1
|
Tarkiainen M, Sipola P, Jalanko M, Helio T, Jaaskelainen P, Magga J, Peuhkurinen K, Husso M, Kivela K, Laine M, Lauerma K, Kuusisto J. Left ventricular septal convexity in differentiating hypertrophic cardiomyopathy from hypertensive heart disease – cardiac MRI study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0210] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Subjects with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) have left ventricular hypertrophy (LVH). It is a common clinical problem to distinguish HCM from HHD. Septal convexity (SC) into the left ventricle is increased in subjects with hypertrophic cardiomyopathy (HCM)-causing mutations with and without LVH.
Purpose
Our objective was to study if SC by cardiac magnetic resonance (CMR) differentiates between HCM and HHD.
Methods
We measured SC in 29 subjects with hypertension and LVH (left ventricular maximal wall thickness (LVMWT) ≥13 mm), in 49 subjects with HCM (LVMWT ≥13 mm) caused by the D175N mutation in the alpha-tropomyosin (TPM1) or the Q1061X mutation in the myosin binding protein C (MYBPC3) genes, and in 20 healthy controls with no LVH. SC into the LV was measured in end-diastolic 4-chamber images as the maximal distance between LV septal endocardial border and a line connecting septal mid-wall points at the level of tricuspid valve insertion and at the level of apical right ventricular insertion on the LV.
Results
Subjects with HCM had significantly increased septal convexity compared to subjects with HHD both in non-indexed and in BSA-indexed measurements (10.7±4.0 mm vs 4.9±2.7 mm, P<0.001 and 5.5±2.1 mm/m2 vs 2.4±1.3 mm/m2, P<0.001). To differentiate between HCM and HHD, septal convexity cutoff value of 7.85 mm performed best with sensitivity of 77% and specificity of 90%. BSA-indexed SC cutoff value of 3.68 mm differentiated between HCM and HHD with sensitivity of 81% and specificity of 86%.
Conclusions
CMR derived septal convexity is easily measured and is useful in discriminating between HCM caused by sarcomere mutations versus HHD.
Measurement of septal convexity
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Foundation of Cardiovascular Research, the special governmental subsidy for health sciences research of the University Hospital of Kuopio
Collapse
Affiliation(s)
- M Tarkiainen
- Kuopio University Hospital, Clinical Radiology, Kuopio, Finland
| | - P Sipola
- Kuopio University Hospital, Clinical Radiology, Kuopio, Finland
| | - M Jalanko
- Helsinki University Hospital, Cardiology, Helsinki, Finland
| | - T Helio
- Helsinki University Hospital, Cardiology, Helsinki, Finland
| | | | - J Magga
- Oulu University Hospital, Cardiology, Oulu, Finland
| | | | - M Husso
- Kuopio University Hospital, Clinical Radiology, Kuopio, Finland
| | - K Kivela
- Kuopio University Hospital, Clinical Radiology, Kuopio, Finland
| | - M Laine
- Helsinki University Hospital, Cardiology, Helsinki, Finland
| | - K Lauerma
- Helsinki University Hospital, Clinical Radiology, Helsinki, Finland
| | - J Kuusisto
- Kuopio University Hospital, Centre for Medicine and Clinical Research, Kuopio, Finland
| |
Collapse
|
2
|
Husso M, Afara IO, Nissi MJ, Kuivanen A, Halonen P, Tarkia M, Teuho J, Saunavaara V, Vainio P, Sipola P, Manninen H, Ylä-Herttuala S, Knuuti J, Töyräs J. Quantification of Myocardial Blood Flow by Machine Learning Analysis of Modified Dual Bolus MRI Examination. Ann Biomed Eng 2020; 49:653-662. [PMID: 32820382 PMCID: PMC7851105 DOI: 10.1007/s10439-020-02591-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is a promising method for estimating myocardial blood flow (MBF). However, it is often affected by noise from imaging artefacts, such as dark rim artefact obscuring relevant features. Machine learning enables extracting important features from such noisy data and is increasingly applied in areas where traditional approaches are limited. In this study, we investigate the capacity of machine learning, particularly support vector machines (SVM) and random forests (RF), for estimating MBF from tissue impulse response signal in an animal model. Domestic pigs (n = 5) were subjected to contrast enhanced first pass MRI (MRI-FP) and the impulse response at different regions of the myocardium (n = 24/pig) were evaluated at rest (n = 120) and stress (n = 96). Reference MBF was then measured using positron emission tomography (PET). Since the impulse response may include artefacts, classification models based on SVM and RF were developed to discriminate noisy signal. In addition, regression models based on SVM, RF and linear regression (for comparison) were developed for estimating MBF from the impulse response at rest and stress. The classification and regression models were trained on data from 4 pigs (n = 168) and tested on 1 pig (n = 48). Models based on SVM and RF outperformed linear regression, with higher correlation (RSVM2 = 0.81, RRF2 = 0.74, Rlinear_regression2 = 0.60; ρSVM = 0.76, ρRF = 0.76, ρlinear_regression = 0.71) and lower error (RMSESVM = 0.67 mL/g/min, RMSERF = 0.77 mL/g/min, RMSElinear_regression = 0.96 mL/g/min) for predicting MBF from MRI impulse response signal. Classifier based on SVM was optimal for detecting impulse response signals with artefacts (accuracy = 92%). Modified dual bolus MRI signal, combined with machine learning, has potential for accurately estimating MBF at rest and stress states, even from signals with dark rim artefacts. This could provide a protocol for reliable and easy estimation of MBF, although further research is needed to clinically validate the approach.
Collapse
Affiliation(s)
- Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland.
| | - Isaac O Afara
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miikka Tarkia
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Pauli Vainio
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Petri Sipola
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Hannu Manninen
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juhani Knuuti
- Turku PET Centre, University Hospital and University of Turku, Turku, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| |
Collapse
|
3
|
Kinnunen AR, Sironen R, Sipola P. Magnetic resonance imaging characteristics in patients with histopathologically proven fibrous dysplasia-a systematic review. Skeletal Radiol 2020; 49:837-845. [PMID: 32040603 PMCID: PMC7170814 DOI: 10.1007/s00256-020-03388-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/14/2019] [Revised: 01/08/2020] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the demographics, lesion location, and characteristic magnetic resonance imaging (MRI) findings in patients with histopathologically proven fibrous dysplasia (FD). MATERIALS AND METHODS A systematic literature search of the MRI findings in patients with histologically proven FD was performed. Altogether, 76 articles with 136 patients were evaluated. RESULTS The mean age of the patients was 35.0 + - 18.5 years (range 1 month-75 years). Fifty-eight of the cases were females, 51 males, and in 27 gender was not defined. The most common locations were craniofacial (n = 55 (40%)), long bones (n = 31 (23%)), and spine (n = 24 (18%)). The monostotic form of FD was the most common. Signal intensities (SI) on T1-weighted images were predominantly hypointense (n = 46 (37%)). The SI was highly variable on T2-weighted images with hyperintensity being most common (n = 22 (18%)). Contrast enhancement was found in 75 (55%) FD patients. Secondary aneurysmal bone cysts (ABCs) and malignant transformation in patients without prior radiotherapy was found in some patients. CONCLUSION Current knowledge of the MRI findings in patients with FD is based mainly on case reports. SI in patients with FD is variable and contrast enhancement is common. FD may explain etiology of spinal bone tumor in some patients. FD with malignant transformation should be considered also in patients without prior radiotherapy. Further studies are needed to clarify if FD displays specific characteristics allowing it to be distinguished from other bone tumors.
Collapse
Affiliation(s)
- Anna-Reetta Kinnunen
- Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
| | - Reijo Sironen
- Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
4
|
Husso M, Nissi MJ, Kuivanen A, Halonen P, Tarkia M, Teuho J, Saunavaara V, Vainio P, Sipola P, Manninen H, Ylä-Herttuala S, Knuuti J, Töyräs J. Quantification of porcine myocardial perfusion with modified dual bolus MRI - a prospective study with a PET reference. BMC Med Imaging 2019; 19:58. [PMID: 31349798 PMCID: PMC6660956 DOI: 10.1186/s12880-019-0359-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 07/17/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The reliable quantification of myocardial blood flow (MBF) with MRI, necessitates the correction of errors in arterial input function (AIF) caused by the T1 saturation effect. The aim of this study was to compare MBF determined by a traditional dual bolus method against a modified dual bolus approach and to evaluate both methods against PET in a porcine model of myocardial ischemia. METHODS Local myocardial ischemia was induced in five pigs, which were subsequently examined with contrast enhanced MRI (gadoteric acid) and PET (O-15 water). In the determination of MBF, the initial high concentration AIF was corrected using the ratio of low and high contrast AIF areas, normalized according to the corresponding heart rates. MBF was determined from the MRI, during stress and at rest, using the dual bolus and the modified dual bolus methods in 24 segments of the myocardium (total of 240 segments, five pigs in stress and rest). Due to image artifacts and technical problems 53% of the segments had to be rejected from further analyses. These two estimates were later compared against respective rest and stress PET-based MBF measurements. RESULTS Values of MBF were determined for 112/240 regions. Correlations for MBF between the modified dual bolus method and PET was rs = 0.84, and between the traditional dual bolus method and PET rs = 0.79. The intraclass correlation was very good (ICC = 0.85) between the modified dual bolus method and PET, but poor between the traditional dual bolus method and PET (ICC = 0.07). CONCLUSIONS The modified dual bolus method showed a better agreement with PET than the traditional dual bolus method. The modified dual bolus method was found to be more reliable than the traditional dual bolus method, especially when there was variation in the heart rate. However, the difference between the MBF values estimated with either of the two MRI-based dual-bolus methods and those estimated with the gold-standard PET method were statistically significant.
Collapse
Affiliation(s)
- Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland.
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland
| | - Miikka Tarkia
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Pauli Vainio
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Petri Sipola
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Hannu Manninen
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecule Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, PO Box 100, 70029, Kuopio, KYS, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| |
Collapse
|
5
|
Tarkiainen M, Sipola P, Jalanko M, Heliö T, Jääskeläinen P, Kivelä K, Laine M, Lauerma K, Kuusisto J. CMR derived left ventricular septal convexity in carriers of the hypertrophic cardiomyopathy-causing MYBPC3-Q1061X mutation. Sci Rep 2019; 9:5960. [PMID: 30976029 PMCID: PMC6459818 DOI: 10.1038/s41598-019-42376-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/26/2018] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
This manuscript has not been published before and is not currently being considered for publication elsewhere. Increased septal convexity of left ventricle has been described in subjects with hypertrophic cardiomyopathy (HCM) -causing mutations without left ventricular hypertrophy (LVH). Our objective was to study septal convexity by cardiac magnetic resonance (CMR) in subjects with the Finnish founder mutation Q1016X in the myosin-binding protein C gene (MYBPC3). Septal convexity was measured in end-diastolic 4-chamber CMR image in 67 study subjects (47 subjects with the MYBPC3-Q1061X mutation and 20 healthy relatives without the mutation). Septal convexity was significantly increased in subjects with the MYBPC3-Q1061X mutation and LVH (n = 32) compared to controls (11.4 ± 4.3 vs 2.7 ± 3.2 mm, P < 0.001). In mutation carriers without LVH, there was a trend for increased septal convexity compared to controls (4.9 ± 2.5 vs 2.7 ± 3.2 mm, P = 0.074). When indexed for BSA, septal convexity in mutation carriers without LVH was 2.8 ± 1.4 mm/m2 and 1.5 ± 1.6 mm/m2 in controls (P = 0.036). In all mutation carriers, septal convexity correlated significantly with body surface area, age, maximal LV wall thickness, LV mass, and late gadolinium enhancement. Subjects with the MYBPC3–Q10961X mutation have increased septal convexity irrespective of the presence of LVH. Septal convexity appears to reflect septal remodeling, and could be useful in recognizing LVH negative mutation carriers.
