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Karanam S, Wang J, Rocha B, Semple T, Krupickova S, Desai A. Management of Left Ventricular Intramural Hematoma- an Unusual Complication of Complete Atrioventricular Septal Defect Repair in a Child. ASAIO J 2024:00002480-990000000-00466. [PMID: 38604137 DOI: 10.1097/mat.0000000000002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Postoperative survival for complete atrioventricular septal defect (cAVSD) is excellent. Common complications of surgery include valvular stenosis/regurgitation, left ventricular outflow tract obstruction, arrythmias, and residual defects. We report a challenging case of a 7-month old girl with Trisomy 21, preoperative obstructive sleep apnea with severe pulmonary hypertension, who underwent AVSD repair and required veno-arterial extracorporeal membrane oxygenation (V-A ECMO) while unable to come off cardiopulmonary bypass and developed left ventricular intramural hematoma during the course. This case highlights the challenges in management of an unusual complication.
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Affiliation(s)
- Sandeep Karanam
- From the Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Justin Wang
- From the Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
| | - Barnabe Rocha
- Cardiac Surgery Department, Royal Brompton Hospital, London, United Kingdom
| | - Thomas Semple
- Radiology Department, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sylvia Krupickova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Paediatric Cardiology Department and Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, United Kingdom
| | - Ajay Desai
- From the Paediatric Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
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Voges I, Caliebe A, Hinz S, Daubeney P, Boroni Gracioli S, Mohiaddin RH, Uebing AS, Pennell DJ, Gabbert DD, Krupickova S. Pediatric Z-Score Calculator of Cardiac MRI Volumetric Measurements. J Magn Reson Imaging 2024. [PMID: 38580327 DOI: 10.1002/jmri.29372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Amke Caliebe
- Medical Faculty, Kiel University, Kiel, Germany
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sophia Hinz
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Piers Daubeney
- Department of Paediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Simona Boroni Gracioli
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Raad H Mohiaddin
- National Heart and Lung Institute, Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ballenberger A, Caliebe A, Krupickova S, Uebing A, Gabbert DD, Voges I. CMR reference values of right ventricular volumetric variables in patients with hypoplastic left heart syndrome. J Cardiovasc Magn Reson 2024:101038. [PMID: 38499270 DOI: 10.1016/j.jocmr.2024.101038] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) has established itself as the gold standard for serial assessment of systemic right ventricular (RV) performance but due to the lack of standardized RV reference values for HLHS patients, the interpretation of RV volumetric data in HLHS remains difficult. Therefore, this study aimed to close this gap by providing CMR reference values for the systemic RV in HLHS patients. METHODS CMR scans of 160 children, adolescents and young adults (age range 2.2 to 25.2 years, 106 males) with HLHS were retrospectively evaluated. All patients were studied following total cavopulmonary connection. Short axis stacks were used to measure RV end-diastolic and end-systolic volumes (RVEDV, RVESV), stroke volume (RVSV), ejection fraction (RVEF) and end-diastolic myocardial mass (RVEDMM). Univariable and multiple linear regression analyses was performed to assess associations between RV parameters and demographic and anthropometric characteristics. Following the results of the regression analysis, reference graphs and tables were created with the LMS-method. RESULTS Multiple linear regression analysis showed strong associations between body height and RVEDV, RVESV as well as RVSV. Age was highly associated with RVEDMM. Therefore, percentile curves and tables were created with respect to body height (RVEDV, RVESV, RVSV) and age (RVEDMM). The influence of demographic and anthropometric parameters on RVEF was mild, thus no percentile curves and tables for RVEF are provided. CONCLUSION We were able to define CMR reference values for RV volumetric variables for HLHS patients. These data might be useful for the assessment and interpretation of CMR scans in these patients and for research in this field.
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Affiliation(s)
- Andrik Ballenberger
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Amke Caliebe
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
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Gabbert DD, Petersen L, Burleigh A, Grazioli SB, Krupickova S, Koch R, Uebing AS, Santarossa M, Voges I. Detection of hypoplastic left heart syndrome anatomy from cardiovascular magnetic resonance images using machine learning. MAGMA 2024; 37:115-125. [PMID: 38214799 PMCID: PMC10876735 DOI: 10.1007/s10334-023-01124-9] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The prospect of being able to gain relevant information from cardiovascular magnetic resonance (CMR) image analysis automatically opens up new potential to assist the evaluating physician. For machine-learning-based classification of complex congenital heart disease, only few studies have used CMR. MATERIALS AND METHODS This study presents a tailor-made neural network architecture for detection of 7 distinctive anatomic landmarks in CMR images of patients with hypoplastic left heart syndrome (HLHS) in Fontan circulation or healthy controls and demonstrates the potential of the spatial arrangement of the landmarks to identify HLHS. The method was applied to the axial SSFP CMR scans of 46 patients with HLHS and 33 healthy controls. RESULTS The displacement between predicted and annotated landmark had a standard deviation of 8-17 mm and was larger than the interobserver variability by a factor of 1.1-2.0. A high overall classification accuracy of 98.7% was achieved. DISCUSSION Decoupling the identification of clinically meaningful anatomic landmarks from the actual classification improved transparency of classification results. Information from such automated analysis could be used to quickly jump to anatomic positions and guide the physician more efficiently through the analysis depending on the detected condition, which may ultimately improve work flow and save analysis time.
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Affiliation(s)
- Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Lennart Petersen
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Computer Science, Kiel University, Kiel, Germany
| | - Abigail Burleigh
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Reinhard Koch
- Department of Computer Science, Kiel University, Kiel, Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
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5
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Voges I, Krupickova S. Editorial for "Right Ventricular Function in Takayasu's Arteritis Patients With Pulmonary Artery Involvement Using MRI Feature Tracking". J Magn Reson Imaging 2023. [PMID: 38059430 DOI: 10.1002/jmri.29145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
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Moscatelli S, Gatehouse P, Krupickova S, Mohiaddin R, Voges I, Giese D, Nielles-Vallespin S, Pennell DJ. Impact of compressed sensing (CS) acceleration of two-dimensional (2D) flow sequences in clinical paediatric cardiovascular magnetic resonance (CMR). MAGMA 2023; 36:869-876. [PMID: 37202654 PMCID: PMC10667407 DOI: 10.1007/s10334-023-01098-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Two-dimensional (2D) through-plane phase-contrast (PC) cine flow imaging assesses shunts and valve regurgitations in paediatric CMR and is considered the reference standard for Clinical quantification of blood Flow (COF). However, longer breath-holds (BH) can reduce compliance with possibly large respiratory manoeuvres altering flow. We hypothesize that reduced BH time by application of CS (Short BH quantification of Flow) (SBOF) retains accuracy while enabling faster, potentially more reliable flows. We investigate the variance between COF and SBOF cine flows. METHODS Main pulmonary artery (MPA) and sinotubular junction (STJ) planes were acquired at 1.5 T in paediatric patients by COF and SBOF. RESULTS 21 patients (mean age 13.9, 10-17y) were enrolled. The BH times were COF mean 11.7 s (range 8.4-20.9 s) vs SBOF mean 6.5 s (min 3.6-9.1 s). The differences and 95% CI between the COF and SBOF flows were LVSV -1.43 ± 13.6(ml/beat), LVCO 0.16 ± 1.35(l/min) and RVSV 2.95 ± 12.3(ml/beat), RVCO 0.27 ± 0.96(l/min), QP/QS were SV 0.04 ± 0.19, CO 0.02 ± 0.23. Variability between COF and SBOF did not exceed intrasession variation of COF. CONCLUSION SBOF reduces breath-hold duration to 56% of COF. RV flow by SBOF was biased compared to COF. The variation (95% CI) between COF and SBOF was similar to the COF intrasession test-retest 95% CI.
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Affiliation(s)
- Sara Moscatelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Peter Gatehouse
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, England.
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Raad Mohiaddin
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | - Sonia Nielles-Vallespin
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
| | - Dudley J Pennell
- Department of CMR, Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, England
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7
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Voges I, Krupickova S. Transcatheter Pulmonary Valve Replacement Candidacy: Is Cardiovascular Magnetic Resonance Angiography Enough? Am J Cardiol 2023; 207:507-508. [PMID: 37802700 DOI: 10.1016/j.amjcard.2023.09.028] [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] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; Department of Pediatric Cardiology, Royal Brompton Hospital, part of Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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8
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Piccinelli E, Bautista-Rodriguez C, Herberg J, Kang H, Krupickova S, Altamar IB, Moscatelli S, Sabatino J, Josen M, Paredes J, Whittaker E, Singh Y, Fraisse A, Di Salvo G. Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children. Cardiol Young 2023; 33:1177-1183. [PMID: 35919031 DOI: 10.1017/s1047951122002414] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking. METHODS We reviewed echocardiography findings of all multi-system inflammatory syndrome cases between 1st April and 31st July, 2020 and typical Kawasaki disease patients with coronary arteries abnormalities consecutively followed between 1st October, 2016 and June 30th, 2019. RESULTS We included 40 multi-system inflammatory syndrome children (25 males, 62.5%) and 45 Kawasaki disease patients (31 males, 68.9%) at a mean age of 6.4 years old and 8 years old, respectively. Four out of 40 multi-system inflammatory syndrome children had coronary arteries abnormalities. Left ventricle ejection fraction was normal in both groups. Global longitudinal strain was normal although Kawasaki disease group had significantly lower values (-20.0 versus -21.7%; p = 0.02). Basal segments were the most affected in Kawasaki disease patients with significant differences in the basal anterior, anterolateral, and anteroseptal strain: -18.2 versus -23.0% (p = 0.002), -16.7 versus -22.0% (p < 0.001), -16.7 versus -19.5% (p = 0.034), respectively. The basal anterolateral and anteroseptal segments in Kawasaki disease patients were the only ones with an absolute reduction of longitudinal strain (-16.7% both) consistent with the greater left main coronary involvement in this cohort. CONCLUSIONS Our findings are consistent with the transient cardiac involvement in multi-system inflammatory syndrome, as opposed to the subtle and chronic myocardial involvement in Kawasaki disease children with coronary arteries abnormalities. We speculate that the mechanism of cardiac impairment in the few multi-system inflammatory syndrome children with reduced global longitudinal strain is not related to coronary arteries abnormalities.
