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Borodzicz-Jazdzyk S, Vink CEM, Demirkiran A, Hoek R, de Mooij GW, Hofman MBM, Wilgenhof A, Appelman Y, Benovoy M, Götte MJW. Clinical implementation of a fully automated quantitative perfusion cardiovascular magnetic resonance imaging workflow with a simplified dual-bolus contrast administration scheme. Sci Rep 2024; 14:9665. [PMID: 38671061 PMCID: PMC11053149 DOI: 10.1038/s41598-024-60503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
This study clinically implemented a ready-to-use quantitative perfusion (QP) cardiovascular magnetic resonance (QP CMR) workflow, encompassing a simplified dual-bolus gadolinium-based contrast agent (GBCA) administration scheme and fully automated QP image post-processing. Twenty-five patients with suspected obstructive coronary artery disease (CAD) underwent both adenosine stress perfusion CMR and an invasive coronary angiography or coronary computed tomography angiography. The dual-bolus protocol consisted of a pre-bolus (0.0075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) and a main bolus (0.075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) at an infusion rate of 3 ml/s. The arterial input function curves showed excellent quality. Stress MBF ≤ 1.84 ml/g/min accurately detected obstructive CAD (area under the curve 0.79; 95% Confidence Interval: 0.66 to 0.89). Combined visual assessment of color pixel QP maps and conventional perfusion images yielded a diagnostic accuracy of 84%, sensitivity of 70% and specificity of 93%. The proposed easy-to-use dual-bolus QP CMR workflow provides good image quality and holds promise for high accuracy in diagnosis of obstructive CAD. Implementation of this approach has the potential to serve as an alternative to current methods thus increasing the accessibility to offer high-quality QP CMR imaging by a wide range of CMR laboratories.
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Affiliation(s)
- S Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097, Warsaw, Poland
| | - C E M Vink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - R Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - G W de Mooij
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Wilgenhof
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M Benovoy
- Area19 Medical Inc., Montreal, H2V2X5, Canada
| | - M J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
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Bhagirath P, Campos FO, Zaidi HA, Chen Z, Elliott M, Gould J, Kemme MJB, Wilde AAM, Götte MJW, Postema P, Prassl AJ, Neic A, Plank G, Rinaldi CA, Bishop MJ. Predicting Post-Infarct Ventricular Tachycardia by Integrating Cardiac MRI and Advanced Computational Reentrant Pathway Analysis. Heart Rhythm 2024:S1547-5271(24)02507-4. [PMID: 38670247 DOI: 10.1016/j.hrthm.2024.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Implantable cardiac defibrillator (ICD) implantation can protect against sudden cardiac death (SCD) after a myocardial infarction. However, improved risk stratification for device requirement is still needed. OBJECTIVE To improve assessment of post-infarct ventricular electro-pathology and prediction of appropriate ICD therapy by combining late gadolinium enhancement (LGE) and advanced computational modelling. METHODS ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct patients (n=40) having undergone LGE imaging pre-ICD implantation. Corridor metrics and 3D surface features were computed from LGE images. The Virtual Induction and Treatment of Arrhythmias (VITA) framework was applied to patient-specific models to comprehensively probe the vulnerability of the scar substrate to sustaining reentrant circuits. Imaging and VITA metrics, related to the numbers of induced VTs and their corresponding round trip times (RTTs), were compared with ICD therapy during follow-up. RESULTS Patients with an event (n=17) had a larger interface between healthy-scar and higher VITA metrics. Cox-regression demonstrated a significant independent association with an event: interface (HR 2.79; 1.44-5.44, p < .01), unique VTs (HR 1.67; CI 1.04-2.68, p = .03), mean RTT (HR 2.14; CI 1.11-4.12, p = .02), maximum RTT (HR 2.13; CI 1.19-3.81, p = .01). CONCLUSION Detailed quantitative analysis of LGE based scarmaps, combined with advanced computational modeling, is able to accurately predict ICD therapy and could facilitate early identification of high-risk patients in addition to LVEF.
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Affiliation(s)
- Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Hassan A Zaidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Zhong Chen
- Royal Brompton & Harefield NHS Foundation Trust
| | - Mark Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pieter Postema
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria; NumeriCor GmbH, Graz, Austria
| | | | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Borodzicz-Jazdzyk S, Götte MJW. Letter to the Editor: "Fully automated pixel-wise quantitative CMR-myocardial perfusion with CMR-coronary angiography to detect hemodynamically significant coronary artery disease". Eur Radiol 2024; 34:2711-2713. [PMID: 37831141 DOI: 10.1007/s00330-023-10293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/16/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- 1St Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
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Hopman LHGA, Solís-Lemus JA, Hofman MBM, Bhagirath P, Borodzicz-Jazdzyk S, van Pouderoijen N, Krafft AJ, Schmidt M, Allaart CP, Niederer SA, Götte MJW. Performance of Image-navigated and Diaphragm-navigated 3D Late Gadolinium-enhanced Cardiac MRI for the Assessment of Atrial Fibrosis. Radiol Cardiothorac Imaging 2024; 6:e230172. [PMID: 38573128 PMCID: PMC11056763 DOI: 10.1148/ryct.230172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Purpose To perform a qualitative and quantitative evaluation of the novel image-navigated (iNAV) 3D late gadolinium enhancement (LGE) cardiac MRI imaging strategy in comparison with the conventional diaphragm-navigated (dNAV) 3D LGE cardiac MRI strategy for the assessment of left atrial fibrosis in atrial fibrillation (AF). Materials and Methods In this prospective study conducted between April and September 2022, 26 consecutive participants with AF (mean age, 61 ± 11 years; 19 male) underwent both iNAV and dNAV 3D LGE cardiac MRI, with equivalent spatial resolution and timing in the cardiac cycle. Participants were randomized in the acquisition order of iNAV and dNAV. Both, iNAV-LGE and dNAV-LGE images were analyzed qualitatively using a 5-point Likert scale and quantitatively (percentage of atrial fibrosis using image intensity ratio threshold 1.2), including testing for overlap in atrial fibrosis areas by calculating Dice score. Results Acquisition time of iNAV was significantly lower compared with dNAV (4.9 ± 1.1 minutes versus 12 ± 4 minutes, P < .001, respectively). There was no evidence of a difference in image quality for all prespecified criteria between iNAV and dNAV, although dNAV was the preferred image strategy in two-thirds of cases (17/26, 65%). Quantitative assessment demonstrated that mean fibrosis scores were lower for iNAV compared with dNAV (12 ± 8% versus 20 ± 12%, P < .001). Spatial correspondence between the atrial fibrosis maps was modest (Dice similarity coefficient, 0.43 ± 0.15). Conclusion iNAV-LGE acquisition in individuals with AF was more than twice as fast as dNAV acquisition but resulted in a lower atrial fibrosis score. The differences between these two strategies might impact clinical interpretation. ©RSNA, 2024.
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Affiliation(s)
- Luuk H. G. A. Hopman
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - José A. Solís-Lemus
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Mark B. M. Hofman
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Pranav Bhagirath
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Sonia Borodzicz-Jazdzyk
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Nikki van Pouderoijen
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Axel J. Krafft
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Michaela Schmidt
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Cornelis P. Allaart
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Steven A. Niederer
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Marco J. W. Götte
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
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Borodzicz-Jazdzyk S, de Mooij GW, van Loon RB, Götte MJW. Microvascular dysfunction in hypertrophic cardiomyopathy: diagnostic role of noninvasive, fully automated quantitative perfusion cardiovascular magnetic resonance imaging. Pol Arch Intern Med 2024; 134:16603. [PMID: 37965961 DOI: 10.20452/pamw.16603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Geoffrey W de Mooij
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Hopman LHGA, Zweerink A, van de Veerdonk MC, van der Lingen ALCJ, Huntelaar MJ, Robbers LFHJ, van Rossum AC, Götte MJW, van Halm VP, Allaart CP. Post-implantation CMR imaging to study biventricular pacing effects on the right ventricle in left bundle branch block patients. Pacing Clin Electrophysiol 2024; 47:121-123. [PMID: 38055567 DOI: 10.1111/pace.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure patients with left ventricular dysfunction and a left bundle branch block. However, its impact on right ventricular (RV) function remains uncertain. This cardiac magnetic resonance imaging study found that CRT did not improve RV volumes and function, and CRT-off during follow-up had an immediate detrimental effect on the RV, which may suggest potential unfavorable RV remodeling with RV pacing during CRT.
