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Voges I, Hansen JH. Critical aortic stenosis - The long-term burden. Int J Cardiol 2024; 408:132134. [PMID: 38705208 DOI: 10.1016/j.ijcard.2024.132134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany.
| | - Jan Hinnerk Hansen
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
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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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Cantinotti M, Voges I, Miller O, Raimondi F, Grotenhuis H, Bharucha T, Garrido AO, Valsangiacomo E, Roest A, Sunnegårdh J, Salaets T, Brun H, Khraiche D, Jossif A, Schokking M, Sabate-Rotes A, Meyer-Szary J, Deri A, Koopman L, Herberg U, du Marchie Sarvaas G, Leskinen M, Tchana B, Ten Harkel ADJ, Ödemis E, Morrison L, Steimetz M, Laser KT, Doros G, Bellshan-Revell H, Muntean I, Anagostopoulou A, Alpman MS, Hunter L, Ojala T, Bhat M, Olejnik P, Wacker J, Bonello B, Ramcharan T, Greil G, Marek J, DiSalvo G, McMahon CJ. Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM. Cardiol Young 2024:1. [PMID: 38557389 DOI: 10.1017/s1047951124000519] [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: 04/04/2024]
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DiLorenzo MP, Lee S, Rathod RH, Raimondi F, Farooqi KM, Jain SS, Samyn MM, Johnson TR, Olivieri LJ, Fogel MA, Lai WW, Renella P, Powell AJ, Buddhe S, Stafford C, Johnson JN, Helbing WA, Pushparajah K, Voges I, Muthurangu V, Miles KG, Greil G, McMahon CJ, Slesnick TC, Fonseca BM, Morris SA, Soslow JH, Grosse-Wortmann L, Beroukhim RS, Grotenhuis HB. Design and implementation of multicenter pediatric and congenital studies with cardiovascular magnetic resonance: Big data in smaller bodies. J Cardiovasc Magn Reson 2024; 26:101041. [PMID: 38527706 PMCID: PMC10990896 DOI: 10.1016/j.jocmr.2024.101041] [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: 11/20/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) has become the reference standard for quantitative and qualitative assessment of ventricular function, blood flow, and myocardial tissue characterization. There is a preponderance of large CMR studies and registries in adults; However, similarly powered studies are lacking for the pediatric and congenital heart disease (PCHD) population. To date, most CMR studies in children are limited to small single or multicenter studies, thereby limiting the conclusions that can be drawn. Within the PCHD CMR community, a collaborative effort has been successfully employed to recognize knowledge gaps with the aim to embolden the development and initiation of high-quality, large-scale multicenter research. In this publication, we highlight the underlying challenges and provide a practical guide toward the development of larger, multicenter initiatives focusing on PCHD populations, which can serve as a model for future multicenter efforts.
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Affiliation(s)
- Michael P. DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Simon Lee
- Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Francesca Raimondi
- Children's Hospital Meyer, University of Florence, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Kanwal M. Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Supriya S. Jain
- New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Margaret M. Samyn
- Medical College of Wisconsin/The Herma Heart Institute at Children's Wisconsin, 8915 W Connell Ct, Milwaukee, WI 53226, USA
| | - Tiffanie R. Johnson
- Indiana University School of Medicine, Riley Children’s Health, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Laura J. Olivieri
- Department of Pediatric Cardiology, Children's Hospital of Pittsburgh, Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA 15224, USA
| | - Mark A. Fogel
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Wyman W. Lai
- CHOC Children's Hospital, 1201 W La Veta Ave, Orange, CA 92868, USA
| | | | | | - Sujatha Buddhe
- Department of Pediatrics, Division of Pediatric Cardiology, Betty Irene Moore Heart Center, Lucile Packard Children’s Hospital, 725 Welch Rd Ste 325, Palo Alto, CA 94304, USA
| | | | - Jason N. Johnson
- Department of Pediatrics, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
- Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, 848 Adams Ave, Memphis, TN 38103, USA
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Sophia's Children's Hospital, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Rotterdam, the Netherlands
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
| | - Inga Voges
- German Centre for Cardiovascular Research, Ootsdamer Str. 58, 10785 Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular Imaging, University College London, Gower Street, London WC1E 6BT, UK
| | - Kimberley G. Miles
- Heart Institute, Cincinnati Children's Hospital Medical Center, 333 Burnet Ave, Kimberley, Cincinnati, OH 45229, USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Colin J. McMahon
- University College of Dublin, School of Medicine and Department of Paediatric Cardiology, Children's Health Ireland, Gate 5, Crumlin, Dublin 12, Ireland
| | - Timothy C. Slesnick
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, Division of Pediatric Cardiology, Emory University School of Medicine, 738 Old Norcross Road, Lawrenceville, GA 30046, USA
| | - Brian M. Fonseca
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Ave, Aurora, CO 80045, USA
| | - Shaine A. Morris
- Division of Cardiology, Department of Pediatrics, Baylor College of Medicine Texas Children's Hospital, 6651 Main Street, Houston, TX 77030, USA
| | - Jonathan H. Soslow
- Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Dr, Portland, OR, USA 97239
| | | | - Heynric B. Grotenhuis
- Pediatric Cardiology, Wilhelmina Children’s Hospital, UMCU, Lundlaan 6, 3584 EA Utrecht, the Netherlands
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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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Cantinotti M, Voges I, Miller O, Raimondi F, Grotenhuis H, Bharucha T, Garrido AO, Valsangiacomo E, Roest A, Sunnegårdh J, Salaets T, Brun H, Khraiche D, Jossif A, Schokking M, Sebate-Rotes A, Meyer-Szary J, Deri A, Koopman L, Herberg U, du Marchie Sarvaas G, Leskinen M, Tchana B, Ten Harkel ADJ, Ödemis E, Morrison L, Steimetz M, Laser KT, Doros G, Bellshan-Revell H, Muntean I, Anagostopoulou A, Alpman MS, Hunter L, Ojala T, Bhat M, Olejnik P, Wacker J, Bonello B, Ramcharan T, Greil G, Marek J, DiSalvo G, McMahon CJ. Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group. Cardiol Young 2024:1-9. [PMID: 38439642 DOI: 10.1017/s1047951124000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND There is limited data on the organisation of paediatric echocardiography laboratories in Europe. METHODS A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. RESULTS Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). CONCLUSION Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione CNR-Regione Toscana G. Monasterio (FTGM), National Research Institute (CNR), Pisa, Italy
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
| | - Inga Voges
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- DZHK (German Center for Cardiovascular Research), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department for Congenital Cardiology and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Owen Miller
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Francesca Raimondi
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Division of Pediatric Cardiology, Meyer University Hospital, Florence University, Firenze, Italy
| | - Heynric Grotenhuis
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Pediatric Cardiology, Wilhelmina Children's Hospital / UMCU, Utrecht, The Netherlands
| | - Tara Bharucha
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Almudena Ortiz Garrido
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department Pediatric Cardiology, Hospital Materno Infantil, Malaga, AL, Spain
| | - Emanuela Valsangiacomo
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Department of Paediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Arno Roest
- Department of Pediatrics, Division of Pediatric Cardiology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan Sunnegårdh
- Children's Heart Centre, The Queen Silvia Children's Hospital Sahlgrenska University Hospital, Göteborg, Sweden
| | - Thomas Salaets
- Department Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Henrik Brun
