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Shearer GC, Block RC, Huang S, Liu L, Herrington DM, Tsai MY, Tintle N, O'Connell TD. Eicosapentaenoic acid and Arachidonic acid Protection Against Left Ventricle Pathology: the Multi-Ethnic Study of Atherosclerosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.05.24308494. [PMID: 38883788 PMCID: PMC11177919 DOI: 10.1101/2024.06.05.24308494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background We have shown that ω3 polyunsaturated fatty acids (PUFAs) reduce risk for heart failure, regardless of ejection fraction status. Ventricular remodeling and reduced ventricular performance precede overt hear failure, however there is little insight into how PUFAs contribute to maladaptive signaling over time. PUFAs are agonists for regulatory activity at g-protein coupled receptors such as Ffar4, and downstream as substrates for monooxygenases (e.g lipoxygenase, cytochrome p450, or cyclooxygenase (COX)) which mediate intracellular adaptive signaling. Methods Plasma phospholipid PUFA abundance at Exam 1 as mass percent EPA, DHA, and arachidonic acid (AA) from the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated using pathway modeling to determine the association with time-dependent changes in left ventricular (LV) mass (LVM), end-diastolic LV volume (EDV), and end-systolic volume (ESV) measured by cardiac MRI at Exams 1 and 5. Ejection fraction (EF) and mass:volume (MV) were calculated posteriorly from the first three. Results 2,877 subjects had available MRI data. Participants with low AA and EPA had accelerated age-dependent declines in LVM. Males with low AA and EPA also had accelerated declines in EDV, but among females there was no PUFA association with EDV declines and exam 5 EDV status was positively associated with AA. Both sexes had nearly the same positive association of AA with changes in ESV. Conclusion Plasma phospholipid AA and EPA are prospectively associated with indices of heart remodeling, including ventricular remodeling and performance. Combined AA and EPA scarcity was associated with the most accelerated age-related changes and exam 5 status, while the greatest benefits were found among participants with both PUFAs. This suggests that both PUFAs are required for optimal slowing of age-related declines in ventricular function.
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Siddiqi N, Vasireddi S, Sattayaprasert P, Thamman R, Narang A, Aneja A. Determination of sources of error and improvement in accuracy of left ventricular mass measurement by echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2129-2137. [PMID: 37726463 DOI: 10.1007/s10554-022-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/18/2022] [Indexed: 01/19/2023]
Abstract
Abnormal Left ventricular mass (LVM) prognosticates adverse cardiovascular events. Conventionally, LVM measured by echo assumes a prolate ellipsoid (PE) shape; however, it poorly correlates with reference standard of cardiac magnetic resonance imaging (CMR) derived LVM. PE model assumes LVL = 2 × LVID. We developed a new echo LVM formula based on LV length and tested for accuracy against CMR. A retrospective study of consecutive patients with an echocardiogram and CMR within 3 months. Derivation (n = 170) and validation cohorts (n = 54) were used to test the new formula. Following analysis of correlation of interventricular septum (IVS), LV internal dimension (LVID), posterior wall (PW) and LVL between echo and CMR, a novel paraboloid-shape linear regression (PLR) model was derived. LVM by both models were compared to CMR. Poor correlation observed between actual and assumed LVL (0.52 with CMR; 0.44 with echo). Strong correlation was noted between echo and CMR measured LVL, LVID, IVS (r > 0.80) and a moderate correlation with PW (r = 0.62). Strong correlation of LVL was harnessed to develop PLR model, which significantly decreased paired error in derivation cohort (from 64 ± 42 to 22 ± 21 gm) and validation cohort (from 63 ± 46 to 25 ± 18 gm). Furthermore, it demonstrates significant reduction in absolute, relative errors and variability along with superior correlation in both cohorts. Between echo and CMR, LVL demonstrates one of the best correlation among LV dimensions. The assumption, LVL = 2 × LVID appears inaccurate. PLR model incorporates LVL and significantly improves accuracy, reduces variability of LVM.
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Affiliation(s)
- Najmul Siddiqi
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
| | - Sunil Vasireddi
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Prasongchai Sattayaprasert
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
| | - Ritu Thamman
- School of Medicine, University of Pittsburgh, 490 E North Avenue, Suite G104, Pittsburgh, PA, 15212, USA
| | - Akhil Narang
- Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 600, Chicago, IL, 60611, USA
| | - Ashish Aneja
- Heart and Vascular Center, MetroHealth Campus of Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
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Kristensen CB, Myhr KA, Grund FF, Vejlstrup N, Hassager C, Mattu R, Mogelvang R. A new method to quantify left ventricular mass by 2D echocardiography. Sci Rep 2022; 12:9980. [PMID: 35705586 PMCID: PMC9200734 DOI: 10.1038/s41598-022-13677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Increased left ventricular mass (LVM) is a strong independent predictor for adverse cardiovascular events, but conventional echocardiographic methods are limited by poor reproducibility and accuracy. We developed a novel method based on adding the mean wall thickness from the parasternal short axis view, to the left ventricular end-diastolic volume acquired using the biplane model of discs. The participants (n = 85) had various left ventricular geometries and were assessed using echocardiography followed immediately by cardiac magnetic resonance, as reference. We compared our novel two-dimensional (2D) method to various conventional one-dimensional (1D) and other 2D methods as well as the three-dimensional (3D) method. Our novel method had better reproducibility in intra-examiner [coefficients of variation (CV) 9% vs. 11–14%] and inter-examiner analysis (CV 9% vs. 10–20%). Accuracy was similar to the 3D method (mean difference ± 95% limits of agreement, CV): Novel: 2 ± 50 g, 15% vs. 3D: 2 ± 51 g, 16%; and better than the “linear” 1D method by Devereux (7 ± 76 g, 23%). Our novel method is simple, has considerable better reproducibility and accuracy than conventional “linear” 1D methods, and similar accuracy as the 3D-method. As the biplane model forms part of the standard echocardiographic protocol, it does not require specific training and provides a supplement to the modern echocardiographic report.
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Affiliation(s)
- Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Katrine Aagaard Myhr
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Frederik Fasth Grund
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Raj Mattu
- Kettering General Hospital NHS Foundation Trust, Kettering, NN16 8UZ, Northants, UK.,University College London, Gower St, London, WC1E 6BT, UK
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center, Rigshospitalet - University hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.,Cardiovascular Research Unit, University of Southern Denmark, Baagoees allé 15, 5700, Svendborg, Denmark
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Kristensen CB, Sattler SM, Lubberding AF, Tfelt-Hansen J, Jespersen T, Hassager C, Mogelvang R. Necropsy Validation of a Novel Method for Left Ventricular Mass Quantification in Porcine Transthoracic and Transdiaphragmal Echocardiography. Front Cardiovasc Med 2022; 9:868603. [PMID: 35592401 PMCID: PMC9110773 DOI: 10.3389/fcvm.2022.868603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Increased left ventricular mass (LVM) is one of the most powerful predictors of adverse cardiovascular events. Clinical evaluation requires reliable, accurate and reproducible echocardiographic LVM-quantification to manage patients. For this purpose, we have developed a novel two-dimensional (2D) method based on adding the mean wall thickness to the left ventricular volume acquired by the biplane method of disks, which has recently been validated in humans using cardiac magnetic resonance as reference value. We assessed the hypothesis that the novel method has better accuracy than conventional one-dimensional (1D) methods, when compared to necropsy LVM in pigs. Materials and Methods Echocardiography was performed during anesthesia in 34 Danish Landrace pigs, weight 47–59 kg. All pigs were euthanized, cardiac necropsy was performed and the left ventricle was trimmed and weighed for necropsy LVM. Trans-thoracic echocardiography was applied for parasternal images. Transdiaphragmal echocardiography was applied for the apical images, which are otherwise difficult to obtain in pigs. We compared the conventional 1D- and 2D-methods and the novel 2D-method to the LVM from cardiac necropsy. Results Necropsy LVM was 132 ± 11 g (mean ± SD). The novel method had better accuracy than other methods (mean difference ± 95% limits of agreement; coefficients of variation; standard error of the estimate, Pearson's correlation). Novel (−1 ± 20 g; 8%; 11 g; r = 0.70), Devereux (+26 ± 37 g; 15%; 33 g; r = 0.52), Area-Length (+27 ± 34 g; 13 %; 33 g; r = 0.63), Truncated Ellipsoid (+10 ± 30 g; 12%; 19 g; r = 0.63), biplane endo-/epicardial tracing (−3 ± 2 g; 10%; 14 g; r = 0.57). No proportional bias in linear regression was detected for any method, when compared to necropsy LVM. Conclusion We confirm high accuracy of the novel 2D-based method compared to conventional 1D/2D-methods.
