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Santens B, Van De Bruaene A, De Meester P, Gewillig M, Troost E, Claus P, Bogaert J, Budts W. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol 2020; 316:94-100. [PMID: 32348813 DOI: 10.1016/j.ijcard.2020.04.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 04/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Arterial switch operation (ASO) is today the first-choice surgical treatment for patients with transposition of the great arteries. Long-term outcome data still remain scarce. Moreover, the course of these patients is not uneventful. Therefore, we wanted to evaluate long-term outcome and determine on which variables to focus during follow-up. METHODS Clinical records of 318 patients who underwent ASO between October 1981 and July 2018 were reviewed. Perioperative, post-operative, and interventional data were collected to determine mortality and the need for re-intervention. Descriptive statistics and Kaplan-Meier survival analysis were performed. RESULTS Mean follow-up time was 11.1 SD 8.5 years (range 0-35) with a mean age of 12.5 SD 9.0 years (range 0-37) at latest follow-up. In-hospital mortality was 7.5% and overall survival 90.9% for a maximum follow-up time of 35 years. Causes of early mortality were cardiogenic shock, severe pulmonary hypertension, septic shock and multiple organ failure. Causes of late mortality were cardiogenic shock, severe pulmonary hypertension, pacemaker lead fracture and fire death. Re-intervention free survival at 5-year was 91.6%, at 10-year 90.7%, at 20-year 79.2%. For all survivors, the most frequent sequelae after ASO were pulmonary artery stenosis (80.9%), of which 13.5% needed an intervention. The threshold for intervening on lesions at the level of the pulmonary artery bifurcation was higher and the percutaneous re-intervention rate was higher for non-bifurcation lesions. CONCLUSIONS Despite a relatively high peri-operative mortality, TGA patients have an excellent overall long-term survival. However, a large proportion of patients requires re-interventions, mainly for pulmonary artery stenosis.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.
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Pierpaolo P, Rolf S, Manuel BP, Davide C, Dresselaers T, Claus P, Bogaert J. Left ventricular global myocardial strain assessment: Are CMR feature-tracking algorithms useful in the clinical setting? Radiol Med 2020; 125:444-450. [PMID: 32125636 DOI: 10.1007/s11547-020-01159-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/19/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Myocardial strains can be calculated using cardiovascular magnetic resonance (CMR) feature-tracking (FT) algorithms. They show excellent intra- and inter-observer agreement but rather disappointing inter-vendor agreement. Currently, it is unknown how well CMR-FT-based strain values agree with manually obtained strain values. METHODS In 45 subjects (15 controls, 15 acute myocardial infarction, 15 non-ischemic dilated cardiomyopathy), end-systolic manually derived strains were compared to four CMR-FT software packages. Global radial strain (GRS), global circumferential strain (GCS) and global longitudinal strain (GLS) were determined. Intra- and inter-observer agreement and agreement between manual and CMR-FT analysis were calculated. Statistical analysis included Bland-Altman plots, intra-class correlation coefficient (ICC) and coefficient of variation (CV). RESULTS Manual contouring yielded excellent intra-observer (ICC 0.903 (GRS) to 0.995 (GCS)) and inter-observer agreement (ICC 0.915 (GRS) to 0.966 (GCS)) with CV ranging 4.7% (GCS) to 20.7% (GRS) and 12.7% (GCS) to 20.0% (GRS), for intra-observer and inter-observer agreement, respectively. Agreement between manual and CMR-FT strain values ranged from poor to excellent, with best agreement for GCS (ICC 0.857-0.935) and intermediate for GLS (ICC 0.591-0.914), while ICC values for GRS ranged widely (ICC 0.271-0.851). In particular, two software packages showed a strong trend toward systematic underestimation of myocardial strain in radial and longitudinal direction, correlating poorly to moderately with manual contouring, i.e., GRS (ICC 0.271, CV 25.2%) and GLS (ICC 0.591, CV 17.6%). CONCLUSION Some CMR-FT values agree poorly with manually derived strains, emphasizing to be cautious to use these software packages in the clinical setting. In particular, radial and longitudinal strain tends to be underestimated when using manually derived strains as reference.
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Affiliation(s)
- Palumbo Pierpaolo
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Symons Rolf
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Barreiro-Pérez Manuel
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, y CIBERCV, Salamanca, Spain
| | - Curione Davide
- Department of Radiology, Ospedale Bambin Jésu, Vatican City, Italy
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Piet Claus
- Lab on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, Louvain, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Mirea O, Vallecilla C, Claus P, Rademakers F, D’hooge J. Experimental validation of the prestretch-strain relationship as a non-invasive index of left ventricular myocardial contractility. PLoS One 2020; 15:e0228027. [PMID: 32101554 PMCID: PMC7043779 DOI: 10.1371/journal.pone.0228027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background The slope of the relationship between segmental PreS and total systolic shortening (S) has been proposed as a non-invasive index of left ventricular contractility. The aim of this study was to correlate this novel parameter to invasive gold standard measurements of contractility and to investigate how it is influenced by afterload. Methods In domestic pigs, afterload was increased by either balloon inflation in the aorta or by administration of phenylephrine while contractility was increased by dobutamine infusion. During all interventions, left ventricular pressure-volume measurements and trans-diaphragmatic two-dimensional echocardiographic images were acquired. The PreS-S slope was constructed from 18 segmental strain curves obtained by speckle tracking analysis and compared to the slope of the end systolic PV relationship (Emax) and the pre-load recruitable stroke work (PRSW). Results Sixteen datasets of increased contractility and afterload were analyzed. During dobutamine infusion, the LV volumes decreased (p<0.05) while ejection fraction increased (p<0.05). Emax, PRSW and the slope of the intra-ventricular PreS-S relation increased significantly during dobutamine infusion. Afterload increase led to increase in systolic blood pressure (105±16mmHg vs. 138±25mmHg; p<0.01) and decrease of LV stroke volume and ejection fraction (p<0.01). The PreS-S slope was not influenced by loading conditions in concordance with the PRSW findings. The absolute values of the PreS-S slope did not correlate with Emax or PRSW. However, the change of the PreS-S slope in relation with different interventions demonstrated good correlation with changes in PRSW or Emax, (r = 0.66, p<0.05 and r = 0.69, p<0.05). Conclusions The slope of the PreS-S relationship is sensitive to changes in inotropy and is less load-dependent than conventional non-invasive parameters of left ventricular function. The magnitude of the change of this slope correlates well with changes in invasive contractility measurements making it an attractive parameter to assess contractile reserve or contractile changes during longitudinal follow-up of patients.
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Affiliation(s)
- Oana Mirea
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- * E-mail:
| | - Carolina Vallecilla
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Frank Rademakers
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
| | - Jan D’hooge
- Department of Cardiovascular Imaging and Dynamics, University of Leuven (KU Leuven), Leuven, Belgium
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Dries E, Amoni M, Vandenberk B, Johnson DM, Gilbert G, Nagaraju CK, Puertas RD, Abdesselem M, Santiago DJ, Roderick HL, Claus P, Willems R, Sipido KR. Altered adrenergic response in myocytes bordering a chronic myocardial infarction underlies in vivo triggered activity and repolarization instability. J Physiol 2020; 598:2875-2895. [PMID: 31900932 PMCID: PMC7496440 DOI: 10.1113/jp278839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/01/2020] [Indexed: 01/24/2023] Open
Abstract
Key points Ventricular arrhythmias are a major complication after myocardial infarction (MI), associated with sympathetic activation. The structurally heterogeneous peri‐infarct zone is a known substrate, but the functional role of the myocytes is less well known. Recordings of monophasic action potentials in vivo reveal that the peri‐infarct zone is a source of delayed afterdepolarizations (DADs) and has a high beat‐to‐beat variability of repolarization (BVR) during adrenergic stimulation (isoproterenol, ISO). Myocytes isolated from the peri‐infarct region have more DADs and spontaneous action potentials, with spontaneous Ca2+ release, under ISO. These myocytes also have reduced repolarization reserve and increased BVR. Other properties of post‐MI remodelling are present in both peri‐infarct and remote myocytes. These data highlight the importance of altered myocyte adrenergic responses in the peri‐infarct region as source and substrate of post‐MI arrhythmias.
Abstract Ventricular arrhythmias are a major early complication after myocardial infarction (MI). The heterogeneous peri‐infarct zone forms a substrate for re‐entry while arrhythmia initiation is often associated with sympathetic activation. We studied the mechanisms triggering these post‐MI arrhythmias in vivo and their relation to regional myocyte remodelling. In pigs with chronic MI (6 weeks), in vivo monophasic action potentials were simultaneously recorded in the peri‐infarct and remote regions during adrenergic stimulation with isoproterenol (isoprenaline; ISO). Sham animals served as controls. During infusion of ISO in vivo, the incidence of delayed afterdepolarizations (DADs) and beat‐to‐beat variability of repolarization (BVR) was higher in the peri‐infarct than in the remote region. Myocytes isolated from the peri‐infarct region, in comparison to myocytes from the remote region, had more DADs, associated with spontaneous Ca2+ release, and a higher incidence of spontaneous action potentials (APs) when exposed to ISO (9.99 ± 4.2 vs. 0.16 ± 0.05 APs/min, p = 0.004); these were suppressed by CaMKII inhibition. Peri‐infarct myocytes also had reduced repolarization reserve and increased BVR (26 ± 10 ms vs. 9 ± 7 ms, P < 0.001), correlating with DAD activity. In contrast to these regional distinctions under ISO, alterations in Ca2+ handling at baseline and myocyte hypertrophy were present throughout the left ventricle (LV). Expression of some of the related genes was, however, different between the regions. In conclusion, altered myocyte adrenergic responses in the peri‐infarct but not the remote region provide a source of triggered activity in vivo and of repolarization instability amplifying the substrate for re‐entry. These findings stimulate further exploration of region‐specific therapies targeting myocytes and autonomic modulation. Ventricular arrhythmias are a major complication after myocardial infarction (MI), associated with sympathetic activation. The structurally heterogeneous peri‐infarct zone is a known substrate, but the functional role of the myocytes is less well known. Recordings of monophasic action potentials in vivo reveal that the peri‐infarct zone is a source of delayed afterdepolarizations (DADs) and has a high beat‐to‐beat variability of repolarization (BVR) during adrenergic stimulation (isoproterenol, ISO). Myocytes isolated from the peri‐infarct region have more DADs and spontaneous action potentials, with spontaneous Ca2+ release, under ISO. These myocytes also have reduced repolarization reserve and increased BVR. Other properties of post‐MI remodelling are present in both peri‐infarct and remote myocytes. These data highlight the importance of altered myocyte adrenergic responses in the peri‐infarct region as source and substrate of post‐MI arrhythmias.
