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Smiseth OA, Rider O, Cvijic M, Valkovič L, Remme EW, Voigt JU. Myocardial Strain Imaging: Theory, Current Practice, and the Future. JACC Cardiovasc Imaging 2024:S1936-878X(24)00301-2. [PMID: 39269417 DOI: 10.1016/j.jcmg.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 09/15/2024]
Abstract
Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.
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Affiliation(s)
- Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Espen W Remme
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway; The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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2
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Deshmukh T, Selvakumar D, Thavapalachandran S, Archer O, Figtree GA, Feneley M, Grieve SM, Thomas L, Pathan F, Chong JJH. Correlation of Noninvasive Cardiac MRI Measures of Left Ventricular Myocardial Function and Invasive Pressure-Volume Parameters in a Porcine Ischemia-Reperfusion Model. Radiol Cardiothorac Imaging 2024; 6:e230252. [PMID: 38842454 PMCID: PMC11211950 DOI: 10.1148/ryct.230252] [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: 08/22/2023] [Revised: 03/24/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Abstract
Purpose To assess the correlation between noninvasive cardiac MRI-derived parameters with pressure-volume (PV) loop data and evaluate changes in left ventricular function after myocardial infarction (MI). Materials and Methods Sixteen adult female swine were induced with MI, with six swine used as controls and 10 receiving platelet-derived growth factor-AB (PDGF-AB). Load-independent measures of cardiac function, including slopes of end-systolic pressure-volume relationship (ESPVR) and preload recruitable stroke work (PRSW), were obtained on day 28 after MI. Cardiac MRI was performed on day 2 and day 28 after infarct. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Ventriculo-arterial coupling (VAC) was derived from PV loop and cardiac MRI data. Pearson correlation analysis was performed. Results GCS (r = 0.60, P = .01), left ventricular ejection fraction (LVEF) (r = 0.60, P = .01), and cardiac MRI-derived VAC (r = 0.61, P = .01) had a significant linear relationship with ESPVR. GCS (r = 0.75, P < .001) had the strongest significant linear relationship with PRSW, followed by LVEF (r = 0.67, P = .005) and cardiac MRI-derived VAC (r = 0.60, P = .01). GLS was not significantly correlated with ESPVR or PRSW. There was a linear correlation (r = 0.82, P < .001) between VAC derived from cardiac MRI and from PV loop data. GCS (-3.5% ± 2.3 vs 0.5% ± 1.4, P = .007) and cardiac MRI-derived VAC (-0.6 ± 0.6 vs 0.3 ± 0.3, P = .001) significantly improved in the animals treated with PDGF-AB 28 days after MI compared with controls. Conclusion Cardiac MRI-derived parameters of MI correlated with invasive PV measures, with GCS showing the strongest correlation. Cardiac MRI-derived measures also demonstrated utility in assessing therapeutic benefit using PDGF-AB. Keywords: Cardiac MRI, Myocardial Infarction, Pressure Volume Loop, Strain Imaging, Ventriculo-arterial Coupling Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Tejas Deshmukh
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Dinesh Selvakumar
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Sujitha Thavapalachandran
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Oliver Archer
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Gemma A. Figtree
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Michael Feneley
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Stuart M. Grieve
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
| | - Liza Thomas
- From the Centre for Heart Research, Westmead Institute for Medical
Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S.,
S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead,
Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health
Sciences, Faculty of Medicine and Health, University of Sydney, Sydney,
Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group,
Kolling Institute, University of Sydney and Royal North Shore Hospital, St
Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St
Vincent’s Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics
Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia
(M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health,
Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.);
Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
(S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean,
University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology,
Nepean Hospital, Kingswood, Australia (F.P.)
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3
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Tsampasian V, Merinopoulos I, Ravindrarajah T, Ring L, Heng EL, Prasad S, Vassiliou VS. Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis. J Cardiovasc Dev Dis 2024; 11:30. [PMID: 38276656 PMCID: PMC10816900 DOI: 10.3390/jcdd11010030] [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: 12/21/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Recent data have suggested that global longitudinal strain (GLS) could be useful for risk stratification of patients with severe aortic stenosis (AS). In this study, we aimed to investigate the prognostic role of GLS in patients with AS and also its incremental value in relation to left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE). METHODS We analysed all consecutive patients with AS and LGE-CMR in our institution. Survival data were obtained from office of national statistics, a national body where all deaths in England are registered by law. Death certificates were obtained from the general register office. RESULTS Some 194 consecutive patients with aortic stenosis were investigated with CMR at baseline and followed up for 7.3 ± 4 years. On multivariate Cox regression analysis, only increasing age remained significant for both all-cause and cardiac mortality, while LGE (any pattern) retained significance for all-cause mortality and had a trend to significance for cardiac mortality. Kaplan-Meier survival analysis demonstrated that patients in the best and middle GLS tertiles had significantly better mortality compared to patients in the worst GLS tertiles. Importantly though, sequential Cox proportional-hazard analysis demonstrated that GLS did not have significant incremental prognostic value for all-cause mortality or cardiac mortality in addition to LVEF and LGE. CONCLUSIONS Our study has demonstrated that age and LGE but not GLS are significant poor prognostic indicators in patients with moderate and severe AS.