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Affiliation(s)
- Charlotte Burup Kristensen
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- *Correspondence: Charlotte Burup Kristensen
| | - Stefan Michael Sattler
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Svendborg, Denmark
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Wang Y, Zhong Y, Zhang Z, Yang S, Zhang Q, Chu B, Hu X. Effect of sodium-glucose cotransporter protein-2 inhibitors on left ventricular hypertrophy in patients with type 2 diabetes: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:1088820. [PMID: 36699027 PMCID: PMC9868415 DOI: 10.3389/fendo.2022.1088820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis was performed to compare the effect of sodium-glucose cotransporter protein-2 inhibitors (SGLT-2i) and placebo on left ventricular hypertrophy (LVH) in patients with type 2 diabetes. METHOD Randomized controlled trials (RCTs) comparing the LVH parameters of SGLT-2i to placebo in patients with type 2 diabetes were included. Our primary outcomes were the changes in left ventricular mass (LVM) and left ventricular mass index (LVMI) from baseline to the study endpoint. Secondary outcomes were the changes in left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the ratio of early mitral inflow velocity to atrial inflow velocity (E/A). Summary odds ratios were estimated using a fixed-effect or random-effect model. RESULTS A total of 11 articles were included. Data were extracted from 11 original studies matching our inclusion criteria. In our meta-analysis, there were significant improvement in LVM (SMD -0.23, 95% CI -0.44 to -0.02, I 2 = 22.6%, p = 0.034), LVMI (SMD -0.25, 95% CI -0.38 to -0.12, I 2 = 0.0%, p = 0.000), LVEDV (SMD -0.19, 95% CI -0.36 to -0.01, I 2 = 62.3%, p = 0.035), and LVESV (SMD -0.21, 95% CI -0.39 to -0.04, I 2 = 32.9%, p = 0.017) in the SGLT-2i group compared with the placebo group. Furthermore, no significant differences were found in LVEF (SMD 0.13, 95% CI 0.00 to 0.26, I 2 = 0.0%, p = 0.050) and E/A (SMD -0.01, 95% CI -0.22 to 0.20, I 2 = 0%, p = 0.908) between the two groups. CONCLUSIONS This meta-analysis confirmed the beneficial effects of SGLT-2i on reversal of left ventricular remodeling. The LVH regression was more pronounced in studies of type 2 diabetes patients receiving SGLT-2i than placebo.
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Affiliation(s)
- Yao Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Yujie Zhong
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Zhehao Zhang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Shuhao Yang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Qianying Zhang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
| | - Bingyang Chu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Bingyang Chu, ; Xulin Hu,
| | - Xulin Hu
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China
- *Correspondence: Bingyang Chu, ; Xulin Hu,
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6
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Echocardiographic Left Ventricular Mass Assessment: Correlation between 2D-Derived Linear Dimensions and 3-Dimensional Automated, Machine Learning-Based Methods in Unselected Patients. J Clin Med 2021; 10:jcm10061279. [PMID: 33808707 PMCID: PMC8003438 DOI: 10.3390/jcm10061279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/20/2023] Open
Abstract
A recently developed algorithm for 3D analysis based on machine learning (ML) principles detects left ventricular (LV) mass without any human interaction. We retrospectively studied the correlation between 2D-derived linear dimensions using the ASE/EACVI-recommended formula and 3D automated, ML-based methods (Philips HeartModel) regarding LV mass quantification in unselected patients undergoing echocardiography. We included 130 patients (mean age 60 ± 18 years; 45% women). There was only discrete agreement between 2D and 3D measurements of LV mass (r = 0.662, r2 = 0.348, p < 0.001). The automated algorithm yielded an overestimation of LV mass compared to the linear method (Bland–Altman positive bias of 13.1 g with 95% limits of the agreement at 4.5 to 21.6 g, p = 0.003, ICC 0.78 (95%CI 0.68−8.4). There was a significant proportional bias (Beta −0.22, t = −2.9) p = 0.005, the variance of the difference varied across the range of LV mass. When the published cut-offs for LV mass abnormality were used, the observed proportion of overall agreement was 77% (kappa = 0.32, p < 0.001). In consecutive patients undergoing echocardiography for any indications, LV mass assessment by 3D analysis using a novel ML-based algorithm showed systematic differences and wide limits of agreements compared with quantification by ASE/EACVI- recommended formula when the current cut-offs and partition values were applied.
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7
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Florido R, Zhao DI, Ndumele CE, Bluemke DA, Heckbert SR, Allison MA, Ambale-Venkatesh B, Liu CY, Lima J, Michos ED. Change in Physical Activity and Cardiac Structure over 10 Years: The Multi-Ethnic Study of Atherosclerosis. Med Sci Sports Exerc 2019; 51:2033-2040. [PMID: 31524816 DOI: 10.1249/mss.0000000000002027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Physical activity (PA) is inversely associated with risk of heart failure and cardiovascular disease (CVD), whereas increased left ventricular (LV) mass and mass to volume (m:v) ratio are unfavorable CVD risk factors. We assessed whether changes in leisure time PA were associated with longitudinal changes in cardiac structure in a community-based population. METHODS We included 2779 Multi-Ethnic Study of Atherosclerosis participants, free of baseline CVD, who had available data on PA and cardiac magnetic resonance imaging at examinations 1 (2000-2002) and 5 (2010-2012). Physical activity was measured by a Typical Week PA Survey and converted to MET-minutes per week of moderate+vigorous activity. We used linear mixed effect models to estimate the associations of baseline and change in PA with baseline and change in cardiac structure, adjusting for CVD risk factors and body size. RESULTS At baseline, the mean age was 59 yr, 53% were women, and 58% of nonwhite race/ethnicity. During average 10-yr follow-up, and after accounting for baseline PA levels, the highest quintiles of PA increase were significantly associated with increases in LV mass (2.3 g; 95% confidence interval [CI], 0.4-4.2), LV end-diastolic volume (4.7 mL; 95% CI, 2.4-7.0), and stroke volume (3.3 mL; 95% CI, 1.6-5.1), but lower M:V ratio (-2.9; 95% CI, -5.0 to -0.8) compared with the lowest quintiles. Increasing exercise PA was associated with increases in LV diameter and reductions in M:V ratio, whereas occupational PA was associated with increases in m:v ratio. Increasing PA over 10 yr was also associated with greater risk of eccentric dilated LV hypertrophy at examination 5. CONCLUSIONS After accounting for baseline PA, greater positive changes in leisure-time PA levels were associated with a more eccentric-type of LV remodeling pattern over 10 yr. The clinical implications of such findings remain to be determined.
