1
|
Lindholm A, Kjellström B, Rådegran G, Arheden H, Ostenfeld E. Right ventricular dyssynchrony predicts outcome in pulmonary arterial hypertension when assessed in multiple CMR views. J Cardiovasc Magn Reson 2024:101103. [PMID: 39326558 DOI: 10.1016/j.jocmr.2024.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 09/09/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Right ventricular (RV) dyssynchrony or post systolic contraction (PSC) cause inefficient pumping and have not been investigated as prognostic markers in pulmonary arterial hypertension (PAH). OBJECTIVES To investigate if RV dyssynchrony and PSC are prognostic markers of transplantation-free survival in PAH and if multiple RV views improve the prognostication. METHODS Patients with PAH undergoing cardiac magnetic resonance (CMR) between 2003-2021 were included. For strain analysis, endocardial end-diastolic RV contours were delineated in RV 3-chamber (RV3ch), 4-chamber (4ch) and midventricular short axis slice (SAX). RV dyssynchrony was defined as standard deviation of time to peak strain in the walls from one (4ch), two (4ch and SAX) or three views (4ch, SAX and RV3ch). PSC was defined as peak strain occurring after pulmonary valve closure. Outcome was defined as death or lung transplantation. RESULTS One hundred-one patients (58±19 years, 66% women) were included. Median follow-up was 37 [51] months. There were 60 events (55 deaths and 5 lung transplantations). Outcome was associated with RV dyssynchrony from three views and with RV strain in 4ch. An increase of RV dyssynchrony - from 3 views - by 1% was associated with a 10% increased risk of lung transplantation or death. There was no association between outcome and RV dyssynchrony in one or two views nor with PSC. CONCLUSION Right ventricular dyssynchrony from three views were associated with outcome in PAH, whereas assessing dyssynchrony from one or two views and PSC were not. This implies that assessment of multiple instead of single RV views potentially could be used for prognostication in PAH.
Collapse
Affiliation(s)
- Anthony Lindholm
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund, Sweden
| | - Barbro Kjellström
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund, Sweden
| | - Göran Rådegran
- Lund University, Department of Clinical Sciences Lund, Cardiology, and the Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund, Sweden
| |
Collapse
|
2
|
Corbett L, O'Driscoll P, Paton M, Oxborough D, Surkova E. Role and application of three-dimensional transthoracic echocardiography in the assessment of left and right ventricular volumes and ejection fraction: a UK nationwide survey. Echo Res Pract 2024; 11:8. [PMID: 38566154 PMCID: PMC10988951 DOI: 10.1186/s44156-024-00044-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Three-dimensional echocardiography (3DE) imaging has permitted advancements in the quantification of left ventricular (LV) and right ventricular (RV) volumes and ejection fraction. We evaluated the availability of 3DE equipment / analysis software, the integration of 3DE assessment of the LV and RV in routine clinical practice, current training provisions in 3DE, and aimed to ascertain barriers preventing the routine use of 3DE for volumetric analysis. Through the British Society of Echocardiography (BSE) regional representatives' network, echocardiographers were invited to participate in an open online survey. A total of 181 participants from echocardiography departments in the United Kingdom (UK), the majority from tertiary centres (61%), completed the 28-question survey. For 3DE quantification, 3DE-LV was adopted more frequently than 3DE-RV (48% vs 11%, respectively). Imaging feasibility was a recognised factor in 3DE RV and LV adoption. Many respondents had access to 3D probes (93%). The largest observed barriers to 3DE routine use were training deficiencies, with 83% reporting they would benefit from additional training opportunities and the duration of time permitted for the scan, with 68% of responders reporting allowances of less than the BSE standard of 45-60 min per patient (8% < 30-min). Furthermore, of those respondents who had undertaken professional accreditation, competence in 3DE was not formally assessed in 89%. This UK survey also reported good accessibility to magnetic resonance imaging (72%), which was related to overall 3DE adoption. In summary, although 3DE is now readily available, it remains underutilised. Further training opportunities, integrated formal assessment, improved adoption of BSE minimum recommended scanning times, alongside industry and societal support, may increase 3DE utilisation in routine practice.
Collapse
Affiliation(s)
- Liam Corbett
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
| | | | | | - David Oxborough
- Research Institute of Sports and Exercise Science and Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Elena Surkova
- Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
3
|
Yamano M, Yamano T, Matoba S. Right ventricular dilatation: echocardiographic differential diagnosis. J Med Ultrason (2001) 2024; 51:275-282. [PMID: 38228943 DOI: 10.1007/s10396-023-01399-4] [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: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected, there is the possibility of RV volume overload, RV pressure overload, RV myocardial disease, and even nonpathological RV dilatation. With respect to congenital heart disease with RV volume overload, defects or valvular abnormalities can be easily detected with TTE, with the exception of some diseases. Volumetric assessment using three-dimensional echocardiography may be useful in determining the intervention timing in these diseases. When the disease progresses in patients with pulmonary hypertension as a result of RV pressure overload, RV dilatation becomes more prominent than hypertrophy, and RV functional parameters predict the prognosis at this stage of maladaptive remodeling. The differential diagnosis of cardiomyopathy or comparison with nonpathological RV dilatation may be difficult in the setting of RV myocardial disease. The characteristics of RV functional parameters such as two-dimensional speckle tracking may help differentiate RV cardiomyopathy from other conditions. We review the diseases presenting with RV dilatation, their characteristics, and echocardiographic findings and parameters that are significant in assessing their status or intervention timing.
Collapse
Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| |
Collapse
|
4
|
Hagendorff A, Kandels J, Metze M, Tayal B, Stöbe S. Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking? Diagnostics (Basel) 2023; 13:1359. [PMID: 37046577 PMCID: PMC10093440 DOI: 10.3390/diagnostics13071359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.
Collapse
Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Bhupendar Tayal
- Harrington Heart and Vascular Center, Department of Cardiology, University Hospitals, Cleveland, OH 44106, USA;
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| |
Collapse
|
5
|
Elhawary EE, Tolba OA, Elkaffas AA, Shabana AH. Right ventricular function in β-thalassemia children: comparing three-dimensional echocardiography with other functional parameters. Pediatr Res 2022; 91:1709-1714. [PMID: 34903834 DOI: 10.1038/s41390-021-01900-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiomyopathy is a major cause of mortality and morbidity in beta-thalassemia major (β-TM), and its early detection is critical for prompt management. We aimed to evaluate right ventricle (RV) function in β-TM, in absence of cardiac symptoms, using 3D echocardiography, and compare it with other functional parameters. METHODS Cross-sectional cohort study was conducted on 50 β-TM children with no cardiac manifestations and 50 healthy controls of matched age and sex. We evaluated RV function using; Fraction Area Change (2DE-RV FAC), Ejection Fraction (3D-RVEF), Tricuspid annular plane systolic excursion (TAPSE), Tissue Doppler imaging (TDI) systolic (S') and diastolic (E', A'), Myocardial performance index (MPI), and speckle tracking (2D-STE) of RV global longitudinal strain (LSS), systolic strain rate (SSR), early diastolic strain rate (DSR E), and late diastolic strain rate (DSR A). RESULTS 3D-RVEF, MPI, and 2D-STE showed significant differences between the two groups. ROC curve analysis measurements had an AUC above 0.7-which indicate at least a fair discriminatory power between the β-TM group with RV dysfunction and normal controls. CONCLUSIONS β-TM patients have decreased RV function indices at a pre-symptomatic stage. Early detection of RV dysfunction is feasible and can allow for closer follow-up to detect pre-clinical changes. IMPACT The key message of this article is to emphasize the importance of the evaluation of right ventricular function in children with beta-thalassemia major. This article adds to the existing literature the use of recent echocardiographic modalities as three-dimensional echocardiography and two-dimensional speckle tracking in the evaluation of right ventricular dysfunction in beta-thalassemia children while cardiac affection is still subclinical. IMPACT Recent echocardiographic functional parameters can be effectively used to evaluate the right ventricle in beta-thalassemia and can detect dysfunction in asymptomatic patients allowing for early intervention.