Collapse
Affiliation(s)
- Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Kati Kivelä
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Lauerma
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
6
|
Jalanko M, Heliö T, Mustonen P, Kokkonen J, Huhtala H, Laine M, Jääskeläinen P, Tarkiainen M, Lauerma K, Sipola P, Laakso M, Kuusisto J, Nikus K. Novel electrocardiographic features in carriers of hypertrophic cardiomyopathy causing sarcomeric mutations. J Electrocardiol 2018; 51:983-989. [PMID: 30497761 DOI: 10.1016/j.jelectrocard.2018.07.009] [Citation(s) in RCA: 3] [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: 06/13/2018] [Revised: 07/04/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The sensitivity and specificity of the conventional 12-lead ECG to identify carriers of hypertrophic cardiomyopathy (HCM) - causing mutations without left ventricular hypertrophy (LVH) has been limited. We assessed the ability of novel electrocardiographic parameters to improve the detection of HCM mutation carriers. METHODS We studied 140 carriers (G+) of the TPM1-Asp175Asn or MYBPC3-Gln1061X pathogenic variants for HCM: The G+/LVH+ group (n = 98) consisted of mutation carriers with LVH and the G+/LVH- group (n = 42) without LVH. The control group consisted of 30 subjects. The standard 12-lead ECG was comprehensively analyzed and two novel ECG variables were introduced: RV1<RV2>RV3 and septal remodeling. A subset of 65 individuals underwent cardiac magnetic resonance imaging and 2D strain echocardiography. RESULTS Conventional major ECG criteria were sensitive (90%) and specific (97%) in identifying G+/LVH+ subjects. RV1<RV2>RV3 and septal remodeling were more prevalent in the G+/LVH- subjects compared to the control group (33% vs 3%, p = 0.005 and 45% vs 3%, p < 0.001, respectively). The combination of RV1<RV2>RV3 and Q waves and repolarization abnormalities (QR) differentiated between the G+/LVH- subjects and the control group with a sensitivity of 52% and specificity of 97%. The combination of septal remodeling and QR differentiated between G+/LVH- subjects and the control group with a sensitivity of 64% and specificity of 97%. CONCLUSIONS The novel ECG-parameters RV1<RV2>RV3 and septal remodeling were effective in identifying G+/LVH- subjects and could be useful in the diagnostics of new suspected HCM patients and in the screening and follow-up of HCM families.
Collapse
Affiliation(s)
- Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Lauerma
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Center for Medicine and Clinical Research, University of Eastern Finland and Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Kuusisto
- Center for Medicine and Clinical Research, University of Eastern Finland and Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Kjell Nikus
- Heart Center, Department of Cardiology, Tampere University Hospital, and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| |
Collapse
|
7
|
Suomalainen JS, Regalado G, Joukainen A, Kääriäinen T, Könönen M, Manninen H, Sipola P, Kokki H. Effects of knee flexion and extension on the tibial tuberosity-trochlear groove (TT-TG) distance in adolescents. J Exp Orthop 2018; 5:31. [PMID: 30116908 PMCID: PMC6095936 DOI: 10.1186/s40634-018-0149-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/09/2018] [Indexed: 01/16/2023] Open
Abstract
Background Measurement of the tibial tubercle–trochlear groove (TT–TG) distance is used to assess patellofemoral instability and rotation. Since patellofemoral instability and acute patellar dislocation are common among adolescents, it is important to clarify the relationship between TT–TG distance and various flexion and extension angles in asymptomatic children. The purpose of the present study was to determine how knee flexion and extension influence TT–TG-distance values measured using 3D imaging in an anatomic axial plane among asymptomatic adolescents. Methods We performed magnetic resonance imaging (MRI) of 26 knees in 13 adolescents (8 boys and 5 girls) of 11–17 years of age, with no known patellofemoral disorders. Imaging was performed with 3.0 T MRI with the knee at four separate angles of flexion between 0° and 30°. Measurements were made by two independent blinded raters. Results The mean TT–TG distance in millimetres was 11.1–0.29 × the angle in degrees. TT–TG distance decreased with greater flexion, showing a mean decrease of 0.29 mm (SD, 0.04) per degree of increased flexion (p < 0.001). We found significant inter-observer (Pearson’s r = 0.636, p = 0.03) and intra-observer (Pearson’s r = 0.792, p ≤ 0.001) correlations. TT–TG values were not significantly correlated with age, length, weight, or body mass index. The rate of TT–TG change (change between consecutive TT–TG values/change between consecutive angles) was significantly negatively correlated with length (p = 0.014), weight (p = 0.004), and body mass index (p = 0.025). Conclusions Our data revealed that TT–TG distance assessed in the anatomic axial plane decreased with greater flexion in adolescent. Moreover, this effect of knee angle was stronger in smaller subjects. These findings support the need for a standardized protocol for TT–TG distance measurement in adolescents.
Collapse
Affiliation(s)
| | - Gideon Regalado
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Antti Joukainen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Tommi Kääriäinen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Mervi Könönen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Manninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, University of Eastern Finland, P.O. BOX 100, FI-70029 KYS, Kuopio, Finland.
| |
Collapse
|
8
|
Jalanko M, Väänänen H, Tarkiainen M, Sipola P, Jääskeläinen P, Lauerma K, Laitinen T, Laitinen T, Laine M, Heliö T, Kuusisto J, Viitasalo M. Fibrosis and wall thickness affect ventricular repolarization dynamics in hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2018; 23:e12582. [PMID: 29974557 DOI: 10.1111/anec.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Received: 11/29/2017] [Revised: 05/11/2018] [Accepted: 06/06/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is characterized by ventricular repolarization abnormalities and risk of ventricular arrhythmias. Our aim was to study the association between the phenotype and ventricular repolarization dynamics in HCM patients. METHODS HCM patients with either the MYBPC3-Q1061X or TPM1-D175N mutation (n = 46) and control subjects without mutation and hypertrophy (n = 35) were studied with 24-hr ambulatory ECG recordings by measuring time intervals of rate-adapted QT (QTe), maximal QT, and T-wave apex to wave end (TPE) intervals and the QTe/RR slope. Findings were correlated to specified echocardiographic and cardiac magnetic resonance imaging (CMRI) findings. RESULTS Rate-adapted QTe interval was progressively longer in HCM patients with decreasing heart rates compared to control subjects (p = 0.020). The degree of hypertrophy correlated with measured QTe values. HCM patients with maximal wall thickness higher than the mean (20.6 mm) had longer maximum QTe and median TPE intervals compared to control subjects and HCM patients with milder hypertrophy (p < 0.001 and p = 0.014, respectively). HCM patients with late gadolinium enhancement (LGE) on CMRI had steeper QTe/RR slopes compared to HCM patients without LGE and control subjects (p = 0.044 and p = 0.001, respectively). LGE was an independent predictor of QTe/RR slope (p = 0.023, B = 0.043). CONCLUSION Dynamics of ventricular repolarization in HCM are affected by hypertrophy and fibrosis. LGE may confer an independent effect on QT dynamics which may increase the arrhythmogenic potential in HCM.
Collapse
Affiliation(s)
- Mikko Jalanko
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Väänänen
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Kirsi Lauerma
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Laitinen
- Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Heliö
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Matti Viitasalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| |
Collapse
|
9
|
Kuusisto J, Sipola P, Jääskeläinen P, Naukkarinen A. Current perspectives in hypertrophic cardiomyopathy with the focus on patients in the Finnish population: a review. Ann Med 2016; 48:496-508. [PMID: 27460395 DOI: 10.1080/07853890.2016.1187764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/25/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease, with the prevalence of about 1/500. During the last two decades, the knowledge of the etiology, pathogenesis, risk stratification and prevention of sudden death in HCM has substantially advanced. Most often, HCM is familial and caused by mutations in sarcomere genes, inherited in an autosomal dominant manner. In Finland, genetic background of HCM is unique, with a few founder mutations in cardiac sarcomere genes accounting for a considerable proportion of the disease. Pathogenic mechanisms induced by disease-causing mutations are still poorly understood, although alterations in intracellular calcium handling and inefficient generation of contractile force in myocytes are considered key features in triggering the hypertrophic response. Clinical features of the disease are highly variable from no symptoms to the spectrum of exertional dyspnea, angina, palpitations, syncope and sudden death. In the current patient care, implantable cardioverter defibrillators (ICDs) are successfully used to prevent sudden cardiac death in high risk subjects. Targeted genetic testing is recommended to confirm the diagnosis in patients with HCM and to identify family members with the disease. Future research is needed to elucidate key cellular mechanisms leading to HCM, which may allow specific prevention and treatment of the disease. Key messages Hypertrophic cardiomyopathy, most often caused by defects in sarcomere genes, is the most common inherited heart disease, and a common cause of sudden cardiac death (SCD) in athletes and young subjects. Cardiac imaging, ECG and genetic testing are pivotal in the diagnosis of the disease in patients and first-degree relatives. Implantable cardioverter defibrillators in patients with high risk for SCD and tailored pharmacotherapy are efficient tools in patient care, but so far, exact mechanisms leading to cardiac hypertrophy in HCM are only partially understood, and there is no curative treatment for the disease.
Collapse
Affiliation(s)
- Johanna Kuusisto
- a Department of Medicine, Centre for Medicine and Clinical Research , University of Eastern Finland and Kuopio University Hospital , Kuopio , Finland
| | - Petri Sipola
- b Department of Clinical Radiology, Diagnostic Imaging Centre , Kuopio University Hospital , Kuopio , Finland
| | | | - Anita Naukkarinen
- d Department of Pathology, Diagnostic Imaging Centre , Kuopio University Hospital , Kuopio , Finland
| |
Collapse
|
10
|
Taina M, Vanninen R, Sipola P, Muuronen A, Jäkälä P, Hedman M. Cardiac CT Differentiates Left Atrial Appendage Thrombi from Circulatory Stasis in Acute Stroke Patients. In Vivo 2016; 30:671-676. [PMID: 27566089] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM The left atrial appendage (LAA) is the most typical origin for a cardioembolic thrombusins' stroke etiology. Although transesophageal echocardiography (TEE) is widely used, this technique encounters difficulties in differentiating solid thrombus from circulatory stasis/spontaneous echo contrast (SEC). We assessed whether cardiac computed tomography (cCT) could more accurately detect LAA thrombi. MATERIALS AND METHODS A total of 102 patients with suspected acute cardioembolic stroke/ transient ischemic attack (TIA) without chronic atrial fibrillation underwent arterial and venous phase cCT and TEE. TEE and cCT were consensus read to define LAA thrombus, while TEE alone was used to determine SEC. The LAA/aorta Houndsfield unit (HU) ratio was measured in both phases independently and blinded to prior visual readings. The optimal LAA/aorta HU ratio cut-off value for differentiating thrombi and SEC was estimated. RESULTS TEE indicated 10 SECs and three thrombi. Consensus reading of cCT and TEE indicated that all thrombi detected in TEE were false-positive but revealed three actual thrombi missed in TEE. The LAA/aorta HU ratio correlated significantly with the presence of SEC both in arterial (p=0.019) and venous phases (p=0.024) and with the presence of thrombi in both phases (p<0.001). The best trade-off values for LAA/aorta HU ratio for the detection of thrombi was <0.245 in both phases. SEC was characterized with HU ratios of >0.245 and <0.577 in the arterial phase and>0.245 and <0.824 in the venous phase. Values of sensitivity, specificity, positive and negative predictive value and accuracy for detection of thrombi were 100% for cCT in both phases. CONCLUSION cCT is more accurate than TEE in the detection of LAA thrombi, especially when combined with the measurement of LAA/aorta HU ratio.
Collapse
Affiliation(s)
- Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jäkälä
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland Heart Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
11
|
Jalanko M, Tarkiainen M, Sipola P, Jääskeläinen P, Lauerma K, Laine M, Nieminen MS, Laakso M, Heliö T, Kuusisto J. Left ventricular mechanical dispersion is associated with nonsustained ventricular tachycardia in hypertrophic cardiomyopathy. Ann Med 2016; 48:417-427. [PMID: 27249556 DOI: 10.1080/07853890.2016.1186826] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 10/21/2022] Open
Abstract
OBJECTIVE We assessed the value of speckle tracking two-dimensional (2D) strain echocardiography (2DSE) measured mechanical dispersion (MD) with other imaging and electrocardiographic parameters in differentiating hypertrophic cardiomyopathy (HCM) patients with and without nonsustained ventricular tachycardia (NSVT) on 24-h ambulatory ECG monitoring. METHODS AND RESULTS We studied 31 patients with HCM caused by the Finnish founder mutation MYBPC3-Q1061X and 20 control subjects with comprehensive 2DSE echocardiography and cardiac magnetic resonance imaging (CMRI). The presence of NSVT was assessed from ambulatory 24-h ECG monitoring. NSVT episodes were recorded in 11 (35%) patients with HCM. MD was significantly higher in HCM patients with NSVT (93 ± 41 ms) compared to HCM patients without NSVT (50 ± 18 ms, p = 0.012) and control subjects (41 ± 16 ms, p < 0.001). MD was the only variable independently associated with the presence of NSVT (OR: 1.60, 95% CI: 1.05-2.45, p = 0.030). Assessed by ROC curves, MD performed best in differentiating between HCM patients with and without NSVT (AUC = 0.81). CONCLUSIONS Increased mechanical dispersion was associated with NSVT in HCM patients on 24-h ambulatory ECG monitoring. Key messages The prediction of sudden cardiac death in hypertrophic cardiomyopathy remains a challenge and novel imaging methods are required to identify individuals at risk of malignant ventricular arrhythmias. Mechanical dispersion by speckle tracking echocardiography is associated with NSVT on 24-h ambulatory ECG monitoring in patients with hypertrophic cardiomyopathy.