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Affiliation(s)
- Eef Dries
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Matthew Amoni
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Bert Vandenberk
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Daniel M Johnson
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium.,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Guillaume Gilbert
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Chandan K Nagaraju
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Rosa Doñate Puertas
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Mouna Abdesselem
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Demetrio J Santiago
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium.,Laboratory of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), C. Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - H Llewelyn Roderick
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Piet Claus
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Rik Willems
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
| | - Karin R Sipido
- Experimental Cardiology, University of Leuven, Herestraat 49 box 911, Leuven, Belgium
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Turco A, Nuyts J, Duchenne J, Gheysens O, Voigt JU, Claus P, Vunckx K. Analysis of partial volume correction on quantification and regional heterogeneity in cardiac PET. J Nucl Cardiol 2020; 27:62-70. [PMID: 28233192 DOI: 10.1007/s12350-016-0773-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The partial volume correction (PVC) of cardiac PET datasets using anatomical side information during reconstruction is appealing but not straightforward. Other techniques, which do not make use of additional anatomical information, could be equally effective in improving the reconstructed myocardial activity. METHODS Resolution modeling in combination with different noise suppressing priors was evaluated as a means to perform PVC. Anatomical priors based on a high-resolution CT are compared to non-anatomical, edge-preserving priors (relative difference and total variation prior). The study is conducted on ex vivo datasets from ovine hearts. A simulation study additionally clarifies the relationship between prior effectiveness and myocardial wall thickness. RESULTS Simple resolution modeling during data reconstruction resulted in over- and underestimation of activity, which hampers the absolute left ventricular quantification when compared to the ground truth. Both the edge-preserving and the anatomy-based PVC techniques improve the absolute quantification, with comparable results (Student t-test, P = .17). The relative tracer distribution was preserved with any reconstruction technique (repeated ANOVA, P = .98). CONCLUSIONS The use of edge-preserving priors emerged as optimal choice for quantification of tracer uptake in the left ventricular wall of the available datasets. Anatomical priors visually outperformed edge-preserving priors when the thinnest structures were of interest.
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Affiliation(s)
- A Turco
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
| | - J Nuyts
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - J Duchenne
- Department of Cardiovascular Sciences, Cardiology, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - O Gheysens
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
- Department of Nuclear Medicine, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - J U Voigt
- Department of Cardiovascular Sciences, Cardiology, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - P Claus
- Department of Cardiovascular Sciences, Cardiology, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - K Vunckx
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, B-3000, Leuven, Belgium
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Degtiarova G, Claus P, Duchenne J, Cvijic M, Schramm G, Nuyts J, Voigt JU, Gheysens O. Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates. EJNMMI Res 2019; 9:105. [PMID: 31820130 PMCID: PMC6901655 DOI: 10.1186/s13550-019-0575-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background In order to better understand the concept of mechanical dyssynchrony, a promising hallmark of cardiac resynchronization therapy (CRT) response, we investigated its effect on regional myocardial metabolism and myocardial blood flow (MBF) in non-ischemic CRT candidates. Results Thirty consecutive non-ischemic CRT eligible patients underwent static 18F-FDG and resting dynamic 13N-NH3 PET/CT. 18F-FDG uptake and MBF for septal and lateral wall were analysed and septal-to-lateral wall ratios (SLR) were calculated. Based on the presence of mechanical dyssynchrony (septal flash and/or apical rocking) on echocardiography, patients were divided into 2 groups, with (n = 23) and without (n = 7) mechanical dyssynchrony. Patients with mechanical dyssynchrony had significantly lower 18F-FDG SUVmean in the septum compared with the lateral wall (5.58 ± 2.65 vs 11.19 ± 4.10, p < 0.0001), while patients without mechanical dyssynchrony had a more homogeneous 18F-FDG distribution (7.33 ± 2.88 vs 8.31 ± 2.50, respectively, p = 0.30). Similarly, MBF was significantly different between the septal and lateral wall in the dyssynchrony group (0.57 ± 0.11 ml/g/min vs 0.92 ± 0.23 ml/g/min, respectively, p < 0.0001), whereas no difference was observed in the non-dyssynchrony group (0.61 ± 0.23 ml/g/min vs 0.77 ± 0.21 ml/g/min, respectively, p = 0.16). 18F-FDG SLR, but not MBF SLR, was associated with the presence of mechanical dyssynchrony and showed a significant inverse correlation with volumetric reverse remodeling after CRT (r = − 0.62, p = 0.001). Conclusions Non-ischemic heart failure patients with mechanical dyssynchrony demonstrate heterogeneous regional metabolism and MBF compared with patients without dyssynchrony. However, only 18F-FDG SLR appeared to be highly associated with the presence of mechanical dyssynchrony. Trial registration Clinicaltrials, NCT02537782. Registered 2 September 2015.
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Affiliation(s)
- Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Georg Schramm
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. .,Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium.
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Turco A, Gheysens O, Duchenne J, Nuyts J, Rega F, Voigt JU, Vunckx K, Claus P. Partial volume and motion correction in cardiac PET: First results from an in vs ex vivo comparison using animal datasets. J Nucl Cardiol 2019; 26:2034-2044. [PMID: 30644052 DOI: 10.1007/s12350-018-01581-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In a previous study on ex vivo, static cardiac datasets, we investigated the benefits of performing partial volume correction (PVC) in cardiac 18F-Fluorodeoxyglucose(FDG) PET datasets. In the present study, we extend the analysis to in vivo cardiac datasets, with the aim of defining which reconstruction technique maximizes quantitative accuracy and, ultimately, makes PET a better diagnostic tool for cardiac pathologies. METHODS In vivo sheep datasets were acquired and reconstructed with/without motion correction and using several reconstruction algorithms (with/without resolution modeling, with/without non-anatomical priors). Corresponding ex vivo scans of the excised sheep hearts were performed on a small-animal PET scanner (Siemens Focus 220, microPET) to provide high-resolution reference data unaffected by respiratory and cardiac motion. A comparison between the in vivo cardiac reconstructions and the corresponding ex vivo ground truth was performed. RESULTS The use of an edge-preserving prior (Total Variation (TV) prior in this work) in combination with motion correction reduces the bias in absolute quantification when compared to the standard clinical reconstructions (- 0.83 vs - 3.74 SUV units), when the end-systolic gate is considered. At end-diastole, motion correction improves absolute quantification but the PVC with priors does not improve the similarity to the ground truth more than a regular iterative reconstruction with motion correction and without priors. Relative quantification was not influenced much by the chosen reconstruction algorithm. CONCLUSIONS The relative ranking of the algorithms suggests superiority of the PVC reconstructions with dual gating in terms of overall absolute quantification and noise properties. A well-tuned edge-preserving prior, such as TV, enhances the noise properties of the resulting images of the heart. The end-systolic gate yields the most accurate quantification of cardiac datasets.
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Affiliation(s)
- A Turco
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Cardiovascular Sciences, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - O Gheysens
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Nuclear Medicine, University Hospitals Leuven, 3000, Leuven, Belgium
| | - J Duchenne
- Department of Cardiovascular Sciences, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - J Nuyts
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - F Rega
- Department of Cardiovascular Sciences, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, 3000, Leuven, Belgium
| | - J U Voigt
- Department of Cardiovascular Sciences, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, 3000, Leuven, Belgium
| | - K Vunckx
- Department of Imaging and Pathology, Nuclear Medicine and Molecular imaging, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - P Claus
- Department of Cardiovascular Sciences, Medical Imaging Research Center (MIRC), KU Leuven - University of Leuven, 3000, Leuven, Belgium.
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Janssens SP, Bogaert J, Zalewski J, Toth A, Adriaenssens T, Belmans A, Bennett J, Claus P, Desmet W, Dubois C, Goetschalckx K, Sinnaeve P, Vandenberghe K, Vermeersch P, Lux A, Szelid Z, Durak M, Lech P, Zmudka K, Pokreisz P, Vranckx P, Merkely B, Bloch KD, Van de Werf F. Nitric oxide for inhalation in ST-elevation myocardial infarction (NOMI): a multicentre, double-blind, randomized controlled trial. Eur Heart J 2019; 39:2717-2725. [PMID: 29800130 DOI: 10.1093/eurheartj/ehy232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/16/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Inhalation of nitric oxide (iNO) during myocardial ischaemia and after reperfusion confers cardioprotection in preclinical studies via enhanced cyclic guanosine monophosphate (cGMP) signalling. We tested whether iNO reduces reperfusion injury in patients with ST-elevation myocardial infarction (STEMI; NCT01398384). Methods and results We randomized in a double-blind, placebo-controlled study 250 STEMI patients to inhale oxygen with (iNO) or without (CON) 80 parts-per-million NO for 4 h following percutaneous revascularization. Primary efficacy endpoint was infarct size as a fraction of left ventricular (LV) size (IS/LVmass), assessed by delayed enhancement contrast magnetic resonance imaging (MRI). Pre-specified subgroup analysis included thrombolysis-in-myocardial-infarction flow in the infarct-related artery, troponin T levels on admission, duration of symptoms, location of culprit lesion, and intra-arterial nitroglycerine (NTG) use. Secondary efficacy endpoints included IS relative to risk area (IS/AAR), myocardial salvage index, LV functional recovery, and clinical events at 4 and 12 months. In the overall population, IS/LVmass at 48-72 h was 18.0 ± 13.4% in iNO (n = 109) and 19.4 ± 15.4% in CON [n = 116, effect size -1.524%, 95% confidence interval (95% CI) -5.28, 2.24; P = 0.427]. Subgroup analysis indicated consistency across clinical confounders of IS but significant treatment interaction with NTG (P = 0.0093) resulting in smaller IS/LVmass after iNO in NTG-naïve patients (n = 140, P < 0.05). The secondary endpoint IS/AAR was 53 ± 26% with iNO vs. 60 ± 26% in CON (effect size -6.8%, 95% CI -14.8, 1.3, P = 0.09) corresponding to a myocardial salvage index of 47 ± 26% vs. 40 ± 26%, respectively, P = 0.09. Cine-MRI showed similar LV volumes at 48-72 h, with a tendency towards smaller increases in end-systolic and end-diastolic volumes at 4 months in iNO (P = 0.048 and P = 0.06, respectively, n = 197). Inhalation of nitric oxide was safe and significantly increased cGMP plasma levels during 4 h reperfusion. The Kaplan-Meier analysis for the composite of death, recurrent ischaemia, stroke, or rehospitalizations showed a tendency toward lower event rates with iNO at 4 months and 1 year (log-rank test P = 0.10 and P = 0.06, respectively). Conclusions Inhalation of NO at 80 ppm for 4 h in STEMI was safe but did not reduce infarct size relative to absolute LVmass at 48-72h. The observed functional recovery and clinical event rates at follow-up and possible interaction with nitroglycerine warrant further studies of iNO in STEMI.