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Affiliation(s)
- Enrico Piccinelli
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jethro Herberg
- Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
| | - Heechan Kang
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sylvia Krupickova
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Ivan B Altamar
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sara Moscatelli
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jolanda Sabatino
- Università degli Studi "Magna Graecia" di Catanzaro, Catanzaro, Italy
| | - Manjit Josen
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
| | - Josefa Paredes
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
| | - Elisabeth Whittaker
- Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious diseases, Department of Infectious diseases, Imperial College London, London, UK
| | - Yogen Singh
- Neonatal Intensive Care Unit, Cambridge University Hospitals, Cambridge, UK
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Giovanni Di Salvo
- Paediatric Cardiology Services, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Università degli Studi di Padova, Padova, Italy
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Krupickova S, Voges I, Mohiaddin R, Bautista C, Li W, Herberg J, Daubeney PEF, Pennell DJ, Fraisse A. Short-term outcome of late gadolinium changes detected on cardiovascular magnetic resonance imaging following coronavirus disease 2019 Pfizer/BioNTech vaccine-related myocarditis in adolescents. Pediatr Radiol 2023; 53:892-899. [PMID: 36622403 PMCID: PMC9838400 DOI: 10.1007/s00247-022-05573-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Rare cases of cardiac inflammation following vaccination for severe acute respiratory coronavirus 2 (SARS-CoV-2) have been reported. OBJECTIVE To study paediatric patients with clinical findings of acute inflammation post coronavirus disease 2019 (COVID-19) Pfizer/BioNTech vaccination using cardiovascular magnetic resonance imaging (MRI) in acute and subacute phases. MATERIALS AND METHODS We enrolled adolescents younger than 18 years who presented at one of two institutions between July 2021 and August 2022 with clinical and laboratory findings of acute myocarditis shortly following COVID-19 Pfizer/BioNTech vaccination. They all underwent cardiovascular MRI using the institutional myocarditis protocol. RESULTS Five adolescents (four boys) underwent eight scans between 3 days and 109 days (mean 49 days) after the onset of symptoms following COVID-19 vaccination. Myocardial oedema appeared on short tau inversion recovery (STIR) T2-weighted images in three adolescents at presentation (3-12 days after symptom onset). In these children, the myocardial oedema/acute inflammation had resolved at follow-up cardiovascular MRI (53-68 days after first MRI). However, in all three adolescents, a persistent area of late gadolinium enhancement was evident at follow-up, suggesting post-myocarditic fibrosis. One adolescent scanned only once, 66 days after being symptomatic, had no acute inflammation but persistent fibrotic changes. This last adolescent, who underwent the first scan 109 days after symptom onset, had findings compatible with an episode of previous myocarditis, with mild ongoing regional myocardial oedema/inflammation. CONCLUSION This study on post-vaccine myocarditis demonstrates residual lesions with persistent areas of late gadolinium enhancement/myocardial fibrosis with ongoing myocardial oedema after resolution of the initial myocardial oedema a few weeks after Pfizer/BioNTech vaccination. There is an urgent need to recognise and fully investigate the outcome of post-vaccination myocarditis.
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Affiliation(s)
- Sylvia Krupickova
- Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carles Bautista
- Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Wei Li
- National Heart and Lung Institute, Imperial College London, London, UK
- Adult Congenital Heart Disease Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Jethro Herberg
- Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious Diseases, Department of Infectious Diseases, Imperial College London, London, UK
| | - Piers E F Daubeney
- Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alain Fraisse
- Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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10
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Azzu A, Antonopoulos AS, Krupickova S, Mohiaddin Z, Almogheer B, Vlachopoulos C, Pantazis A, Pennell DJ, Mohiaddin RH. Myocardial strain analysis by cardiac magnetic resonance 3D feature-tracking identifies subclinical abnormalities in patients with neuromuscular disease and no overt cardiac involvement. Eur Heart J Cardiovasc Imaging 2023; 24:503-511. [PMID: 35793360 DOI: 10.1093/ehjci/jeac129] [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: 03/18/2022] [Revised: 06/09/2022] [Accepted: 06/18/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) is valuable for the detection of cardiac involvement in neuromuscular diseases (NMDs). We explored the value of 2D- and 3D-left ventricular (LV) myocardial strain analysis using feature-tracking (FT)-CMR to detect subclinical cardiac involvement in NMD. METHODS AND RESULTS The study included retrospective analysis of 111 patients with NMD; mitochondrial cytopathies (n = 14), Friedreich's ataxia (FA, n = 27), myotonic dystrophy (n = 27), Becker/Duchenne's muscular dystrophy (BMD/DMD, n = 15), Duchenne's carriers (n = 6), or other (n = 22) and 57 age- and sex-matched healthy volunteers. Biventricular volumes, myocardial late gadolinium enhancement (LGE), and LV myocardial deformation were assessed by FT-CMR, including 2D and 3D global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), and torsion. Compared with the healthy volunteers, patients with NMD had impaired 2D-GCS (P < 0.001) and 2D-GRS (in the short-axis, P < 0.001), but no significant differences in 2D-GRS long-axis (P = 0.101), 2D-GLS (P = 0.069), or torsion (P = 0.122). 3D-GRS, 3D-GCS, and 3D-GLS values were all significantly different to the control group (P < 0.0001 for all). Especially, even NMD patients without overt cardiac involvement (i.e. LV dilation/hypertrophy, reduced LVEF, or LGE presence) had significantly impaired 3D-GRS, GCS, and GLS vs. the control group (P < 0.0001). 3D-GRS and GCS values were significantly associated with the LGE presence and pattern, being most impaired in patients with transmural LGE. CONCLUSIONS 3D-FT CMR detects subclinical cardiac muscle disease in patients with NMD even before the development of replacement fibrosis or ventricular remodelling which may be a useful imaging biomarker for early detection of cardiac involvement.
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Affiliation(s)
- Alessia Azzu
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP London, UK
| | - Alexios S Antonopoulos
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
- Unit of Inherited Cardiac Conditions, 1st Cardiology Department, University of Athens, 11527 Athens, Greece
| | - Sylvia Krupickova
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
| | - Zain Mohiaddin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 2AD London, UK
| | - Batool Almogheer
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions, 1st Cardiology Department, University of Athens, 11527 Athens, Greece
| | - Antonis Pantazis
- Cardiomyopathy Unit, Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, E1 1BB London, UK
| | - Dudley J Pennell
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP London, UK
| | - Raad H Mohiaddin
- CMR Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, SW3 6NP London, UK
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, SW3 6NP London, UK
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11
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Voges I, Caliebe A, Hinz S, Boroni Grazioli S, Gabbert DD, Daubeney PEF, Uebing AS, Pennell DJ, Krupickova S. Pediatric Cardiac Magnetic Resonance Reference Values for Biventricular Volumes Derived From Different Contouring Techniques. J Magn Reson Imaging 2023; 57:774-788. [PMID: 35713958 DOI: 10.1002/jmri.28299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/24/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Measurement of ventricular volumes and function using MRI is an important tool in pediatric congenital heart disease. However, normal values for children are sparce and analysis methods are inconsistent. PURPOSE To propose biventricular reference values in children for two MRI postprocessing (contouring) techniques. STUDY TYPE Retrospective. SUBJECTS A total of 154 children from two institutions (13.9 ± 2.8 years; 101 male) that were referred for a clinical MRI study. FIELD STRENGTH/SEQUENCE 1.5 T; balanced steady-state free precession (bSSFP) sequence. ASSESSMENT Left ventricular (LV) and right ventricular (RV) end-diastolic and end-systolic volumes (LVEDV, LVESV, RVEDV, RVESV) and end-diastolic and end-systolic myocardial mass (LVEDMM, LVESMM, RVEDMM, RVESMM) were measured from short-axis images using two contouring techniques: 1) papillary muscles, trabeculations and the moderator band were included in the ventricular blood volume and excluded from the myocardial mass, 2) papillary muscles, trabeculations and the moderator band were excluded from the ventricular volume and included in the ventricular mass. STATISTICAL TESTS Univariable and multivariable linear regression models were used to evaluate relationships between sex, weight, height, body surface area (BSA) and age and volumetric results. Reference graphs and tables were created with the LMS-method. Contouring techniques were compared by intraclass correlation, regression analysis and Bland-Altman plots. A P value < 0.05 was considered statistically significant. RESULTS Height and BSA were significantly associated with LVESV (method 1) and with LVEDV and RVEDV (method 2). LVESV (method 2), RVESV (both methods), RVEDV (method 1), and LVEDMM and RVEDMM (both methods), showed significant associations with height and weight. LVSV and RVSV (both methods) were significantly associated with BSA and weight. RVESV (method 1) was significantly associated with age. Gender showed significant associations for all parameters. DATA CONCLUSION The proposed pediatric reference values can be used in the diagnosis and follow-up of congenital or acquired heart disease and for research purposes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Amke Caliebe
- Medical Faculty, Kiel University, Germany
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sophia Hinz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Dominik D Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
| | - Anselm S Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Dudley J Pennell
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
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12
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Voges I, Caliebe A, Hinz S, Boroni Grazioli S, Gabbert DD, Wegner P, Uebing AS, Daubeney PEF, Pennell DJ, Krupickova S. Reference Values for Pediatric Atrial Volumes Assessed by Steady-State Free-Precession Magnetic Resonance Imaging Using Monoplane and Biplane Area-Length Methods. J Magn Reson Imaging 2023; 57:532-542. [PMID: 35535720 DOI: 10.1002/jmri.28230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/28/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Measurement of atrial volumes by MRI is becoming increasingly important in pediatric cardiac disorders. However, MRI normal values for atrial volumes in children are lacking. PURPOSE To establish pediatric reference values for atrial volumes. STUDY TYPE Retrospective. SUBJECTS A total of 155 healthy children from two large institutions (103 male, age 13.9 ± 2.8 years, range 4-18 years). FIELD STRENGTH/SEQUENCE A 1.5 T; balanced steady-state free precession (bSSFP) sequence. ASSESSMENT The monoplane and biplane area-length methods were used to measure minimal and maximal left and right atrial volumes (LAmin , LAmax , RAmin , and RAmax ) from four-chamber (4ch) and two-chamber (2ch) MR cine images. Centile charts and tables for atrial volumes were created. STATISTICAL TESTS Descriptive statistics, lambda-mu-sigma (LMS)-method of Cole and Green, univariable and multivariable linear regression models. A P value < 0.05 was considered to be statistically significant. RESULTS In the multivariable linear model, body surface area was significantly associated with all atrial volumes and sex was significantly associated with RA volumes, LA volumes measured in the 2ch-view as well as biplane LAmax. Average atrial volumes measured: monoplane 4ch: LAmin 13.1 ± 4.8 mL/m2 , LAmax 33.4 ± 8.8 mL/m2 , RAmin 18.5 ± 6.8 mL/m2 , RAmax 33.2 ± 9.6 mL/m2 ; monoplane 2ch: LAmin 12.7 ± 4.9 mL/m2 , LAmax 30.5 ± 9.5 mL/m2 ; biplane: LAmin 12.3 ± 4.5 mL/m2 , LAmax 30.9 ± 8.7 mL/m2 . DATA CONCLUSION Pediatric MRI reference values for atrial volumes have been provided. TECHNICAL EFFICACY 2 EVIDENCE LEVEL: 4.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Medical Faculty, Kiel University, Germany
| | - Sophia Hinz
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Daniel Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
| | - Dudley J Pennell
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College, London, UK
- CMR Unit, Royal Brompton Hospital, London, UK
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13
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Voges I, Negwer I, Caliebe A, Boroni Grazioli S, Daubeney PEF, Uebing A, Pennell DJ, Krupickova S. Myocardial Deformation in the Pediatric Age Group: Normal Values for Strain and Strain Rate Using 2D Magnetic Resonance Feature Tracking. J Magn Reson Imaging 2022; 56:1382-1392. [PMID: 35072310 DOI: 10.1002/jmri.28073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/04/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Myocardial deformation can be assessed from routine cardiac magnetic resonance (MR) images using two-dimensional feature tracking (2D-FT). Although reference values are essential for implementation of strain imaging in clinical practice, data for the healthy pediatric age group are limited. PURPOSE To provide pediatric MR reference values for strain and strain rate for all four heart chambers. STUDY TYPE Retrospective. SUBJECTS One hundred and fifty-seven healthy children from two institutions (102 male, age 4.7-18 years). FIELD STRENGTH/SEQUENCE 1.5 T; balanced steady-state free precession sequence. ASSESSMENT Left ventricular (LV) global and regional longitudinal, circumferential, and radial strain and strain rate as well as right ventricular (RV) and atrial global and regional longitudinal strain and strain rate were measured in two-, three-, and four-chamber views and the short axis stack. The relationships between strain parameters and age, height, weight, and gender were investigated. Age- and height-specific centile curves and tables were created for LV strain and strain rate. For all other global strain parameters, the mean was calculated as a reference. STATISTICAL TESTS Lambda-mu-sigma (LMS)-method of Cole and Green, univariable, and multivariable linear regression models. A P value <0.05 was considered to be statistically significant. RESULTS Age, height and weight had a significant influence on LV global strain values. These parameters also showed an influence on RV strain but only in boys (girls P = 0.12) and none of the variables had a significant influence on atrial strain (P = 0.19-0.49). Gender differences were only found for RV strain values. DATA CONCLUSION Pediatric potential reference values for myocardial deformation parameters of both ventricles and atria are provided. The values may serve as a reference in future studies and clinical practice. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Inken Negwer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Medical Faculty, Kiel University, Kiel, Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Piers E F Daubeney
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Sciences, Imperial College, London, UK
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Dudley J Pennell
- Cardiovascular Sciences, Imperial College, London, UK.,CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK.,Cardiovascular Sciences, Imperial College, London, UK.,CMR Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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Moscatelli S, Nielles-Vallespin S, Pennell DJ, Krupickova S, Gatehouse P. Impact of compressed sensing (CS) acceleration of two-dimensional (2D) flow sequences in clinical paediatric cardiac magnetic resonance (CMR). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Two-dimensional (2D) through-plane phase-contrast (PC) cine flow imaging assesses shunts and valve regurgitations in paediatric CMR, and is considered the reference standard for Clinical quantification Of blood Flow (COF). However, the longer breath-hold (BH) for a flow cine can reduce patient compliance with possibly large respiratory maneuvers altering flow. Compressed sensing (CS) flow has not been widely evaluated in pediatric clinical CMR, although CS flow reduces scan time with persistent accuracy [1–3]. Kocaoglu et al applied CS to ascending and descending aorta and SVC with good results. We used main pulmonary artery (MPA) and sinotubular junction (STJ) planes as usual for clinical CMR.