Collapse
Affiliation(s)
- Eslam E Elhawary
- Hematology and Bone Marrow Transplantation Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Osama A Tolba
- Cardiology Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa A Elkaffas
- Hematology and Bone Marrow Transplantation Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed H Shabana
- Cardiology Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
6
|
Investigating the Accuracy of Quantitative Echocardiographic-Modified Task Force Criteria for Arrhythmogenic Ventricular Cardiomyopathy in Adolescent Male Elite Athletes. Pediatr Cardiol 2022; 43:457-464. [PMID: 34689217 PMCID: PMC8850234 DOI: 10.1007/s00246-021-02744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
Athlete preparticipation screening focuses on preventing sudden cardiac death (SCD) by detecting diseases such as arrhythmogenic ventricular cardiomyopathy (AVC), which affects primarily the right ventricular myocardium. Diagnosis may be obscured by physiological remodeling of the athlete heart. Healthy athletes may meet the 2010 Task Force Criteria right ventricular outflow tract (RVOT) dimension cut-offs, questioning the suitability of the modified Task Force Criteria (mTFC) in adolescent athletes. In this study, 67 male adolescent footballers undergoing preparticipation screening were reviewed. All athletes underwent a screening for resting ECG and echocardiogram according to the English FA protocol, as well as cardiopulmonary exercise testing, stress ECG, and exercise echocardiography. Athletes' right ventricular outflow tract (RVOT) that met the major AVC diagnostic criteria for dilatation were identified. Of 67 evaluated athletes, 7 had RVOT dilatation that met the major criteria, all in the long axis parasternal view measurement. All had normal right ventricular systolic function, including normal free-wall longitudinal strain (ranging from - 21.5 to - 32.7%). Left ventricular ejection fraction ranged from 52 to 67%, without evidence of structural changes. Resting ECGs and cardiopulmonary exercise tests were normal in all individuals. In a series of healthy athletes meeting the major AVC diagnostic criteria for RVOT dilatation, none had any other pathological changes on a detailed screening including ECG, exercise testing, and echocardiography. This report highlights that current AVC echocardiographic diagnosis criteria have limitations in this population.
Collapse
|
7
|
Bowen DJ, Yalcin YC, Strachinaru M, McGhie JS, van den Bosch AE, Soliman OI, Caliskan K. Right ventricular functional assessment by 2D multi-plane echocardiography prior to left ventricular assist device implantation. Echocardiography 2021; 39:7-19. [PMID: 34877695 PMCID: PMC9300057 DOI: 10.1111/echo.15191] [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] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Right ventricular (RV) failure post left ventricular assist device (LVAD) implantation is associated with increased morbidity and mortality. A novel RV multi‐plane imaging method using two‐dimensional echocardiography and electronic plane rotation (MPE) was used to quantify RV function prior to LVAD implantation and to identify potential added value in this patient population. Methods In twenty‐five end‐stage heart failure patients (age 58.9 ± 6.8 years, 76% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated from one focussed apical view using MPE. Results Feasibility of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (RV‐S') measurements were high (84–100%), with lower TAPSE values measured in the inferior (14.2 ± 4.6 mm) and inferior coronal (12.3 ± 5.0 mm) walls compared to the lateral (16.3 ± 4.5 mm) and anterior walls (16.0 ± 4.5 mm). RV wall longitudinal strain (RV‐LS) measurement was most feasible in the lateral wall (80%; mean: –12.1 ± 4.2%). TAPSE and RV‐LS values were significantly reduced in patients compared to matched healthy individuals (p = <0.001). Seven (28%) patients who developed moderate to severe RV failure (RVF) early post‐implant (≤30 days) had lower pre‐implant values across all multi‐plane parameters compared to those without significant post‐implant RVF, notably four‐wall averaged TAPSE (11.1 ± 3.4 mm vs 15.9 ± 4.0 mm; p = 0.02). Conclusion 2D MPE was highly feasible for RV wall quantification pre‐LVAD surgery, detecting differences in regional wall function. This novel method comprehensively quantifies RV wall function and could complement current pre‐LVAD screening protocols.
Collapse
Affiliation(s)
- Daniel J Bowen
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yunus C Yalcin
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jackie S McGhie
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Osama I Soliman
- Department of Cardiology, College of Medicine, Nursing and Health Sciences, National University of Galway, Galway, Ireland
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Vaid A, Johnson KW, Badgeley MA, Somani SS, Bicak M, Landi I, Russak A, Zhao S, Levin MA, Freeman RS, Charney AW, Kukar A, Kim B, Danilov T, Lerakis S, Argulian E, Narula J, Nadkarni GN, Glicksberg BS. Using Deep-Learning Algorithms to Simultaneously Identify Right and Left Ventricular Dysfunction From the Electrocardiogram. JACC Cardiovasc Imaging 2021; 15:395-410. [PMID: 34656465 PMCID: PMC8917975 DOI: 10.1016/j.jcmg.2021.08.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to develop DL models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population. BACKGROUND Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECGs) can assist diagnostic workflow. However, DL tools to estimate right- ventricular (RV) function do not exist, whereas those to estimate left ventricular (LV) function are restricted to quantification of very low LV function only. METHODS A multicenter study was conducted with data from 5 New York City hospitals: 4 for internal testing and 1 serving as external validation. We created novel DL models to classify left ventricular ejection fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation. RESULTS We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used natural language processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, area under curve (AUC) at detection of LVEF ≤40%, 40% < LVEF ≤50%, and LVEF >50% was 0.94 (95% CI: 0.94-0.94), 0.82 (95% CI: 0.81-0.83), and 0.89 (95% CI: 0.89-0.89), respectively. For external validation, these results were 0.94 (95% CI: 0.94-0.95), 0.73 (95% CI: 0.72-0.74), and 0.87 (95% CI: 0.87-0.88). For regression, the mean absolute error was 5.84% (95% CI: 5.82%-5.85%) for internal testing and 6.14% (95% CI: 6.13%-6.16%) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (95% CI: 0.84-0.84) in both internal testing and external validation. CONCLUSIONS DL on ECG data can be used to create inexpensive screening, diagnostic, and predictive tools for both LV and RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease.