- Department of Paediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Antonis Jossif
- Paedi Center for Specialized Pediatrics, Strovolos, Cyprus
| | | | - Anna Sebate-Rotes
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaroslaw Meyer-Szary
- Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Antigoni Deri
- Department Paediatric Cardiology, Leeds University, Leeds, UK
| | - Laurens Koopman
- Division of Pediatric Cardiology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ulrike Herberg
- Department or Pediatric Cardiology and Congenital Heart Disease, University of Aachen, Aachen, Germany
| | - Gideon du Marchie Sarvaas
- Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Markku Leskinen
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Bertrand Tchana
- Parma University Hospital, Department of Mother and Child Pediatric Cardiology Unit, Parma, Italy
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Ender Ödemis
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Louise Morrison
- Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Micheal Steimetz
- Department of Pediatric Cardiology and Intensive Care Medicine (M.S.), University Medical Center, Georg-August-University, Goettingen, Germany
| | - Kai Thorsten Laser
- Department of Congenital Heart Defects, Heart and Diabetes Center, North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Gabriela Doros
- Victor Babes UMF, IIIrd Pediatric Clinic, Louis Turcanu Emergency Children Hospital, Timisoara, Romania
| | | | - Iolanda Muntean
- Clinic of Paediatric Cardiology, Institute for Cardiovascular Diseases and Transplantation, UMFST "George Emil Palade", Timisoara, Romania
| | | | - Maria Sjoborg Alpman
- Pediatric Cardiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lindsey Hunter
- Department Paediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Tiina Ojala
- Department Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Misha Bhat
- Department of Pediatric Cardiology, Children's Heart Center, Skåne University Hospital in Lund, Lund, Sweden
| | - Peter Olejnik
- Pediatric Cardiology Center, Bratislava, Slovakia and Department of Pediatric Cardiology, Faculty of Medicine, National Institute of Cardiovascular Diseases, Comenius University, Bratislava, Slovakia
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child and Adolescent Medicine, Children University Hospital of Geneva, Geneva, Switzerland
| | - Beatrice Bonello
- Department Paediatric Cardiology, Great Ormond Street NHS Trust, London, England
| | | | - Gerald Greil
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- Department of Pediatrics, Division of Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | - Jan Marek
- Department Paediatric Cardiology, Great Ormond Street NHS Trust, London, England
| | - Giovanni DiSalvo
- European Association Cardiovascular Imaging (EACVI), Taskforce on Congenital Heart Disease, Lyon, France
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University Hospital of Padova, University of Padua, Padua, Italy
| | - Colin J McMahon
- Association for European Paediatric and Congenital Cardiology (AEPC), Imaging Work Group Committee
- University School of Medicine, University College Dublin 4, Dublin, Ireland
- Children's Health Ireland and Crumlin, Dublin, Ireland
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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McMahon CJ, Milanesi O, Pitkänen-Argillander O, Albert-Brotons DC, Michel-Behnke I, Voges I, Sendzikaite S, Heying R. Assessment for learning of paediatric cardiology trainees in 41 centres from 19 European countries. Cardiol Young 2024; 34:588-596. [PMID: 37641941 DOI: 10.1017/s1047951123003098] [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: 08/31/2023]
Abstract
BACKGROUND Limited data exist on how trainees in paediatric cardiology are assessed among countries affiliated with the Association of European Paediatric and Congenital Cardiology. METHODS A structured and approved questionnaire was circulated to educationalists/trainers in 95 Association for European Paediatric and Congenital Cardiology training centres. RESULTS Trainers from 46 centres responded with complete data in 41 centres. Instructional design included bedside teaching (41/41), didactic teaching (38/41), problem-based learning (28/41), cardiac catheterisation calculations (34/41), journal club (31/41), fellows presenting in the multidisciplinary meeting (41/41), fellows reporting on echocardiograms (34/41), clinical simulation (17/41), echocardiography simulation (10/41), and catheterisation simulation (3/41). Assessment included case-based discussion (n = 27), mini-clinical evaluation exercise (mini-CEX) (n = 12), directly observed procedures (n = 12), oral examination (n = 16), long cases (n = 11), written essay questions (n = 6), multiple choice questions (n = 5), and objective structured clinical examination (n = 2). Entrustable professional activities were utilised in 10 (24%) centres. Feedback was summative only in 17/41 (41%) centres, formative only in 12/41 (29%) centres and a combination of formative and summative feedback in 10/41 (24%) centres. Written feedback was provided in 10/41 (24%) centres. Verbal feedback was most common in 37/41 (90 %) centres. CONCLUSION There is a marked variation in instructional design and assessment across European paediatric cardiac centres. A wide mix of assessment tools are used. Feedback is provided by the majority of centres, mostly verbal summative feedback. Adopting a programmatic assessment focusing on competency/capability using multiple assessment tools with regular formative multisource feedback may promote assessment for learning of paediatric cardiology trainees.
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Affiliation(s)
- Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- School of Health Professions Education (SHE), Maastricht University, Maastricht, Netherlands
| | - Ornella Milanesi
- Paediatric Cardiac Unit, Department of Paediatrics, University of Padova, School of Medicine, Padua, Italy
| | | | | | - Ina Michel-Behnke
- Division of Pediatric Cardiology, University Hospital for Children and Adolescent Medicine, Paediatric Heart Centre, Medical University Vienna, Vienna, Austria
| | - Inga Voges
- Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Ruth Heying
- Department of Paediatric Cardiology, University Hospital Leuven, Leuven, Belgium
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Maslova V, Demming T, Nonnenmacher M, Voges I, Lyan E. Ablation of atrial flutter in a patient after Fontan procedure: a case report of challenging access to the common atrium. Eur Heart J Case Rep 2024; 8:ytae048. [PMID: 38332919 PMCID: PMC10852018 DOI: 10.1093/ehjcr/ytae048] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
Background In patients with a total cavopulmonary connection in Fontan circulation, the access to the common atrium (CA) during a catheter ablation can be challenging, even in the presence of fenestration in an intra-atrial lateral tunnel (IALT). In our department, the fenestration is typically marked with metal clips (MCs). To the best of our knowledge, there is no previous report of balloonoplasty of clipped fenestration. Case summary A 19-year-old male with hypoplastic left heart syndrome (HLHS) was scheduled for catheter ablation of recurrent atrial tachycardia. He was diagnosed with HLHS prenatally and underwent a stepwise surgical palliation. Fontan circulation was completed with the creation of a fenestrated IALT. The fenestration was marked by four MCs. During the ablation procedure, the passage of the steerable sheath with mapping catheter to the CA was prevented by a small fenestration size and rigidness of the edges of the fenestration caused by the MCs. Multiple attempts to dilate the fenestration using a peripheric angioplasty balloon failed. Only angioplasty with the 'balloon-against-dilator' technique was finally successful. Activation map showed a counterclockwise atrial flutter in the CA; successful ablation was performed. Discussion We present a case of challenging access to the CA through a clipped fenestration in a polytetrafluoroethylene baffle for atrial tachycardia ablation. Even though a tunnel fenestration in Fontan patients facilitates access to the CA, the passage of a steerable introducer with a mapping catheter may be challenging due to diameter mismatch and the rigidity of its edges caused by MCs. The balloon-against-dilator technique might be helpful when conventional balloon angioplasty fails.