Purpose
We hypothesise that reduced BH time by modest application of CS to 2D cine through-plane flows (Short BH quantification of Flow) (SBOF) retains accuracy while enabling faster and potentially more reliable paediatric flows. We therefore investigate the variance between conventional COF and new SBOF cine flows in paediatric CMR.
Methods
Paediatric patients were enrolled. Aortic (AO) and MPA COFs were planned from cines of the left and right ventricular outflow tracts. For AO flow the plane was placed at the STJ, and MPA flow was acquired above the pulmonary valve. The same planes were used for COF and SBOF flows at nominally similar parameters except the moderate application of CS exploiting redundancy across the cine frames, SBOF being segmented CS cines not real-time. CVI42 (5.10; Circle CVI) was used for flow analysis (single observer, 3 years' experience). Paired t-tests found the overall differences, and variability was defined at ±2SD for STJSV, MPASV, STJCO, MPACO, and Qp/Qs.
Results and discussion
20 patients (mean age 13.7, range 10–17y) were enrolled (12 CHDs, 7 cardiomyopathies or other diseases). The BH times were COF mean 11.7s (range 8.4–20.9s) vs SBOF mean 6.5s (min 3.6–9.1s). For STJ flows the differences and variabilities between the COF and SBOF flows were SV 6.95±13.6 (ml/beat), CO 0.16±1.35 (l/min) and for MPA flows SV 2.95±12.3 (ml/beat), CO 0.27±0.96 (l/min) and for Qp/Qs were 0.04±0.19 by ml/beat and 0.02±0.23 by l/min. The mean differences were non significant, and variability between SBOF and COF was similar to intrasession repeatability of COF in a separate paediatric population at our centre (unpublished), that might arise from physiological flow changes, possibly in terms of pre and post load and heart rate. With shorter BHs also assisting patient compliance of the SBOF, physiological flow effects might be reduced, although given the variability in COV this was unconfirmed.
Conclusion
Moderate CS applied to clinical segmented-cine paediatric phase-contrast flows in the STJ and MPA planes did not degrade flow repeatability or cause bias. SBOF assists clinical flows by shorter BHs and also may aid compliance and reduce physiological variations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Moscatelli
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | | | - D J Pennell
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S Krupickova
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - P Gatehouse
- Royal Brompton and Harefield Hospital , London , United Kingdom
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Puricelli F, Voges I, Gatehouse P, Rigby M, Izgi C, Pennell DJ, Krupickova S. Performance of Cardiac MRI in Pediatric and Adult Patients with Fontan Circulation. Radiol Cardiothorac Imaging 2022; 4:e210235. [PMID: 35833165 PMCID: PMC9274315 DOI: 10.1148/ryct.210235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Cardiac MRI has become a widely accepted standard for anatomic and functional assessment of complex Fontan physiology, because it is noninvasive and suitable for comprehensive follow-up evaluation after Fontan completion. The use of cardiac MRI in pediatric and adult patients after completion of the Fontan procedure are described, and a practical and experience-based cardiac MRI protocol for evaluating these patients is provided. The current approach and study protocol in use at the authors' institution are presented, which address technical considerations concerning sequences, planning, and optimal image acquisition in patients with Fontan circulation. Additionally, for each sequence, the information that can be obtained and guidance on how to integrate it into clinical decision-making is discussed. Keywords: Pediatrics, MRI, MRI Functional Imaging, Heart, Congenital © RSNA, 2022.
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Voges I, Krupickova S. Reflections on the importance of exercise training in patients with a Fontan circulation: what we still need to understand. Eur J Prev Cardiol 2022; 29:e211-e212. [DOI: 10.1093/eurjpc/zwaa017] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Inga Voges
- Department of congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, Sydney Street, SW3 6NP London, UK
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Hinz S, Krupickova S, Caliebe A, Wage R, Uebing A, Voges I. Paediatric Cardiovascular Magnetic Resonance Reference Values for Biventricular Volumes Derived from Different Contouring Techniques and Biatrial Volumes. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743027] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Hinz
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - A. Caliebe
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - R. Wage
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Uebing
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - I. Voges
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Krupickova S, Bautista-Rodriguez C, Hatipoglu S, Kang H, Fraisse A, Di Salvo G, Piccinelli E, Rowlinson G, Lane M, Altamar Bermejo I, Moscatelli S, Wage R, Mohiaddin R, Pennell DJ, Voges I. Myocardial deformation assessed by CMR in children after multisystem inflammatory syndrome (MIS-C). Int J Cardiol 2022; 346:105-106. [PMID: 34798209 DOI: 10.1016/j.ijcard.2021.11.036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/24/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Short-term sequelae of Multisystem Inflammatory Syndrome in Children (MIS-C), recently published by our institution, showed rapid improvement of the cardiac abnormalities within a few weeks after the onset of the disease. However, subtle residual abnormalities, affecting mainly the myocardial interstitium, were shown in some of the patients. The current study aimed to assess myocardial deformation with CMR shortly after MIS-C. METHODS Sixty children were included into the study; 30 following MIS-C (onset-to-scan mean 27 days, SD 11) and 30 controls. Strain values were compared between patients and controls and additionally to published paediatric normal CMR values. U-Mann Whitney test was used for comparison of the myocardial deformation between patients and controls. RESULTS Median age of the patients was 9.0 years (range 0.99-14.4) and controls 9.8 years (range 4.7-14.9). All conventional CMR parameters in patients were in normal range. Strain values were significantly lower in patients than in controls. When compared to published centile graphs, radial and circumferential global strain was within 2.5th and 97.5th centile in all patients. Eleven patients had global longitudinal strain between 2.5th centile and 50th centile, 1 patient was below 2.5th centile and all the others above 50th centile. Only 3 controls had global longitudinal strain between 2.5th centile and 50th centile, all other had higher strain. CONCLUSIONS This study demonstrates that myocardial deformation indices measured by CMR are within normal range in the vast majority of the patients within a few weeks after the onset of MIS-C. However, when compared to healthy controls, all strain parameters were lower in patients.
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Affiliation(s)
- Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK.
| | - Carles Bautista-Rodriguez
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Suzan Hatipoglu
- Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Heechan Kang
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Giselle Rowlinson
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Mary Lane
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Ivan Altamar Bermejo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK
| | - Sara Moscatelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK; Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK
| | - Rick Wage
- Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance department, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Bates O, Semple T, Krupickova S, Bautista-Rodriguez C. Case report of a Gore-Tex TCPC conduit dissection causing severe stenosis. Eur Heart J Case Rep 2021; 5:ytab377. [PMID: 34746637 PMCID: PMC8567081 DOI: 10.1093/ehjcr/ytab377] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/16/2021] [Revised: 05/07/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022]
Abstract
Background The patient is a 15-year-old male with situs inversus, dextrocardia, bilateral superior caval veins, atrioventricular discordance with a single outlet, large perimembranous ventricular septal defect, aortic override, pulmonary atresia, and right aortic arch. The complex anatomy with a Ventricular Septal Defect (VSD) distant from the aorta (unsuitable for baffling to the aorta) meant he was unsuitable for biventricular repair and proceeded down a univentricular palliation pathway. Case summary Post-total cavopulmonary connection his clinical course was uneventful until the age of 5 when he developed fatigability with desaturation. An accessory hepatic vein was surgically banded with improved saturations and exercise tolerance. At the age of 15, cardiovascular magnetic resonance (CMR) was performed to investigate borderline saturations and as workup for transition to adult services. Cardiovascular magnetic resonance and cardiac computed tomography (CT) imaging demonstrated an eccentric thrombus causing stenosis of the extracardiac conduit and a thrombus outside of the lumen contained by the thin outer membrane of the Gore-Tex conduit. Collateralization suggested this was longstanding. Cardiac catheterization demonstrated a 4 mm × 6 mm stenosis at the junction of the conduit with the pulmonary arteries. The region was successfully balloon dilated and stented with a 34 mm-long Cheatham Platinum stent, with no complications. Discussion To date, this is the first documented case of a dissecting thrombus of a Gore-Tex graft in the literature. This case emphasizes the need for anticoagulation and serial cross-sectional imaging (CT or CMR) in Fontan patients with prosthetic grafts throughout a patients’ lifetime.
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Affiliation(s)
- Oliver Bates
- Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Thomas Semple
- Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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20
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Hatipoglu S, Gatehouse P, Krupickova S, Banya W, Daubeney P, Almogheer B, Izgi C, Weale P, Hayes C, Firmin D, Pennell DJ. Reliability of pediatric ventricular function analysis by short-axis "single-cycle-stack-advance" single-shot compressed-sensing cines in minimal breath-hold time. Eur Radiol 2021; 32:2581-2593. [PMID: 34713331 PMCID: PMC8921124 DOI: 10.1007/s00330-021-08335-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/09/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022]
Abstract
Objectives Cardiovascular magnetic resonance (CMR) cine imaging by compressed sensing (CS) is promising for patients unable to tolerate long breath-holding. However, the need for a steady-state free-precession (SSFP) preparation cardiac cycle for each slice extends the breath-hold duration (e.g. for 10 slices, 20 cardiac cycles) to an impractical length. We investigated a method reducing breath-hold duration by half and assessed its reliability for biventricular volume analysis in a pediatric population. Methods Fifty-five consecutive pediatric patients (median age 12 years, range 7–17) referred for assessment of congenital heart disease or cardiomyopathy were included. Conventional multiple breath-hold SSFP short-axis (SAX) stack cines served as the reference. Real-time CS SSFP cines were applied without the steady-state preparation cycle preceding each SAX cine slice, accepting the limitation of omitting late diastole. The total acquisition time was 1 RR interval/slice. Volumetric analysis was performed for conventional and “single-cycle-stack-advance” (SCSA) cine stacks. Results Bland–Altman analyses [bias (limits of agreement)] showed good agreement in left ventricular (LV) end-diastolic volume (EDV) [3.6 mL (− 5.8, 12.9)], LV end-systolic volume (ESV) [1.3 mL (− 6.0, 8.6)], LV ejection fraction (EF) [0.1% (− 4.9, 5.1)], right ventricular (RV) EDV [3.5 mL (− 3.34, 10.0)], RV ESV [− 0.23 mL (− 7.4, 6.9)], and RV EF [1.70%, (− 3.7, 7.1)] with a trend toward underestimating LV and RV EDVs with the SCSA method. Image quality was comparable for both methods (p = 0.37). Conclusions LV and RV volumetric parameters agreed well between the SCSA and the conventional sequences. The SCSA method halves the breath-hold duration of the commercially available CS sequence and is a reliable alternative for volumetric analysis in a pediatric population. Key Points • Compressed sensing is a promising accelerated cardiovascular magnetic resonance imaging technique. • We omitted the steady-state preparation cardiac cycle preceding each cine slice in compressed sensing and achieved an acquisition speed of 1 RR interval/slice. • This modification called “single-cycle-stack-advance” enabled the acquisition of an entire short-axis cine stack in a single short breath hold. • When tested in a pediatric patient group, the left and right ventricular volumetric parameters agreed well between the “single-cycle-stack-advance” and the conventional sequences.
