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Al-Wakeel-Marquard N, Seidel F, Kühnisch J, Kuehne T, Berger F, Messroghli DR, Klaassen S. Midwall Fibrosis and Cardiac Mechanics: Rigid Body Rotation Is a Novel Marker of Disease Severity in Pediatric Primary Dilated Cardiomyopathy. Front Cardiovasc Med 2022; 8:810005. [PMID: 35252369 PMCID: PMC8891497 DOI: 10.3389/fcvm.2021.810005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Midwall fibrosis (MWF) detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse outcome in adults with dilated cardiomyopathy (DCM). Its relevance in children and adolescents is relatively unknown. Left ventricular (LV) strain, rotation and twist are important parameters of cardiac function; yet, their role in pediatric heart failure is understudied. This study aimed to evaluate MWF and cardiac mechanics in pediatric DCM. Methods Patients ≤21 years with primary DCM were prospectively enrolled and underwent standardized CMR including LGE. All participants were categorized according to the presence or absence of MWF (MWF+ vs. MWF–). Cardiac mechanics were assessed using CMR feature tracking. Impaired LV twist with apex and base rotating in the same direction was termed rigid body rotation (RBR). Results In total, 17 patients (median age 11.2 years) were included. MWF was present in seven patients (41%). Median N-terminal pro brain natriuretic peptide (NT-proBNP) was higher (5,959 vs. 242 pg/ml, p = 0.887) and LV ejection fraction (LVEF) lower (28 vs. 39%, p = 0.536) in MWF+ vs. MWF– patients, yet differences were not statistically significant. MWF+ patients had reduced global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), again without statistical significance (p = 0.713, 0.492 and 1.000, respectively). A relationship between MWF and adverse outcome was not seen (p = 0.637). RBR was more common in MWF+ (67 vs. 50%), and was associated with the occurrence of adverse events (p = 0.041). Patients with RBR more frequently were in higher New York Heart Association classes (p = 0.035), had elevated NT-proBNP levels (p = 0.002) and higher need for catecholamines (p = 0.001). RBR was related to reduced GLS (p = 0.008), GCS (p = 0.031), GRS (p = 0.012), LV twist (p = 0.008), peak apical rotation (p < 0.001), and LVEF (p = 0.001), elevated LV end-diastolic volume (p = 0.023) and LV end-systolic volume (p = 0.003), and lower right ventricular stroke volume (p = 0.023). Conclusions MWF was common, but failed to predict heart failure. RBR was associated with clinical and biventricular functional signs of heart failure as well as the occurrence of adverse events. Our findings suggest that RBR may predict outcomes and may serve as a novel marker of disease severity in pediatric DCM. Clinical Trial Registration:https://clinicaltrials.gov/, identifier: NCT03572569.
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Affiliation(s)
- Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- *Correspondence: Nadya Al-Wakeel-Marquard
| | - Franziska Seidel
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jirko Kühnisch
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel R. Messroghli
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine – Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Klaassen
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Stepwise approach for diagnosis and management of Takotsubo syndrome with cardiac imaging tools. Heart Fail Rev 2022; 27:545-558. [PMID: 35040000 DOI: 10.1007/s10741-021-10205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
Takotsubo syndrome is featured by transient left ventricle dysfunction in the absence of significant coronary artery disease, mainly triggered by emotional or physical stress. Its clinical presentation is similar to acute coronary syndrome; therefore, cardiac imaging tools have a crucial role. Coronary angiography is mandatory for exclusion of pathological stenosis. On the other side, transthoracic echocardiography is the first non-invasive imaging modality for an early evaluation of left ventricle systolic and diastolic function. Left ventricle morphologic patterns could be identified according to the localization of wall motion abnormalities. Moreover, an early identification of potential mechanical and electrical complications such as left ventricle outflow tract obstruction, mitral regurgitation, thrombus formation, right ventricular involvement, cardiac rupture, and cardiac rhythm disorders could provide additional information for clinical management and therapy. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. Advanced techniques, including speckle-tracking echocardiography, cardiac magnetic resonance, and nuclear imaging can provide mechanistic and pathophysiologic insights into this syndrome. This review focuses on these aspects and provide a stepwise approach of all cardiac imaging tools for the diagnosis and the management of Takotsubo syndrome.
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Hasin T, Mann D, Welt M, Barrett O, Shalev A, Godfrey M, Kovacs A, Bogot N, Carasso S, Glikson M, Wolak A. Loss of left ventricular rotation is a significant determinant of functional mitral regurgitation. Int J Cardiol 2021; 345:143-149. [PMID: 34626742 DOI: 10.1016/j.ijcard.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
AIM To evaluate insufficient rotational movement of the left ventricle (LV) as a potential novel mechanism for functional regurgitation of the mitral valve (FMR). METHODS AND RESULTS We compared reference subjects and patients with LV dysfunction (LVD, ejection fraction EF < 50%) with and without FMR (regurgitant volume RVol>10 ml). Subjects without structural mitral valve pathology undergoing cardiac MRI were evaluated. Delayed enhancement, global LV remodeling parameters, systolic twist and torsion were measured (using manual and novel automated cardiac MRI tissue-tracking). The study included 117 subjects with mean ± SD age 50.4 ± 17.8 years, of which 30.8% were female. Compared to subjects with LVD without FMR (n = 31), those with FMR (n = 37) had similar clinical characteristics, diagnoses, delayed enhancement, EF, and longitudinal strain. Subjects with FMR had significantly larger left ventricles (EDVi:136.6 ± 41.8 vs 97.5 ± 26.2 ml/m, p < 0.0001) with wider separation between papillary muscles (21.1 ± 7.6 vs 17.2 ± 5.7 mm, p = 0.023). Notably, they had lower apical (p < 0.0001) but not basal rotation and lower peak systolic twist (3.1 ± 2.4° vs 5.5 ± 2.5°, p < 0.0001) and torsion (0.56 ± 0.38°/cm vs 0.88 ± 0.52°/cm, p = 0.004). In a multivariate model for RVol including age, gender, twist, LV end-diastolic volume, sphericity index and separation between papillary muscles, only gender, volume and twist were significant. Twist was the most powerful correlate (beta -2.23, CI -3.26 to -1.23 p < 0.001). In patients with FMR, peak systolic twist negatively correlates with RVol (r = -0.73, p < 0.0001). CONCLUSION Reduced rotational systolic LV motion is significantly and independently associated with RVol among patients with FMR, suggesting a novel pathophysiological mechanism and a potential therapeutic target.
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Affiliation(s)
- Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Daniel Mann
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Welt
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Cardiology, The Edith Wolfson Medical Center, Holon, Israel
| | - Orit Barrett
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Aryeh Shalev
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
| | - Max Godfrey
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andras Kovacs
- Department of Cardiology, Hungarian Defense Forces Medical Center, Budapest, Hungary
| | - Naama Bogot
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shemy Carasso
- Department of Cardiology, Padeh Poria Medical Center, Poria, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
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Ludmila DS, Sikorska K, Raczak G. The role of speckle tracking echocardiography in monitoring cardiac function in patients with hereditary hemochromatosis. Ir J Med Sci 2020; 189:475-476. [DOI: 10.1007/s11845-019-02114-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
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Sabatino J, Di Salvo G, Krupickova S, Fraisse A, Prota C, Bucciarelli V, Josen M, Paredes J, Sirico D, Voges I, Indolfi C, Prasad S, Daubeney P. Left Ventricular Twist Mechanics to Identify Left Ventricular Noncompaction in Childhood. Circ Cardiovasc Imaging 2020; 12:e007805. [PMID: 31002265 DOI: 10.1161/circimaging.118.007805] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular noncompaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood. Standard diagnostic criteria are still controversial, especially in young patients. Recent studies in adults demonstrated that left ventricular (LV) twist is abnormal in LVNC, but it has not been investigated in pediatric patients to date. Our aim was to assess LV cardiac mechanics, LV twist, and the prevalence of rigid body rotation, using 2-dimensional speckle tracking echocardiography, in young patients with LVNC and LV hypertrabeculation. METHODS Forty-seven children (age range: 0-18 years) were assessed for suspected LVNC. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging at 1.5 Tesla (T). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group. Forty-seven age- and sex-matched healthy volunteers were used as controls. RESULTS The average LV twist was significantly reduced in LVNC compared with control and LV hypertrabeculation. Rigid body rotation was recognized in 13 (56%) children with LVNC and in 1 (4%) child with LV hypertrabeculation and a strong family history for LVNC. Multivariable analysis demonstrated that LV twist is an independent predictor of LVNC ( P=0.006; coefficient=0.462). The receiver operating characteristics curve showed that LV twist had optimal predictive value to discriminate patients with LVNC (cutoff value <5.8°; sensitivity, 82%; specificity, 92%; area under the curve=0.914). CONCLUSIONS LV twist has good predictive value in diagnosing LVNC in young patients. Our findings strongly support the routine use of 2-dimensional speckle tracking echocardiography in the evaluation of young patients with suspected LVNC.