Collapse
Affiliation(s)
- Akhil Vaid
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kipp W Johnson
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sulaiman S Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mesude Bicak
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isotta Landi
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Russak
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shan Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew A Levin
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert S Freeman
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander W Charney
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Atul Kukar
- Department of Cardiology, Mount Sinai Queens Hospital, Astoria, New York, USA, and Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Cardiology, Mount Sinai West Hospital and Icahn School of Medicine at Mount Sinai, New York, New York USA
| | - Bette Kim
- Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatyana Danilov
- Department of Cardiology, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin S Glicksberg
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
9
|
Unchanged right ventricular strain in repaired tetralogy of Fallot after pulmonary valve replacement with radial long-axis cine magnetic resonance images. Sci Rep 2021; 11:18879. [PMID: 34556756 PMCID: PMC8460644 DOI: 10.1038/s41598-021-98464-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
We measured right ventricular (RV) strain by applying a novel postprocessing technique to conventional short-axis cine magnetic resonance imaging in the repaired tetralogy of Fallot (TOF) and investigated whether pulmonary valve replacement (PVR) changes the RV strain. Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P = 0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P = 0.002 for both, before and after GLSs: P < 0.0001 and P = 0.0003). RV strains from radially reconstructed short-axis cine images revealed unchanged myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.
Collapse
|
10
|
Chhikara S, Hooks M, Athwal PSS, Hughes A, Ismail MF, Joppa S, Velangi PS, Nijjar PS, Blaes AH, Shenoy C. Long-term prognostic value of right ventricular dysfunction on cardiovascular magnetic resonance imaging in anthracycline-treated cancer survivors. Eur Heart J Cardiovasc Imaging 2021; 23:1222-1230. [PMID: 34297807 DOI: 10.1093/ehjci/jeab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS We aimed to determine the prevalence of right ventricular (RV) systolic dysfunction on cardiovascular magnetic resonance imaging (CMR) and its impact on long-term adverse outcomes in a large cohort of cancer survivors treated with anthracycline-based chemotherapy. METHODS AND RESULTS Consecutive cancer survivors treated with anthracyclines who underwent clinical CMR for suspected anthracycline-related cardiomyopathy were studied. The primary endpoint was a composite of all-cause death or major adverse cardiac events (MACE): heart failure hospitalization, heart transplantation, ventricular assist device implantation, resuscitated cardiac arrest, or life-threatening ventricular arrhythmia. The secondary endpoints were all-cause death, and cardiac death or MACE. Among 249 survivors who underwent CMR at a median of 2.9 years after cancer treatment, RV systolic dysfunction was present in 54 (21.7%). Of these, 50 (92.6%) had an abnormal left ventricular ejection fraction (LVEF). At a median follow-up time after the CMR of 2.7 years, 105 survivors experienced the primary endpoint. On Kaplan-Meier analyses, the cumulative incidence of the primary endpoint was significantly higher in survivors with abnormal RVEF compared with those with normal RVEF (P = 0.002). However, on Cox multivariable analyses, RVEF was not associated with the primary endpoint (HR 1.04 per 5% decrease; 95% CI 0.93-1.17; P = 0.46) after adjustment for non-imaging variables and LVEF. RVEF was also not associated with the secondary endpoints. CONCLUSION Among anthracycline-treated cancer survivors undergoing CMR for suspected cardiotoxicity, RV systolic dysfunction was present in one in five cases, accompanied by LV systolic dysfunction in nearly all cases, and was not independently associated with long-term outcomes.
Collapse
Affiliation(s)
- Sanya Chhikara
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Matthew Hooks
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Pal Satyajit Singh Athwal
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Mohamed F Ismail
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Stephanie Joppa
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Anne H Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| |
Collapse
|
11
|
Kresoja KP, Rommel KP, Lücke C, Unterhuber M, Besler C, von Roeder M, Schöber AR, Noack T, Gutberlet M, Thiele H, Lurz P. Right Ventricular Contraction Patterns in Patients Undergoing Transcatheter Tricuspid Valve Repair for Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2021; 14:1551-1561. [PMID: 34294396 DOI: 10.1016/j.jcin.2021.05.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigated patterns of right ventricular (RV) contraction by using cardiac magnetic resonance (CMR) imaging in patients undergoing transcatheter tricuspid valve repair (TTVR). BACKGROUND The role of RV function in patients with severe tricuspid regurgitation undergoing TTVR is poorly understood. METHODS Global RV dysfunction was defined as CMR-derived RV ejection fraction (RVEF) ≤45% and longitudinal RV dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) <17 mm on echocardiography. Patients were stratified into 3 types of RV contraction: type I, TAPSE ≥17 and RVEF >45%; type II, TAPSE <17 and RVEF >45%; and type III, TAPSE <17 and RVEF ≤45%. CMR feature tracking was performed to assess longitudinal and circumferential RV strain. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization. RESULTS Of 79 patients (median age 79 years, 51% female), 18 (23%) presented with global and 40 (51%) presented with longitudinal RV dysfunction. The composite outcome occurred in 22 patients (median follow-up 362 days). Global RV dysfunction but not longitudinal RV dysfunction (hazard ratio: 6.62; 95% confidence interval: 2.77-15.77; and hazard ratio: 1.30; 95% confidence interval: 0.55-3.08, respectively) was associated with the composite outcome. Compared with type I RV contraction, patients with type II RV contraction exhibited increased circumferential strain, with a preservation of RVEF despite diminished longitudinal strain. Patients with type III RV contraction exhibited both diminished longitudinal and circumferential strain, resulting in an impaired RVEF. Patients with type III RV contraction showed the worst survival (P < 0.001). CONCLUSIONS Global RV dysfunction is a predictor of outcomes among TTVR patients. Tricuspid regurgitation patients can be stratified into 3 types of RV contraction, in which a loss of longitudinal function can be compensated by increasing circumferential function, preserving RVEF and favorable outcomes.
Collapse
Affiliation(s)
- Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Lücke
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Anne Rebecca Schöber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
| |
Collapse
|
12
|
Abstract
Purpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH.
Collapse
|
13
|
Feasibility, Reproducibility and Validation of Right Ventricular Volume and Function Assessment Using Three-Dimensional Echocardiography. Diagnostics (Basel) 2021; 11:diagnostics11040699. [PMID: 33919794 PMCID: PMC8070805 DOI: 10.3390/diagnostics11040699] [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] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
Three-dimensional echocardiography (3DE) is advised for right ventricular (RV) assessment. Data regarding the optimal acquisition settings and optimization are still scarce. We aimed to evaluate the feasibility, reproducibility and validation of 3DE for RV volume and function assessment, using cardiac magnetic resonance (CMR) as gold standard. Thirty healthy volunteers and 36 consecutive patients were prospectively included. CMR was performed in the latter. Standard apical four-chamber view (A4CV), focused A4CV and modified A4CV were used for 3DE RV acquisition. Feasibility (and the effect of changes in settings) was evaluated. Intra and interobserver analyses were performed by three observers (expert vs. novice). RV parameters by echocardiography were compared to CMR. Feasibility of acquisition was 16.7% for A4CV, 80.0% for focused A4CV and 16.7% for modified A4CV. Changes in settings had no significant influence on feasibility and further analysis. Intraobserver variability was good in both expert and novice, interobserver variability was good between experienced observers. Compared to CMR, 3DE volumes were significantly lower with fair to moderate correlation (EDV: 91.1 ± 24.4 mL vs. 144.3 ± 43.0 mL (p < 0.001), r = 0.653 and ESV: 48.1 ± 16.4 mL vs. 60.4 ± 21.2 mL (p < 0.001), r = 0.530, by multi-beat 3DE and CMR respectively). These findings suggest that standardization is needed in order to implement this technique in clinical practice, thus further studies are required.