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Affiliation(s)
- Suzan Hatipoglu
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
| | - Peter Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Winston Banya
- Research Office, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Piers Daubeney
- Pediatric Cardiology Department, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Batool Almogheer
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Cemil Izgi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | | | - David Firmin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College, London, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College, London, UK
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21
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Voges I, Hinz S, Caliebe A, Boroni Gracioli S, Wage R, Gabbert D, Uebing A, Krupickova S. Normal values for paediatric atrial volumes assessed by steady-state free-precession cardiovascular magnetic resonance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
Measurement of atrial volumes by steady-state free precession (SSFP)cardiovascular magnetic resonance (CMR) is becoming increasingly important in the treatment and follow-up of paediatric congenital heart disease. It has prognostic value in terms of heart failure and cardiovascular death. However, CMR normal values for the clinically often used mono- and biplane area-length method in children are lacking.
Aims
We sought to create paediatric normal values for atrial volumes using the mono- and biplane area-length method.
Methods
In a retrospective study design, CMR data sets of 157 healthy children with an age range between 4 and 18 years from two centers in the UK and Germany were evaluated. In a four-chamber (4ch-) view, left and right atrial (LA, RA) endocardial borders were segmented during end-diastole and end-systole to calculate minimal and maximal atrial volumes (LAmin, LAmax, RAmin, RAmax) using the monoplane area-length method. Additionally, end-diastolic and end-systolic LA endocardial borders were segmented in a two-chamber (2ch-) view. Using the measurements from the 2ch- and 4ch-views, minimal and maximal LA volumes were calculated using the biplane area-length method. Atrial volumes were normalized for body surface area (BSA in m2). Sex-specific reference curves were created using the lambda mu sigma method.
Results
The median age was 13.8±2.81 years (53 girls).
In children from 4–10 years average atrial volumes measured: monoplane 4ch: LAmin 10.2±3.5 ml/m2, LAmax 28.8±7.4 ml/m2, RAmin 14.1±6.3 ml/m2, RAmax 27.0±11.4 ml/m2; monoplane 2ch: LAmin 10.9±4.1 ml/m2, LAmax 27.0±6.1 ml/m2; biplane: LAmin 10.2±3.3 ml/m2, LAmax 27.4±5.7 ml/m2.
In children from 11–18 years average atrial volumes measured: monoplane 4ch: LAmin 13.6±4.9 ml/m2, LAmax 34.1±9.1 ml/m2, RAmin 19.2±6.8 ml/m2, RAmax 34.2±9.6 ml/m2; monoplane 2ch: LAmin 13.2±4.9 ml/m2, LAmax 31.4±9.7 ml/m2; biplane: LAmin 12.9±4.4 ml/m2, LAmax 31.8±8.8 ml/m2.
Separate centile charts and centile tables for boys and girls for all volumetric parameters were created.
Conclusion
We provide paediatric CMR reference values for atrial volumes. They can be used in the diagnosis and follow-up of congenital or acquired heart disease in children and for research purposes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - S Hinz
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Caliebe
- Christian-Albrechts-University Kiel, Department for Medical Informatics and Statistics, Kiel, Germany
| | | | - R Wage
- Royal Brompton Hospital, Cardiovascular Magnetic Resonance Unit, London, United Kingdom
| | - D Gabbert
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Uebing
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - S Krupickova
- Royal Brompton Hospital, Paediatric Cardiology and Cardiovascular Magnetic Resonance Unit, London, United Kingdom
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22
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Hinz S, Caliebe A, Wage R, Boroni Grazioli S, Uebing A, Voges I, Krupickova S. Normal values for paediatric biventricular volumes, ejection fraction and mass – influence of cardiovascular magnetic resonance analysis techniques. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Background
Measurement of ventricular volumes and function by steady-state free precession (SSFP) cardiovascular magnetic resonance (CMR) is an important diagnostic tool in the treatment and follow-up of paediatric congenital heart disease. However, normal values are rare and the CMR analysis methods are inconsistent.
Aims
We sought to create two sets of ventricular normal values for different CMR analysis (contouring) methods.
Methods
In a retrospective study design, CMR data sets of 154 healthy children with an age range between 4 and 18 years from two centers in the UK and Germany were evaluated. Left and right ventricular end-diastolic and end-systolic volumes (LVEDV, LVESV, RVEDV, RVESV), ejection fraction (RVEF, LVEF) and myocardial mass (LVMM, RVMM) were analysed from short axis steady-state free precession images by using two different analysis techniques: 1) papillary muscles, myocardial trabeculations and the moderator band were included in the ventricular volume and excluded from the ventricular mass (Figure 1), 2) papillary muscles, myocardial trabeculations and the moderator band were excluded from the ventricular volume and included in the ventricular mass (Figure 2). Sex-specific reference curves were created separately for both ventricular contouring methods using the lambda mu sigma method. Correlations between variables were analyzed with the Spearman's rank correlation. Contouring methods were compared through Bland-Altman analysis.
Results
The mean age was 13.85±2.8 years (53 girls).
In children from 4 to 10 years average ventricular volumes and mass normalized for body surface area (BSA) measured:
In children from 11 to 18 years average ventricular volumes and mass measured:
Separate centile charts and centile tables for boys and girls for all cardiac parameters were created.
Conclusion
We provide paediatric CMR reference values for biventricular volumes, ejection and masses for two different CMR contouring methods. They can be used in the diagnosis and follow-up of congenital or acquired heart disease in children and for research purposes.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- S Hinz
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Caliebe
- Christian-Albrechts-University Kiel, Department for Medical Informatics and Statistics, Kiel, Germany
| | - R Wage
- Royal Brompton Hospital, Cardiovascular Magnetic Resonance Unit, London, United Kingdom
| | | | - A Uebing
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - S Krupickova
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom
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23
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Voges I, Krupickova S. The role of propanolol in cardiomyocyte proliferation in tetralogy of Fallot - new market for an 'old' drug? Int J Cardiol 2021; 342:39-40. [PMID: 34371030 DOI: 10.1016/j.ijcard.2021.08.004] [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: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
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Schuwerk R, Freitag-Wolf S, Krupickova S, Gabbert DD, Uebing A, Langguth P, Voges I. Ventricular and atrial function and deformation is largely preserved after arterial switch operation. Heart 2021; 107:1644-1650. [PMID: 34349009 DOI: 10.1136/heartjnl-2021-319410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To test the hypothesis that ventricular and atrial function are different between patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) and healthy controls. METHODS 103 consecutive patients with TGA (median age: 16.7 years, 4.3-39.6 years, 71.8% male) were compared with 77 controls (median age: 15.4 years, 6.3-43.2 years, 66.2% male). Biventricular and biatrial function were assessed using standard cardiovascular magnetic resonance (CMR) techniques and feature tracking. Group comparison was performed with conventional non-parametrical statistics and machine learning methods to find the variables most discriminative between patients and controls. These variables were used to build a multivariable logistic regression model to assess the case-control status. RESULTS Markers of left and right ventricular function (LV; RV) (ejection fraction, MAPSE, TAPSE, LV long-axis strain) as well as LV global longitudinal (-20.7 (-24.1; -17.9) vs -23.7 (-26.1; -21.6), p<0.001), circumferential (-29.4 (-32.2; -26.5) vs -30.5 (-33.6; 29), p=0.001) and atrial longitudinal strain (left atrium (LA): 23.3 (18.6; 28.8) vs 36.7 (30.7; 44), p<0001; right atrium: 21.7 (18.2; 27.8) vs 34.9 (26.9; 40.3), p<0.001) were reduced in patients compared with controls using non-parametrical testing. The logistic regression model including the most discriminative variables from univariate and machine learning analysis demonstrated significant differences between patients and controls only for TAPSE and LA global longitudinal strain. CONCLUSIONS Biventricular and biatrial function are largely preserved after ASO for TGA. Using a comprehensive CMR protocol along with statistical machine learning methods and a regression approach, only RV longitudinal function and LA function are significantly impaired.
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Affiliation(s)
- Roman Schuwerk
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Patrick Langguth
- Department of Radiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Schleswig-Holstein, Germany
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25
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Hatipoglu S, Almogheer B, Mahon C, Houshmand G, Uygur B, Giblin GT, Krupickova S, Baksi AJ, Alpendurada F, Prasad SK, Babu-Narayan SV, Gatzoulis MA, Mohiaddin RH, Pennell DJ, Izgi C. Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2021; 14:e012371. [PMID: 34384233 DOI: 10.1161/circimaging.120.012371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. METHODS We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. RESULTS A total of 215 patients (median age 46 years; range, 6-83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57-157] mL/m2, P=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. CONCLUSIONS This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.
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Affiliation(s)
- Suzan Hatipoglu
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Batool Almogheer
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Ciara Mahon
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Golnaz Houshmand
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- Royal Brompton Hospital, London, United Kingdom; Now with Rajaie Cardiovascular Medical and Research Centre, Tehran, Iran (G.H.)
| | - Begum Uygur
- Cardiology Department, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey (B.U.)
| | - Gerard T Giblin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (S.K.)
| | - A John Baksi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Francisco Alpendurada
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sanjay K Prasad
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sonya V Babu-Narayan
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Michael A Gatzoulis
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Raad H Mohiaddin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Cemil Izgi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
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26
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Krupickova S, Hatipoglu S, DiSalvo G, Voges I, Redfearn D, Foldvari S, Eichhorn C, Chivers S, Puricelli F, Delle-Donne G, Barth C, Pennell DJ, Prasad SK, Daubeney PEF. Left ventricular noncompaction in pediatric population: could cardiovascular magnetic resonance derived fractal analysis aid diagnosis? J Cardiovasc Magn Reson 2021; 23:90. [PMID: 34233715 PMCID: PMC8265058 DOI: 10.1186/s12968-021-00778-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/10/2021] [Accepted: 05/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) derived fractal analysis of the left ventricle (LV) has been shown in adults to be a useful quantitative measure of trabeculation with high reproducibility and accuracy for the diagnosis of LV non-compaction (LVNC). The aim of this study was to investigate the utility and feasibility of fractal analysis in children. METHODS Eighty-four subjects underwent CMR: (1) 28 patients with LVNC (as defined by the Petersen criteria with NC/C ratio [Formula: see text] 2.3); (2) 28 patients referred by clinicians for assessment of hyper-trabeculation and found not to qualify as LVNC (NC/C [Formula: see text] 1.8 and < 2.3); (3) 28 controls. The fractal scores for each group were presented as global and maximal fractal dimension as well as for 3 segments of the LV: basal, mid, and apical. Statistical comparison of the fractal scores between the 3 groups was performed. RESULTS Global fractal dimension (FD) was higher in the LVNC group than in the hyper-trabeculated group: 1.345 (SEM 0.053) vs 1.252 (SEM 0.034), p < 0.001 and higher in hyper-trabeculated group than in controls: 1.252 (SEM 0.034) vs 1.158 (SEM 0.038), p < 0.001. The highest maximum FD was in the apical portion of the LV in the LVNC group, (1.467; SEM 0.035) whereas it was in the mid ventricle in the hyper-trabeculated (1.327; SEM 0.025) and healthy groups (1.251; SEM 0.042). Fractal analysis showed lower intra- and interobserver variability than the Petersen and Jacquier methods. CONCLUSIONS It is technically feasible to perform fractal analysis in children using CMR and that it is quick, accurate and reproducible. Fractal scoring accurately distinguishes between LVNC, hyper-trabeculation and healthy controls as defined by the Petersen criteria.