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Affiliation(s)
- Stefan P Janssens
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Division of Radiology, University Hospitals Leuven and Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jaroslaw Zalewski
- Department of Coronary Heart Disease, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Tom Adriaenssens
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ann Belmans
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Johan Bennett
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Walter Desmet
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Christophe Dubois
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium
| | - Peter Sinnaeve
- The Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, Leuven, Belgium.,The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Pieter Vermeersch
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Arpad Lux
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Monika Durak
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Piotr Lech
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Krzysztof Zmudka
- Department of Interventional Cardiology, Jagiellonian University, Medical College, John Paul II Hospital, Pradnicka 80, Krakow, Poland
| | - Peter Pokreisz
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Pascal Vranckx
- Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor u. 68, Budapest, Hungary
| | - Kenneth D Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine, and Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Fruit street 55, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - Frans Van de Werf
- The Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Dries E, Santiago DJ, Gilbert G, Lenaerts I, Vandenberk B, Nagaraju CK, Johnson DM, Holemans P, Roderick HL, Macquaide N, Claus P, Sipido KR. Hyperactive ryanodine receptors in human heart failure and ischaemic cardiomyopathy reside outside of couplons. Cardiovasc Res 2019; 114:1512-1524. [PMID: 29668881 PMCID: PMC6106102 DOI: 10.1093/cvr/cvy088] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 09/13/2017] [Accepted: 04/12/2018] [Indexed: 12/26/2022] Open
Abstract
Aims In ventricular myocytes from humans and large mammals, the transverse and axial tubular system (TATS) network is less extensive than in rodents with consequently a greater proportion of ryanodine receptors (RyRs) not coupled to this membrane system. TATS remodelling in heart failure (HF) and after myocardial infarction (MI) increases the fraction of non-coupled RyRs. Here we investigate whether this remodelling alters the activity of coupled and non-coupled RyR sub-populations through changes in local signalling. We study myocytes from patients with end-stage HF, compared with non-failing (non-HF), and myocytes from pigs with MI and reduced left ventricular (LV) function, compared with sham intervention (SHAM). Methods and results Single LV myocytes for functional studies were isolated according to standard protocols. Immunofluorescent staining visualized organization of TATS and RyRs. Ca2+ was measured by confocal imaging (fluo-4 as indicator) and using whole-cell patch-clamp (37°C). Spontaneous Ca2+ release events, Ca2+ sparks, as a readout for RyR activity were recorded during a 15 s period following conditioning stimulation at 2 Hz. Sparks were assigned to cell regions categorized as coupled or non-coupled sites according to a previously developed method. Human HF myocytes had more non-coupled sites and these had more spontaneous activity than in non-HF. Hyperactivity of these non-coupled RyRs was reduced by Ca2+/calmodulin-dependent kinase II (CaMKII) inhibition. Myocytes from MI pigs had similar changes compared with SHAM controls as seen in human HF myocytes. As well as by CaMKII inhibition, in MI, the increased activity of non-coupled sites was inhibited by mitochondrial reactive oxygen species (mito-ROS) scavenging. Under adrenergic stimulation, Ca2+ waves were more frequent and originated at non-coupled sites, generating larger Na+/Ca2+ exchange currents in MI than in SHAM. Inhibition of CaMKII or mito-ROS scavenging reduced spontaneous Ca2+ waves, and improved excitation–contraction coupling. Conclusions In HF and after MI, RyR microdomain re-organization enhances spontaneous Ca2+ release at non-coupled sites in a manner dependent on CaMKII activation and mito-ROS production. This specific modulation generates a substrate for arrhythmia that appears to be responsive to selective pharmacologic modulation.
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Affiliation(s)
- Eef Dries
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Demetrio J Santiago
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Guillaume Gilbert
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Ilse Lenaerts
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Chandan K Nagaraju
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Daniel M Johnson
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Patricia Holemans
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - H Llewelyn Roderick
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Niall Macquaide
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
| | - Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, Campus Gasthuisberg, Herestraat Leuven, Belgium
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60
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Helsen F, Claus P, Van De Bruaene A, Claessen G, La Gerche A, De Meester P, Claeys M, Gabriels C, Petit T, Santens B, Troost E, Voigt JU, Bogaert J, Budts W. Advanced Imaging to Phenotype Patients With a Systemic Right Ventricle. J Am Heart Assoc 2019; 7:e009185. [PMID: 30371262 PMCID: PMC6474967 DOI: 10.1161/jaha.118.009185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Reduced ventricular function and decreased exercise capacity are widespread in adults with complete transposition of the great arteries after atrial switch (TGA‐Mustard/Senning) and congenitally corrected TGA (ccTGA). Advanced imaging techniques may help to better phenotype these patients and evaluate exercise cardiac response. Methods and Results Thirty‐three adults with a systemic right ventricle (70% TGA‐Mustard/Senning, 37±9 years of age, 24% female, 94% New York Heart Association class I‐II) underwent echocardiogram, cardiopulmonary exercise testing, and cardiovascular magnetic resonance imaging at rest and during a 4‐stage free‐breathing bicycle test. They were compared with 12 healthy controls (39±10 years of age, 25% female, all New York Heart Association class I). TGA‐Mustard/Senning patients had a higher global circumferential strain (−15.8±3.6 versus −11.2±5.2%, P=0.008) when compared with ccTGA, whereas global longitudinal strain and systemic right ventricle contractility during exercise were similar in both groups. Septal extracellular volume (ECV) in ccTGA was significantly higher than in TGA‐Mustard/Senning (30.2±2.0 versus 27.1±2.7%, P=0.005). During exercise, TGA‐Mustard/Senning had a fall in end‐diastolic volume and stroke volume (11% and 8%, respectively; both P≤0.002), whereas ccTGA could increase their stroke volume in the same way as healthy controls. Because of a greater heart rate reserve in TGA‐Mustard/Senning (P for interaction=0.010), cardiac index and peak oxygen uptake were similar between both patient groups. Conclusions Caution should be exercised when evaluating pooled analyses of systemic right ventricle patients, given the differences in myocardial contraction pattern, septal extracellular volume, and the exercise response of TGA‐Mustard/Senning versus ccTGA patients. Longitudinal follow‐up will determine whether abnormal exercise cardiac response is a marker of earlier failure.
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Affiliation(s)
- Frederik Helsen
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Piet Claus
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium
| | - Alexander Van De Bruaene
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Guido Claessen
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - André La Gerche
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,3 Sports Cardiology and Cardiac Magnetic Resonance Imaging Lab Baker Heart and Diabetes Institute Melbourne Australia.,4 Department of Cardiology St Vincent's Hospital Melbourne Australia
| | - Pieter De Meester
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Mathias Claeys
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Charlien Gabriels
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Thibault Petit
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Béatrice Santens
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Els Troost
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Jens-Uwe Voigt
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Jan Bogaert
- 5 Department of Imaging & Pathology KU Leuven-University of Leuven Belgium.,6 Department of Radiology University Hospitals Leuven Belgium
| | - Werner Budts
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
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61
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Duchenne J, Cvijic M, Turco A, Unlu S, Pagourelias ED, Bezy S, Vunckx K, Nuyts J, Claus P, Gheysens O, Rega F, Voigt JU. P619Stress-strain loop area better represents regional myocardial work than pressure-strain loop area in the dyssynchronous and remodelled left ventricle. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pressure-strain-loops (PSL) have been suggested as surrogate parameter of regional myocardial work. However, in left ventricles (LV) with inhomogeneous remodelling, e.g. due to left bundle branch block (LBBB), wall stress may be unevenly distributed. Stress-strain loops (SSL) include information on both regional wall thickness and curvature, and may therefore provide a better surrogate.
Study plan
We therefore compared the correlation of segmental myocardial work estimated through both PSL and SSL to segmental myocardial glucose metabolism as a gold standard, in an animal model of pacing-induced LV remodelling.
Methods
Twelve sheep developed LV dilatation, thinned septum and thickened lateral wall, due to eight weeks of rapid right-atrial and right-ventricular free wall (DDD) pacing (at 180 bpm), causing a LBBB-like dyssynchrony. Invasive LV pressure and echocardiographic speckle tracking based circumferential strain were used to construct PSL. SSL were calculated by considering in addition dynamic changes in segmental myocardial wall thickness and curvature using the formula of Laplace. 18F-fluorodeoxyglucose (FDG)-uptake was measured by positron emission tomography (PET) in absolute values as standardised uptake ratio (SUR). Spatial resolution of PET was improved by ECG- and breathing-gating and using anatomical priors. All imaging was performed during dyssynchronous DDD-pacing and synchronous AAI-pacing (right-atrial pacing only), at baseline (n=3 animals), and after eight weeks of pacing induced remodelling (n=12 animals).
Results
Both at baseline (Fig. A+B) and after 8 weeks (Fig. D+E), switching between AAI and DDD-pacing caused an acute re-distribution of regional myocardial work as measured by both PSL and SSL. In contrast to PSL, however, SSL identified more regional differences among walls in remodelled hearts and showed clearer regional changes when switching between AAI and DDD-pacing. The correlation between regional work, assessed by PSL and SSL, and metabolism by PET, was comparable at baseline (r=0.65 and r=0.64, respectively) (Fig. C). In remodelled hearts after 8 weeks, however, the correlation of regional work assessed by SSL and glucose uptake by PET was significantly higher compared to PSL (r=0.73 vs. r=0.59, respectively; p<0.05) (Fig. F).
Conclusions
Regional myocardial work assessed by stress-strain loops correlates significantly better to regional metabolism as measured by PET glucose uptake, particularly after remodelling. Our findings therefore suggest that integrating information on wall thickness and curvature is essential for the reliable assessment of regional myocardial work, especially in dyssynchronous and remodelled left ventricles.
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Affiliation(s)
- J Duchenne
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - M Cvijic
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - A Turco
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - S Unlu
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | | | - S Bezy
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - K Vunckx
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - J Nuyts
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - O Gheysens
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - F Rega
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - J U Voigt
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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Popevska S, Fraser A, Rademakers F, D'hooge J, Rega F, Claus P. P1609Adverse left ventricular remodeling in descending thoracic vs ascending aorta banding in novel porcin model. cMRI study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0368] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Based on differences in the timing of left ventricular (LV) peak systolic pressure, distinction between early from late LV systolic loading is made. Reduced ascending aortic compliance results with chronic early LV systolic loading. Chronic late LV systolic loading associates with end-systolic wave refection's and developing earlier heart failure. The LV remodeling in chronic late vs early systolic loading has not been studied previously in a porcine model.
Objective
To develop novel porcin model and to study the LV hypertrophic remodeling in chronic late vs early LV systolic loading, during thoracic aorta banding.