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Affiliation(s)
| | - Alwin Zweerink
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | | | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Hopman LHGA, Beunder KP, Borodzicz-Jazdzyk S, Götte MJW, van Halm VP. Loss of capture of conduction system pacemaker caused by fibrosis surrounding the lead: a case report. BMC Cardiovasc Disord 2023; 23:621. [PMID: 38114911 PMCID: PMC10729341 DOI: 10.1186/s12872-023-03656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Conduction system pacing (CSP) is a novel technique that involves pacing the His-Purkinje system instead of the traditional right ventricular (RV) apex. This technique aims to avoid the adverse effects of RV apical pacing, which can lead to ventricular dyssynchrony and heart failure over time. CSP is gaining popularity but its long-term efficacy and challenges remain uncertain. This report discusses a case where CSP was initially successful but faced complications due to an increasing pacing threshold. CASE PRESENTATION A 65-year-old female with total atrioventricular block was referred for brady-pacing. Due to the potential for chronic RV pacing, CSP was chosen. The CSP implantation involved subcutaneous device placement, with a CSP lead in the left bundle branch area (LBBA) and an RV backup lead. A year after successful implantation, the LBBA pacing threshold progressively increased. Subsequent efforts to correct it led to anodal capture and battery depletion. Cardiac magnetic resonance imaging (CMR) revealed mid-septal fibrosis at the area of LBBA lead placement and suggested cardiac sarcoidosis as a possible cause. CONCLUSION CSP is a promising technique for treating bradyarrhythmias, but this case underscores the need for vigilance in monitoring pacing thresholds. Increasing thresholds can render CSP ineffective, necessitating alternative pacing methods. The CMR findings of mid-septal fibrosis and the potential diagnosis of cardiac sarcoidosis emphasize the importance of pre-implantation assessment, as CSP may be compromised by underlying structural abnormalities. This report highlights the complexities of pacing strategy selection and the significance of comprehensive evaluation before adopting CSP.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Kyle P Beunder
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Roney CH, Solis Lemus JA, Lopez Barrera C, Zolotarev A, Ulgen O, Kerfoot E, Bevis L, Misghina S, Vidal Horrach C, Jaffery OA, Ehnesh M, Rodero C, Dharmaprani D, Ríos-Muñoz GR, Ganesan A, Good WW, Neic A, Plank G, Hopman LHGA, Götte MJW, Honarbakhsh S, Narayan SM, Vigmond E, Niederer S. Constructing bilayer and volumetric atrial models at scale. Interface Focus 2023; 13:20230038. [PMID: 38106921 PMCID: PMC10722212 DOI: 10.1098/rsfs.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
To enable large in silico trials and personalized model predictions on clinical timescales, it is imperative that models can be constructed quickly and reproducibly. First, we aimed to overcome the challenges of constructing cardiac models at scale through developing a robust, open-source pipeline for bilayer and volumetric atrial models. Second, we aimed to investigate the effects of fibres, fibrosis and model representation on fibrillatory dynamics. To construct bilayer and volumetric models, we extended our previously developed coordinate system to incorporate transmurality, atrial regions and fibres (rule-based or data driven diffusion tensor magnetic resonance imaging (MRI)). We created a cohort of 1000 biatrial bilayer and volumetric models derived from computed tomography (CT) data, as well as models from MRI, and electroanatomical mapping. Fibrillatory dynamics diverged between bilayer and volumetric simulations across the CT cohort (correlation coefficient for phase singularity maps: left atrial (LA) 0.27 ± 0.19, right atrial (RA) 0.41 ± 0.14). Adding fibrotic remodelling stabilized re-entries and reduced the impact of model type (LA: 0.52 ± 0.20, RA: 0.36 ± 0.18). The choice of fibre field has a small effect on paced activation data (less than 12 ms), but a larger effect on fibrillatory dynamics. Overall, we developed an open-source user-friendly pipeline for generating atrial models from imaging or electroanatomical mapping data enabling in silico clinical trials at scale (https://github.com/pcmlab/atrialmtk).
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Affiliation(s)
- Caroline H. Roney
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carlos Lopez Barrera
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- Center for Research in Advanced Materials S.C (CIMAV), Chihuahua, Mexico
| | - Alexander Zolotarev
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Onur Ulgen
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Laura Bevis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Semhar Misghina
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Caterina Vidal Horrach
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Ovais A. Jaffery
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Mahmoud Ehnesh
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Cristobal Rodero
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gonzalo R. Ríos-Muñoz
- Bioengineering Department, Universidad Carlos III de Madrid, Madrid 28911, Spain
- Department of Cardiology, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid 28029, Spain
| | - Anand Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | | | - Gernot Plank
- Gottfried Schatz Research Center-Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | | | | | - Shohreh Honarbakhsh
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- IMB, UMR 5251, University Bordeaux, Talence 33400, France
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, UK
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9
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Hopman LHGA, van Pouderoijen N, Mulder MJ, van der Laan AM, Bhagirath P, Nazarian S, Niessen HWM, Ferrari VA, Allaart CP, Götte MJW. Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance: Review of Imaging Strategies and Histological Correlations. JACC Clin Electrophysiol 2023; 9:2665-2679. [PMID: 37737780 DOI: 10.1016/j.jacep.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
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Affiliation(s)
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Saman Nazarian
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Victor A Ferrari
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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10
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Bhagirath P, Campos FO, Postema PG, Kemme MJB, Wilde AAM, Prassl AJ, Neic A, Rinaldi CA, Götte MJW, Plank G, Bishop MJ. Arrhythmogenic vulnerability of re-entrant pathways in post-infarct ventricular tachycardia assessed by advanced computational modelling. Europace 2023; 25:euad198. [PMID: 37421339 PMCID: PMC10481251 DOI: 10.1093/europace/euad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Substrate assessment of scar-mediated ventricular tachycardia (VT) is frequently performed using late gadolinium enhancement (LGE) images. Although this provides structural information about critical pathways through the scar, assessing the vulnerability of these pathways for sustaining VT is not possible with imaging alone.This study evaluated the performance of a novel automated re-entrant pathway finding algorithm to non-invasively predict VT circuit and inducibility. METHODS Twenty post-infarct VT-ablation patients were included for retrospective analysis. Commercially available software (ADAS3D left ventricular) was used to generate scar maps from 2D-LGE images using the default 40-60 pixel-signal-intensity (PSI) threshold. In addition, algorithm sensitivity for altered thresholds was explored using PSI 45-55, 35-65, and 30-70. Simulations were performed on the Virtual Induction and Treatment of Arrhythmias (VITA) framework to identify potential sites of block and assess their vulnerability depending on the automatically computed round-trip-time (RTT). Metrics, indicative of substrate complexity, were correlated with VT-recurrence during follow-up. RESULTS Total VTs (85 ± 43 vs. 42 ± 27) and unique VTs (9 ± 4 vs. 5 ± 4) were significantly higher in patients with- compared to patients without recurrence, and were predictive of recurrence with area under the curve of 0.820 and 0.770, respectively. VITA was robust to scar threshold variations with no significant impact on total and unique VTs, and mean RTT between the four models. Simulation metrics derived from PSI 45-55 model had the highest number of parameters predictive for post-ablation VT-recurrence. CONCLUSION Advanced computational metrics can non-invasively and robustly assess VT substrate complexity, which may aid personalized clinical planning and decision-making in the treatment of post-infarction VT.
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Affiliation(s)
- Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
- Department of Cardiology, St Thomas' Hospital, London SE1 7EH, UK
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Aurel Neic
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
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Hopman LHGA, Zweerink A, van der Lingen ALCJ, Huntelaar MJ, Mulder MJ, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MJW, Allaart CP. Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy. J Clin Med 2023; 12:3998. [PMID: 37373691 PMCID: PMC10298880 DOI: 10.3390/jcm12123998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. METHODS Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure-volume measurements were performed, matching the CRT settings used during CMR. RESULTS Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. CONCLUSIONS Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; (L.H.G.A.H.)
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12
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Hopman LHGA, Frenaij IM, Solís-Lemus JA, el Mathari S, Niederer SA, Allaart CP, Götte MJW. Quantification of left atrial appendage fibrosis by cardiac magnetic resonance: an accurate surrogate for left atrial fibrosis in atrial fibrillation patients? Europace 2023; 25:euad084. [PMID: 36960602 PMCID: PMC10228533 DOI: 10.1093/europace/euad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - Irene M Frenaij
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - José A Solís-Lemus
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
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13
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el Mathari S, Kluin J, Hopman LHGA, Bhagirath P, Oudeman MAP, Vonk ABA, Nederveen AJ, Eberl S, Klautz RJM, Chamuleau SAJ, van Ooij P, Götte MJW. The role and implications of left atrial fibrosis in surgical mitral valve repair as assessed by CMR: the ALIVE study design and rationale. Front Cardiovasc Med 2023; 10:1166703. [PMID: 37252116 PMCID: PMC10213679 DOI: 10.3389/fcvm.2023.1166703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/03/2023] [Indexed: 05/31/2023] Open
Abstract
Background Patients with mitral regurgitation (MR) commonly suffer from left atrial (LA) remodeling. LA fibrosis is considered to be a key player in the LA remodeling process, as observed in atrial fibrillation (AF) patients. Literature on the presence and extent of LA fibrosis in MR patients however, is scarce and its clinical implications remain unknown. Therefore, the ALIVE trial was designed to investigate the presence of LA remodeling including LA fibrosis in MR patients prior to and after mitral valve repair (MVR) surgery. Methods The ALIVE trial is a single center, prospective pilot study investigating LA fibrosis in patients suffering from MR in the absence of AF (identifier NCT05345730). In total, 20 participants will undergo a CMR scan including 3D late gadolinium enhancement (LGE) imaging 2 week prior to MVR surgery and at 3 months follow-up. The primary objective of the ALIVE trial is to assess the extent and geometric distribution of LA fibrosis in MR patients and to determine effects of MVR surgery on reversed atrial remodelling. Implications This study will provide novel insights into the pathophysiological mechanism of fibrotic and volumetric atrial (reversed) remodeling in MR patients undergoing MVR surgery. Our results may contribute to improved clinical decision making and patient-specific treatment strategies in patients suffering from MR.