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Affiliation(s)
- Roberta Florido
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D I Zhao
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chiadi E Ndumele
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | | | - Chia-Ying Liu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD.,Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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8
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Chatzaraki V, Thali MJ, Schweitzer W, Ampanozi G. Left myocardial wall measurements on postmortem imaging compared to autopsy. Cardiovasc Pathol 2019; 43:107149. [PMID: 31639653 DOI: 10.1016/j.carpath.2019.107149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/27/2019] [Accepted: 08/12/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aims of this study were, firstly, to determine the relationship of left ventricular wall thickness (LVWT) measurements between postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMR) and, secondly, to assess the utility of postmortem imaging for LVWT measurements compared to autopsy. MATERIALS AND METHODS All cases ≥18years old, with postmortem interval ≤4days, cardiac PMCT, PMMR, and full forensic autopsy, were reviewed in our database retrospectively. Exclusion criteria were gas accumulations in the myocardial wall and cardiac trauma. LVWT on PMCT and PMMR was assessed. The measurements were repeated by the same rater after 2months. Autopsy reports were reviewed, and LVWT and pericardial fluid volume measured at autopsy were noted. Pericardial fluid volume >50ml was determined positive for pericardial effusion. RESULTS A total of 113 cases were included in the study. Twelve cases had pericardial effusion. Intrarater reliability for imaging based LVWT was excellent. LVWT (free wall) was significantly larger on PMCT (18.3mm) compared to PMMR (17.6mm), but these measurements correlated positively. LVWT (anterior wall) was significantly larger on PMMR (15mm) than at autopsy (14mm), and these measurements also correlated positively. Pericardial effusions led to larger differences between PMMR and autopsy measurements, however without statistical significance. DISCUSSION There exist discrepancies between LVWT as measured on postmortem imaging and at autopsy. Specialists should be aware in order to not misinterpret imaging measurements.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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10
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Pepe A, Pizzino F, Gargiulo P, Perrone-Filardi P, Cadeddu C, Mele D, Monte I, Novo G, Zito C, Di Bella G. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology. J Cardiovasc Med (Hagerstown) 2017; 17 Suppl 1 Special issue on Cardiotoxicity from Antiblastic Drugs and Cardioprotection:e45-e54. [PMID: 27755242 DOI: 10.2459/jcm.0000000000000380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chemotherapy-induced cardiotoxicity (CTX) is a determining factor for the quality of life and mortality of patients administered potentially cardiotoxic drugs and in long-term cancer survivors. Therefore, prevention and early detection of CTX are highly desirable, as is the exploration of alternative therapeutic strategies and/or the proposal of potentially cardioprotective treatments. In recent years, cardiovascular imaging has acquired a pivotal role in this setting. Although echocardiography remains the diagnostic method most used to monitor cancer patients, the need for more reliable, reproducible and accurate detection of early chemotherapy-induced CTX has encouraged the introduction of second-line advanced imaging modalities, such as cardiac magnetic resonance (CMR) and nuclear techniques, into the clinical setting. This review of the Working Group on Drug Cardiotoxicity and Cardioprotection of the Italian Society of Cardiology aims to afford an overview of the most important findings from the literature about the role of CMR and nuclear techniques in the management of chemotherapy-treated patients, describe conventional and new parameters for detecting CTX from both diagnostic and prognostic perspectives and provide integrated insight into the role of CMR and nuclear techniques compared with other imaging tools and versus the positions of the most important international societies.
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Affiliation(s)
- Alessia Pepe
- aU.O.C. Magnetic Resonance Imaging, Fondazione Toscana G. Monasterio C.N.R., Pisa bDepartment of Clinical and Experimental Medicine. Section of Cardiology A.O.U. Policlinico 'G. Martino' University of Messina, Messina cSDN, Institute of Diagnostic and Nuclear Development dDepartment of Advanced Biomedical Sciences, 'Federico II' University, Naples eDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari fCardiology Unit, University Hospital of Ferrara, Ferrara gDepartment of General Surgery and Medical-Surgery Specialities, University of Catania, Catania hChair and Division of Cardiology, University of Palermo, Palermo, Italy
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11
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Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
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Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
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12
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Assessment of the accuracy of common clinical thresholds for cardiac morphology and function by transthoracic echocardiography. J Echocardiogr 2016; 15:27-36. [PMID: 27817093 DOI: 10.1007/s12574-016-0322-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the ability of transthoracic echocardiography (TTE) to correctly identify abnormal left ventricular (LV) size, function, and mass when compared to cardiac magnetic resonance (CMR). Whilst numerous studies have compared TTE and CMR with respect to correlation between measurements and study reproducibility, few have employed categorical analysis relevant to clinical practice. METHODS Two hundred and fifteen consecutive patients who underwent both TTE and CMR were evaluated for the presence of abnormal LV size, systolic function, and mass. Abnormal LV systolic function was further categorized into grades (mild, moderate, and severe). Quantification of LV morphology and function was performed on TTE and CMR according to published guidelines. The level of agreement between TTE and CMR was compared across binary and categorical variables using Cohen's kappa. RESULTS Compared to CMR, TTE demonstrated excellent agreement in identification of abnormal versus normal function (κ = 0.87). However, agreement across grades of LV function was less strong (κ = 0.63). Whilst agreement for identification of severe LV dysfunction was good (κ = 0.68), this would still lead to misclassification of severe dysfunction in approximately one in seven cases. Agreement between TTE and CMR was moderate to good for identification of LV dilation (κ = 0.43-0.63), but poor for identification of increased mass (κ = 0.04). CONCLUSIONS Whilst in clinical practice TTE performs well in identification of normal versus abnormal systolic function, it has substantial limitations across grades of dysfunction and in the assessment of LV size and mass. These limitations have important implications when considering management decisions for patients based on thresholds of LV morphology or function.
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Cho JY, Sun JS, Sur YK, Park JS, Kang DK. Relationship between left ventricular mass and coronary artery disease in young adults: a single-center study using cardiac computed tomography. Int J Cardiovasc Imaging 2015; 31 Suppl 2:187-96. [DOI: 10.1007/s10554-015-0772-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
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Hashem MS, Kalashyan H, Choy J, Chiew SK, Shawki AH, Dawood AH, Becher H. Left ventricular relative wall thickness versus left ventricular mass index in non-cardioembolic stroke patients. Medicine (Baltimore) 2015; 94:e872. [PMID: 25997067 PMCID: PMC4602891 DOI: 10.1097/md.0000000000000872] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In non-cardioembolic stroke patients, the cardiac manifestations of high blood pressure are of particular interest. Emerging data suggest that echocardiographically determined left ventricular hypertrophy is independently associated with risk of ischemic stroke.The primary objective of this study was to evaluate the frequency of different patterns of left ventricular (LV) remodeling and hypertrophy in a group of consecutive patients admitted with non-cardioembolic stroke or transient ischemic attack (TIA). In particular, we were interested in how often the relative wall thickness (RWT) was abnormal in patients with normal LV mass index (LVMI). As both abnormal RWT and LVMI indicate altered LV remodeling, the secondary objective of this research was to study whether a significant number of patients would be missing the diagnosis of LV remodeling if the RWT is not measured.All patients were referred within 48 hours after a stroke or a TIA for a clinically indicated transthoracic echocardiogram. The echocardiographic findings of consecutive patients with non-cardioembolic stroke or TIA were analyzed.All necessary measurements were performed in 368 patients, who were enrolled in the study. Mean age was 63.7 ± 12.5 years, 64.4% men. Concentric remodeling carried the highest frequency, 49.2%, followed by concentric hypertrophy, 30.7%, normal pattern, 15.5%, and eccentric hypertrophy, 4.1%. The frequency of abnormal left ventricular RWT (80.4%) was significantly higher than that of abnormal LVMI (35.3%), (McNemar P < 0.05).In this group of non-cardioembolic stroke patients, abnormal LV remodeling as assessed by relative wall thickness is very frequent. As RWT was often found without increased LV mass, the abnormal left ventricular geometry may be missed if RWT is not measured or reported.
