Automated Description of Regional Left Ventricular Motion in Patients With Cardiac Amyloidosis: A Quantitative Study Using Heart Deformation Analysis. AJR Am J Roentgenol. 2017;209:W57-W63. [PMID: 28537770 DOI: 10.2214/AJR.16.16982]

Cine MRI characterizes HFpEF and HFrEF in post-capillary pulmonary hypertension

PURPOSE

To test the hypothesis that cine MRI can be used to characterize features of left and right ventricles in post-capillary pulmonary hypertension (PH) caused by heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF).

METHODS

With the approval of institution review board (IRB), 28 consecutive post-capillary PH patients (11 males, 62.1 ± 13.4 years old, range 39-89 years old) underwent cine MRI scans. Cine MRI-derived left ventricular (LV) ejection fraction (LVEF) and other function, motion, and deformation indices (acquired with heart deformation analysis [HDA]) were compared between PH-HFpEF (defined as LVEF ≥ 50 %]) and PH-HFrEF (LVEF < 50 %) patients and were related with right ventricular (RV) indices and right heart catheterization (RHC)-derived pulmonary artery measurements.

RESULTS

Totally 19 patients (68 %, 95 % confident interval [CI] 49 %-86 %) were assigned to PH-HFpEF group while 9 (32 %) was assigned to the PH-HFrEF group. There were differences of LV and right ventricular (RV) global functional indices, LV mass, LV displacement, velocity, strain and strain rate between the two patient groups. Cine MRI-derived LV indices had broad associations with RV indices and RHC measurements. LVEF was negatively correlated with pulmonary capillary wedge pressure (PCWP) (r = -0.5, p = 0.007). LV cardiac index (LVCI) was associated with systolic pulmonary artery pressure (sPAP) (r = 0.443, p = 0.018).

CONCLUSIONS

PH-HFpEF and PH-HFrEF patients present dissimilar function, motion and deformation features in LV and RV. Cine MRI-derived LV measures are correlated with hemodynamic abnormalities of PH.

Cine MRI detects elevated left heart pressure in pulmonary hypertension

Cine magnetic resonance imaging (MRI) is an emerging modality for evaluating left ventricular (LV) motion/deformation patterns, which may have potential to identify LV dysfunctions underlying postcapillary pulmonary hypertension (PH). The aim of this study was to test the hypothesis that cine MRI-derived LV motion/deformation indices can be used to identify an elevated left heart pressure in PH. This was a retrospective study, which included 26 precapillary and 28 postcapillary PH patients (23 males, 58.9 ± 13.5 years old). All patients underwent right heart catheterization (the "reference standard") and cardiac MRI. Balanced steady-state free precession cine sequence acquired at 1.5 T was used. Cine MRI datasets were analyzed by using heart deformation analysis. LV motion/deformation indices were measured through 25 phases within a cardiac cycle. Peak LV displacement, velocity, strain, and strain rates at systole, early and late diastole were compared between the two patient groups using t-tests. The Pearson correlation coefficient (r) was used to investigate the association between cine MRI-derived indices and pulmonary capillary wedge pressure (PCWP). Multivariable linear and logistic regression models were applied to assess the ability of MRI-derived parameters to predict PCWP and postcapillary PH. Compared to 26 precapillary PH patients, the 28 postcapillary PH patients had lower peak late radial diastolic displacement (0.43 ± 0.19 cm vs. 0.64 ± 0.18 cm) and velocity (12.2 ± 5.8 mm/s vs. 18.9 ± 5.6 mm/s) and peak late radial (52.1 ± 32.7%/s vs. 97.1 ± 38%/s) and circumferential (38 ± 19.8%/s vs. 63.1 ± 22.9%/s) strain rates. PCWP was correlated with peak late radial diastolic displacement (r = -0.54) and velocity (r = -0.57) and peak late radial (r = -0.63) and circumferential diastolic (r = -0.63) strain rates. Peak late radial strain rate could predict PCWP (β = -0.09) and postcapillary PH (β = -0.036). All p < 0.05. Cine MRI-derived LV late diastolic motion/deformation properties can be used to estimate elevated left heart pressure in PH. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 1.

Cardiac MRI Reveals Late Diastolic Changes in Left Ventricular Relaxation Patterns During Healthy Aging

BACKGROUND

Cardiac MRI is an emerging modality for evaluating left ventricular (LV) diastolic dysfunction (LVDD), a pathological condition that is prevalent in aging populations. However, there is a lack of reports of MRI-derived LV diastolic properties in late diastole.

PURPOSE

To test the hypothesis that cine MRI-derived motion/deformation indices can be used to characterize age-related changes on LV relaxation patterns in late diastole.

STUDY TYPE

Retrospective.

POPULATION

In all, 412 participants (72.5 ± 4.6 years old, range 65-84) without a documented history of cardiovascular diseases.

FIELD STRENGTH/SEQUENCE

Balanced steady-state free precession(bSSFP) acquired at 1.5T.

