from 453 patients with NIDCM and 150 healthy control subjects were included between 2005 and 2013 and were analyzed retrospectively. Myocardial contraction fraction (MCF) was calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume, and long-axis strain (LAS) was calculated from the distances between the epicardial border of the LV apex and the midpoint of a line connecting the origins of the mitral valve leaflets at end systole and end diastole. Receiver operating characteristic curve, Kaplan-Meier method, Cox regression, and classification and regression tree (CART) analyses were performed for diagnostic and prognostic performances. Results LAS (area under the receiver operating characteristic curve [AUC] = 0.93, P < .001) and MCF (AUC = 0.92, P < .001) can be used to discriminate patients with NIDCM from age- and sex-matched control subjects. A total of 97 patients reached the combined end point during a median follow-up of 4.8 years. In multivariate Cox regression analysis, only LV ejection fraction (EF) and LAS independently indicated the combined end point (hazard ratio = 2.8 and 1.9, respectively; P < .001 for both). In a risk stratification approach with classification and regression tree analysis, combined LV EF and LAS cutoff values were used to stratify patients into three risk groups (log-rank test, P < .001). Conclusion Cardiovascular MR-derived MCF and LAS serve as reliable diagnostic and prognostic markers in patients with NIDCM. LAS, as a marker for longitudinal contractile function, is an independent parameter for outcome and offers incremental information beyond LV EF and the presence of myocardial fibrosis. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Nisha Arenja
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Johannes H Riffel
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Thomas Fritz
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Florian André
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Fabian Aus dem Siepen
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Matthias Mueller-Hennessen
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Evangelos Giannitsis
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Hugo A Katus
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Matthias G Friedrich
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
| | - Sebastian J Buss
- From the Department of Cardiology, Angiology, and Pneumology (N.A., J.H.R., T.F., F.A., F.a.d.S., M.M.H., E.G., H.A.K., M.G.F., S.J.B.), University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany; Department of Cardiology, Solothurner Spitäler, Solothurn, Switzerland (N.A.); DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany (H.A.K.); and Radiology Center, Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany (S.J.B.)
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Pennell DJ, Baksi AJ, Prasad SK, Mohiaddin RH, Alpendurada F, Babu-Narayan SV, Schneider JE, Firmin DN. Review of Journal of Cardiovascular Magnetic Resonance 2015. J Cardiovasc Magn Reson 2016; 18:86. [PMID: 27846914 PMCID: PMC5111217 DOI: 10.1186/s12968-016-0305-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication.
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Affiliation(s)
- D. J. Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - A. J. Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. K. Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - R. H. Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - F. Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - S. V. Babu-Narayan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - J. E. Schneider
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
| | - D. N. Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW 3 6NP UK
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38
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Arenja N, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Zelniker T, Kristen AV, Korosoglou G, Katus HA, Buss SJ. Right ventricular long axis strain—validation of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging. Eur J Radiol 2016; 85:1322-8. [DOI: 10.1016/j.ejrad.2016.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/22/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
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Riffel JH, Keller MGP, Rost F, Arenja N, Andre F, Aus dem Siepen F, Fritz T, Ehlermann P, Taeger T, Frankenstein L, Meder B, Katus HA, Buss SJ. Left ventricular long axis strain: a new prognosticator in non-ischemic dilated cardiomyopathy? J Cardiovasc Magn Reson 2016; 18:36. [PMID: 27268238 PMCID: PMC4897821 DOI: 10.1186/s12968-016-0255-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long axis strain (LAS) has been shown to be a fast assessable parameter representing global left ventricular (LV) longitudinal function in cardiovascular magnetic resonance (CMR). However, the prognostic value of LAS in cardiomyopathies with reduced left ventricular ejection fraction (LVEF) has not been evaluated yet. METHODS AND RESULTS In 146 subjects with non-ischemic dilated cardiomyopathy (NIDCM, LVEF ≤45 %) LAS was assessed retrospectively from standard non-contrast SSFP cine sequences by measuring the distance between the epicardial border of the left ventricular apex and the midpoint of a line connecting the origins of the mitral valve leaflets in end-systole and end-diastole. The final values were calculated according to the strain formula. The primary endpoint of the study was defined as a combination of cardiac death, heart transplantation or aborted sudden cardiac death and occurred in 24 subjects during follow-up. Patients with LAS values > -5 % showed a significant higher rate of cardiac events independent of the presence of late gadolinium enhancement (LGE). The multivariate Cox regression analysis revealed that LVEDV/BSA (HR: 1.01, p < 0.05), presence of LGE (HR: 2.51, p < 0.05) and LAS (HR: 1.28, p < 0.05) were independent predictors for cardiac events. In a sequential cox regression analysis LAS offered significant incremental information (p < 0.05) for the prediction of outcome in addition to LGE and LVEDV/BSA. Using a dichotomous three point scoring model for risk stratification, including LVEF <35 %, LAS > -10 % and the presence of LGE, patients with 3 points had a significantly higher risk for cardiac events than those with 2 or less points. CONCLUSION Assessment of long axis function with LAS offers significant incremental information for the prediction of cardiac events in NIDCM and improves risk stratification beyond established CMR parameters.