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Affiliation(s)
- Vera Maslova
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Arnold-Heller str. 3, Kiel 24105, Germany
| | - Thomas Demming
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Arnold-Heller str. 3, Kiel 24105, Germany
| | - Marc Nonnenmacher
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller str. 3, Kiel 24105, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller str. 3, Kiel 24105, Germany
| | - Evgeny Lyan
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Arnold-Heller str. 3, Kiel 24105, Germany
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9
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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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10
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Rolfs N, Huber C, Schwarzkopf E, Mentzer D, Keller-Stanislawski B, Opgen-Rhein B, Frede W, Rentzsch A, Hecht T, Boehne M, Grafmann M, Kiski D, Graumann I, Foth R, Voges I, Schweigmann U, Ruf B, Fischer M, Wiegand G, Klingel K, Pickardt T, Friede T, Messroghli D, Schubert S, Seidel F. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multicenter registry-"MYKKE". Am Heart J 2024; 267:101-115. [PMID: 37956921 DOI: 10.1016/j.ahj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents. METHODS Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multicenter registry for pediatric myocarditis "MYKKE." Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics. RESULTS From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45%-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (P = .003), arrhythmias (P = .031), left ventricular dilatation (P = .045), lower LVEF (P < .001) and major cardiac adverse events (P = .102). CONCLUSIONS Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
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Affiliation(s)
- Nele Rolfs
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Cynthia Huber
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Eicke Schwarzkopf
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dirk Mentzer
- Paul-Ehrlich-Institut - Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Bernd Opgen-Rhein
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wiebke Frede
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Axel Rentzsch
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany
| | - Tobias Hecht
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maria Grafmann
- Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Kiski
- Department of Pediatric Cardiology, University Hospital Muenster, Muenster, Germany
| | - Iva Graumann
- Department of Pediatrics, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rudi Foth
- Department of Pediatric Cardiology, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Kiel, Germany
| | | | - Bettina Ruf
- Department of Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Gesa Wiegand
- Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Tim Friede
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Daniel Messroghli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Stephan Schubert
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
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11
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McMahon CJ, Voges I, Jenkins P, Brida M, van der Bosch AE, Dellborg M, Heying R, Stein JI, Georgiev B, Mesihovic-Dinarevic S, Prokšelj K, Oskarsson G, Frogoudaki A, Karagöz T, Jossif A, Doros G, Nielsen D, Jalanko M, Sanchez Perez I, Alvares S, Estensen ME, Petropoulos A, Tagen R, Gumbienė L, Michel-Behnke I, Olejnik P, Clift PF, Sendzikaite S, Albert-Brotons DC, Rhodes M, Pitkänen O, Bassareo PP, Gatzoulis MA, Walsh K, Milanesi O, Ladouceur M, Chessa M, Budts W. Adult congenital heart disease training in Europe: current status, disparities and potential solutions. Open Heart 2023; 10:e002558. [PMID: 38097363 PMCID: PMC10729203 DOI: 10.1136/openhrt-2023-002558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. METHODS A questionnaire was sent to ACHD cardiologists from 34 European countries. RESULTS Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). CONCLUSION Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.
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Affiliation(s)
- Colin J McMahon
- Children's Health Ireland at Crumlin, Crumlin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
| | | | - Petra Jenkins
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- Medical Rehabilitation, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Mikael Dellborg
- Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ruth Heying
- Department Paediatric Cardiology Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jörg I Stein
- Department of Paediatric Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Katja Prokšelj
- Department of cardiology, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Tevfik Karagöz
- Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children's Hospital, Ankara, Turkey
| | - Antonis Jossif
- Paedi Center for Specialized Pediatrics, Strovolos, Cyprus
| | - Gabriela Doros
- Paediatric Cardiology, Louis Turcanu Emergency Children Hospital, Timisoara, Romania
| | - Dorte Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikko Jalanko
- Heart and Lung Centre, HYKS sairaanhoitopiiri, Helsinki, Finland
| | | | - Sílvia Alvares
- Pediatric Cardiology Department, Oporto Medical Center, Porto, Portugal
| | | | - Andreas Petropoulos
- Ped.Cardiology, Merkezi klinika, Baku, Azerbaijan
- Pediatrics, Azerbaycan Tibb Universiteti Nariman Narimanov, Baku, Azerbaijan
| | - Raili Tagen
- Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Vilniaus universitetas Medicinos fakultetas, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilniaus Universiteto ligonines Santariskiu klinikos, Vilnius, Lithuania
| | - Ina Michel-Behnke
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Olejnik
- Department of Pediatric Cardiology, Comenius University, Bratislava, Slovakia
| | - Paul F Clift
- Grown Up Congenital Heart Disease Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Olli Pitkänen
- Divisions of Pediatric Cardiology, Children's Hospital/Helsinki University Hospital, Helsinki, Finland
| | | | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Kevin Walsh
- Heart House, Mater Misericordiae Hospital, Dublin, Ireland
| | | | - Magalie Ladouceur
- Cardiology, Hopital Europeen Georges Pompidou, Paris, France
- Pediatric Cardiology, Hopital universitaire Necker-Enfants malades, Paris, France
| | - Massimo Chessa
- Pediatric Cardiology Department and GUCH Unit, Policlinico San Donato, San Donato Milanese, Italy
| | - Werner Budts
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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12
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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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13
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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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14
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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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15
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Jussli-Melchers J, Hansen JH, Scheewe J, Attmann T, Eide M, Logoteta J, Dütschke P, Salehi Ravesh M, Uebing A, Voges I. Pulmonary valve reconstruction for acquired pulmonary regurgitation in patients with treated congenital heart disease. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad105. [PMID: 37341633 PMCID: PMC10581336 DOI: 10.1093/icvts/ivad105] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/09/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Pulmonary valve regurgitation is a common problem after relief of right ventricular outflow tract (RVOT) obstruction with a transannular patch. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. Longevity of biological valves and the availability of homografts are limited. Alternatives to restore RVOT competence are evaluated. The goal of this study was to present intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation. METHODS PVr was performed in 24 patients (August 2006‒July 2018). We analysed perioperative data, pre- and postoperative cardiac magnetic resonance (CMR) imaging studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction. RESULTS The underlying diagnoses were tetralogy of Fallot (n = 18, 75%), pulmonary stenosis (n = 5, 20.8%) and the double outlet right ventricle post banding procedure (n = 1, 4.2%). The median age was 21.5 (14.8-23.7) years. Main (n = 9, 37.5%) and branch pulmonary artery procedures (n = 6, 25%) and surgery of the RVOT (n = 16, 30.2%) were often part of the reconstruction. The median follow-up after the operation was 8.0 (4.7-9.7) years. Freedom from valve failure was 96% at 2 and 90% at 5 years. The mean longevity of the reconstructive surgery was 9.9 years (95% confidence interval: 8.8-11.1 years). CMR before and 6 months after surgery showed a reduction in the regurgitation fraction [41% (33-55) vs 20% (18-27) P = 0.00] and of the indexed right ventricular end-diastolic volume [156 ml/m2 (149-175) vs 116 ml/m2 (100-143), P = 0.004]. Peak velocity across the pulmonary valve (determined by CMR) half a year after surgery was 2.0, unchanged. CONCLUSIONS PVr can be achieved with acceptable intermediate-term results and may delay pulmonary valve replacement.