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Affiliation(s)
- M-Sherif Hashem
- From the Jeddah Heart Institute, Erfan & Bagedo Hospital, Jeddah, Saudi Arabia (M-SH, A-HS, AHD); and Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Canada (HK, JC, SKC, HB)
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Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP, Banchs J, Cardinale D, Carver J, Cerqueira M, DeCara JM, Edvardsen T, Flamm SD, Force T, Griffin BP, Jerusalem G, Liu JE, Magalhães A, Marwick T, Sanchez LY, Sicari R, Villarraga HR, Lancellotti P. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014; 15:1063-93. [PMID: 25239940 PMCID: PMC4402366 DOI: 10.1093/ehjci/jeu192] [Citation(s) in RCA: 628] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Ana Barac
- Medstar Washington Hospital Center, Washington, District of Columbia
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Bonnie Ky
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Igal A Sebag
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | | | | | - Jose Banchs
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - Joseph Carver
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Thor Edvardsen
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | - Jennifer E Liu
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Liza Y Sanchez
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Rosa Sicari
- CNR Institute of Clinical Physiology, Pisa, Italy
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Farber NJ, Reddy ST, Doyle M, Rayarao G, Thompson DV, Olson P, Glass J, Williams RB, Yamrozik JA, Murali S, Biederman RW. Ex vivo cardiovascular magnetic resonance measurements of right and left ventricular mass compared with direct mass measurement in excised hearts after transplantation: a first human SSFP comparison. J Cardiovasc Magn Reson 2014; 16:74. [PMID: 25315015 PMCID: PMC4180950 DOI: 10.1186/s12968-014-0074-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/28/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND CMR is considered the 'gold standard' for non-invasive LV and RV mass quantitation. This information is solely based on gradient-recalled echo (GRE) sequences while contrast dependent on intrinsic T1/T2 characteristics potentially offers superior image contrast between blood and myocardium. This study aims, for the first time in humans, to validate the SSFP approach using explanted hearts obtained from heart transplant recipients. Our objective is establish the correlation between and to validate steady-state free precession (SSFP) derived LV and RV mass vs. autopsy mass of hearts from cardiac transplants patients. METHODS Over three-years, 58 explanted cardiomyopathy hearts were obtained immediately upon orthotopic heart transplantation from the OR. They were quickly cleaned, prepared and suspended in a saline-filled container and scanned ex vivo via SSFP-SA slices to define LV/RV mass. Using an automatic thresholding program, segmentation was achieved in combination with manual trimming (ATMT) of extraneous tissue incorporating 3D cardiac modeling performed by independent and blinded readers. The explanted hearts were then dissected with the ventricles surgically separated at the interventricular septum. Weights of the total heart not excluding papillary and trabecular myocardium, LV and RV were measured via high-fidelity scale. Linear regression and Bland-Altman plots were used to analyze the data. The intra-class correlation coefficient was used to assess intra-observer reliability. RESULTS Of the total of 58 explanted hearts, 3 (6%) were excluded due to poor image quality leaving 55 patients (94%) for the final analysis. Significant positive correlations were found between total 3D CMR mass (450 ± 111 g) and total pathology mass (445 ± 116 g; r = 0.99, p < 0.001) as well as 3D CMR measured LV mass (301 ± 93 g) and the pathology measured LV mass (313 ± 96 g; r = 0.95, p < 0.001). Strong positive correlations were demonstrated between the 3D CMR measured RV mass (149 ± 46 g) and the pathology measured RV mass (128 ± 40 g; r = 0.76, p < 0.001). The mean bias between 3D-CMR and pathology measures for total mass, LV mass and RV mass were: 3.0 g, -16 g and 19 g, respectively. CONCLUSIONS SSFP-CMR accurately determines total myocardial, LV and RV mass as compared to pathology weighed explanted hearts despite variable surgical removal of instrumentation (left and right ventricular assist devices, AICD and often apical core removals). Thus, this becomes the first-ever human CMR confirmation for SSFP now validating the distinction of 'gold standard'.
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Affiliation(s)
- Nicholas J Farber
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Sahadev T Reddy
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Mark Doyle
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Geetha Rayarao
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Diane V Thompson
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Peter Olson
- Department of Pathology, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Jerry Glass
- Department of Pathology, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Ronald B Williams
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - June A Yamrozik
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Srinivas Murali
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
| | - Robert Ww Biederman
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
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Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP, Banchs J, Cardinale D, Carver J, Cerqueira M, DeCara JM, Edvardsen T, Flamm SD, Force T, Griffin BP, Jerusalem G, Liu JE, Magalhães A, Marwick T, Sanchez LY, Sicari R, Villarraga HR, Lancellotti P. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2014; 27:911-39. [PMID: 25172399 DOI: 10.1016/j.echo.2014.07.012] [Citation(s) in RCA: 864] [Impact Index Per Article: 86.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Ana Barac
- Medstar Washington Hospital Center, Washington, District of Columbia
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Bonnie Ky
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Igal A Sebag
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | | | | | - Jose Banchs
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | | | - Joseph Carver
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Thor Edvardsen
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | - Jennifer E Liu
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Liza Y Sanchez
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Rosa Sicari
- CNR Institute of Clinical Physiology, Pisa, Italy
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Müller C, Wallaschofski H, Brabant G, Wahnschaffe U, Samietz S, Nauck M, Friedrich N. The association between IGF-I/IGFBP-3 and subclinical end points: epidemiology faces the limits. J Clin Endocrinol Metab 2014; 99:2804-12. [PMID: 24823454 DOI: 10.1210/jc.2013-3746] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The variation in laboratory measurements represents a challenge in clinical practice and epidemiological research. The use of different analytical platforms might have led to different results, which were often discussed in the interpretation of conflicting results. We aim to study the impact of two different IGF-I and IGF binding protein 3 assays on published epidemiological studies. METHODS We compared epidemiological results based on the previous gold standard Nichols Advantage, which is no longer available, with these based on the IDS-iSYS assay. The latter follows the recently proposed Keswick criteria. We reinvestigated published association studies between IGF-I or IGF binding protein 3 and anthropometry, subclinical cardiovascular diseases including intima-media thickness or left ventricular mass index, and hard end points like mortality and single-nucleotide polymorphisms of our genome-wide association study in the Study of Health in Pomerania. RESULTS We demonstrated that there are significant differences in the associations of IGF-I measured by the Nichols or IDS-iSYS assay and subclinical outcomes including intima-media thickness and left ventricular mass index. However, concerning hard outcomes like mortality or single-nucleotide polymorphisms, our analyses revealed similar results with comparable regression estimates. CONCLUSION With our study we queried not only the accuracy of measurement but also the effect of different methods on study results. The establishment of laboratory standards like the Keswick criteria should be enforced to allow reliable comparisons of different methods and thus clinical and epidemiological studies. Single-center studies have to be interpreted carefully. Moreover, to assure the reliability of studies, their results should be replicated in a meta-analysis, and a generated hypothesis by epidemiology should be proven by intervention studies.