Collapse
Affiliation(s)
- Mikko Jalanko
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Mika Tarkiainen
- b Department of Clinical Radiology , Kuopio University Hospital , Kuopio , Finland
| | - Petri Sipola
- b Department of Clinical Radiology , Kuopio University Hospital , Kuopio , Finland
| | | | - Kirsi Lauerma
- d HUS Medical Imaging Center, Radiology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mika Laine
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Markku S Nieminen
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Markku Laakso
- e Institute of Clinical Medicine, Internal Medicine and Kuopio University Hospital , Kuopio , Finland
| | - Tiina Heliö
- a Department of Cardiology , Helsinki University Hospital, Heart and Lung Center , Helsinki , Finland
| | - Johanna Kuusisto
- e Institute of Clinical Medicine, Internal Medicine and Kuopio University Hospital , Kuopio , Finland
| |
Collapse
|
12
|
Tarkiainen M, Sipola P, Jalanko M, Heliö T, Laine M, Järvinen V, Häyrinen K, Lauerma K, Kuusisto J. Cardiovascular magnetic resonance of mitral valve length in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2016; 18:33. [PMID: 27259862 PMCID: PMC4893285 DOI: 10.1186/s12968-016-0250-5] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous data suggest that mitral valve leaflets are elongated in hypertrophic cardiomyopathy (HCM), and mitral valve leaflet elongation may constitute a primary phenotypic expression of HCM. Our objective was to measure the length of mitral valve leaflets by cardiovascular magnetic resonance (CMR) in subjects with HCM caused by a Finnish founder mutation in the myosin-binding protein C gene (MYBPC3-Q1061X), carriers of the same mutation without left ventricular hypertrophy, as well as in unselected consecutive patients with HCM, and respective controls. METHODS Anterior mitral valve leaflet (AML) and posterior mitral valve leaflet (PML) lengths were measured by CMR in 47 subjects with the Q1061X mutation in the gene encoding MYBPC3 and in 20 healthy relatives without the mutation. In addition, mitral valve leaflet lengths were measured by CMR in 80 consecutive non-genotyped patients with HCM in CMR and 71 age- and gender-matched healthy subjects. RESULTS Of the subjects with the MYBPC-Q1016X mutation, 32 had left ventricular hypertrophy (LVH, LV maximal wall thickness ≥ 13 mm in CMR) and 15 had no hypertrophy. PML was longer in patients with the MYBPC3-Q1061X mutation and LVH than in controls of the MYBPC group (12.8 ± 2.8 vs 10.6 ± 1.9 mm, P = 0.013), but the difference between the groups was not statistically significant when PML was indexed for BSA (P = 0.066), or when PML length was adjusted for BSA, age, gender, LV mass and ejection fraction (P = 0.195). There was no significant difference in the PML length in mutation carriers without LVH and controls (11.1 ± 3.4 vs 10.6 ± 1.9, P = 0.52). We found no difference in AML lengths between the MYBPC mutation carriers with or without hypertrophy and controls. In 80 consecutive non-genotyped patients with HCM, there was no difference either in AML or PML lengths in subjects with HCM compared to respective control subjects. CONCLUSIONS In subjects with HCM caused by the Q1061X mutation in the MYBPC3 gene, the posterior mitral valve leaflets may be elongated, but mitral valve elongation does not constitute primary phenotypic expression of the disease. Instead, elongated mitral valve leaflets seem to be associated with body size and left ventricular remodeling.
Collapse
Affiliation(s)
- Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Vesa Järvinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Kirsi Lauerma
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| |
Collapse
|
13
|
Taina M, Rissanen V, Hedman M, Jäkälä P, Järvinen V, Vanninen R, Sipola P. Diagnostic Performance of Left Atrial Diameter Measurement in Computed Tomography to Detect Increased Left Atrial Volume. In Vivo 2015; 29:487-491. [PMID: 26130793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The left atrium (LA) is frequently imaged in cardiac computed tomographic (cCT) examinations. The LA volume can be accurately measured with three-dimensional (3D) volumetry but this method is time consuming and thus not routinely used in clinical practice. Accordingly, increased LA size may be overlooked although volume enlargement is associated with adverse cardiovascular events. We evaluated the accuracy of LA diameter measurement in cCT and in transthoracic echocardiography (TTE) in the diagnosis of LA enlargement using 3D cCT as the reference standard. PATIENTS AND METHODS Altogether, 146 patients with suspected cardiogenic stroke underwent cCT and TTE. LA volume by cCT was determined for all patients. LA diameter was measured in both modalities. Furthermore, 40 healthy controls were analyzed in order to assess the cut-off values for normal LA volume. Diagnostic performance of cCT and conventional TTE diametrical measurements for detecting enlarged LA volume were analyzed and compared using Cohen's kappa (κ). RESULTS In controls, the mean LA volume was 59.8±15.3 ml and the mean LA diameter was 30.4±5.0 mm by cCT. The mean value plus twice the standard deviation, which was considered the upper limit, for normal LA volume and diameter were 90.4 ml and 40.4 mm, respectively. Age- and gender-matched patients with stroke had statistically significantly (p<0.001) larger LA volumes (85.5±21.1 vs. 59.8±15.3 ml) and diameters (37.6±5.7 vs. 30.4±5.0 mm) than controls. LA diameter measurement by cCT was more reliable in detecting an LA volume enlargement than the corresponding measurement with TTE (κ=0.489 vs. 0.234; p=0.002). CONCLUSION An enlarged LA diameter measured by cCT was more reliable than TTE at detecting enlarged LA volume.
Collapse
Affiliation(s)
- Mikko Taina
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Unit of Clinical Radiology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Valtteri Rissanen
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Unit of Clinical Radiology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Neuro Center, Kuopio University Hospital, Kuopio, Finland Unit of Neurology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Vesa Järvinen
- Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Hyvinkää Hospital, Hyvinkää, Finland
| | - Ritva Vanninen
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Unit of Clinical Radiology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland Unit of Clinical Radiology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
14
|
Arponen O, Muuronen A, Taina M, Sipola P, Hedman M, Jäkälä P, Vanninen R, Pulkki K, Mustonen P. Acute phase IL-10 plasma concentration associates with the high risk sources of cardiogenic stroke. PLoS One 2015; 10:e0120910. [PMID: 25923658 PMCID: PMC4414573 DOI: 10.1371/journal.pone.0120910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
Background Etiological assessment of stroke is essential for accurate treatment decisions and for secondary prevention of recurrence. There is evidence that interleukin-10 (IL-10) associates with ischemic stroke. The aim of this prospective study was to assess the levels of IL-10 in ischemic stroke with unknown or suspected cardiogenic etiology, and evaluate the correlation between IL-10 plasma concentration and the number of diagnosed high risk sources for cardioembolism. Methods A total of 141 patients (97 males; mean age 61±11 years) with acute ischemic stroke with unknown etiology or suspected cardiogenic etiology other than known atrial fibrillation (AF) underwent imaging investigations to assess high risk sources for cardioembolic stroke established by the European Association of Echocardiography (EAE). IL-10 was measured on admission to the hospital and on a three month follow-up visit. Results Acute phase IL-10 concentration was higher in patients with EAE high risk sources, and correlated with their number (p<0.01). In patients with no risk sources (n = 104), the mean IL-10 concentration was 2.7±3.1 ng/L (range 0.3–16.3 ng/L), with one risk source (n = 26) 3.7±5.5 ng/L (0.3–23.6 ng/L), with two risk sources (n = 10) 7.0±10.0 ng/L (1.29–34.8 ng/L) and with three risk sources (n = 1) 37.2 ng/L. IL-10 level was not significantly associated with cerebral infarct volume, presence of previous or recent myocardial infarction, carotid/vertebral artery atherosclerosis, paroxysmal AF registered on 24-hour ECG Holter monitoring or given intravenous thrombolytic treatment. Conclusion IL-10 plasma concentration correlates independently with the number of EAE cardioembolic risk sources in patients with acute stroke. IL-10 may have potential to improve differential diagnostics of stroke with unknown etiology.
Collapse
Affiliation(s)
- Otso Arponen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
- * E-mail:
| | - Antti Muuronen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
| | - Mikko Taina
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Petri Sipola
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
| | - Marja Hedman
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland, and Unit of Neurology, University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland
- Eastern Finland Laboratory Centre, Kuopio, Finland
| | - Pirjo Mustonen
- Keski-Suomi Central Hospital, Department of Cardiology, Jyväskylä, Finland
| |
Collapse
|
15
|
Muuronen AT, Taina M, Hedman M, Marttila J, Kuusisto J, Onatsu J, Vanninen R, Jäkälä P, Sipola P, Mustonen P. Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS). PLoS One 2015; 10:e0120598. [PMID: 25756793 PMCID: PMC4354901 DOI: 10.1371/journal.pone.0120598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/24/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The etiology of an ischemic stroke remains undetermined in 20-35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT) is a suggested new risk factor for both carotid artery atherosclerosis (CAA) and atrial fibrillation (AF), but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS) after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke. METHODS Altogether 58 patients (mean age 57.7 ± 10.2 years, 44 men) with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol) were also registered. RESULTS Mean VAT area was significantly higher in stroke patients (205 ± 103 cm2 for men and 168 ± 99 cm2 for women) compared to all reference populations (P < 0.01). 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI). Increased VAT was more common than any of the conventional risk factors. CONCLUSION Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.