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Affiliation(s)
- Jill Jussli-Melchers
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan Hinnerk Hansen
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Martin Eide
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jana Logoteta
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Dütschke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anselm Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
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16
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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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17
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Cantinotti M, Marchese P, Scalese M, Giordano R, Franchi E, Assanta N, Koestenberger M, Barnes BT, Celi S, Jani V, Voges I, Kutty S. Characterization of Aortic Flow Patterns by High-Frame-Rate Blood Speckle Tracking Echocardiography in Children. J Am Heart Assoc 2023; 12:e026335. [PMID: 37066781 PMCID: PMC10227241 DOI: 10.1161/jaha.122.026335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/26/2022] [Indexed: 04/18/2023]
Abstract
Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Adult Institute of Clinical PhysiologyPisaItaly
| | - Pietro Marchese
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Scuola Superiore Sant’AnnaPisaItaly
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical SciencesUniversity of Naples “Federico II”NapoliItaly
| | - Eliana Franchi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Nadia Assanta
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
| | - Benjamin T. Barnes
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Simona Celi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Vivek Jani
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric CardiologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Shelby Kutty
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
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Rolfs N, Seidel F, Opgen-Rhein B, Böhne M, Wannenmacher B, Hecht T, Mannert J, Reineker K, Rentzsch A, Grafmann M, Wiegand G, Kiski D, Fischer M, Ruf B, Papakostas K, Hellwig R, Foth R, Kaestner M, Kramp J, Voges I, Blank A, Tarusinov G, Schweigmann U, Oezcan S, Graumann I, Knirsch W, Pickardt T, Schwarzkopf E, Klingel K, Messroghli D, Schubert S. Mechanical Circulatory Support, Heart Transplantation and Death in a Large-Scale Population of the Multicenter Registry for Suspected Pediatric Myocarditis - "MYKKE". J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.687] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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19
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Weis A, Krueck S, Dombrowsky G, Schänzer A, Jux C, Uebing A, Voges I, Hitz MP, Rupp S. Genetic Screening Reveals Heterogeneous Clinical Phenotypes in Patients with Dilated Cardiomyopathy and Troponin T2 Variants. J Pers Med 2023; 13:jpm13040611. [PMID: 37108997 PMCID: PMC10145473 DOI: 10.3390/jpm13040611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Cardiomyopathies (CMs) are a heterogeneous and severe group of diseases that shows a highly variable cardiac phenotype and an incidence of app. 1/100.000. Genetic screening of family members is not yet performed routinely. Patients and methods: Three families with dilated cardiomyopathy (DCM) and pathogenic variants in the troponin T2, Cardiac Type (TNNT2) gene were included. Pedigrees and clinical data of the patients were collected. The reported variants in the TNNT2 gene showed a high penetrance and a poor outcome, with 8 of 16 patients dying or receiving heart transplantation. The age of onset varied from the neonatal period to the age of 52. Acute heart failure and severe decompensation developed within a short period in some patients. Conclusion: Family screening of patients with DCM improves risk assessment, especially for individuals who are currently asymptomatic. Screening contributes to improved treatment by enabling practitioners to set appropriate control intervals and quickly begin interventional measures, such as heart failure medication or, in selected cases, pulmonary artery banding.
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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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21
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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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Rolfs N, Schwarzkopf E, Mentzer D, Opgen-Rhein B, Hellwig R, Frede W, Rentzsch A, Hecht T, Böhne M, Kiski D, Graumann I, Foth R, Fischer G, Voges I, Schweigmann U, Ruf B, Fischer M, Pattathu J, Wiegand G, Kramp J, Pickardt T, Messroghli D, Schubert S, Seidel F. Clinical Course and Short-Term Follow-up of SARS-CoV-2 Vaccine–Related Myocarditis in Children and Adolescents within the Prospective German Registry for Suspected Myocarditis “MYKKE”. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761868] [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: 03/22/2023]
Affiliation(s)
- N. Rolfs
- German Heart Institute Berlin, Berlin, Deutschland
| | | | - D. Mentzer
- Paul Ehrlich Institute, Langen (Hessen), Deutschland
| | - B. Opgen-Rhein
- Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - R. Hellwig
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - W. Frede
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - A. Rentzsch
- Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T. Hecht
- HDZ NRW, Bad Oeynhausen, Deutschland
| | - M. Böhne
- Pediatric Cardiology, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - D. Kiski
- Pediatric Cardiology, Universitätsklinikum Münster, Münster, Deutschland
| | - I. Graumann
- University Hospital Halle (Saale), Halle (Saale), Deutschland
| | - R. Foth
- University Medicine Göttingen, Göttingen, Deutschland
| | - G. Fischer
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - I. Voges
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - B. Ruf
- Pediatric Cardiology, Deutsches Herzzentrum München, Munich, Deutschland
| | - M. Fischer
- Ludwig Maximilian University of Munich, München, Deutschland
| | - J. Pattathu
- Ludwig Maximilian University of Munich, München, Deutschland
| | - G. Wiegand
- Department of Pediatric Cardiology, University of Tuebingen, Deutschland
| | - J. Kramp
- Uniklinik Köln, Köln, Deutschland
| | - T. Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Deutschland
| | - D. Messroghli
- Department for Cardiology, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | | | - F. Seidel
- Augustenburger Platz 1, Berlin, Deutschland
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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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Voges I, Latus H. Family screening of hypertrophic cardiomyopathy in children: a case report. Eur Heart J Case Rep 2022; 6:ytac360. [PMID: 36128439 PMCID: PMC9477208 DOI: 10.1093/ehjcr/ytac360] [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: 09/26/2021] [Revised: 12/17/2021] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
Background Paediatric hypertrophic cardiomyopathy (HCM) caused by sarcomere protein gene mutations is more common than previously thought. We present the case of a 9-year-old boy that was diagnosed with HCM during family screening. Case summary We present a case of a 9-year-old boy with a family history of sarcomeric HCM who was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) during clinical screening. Echocardiography and cardiovascular magnetic resonance imaging revealed asymmetric left ventricular hypertrophy with a maximum wall thickness of 18–19 mm. Cardiovascular magnetic resonance late gadolinium enhancement imaging showed patchy fibrosis within the area of maximum wall thickness. Genetic testing confirmed the presence of the familial mutation in the MYL2 gene. The patient was started on bisoprolol. Furthermore, risk stratification was performed and a recommendation for implantable cardioverter-defibrillator implantation was made. Discussion This case demonstrates that significant HCM can already start in childhood and discusses the recommendations for family screening on the basis of recently published studies and the present European Society of Cardiology guideline.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein , Arnold-Heller-Str. 3, Haus 9, Campus Kiel, Kiel 24105 , Germany
| | - Heiner Latus
- Department of Pediatric Cardiology, Olgahospital , Stuttgart 70174 , Germany
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Voges I, Gabbert D. Reply to Van den Eyde et al. Eur J Cardiothorac Surg 2022; 62:6528952. [PMID: 35167668 DOI: 10.1093/ejcts/ezac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Dominik Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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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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Niemann A, Rinne K, Hansen JH, Scheewe J, Uebing A, Voges I. Effect of Leisure Sports on Exercise Capacity and Quality of Life in Patients with a Fontan Circulation. Am J Cardiol 2022; 171:140-145. [PMID: 35279276 DOI: 10.1016/j.amjcard.2022.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/16/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/01/2022]
Abstract
Despite improvement in survival, patients with a Fontan circulation are at risk for numerous complications, and exercise capacity and quality of life are usually reduced compared with healthy controls. However, only a few studies have assessed the impact of the amount of sporting activity on exercise capacity and health-related quality of life. We analyzed cardiopulmonary exercise tests (CPET) in a large cohort of patients with a Fontan circulation. Questionnaires were used to assess health-related quality of life and sporting activity. A total of 79 patients with a median age of 13.0 (6.5 to 34.4) years at CPET were included (female, n = 31). Questionnaires revealed that 80% of patients (n = 63) do leisure sports with 43% (n = 27) exercising more than 2 hours per /week. In a subgroup analysis on pediatric patients (n = 52) we found that nearly all participate in school sports (n = 51) and report good subjective health (n = 48). In the pediatric subgroup, oxygen uptake at the anaerobic threshold and peak oxygen uptake correlated with subjective health (p <0.05) and the amount of leisure sports activity (p <0.01). In the overall cohort, running time and running distance were significantly associated with the hours of sports per week (p <0.01). CPET results did not significantly differ between single right and single left ventricle patients. Furthermore, an open fenestration was not associated with reduced exercise capacity. In conclusion, most patients with a Fontan circulation participate in leisure sports and report good subjective healthiness. In pediatric patients, increased sports activity is associated with better exercise capacity and subjective healthiness.