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Affiliation(s)
- Christiane Müller
- Institute of Clinical Chemistry and Laboratory Medicine (C.M., H.W., M.N., N.F.) and Department of Prosthetic Dentistry, Gerodontology, and Biomaterials (S.S.), Center of Oral Health, University Medicine Greifswald, 17475 Greifswald, Germany; Med Clinic I (G.B.), University of Lübeck, 23538 Lübeck, Germany; and Klinik für Innere Medizin I (U.W.), Evangelisches Waldkrankenhaus Spandau, 13589 Berlin, Germany
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Quantification of congenital aortic valve stenosis in pediatric patients: comparison between cardiac magnetic resonance imaging and transthoracic echocardiography. Pediatr Cardiol 2014; 35:771-7. [PMID: 24343730 DOI: 10.1007/s00246-013-0851-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Previous studies showed the reliability of cardiac magnetic resonance imaging (cMRI) in the quantification of aortic valve stenosis in adults. The aim of this retrospective study was to assess the ability of cMRI in the quantification of congenital aortic valve stenosis (CAS) in children. Nineteen patients (mean age 14.0 ± 3.2 years, 15 boys and 4 girls) with CAS were imaged by cMRI and transthoracic echocardiography (TTE). cMRI was performed on a 1.5-Tesla MR scanner (Magnetom Avanto; Siemens Healthcare, Erlangen, Germany) using cine steady-state free precession sequences for the assessment of the aortic valve area (AVA) by MR planimetry and left-ventricular function. Phase-contrast measurement was used in cMRI to assess peak flow velocity above the aortic valve. A positive correlation was found between maximum systolic pressure gradient (MPG) as assessed by cMRI and TTE (28.9 ± 21.2 vs. 41.3 ± 22.7 mmHg, r = 0.84, p = 0.001) with a mean underestimation of 12.4 mmHg by cMRI. Only a weak correlation could be observed between AVA by cMRI and MPG at the aortic valve by TTE (r = -0.50, p = 0.029) and cMRI (r = -0.27, p = 0.40). Furthermore, a positive correlation between myocardial mass (cMRI) and MPG (TTE, r = 0.57, p = 0.01), but not between myocardial mass (cMRI) and AVA (cMRI, r = 0.07, p = 0.77), was found. The assessment of MPG by cMRI in patients with CAS is feasible with a trend toward underestimatation compared with TTE. Moreover, MPG seems to be a more accurate parameter than AVA regarding the prediction of myocardial hypertrophy.
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Simprini LA, Goyal P, Codella N, Fieno DS, Afroz A, Mullally J, Cooper M, Wang Y, Finn JP, Devereux RB, Weinsaft JW. Geometry-independent inclusion of basal myocardium yields improved cardiac magnetic resonance agreement with echocardiography and necropsy quantified left-ventricular mass. J Hypertens 2014; 31:2069-76. [PMID: 24107735 DOI: 10.1097/hjh.0b013e328362d935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Left-ventricular mass (LVM) is widely used to guide clinical decision-making. Cardiac magnetic resonance (CMR) quantifies LVM by planimetry of contiguous short-axis images, an approach dependent on reader-selection of images to be contoured. Established methods have applied different binary cut-offs using circumferential extent of left-ventricular myocardium to define the basal left ventricle (LV), omitting images containing lesser fractions of left-ventricular myocardium. This study tested impact of basal slice variability on LVM quantification. METHODS CMR was performed in patients and laboratory animals. LVM was quantified with full inclusion of left-ventricular myocardium, and by established methods that use different cut-offs to define the left-ventricular basal-most slice: 50% circumferential myocardium at end diastole alone (ED50), 50% circumferential myocardium throughout both end diastole and end systole (EDS50). RESULTS One hundred and fifty patients and 10 lab animals were studied. Among patients, fully inclusive LVM (172.6±42.3g) was higher vs. ED50 (167.2±41.8g) and EDS50 (150.6±41.1g; both P<0.001). Methodological differences yielded discrepancies regarding proportion of patients meeting established criteria for left-ventricular hypertrophy and chamber dilation (P<0.05). Fully inclusive LVM yielded smaller differences with echocardiography (Δ=11.0±28.8g) than did ED50 (Δ=16.4±29.1g) and EDS50 (Δ=33.2±28.7g; both P<0.001). Among lab animals, ex-vivo left-ventricular weight (69.8±13.2g) was similar to LVM calculated using fully inclusive (70.1±13.5g, P=0.67) and ED50 (69.4±13.9g; P=0.70) methods, whereas EDS50 differed significantly (67.9±14.9g; P=0.04). CONCLUSION Established CMR methods that discordantly define the basal-most LV produce significant differences in calculated LVM. Fully inclusive quantification, rather than binary cut-offs that omit basal left-ventricular myocardium, yields smallest CMR discrepancy with echocardiography-measured LVM and non-significant differences with necropsy-measured left-ventricular weight.
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Affiliation(s)
- Lauren A Simprini
- aDepartment of Medicine (Cardiology) bDepartment of Radiology cDepartment of Biomedical Engineering, Weill Cornell Medical College dMemorial Sloan Kettering Cancer Center eIBM TJ Watson Research Center, Yorktown, New York fHeart South Cardiovascular Group, Alabaster, Alabama gUCLA Health System, Los Angeles, California, USA
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Takami Y, Tajima K. Impact of secondary hyperparathyroidism on ventricular mass regression after aortic valve replacement for aortic stenosis in hemodialysis-dependent patients. Heart Vessels 2014; 30:510-5. [DOI: 10.1007/s00380-014-0512-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/04/2014] [Indexed: 12/21/2022]
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Zheng XZ, Yang B, Wu J. Fetal left ventricular mass determination on 2-dimensional echocardiography using area-length calculation methods. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:349-354. [PMID: 24449740 DOI: 10.7863/ultra.33.2.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Fetal cardiac examination is an important part of fetal malformation screening. The purposes of this study were to describe the left ventricular (LV) mass in the second and third trimesters by 2-dimensional echocardiography using area-length calculation methods and to examine the clinical usefulness of this procedure in evaluation of gestational age (GA)- and fetal weight-related LV mass changes. METHODS Five hundred healthy fetuses were divided into 2 groups (250 participants per group): second- and third-trimester groups. The estimated fetal weight (EFW) was computed according to the Hadlock formula (Radiology 1984; 150:535-540). The LV mass at end diastole (LVd mass) and LV mass at end systole (LVs mass) were measured, and the difference between the LVd mass and LVs mass [LV(d-s) mass], LVd mass/EFW ratio, and LVs mass/EFW ratio were calculated. RESULTS The EFW, LVd mass, LVs mass, and LV(d-s) mass were all significantly greater in the third-trimester group than the second-trimester group (P < .05), whereas the LVd mass/EFW and LVs mass/EFW ratios did not differ between the groups (P > .05). The LVd mass, LVs mass, and LV(d-s) mass all significantly correlated with GA and weight (P< .001), but the LVd mass/EFW and LVs mass/EFW ratios did not (P > .05). CONCLUSIONS Two-dimensional echocardiography using area-length calculation methods can effectively provide measurements for LV mass and can sensitively indicate fetal weight- and GA -related changes in LV mass. Fetal cardiac mass measurement is a useful parameter for evaluation of fetal heart development.