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Affiliation(s)
- Jolanda Sabatino
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Giovanni Di Salvo
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Sylvia Krupickova
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Costantina Prota
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Valentina Bucciarelli
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Manjit Josen
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Josefa Paredes
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Domenico Sirico
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Inga Voges
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.)
| | - Ciro Indolfi
- Department of Cardiology, Magna Graecia University, Catanzaro, Italy (C.I.)
| | - Sanjay Prasad
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
| | - Piers Daubeney
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (J.S., G.D.S., S.K., A.F., C.P., V.B., M.J., J.P., D.S., I.V., S.P., P.D.).,National Heart and Lung Institute, Imperial College, London, United Kingdom (G.D.S., S.P., A.F., P.D.)
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M H BT, H Z, H P, Sh N, A E, A G. Sex-related Left Ventricle Rotational and Torsional Mechanics by Block Matching Algorithm. J Biomed Phys Eng 2019; 9:541-550. [PMID: 31750268 PMCID: PMC6820028 DOI: 10.31661/jbpe.v0i0.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
Background: The aim of the present study was to evaluate how left ventricular twist and torsion are associated with sex between sex groups of the same age.
Materials and Methods: In this analytical study, twenty one healthy subjects were scanned in left ventricle basal and apical short axis views to run the block matching algorithm; instantaneous changes in the base and apex rotation angels were estimated by this algorithm and then instantaneous changes of the twist and torsion were calculated over the cardiac cycle.
Results: The rotation amount between the consecutive frames in basal and apical levels was extracted from short axis views by tracking the speckle pattern of images. The maximum basal rotation angle for men and women were -6.94°±1.84 and 9.85°±2.36 degrees (p-value = 0.054), respectively. Apex maximum rotation for men was -8.89°±2.04 and for women was 12.18°±2.33 (p-value < 0.05). The peak of twist angle for men and women was 16.78 ± 1.83 and 20.95± 2.09 degrees (p-value < 0.05), respectively. In men and women groups, the peak of calculated torsion angle was 5.49°±1.04 and 7.12± 1.38 degrees (p-value < 0.05), respectively.
Conclusion: The conclusion is that although torsion is an efficient parameter for left ventricle function assessment, because it can take in account the heart diameter and length,
statistic evaluation of the results shows that among men and women LV mechanical parameters are significantly different. This study was mainly ascribed to the dependency of the torsion and twist on patient sex.
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Affiliation(s)
- Bahreini Toosi M H
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zarghani H
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Poorzand H
- MD, Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naseri Sh
- PhD, Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eshraghi A
- MD, Atherosclerosis Prevention Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Golabpour A
- PhD, Biomedical Informatics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Rozwadowska K, Daniłowicz-Szymanowicz L, Fijałkowski M, Sikorska K, Gałąska R, Kozłowski D, Gruchała M, Raczak G. Can two-dimensional speckle tracking echocardiography be useful for left ventricular assessment in the early stages of hereditary haemochromatosis? Echocardiography 2018; 35:1772-1781. [DOI: 10.1111/echo.14141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology; Medical University of Gdansk; Gdansk Poland
| | - Rafał Gałąska
- I Department of Cardiology; Medical University of Gdansk; Gdansk Poland
| | - Dariusz Kozłowski
- II Department of Cardiology and Electrotherapy; Medical University of Gdansk; Gdansk Poland
| | - Marcin Gruchała
- I Department of Cardiology; Medical University of Gdansk; Gdansk Poland
| | - Grzegorz Raczak
- II Department of Cardiology and Electrotherapy; Medical University of Gdansk; Gdansk Poland
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Di Odoardo LAF, Giuditta M, Cassinerio E, Roghi A, Pedrotti P, Vicenzi M, Sciumbata VM, Cappellini MD, Pierini A. Myocardial deformation in iron overload cardiomyopathy: speckle tracking imaging in a beta-thalassemia major population. Intern Emerg Med 2017; 12:799-809. [PMID: 28456904 DOI: 10.1007/s11739-017-1670-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/24/2017] [Indexed: 12/13/2022]
Abstract
Traditional echocardiography is unable to detect neither the early stages of iron overload cardiomyopathy nor myocardial iron deposition. The aim of the study is to determine myocardial systolic strain indices in thalassemia major (TM), and assess their relationship with T2*, a cardiac magnetic resonance index of the severity of cardiac iron overload. 55 TM cases with recent cardiac magnetic resonance (CMR-T2*) underwent speckle tracking analysis to assess regional myocardial strains and rotation. The results were compared with a normal control group (n = 20), and were subsequently analyzed on the basis of the CMR-T2* values. Two TM groups were studied: TM with significant cardiac iron overload ("low" T2*, ≤20 ms; n = 21), and TM with normal T2* values ("normal" T2*, >20 ms; n = 34). TM patients show significant, uniform decrease in circumferential and radial strain (P < 0.05), and a remarkable reduction in end-systolic rotation, both global, and for all segments (P < 0.001). No significant differences were found between the low- and the normal T2* group either in regional strains and rotation or in standard echocardiographic and CMR parameters. Spearman's correlation coefficient shows no significant correlation between myocardial strains, rotation and cardiac T2* values. In conclusion, our results are in accordance with recent evidence that myocardial iron overload is not the only mechanism underlying iron cardiomyopathy in TM. Strain imaging can predict subclinical myocardial dysfunction irrespective of CMR-T2* values, although it cannot replace CMR-T2* in assessing cardiac iron overload. Finally, it might be useful to appropriately time cardioactive treatment.
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Affiliation(s)
- Luca Antonio Felice Di Odoardo
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy.
| | - Marianna Giuditta
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
- Rare Diseases Center, Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy
| | - Elena Cassinerio
- Rare Diseases Center, Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy
| | - Alberto Roghi
- Cardiovascular Magnetic Resonance Unit, Department of Cardiology, Niguarda Cà Granda Hospital, P.zza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Patrizia Pedrotti
- Cardiovascular Magnetic Resonance Unit, Department of Cardiology, Niguarda Cà Granda Hospital, P.zza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
| | - Veronica Maria Sciumbata
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy
| | - Maria Domenica Cappellini
- Rare Diseases Center, Department of Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122, Milan, Italy
- Department of Clinical Science and Community Health, Università Degli Studi di Milano, via F. Sforza 35, 20122, Milan, Italy
| | - Alberto Pierini
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, via F. Sforza 35, 20122, Milan, Italy
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Sims JA, Giorgi MC, Oliveira MA, Meneghetti JC, Gutierrez MA. Directional analysis of cardiac motion field from gated fluorodeoxyglucose PET images using the Discrete Helmholtz Hodge Decomposition. Comput Med Imaging Graph 2017; 65:69-78. [PMID: 28688629 DOI: 10.1016/j.compmedimag.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/31/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Extract directional information related to left ventricular (LV) rotation and torsion from a 4D PET motion field using the Discrete Helmholtz Hodge Decomposition (DHHD). MATERIALS AND METHODS Synthetic motion fields were created using superposition of rotational and radial field components and cardiac fields produced using optical flow from a control and patient image. These were decomposed into curl-free (CF) and divergence-free (DF) components using the DHHD. RESULTS Synthetic radial components were present in the CF field and synthetic rotational components in the DF field, with each retaining its center position, direction of motion and diameter after decomposition. Direction of rotation at apex and base for the control field were in opposite directions during systole, reversing during diastole. The patient DF field had little overall rotation with several small rotators. CONCLUSIONS The decomposition of the LV motion field into directional components could assist quantification of LV torsion, but further processing stages seem necessary.