Collapse
Affiliation(s)
- Antti T. Muuronen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- * E-mail:
| | - Mikko Taina
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Marja Hedman
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- Kuopio University Hospital, Heart Center, Kuopio, Finland
| | - Jarkko Marttila
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Johanna Kuusisto
- Kuopio University Hospital, Department of Medicine, Kuopio, Finland
| | - Juha Onatsu
- Kuopio University Hospital, Neuro Center, Kuopio, Finland
| | - Ritva Vanninen
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
| | - Pekka Jäkälä
- Kuopio University Hospital, Neuro Center, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Neurology, Kuopio, Finland
| | - Petri Sipola
- Kuopio University Hospital, Diagnostic Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine, Unit of Radiology, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| |
Collapse
|
16
|
Turco A, Duchenne J, Nuyts J, Gheysens O, Voigt JU, Claus P, Vunckx K, Muhtarov K, Ozer N, Turk G, Sunman H, Karakulak U, Sahiner L, Kaya B, Yorgun H, Hazirolan T, Aytemir K, Warita S, Kawasaki M, Tanaka R, Houle H, Yagasaki H, Nagaya M, Ono K, Noda T, Watanabe S, Minatoguchi S, Kyle A, Dauphin C, Lusson JR, Dragoi Galrinho R, Rimbas R, Ciobanu A, Marinescu B, Cinteza M, Vinereanu D, Dragoi Galrinho R, Ciobanu A, Rimbas R, Marinescu B, Cinteza M, Vinereanu D, Aparina O, Stukalova O, Butorova E, Makeev M, Bolotova M, Parkhomenko D, Golitsyn S, Zengin E, Hoffmann BA, Ramuschkat M, Ojeda F, Weiss C, Willems S, Blankenberg S, Schnabel RB, Sinning CR, Schubert U, Suhai FI, Toth A, Kecskes K, Czimbalmos C, Csecs I, Maurovich-Horvat P, Simor T, Merkely B, Vago H, Slawek D, Chrzanowski L, Krecki R, Binkowska A, Kasprzak JD, Palombo C, Morizzo C, Kozakova M, Charisopoulou D, Koulaouzidis G, Rydberg A, Henein M, Kovacs A, Olah A, Lux A, Matyas C, Nemeth B, Kellermayer D, Ruppert M, Birtalan E, Merkely B, Radovits T, Henri C, Dulgheru R, Magne J, Kou S, Davin L, Nchimi A, Oury C, Pierard L, Lancellotti P, Sahin ST, Cengiz B, Yurdakul S, Altuntas E, Aytekin V, Aytekin S, Bajraktari G, Ibrahimi P, Bytyci I, Ahmeti A, Batalli A, Elezi S, Henein M, Pavlyukova E, Tereshenkova E, Karpov R, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Maltagliati M, Tumasyan L, Adamyan K, Chilingaryan A, Tunyan L, Kowalik E, Klisiewicz A, Biernacka E, Hoffman P, Park C, Yi J, Cho J, Ihm S, Kim H, Cho E, Jeon H, Jung H, Youn H, Mcghie J, Menting M, Vletter W, Roos-Hesselink J, Geleijnse M, Van Der Zwaan H, Van Den Bosch A, Spethmann S, Baldenhofer G, Stangl V, Baumann G, Stangl K, Laule M, Dreger H, Knebel F, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Keramida K, Kouris N, Kostopoulos V, Kostakou P, Petrogiannos C, Olympios C, Bajraktari G, Berisha G, Bytyci I, Ibrahimi P, Rexhepaj N, Henein M, Wdowiak-Okrojek K, Shim A, Wejner-Mik P, Szymczyk E, Michalski B, Kasprzak J, Lipiec P, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Haykal M, Ryu S, Park J, Kim S, Choi J, Goh C, Byun Y, Choi J, Sonoko M, Onishi T, Fujimoto W, Yamada S, Taniguchi Y, Yasaka Y, Kawai H, Okura H, Sakamoto Y, Murata E, Kanai M, Kataoka T, Kimura T, Watanabe N, Kuriyama N, Nakama T, Furugen M, Sagara S, Koiwaya H, Ashikaga K, Matsuyama A, Shibata Y, Meimoun P, Abouth S, Martis S, Boulanger J, Elmkies F, Zemir H, Tzvetkov B, Luycx-Bore A, Clerc J, Galli E, Oger E, Guirette Y, Daudin M, Fournet M, Donal E, Galli E, Guirette Y, Mabo P, Donal E, Keramida K, Kouris N, Kostopoulos V, Psarrou G, Petrogiannos C, Hatzigiannis P, Olympios C, Igual Munoz B, Erdociain Perales M, Maceira Gonzalez Alicia A, Vazquez Sanchez A, Miro Palau V, Alonso Fernandez P, Donate Bertolin L, Estornell Erill J, Cervera A, Montero Argudo Anastasio A, Okura H, Koyama T, Maehama T, Imai K, Yamada R, Kume T, Neishi Y, Caballero Jimenez L, Garcia-Navarro M, Saura D, Oliva M, Gonzalez-Carrillo J, Espinosa M, Valdes M, De La Morena G, Venkateshvaran A, Sola S, Dash PK, Annappa C, Manouras A, Winter R, Brodin L, Govind SC, Laufer-Perl L, Topilsky Y, Stugaard M, Koriyama H, Katsuki K, Masuda K, Asanuma T, Takeda Y, Sakata Y, Nakatani S, Marta L, Abecasis J, Reis C, Dores H, Cafe H, Ribeiras R, Andrade M, Mendes M, Goebel B, Hamadanchi A, Schmidt-Winter C, Otto S, Jung C, Figulla H, Poerner T, Kim DH, Sun B, Jang J, Choi H, Song JM, Kang DH, Song JK, Zakhama L, Slama I, Boussabah E, Antit S, Herbegue B, Annabi M, Jalled A, Ben Ameur W, Thameur M, Ben Youssef S, O' Grady H, Gilmore M, Delassus P, Sturmberger T, Ebner C, Aichinger J, Tkalec W, Eder V, Nesser H, Caggegi AM, Scandura S, Capranzano P, Grasso C, Mangiafico S, Ronsivalle G, Dipasqua F, Arcidiacono A, Cannata S, Tamburino C, Chapman M, Henthorn R, Surikow S, Zoontjens J, Stocker B, Mclean T, Zeitz CJ, Fabregat Andres O, Estornell-Erill J, Ridocci-Soriano F, De La Espriella R, Albiach-Montanana C, Trejo-Velasco B, Perdomo-Londono D, Facila L, Morell S, Cortijo-Gimeno J, Kouris N, Keramida K, Kostopoulos V, Psarrou G, Kostakou P, Olympios C, Kuperstein R, Blechman I, Freimatk D, Arad M, Ochoa JP, Fernandez A, Vaisbuj F, Salmo F, Fava A, Casabe H, Guevara E, Fernandes A, Cateano F, Almeida I, Silva J, Trigo J, Botelho A, Sanches C, Venancio M, Goncalves L, Schnell F, Daudin M, Oger E, Bouillet P, Mabo P, Carre F, Donal E, Petrella L, Fabiani D, Paparoni S, De Remigis F, Tomassoni G, Prosperi F, Napoletano C, Marchel M, Serafin A, Kochanowski J, Steckiewicz R, Madej-Pilarczyk A, Filipiak K, Opolski G, Abid L, Ben Kahla S, Charfeddine S, Kammoun S, Monivas Palomero V, Mingo Santos S, Goirigoizarri Artaza J, Rodriguez Gonzalez E, Restrepo Cordoba A, Rivero Arribas B, Garcia Lunar I, Gomez Bueno M, Sayago Silva I, Segovia Cubero J, Zengin E, Radunski UK, Klusmeier M, Ojeda F, Rybczynski M, Barten M, Muellerleile K, Reichenspurner H, Blankenberg S, Sinning CR, Romano G, Licata P, Tuzzolino F, Clemenza F, Di Gesaro G, Hernandez Baravoglia C, Scardulla C, Pilato M, Hashimoto G, Suzuki M, Yoshikawa H, Otsuka T, Isekame Y, Iijima R, Hara H, Nakamura M, Sugi K, Melnikova M, Krestjyaninov M, Ruzov V, Magnino C, Omede' P, Avenatti E, Presutti D, Moretti C, Ravera A, Sabia L, Gaita F, Veglio F, Milan A, Magda S, Mincu R, Soare A, Mihai C, Florescu M, Mihalcea D, Cinteza M, Vinereanu D, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Petroni R, Acitelli A, Cicconetti M, Di Mauro M, Altorio S, Romano S, Petroni A, Penco M, Apostolovic S, Stanojevic D, Jankovic-Tomasevic R, Salinger-Martinovic S, Pavlovic M, Djordjevic-Radojkovic D, Tahirovic E, Dungen H, Jung IH, Byun YS, Goh CW, Kim BO, Rhee KJ, Lee DS, Kim MJ, Seo HS, Kim HY, Tsverava M, Tsverava D, Zaletova T, Shamsheva D, Parkhomenko O, Bogdanov A, Derbeneva S, Leotescu A, Tudor I, Gurghean A, Bruckner I, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Sharma P, Sharma D, Garg S, Vazquez Lopez-Ibor J, Monivas Palomero V, Solano-Lopez J, Zegri Reiriz I, Dominguez Rodriguez F, Gonzalez Mirelis J, Mingo Santos S, Sayago I, Garcia Pavia P, Segovia Cubero J, Florescu M, Mihalcea D, Magda S, Radu E, Chirca A, Acasandrei A, Jinga D, Mincu R, Enescu O, Vinereanu D, Saura Espin D, Caballero Jimenez L, Oliva Sandoval M, Gonzalez Carrillo J, Garcia Navarro M, Espinosa Garcia M, Valdes Chavarri M, De La Morena Valenzuela G, Abul Fadl A, Mourad M, Campanale CM, Di Maria S, Mega S, Nusca A, Marullo F, Di Sciascio G, Pardo Gonzalez L, Delgado M, Ruiz M, Rodriguez S, Hidalgo F, Ortega R, Mesa D, Suarez De Lezo Cruz Conde J, Bengrid TM, Zhao Y, Henein M, Kenjaev S, Alavi A, Kenjaev M, Mendes L, Lima S, Dantas C, Melo I, Madeira V, Balao S, Alves H, Baptista E, Mendes P, Santos J, Scali M, Mandoli G, Simioniuc A, Massaro F, Di Bello V, Marzilli M, Dini F, Cifra B, Dragulescu A, Friedberg M, Mertens L, Scali M, Bayramoglu A, Tasolar H, Otlu Y, Hidayet S, Kurt F, Dogan A, Pekdemir H, Stefani L, Galanti G, De Luca A, Toncelli L, Pedrizzetti G, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Ho SJ, Hung SC, Chang FY, Liao JN, Niu DM, Yu WC, Nemes A, Kalapos A, Domsik P, Forster T, Siarkos M, Sammut E, Lee L, Jackson T, Carr-White G, Rajani R, Kapetanakis S, Jarvinen V, Sipola P, Madeo A, Piras P, Evangelista A, Giura G, Dominici T, Nardinocchi P, Varano V, Chialastri C, Puddu P, Torromeo C, Sanchis Ruiz L, Montserrat S, Obach V, Cervera A, Bijnens B, Sitges M, Charisopoulou D, Banner NR, Rahman-Haley S, Imperadore F, Del Greco M, Jermendy A, Horcsik D, Horvath T, Celeng C, Nagy E, Bartykowszki A, Tarnoki D, Merkely B, Maurovich-Horvat P, Jermendy G, Whitaker J, Demir O, Walton J, Wragg A, Alfakih K, Karolyi M, Szilveszter B, Raaijmakers R, Giepmans W, Horvath T, Merkely B, Maurovich-Horvat P, Koulaouzidis G, Charisopoulou D, Mcarthur T, Jenkins P, Henein M, Silva T, Ramos R, Oliveira M, Marques H, Cunha P, Silva M, Barbosa C, Sofia A, Pimenta R, Ferreira R, Al-Mallah M, Alsaileek A. Poster session 5: Friday 5 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Kuittinen P, Sipola P, Saari T, Aalto TJ, Sinikallio S, Savolainen S, Kröger H, Turunen V, Leinonen V, Airaksinen O. Visually assessed severity of lumbar spinal canal stenosis is paradoxically associated with leg pain and objective walking ability. BMC Musculoskelet Disord 2014; 15:348. [PMID: 25319184 PMCID: PMC4203914 DOI: 10.1186/1471-2474-15-348] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Lumbar spinal stenosis (LSS) is the common term used to describe patients with symptoms related to the anatomical reduction of the lumbar spinal canal size. However, some subjects may have a markedly narrowed canal without any symptoms. This raises the question of what is the actual role of central canal stenosis in symptomatic patients. The purpose of this study was to compare radiological evaluations of LSS, both visually and quantitatively, with the clinical findings of patients with LSS. Methods Eighty patients [mean age 63 (11) years, 44% male], with symptoms severe enough to indicate LSS surgery, were included in this prospective single-center study. Lumbar magnetic resonance imaging was performed and one experienced neuroradiologist classified patients into three groups: 0 = normal or mild stenosis, 1 = moderate stenosis, and 2 = severe stenosis. In addition, the same observer measured the minimal dural sac area level by level from the inferior aspect of L1 to the inferior aspect of S1. The association between radiological and clinical findings were tested with Oswestry Disability Index, overall visual analog pain scale, specific low back pain, specific leg pain, Beck Depression Inventory, and walking distance on treadmill exercise test. Results In the visual classification of the central spinal canal, leg pain was significantly higher and walking distance achieved was shorter among patients with moderate central stenosis than in patients with severe central stenosis (7.33 (2.29) vs 5.80 (2.72); P = 0.008 and 421 (431) m vs 646 (436) m; P = 0.021, respectively). Patients with severe stenosis at only one level also achieved shorter walking distance than patients with severe stenosis of at least two levels. No correlation between visually or quantitatively assessed stenosis and other clinical findings was found. Conclusions There is no straightforward association between the stenosis of dural sac and patient symptoms or functional capacity. These findings indicated that dural sac stenosis is not the single key element in the pathophysiology of LSS. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-348) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Pekka Kuittinen
- Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 1777, Kuopio 70210, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kuittinen P, Sipola P, Leinonen V, Saari T, Sinikallio S, Savolainen S, Kröger H, Turunen V, Airaksinen O, Aalto T. Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis. PLoS One 2014; 9:e106404. [PMID: 25229343 PMCID: PMC4167706 DOI: 10.1371/journal.pone.0106404] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/01/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To study the predictive value of preoperative magnetic resonance imaging (MRI) findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS). METHODS 84 patients (mean age 63±11 years, male 43%) with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0-100%) and treadmill test (0-1000 m), pain symptoms with the overall Visual Analogue Scale (VAS 0-100 mm), and specific low back pain (LBP) and specific leg pain (LP) separately with a numeric rating scale from 0-10 (NRS-11). Satisfaction with the surgical outcome was also assessed. RESULTS Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05). Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029). Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031) and lowered the walking distance in the treadmill test (p = 0.001). The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026). No significant differences were detected between quantitative measurements and the patient outcome. CONCLUSIONS Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.