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Affiliation(s)
- Xiao-Zhi Zheng
- Department of Ultrasound, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Rd, 210002 Nanjing, Jiangsu, China
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Spence AL, Naylor LH, Carter HH, Dembo L, Murray CP, O'Driscoll G, George KP, Green DJ. Does echocardiography accurately reflect CMR-determined changes in left ventricular parameters following exercise training? A prospective longitudinal study. J Appl Physiol (1985) 2013; 114:1052-7. [PMID: 23393067 DOI: 10.1152/japplphysiol.01348.2012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cardiac adaptation in response to exercise has historically been described using echocardiography. Cardiac magnetic resonance (CMR), however, has evolved as a preferred imaging methodology for cardiac morphological assessment. While direct imaging modality comparisons in athletes suggest that large absolute differences in cardiac dimensions exist, it is currently unknown whether changes in cardiac morphology in response to exercise training are comparable when using echocardiography and CMR. Twenty-two young men were randomly assigned to undertake a supervised and intensive endurance or resistance exercise-training program for 24 wk. Echocardiography and CMR assessment of left ventricular (LV) mass, LV end-diastolic volume, internal cavity dimensions, and wall thicknesses were completed before and after training. At baseline, pooled data for all cardiac parameters were significantly different between imaging methods, while LV mass (r = 0.756, P < 0.001) and volumes (LV end-diastolic volume, r = 0.792, P < 0.001) were highly correlated across modalities. Changes in cardiac morphology data with exercise training were not significantly related when echocardiographic and CMR measures were compared. For example, posterior wall thickness increased by 8.3% (P < 0.05) when assessed using echocardiography, but decreased by 2% when using CMR. In summary, echocardiography and CMR imaging modalities produce findings that differ with respect to changes in cardiac size and volume following exercise training.
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Affiliation(s)
- Angela L Spence
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia.
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Bouzas-Mosquera A, Broullón FJ, Álvarez-García N, Peteiro J, Mosquera VX, Castro-Beiras A. Association of left ventricular mass with all-cause mortality, myocardial infarction and stroke. PLoS One 2012; 7:e45570. [PMID: 23049815 PMCID: PMC3458916 DOI: 10.1371/journal.pone.0045570] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/22/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Our aim was to assess the association of left ventricular mass with mortality and nonfatal cardiovascular events. METHODOLOGY/PRINCIPAL FINDINGS Left ventricular mass was measured by echocardiography in 40138 adult patients (mean age 61.1 ± 16.4 years, 52.5% male). The primary endpoint was all-cause mortality. Secondary endpoints included nonfatal myocardial infarction and nonfatal stroke. During a mean follow-up period of 5.6 ± 3.9 years, 9181 patients died, 901 patients had a nonfatal myocardial infarction, and 2139 patients had a nonfatal stroke. Cumulative 10-year mortality was 26.8%, 31.9%, 37.4% and 46.4% in patients with normal, mildly, moderately and severely increased left ventricular mass, respectively (p<0.001). Ten-year rates of nonfatal myocardial infarction and stroke ranged from 3.2% and 6.7% in patients with normal left ventricular mass to 5.3% and 12.7% in those with severe increase in left ventricular mass, respectively. After multivariate adjustment, left ventricular mass remained an independent predictor of all-cause mortality (hazard ratio [HR] per 100 g increase 1.21, 95% confidence interval [CI] 1.14-1-27, p<0.001 in women, and HR 1.09, 95% CI 1.04-1-13, p<0.001 in men), myocardial infarction (HR 1.60, 95% CI 1.31-1.94, p<0.001 in women and HR 1.15, 95% CI 1.02-1.29, p=0.019 in men) and stroke (HR 1.26, 95% CI 1.13-1.40, p<0.001 in women and HR 1.19, 95% CI 1.09-1.30, p<0.001 in men). CONCLUSIONS/SIGNIFICANCE Left ventricular mass has a graded and independent association with all-cause mortality, myocardial infarction and stroke.
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Zheng XZ, Ji P, Mao HW. Reduced difference in left ventricular mass at end diastole and peak systole is a predictor of major stenosis of the left coronary artery territory. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1437-1442. [PMID: 22922624 DOI: 10.7863/jum.2012.31.9.1437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the feasibility of using the difference in left ventricular (LV) mass at end diastole and peak systole as determined by area-length calculation methods to detect major stenosis of the left coronary artery territory by 2-dimensional echocardiography. METHODS The LV mass at end diastole, LV mass at peak systole, and LV mass difference between end diastole and peak systole were measured and compared between 39 healthy participants and 40 patients with coronary artery disease (CAD) referred for coronary angiography. The mass difference was compared to the mean percent stenosis diameter by linear correlation analysis, and its performance in discrimination between the patients with CAD and the healthy participants was analyzed. RESULTS Compared to the healthy participants, the patients with CAD had significantly higher LV mass at peak systole (mean ± SD, 101.97 ± 30.34 versus 89.87 ± 28.71 g; P< .05) and a lower mass difference between end diastole and peak systole (21.36 ± 17.55 versus 40.12 ± 14.37 g; P < .01). The mass difference correlated significantly with the mean percent stenosis diameter (r = -0.71; P < .001) in patients with CAD . With the use of the mass difference as the criterion to distinguish patients with CAD from healthy participants, the area under the receiver operating characteristic curve was 0.81 (P < .05). The sensitivity, specificity, and accuracy for the prediction of major stenosis (>70%) of the left coronary artery were 82.35%, 70.37%, and 75% respectively for a mass difference of less than 30.2 g. CONCLUSIONS The LV mass difference between end diastole and peak systole can effectively reflect the diameter changes of the left coronary artery, and a reduced mass difference is a sensitive and specific predictor of major stenosis of the left coronary artery territory.
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Affiliation(s)
- Xiao-Zhi Zheng
- Department of Ultrasound, Fourth Affiliated Hospital of Nantong University, First People's Hospital of Yancheng, 14 Yuehe Rd, 224006 Yancheng, Jiangsu Province, China.
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Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012; 5:837-48. [PMID: 22897998 PMCID: PMC3501209 DOI: 10.1016/j.jcmg.2012.06.003] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 01/16/2023]
Abstract
The authors investigated 3 important areas related to the clinical use of left ventricular mass (LVM): accuracy of assessments by echocardiography and cardiac magnetic resonance (CMR), the ability to predict cardiovascular outcomes, and the comparative value of different indexing methods. The recommended formula for echocardiographic estimation of LVM uses linear measurements and is based on the assumption of the left ventricle (LV) as a prolate ellipsoid of revolution. CMR permits a modeling of the LV free of cardiac geometric assumptions or acoustic window dependency, showing better accuracy and reproducibility. However, echocardiography has lower cost, easier availability, and better tolerability. From the MEDLINE database, 26 longitudinal echocardiographic studies and 5 CMR studies investigating LVM or LV hypertrophy as predictors of death or major cardiovascular outcomes were identified. LVM and LV hypertrophy were reliable cardiovascular risk predictors using both modalities. However, no study directly compared the methods for the ability to predict events, agreement in hypertrophy classification, or performance in cardiovascular risk reclassification. Indexing LVM to body surface area was the earliest normalization process used, but it seems to underestimate the prevalence of hypertrophy in obese and overweight subjects. Dividing LVM by height to the allometric power of 1.7 or 2.7 is the most promising normalization method in terms of practicality and usefulness from a clinical and scientific standpoint for scaling myocardial mass to body size. The measurement of LVM, calculation of LVM index, and classification for LV hypertrophy should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision making.