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Affiliation(s)
- Vasiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
- Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7UG, UK
| | - Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
| | - Thuwarahan Ravindrarajah
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
| | - Liam Ring
- Department of Cardiology, West Suffolk Hospital, Hardwick Ln, Bury Saint Edmunds IP33 2QZ, UK;
| | - Ee Ling Heng
- Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK;
| | - Sanjay Prasad
- Faculty of Medicine, Imperial College London, London SW7 5NH, UK;
| | - Vassilios S. Vassiliou
- Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7UG, UK
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4
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Schulz A, Lange T, Evertz R, Kowallick JT, Hasenfuß G, Backhaus SJ, Schuster A. Sex-Specific Impairment of Cardiac Functional Reserve in HFpEF: Insights From the HFpEF Stress Trial. JACC. ADVANCES 2023; 2:100327. [PMID: 38938247 PMCID: PMC11198589 DOI: 10.1016/j.jacadv.2023.100327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/06/2023] [Accepted: 02/28/2023] [Indexed: 06/29/2024]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) has been observed to have a twice as high prevalence in women compared to men with similar predisposing risk factors between both sexes. Objectives This study aimed to identify sex-specific pathophysiological features in HFpEF using rest and exercise stress right heart catheterization (RHC), echocardiography and cardiovascular magnetic resonance imaging (CMR). Methods Seventy-five patients with exertional dyspnea, preserved ejection fraction (EF) (≥50%), and signs of diastolic dysfunction on echocardiography were prospectively recruited in the HFpEF Stress Trial. Patients underwent RHC, echocardiography and CMR at rest and during exercise stress. Patients were diagnosed with HFpEF and noncardiac dyspnea according to RHC measurements. Results After exclusion, the final study cohort comprised 68 patients (females n = 44, males n = 24) with a mean age of 66.9 ± 9.7 years. Compared to men, women with HFpEF revealed lower right ventricular stroke volumes during exercise stress (females 38.1 vs males 50.4 mL/m2 BSA; P = 0.011). This was accompanied by a decreasing left atrial EF in women but not men comparing resting to exercise conditions (females -2.7% vs males 2.5%, P = 0.020) and impaired left ventricular filling (females 35.5 vs males 44.2 mL/m2 BSA, P = 0.017) in women with HFpEF during exercise stress. These sex-specific differences were not present in noncardiac dyspnea. Conclusions Women with HFpEF demonstrate sex-specific functional alterations of right ventricular, left atrial, and left ventricular function during exercise stress. This unique pathophysiology represents a sex-specific diagnostic target, which may allow early identification of women with HFpEF for future individualized therapeutic approaches.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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5
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Bourfiss M, Sander J, de Vos BD, Te Riele ASJM, Asselbergs FW, Išgum I, Velthuis BK. Towards automatic classification of cardiovascular magnetic resonance Task Force Criteria for diagnosis of arrhythmogenic right ventricular cardiomyopathy. Clin Res Cardiol 2023; 112:363-378. [PMID: 36066609 PMCID: PMC9998324 DOI: 10.1007/s00392-022-02088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is diagnosed according to the Task Force Criteria (TFC) in which cardiovascular magnetic resonance (CMR) imaging plays an important role. Our study aims to apply an automatic deep learning-based segmentation for right and left ventricular CMR assessment and evaluate this approach for classification of the CMR TFC. METHODS We included 227 subjects suspected of ARVC who underwent CMR. Subjects were classified into (1) ARVC patients fulfilling TFC; (2) at-risk family members; and (3) controls. To perform automatic segmentation, a Bayesian Dilated Residual Neural Network was trained and tested. Performance of automatic versus manual segmentation was assessed using Dice-coefficient and Hausdorff distance. Since automatic segmentation is most challenging in basal slices, manual correction of the automatic segmentation in the most basal slice was simulated (automatic-basal). CMR TFC calculated using manual and automatic-basal segmentation were compared using Cohen's Kappa (κ). RESULTS Automatic segmentation was trained on CMRs of 70 subjects (39.6 ± 18.1 years, 47% female) and tested on 157 subjects (36.9 ± 17.6 years, 59% female). Dice-coefficient and Hausdorff distance showed good agreement between manual and automatic segmentations (≥ 0.89 and ≤ 10.6 mm, respectively) which further improved after simulated correction of the most basal slice (≥ 0.92 and ≤ 9.2 mm, p < 0.001). Pearson correlation of volumetric and functional CMR measurements was good to excellent (automatic (r = 0.78-0.99, p < 0.001) and automatic-basal (r = 0.88-0.99, p < 0.001) measurements). CMR TFC classification using automatic-basal segmentations was comparable to manual segmentations (κ 0.98 ± 0.02) with comparable diagnostic performance. CONCLUSIONS Combining automatic segmentation of CMRs with correction of the most basal slice results in accurate CMR TFC classification of subjects suspected of ARVC.
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Affiliation(s)
- Mimount Bourfiss
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jörg Sander
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bob D de Vos
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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6
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Tang L, Diao K, Deng Q, Wu X, Peng P, Yue X, Wu T, Cheng W, Li Y, Zhou X, Wetzl J, Chen Y, Yue W, Sun J. Comparison between pre- and post-contrast cardiac MRI cine images: the impact on ventricular volume and strain measurement. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1055-1064. [PMID: 36840896 DOI: 10.1007/s10554-023-02809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023]
Abstract
To explore whether contrast agent administration will affect ventricular volume and strain parameters measured on cardiac magnetic resonance cine images. This prospective study enrolled 88 patients, including 32 patients with cardiac amyloidosis (CA), 32 patients with hypertrophic cardiomyopathy (HCM), and 24 control participants, to perform steady-state free precession (SSFP)-cine imaging twice, respectively before and after contrast agent injection. Indexed left and right ventricular (LV and RV) volume and LV strain parameters (peak radial strain [PRS], peak circumferential strain [PCS], peak longitudinal strain [PLS]) were analyzed and compared between the pre- and post-contrast cine groups. Compared to the group of pre-contrast cine, the end-diastolic volume index (EDVi) and end-systolic volume index (ESVi) significantly increased in the group using post-contrast cine images (all p < 0.05), especially in the right ventricle. After contrast injection, the right ventricular ejection fraction (RVEF) decreased significantly (p < 0.05), while the left ventricular ejection fraction (LVEF) only reduced for patients with HCM (p < 0.05). The PRS (37.1 ± 15.2 vs. 32.0 ± 15.4, p < 0.001) and PCS (- 14.9 ± 4.3 vs. - 14.0 ± 4.1, p < 0.001) derived from post-contrast cine images reduced significantly in all patients and this tendency remained in subgroup analysis except for PCS in the control group. The administration of a contrast agent may influence the measurements of ventricular volume and strain. Acquiring pre-contrast cine images were suggested for patients who required more accurate right ventricle evaluation or precise strain assessment.