Methods
Domestic male pigs (28±3.4kg, n=14) underwent thoracic aorta banding. Ascending aorta banding (PB, n=6) induced chronic early LV systolic loading. Descending thoracic aorta banding (DB n=8) provoked chronic late LV systolic loading. 3T cMRI with T1 mapping was performed at baseline, 4 and 8 weeks. Hemodynamic measurements were obtained using 5Fr Millar P-V catheter in LabChart, after 4 and 8 weeks. ANOVA two-way for repeated measurements was performed (R studio 3.5.1). Leven and Shapiro-Wilk normality testing was done. Analysis of variance of aligned rank transformed data was performed. Linear regression showed correlation between relevant parameters.
Results
Hemodynamic measurements are presented as means±se and means±sd for cMRI, for significant p<0.05. After 8 weeks of thoracic aorta banding, the timing of peak systolic LV pressure was prolonged in DB (PB 159±6 msec; DB 329±16 msec; p<0.01), correlating with LV dPdtmax (p=0.017, r=−0.8), Ea (p=0.04, r=0.73), LVEF (p=0.035, r=−0.74) and native T1 (p=0.01, r=−0.83) in DB. Tau was not different (p=0.8), correlated with the timing of peak LV pressure in DB (p=0.015, r=0.81). The gradients were not different (PB 25±5mmHg; DB 16±1mmHg; p=0.88) and LV systolic pressure (p=0.61). The isovolumic contraction phase was prolonged in DB (PB 34±4msec; DB 56±4msec, p<0.01). LV mass index increased (p=0.013) and was not different between the groups (PB 95±14g/m2; DB 89±12g/m2; p=0.89). RWT was different within (p<0.01) and between the groups (p=0.02),correlating with LVEFas dPdtmax (p=0.013, r=−0.82), whilst with dPdtmin (p=0.018, r=0.8) in DB. There was an interaction for site of aortic constriction and LV remodeling (RWT 0.067±0.08 in PB; 0.45±0.04 in DB, p=0.004; posterior LV wall thickness (PWT) p=0.012). RWT correlated with native T1 in PB (p=0.04) and DB (p<0.01, r=−0.8).
Des. aorta banding in late LV loadining
Conclusion
The LV hypertrophic remodeling, defined by RWT, PWT and hemodynamic correlates is different between chronic late and early LV systolic loading, in this novel porcine model. The timing of peak LV afterload associates with increased LV afterload and adverse LV remodeling in presence of chronic late LV systolic loading, in the porcin model of descending thoracic aorta banding. Increased RWT ratio associates with adverse LV remodeling in the porcine model of descending thoracic aortic constriction.
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Affiliation(s)
| | | | | | | | - F Rega
- KU Leuven, Leuven, Belgium
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Fernández-Avilés F, Sanz-Ruiz R, Bogaert J, Casado Plasencia A, Gilaberte I, Belmans A, Fernández-Santos ME, Charron D, Mulet M, Yotti R, Palacios I, Luque M, Sádaba R, San Román JA, Larman M, Sánchez PL, Sanchís J, Jiménez MF, Claus P, Al-Daccak R, Lombardo E, Abad JL, DelaRosa O, Corcóstegui L, Bermejo J, Janssens S. Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With ST-Segment Elevation Myocardial Infarction and Left Ventricular Dysfunction. Circ Res 2019; 123:579-589. [PMID: 29921651 DOI: 10.1161/circresaha.118.312823] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 01/17/2023]
Abstract
RATIONALE Allogeneic cardiac stem cells (AlloCSC-01) have shown protective, immunoregulatory, and regenerative properties with a robust safety profile in large animal models of heart disease. OBJECTIVE To investigate the safety and feasibility of early administration of AlloCSC-01 in patients with ST-segment-elevation myocardial infarction. METHODS AND RESULTS CAREMI (Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With STEMI and Left Ventricular Dysfunction) was a phase I/II multicenter, randomized, double-blind, placebo-controlled trial in patients with ST-segment-elevation myocardial infarction, left ventricular ejection fraction ≤45%, and infarct size ≥25% of left ventricular mass by cardiac magnetic resonance, who were randomized (2:1) to receive AlloCSC-01 or placebo through the intracoronary route at days 5 to 7. The primary end point was safety and included all-cause death and major adverse cardiac events at 30 days (all-cause death, reinfarction, hospitalization because of heart failure, sustained ventricular tachycardia, ventricular fibrillation, and stroke). Secondary safety end points included major adverse cardiac events at 6 and 12 months, adverse events, and immunologic surveillance. Secondary exploratory efficacy end points were changes in infarct size (percentage of left ventricular mass) and indices of ventricular remodeling by magnetic resonance at 12 months. Forty-nine patients were included (92% male, 55±11 years), 33 randomized to AlloCSC-01 and 16 to placebo. No deaths or major adverse cardiac events were reported at 12 months. One severe adverse events in each group was considered possibly related to study treatment (allergic dermatitis and rash). AlloCSC-01 elicited low levels of donor-specific antibodies in 2 patients. No immune-related adverse events were found, and no differences between groups were observed in magnetic resonance-based efficacy parameters at 12 months. The estimated treatment effect of AlloCSC-01 on the absolute change from baseline in infarct size was -2.3% (95% confidence interval, -6.5% to 1.9%). CONCLUSIONS AlloCSC-01 can be safely administered in ST-segment-elevation myocardial infarction patients with left ventricular dysfunction early after revascularization. Low immunogenicity and absence of immune-mediated events will facilitate adequately powered studies to demonstrate their clinical efficacy in this setting. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov . Unique identifier: NCT02439398.
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Affiliation(s)
- Francisco Fernández-Avilés
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Ricardo Sanz-Ruiz
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | | | - Ana Casado Plasencia
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Inmaculada Gilaberte
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Ann Belmans
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Maria Eugenia Fernández-Santos
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Dominique Charron
- HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (D.C., R.A.-D.)
| | - Miguel Mulet
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Raquel Yotti
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.)
| | - Itziar Palacios
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Manuel Luque
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Rafael Sádaba
- Department of Cardiac Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain (R.S.)
| | - J Alberto San Román
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain (J.A.S.R.)
| | - Mariano Larman
- Department of Cardiology, Policlínia Guipuzcoa, San Sebastián, Spain (M.L.)
| | - Pedro L Sánchez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Hospital Clínico Universitario, Salamanca, Spain (P.L.S.)
| | - Juan Sanchís
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain (J.S.)
| | - Manuel F Jiménez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiology, IBIMA, UMA, UGC Corazón Hospital Clínico Virgen de la Victoria, Málaga, Spain (M.F.J.)
| | - Piet Claus
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Reem Al-Daccak
- HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (D.C., R.A.-D.)
| | - Eleuterio Lombardo
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - José Luis Abad
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Olga DelaRosa
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Lucia Corcóstegui
- Coretherapix S.L.U./Tigenix Group Madrid, Spain (I.G., M.M., I.P., M.L., E.L., J.L.A., O.D., L.C.)
| | - Javier Bermejo
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J.B.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (F.F.-A., R.S.-R., A.C.P., M.E.F.-S., R.Y., J.A.S.R., P.L.S., J.S., M.F.J., J.B.).,Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
| | - Stefan Janssens
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Belgium (J.B., A.B., P.C., S.J.)
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Cauwenberghs N, Tabassian M, Thijs L, Yang WY, Wei FF, Claus P, D'hooge J, Staessen JA, Kuznetsova T. Area of the pressure-strain loop during ejection as non-invasive index of left ventricular performance: a population study. Cardiovasc Ultrasound 2019; 17:15. [PMID: 31382957 PMCID: PMC6683340 DOI: 10.1186/s12947-019-0166-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background Previous studies highlighted the usefulness of integrating left ventricular (LV) deformation (strain) and hemodynamic parameters to quantify LV performance. In a population sample, we investigated the anthropometric and clinical determinants of a novel non-invasive index of LV systolic performance derived from simultaneous registration of LV strain and brachial pressure waveforms. Methods Three hundred fifty-six randomly recruited subjects (44.7% women; mean age, 53.9 years; 47.5% hypertensive) underwent echocardiographic and arterial data acquisition. We constructed pressure-strain loops from simultaneously recorded two-dimensional LV strain curves and brachial pressure waveforms obtained by finger applanation tonometry. We defined the area of this pressure-strain loop during ejection as LV ejection work density (EWD). We reported effect sizes as EWD changes associated with a 1-SD increase in covariables. Results In multivariable-adjusted analyses, higher EWD was associated with age, female sex and presence of hypertension (P ≤ 0.0084). In both men and women, EWD increased independently with augmentation pressure (effect size: + 59.1 Pa), central pulse pressure (+ 65.7 Pa) and pulse wave velocity (+ 44.8 Pa; P ≤ 0.0006). In men, EWD decreased with relative wall thickness (− 29.9 Pa) and increased with LV ejection fraction (+ 23.9 Pa; P ≤ 0.040). In women, EWD increased with left atrial (+ 76.2 Pa) and LV end-diastolic (+ 43.8 Pa) volume indexes and with E/e’ ratio (+ 51.1 Pa; P ≤ 0.026). Conclusion Older age, female sex and hypertension were associated with higher EWD. Integration of the LV pressure-strain loop during ejection might be a useful tool to non-invasively evaluate sex-specific and interdependent effects of preload and afterload on LV myocardial performance. Electronic supplementary material The online version of this article (10.1186/s12947-019-0166-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Mahdi Tabassian
- Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Fang-Fei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Piet Claus
- Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan D'hooge
- Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Meyns B, Bogaert J, Willems R, Claus P, Delcroix M. Impaired Cardiac Reserve and Abnormal Vascular Load Limit Exercise Capacity in Chronic Thromboembolic Disease. JACC Cardiovasc Imaging 2019; 12:1444-1456. [DOI: 10.1016/j.jcmg.2018.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
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Dobrovie M, Barreiro-Pérez M, Curione D, Symons R, Claus P, Voigt JU, Bogaert J. Inter-vendor reproducibility and accuracy of segmental left ventricular strain measurements using CMR feature tracking. Eur Radiol 2019; 29:6846-6857. [PMID: 31297633 DOI: 10.1007/s00330-019-06315-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Our aim was to evaluate the inter-vendor reproducibility of cardiovascular MR feature tracking (CMR-FT) for the measurement of segmental strain (SS) of the left ventricle (LV) as well as to test the accuracy of CMR-FT to detect regional myocardial pathology. METHODS We selected 45 patients: 15 with normal CMR findings, 15 with dilated cardiomyopathy, and 15 with acute myocardial infarction. Segmental longitudinal, circumferential, and radial strains were assessed with 4 different software. The inter-vendor difference as well as intra- and inter-observer variability was investigated. Furthermore, the accuracy of CMR-FT for the detection of structural (infarcted segments) as well as functional pathology (septal vs. lateral wall strain in left bundle branch block) was tested. RESULTS Between vendors, there were significant differences in values for all strains (p < 0.001). The software using a non-rigid algorithm for image registration and segmentation demonstrated the best intra- as well as inter-observer variability with interclass correlation coefficient (ICC) > 0.962 and coefficient of variation (CV) < 24%. For infarct location, the same software yielded the highest area under the curve values for radial and circumferential SS (0.872 and 0.859, respectively). One of the other three software using optical flow technology performed best for longitudinal SS (0.799) and showed the largest differences in SS between septum and lateral wall in the dilated cardiomyopathy group. CONCLUSION SS values obtained by CMR-FT are not interchangeable between vendors, and intra- and inter-observer reproducibility shows substantial variability among vendors. Overall, the different packages score relatively well to depict focal structural or functional LV pathology. KEY POINTS • Segmental myocardial strain values obtained by CMR feature tracking are not interchangeable between different vendors. • Intra- and inter-observer reproducibility shows substantial variability among vendors. • Segmental myocardial strains measured by CMR feature tracking score relatively well to depict focal structural or functional LV pathology.