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Affiliation(s)
- Anderson C. Armstrong
- Johns Hopkins University/Division of Cardiology, Universidade Federal do Vale do São Francisco/School of Medicine, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
| | - Samuel Gidding
- Nemours Cardiac Center/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899
| | - Ola Gjesdal
- Johns Hopkins University/Division of Cardiology, Johns Hopkins University/Division of Cardiology, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
| | - Colin Wu
- National Heart, Lung, and Blood Institute, NIH / Office of Biostatistics Research, 6701 Rockledge Drive, MSC 7938, Bethesda, MD 20892-7938, USA
| | - David A Bluemke
- National Institute of Health/Radiology and Imaging Sciences, 10 Center Drive, MSC 1074, Bethesda, Maryland 20892-1074
| | - João A. Lima
- Johns Hopkins University/Division of Cardiology, 600 N. Wolfe Street, Blalock 524D1, Baltimore, MD 21287
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Barbier CE, Johansson L, Lind L, Ahlström H, Bjerner T. Several sources of error in estimation of left ventricular mass with M-mode echocardiography in elderly subjects. Ups J Med Sci 2011; 116:258-64. [PMID: 22066974 PMCID: PMC3207301 DOI: 10.3109/03009734.2011.596586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION M-mode echocardiography estimates of the left ventricular mass (LVM) were greater than magnetic resonance imaging (MRI) estimates. There are substantial differences between the methods both in the means of measuring and the calculation formula. The aim of this study was to investigate whether any difference in estimates of LVM between M-mode echocardiography and MRI is due to the means of measuring or to the calculation formula, using MRI as the gold standard. MATERIAL AND METHODS M-mode echocardiography and MRI were performed on 229 randomly selected 70-year-old community-living subjects. LVM was calculated from echocardiography (LVM(echo)) and from MRI (LVM(MRI)) measurements using standard techniques. Additionally LVM was calculated with the echocardiography formula from echo-mimicking measurements made on MR images (LVM(MRI/ASE)). RESULTS There were significant differences between all three LVM estimates in women, in men, and in the entire population. Echocardiography estimated LVM to be larger than did MRI, and the LVM(MRI/ASE) estimate was larger than the LVM(MRI). The difference between LVM(MRI) and LVM(MRI/ASE) was larger than the difference between LVM(echo) and LVM(MRI/ASE). There was a low correlation between LVM(echo) and LVM(MRI) (R(2) = 0.46) as well as between LVM(MRI/ASE) and LVM(MRI) (R(2) = 0.65). CONCLUSION The means of measuring and the calculation formula both independently add to the error in LVM estimation with M-mode echocardiography. The error of the calculation formula seems to be greater than the error of the means of measuring in a population of community-living elderly men and women.
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Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease. Int J Cardiovasc Imaging 2010; 26 Suppl 1:123-31. [PMID: 20049536 DOI: 10.1007/s10554-009-9574-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 12/18/2009] [Indexed: 01/24/2023]
Abstract
To determine the prognosis of a myocardial scar assessed by a late gadolinium enhancement (LGE) technique of cardiac magnetic resonance (CMR) in hypertensive patients with known or suspected coronary artery disease (CAD). Patients with systemic hypertension with known or suspected CAD without a clinical history of myocardial infarction were enrolled. All patients underwent CMR for assessment of cardiac function and LGE. Prognostic data was determined by the occurrence of a hard cardiac endpoint, defined as cardiac death or a non-fatal myocardial infarction, or major adverse cardiac events (MACEs), defined as cardiac death, a non-fatal myocardial infarction, or hospitalization due to heart failure, unstable angina, or life-threatening ventricular arrhythmia. A total of 1,644 patients were enrolled; 48% were males and the mean age was 65 +/- 11 years. The average follow-up time was 863 +/- 559 days. Four hundred fifty-three (28%) patients had LGE. LGE was the strongest and most independent predictor for hard events and MACEs with hazard ratios of 4.77 and 3.38, respectively. Other independent predictors of hard events and MACEs were left ventricular ejection fraction and mass, the use of a beta-blocker, and a history of heart failure. The risk of cardiac events increased as the extent of LGE increased; the hazard ratio was 12.74 for hard events for those with a LGE >20% of the myocardium. LGE is the most important and independent predictor for cardiac events in hypertensive patients with known or suspected CAD.
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Prognostic significance of left ventricular mass by magnetic resonance imaging study in patients with known or suspected coronary artery disease. J Hypertens 2009; 27:2249-56. [DOI: 10.1097/hjh.0b013e3283309ac4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cheng S, Fernandes VRS, Bluemke DA, McClelland RL, Kronmal RA, Lima JAC. Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2009; 2:191-8. [PMID: 19808592 DOI: 10.1161/circimaging.108.819938] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age-related alterations of left ventricular (LV) structure and function that may predispose to cardiovascular events are not well understood. METHODS AND RESULTS We used cardiac MRI to examine age-related differences in LV structure and function in 5004 participants without overt cardiovascular disease when enrolled in the Multi-Ethnic Study of Atherosclerosis; 1099 participants received additional strain analyses by MRI tagging. We also assessed the relation of age-associated remodeling with cardiovascular outcomes using Cox proportional hazard models adjusting for cardiovascular risk factors. Although LV mass decreased with age (-0.3 g per year), the mass-to-volume ratio markedly increased (+5 mg/mL per year, P<0.0001), driven by a substantial reduction in end-diastolic volume (-0.8 mL per year, P<0.0001). Age was also associated with a significant fall in stroke volume (-0.4 mL per year, P<0.0001), along with strain patterns reflecting systolic (P<0.0001) as well as diastolic (P<0.01) myocardial dysfunction-despite a modestly enhanced ejection fraction (+0.1% per year, P<0.0001). Increased mass-to-volume ratio conferred a significant risk for total cardiovascular events; this trend was strongest among younger (<65 years; hazard ratio, 3.69 [CI, 1.34 to 10.10]) versus older (> or =65 years; hazard ratio, 1.68 [CI 0.77 to 3.68]) individuals with the highest compared to lowest mass-to-volume ratio quintile (P(interaction)=0.013). CONCLUSIONS Age is associated with a phenotype of LV remodeling marked by increased mass-to-volume ratio and accompanied by systolic as well as diastolic myocardial dysfunction that is not reflected by preserved ejection fraction. This pattern of ventricular remodeling confers significant cardiovascular risk, particularly when present earlier in life.