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Affiliation(s)
- Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Maurice A. P. Oudeman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Alexander B. A. Vonk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Rotterdam, Netherlands
| | | | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
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14
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Hopman LHGA, Mulder MJ, van der Laan AM, Bhagirath P, Demirkiran A, von Bartheld MB, Kemme MJB, van Rossum AC, Allaart CP, Götte MJW. Left atrial strain is associated with arrhythmia recurrence after atrial fibrillation ablation: Cardiac magnetic resonance rapid strain vs. feature tracking strain. Int J Cardiol 2023; 378:23-31. [PMID: 36804765 DOI: 10.1016/j.ijcard.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients. METHODS This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring. RESULTS Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70). CONCLUSION Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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15
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Hopman LHGA, Frenaij IM, van Luijk RD, van de Veerdonk MC, Götte MJW, Allaart CP. A comprehensive view on real-time magnetic resonance-guided flutter ablation image planes from an electrophysiological perspective. Eur Heart J Cardiovasc Imaging 2023; 24:401-403. [PMID: 36726026 PMCID: PMC10029834 DOI: 10.1093/ehjci/jead014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Irene M Frenaij
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Raschel D van Luijk
- Department of Radiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
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16
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Hopman LHGA, van de Veerdonk MC, Nelissen JL, Allaart CP, Götte MJW. Real-time magnetic resonance-guided right atrial flutter ablation after cryo-balloon pulmonary vein isolation. Eur Heart J Cardiovasc Imaging 2022; 24:e23. [PMID: 36288513 PMCID: PMC9762942 DOI: 10.1093/ehjci/jeac211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | | | - Jules L Nelissen
- Department of Radiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Hopman LHGA, Bhagirath P, Götte MJW. MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation for Patients With Persistent Atrial Fibrillation. JAMA 2022; 328:1643-1644. [PMID: 36282264 DOI: 10.1001/jama.2022.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, England
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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18
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Bhagirath P, Campos FO, Costa CM, Wilde AAM, Prassl AJ, Neic A, Plank G, Rinaldi CA, Götte MJW, Bishop MJ. Predicting arrhythmia recurrence following catheter ablation for ventricular tachycardia using late gadolinium enhancement magnetic resonance imaging: Implications of varying scar ranges. Heart Rhythm 2022; 19:1604-1610. [PMID: 35644355 DOI: 10.1016/j.hrthm.2022.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thresholding-based analysis of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) can create scar maps and identify corridors that might provide a reentrant substrate for ventricular tachycardia (VT). Current recommendations use a full-width-at-half-maximum approach, effectively classifying areas with a pixel signal intensity (PSI) >40% as border zone (BZ) and >60% as core. OBJECTIVE The purpose of this study was to investigate the impact of 4 different threshold settings on scar and corridor quantification and to correlate this with postablation VT recurrence. METHODS Twenty-seven patients with ischemic cardiomyopathy who had undergone catheter ablation for VT were included for retrospective analysis. LGE-CMR images were analyzed using ADAS3D LV. Scar maps were created for 4 PSI thresholds (40-60, 35-65, 30-70, and 45-55), and the extent of variation in BZ and core, as well as the number and weight of conduction corridors, were quantified. Three-dimensional representations were reconstructed from exported segmentations and used to quantify the surface area between healthy myocardium and scar (BZ + core), and between BZ and core. RESULTS A wider PSI threshold was associated with an increase in BZ mass and decrease in scar (P <.001). No significant differences were observed for the total number of corridors and their mass with increasing PSI threshold. The best correlation in predicting arrhythmia recurrence was observed for PSI 45-55 (area under the curve 0.807; P = .001). CONCLUSION Varying PSI has a significant impact on quantification of LGE-CMR parameters and may have incremental clinical value in predicting arrhythmia recurrence. Further prospective investigation is warranted to clarify the functional implications of these findings for LGE-CMR-guided ventricular ablation.
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Affiliation(s)
- Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Caroline M Costa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Aurel Neic
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Quantification of left atrial fibrosis by 3D late gadolinium-enhanced cardiac magnetic resonance imaging in patients with atrial fibrillation: impact of different analysis methods. Eur Heart J Cardiovasc Imaging 2022; 23:1182-1190. [PMID: 35947873 PMCID: PMC9365307 DOI: 10.1093/ehjci/jeab245] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Various methods and post-processing software packages have been developed to quantify left atrial (LA) fibrosis using 3D late gadolinium-enhancement cardiac magnetic resonance (LGE-CMR) images. Currently, it remains unclear how the results of these methods and software packages interrelate.
Methods and results
Forty-seven atrial fibrillation (AF) patients underwent 3D-LGE-CMR imaging prior to their AF ablation. LA fibrotic burden was derived from the images using open-source CEMRG software and commercially available ADAS 3D-LA software. Both packages were used to calculate fibrosis based on the image intensity ratio (IIR)-method. Additionally, CEMRG was used to quantify LA fibrosis using three standard deviations (3SD) above the mean blood pool signal intensity. Intraclass correlation coefficients were calculated to compare LA fibrosis quantification methods and different post-processing software outputs. The percentage of LA fibrosis assessed using IIR threshold 1.2 was significantly different from the 3SD-method (29.80 ± 14.15% vs. 8.43 ± 5.42%; P < 0.001). Correlation between the IIR-and SD-method was good (r = 0.85, P < 0.001) although agreement was poor [intraclass correlation coefficient (ICC) = 0.19; P < 0.001]. One-third of the patients were allocated to a different fibrosis category dependent on the used quantification method. Fibrosis assessment using CEMRG and ADAS 3D-LA showed good agreement for the IIR-method (ICC = 0.93; P < 0.001).
Conclusions
Both, the IIR1.2 and 3SD-method quantify atrial fibrotic burden based on atrial wall signal intensity differences. The discrepancy in the amount of LA fibrosis between these methods may have clinical implications when patients are classified according to their fibrotic burden. There was no difference in results between post-processing software packages to quantify LA fibrosis if an identical quantification method including the threshold was used.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Iris N Eggink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
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Hopman LHGA, Visch JE, Bhagirath P, van der Laan AM, Mulder MJ, Razeghi O, Kemme MJB, Niederer SA, Allaart CP, Götte MJW. Right atrial function and fibrosis in relation to successful atrial fibrillation ablation. Eur Heart J Cardiovasc Imaging 2022; 24:336-345. [PMID: 35921538 PMCID: PMC9936834 DOI: 10.1093/ehjci/jeac152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Bi-atrial remodelling in patients with atrial fibrillation (AF) is rarely assessed and data on the presence of right atrial (RA) fibrosis, the relationship between RA and left atrial (LA) fibrosis, and possible association of RA remodelling with AF recurrence after ablation in patients with AF is limited. METHODS AND RESULTS A total of 110 patients with AF undergoing initial pulmonary vein isolation (PVI) were included in the present study. All patients were in sinus rhythm during cardiac magnetic resonance (CMR) imaging performed prior to ablation. LA and RA volumes and function (volumetric and feature tracking strain) were derived from cine CMR images. The extent of LA and RA fibrosis was assessed from 3D late gadolinium enhancement images. AF recurrence was followed up for 12 months after PVI using either 12-lead electrocardiograms or Holter monitoring. Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (interquartile range: 122-286) days. RA remodelling parameters were not significantly different between patients with and without AF recurrence after ablation, whereas LA remodelling parameters were different (volume, emptying fraction, and strain indices). LA fibrosis had a strong correlation with RA fibrosis (r = 0.88, P < 0.001). Both LA and RA fibrosis were not different between patients with and without AF recurrence. CONCLUSIONS This study shows that RA remodelling parameters were not predictive of AF recurrence after AF ablation. Bi-atrial fibrotic remodelling is present in patients with AF and moreover, the amount of LA fibrosis had a strong correlation with the amount of RA fibrosis.