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Affiliation(s)
- J A Sims
- Laboratory of Biomedical Engineering, Polytechnic School, University of São Paulo, São Paulo, Brazil.
| | - M C Giorgi
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - M A Oliveira
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - J C Meneghetti
- Department of Nuclear Medicine and Molecular Imaging, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - M A Gutierrez
- Laboratory of Biomedical Engineering, Polytechnic School, University of São Paulo, São Paulo, Brazil; Informatics Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
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von Lueder TG, Hodt A, Gjerdalen GF, Steine K. Left ventricular biomechanics in professional football players. Scand J Med Sci Sports 2017; 28:187-195. [PMID: 28378431 DOI: 10.1111/sms.12893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, P<.01). Diastolic untwisting rate (UTWR) was higher in players (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both P<.05). Untwisting/twisting ratio (-1.48±0.05 vs -1.11±0.08; P<.001) and untwisting performance (=UTR/TW; -9.25±0.34 vs -7.38±0.40 s-1 , P<.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy.
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Affiliation(s)
- T G von Lueder
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - A Hodt
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - G F Gjerdalen
- Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - K Steine
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
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Kauer F, van Dalen BM, Michels M, Schinkel AFL, Vletter WB, van Slegtenhorst M, Soliman OII, Geleijnse ML. Delayed and decreased LV untwist and unstrain rate in mutation carriers for hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2017; 18:383-389. [PMID: 28013283 DOI: 10.1093/ehjci/jew213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/15/2016] [Indexed: 11/12/2022] Open
Abstract
Background The echocardiographic focus to detect abnormalities in genetically hypertrophic cardiomyopathy (HCM) affected subjects without left ventricular (LV) hypertrophy (G+/LVH-) has been on diastolic abnormalities in transmitral flow and longitudinal myocardial function with tissue Doppler imaging. The aim of this study was to assess diastolic LV unstrain and untwist. Methods and results Forty-one consecutive genotyped family members of HCM patients (mean age 37 ± 11 years, 16 men) and 41 age- and gender-matched healthy volunteers underwent speckle-tracking echocardiography to measure untwist and unstrain. No significant differences between G+/LVH- and control subjects were seen in maximal systolic twist and global longitudinal strain. In diastole, the early peak untwist rate was significantly lower in G+/LVH- subjects compared with control subjects (62 ± 19°s - 1 vs. 76 ± 30°s - 1, P <0.05), whereas the late peak untwist rate tended to be higher. Untwist from maximal twist until the first 20% of diastole was delayed in G+/LVH- subjects (39.3 ± 12.9% vs. 51.3 ± 15.6%, P <0.005). Late diastolic unstrain rate was significantly higher in G+/LVH- subjects in the inferoseptal wall (111 ± 33 s - 1 vs. 94 ± 32 s - 1, P = 0.024), the inferolateral wall (105 ± 42 vs. 75 ± 35 s - 1, P = 0.007) and the anteroseptal wall (97 ± 26 vs. 80 ± 23 s - 1, P = 0.010). Unstrain from maximal twist until the first 20% of diastole was delayed in G+/LVH- subjects in the inferoseptal (18.9 ± 14.0% vs. 30.1 ± 17.7%, P = 0.005), inferolateral (27.1 ± 16.3% vs. 39.2 ± 18.0%, P = 0.015) and anteroseptal (19.1 ± 14.7% vs. 35.8 ± 18.5%, P = 0.0003) segments. Conclusions In mutation carriers, for HCM LV, untwist and unstrain are delayed and untwist rate and unstrain rate are decreased.
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Affiliation(s)
- Floris Kauer
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wim B Vletter
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjon van Slegtenhorst
- Department of Genetics, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Osama I I Soliman
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
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Jansen-Park SH, Hsu PL, Müller I, Steinseifer U, Abel D, Autschbach R, Rossaint R, Schmitz-Rode T. A mock heart engineered with helical aramid fibers for in vitro cardiovascular device testing. BIOMED ENG-BIOMED TE 2017; 62:139-148. [PMID: 28375841 DOI: 10.1515/bmt-2016-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 03/01/2017] [Indexed: 11/15/2022]
Abstract
Mock heart circulation loops (MHCLs) serve as in-vitro platforms to investigate the physiological interaction between circulatory systems and cardiovascular devices. A mock heart (MH) engineered with silicone walls and helical aramid fibers, to mimic the complex contraction of a natural heart, has been developed to advance the MHCL previously developed in our group. A mock aorta with an anatomical shape enables the evaluation of a cannulation method for ventricular assist devices (VADs) and investigation of the usage of clinical measurement systems like pressure-volume catheters. Ventricle and aorta molds were produced based on MRI data and cast with silicone. Aramid fibers were layered in the silicone ventricle to reproduce ventricle torsion. A rotating hollow shaft was connected to the apex enabling the rotation of the MH and the connection of a VAD. Silicone wall thickness, aramid fiber angle and fiber pitch were varied to generate different MH models. All MH models were placed in a tank filled with variable amounts of water and air simulating the compliance. In this work, physiological ventricular torsion angles (15°-26°) and physiological pressure-volume loops were achieved. This MHCL can serve as a comprehensive testing platform for cardiovascular devices, such as artificial heart valves and cannulation of VADs.
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Affiliation(s)
| | - Po-Lin Hsu
- Artificial Organ Technology Laboratory, Biomufacturing Centre, School of Mechanical and Electric Engineering, Soochow University, Jiangsu
| | - Indra Müller
- Institute of Applied Medical Engineering, RWTH Aachen University, Aachen
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, RWTH Aachen University, Aachen
| | - Dirk Abel
- Institute of Automatic Control, RWTH Aachen University, Aachen
| | - Rüdiger Autschbach
- Department of Cardiothoracic and Vascular Surgery, University Hospital Aachen, Aachen
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital Aachen, Aachen
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Swoboda PP, Erhayiem B, McDiarmid AK, Lancaster RE, Lyall GK, Dobson LE, Ripley DP, Musa TA, Garg P, Ferguson C, Greenwood JP, Plein S. Relationship between cardiac deformation parameters measured by cardiovascular magnetic resonance and aerobic fitness in endurance athletes. J Cardiovasc Magn Reson 2016; 18:48. [PMID: 27535657 PMCID: PMC4989526 DOI: 10.1186/s12968-016-0266-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Athletic training leads to remodelling of both left and right ventricles with increased myocardial mass and cavity dilatation. Whether changes in cardiac strain parameters occur in response to training is less well established. In this study we investigated the relationship in trained athletes between cardiovascular magnetic resonance (CMR) derived strain parameters of cardiac function and fitness. METHODS Thirty five endurance athletes and 35 age and sex matched controls underwent CMR at 3.0 T including cine imaging in multiple planes and tissue tagging by spatial modulation of magnetization (SPAMM). CMR data were analysed quantitatively reporting circumferential strain and torsion from tagged images and left and right ventricular longitudinal strain from feature tracking of cine images. Athletes performed a maximal ramp-incremental exercise test to determine the lactate threshold (LT) and maximal oxygen uptake (V̇O2max). RESULTS LV circumferential strain at all levels, LV twist and torsion, LV late diastolic longitudinal strain rate, RV peak longitudinal strain and RV early and late diastolic longitudinal strain rate were all lower in athletes than controls. On multivariable linear regression only LV torsion (beta = -0.37, P = 0.03) had a significant association with LT. Only RV longitudinal late diastolic strain rate (beta = -0.35, P = 0.03) had a significant association with V̇O2max. CONCLUSIONS This cohort of endurance athletes had lower LV circumferential strain, LV torsion and biventricular diastolic strain rates than controls. Increased LT, which is a major determinant of performance in endurance athletes, was associated with decreased LV torsion. Further work is needed to understand the mechanisms by which this occurs.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Rosalind E. Lancaster
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Gemma K. Lyall
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Carrie Ferguson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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14
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Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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James A, Corcoran JD, Mertens L, Franklin O, El-Khuffash A. Left Ventricular Rotational Mechanics in Preterm Infants Less Than 29 Weeks' Gestation over the First Week after Birth. J Am Soc Echocardiogr 2015; 28:808-17.e1. [PMID: 25819342 DOI: 10.1016/j.echo.2015.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of data on left ventricular (LV) rotational physiology, twist, and torsional mechanics in preterm infants. The principal aims of the present study were to assess the feasibility and reproducibility of measuring LV rotation, twist, and torsion in preterm infants (<29 weeks' gestation) using two-dimensional speckle-tracking echocardiography and to examine the changes in those parameters over the first week after birth. METHODS This was a prospective observational study involving preterm infants <29 weeks' gestation. Echocardiographic evaluations were performed on days 1, 2, and 5 to 7 after delivery. LV basal and apical rotation, LV twist, LV twist rate (LVTR), and LV untwist rate (LVUTR) were measured from the basal and apical short-axis parasternal views and calculated using two-dimensional speckle-tracking echocardiography. Torsion was also calculated by normalizing LV twist to LV end-diastolic length. One-way repeated-measures analysis of variance was used to compare values across the three time points. Intra- and interobserver reproducibility were assessed using Bland-Altman analysis and the intraclass correlation coefficient. RESULTS Fifty-one infants with a mean ± SD gestational age of 26.8 ± 1.5 weeks and a mean birth weight of 945 ± 233 g were included. There was high intra- and interobserver reproducibility for basal and apical rotation, LV twist, and LV torsion, with intraclass correlation coefficients ranging from 0.78 to 0.96 (P < .001 for all). Intra- and interobserver intraclass correlation coefficients for LVTR and LVUTR ranged from 0.70 to 0.88 (P < .001 for all). Apical rotation remained constant over the first week of age in a positive counterclockwise fashion (11.8 ± 5.0° vs 12.1 ± 6.1° vs 11.7 ± 8.3°, P = .92). Basal rotation changed from counterclockwise on day 1 to clockwise on day 7 (median, 5.5° [interquartile range, -0.3° to 8.3°] vs 4.0 [interquartile range, -4.7° to 7.2°] vs -4.5° [interquartile range, -5.8° to -2.3°], P < .001), with resultant net increases in twist and torsion (P < .05). There was no change in LVTR (P = .60), but LVUTR increased across the same time period (P = .01). CONCLUSIONS Assessment of twist, LVTR, and LVUTR is feasible in preterm infants, with acceptable reproducibility. There are increases in LV twist and torsion in addition to LVUTR, suggesting changes in LV mechanics during the first week of age.