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Affiliation(s)
- Monica Dobrovie
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Cardiovascular Disease Emergency Institute CC Iliescu Bucharest, Bucharest, Romania.
| | - Manuel Barreiro-Pérez
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, y CIBERCV, Universidad de Salamanca, Salamanca, Spain
| | - Davide Curione
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
- Advanced Cardiovascular Imaging Unit - Radiology and Bioimaging Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Rolf Symons
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Piet Claus
- Laboratory on Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Herestraat 49, 3000, Leuven, Belgium
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67
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Pedrosa J, Duchenne J, Queirós S, Degtiarova G, Gheysens O, Claus P, Voigt JU, D'hooge J. Non-invasive myocardial performance mapping using 3D echocardiographic stress-strain loops. Phys Med Biol 2019; 64:115026. [PMID: 31096199 DOI: 10.1088/1361-6560/ab21f8] [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: 11/12/2022]
Abstract
Regional contribution to left ventricular (LV) ejection is of much clinical importance but its assessment is notably challenging. While deformation imaging is often used, this does not take into account loading conditions. Recently, a method for intraventricular pressure estimation was proposed, thus allowing for loading conditions to be taken into account in a non-invasive way. In this work, a method for 3D automatic myocardial performance mapping in echocardiography is proposed by performing 3D myocardial segmentation and tracking, thus giving access to local geometry and strain. This is then used to assess local LV stress-strain relationships which can be seen as a measure of local myocardial work. The proposed method was validated against 18F-fluorodeoxyglucose positron emission tomography, the reference method to clinically assess local metabolism. Averaged over all patients, the mean correlation between FDG-PET and the proposed method was [Formula: see text]. In conclusion, stress-strain loops were, for the first time, estimated from 3D echocardiography and correlated to the clinical gold standard for local metabolism, showing the future potential of real-time 3D echocardiography (RT3DE) for the assessment of local metabolic activity of the heart.
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Affiliation(s)
- João Pedrosa
- Laboratory on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Belgium
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68
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Los J, Wu M, Janssens T, Gillijns H, Janssens S, Claus P. 249Native T1 mapping discriminates microvascular obstruction in the acute phase of reperfused STEMI. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez120.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Los
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - M Wu
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - T Janssens
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - H Gillijns
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - S Janssens
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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Dobrovie M, Barreiro-Perez M, Curione D, Symons R, Claus P, Voigt JU, Bogaert J. P162Segmental left ventricular strain measurements using cardiac magnetic resonance feature tracking - reproducibility and accuracy among four vendors. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Dobrovie
- KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | | | - D Curione
- KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - R Symons
- KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - P Claus
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J Bogaert
- KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
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Degtiarova G, Claus P, Duchenne J, Voigt JU, Verberne HJ, Schramm G, Nuyts J, Gheysens O. P154Absolute vs semiquantitative 13N-NH3 myocardial perfusion and 18F-FDG metabolism in non-ischemic patients with LBBB selected for cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Degtiarova
- University Hospitals (UZ) Leuven, Nuclear Medicine and Molecular Imaging, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Cardiovascular Imaging and Dynamics, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Cardiovascular Sciences, Cardiology, Leuven, Belgium
| | - J-U Voigt
- KU Leuven, Cardiovascular Sciences, Cardiology, Leuven, Belgium
| | - H J Verberne
- University of Amsterdam, Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands (The)
| | - G Schramm
- KU Leuven, Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, Leuven, Belgium
| | - J Nuyts
- KU Leuven, Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, Leuven, Belgium
| | - O Gheysens
- University Hospitals (UZ) Leuven, Nuclear Medicine and Molecular Imaging, Leuven, Belgium
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Duchenne J, Turco A, Ünlü S, Pagourelias ED, Vunckx K, Degtiarova G, Bézy S, Cvijic M, Nuyts J, Claus P, Rega F, Gheysens O, Voigt JU. Left Ventricular Remodeling Results in Homogenization of Myocardial Work Distribution. Circ Arrhythm Electrophysiol 2019; 12:e007224. [DOI: 10.1161/circep.118.007224] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Efstathios D. Pagourelias
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiothoracic Surgery (F.R.), University Hospitals Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
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Novillo F, Van Eyndhoven S, Moeyersons J, Bogaert J, Claessen G, La Gerche A, Van Huffel S, Claus P. Unsupervised respiratory signal extraction from ungated cardiac magnetic resonance imaging at rest and during exercise. Phys Med Biol 2019; 64:065001. [PMID: 30695762 DOI: 10.1088/1361-6560/ab02cd] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
We propose and evaluate a method to estimate a respiratory signal from ungated cardiac magnetic resonance (CMR) images. Ungated CMR images were acquired in five subjects who performed exercise at different intensity levels under different physiological conditions while breathing freely. The respiratory motion was estimated by applying principal components analysis (PCA). A sign correction procedure was developed to correctly define inspiration and expiration, based on either tracking of the diaphragmatic motion or estimation of the lung volume or a combination of both. Evaluation was done using a plethysmograph signal as reference. There was a good correspondence between the plethysmograph and the estimated respiratory signals. Respiratory motion was effectively captured by one of the PCA components in 88% of the cases. Moreover, the proposed method successfully estimated the respiratory phase in 91% of the evaluated slices. The pipeline is robust, admitting a slight decline in performance with increased exercise intensity. Respiratory motion was accurately estimated by means of PCA and the application of a sign correction procedure. Our method showed promising results even for acquisitions during exercise where excessive body motion occurs. The proposed method provides a way to extract the respiratory signal from ungated CMR images, at rest as well as during exercise, in a fully unsupervised fashion, which may reduce the clinician's workload drastically.
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Affiliation(s)
- Felipe Novillo
- KU Leuven, Department of Cardiovascular Sciences, Cardiovascular Imaging and Dynamics, Leuven, Belgium
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Van Puyvelde J, Rega F, Minami T, Claus P, Cools B, Gewillig M, Meyns B. Creation of the Fontan circulation in sheep: a survival model. Interact Cardiovasc Thorac Surg 2019; 29:15-21. [DOI: 10.1093/icvts/ivz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joeri Van Puyvelde
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tomoyuki Minami
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Claessen G, La Gerche A, Van De Bruaene A, Claeys M, Willems R, Dymarkowski S, Bogaert J, Claus P, Budts W, Heidbuchel H, Gewillig M. Heart Rate Reserve in Fontan Patients: Chronotropic Incompetence or Haemodynamic Limitation? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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75
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Beaudry RI, Howden EJ, Foulkes S, Bigaran A, Claus P, Haykowsky MJ, Gerche AL. Determinants of exercise intolerance in breast cancer patients prior to anthracycline chemotherapy. Physiol Rep 2019; 7:e13971. [PMID: 30632311 PMCID: PMC6328913 DOI: 10.14814/phy2.13971] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Women with early-stage breast cancer have reduced peak exercise oxygen uptake (peak VO2 ). The purpose of this study was to evaluate peak VO2 and right (RV) and left (LV) ventricular function prior to adjuvant chemotherapy. Twenty-nine early-stage breast cancer patients (mean age: 48 years) and 10 age-matched healthy women were studied. Participants performed an upright cycle exercise test with expired gas analysis to measure peak VO2 . RV and LV volumes and function were measured at rest, submaximal and peak supine cycle exercise using cardiac magnetic resonance imaging. Peak VO2 was significantly lower in breast cancer patients versus controls (1.7 ± 0.4 vs. 2.3 ± 0.5 L/min, P = 0.0013; 25 ± 6 vs. 35 ± 6 mL/kg/min, P = 0.00009). No significant difference was found between groups for peak upright exercise heart rate (174 ± 13 vs. 169 ± 16 bpm, P = 0.39). Rest, submaximal and peak exercise RV and LV end-diastolic and end-systolic volume index, stroke index, and cardiac index were significantly lower in breast cancer patients versus controls (P < 0.05 for all). No significant difference was found between groups for rest and exercise RV and LV ejection fraction. Despite preserved RV and LV ejection fraction, the decreased peak VO2 in early-stage breast cancer patients prior to adjuvant chemotherapy is due in part to decreased peak cardiac index secondary to reductions in RV and LV end-diastolic volumes.