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Affiliation(s)
- Sylvia Krupickova
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Suzan Hatipoglu
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
| | - Giovanni DiSalvo
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
| | - Daniel Redfearn
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Sandrine Foldvari
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Christian Eichhorn
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
| | - Sian Chivers
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Filippo Puricelli
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
| | - Grazia Delle-Donne
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Courtney Barth
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sanjay K Prasad
- Cardiovascular Magnetic Resonance Department, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Imperial College and Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College, London, UK.
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27
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Michielon G, DiSalvo G, Fraisse A, Carvalho JS, Krupickova S, Slavik Z, Bartsota M, Daubeney P, Bautista C, Desai A, Burmester M, Macrae D. In-hospital interstage improves interstage survival after the Norwood stage 1 operation. Eur J Cardiothorac Surg 2021; 57:1113-1121. [PMID: 32236554 DOI: 10.1093/ejcts/ezaa074] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The interstage mortality rate after a Norwood stage 1 operation remains 12-20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood-Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock-Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan-Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan-Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome.
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Affiliation(s)
- Guido Michielon
- Department of Congenital Heart Surgery, Royal Brompton Hospital, Imperial College, London, UK
| | - Giovanni DiSalvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Julene S Carvalho
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Zdenek Slavik
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Margarita Bartsota
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Pierce Daubeney
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Carles Bautista
- Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College, London, UK
| | - Ajay Desai
- Department of Paediatric Intensive Care, Royal Brompton Hospital, Imperial College, London, UK
| | - Margarita Burmester
- Department of Paediatric Intensive Care, Royal Brompton Hospital, Imperial College, London, UK
| | - Duncan Macrae
- Department of Paediatric Intensive Care, Royal Brompton Hospital, Imperial College, London, UK
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28
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Sabatino J, Borrelli N, Fraisse A, Herberg J, Karagadova E, Avesani M, Bucciarelli V, Josen M, Paredes J, Piccinelli E, Spada M, Krupickova S, Indolfi C, Di Salvo G. Abnormal myocardial work in children with Kawasaki disease. Sci Rep 2021; 11:7974. [PMID: 33846402 PMCID: PMC8042008 DOI: 10.1038/s41598-021-86933-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2020] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) can be associated with high morbidity and mortality due to coronary artery aneurysms formation and myocardial dysfunction. Aim of this study was to evaluate the diagnostic performance of non-invasive myocardial work in predicting subtle myocardial abnormalities in Kawasaki disease (KD) children with coronary dilatation (CADL). A total of 100 patients (age 8.7 ± 5 years) were included: 45 children with KD and CADL (KD/CADL) (Z-score > 2.5), 45 age-matched controls (CTRL) and, finally, an additional group of 10 children with KD in absence of coronary dilatation (KD group). Left ventricular (LV) systolic function and global longitudinal strain (GLS) were assessed. Global myocardial work index (MWI) was calculated as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Despite normal LV systolic function by routine echocardiography, KD/CADL patients had lower MWI (1433.2 ± 375.8 mmHg% vs 1752.2 ± 265.7 mmHg%, p < 0.001), MCW (1885.5 ± 384.2 mmHg% vs 2175.9 ± 292.4 mmHg%, p = 0.001) and MWE (994.0 ± 4.8% vs 95.9 ± 2.0%, p = 0.030) compared to CTRL. Furthermore, MWI was significantly reduced in children belonging to the KD group in comparison with controls (KD: 1498.3 ± 361.7 mmHg%; KD vs CTRL p = 0.028) and was comparable between KD/CADL and KD groups (KD/CADL vs KD p = 0.896). Moreover, KD/CADL patients with normal GLS (n = 38) preserved significant differences in MWI and MCW in comparison with CTRL. MWI, MCW and MWE were significantly reduced in KD children despite normal LVEF and normal GLS. These abnormalities seems independent from CADL. Thus, in KD with normal LVEF and normal GLS, estimation of MWI may be a more sensitive indicator of myocardial dysfunction.
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Affiliation(s)
- Jolanda Sabatino
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
| | - Nunzia Borrelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Jethro Herberg
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Elena Karagadova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Martina Avesani
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Valentina Bucciarelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Enrico Piccinelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Maraisa Spada
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, URT-CNR, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, SW36NP, UK. .,National Heart and Lung Institute, Imperial College, London, UK.
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29
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Strodka F, Logoteta J, Schuwerk R, Salehi Ravesh M, Gabbert DD, Uebing AS, Krupickova S, Voges I. Myocardial deformation in patients with a single left ventricle using 2D cardiovascular magnetic resonance feature tracking: a case-control study. Int J Cardiovasc Imaging 2021; 37:2549-2559. [PMID: 33788063 PMCID: PMC8302517 DOI: 10.1007/s10554-021-02230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Ventricular dysfunction is a well-known complication in single ventricle patients in Fontan circulation. As studies exclusively examining patients with a single left ventricle (SLV) are sparse, we assessed left ventricular (LV) function in SLV patients by using 2D-cardiovascular magnetic resonance (CMR) feature tracking (2D-CMR-FT) and 2D-speckle tracking echocardiography (2D-STE). 54 SLV patients (11.4, 3.1–38.1 years) and 35 age-matched controls (12.3, 6.3–25.8 years) were included. LV global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and strain rate (GLSR, GCSR, GRSR) were measured using 2D-CMR-FT. LV volumes, ejection fraction (LVEF) and mass were determined from short axis images. 2D-STE was applied in patients to measure peak systolic GLS and GLSR. In a subgroup analysis, we compared double inlet left ventricle (DILV) with tricuspid atresia (TA) patients. The population consisted of 19 DILV patients, 24 TA patients and 11 patients with diverse diagnoses. 52 patients were in NYHA class I and 2 patients were in class II. Most SLV patients had a normal systolic function but median LVEF in patients was lower compared to controls (55.6% vs. 61.2%, p = 0.0001). 2D-CMR-FT demonstrated reduced GLS, GCS and GCSR values in patients compared to controls. LVEF correlated with GS values in patients (p < 0.05). There was no significant difference between GLS values from 2D-CMR-FT and 2D-STE in the patient group. LVEF, LV volumes, GS and GSR (from 2D-CMR-FT) were not significantly different between DILV and TA patients. Although most SLV patients had a preserved EF derived by CMR, our results suggest that, LV deformation and function may behave differently in SLV patients compared to healthy subjects.
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Affiliation(s)
- Fabian Strodka
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jana Logoteta
- Department of Paediatric Cardiology, Children's Hospital of Zurich, Zurich, Switzerland
| | - Roman Schuwerk
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | | | - Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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30
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Voges I, Boll C, Caliebe A, Gabbert D, Uebing A, Krupickova S. Reference Values for Ventricular Volumes and Pulmonary Artery Dimensions in Pediatric Patients with Transposition of the Great Arteries After Arterial Switch Operation. J Magn Reson Imaging 2021; 54:1233-1245. [PMID: 33749058 DOI: 10.1002/jmri.27602] [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] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary artery (PA) anatomy in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects, and stenoses of the PA are common. Magnetic resonance imaging (MRI) is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease-specific reference values for PA size are scarce. PURPOSE To establish disease-specific reference ranges for PA dimensions and for biventricular volumes and mass. STUDY TYPE Retrospective. SUBJECTS A total of 69 pediatric patients with TGA after ASO (median age 12.6 years; range 5-17.8 years; 13 females and 56 males). FIELD STRENGTH/SEQUENCE 3.0 T, steady-state free precession (SSFP) and gradient echo cine sequences and four-dimensional time-resolved magnetic resonance angiography with keyhole. ASSESSMENT Right and left PA (RPA, LPA) were each measured at three locations during its course around the aorta. Ventricular volumes, mass, and ejection fraction were measured from a stack of short axis cine images. STATISTICAL TESTS The lambda-mu-sigma (LMS) method of Cole and Green, univariate and multivariate linear models, and t-test. RESULTS Centile graphs and tables for PA dimensions, biventricular volumes, mass, and ejection fraction were created. Univariate linear analysis showed significant associations (P < 0.05) between body surface area (BSA), height, and weight with systolic MPA and RPA diameter. In multivariate linear analysis, only BSA remained a strong predictor for main PA and RPA diameters. For biventricular volumes, the univariate linear model revealed a strong influence of BSA, height, weight, and age (all P < 0.05). On multivariate linear analysis, only body height remained associated. DATA CONCLUSION Uni- and multivariate linear analyses showed a strong association between BSA and PA diameters, as well as between height and biventricular volumes, and therefore, centile tables and graphs are presented accordingly. Our data may improve MR image interpretation and may serve as a reference in future studies. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Christien Boll
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Amke Caliebe
- Department for Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Sylvia Krupickova
- Department of Pediatric Cardiology and CMR Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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31
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Bermejo IA, Bautista-Rodriguez C, Fraisse A, Voges I, Gatehouse P, Kang H, Piccinelli E, Rowlinson G, Lane M, Semple T, Moscatelli S, Dwornik M, Lota A, Di Salvo G, Wage R, Prasad SK, Mohiaddin R, Pennell DJ, Thavendiranathan P, Krupickova S. Short-Term sequelae of Multisystem Inflammatory Syndrome in Children Assessed by CMR. JACC Cardiovasc Imaging 2021; 14:1666-1667. [PMID: 33744139 DOI: 10.1016/j.jcmg.2021.01.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
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32
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Piccinelli E, Sabatino J, Krupickova S, Fraisse A, Prota C, Bucciarelli V, Avesani M, Borrelli N, Delle Donne G, Josen M, Paredes J, Sirico D, Indolfi C, Daubeney P, Di Salvo G. LV twist predicts prognosis in children and adolescents with non-compaction cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown.
The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients.
Methods
Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation.
Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs).
Results
Recruited for the study were 47 children (mean age: 11.1± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT).
They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC.
Conclusions
LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention.
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Affiliation(s)
- E Piccinelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sabatino
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - S Krupickova
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Fraisse
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - C Prota
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - V Bucciarelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Avesani
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Borrelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - G Delle Donne
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Josen
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Paredes
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Sirico
- University of Padua, Padova, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - P Daubeney
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Schuwerk R, Freitag-Wolf S, Krupickova S, Gabbert D, Uebing A, Langguth P, Voges I. Ventricular and atrial function in transposition of the great arteries after arterial switch operation - a comprehensive cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although good long-term results after arterial switch operation (ASO) in patients with transposition of the great arteries (TGA) have been described, a few studies suggest that patients can develop ventricular dysfunction. We established a comprehensive cardiovascular magnetic resonance (CMR) analysis protocol to evaluate biventricular and atrial function markers in a large cohort of paediatric and adult TGA patients after ASO.
Methods
103 TGA patients (median age 16.7 years, range 4.3-39.6 years) who underwent ASO were retrospectively included. 66 patients had simple transposition and 37 patients had associated anomalies (ventricular septal defect (VSD) n= 30, aortic coarctation n= 11). 77 healthy subjects were enrolled as controls (median age 15.4 years, range 6.3-43.2 years).