Collapse
|
14
|
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.
Collapse
|
15
|
Myhr KA, Kristensen CB, Pedersen FHG, Hassager C, Vejlstrup N, Mattu R, Pecini R, Mogelvang R. Accuracy and sensitivity of three-dimensional echocardiography to detect changes in right ventricular volumes: comparison study with cardiac magnetic resonance. Int J Cardiovasc Imaging 2020; 37:493-502. [PMID: 32914403 DOI: 10.1007/s10554-020-02017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
We aimed to investigate the ability of three-dimensional transthoracic echocardiography (3DE) to detect changes in RV volumes compared to cardiac magnetic resonance (CMR). Eighty-five subjects including 45 with no known cardiac disease and 40 patients with a variety of cardiac diseases were included. Two- and three-dimensional echocardiography as well as CMR of the RV was performed before and after infusion of on average two litres of saline. Examinations were analysed with estimation of RV dimensions, volumes and ejection fraction (RVEF). Intra- and inter-examiner variability was evaluated in 25 patients randomly selected from the cohort. Three-dimensional echocardiography underestimated volumes and RVEF compared to CMR with mean differences and 95% limits of agreement of 110.3 ± 59 mL for RV end-diastolic volume (RVEDV), 43.3 ± 32 mL for RV end-systolic volume (RVESV) and 3.5 ± 10.7% for RVEF. CMR was more reproducible than 3DE, with intra-observer coefficient of variation (CV) of 4% vs. 14.2% for RVEDV, 9.7% vs. 16.7% for RVESV and 6.3% vs. 8.6% for RVEF. The RVEDV, RVESV and RV stroke volume (RVSV) by CMR significantly increased after saline infusion by 15.3 ± 16.2 mL, 3.5 ± 14.2 mL and 11.8 ± 12.6 mL, respectively, as well as RVEF by 1.5 ± 4.6% (p < 0.05). However, 3DE was not able to detect any of these changes in RV volumes (p ≥ 0.05). Compared to CMR imaging of the RV, three-dimensional echocardiography appears unable and unreliable in detecting RV volume changes of less than 15%, highlighting the need for cautious utility of 3DE in these circumstances.
Collapse
Affiliation(s)
- K A Myhr
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | - C B Kristensen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - F H G Pedersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - C Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen O, Denmark
| | - N Vejlstrup
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - R Mattu
- Kettering General Hospital NHS Foundation Trust, Rothwell Road, Kettering, Northants, NN16 8UZ, UK
- Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - R Pecini
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - R Mogelvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen O, Denmark
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700, Svendborg, Denmark
| |
Collapse
|
16
|
Affiliation(s)
- Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten), Department of Cardiology, Universitair Ziekenhuis, 101 Laarbeeklaan, B Brussels, Belgium.,ICMI (In Vivo Molecular and Cellular Imaging Center), Brussels, Belgium
| | - Thierry Le Tourneau
- Department of Cardiology, Thorax Institute, Centre Hospitalier Universitaire de Nantes, Site Hotel-Dieu-Hme 1, Place Alexis Ricordeau, Nantes, France
| | - Lawrence Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, 3755 Rue Cote-Sainte-Catherine Suite E206, Montreal, Quebec, Canada
| |
Collapse
|
17
|
Ostenfeld E, Kjellström B. The Conundrum of Right Ventricular Remodeling and Outcome in Pulmonary Hypertension. Circ Cardiovasc Imaging 2020; 13:e011208. [PMID: 32673507 DOI: 10.1161/circimaging.120.011208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, Sweden (E.O., B.K.)
| | - Barbro Kjellström
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, Sweden (E.O., B.K.).,Swedish Pulmonary Arterial Hypertension Registry, Uppsala Clinical Research Centre, Uppsala University, Sweden (B.K.)
| |
Collapse
|
18
|
Evaldsson AW, Lindholm A, Jumatate R, Ingvarsson A, Smith GJ, Waktare J, Rådegran G, Roijer A, Meurling C, Ostenfeld E. Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance. BMC Cardiovasc Disord 2020; 20:259. [PMID: 32487063 PMCID: PMC7268227 DOI: 10.1186/s12872-020-01548-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEFCMR), however this is a crude measure. New CMR measures of RV function beyond RVEFCMR have emerged, such as RV lateral atrio-ventricular plane displacement (AVPDlat), maximum emptying velocity (S'CMR), RV fractional area change (FACCMR) and feature tracking of the RV free wall (FWSCMR). However, it is not fully elucidated if these CMR measures are in parity with the equivalent echocardiography-derived measurements: tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity (S'echo), RV fractional area change (FACecho) and RV free wall strain (FWSecho). The aim of this study was to compare regional RV function parameters derived from CMR to their echocardiographic equivalents in patients with pulmonary hypertension and to RVEFCMR. METHODS Fifty-five patients (37 women, 62 ± 15 years) evaluated for pulmonary hypertension underwent CMR and echocardiography. AVPDlat, S'CMR, FACCMR and FWSCMR from cine 4-chamber views were compared to corresponding echocardiographic measures and to RVEFCMR delineated in cine short-axis stack. RESULTS A strong correlation was demonstrated for FAC whereas the remaining measurements showed moderate correlation. The absolute bias for S' was 2.4 ± 3.0 cm/s (relative bias 24.1 ± 28.3%), TAPSE/AVPDlat 5.5 ± 4.6 mm (33.2 ± 25.2%), FWS 4.4 ± 5.8% (20.2 ± 37.5%) and for FAC 5.1 ± 8.4% (18.5 ± 32.5%). In correlation to RVEFCMR, FACCMR and FWSecho correlated strongly, FACecho, AVPDlat, FWSCMR and TAPSE moderately, whereas S' had only a weak correlation. CONCLUSION This study has demonstrated a moderate to strong correlation of regional CMR measurements to corresponding echocardiographic measures. However, biases and to some extent wide limits of agreement, exist between the modalities. Consequently, the equivalent measures are not interchangeable at least in patients with pulmonary hypertension. The echocardiographic parameter that showed best correlation with RVEFCMR was FWSecho. At present, FACecho and FWSecho as well as RVEFCMR are the preferred methods to assess and follow up RV function in patients with pulmonary hypertension. Future investigations of the CMR right ventricular measures, beyond RVEF, are warranted.