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Affiliation(s)
| | - Julia E Visch
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Orod Razeghi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Marco J W Götte
- Corresponding author. Tel: +31 20 444 0123; Fax: +31 20 4442446. E-mail:
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21
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Extent of Left Atrial Fibrosis Correlates with Descending Aorta Proximity at 3D Late Gadolinium Enhancement Cardiac MRI in Patients with Atrial Fibrillation. Radiol Cardiothorac Imaging 2022; 4:e210192. [PMID: 35795718 PMCID: PMC8893208 DOI: 10.1148/ryct.210192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 05/04/2023]
Abstract
PURPOSE To determine whether the distance between the descending aorta and left atrial (LA) wall correlates with the amount of fibrosis quantified in the posterior left inferior pulmonary vein (LIPV) area of the LA in patients with atrial fibrillation (AF). MATERIALS AND METHODS In this retrospective study, patients with AF underwent cardiac MRI in sinus rhythm prior to a pulmonary vein isolation procedure (July 2018 to February 2020). The mean distance (distancemean) and shortest distance (distanceshort) between the descending aorta and the LA wall were measured on three-dimensional (3D) contrast-enhanced MR angiograms; distancemean was defined as the average of five measurements at different levels between the descending aorta and the LA wall. The extent of LA fibrosis, both global fibrosis and regional fibrosis within the LIPV area, was derived from postprocessed, 3D, late gadolinium-enhanced images. Associations between the extent of fibrosis and the proximity of the descending aorta were analyzed by using correlative and multivariable analyses. RESULTS A total of 47 (mean age, 60 years ± 8 [standard deviation]; 31 men) patients were included for analysis. The extent of fibrosis in the posterior LIPV area was correlated with the distancemean (r s = -0.48; P < .01) and distanceshort (r s = -0.49; P < .01). Patients with a short distance between the descending aorta and LA wall (defined as a distanceshort < 2 mm) had a higher percentage of fibrosis in the posterior LIPV area than patients with a distanceshort greater than 2 mm (38.7% ± 22.7 vs 21.2% ± 17.8; P < .01). CONCLUSION The distance between the descending aorta and LA was correlated with the extent of quantified fibrosis within the posterior LIPV area.Keywords: MRI, Cardiac, Left Atrium Supplemental material is available for this article. © RSNA, 2022.
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22
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Mulder MJ, Kemme MJB, Hopman LHGA, Kuşgözoğlu E, Gülçiçek H, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. Int J Cardiol 2021; 344:103-110. [PMID: 34555444 DOI: 10.1016/j.ijcard.2021.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. METHODS A total of 482 AF patients (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. RESULTS Median follow-up was 16 (12-31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). CONCLUSIONS Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Elif Kuşgözoğlu
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Hatice Gülçiçek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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23
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Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, Allaart CP, Götte MJW. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson 2021; 23:131. [PMID: 34758820 PMCID: PMC8582184 DOI: 10.1186/s12968-021-00820-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with profound structural and functional changes in the atria. In the present study, we investigated the association between left atrial (LA) phasic function and the extent of LA fibrosis using advanced cardiovascular magnetic resonance (CMR) imaging techniques, including 3-dimensional (3D) late gadolinium enhancement (LGE) and feature tracking. METHODS Patients with paroxysmal and persistent AF (n = 105) underwent CMR in sinus rhythm. LA global reservoir strain, conduit strain and contractile strain were derived from cine CMR images using CMR feature tracking. The extent of LA fibrosis was assessed from 3D LGE images. Healthy subjects underwent CMR and served as controls (n = 19). RESULTS Significantly lower LA reservoir strain, conduit strain and contractile strain were found in AF patients, as compared to healthy controls (- 15.9 ± 3.8% vs. - 21.1 ± 3.6% P < 0.001, - 8.7 ± 2.7% vs. - 12.6 ± 2.5% P < 0.001 and - 7.2 ± 2.3% vs. - 8.6 ± 2.2% P = 0.02, respectively). Patients with a high degree of LA fibrosis (dichotomized by the median value) had lower reservoir strain and conduit strain compared to patients with a low degree of LA fibrosis (- 15.0 ± 3.9% vs. - 16.9 ± 3.3%, P = 0.02 and - 7.9 ± 2.7% vs. - 9.5 ± 2.6%, P = 0.01, respectively). In contrast, no difference was found for LA contractile strain (- 7.1 ± 2.4% vs. - 7.4 ± 2.3%, P = 0.55). CONCLUSIONS Impaired LA reservoir and conduit strain are present in AF patients with extensive atrial fibrosis. Future studies are needed to examine the biologic nature of this association and possible therapeutic implications.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Anja M. van der Laan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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24
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Vink CEM, van de Hoef TP, Götte MJW, Eringa EC, Appelman Y. Reduced Microvascular Blood Volume as a Driver of Coronary Microvascular Disease in Patients With Non-obstructive Coronary Artery Disease: Rationale and Design of the MICORDIS Study. Front Cardiovasc Med 2021; 8:730810. [PMID: 34660730 PMCID: PMC8514690 DOI: 10.3389/fcvm.2021.730810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Ischemia with non-obstructive coronary arteries (INOCA) is part of the ischemic heart disease spectrum, and is particularly observed in women. INOCA has various mechanisms, such as coronary vasospasm and coronary microvascular dysfunction (CMD). A decreased coronary flow reserve (CFR) and-or increased myocardial resistance (MR) are commonly used to diagnose CMD. However, CFR and MR do not describe all pathophysiological mechanisms underlying CMD. Increased myocardial oxygen consumption (MVO2) normally increases myocardial blood volume (MBV), independently from myocardial blood flow (MBF). In addition insulin enhances MBV in healthy skeletal muscle, and this effect is impaired in INOCA-related conditions such as diabetes and obesity. Therefore, we propose that MBV is reduced in INOCA patients. Aim: To assess whether myocardial blood volume (MBV) is decreased in INOCA patients, at baseline, during hyperinsulinemia and during stress. Design: The MICORDIS-study is a single-center observational cross-sectional cohort study (identifier NTR7515). The primary outcome is MBV, compared between INOCA patients and matched healthy controls. The patient group will undergo coronary function testing using a Doppler guidewire, intracoronary adenosine and acetylcholine to measure CFR and coronary vasospasm. Both the patient- and the control group will undergo myocardial contrast echocardiography (MCE) to determine MBV at baseline, during hyperinsulinemia and during stress. Subsequently, cardiac magnetic resonance (CMR) will be evaluated as a new and noninvasive diagnostic tool for CMD in INOCA patients. Microvascular endothelial function is a determinant of MBV and will be evaluated by non-invasive microvascular function testing using EndoPAT and by measuring NO production in circulating endothelial cells (ECFCs).
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Affiliation(s)
- Caitlin E M Vink
- Departments of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences (ACS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tim P van de Hoef
- Departments of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences (ACS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M J W Götte
- Departments of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences (ACS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - E C Eringa
- Departments of Physiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences (ACS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yolande Appelman
- Departments of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences (ACS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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25
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Demirkiran A, van Ooij P, Westenberg JJM, Hofman MBM, van Assen HC, Schoonmade LJ, Asim U, Blanken CPS, Nederveen AJ, van Rossum AC, Götte MJW. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging 2021; 23:154-165. [PMID: 34143872 PMCID: PMC8787996 DOI: 10.1093/ehjci/jeab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Identification of flow patterns within the heart has long been recognized as a potential contribution to the understanding of physiological and pathophysiological processes of cardiovascular diseases. Although the pulsatile flow itself is multi-dimensional and multi-directional, current available non-invasive imaging modalities in clinical practice provide calculation of flow in only 1-direction and lack 3-dimensional volumetric velocity information. Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) has emerged as a novel tool that enables comprehensive and critical assessment of flow through encoding velocity in all 3 directions in a volume of interest resolved over time. Following technical developments, 4D flow CMR is not only capable of visualization and quantification of conventional flow parameters such as mean/peak velocity and stroke volume but also provides new hemodynamic parameters such as kinetic energy. As a result, 4D flow CMR is being extensively exploited in clinical research aiming to improve understanding of the impact of cardiovascular disease on flow and vice versa. Of note, the analysis of 4D flow data is still complex and accurate analysis tools that deliver comparable quantification of 4D flow values are a necessity for a more widespread adoption in clinic. In this article, the acquisition and analysis processes are summarized and clinical applications of 4D flow CMR on the heart including conventional and novel hemodynamic parameters are discussed. Finally, clinical potential of other emerging intra-cardiac 4D flow imaging modalities is explored and a near-future perspective on 4D flow CMR is provided.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Usman Asim
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carmen P S Blanken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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26
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Schuuring MJ, van der Bom T, Konings TC, Götte MJW, Koolbergen DR, Boekholdt SM, de Winter RJ. Multimodality Evaluation of a Septal Cystic Cavity and Ventricular Septal Defect in the Setting of Neurocysticercosis and Endocarditis. Circ Cardiovasc Imaging 2021; 14:e011688. [PMID: 33794648 DOI: 10.1161/circimaging.120.011688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark J Schuuring
- Department of Cardiology (M.J.S., T.v.d.B., S.M.B., R.J.d.W.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - Teun van der Bom
- Department of Cardiology (M.J.S., T.v.d.B., S.M.B., R.J.d.W.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, location VUmc, University of Amsterdam, the Netherlands (T.C.K., M.J.W.G.)