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Affiliation(s)
- Adam James
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | | | - Luc Mertens
- The Labatt Family Heart Centre, The Hospital for Children, Toronto, Ontario, Canada
| | - Orla Franklin
- Department of Pediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; Department of Pediatrics, The Royal College of Surgeons in Ireland, Dublin, Ireland.
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Kurt M, Tanboga IH, Aksakal E. Two-Dimensional Strain Imaging: Basic principles and Technical Consideration. Eurasian J Med 2015; 46:126-30. [PMID: 25610311 DOI: 10.5152/eajm.2014.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/22/2022] Open
Abstract
Tissue Doppler Imaging (TDI) and TDI-derived strain provide considerably accurate information in the non-invasive assessment of local myocardial functions. Given its high temporal and spatial resolution, TDI allows assessment of local myocardial functions in each phase of cardiac cycle. However, the most important limitation of this method is its angle dependence. New techniques to measure myocardial deformation, such as speckle tracking echocardiography, overcome the angle-dependence limitation of TDI-derived strain. Moreover, these techniques provide more unique information about myocardial fiber orientation. This review examines the architectural structure and function of the myocardium and includes technical revisions of this information that will provide a basis for STE.
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Affiliation(s)
- Mustafa Kurt
- Department of Cardiology, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | | | - Enbiya Aksakal
- Department of Cardiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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17
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Zhou W, Benharash P, Chua JH, Nakahara S, Ho JK, Mahajan A. Acute Effects of Pacing at Different Ventricular Sites on Left Ventricular Rotational Mechanics in a Porcine Model. J Cardiothorac Vasc Anesth 2014; 29:1148-54. [PMID: 25824449 DOI: 10.1053/j.jvca.2014.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the acute effects of pacing at different ventricular sites on hemodynamics and left ventricular (LV) rotational mechanics using speckle-tracking echocardiography (STE) in a porcine model. DESIGN A prospective laboratory investigation. SETTING University research laboratory. PARTICIPANTS Yorkshire pigs. INTERVENTIONS In 9 pigs, after midline sternotomy, epicardial pacing was performed from the right ventricular outflow tract (RVOT), right ventricular apex (RVA), and LV free wall. MEASUREMENTS AND MAIN RESULTS Two-dimensional STE and conductance catheter-derived LV pressure-volume measurements were made to determine the impact of pacing from various sites on LV rotational parameters (twist/untwist) and hemodynamics. RVOT pacing caused the least decrease in end-systolic pressure from baseline (-9.5%), when compared with RVA (-19.1%) and LV (-23.4%). Systolic and diastolic parameters (Emax, Tau) also were different among RVOT (4.7±0.8 mmHg/mL, 32±4 ms), RVA (3.9±0.7 mmHg/mL, 37±6 ms), and LV sites (3.6±0.8 mmHg/mL, 42±7 ms). Similar to the effects of pacing on hemodynamics, RVOT pacing better preserved LV twist (11.1±1.8 v 8.6±1.7, 5.9±0.7 °) and untwisting rate (64.6±8.5 v 56.2±5.3, 48.2±8.5 °/s) when compared with RV apical pacing and LV pacing. Furthermore, prolongation of conduction from LV lateral to anteroseptal at LV base (26.5±3.8 v 13.8±3.3 ms, p<0.05) and LV midpapillary muscle level (35.6±5.6 v 14.1±2.4 ms, p<0.05) was observed with LV pacing compared with RVOT pacing. CONCLUSIONS The present data showed that the LV twist/untwist and cardiac systolic and diastolic function were least affected by RVOT pacing. This finding may be explained by the proximity of this location to the native ventricular conduction system.
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Affiliation(s)
| | - Peyman Benharash
- Cardiovascular Surgery, University of California Los Angeles, Los Angeles, CA
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Jiang K, Yu X. Quantification of regional myocardial wall motion by cardiovascular magnetic resonance. Quant Imaging Med Surg 2014; 4:345-57. [PMID: 25392821 DOI: 10.3978/j.issn.2223-4292.2014.09.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is a versatile tool that also allows comprehensive and accurate measurement of both global and regional myocardial contraction. Quantification of regional wall motion parameters, such as strain, strain rate, twist and torsion, has been shown to be more sensitive to early-stage functional alterations. Since the invention of CMR tagging by magnetization saturation in 1988, several CMR techniques have been developed to enable the measurement of regional myocardial wall motion, including myocardial tissue tagging, phase contrast mapping, displacement encoding with stimulated echoes (DENSE), and strain encoded (SENC) imaging. These techniques have been developed with their own advantages and limitations. In this review, two widely used and closely related CMR techniques, i.e., tissue tagging and DENSE, will be discussed from the perspective of pulse sequence development and image-processing techniques. The clinical and preclinical applications of tissue tagging and DENSE in assessing wall motion mechanics in both normal and diseased hearts, including coronary artery diseases, hypertrophic cardiomyopathy, aortic stenosis, and Duchenne muscular dystrophies, will be discussed.