Collapse
Affiliation(s)
- Anna Werther Evaldsson
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden.
| | - Anthony Lindholm
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Raluca Jumatate
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | - Annika Ingvarsson
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | - Gustav Jan Smith
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | | | - Göran Rådegran
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | - Anders Roijer
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | - Carl Meurling
- Lund University, Department of Clinical Sciences Lund, Cardiology, Section for Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| |
Collapse
|
19
|
Long-term changes of right ventricular myocardial deformation and remodeling studied by cardiac magnetic resonance imaging in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy. Int J Cardiol 2020; 300:282-288. [DOI: 10.1016/j.ijcard.2019.09.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/22/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
|
20
|
Computational Simulation of Cardiac Function and Blood Flow in the Circulatory System under Continuous Flow Left Ventricular Assist Device Support during Atrial Fibrillation. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prevalence of atrial fibrillation (AF) is high in heart failure patients supported by a continuous flow left ventricular assist device (CF-LVAD); however, the long term effects remain unclear. In this study, a computational model simulating effects of AF on cardiac function and blood flow for heart failure and CF-LVAD support is presented. The computational model describes left and right heart, systemic and pulmonary circulations and cerebral circulation, and utilises patient-derived RR interval series for normal sinus rhythm (SR). Moreover, AF was simulated using patient-derived unimodal and bimodal distributed RR interval series and patient specific left ventricular systolic functions. The cardiovascular system model simulated clinically-observed haemodynamic outcomes under CF-LVAD support during AF, such as reduced right ventricular ejection fraction and elevated systolic pulmonary arterial pressure. Moreover, relatively high aortic peak pressures and middle arterial peak flow rates during AF with bimodal RR interval distribution, reduced to similar levels as during normal SR and AF with unimodal RR interval distribution under CF-LVAD support. The simulation results suggest that factors such as distribution of RR intervals and systolic left ventricular function may influence haemodynamic outcome of CF-LVAD support during AF.
Collapse
|
21
|
Bozkurt S. Mathematical modeling of cardiac function to evaluate clinical cases in adults and children. PLoS One 2019; 14:e0224663. [PMID: 31671136 PMCID: PMC6822734 DOI: 10.1371/journal.pone.0224663] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022] Open
Abstract
Time-varying elastance models can simulate only the pressure and volume signals in the heart chambers while the diagnosis of clinical cases and evaluation of different treatment techniques require more information. In this study, an extended model utilizing the geometric dimensions of the heart chambers was developed to describe the cardiac function. The new cardiac model was evaluated by simulating a healthy and dilated cardiomyopathy (DCM) condition for adults and children. The left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 53.60%, 125 mL, 5.08 cm and 1.82 in the healthy adult cardiovascular system model and 23.70%, 173 mL, 6.60 cm and 1.40 in the DCM adult cardiovascular system model. In the healthy child cardiovascular system model, the left ventricular ejection fraction, end-diastolic volume, end-diastolic diameter and diastolic sphericity index were 59.70%, 92 mL, 4.10 cm and 2.26 respectively and 30.70%, 125 mL, 4.94 cm and 1.87 in the DCM child cardiovascular system model. The developed cardiovascular system model simulates the hemodynamic variables and clinical diagnostic indicators within the physiological range for healthy and DCM conditions proving the feasibility of this new model to evaluate clinical cases in adults and children.
Collapse
Affiliation(s)
- Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, United Kingdom
- * E-mail:
| |
Collapse
|
22
|
Ash SY, Sanchez-Ferrero GV, Schiebler ML, Rahaghi FN, Rai A, Come CE, Ross JC, Colon AG, Cardet JC, Bleecker ER, Castro M, Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Lempel JK, Mauger DT, Tattersall MC, Wenzel SE, Levy BD, Washko GR, Israel E, San Jose Estepar R. Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort. Chest 2019; 157:258-267. [PMID: 31521672 DOI: 10.1016/j.chest.2019.08.2185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size. METHODS We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression. RESULTS Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations. CONCLUSIONS In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | | | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Ashish Rai
- Department of Medicine, North Shore Medical Center, Salem, MA
| | - Carolyn E Come
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Alysha G Colon
- College of Medicine, University of Florida, Gainesville, FL
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Benjamin M Gaston
- Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA
| | - Nizar N Jarjour
- Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jason K Lempel
- Department of Radiology, Cleveland Clinic, Cleveland, OH
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA
| | - Matthew C Tattersall
- Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | | | | |
Collapse
|
23
|
Greiner S, André F, Heimisch M, Aurich M, Steen H, Katus HA, Mereles D. A closer look at right ventricular 3D volume quantification by transthoracic echocardiography and cardiac MRI. Clin Radiol 2019; 74:490.e7-490.e14. [PMID: 30954234 DOI: 10.1016/j.crad.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/05/2019] [Indexed: 11/17/2022]
Abstract
AIM To compare right ventricular (RV) volumetry using state-of-the-art three-dimensional (3D) transthoracic echocardiography (3DE) and cardiac magnetic resonance imaging (CMR) near-simultaneously in a clinical setting. MATERIALS AND METHODS Forty-seven consecutive patients received comprehensive echocardiography including 3DE within 30 minutes of CMR. RV volumetry was performed offline with semi-automated 3D endocardial border tracing as well as manual delineation of the compacted myocardium in short-axis views by CMR. RESULTS Forty-two examinations (89%) could be analysed offline by 3D RV reconstruction. Mean RV volumes assessed by CMR and 3DE were 215±63 and 127±42 ml for end-diastole (RV-EDV), as well as 110±43 and 62±27 ml for end-systole (RV-ESV). RV-EDV, RV-ESV, and RV stroke volume measured by 3DE were significantly lower than RV volumetry by CMR. Mean bias were -88, -48, and -41 ml, respectively. Mean RV ejection fraction (-EF) showed a non-significant deviation of +2% between 3DE and CMR and the correlation coefficient was r=0.58 for RV-EF. CONCLUSION RV-EF can be assessed reliably using transthoracic 3DE in patients with good image quality; however, absolute RV volumes measured by 3DE show a systematic deviation to CMR volumetry that has been previously neglected and requires careful interpretation regarding anatomical cardiac imaging.
