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Ouyang R, Leng S, Chen L, Ma Y, Hu L, Sun A, Wang Q, Zhao X, Tan RS, Guo C, Yao X, Zhong L, Zhong Y. Assessment of right ventricular diastolic function in pediatric patients with repaired tetralogy of Fallot by cardiovascular magnetic resonance and echocardiography. Eur Radiol 2024; 34:5487-5500. [PMID: 38180528 DOI: 10.1007/s00330-023-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Cardiovascular magnetic resonance (CMR) imaging is routinely performed for assessing right ventricular (RV) systolic but not diastolic function. We aimed to investigate CMR-based assessment of RV diastolic function in pediatric patients with repaired tetralogy of Fallot (rTOF), compared to transthoracic echocardiography (TTE) measurements. METHODS A total of 130 consecutive pediatric patients with rTOF who underwent clinically indicated CMR and same-day TTE were included. Forty-three controls were recruited. Phase-contrast images were used to measure trans-tricuspid valve flow velocities during early (E) and late diastolic (A) phases (measured in cm/s). Feature tracking of the tricuspid annulus was performed to derive early (e') and late diastolic (a') myocardial velocities (measured in cm/s). RV diastolic function was evaluated by E/A ratio, E/e' ratio, and E-wave deceleration time (measured in milliseconds). Regression analyses were utilized to identify potential variables associated with RV diastolic dysfunction (DD). The performance of CMR-derived parameters in diagnosing RV DD was assessed using receiver-operating characteristic analyses. RESULTS Good agreement was found between CMR and TTE measurements (ICC 0.70-0.89). Patients with RV DD (n = 67) showed significantly different CMR-derived parameters including E and e' velocities, and E/A and E/e' ratio, compared to patients without DD (n = 63) (all p < 0.05). CMR-derived E and e' velocities and E/e' ratio were independent predictors of RV DD. E/e' of 5.8 demonstrated the highest discrimination of RV DD (AUC 0.76, sensitivity 70%, specificity 86%). CONCLUSIONS CMR-derived parameters showed good agreement with TTE parameters in determining RV DD. CMR-derived E/e' was proved to be the most effective in identifying RV DD. CLINICAL RELEVANCE STATEMENT This study demonstrated the feasibility and efficacy of CMR in assessing diastolic function in pediatric patients. RV DD was presented in over half of patients according to current TTE guidelines, highlighting the need for assessing RV diastolic function during follow-up. KEY POINTS • Routinely acquired cine and phase-contrast cardiovascular magnetic resonance (CMR) images yielded right ventricular (RV) diastolic parameters which demonstrated good agreement with transthoracic echocardiography (TTE) measurements. • There was a high prevalence of RV diastolic function impairment in pediatric patients with repaired tetralogy of Fallot (rTOF). • CMR is a reliable complementary modality of TTE for RV diastolic function evaluation.
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Affiliation(s)
- Rongzhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Yanyan Ma
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Aimin Sun
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Qian Wang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Chen Guo
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaofen Yao
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Department of Biomedical Engineering, National University of Singapore, Engineering Drive 3 Block 4, Singapore, 117583, Singapore.
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China.
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Finnegan RN, Quinn A, Booth J, Belous G, Hardcastle N, Stewart M, Griffiths B, Carroll S, Thwaites DI. Cardiac substructure delineation in radiation therapy - A state-of-the-art review. J Med Imaging Radiat Oncol 2024. [PMID: 38757728 DOI: 10.1111/1754-9485.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Delineation of cardiac substructures is crucial for a better understanding of radiation-related cardiotoxicities and to facilitate accurate and precise cardiac dose calculation for developing and applying risk models. This review examines recent advancements in cardiac substructure delineation in the radiation therapy (RT) context, aiming to provide a comprehensive overview of the current level of knowledge, challenges and future directions in this evolving field. Imaging used for RT planning presents challenges in reliably visualising cardiac anatomy. Although cardiac atlases and contouring guidelines aid in standardisation and reduction of variability, significant uncertainties remain in defining cardiac anatomy. Coupled with the inherent complexity of the heart, this necessitates auto-contouring for consistent large-scale data analysis and improved efficiency in prospective applications. Auto-contouring models, developed primarily for breast and lung cancer RT, have demonstrated performance comparable to manual contouring, marking a significant milestone in the evolution of cardiac delineation practices. Nevertheless, several key concerns require further investigation. There is an unmet need for expanding cardiac auto-contouring models to encompass a broader range of cancer sites. A shift in focus is needed from ensuring accuracy to enhancing the robustness and accessibility of auto-contouring models. Addressing these challenges is paramount for the integration of cardiac substructure delineation and associated risk models into routine clinical practice, thereby improving the safety of RT for future cancer patients.
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Affiliation(s)
- Robert N Finnegan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Quinn
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Gregg Belous
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Maegan Stewart
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Griffiths
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK
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de Oliveira DC, Espino DM, Deorsola L, Buchan K, Dawson D, Shepherd DET. A geometry-based finite element tool for evaluating mitral valve biomechanics. Med Eng Phys 2023; 121:104067. [PMID: 37985031 DOI: 10.1016/j.medengphy.2023.104067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
Mitral valve function depends on its complex geometry and tissue health, with alterations in shape and tissue response affecting the long-term restorarion of function. Previous computational frameworks for biomechanical assessment are mostly based on patient-specific geometries; however, these are not flexible enough to yield a variety of models and assess mitral closure for individually tuned morphological parameters or material property representations. This study details the finite element approach implemented in our previously developed toolbox to assess mitral valve biomechanics and showcases its flexibility through the generation and biomechanical evaluation of different models. A healthy valve geometry was generated and its computational predictions for biomechanics validated against data in the literature. Moreover, two mitral valve models including geometric alterations associated with disease were generated and analysed. The healthy mitral valve model yielded biomechanical predictions in terms of valve closure dynamics, leaflet stresses and papillary muscle and chordae forces comparable to previous computational and experimental studies. Mitral valve function was compromised in geometries representing disease, expressed by the presence of regurgitating areas, elevated stress on the leaflets and unbalanced subvalvular apparatus forces. This showcases the flexibility of the toolbox concerning the generation of a range of mitral valve models with varying geometric definitions and material properties and the evaluation of their biomechanics.
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Affiliation(s)
- Diana C de Oliveira
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; Current affiliation: Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, United Kingdom.
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Luca Deorsola
- Paedriatic Cardiac Surgery, Ospedale Infantile Regina Margherita Sant Anna, Turin 10126, Italy
| | - Keith Buchan
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen AB24 2ZN, Scotland, UK
| | - Dana Dawson
- School of Medicine, University of Aberdeen, Aberdeen AB25 2ZD, Scotland, UK; Cardiology Department, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK
| | - Duncan E T Shepherd
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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Rajiah PS, Reddy P, Baliyan V, Hedgire SS, Foley TA, Williamson EE, Eleid MF. Utility of CT and MRI in Tricuspid Valve Interventions. Radiographics 2023; 43:e220153. [PMID: 37384544 DOI: 10.1148/rg.220153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Prajwal Reddy
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Vinit Baliyan
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Sandeep S Hedgire
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Thomas A Foley
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Eric E Williamson
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Mackram F Eleid
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
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Krawczyk-Ożóg A, Hołda MK, Batko J, Bartuś S, Rajtar-Salwa R. Three-dimensional cardiac computed tomography compared with autopsied material for the assessment of the mitral valve. Clin Anat 2023; 36:250-255. [PMID: 36271778 DOI: 10.1002/ca.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022]
Abstract
To compare the morphometrical features of non-diseased mitral valves imaged in three-dimensional (3D) cardiac computed tomography with those analyzed macroscopically in autopsied healthy human hearts. A total of 51 cardiac computed tomography scans and 120 adult autopsied human hearts without cardiovascular disease were examined. The 3D reconstruction and visualization software (Mimics Innovation Suite 22, Materialise) was used for heart chambers semi-automatic segmentation and myocardial manual segmentation to visualize a 3D structure of the mitral valve complex and to perform all measurements. Direct comparison of corresponding mitral valve parameters revealed significant differences between obtained results. Significantly larger intercommisural diameter, aorto-mural diameter, and perimeter of the mitral annulus were observed in tomographic scans (all p < 0.0001). However, the intercommissural/aorto-mural diameter ratio showed comparable values for both groups. Nevertheless, the size of anterior mitral leaflet was higher in autopsied material. The height of the P2 scallops was the only parameter that show no significant difference between two groups (p = 0.3). The use of 3D postprocessing algorithms provides a very accurate image of the mitral valve structure, which could be useful for the precise non-invasive assessment of mitral valve size and structure. Three-dimensional contrast enhanced cardiac computed tomography significantly overestimates the measurements of the mitral annulus compared to postmortem analysis.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Jakub Batko
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
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Guta AC, El-Tallawi KC, Nguyen DT, Qamar F, Nguyen T, Zoghbi WA, Lawrie G, Graviss EA, Shah DJ. Prevalence and Clinical Implications of Tricuspid Valve Prolapse Based on Magnetic Resonance Diagnostic Criteria. J Am Coll Cardiol 2023; 81:S0735-1097(22)07642-2. [PMID: 36813687 DOI: 10.1016/j.jacc.2022.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND Tricuspid valve prolapse (TVP) is an uncertain diagnosis with unknown clinical significance because of a scarcity of published data. OBJECTIVES In this study, cardiac magnetic resonance was used to: 1) propose diagnostic criteria for TVP; 2) evaluate the prevalence of TVP in patients with primary mitral regurgitation (MR); and 3) identify the clinical implications of TVP with regard to tricuspid regurgitation (TR). METHODS Forty-one healthy volunteers were analyzed to identify normal tricuspid leaflet displacement and propose criteria for TVP. A total of 465 consecutive patients with primary MR (263 with mitral valve prolapse [MVP] and 202 with nondegenerative mitral valve disease [non-MVP]) were phenotyped for the presence and clinical significance of TVP. RESULTS The proposed TVP criteria included right atrial displacement of ≥2 mm for the anterior and posterior tricuspid leaflets and ≥3 mm for the septal leaflet. Thirty-one (24%) subjects with single-leaflet MVP and 63 (47%) with bileaflet MVP met the proposed criteria for TVP. TVP was not evident in the non-MVP cohort. Patients with TVP were more likely to have severe MR (38.3% vs 18.9%; P < 0.001) and advanced TR (23.4% of patients with TVP demonstrated moderate or severe TR vs 6.2% of patients without TVP; P < 0.001), independent of right ventricular systolic function. CONCLUSIONS TR in subjects with MVP should not be routinely considered functional, as TVP is a prevalent finding associated with MVP and more often associated with advanced TR compared with patients with primary MR without TVP. A comprehensive assessment of tricuspid anatomy should be an important component of the preoperative evaluation for mitral valve surgery.