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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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Kanngiesser LM, Freitag-Wolf S, Boroni Grazioli S, Gabbert DD, Hansen JH, Uebing AS, Voges I. Serial Assessment of Right Ventricular Deformation in Patients With Hypoplastic Left Heart Syndrome: A Cardiovascular Magnetic Resonance Feature Tracking Study. J Am Heart Assoc 2022; 11:e025332. [PMID: 35475354 PMCID: PMC9238584 DOI: 10.1161/jaha.122.025332] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background As right ventricular dysfunction is a major cause of adverse outcome in patients with hypoplastic left heart syndrome, the aim was to assess right ventricular function and deformation after Fontan completion by performing 2-dimensional cardiovascular magnetic resonance feature tracking in serial cardiovascular magnetic resonance studies. Methods and Results Cardiovascular magnetic resonance examinations of 108 patients with hypoplastic left heart syndrome (female: 31) were analyzed. Short-axis cine images were used for right ventricular volumetry. Two-dimensional cardiovascular magnetic resonance feature tracking was performed using long-axis and short-axis cine images to measure myocardial global longitudinal, circumferential, and radial strain. All patients had at least 2 cardiovascular magnetic resonance examinations after Fontan completion and 41 patients had 3 examinations. Global strain values and right ventricular ejection fraction decreased from the first to the third examination with a significant decline in global longitudinal strain from the first examination to the second examination (median, first, and third quartile: -18.8%, [-20.5;-16.5] versus -16.9%, [-19.3;-14.7]) and from the first to the third examination in 41 patients (-18.6%, [-20.9;-15.7] versus -15.8%, [-18.7;-12.6]; P-values <0.004). Right ventricular ejection fraction decreased significantly from the first to the third examination (55.4%, [49.8;59.3] versus 50.2%, [45.0;55.9]; P<0.002) and from the second to the third examination (53.8%, [47.2;58.7] versus 50.2%, [45.0;55.9]; P<0.0002). Conclusions Serial assessment of cardiovascular magnetic resonance studies in patients with hypoplastic left heart syndrome after Fontan completion demonstrates a significant reduction in global strain values and right ventricular ejection fraction at follow-up. The significant reduction in global longitudinal strain between the first 2 examinations with non-significant changes in right ventricular ejection fraction suggest that global longitudinal strain measured by 2-dimensional cardiovascular magnetic resonance feature tracking might be a superior technique for the detection of changes in myocardial function.
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Affiliation(s)
- Luca Mitch Kanngiesser
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and StatisticsKiel UniversityUniversity Hospital Schleswig-Holstein Kiel Germany
| | - Simona Boroni Grazioli
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Jan Hinnerk Hansen
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Anselm Sebastian Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology University Hospital Schleswig-Holstein Kiel Germany.,DZHK (German Centre for Cardiovascular Research)Partner Site Hamburg/Kiel/Lübeck Kiel Germany
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Saleh M, Gendy D, Voges I, Nyktari E, Arzanauskaite M. Complex adult congenital heart disease on cross-sectional imaging: an introductory overview. Insights Imaging 2022; 13:78. [PMID: 35467233 PMCID: PMC9038985 DOI: 10.1186/s13244-022-01201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Congenital heart disease is the most common group of congenital pathology. Over the past few decades, advances in surgical treatment have resulted in a rising population of adult patients with repaired complex congenital heart disease. Although the quality of life has greatly improved, a significant proportion of morbidities encountered in clinical practice is now seen in adults rather than in children. These patients often have significant haemodynamic pathophysiology necessitating repeat intervention. CT and MRI are excellent imaging modalities, which help elucidate potential complications that may need urgent management. Although imaging should be performed in specialised centres, occasionally patients may present acutely to emergency departments in hospitals with little experience in managing potentially complex patients. The purpose of this article is to provide an introductory overview to the radiologist who may not be familiar with complex congenital heart disease in adult patients. This educational review has three main sections: (1) a brief overview of the post-operative anatomy and surgical management of the most common complex conditions followed by (2) a discussion on CT/MRI protocols and (3) a review of the various complications and their CT/MRI findings.
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Affiliation(s)
- Mahdi Saleh
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - David Gendy
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Eva Nyktari
- Cardiovascular MRI Unit, BIOIATRIKI SA (Biomedicine Group of Companies), Athens, Greece
| | - Monika Arzanauskaite
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Cardiovascular Research Center-ICCC, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
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Voges I. Editorial: Case Reports in Pediatric Cardiology: 2021. Front Cardiovasc Med 2022; 9:900584. [PMID: 35497992 PMCID: PMC9043448 DOI: 10.3389/fcvm.2022.900584] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
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Tayal U, Gregson J, Buchan R, Whiffin N, Halliday BP, Lota A, Roberts AM, Baksi AJ, Voges I, Jarman JWE, Baruah R, Frenneaux M, Cleland JGF, Barton P, Pennell DJ, Ware JS, Cook SA, Prasad SK. Moderate excess alcohol consumption and adverse cardiac remodelling in dilated cardiomyopathy. Heart 2022; 108:619-625. [PMID: 34380661 PMCID: PMC8961767 DOI: 10.1136/heartjnl-2021-319418] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/12/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM. METHODS Prospective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; >14 units/week for women, >21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited. RESULTS DCM patients with a history of moderate excess alcohol consumption (n=98, 16%) had lower biventricular function and increased chamber dilatation of the left ventricle, right ventricle and left atrium, as well as increased left ventricular hypertrophy compared with patients without moderate alcohol consumption. They were more likely to be male (alcohol excess group: n=92, 94% vs n=306, 61%, p=<0.001). After adjustment for biological sex, moderate excess alcohol was not associated with adverse cardiac structure. There was no difference in midwall myocardial fibrosis between groups. Prior moderate excess alcohol consumption did not affect prognosis (HR 1.29, 95% CI 0.73 to 2.26, p=0.38) during median follow-up of 3.9 years. CONCLUSION DCM patients with moderate excess alcohol consumption have adverse cardiac structure and function at presentation, but this is largely due to biological sex. Alcohol may contribute to sex-specific phenotypic differences in DCM. These findings help to inform lifestyle discussions for patients with DCM.