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MESH Headings
- Adult
- Aged
- Biomechanical Phenomena
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/surgery
- Chi-Square Distribution
- Contrast Media/administration & dosage
- Death, Sudden, Cardiac/etiology
- Female
- Heart Transplantation
- Humans
- Kaplan-Meier Estimate
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/physiopathology
- Multivariate Analysis
- Observer Variation
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Reproducibility of Results
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Function, Left
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Affiliation(s)
- Johannes H Riffel
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Marius G P Keller
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Franziska Rost
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Nisha Arenja
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Florian Andre
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Thomas Fritz
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Tobias Taeger
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Rangarajan V, Chacko SJ, Romano S, Jue J, Jariwala N, Chung J, Farzaneh-Far A. Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events. J Cardiovasc Magn Reson 2016; 18:35. [PMID: 27266262 PMCID: PMC4897936 DOI: 10.1186/s12968-016-0257-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular pump function requires a complex interplay involving myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis dysfunction appears to be an early marker for a number of pathological states. We hypothesized that mitral annular plane systolic excursion (MAPSE) measured during cine-cardiovascular magnetic resonance (CMR) reflects changes in long axis function and may be an early marker for adverse cardiovascular outcomes. The aims of this study were therefore: 1) To assess the feasibility and reproducibility of MAPSE measurements during routine cine-CMR; and 2) To assess whether MAPSE, as a surrogate for long axis function, is a predictor of major adverse cardiovascular events (MACE). METHODS Four hundred consecutive patients undergoing CMR were prospectively enrolled. MAPSE was measured in the 4-chamber cine view. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or unstable angina, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Net reclassification improvement (NRI) was calculated to assess whether addition of MAPSE resulted in improved risk reclassification of MACE. RESULTS Seventy-two MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE <1.11 cm (median) experienced significantly higher incidence of MACE than patients with a MAPSE ≥1.11 cm (p = 0.027). After adjustment for established clinical risk factors which were univariate predictors (age, diabetes, hypertension, NYHA class, LV mass), lateral MAPSE remained a significant independent predictor of MACE (HR = 4.384 per cm decrease or 1.344 per 2 mm decrease; p = 0.020). Incorporation of lateral MAPSE into this risk model resulted in a net reclassification improvement (NRI) of 0.18 (p = 0.006). CONCLUSIONS Reduced long axis function assessed with lateral MAPSE during cine-CMR is an independent predictor of MACE.
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Affiliation(s)
- Vibhav Rangarajan
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Satish Jacob Chacko
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Jennifer Jue
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Nikhil Jariwala
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Jaehoon Chung
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Afshin Farzaneh-Far
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA.