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Affiliation(s)
- Susan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Md., USA
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Bluemke DA, Kronmal RA, Lima JAC, Liu K, Olson J, Burke GL, Folsom AR. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 2009; 52:2148-55. [PMID: 19095132 DOI: 10.1016/j.jacc.2008.09.014] [Citation(s) in RCA: 586] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/27/2008] [Accepted: 09/04/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship of left ventricular (LV) mass and geometry measured with cardiac magnetic resonance imaging (MRI) to incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis) study. BACKGROUND MRI is highly accurate for evaluation of heart size and structure and has not previously been used in a large epidemiologic study to predict cardiovascular events. METHODS A total of 5,098 participants in the MESA study underwent cardiac MRI at the baseline examination and were followed up for a median of 4 years. Cox proportional hazard models were constructed to predict the end points of coronary heart disease (CHD), stroke, and heart failure (HF) after adjustment for cardiovascular risk factors. RESULTS A total of 216 incident events were observed during the follow-up period. In adjusted models, the end points of incident CHD and stroke were positively associated with increased LV mass-to-volume ratio (CHD, hazard ratio [HR]: 2.1 per g/ml, p = 0.02; stroke, HR: 4.2 per g/ml, p = 0.005). In contrast, LV mass showed the strongest association with incident HF events (HR: 1.4 per 10% increment, p < 0.0001). The HF events occurred primarily in participants with LV hypertrophy, that is, >or=95th percentile of LV mass (HR: 8.6, 95% confidence interval: 3.7 to 19.9, reference group <50th percentile of LV mass). CONCLUSIONS The LV size was related to incident HF, stroke, and CHD in this multiethnic cohort. Whereas body size-adjusted LV mass alone predicted incident HF, concentric ventricular remodeling predicted incident stroke and CHD.
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Affiliation(s)
- David A Bluemke
- Department of Radiology, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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Shehata ML, Turkbey EB, Vogel-Claussen J, Bluemke DA. Role of cardiac magnetic resonance imaging in assessment of nonischemic cardiomyopathies. Top Magn Reson Imaging 2008; 19:43-57. [PMID: 18690160 DOI: 10.1097/rmr.0b013e31816fcb22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnosis of nonischemic cardiomyopathy is a challenging process that influences patient morbidity and mortality. Currently, the well known World Health Organization classification has been revisited by an American Heart Association expert consensus panel. The contemporary classification is compatible with the rapid evolution in molecular genetics and evolving diagnostic tools such as cardiac magnetic resonance imaging (MRI). Magnetic resonance imaging is a robust diagnostic tool that offers various techniques to assess the function, morphology, perfusion, and scarring of myocardial tissue thus providing better understanding of the underlying causes of nonischemic cardiomyopathies. In this review, we discuss the current role of cardiac MRI in the evaluation of nonischemic cardiomyopathy, in the context of the current American Heart Association classification of these disorders.
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Affiliation(s)
- Monda L Shehata
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Gandy SJ, Waugh SA, Nicholas RS, Simpson HJ, Milne W, Houston JG. Comparison of the reproducibility of quantitative cardiac left ventricular assessments in healthy volunteers using different MRI scanners: a multicenter simulation. J Magn Reson Imaging 2008; 28:359-65. [PMID: 18666157 DOI: 10.1002/jmri.21401] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To derive reproducibility assessments of ejection fraction (EF) and left ventricular mass (LVM) from short-axis cardiac MR images acquired at single and multiple time-points on different 1.5T scanner models. MATERIALS AND METHODS Images of 15 healthy volunteers were acquired twice using a Magnetom Avanto scanner (Siemens, Erlangen, Germany) and once using a Signa Excite scanner (General Electric, Milwaukee, WI, USA) over four months, and analyzed using ARGUS and MASS Analysis+ software, respectively. Two physicists independently segmented the myocardial borders in order to derive intra- and interobserver assessments of EF and LVM for single and multiple time-points on the same and different scanners. RESULTS For EF, the coefficient of repeatability (CoR) increased as different observers, multiple time-points, and different scanners were introduced. The CoR ranged from 2.8% (intraobserver measurements, single time-point, same scanner) to 10.0% (interobserver measurements, different time-points, different scanners). For LVM, intraobserver CoR parameters were consistently smaller than interobserver values. The CoR ranged from 7.8 g (intraobserver measurements, single time-point, same scanner) to 39.5 g (interobserver measurements, different time-points, different scanners). CONCLUSION Reproducible EF data can be obtained at single or multiple time-points using different scanners. However, LVM is notably susceptible to interobserver variation, and this should be carefully considered if similar evaluations are planned as part of multicenter or longitudinal investigations.
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Affiliation(s)
- Stephen J Gandy
- Department of Clinical Radiology, Ninewells Hospital, National Health Service (NHS) Tayside, Dundee, UK.
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Buba F, Okeahialam B, Anjorin C. The Value of Chest Radiogram and Electrocardiogram in the Assessment of Left Ventricular Hypertrophy among Adult Hypertensives. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.298.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Kramer H, Weckbach S, van Kaick G, Reiser MF, Schoenberg SO. [Screening in cardiovascular diseases]. Radiologe 2008; 48:52-62. [PMID: 18210053 DOI: 10.1007/s00117-007-1607-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease still ranks number one in the mortality statistics in the industrialized world. In Germany the five most common causes of death are all associated with arteriosclerotic changes of the arterial vasculature. As the treatment often extends over long periods and it can be impossible for patients to work, peripheral arterial occlusive disease (PAOD) constitutes a not inconsiderable economic factor. Thus, screening for arteriosclerotic disease seems to be reasonable, because the potential for influencing arteriosclerotic changes is known to be higher in an early stage of the disease even before symptoms become apparent. Not every case can be cured, but progression can frequently be slowed down. The need for invasive procedures, some of them associated with ionizing radiation, limited the use of imaging of the arterial vasculature for a long time. Noninvasive clinical examinations such as the "ankle brachial index" (ABI) can indicate the presence of PAOD, though exact localization of the pathologic changes is not possible except with imaging methods. In contrast to these, MRI is a noninvasive imaging modality that does not involve ionizing radiation but offers high spatial resolution arterial imaging.
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Affiliation(s)
- H Kramer
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität München, München, Deutschland.
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Abstract
Coronary events are the leading cause of death in the United States, and sudden coronary death is often the first presenting symptom. Because there is such a large population at risk for coronary events and because many of these patients go undetected before presenting with a significant cardiovascular event or sudden death, there is great interest in better detection and characterization of subclinical disease before it causes morbidity and mortality. This chapter will focus on promising imaging-based methods for the evaluation of subclinical cardiovascular disease. Several imaging methods that are most likely to be useful for future screening and intervention studies for characterizing risk among asymptomatic persons will be presented.
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Bluemke DA, Lima JAC. Heart size matters: lessons with MRI. Future Cardiol 2007; 3:1-4. [DOI: 10.2217/14796678.3.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David A Bluemke
- The Johns Hopkins Hospital, MRI Room 143 (Nelson Basement), 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - João AC Lima
- Department of Radiology & Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
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Abstract
The presence of left ventricular hypertrophy (LVH) in hypertension, as detected by the electrocardiogram or echocardiography, is associated with an increased risk of mortality and morbidity several times above and beyond the risk of hypertension alone. The LIFE (Losartan Intervention For Endpoint reduction in hypertension) study confirmed that pharmacological agents, which reduce LVH, confer further reduction in morbidity and mortality. This makes the identification of patients with LVH all the more important. In this article we describe the various methods available to diagnose the presence of LVH in patients with hypertension, and consider their strengths and their place in clinical practice and in research.
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Affiliation(s)
- Khaled Alfakih
- Cardiology Department, Queens Medical Centre, Nottingham, UK.
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