Collapse
Affiliation(s)
- Pekka Kuittinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland and Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland and Unit of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tapani Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Sanna Sinikallio
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sakari Savolainen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics and Traumatology, Kuopio University Hospital and Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Veli Turunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Olavi Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Timo Aalto
- Health Center Ikioma OY, Mikkeli, Finland
| |
Collapse
|
19
|
Kuittinen P, Sipola P, Aalto TJ, Määttä S, Parviainen A, Saari T, Sinikallio S, Savolainen S, Turunen V, Kröger H, Airaksinen O, Leinonen V. Correlation of lateral stenosis in MRI with symptoms, walking capacity and EMG findings in patients with surgically confirmed lateral lumbar spinal canal stenosis. BMC Musculoskelet Disord 2014; 15:247. [PMID: 25051886 PMCID: PMC4112604 DOI: 10.1186/1471-2474-15-247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 07/18/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To evaluate the clinical significance of lateral lumbar spinal canal stenosis (LLSCS), found by magnetic resonance imaging (MRI), through correlating the imaging findings with patient symptoms, walking capacity and electromyography (EMG) measurements. METHOD 102 patients with symptoms of LSS referred for operative treatment were studied in this uncontrolled study. Of these patients, subjects with distinct only lateral LSS were included. Accordingly, 140 roots in 14 patients (mean age 58, range 48-76 years, male 43%) were evaluated. In MR images the entrance and mid zones of the lateral lumbar nerve root canal were graded as normal, narrowed but not compressed, or compressed. In quantitative analysis, the minimal widths of the lateral recess and mid zone area were measured. Clinical symptoms were recorded with the Oswestry Disability Index (ODI), overall Visual Analogue Scale (VAS), specific low back pain (LBP; NRS-11), specific leg pain (LP NRS-11), Beck Depression Inventory (BDI) and walking distance in the treadmill test. Lumbar paraspinal (L2- L5) and lower limb (L3 - S1) needle EMG studies were performed. The findings were classified root by root as 1 = normal, 2 = abnormal. The associations between radiological, EMG and clinical findings were tested with each other. RESULTS EMG findings were normal in 92 roots and abnormal in 48 roots. All of the patients had at least one abnormal nerve root finding. Severity of the mid zone stenosis in MRI correlated with abnormal EMG findings (p = 0.015). Patients with abnormal EMG had also higher scores in the VAS (41.9 ± 25.7 vs 31.5 ± 18.1; p = 0.018), NRS leg pain (7.5 ± 1.5 vs 6.3 ± 2.1; p = 0.000) and BDI (9.8 ± 3.8 vs 8.0 ± 3.9; p = 0.014). However, no statistically significant correlations between MRI findings and clinical symptoms or walking capacity were found. CONCLUSIONS Among persons previously selected for surgery, lateral stenosis seen on MRI correlates with EMG, and thus may be a clinically significant finding. Our EMG findings were also associated with patient symptoms. However, no relationships between the MRI findings and symptoms or walking capacity were found, suggesting their multifactorial etiology.
Collapse
Affiliation(s)
- Pekka Kuittinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Taina M, Korhonen M, Haataja M, Muuronen A, Arponen O, Hedman M, Jäkälä P, Sipola P, Mustonen P, Vanninen R. Morphological and volumetric analysis of left atrial appendage and left atrium: cardiac computed tomography-based reproducibility assessment. PLoS One 2014; 9:e101580. [PMID: 24988467 PMCID: PMC4079282 DOI: 10.1371/journal.pone.0101580] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/07/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Left atrial appendage (LAA) dilatation and morphology may influence an individual's risk for intracardiac thrombi and ischemic stroke. LAA size and morphology can be evaluated using cardiac computed tomography (cCT). The present study evaluated the reproducibility of LAA volume and morphology assessments. METHODS A total of 149 patients (47 females; mean age 60.9±10.6 years) with suspected cardioembolic stroke/transient ischemic attack underwent cCT. Image quality was rated based on four categories. Ten patients were selected from each image quality category (N = 40) for volumetric reproducibility analysis by two individual readers. LAA and left atrium (LA) volume were measured in both two-chamber (2CV) and transversal view (TV) orientation. Intertechnique reproducibility was assessed between 2CV and TV (200 measurement pairs). LAA morphology (A = Cactus, B = ChickenWing, C = WindSock, D = CauliFlower), LAA opening height, number of LAA lobes, trabeculation, and orientation of the LAA tip was analysed in all study subjects by three individual readers (447 interobserver measurement pairs). The reproducibility of volume measurements was assessed by intra-class correlation (ICC) and the reproducibility of LAA morphology assessments by Cohen's kappa. RESULTS The intra-observer and interobserver reproducibility of LAA and LA volume measurements was excellent (ICCs>0.9). The LAA (ICC = 0.954) and LA (ICC = 0.945) volume measurements were comparable between 2CV and TV. Morphological classification (ĸ = 0.24) and assessments of LAA opening height (ĸ = 0.1), number of LAA lobes (ĸ = 0.16), trabeculation (ĸ = 0.15), and orientation of the LAA tip (ĸ = 0.37) was only slightly to fairly reproducible. CONCLUSIONS LA and LAA volume measurements on cCT provide excellent reproducibility, whereas visual assessment of LAA morphological features is challenging and results in unsatisfactory agreement between readers.
Collapse
Affiliation(s)
- Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mika Haataja
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Otso Arponen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
21
|
Taina M, Sipola P, Muuronen A, Hedman M, Mustonen P, Kantanen AM, Jäkälä P, Vanninen R. Determinants of left atrial appendage volume in stroke patients without chronic atrial fibrillation. PLoS One 2014; 9:e90903. [PMID: 24595515 PMCID: PMC3942499 DOI: 10.1371/journal.pone.0090903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Left atrial appendage (LAA) volume has been shown to be increased in patients with acute cryptogenic stroke. Atrial fibrillation (AF) is a well-recognized risk factor but it is not the only one associated with LAA enlargement. The aim of the study was to clarify the multifactorial etiology of LAA enlargement in cardiogenic stroke/TIA patients without AF. METHODS Altogether 149 patients with suspected cardioembolic stroke/TIA (47 females; mean age 61 years) underwent cardiac CT. Diagnosed AF on admittance was an exclusion criteria but 24-hour Holter ambulatory ECG revealed paroxysmal AF (PAF) in 20 patients. Body surface area adjusted LAA volume was evaluated. Eighteen different variables were registered including general characteristics, definite and potential causal risk factors for ischemic stroke/TIA, clinical echoparameters and CT based cardiac volumetric and adipose tissue measurements. A stepwise linear regression analysis was performed to achieve a model adjusted for the number of predictors of LAA volume increase. RESULTS In linear regression analysis, the best model accounted for 30% of the variability in LAA volume, including PAF (19%) and enlarged left atrial volume (6%), enlarged left ventricle end-systolic diameter (3%) and decreased pericardial adipose tissue (2%). No multi-colinearity between variables was observed. In addition to PAF, no other definitive or potential causal risk factors could account for the LAA volume in these patients. CONCLUSIONS LAA volume increase seems to be poorly associated with currently known stroke/TIA risk factors, except for AF. Targeting more comprehensive ECG monitoring for stroke patients with increased LAA volume should be considered.
Collapse
Affiliation(s)
- Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Pirjo Mustonen
- Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Anne-Mari Kantanen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
22
|
Husso M, Sipola P, Kuittinen T, Manninen H, Vainio P, Hartikainen J, Saarakkala S, Töyräs J, Kuikka J. Assessment of myocardial perfusion with MRI using a modified dual bolus method. Physiol Meas 2014; 35:533-47. [PMID: 24577344 DOI: 10.1088/0967-3334/35/4/533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quantification of regional myocardial blood flow (rMBF) with first-pass magnetic resonance imaging (FP-MRI) requires two contrast agent injections (dual bolus technique), inducing error in the determined rMBF if the injections differ. We hypothesize that using input and residue curves of the same injection would be more reliable. We aim to introduce and evaluate a novel method to correct the high concentration arterial input function (AIF) for determination of rMBF. Sixteen patients with non-Hodgkin's lymphoma were examined before and after chemotherapy. The input function was solved by correcting initial high concentration AIF using the ratio of low and high contrast AIF areas, normalized by corresponding heart rates (modified dual bolus method). For comparison, the scaled low contrast AIF was used as an input function (dual bolus method). Unidirectional transfer coefficient K(trans) was calculated using both methods. K(trans)-values determined with the dual bolus (0.81 ± 0.32 ml g(-1) min(-1)) and modified dual bolus (0.77 ± 0.42 ml g(-1) min(-1)) methods were in agreement (p = 0.21). Mean K(trans)-values increased from 0.76 ± 0.43 to 0.89 ± 0.55 ml g(-1) min(-1) after chemotherapy (p = 0.17). The modified dual bolus technique agrees with the dual bolus technique (R2 = 0.899) when the low and high contrast injections are similar. However, when this is not the case, the modified dual bolus technique may be more reliable.
Collapse
Affiliation(s)
- M Husso
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Taina M, Vanninen R, Hedman M, Jäkälä P, Kärkkäinen S, Tapiola T, Sipola P. Left atrial appendage volume increased in more than half of patients with cryptogenic stroke. PLoS One 2013; 8:e79519. [PMID: 24223960 PMCID: PMC3817123 DOI: 10.1371/journal.pone.0079519] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ischemic strokes without a well-defined etiology are labeled as cryptogenic, and account for 30-40% of strokes in stroke registries. The left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation when associated with atrial fibrillation. Here, we examined whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients. METHODS This study included 82 stroke/TIA patients (57 males; mean age, 58 years) with a diagnosis of cryptogenic stroke after extensive radiological and cardiological investigations. Cases were classified using the TOAST criteria modified by European Association of Echocardiography recommendations for defining cardiac sources of embolism. Forty age- and gender-matched control subjects without cardiovascular diseases were selected for pair-wise comparisons (21 males; mean age, 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the LAA borders on electrocardiogram-gated CT slices. RESULTS In control subjects, mean LAA volume was 3.4±1.1 mL/m(2). Mean+2SD, which was considered the upper limit for normal LAA volume was 5.6 mL/m(2). In paired Student t-test between the patient group and matched controls, LAA volume was 67% larger in cryptogenic stroke/TIA patients (5.7±2.0 mL/m(2) vs. 3.4±1.1 mL/m(2); P<0.001). Forty-five (55%) patients with cryptogenic stroke/TIA had enlarged LAA. CONCLUSION LAA is significantly enlarged in more than half of patients with cryptogenic stroke/TIA. LAA thrombosis may contribute to the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation.
Collapse
Affiliation(s)
- Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Tero Tapiola
- Department of Neurology, North Kymi Hospital, Kouvola, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
24
|
Simula S, Muuronen AT, Taina M, Jäkälä P, Sipola P, Vanninen R, Hedman M. Effect of middle cerebral artery territory ischemic stroke on QT interval. J Stroke Cerebrovasc Dis 2013; 23:717-23. [PMID: 24045085 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.032] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/11/2013] [Accepted: 06/19/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prolonged QT interval associates with increased risk for sudden cardiac death after acute ischemic stroke. However, pathophysiology of prolonged QT interval after stroke is poorly elucidated. In this study, we investigated whether QT interval dynamics is different in patients with right and left middle cerebral artery (MCA) territory stroke. METHOD Electrocardiogram (ECG) intervals were compared between baseline (retrieved retrospectively from medical records) and admission (acquired at the acute hospital admission) in 33 patients (65 ± 9.5 years) with right or left MCA territory ischemic stroke. Head computed tomography (CT), cardiac ultrasound, and cardiac CT scans were undertaken. RESULTS Stroke was located in the right MCA territory in 21 (64%) and in the left MCA territory in 12 (36%) patients. Patients with right and left MCA stroke were similar with respect to time interval between baseline and admission ECG recordings, positive history of heart disease, and left ventricular dimensions. Increase in heart rate-corrected QT interval (QTc) from baseline to admission was demonstrated to occur more often in patients with right (16 of 21; 76%) than in patients with left (3 of 12; 25%; P < .01) MCA stroke. ΔQTc between baseline and admission was significantly longer in patients with right (23 ± 23 milliseconds) than in patients with left (-11 ± 19 milliseconds; P < .0001) MCA stroke. Percent ΔQTc between baseline and admission was longer in patients with right (5.5% ± 5.5%) than in patients with left (-2.6% ± 4.7%; P < .001) MCA stroke. CONCLUSIONS Right MCA ischemic stroke results in prolongation of QT interval. Findings indicate cerebral asymmetry in brain-heart interaction during acute ischemic stroke.