Biventricular volumes, wall thickness as well as ventricular and atrial functional and deformation parameters were assessed using standard CMR analyses techniques as well as CMR feature tracking (FT). For statistical analysis each clinical variable was evaluated by standard nonparametrical tests and jointly assessed with machine learning methods (random forest, Boruta). The significant variables were used to build a logistic regression model for predicting the case-control status
Results
Results from Mann-Whitney-U test revealed that both, left and right ventricular function markers (left ventricular ejection fraction (LVEF); right ventricular ejection fraction (RVEF); MAPSE; TAPSE; LV long-axis strain) were reduced in patients compared to controls. In addition, left ventricular global longitudinal (-21.18 ± 4.49 / -23.93 ± 3.41; p < 0.001) and circumferential strain values (-29.28 ± 4.30 / -31.32 ± 3.63; p = 0.001) as well as longitudinal strain values for both atria (LA: 24.18 ± 8.04 / 37.81 ± 10.30; p < 0001; RA: 23.89 ± 11.12 / 34.47 ± 10.87; p < 0.001) were lower in patients compared to controls. Segmental FT analysis revealed that the interventricular septum appeared most affected. The logistic regression model demonstrated significant differences for MAPSE, TAPSE (Figure), left atrial global longitudinal strain and basal inferoseptal radial strain. Strong correlations were found between MAPSE and TAPSE (Figure) as well as between left atrial global longitudinal strain and MAPSE (r= 0.54, p < 0.001).
Conclusions
TGA patients after ASO are at risk for ventricular and atrial dysfunction. Using a comprehensive CMR analysis protocol along with statistical machine learning methods and a regression approach, we could demonstrate that especially biventricular longitudinal function, left atrial function and basal septal deformation is impaired.
Abstract Figure
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Affiliation(s)
- R Schuwerk
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - S Freitag-Wolf
- Christian-Albrechts-University Kiel, Department for Medical Informatics and Statistics, Kiel, Germany
| | - S Krupickova
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - D Gabbert
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Uebing
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - P Langguth
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
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Piccinelli E, Herberg J, Kang H, Fraisse A, Krupickova S, Altamar IB, Sabatino J, Singh Y, Bautista-Rodriguez C, Di Salvo G. Segmental and global longitudinal strain differences between children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 pandemic and Kawasaki disease. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC7929042 DOI: 10.1093/ehjci/jeaa356.186] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction The paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD) have overlapping features. This study aimed to describe the strain segmental analysis among both entities. Methods Retrospective review of strain segmental analysis within 4 weeks of presentation of symptoms among children diagnosed with PIMS-TS between April and June 2020 and a historic cohort of typical KD from the Royal Brompton Hospital, London. Results We included 33 PIMS-TS patients (23 males, 69.7%) at a mean age of 8 ± 4,9 years old and 45 KD patients (31 males, 68,9%) at a mean age of 5,8 ± 4,5 years old. PIMS-TS patients were older at presentation (p = 0.038). Left ventricle ejection fraction (LVEF) was normal in both groups (63,3% vs 63,5%; p= 0,89), 4/33 PIMS-TS children (12,1%) had coronary arteries abnormalities (CAA), whereas 100% of KD cohort had CAA. Both groups had a normal global longitudinal strain (GLS),but in PIMS-TS it was significantly reduced compared to the KD group (-20% vs -22%; p = 0,008). Basal segments were the most affected in PIMS-TS with significant difference in the basal anterior and anterolateral strain compared to KD (respectively -18,2% vs -23,4%; p < 0,001 and - 16,7% vs -22,7%; p < 0,001). PIMS-TS had a greater anterior, anterolateral and posterior segments involvement with a significant reduction in the anterolateral mid-wall longitudinal strain (-18,3% vs -22%; p = 0,002). Apical segments were less involved, with significant difference only in the septal and inferior apical strain (respectively p = 0.001 and p = 0,032). Conclusions These preliminary data showed that after 4 weeks from the onset of symptoms, all PIMS-TS patients had a normal LVEF but they had a significant reduction in GLS and different segmental involvement compared to KD cohort. We hypothesize that these findings may be related to direct myocardial damage in PIMS-TS rather than caused by coronaries perfusion abnormalities. Abstract Figure. Bull"s eye ![]()
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Affiliation(s)
- E Piccinelli
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Herberg
- St Mary"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kang
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Fraisse
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Krupickova
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - IB Altamar
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - J Sabatino
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Y Singh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - C Bautista-Rodriguez
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Boll C, Voges I, Caliebe A, Gati S, Puricelli F, Wage R, Krupickova S. Cardiovascular magnetic resonance (CMR) normal values for pulmonary arteries in healthy children and adolescents. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Changes in the right ventricular outflow tract (RVOT) and pulmonary arteries (PAs) are often seen in paediatric patients with congenital heart disease (CHD), pulmonary hypertension or genetic disorders (e.g. Marfan syndrome, Loeys-Dietz syndrome, Williams syndrome, DiGeorge syndrome). Cardiovascular magnetic resonance (CMR) imaging is an excellent method to visualize the RVOT and PAs without the use of ionizing radiation and contrast media but for the interpretation of CMR data in the paediatric population the knowledge of normal values is crucial. However, normal values for pulmonary arteries from contrast-free cine CMR images are lacking.
Purpose
The aim of this retrospective multicentre study was to establish reference ranges for the diameters of the mean PA (MPA), right PA (RPA) and left PA (LPA).
Methods
163 CMR scans of healthy children and adolescents (mean age 13.8 ± 2.9 years; range 5-18 years) from two centres in the UK and Germany were included. The diameter of the MPA was measured in sagittal-oblique RVOT cine images and transaxial cine stacks, whereas the diameter of the RPA and LPA were measured from transaxial stacks and specific pulmonary artery branch cine images.
Results
Mean systolic and diastolic diameters for the MPA were 22.1 ± 2.8 mm (14.4 ± 2.2 mm/m²)/ 17.2 ± 2.3 mm (11.3 ± 1.9 mm/m²) measured in RVOT cine stacks. Mean systolic and diastolic diameters for the RPA and LPA were: 1) RPA, 12.4 ± 1.7 mm (7,9 ± 1,6 mm/m²)/ 9.8 ± 1.6 mm (5.9 ± 1.8 mm/m²) and 2) LPA, 13.3 ± 1.5 mm (8.3 ± 2.1 mm/m²)/ 10.8 ± 1.5 mm (6.8 ± 1.8 mm/m²). Separate centile charts for boys and girls for the MPA were created.
Conclusions
We established CMR normal values for the MPA, RPA and LPA for children and adolescents. Our data might be useful for the detection of PA stenosis and dilatation and may serve as a reference in future studies.
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Affiliation(s)
- C Boll
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Caliebe
- Christian-Albrechts-University Kiel, Department for Medical Informatics and Statistics, Kiel, Germany
| | - S Gati
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - F Puricelli
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - R Wage
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
| | - S Krupickova
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
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Voges I, Boll C, Caliebe A, Uebing A, Krupickova S. Cardiovascular magnetic resonance normal values for pulmonary arteries and ventricular volumes in paediatric patients with transposition of the great arteries after arterial switch operation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The anatomy of the pulmonary arteries (PA) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects and stenoses of the PA are known to occur. Cardiovascular magnetic resonance (CMR) imaging is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease specific normal values for PA size do not exist. Furthermore, the impact of pulmonary artery size, age and gender on ventricular volumes and function is unknown. Therefore, we sought to establish disease specific normative ranges for PA dimensions as well as biventricular volumes and function.
Methods
70 CMR scans of paediatric patients with TGA after ASO with Lecompte manoeuvre (mean age 12.3 ± 3.6 years; range 5-18 years; 57 males) were included. Cine CMR sequences as well as contrast-enhanced magnetic resonance angiography (CE-MRA) data were used to measure pulmonary artery dimensions. Right and left PA were each measured at three locations during its course around the aorta. Ventricular volumes, mass and ejection fraction were measured from a stack of short axis cine images.
Results
Mean systolic and diastolic diameters of the MPA were 15.0 ± 2.3 mm (10.5 ± 2.7 mm/m²) / 13.2 ± 2.9 mm (9.2 ± 2.9 mm/m²) and mean cross-sectional MPA area was 286.7 ± 81.7 mm². Mean systolic and diastolic diameters for the RPA and LPA at the narrowest point were: RPA 10.5 ± 2.8 mm (7.8 ± 2.4 mm/m²) / 8.1 ± 2.2 mm (6.0 ± 1.9 mm/m²); LPA 8.4 ± 2.8 mm (6.2 ± 2.1 mm/m²) / 7.4 ± 2.3 mm (5.4 ± 1.6 mm/m²). Mean values for biventricular volumes, ejection fraction and mass were as follows: 1) left ventricular (LV) end-diastolic volume (EDV) 89.0 ± 20.3 ml/m² and end-systolic volume (ESV) 35.1 ± 11.7 ml/m², 2) right ventricular (RV) EDV 76.4 ± 15.4 ml/m² and ESV 32.4 ± 9.1 ml/m², 3) LV and RV ejection fraction 61.1 ± 6.5 % / 58.9 ± 6.1 % and 4) LV and RV mass 59.6 ± 15.2 g/m² / 23.3 ± 7.4 g/m². Separate centile charts for boys and girls for PA dimensions as well as biventricular volumes, mass and ejection fraction were created.
Conclusion
We established disease specific CMR normal values for the PA dimensions as well as for ventricular volumes, mass and ejection fraction in paediatric patients with TGA after ASO. Our data will improve CMR image interpretation and may serve as a reference in future studies.
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Affiliation(s)
- I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - C Boll
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Caliebe
- Christian-Albrechts-University Kiel, Department for Medical Informatics and Statistics, Kiel, Germany
| | - A Uebing
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - S Krupickova
- Royal Brompton and Harefield Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland
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Krupickova S, Risch J, Gati S, Caliebe A, Sarikouch S, Beerbaum P, Puricelli F, Daubeney PEF, Barth C, Wage R, Boroni Grazioli S, Uebing A, Pennell DJ, Voges I. Cardiovascular magnetic resonance normal values in children for biventricular wall thickness and mass. J Cardiovasc Magn Reson 2021; 23:1. [PMID: 33390185 PMCID: PMC7780624 DOI: 10.1186/s12968-020-00692-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pediatric patients are becoming increasingly referred for cardiovascular magnetic resonance (CMR). Measurement of ventricular wall thickness is typically part of the assessment and can be of diagnostic importance, e.g. in arterial hypertension. However, normal values for left ventricular (LV) and right ventricular (RV) wall thickness in pediatric patients are lacking. The aim of this study was to establish pediatric centile charts for segmental LV and RV myocardial thickness in a retrospective multicenter CMR study. METHODS CMR was performed in 161 healthy children and adolescents with an age range between 6 and 18 years from two centers in the UK and Germany as well as from a previously published CMR project of the German Competence Network for Congenital Heart Defects. LV myocardial thickness of 16 segments was measured on the short axis stack using the American Heart Association segmentation model. In addition, the thickness of the RV inferior and anterior free wall as well as biventricular mass was measured. RESULTS The mean age (standard deviation) of the subjects was 13.6 (2.9) years, 64 (39.7%) were female. Myocardial thickness of the basal septum (basal antero- and inferoseptal wall) was 5.2 (1.1) mm, and the basal lateral wall (basal antero- and inferolateral) measured 5.1 (1.2) mm. Mid-ventricular septum (antero- and inferoseptal wall) measured 5.5 (1.2) mm, and mid-ventricular lateral wall (antero- and inferolateral wall) was 4.7 (1.2) mm. Separate centile charts for boys and girls for all myocardial segments and myocardial mass were created because gender was significantly correlated with LV myocardial thickness (p < 0.001 at basal level, p = 0.001 at midventricular level and p = 0.005 at the apex) and biventricular mass (LV, p < 0.001; RV, p < 0.001). CONCLUSION We established CMR normal values of segmental myocardial thickness and biventricular mass in children and adolescents. Our data are of use for the detection of abnormal myocardial properties and can serve as a reference in future studies and clinical practice.