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Affiliation(s)
- Andrada C Guta
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | - Duc T Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Fatima Qamar
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Thuy Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Gerald Lawrie
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Edward A Graviss
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
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Papadopoulos K, Ikonomidis I, Özden Ö, Tzikas A, Arampatzis CA, Vannan MA. Level of agreement between three-dimensional transthoracic and transesophageal echocardiography for mitral annulus evaluation: A feasibility and comparison study. Echocardiography 2022; 39:1512-1521. [PMID: 36350103 DOI: 10.1111/echo.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/17/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Mitral annulus assessment is of utmost importance for the management of patients with mitral valve (MV) abnormalities, as it helps to determine the decision for surgical or transcatheter treatment. Three-dimensional (3D) transesophageal echocardiography (TOE) has been the only reliable echocardiographic method for the evaluation of the mitral annulus by now. However, newer transthoracic echocardiography (TTE) 3D probes have enabled to provide accurate measurements as well and become a valuable tool when TOE is contraindicated. The aim of this study is to assess the feasibility of 3D TTE analysis of mitral annulus and the level of agreement with 3D TOE measurements. METHODS A total of 121 consecutive patients were assessed with 3D TTE and TOE. All mitral annulus parameters were retrospectively analyzed with the dedicated 4D autoMVQ application. Bland-Altman analysis and intraclass correlation coefficient were used for the comparison and agreement between the two methods. Half of our patients had normal mitral valves and served as control group, while the other half had various mitral valve pathologies. RESULTS AutoMVQ analysis was not feasible in 11 out of 121 TTE examinations (91% feasibility) and in 4 out of 121 TOE examinations (96% feasibility). Mitral annular area and perimeter were slightly larger in TTE than those measured by TOE (12.7 ± 3.6 vs. 12.4 ± 3.2 cm2 for area and 12.7 ± 1.7 vs. 12.5 ± 1.6 cm for perimeter), however still showing strong correlation (r = .942 and r = .922, respectively). The majority of mitral valve measurements (anterior-posterior, medial-lateral and commissural diameter, aorto-mitral angle and anterior leaflet length) were similar among the two methods with strong correlation (r > .80). Inter-trigonal distance, posterior leaflet length and tenting height showed weaker agreement between TTE and TOE (r = .687, r = .687, r = .634, respectively). Mitral annular dimensions (by 3D area) were found to be significantly larger in patients with MV pathology (13.5 ± 3.5 vs. 11 ± 2.3 cm2 ), atrial fibrillation (14.4 ± 3 vs. 11.4 ± 2.8 cm2 ), left ventricular (13.8 ± 3.1 vs. 11.7 ± 3.1cm2 ) and left atrial dilatation (13 ± 3.3 vs. 10.6 ± 2.3cm2 ) compared to the individuals in the control group (p < .001 for all comparisons). CONCLUSIONS Assessment of the MV with 3D TTE with dedicated MVQ software is feasible and accurate, showing strong correlation and agreement with TOE measurements.
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Affiliation(s)
| | - Ignatios Ikonomidis
- Echocardiography Laboratory, 2nd Cardiology Department, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Özge Özden
- Cardiology Department, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Apostolos Tzikas
- Cardiology Department, European Interbalkan Medical center, Thessaloniki, Greece
| | | | - Manni A Vannan
- Structural and Valvular Center of Excellence, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
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Henry MP, Cotella J, Mor-Avi V, Addetia K, Miyoshi T, Schreckenberg M, Blankenhagen M, Hitschrich N, Amuthan V, Citro R, Daimon M, Gutiérrez-Fajardo P, Kasliwal R, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Tude Rodrigues AC, Ronderos R, Sadeghpour A, Scalia G, Takeuchi M, Tsang W, Tucay ES, Zhang M, Lang RM, Asch FM. Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2022; 35:738-751.e1. [PMID: 35245668 DOI: 10.1016/j.echo.2022.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved using three-dimensional echocardiography. Understanding normal valve size, structure, and function is essential for differentiation of healthy from disease states. The aims of this study were to establish normative values for MV apparatus size and morphology and to determine how they vary across age, sex, and race groups using data from the World Alliance Societies of Echocardiography Normal Values Study. METHODS Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements. RESULTS Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality. CONCLUSIONS This analysis of the World Alliance Societies of Echocardiography data provides normative values of mitral apparatus size and morphology. Although sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.
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Affiliation(s)
| | | | | | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | | | | | | | | | | | | | | | - Denisa Muraru
- Instituto Auxologico Italiano, IRCCS, San Luca Hospital and University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Ricardo Ronderos
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mei Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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Al-Ahmad O, Ourak M, Vlekken J, Poorten EV. Local One-Dimensional Motion Estimation Using FBG-Based Shape Sensing for Cardiac Applications. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3186761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Omar Al-Ahmad
- Department of Mechanical Engineering, KU Leuven University, Leuven, Belgium
| | - Mouloud Ourak
- Department of Mechanical Engineering, KU Leuven University, Leuven, Belgium
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Moss R, Wülfers EM, Schuler S, Loewe A, Seemann G. A Fully-Coupled Electro-Mechanical Whole-Heart Computational Model: Influence of Cardiac Contraction on the ECG. Front Physiol 2022; 12:778872. [PMID: 34975532 PMCID: PMC8716847 DOI: 10.3389/fphys.2021.778872] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 01/12/2023] Open
Abstract
The ECG is one of the most commonly used non-invasive tools to gain insights into the electrical functioning of the heart. It has been crucial as a foundation in the creation and validation of in silico models describing the underlying electrophysiological processes. However, so far, the contraction of the heart and its influences on the ECG have mainly been overlooked in in silico models. As the heart contracts and moves, so do the electrical sources within the heart responsible for the signal on the body surface, thus potentially altering the ECG. To illuminate these aspects, we developed a human 4-chamber electro-mechanically coupled whole heart in silico model and embedded it within a torso model. Our model faithfully reproduces measured 12-lead ECG traces, circulatory characteristics, as well as physiological ventricular rotation and atrioventricular valve plane displacement. We compare our dynamic model to three non-deforming ones in terms of standard clinically used ECG leads (Einthoven and Wilson) and body surface potential maps (BSPM). The non-deforming models consider the heart at its ventricular end-diastatic, end-diastolic and end-systolic states. The standard leads show negligible differences during P-Wave and QRS-Complex, yet during T-Wave the leads closest to the heart show prominent differences in amplitude. When looking at the BSPM, there are no notable differences during the P-Wave, but effects of cardiac motion can be observed already during the QRS-Complex, increasing further during the T-Wave. We conclude that for the modeling of activation (P-Wave/QRS-Complex), the associated effort of simulating a complete electro-mechanical approach is not worth the computational cost. But when looking at ventricular repolarization (T-Wave) in standard leads as well as BSPM, there are areas where the signal can be influenced by cardiac motion of the heart to an extent that should not be ignored.