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41
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Werys K, Petryka-Mazurkiewicz J, Błaszczyk Ł, Miśko J, Śpiewak M, Małek ŁA, Mazurkiewicz Ł, Miłosz-Wieczorek B, Marczak M, Kubik A, Dąbrowska A, Piątkowska-Janko E, Sawionek B, Wijesurendra R, Piechnik SK, Bogorodzki P. Cine dyscontractility index: A novel marker of mechanical dyssynchrony that predicts response to cardiac resynchronization therapy. J Magn Reson Imaging 2016; 44:1483-1492. [PMID: 27131044 DOI: 10.1002/jmri.25295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate whether magnetic resonance imaging (MRI) cine-derived dyssynchrony indices provide additional information compared to conventional tagged MRI (tMRI) acquisitions in heart failure patients undergoing cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Patients scheduled for CRT (n = 52) underwent preprocedure MRI including cine and tMRI acquisitions. Segmental strain curves were calculated for both cine and tMRI to produce a range of standard indices for direct comparison between modalities. We also proposed and evaluated a novel index of "dyscontractility," which detects the presence of focal areas with paradoxically positive circumferential strain. RESULTS Across conventional strain indices, there was only moderate-to-poor (R = 0.3-0.6) correlation between modalities; eight cine-derived indices showed statistically significant (P < 0.05) relations to CRT outcome compared to just two tMRI-based counterparts. The novel dyscontractility index calculated on basal slice cine images (cine dyscontractility index, "CDI") was the single best predictor of clinical response to CRT (area under the curve AUC = 0.81, P < 0.001). While poorly correlated to its tMRI counterpart (R = 0.33), CDI performed significantly better in predicting response to CRT (P < 0.005), and was also numerically better than all other tMRI indices (AUC 0.53-0.76, all P for AUC comparisons <0.17). CONCLUSION Cine-derived strain indices offer potentially new information compared to tMRI. Specifically, the novel CDI is most strongly linked to response to cardiac resynchronization therapy in a contemporary patient cohort. It utilizes readily available MRI data, is relatively straightforward to process, and compares favorably with any conventional tagging index. J. Magn. Reson. Imaging 2016;44:1483-1492.
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Affiliation(s)
- Konrad Werys
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Łukasz Błaszczyk
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Jolanta Miśko
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Mateusz Śpiewak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Łukasz A Małek
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Magdalena Marczak
- Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | - Agata Kubik
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland.,Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland
| | | | - Ewa Piątkowska-Janko
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Błażej Sawionek
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
| | - Rohan Wijesurendra
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Piotr Bogorodzki
- Institute of Radioelectronics and Multimedia Technology, Warsaw University of Technology, Warsaw, Poland
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42
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André F, Stock FT, Riffel J, Giannitsis E, Steen H, Scharhag J, Katus HA, Buss SJ. Incremental value of cardiac deformation analysis in acute myocarditis: a cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 2016; 32:1093-101. [PMID: 27100527 DOI: 10.1007/s10554-016-0878-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
The aim of this study was to assess cardiac deformation patterns in myocarditis applying feature tracking imaging (FTI) to cardiovascular magnetic resonance (CMR) images. Thirty-six patients (31 males) with acute myocarditis and 36 age- and gender-matched healthy volunteers were studied. CMR examinations were performed in a 1.5 T MR-scanner including late gadolinium enhancement (LGE). FTI was applied to standard cine images of long and short axis views. Global peak circumferential, longitudinal and radial systolic strains as well as long axis strain (LAS) were measured. Patients showed significantly impaired global peak circumferential (-24.4 ± 4.2 % vs. -28.8 ± 3.8 %, p < 0.0001), longitudinal (-17.6 ± 4.4 % vs. -23.8 ± 3.1 %, p < 0.0001) and radial (26.1 ± 5.4 % vs. 37.9 ± 7.6 %, p < 0.0001) systolic strains. Even patients with a preserved ejection fraction (pEF, ≥55 %) had significantly reduced longitudinal (-20.0 ± 4.8 % vs. -23.8 ± 3.1 %, p < 0.01) and radial (27.7 ± 5.5 % vs. 37.9 ± 7.6 %, p < 0.0001) strains. The extent of LGE in patients did not correlate to their respective strains. Regarding the differentiation between patients and controls, the addition of global peak systolic strains to ejection fraction led to a significant improvement of the logistic regression model (χ(2) 48.7 vs. 71.5; p < 0.001) resulting in a high AUC of 0.98. Applying previously published reference values, 75 % or 31 % of patients with pEF showed at least one strain value or a LAS, which fell below the limit of 1 or respectively 2 standard deviations from the reference mean value. Cardiac strains measured by CMR-FTI are significantly impaired in patients with acute myocarditis even in those with pEF. Therefore, strain assessment may improve the diagnostic accuracy of CMR for myocarditis.