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Affiliation(s)
- Sylvia Krupickova
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Julian Risch
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Sabiha Gati
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Amke Caliebe
- Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Medical Faculty, Kiel University, Kiel, Germany
| | - Samir Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine At the Hannover Medical School, Hannover, Germany
| | | | - Piers E F Daubeney
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Rick Wage
- CMR Unit, Royal Brompton Hospital, London, UK
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Dudley J Pennell
- CMR Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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Schweikert L, Gabbert D, Krupickova S, Voges I. The Impact of a Bicuspid Aortic Valve on Aortic Geometry and Function in Patients with Aortic Coarctation: A Comprehensive CMR Study. CONGENIT HEART DIS 2021. [DOI: 10.32604/chd.2021.016635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Avesani M, Borrelli N, Krupickova S, Sabatino J, Piccinelli E, Josen M, Michielon G, Fraisse A, Di Salvo G. Echocardiography and cardiac magnetic resonance in children with repaired tetralogy of fallot and their correlations with exercise capacity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Severe pulmonary regurgitation (PR) and progressive right ventricular (RV) dilation and disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF) and should be carefully monitored during the follow up of these patients. In this contest, Echocardiography and Cardiac Magnetic Resonance (CMR) have a complementary diagnostic role.
Purpose
To correlate Echo and CMR parameters in children (<18 years) with r-TOF with at least moderate PR assessed by Echocardiography and to analyse which parameter was associated with peak oxygen consumption (Vo2).
Methods
Paediatric patients with r- TOF with at least moderate PR at the echo evaluation who underwent a CMR study within six months were included by using hospital databases. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT), PR index, ratio of diastolic and systolic time-velocity integrals (DSTVI) of the main pulmonary artery. By speckle tracking we measured also RV global longitudinal strain (RVGLS) and right atrial strain (RAS). All the patients underwent CMR to assess PR and right ventricular volumes and ejection fraction (EF). Of these, 36 patients underwent cardiopulmonary exercise test (CPET).
Results
Fourty-six children (aged 13.7±3.0 years) were included. Echo derived RV areas correlated significantly with CMR RV volumes (r=0.72, p<0.0001). RVEDA >21.9 cm2/m2 had a good sensitivity (83.3%) and specificity (73.5%) to identify a RV end-diastolic volume (RVEDV) ≥150 ml/m2. No correlation was found among TAPSE, FAC, RVGLS and RVEF calculated by CMR nor between PHT, PR index and DSTVI and PR-RF. Only A' wave velocity showed a significant but modest correlation with CMR RF (r=0.57, p<0.0001). Flow reversal in pulmonary branches showed a sensitivity of 95.8% and a specificity of 59.1% to identify PR RF ≥35%. RVEF by CMR was preserved in all patients, while TAPSE was reduced in 78.2% and RVGLS in 60.8%. None of the CMR parameters correlated with peak Vo2. At the multivariate analysis RAS was the best independent predictor of peak Vo2 (p<0.0001).
Conclusion
In children, flow reversal in pulmonary branches identifies hemodynamically significant PR at CMR. RV area by echocardiogram is a valid first-line parameter to screen RV dilation. Our study suggests that, also for the RV, there is longitudinal systolic dysfunction in presence of preserved RV EF. RAS is the best predictor of peak Vo2 and should be added in the follow up of these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Avesani
- Royal Brompton Hospital, London, United Kingdom
| | - N Borrelli
- Royal Brompton Hospital, London, United Kingdom
| | | | - J Sabatino
- Royal Brompton Hospital, London, United Kingdom
| | | | - M Josen
- Royal Brompton Hospital, London, United Kingdom
| | - G Michielon
- Royal Brompton Hospital, London, United Kingdom
| | - A Fraisse
- Royal Brompton Hospital, London, United Kingdom
| | - G Di Salvo
- University Hospital of Padova, Paediatric Department, Padua, Italy
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Naqvi N, Babu-Narayan SV, Krupickova S, Muthialu N, Maiya S, Chandershekar P, Cheang MH, Kostolny M, Tsang V, Marek J. Myocardial Function Following Repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery in Children. J Am Soc Echocardiogr 2020; 33:622-630. [PMID: 32122741 DOI: 10.1016/j.echo.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/02/2018] [Revised: 11/22/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to assess the change in global and regional myocardial function before and after surgical revascularization and their added value when compared with conventional measures in children with anomalous left coronary artery from the pulmonary artery (ALCAPA). METHODS Advanced echocardiographic assessment was performed pre- and postoperatively in 22 children with ALCAPA (eight male; median surgery age, 0.4 years; interquartile range, 0.21-1.05) and 22 healthy controls. Measurements included global and segmental longitudinal, radial, and circumferential two-dimensional speckle-tracking strain and postsystolic index. RESULTS Global strains were lower in preoperative patients than in controls (longitudinal: -9% vs -21%; P < .001; circumferential: -11% vs -21%; P < .001; radial: 18% vs 60%; P < .001) and improved postoperatively when compared with preoperative findings (longitudinal: -9% pre vs -16% post; P = .002, circumferential:-11% pre vs -17% post; P = .012, radial: 18% pre vs 53% post; P = .001). Preoperatively, patients with normal global systolic function on conventional echocardiography had significantly impaired global longitudinal and radial strain compared with healthy controls. Global mechanical dyssynchrony improved significantly postoperatively (longitudinal postsystolic index 43 pre vs 6 post, P < .001; circumferential 15 pre vs 2 post, P = .001; radial 48 pre vs 5 post, P = .003). Despite overall improvement in most segments, global longitudinal and circumferential and segmental peak strain in some of the segments supplied by the ALCAPA remained postoperatively abnormal. CONCLUSIONS This study shows that myocardial deformation indices were a more sensitive measure of LV dysfunction in patients before and after ALCAPA repair than conventional echocardiographic measures. We believe, therefore, they should be added to routine preoperative and serial postoperative follow-up assessment.
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Affiliation(s)
- Nitha Naqvi
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sylvia Krupickova
- Department of Adult Congenital Heart Disease, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Nagarajan Muthialu
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shreesha Maiya
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Prathiba Chandershekar
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mun Hong Cheang
- Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Martin Kostolny
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Victor Tsang
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom
| | - Jan Marek
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, London, United Kingdom; Institute of Cardiovascular Sciences University College London, London, United Kingdom.
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Sabatino J, Di Salvo G, Krupickova S, Fraisse A, Prota C, Bucciarelli V, Josen M, Paredes J, Sirico D, Voges I, Indolfi C, Prasad S, Daubeney P. Left Ventricular Twist Mechanics to Identify Left Ventricular Noncompaction in Childhood. Circ Cardiovasc Imaging 2020; 12:e007805. [PMID: 31002265 DOI: 10.1161/circimaging.118.007805] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 11/16/2022]
Abstract
BACKGROUND Left ventricular noncompaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood. Standard diagnostic criteria are still controversial, especially in young patients. Recent studies in adults demonstrated that left ventricular (LV) twist is abnormal in LVNC, but it has not been investigated in pediatric patients to date. Our aim was to assess LV cardiac mechanics, LV twist, and the prevalence of rigid body rotation, using 2-dimensional speckle tracking echocardiography, in young patients with LVNC and LV hypertrabeculation. METHODS Forty-seven children (age range: 0-18 years) were assessed for suspected LVNC. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging at 1.5 Tesla (T). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group. Forty-seven age- and sex-matched healthy volunteers were used as controls. RESULTS The average LV twist was significantly reduced in LVNC compared with control and LV hypertrabeculation. Rigid body rotation was recognized in 13 (56%) children with LVNC and in 1 (4%) child with LV hypertrabeculation and a strong family history for LVNC. Multivariable analysis demonstrated that LV twist is an independent predictor of LVNC ( P=0.006; coefficient=0.462). The receiver operating characteristics curve showed that LV twist had optimal predictive value to discriminate patients with LVNC (cutoff value <5.8°; sensitivity, 82%; specificity, 92%; area under the curve=0.914). CONCLUSIONS LV twist has good predictive value in diagnosing LVNC in young patients. Our findings strongly support the routine use of 2-dimensional speckle tracking echocardiography in the evaluation of young patients with suspected LVNC.
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Affiliation(s)
- Jolanda Sabatino
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Costantina Prota
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Valentina Bucciarelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Domenico Sirico
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Inga Voges
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Ciro Indolfi
- Department of Cardiology, Magna Graecia University, Catanzaro, Italy (C.I.)
| | - Sanjay Prasad
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Piers Daubeney
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
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Avesani M, Borrelli N, Filippini E, Delle Donne G, Krupickova S, Josen M, Iliceto S, Di Salvo G. 1160 Which parameters do correlate better with functional exercise capacity in children with repaired Tetralogy of Fallot? An echo and CMR study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2022] Open
Abstract
Abstract
Background
Severe pulmonary regurgitation (PR) and progressive right ventricular (RV) disfunction are common in patients with repaired Tetralogy of Fallot (r-TOF), and CMR has become the gold standard for PR and RV volumes assessment. However, in paediatric patients CMR use can be limited by the need for general anaesthesia.
Purpose
The aim of our study was to analyse a paediatric population (<18 years) of r-TOF with at least moderate PR (regurgitant fraction (RF) >20%), assessed by CMR and to assess which Echo or CMR parameter is associated with functional capacity evaluated by cardiopulmonary exercise test (CPET).
Methods
Consecutive r-TOF patients regularly followed at our Institution, with at least moderate PR (RF >20% by CMR), were included in the study. Echocardiographic and CMR studies were performed within six months. Echo study: PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT), PR index, ratio of diastolic and systolic time-velocity integrals (DSTVI) of the main pulmonary artery. RV end-diastolic area (RVEDA), end-systolic area (RVESA), right ventricle outflow tract (RVOT) end-diastolic area, fractional area change (FAC) and TAPSE were calculated. By speckle tracking analysis we measured also RV global longitudinal strain (RVGLS) and right atrial strain (RAS). CMR study: we evaluated PR as RF, end-diastolic and systolic volumes (RVEDV, RVESV) and right ventricle ejection fraction (RVEF). In addition, patients underwent CPET within one month from CMR and peak oxygen consumption (Vo2) values were measured.
Results
We studied 53 r-TOF patients (aged 13.8 ± 2.5 years, ranged between 7.1 and 17.6 years, male 57%, surgical repair at a mean age of 1.1 ± 0.75 years). Based on CMR data, 38 out of 53 had free PR (RF >35%) and nobody had > mild tricuspid regurgitation. We found a good correlation between RVEDA and CMR RVEDV (p <0.0001, r =0.73), which slightly improved adding RVOT area (p < 0.0001, r =0.75). RVEDA indexed (RVEDAi) > 21.3 cm2/mq was found to have a good sensitivity (83.3%, specificity 64.9%, AUC0.74) for RVEDV indexed (RVEDVi) >150 ml/mq. No correlation was found between TAPSE, FAC, RVGLS measured by echo and RVEF calculated by CMR. No correlation was found between echo Doppler parameters used to assess PR severity and PR RF measured by CMR. None of the CMR studied parameters (RV volumes, RVEF, RF) correlated with peak Vo2. Among the Echo parameters only RAS demonstrated a good correlation (p <0.0001, r =0.70) with peak Vo2. At the multivariate analysis including RAS, TAPSE, FAC, RVGLS, RVEF and RVEDV, RAS was the best independent predictor of peak Vo2 (p <0.0001).