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Affiliation(s)
- Lu Tang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Qiao Deng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xi Wu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Pengfei Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xun Yue
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Tao Wu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yangjie Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Jens Wetzl
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjun Yue
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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7
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Urmeneta Ulloa J, Pozo Osinalde E, Cabrera JA, Recio Rodríguez M, Thuissard-Vasallo IJ, Andreu-Vázquez C, Islas F, Pérez de Isla L, Marcos-Alberca P, Mahía P, Cobos MA, Cabeza B, Rodríguez-Hernández JL, Luaces Méndez M, Gómez de Diego JJ, Bustos A, Pérez-Villacastín J, de Agustín A, Martínez de Vega V. Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy. BMC Cardiovasc Disord 2023; 23:13. [PMID: 36635626 PMCID: PMC9835255 DOI: 10.1186/s12872-023-03044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.
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Affiliation(s)
- J Urmeneta Ulloa
- Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.
| | - E Pozo Osinalde
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J A Cabrera
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - M Recio Rodríguez
- Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - I J Thuissard-Vasallo
- Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | - C Andreu-Vázquez
- Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | - F Islas
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - L Pérez de Isla
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - P Marcos-Alberca
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - P Mahía
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - M A Cobos
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - B Cabeza
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | | | - M Luaces Méndez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J J Gómez de Diego
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - A Bustos
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J Pérez-Villacastín
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - A de Agustín
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - V Martínez de Vega
- Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain
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8
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Evertz R, Hub S, Kowallick JT, Seidler T, Danner BC, Hasenfuß G, Toischer K, Schuster A. Impact of observer experience on multi-detector computed tomography aortic valve morphology assessment and valve size selection for transcatheter aortic valve replacement. Sci Rep 2022; 12:21430. [PMID: 36509862 PMCID: PMC9744877 DOI: 10.1038/s41598-022-23936-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become the standard treatment for aortic stenosis in older patients. It increasingly relies on accurate pre-procedural planning using multidetector computed tomography (MDCT). Since little is known about the required competence levels for MDCT analyses, we comprehensively assessed MDCT TAVR planning reproducibility and accuracy with regard to valve selection in various healthcare workers. 20 randomly selected MDCT of TAVR patients were analyzed using dedicated software by healthcare professionals with varying backgrounds and experience (two structural interventionalists, one imaging specialist, one cardiac surgeon, one general physician, and one medical student). Following the analysis, the most appropriate Edwards SAPIEN 3™ and Medtronic CoreValve valve size was selected. Intra- and inter-observer variability were assessed. The first structural interventionalist was considered as reference standard for inter-observer comparison. Excellent intra- and inter-observer variability was found for the entire group in regard to the MDCT measurements. The best intra-observer agreement and reproducibility were found for the structural interventionalist, while the medical student had the lowest reproducibility. The highest inter-observer agreement was between both structural interventionalists, followed by the imaging specialist. As to valve size selection, the structural interventionalist showed the highest intra-observer reproducibility, independent of the brand of valve used. Compared to the reference structural interventionalist, the second structural interventionalist showed the highest inter-observer agreement for valve size selection [ICC 0.984, 95% CI 0.969-0.991] followed by the cardiac surgeon [ICC 0.947, 95%CI 0.900-0.972]. The lowest inter-observer agreement was found for the medical student [ICC 0.507, 95%CI 0.067-0.739]. While current state-of-the-art MDCT analysis software provides excellent reproducibility for anatomical measurements, the highest levels of confidence in terms of valve size selection were achieved by the performing interventional physicians. This was most likely attributable to observer experience.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sebastian Hub
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August-University, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Bernhard C Danner
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Cardiac, Thoracic and Vascular Surgery, Georg-August-University, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center Göttingen (UMG), Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany.
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9
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Fong LCW, Lee NHC, Poon JWL, Chin CWL, He B, Luo L, Chen C, Wan EYF, Pennell DJ, Mohiaddin R, Ng MY. Prognostic value of cardiac magnetic resonance derived global longitudinal strain analysis in patients with ischaemic and non-ischaemic dilated cardiomyopathy: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2022; 38:2707-2721. [DOI: 10.1007/s10554-022-02679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022]
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10
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Morales MA, Cirillo J, Nakata K, Kucukseymen S, Ngo LH, Izquierdo-Garcia D, Catana C, Nezafat R. Comparison of DeepStrain and Feature Tracking for Cardiac MRI Strain Analysis. J Magn Reson Imaging 2022; 57:1507-1515. [PMID: 35900119 DOI: 10.1002/jmri.28374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Myocardial feature tracking (FT) provides a comprehensive analysis of myocardial deformation from cine balanced steady-state free-precession images (bSSFP). However, FT remains time-consuming, precluding its clinical adoption. PURPOSE To compare left-ventricular global radial strain (GRS) and global circumferential strain (GCS) values measured using automated DeepStrain analysis of short-axis cine images to those calculated using manual commercially available FT analysis. STUDY TYPE Retrospective, single-center. POPULATION A total of 30 healthy subjects and 120 patients with cardiac disease for DeepStrain development. For evaluation, 47 healthy subjects (36 male, 53 ± 5 years) and 533 patients who had undergone a clinical cardiac MRI (373 male, 59 ± 14 years). FIELD STRENGTH/SEQUENCE: bSSFP sequence at 1.5 T (Phillips) and 3 T (Siemens). ASSESSMENT Automated DeepStrain measurements of GRS and GCS were compared to commercially available FT (Circle, cvi42) measures obtained by readers with 1 year and 3 years of experience. Comparisons were performed overall and stratified by scanner manufacturer. STATISTICAL TESTS Paired t-test, linear regression slope, Pearson correlation coefficient (r). RESULTS Overall, FT and DeepStrain measurements of GCS were not significantly different (P = 0.207), but measures of GRS were significantly different. Measurements of GRS from Philips (slope = 1.06 [1.03 1.08], r = 0.85) and Siemens (slope = 1.04 [0.99 1.09], r = 0.83) data showed a very strong correlation and agreement between techniques. Measurements of GCS from Philips (slope = 0.98 [0.98 1.01], r = 0.91) and Siemens (slope = 1.0 [0.96 1.03], r = 0.88) data similarly showed a very strong correlation. The average analysis time per subject was 4.1 ± 1.2 minutes for FT and 34.7 ± 3.3 seconds for DeepStrain, representing a 7-fold reduction in analysis time. DATA CONCLUSION This study demonstrated high correlation of myocardial GCS and GRS measurements between freely available fully automated DeepStrain and commercially available manual FT software, with substantial time-saving in the analysis. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Cirillo