Collapse
Affiliation(s)
- S Greiner
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany.
| | - F André
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
| | - M Heimisch
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
| | - M Aurich
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
| | - H Steen
- Herz-Neuro-Zentrum Bodensee, Kreuzlingen, Switzerland
| | - H A Katus
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
| | - D Mereles
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
| |
Collapse
|
24
|
Lindholm A, Hesselstrand R, Rådegran G, Arheden H, Ostenfeld E. Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se. Clin Physiol Funct Imaging 2019; 39:215-225. [PMID: 30597705 PMCID: PMC6850088 DOI: 10.1111/cpf.12561] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/28/2018] [Indexed: 02/06/2023]
Abstract
Purpose Patients with pulmonary arterial hypertension (PAH) due to systemic sclerosis (SSc) have high mortality. Left ventricular (LV) peak global longitudinal strain (GLS) is decreased in SSc. It is unknown whether low GLS is due to SSc or PAH. Therefore, our primary aim was to evaluate both LV and right ventricular free wall GLS (RVFW GLS) in SSc, with and without PAH, using cardiac magnetic resonance with feature tracking. Secondary aim was to relate GLS to invasive mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Methods Thirty‐eight patients with SSc, 19 patients with SSc‐PAH and 19 healthy controls for comparison, were included. Endocardial and epicardial borders were delineated in cine images (short‐axis stack and three long‐axis views) for volumetric and strain calculations. Results Systemic sclerosis‐PAH had lower LV and RVFW GLS than SSc (LV: P = 0·01, RV: P<0·001) and controls (LV: P = 0·02; RV: P<0·001), with no difference between SSc and controls. LV strain correlated with mPAP (R = 0·42, P = 0·03) and PVR (R = 0·52, P = 0·006). RVFW GLS correlated with mPAP (R = 0·68, P<0·001) and PVR (R = 0·59, P = 0·001). ROC curves for predicting PAH had AUC 0·73 for LV strain (P = 0·003) and 0·86 for RVFW GLS (P<0·001). Conclusions Lower GLS is mainly determined by increased pulmonary pressure and not by SSc per se. Low LV and RVFW GLS are indicative of increased mPAP and PVR, which opens for improved non‐invasive methods to select patients eligible for right heart catheterization and to monitor the effects of PAH therapy.
Collapse
Affiliation(s)
- Anthony Lindholm
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
25
|
Laser KT, Karabiyik A, Körperich H, Horst JP, Barth P, Kececioglu D, Burchert W, DallaPozza R, Herberg U. Validation and Reference Values for Three-Dimensional Echocardiographic Right Ventricular Volumetry in Children: A Multicenter Study. J Am Soc Echocardiogr 2018; 31:1050-1063. [DOI: 10.1016/j.echo.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Indexed: 01/24/2023]
|
26
|
Dellegrottaglie S, Ostenfeld E, Sanz J, Scatteia A, Perrone-Filardi P, Bossone E. Imaging the Right Heart-Pulmonary Circulation Unit. Heart Fail Clin 2018; 14:377-391. [DOI: 10.1016/j.hfc.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
27
|
Albulushi A, Giannopoulos A, Kafkas N, Dragasis S, Pavlides G, Chatzizisis YS. Acute right ventricular myocardial infarction. Expert Rev Cardiovasc Ther 2018; 16:455-464. [PMID: 29902098 DOI: 10.1080/14779072.2018.1489234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Acute right ventricular myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction (MI) and, occasionally, with anterior wall MI. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps, and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography, and coronary angiography, whereas noninvasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role. Early revascularization, percutaneous or pharmacological, represents key step in the management of RMVI. Maintenance of reasonable heart rate and atrioventricular synchrony is essential to sustain adequate cardiac output in these patients. When conventional treatment is not successful, mechanical circulatory support, including right ventricle assist devices, percutaneous cardiopulmonary support, and intra-aortic balloon pump, might be considered. The prognosis associated with RVMI is worse in the short term, compared to non-RVMI, but those patients who survive hospitalization have a relatively good long-term prognosis.
Collapse
Affiliation(s)
- Arif Albulushi
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
| | - Andreas Giannopoulos
- b Cardiac Imaging, Department of Nuclear Medicine , University Hospital Zurich , Zurich , Switzerland
| | - Nikolaos Kafkas
- c Cardiology Department , General Hospital KAT , Athens , Greece
| | | | - Gregory Pavlides
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
| | - Yiannis S Chatzizisis
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
| |
Collapse
|
28
|
Huang KC, Lin LY, Chen YS, Lai CH, Hwang JJ, Lin LC. Three-Dimensional Echocardiography–Derived Right Ventricular Ejection Fraction Correlates with Success of Decannulation and Prognosis in Patients Stabilized by Venoarterial Extracorporeal Life Support. J Am Soc Echocardiogr 2018; 31:169-179. [DOI: 10.1016/j.echo.2017.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Indexed: 10/18/2022]
|
29
|
Barczuk-Falęcka M, Małek ŁA, Krysztofiak H, Roik D, Brzewski M. Cardiac Magnetic Resonance Assessment of the Structural and Functional Cardiac Adaptations to Soccer Training in School-Aged Male Children. Pediatr Cardiol 2018; 39. [PMID: 29520462 PMCID: PMC5958145 DOI: 10.1007/s00246-018-1844-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Physical training is associated with changes in cardiac morphology called the "athlete's heart", which has not been sufficiently studied in children. The aim of the study was to analyze cardiac adaptation to exercise in pre-adolescent soccer players. Thirty-six soccer players (mean age 10.1 ± 1.4 years) and 24 non-athlete male controls (10.4 ± 1.7 years) underwent cardiac magnetic resonance. Measurements of myocardial mass, end-diastolic and end-systolic volume, stroke volume and ejection fraction for left and right ventricle (LV, RV) were performed. Additionally, left and right atrial (LA, RA) areas and volumes were analysed. Relative wall thickness (RWT) was calculated to describe the pattern of cardiac remodeling. Interventricular wall thickness and LV mass were significantly higher in athletes, but remained within the reference (6.9 ± 0.8 vs. 6.2 ± 0.9 mm/√m2, p = 0.003 and 57.1 ± 7.4 vs. 50.0 ± 7.1 g/m2, p = 0.0006, respectively) with no changes in LV size and function between groups. The RWT tended to be higher among athletes (p = 0.09) indicating LV concentric remodeling geometry. Soccer players had significantly larger RV size (p < 0.04) with similar function and mass. Also, the LA volume (p = 0.01), LA area (p = 0.03) and LA diameter (p = 0.009) were significantly greater in players than in controls. Cardiac adaptations in pre-adolescent soccer players are characterized by an increased LV mass without any changes in LV size and systolic function, which is typical of resistance training with tendency to concentric remodeling. This is accompanied by increase of LA and RV size. It should be taken into account during annual pre-participation evaluation.
Collapse
Affiliation(s)
- Marzena Barczuk-Falęcka
- Department of Pediatric Radiology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
| | - Łukasz A. Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland
| | - Hubert Krysztofiak
- Department of Applied Physiology, Mossakowski Medical Research Centre PAS, Pawińskiego 5, Warsaw, Poland
| | - Danuta Roik
- Department of Pediatric Radiology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland
| |
Collapse
|
30
|
Sex- and Age-Related Reference Values in Cardiology, with Annotations and Guidelines for Interpretation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:677-706. [PMID: 30051414 DOI: 10.1007/978-3-319-77932-4_41] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The definition of "abnormal" in clinical sciences is often based on so-called reference values which point to a range that experts by some sort of consensus consider as normal when looking at biological variables. Such a level is commonly calculated by taking (twice) the standard deviation from the mean, or considering certain percentiles. The suspicion or even confirmation of a disease is then established by demonstrating that the value measured exceeds the upper or lower reference value. As is often the case, the measurement accuracy may depend on the conditions and specific method employed to collect and analyze data. This implies that, for example, data assessed by 2D echocardiography possibly differ from those obtained by MRI and therefore require modality-specific reference values. In this review we summarize reference values for the electrocardiogram, cardiac compartmental volumes, and arterial vessel size in males and females for various age groups. These values may further depend on other variables such as body size, physical training status, and ethnicity. Additional variables relevant for cardiology such as those referring to the microcirculation and biomarkers are only mentioned with reference to the pertinent literature. In general, the sex- and age-specific differences observed are often remarkable and warrant consideration in clinical practice and basic biomedical sciences.