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, location VUmc, University of Amsterdam, the Netherlands (T.C.K., M.J.W.G.)
| | - David R Koolbergen
- Department of Surgery (D.R.K.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology (M.J.S., T.v.d.B., S.M.B., R.J.d.W.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology (M.J.S., T.v.d.B., S.M.B., R.J.d.W.), Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
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27
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Demirkiran A, Amier RP, Hofman MBM, van der Geest RJ, Robbers LFHJ, Hopman LHGA, Mulder MJ, van de Ven P, Allaart CP, van Rossum AC, Götte MJW, Nijveldt R. Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling. Sci Rep 2021; 11:5965. [PMID: 33727587 PMCID: PMC7966746 DOI: 10.1038/s41598-021-85176-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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28
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Demirkiran A, Everaars H, Amier RP, Beijnink C, Bom MJ, Götte MJW, van Loon RB, Selder JL, van Rossum AC, Nijveldt R. Cardiovascular magnetic resonance techniques for tissue characterization after acute myocardial injury. Eur Heart J Cardiovasc Imaging 2020; 20:723-734. [PMID: 31131401 DOI: 10.1093/ehjci/jez094] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/19/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
The annual incidence of hospital admission for acute myocardial infarction lies between 90 and 312 per 100 000 inhabitants in Europe. Despite advances in patient care 1 year mortality after ST-segment elevation myocardial infarction (STEMI) remains around 10%. Cardiovascular magnetic resonance imaging (CMR) has emerged as a robust imaging modality for assessing patients after acute myocardial injury. In addition to accurate assessment of left ventricular ejection fraction and volumes, CMR offers the unique ability of visualization of myocardial injury through a variety of imaging techniques such as late gadolinium enhancement and T2-weighted imaging. Furthermore, new parametric mapping techniques allow accurate quantification of myocardial injury and are currently being exploited in large trials aiming to augment risk management and treatment of STEMI patients. Of interest, CMR enables the detection of microvascular injury (MVI) which occurs in approximately 40% of STEMI patients and is a major independent predictor of mortality and heart failure. In this article, we review traditional and novel CMR techniques used for myocardial tissue characterization after acute myocardial injury, including the detection and quantification of MVI. Moreover, we discuss clinical scenarios of acute myocardial injury in which the tissue characterization techniques can be applied and we provide proposed imaging protocols tailored to each scenario.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Casper Beijnink
- Department of Cardiology, Radboudumc, Geert Grooteplein Zuid 10, GA, Nijmegen, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Jasper L Selder
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands.,Department of Cardiology, Radboudumc, Geert Grooteplein Zuid 10, GA, Nijmegen, the Netherlands
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Mulder MJ, Kemme MJB, Hagen AMD, Hopman LHGA, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation. Int J Cardiol Heart Vasc 2020; 29:100574. [PMID: 32642554 PMCID: PMC7334811 DOI: 10.1016/j.ijcha.2020.100574] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
Ablation Index-guided ablation allows for ablation lesions of consistent depth. Ablation Index-guided ablation is limited by ignoring local wall thickness. Local atrial wall thickness is associated with acute pulmonary vein reconnection. Wall thickness adjusted Ablation Index targets may improve ablation outcomes.
Background Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
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30
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Mulder MJ, Kemme MJB, Götte MJW, van de Ven PM, Hauer HA, Tahapary GJM, van Rossum AC, Allaart CP. Differences between gap-related persistent conduction and carina-related persistent conduction during radiofrequency pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:1616-1627. [PMID: 32406138 PMCID: PMC7383882 DOI: 10.1111/jce.14544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND During pulmonary vein isolation (PVI), nonisolation after initial encircling of the pulmonary veins (PVs) may be due to gaps in the initial ablation line, or alternatively, earliest PV activation may occur on the intervenous carina and ablation within the wide-area circumferential ablation (WACA) circle is needed to eliminate residual conduction. This study investigated prognostic implications and predictors of gap-related persistent conduction (gap-RPC) and carina-related persistent conduction (carina-RPC) during PVI. METHODS AND RESULTS Two hundred fourteen atrial fibrillation (AF) patients (57% paroxysmal, 61% male, mean age 62 ± 9 years) undergoing first contact force-guided radiofrequency PVI were studied. Preprocedural cardiac computed tomography imaging was used to assess left atrial and PV anatomy. PVI was assessed directly after initial WACA circle creation, after a minimum waiting period of 30 minutes, and after adenosine infusion. Persistent conduction was targeted for additional ablation and classified as gap-RPC or carina-RPC, depending on the earliest activation site. The 1-year AF recurrence rate was higher in patients with gap-RPC (47%) compared to patients without gap-RPC (28%; P = .003). No significant difference in 1-year recurrence rate was found between patients with carina-RPC (37%) and patients without carina-RPC (31%; P = .379). Multivariate analyses identified paroxysmal AF and WACA circumference as independent predictors of gap-RPC, whereas carina width and WACA circumference correlated with carina-RPC. CONCLUSIONS Gap-RPC is associated with increased AF recurrence risk after PVI, whereas carina-RPC does not predict AF recurrence. Moreover, gap-RPC and carina-RPC have different correlates and may thus have different underlying mechanisms.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Location Amsterdam Zuid, Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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31
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Mulder MJ, Kemme MJB, Visser CL, Hopman LHGA, van Diemen PA, van de Ven PM, Götte MJW, Danad I, Knaapen P, van Rossum AC, Allaart CP. Left atrial sphericity as a marker of atrial remodeling: Comparison of atrial fibrillation patients and controls. Int J Cardiol 2020; 304:69-74. [PMID: 32005449 DOI: 10.1016/j.ijcard.2020.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results. The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF. METHODS Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined using computed tomography (CT) imaging data in 293 AF patients (62% paroxysmal AF) and 110 controls. RESULTS LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m2 vs. 41.6 ± 11.1 ml/m2; p < 0.001) were significantly larger in AF patients compared to controls, also after adjustment for covariates. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity. CONCLUSIONS The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Charlotte L Visser
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Götte MJW, Allaart CP. [MRI in patients with a pacemaker or ICD requires expertise]. Ned Tijdschr Geneeskd 2018; 162:D2910. [PMID: 30040331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Nazarian et al. recently studied the safety of magnetic resonance imaging in a large cohort of patients with cardiac devices not considered to be MRI-conditional (termed a "legacy" device). More than 2100 thoracic and nonthoracic MRI examinations were performed in 1509 patients. It was found that with appropriate precautions, including a prespecified safety protocol, no long-term clinically significant adverse events occurred. It could easily be concluded from these observations that MRI can now be considered "safe" in this category of patients. Whether such a conclusion is justified, is questionable however. Although not life-threatening, interactions between MRI and devices still occur and clinical consequences remain unpredictable. It is therefore strongly recommended that MRI in patients with a legacy device should exclusively be performed in centres of excellence. Only in the presence of a multidisciplinary radiological and cardiac expert team can MRI be conducted with acceptable risks in patients with a legacy device.