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Affiliation(s)
- Robin Moss
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eike Moritz Wülfers
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen Schuler
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Gonzales RA, Seemann F, Lamy J, Mojibian H, Atar D, Erlinge D, Steding-Ehrenborg K, Arheden H, Hu C, Onofrey JA, Peters DC, Heiberg E. MVnet: automated time-resolved tracking of the mitral valve plane in CMR long-axis cine images with residual neural networks: a multi-center, multi-vendor study. J Cardiovasc Magn Reson 2021; 23:137. [PMID: 34857009 PMCID: PMC8638514 DOI: 10.1186/s12968-021-00824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mitral annular plane systolic excursion (MAPSE) and left ventricular (LV) early diastolic velocity (e') are key metrics of systolic and diastolic function, but not often measured by cardiovascular magnetic resonance (CMR). Its derivation is possible with manual, precise annotation of the mitral valve (MV) insertion points along the cardiac cycle in both two and four-chamber long-axis cines, but this process is highly time-consuming, laborious, and prone to errors. A fully automated, consistent, fast, and accurate method for MV plane tracking is lacking. In this study, we propose MVnet, a deep learning approach for MV point localization and tracking capable of deriving such clinical metrics comparable to human expert-level performance, and validated it in a multi-vendor, multi-center clinical population. METHODS The proposed pipeline first performs a coarse MV point annotation in a given cine accurately enough to apply an automated linear transformation task, which standardizes the size, cropping, resolution, and heart orientation, and second, tracks the MV points with high accuracy. The model was trained and evaluated on 38,854 cine images from 703 patients with diverse cardiovascular conditions, scanned on equipment from 3 main vendors, 16 centers, and 7 countries, and manually annotated by 10 observers. Agreement was assessed by the intra-class correlation coefficient (ICC) for both clinical metrics and by the distance error in the MV plane displacement. For inter-observer variability analysis, an additional pair of observers performed manual annotations in a randomly chosen set of 50 patients. RESULTS MVnet achieved a fast segmentation (<1 s/cine) with excellent ICCs of 0.94 (MAPSE) and 0.93 (LV e') and a MV plane tracking error of -0.10 ± 0.97 mm. In a similar manner, the inter-observer variability analysis yielded ICCs of 0.95 and 0.89 and a tracking error of -0.15 ± 1.18 mm, respectively. CONCLUSION A dual-stage deep learning approach for automated annotation of MV points for systolic and diastolic evaluation in CMR long-axis cine images was developed. The method is able to carefully track these points with high accuracy and in a timely manner. This will improve the feasibility of CMR methods which rely on valve tracking and increase their utility in a clinical setting.
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Affiliation(s)
- Ricardo A. Gonzales
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Electrical Engineering, Universidad de Ingeniería y Tecnología, Lima, Peru
| | - Felicia Seemann
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Chenxi Hu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - John A. Onofrey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Urology, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut United States of America
| | - Dana C. Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut United States of America
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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12
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Laurence DW, Lee CH. Determination of a Strain Energy Density Function for the Tricuspid Valve Leaflets Using Constant Invariant-Based Mechanical Characterizations. J Biomech Eng 2021; 143:1120829. [PMID: 34596679 DOI: 10.1115/1.4052612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/08/2022]
Abstract
The tricuspid valve (TV) regulates the blood flow within the right side of the heart. Despite recent improvements in understanding TV mechanical and microstructural properties, limited attention has been devoted to the development of TV-specific constitutive models. The objective of this work is to use the first-of-its-kind experimental data from constant invariant-based mechanical characterizations to determine a suitable invariant-based strain energy density function (SEDF). Six specimens for each TV leaflet are characterized using constant invariant mechanical testing. The data is then fit with three candidate SEDF forms: (i) a polynomial model-the transversely isotropic version of the Mooney-Rivlin model, (ii) an exponential model, and (iii) a combined polynomial-exponential model. Similar fitting capabilities were found for the exponential and the polynomial forms (R2=0.92-0.99 versus 0.91-0.97) compared to the combined polynomial-exponential SEDF (R2=0.65-0.95). Furthermore, the polynomial form had larger Pearson's correlation coefficients than the exponential form (0.51 versus 0.30), indicating a more well-defined search space. Finally, the exponential and the combined polynomial-exponential forms had notably smaller but more eccentric model parameter's confidence regions than the polynomial form. Further evaluations of invariant decoupling revealed that the decoupling of the invariant terms within the exponential form leads to a less satisfactory performance. From these results, we conclude that the exponential form is better suited for the TV leaflets owing to its superb fitting capabilities and smaller parameter's confidence regions.
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Affiliation(s)
- Devin W Laurence
- Biomechanics and Biomaterials Design Laboratory, The University of Oklahoma, Norman, OK 73019
| | - Chung-Hao Lee
- Biomechanics and Biomaterials Design Laboratory, The University of Oklahoma, 865 Asp Avenue, Felgar Hall 219C, Norman, OK 73019; Institute for Biomedical Engineering, Science and Technology, The University of Oklahoma, 865 Asp Avenue, Felgar Hall 219C, Norman, OK 73019
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13
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Right Heart Morphology of Candidate Patients for Transcatheter Tricuspid Valve Interventions. Cardiovasc Eng Technol 2021; 13:573-589. [PMID: 34854068 PMCID: PMC9499909 DOI: 10.1007/s13239-021-00595-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022]
Abstract
Purpose This study quantitatively evaluated the phasic right heart morphology of candidate patients for a transcatheter tricuspid valve intervention (N=32) and of subjects with trace to no tricuspid regurgitation (N = 14). Methods Cardiac computed tomography angiography (CCTA) and transthoracic/transesophageal echocardiography (TTE/TEE) images were analyzed using dedicated research and clinical software. Using CCTA, the phasic right atrial and ventricular volumes, annulus dimensions, annulus-to-right coronary artery (RCA) distances, circumferential topography of the annular tissue shelf, vena cava dimensions (inferior and superior), vena cava positions, axis angles, and annular excursions were quantified. Using TTE/TEE, leaflet geometry, regurgitation, hemodynamics, and heart function were quantified. Measurements within and between groups were quantitatively compared with regression analyses to explore relationships between right heart features. Results The phasic position and orientation of the vena cava and the circumferential topography of the annular tissue shelf were quantitatively presented for the first time. The candidate patient group exhibited greater chamber dimensions, enlarged vena cava, distended vena cava positions, positional shallowing of the annular tissue shelf, geometric annular distortion, leaflet distention, moderate or greater regurgitation, and impaired ventricular function. Atrial volume correlated strongly with directional vena cava positions as well as with annular dimensions. Annulus-to-RCA distances and annular excursions were comparable between groups. Conclusions This study provides new and further insight to the right heart morphology and functional characteristics of candidate patients for a transcatheter tricuspid valve intervention. These data provide a platform from which these patients can continue to be better understood for further improving transcatheter system design and use. Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00595-y.
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14
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Lopes BBC, Hashimoto G, Bapat VN, Sorajja P, Scherer MD, Cavalcante JL. Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up. Interv Cardiol Clin 2021; 11:27-40. [PMID: 34838295 DOI: 10.1016/j.iccl.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) are rapidly growing as a less invasive treatment of high surgical risk patients with advanced TR. A comprehensive anatomic and functional assessment of the tricuspid valve and right-sided chambers is essential for candidate selection and procedural planning. Advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can provide accurate anatomic and functional assessment of the tricuspid valve, its apparatus, and the right-sided chambers. In this review, we provide an updated overview of the emerging role of CCT and CMR for TR patient evaluation, TTVI planning, and follow-up.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA
| | - Markus D Scherer
- Sanger Heart & Vascular Institute Adult Cardiology Kenilworth, 1237 Harding Place Suite 3100, Charlotte, NC 28203, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA; Valve Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN 55047, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55047, USA.
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15
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Johnson EL, Laurence DW, Xu F, Crisp CE, Mir A, Burkhart HM, Lee CH, Hsu MC. Parameterization, geometric modeling, and isogeometric analysis of tricuspid valves. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2021; 384:113960. [PMID: 34262232 PMCID: PMC8274564 DOI: 10.1016/j.cma.2021.113960] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Approximately 1.6 million patients in the United States are affected by tricuspid valve regurgitation, which occurs when the tricuspid valve does not close properly to prevent backward blood flow into the right atrium. Despite its critical role in proper cardiac function, the tricuspid valve has received limited research attention compared to the mitral and aortic valves on the left side of the heart. As a result, proper valvular function and the pathologies that may cause dysfunction remain poorly understood. To promote further investigations of the biomechanical behavior and response of the tricuspid valve, this work establishes a parameter-based approach that provides a template for tricuspid valve modeling and simulation. The proposed tricuspid valve parameterization presents a comprehensive description of the leaflets and the complex chordae tendineae for capturing the typical three-cusp structural deformation observed from medical data. This simulation framework develops a practical procedure for modeling tricuspid valves and offers a robust, flexible approach to analyze the performance and effectiveness of various valve configurations using isogeometric analysis. The proposed methods also establish a baseline to examine the tricuspid valve's structural deformation, perform future investigations of native valve configurations under healthy and disease conditions, and optimize prosthetic valve designs.