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Affiliation(s)
- Rhys I. Beaudry
- Integrated Cardiovascular Exercise Physiology and Rehabilitation LaboratoryCollege of Nursing and Health InnovationUniversity of Texas at ArlingtonArlingtonTexas
| | - Erin J. Howden
- Sports Cardiology LabBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Steve Foulkes
- Sports Cardiology LabBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- School of Exercise & Nutrition SciencesDeakin University Faculty of HealthBurwoodVictoriaAustralia
| | - Ashley Bigaran
- Sports Cardiology LabBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Exercise and Nutrition Research ProgramMary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneVictoriaAustralia
| | - Piet Claus
- Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium
| | - Mark J. Haykowsky
- Integrated Cardiovascular Exercise Physiology and Rehabilitation LaboratoryCollege of Nursing and Health InnovationUniversity of Texas at ArlingtonArlingtonTexas
- Sports Cardiology LabBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Andre La Gerche
- Sports Cardiology LabBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
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76
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Tilborghs S, Dresselaers T, Claus P, Claessen G, Bogaert J, Maes F, Suetens P. Robust motion correction for cardiac T1 and ECV mapping using a T1 relaxation model approach. Med Image Anal 2018; 52:212-227. [PMID: 30597459 DOI: 10.1016/j.media.2018.12.004] [Citation(s) in RCA: 9] [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: 05/31/2018] [Revised: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023]
Abstract
T1 and ECV mapping are quantitative methods for myocardial tissue characterization using cardiac MRI, and are highly relevant for the diagnosis of diffuse myocardial diseases. Since the maps are calculated pixel-by-pixel from a set of MRI images with different T1-weighting, it is critical to assure exact spatial correspondence between these images. However, in practice, different sources of motion e.g. cardiac motion, respiratory motion or patient motion, hamper accurate T1 and ECV calculation such that retrospective motion correction is required. We propose a new robust non-rigid registration framework combining a data-driven initialization with a model-based registration approach, which uses a model for T1 relaxation to avoid direct registration of images with highly varying contrast. The registration between native T1 and enhanced T1 to obtain a motion free ECV map is also calculated using information from T1 model-fitting. The method was validated on three datasets recorded with two substantially different acquisition protocols (MOLLI (dataset 1 (n=15) and dataset 2 (n=29)) and STONE (dataset 3 (n = 210))), one in breath-hold condition and one free-breathing. The average Dice coefficient increased from 72.6 ± 12.1% to 82.3 ± 7.4% (P < 0.05) and mean boundary error decreased from 2.91 ± 1.51mm to 1.62 ± 0.80mm (P < 0.05) for motion correction in a single T1-weighted image sequence (3 datasets) while average Dice coefficient increased from 63.4 ± 22.5% to 79.2 ± 8.5% (P < 0.05) and mean boundary error decreased from 3.26 ± 2.64mm to 1.77 ± 0.86mm (P < 0.05) between native and enhanced sequences (dataset 1 and 2). Overall, the native T1 SD error decreased from 67.32 ± 32.57ms to 58.11 ± 21.59ms (P < 0.05), enhanced SD error from 30.15 ± 25ms to 22.74 ± 8.94ms (P < 0.05) and ECV SD error from 10.08 ± 9.59% to 5.42 ± 3.21% (P < 0.05) (dataset 1 and 2).
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Affiliation(s)
- Sofie Tilborghs
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium.
| | - Tom Dresselaers
- Department of Imaging and Pathology, Radiology, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, Radiology, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium
| | - Frederik Maes
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium
| | - Paul Suetens
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium; Medical Imaging Research Center, UZ Leuven, Herestraat 49 - 7003, Leuven, 3000, Belgium
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De Coster T, Claus P, Seemann G, Willems R, Sipido KR, Panfilov AV. Myocyte Remodeling Due to Fibro-Fatty Infiltrations Influences Arrhythmogenicity. Front Physiol 2018; 9:1381. [PMID: 30344493 PMCID: PMC6182296 DOI: 10.3389/fphys.2018.01381] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022] Open
Abstract
The onset of cardiac arrhythmias depends on the electrophysiological and structural properties of cardiac tissue. Electrophysiological remodeling of myocytes due to the presence of adipocytes constitutes a possibly important pathway in the pathogenesis of atrial fibrillation. In this paper we perform an in-silico study of the effect of such myocyte remodeling on the onset of atrial arrhythmias and study the dynamics of arrhythmia sources—spiral waves. We use the Courtemanche model for atrial myocytes and modify their electrophysiological properties based on published cellular electrophysiological measurements in myocytes co-cultered with adipocytes (a 69–87 % increase in APD90 and an increase of the RMP by 2.5–5.5 mV). In a generic 2D setup we show that adipose tissue remodeling substantially affects the spiral wave dynamics resulting in complex arrhythmia and such arrhythmia can be initiated under high frequency pacing if the size of the remodeled tissue is sufficiently large. These results are confirmed in simulations with an anatomically accurate model of the human atria.
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Affiliation(s)
- Tim De Coster
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg • Bad Krozingen, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alexander V Panfilov
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium.,Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Centre Leiden, Leiden University Medical Center, Leiden, Netherlands.,Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
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78
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Duchenne J, Claus P, Houfflyn S, Fresiello L, Van Puyvelde J, Haemers P, Cools B, Gheysens O, Rega F, Voigt JU. P3736Assessment of myocardial contractility in the presence of left ventricular dyssynchrony. Which parameter is most robust? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Duchenne
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - S Houfflyn
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - L Fresiello
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | | | - P Haemers
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - B Cools
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - O Gheysens
- KU Leuven, Imaging & Pathology, Leuven, Belgium
| | - F Rega
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - J.-U Voigt
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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79
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Wu M, Claus P, Meyer J, Scheerer NA, Janssens T, Stampfuss J, Gillijns H, Grah C, Moosmang S, Meibom D, Janssens S. P6416Introducing microvascular dysfunction in a large animal model of ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Wu
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - P Claus
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - J Meyer
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | - N A Scheerer
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | | | - J Stampfuss
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | - H Gillijns
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - C Grah
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | - S Moosmang
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | - D Meibom
- Bayer AG, Drug Discovery, Pharmaceuticals, Wuppertal, Germany
| | - S Janssens
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
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80
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Duchenne J, Turco A, Claus P, Vunckx K, Nuyts J, Beela AS, Unlu S, Rega F, Gheysens O, Voigt JU. P5659How does mechanical dyssynchrony affect the efficiency of the left ventricle? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Duchenne
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - A Turco
- KU Leuven, Imaging & Pathology, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - K Vunckx
- KU Leuven, Imaging & Pathology, Leuven, Belgium
| | - J Nuyts
- KU Leuven, Imaging & Pathology, Leuven, Belgium
| | - A S Beela
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - S Unlu
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - F Rega
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - O Gheysens
- KU Leuven, Imaging & Pathology, Leuven, Belgium
| | - J.-U Voigt
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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81
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Claeys M, Verbelen T, Rega F, Minami T, Los J, Vandenberk B, Holemans P, Willems R, Claus P. P249Cardiac resynchronisation in experimental right heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Claeys
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - T Verbelen
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - F Rega
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - T Minami
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - J Los
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - B Vandenberk
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - P Holemans
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - R Willems
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - P Claus
- University Hospitals (UZ) Leuven, Cardiovascular Sciences, Leuven, Belgium
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82
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Barreiro-Pérez M, Curione D, Symons R, Claus P, Voigt JU, Bogaert J. Left ventricular global myocardial strain assessment comparing the reproducibility of four commercially available CMR-feature tracking algorithms. Eur Radiol 2018; 28:5137-5147. [DOI: 10.1007/s00330-018-5538-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
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83
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Symons R, Pontone G, Schwitter J, Francone M, Iglesias JF, Barison A, Zalewski J, de Luca L, Degrauwe S, Claus P, Guglielmo M, Nessler J, Carbone I, Ferro G, Durak M, Magistrelli P, Lo Presti A, Aquaro GD, Eeckhout E, Roguelov C, Andreini D, Vogt P, Guaricci AI, Mushtaq S, Lorenzoni V, Muller O, Desmet W, Agati L, Janssens S, Bogaert J, Masci PG. Long-Term Incremental Prognostic Value of Cardiovascular Magnetic Resonance After ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Imaging 2018; 11:813-825. [DOI: 10.1016/j.jcmg.2017.05.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
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84
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Symons R, Claus P, Marchi A, Dresselaers T, Bogaert J. Quantitative and qualitative assessment of acute myocardial injury by CMR at multiple time points after acute myocardial infarction. Int J Cardiol 2018; 259:43-46. [PMID: 29506936 DOI: 10.1016/j.ijcard.2018.02.093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/11/2018] [Accepted: 02/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent experimental studies have shown a dynamic time course of myocardial edema with an initial wave of edematous reaction within hours after reperfusion which almost resolved at 24 h. However, this dynamic pattern appears to be absent in clinical cohort studies. Thus far, no studies have combined a quantitative and qualitative assessment of acute myocardial injury in a large clinical cohort to explain these divergent findings. METHODS A cohort of 225 patients (59 ± 11 years, 83% men) with successfully reperfused STEMI within 12 h of symptom onset were included. Quantitative measurements of myocardial damage such as T1 mapping and T2 triple short-tau inversion recovery (STIR), contrast-to-noise ratio (CNR) and their impact on area-at-risk (AAR), infarct size (IS), and myocardial salvage index (MSI) were assessed at different time points. One-way analysis of variance (ANOVA) and linear regression analysis was used to compare myocardial damage at the different time points. RESULTS A small fraction of patients underwent CMR within 24 h of reperfusion (17/225, 7.6%). No significant variations in AAR, IS, MSI, T2 STIR CNR, or native T1 maps were observed between the different time points after reperfusion. Time of CMR was not a significant predictor of AAR (P = 0.90), IS (P = 0.27), MSI (P = 0.23) or T2 STIR CNR (P = 0.23). CONCLUSIONS The majority of CMR exams in STEMI patients are performed outside the dynamic time window of early post-MI edema. The stable pattern of markers of acute myocardial damage at different time points suggests these markers are reliable for the prognostication of patients after STEMI.
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Affiliation(s)
- Rolf Symons
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alberto Marchi
- Medical Pathology Department, Careggi University Hospital, Florence, Italy
| | - Tom Dresselaers
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium.