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Bhagirath P, van der Graaf AWM, de Hooge J, de Groot NMS, Götte MJW. Integrated whole-heart computational workflow for inverse potential mapping and personalized simulations. J Transl Med 2016; 14:147. [PMID: 27226006 PMCID: PMC4880856 DOI: 10.1186/s12967-016-0902-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/12/2016] [Indexed: 12/04/2022] Open
Abstract
Background Integration of whole-heart activation simulations and inverse potential mapping (IPM) could benefit the guidance and planning of electrophysiological procedures. Routine clinical application requires a fast and adaptable workflow. These requirements limit clinical translation of existing simulation models. This study proposes a comprehensive finite element model (FEM) based whole-heart computational workflow suitable for IPM and simulations. Methods Three volunteers and eight patients with premature ventricular contractions underwent body surface potential (BSP) acquisition followed by a cardiac MRI (CMR) scan. The cardiac volumes were segmented from the CMR images using custom written software. The feasibility to integrate tissue-characteristics was assessed by generating meshes with virtual edema and scar. Isochronal activation maps were constructed by identifying the fastest route through the cardiac volume using the Möller–Trumbore and Floyd–Warshall algorithms. IPM’s were reconstructed from the BSP’s. Results Whole-heart computational meshes were generated within seconds. The first point of atrial activation on IPM was located near the crista terminalis of the superior vena cave into the right atrium. The IPM demonstrated the ventricular epicardial breakthrough at the attachment of the moderator band with the right ventricular free wall. Simulations of sinus rhythm were successfully performed. The conduction through the virtual edema and scar meshes demonstrated delayed activation or a complete conductional block respectively. Conclusion The proposed FEM based whole-heart computational workflow offers an integrated platform for cardiac electrical assessment using simulations and IPM. This workflow can incorporate patient-specific electrical parameters, perform whole-heart cardiac activation simulations and accurately reconstruct cardiac activation sequences from BSP’s. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0902-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Bhagirath
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
| | - A W M van der Graaf
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - J de Hooge
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - N M S de Groot
- Department of Cardiology, Thorax Center, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - M J W Götte
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
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van der Graaf AWM, Bhagirath P, Scheffer MG, de Medina RR, Götte MJW. MR feature tracking in patients with MRI-conditional pacing systems: The impact of pacing. J Magn Reson Imaging 2016; 44:964-71. [PMID: 26990922 DOI: 10.1002/jmri.25229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To develop feature tracking (FT) software to perform strain analysis on conventional (nontagged) cardiac magnetic resonance imaging (MRI) function images. With the advent of MRI-conditional pacemaker systems, effects of cardiac pacing on myocardial strain can be studied using MR. In this study the impact of pacing on left ventricular (LV) strain was investigated using MR-FT in patients with an MRI-conditional cardiac implantable electronic device (CIED). MATERIALS AND METHODS FT was performed on 32 1.5T MR studies (16 patients with an MRI-conditional CIED and 16 control patients with normal scans). Short- and long-axis steady state free precession (SSFP) cines were used for the FT analysis. Strain was assessed using CVI(42) software (Circle Cardiovascular Imaging, Alberta, Canada). In addition, the intra- and interobserver variability was determined using the intraclass correlation coefficient. RESULTS Of the 16 patients with an MRI-conditional CIED, five patients were paced during the MRI exam. Despite the occasional presence of susceptibility artifacts induced by the CIED, radial, circumferential, and longitudinal strain parameters could be derived for all patients. Peak radial strain and peak circumferential strain were reduced during pacing when compared to the control group; for radial strain: 20.1 ± 4.7% vs. 33.1 ± 6.9%, P < 0.001, and for circumferential strain -7.5 ± 3.5% vs. -14.9 ± 3.2%, P < 0.05. Peak strain parameters were reproducible on an intra- and interobserver level. CONCLUSION MR-FT is feasible in patients with an MRI-conditional CIED and can be used to quantify regional wall motion. J. MAGN. RESON. IMAGING 2016;44:964-971.
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Affiliation(s)
| | - Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mike G Scheffer
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.,Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Marco J W Götte
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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Bhagirath P, van der Graaf M, van Dongen E, de Hooge J, van Driel V, Ramanna H, de Groot N, Götte MJW. Feasibility and Accuracy of Cardiac Magnetic Resonance Imaging-Based Whole-Heart Inverse Potential Mapping of Sinus Rhythm and Idiopathic Ventricular Foci. J Am Heart Assoc 2015; 4:e002222. [PMID: 26467997 PMCID: PMC4845111 DOI: 10.1161/jaha.115.002222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Inverse potential mapping (IPM) noninvasively reconstructs cardiac surface potentials using body surface potentials. This requires a volume conductor model (VCM), usually constructed from computed tomography; however, computed tomography exposes the patient to harmful radiation and lacks information about tissue structure. Magnetic resonance imaging (MRI) is not associated with this limitation and might have advantages for mapping purposes. This feasibility study investigated a magnetic resonance imaging–based IPM approach. In addition, the impact of incorporating the lungs and their particular resistivity values was explored. Methods and Results Three volunteers and 8 patients with premature ventricular contractions scheduled for ablation underwent 65‐electrode body surface potential mapping. A VCM was created using magnetic resonance imaging. Cardiac surface potentials were estimated from body surface potentials and used to determine the origin of electrical activation. The IPM‐defined origin of sinus rhythm corresponded well with the anatomic position of the sinus node, as described in the literature. In patients, the IPM‐derived premature ventricular contraction focus was 3‐dimensionally located within 8.3±2.7 mm of the invasively determined focus using electroanatomic mapping. The impact of lungs on the IPM was investigated using homogeneous and inhomogeneous VCMs. The inhomogeneous VCM, incorporating lung‐specific conductivity, provided more accurate results compared with the homogeneous VCM (8.3±2.7 and 10.3±3.1 mm, respectively; P=0.043). The interobserver agreement was high for homogeneous (intraclass correlation coefficient 0.862, P=0.003) and inhomogeneous (intraclass correlation coefficient 0.812, P=0.004) VCMs. Conclusion Magnetic resonance imaging–based whole‐heart IPM enables accurate spatial localization of sinus rhythm and premature ventricular contractions comparable to electroanatomic mapping. An inhomogeneous VCM improved IPM accuracy.
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Affiliation(s)
- Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Maurits van der Graaf
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Elise van Dongen
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Jacques de Hooge
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Vincent van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
| | - Natasja de Groot
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (N.G.)
| | - Marco J W Götte
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (P.B., M.G., E.D., J.H., V.D., H.R., M.W.)
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van der Graaf AWM, Bhagirath P, de Hooge J, Ramanna H, van Driel VJHM, de Groot NMS, Götte MJW. Non-invasive focus localization, right ventricular epicardial potential mapping in patients with an MRI-conditional pacemaker system - a pilot study. J Interv Card Electrophysiol 2015; 44:227-34. [PMID: 26369330 PMCID: PMC4641154 DOI: 10.1007/s10840-015-0054-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/18/2015] [Indexed: 11/09/2022]
Abstract
Background With the advent of magnetic resonance imaging (MRI) conditional pacemaker systems, the possibility of performing MRI in pacemaker patients has been introduced. Besides for the detailed evaluation of atrial and ventricular volumes and function, MRI can be used in combination with body surface potential mapping (BSPM) in a non-invasive inverse potential mapping (IPM) strategy. In non-invasive IPM, epicardial potentials are reconstructed from recorded body surface potentials (BSP). In order to investigate whether an IPM method with a limited number of electrodes could be used for the purpose of non-invasive focus localization, it was applied in patients with implanted pacing devices. Ventricular paced beats were used to simulate ventricular ectopic foci. Methods Ten patients with an MRI-conditional pacemaker system and a structurally normal heart were studied. Patient-specific 3D thorax volume models were reconstructed from the MRI images. BSP were recorded during ventricular pacing. Epicardial potentials were inversely calculated from the BSP. The site of epicardial breakthrough was compared to the position of the ventricular lead tip on MRI and the distance between these points was determined. Results For all patients, the site of earliest epicardial depolarization could be identified. When the tip of the pacing lead was implanted in vicinity to the epicardium, i.e. right ventricular (RV) apex or RV outflow tract, the distance between lead tip position and epicardial breakthrough was 6.0 ± 1.9 mm. Conclusions In conclusion, the combined MRI and IPM method is clinically applicable and can identify sites of earliest depolarization with a clinically useful accuracy. Electronic supplementary material The online version of this article (doi:10.1007/s10840-015-0054-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - Jacques de Hooge
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | - Vincent J H M van Driel
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands
| | | | - Marco J W Götte
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
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van der Graaf AWM, Bhagirath P, van Driel VJHM, Ramanna H, de Hooge J, de Groot NMS, Götte MJW. Computing volume potentials for noninvasive imaging of cardiac excitation. Ann Noninvasive Electrocardiol 2014; 20:132-9. [PMID: 25041476 DOI: 10.1111/anec.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In noninvasive imaging of cardiac excitation, the use of body surface potentials (BSP) rather than body volume potentials (BVP) has been favored due to enhanced computational efficiency and reduced modeling effort. Nowadays, increased computational power and the availability of open source software enable the calculation of BVP for clinical purposes. In order to illustrate the possible advantages of this approach, the explanatory power of BVP is investigated using a rectangular tank filled with an electrolytic conductor and a patient specific three dimensional model. METHODS MRI images of the tank and of a patient were obtained in three orthogonal directions using a turbo spin echo MRI sequence. MRI images were segmented in three dimensional using custom written software. Gmsh software was used for mesh generation. BVP were computed using a transfer matrix and FEniCS software. RESULTS The solution for 240,000 nodes, corresponding to a resolution of 5 mm throughout the thorax volume, was computed in 3 minutes. The tank experiment revealed that an increased electrode surface renders the position of the 4 V equipotential plane insensitive to mesh cell size and reduces simulated deviations. In the patient-specific model, the impact of assigning a different conductivity to lung tissue on the distribution of volume potentials could be visualized. CONCLUSION Generation of high quality volume meshes and computation of BVP with a resolution of 5 mm is feasible using generally available software and hardware. Estimation of BVP may lead to an improved understanding of the genesis of BSP and sources of local inaccuracies.