Collapse
Affiliation(s)
- Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland.
| | - Antti T Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland; Unit of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
25
|
Taina M, Vanninen R, Hedman M, Jäkälä P, Sipola P. Abstract TP230: Left Atrial Appendage Volume Is Increased In More Than Half Of Patients With Cryptogenic Stroke. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.atp230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Ischemic stroke without a well-defined etiology is labelled as cryptogenic, and it accounts for 30 − 40 % of strokes in modern stroke registries. Enlarged left atrial appendage (LAA) is the most typical origin for intracardiac thrombus formation. We studied whether increased LAA volume detected with cardiac computed tomography (cCT) constitutes a risk factor in cryptogenic stroke patients.
Materials and methods:
Consecutive stroke or TIA patients with cryptogenic etiology for stroke after profound clinical, radiological and cardiological investigations were selected for the study. The 1993 TOAST criteriae modified by 2010 EAE recommendations for defining cardiac sources of embolism were used for classification. Eighty-two patients (57 males; mean age 58 years) were identified. Forty control subjects without cardiovascular diseases, matched for age and gender, were selected for pair-wise comparisons (21 males; mean age 54 years). LAA volume adjusted for body surface area was measured three dimensionally by tracing the borders of LAA on CT slices. The upper limit for normal LAA volume was defined as mean + 2 SD in control subjects.
Results:
In control subjects LAA volume was 3.4 ± 1.1 mL/m
2
(range 1.3 − 6.0 mL/m
2
). The upper limit for normal LAA was 5.6 mL/m
2
. Of the patients with cryptogenic stroke/TIA 45 (55 %) had enlarged LAA. In matched pair-wise comparisons LAA volume was 67 % larger in cryptogenic stroke/TIA patients than in control subjects (5.7 ± 2.0 mL/m
2
vs. 3.4 ± 1.1 mL/m
2
;
P
< 0.001).
Conclusions:
LAA is significantly enlarged in more than half of patients with cryptogenic stroke, and thus do not have atrial fibrillation as a preceding risk factor. LAA thrombosis may contribute in the pathogenesis of stroke in patients considered to have cryptogenic stroke after conventional evaluation.
Collapse
|
26
|
Sipola P, Hedman M, Onatsu J, Turpeinen A, Halinen M, Jäkälä P, Vanninen R. Computed Tomography and Echocardiography together Reveal More High-Risk Findings than Echocardiography Alone in the Diagnostics of Stroke Etiology. Cerebrovasc Dis 2013; 35:521-30. [DOI: 10.1159/000350734] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/05/2013] [Indexed: 11/19/2022] Open
|
27
|
Kuittinen P, Aalto TJ, Heikkilä T, Leinonen V, Savolainen S, Sipola P, Kröger H, Turunen V, Airaksinen O. Accuracy and reproducibility of a retrospective outcome assessment for lumbar spinal stenosis surgery. BMC Musculoskelet Disord 2012; 13:83. [PMID: 22642923 PMCID: PMC3407481 DOI: 10.1186/1471-2474-13-83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/29/2012] [Indexed: 11/27/2022] Open
Abstract
Background Retrospective assessment of surgery outcome is considered problematic. The aims of this study were to evaluate the reproducibility and accuracy of a retrospective outcome assessment of lumbar spinal stenosis surgery with reference to prospective outcome scale measurements. Method Outcome of surgery from 100 lumbar spinal stenosis (LSS) patients was evaluated retrospectively from patient files of a 3-month outpatient visit performed according to a standard clinical protocol by two independent researchers. In the retrospective analysis, outcome was graded as 2 = good if the clinical condition had clearly improved, 1 = moderate if it had just slightly improved, 0 = poor if it had not improved or was even worse than before the surgical treatment (Retrospective 3- point scale). A prospectively assessed Oswestry Disability Index questionnaire (ODI), Visual analogue pain scale (VAS) and a patient satisfaction questionnaire were used as references of standards. Reproducibility of the measurements was evaluated. Results The retrospective 3-point scale correlated with ODI (r = 0.528; P < 0.001) and VAS (r = 0.368; P < 0.001). The agreement was better in the good and poor outcome than in the moderate outcome. Retrospective 3-point scale demonstrated substantial intra-rater and inter-rater repeatability (κ = 0.682, P < 0.001 and κ = 0.630, P < 0.001, respectively). Conclusions Retrospective assessment of spinal surgery outcome is highly reproducible. Accuracy is highest in the patients with poor and good surgical result.
Collapse
Affiliation(s)
- Pekka Kuittinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kuusisto J, Kärjä V, Sipola P, Kholová I, Peuhkurinen K, Jääskeläinen P, Naukkarinen A, Ylä-Herttuala S, Punnonen K, Laakso M. Low-grade inflammation and the phenotypic expression of myocardial fibrosis in hypertrophic cardiomyopathy. Heart 2012; 98:1007-13. [PMID: 22447464 PMCID: PMC3368494 DOI: 10.1136/heartjnl-2011-300960] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the role of inflammation in the phenotypic expression of myocardial fibrosis in hypertrophic cardiomyopathy (HCM). Design Clinical study. Setting Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. Subjects Twenty-four patients with a single HCM-causing mutation D175N in the α-tropomyosin gene and 17 control subjects. Main outcome measures Endomyocardial biopsy samples taken from the patients with HCM were compared with matched myocardial autopsy specimens. Levels of high-sensitivity C-reactive protein (hsCRP) and proinflammatory cytokines were measured in patients and controls. Myocardial late gadolinium enhancement (LGE) in cardiac MRI (CMRI) was detected. Results Endomyocardial samples in patients with HCM showed variable myocyte hypertrophy and size heterogeneity, myofibre disarray, fibrosis, inflammatory cell infiltration and nuclear factor kappa B (NF-κB) activation. Levels of hsCRP and interleukins (IL-1β, IL-1RA, IL-6, IL-10) were significantly higher in patients with HCM than in control subjects. In patients with HCM, there was a significant association between the degree of myocardial inflammatory cell infiltration, fibrosis in histopathological samples and myocardial LGE in CMRI. Levels of hsCRP were significantly associated with histopathological myocardial fibrosis. hsCRP, tumour necrosis factor α and IL-1RA levels had significant correlations with LGE in CMRI. Conclusions A variable myocardial and systemic inflammatory response was demonstrated in patients with HCM attributable to an identified sarcometric mutation. Inflammatory response was associated with myocardial fibrosis, suggesting that myocardial fibrosis in HCM is an active process modified by an inflammatory response.
Collapse
Affiliation(s)
- Johanna Kuusisto
- Kuopio University Hospital, Department of Medicine/Center for Medicine and Clinical Research, Puijonlaaksontie 2, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sipola P, Leinonen V, Niemeläinen R, Aalto T, Vanninen R, Manninen H, Airaksinen O, Battié MC. Visual and quantitative assessment of lateral lumbar spinal canal stenosis with magnetic resonance imaging. Acta Radiol 2011; 52:1024-31. [PMID: 21969705 DOI: 10.1258/ar.2011.110083] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lateral lumbar spinal canal stenosis is a common etiology of lumbar radicular symptoms. Quantitative measurements have commonly demonstrated better repeatability than visual assessments. We are not aware of any studies examining the repeatability of quantitative assessment of the lateral canal. PURPOSE To evaluate the repeatability of visual assessments and newly developed quantitative measurements of lateral lumbar spinal canal stenosis using magnetic resonance imaging (MRI). MATERIAL AND METHODS Twenty-eight patients with lateral lumbar spinal canal stenosis or prior spinal surgery with recurrent symptoms were imaged with MRI. A radiologist, a neurosurgeon and a spine research trainee graded visually and quantitatively subarticular (n = 188) and foraminal zones (n = 260) of the lateral spinal canal. Quantitative measurements included the minimal subarticular width and the cross-sectional area of the foramen. RESULTS The repeatability of visual assessment at the subarticular zone and foraminal zones between raters varied from 0.45-0.59 and 0.42-0.53, respectively. Similarly, the intraclass correlation coefficients for the quantitative measurements varied from 0.67-0.71 and 0.66-0.76, respectively. The intra-rater repeatability for the visual assessments of the subarticular and foraminal zones was 0.70 and 0.62, respectively, while the corresponding intraclass correlation coefficients for quantitative measurements were 0.83 and 0.81, respectively. CONCLUSION Inter-rater repeatability of visual assessments of lateral stenosis is moderate, whereas quantitative measurements of both subarticular width and the cross-sectional area of the foramen have substantial reproducibility and may be particularly useful for longitudinal studies and research purposes. The clinical value of these parameters requires further study.
Collapse
Affiliation(s)
- Petri Sipola
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Department of Clinical Radiology, Kuopio, Finland
- Kuopio University Hospital, Clinical Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Ville Leinonen
- Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland
| | - Riikka Niemeläinen
- Kuopio University Hospital, Clinical Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Timo Aalto
- Kyyhkylä Rehabilitation Center and Hospital, Mikkeli, Finland
| | - Ritva Vanninen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Department of Clinical Radiology, Kuopio, Finland
- Kuopio University Hospital, Clinical Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Hannu Manninen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Department of Clinical Radiology, Kuopio, Finland
- Kuopio University Hospital, Clinical Imaging Centre, Department of Clinical Radiology, Kuopio, Finland
| | - Olavi Airaksinen
- Kuopio University Hospital, Department of Physical and Rehabilitation Medicine and University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Kuopio, Finland
| | - Michele C Battié
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
30
|
Partanen N, Husso M, Vuolteenaho O, Sipola P, Ruskoaho H, Peuhkurinen K, Magga J. N-terminal pro-atrial natriuretic peptide reflects cardiac remodelling in stage 1 hypertension. J Hum Hypertens 2011; 25:746-51. [PMID: 21248782 DOI: 10.1038/jhh.2010.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Early detection of left ventricular hypertrophy (LVH) is beneficial, since treatment-induced regression of LVH has been unequivocally associated with a better prognosis. Our aim was to study the relation of cardiac remodelling and natriuretic peptides (NPs) in stage 1 hypertension. We studied 175 (46±7 years, 87 women and 88 men) apparently healthy middle-aged that had never been treated for hypertension. Left ventricular and atrial parameters were determined by magnetic resonance imaging. Systolic blood pressure (BP) correlated with left ventricular mass index (LVMI) (r=0.23, P<0.01) and ventricular septum thickness index (IVSI) (r=0.29, P<0.001). N-terminal pro-B-type NP (NT-proBNP) or N-terminal pro-atrial NP (NT-proANP) did not correlate with BP, LVMI or IVSI. NT-proANP correlated with left atrial area index (LAAI) (r=0.38, P<0.001), and subjects with LVH had higher LAAI than subjects with normal left ventricular geometry and no LVH (11.2±0.3 vs 10.0±0.2 cm(2) m(-2), P<0.001). In conclusion, measurement of NT-proBNP or NT-proANP does not appear to discriminate LVH in middle-aged, never treated and apparently healthy hypertensives. NT-proANP, but not NT-proBNP, reflects early cardiac remodelling in hypertensive heart disease.
Collapse
Affiliation(s)
- N Partanen
- Department of Internal Medicine, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
| | | | | | | | | | | | | |
Collapse
|
31
|
Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U. Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging - a prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol 2010; 36:1981-1989. [PMID: 20965645 DOI: 10.1016/j.ultrasmedbio.2010.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/23/2010] [Accepted: 09/05/2010] [Indexed: 05/30/2023]
Abstract
The aim of this study was to compare the accuracy of ultrasonography (US) and magnetic resonance artrography (MRA) for the detection and measurement of rotator cuff tears, using surgical findings as a standard. A total of 77 consecutive patients with suspected rotator cuff tears were prospectively studied with US and MRA. Rotator cuff tears were identified by US with sensitivity, specificity, positive predictive and negative predictive values of 92%, 45%, 91% and 50%, respectively, and by MRA with values of 97%, 82%, 97% and 82%, respectively. US was not reliable for differentiating between partial and full thickness tears. US and MRA underestimated the tear sizes by an average of 15 mm and 4 mm, respectively. Our results suggest that US could be used as a screening test to confirm a suspected rotator cuff tear. In patients with negative findings, an MRA should be considered for substantiation.