Collapse
|
31
|
Cantinotti M, Giordano R, Paterni M, Saura D, Scalese M, Franchi E, Assanta N, Koestenberg M, Dulgheru R, Sugimoto T, Bernard A, Caballero L, Lancellotti P. Adult echocardiographic nomograms: overview, critical review and creation of a software for automatic, fast and easy calculation of normal values. J Thorac Dis 2017; 9:5404-5422. [PMID: 29312752 PMCID: PMC5757044 DOI: 10.21037/jtd.2017.11.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 01/15/2023]
Abstract
There is a crescent interest on normal adult echocardiographic values and the introduction of new deformation imaging and 3D parameters pose the issue of normative data. A multitude of nomograms has been recently published, however data are often fragmentary, difficult to find, and their strengths/limitations have been never evaluated. AIMS (I) to provide a review of current echocardiographic nomograms; (II) to generate a tool for easy and fast access to these data. A literature search was conducted accessing the National Library of Medicine using the keywords: 2D/3D echocardiography, strain, left/right ventricle, atrial, mitral/tricuspid valve, aorta, reference values/nomograms/normal values. Adding the following keywords, the results were further refined: range/intervals, myocardial velocity, strain rate and speckle tracking. Forty one published studies were included. Our study reveals that for several of 2D/3D parameters sufficient normative data exist, however, a few limitations still persist. For some basic parameters (i.e., mitral/tricuspid/pulmonary valves, great vessels) and for 3D valves data are scarce. There is a lack of studies evaluating ethnic differences. Data have been generally expressed as mean values normalised for gender and age instead of computing models incorporating different variables (age/gender/body sizes) to calculate z scores. To summarize results a software (Echocardio-Normal Values) who automatically calculate range of normality for a broad range of echocardiographic measurements according to age/gender/weight/height, has been generated. We provide an up-to-date and critical review of strengths/limitation of current adult echocardiographic nomograms. Furthermore we generated a software for automatic, easy and fast access to multiple echocardiographic normative data.
Collapse
Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
- Institute of Clinical Physiology, Pisa, Italy
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Daniel Saura
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Martin Koestenberg
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Raluca Dulgheru
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
| | - Tadafumi Sugimoto
- Department of University Cardiology, University of Milano School of Medicine, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anne Bernard
- CHU Tours, France et Université de Tours, Tours, France
| | - Luis Caballero
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Patrizio Lancellotti
- Department of Cardiology, Cardio-Oncology Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| |
Collapse
|
32
|
Ferrara F, Gargani L, Ostenfeld E, D'Alto M, Kasprzak J, Voilliot D, Selton-Suty C, Vriz O, Marra AM, Argiento P, Stanziola AA, Cittadini A, D'Andrea A, Bossone E. Imaging the right heart pulmonary circulation unit: Insights from advanced ultrasound techniques. Echocardiography 2017; 34:1216-1231. [DOI: 10.1111/echo.13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Francesco Ferrara
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R.; Pisa Italy
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund; Clinical Physiology and Skane University Hospital; Lund University; Lund Sweden
| | - Michele D'Alto
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Jaroslaw Kasprzak
- Department of Cardiology; Bieganski Hospital; Medical University of Lodz; Lodz Poland
| | - Damien Voilliot
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Christine Selton-Suty
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Olga Vriz
- Cardiology and Emergency Department; Hospital of San Daniele del Friuli; Udine Italy
| | | | - Paola Argiento
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Anna A. Stanziola
- Department of Respiratory Diseases; Monaldi Hospital; University “Federico II,”; Naples Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences; University Federico II of Naples; Naples Italy
| | | | - Eduardo Bossone
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
| |
Collapse
|
33
|
Cameli M, Loiacono F, Sparla S, Solari M, Iardino E, Mandoli GE, Bernazzali S, Maccherini M, Mondillo S. Systematic Left Ventricular Assist Device Implant Eligibility with Non-Invasive Assessment: The SIENA Protocol. J Cardiovasc Ultrasound 2017; 25:39-46. [PMID: 28770031 PMCID: PMC5526884 DOI: 10.4250/jcu.2017.25.2.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022] Open
Abstract
In patients with end-stage left ventricular (LV) heart failure who receive LV assist device (LVAD) implantation, right ventricular (RV) failure represents a possible critical complication that heavily affects morbidity and mortality. Several clinical, laboratory, hemodynamic, and echocardiographic variables have been found to be associated with RV failure occurrence after surgery. Different models and risk scores have been proposed, with poor results. No accordance has ever been reached about RV pre-operative evaluation, and time has come to introduce a standardized systematic protocol for LVAD suitability assessment according to RV function. We analyzed imaging parameters associated with LVAD implantation-related RV failure, in order to identify the minimum number for pre-operative reliable prediction of post-operative RV failure. A few echocardiographic parameters have been identified as the most reliable, or promising, and reproducible tools in this field: free-wall RV longitudinal strain, RV fractional area change, RV sphericity index, and RV ejection fraction with 3D-echocardiography. We propose the Systematic LVAD Implant Eligibility with Non-invasive Assessment protocol–the SIENA protocol–as a new and simple way of pre-operative evaluation of patients candidates to LVAD implantation.
Collapse
Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Stefania Sparla
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Marco Solari
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Elisabetta Iardino
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Sonia Bernazzali
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Massimo Maccherini
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| |
Collapse
|
34
|
Moreira HT, Volpe GJ, Marin-Neto JA, Nwabuo CC, Ambale-Venkatesh B, Gali LG, Almeida-Filho OC, Romano MM, Pazin-Filho A, Maciel BC, Lima JA, Schmidt A. Right Ventricular Systolic Dysfunction in Chagas Disease Defined by Speckle-Tracking Echocardiography: A Comparative Study with Cardiac Magnetic Resonance Imaging. J Am Soc Echocardiogr 2017; 30:493-502. [DOI: 10.1016/j.echo.2017.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Indexed: 01/13/2023]
|
35
|
Affiliation(s)
- Sara L. Partington
- From the Philadelphia Adult Congenital Heart Disease Program, A Joint Program of the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia (S.L.P.); and CMR Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom (P.J.K.)
| | - Philip J. Kilner
- From the Philadelphia Adult Congenital Heart Disease Program, A Joint Program of the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia (S.L.P.); and CMR Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom (P.J.K.)