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Affiliation(s)
- Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Devin W. Laurence
- School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Fei Xu
- Ansys Inc., 807 Las Cimas Parkway, Austin, Texas 78746, USA
| | - Caroline E. Crisp
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Arshid Mir
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Harold M. Burkhart
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Chung-Hao Lee
- School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma 73019, USA
- Institute for Biomedical Engineering, Science and Technology (IBEST), The University of Oklahoma, Norman, Oklahoma 73019, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
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16
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Abstract
PURPOSE OF REVIEW The rapid search for suitable tricuspid transcatheter devices has ignited renewed enthusiasm in accurate characterization of tricuspid valve disease. Cardiovascular magnetic resonance (CMR), traditionally used as the gold standard in assessment for right ventricular size and function, has recently seen its use expanded to assess both the structure and function of the tricuspid apparatus. This review will highlight the role of CMR in tricuspid valve disease and compare it with other commonly used imaging modalities. RECENT FINDINGS Dynamic anatomical assessment of the tricuspid apparatus, in combination with accurate leaflet identification, is possible with CMR. Tricuspid regurgitation volume and fraction are derived through an indirect volumetric method, and therefore, able to overcome many traditional hurdles involved with valve regurgitation quantitation. Adverse right heart prognostic factors in tricuspid valve disease, such as right heart volumes, function, and tissue characterization, are optimally assessed using CMR. SUMMARY Cardiovascular magnetic resonance is a powerful modality that should be harnessed in order to obtain a multifaceted assessment of tricuspid valve structure, function, and the effects of valve disease on right heart remodeling.
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17
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de Oliveira DC, Espino DM, Deorsola L, Mynard JP, Rajagopal V, Buchan K, Dawson D, Shepherd DET. A toolbox for generating scalable mitral valve morphometric models. Comput Biol Med 2021; 135:104628. [PMID: 34246162 DOI: 10.1016/j.compbiomed.2021.104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
The mitral valve is a complex anatomical structure, whose shape is key to several traits of its function and disease, being crucial for the success of surgical repair and implantation of medical devices. The aim of this study was to develop a parametric, scalable, and clinically useful model of the mitral valve, enabling the biomechanical evaluation of mitral repair techniques through finite element simulations. MATLAB was used to parameterize the valve: the annular boundary was sampled from a porcine mitral valve mesh model and landmark points and relevant boundaries were selected for the parameterization of leaflets using polynomial fitting. Several geometric parameters describing the annulus, leaflet shape and papillary muscle position were implemented and used to scale the model according to patient dimensions. The developed model, available as a toolbox, allows for the generation of a population of models using patient-specific dimensions obtained from medical imaging or averaged dimensions evaluated from empirical equations based on the Golden Proportion. The average model developed using this framework accurately represents mitral valve shapes, associated with relative errors reaching less than 10% for annular and leaflet length dimensions, and less than 24% in comparison with clinical data. Moreover, model generation takes less than 5 min of computing time, and the toolbox can account for individual morphological variations and be employed to evaluate mitral valve biomechanics; following further development and validation, it will aid clinicians when choosing the best patient-specific clinical intervention and improve the design process of new medical devices.
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Affiliation(s)
- Diana C de Oliveira
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Luca Deorsola
- Paedriatic Cardiac Surgery, Ospedale Infantile Regina Margherita Sant Anna, Turin, 10126, Italy
| | - Jonathan P Mynard
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia; Heart Research, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, 3052, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, 3052, Australia
| | - Vijay Rajagopal
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Keith Buchan
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, AB24 2ZN, Scotland, UK
| | - Dana Dawson
- School of Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, UK; Cardiology Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, Scotland, UK
| | - Duncan E T Shepherd
- Department of Mechanical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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18
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Leng S, Guo J, Tan RS, Chai P, Teo L, Fortier MV, Gong C, Zhao X, Ong CC, Allen JC, Ruan W, Koh AS, Tan TH, Yip JW, Tan JL, Chen Y, Zhong L. Age- and Sex-Specific Changes in CMR Feature Tracking-Based Right Atrial and Ventricular Functional Parameters in Healthy Asians. Front Cardiovasc Med 2021; 8:664431. [PMID: 34150866 PMCID: PMC8213369 DOI: 10.3389/fcvm.2021.664431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) is the reference standard for non-invasive assessment of right-sided heart function. Recent advances in CMR post-processing facilitate quantification of tricuspid annular (TA) dynamics and longitudinal strains of the right ventricle (RV) and right atrium (RA). We aimed to determine age- and sex-specific changes in CMR-derived TA dynamics, and RV and RA functional parameters in healthy Asian adults. We studied 360 healthy subjects aged 21-79 years, with 30 men and 30 women in each of the six age groups. Functional parameters of RV and RA were measured on standard four-chamber cine CMR using fast feature tracking: (1) TA peak velocities (systolic velocity S', early diastolic velocity E', late diastolic velocity A') and TA plane systolic excursion (TAPSE); (2) RV global longitudinal strain (GLS) and strain rates; and (3) RA phasic longitudinal strains and strain rates. S' and TAPSE exhibited negative correlations with age. RV GLS was significantly higher in females than in males but not associated with age in both sexes. Females had similar E', lower A', and higher E'/A' ratios compared to males. Positive associations of E' and E'/A', and negative association of A' with age were observed in both sexes. Females had higher RA reservoir and conduit strains compared to males. There were significantly negative and positive associations between RA conduit and booster strains, respectively, with age. Age- and sex-specific reference ranges were established, and associations revealed, for fast CMR feature tracking parameters of right heart function in a large normal Asian population.
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Affiliation(s)
- Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - Jiajun Guo
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lynette Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore.,Singapore Institute for Clinical Sciences, ASTAR, Singapore, Singapore
| | - Chao Gong
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Ching Ching Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | | | - Wen Ruan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yucheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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19
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Tricuspid Annulus Disjunction: Novel Findings by Cardiac Magnetic Resonance in Patients With Mitral Annulus Disjunction. JACC Cardiovasc Imaging 2021; 14:1535-1543. [PMID: 33744128 DOI: 10.1016/j.jcmg.2021.01.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/22/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aimed to assess whether patients with MAD also have disjunction of the tricuspid annulus. BACKGROUND Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus. Whether the disjunction extends to the right side of the heart is not known. METHODS In a cohort of patients with MAD, we assessed the presence of tricuspid annulus disjunction (TAD) with the use of cardiac magnetic resonance. We explored the associations between TAD and MAD characteristics and the relationship to ventricular arrhythmias (nonsustained/sustained ventricular tachycardias and aborted cardiac arrest). RESULTS We included 84 patients (mean age: 48 ± 16 years; 63% female). We observed TAD in 42 (50%). Patients with TAD were older (age 52 ± 16 years vs. 43 ± 15 years; p = 0.02), had greater circumferential extent of MAD (164 ± 57° vs. 115 ± 58°; p = 0.002), greater maximum longitudinal MAD distance (9.4 ± 2.9 mm vs. 6.2 ± 2.8 mm; p < 0.001), and more frequent mitral valve prolapse (n = 39 [92%] vs. n = 24 [57%]; p < 0.001). Ventricular arrhythmias had occurred in 34 patients (41%), who were younger (age 39 ± 14 years vs. 54 ± 14 years; p < 0.001) and had lower prevalence of TAD (n = 22 [29%] vs. n = 12 [52%]; p = 0.03). TAD was not associated with ventricular arrhythmias when adjusted for age (odds ratio adjusted for age: 0.54; 95% confidence interval: 0.20 to 1.45; p = 0.22). CONCLUSIONS We report for the first time the existence of right-sided annulus disjunction as a common finding in patients with MAD. TAD was associated with more severe left-sided annulus disjunction and mitral valve prolapse, but not with ventricular arrhythmias.
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20
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The influence of tricuspid annuloplasty prostheses on ovine annular geometry and kinematics. J Thorac Cardiovasc Surg 2021; 161:e191-e207. [DOI: 10.1016/j.jtcvs.2019.09.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022]
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21
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Kapadia S, Krishnaswamy A, Layoun H, Griffin BP, Wierup P, Schoenhagen P, Harb SC. Tricuspid annular dimensions in patients with severe mitral regurgitation without severe tricuspid regurgitation. Cardiovasc Diagn Ther 2021; 11:68-80. [PMID: 33708479 DOI: 10.21037/cdt-20-903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Concomitant TV repair during mitral valve (MV) surgery based on tricuspid valve annulus (TVA) dilation, rather than the degree of tricuspid regurgitation (TR), is beneficial and supported by the valve guidelines. We sought to determine TVA geometry and dimensions in controls and assess the changes that occur in patients with severe primary (PMR) and secondary (SMR) mitral regurgitation without TR. Methods We analyzed cardiac computed tomographic angiography (CCTA) of 125 consecutive subjects: 50 controls with normal coronary CCTA and no valvular dysfunction, 50 PMR patients referred for robotic repair, and 25 SMR patients referred for transcatheter therapy. Patients with >2+ TR on echocardiography were excluded. Annular measurements were performed using dedicated software and compared. Correlations and determinants of TVA dimensions were analyzed. Results Patients with SMR were older and had significantly more comorbidities. In controls, the TVA was larger and more planar and eccentric compared to the MV annulus (all P<0.01). Dimensions of both annuli correlated significantly (r≥0.5; P<0.001 for all dimensions) in controls and patients with severe MR. In both PMR and SMR, the TVA enlarged in all dimensions (P<0.01) with a trend towards becoming more circular. On multivariable regression, the MV annular area was the primary determinant of the TVA area (adjusted β=0.430, P<0.001). Conclusions Substantial changes in TVA dimensions are encountered in patients with severe MR even in the absence of severe TR such that TVA and MVA dimensions remain correlated. Close attention to the TVA in patients with severe MR is warranted.