Collapse
Affiliation(s)
- Petri Sipola
- Department of Clinical Radiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | |
Collapse
|
32
|
Sipola P, Peuhkurinen K, Vanninen E. Comparison of gated single-photon emission computed tomography with magnetic resonance imaging for evaluation of left ventricular volumes and ejection fraction in patients with idiopathic dilated cardiomyopathy. Int J Cardiovasc Imaging 2010; 27:629-34. [DOI: 10.1007/s10554-010-9702-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 09/10/2010] [Indexed: 11/25/2022]
|
33
|
Sipola P, Ruuskanen A, Yawu L, Husso M, Vanninen R, Hippeläinen M, Manninen H. Preinterventional quantitative magnetic resonance imaging predicts uterus and leiomyoma size reduction after uterine artery embolization. J Magn Reson Imaging 2010; 31:617-24. [DOI: 10.1002/jmri.22063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
34
|
Turpeinen AK, Vanninen E, Magga J, Tuomainen P, Kuusisto J, Sipola P, Punnonen K, Vuolteenaho O, Peuhkurinen K. Cardiac sympathetic activity is associated with inflammation and neurohumoral activation in patients with idiopathic dilated cardiomyopathy. Clin Physiol Funct Imaging 2009; 29:414-9. [PMID: 19622106 DOI: 10.1111/j.1475-097x.2009.00887.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Idiopathic dilated cardiomyopathy (IDC) is characterized by sympathetic nervous overactivity, inflammation and neurohumoral activation; however, their interrelationships are poorly understood. METHODS AND RESULTS We studied 99 patients with IDC (age 54 +/- 1 years, left ventricular ejection fraction (EF) 40 +/- 1%, maximum oxygen uptake (VO(2)max) 20 +/- 1 ml kg(-1) min(-2), mean +/- SEM) by using (123)I-metaiodobenzylguanidine (MIBG) imaging. MIBG washout and MIBG heart/mediastinum (H/M)-ratio at 4 h postinjection were calculated. In addition, the plasma levels of interleukin (IL)-6 and N-terminal B-type natriuretic peptide (NT-proBNP) were measured. MIBG washout and MIBG H/M ratio had a significant correlation with IL-6 (r = 0.42, P<0.001 and r = -0.31, P<0.01) and NT-proBNP (r = 0.48, P<0.001 and r = -0.40, P<0.001). During a median follow-up of 4.1 years, 20 patients (20%) had an adverse cardiac event (death, heart transplantation or application of biventricular pacemaker or implantable cardioverter-defibrillator). In these patients, MIBG washout was higher (53 +/- 4 versus 40 +/- 2%, P = 0.01) and H/M ratio lower (1.38 +/- 0.04 versus 1.51 +/- 0.02, P = 0.01) than in patients without an event. CONCLUSIONS In dilated cardiomyopathy, myocardial sympathetic innervation and activity are related to inflammation and neurohumoral activation. These relationships are at least partly independent of left ventricular function and exercise capacity.
Collapse
Affiliation(s)
- Anu K Turpeinen
- Department of Medicine, Kuopio University Hospital and University of Kuopio, Kuopio, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Ruuskanen A, Sipola P, Hippeläinen M, Wüstefeld M, Manninen H. Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol 2009; 19:2977-85. [DOI: 10.1007/s00330-009-1481-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 11/29/2022]
|
36
|
Sipola P, Heikkinen J, Laaksonen DE, Kettunen R. Influence of 12 weeks of jogging on magnetic resonance-determined left ventricular characteristics in previously sedentary subjects free of cardiovascular disease. Am J Cardiol 2009; 103:567-71. [PMID: 19195522 DOI: 10.1016/j.amjcard.2008.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 08/12/2008] [Revised: 10/13/2008] [Accepted: 10/13/2008] [Indexed: 11/30/2022]
Abstract
Hypertrophy of the left ventricle is a diagnostic dilemma in subjects who engage in regular endurance exercise. We studied prospectively whether endurance training in previously sedentary young and middle-aged men and women can alter left ventricular (LV) characteristics. We recruited 33 healthy young and middle-aged subjects (18 women, 15 men, ages 21 to 59 years) to undergo 12 weeks of home-based brisk walking and jogging at a target heart rate > or =120 beats/min for > or =30 minutes 3 times a week. LV characteristics were measured by cine magnetic resonance imaging. Training intensity as estimated by heart rate correlated positively with the increase in LV myocardial area (r = 0.51, p = 0.005) in the 28 men and women completing the study. In the 13 men and women who trained with heart rate of > or =120 beats/min, LV myocardial area was larger after than before training (17.7 +/- 2.9 vs 16.8 +/- 2.8 cm(2), p <0.05). Moreover, in these subjects LV myocardial area increased more (5.5 +/- 9.0% vs -3.0 +/- 5.0%) than in the 15 men and women who trained at a lower intensity (p <0.05). LV end-systolic and end-diastolic area and ejection fraction did not change significantly. In conclusion, moderate-to-vigorous endurance training at moderate volumes does not influence LV end-diastolic volume or ejection fraction, but has a minor influence on LV hypertrophy in previously sedentary young and middle-aged men and women.
Collapse
Affiliation(s)
- Petri Sipola
- Department of Clinical Radiology, Kuopio University, Kuopio University Hospital, Finland.
| | | | | | | |
Collapse
|
37
|
Koikkalainen JR, Antila M, Lötjönen JMP, Heliö T, Lauerma K, Kivistö SM, Sipola P, Kaartinen MA, Kärkkäinen STJ, Reissell E, Kuusisto J, Laakso M, Orešič M, Nieminen MS, Peuhkurinen KJ. Early Familial Dilated Cardiomyopathy: Identification with Determination of Disease State Parameter from Cine MR Image Data. Radiology 2008; 249:88-96. [DOI: 10.1148/radiol.2491071584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
38
|
Magga J, Sipola P, Vuolteenaho O, Risteli J, Jääskeläinen P, Peuhkurinen K, Kuusisto J. Significance of plasma levels of N-terminal Pro-B-type natriuretic peptide on left ventricular remodeling in non-obstructive hypertrophic cardiomyopathy attributable to the Asp175Asn mutation in the alpha-tropomyosin gene. Am J Cardiol 2008; 101:1185-90. [PMID: 18394456 DOI: 10.1016/j.amjcard.2007.11.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
Abstract
Hypertrophic cardiomyopathy (HC) is an inherited heart disease characterized by left ventricular (LV) remodeling. The present study was conducted to investigate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels with LV remodeling on magnetic resonance imaging and procollagen formation in 17 healthy controls and 24 patients with nonobstructive HC attributable to an identical Asp175Asn (aspartic acid to asparagine at codon 175) mutation in the alpha-tropomyosin gene. None of the patients had history of decompensated heart failure, and all patients had normal LV ejection fraction. Patients with HC had higher NT-pro-BNP levels compared with controls (median 60 pmol/L, range <40 to 359, vs <40 pmol/L; p <0.001), but 9 patients with HC had normal NT-pro-BNP levels (<40 pmol/L). In patients with HC, levels of NT-pro-BNP were correlated significantly with LV end-systolic volume index (r = 0.50, p <0.05), LV mass index (r = 0.47, p <0.05), proportion of hypokinetic segments (r = 0.50, p <0.05), and levels of serum aminoterminal propeptide of type III procollagen (r = 0.52, p <0.01). When patients with HC were divided into 3 groups on the basis of their NT-pro-BNP levels, there were statistically significant linear associations of LV end-systolic volume (test for linearity p = 0.034), LV mass index (p = 0.009), proportion of hypokinetic segments (p = 0.016), and levels of serum aminoterminal propeptide of type III procollagen (p = 0.020) with NT-pro-BNP levels over the 3 groups, suggesting a tight relation between LV remodeling and levels of NT-pro-BNP. In conclusion, in patients with nonobstructive HC attributable to an Asp175Asn mutation in the alpha-tropomyosin gene, elevated NT-pro-BNP levels are associated with incipient LV remodeling, suggesting that NT-pro-BNP could be used to diagnose insidious unfavorable LV remodeling in HC.
Collapse
|
39
|
Vottonen P, Husso M, Sipola P, Vanninen R, Peuhkurinen K, Magga J. Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy in middle-aged subjects. Blood Press 2007; 16:328-34. [PMID: 17852087 DOI: 10.1080/08037050701288255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the usefulness of electrocardiographic left ventricular hypertrophy (ECG LVH) as a marker of LVH in middle-aged subjects. METHODS LVH was determined by cardiovascular magnetic resonance imaging (MRI) in 188 apparently healthy middle-aged [97 men (45+/-7 years) and 91 women (47+/-6 years)]. Receiver operating characteristic (ROC) curves, test sensitivity, specificity, positive and negative predictive values for identifying LVH at different ECG criteria were calculated. RESULTS Systolic and diastolic blood pressures were 142+/-13 mmHg and 90+/-8 mmHg in men and 139+/-10 mmHg and 90+/-8 mmHg in women, respectively. LVMI was 78+/-17 g/m2 in men and 67+/-12 g/m2 in women, and 14% of men and 22% of women had LVH in cardiac MRI. Only Sokolow-Lyon and Sokolow-Lyon product had the area under the ROC curve over 0.70. Sokolow-Lyon product had the highest sensitivity (47%). All ECG criteria had high negative predictive values, but the positive predictive values were below 46%. CONCLUSIONS Commonly used ECG criteria of LVH have low discrimination ability in middle-aged subjects. ECG LVH alone should not be used as a marker of target organ damage in middle-aged, never treated and apparently healthy hypertensives.
Collapse
Affiliation(s)
- Pasi Vottonen
- Department of Internal Medicine, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
| | | | | | | | | | | |
Collapse
|
40
|
Sipola P, Jäkälä P, Hedman M, Peuhkurinen K, Manninen H, Vanninen R. Cardiac computed tomography findings in 76 consecutive patients with suspected cardiogenic transient ischemic attack or stroke. Int J Cardiol 2007. [DOI: 10.1016/j.ijcard.2007.03.064] [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: 10/23/2022]
|
41
|
Magga J, Vottonen P, Sipola P, Husso M, Vanninen R, Peuhkurinen K. Electrocardiographic left ventricular hypertrophy has low diagnostic accuracy. Int J Cardiol 2007. [DOI: 10.1016/j.ijcard.2007.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
Tuunanen H, Kuusisto J, Toikka J, Jääskeläinen P, Marjamäki P, Peuhkurinen K, Viljanen T, Sipola P, Stolen KQ, Hannukainen J, Nuutila P, Laakso M, Knuuti J. Myocardial perfusion, oxidative metabolism, and free fatty acid uptake in patients with hypertrophic cardiomyopathy attributable to the Asp175Asn mutation in the α-tropomyosin gene: A positron emission tomography study. J Nucl Cardiol 2007; 14:354-65. [PMID: 17556170 DOI: 10.1016/j.nuclcard.2006.12.329] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 12/22/2006] [Accepted: 12/22/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between myocardial metabolic changes and the severity of left ventricular (LV) hypertrophy in patients with hypertrophic cardiomyopathy (HCM) is largely unknown. We characterized metabolic abnormalities in patients with a genetically identical cause for HCM but with variable LV hypertrophy. METHODS AND RESULTS Eight patients with HCM attributable to the Asp175Asn mutation in the alpha-tropomyosin gene underwent myocardial perfusion, oxidative, and free fatty acid (FFA) metabolism measurements via positron emission tomography and oxygen 15-labeled water, carbon 11 acetate, and fluorine 14(R,S)-[18F] Fluoro-6-thia-heptadecanoic acid (18 FTHA). LV mass, work, and efficiency were assessed by echocardiography. Thirty-six healthy volunteers served as control subjects. Compared with control subjects, HCM patients had increased myocardial oxidative metabolism and FFA uptake (P < .05). However, in patients, LV mass was inversely related to global myocardial perfusion, oxidative metabolism, and FFA uptake (all P < .03), and regional wall thickness was inversely related to regional perfusion (P < .01), oxidative metabolism (P < .001), and FFA uptake (P < .01). Therefore patients with mild (LV mass less than median of 177 g) but not advanced LV hypertrophy were characterized by increased perfusion, oxidative metabolism, and LV efficiency as compared with control subjects (P < .05). CONCLUSIONS In HCM attributable to the Asp175Asn mutation in the alpha-tropomyosin gene, myocardial oxidative metabolism and FFA metabolism are increased and inversely related to LV hypertrophy at both the whole heart and regional level. Increased metabolism and efficiency characterize patients with mild myocardial hypertrophy. These hypermetabolic alterations regress with advanced hypertrophy.