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Abstract
Magnetic resonance imaging (MRI) has evolved into an essential diagnostic modality for the evaluation of all patient categories. This gain in popularity coincided with an increase in the number of implanted cardiac implantable electronic devices (CIEDs). Therefore, questions arose with regard to the MRI compatibility of these devices. Various investigators have reported the harmless performance of MRI in patients with conventional (non-MRI conditional) devices. The recently published European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronisation therapy (CRT) indicate that MRI can be safely performed in patients with an implanted pacemaker or ICD (MRI conditional or not), as long as strict safety conditions are met. This is a major modification of the former general opinion that patients with a pacemaker or ICD were not eligible to undergo MRI. This review paper attempts to elucidate the current situation for practising cardiologists by providing a clear overview of the potential life-threatening interactions and discuss safety measures to be taken prior to and during scanning. An overview of all available MRI conditional devices and their individual restrictions is given. In addition, an up-to-date safety protocol is provided that can be used to ensure patient safety before, during and after the scan. Key points • Historically, MRI examination of patients with a CIED has been considered hazardous. • Ongoing advances in technology and increasing usage of MRI in clinical practice have led to the introduction of MRI conditional CIEDs and to more lenient regulations on the examination of patients with non-conditional CIEDs. • MRI investigations can be performed safely in selected patients when adhering to a standardised up-to-date safety protocol.
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Affiliation(s)
- A W M van der Graaf
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, the Netherlands,
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39
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Germans T, Nijveldt R, Brouwer WP, Groothuis JGJ, Beek AM, Götte MJW, van Rossum AC. The role of cardiac magnetic resonance imaging in differentiating the underlying causes of left ventricular hypertrophy. Neth Heart J 2011; 18:135-43. [PMID: 20390064 DOI: 10.1007/bf03091752] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The onset of sudden cardiac death and large inter- and intra-familial clinical variability of hypertrophic cardiomyopathy pose an important clinical challenge. Cardiac magnetic resonance imaging is a high-resolution imaging modality that has become increasingly available in the past decade and has the unique possibility to demonstrate the presence of fibrosis or scar using late gadolinium enhancement imaging. As a result, the diagnostic and prognostic potential of cardiac magnetic resonance imaging has been extensively explored in acute and chronic ischaemic cardiomyopathy, as well as in several nonischaemic cardiomyopathies.This review aims to provide a critical overview of recently published studies on hypertrophic cardiomyopathy and discusses the role of cardiac magnetic resonance imaging in differentiating underlying causes of hypertrophic cardiomyopathy, such as familial hypertrophic cardiomyopathy, cardiac involvement in systemic disease and left ventricular hypertrophy due to endurance sports. Also, it demonstrates the use of cardiac magnetic resonance in risk stratification for the onset of sudden cardiac death, and early identification of asymptomatic family members of hypertrophic cardiomyopathy patients who are at risk for the development of hypertrophic cardiomyopathy. (Neth Heart J 2010;18:135-43.).
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Affiliation(s)
- T Germans
- VU University Medical Center, Amsterdam, the Netherlands
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Timmer SAJ, Knaapen P, Germans T, Dijkmans PA, Lubberink M, Ten Berg JM, Ten Cate FJ, Rüssel IK, Götte MJW, Lammertsma AA, van Rossum AC. Effects of alcohol septal ablation on coronary microvascular function and myocardial energetics in hypertrophic obstructive cardiomyopathy. Am J Physiol Heart Circ Physiol 2011; 301:H129-37. [PMID: 21490327 DOI: 10.1152/ajpheart.00077.2011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigated the effects of alcohol septal ablation (ASA) on microcirculatory function and myocardial energetics in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. In 15 HCM patients who underwent ASA, echocardiography was performed before and 6 mo after the procedure to assess the LVOT gradient (LVOTG). Additionally, [(15)O]water PET was performed to obtain resting myocardial blood flow (MBF) and coronary vasodilator reserve (CVR). Changes in LV mass (LVM) and volumes were assessed by cardiovascular magnetic resonance imaging. Myocardial oxygen consumption (MVo(2)) was evaluated by [(11)C]acetate PET in a subset of seven patients to calculate myocardial external efficiency (MEE). After ASA, peak LVOTG decreased from 41 ± 32 to 23 ± 19 mmHg (P = 0.04), as well as LVM (215 ± 74 to 169 ± 63 g; P < 0.001). MBF remained unchanged (0.94 ± 0.23 to 0.98 ± 0.15 ml·min(-1)·g(-1); P = 0.45), whereas CVR increased (2.55 ± 1.23 to 3.05 ± 1.24; P = 0.05). Preoperatively, the endo-to-epicardial MBF ratio was lower during hyperemia compared with rest (0.80 ± 0.18 vs. 1.18 ± 0.15; P < 0.001). After ASA, the endo-to-epicardial hyperemic (h)MBF ratio increased to 1.03 ± 0.26 (P = 0.02). ΔCVR was correlated to ΔLVOTG (r = -0.82; P < 0.001) and ΔLVM (r = -0.54; P = 0.04). MEE increased from 15 ± 6 to 20 ± 9% (P = 0.04). Coronary microvascular dysfunction in obstructive HCM is at least in part reversible by relief of LVOT obstruction. After ASA, hMBF and CVR increased predominantly in the subendocardium. The improvement in CVR was closely correlated to the absolute reduction in peak LVOTG, suggesting a pronounced effect of LV loading conditions on microvascular function of the subendocardium. Furthermore, ASA has favorable effects on myocardial energetics.
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Affiliation(s)
- Stefan A J Timmer
- Dept. of Cardiology, 5F, VU Univ. Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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41
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Timmer SAJ, Lubberink M, Germans T, Götte MJW, ten Berg JM, ten Cate FJ, van Rossum AC, Lammertsma AA, Knaapen P. Potential of [11C]acetate for measuring myocardial blood flow: Studies in normal subjects and patients with hypertrophic cardiomyopathy. J Nucl Cardiol 2010; 17:264-75. [PMID: 20039151 DOI: 10.1007/s12350-009-9181-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 12/04/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measuring the rate of clearance of carbon-11 labelled acetate from myocardium using positron emission tomography (PET) is an accepted technique for noninvasively assessing myocardial oxygen consumption. Initial myocardial uptake of [(11)C]acetate, however, is related to myocardial blood flow (MBF) and several tracer kinetic models for quantifying MBF using [(11)C]acetate have been proposed. The objective of this study was to assess these models. METHODS Eighteen healthy subjects and 18 patients with hypertrophic cardiomyopathy (HCM) were studied under baseline conditions with [(11)C]acetate and [(15)O]water. Four previously reported methods, including single- and multi-tissue compartment models, were used to calculate MBF from the measured [(11)C]acetate rate of influx K (1) and the (previously) reported relationship between K (1) and MBF. These MBF values were then compared with those derived from corresponding [(15)O]water studies. RESULTS For all models, correlations between [(11)C]acetate and [(15)O]water-derived MBF ranged from .67 to .86 (all P < .005) in the control group and from .73 to .85 (all P < .001) in the HCM group. Two out of four models systematically underestimated perfusion with [(11)C]acetate, whilst the third model resulted in an overestimation. The fourth model, based on a simple single tissue compartment model with spillover, partial volume and recirculating metabolite corrections, resulted in a regression equation with a slope of near unity and an Y-intercept of almost zero (controls, K(1) = .74[MBF] + .09, r = .86, SEE = .13, P < .001 and HCM, K(1) = .89[MBF] + .03, r = .85, SEE = .12, P < .001). CONCLUSION [(11)C]acetate enables quantification of MBF in fairly good agreement with actual MBF in both healthy individuals and patients with HCM. A single tissue compartment model with standardized correction for recirculating metabolites and with corrections for partial volume and spillover provided the best results.