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Affiliation(s)
- Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Buchan
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Amrit Lota
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Angharad M Roberts
- Medical Research Council Clinical Sciences Centre, Imperial College London, London, UK
| | - A John Baksi
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | - Julian W E Jarman
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | | | | | - John G F Cleland
- National Heart and Lung Institute, Imperial College London, London, UK
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Paul Barton
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - Dudley J Pennell
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
- Medical Research Council Clinical Sciences Centre, Imperial College London, London, UK
| | - Stuart A Cook
- Medical Research Council Clinical Sciences Centre, Imperial College London, London, UK
- Duke NUS, Singapore
| | - Sanjay K Prasad
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton Hospital, London, UK
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Latus H, Stammermann J, Voges I, Waschulzik B, Gutberlet M, Diller GP, Schranz D, Ewert P, Beerbaum P, Kühne T, Sarikouch S. Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot. J Am Heart Assoc 2022; 11:e022694. [PMID: 35301850 PMCID: PMC9075442 DOI: 10.1161/jaha.121.022694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow-up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow-up of 10.1 (0.1-12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00-1.06; P=0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47-9.27; P=0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15-30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.
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Affiliation(s)
- Heiner Latus
- Clinic for Pediatric Cardiology and Congenital Heart Disease German Heart Centre Munich Munich Germany
| | | | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology University Children's Hospital Kiel Kiel Germany
| | - Birgit Waschulzik
- Institute for AI and Informatics in MedicineTechnical University Munich Munich Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology Heart Centre Leipzig-University Leipzig Leipzig Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease Department of Cardiovascular Medicine University Hospital of Muenster Muenster Germany
| | | | - Peter Ewert
- Clinic for Pediatric Cardiology and Congenital Heart Disease German Heart Centre Munich Munich Germany.,DZHK (German Centre for Cardiovascular Research) Partner Site Munich Heart AllianceMunich Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology Hannover Medical School Hannover Germany
| | - Titus Kühne
- Clinic for Pediatric Cardiology and Congenital Heart Disease German Heart Centre Berlin Berlin Germany
| | - Samir Sarikouch
- Department of Heart, Thoracic, Transplantation and Vascular Surgery Hannover Medical School Hannover Germany
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Schöber A, Voges I, Jerosch-Herold M, Wegner P, Gabbert D, Scheewe J, Uebing A, Kramer HH, Rickers C. Global Longitudinal Strain of the Left Ventricle in Patients with Transposition of the Great Arteries Is Associated with Aortic Elastic Properties and Left Atrial Function—Assessment of a Complex Interplay with MRI. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743023] [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)
- A. Schöber
- Herzzentrum Leipzig, Leipzig, Deutschland
| | - I. Voges
- Department of Pediatric Cardiology, Kiel, Deutschland
| | - M. Jerosch-Herold
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - P. Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - D. Gabbert
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Scheewe
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Uebing
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - C. Rickers
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
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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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Latus H, Voges I, Blank AE, Gummel K, Reich B, Klingel K, Khalil M, Kerst G, Skrzypek S, Schranz D, Jux C. Fibrotic Myocardial Remodeling in Children and Adolescents after Cardiac Transplantation—A CMR Native T1 Mapping Study. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743039] [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)
- H. Latus
- Deutsches Herzzentrum München, München, Deutschland
| | - I. Voges
- Department of Pediatric Cardiology, Kiel, Deutschland
| | - A.-E. Blank
- Pediatric Heart Center, Giessen, Deutschland
| | - K. Gummel
- Pediatric Heart Center, Giessen, Deutschland
| | - B. Reich
- Deutsches Herzzentrum München, München, Deutschland
| | | | - M. Khalil
- Pediatric Heart Center, Giessen, Deutschland
| | - G. Kerst
- Department of Pediatric Cardiology, Aachen, Deutschland
| | - S. Skrzypek
- Pediatric Heart Center, Giessen, Deutschland
| | - D. Schranz
- Pediatric Heart Center, Giessen, Deutschland
| | - C. Jux
- Pediatric Heart Center, Giessen, Deutschland
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Latus H, Hofmann L, Gummel K, Khalil M, Yerebakan C, Waschulzik B, Schranz D, Voges I, Jux C, Reich B. Exercise-dependent changes in ventricular-arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study. Eur Heart J Cardiovasc Imaging 2022; 24:88-97. [PMID: 35045176 PMCID: PMC9762934 DOI: 10.1093/ehjci/jeac001] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Inefficient ventricular-arterial (V-A) coupling has been described in Fontan patients and may result in adverse haemodynamics. A varying amount of aortopulmonary collateral (APC) flow is also frequently present that increases volume load of the single ventricle. The aim of the study was to assess changes in V-A coupling and APC flow during exercise CMR. METHODS AND RESULTS Eighteen Fontan patients (age 24 ± 3 years) and 14 controls (age 23 ± 4 years) underwent exercise CMR using a cycle ergometer. Ventricular volumetry and flow measurements in the ascending aorta (AAO), inferior (IVC), and superior (SVC) vena cava were assessed using real-time sequences during stepwise increases in work load. Measures of systemic arterial elastance Ea, ventricular elastance Ees, and V-A coupling (Ea/Ees) were assessed. APC flow was quantified as AAO - (SVC + IVC). Ea remained unchanged during all levels of exercise in both groups (P = 0.39 and P = 0.11). Ees increased in both groups (P = 0.001 and P < 0.001) with exercise but was lower in the Fontan group (P = 0.04). V-A coupling was impaired in Fontan patients at baseline (P = 0.04). Despite improvement during exercise (P = 0.002) V-A coupling remained impaired compared with controls (P = 0.001). Absolute APC flow in Fontan patients did not change during exercise even at maximum work load (P = 0.98). CONCLUSIONS Inefficient V-A coupling was already present at rest in Fontan patients and aggravated during exercise due to a limited increase in ventricular contractility which demonstrates the importance of a limited functional reserve of the single ventricle. APC flow remained unchanged suggesting no further increase in volume load during exercise.