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kei Nakata
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Long H Ngo
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David Izquierdo-Garcia
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Ciprian Catana
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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11
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Left ventricular dysfunction and intra-ventricular dyssynchrony in idiopathic pulmonary arterial hypertension. Int J Cardiol 2022; 365:131-139. [PMID: 35870633 DOI: 10.1016/j.ijcard.2022.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/27/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Left ventricular (LV) filling pressures are normal in idiopathic pulmonary arterial hypertension (IPAH). However, direct and indirect interactions between the RV and LV can affect LV performance. We explored LV strain and LV intra-ventricular dyssynchrony in IPAH using feature tracking CMR (CMR-FT). METHODS Seventy IPAH patients and 40 healthy volunteers were included. Patients underwent CMR and right heart catheterisation. The 4-chamber cine was used to calculate LV longitudinal strain (EllLV). LV circumferential (EccLV) and radial strain (ErrLV) were derived from a short axis cine. LV longitudinal, circumferential and radial intra-ventricular dyssynchrony indices were calculated. RESULTS There were no differences between the IPAH and healthy volunteer group in LV ejection fraction (66.1% vs 64.2% p = 0.6672). EccLV (-29.1 vs -32.1 p = 0.0323) and EllLV (-16.6 vs -23.7 p < 0.0001) were lower in IPAH. In patients with more severe disease, there was greater impairment of ErrLV compared to mild disease (50.9 vs 87.5 P < 0.0001). LV synchrony was impaired in all directions in IPAH. ErrLV was associated with RV ejection fraction (r = 0.66), RV end-systolic volume index (r = -0.59), pulmonary vascular resistance (PVR)(r = 0.51) and stroke volume index (SVI)(r = 0.44). In a multivariate model with age, SVI and PVR, ErrLV (HR 0.970 p = 002) and radial dyssynchrony (HR 3.759 p < 0.0001) independently predicted survival. CONCLUSION In IPAH, LV is dyssynchronous with impaired function. Measures of LV strain and intraventricular synchrony were associated with known markers of disease severity. These LV variables which are likely to be related to ventricular interaction, may add incremental value to known prognostic variables in IPAH.
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12
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Dey N, V. R. Abnormality detection in heart MRI with spotted hyena algorithm-supported Kapur/Otsu thresholding and level set segmentation. Magn Reson Imaging 2022. [DOI: 10.1016/b978-0-12-823401-3.00006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Overhoff D, Ansari U, Hohneck A, Tülümen E, Rudic B, Kuschyk J, Lossnitzer D, Baumann S, Froelich MF, Waldeck S, Akin I, Borggrefe M, Schoenberg SO, Papavassiliu T. Prediction of cardiac events with non-contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy. ESC Heart Fail 2021; 9:574-584. [PMID: 34818694 PMCID: PMC8788051 DOI: 10.1002/ehf2.13712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/24/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.
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Affiliation(s)
- Daniel Overhoff
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.,Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Uzair Ansari
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Anna Hohneck
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Boris Rudic
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan Baumann
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Stephan Waldeck
- Department of Radiology and Neuroradiology, German Federal Armed Forces Central Hospital, Koblenz, Germany
| | - Ibrahim Akin
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Heidelberg, D-68167, Germany.,DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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14
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Holtackers RJ, Wildberger JE, Wintersperger BJ, Chiribiri A. Impact of Field Strength in Clinical Cardiac Magnetic Resonance Imaging. Invest Radiol 2021; 56:764-772. [PMID: 34261084 DOI: 10.1097/rli.0000000000000809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Cardiac magnetic resonance imaging (MRI) is widely applied for the noninvasive assessment of cardiac structure and function, and for tissue characterization. For more than 2 decades, 1.5 T has been considered the field strength of choice for cardiac MRI. Although the number of 3-T systems significantly increased in the past 10 years and numerous new developments were made, challenges seem to remain that hamper a widespread clinical use of 3-T MR systems for cardiac applications. As the number of clinical cardiac applications is increasing, with each having their own benefits at both field strengths, no "holy grail" field strength exists for cardiac MRI that one should ideally use. This review describes the physical differences between 1.5 and 3 T, as well as the effect of these differences on major (routine) cardiac MRI applications, including functional imaging, edema imaging, late gadolinium enhancement, first-pass stress perfusion, myocardial mapping, and phase contrast flow imaging. For each application, the advantages and limitations at both 1.5 and 3 T are discussed. Solutions and alternatives are provided to overcome potential limitations. Finally, we briefly elaborate on the potential use of alternative field strengths (ie, below 1.5 T and above 3 T) for cardiac MRI and conclude with field strength recommendations for the future of cardiac MRI.
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15
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Recovery of right ventricular function and strain in patients with ST-segment elevation myocardial infarction and concurrent chronic total occlusion. Int J Cardiovasc Imaging 2021; 38:631-641. [PMID: 34554368 PMCID: PMC8926979 DOI: 10.1007/s10554-021-02423-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/16/2021] [Indexed: 12/04/2022]
Abstract
The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (− 26.0 ± 8.3% versus − 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.
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Abstract
PURPOSE OF REVIEW Takotsubo syndrome (TTS) is a transient but severe myocardial dysfunction that has been known for decades and is still to be fully understood regarding its clinical presentations and pathophysiological mechanisms. Cardiac magnetic resonance (CMR) imaging plays a key role in the comprehensive analysis of patients with TTS in acute and follow-up examinations. In this review, we focus on the major advantages and latest evolutions of CMR in diagnosis and prognostication of TTS and discuss future perspectives and needs in the field of research and cardiovascular imaging in TTS. RECENT FINDINGS Specific CMR criteria for TTS diagnosis at the time of acute presentation are established. In addition to identifying the typical regional wall motion abnormalities, CMR allows for precise quantification of right ventricular and left ventricular (LV) function, the assessment of additional abnormalities/complications (e.g. pericardial and/or pleural effusion, LV thrombi), and most importantly myocardial tissue characterization (myocardial oedema, inflammation, necrosis/fibrosis). CMR enables a comprehensive assessment of the entire spectrum of functional and structural changes that occur in patients with TTS and may have also a prognostic impact. CMR can distinguish between TTS and other important differential diagnoses (myocarditis, myocardial infarction) with direct consequences on medical therapy.