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Affiliation(s)
- Sohum Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- Department of Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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22
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Ricci F, Aung N, Gallina S, Zemrak F, Fung K, Bisaccia G, Paiva JM, Khanji MY, Mantini C, Palermi S, Lee AM, Piechnik SK, Neubauer S, Petersen SE. Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort. J Cardiovasc Magn Reson 2020; 23:5. [PMID: 33407573 PMCID: PMC7788733 DOI: 10.1186/s12968-020-00688-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults. METHODS 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45-54, 55-64, 65-74 years). RESULTS Overall, 721 (14.2%) truly healthy participants aged 45-74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m2) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97. CONCLUSIONS We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa Di Cura Villa Serena, 65013, Città Sant'Angelo, Pescara, Italy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Stefano Palermi
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK.
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Laurence DW, Johnson EL, Hsu MC, Baumwart R, Mir A, Burkhart HM, Holzapfel GA, Wu Y, Lee CH. A pilot in silico modeling-based study of the pathological effects on the biomechanical function of tricuspid valves. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3346. [PMID: 32362054 PMCID: PMC8039906 DOI: 10.1002/cnm.3346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/23/2020] [Accepted: 04/22/2020] [Indexed: 05/12/2023]
Abstract
Current clinical assessment of functional tricuspid valve regurgitation relies on metrics quantified from medical imaging modalities. Although these clinical methodologies are generally successful, the lack of detailed information about the mechanical environment of the valve presents inherent challenges for assessing tricuspid valve regurgitation. In the present study, we have developed a finite element-based in silico model of one porcine tricuspid valve (TV) geometry to investigate how various pathological conditions affect the overall biomechanical function of the TV. There were three primary observations from our results. Firstly, the results of the papillary muscle (PM) displacement study scenario indicated more pronounced changes in the TV biomechanical function. Secondly, compared to uniform annulus dilation, nonuniform dilation scenario induced more evident changes in the von Mises stresses (83.8-125.3 kPa vs 65.1-84.0 kPa) and the Green-Lagrange strains (0.52-0.58 vs 0.47-0.53) for the three TV leaflets. Finally, results from the pulmonary hypertension study scenario showed opposite trends compared to the PM displacement and annulus dilation scenarios. Furthermore, various chordae rupture scenarios were simulated, and the results showed that the chordae tendineae attached to the TV anterior and septal leaflets may be more critical to proper TV function. This in silico modeling-based study has provided a deeper insight into the tricuspid valve pathologies that may be useful, with moderate extensions, for guiding clinical decisions. NOVELTY STATEMENT: The novelties of the research are summarized below: A comprehensive in silico pilot study of how isolated functional tricuspid regurgitation pathologies and ruptured chordae tendineae would alter the tricuspid valve function; An extensive analysis of the tricuspid valve function, including mechanical quantities (eg, the von Mises stress and the Green-Lagrange strain) and clinically-relevant geometry metrics (eg, the tenting area and the coaptation height); and A developed computational modeling pipeline that can be extended to evaluate patient-specific tricuspid valve geometries and enhance the current clinical diagnosis and treatment of tricuspid regurgitation.
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Affiliation(s)
- Devin W. Laurence
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA
| | - Emily L. Johnson
- Computational Fluid-Structure Interaction Laboratory, Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Ming-Chen Hsu
- Computational Fluid-Structure Interaction Laboratory, Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Ryan Baumwart
- Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - Arshid Mir
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Harold M. Burkhart
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Stremayrgasse 16/2 8010 Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Yi Wu
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA
| | - Chung-Hao Lee
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK 73019, USA
- Institute for Biomedical Engineering, Science, and Technology, The University of Oklahoma, Norman, OK 73019, USA
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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25
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Topilsky Y. Mitral Regurgitation: Anatomy, Physiology, and Pathophysiology-Lessons Learned From Surgery and Cardiac Imaging. Front Cardiovasc Med 2020; 7:84. [PMID: 32548127 PMCID: PMC7272584 DOI: 10.3389/fcvm.2020.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 04/20/2020] [Indexed: 02/04/2023] Open
Abstract
The normal mitral valve is a dynamic structure that permits blood to flow from the left atrial (LA) to left ventricle (LV) during diastole and sealing of the LA from the LV during systole. The main components of the mitral apparatus are the mitral annulus (MA), the mitral leaflets, the chordae tendineae, and the papillary muscles (PM) (Figure 1). Normal valve function is dependent on the integrity and normal interplay of these components. Abnormal function of any one of the components, or their interplay can result in mitral regurgitation (MR). Understanding the anatomy and physiology of all the component of the mitral valve is important for the diagnosis, and for optimal planning of repair procedures. In this review we will focus first on normal anatomy and physiology of the different parts of the mitral valve (MA, leaflets, chordae tendineae, and PM). In the second part we will focus on the pathologic anatomic and physiologic derangements associated with different types of MR.
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Affiliation(s)
- Yan Topilsky
- The Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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26
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Multimodality Imaging of the Tricuspid Valve and Right Heart Anatomy. JACC Cardiovasc Imaging 2020; 12:516-531. [PMID: 30846125 DOI: 10.1016/j.jcmg.2019.01.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
The characterization of tricuspid valve and right-heart anatomy has been gaining significant interest in the setting of new percutaneous transcatheter interventions for tricuspid regurgitation. Multimodality cardiac imaging provides a wealth of information about the anatomy and function of the tricuspid valve apparatus, right ventricle, and right atrium, which is pivotal for diagnosis and prognosis and for planning of percutaneous interventions. The present review describes the role of echocardiography, cardiac magnetic resonance, and multidetector row cardiac computed tomography for right heart and tricuspid valve assessment.
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27
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Rausch MK, Mathur M, Meador WD. Biomechanics of the Tricuspid Annulus: A Review of the Annulus' In Vivo Dynamics With Emphasis on Ovine Data. MITTEILUNGEN DER GESELLSCHAFT FUR ANGEWANDTE MATHEMATIK UND MECHANIK 2019; 42:e201900012. [PMID: 38690196 PMCID: PMC11058966 DOI: 10.1002/gamm.201900012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/28/2019] [Indexed: 05/02/2024]
Abstract
The tricuspid annulus forms the boundary between the tricuspid valve leaflets and their surrounding perivalvular tissue of the right atrioventricular junction. Its shape changes throughout the cardiac cycle in response to the forces from the contracting right heart myocardium and the blood-valve interaction. Alterations to annular shape and dynamics in disease lead to valvular dysfunctions such as tricuspid regurgitation from which millions of patients suffer. Successful treatment of such dysfunction requires an in-depth understanding of the normal shape and dynamics of the tricuspid annulus and of the changes following disease and subsequent repair. In this manuscript we review what we know about the shape and dynamics of the normal tricuspid annulus and about the effects of both disease and repair based on non-invasive imaging studies and invasive fiduciary marker-based studies. We further show, by means of ovine data, that detailed engineering analyses of the tricuspid annulus provide regionally-resolved insight into the kinematics of the annulus which would remain hidden if limiting analyses to simple geometric metrics.
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Affiliation(s)
- Manuel K. Rausch
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - Mrudang Mathur
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
| | - William D. Meador
- Aerospace Engineering & Engineering Mechanics, Biomedical Engineering, Institute for Computational Engineering and Sciences, University of Texas at Austin, TX, USA
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28
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Sonomicrometry-derived 3-dimensional geometry of the human tricuspid annulus. J Thorac Cardiovasc Surg 2019; 157:1452-1461.e1. [DOI: 10.1016/j.jtcvs.2018.08.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/17/2022]
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Morphological Assessment of the Tricuspid Apparatus and Grading Regurgitation Severity in Patients With Functional Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:652-664. [DOI: 10.1016/j.jcmg.2018.09.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 01/20/2023]
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30
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Lin SI, Miura M, Maisano F, Zuber M, Gavazzoni M, Ho EC, Pozzoli A, Taramasso M. Transcatheter Edge-to-edge Repair of Severe Tricuspid Regurgitation. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2018.20.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the increasing knowledge of the long-term adverse consequence of severe tricuspid regurgitation (TR), most patients with moderate- to-severe TR are still treated conservatively because of the high risk of surgery. Percutaneous procedures have emerged as an attractive alternative treatment. Transcatheter edge-to-edge repair is a validated technique to treat mitral regurgitation. In recent years, the same concept has been applied to patients with TR and prohibitive operative risk. Early trials have shown feasibility and safety. More clinical experiences and long-term results are still being gathered. In this article, we provide an overview of transcatheter edge-to-edge repair and look at the current evidence and clinical results regarding procedure.