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Affiliation(s)
- Heiner Latus
- Corresponding author. Tel: +49 89 1218 3011; Fax: +49 89 1218 3013. E-mail: ;
| | - Lucas Hofmann
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
| | - Kerstin Gummel
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
| | - Markus Khalil
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
| | - Can Yerebakan
- Department of Cardiovascular Surgery, Children's National Hospital, Children's National Heart Institute, The George WashingtonUniversity School of Medicine and Health Sciences, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Birgit Waschulzik
- Institute for AI and Informatics Medicine, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
| | - Inga Voges
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany,Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str 3, 24105 Kiel, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Christian Jux
- Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
| | - Bettina Reich
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany,Pediatric Heart Center, Justus-Liebig University Hospital Giessen, Feulgenstr 10-12, 35385 Giessen, Germany
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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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Gabbert DD, Trotz P, Kheradvar A, Jerosch-Herold M, Scheewe J, Kramer HH, Voges I, Rickers C. Abnormal torsion and helical flow patterns of the neo-aorta in hypoplastic left heart syndrome assessed with 4D-flow MRI. Cardiovasc Diagn Ther 2021; 11:1379-1388. [PMID: 35070806 PMCID: PMC8748477 DOI: 10.21037/cdt-20-770] [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] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/08/2020] [Indexed: 07/22/2023]
Abstract
BACKGROUND The Norwood procedure is the first stage of correction for patients with hypoplastic left heart syndrome (HLHS) and may lead to an abnormal neoaortic anatomy. We prospectively studied the neoaorta's fluid dynamics and the abnormal twist of the neoaorta by MRI examinations of HLHS patients in Fontan circulation. This study for the first time investigates the hypothesis that the neoaorta twist is associated with increased helical flow patterns, which may lead to an increased workload for the systemic right ventricle (RV) and ultimately to RV hypertrophy. METHODS A group of forty-two HLHS patients with a median age of 4.9 (2.9-17.0) years, at NYHA I was studied along with a control group of eleven subjects with healthy hearts and a median age of 12.1 (4.0-41.6). All subjects underwent MRI of the thoracic aorta including ECG-gated 2D balanced SSFP cine for an axial slice stack and 4D-flow MRI for a sagittal volume slab covering the thoracic aorta. The twist of the neoaortic arch was quantified by the effective geometric torsion, defined as the product of curvature and geometric torsion. Fluid dynamics and geometry in the neoaorta, including the flow helicity index, were evaluated using an in-house analysis software (MeVisLab-based). Myocardial mass of the systemic ventricle at end-diastole was estimated by planimetry of the short-axis stack. RESULTS Compared to the control group, the neoaorta in the HLHS patients shows an increased twist (P=0.04) and higher peak helicity density (P=0.03). The maximum helicity density was correlated with maximum effective torsion of the ascending neoaorta (P<0.001). The degree of maximum twist correlated with the increase in RV myocardial mass (P<0.01). CONCLUSIONS This study shows that the abnormal twist of the neoaortic arch in HLHS patients is associated with abnormal helical flow patterns, which may contribute to increased RV afterload and may adversely affect the systemic RV by stimulation of myocardial hypertrophy. These findings suggest that further improvements of surgical aortic reconstruction, guided by insights from 4D-flow MRI, could lead to better neoaortic fluid dynamics in patients with HLHS.
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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
| | - Patrick Trotz
- 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
| | - Arash Kheradvar
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, CA, Irvine, USA
| | | | - Jens Scheewe
- 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 Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hans-Heiner Kramer
- 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
| | - Carsten Rickers
- 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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Gabbert DD, Kheradvar A, Jerosch-Herold M, Oechtering TH, Uebing AS, Kramer HH, Voges I, Rickers C. MRI-based comprehensive analysis of vascular anatomy and hemodynamics. Cardiovasc Diagn Ther 2021; 11:1367-1378. [DOI: 10.21037/cdt-20-767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/18/2020] [Indexed: 11/06/2022]
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Kanngiesser L, Gabbert DD, Uebing A, Voges I. Serial assessment of right ventricular function and deformation in patients with hypoplastic left heart syndrome: a cardiovascular magnetic resonance study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1596] [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
Background
In patients with hypoplastic left heart syndrome (HLHS), right ventricular (RV) dysfunction and failure is a major cause of adverse outcome. Most studies have assessed RV function and size during staged palliation but serial data about RV deformation and function after completion of the Fontan circulation are rare. We assessed RV function and deformation by analysing serial cardiovascular magnetic resonance (CMR) studies in a large cohort of HLHS patients after completion of the total cavopulmonary connection (TCPC).
Methods
CMR examinations of 105 HLHS patients (female: 31, male: 74) were retrospectively analysed. Short axis cine images were used to measure RVEF and end-diastolic myocardial mass indexed to body surface area (RVMMi). 2-dimensional CMR feature tracking (2D-CMR-FT) was performed using long-axis and short axis cine images to measure myocardial global longitudinal, circumferential and radial strain (GLS, GCS, GRS) values.
Results
From 105 patients, all had at least two CMR examinations after TCPC completion (mean age at TCPC: 2.7±0.8 years; mean interval between examinations 5.4±1.6 years). 36 patients had three examinations (mean interval between first and third scan 9.9±2.2 years). The first scan was performed at a mean age of 5.6±2.9 years. Global strain values and RVEF decreased from the first to the third examination with a significant decline in GLS from the first examination to the second examination (median and interquartile range (IQR): −18.6%, IQR −20.4 to −16.3 vs. −16.8%, IQR −19.2 to −14.7) and from the first to the third examination in 36 patients (−18.6%, IQR −20.8 to −16.1 vs. −15.9%, IQR −18.3 to −12.4) (all p-values <0.004). RVEF decreased significantly from the first to the third examination (55.9%, IQR 50.2–59.8 vs. 50.4%, IQR 45.0–57.6; p<0.002) and from the second to the third examination (55.1%, IQR 47.1–58.7 vs. 50.4%, IQR 45.0–57.6; p<0.0004). The decrease in RVEF between the first and second scan and the changes in GCS and GRS across the examinations did not reach statistical significance. Median RVMMi increased significantly between the first and second scan (47.4 g/m2, IQR 39.0–55.3 vs. 50.2 g/m2, IQR 42.6–61.7; p<0.0007) and slightly but not significantly between the first and third scan in patients with three examinations (47.4 g/m2, IQR 39.5–56.2 vs. 50.1 g/m2, IQR 45.3–60.4). Negative correlations between GCS and RVEF (r=−0.57 to −0.76; p all <0.0001) as well as between GLS and RVEF (r=−0.31 to −0.59; p all <0.002) at all three time points could be demonstrated.
Conclusion
Serial assessment of CMR studies in HLHS patients after TCPC completion demonstrates a significant reduction in global strain values and RVEF at mid-term follow-up. The significant reduction in GLS between the first two examinations with non-significant changes in RVEF suggest that 2D-CMR-FT might be a suitable technique for the detection of early myocardial dysfunction.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Kanngiesser
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - D D Gabbert
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - A Uebing
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - I Voges
- University Medical Center of Schleswig-Holstein, Kiel, Germany
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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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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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Mueller F, Gummel K, Reich B, Latus H, Jux C, Voges I. Bioelastic properties of the aorta in children, adolescents and young adults after cardiac transplantation: a cardiovascular magnetic resonance study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0225] [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
Long-term complications after cardiac transplantation are common and typically include arterial hypertension and coronary allograft vasculopathy. Few studies also suggested that heart transplant recipients have an increased arterial stiffness.