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85
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Dries E, Vandenberk B, Gilbert G, Amoni M, Holemans P, Willems R, Claus P, Sipido KR. P519Regional heterogeneity of hyperactive non-coupled ryanodine receptors makes the peri-infarct region more prone to triggered activities after myocardial infarction. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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86
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De Coster T, Claus P, Panfilov A. P309Myocyte remodelling due to fibro-fatty infiltrations influences arrhythmogenicity. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T De Coster
- Ghent University, Physics and Astronomy, Ghent, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - A Panfilov
- Ghent University, Physics and Astronomy, Ghent, Belgium
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87
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Claessen G, Schnell F, Bogaert J, Claeys M, Pattyn N, De Buck F, Dymarkowski S, Claus P, Carré F, Van Cleemput J, La Gerche A, Heidbuchel H. Exercise cardiac magnetic resonance to differentiate athlete’s heart from structural heart disease. Eur Heart J Cardiovasc Imaging 2018; 19:1062-1070. [DOI: 10.1093/ehjci/jey050] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/11/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Schnell
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- Department of Physiology, Rennes 1 University, Rennes, France
| | - Jan Bogaert
- University Hospitals Leuven, Leuven, Belgium
- Department of Imaging & Pathology, University of Leuven, Leuven, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Frederik De Buck
- University Hospitals Leuven, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Dymarkowski
- University Hospitals Leuven, Leuven, Belgium
- Department of Imaging & Pathology, University of Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Francois Carré
- Department of Physiology, Rennes 1 University, Rennes, France
| | - Johan Van Cleemput
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | - Andre La Gerche
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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88
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Duchenne J, Claus P, Pagourelias ED, Mada RO, Van Puyvelde J, Vunckx K, Verbeken E, Gheysens O, Rega F, Voigt JU. Sheep can be used as animal model of regional myocardial remodeling and controllable work. Cardiol J 2018; 26:375-384. [PMID: 29570208 DOI: 10.5603/cj.a2018.0007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pacing the right heart has been shown to induce reversible conduction delay and subse-quent asymmetric remodeling of the left ventricle (LV) in dogs and pigs. Both species have disadvantages in animal experiments. Therefore the aim of this study was to develop a more feasible and easy-to-use animal model in sheep. METHODS Dual-chamber (DDD) pacemakers with epicardial leads on the right atrium and right ven-tricular free wall were implanted in 13 sheep. All animals underwent 8 weeks of chronic rapid pacing at 180 bpm. Reported observations were made at 110 bpm. RESULTS DDD pacing acutely induced a left bundle branch block (LBBB) - like pattern with almost doubling in QRS width and the appearance of a septal flash, indicating mechanical dyssynchrony. Atrial pacing (AAI) resulted in normal ventricular conduction and function. During 8 weeks of rapid DDD pacing, animals developed LV remodeling (confirmed with histology) with septal wall thinning (-30%, p < 0.05), lateral wall thickening (+22%, p < 0.05), LV volume increase (+32%, p < 0.05), decrease of LV ejection fraction (-31%, p < 0.05), and functional mitral regurgitation. After 8 weeks, segmental pressure-strain-loops, representing regional myocardial work, were recorded. Switching from AAI to DDD pacing decreased immediately work in the septum and increased it in the lateral wall (-69 and +41%, respectively, p < 0.05). Global LV stroke work and dP/dtmax decreased (-27% and -25%, respectively, p < 0.05). CONCLUSIONS This study presents the development a new sheep model with an asymmetrically remod-eled LV. Simple pacemaker programing allows direct modulation of regional myocardial function and work. This animal model provides a new and valuable alternative for canine or porcine models and has the potential to become instrumental for investigating regional function and loading conditions on regional LV remodeling.
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Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.
| | - Piet Claus
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Razvan O Mada
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Joeri Van Puyvelde
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Imaging and Pathology and Department of Pathology, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
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Duchenne J, Turco A, Bézy S, Ünlü S, Pagourelias ED, Beela AS, Degtiarova G, Vunckx K, Nuyts J, Coudyzer W, Claus P, Rega F, Gheysens O, Voigt JU. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging 2018; 20:84-91. [DOI: 10.1093/ehjci/jey043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiothoracic Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Helsen F, De Meester P, Van De Bruaene A, Gabriels C, Santens B, Claeys M, Claessen G, Goetschalckx K, Buys R, Gewillig M, Troost E, Voigt JU, Claus P, Bogaert J, Budts W. Right ventricular systolic dysfunction at rest is not related to decreased exercise capacity in patients with a systemic right ventricle. Int J Cardiol 2018. [PMID: 29530621 DOI: 10.1016/j.ijcard.2018.03.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND To evaluate the relationship between right ventricular (RV) systolic dysfunction at rest and reduced exercise capacity in patients with a systemic RV (sRV). METHODS All patients with congenitally corrected transposition of the great arteries (ccTGA) or complete TGA after atrial switch (TGA-Mustard/Senning) followed in our institution between July 2011 and September 2017 who underwent cardiac imaging within a six-month time period of cardiopulmonary exercise testing (CPET) were analyzed. We assessed sRV systolic function with TAPSE and fractional area change on echocardiogram and, if possible, with ejection fraction, global longitudinal and circumferential strain on cardiac magnetic resonance (CMR) imaging. RESULTS We studied 105 patients with an sRV (median age 34 [IQR 28-42] years, 29% ccTGA and 71% TGA-Mustard/Senning) of which 39% had either a pacemaker (n = 17), Eisenmenger physiology (n = 6), severe systemic atrioventricular valve regurgitation (n = 14), or peak exercise arterial oxygen saturation < 92% (n = 17). Most patients were asymptomatic or mildly symptomatic (NYHA class I/II/III in 71/23/6%). Sixty-four percent had evidence of moderate or severe sRV dysfunction on cardiac imaging. Mean peak oxygen uptake (pVO2) was 24.1 ± 7.4 mL/kg/min, corresponding to a percentage of predicted pVO2 (%ppVO2) of 69 ± 17%. No parameter of sRV systolic function as evaluated on echocardiography (n = 105) or CMR (n = 46) was correlated with the %ppVO2, even after adjusting for associated cardiac defects or pacemakers. CONCLUSIONS In adults with an sRV, there is no relation between echocardiographic or CMR-derived sRV systolic function parameters at rest and peak oxygen uptake. Exercise imaging may be superior to evaluate whether sRV contractility limits exercise capacity.
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Affiliation(s)
- Frederik Helsen
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Meester
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Gabriels
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Béatrice Santens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Mathias Claeys
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Unit of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Roselien Buys
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Research Group for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Marc Gewillig
- Unit of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Els Troost
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Unit of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jan Bogaert
- Unit of Translational MRI, Department of Imaging & Pathology, KU Leuven - University of Leuven, Leuven, Belgium; Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Unit of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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91
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De Coster T, Claus P, Kazbanov IV, Haemers P, Willems R, Sipido KR, Panfilov AV. Arrhythmogenicity of fibro-fatty infiltrations. Sci Rep 2018; 8:2050. [PMID: 29391548 PMCID: PMC5795000 DOI: 10.1038/s41598-018-20450-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/18/2018] [Indexed: 12/14/2022] Open
Abstract
The onset of cardiac arrhythmias depends on electrophysiological and structural properties of cardiac tissue. One of the most important changes leading to arrhythmias is characterised by the presence of a large number of non-excitable cells in the heart, of which the most well-known example is fibrosis. Recently, adipose tissue was put forward as another similar factor contributing to cardiac arrhythmias. Adipocytes infiltrate into cardiac tissue and produce in-excitable obstacles that interfere with myocardial conduction. However, adipose infiltrates have a different spatial texture than fibrosis. Over the course of time, adipose tissue also remodels into fibrotic tissue. In this paper we investigate the arrhythmogenic mechanisms resulting from the presence of adipose tissue in the heart using computer modelling. We use the TP06 model for human ventricular cells and study how the size and percentage of adipose infiltrates affects basic properties of wave propagation and the onset of arrhythmias under high frequency pacing in a 2D model for cardiac tissue. We show that although presence of adipose infiltrates can result in the onset of cardiac arrhythmias, its impact is less than that of fibrosis. We quantify this process and discuss how the remodelling of adipose infiltrates affects arrhythmia onset.
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Affiliation(s)
- Tim De Coster
- Department of Physics and Astronomy, Ghent University, Gent, 9000, Belgium. .,Department of Cardiovascular Sciences, KU Leuven, Leuven, 3000, Belgium.
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, 3000, Belgium
| | - Ivan V Kazbanov
- Department of Physics and Astronomy, Ghent University, Gent, 9000, Belgium
| | - Peter Haemers
- Department of Cardiovascular Sciences, KU Leuven, Leuven, 3000, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, 3000, Belgium
| | - Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, Leuven, 3000, Belgium
| | - Alexander V Panfilov
- Department of Physics and Astronomy, Ghent University, Gent, 9000, Belgium. .,Moscow Institute of Physics and Technology, (State University), Dolgoprudny, Moscow Region, 141701, Russia. .,Laboratory of Experimental Cardiology, Department of Cardiology, Heart Lung Centre Leiden, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands.
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92
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Schnell F, Claessen G, La Gerche A, Claus P, Bogaert J, Delcroix M, Carré F, Heidbuchel H. Atrial volume and function during exercise in health and disease. J Cardiovasc Magn Reson 2017; 19:104. [PMID: 29254488 PMCID: PMC5735907 DOI: 10.1186/s12968-017-0416-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although atrial function has prognostic significance in many cardiovascular conditions, changes during exercise have not previously been assessed. The aim of this study was to evaluate left atrial (LA) and right atrial (RA) volume and function during incremental exercise, both in normal individuals, healthy athletes, and in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Fifteen healthy non-athletes, 15 athletes and 15 CTEPH patients underwent multi-slice real-time cardiovascular magnetic resonance imaging at rest and during supine bicycle exercise with simultaneous invasive hemodynamic measurements. RESULTS At rest, athletes had larger indexed maximal RA and LA volumes (iRAVmax, iLAVmax) than CTEPH patients and non-athletes, the latter two groups having similar values. CTEPH patients had lower RA and LA emptying functions (EmF) at rest. During exercise, RA volumes (maximum and minimum) increased in CTEPH patients, whilst decreasing in athletes and non-athletes (P < 0.001). The exercise-induced change in iLAVmax was similar between groups, but iLAVmin did not decrease in CTEPH patients. Thus exercise-induced increases in RAEmF and LAEmF, as seen in normal physiology, were significantly impaired in CTEPH patients. At peak exercise, RA volumes (maximum and minimum) and EmF correlated strongly with RA pressure (R = 0.70; P = 0.005; R = 0.83; P < 0.001; R = -0.87; P < 0.001). On multivariate analysis, peak exercise RAEmF and iLAVmin were independent predictors of VO2peak in CTEPH patients and together explained 72% of the variance in VO2peak (ß =0.581 and ß = -0.515, respectively). CONCLUSIONS In normal physiology, RAEmF and LAEmF increase with exercise, whereas CTEPH patients have impaired LAEmF and RAEmF, which becomes more apparent during exercise. Therefore, the changes in atrial volumes and function during exercise enable a far better distinction between physiological and pathological atrial remodeling than resting measures of volumes which are prone to confounding factors (e.g. endurance training). Peak exercise RAEmF is a good marker of poor functional state in CTEPH patients.