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Affiliation(s)
- Philipp-Johannes Jensch
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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17
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Backhaus SJ, Metschies G, Billing M, Schmidt-Rimpler J, Kowallick JT, Gertz RJ, Lapinskas T, Pieske-Kraigher E, Pieske B, Lotz J, Bigalke B, Kutty S, Hasenfuß G, Kelle S, Schuster A. Defining the optimal temporal and spatial resolution for cardiovascular magnetic resonance imaging feature tracking. J Cardiovasc Magn Reson 2021; 23:60. [PMID: 34001175 PMCID: PMC8127257 DOI: 10.1186/s12968-021-00740-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Myocardial deformation analyses using cardiovascular magnetic resonance (CMR) feature tracking (CMR-FT) have incremental value in the assessment of cardiac function beyond volumetric analyses. Since guidelines do not recommend specific imaging parameters, we aimed to define optimal spatial and temporal resolutions for CMR cine images to enable reliable post-processing. METHODS Intra- and inter-observer reproducibility was assessed in 12 healthy subjects and 9 heart failure (HF) patients. Cine images were acquired with different temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolutions (high in-plane 1.5 × 1.5 mm through-plane 5 mm, standard 1.8 × 1.8 x 8mm and low 3.0 × 3.0 x 10mm). CMR-FT comprised left ventricular (LV) global and segmental longitudinal/circumferential strain (GLS/GCS) and associated systolic strain rates (SR), and right ventricular (RV) GLS. RESULTS Temporal but not spatial resolution did impact absolute strain and SR. Maximum absolute changes between lowest and highest temporal resolution were as follows: 1.8% and 0.3%/s for LV GLS and SR, 2.5% and 0.6%/s for GCS and SR as well as 1.4% for RV GLS. Changes of strain values occurred comparing 20 and 30 frames/cardiac cycle including LV and RV GLS and GCS (p < 0.001-0.046). In contrast, SR values (LV GLS/GCS SR) changed significantly comparing all successive temporal resolutions (p < 0.001-0.013). LV strain and SR reproducibility was not affected by either temporal or spatial resolution, whilst RV strain variability decreased with augmentation of temporal resolution. CONCLUSION Temporal but not spatial resolution significantly affects strain and SR in CMR-FT deformation analyses. Strain analyses require lower temporal resolution and 30 frames/cardiac cycle offer consistent strain assessments, whilst SR measurements gain from further increases in temporal resolution.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marcus Billing
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Jonas Schmidt-Rimpler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Roman J. Gertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elisabeth Pieske-Kraigher
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD 21287 USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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18
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Quantification of Myocardial Deformation Applying CMR-Feature-Tracking-All About the Left Ventricle? Curr Heart Fail Rep 2021; 18:225-239. [PMID: 33931818 PMCID: PMC8342400 DOI: 10.1007/s11897-021-00515-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
Purpose of Review Cardiac magnetic resonance-feature-tracking (CMR-FT)-based deformation analyses are key tools of cardiovascular imaging and applications in heart failure (HF) diagnostics are expanding. In this review, we outline the current range of application with diagnostic and prognostic implications and provide perspectives on future trends of this technique. Recent Findings By applying CMR-FT in different cardiovascular diseases, increasing evidence proves CMR-FT-derived parameters as powerful diagnostic and prognostic imaging biomarkers within the HF continuum partly outperforming traditional clinical values like left ventricular ejection fraction. Importantly, HF diagnostics and deformation analyses by CMR-FT are feasible far beyond sole left ventricular performance evaluation underlining the holistic nature and accuracy of this imaging approach. Summary As an established and continuously evolving technique with strong prognostic implications, CMR-FT deformation analyses enable comprehensive cardiac performance quantification of all cardiac chambers.
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19
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Evaluation of Myocardial Strain Using Cardiac Magnetic Resonance in Patients with Wilson's Disease. J Clin Med 2021; 10:jcm10020335. [PMID: 33477453 PMCID: PMC7830163 DOI: 10.3390/jcm10020335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Wilson’s disease (WD) is an inherited autosomal recessive disorder with the excessive deposition of copper into different organs, including the heart. Previous studies showed structural cardiac changes even in patients with no signs of heart failure. The aim of this study was to perform cardiac magnetic resonance-based strain analysis in WD patients, as it is a powerful independent predictor of mortality. (2) Methods: We conducted a prospective cardiac magnetic resonance study that included 61 patients and 61 age and sex-matched controls, and performed strain analysis of the left and right ventricle. (3) Results: Left ventricular global longitudinal strain (GLS) as a prognostic marker of increased mortality was not altered (control −22.8 (4.8) % vs. WD patients −21.8 (5.1) %, p = 0.124). However, 4 of the 61 patients had a markedly reduced GLS. Global circumferential strain did not significantly differ between the groups either (p = 0.534). WD patients had significantly reduced global radial strain (p = 0.002). Right ventricular GLS was also significantly reduced in WD patients (p = 0.01). (4) Conclusions: Strain analysis revealed functional impairment of the left and right ventricle in a small number of patients as a potential early sign of cardiac manifestation in asymptomatic WD patients.