Purpose
This prospective study aimed to assess the bioelastic properties of the aorta as well as LV function, morphology and structure in children and young adults after cardiac transplantation.
Methods
CMR studies from 34 patients (median age: 17.1 years, range: 8–24 years) who underwent cardiac transplantation in childhood were analysed. Aortic anatomy and distensibility were assessed at five locations of the thoracic aorta using steady-state free precession cine sequences. Pulse wave velocity (PWV) of the aortic arch and the descending thoracic aorta was measured from 2-dimensional phase contrast images. Size and function of the left atrium and the ventricles were assessed from a stack of short axis slices. Myocardial T1 times were determined using a standard MOLLI sequence.
Results
Cross-sectional areas of the ascending aorta and the aortic arch tended to be lower in patients compared to controls (ascending aorta 464.5±172.5 mm2 vs. 515.3±186.3 mm2, aortic arch 342.4±113.3 mm2 vs. 376.9±148.5 mm2) whereas cross-sectional areas of the descending aorta tended to be higher (aortic isthmus 283.7±102.1 mm2 vs. 257.9±89.5 mm2, aorta descendens diaphragmal 218.4±75.8 mm2 vs. 214.2±75.0 mm2) and showed a correlation with systolic blood pressure (r=0.33). PWV was higher in the aortic arch (4.8±2.4 m/s vs. 3.6±0.7 m/s).
Aortic distensibility was slightly higher at all measuring points in the study population compared to the control group and showed an increase with rising distance from the heart (ascending aorta 10.5±5.8 10–3 mm Hg-1, aortic isthmus 13.1±7.5 10–3 mm Hg-1, descending aorta 16.6±6.8 10–3 mm Hg-1). Biventricular volumes were slightly reduced in the patient group compared to the control group but this was not statistically significant. Only left ventricular mass messured during the systolic phase was higher in the study population compared to the control group (males 55.1 g/m2 vs. 53.0 g/m2, females 46.2 g/m2 vs. 45.2 g/m2). T1 mapping demonstrated increased T1 times in the heart-transplanted group compared to published data in healthy adults. In particular, T1 times of the lateral and inferior myocardial segments were higher.
Conclusion
Patients who underwent cardiac transplantation in childhood seem to have a reduced bioelasticity of the thoracic aorta. Increased myocardial T1 times suggesting alterations in myocardial structure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Mueller
- University hospital Giessen and Marburg, Paediatric Heart Centre Giessen, Giessen, Germany
| | - K Gummel
- University hospital Giessen and Marburg, Paediatric Heart Centre Giessen, Giessen, Germany
| | - B Reich
- University hospital Giessen and Marburg, Paediatric Heart Centre Giessen, Giessen, Germany
| | - H Latus
- Deutsches Herzzentrum Muenchen Technical University of Munich, Department of Paediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - C Jux
- University hospital Giessen and Marburg, Paediatric Heart Centre Giessen, Giessen, Germany
| | - I Voges
- University Medical Center of Schleswig-Holstein - Campus Kiel, Department of Congenital Heart Disease and Paediatric Cardiology, Kiel, Germany
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Rickers C, Wegner P, Silberbach M, Madriago E, Gabbert DD, Kheradvar A, Voges I, Scheewe J, Attmann T, Jerosch-Herold M, Kramer HH. Myocardial Perfusion in Hypoplastic Left Heart Syndrome. Circ Cardiovasc Imaging 2021; 14:e012468. [PMID: 34610753 DOI: 10.1161/circimaging.121.012468] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The status of the systemic right ventricular coronary microcirculation in hypoplastic left heart syndrome (HLHS) is largely unknown. It is presumed that the systemic right ventricle's coronary microcirculation exhibits unique pathophysiological characteristics of HLHS in Fontan circulation. The present study sought to quantify myocardial blood flow by cardiac magnetic resonance imaging and evaluate the determinants of microvascular coronary dysfunction and myocardial ischemia in HLHS. METHODS One hundred nineteen HLHS patients (median age, 4.80 years) and 34 healthy volunteers (median age, 5.50 years) underwent follow-up cardiac magnetic resonance imaging ≈1.8 years after total cavopulmonary connection. Right ventricle volumes and function, myocardial perfusion, diffuse fibrosis, and late gadolinium enhancement were assessed in 4 anatomic HLHS subtypes. Myocardial blood flow (MBF) was quantified at rest and during adenosine-induced hyperemia. Coronary conductance was estimated from MBF at rest and catheter-based measurements of mean aortic pressure (n=99). RESULTS Hyperemic MBF in the systemic ventricle was lower in HLHS compared with controls (1.89±0.57 versus 2.70±0.84 mL/g per min; P<0.001), while MBF at rest normalized by the rate-pressure product, was similar (1.25±0.36 versus 1.19±0.33; P=0.446). Independent risk factors for a reduced hyperemic MBF were an HLHS subtype with mitral stenosis and aortic atresia (P=0.017), late gadolinium enhancement (P=0.042), right ventricular diastolic dysfunction (P=0.005), and increasing age at total cavopulmonary connection (P=0.022). The coronary conductance correlated negatively with systemic blood oxygen saturation (r, -0.29; P=0.02). The frequency of late gadolinium enhancement increased with age at total cavopulmonary connection (P=0.014). CONCLUSIONS The coronary microcirculation of the systemic ventricle in young HLHS patients shows significant differences compared with controls. These hypothesis-generating findings on HLHS-specific risk factors for microvascular dysfunction suggest a potential benefit from early relief of frank cyanosis by total cavopulmonary connection.
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Affiliation(s)
- Carsten Rickers
- University Heart Center, Adult Congenital Heart Disease Unit, University Hospital Hamburg-Eppendorf, Hamburg, Germany (C.R.)
| | - Philip Wegner
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Silberbach
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Erin Madriago
- Department of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland (M.S., E.M.)
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arash Kheradvar
- Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine (A.K.)
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jens Scheewe
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tim Attmann
- Department of Cardiovascular Surgery (J.S., T.A.), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.J.-H.)
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology (P.W., D.D.G., I.V., H.-H.K.) University Hospital Schleswig-Holstein, Kiel, Germany
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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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Voges I, Nyktari E. Late presentation of shunt lesions in Down syndrome patients: the importance of multidisciplinary assessment and lifelong follow-up. Eur Heart J Case Rep 2021; 5:ytab238. [PMID: 34377920 PMCID: PMC8340798 DOI: 10.1093/ehjcr/ytab238] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - Evangelia Nyktari
- Cardiovascular MRI Unit, BIOATRIKI SA (Biomedicine Group of Companies), Athens, Greece
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Hazekamp MG, Barron DJ, Dangel J, Homfray T, Jongbloed MRM, Voges I. Consensus document on optimal management of patients with common arterial trunk. Eur J Cardiothorac Surg 2021; 60:7-33. [PMID: 34017991 DOI: 10.1093/ejcts/ezaa423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mark G Hazekamp
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, Netherlands
| | - David J Barron
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Joanna Dangel
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Tessa Homfray
- Department of Medical Genetics, Royal Brompton and Harefield hospitals NHS Trust, London, UK
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric Cardiology, University Medical Center of Schleswig-Holstein, Kiel, Germany
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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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