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Affiliation(s)
- Kai Jiang
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xin Yu
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
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19
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Zhou ZW, Zhang BC, Yu Y, Guo K, Li W, Zhang R, Zhang PP, Li YG. Acute impact of pacing at different cardiac sites on left ventricular rotation and twist in dogs. PLoS One 2014; 9:e111231. [PMID: 25340769 PMCID: PMC4207788 DOI: 10.1371/journal.pone.0111231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives We evaluated the acute impact of different cardiac pacing sites on two-dimensional speckle-tracking echocardiography (STE) derived left ventricular (LV) rotation and twist in healthy dogs. Methods Twelve dogs were used in this study. The steerable pacing electrodes were positioned into right heart through the superior or inferior vena cava, into LV through aorta across the aortic valve. The steerable pacing electrodes were positioned individually in the right atrium (RA), right ventricular apex (RVA), RV outflow tract (RVOT), His bundle (HB), LV apex (LVA) and LV high septum (LVS), individual pacing mode was applied at 10 minutes interval for at least 5 minutes from each position under fluoroscopy and ultrasound guidance and at stabilized hemodynamic conditions. LV short-axis images at the apical and basal levels were obtained during sinus rhythm and pacing. Offline STE analysis was performed. Rotation, twist, time to peak rotation (TPR), time to peak twist (TPT), and apical-basal rotation delay (rotational synchronization index, RSI) values were compared at various conditions. LV pressure was monitored simultaneously. Results Anesthetic death occurred in 1 dog, and another dog was excluded because of bad imaging quality. Data from 10 dogs were analyzed. RVA, RVOT, HB, LVA, LVS, RARV (RA+RVA) pacing resulted in significantly reduced apical and basal rotation and twist, significantly prolonged apical TPR, TPT and RSI compared to pre-pacing and RA pacing (all P<0.05). The apical and basal rotation and twist values were significantly higher during HB pacing than during pacing at ventricular sites (all P<0.05, except basal rotation at RVA pacing). The apical TPR during HB pacing was significantly shorter than during RVOT and RVA pacing (both P<0.05). The LV end systolic pressure (LVESP) was significantly lower during ventricular pacing than during pre-pacing and RA pacing. Conclusions Our results show that RA and HB pacing results in less acute reduction on LV twist, rotation and LVESP compared to ventricular pacing.
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Affiliation(s)
- Zhi-Wen Zhou
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, People's Republic of China
| | - Bu-Chun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical College, Jiangsu province, People's Republic of China
| | - Yi Yu
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Kai Guo
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wei Li
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rui Zhang
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Peng-Pai Zhang
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yi-Gang Li
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- * E-mail:
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Gardiner HM, Matsui H, Roughton M, Greenwald SE, Diemert A, Taylor MJO, Hecher K. Cardiac function in 10-year-old twins following different fetal therapies for twin-twin transfusion syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:652-657. [PMID: 24347245 DOI: 10.1002/uog.13279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/02/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare cardiac function at 10 years of age in four groups of monochorionic diamniotic (MCDA) twin pairs: uncomplicated MCDA twins (n = 6) (Group 1); twins that had had twin-twin transfusion syndrome (TTTS) managed by amnioreduction (TTTS-amnio, n = 9) (Group 2) or laser photocoagulation (TTTS-laser, n = 10) (Group 3); and dichorionic diamniotic controls (DCDA, n = 6) (Group 4). METHODS Echocardiograms optimizing apical four-chamber and short-axis left ventricular views were stored for offline speckle-tracking analysis, blinded to twin type. Myocardial long-axis shortening and lengthening velocities were measured using pulsed Doppler ultrasound at the cardiac base. M-mode measurements of fractional shortening (short axis) and maximal excursion of the atrioventricular annulus (four-chamber) were recorded. Syngo Vector Velocity Imaging software tracked left ventricular myocardial motion offline to produce free wall strain, strain rate and rotation. Intertwin pair and group differences were investigated using ANOVA. RESULTS Cardiac measurements were within the normal ranges for 10-year-olds. No significant within-twin-pair and intergroup differences were found in current size, heart rates, strain or strain rate. Compared to DCDA controls, TTTS twins showed less cardiac rotation (TTTS-laser, P < 0.001 and TTTS-amnio, P = 0.054) with significant intertwin reduction in the ex-recipient (TTTS-amnio, P = 0.006) and larger MCDA twins (P = 0.027) compared with their cotwins. A similar pattern was seen in left ventricular early diastolic mitral valve tissue velocity (MVE') in all monochorionic groups, but only achieving significance in TTTS-amnio twins (P = 0.037). Intrapair differences in rotation and MVE' were significantly different following treatment at Quintero stages III or IV. CONCLUSIONS Within-twin-pair patterns of left ventricular rotation and diastolic function differ at 10 years of age in ex-recipients of TTTS twins treated with amnioreduction compared with those treated by laser photocoagulation and controls. .
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Affiliation(s)
- H M Gardiner
- Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK; Royal Brompton NHS Foundation Trust Hospital, London, UK
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Chong A, MacLaren G, Chen R, Connelly KA. Perioperative Applications of Deformation (Myocardial Strain) Imaging With Speckle-Tracking Echocardiography. J Cardiothorac Vasc Anesth 2014; 28:128-140. [DOI: 10.1053/j.jvca.2013.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 12/24/2022]
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Deng Y, Pandit A, Heilman RL, Chakkera HA, Mazur MJ, Mookadam F. Left ventricular torsion changes post kidney transplantation. J Cardiovasc Ultrasound 2013; 21:171-6. [PMID: 24459564 PMCID: PMC3894368 DOI: 10.4250/jcu.2013.21.4.171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/04/2013] [Accepted: 11/12/2013] [Indexed: 11/22/2022] Open
Abstract
Background To quantify changes of left ventricular (LV) torsion in patients' pre and post kidney transplantation. Methods A prospective study was conducted on 48 patients who received kidney transplantation for end stage renal disease and without myocardial infarction. The rotation, twist and torsion of LV were studied pre and post kidney transplantation (6 months post transplantation) using velocity vector imaging by echocardiography. The data is expressed as mean ± standard deviation and compared by paired t-test at the p < 0.05 significance level. Results Six months post kidney transplantation, left ventricular ejection fraction (from 40.33 ± 11.42 to 61.00 ± 13.68%), ratio of mitral early and late diastolic filling velocity (from 1.04 ± 0.57 to 1.21 ± 0.52), rotation of basal LV (from 4.48 ± 2.66 to 5.65 ± 2.64 degree), rotation of apical LV (from 4.27 ± 3.08 to 5.50 ± 4.25 degree), LV twist (8.75 ± 4.45 to 11.14 ± 5.25 degree) and torsion (from 1.06 ± 0.54 to 1.33 ± 0.61 degree/cm) were increased significantly (p < 0.05). Interventricular septum thickness (from 11.67 ± 2.39 to 9.67 ± 0.48 mm), left ventricular mass index (from 104.00 ± 16.47 to 95.50 ± 21.44 g/m2), systolic blood pressure (from 143.50 ± 34.99 to 121.50 ± 7.09 mmHg), serum blood urea nitrogen (from 42.40 ± 7.98 to 30.43 ± 13.85 mg/dL) and creatinine (from 4.53 ± 1.96 to 2.73 ± 2.57 mg/dL) were decreased significantly (p < 0.05). Conclusion Kidney transplantation in end stage renal disease without myocardial infarction results in improvement in left ventricular structure, function and myocardial mechanics as detected by echocardiography and velocity vector imaging. Velocity vector imaging provided valuable information for detection and follow-up of cardiac abnormalities in patients with end stage renal disease.
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Affiliation(s)
- Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Sichuan, China
| | - Anil Pandit
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Marek J Mazur
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Farouk Mookadam
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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Del-Canto I, López-Lereu MP, Monmeneu JV, Croisille P, Clarysse P, Chorro FJ, Bodí V, Moratal D. Characterization of normal regional myocardial function by MRI cardiac tagging. J Magn Reson Imaging 2013; 41:83-92. [PMID: 24339144 DOI: 10.1002/jmri.24539] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/14/2013] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The aim of this study was to establish reference values for segmental myocardial strain measured by magnetic resonance (MR) cardiac tagging in order to characterize the regional function of the heart. MATERIAL AND METHODS We characterized the left ventricular (LV) systolic deformation in 39 subjects (26 women and 13 men, age 58.8 ± 11.6 years) whose cardiological study had not revealed any significant abnormality. The deformation was measured from MR-tagged (Siemens 1.5T MR) images using an algorithm based on sine wave modeling. Circumferential and radial peak systolic strain values along with the torsion angle and circumferential-longitudinal (CL) shear were determined in 16 LV segments in order to settle the reference values for these parameters. RESULTS Circumferential strain was highest at the anterior and lateral walls (-20.2 ± 4.0% and -21.8 ± 4.3%, respectively; P < 0.05) and was lowest at the base level (-17.2 ± 3.1% vs. -20.1 ± 3.1% "mid level," P < 0.05; -17.2 ± 3.1% vs. -20.3 ± 3.0% "apical level," P < 0.05). Radial strain highest values were from inferior and lateral walls (13.7 ± 7.4% and 12.8 ± 7.8%, respectively; P < 0.05) and it was lowest medially (9.4 ± 4.1% vs. 13.1 ± 4.1% "base level," P < 0.05; 9.4 ± 4.1% vs. 12.1 ± 4.4% "apical level," P < 0.05). Torsion angle (counterclockwise when viewed from the apex) increased with the distance from the base (7.9 ± 2.4° vs. 16.8 ± 4.4°, P < 0.05), and the highest and lowest values were found at lateral (medial lateral: 12.0 ± 4.4°, apical lateral: 25.1 ± 6.4°, P < 0.05) and septal wall (medial septal: 3.6 ± 2.1°, apical septal: 8.3 ± 5.3°, P < 0.05), respectively. These differences were found again in CL shear values, around the LV circumference. However, CL shear remained constant with increasing distance from the base (9.1 ± 2.6°, medium and 9.8 ± 2.4°, apex). CONCLUSION In summary, this study provides reference values for the assessment of regional myocardial function by MR cardiac tagging. Comparison of patient deformation parameters with normal deformation patterns may permit early detection of regional systolic dysfunction.