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20
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Lim C, Blaszczyk E, Riazy L, Wiesemann S, Schüler J, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Quantification of myocardial strain assessed by cardiovascular magnetic resonance feature tracking in healthy subjects-influence of segmentation and analysis software. Eur Radiol 2020; 31:3962-3972. [PMID: 33277669 PMCID: PMC8128822 DOI: 10.1007/s00330-020-07539-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/16/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Objectives Quantification of myocardial deformation by feature tracking is of growing interest in cardiovascular magnetic resonance. It allows the assessment of regional myocardial function based on cine images. However, image acquisition, post-processing, and interpretation are not standardized. We aimed to assess the influence of segmentation procedure such as slice selection and different types of analysis software on values and quantification of myocardial strain in healthy adults. Methods Healthy volunteers were retrospectively analyzed. Post-processing was performed using CVI42 and TomTec. Longitudinal and radialLong axis (LAX) strain were quantified using 4-chamber-view, 3-chamber-view, and 2-chamber-view. Circumferential and radialShort axis (SAX) strain were assessed in basal, midventricular, and apical short-axis views and using full coverage. Global and segmental strain values were compared to each other regarding their post-processing approach and analysis software package. Results We screened healthy volunteers studied at 1.5 or 3.0 T and included 67 (age 44.3 ± 16.3 years, 31 females). Circumferential and radialSAX strain values were different between a full coverage approach vs. three short slices (− 17.6 ± 1.8% vs. − 19.2 ± 2.3% and 29.1 ± 4.8% vs. 34.6 ± 7.1%). Different analysis software calculated significantly different strain values. Within the same vendor, different field strengths (− 17.0 ± 2.1% at 1.5 T vs. − 17.0 ± 1.7% at 3 T, p = 0.845) did not influence the calculated global longitudinal strain (GLS), and were similar in gender (− 17.4 ± 2.0% in females vs. − 16.6 ± 1.8% in males, p = 0.098). Circumferential and radial strain were different in females and males (circumferential strain − 18.2 ± 1.7% vs. − 17.1 ± 1.8%, p = 0.029 and radial strain 30.7 ± 4.7% vs. 27.8 ± 4.6%, p = 0.047). Conclusions Myocardial deformation assessed by feature tracking depends on segmentation procedure and type of analysis software. CircumferentialSAX and radialSAX depend on the number of slices used for feature tracking analysis. As known from other imaging modalities, GLS seems to be the most stable parameter. During follow-up studies, standardized conditions should be warranted. Trial registration Retrospectively registered Key Points • Myocardial deformation assessed by feature tracking depends on the segmentation procedure. • Global myocardial strain values differ significantly among vendors. • Standardization in post-processing using CMR feature tracking is essential. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07539-5.
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Affiliation(s)
- Carolin Lim
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Edyta Blaszczyk
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Leili Riazy
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Berlin Ultrahigh Field Facility at the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Stephanie Wiesemann
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Johannes Schüler
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians - University München, Hausham, Germany
| | - Jeanette Schulz-Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.
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21
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Maceira AM, Guardiola S, Ripoll C, Cosin-Sales J, Belloch V, Salazar J. Detection of subclinical myocardial dysfunction in cocaine addicts with feature tracking cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:70. [PMID: 32981526 PMCID: PMC7520970 DOI: 10.1186/s12968-020-00663-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cocaine is an addictive, sympathomimetic drug with potentially lethal effects. We have previously shown with cardiovascular magnetic resonance (CMR) the presence of cardiovascular involvement in a significant percentage of consecutive asymptomatic cocaine addicts. CMR with feature-tracking analysis (CMR-FT) allows for the quantification of myocardial deformation which may detect preclinical involvement. Therefore, we aimed to assess the effects of cocaine on the left ventricular myocardium in a group of asymptomatic cocaine users with CMR-FT. METHODS In a cohort of asymptomatic cocaine addicts (CA) who had been submitted to CMR at 3 T, we used CMR-FT to measure strain, strain rate and dyssynchrony index in CA with mildly decreased left ventricular ejection fraction (CA-LVEFd) and in CA with preserved ejection fraction (CA-LVEFp). We also measured these parameters in 30 age-matched healthy subjects. RESULTS There were no differences according to age. Significant differences were seen in global longitudinal, radial and circumferential strain, in global longitudinal and radial strain rate and in radial and circumferential dyssynchrony index among the groups, with the lowest values in CA-LVEFd and intermediate values in CA-LVEFp. Longitudinal, radial and circumferential strain values were significantly lower in CA-LVEFp with respect to controls. CONCLUSIONS CA-LVEFp show decreased systolic strain and strain rate values, with intermediate values between healthy controls and CA-LVEFd. Signs suggestive of dyssynchrony were also detected. In CA, CMR-FT based strain analysis can detect early subclinical myocardial involvement.
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Affiliation(s)
- Alicia M. Maceira
- Cardiovascular Unit, Ascires Biomedical Grup, C/ Marques de San Juan Nº6, 46015, Valencia, Spain
- Department of Medicine, Health Sciences School, CEU-Cardenal Herrera University, C/ Santiago Ramón y Cajal, s/n, 46115 Alfara del Patriarca, Moncada-Valencia, Spain
| | - Sara Guardiola
- Cardiovascular Unit, Ascires Biomedical Grup, C/ Marques de San Juan Nº6, 46015, Valencia, Spain
| | - Carmen Ripoll
- Addictions Treatment Unit of Campanar, La Fe Hospital, Valencia, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Vicente Belloch
- Cardiovascular Unit, Ascires Biomedical Grup, C/ Marques de San Juan Nº6, 46015, Valencia, Spain
| | - Jose Salazar
- Department of Psychiatry, Hospital General Universitario, Valencia, Spain
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22
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Kachenoura N, Bollache E, Soulat G, Clément-Guinaudeau S, Ashrafpoor G, Perdrix L, Diebold B, Ladouceur M, Mousseaux E. Right ventricular diastolic function in aging: a head-to-head comparison between phase-contrast MRI and Doppler echocardiography. Int J Cardiovasc Imaging 2020; 37:663-674. [PMID: 32980983 DOI: 10.1007/s10554-020-02040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
To evaluate right ventricle (RV) diastolic function from phase-contrast MRI (PC-MRI) in aging. 89 healthy individuals (50 men, 43 ± 15 years) underwent cardiac MRI including 2D PC-MRI (1.5T) and reference Doppler echocardiography of both ventricles on the same day. Conventional echocardiographic parameters were estimated: early (E, cm/s) and atrial (A) peak velocities as well as myocardial early peak longitudinal velocity (E'). PC-MRI images were analyzed using custom software, providing: E', E and A waves along with respective peak flow rates (Ef, Af, mL/s) and filling volume (mL), for both ventricles. Intra- and inter-observer reproducibility was studied in 30 subjects and coefficients of variation (CoV) as well as intra-class correlation coefficients (ICC) were provided. RV diastolic function indices derived from PC-MRI data were reproducible (CoV ≤ 21%, ICC ≥ 0.75) and reliable as reflected by significant associations with left ventricular diastolic function indices assessed using both echocardiography (linear regression Pearson correlation coefficient r ≤ 0.59) and PC-MRI (r ≤ 71). Despite the fair associations between RV echocardiography and PC-MRI (r ≤ 0.25), the highest correlation with age was obtained for MRI Ef/Af ratio (r = - 0.64, p < 0.0001 vs. r = - 0.40, p = 0.0001 for echocardiographic E/A). Among PC-MRI E/A ratios, highest correlations with age were observed for flow rate and mean velocity ratios (r = - 0.61, p < 0.0001) as compared to maximal velocity ratios (r = - 0.56, p < 0.0001). Associations with age for E' were equivalent between PC-MRI (mean velocity: r = - 0.40, p < 0.0001; maximal velocity: r = - 0.36, p = 0.0005) and echocardiography (r = - 0.36, p = 0.0006). Finally, the significant and age-independent associations between RV mass/end-diastolic volume and E' were stronger for PC-MRI (mean velocity: r = - 0.36, p = 0.0006; maximal velocity: r = - 0.28, p = 0.007) than echocardiography (r = - 0.09, p = 0.38). PC-MRI tricuspid inflow and annulus myocardial velocity parameters were reproducible and able to characterize age-related variations in RV diastolic function.