ASSESSMENT

Participants were divided into younger (65-74 years old, n = 275) and older (75-84 years old, n = 137) groups. Status of diabetes mellitus (DM), hypertension (HTN), and lipid disorders were recorded for each participant. Cine MRI datasets were analyzed by using heart deformation analysis (HDA). LV motion/deformation indices (displacement, velocity, strain, and strain rate) were measured through 22 phases within a cardiac cycle.

STATISTICAL TESTS

The prevalence of traditional cardiovascular risk conditions, LV ejection fraction (LVEF), peak LV regional displacement, velocity, and strain rates at early and late diastole were compared between two participant groups using chi-square tests or t-tests.

RESULTS

Older participants had a significantly lower peak early radial displacement (0.797 ± 0.249 cm vs. 0.876 ± 0.286 cm), radial velocity (19.3 ± 6.3 mm/s vs. 17.5 ± 5.2 mm/s), and circumferential strain rate (64.6 ± 15.7%/s vs. 70.1 ± 17%/s) but a higher peak late circumferential strain rate (69.8 ± 16.3 %/s vs. 66 ± 15.8 %/s) than their younger counterparts.

DATA CONCLUSION

Cine MRI can be used to characterize age-related LV relaxation patterns in late diastole.

LEVEL OF EVIDENCE

3.

TECHNICAL EFFICACY STAGE

1.

Left ventricular myocardial deformation: a study on diastolic function in the Chinese male population and its relationship with fat distribution

Background

Obesity has become an epidemic in China with its increased prevalence, especially in the male population. Disparities in fat distribution rather than increasing body mass index (BMI) confer the risk of different diseases, including cardiac abnormalities. Therefore, early detection of cardiac abnormalities is important for treatment to reverse the progression to heart failure. Nowadays, strain analysis based on cardiac magnetic resonance (CMR) imaging has been established to assess myocardial function in diverse cardiac diseases. We aimed to assess the relationship between fat distribution and subclinical diastolic dysfunction in obese Chinese men assessed by deformation registration algorithm (DRA)-based myocardial strain rate (SR) analysis.

Methods

A total of 115 male participants with different BMI underwent CMR scanning using a 1.5T MAGNETOM Aera (Siemens Healthcare, Erlangen, Germany) and computed tomography (CT) scan. All the participants were enrolled from September 2017 to April 2018. They were classified into 3 groups according to their BMIs with 23 and 27.5 kg/m² being the cutoff values. A Trufi-Strain prototype software (version 2.0, Siemens Healthcare, Erlangen, Germany) was used to quantify SR in both early and late diastole from CMR cine images. Ratios of early and late SRs were calculated. Areas of epicardial and pericardial adipose tissue (EAT and PAT) were measured on a single 4-chamber-view slice of cine images. Volumes of visceral and subcutaneous adipose tissue (VAT and SAT) were acquired semi-automatically from CT images using the dedicated software Cardiac Risk2.0 (Siemens Healthcare). Waist and hip circumferences were manually measured (WC and HC). Analysis of variance or nonparametric tests, along with correlation and stepwise multivariate regression analysis models, was applied for statistical analysis.

Results

Peak late diastolic SRs were higher in obese men compared with their lean counterparts [-36.25±10.46 vs. -29.46±8.17, 66.97±18.58 vs. 45.62 (42.44, 55.96), and 56.81±15.07 vs. 41.40±6.41 for radial, circumferential, and longitudinal SRs, respectively; P<0.05]. All SR ratios in the obese subgroups were lower than those of lean men (3.12±1.14 vs. 4.63±1.24, 2.12±0.58 vs. 2.96±0.62 and 1.63±0.50 vs. 2.20±0.63 for radial, circumferential, and longitudinal directions, respectively; P<0.05). EAT was a significant predictor of diastolic function assessed by radial and circumferential SR ratios (β=-0.439 and -0.337 respectively; all P<0.001), while VAT was a significant predictor of circumferential and longitudinal SR ratios (β=-0.216 and -0.355, respectively, P<0.05).

Conclusions

Decreased LV diastolic function assessed by DRA-based SR analysis in obesity is associated with fat distribution. Furthermore, EAT and VAT might be better predictors of a decrease of diastolic function in obese Chinese men than BMI.

Multi-modality imaging in transthyretin amyloid cardiomyopathy

Transthyretin amyloid (TTR) cardiomyopathy is a disease of insidious onset, which is often accompanied by debilitating neurological and/or cardiac complications. The true prevalence is not fully known due to its elusive presentation, being often under-recognized and usually diagnosed only late in its natural history and in older patients. Because of this, effective treatment options are usually precluded by multiple comorbidities and frailty associated with such patients. Therefore, high clinical suspicion with earlier and better detection of this disease is needed. In this review, the novel applications of multimodality imaging in the diagnostic pathway of TTR cardiomyopathy are explored. These include the complimentary roles of transthoracic echocardiography, cardiac magnetic resonance, nuclear scintigraphy and positron emission tomography in quantifying cardiac dysfunction, diagnosis and risk stratification. Recent advances in novel therapeutic options for TTR have further enhanced the importance of a timely and accurate diagnosis of this disease.