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Affiliation(s)
- Irene Del-Canto
- Fundación de Investigación del Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
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Bloechlinger S, Berger D, Bryner J, Wiegand J, Dünser MW, Takala J. Left ventricular torsion abnormalities in septic shock and corrective effect of volume loading: a pilot study. Can J Cardiol 2013; 29:1665-71. [PMID: 24267806 DOI: 10.1016/j.cjca.2013.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ventricular torsion is an important component of cardiac function. The effect of septic shock on left ventricular torsion is not known. Because torsion is influenced by changes in preload, we compared the effect of fluid loading on left ventricular torsion in septic shock with the response in matched healthy control subjects. METHODS We assessed left ventricular torsion parameters using transthoracic echocardiography in 11 patients during early septic shock and in 11 age- and sex-matched healthy volunteers before and after rapid volume loading with 250 mL of a Ringer's lactate solution. RESULTS Peak torsion and peak apical rotation were reduced in septic shock (10.2 ± 5.2° and 5.6 ± 5.4°) compared with healthy volunteers (16.3 ± 4.5° and 9.6 ± 1.5°; P = 0.009 and P = 0.006 respectively). Basal rotation was delayed and diastolic untwisting velocity reached its maximum later during diastole in septic shock patients than in healthy volunteers (104 ± 16% vs 111 ± 14% and 13 ± 5% vs 21 ± 10%; P = 0.03 and P = 0.034, respectively). Fluid challenge increased peak torsion in both groups (septic shock, 10.2 ± 5.3° vs 12.6 ± 3.9°; healthy volunteers, 16.3 ± 4.5° vs 18.1 ± 6°; P = 0.01). Fluid challenge increased left ventricular stroke volume in septic shock patients (P = 0.003). CONCLUSIONS Compared with healthy volunteers, left ventricular torsion is impaired in septic shock patients. Fluid loading attenuates torsion abnormalities in parallel with increasing stroke volume. Reduced torsional motion might constitute a relevant component of septic cardiomyopathy, a notion that merits further testing in larger populations.
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Affiliation(s)
- Stefan Bloechlinger
- Department of Intensive Care Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland; Department of Cardiology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
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Effect of age and gender on left ventricular rotation and twist in a large group of normal adults — A multicenter study. Int J Cardiol 2013; 167:2215-21. [DOI: 10.1016/j.ijcard.2012.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 11/17/2022]
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Functional Imaging in Fetal Echocardiography: A Review of Conventional and Novel Approaches. Cardiovasc Eng Technol 2013; 4:276-285. [DOI: 10.1007/s13239-013-0132-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/05/2013] [Indexed: 02/06/2023]
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Koh C, Hong WJ, Yung TC, Lun KS, Wong SJ, Cheung YF. Left ventricular torsional mechanics and diastolic function in congenital heart block with right ventricular pacing. Int J Cardiol 2012; 160:31-5. [DOI: 10.1016/j.ijcard.2011.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/08/2011] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
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A'roch R, Gustafsson U, Poelaert J, Johansson G, Haney M. Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load. Cardiovasc Ultrasound 2012; 10:26. [PMID: 22731666 PMCID: PMC3488500 DOI: 10.1186/1476-7120-10-26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 06/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV) contractility. METHODS Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB) catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon's Signed Rank test. RESULTS The inferior vena cava balloon occlusion (IVCBO) load change compared for first to last beat resulted in LV twist increase (11.67° ±2.65° vs. 16.17° ±3.56° respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56° ±5.1° vs. 16.57° ±4.6° (p < 0.013), and though increased, didn't reach significance in negative inotropic condition. Untwisting rate increased significantly at baseline from -41.7°/s ±41.6°/s vs.-122.6°/s ±55.8°/s (P < 0.039) and under adrenaline stimulation untwisting rate increased (-55.3°/s ±3.8°/s vs.-111.4°/s ±24.0°/s (p < 0.05), but did not systematically changed in negative inotropic condition. CONCLUSIONS Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.
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Affiliation(s)
- Roman A'roch
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, University Hospital of Umeå, 90185, Umeå, Sweden.
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Germanakis I, Gardiner H. Assessment of Fetal Myocardial Deformation Using Speckle Tracking Techniques. Fetal Diagn Ther 2012; 32:39-46. [DOI: 10.1159/000330378] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/07/2011] [Indexed: 11/19/2022]
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Crispi F, Gratacós E. Fetal cardiac function: technical considerations and potential research and clinical applications. Fetal Diagn Ther 2012; 32:47-64. [PMID: 22614129 DOI: 10.1159/000338003] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022]
Abstract
Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.
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Affiliation(s)
- Fatima Crispi
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Wu Z, Shu X, Fan B, Dong L, Pan C, Chen S. Differentiation of transmural and nontransmural infarction using speckle tracking imaging to assess endocardial and epicardial torsion after revascularization. Int J Cardiovasc Imaging 2012; 29:63-70. [PMID: 22527261 DOI: 10.1007/s10554-012-0050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
Abstract
Assessment of transmural extent (TME) of necrosis after acute myocardial infarction (MI) remains a major problem in clinical practice. The study sought to determine whether speckle tracking imaging (STI) could differentiate transmural from nontransmural acute MI by assessment of endocardial and epicardial torsion. TME of infarct was measured by contrast-enhanced magnetic resonance imaging. Patients were divided into two groups according to TME (transmural MI group [TME ≥ 50%, n = 36] and nontransmural MI group [TME < 50%, n = 35]). As a control group, 30 subjects without evidence of structural heart disease were included. Conventional echocardiography and STI were done in controls and patients before and 1 month after percutaneous coronary intervention. Compared with control subjects, endocardial and epicardial torsion in patients with transmural and nontransmural MI were all extremely decreased (all P < 0.01). One month after percutaneous coronary intervention, there was no significant increase in endocardial and epicardial torsion in transmural MI patients. However, apical rotation and left ventricular torsion resumed slightly but significantly in the epicardium (but not endocardium) in patient with nontransmural MI (3.11 ± 0.81 vs. 4.37 ± 1.15°, P < 0.01; 3.69 ± 1.07 vs. 5.52 ± 1.89°, P < 0.01, respectively). The combined evaluation of endocardial and epicardial torsion by STI may be used to differentiate transmural from nontransmural MI after revascularization.