Collapse
|
43
|
Sipola P, Peuhkurinen K, Lauerma K, Husso M, Jääskeläinen P, Laakso M, Aronen HJ, Risteli J, Kuusisto J. Myocardial late gadolinium enhancement is associated with raised serum amino-terminal propeptide of type III collagen concentrations in patients with hypertrophic cardiomyopathy attributable to the Asp175Asn mutation in the alpha tropomyosin gene: magnetic resonance imaging study. Heart 2006; 92:1321-2. [PMID: 16908707 PMCID: PMC1861167 DOI: 10.1136/hrt.2005.075523] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
44
|
Ala-Korpela M, Sipola P, Kaski K. Characterization and molecular detection of atherothrombosis by magnetic resonance--potential tools for individual risk assessment and diagnostics. Ann Med 2006; 38:322-36. [PMID: 16938802 DOI: 10.1080/07853890600862418] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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] [Indexed: 10/24/2022] Open
Abstract
This review focuses on recent non-invasive or minimally invasive magnetic resonance (MR) approaches to study atherothrombosis. The potential benefits of combining diverse metabolic information obtained by the variety of MR techniques from tissues in vivo and ex vivo and from body fluids in vitro are also briefly discussed. A well established methodology is available for lipoprotein subclass quantification from plasma by 1H MR spectroscopy providing information for assessing the long-term risk of atherosclerosis. Multi-contrast MR imaging in vivo relying on endogenous contrast allows partial characterization of components in atherothrombotic plaques. The use of exogenous contrast agents in MR angiography enhances blood-tissue contrast and provides functional information on plaque metabolism, improving plaque characterization and assessment of plaque vulnerability by MR imaging. Recent applications of molecular targeted MR imaging have revealed novel opportunities for specific early detection of atherothrombotic processes, such as angiogenesis and accumulation of macrophages. Currently, MR imaging and spectroscopy can produce such metabolic in vivo and in vitro information that in combination could facilitate the screening, identification and follow-up of cardiovascularly vulnerable patients in research settings. The recent developments imply that in the near future MR techniques will be part of clinical protocols for individual diagnostics in atherothrombosis.
Collapse
Affiliation(s)
- Mika Ala-Korpela
- Laboratory of Computational Engineering, Systems Biology and Bioinformation Technology, Helsinki University of Technology, Finland.
| | | | | |
Collapse
|
45
|
Hakala T, Berg L, Berg E, Makinen K, Sipola P. Repair of right ventricular free wall defect with a de-epithelized pedicled myocutaneous latissimus dorsi muscle flap. Ann Thorac Surg 2005; 80:2360-2. [PMID: 16305912 DOI: 10.1016/j.athoracsur.2004.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 05/16/2004] [Revised: 07/05/2004] [Accepted: 07/09/2004] [Indexed: 11/25/2022]
Abstract
Rupture of the right ventricle may occur because of sternal dehiscence or mediastinitis after cardiac surgery. Direct suture, polytetrafluoroethylene patch, fasciae, and muscle flaps have been used to close a right ventricular rupture. A unique occurrence of repair of a full-thickness right ventricle defect with a de-epithelized myocutaneous flap is presented. Our patient experienced a rupture of the right ventricle complicating sternal wound infection. The rupture was reconstructed with a polytetrafluoroethylene patch, but the patch needed to be removed because of infection. The defect was reconstructed with a de-epithelized myocutaneous latissimus dorsi flap. The patient indicated no signs of complication during follow-up.
Collapse
Affiliation(s)
- Tapio Hakala
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | |
Collapse
|
46
|
Kuittinen T, Husso-Saastamoinen M, Sipola P, Vuolteenaho O, Ala-Kopsala M, Nousiainen T, Jantunen E, Hartikainen J. Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation. Bone Marrow Transplant 2005; 36:1077-82. [PMID: 16247436 DOI: 10.1038/sj.bmt.1705175] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiotoxicity is potentially the most threatening nonhaematological side effect of high-dose CY. We prospectively evaluated the very acute cardiac effects of high-dose CY in 17 adult non-Hodgkin's lymphoma (NHL) patients receiving CY 1500 mg/m2/day as a part of BEAC high-dose therapy (HDT). Magnetic resonance imaging (MRI) and plasma natriuretic peptide (NT-proBNP, NT-proANP) measurements were performed prior to HDT (d-7) and just after completing HDT (d-2). After the high-dose CY left atrial end-systolic area increased from 15.2+/-1.2 to 18.5+/-1.4 cm2 (P=0.001), left ventricular end-diastolic volume from 136.1+/-12.3 to 156.6+/-11.1 cm3 (P=0.04) and left ventricular end-systolic volume from 67.4+/-7.8 to 75.3+/-7.1 cm3 (P=0.018). However, no significant change in left ventricular ejection fraction (LVEF) was observed. At the same time, plasma levels of NT-proBNP increased from 134.9+/-53.3 to 547.1+/-168.4 pmol/l (P=0.003) and NT-proANP from 481.1+/-105.5 to 1056.6+/-193.1 pmol/l (P=0.001), respectively. To conclude, high-dose CY results in very acute cardiac toxicity characterised by enlargement of the heart chambers in NHL patients previously treated with anthracyclines. This toxicity can be detected with increased concentrations of circulating natriuretic peptides but not with LVEF measurement.
Collapse
Affiliation(s)
- T Kuittinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Sipola P, Lauerma K, Jääskeläinen P, Laakso M, Peuhkurinen K, Manninen H, Aronen HJ, Kuusisto J. Cine MR Imaging of Myocardial Contractile Impairment in Patients with Hypertrophic Cardiomyopathy Attributable to Asp175Asn Mutation in the α-Tropomyosin Gene. Radiology 2005; 236:815-24. [PMID: 16014439 DOI: 10.1148/radiol.2363041165] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To prospectively investigate the relationship between myocardial contractile impairment and left ventricular (LV) hypertrophy measured at cardiac magnetic resonance (MR) imaging in patients with hypertrophic cardiomyopathy (HCM) caused by the substitution of aspartic acid 175 with asparagine (ie, Asp175Asn mutation) in the alpha-tropomyosin gene (TPM1). MATERIALS AND METHODS The study protocol was approved by the hospital ethics committee, and all subjects gave written informed consent. LV mass, maximal LV wall thickness, and myocardial fractional thickening during systole were measured at cine MR imaging in 24 subjects (11 male, 13 female; mean age, 42 years; age range, 17-68 years) with the Asp175Asn mutation in TPM1 and in 17 healthy volunteers (eight men, nine women; mean age, 38 years; age range, 23-60 years). The proportion of hypokinetic LV segments was calculated as the number of LV segments with fractional thickening of less than 30% divided by the total number of segments measured. Anthropometric and biochemical correlates of LV hypertrophy were determined. Univariate and multiple linear regression analyses were used to investigate the association of the proportion of hypokinetic segments and other correlates of LV hypertrophy with LV mass and maximal wall thickness. RESULTS The proportion of hypokinetic segments was higher in patients with HCM than in control subjects (37% +/- 20 [standard deviation] vs 12% +/- 12, P < .001). In stepwise multiple regression analysis, the proportion of hypokinetic segments accounted for 42% (P < .001); the LV end-diastolic volume, for 24% (P = .003); and male sex, for 10% (P = .014) of the variability in LV mass in patients with HCM. The proportion of hypokinetic LV segments, which accounted for 48% of the variability in LV maximal wall thickness (P < .001), was the only variable significantly associated with maximal wall thickness. CONCLUSION The extent of myocardial contractile impairment is strongly and independently related to LV mass and maximal wall thickness in patients with HCM attributable to the Asp175Asn mutation in TPM1.
Collapse
Affiliation(s)
- Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio FIN-70210, Finland
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Berg M, Zhang Z, Ikonen A, Sipola P, Kälviäinen R, Manninen H, Vanninen R. Multi-detector row CT angiography in the assessment of carotid artery disease in symptomatic patients: comparison with rotational angiography and digital subtraction angiography. AJNR Am J Neuroradiol 2005; 26:1022-34. [PMID: 15891155 PMCID: PMC8158636] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND PURPOSE Compared with the single-detector technique, multi-detector row CT angiography permits larger anatomic coverage that includes both the epiaortic and entire carotid circulations. We evaluated the accuracy of multi-detector row CT angiography by using multiplanar reformation (MPR) for measuring carotid artery diameters compared with that of rotational angiography. We also evaluated the diagnostic performance of CT angiography compared with digital subtraction angiography (DSA). METHODS In 35 patients, CT angiograms of 70 carotid arteries were compared with DSA images, and CT angiograms of 33 carotid arteries were compared with rotational angiograms. CT angiographic interpretation was performed first interactively at a workstation. Diameter measurements of normal and stenosed carotid arteries were performed on cross-sectional and oblique sagittal MPRs. Degree of stenosis was calculated per North American Symptomatic Carotid Endarterectomy Trial criteria independently by two observers for each technique. RESULTS Degree of stenosis was slightly underestimated with CT angiography, with mean differences (+/- SD) per observer of 6.9 +/- 17.6% and 10.7 +/- 16.1% for cross-sectional and 2.8 +/- 19.2% and 9.1 +/- 16.8% for oblique sagittal MPRs compared with rotational angiography. CT angiography was somewhat inaccurate for measuring the absolute minimal diameter of high-grade stenoses. On symptomatic sides (n = 35), interactive CT angiographic interpretation combined with MPR measurements for lesions with a visual estimate of 50% or greater stenosis achieved a sensitivity of 95% (20/21) and specificity of 93% (13/14) in the detection of carotid stenosis (>/= 50%) verified with DSA. CONCLUSION Regardless of slight underestimation of carotid stenosis with CT angiography compared with rotational angiography, diagnostic performance of CT angiography with interactive interpretation proved to be good. Also, the method is highly sensitive for detection of carotid artery stenosis, indicating the suitability of CT angiography as a screening method for symptomatic patients. For hemodynamically significant stenoses revealed by CT angiographic screening, conventional angiography still seems to be necessary.
Collapse
Affiliation(s)
- Marja Berg
- Department of Clinical Radiology, Kuopio University Hospital, Finland
| | | | | | | | | | | | | |
Collapse
|
49
|
Knuuti J, Sipola P. Is it time for cardiac innervation imaging? Q J Nucl Med Mol Imaging 2005; 49:97-105. [PMID: 15724139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The autonomic nervous system plays an important role in the regulation of cardiac function and the regional distribution of cardiac nerve terminals can be visualized using scintigraphic techniques. The most commonly used tracer is iodine-123-metaiodobenzylguanidine (MIBG) but C-11-hydroxyephedrine has also been used with PET. When imaging with MIBG, the ratio of heart-to-mediastinal counts is used as an index of tracer uptake, and regional distribution is also assessed from tomographic images. The rate of clearance of the tracer can also be measured and indicates the function of the adrenergic system. Innervation imaging has been applied in patients with susceptibility to arrhythmias, coronary artery disease, hypertrophic and dilated cardiomyopathy and anthracycline induced cardiotoxicity. Abnormal adrenergic innervation or function appear to exist in many pathophysiological conditions indicating that sympathetic neurons are very susceptible to damage. Abnormal findings in innervation imaging also appear to have significant prognostic value especially in patients with cardiomyopathy. Recently, it has also been shown that innervation imaging can monitor drug-induced changes in cardiac adrenergic activity. Although innervation imaging holds great promise for clinical use, the method has not received wider clinical acceptance. Larger randomized studies are required to confirm the value of innervation imaging in various specific indications.
Collapse
Affiliation(s)
- J Knuuti
- Turku PET Centre, PO Box 52, University of Turku, FI-20521 Turku, Finland.
| | | |
Collapse
|
50
|
Halinen M, Jäkälä P, Sipola P, Tapiola T, Mustonen P, Kokkonen J. [Cardiogenic brain embolism]. Duodecim 2005; 121:1961-8. [PMID: 16300310] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|