Conclusion
Echo parameters studied to assess PR are unsatisfactory and showed no correlation with PR RF by CMR. RVEDAi is well correlated with CMR volumes. Right atrial strain is the best predictor of peak Vo2 in young patients with r-TOF and should be included in their follow up.
Abstract 1160 Figure.
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Affiliation(s)
- M Avesani
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Borrelli
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - E Filippini
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - G Delle Donne
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Krupickova
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Josen
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Iliceto
- University of Padova, Cardiology Department, Padua, Italy
| | - G Di Salvo
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Ibrahim A, Borrelli N, Krupickova S, Sabatino J, Paredes J, Josen M, D'Ascenzi F, Mondillo S, Di Salvo G. P2734Aortic regurgitation in paediatric patients: new echo parameter strongly correlates with CMR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Aortic regurgitation (AR) continues to be an important cause of morbidity and mortality, particularly in paediatric patients. In the paediatric population the prevalence of AR has increased, also due to expanded use of new surgical and hemodynamic procedures. While echocardiographic parameters are well established for the adults, there are no clear cut-off values to assess AR severity in children. Cardiac magnetic resonance (CMR) imaging is widely used to assess diagnostic and prognostic information and is considered a “gold standard” for a quantitative evaluation of the aortic regurgitation.
Purpose
The aim of the study is to assess which echo parameters can accurately define AR severity as assessed by CMR in paediatric patients.
Methods
A total of 36 paediatric patients (12±3,2 years of age, age range 6–18) with different degree of AR underwent echocardiographic assessment within an average of 25 days from CMR (no therapeutic changes were made in this period). Heart rate and arterial blood pressure were comparable during echo and CMR. CMR included phase-contrast velocity-encoded imaging for the measurement of regurgitant fraction (RF) at the sinotubular junction. Severe AR was defined as RF>33%. Echocardiographic evaluation included vena contracta (VC), pressure half time (PHT), the ratio between the AR jet and the LVOT diameter (jet/LVOT), presence of holodiastolic reversal flow in abdominal aorta (abdAo), the ratio between the velocity-time integral of the reversal flow over the forward flow in descending aorta (dAo-ratio).
Results
Among the echo parameters studied, the strongest predictor of severe aortic regurgitation, as assessed by CMR with RF, was dAo-ratio. ROC curve showed, for a cut-off >0.38: AUC 0.882, p<0.0001, sensitivity 71.4%, specificity 96.6%. Correlation coefficient between dAo-ratio and RF was R=0.9183 with a p<0.0001.
ROC curves were performed for all the echo parameters. PHT <410 ms: AUC 0,800, p=0,0001, sensitivity 100%, specificity 62,1%; VC >4 mm: AUC 0.783, p=0.0004, sensitivity 71.4%, specificity 72.4%; jet/LVOT >0.35: AUC 0.813, p=0,0002, sensitivity 71,4%, specificity 86,2%; abdAo =1: AUC 0,734, p 0,026, sensitivity 57,1%, specificity 89,7%.
dAo-ratio: measurement and statistics
Conclusions
Our findings suggest that dAo-ratio is a strong marker of severe aortic regurgitation in the paediatric population. This parameter should be routinely added in the standard echo evaluation of paediatric patients with aortic regurgitation.
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Affiliation(s)
- A Ibrahim
- Royal Brompton Hospital, London, United Kingdom
| | - N Borrelli
- Royal Brompton Hospital, London, United Kingdom
| | | | - J Sabatino
- Royal Brompton Hospital, London, United Kingdom
| | - J Paredes
- Royal Brompton Hospital, London, United Kingdom
| | - M Josen
- Royal Brompton Hospital, London, United Kingdom
| | - F D'Ascenzi
- Polyclinic Santa Maria alle Scotte, Cardiologia universitaria, Siena, Italy
| | - S Mondillo
- Polyclinic Santa Maria alle Scotte, Cardiologia universitaria, Siena, Italy
| | - G Di Salvo
- Royal Brompton Hospital, London, United Kingdom
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Krupickova S, Hatipoglu S, Di Salvo G, Voges I, Foldvari S, Eichhorn CH, Chivers S, Prasad SK, Daubeney PEF. P180Quantification of left ventricular trabeculations using fractal analysis in children. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.042] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Krupickova
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Hatipoglu
- Royal Brompton Hospital, CMR department, London, United Kingdom of Great Britain & Northern Ireland
| | - G Di Salvo
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - I Voges
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Foldvari
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Eichhorn
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Chivers
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S K Prasad
- Royal Brompton Hospital, CMR department, London, United Kingdom of Great Britain & Northern Ireland
| | - P E F Daubeney
- Royal Brompton Hospital, Paediatric Cardiology, London, United Kingdom of Great Britain & Northern Ireland
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Krupickova S, Vazquez-Garcia L, Obeidat M, Banya W, DiSalvo G, Ghez O, Michielon G, Castellano I, Rubens M, Semple T, Nicol E, Slavik Z, Rigby ML, Fraisse A. Accuracy of computed tomography in detection of great vessel stenosis or hypoplasia before superior bidirectional cavopulmonary connection: Comparison with cardiac catheterization and surgical findings. Arch Cardiovasc Dis 2019; 112:12-21. [DOI: 10.1016/j.acvd.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/11/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
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Krupickova S, Li W, Cheang MH, Rigby ML, Uebing A, Davlouros P, Dimopoulos K, Di Salvo G, Fraisse A, Swan L, Alonso-Gonzalez R, Kempny A, Pennell DJ, Senior R, Gatzoulis MA, Babu-Narayan SV. Ramipril and left ventricular diastolic function in stable patients with pulmonary regurgitation after repair of tetralogy of Fallot. Int J Cardiol 2018; 272:64-69. [DOI: 10.1016/j.ijcard.2018.07.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 01/15/2023]
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Sabatino J, Prota C, Bucciarelli V, Sirico D, Daubeney P, Voges I, Krupickova S, Uy Pernia M, Paredes J, Josen M, Di Salvo G. P843Left ventricular twist for the diagnosis of left ventricular non-compaction in children and young adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p843] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Sabatino
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - C Prota
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - V Bucciarelli
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - D Sirico
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - P Daubeney
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - I Voges
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - S Krupickova
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - M Uy Pernia
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - J Paredes
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - M Josen
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
| | - G Di Salvo
- Royal Brompton Hospital, Pediatric Cardiology, London, United Kingdom
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Krupickova S, Muthurangu V, Hughes M, Tann O, Carr M, Christov G, Awat R, Taylor A, Marek J. Echocardiographic arterial measurements in complex congenital diseases before bidirectional Glenn: comparison with cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2018; 18:332-341. [PMID: 27099275 DOI: 10.1093/ehjci/jew069] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/08/2016] [Indexed: 11/13/2022] Open
Abstract
Aims This study sought to investigate diagnostic accuracy of echocardiographic measures of great vessels in patients before bidirectional cavopulmonary connection (BCPC) compared with cardiovascular magnetic resonance (CMR). Methods and results Seventy-two patients (61% after Norwood operation) undergoing BCPC between 2007 and 2012 were assessed pre-operatively using echocardiography and CMR. Bland-Altman analysis and correlation coefficients were used for comparison of echocardiography and CMR measurements. Sensitivity, specificity, and positive and negative predictive values were calculated to assess the ability of echocardiography to detect vessel stenosis. Twenty-four percent of all vessel measurements could not be made by echocardiography due to poor image quality. Acquisition of unsatisfactory images was higher in non-sedated patients. Although there was a reasonable correlation (0.68-0.90) and low bias (-0.8 to 0.5), there were wide limits of agreement between echocardiography and CMR demonstrating poor agreement. Sensitivity and specificity for pulmonary branches were moderate [sensitivity for right pulmonary artery (RPA) 67%, left pulmonary artery (LPA) 54%, specificity for RPA 65%, LPA 72%] with low levels of accuracy (RPA and LPA 42%). Sensitivity, specificity, and accuracy were better for aorta (82, 86, and 63%, respectively). Conclusion This study demonstrates modest agreement between echocardiographic and CMR measures of vessel diameter and stenosis detection. Approximately a quarter of all vessel segments could not be measured using echocardiography due to poor image quality, which was significantly lower in non-sedated patients. These findings show that echocardiography cannot substitute CMR for reliable identification of great vessel stenoses in complex patients prior to the BCPC, particularly those with Blalock-Taussig shunts.
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Affiliation(s)
- Sylvia Krupickova
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Vivek Muthurangu
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science London, London, UK
| | - Marina Hughes
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Oliver Tann
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Michelle Carr
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Georgi Christov
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Ram Awat
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
| | - Andrew Taylor
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science London, London, UK
| | - Jan Marek
- Cardiorespiratory Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.,Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science London, London, UK
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Krupickova S, Morgan GJ, Cheang MH, Rigby ML, Franklin RC, Battista A, Spanaki A, Bonello B, Ghez O, Anderson D, Tsang V, Michielon G, Marek J, Fraisse A. Symptomatic partial and transitional atrioventricular septal defect repaired in infancy. Heart 2017; 104:1411-1416. [DOI: 10.1136/heartjnl-2017-312195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/17/2017] [Accepted: 12/06/2017] [Indexed: 11/03/2022] Open
Abstract
ObjectivesInfants with symptomatic partial and transitional atrioventricular septal defect undergoing early surgical repair are thought to be at greater risk. However, the outcome and risk profile of this cohort of patients are poorly defined. The aim of this study was to investigate the outcome of symptomatic infants undergoing early repair and to identify risk factors which may predict mortality and reoperation.MethodsThis multicentre study recruited 51 patients (24 female) in three tertiary centres between 2000 and 2015. The inclusion criteria were as follows: (1) partial and transitional atrioventricular septal defect, (2) heart failure unresponsive to treatment, (3) biventricular repair during the first year of life.ResultsMedian age at definitive surgery was 179 (range 0–357) days. Sixteen patients (31%) had unfavourable anatomy of the left atrioventricular valve: dysplastic (n=7), double orifice (n=3), severely deficient valve leaflets (n=1), hypoplastic left atrioventricular orifice and/or mural leaflet (n=3), short/poorly defined chords (n=2). There were three inhospital deaths (5.9%) after primary repair. Eleven patients (22%) were reoperated at a median interval of 40 days (4 days to 5.1 years) for severe left atrioventricular valve regurgitation and/or stenosis. One patient required mechanical replacement of the left atrioventricular valve. After median follow-up of 3.8 years (0.1–11.4 years), all patients were in New York Heart Association (NYHA) class I. In multivariable analysis, unfavourable anatomy of the left atrioventricular valve was the only risk factor associated with left atrioventricular valve reoperation.ConclusionsAlthough surgical repair is successful in the majority of the cases, patients with partial and transitional atrioventricular septal defect undergoing surgical repair during infancy experience significant morbidity and mortality. The reoperation rate is high with unfavourable left atrioventricular valve anatomy.
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Krupickova S, Rigby ML, Jicinska H, Marais G, Rubens M, Carvalho JS. Total anomalous pulmonary venous connection to unroofed coronary sinus diagnosed in a fetus with spinal muscular atrophy Type I. Ultrasound Obstet Gynecol 2017; 50:657-658. [PMID: 28170121 DOI: 10.1002/uog.17432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/06/2017] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Affiliation(s)
- S Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - M L Rigby
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
| | - H Jicinska
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
| | - G Marais
- Department of Paediatrics, Croydon Hospital, Croydon, UK
| | - M Rubens
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - J S Carvalho
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, UK
- Fetal Medicine Unit, St George's Hospital, London, UK
- Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
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