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Affiliation(s)
- Zhiming Wu
- Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University, NO.68, Changle Street, Nanjing City, Jiangsu, 210006, People's Republic of China
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Soullier C, Obert P, Doucende G, Nottin S, Cade S, Perez-Martin A, Messner-Pellenc P, Schuster I. Exercise response in hypertrophic cardiomyopathy: blunted left ventricular deformational and twisting reserve with altered systolic-diastolic coupling. Circ Cardiovasc Imaging 2012; 5:324-32. [PMID: 22414888 DOI: 10.1161/circimaging.111.968859] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abnormal left ventricular (LV) deformational mechanics have been demonstrated in patients with hypertrophic cardiomyopathy (HCM) at rest, but there is a lack of information on their adaptation to exercise. The aim of this study was to assess the adaptability of LV strains and torsional mechanics during exercise in HCM patients. METHODS AND RESULTS Twenty nonobstructive HCM patients (age, 48.3±12.3 years; 14 men) and 20 control subjects underwent speckle-tracking echocardiographic measurement of longitudinal, radial, and circumferential strains, systolic twist, and diastolic untwisting rate (UTR) at rest and submaximal exercise. HCM patients showed lower resting longitudinal (-15.7±5.0% versus -19.4±2.6%, P<0.001) and radial (38.1±11.3% versus 44.7±14.4%, P<0.05) strains but higher circumferential strain (-21.9±4.0% versus -18.8±2.3%, P<0.05) and twist (15.7±3.6° versus 9.3±2.6°, P<0.0001) than control subjects. Exercise induced an increase in all strains in control subjects but only a moderate increase in longitudinal strain (to -18.4±5.0%), without significant changes in radial and circumferential strains or twist in HCM patients. Exercise peak UTR was lower (-119.0±31.5°/s versus -137.3±41.1°/s) and occurred later (137±18% versus 125±11% systolic time, P<0.05) in HCM than in control subjects. A significant relationship between twist and UTR was obtained in control subjects (ß=-0.0807, P<0.001) but not in HCM patients (ß=-0.0051, P=0.68). CONCLUSIONS HCM patients had severely limited strain adaptability and no LV twisting reserve at exercise. They had reduced and delayed UTR with reduced systolic-diastolic coupling efficiency by twist-untwist mechanics.
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Dedobbeleer C, Rai M, Donal E, Pandolfo M, Unger P. Normal left ventricular ejection fraction and mass but subclinical myocardial dysfunction in patients with Friedreich's ataxia. Eur Heart J Cardiovasc Imaging 2011; 13:346-52. [DOI: 10.1093/ejechocard/jer267] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meimoun P, Passos P, Benali T, Boulanger J, Elmkies F, Zemir H, Clerc J, Luycx-Bore A. Assessment of left ventricular twist mechanics in Tako-tsubo cardiomyopathy by two-dimensional speckle-tracking echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:931-9. [DOI: 10.1093/ejechocard/jer183] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ashrafian H, McKenna WJ, Watkins H. Disease pathways and novel therapeutic targets in hypertrophic cardiomyopathy. Circ Res 2011; 109:86-96. [PMID: 21700950 DOI: 10.1161/circresaha.111.242974] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As described in earlier reviews in this series on the molecular basis of hypertrophic cardiomyopathy (HCM), HCM is one of the archetypal monogenic cardiovascular disorders to be understood at the molecular level. Twenty years after the discovery of the first HCM disease gene, genetic studies still confirm that HCM is principally a disease of the sarcomere. At the biophysical level, myofilament mutations generally enhance Ca(2+) sensitivity, maximal force production, and ATPase activity. These defects ultimately appear to converge on energy deficiency and altered Ca(2+) handling as major common paths leading to the anatomic (hypertrophy, myofiber disarray, and fibrosis) and functional features (pathological signaling and diastolic dysfunction) characteristic of HCM. In this review, we provide an account of the consequences of HCM mutations and describe how specifically targeting these molecular features has already yielded early promise for novel therapies for HCM. Although substantial efforts are still required to understand the molecular link between HCM mutations and their clinical consequences, HCM endures as an exemplar of how novel insights derived from molecular characterization of Mendelian disorders can inform the understanding of biological processes and translate into rational therapies.
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Affiliation(s)
- Houman Ashrafian
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
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Evaluation of left ventricular twist in acute myocardial infarction patients using speckle tracking imaging. Cell Biochem Biophys 2011; 61:673-8. [PMID: 21713529 DOI: 10.1007/s12013-011-9223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study is to evaluate the differences of left ventricular (LV) twist and untwisting rate in patients with acute myocardial infarction (AMI) as compared with healthy subjects by means of Speckle Tracking Imaging (STI). 45 AMI patients (AMI group) and 48 healthy subjects (NOR group) were studied. Two-dimensional STI was performed in all patients. Peak apical rotation, peak basal rotation, peak LV twist, peak basal untwisting rate, peak apical untwisting rate, peak LV untwisting rate, time to peak LV twist, and untwisting rate were measured. In comparison with the NOR group, peak LV rotational parameters were found to be decreased in the AMI group (P < 0.01). A strong correlation was found between the peak LV twist and LV ejection fraction in the overall study population (P < 0.001). The LV twist is strongly related to LV systolic function, and the impairment of LV function observed in patients with AMI is associated with a decrease of LV twist and untwist rate. The STI appears to accurately evaluate LV function.
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van Dalen BM, Caliskan K, Soliman OI, Kauer F, van der Zwaan HB, Vletter WB, van Vark LC, ten Cate FJ, Geleijnse ML. Diagnostic Value of Rigid Body Rotation in Noncompaction Cardiomyopathy. J Am Soc Echocardiogr 2011; 24:548-55. [DOI: 10.1016/j.echo.2011.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Indexed: 10/18/2022]
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Matsui H, Germanakis I, Kulinskaya E, Gardiner HM. Temporal and spatial performance of vector velocity imaging in the human fetal heart. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:150-157. [PMID: 20814875 DOI: 10.1002/uog.8815] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To assess the spatial and temporal performance of fetal myocardial speckle tracking, using high-frame-rate (HFR) storing and Lagrangian strain analysis. METHODS Dummy electrocardiographic signaling permitted DICOM HFR in 124 normal fetuses and paired low-frame-rate (LFR) video storing at 25 Hz in 93 of them. Vector velocity imaging (VVI) tracking co-ordinates were used to compare time and spatial domain measures. We compared tracking success, Lagrangian strain, peak diastolic velocity and positive strain rate values in HFR vs. LFR video storing. Further comparisons within an HFR subset included Lagrangian vs. natural strain, VVI vs. M-mode annular displacement, and VVI vs. pulsed-wave tissue Doppler imaging (TDI) peak velocities. RESULTS HFR (average 79.4 Hz) tracking was more successful than LFR (86 vs. 76%, P = 0.024). Lagrangian and natural HFR strain correlated highly (left ventricle (LV): r = 0.883, P < 0.001; right ventricle (RV): r = 0.792, P < 0.001) but natural strain gave 20% lower values, suggesting reduced reliability of measurement. Lagrangian HFR strain was similar in LV and RV and decreased with gestation (P = 0.015 and P < 0.001, respectively). LV Lagrangian LFR strain was significantly lower than the values for the RV (P < 0.001) and those using paired LV-HFR recordings (P = 0.007). Annular displacement methods correlated highly (LV = 1.046, r = 0.90, P < 0.001; RV = 1.170, r = 0.88, P < 0.001). Early diastolic waves were visible in 95% of TDI, but in only 26% of HFR and 0% of LFR recordings, and HFR-VVI velocities were significantly lower than those for TDI (P < 0.001). CONCLUSIONS Doppler estimation of velocities remains superior to VVI but image gating and use of original co-ordinates should improve offline VVI assessment of fetal myocardial function.
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Affiliation(s)
- H Matsui
- Department of Reproductive Biology, Imperial College at Queen Charlotte's and Chelsea Hospital, London, UK
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Krishnamurthy R, Pednekar A, Cheong B, Muthupillai R. High temporal resolution SSFP cine MRI for estimation of left ventricular diastolic parameters. J Magn Reson Imaging 2010; 31:872-80. [PMID: 20373431 DOI: 10.1002/jmri.22123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To obtain high temporal resolution (HTR) magnetic resonance (MR) steady-state free-precession (SSFP) cine cardiac images by using multichannel radiofrequency (RF) hardware and parallel imaging techniques; to study the effect of temporal resolution; and to compare the derived left ventricular (LV) diastolic filling parameters with echocardiographic results. MATERIALS AND METHODS HTR images were acquired in 13 healthy volunteers using a 1.5 T scanner with 32 RF channels and sensitivity encoding (SENSE) and k-t broad-use linear-acquisition speedup technique (k-t BLAST) imaging techniques. LV diastolic parameters were calculated and compared to conventional echocardiographic indices such as the isovolumic relaxation time (IVRT) and E/A ratio. The need for HTR was assessed and the MR results were compared with echocardiographic results. RESULTS The HTR (approximately 6-ms) images yielded higher peak filling rates, peak ejection rates, and peak atrial filling rates. A progressive decline in filling and ejection rates was observed with worsening temporal resolution. The IVRTs and E/A ratios measured with MR versus echocardiography were in broad agreement. Also, SENSE and k-t BLAST yielded similar diastolic functional parameters. CONCLUSION With SENSE or k-t BLAST and modern hardware, HTR cine images can be obtained. The lower temporal resolutions (30-50 ms) used in clinical practice reduce LV filling rates by <or=30% and may hinder characterization of transient phenomena such as the IVRT.