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Affiliation(s)
- Shu-I Lin
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Cardiovascular Center, MacKay Memorial Hospital, Tamsui, Taiwan
| | - Mizuki Miura
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Michel Zuber
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Mara Gavazzoni
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Cardiology Department, University of Brescia, Brescia, Italy
| | - Edwin C Ho
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland; Division of Cardiology, St Michael’s Hospital, Toronto, Canada
| | - Alberto Pozzoli
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
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31
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Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic Types of Tricuspid Regurgitation. JACC Cardiovasc Imaging 2019; 12:491-499. [DOI: 10.1016/j.jcmg.2018.09.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 12/18/2022]
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32
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Androulakis I, Faure ME, Budde RPJ, van Walsum T. Automated Quantification of Bileaflet Mechanical Heart Valve Leaflet Angles in CT Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:753-761. [PMID: 30235123 DOI: 10.1109/tmi.2018.2871366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cardiac computed tomography (CT) is a valuable tool for functional mechanical heart valve (MHV) assessment. An important aspect of bileaflet MHV assessment is evaluation and measurement of leaflet opening and closing angles. Performed manually, however, it is a laborious and time consuming task. In this paper, we propose an automated approach for bileaflet MHV leaflet angle computation. This method consists of four steps. After a one click selection of the MHV region on an axial image, an automatic MHV extraction using thresholding, and a connected component analysis based on voxel intensities is performed. Then, the MHV component (valve ring and two leaflets) positions are identified using random sample consensus and least square fitting. Finally, the angles are automatically computed based on the orientation of the components in each timeframe. Five multiphase CT scans from patients with a bileaflet MHV containing between 14 and 17 timepoints were used for development and another 15 were used for evaluation. The detected MHV components were scored for their overlap with real components as successful or unsuccessful. For successful results, the angles were compared to those measured by a radiologist. Qualitatively evaluated on a data set of 222 images, a total of 398 out of 444 angle computations (89.6%) were rated as successful. Compared to the angles measured by the radiologist, the successful angles showed a mean difference of 0.54° ± 3.63° from the manual calculations. The method provides a high success rate and an accurate computation of leaflet opening angles compared to manual measurements.
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Singh-Gryzbon S, Siefert AW, Pierce EL, Yoganathan AP. Tricuspid Valve Annular Mechanics: Interactions with and Implications for Transcatheter Devices. Cardiovasc Eng Technol 2019; 10:193-204. [PMID: 30756336 DOI: 10.1007/s13239-019-00405-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/01/2019] [Indexed: 02/06/2023]
Abstract
In the interventional treatment of tricuspid valve regurgitation, the majority of prosthetic devices interact with or are implanted to the tricuspid valve annulus. For new transcatheter technologies, there exists a growing body of clinical experience, literature, and professional discourse related to the difficulties in delivering, securing, and sustaining the function of these devices within the dynamic tricuspid annulus. Many of the difficulties arise from circumstances not encountered in open-heart surgery, namely; a non-arrested heart, indirect visualization, and a reliance on non-suture-based methods. These challenges require the application of procedural techniques or system designs to account for tricuspid annular motion, forces, and underlying tissue strength. Improved knowledge in these interactions will support the goals of improving device systems, their procedures, and patient outcomes. This review aims to describe current concepts of tricuspid annular mechanics, key device and procedural implications, and highlight current knowledge gaps for future consideration.
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Affiliation(s)
- Shelly Singh-Gryzbon
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, 387 Technology Circle NW, Atlanta, GA, 30313-2412, USA
| | - Andrew W Siefert
- Cardiac Implants LLC, 25 Lake Terrace, Tarrytown, NY, 10591, USA
| | - Eric L Pierce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, 387 Technology Circle NW, Atlanta, GA, 30313-2412, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, 387 Technology Circle NW, Atlanta, GA, 30313-2412, USA.
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Leng S, Zhao X, Koh AS, Zhao L, Allen JC, Tan RS, Ma X, Zhong L. Age-related changes in four-dimensional CMR-derived atrioventricular junction velocities and displacements: Implications for the identification of altered annular dynamics for ventricular function assessment. IJC HEART & VASCULATURE 2018; 22:6-12. [PMID: 30480084 PMCID: PMC6240643 DOI: 10.1016/j.ijcha.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
Abstract
Background We determined the age-related changes in atrioventricular junction (AVJ) velocities and displacements by feature tracking cardiovascular magnetic resonance (FT-CMR) in a healthy community-based population. We also investigated the importance of age-matching for the identification of altered AVJ dynamics. Methods FT-CMR was performed in 230 controls (18-78 years) and in two patient groups each consisting of 40 subjects (group 1: 23-55 years, group 2: 56-80 years). AVJ dynamic parameters, including systolic velocity Sm, early diastolic velocity Em, late diastolic velocity Am, maximal systolic excursion MAPSE and the new parameter sweep surface area velocity SSAV were measured. Results Increasing age in the control group was significantly associated with reductions in Sm, Em, MAPSE (r = -0.40, -0.76, -0.34, all P < 0.001) and an increase in Am (r = 0.45, P < 0.001). For patient group 1, the selection of an age-unmatched control group (56-76 years) underestimated the number of patients with abnormal AVJ dynamics during systole and early diastole (38% vs. 70% for Sm; 20% vs. 60% for Em; 35% vs. 50% for MAPSE). In contrast, for patient group 2, the number of patients with systolic and early diastolic AVJ dynamic abnormalities was overestimated (88% vs. 63% for Sm; 90% vs. 68% for Em; 73% vs. 58% for MAPSE) when compared with age-unmatched controls (24-55 years). Fifty-percent (20/40) of the sub-group of patients with normal left ventricular ejection fraction exhibited abnormal systolic Sm or MAPSE measurements. Conclusions Significant correlations exist between age and AVJ dynamics. Age matching is important for evaluating AVJ long-axis function.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Angela S Koh
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Lei Zhao
- Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - John C Allen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Xiaohai Ma
- Beijing Anzhen Hospital, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
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35
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Dumont KA, Kvitting JPE, Karlsen JS, Remme EW, Hausken J, Lundblad R, Fiane AE, Urheim S. Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2018; 32:303-316.e4. [PMID: 30293779 DOI: 10.1016/j.echo.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Three-dimensional (3D) echocardiography with multiplanar reconstruction (MPR) is used clinically to quantify the mitral annulus. MPR images are, however, presented on a two-dimensional screen, calling into question their accuracy. An alternative to MPR is an autostereoscopic holographic display that enables in-depth visualization of 3D echocardiographic data without the need for special glasses. The aim of this study was to validate an autostereoscopic display using sonomicrometry as a gold standard. METHODS In 11 anesthetized open-chest pigs, sonomicrometric crystals were placed along the mitral annulus and near the left ventricular apex. High-fidelity catheters measured left atrial and ventricular pressures. Adjustments of pre- and afterload were done by constriction of the inferior vena cava and the ascending aorta, respectively. Three-dimensional epicardial echocardiography was obtained from an apical view and converted to the autostereoscopic display. A 3D virtual semitransparent annular surface (VSAS) was generated to measure commissure width (CW), septal-lateral length, area of the mitral annular surface, nonplanarity angle, and the annular height-to-commissure width ratio in mid-systole and late diastole. RESULTS Mitral annular measurements from the 3D VSAS derived from the 3D echocardiographic images and autostereoscopic display correlated well with sonomicrometry over a range of loading conditions: CW length (r = 0.98, P < .00001), septal-lateral length (r = 0.98, P < .00001), annular surface area (r = 0.93, P < .001), nonplanarity angle (r = 0.87, P < .001), and annular height-to-commissure width ratio (r = 0.85, P < .01). The 3D VSAS showed better agreement with the sonomicrometric measurements compared with MPR. CONCLUSIONS Mitral annular measurements using 3D VSAS correlate well with sonomicrometry over a range of loading conditions and may represent a powerful tool for noninvasive quantification of mitral annular dynamics.
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Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | | | | | - Espen W Remme
- Institute for Surgical Research, The Intervention Center, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - John Hausken
- Department of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arnt E Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Bergen, Norway
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Van Praet KM, Stamm C, Starck CT, Sündermann S, Meyer A, Montagner M, Nazari Shafti TZ, Unbehaun A, Jacobs S, Falk V, Kempfert J. An overview of surgical treatment modalities and emerging transcatheter interventions in the management of tricuspid valve regurgitation. Expert Rev Cardiovasc Ther 2018; 16:75-89. [DOI: 10.1080/14779072.2018.1421068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph T. Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Timo Z. Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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Leng S, Zhang S, Jiang M, Zhao X, Wu R, Allen J, He B, Tan RS, Zhong L. Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking. Sci Rep 2018; 8:81. [PMID: 29311562 PMCID: PMC5758818 DOI: 10.1038/s41598-017-18354-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022] Open
Abstract
Feature tracking in cine cardiac magnetic resonance (CMR) is a quantitative technique to assess heart structure and function. We investigated 4-dimensional (4D) dynamics and morphology of the mitral annulus (MA) using a novel tracking system based on radially rotational long-axis cine CMR series. A total of 30 normal controls and patients with mitral regurgitation were enrolled. The spatiotemporal changes of the MA were characterized by an in-house developed program. Dynamic and morphological parameters extracted from all 18 radial slices were used as references and were compared with those from subsequently generated sub-datasets with different degrees of sparsity. An excellent agreement was found among all datasets including routine 2-, 3- and 4-chamber views for MA dynamics such as peak systolic velocity (Sm) and mitral annular plane systolic excursion (MAPSE). MA morphology for size and shape was addressed adequately by as few as 6 radial slices, but poorly by only three routine views. Patients with regurgitation showed significantly reduced mitral dynamics and mild annular deformation, which was consistent between three routine views and 18 reference slices. In conclusion, feature tracking cine CMR provided a comprehensive and distinctive profile for 4D MA dynamics and morphology, which may help in studying different cardiac diseases.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Shuo Zhang
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Philips Healthcare, 622 Lorong 1, Toa Payoh, 319763, Singapore, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Rui Wu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - John Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Abstract
Mitral regurgitation (MR) is the most prevalent cause of valvular heart disease (VHD) in western countries. In the Euro Heart Survey on VHD, MR was the second most common heart VHD requiring surgery. It is also the most common form of VHD in community and population-based studies from the United States. The categorization of MR based on causes and mechanisms is a major determinant of clinical outcome, of possible therapies for the MR and of the effectiveness of these therapies. Surgical mitral valve (MV) repair has been shown to improve survival in patients with severe primary MR compared with MV replacement. In addition, new percutaneous repair and replacement procedures have been recently developed. Hence, accurate understanding of the functional anatomy of the MV and the pathophysiologic principles underlying MR is needed to appropriately target valve lesions. Recent advances in cardiac imaging have allowed to deeply strengthen the knowledge of the function of the MV. The present review aims at describing the functional anatomy and pathophysiology of MR through different cardiac imaging modalities.