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Affiliation(s)
- Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.
| | - Emilie Bollache
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France
| | - Gilles Soulat
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | | | - Golmehr Ashrafpoor
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Ludivine Perdrix
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Benoit Diebold
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.,PARCC, INSERM, Université de Paris, 75015, Paris, France
| | - Magalie Ladouceur
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Elie Mousseaux
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
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23
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Backhaus SJ, Metschies G, Zieschang V, Erley J, Mahsa Zamani S, Kowallick JT, Lapinskas T, Pieske B, Lotz J, Kutty S, Hasenfuß G, Kelle S, Schuster A. Head-to-head comparison of cardiovascular MR feature tracking cine versus acquisition-based deformation strain imaging using myocardial tagging and strain encoding. Magn Reson Med 2020; 85:357-368. [PMID: 32851707 DOI: 10.1002/mrm.28437] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Myocardial feature-tracking (FT) deformation imaging is superior for risk stratification compared with volumetric approaches. Because there is no clear recommendation regarding FT postprocessing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain-encoded (SENC) MRI. METHODS Feature-tracking software from four different vendors (TomTec, Medis, Circle [CVI], and Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential strains (GCS) and longitudinal strains (GLS) in 12 healthy volunteers and 12 patients with heart failure. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as Pearson correlation coefficients. RESULTS For FT-GCS, consistency was excellent comparing different FT vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and in comparison to fast SENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared with tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements among FT vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared with both tagging and fast SENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64), and lowest for TomTec (ICCa = 0.41 and 0.47). For FT-GLS, consistency was excellent (ICCc ≥ 0.86, r ≥ 0.76). Absolute agreements among FT vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared with tagging, but excellent compared with fast SENC (ICCa = 0.77-0.90). CONCLUSION Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high regardless of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Victoria Zieschang
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Jennifer Erley
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Seyedeh Mahsa Zamani
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
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von Knobelsdorff-Brenkenhoff F, Schunke T, Reiter S, Scheck R, Höfling B, Pilz G. Influence of contrast agent and spatial resolution on myocardial strain results using feature tracking MRI. Eur Radiol 2020; 30:6099-6108. [PMID: 32472273 DOI: 10.1007/s00330-020-06971-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/10/2020] [Accepted: 05/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Feature tracking for assessing myocardial strain from cardiac magnetic resonance (CMR) cine images detects myocardial deformation abnormalities with prognostic implication, e.g., in myocardial infarction and cardiomyopathy. Standards for image acquisition and processing are not yet available. Study aim was analyzing the influence of spatial resolution and contrast agent on myocardial strain results. METHODS Seventy-five patients underwent CMR for analyzing peak systolic circumferential, longitudinal, and radial strain. Group A included n = 50 with normal left ventricular ejection fraction, no wall motion abnormality, and no fibrosis on late enhancement imaging. Group B included n = 25 with chronic myocardial infarct. For feature tracking, steady-state free precession cine images were acquired repeatedly. (1) Native standard cine (spatial resolution 1.4 × 1.4 × 8 mm3). (2) Native cine with lower spatial resolution (2.0 × 2.0 × 8 mm3). (3) Cine equal to variant 1 acquired after administration of gadoteracid. RESULTS Lower spatial resolution was associated with elevated longitudinal strain (- 21.7% vs. - 19.8%; p < 0.001) in viable myocardium in group A, and with elevated longitudinal (- 17.0% vs. - 14.3%; p = 0.001), circumferential (- 18.6% vs. - 14.6%; p = 0.002), and radial strain (36.8% vs. 31.0%; p = 0.013) in infarcted myocardium in group B. Gadolinium administration was associated with reduced circumferential (- 21.4% vs. - 22.3%; p = 0.001) and radial strain (44.4% vs. 46.9%; p = 0.016) in group A, whereas strain results of the infarcted tissue in group B did not change after contrast agent administration. CONCLUSIONS Variations in spatial resolution and the administration of contrast agent may influence myocardial strain results in viable and partly in infarcted myocardium. Standardized image acquisition seems important for CMR feature tracking. KEY POINTS • Feature tracking is used for calculating myocardial strain from cardiac magnetic resonance (CMR) cine images. • This prospective study demonstrated that CMR strain results may be influenced by spatial resolution and by the administration of gadolinium-based contrast agent. • The results underline the need for standardized image acquisition for CMR strain analysis, with constant imaging parameters and without contrast agent.