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Affiliation(s)
- S A J Timmer
- Department of Nuclear Medicine & PET Research, VU University Medical Centre, Amsterdam, The Netherlands
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Groothuis JGJ, Beek AM, Brinckman SL, Meijerink MR, Koestner SC, Nijveldt R, Götte MJW, Hofman MBM, van Kuijk C, van Rossum AC. Low to Intermediate Probability of Coronary Artery Disease: Comparison of Coronary CT Angiography with First-Pass MR Myocardial Perfusion Imaging. Radiology 2010; 254:384-92. [DOI: 10.1148/radiol.09090802] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rüssel IK, Götte MJW, Bronzwaer JG, Knaapen P, Paulus WJ, van Rossum AC. Left ventricular torsion: an expanding role in the analysis of myocardial dysfunction. JACC Cardiovasc Imaging 2009; 2:648-55. [PMID: 19442954 DOI: 10.1016/j.jcmg.2009.03.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/09/2009] [Accepted: 03/09/2009] [Indexed: 12/17/2022]
Abstract
During left ventricular (LV) torsion, the base rotates in an overall clockwise direction and the apex rotates in a counterclockwise direction when viewed from apex to base. LV torsion is followed by rapid untwisting, which contributes to ventricular filling. Because LV torsion is directly related to fiber orientation, it might depict subclinical abnormalities in heart function. Recently, ultrasound speckle tracking was introduced for quantification of LV torsion. This fast, widely available technique may contribute to a more rapid introduction of LV torsion as a clinical tool for detection of myocardial dysfunction. However, knowledge of the exact function and structure of the heart is fundamental for understanding the value of LV torsion. LV torsion has been investigated with different measurement methods during the past 2 decades, using cardiac magnetic resonance as the gold standard. The results obtained over the years are helpful for developing a standardized method to quantify LV torsion and have facilitated the interpretation and value of LV torsion before it can be used as a clinical tool.
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Affiliation(s)
- Iris K Rüssel
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands.
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Knaapen P, Götte MJW, de Cock CC. Myocardial bridging in aborted sudden death: just an innocent bystander? N Z Med J 2009; 122:61-63. [PMID: 19652682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Knaapen P, Camici PG, Marques KM, Nijveldt R, Bax JJ, Westerhof N, Götte MJW, Jerosch-Herold M, Schelbert HR, Lammertsma AA, van Rossum AC. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009; 104:485-98. [PMID: 19468781 PMCID: PMC2722717 DOI: 10.1007/s00395-009-0037-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 05/11/2009] [Accepted: 05/13/2009] [Indexed: 12/20/2022]
Abstract
Coronary microvascular dysfunction is a topic that has recently gained considerable interest in the medical community owing to the growing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications. With this growing awareness, comes the desire to accurately assess the functional capacity of the coronary microcirculation for diagnostic purposes as well as to monitor the effects of therapeutic interventions that are targeted at reversing the extent of coronary microvascular dysfunction. Measurements of coronary microvascular resistance play a pivotal role in achieving that goal and several invasive and noninvasive methods have been developed for its quantification. This review is intended to provide an update pertaining to the methodology of these different imaging techniques, including the discussion of their strengths and weaknesses.
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Affiliation(s)
- Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
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van der Bilt IAC, van Dijk J, van den Brink RBA, Götte MJW, Visser FC. Examining the octopus pot: multimodality imaging of a typical takotsubo cardiomyopathy. Echocardiography 2009; 25:794-6. [PMID: 18767208 DOI: 10.1111/j.1540-8175.2008.00662.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ivo A C van der Bilt
- Department of Cardiology of the Academic Medical Center Amsterdam, The Netherlands.
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Timmer SAJ, De Boer K, Knaapen P, Götte MJW, Van Rossum AC. The potential role of erythropoietin in chronic heart failure: from the correction of anemia to improved perfusion and reduced apoptosis? J Card Fail 2008; 15:353-61. [PMID: 19398085 DOI: 10.1016/j.cardfail.2008.10.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 09/14/2008] [Accepted: 10/15/2008] [Indexed: 02/02/2023]
Abstract
Besides stimulating erythropoiesis, erythropoietin (EPO) exerts powerful proangiogenic and antiapoptotic effects. These erythropoiesis-independent effects are potentially useful as a supplement for the treatment of chronic heart failure (CHF). EPO may improve microvascular capacity of ischemic myocardial tissue and could thereby (partially) restore myocardial function. In addition, EPO could protect cardiomyocytes from hypoxic damage and prevent them from apoptosis. However, the clinical value of these erythropoiesis-independent effects for the treatment of CHF remains to be elucidated. Small-sized trials evaluating the effects of EPO treatment on surrogate endpoints in patients with CHF showed positive effects in general; however, their mutual results are not always unambiguous. Moreover, increasing hematocrit levels with EPO has been associated with increased blood viscosity and an inherent risk of thromboembolic events. A currently running multicenter phase III trial is designed to provide clarity concerning the effects of EPO on outcome and safety in patients with CHF. Focusing primarily on outcome, however, does not provide insight into the mode of action and isolated benefits of the erythropoiesis-independent effects of EPO. Further exploration of these effects is a key issue to gain knowledge of the full potential of EPO for the treatment of CHF.
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Affiliation(s)
- Stefan A J Timmer
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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48
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Rüssel IK, van Dijk J, Kleijn SA, Germans T, de Roest G, Marcus JT, Kamp O, Götte MJW, van Rossum AC. Relation between three-dimensional echocardiography derived left ventricular volume and MRI derived circumferential strain in patients eligible for cardiac resynchronization therapy. Int J Cardiovasc Imaging 2008; 25:1-11. [DOI: 10.1007/s10554-008-9339-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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van Dijk J, Dijkmans PA, Götte MJW, Spreeuwenberg MD, Visser CA, Kamp O. Evaluation of global left ventricular function and mechanical dyssynchrony in patients with an asymptomatic left bundle branch block: a real-time 3D echocardiography study. Eur J Echocardiogr 2008; 9:40-6. [PMID: 17446139 DOI: 10.1016/j.euje.2007.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A left bundle branch block (LBBB) affects both global left ventricular (LV) function and mechanical dyssynchrony. The aim was to evaluate global LV function and mechanical dyssynchrony with real-time 3D echocardiography (RT3DE), in asymptomatic LBBB patients, healthy volunteers and patients with symptomatic heart failure (HF) and a LBBB. Furthermore, the relation between presence or absence of symptoms of HF and mechanical dyssynchrony was investigated. METHODS RT3DE was performed in 61 consecutive patients: 16 healthy volunteers, 22 patients with an asymptomatic LBBB and 23 patients with symptomatic HF and a LBBB. Global LV function and the systolic dyssynchrony index (SDI) were measured. RESULTS In healthy volunteers, mean LV ejection fraction was 54 +/- 5%, in asymptomatic LBBB patients 50 +/- 9%, and in HF patients 29 +/- 9%. SDI was 5.6 +/- 3.6%, 7.3 +/- 3.2% and 12.8 +/- 4.8% for healthy volunteers, asymptomatic LBBB patients and HF patients respectively. SDI differed significantly between HF patients and both other groups. A cut-off value for SDI for presence of symptoms of HF was 10.8%. CONCLUSION Asymptomatic LBBB patients have more depressed global LV function than healthy volunteers have; patients with symptoms of HF and a LBBB have severe global LV dysfunction. Asymptomatic LBBB patients have an intermediate mechanical dyssynchrony; HF patients with a LBBB have the most severe mechanical dyssynchrony. A substantial amount of mechanical dyssynchrony might be accompanied by the presence of symptoms of HF.
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Affiliation(s)
- Jeroen van Dijk
- Department of Cardiology ZH 6D 120, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Rüssel IK, Zwanenburg JJM, Germans T, Marcus JT, Allaart CP, de Cock CC, Götte MJW, van Rossum AC. Mechanical dyssynchrony or myocardial shortening as MRI predictor of response to biventricular pacing? J Magn Reson Imaging 2008; 26:1452-60. [PMID: 17968903 DOI: 10.1002/jmri.21133] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate whether mechanical dyssynchrony (regional timing differences) or heterogeneity (regional strain differences) in myocardial function should be used to predict the response to cardiac resynchronization therapy (CRT). MATERIALS AND METHODS Baseline mechanical function was studied with MRI in 29 patients with chronic heart failure. Using myocardial tagging, two mechanical dyssynchrony parameters were defined: the standard deviation (SD) in onset time (T onset) and in time to first peak (T peak,first) of circumferential shortening. Electrical dyssynchrony was described by QRS width. Further, two heterogeneity parameters were defined: the coefficient of variation (CV) in end-systolic strain and the difference between peak septal and lateral strain (DiffSLpeakCS). The relative increase in maximum rate of left ventricle pressure rise (dP/dt max) quantified the acute response to CRT. RESULTS The heterogeneity parameters correlated better with acute response (CV: r = 0.58, DiffSLpeakCS: r = 0.63, P < 0.005) than the mechanical dyssynchrony parameters (SD(T onset): r = 0.36, SD(T peak,first) r = 0.47, P = 0.01, but similar to electrical dyssynchrony (r = 0.62, P < 0.001). When a heterogeneity parameter was combined with electrical dyssynchrony, the correlation increased (r > 0.70, P incr < 0.05). CONCLUSION Regional heterogeneity in myocardial shortening correlates better with response to CRT than mechanical dyssynchrony, but should be combined with electrical dyssynchrony to improve prediction of response beyond the prediction from electrical dyssynchrony only.
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Affiliation(s)
- Iris K Rüssel
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
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