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3-Dimensional Echocardiographic Analysis of the Tricuspid Annulus Provides New Insights Into Tricuspid Valve Geometry and Dynamics. JACC Cardiovasc Imaging 2017; 12:401-412. [PMID: 29153573 DOI: 10.1016/j.jcmg.2017.08.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The authors used transthoracic 3-dimensional transthoracic echocardiography (3DE) to characterize tricuspid annulus (TA) geometry and dynamics in healthy volunteers. BACKGROUND Accurate sizing of the TA is essential for planning tricuspid annuloplasty and for implantation of new percutaneous tricuspid devices. METHODS 3DE of the TA from 209 healthy volunteers was analyzed using custom software to measure TA area, perimeter, circularity, and dimensions at end diastole (equals tricuspid valve closure), mid-systole, end systole, and late diastole. TA intercommissural distances were measured at mid-systole. For comparison, TA diameters were measured at the same time points on multiplanar reconstruction of the 3DE datasets and on 2-dimensional transthoracic echocardiography (2DE) apical 4-chamber and right ventricular focused views. In 13 subjects with both 3DE and computed tomography, TA parameters were compared. RESULTS 3DE TA area, perimeter, and dimensions were largest in late diastole and smallest at mid-systole/end systole. Normal tricuspid valve parameters in end diastole were 8.6 ± 2.0 cm2 for area; 10.5 ± 1.2 cm for perimeter; 36 ± 4 mm and 30 ± 4 mm for longest and shortest dimensions, respectively; and 0.83 ± 0.10 for circularity. There were no age-related changes in TA parameters. Women had larger indexed TA perimeter and longer long-axis dimensions compared with men. The longest 3DE TA dimension was significantly longer than diameters measured from both 2DE and 3D multiplanar reconstruction. 3DE TA area, perimeter, and dimensions correlated with both right atrial and right ventricular volumes, suggesting that both chambers may be determinants of TA size. TA fractional area change was 35 ± 10%. Fractional changes in both perimeter and dimensions were ≥20%. When compared with computed tomography, 3DE systematically underestimated TA parameters. CONCLUSIONS Gender and body size should be taken into account to identify the reference values of TA dimensions. 2DE underestimates TA dimensions.
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Saremi F, Sánchez-Quintana D, Mori S, Muresian H, Spicer DE, Hassani C, Anderson RH. Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging. Radiographics 2017; 37:1330-1351. [DOI: 10.1148/rg.2017170004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Damián Sánchez-Quintana
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Shumpei Mori
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Horia Muresian
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Diane E. Spicer
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Cameron Hassani
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
| | - Robert H. Anderson
- From the Department of Radiology, University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (F.S., C.H.); Department of Human Anatomy, University of Extremadura, Badajoz, Spain (D.S.Q.); Division of Cardiovascular Medicine, Kobe University, Kobe, Japan (S.M.); Department of Cardiovascular Surgery, University Hospital of Bucharest, Bucharest, Romania (H.M.); Department
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Hai T, Amador Y, Mahmood F, Jeganathan J, Khamooshian A, Knio ZO, Matyal R, Nicoara A, Liu DC, Senthilnathan V, Khabbaz KR. Changes in Tricuspid Annular Geometry in Patients with Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2017; 31:2106-2114. [PMID: 29100836 DOI: 10.1053/j.jvca.2017.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether the indices of tricuspid annular dynamics that signify irreversible tricuspid valvular remodeling can improve surgical decision making by helping to better identify patients with functional tricuspid regurgitation who could benefit from annuloplasty. DESIGN Retrospective analysis study. SETTING Tertiary hospital. PARTICIPANTS A total number of 55 patients were selected, 18 with functional tricuspid valve (TV) regurgitation and 37 normal nonregurgitant TVs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS When comparing the basal, mid, and longitudinal diameters of the right ventricle between the nonregurgitant valve (NTR) group and the functional tricuspid regurgitation (FTR) group, tricuspid annulus was more dilated (p < 0.001, p = 0.001, and p = 0.006, respectively) and less nonplanar (p < 0.001) in the FTR group. At end-systole (ES), the posterolateral-anteroseptal axis was significantly greater in the FTR group than in the NTR group (mean difference = 7.15 mm; p < 0.001). The right ventricle in the FTR group was also significantly dilated with greater leaflet restriction (p = 0.015). CONCLUSIONS As compared to NTR TVs, FTR is associated with identifiable indices of tricuspid annular structural changes that are indicative of irreversible remodeling.
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Affiliation(s)
- Ting Hai
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia, Hospital México, University of Costa Rica, San José, Costa Rica
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arash Khamooshian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ziyad O Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - David C Liu
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Venkatachalam Senthilnathan
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Sturla F, Onorati F, Puppini G, Pappalardo OA, Selmi M, Votta E, Faggian G, Redaelli A. Dynamic and quantitative evaluation of degenerative mitral valve disease: a dedicated framework based on cardiac magnetic resonance imaging. J Thorac Dis 2017; 9:S225-S238. [PMID: 28540065 DOI: 10.21037/jtd.2017.03.84] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate quantification of mitral valve (MV) morphology and dynamic behavior over the cardiac cycle is crucial to understand the mechanisms of degenerative MV dysfunction and to guide the surgical intervention. Cardiac magnetic resonance (CMR) imaging has progressively been adopted to evaluate MV pathophysiology, although a dedicated framework is required to perform a quantitative assessment of the functional MV anatomy. METHODS We investigated MV dynamic behavior in subjects with normal MV anatomy (n=10) and patients referred to surgery due to degenerative MV prolapse, classified as fibro-elastic deficiency (FED, n=9) and Barlow's disease (BD, n=10). A CMR-dedicated framework was adopted to evaluate prolapse height and volume and quantitatively assess valvular morphology and papillary muscles (PAPs) function over the cardiac cycle. Multiple comparison was used to investigate the hallmarks associated to MV degenerative prolapse and evaluate the feasibility of anatomical and functional distinction between FED and BD phenotypes. RESULTS On average, annular dimensions were significantly (P<0.05) larger in BD than in FED and normal subjects while no significant differences were noticed between FED and normal. MV eccentricity progressively decreased passing from normal to FED and BD, with the latter exhibiting a rounder annulus shape. Over the cardiac cycle, we noticed significant differences for BD during systole with an abnormal annular enlargement between mid and late systole (LS) (P<0.001 vs. normal); the PAPs dynamics remained comparable in the three groups. Prolapse height and volume highlighted significant differences among normal, FED and BD valves. CONCLUSIONS Our CMR-dedicated framework allows for the quantitative and dynamic evaluation of MV apparatus, with quantifiable annular alterations representing the primary hallmark of severe MV degeneration. This may aid surgeons in the evaluation of the severity of MV dysfunction and the selection of the appropriate MV treatment.
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Affiliation(s)
- Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Radiology, Università degli Studi di Verona, Verona, Italy
| | - Omar A Pappalardo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Matteo Selmi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.,Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, Università degli Studi di Verona, Verona, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Knio ZO, Montealegre-Gallegos M, Yeh L, Chaudary B, Jeganathan J, Matyal R, Khabbaz KR, Liu DC, Senthilnathan V, Mahmood F. Tricuspid annulus: A spatial and temporal analysis. Ann Card Anaesth 2017; 19:599-605. [PMID: 27716689 PMCID: PMC5070318 DOI: 10.4103/0971-9784.191569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Traditional two-dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single-frame measurements of the septolateral (S-L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real-time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R-wave-gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end- and mid-systole, end- and mid-diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral-anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end-systole (P < 0.001), mid-diastole (P = 0.014), and mid-systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S-L) that is routinely measured with 2D TEE.