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Affiliation(s)
- Florian von Knobelsdorff-Brenkenhoff
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, Hausham, Agatharied, 83734, Munich, Germany.
| | - Tobias Schunke
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, Hausham, Agatharied, 83734, Munich, Germany
| | - Stephanie Reiter
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, Hausham, Agatharied, 83734, Munich, Germany
| | - Roland Scheck
- Radiology Oberland, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Agatharied, Munich, Germany
| | - Berthold Höfling
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, Hausham, Agatharied, 83734, Munich, Germany
| | - Günter Pilz
- Department of Cardiology, Clinic Agatharied, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, Hausham, Agatharied, 83734, Munich, Germany
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Bucius P, Erley J, Tanacli R, Zieschang V, Giusca S, Korosoglou G, Steen H, Stehning C, Pieske B, Pieske-Kraigher E, Schuster A, Lapinskas T, Kelle S. Comparison of feature tracking, fast-SENC, and myocardial tagging for global and segmental left ventricular strain. ESC Heart Fail 2019; 7:523-532. [PMID: 31800152 PMCID: PMC7160507 DOI: 10.1002/ehf2.12576] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/10/2019] [Accepted: 11/11/2019] [Indexed: 01/11/2023] Open
Abstract
AIMS A multitude of cardiac magnetic resonance (CMR) techniques are used for myocardial strain assessment; however, studies comparing them are limited. We sought to compare global longitudinal (GLS), circumferential (GCS), segmental longitudinal (SLS), and segmental circumferential (SCS) strain values, as well as reproducibility between CMR feature tracking (FT), tagging (TAG), and fast-strain-encoded (fast-SENC) CMR techniques. METHODS AND RESULTS Eighteen subjects (11 healthy volunteers and seven patients with heart failure) underwent two CMR scans (1.5T, Philips) with identical parameters. Global and segmental strain values were measured using FT (Medis), TAG (Medviso), and fast-SENC (Myocardial Solutions). Friedman's test, linear regression, Pearson's correlation coefficient, and Bland-Altman analyses were used to assess differences and correlation in measured GLS and GCS between the techniques. Two-way mixed intra-class correlation coefficient (ICC), coefficient of variance (COV), and Bland-Altman analysis were used for reproducibility assessment. All techniques correlated closely for GLS (Pearson's r: 0.86-0.92) and GCS (Pearson's r: 0.85-0.94). Intra-observer and inter-observer reproducibility was excellent in all techniques for both GLS (ICC 0.92-0.99, CoV 2.6-10.1%) and GCS (ICC 0.89-0.99, CoV 4.3-10.1%). Inter-study reproducibility was similar for all techniques for GLS (ICC 0.91-0.96, CoV 9.1-10.8%) and GCS (ICC 0.95-0.97, CoV 7.6-10.4%). Combined segmental intra-observer reproducibility was good in all techniques for SLS (ICC 0.914-0.953, CoV 12.35-24.73%) and SCS (ICC 0.885-0.978, CoV 10.76-19.66%). Combined inter-study SLS reproducibility was the worst in FT (ICC 0.329, CoV 42.99%), while fast-SENC performed the best (ICC 0.844, CoV 21.92%). TAG had the best reproducibility for combined inter-study SCS (ICC 0.902, CoV 19.08%), while FT performed the worst (ICC 0.766, CoV 32.35%). Bland-Altman analysis revealed considerable inter-technique biases for GLS (FT vs. fast-SENC 3.71%; FT vs. TAG 8.35%; and TAG vs. fast-SENC 4.54%) and GCS (FT vs. fast-SENC 2.15%; FT vs. TAG 6.92%; and TAG vs. fast-SENC 2.15%). Limits of agreement for GLS ranged from ±3.1 (TAG vs. fast-SENC) to ±4.85 (FT vs. TAG) for GLS and ±2.98 (TAG vs. fast-SENC) to ±5.85 (FT vs. TAG) for GCS. CONCLUSIONS We found significant differences in measured GLS and GCS between FT, TAG, and fast-SENC. Global strain reproducibility was excellent for all techniques. Acquisition-based techniques had better reproducibility than FT for segmental strain.
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Affiliation(s)
- Paulius Bucius
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jennifer Erley
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sorin Giusca
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Grigorious Korosoglou
- Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Henning Steen
- Department of Internal Medicine/Cardiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | | | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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Effect of comprehensive initial training on the variability of left ventricular measures using fast-SENC cardiac magnetic resonance imaging. Sci Rep 2019; 9:12223. [PMID: 31434950 PMCID: PMC6704124 DOI: 10.1038/s41598-019-48685-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
Cardiac magnetic resonance (CMR) is becoming the imaging modality of choice in multicenter studies where highly reproducible measurements are necessary. The purpose of this study was to assess the effect of comprehensive initial training on reproducibility of quantitative left ventricular (LV) parameters estimated using strain-encoded (SENC) imaging. Thirty participants (10 patients with heart failure (HF) and preserved LV ejection fraction (HFpEF), 10 patients with HF and reduced LV ejection fraction (HFrEF) and 10 healthy volunteers) were examined using fast-SENC imaging. Four observers with different experience in non-invasive cardiac imaging completed comprehensive initial training course and were invited to perform CMR data analysis. To assess agreement between observers, LV volumes, mass, ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) were estimated using dedicated software (MyoStrain, USA). To test intraobserver agreement data analysis was repeated after 4 weeks. SENC imaging and analysis were fast and were completed in less than 5 minutes. LV end-diastolic volume index (LVEDVi), LVEF and strain were significantly lower in HFpEF patients than in healthy volunteers (p = 0.019 for LVEDVi; p = 0.023 for LVEF; p = 0.004 for GLS and p < 0.001 for GCS). All LV functional parameters were further reduced in HFrEF. Excellent interobserver agreement was found for all LV parameters independently of the level of experience. The reproducibility of LV mass was lower, especially at the intraobserver level (ICC 0.91; 95% CI 0.74–0.96). LV volumetric and functional parameters derived using fast-SENC imaging, are highly reproducible. The appropriate initial training is relevant and allows to achieve highest concordance in fast-SENC measurements.
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