| |
Collapse
|
36
|
Popelová JR, Tomková M, Tomek J. NT-proBNP predicts mortality in adults with transposition of the great arteries late after Mustard or Senning correction. CONGENIT HEART DIS 2017; 12:448-457. [DOI: 10.1111/chd.12466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/18/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jana Rubáčková Popelová
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Pediatric Heart Centre, Faculty Hospital Motol; Prague Czech Republic
| | - Markéta Tomková
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Nuffield Department of Medicine; University of Oxford; Oxford United Kingdom
| | - Jakub Tomek
- Department of Cardiac Surgery; Hospital Na Homolce; Prague Czech Republic
- Department of Physiology, Anatomy and Genetics; University of Oxford; Oxford United Kingdom
| |
Collapse
|
37
|
Cardiovascular Mechanisms of Extravascular Lung Water Accumulation in Divers. Am J Cardiol 2017; 119:929-932. [PMID: 28189252 DOI: 10.1016/j.amjcard.2016.11.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
This study assessed the relation between altered cardiac function and the development of interstitial pulmonary edema in scuba divers. Fifteen healthy men performed a 30-minute scuba dive in open sea. They were instructed to fin for 30 minutes and were wearing wet suits. Before and immediately after immersion, cardiac indexes and extravascular lung water were measured using echocardiography and lung ultrasound, respectively. The mean ultrasound lung comet score increased from 0 to 4.6 ± 3.4. The diameter of the inferior caval vein increased by 47 ± 5.2%, systolic pulmonary artery pressure by 105 ± 8.6%, left atrial volume by 18.0 ± 3.3%, and left ventricle end-diastolic volume by 10 ± 2.4% suggesting that both right and left ventricular (LV) filling pressures were elevated. Doppler studies showed an increased mitral E peak (+2.5 ± 0.3%) and E/A ratio (+22.5 ± 3.4%) with a decreased mitral A peak (-16.4 ± 2.7%), E peak deceleration time (-14.5 ± 2.4%) consistent with rapid early LV filling but without a change in LV stroke volume. There was an increase in right/left ventricle diameter ratio (+33.6 ± 4.8%) suggesting a relative increase in right-sided heart output compared with the left. Furthermore, the lung comet score correlated significantly with inferior caval vein diameter, systolic pulmonary artery pressure, right/left ventricle diameter ratio, and E-wave deceleration time. In conclusion, the altered right/left heart stroke volume balance could play an essential role in the development of immersion pulmonary edema. Our findings have important implications for the pathogenesis of cardiogenic pulmonary edema.
Collapse
|
38
|
Song FY, Shi J, Guo Y, Zhang CJ, Xu YC, Zhang QL, Shu XH, Cheng LL. Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy. Int J Cardiovasc Imaging 2017; 33:857-868. [PMID: 28255826 DOI: 10.1007/s10554-017-1082-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/24/2017] [Indexed: 12/25/2022]
Abstract
The aim of this study was to investigate the usefulness of three-dimensional (3D) speckle tracking echocardiography (STE) for assessment of both left and right ventricular systolic function in patients with lymphoma after anthracycline chemotherapy, compared with two-dimensional (2D) STE. Totally eighty-nine patients undergoing anthracycline containing chemotherapy were studied. Echocardiographic assessment included 2D and 3D left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS) and right ventricular (RV) GLS. All the parameters were analyzed at baseline, after the completion of four cycles and at the end of the regimen respectively. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic parameters to discriminate between before and after chemotherapy. Compared with those at baseline, the 3D GLS and GCS of LV and GLS of RV decreased significantly after four cycles of the therapy (all p < 0.01). At the end of the treatment, 2D GLS and GCS of LV deteriorated markedly (both p < 0.05). The area under the curve for GLS, GCS of LV and GLS of RV derived by 3D were 0.81, 0.66 and 0.78, respectively. The cutoff value with -20.4% of LV GLS by 3D had sensitivity of 81% and specificity of 66% for differentiating patients after therapy from baselines. The cutoff value with -21.9% of RV GLS by 3D had sensitivity of 71% and specificity of 74% fordifferentiating patients after therapy from baselines. The data from this study demonstrated that both 2D and 3D STE can be conducted to evaluate the slight myocardial damage for lymphoma patients after anthracycline chemotherapy. 3D STE could examine subclinical biventricular dysfunction in earlier point than 2D STE.
Collapse
MESH Headings
- Adult
- Aged
- Anthracyclines/adverse effects
- Antibiotics, Antineoplastic/adverse effects
- Area Under Curve
- Biomarkers/blood
- Biomechanical Phenomena
- Cardiotoxicity
- Early Diagnosis
- Echocardiography, Doppler, Pulsed
- Echocardiography, Three-Dimensional
- Female
- Heart Diseases/blood
- Heart Diseases/chemically induced
- Heart Diseases/diagnostic imaging
- Heart Diseases/physiopathology
- Humans
- Image Interpretation, Computer-Assisted
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Observer Variation
- Predictive Value of Tests
- Prospective Studies
- ROC Curve
- Reproducibility of Results
- Risk Factors
- Stress, Mechanical
- Systole
- Time Factors
- Ventricular Function, Left/drug effects
- Ventricular Function, Right/drug effects
- Young Adult
Collapse
Affiliation(s)
- Fei-Yan Song
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jing Shi
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China.
| | - Chu-Jie Zhang
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yu-Chen Xu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Qun-Ling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, China
| | - Xian-Hong Shu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Lei-Lei Cheng
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| |
Collapse
|
39
|
Truong VT, Safdar KS, Kalra DK, Gao X, Ambach S, Taylor MD, Moore R, Taylor RJ, Germann J, Toro-Salazar O, Jefferies JL, Bartone C, Raman SV, Ngo T, Mazur W. Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values. Magn Reson Imaging 2017; 38:189-195. [PMID: 28093270 DOI: 10.1016/j.mri.2017.01.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT). METHODS A total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT. The age range was 4-81years with a median of 32years (interquartile range, 15 to 56years). RESULTS Analysis time per patient was <5min. The peak longitudinal strain (Ell) was -22.11±3.51%. The peak circumferential strains (Ecc) for global, basal, mid-cavity and apical segments were as follows: -11.69±2.25%, -11.00±2.45%, -11.17±3.36%, -12.90±3.34%. There were significant gender differences in peak Ecc at the base (P=0.04) and the mid-cavity (P=0.03) with greater deformation in females than in males. On Bland-Altman analysis, peak Ell (mean bias, 0.22±1.67; 95% CI -3.05 to 3.49) and mid-cavity Ecc (mean bias, 0.036±1.75; 95% CI, -3.39 to 3.47) had the best intra-observer agreement and inter-observer agreement, respectively. CONCLUSIONS RV longitudinal and circumferential strains can be quickly assessed with good intra-observer and inter-observer variability using TT.
Collapse
Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, OH, USA; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | | | - Xuexin Gao
- Circle Cardiovascular Imaging Inc., Calgary, Canada
| | - Stephanie Ambach
- The University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, USA
| | - Michael D Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ryan Moore
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robin J Taylor
- Centre for Cardiovascular Sciences University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Joshua Germann
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - John L Jefferies
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Subha V Raman
- The Ohio State University Medical Center, Columbus, OH, USA
| | - Tam Ngo
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Wojciech Mazur
- The Christ Hospital Health Network, Cincinnati, OH, USA.
| |
Collapse
|
40
|
Guarracino F, Bertini P, Pinsky MR. Right Ventriculo-Arterial Coupling in the Critically Ill. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2017. [DOI: 10.1007/978-3-319-51908-1_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|