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Affiliation(s)
- Ziyad O Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lu Yeh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia and Pain Medicine, University Medical Center, University of Groningen, Groningen, Netherlands,
| | - Bilal Chaudary
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David C Liu
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Venkatachalam Senthilnathan
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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46
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Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease. Curr Probl Cardiol 2017; 42:71-100. [DOI: 10.1016/j.cpcardiol.2017.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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47
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Seemann F, Pahlm U, Steding-Ehrenborg K, Ostenfeld E, Erlinge D, Dubois-Rande JL, Jensen SE, Atar D, Arheden H, Carlsson M, Heiberg E. Time-resolved tracking of the atrioventricular plane displacement in Cardiovascular Magnetic Resonance (CMR) images. BMC Med Imaging 2017; 17:19. [PMID: 28241751 PMCID: PMC5330030 DOI: 10.1186/s12880-017-0189-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Atrioventricular plane displacement (AVPD) is an indicator for systolic and diastolic function and accounts for 60% of the left ventricular, and 80% of the right ventricular stroke volume. AVPD is commonly measured clinically in echocardiography as mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE), but has not been applied widely in cardiovascular magnetic resonance (CMR). To date, there is no robust automatic algorithm available that allows the AVPD to be measured clinically in CMR with input in a single timeframe. This study aimed to develop, validate and provide a method that automatically tracks the left and right ventricular AVPD in CMR images, which can be used in the clinical setting or in applied cardiovascular research in multi-center studies. Methods The proposed algorithm is based on template tracking by normalized cross-correlation combined with a priori information by principal component analysis. The AVPD in each timeframe is calculated for the left and right ventricle separately using CMR long-axis cine images of the 2, 3, and 4-chamber views. The algorithm was developed using a training set (n = 40), and validated in a test set (n = 113) of healthy subjects, athletes, and patients after ST-elevation myocardial infarction from 10 centers. Validation was done using manual measurements in end diastole and end systole as reference standard. Additionally, AVPD, peak emptying velocity, peak filling velocity, and atrial contraction was validated in 20 subjects, where time-resolved manual measurements were used as reference standard. Inter-observer variability was analyzed in 20 subjects. Results In end systole, the difference between the algorithm and the reference standard in the left ventricle was (mean ± SD) -0.6 ± 1.9 mm (R = 0.79), and −0.8 ± 2.1 mm (R = 0.88) in the right ventricle. Inter-observer variability in end systole was −0.6 ± 0.7 mm (R = 0.95), and −0.5 ± 1.4 mm (R = 0.95) for the left and right ventricle, respectively. Validation of peak emptying velocity, peak filling velocity, and atrial contraction yielded lower accuracy than the displacement measures. Conclusions The proposed algorithm show good agreement and low bias with the reference standard, and with an agreement in parity with inter-observer variability. Thus, it can be used as an automatic method of tracking and measuring AVPD in CMR. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0189-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felicia Seemann
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Numerical Analysis, Faculty of Engineering, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
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Ochs MM, Fritz T, André F, Riffel J, Mereles D, Müller-Hennessen M, Giannitsis E, Katus HA, Friedrich MG, Buss SJ. A comprehensive analysis of cardiac valve plane displacement in healthy adults: age-stratified normal values by cardiac magnetic resonance. Int J Cardiovasc Imaging 2017; 33:721-729. [PMID: 28110433 DOI: 10.1007/s10554-016-1058-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/28/2016] [Indexed: 11/25/2022]
Abstract
Cardiac valve plane displacement (CVPD) reflects longitudinal LV function. The purpose of the present study was to determine regional heterogeneity of CVPD in healthy adults to provide normal values by cardiac magnetic resonance (CMR). We measured the anterior aortic plane systolic excursion (AAPSE); the anterior, anterolateral, inferolateral, inferior, and inferoseptal mitral annular plane systolic excursion (MAPSE); and the lateral tricuspid annulus plane systolic excursion (TAPSE). Systolic excursion was measured as the distance from peak end-diastolic to peak end-sysstolic annular position (peak-to-peak) in cine images acquired in 2-, 3- and 4-chamber views. Echocardiographic measurements of CVPD were performed in M-Mode as previously described. We retrospectively analyzed 209 healthy Caucasians (57% men), who participated in the Heidelberg normal cohort between March 2009 and September 2014. The analysis was possible in all participants. Mean values were: AAPSE = 14 ± 3 mm (8-20); MAPSEanterior = 14 ± 3 mm (8-20); MAPSEanterolateral = 16 ± 3 mm (10-22); MAPSEinferolateral = 16 ± 3 mm (10-22); MAPSEinferior = 17 ± 3 mm (11-23); MAPSEinferoseptal = 13 ± 3 mm (7-19) and TAPSE = 26 ± 4 mm (18-34) respectively. MAPSE was significantly elevated in lateral compared to septal regions (p = 0.0001). Sex-differences for CVPD were not found. Age-dependency of CVPD revealed distinct regional differences. AAPSE decreased the most with age (B=-0.48; p = 0.0001), whereas MAPSEinferior was the least age-dependent site (B=-0.17; p = 0.01). AAPSE revealed favorable intra-/interobserver reproducibility and interstudy agreement. Intermethod-comparison of CMR and M-Mode echocardiography showed good agreement between both measurements of CVPD. Age-stratified normal values of regional CVPD are provided. AAPSE revealed the most pronounced age-related decrease and provided favorable reproducibility compared to other regions of cardiac valve plane.
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Affiliation(s)
- Marco M Ochs
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Thomas Fritz
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | | | - Evangelos Giannitsis
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
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Ochs MM, Riffel J, Kristen AV, Hegenbart U, Schönland S, Hardt SE, Katus HA, Mereles D, Buss SJ. Anterior Aortic Plane Systolic Excursion: A Novel Indicator of Transplant-Free Survival in Systemic Light-Chain Amyloidosis. J Am Soc Echocardiogr 2016; 29:1188-1196. [PMID: 28042785 DOI: 10.1016/j.echo.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anterior aortic plane systolic excursion (AAPSE) was evaluated in the present pilot study as a novel echocardiographic indicator of transplant-free survival in patients with systemic light-chain amyloidosis. METHODS Eighty-nine patients with light-chain amyloidosis were included in the post-hoc analysis. A subgroup of 54 patients with biopsy-proven cardiac amyloid infiltration were compared with 41 healthy individuals to evaluate the discriminative ability of echocardiographic findings. AAPSE is defined as the systolic excursion of the anterior aortic margin. To quantify AAPSE, the M-mode cursor was placed on the aortic valve plane in parasternal long-axis view at end-diastole. Index echocardiography had been performed before chemotherapy. Median follow-up duration was 2.4 years. The primary combined end point was heart transplantation or overall death. RESULTS Mean AAPSE was 14 ± 2 mm in healthy individuals (mean age=57 ± 10 years; 56% men; BMI=25 ± 4 kg/m2). AAPSE < 11 mm separated patients from age-, gender-, and BMI-matched control subjects with 93% sensitivity and 97% specificity. Median transplant-free survival of patients with AAPSE < 5 mm was 0.7 versus 4.8 years (P = .0001). AAPSE was an independent indicator of transplant-free survival in multivariate Cox regression (echocardiographic model: hazard ratio=0.72 [P = .03]; biomarker model: hazard ratio=0.62 [P = .0001]). Sequential regression analysis suggested incremental power of AAPSE as a marker of transplant-free survival. An ejection fraction-based model with an overall χ2 value of 22.8 was improved by the addition of log NT-proBNP (χ2 = 32.6, P < .005), troponin-T (χ2 = 39.6, P < .01), and AAPSE (χ2 = 54.0, P < .0001). CONCLUSIONS AAPSE is suggested as an indicator of transplant-free survival in patients with systemic light-chain amyloidosis. AAPSE provided significant incremental value to established staging models.
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Affiliation(s)
- Marco M Ochs
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Hematooncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Schönland
- Department of Hematooncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan E Hardt
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
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Muraru D, Surkova E, Badano LP. Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management. Korean Circ J 2016; 46:443-55. [PMID: 27482252 PMCID: PMC4965422 DOI: 10.4070/kcj.2016.46.4.443] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/08/2016] [Indexed: 12/19/2022] Open
Abstract
Current knowledge of functional tricuspid regurgitation (FTR) as a progressive entity, worsening the prognosis of patients irrespective of its aetiology, has led to renewed interest in the pathophysiology and assessment of FTR. For the proper management of FTR, not only its severity, but also the mechanisms, the mode of leaflet coaptation, the degree of tricuspid annulus enlargement and leaflet tenting, and the haemodynamic consequences for right atrial and right ventricular morphology and function have to be taken into account. A better assessment of the anatomy and function of tricuspid apparatus and tricuspid regurgitation severity should help with the appropriate selection of patients who will benefit from either surgical tricuspid valve repair/replacement or a percutaneous procedure, especially among patients who are to undergo or have undergone primary left-sided valvular surgery. In this article, we review the anatomy, pathophysiology and the use of imaging techniques to assess patients with FTR, as well as the various treatment options for FTR, including emerging transcatheter procedures. The limitations affecting the current approach to FTR patients and the unmet clinical needs for their management have also been discussed.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
| | - Elena Surkova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, School of Medicine, Padua, Italy
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