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Affiliation(s)
- Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Florian T Stock
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Henning Steen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jürgen Scharhag
- Institute for Sports and Preventive Medicine, Saarland University, Campus Geb. B8 2, 66123, Saarbrücken, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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43
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de Gregorio C, Di Bella G. Merging strain-echo measurements with late gadolinium enhancement at cardiac MRI: An upcoming chance for advanced functional assessment of fibrosis in hypertrophic cardiomyopathy? Int J Cardiol 2016; 203:632-4. [PMID: 26590884 DOI: 10.1016/j.ijcard.2015.10.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit, Messina University Hospital, Messina, Italy.
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, Messina University Hospital, Messina, Italy
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44
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Gjesdal O, Yoneyama K, Mewton N, Wu C, Gomes AS, Hundley G, Prince M, Shea S, Liu K, Bluemke DA, Lima JAC. Reduced long axis strain is associated with heart failure and cardiovascular events in the multi-ethnic study of Atherosclerosis. J Magn Reson Imaging 2016; 44:178-85. [PMID: 26731196 DOI: 10.1002/jmri.25135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/02/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To propose long axis strain (LAS), a novel index of global left ventricle (LV) function, as a sensitive and powerful predictor of hard cardiovascular events and heart failure in the Multi-Ethnic Study of Atherosclerosis (MESA). MATERIALS AND METHODS Strain is an index of relative myocardial deformation, and enables normalization for differences in heart size. Measurement of strain conventionally requires dedicated software and protocols for image acquisition. LAS, however, can be analyzed using a caliper tool from conventional LV long axis magnetic resonance imaging (MRI) cine loops, reflecting the average myocardial contraction in the longitudinal direction. In all, 1651 participants (53% men) of the MESA study, without a history of myocardial infarction or heart failure, were assessed using conventional cine MR images. LV lengths were assessed at end-diastole (EDL ) and end-systole (ESL ), and LAS was calculated as 100*(EDL -ESL )/EDL . Participants were followed for 6.8 ± 1.8 years for a composite endpoint of congestive heart failure or hard cardiovascular events, and the predictive ability of LAS was tested, unadjusted and adjusted for established cardiovascular risk factors. RESULTS A total of 114 events were observed. Mean LAS was 11.7 ± 2.5% and 10.0 ± 2.7% in participants without and with events, respectively (P < 0.001). Increased LAS reduced the hazard ratio to 0.75 for univariate, and 0.88 for multivariate assessments, respectively (both P < 0.001). CONCLUSION Assessment of long axis LV deformation by LAS is feasible and reproducible. Moreover, LAS predicts hard cardiovascular events and congestive heart failure in a multi-ethnic population without overt cardiovascular disease at inclusion. J. Magn. Reson. Imaging 2016;44:178-185.
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Affiliation(s)
- Ola Gjesdal
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.,Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - Kihei Yoneyama
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
| | - Nathan Mewton
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
| | - Colin Wu
- National Heart, Lung and Blood Institute, Office of Biostatistics Research, Bethesda, Maryland, USA
| | - Antoinette S Gomes
- UCLA School of Medicine, Department of Radiology, Los Angeles, California, USA
| | - Gregory Hundley
- Wake Forest University Health Sciences, Department of Cardiology, Winston-Salem, North Carolina, USA
| | - Martin Prince
- Columbia University, Department of Radiology, New York, New York, USA
| | - Steven Shea
- Columbia University, Departments of Medicine and Epidemiology, New York, New York, USA
| | - Kiang Liu
- Northwestern University Medical School, Department of Preventive Medicine, Chicago, Illinois, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - Joao A C Lima
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
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