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Affiliation(s)
- Frédéric Schnell
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Guido Claessen
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - André La Gerche
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University of Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - François Carré
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Verbelen T, Claus P, Burkhoff D, Driesen RB, Kadur Nagaraju C, Verbeken E, Sipido K, Delcroix M, Rega F, Meyns B. Low-flow support of the chronic pressure-overloaded right ventricle induces reversed remodeling. J Heart Lung Transplant 2017; 37:151-160. [PMID: 29056459 DOI: 10.1016/j.healun.2017.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/11/2017] [Revised: 07/25/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Mechanical right ventricular (RV) support in pulmonary arterial hypertension patients has been feared to cause pulmonary hemorrhage and to be detrimental for the after-load-sensitive RV. Continuous low-flow pumps offer promise but remain insufficiently tested. METHODS The pulmonary artery was banded in 20 sheep in this study. Eight weeks later, a Synergy micro-pump (HeartWare International, Framingham MA) was inserted in 10 animals, driving blood from the right atrium to the pulmonary artery. After magnetic resonance imaging, hemodynamics and RV pressure-volume loop data were recorded. Eight weeks later, RV function was assessed in the same way, followed by histologic analysis of the ventricular tissue. RESULTS During the 8 weeks of support, RV volumes and central venous pressure decreased significantly, whereas RV contractility increased. Pulmonary artery pressure increased modestly, particularly its diastolic component. RV contribution to total right-sided cardiac output increased from 12 ± 12% to 41 ± 9% (p < 1 × 10-4). After pump inactivation, and compared with 8 weeks earlier, RV volumes had significantly decreased, tricuspid valve regurgitation had almost disappeared, and RV contractility had significantly increased, resulting in significantly increased RV forward power (0.25 ± 0.05 vs 0.16 ± 0.06 W, p = 0.014). Fulton index and RV myocyte size were significantly smaller, and without changes in fibrosis, when compared with controls. CONCLUSIONS Prolonged continuous low-flow RV mechanical support significantly unloads the chronic pressure-overloaded RV and improves cardiac output. After 8 weeks, RV hemodynamic recovery and reverse remodeling begin to occur, without increased fibrosis.
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Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Division of Experimental Cardiac Surgery, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Piet Claus
- Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ronald B Driesen
- Division of Experimental Cardiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Chandan Kadur Nagaraju
- Division of Experimental Cardiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Erik Verbeken
- Division of Translational Cell & Tissue Research, Department of Imaging & Pathology, University of Leuven, Leuven, Belgium
| | - Karin Sipido
- Division of Experimental Cardiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Marion Delcroix
- Respiratory Division, University Hospitals Leuven Leuven, Belgium; Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Division of Experimental Cardiac Surgery, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Division of Experimental Cardiac Surgery, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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94
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Nagaraju CK, Dries E, Popovic N, Singh AA, Haemers P, Roderick HL, Claus P, Sipido KR, Driesen RB. Global fibroblast activation throughout the left ventricle but localized fibrosis after myocardial infarction. Sci Rep 2017; 7:10801. [PMID: 28883544 PMCID: PMC5589875 DOI: 10.1038/s41598-017-09790-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 04/12/2017] [Accepted: 07/28/2017] [Indexed: 11/09/2022] Open
Abstract
Fibroblast (Fb) differentiation and interstitial fibrosis contribute to cardiac remodeling and loss of function after myocardial infarction (MI). We investigated regional presence and regulation of fibrosis in a pig MI model. In vivo analysis of regional function and perfusion defined three regions: the scar, the myocardium adjacent to the scar (MIadjacent, reduced function, reduced perfusion reserve), and the remote myocardium (MIremote, minimal functional deficit, maintained perfusion). Interstitial and perivascular fibrosis, and increase of collagen type I, was only observed in the MIadjacent. Fb activated protein-alpha (FAP-α) was enriched in MIadjacent compared to MIremote. TGF-β1, which triggers Fb differentiation, was upregulated in both MIadjacent and MIremote, whereas lysyl oxidase, a regulator of collagen cross-linking, and the proteoglycans decorin and biglycan were only increased in the MIadjacent. Fb isolated and cultured for 4 days had myoFb characteristics with little difference between MIremote and MIadjacent, although RNA sequencing revealed differences in gene expression profiles. Fbs from all regions maintained proliferative capacity, and induced contraction of 3-D collagen matrices but scar myoFb was more effective. These data suggest that after MI, signaling through TGF-β1, possibly related to increased mechanical load, drives Fb activation throughout the left ventricle while regional signaling determines further maturation and extracellular matrix remodeling after MI.
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Affiliation(s)
- Chandan K Nagaraju
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Eef Dries
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Natasa Popovic
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Abhishek A Singh
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Peter Haemers
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - H Llewelyn Roderick
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
| | - Karin R Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
| | - Ronald B Driesen
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, 3000, Belgium
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Claeys M, Claessen G, La Gerche A, Petit T, Belge C, Claus P, Bogaert J, Willems R, Delcroix M. P724Peak oxygen consumption in chronic thromboembolic pulmonary vascular disease is determined predominately by cardiac reserve and not by dead space ventilation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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96
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Duchenne J, Bezy S, Turco A, Claus P, Vunckx K, Pagourelias E, Unlu S, Nuyts J, Coudyzer W, Rega F, Gheysens O, Voigt J. 3867Subvalvular geometry and increased sphericity significantly increases papillary muscle contribution to myocardial workload in dilated left ventricles. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3867] [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: 11/12/2022] Open
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Kalyon N, Hofmann K, Malter J, Lucas M, Claus P, Albert B. Catalytic activity of nanoscale borides: Co2B and Ni7B3 in the liquid-phase hydrogenation of citral. J Catal 2017. [DOI: 10.1016/j.jcat.2017.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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98
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Helsen F, Claus P, Van De Bruaene A, Claessen G, De Meester P, Gabriels C, Claeys M, Petit T, Troost E, Voigt JU, Bogaert J, Budts W. P1635Differences in systemic right ventricular response during physiological exercise between ccTGA and complete TGA post atrial switch procedure: an exercise cardiac magnetic resonance study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1635] [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: 11/12/2022] Open
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99
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Fresiello L, Rademakers F, Claus P, Ferrari G, Di Molfetta A, Meyns B. Exercise physiology with a left ventricular assist device: Analysis of heart-pump interaction with a computational simulator. PLoS One 2017; 12:e0181879. [PMID: 28738087 PMCID: PMC5524292 DOI: 10.1371/journal.pone.0181879] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/07/2017] [Indexed: 12/02/2022] Open
Abstract
Patients with a Ventricular Assist Device (VAD) are hemodynamically stable but show an impaired exercise capacity. Aim of this work is to identify and to describe the limiting factors of exercise physiology with a VAD. We searched for data concerning exercise in heart failure condition and after VAD implantation from the literature. Data were analyzed by using a cardiorespiratory simulator that worked as a collector of inputs coming from different papers. As a preliminary step the simulator was used to reproduce the evolution of hemodynamics from rest to peak exercise (ergometer cycling) in heart failure condition. Results evidence an increase of cardiac output of +2.8 l/min and a heart rate increase to 67% of the expected value. Then, we simulated the effect of a continuous-flow VAD at both rest and exercise. Total cardiac output increases of +3.0 l/min (+0.9 l/min due to the VAD and +2.1 l/min to the native ventricle). Since the left ventricle works in a non-linear portion of the diastolic stiffness line, we observed a consistent increase of pulmonary capillary wedge pressure (from 14 to 20 mmHg) for a relatively small increase of end-diastolic volume (from 182 to 189 cm3). We finally increased VAD speed during exercise to the maximum possible value and we observed a reduction of wedge pressure (-4.5 mmHg), a slight improvement of cardiac output (8.0 l/min) and a complete unloading of the native ventricle. The VAD can assure a proper hemodynamics at rest, but provides an insufficient unloading of the left ventricle and does not prevent wedge pressure from rising during exercise. Neither the VAD provides major benefits during exercise in terms of total cardiac output, which increases to a similar extend to an unassisted heart failure condition. VAD speed modulation can contribute to better unload the ventricle but the maximal flow reachable with the current devices is below the cardiac output observed in a healthy heart.
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Affiliation(s)
- Libera Fresiello
- KU Leuven, Department of Cardiac Surgery, Leuven, Belgium
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
- * E-mail:
| | - Frank Rademakers
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Piet Claus
- KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - Gianfranco Ferrari
- Nałecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Arianna Di Molfetta
- Medical and Surgical Department of Pediatric Cardiology, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Bart Meyns
- KU Leuven, Department of Cardiac Surgery, Leuven, Belgium
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Sanz-Ruiz R, Casado Plasencia A, Borlado LR, Fernández-Santos ME, Al-Daccak R, Claus P, Palacios I, Sádaba R, Charron D, Bogaert J, Mulet M, Yotti R, Gilaberte I, Bernad A, Bermejo J, Janssens S, Fernández-Avilés F. Rationale and Design of a Clinical Trial to Evaluate the Safety and Efficacy of Intracoronary Infusion of Allogeneic Human Cardiac Stem Cells in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction. Circ Res 2017; 121:71-80. [DOI: 10.1161/circresaha.117.310651] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 01/22/2017] [Revised: 05/13/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023]
Abstract
Rationale:
Stem cell therapy has increased the therapeutic armamentarium in the fight against ischemic heart disease and heart failure. The administration of exogenous stem cells has been investigated in patients suffering an acute myocardial infarction, with the final aim of salvaging jeopardized myocardium and preventing left ventricular adverse remodeling and functional deterioration. However, phase I and II clinical trials with autologous and first-generation stem cells have yielded inconsistent benefits and mixed results.
Objective:
In the search for new and more efficient cellular regenerative products, interesting cardioprotective, immunoregulatory, and cardioregenerative properties have been demonstrated for human cardiac stem cells. On the other hand, allogeneic cells show several advantages over autologous sources: they can be produced in large quantities, easily administered off-the-shelf early after an acute myocardial infarction, comply with stringent criteria for product homogeneity, potency, and quality control, and may exhibit a distinctive immunologic behavior.
Methods and Results:
With a promising preclinical background, CAREMI (Cardiac Stem Cells in Patients With Acute Myocardial Infarction) has been designed as a double-blind, 2:1 randomized, controlled, and multicenter clinical trial that will evaluate the safety, feasibility, and efficacy of intracoronary delivery of allogeneic human cardiac stem cell in 55 patients with large acute myocardial infarction, left ventricular dysfunction, and at high risk of developing heart failure.
Conclusions:
This phase I/II clinical trial represents a novel experience in humans with allogeneic cardiac stem cell in a rigorously imaging-based selected group of acute myocardial infarction patients, with detailed safety immunologic assessments and magnetic resonance imaging–based efficacy end points.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02439398.
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Affiliation(s)
- Ricardo Sanz-Ruiz
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Ana Casado Plasencia
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Luis R. Borlado
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - María Eugenia Fernández-Santos
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Reem Al-Daccak
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Piet Claus
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Itziar Palacios
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Rafael Sádaba
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Dominique Charron
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Jan Bogaert
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Miguel Mulet
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Raquel Yotti
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Immaculada Gilaberte
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Antonio Bernad
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Javier Bermejo
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Stefan Janssens
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
| | - Franciso Fernández-Avilés
- From the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Facultad de Medicina, Universidad Complutense, Centro de Investigación Biomédica en Red–Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (R.S.-R., A.C.P., M.E.F.-S., R.Y., J. Bermejo, F.F.-A.); Coretherapix S.L.U./Tigenix Group, Madrid, Spain (L.R.B., I.P., M.M., I.G.); HLA et Medicine (HLA-MED), Hôpital Saint-Louis, Paris, France (R.A.-D., D.C.)
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