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Left ventricular rotation: a neglected aspect of the cardiac cycle. Intensive Care Med 2010; 37:156-63. [DOI: 10.1007/s00134-010-2053-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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Andrade J, Cortez LD, Campos O, Arruda AL, Pinheiro J, Vulcanis L, Shiratsuchi TS, Kalil-Filho R, Cerri GG. Left ventricular twist: comparison between two- and three-dimensional speckle-tracking echocardiography in healthy volunteers. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:76-9. [DOI: 10.1093/ejechocard/jeq111] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Codreanu I, Robson MD, Golding SJ, Jung BA, Clarke K, Holloway CJ. Longitudinally and circumferentially directed movements of the left ventricle studied by cardiovascular magnetic resonance phase contrast velocity mapping. J Cardiovasc Magn Reson 2010; 12:48. [PMID: 20716369 PMCID: PMC2929230 DOI: 10.1186/1532-429x-12-48] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 08/17/2010] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Using high resolution cardiovascular magnetic resonance (CMR), we aimed to detect new details of left ventricular (LV) systolic and diastolic function, to explain the twisting and longitudinal movements of the left ventricle. METHODS Using CMR phase contrast velocity mapping (also called Tissue Phase Mapping) regional wall motion patterns and longitudinally and circumferentially directed movements of the left ventricle were studied using a high temporal resolution technique in healthy male subjects (n = 14, age 23 +/- 3 years). RESULTS Previously undescribed systolic and diastolic motion patterns were obtained for left ventricular segments (based on the AHA segmental) and for basal, mid and apical segments. The summation of segmental motion results in a complex pattern of ventricular twisting and longitudinal motion in the normal human heart which underlies systolic and diastolic function. As viewed from the apex, the entire LV initially rotates in a counter-clockwise direction at the beginning of ventricular systole, followed by opposing clockwise rotation of the base and counter-clockwise rotation at the apex, resulting in ventricular torsion. Simultaneously, as the entire LV moves in an apical direction during systole, the base and apex move towards each other, with little net apical displacement. The reverse of these motion patterns occur in diastole. CONCLUSION Left ventricular function may be a consequence of the relative orientations and moments of torque of the sub-epicardial relative to the sub-endocardial myocyte layers, with influence from tethering of the heart to adjacent structures and the directional forces associated with blood flow. Understanding the complex mechanics of the left ventricle is vital to enable these techniques to be used for the evaluation of cardiac pathology.
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Affiliation(s)
- Ion Codreanu
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Matthew D Robson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
| | - Stephen J Golding
- MRI Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bernd A Jung
- Department of Diagnostic Radiology, Medical Physics, University Hospital, Freiburg, Germany
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Cameron J Holloway
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
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Reversed apical rotation and paradoxical increased left ventricular torsion in children with left ventricular non-compaction. Int J Cardiol 2010; 145:558-9. [PMID: 20920949 DOI: 10.1016/j.ijcard.2010.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/16/2010] [Indexed: 12/21/2022]
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Zhou Z, Ashraf M, Hu D, Dai X, Xu Y, Kenny B, Cameron B, Nguyen T, Xiong L, Sahn DJ. Three-dimensional speckle-tracking imaging for left ventricular rotation measurement: an in vitro validation study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:903-909. [PMID: 20498464 DOI: 10.7863/jum.2010.29.6.903] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Left ventricular (LV) twist is manifested in oppositely directed apical and basal rotation. We studied a new 3-dimensional (3D) echocardiography program (wall motion tracking; Toshiba America Medical Systems, Inc, Tustin, CA) for left ventricular rotation. METHODS We used a rotation model with a variable-speed motor to rotate hearts in a water bath. We studied 10 freshly harvested pig hearts, which were mounted on the rotary actuator of our twist phantom with the heart base rotating and the apex held fixed to avoid translational motion, at rotations of 0 degrees , 15 degrees , 20 degrees , and 25 degrees . Full-volume 3D image loops were acquired on a Toshiba Aplio Artida ultrasound system at a maximized frame rate. RESULTS As the actual heart rotation increased, computed segmental and global rotation also increased accordingly, with the measured rotations of the basal and middle segments greater than that of the apex (both P < .001). Segmental and global rotation at all 3 levels correlated well with the actual rotation (base: r = 0.93; middle: r = 0.92; apex: r = 0.82; global: r = 0.95; all P < .001). CONCLUSIONS The new 3D program tracked LV rotation accurately.
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Affiliation(s)
- Zhiwen Zhou
- Shanghai 10th People's Hospital, affiliated with Tongji University, Shanghai, China
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Esch BT, Scott JM, Haykowsky MJ, Paterson I, Warburton DER, Cheng-Baron J, Chow K, Thompson RB. Changes in ventricular twist and untwisting with orthostatic stress: endurance athletes versus normally active individuals. J Appl Physiol (1985) 2010; 108:1259-66. [DOI: 10.1152/japplphysiol.01186.2009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endurance-trained individuals exhibit larger reductions in left ventricular (LV) end-diastolic volume in response to lower body negative pressure (LBNP) compared with normally active individuals. However, the relationship between LV torsion and untwisting and the LV volume response to LBNP in endurance athletes is unknown. Eight endurance-trained athletes [maximal oxygen consumption (V̇o2max): 66.4 ± 7.2 ml·kg−1·min−1] and eight normally active individuals (V̇o2max: 41.9 ± 9.0 ml·kg−1·min−1) (all men) underwent two cardiac magnetic resonance imaging (MRI) assessments, the first during supine rest and the second during −30 mmHg LBNP. Right ventricular (RV) and LV volumes were assessed, myocardial tagging was applied in order to quantify LV peak torsion and peak untwisting rate, and filling rates were measured with phase-contrast MRI. In response to LBNP, endurance-trained individuals had greater reductions in RV and LV end-diastolic volume and stroke volume ( P < 0.05). Endurance athletes had reduced untwisting rates (20.3 ± 8.7°/s), while normally active individuals had increased untwisting rates (−16.2 ± 32.1°/s) in response to LBNP ( P < 0.05). Changes in peak untwisting rate were significantly correlated with change in peak torsion ( R = −0.87, P < 0.05), with the change in early filling rate and V̇o2max, but not with changes in end-diastolic or end-systolic volume ( P > 0.05). We conclude that increased untwisting rates in normally active subjects may mitigate the drop in early filling rate with LBNP and thus may be a compensatory mechanism for the reduction in stroke volume with volume unloading. The opposite response in athletes, who showed a decreased untwisting rate, may contribute to their larger reductions in LV end-diastolic and stroke volumes with volume unloading and their orthostatic intolerance.
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Affiliation(s)
- Ben T. Esch
- University of British Columbia, Vancouver, British Columbia; and
| | - Jessica M. Scott
- University of British Columbia, Vancouver, British Columbia; and
| | | | - Ian Paterson
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Kelvin Chow
- University of Alberta, Edmonton, Alberta, Canada
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Abstract
Non-invasive evaluation of diastolic function continues to play a critical role in furthering our understanding of diastole, improving the diagnosis of diastolic dysfunction, evaluating left ventricular filling pressures, and providing important prognostic information for patients with heart failure. Echocardiography, cardiovascular magnetic resonance, and nuclear cardiology each provide important tools for evaluating diastolic performance. This review will focus on the techniques from multiple cardiovascular imaging modalities which have been used for the clinical assessment of diastolic function.
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Affiliation(s)
- Michael Salerno
- University of Virginia Health System, Box 800662, Charlottesville, VA 22908, USA.
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Choi HF, D'hooge J, Rademakers FE, Claus P. The influence of left-ventricular shape on end-diastolic fiber stress and strain. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:2887-90. [PMID: 19964050 DOI: 10.1109/iembs.2009.5333112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Passive filling is a major determinant for the pump performance of the left ventricle and is determined by the filling pressure and the ventricular compliance. We quantified the influence of left-ventricular shape on the overall compliance and the distribution of passive fiber stress and strain during the filling period in normal myocardium. Hereto, fiber stress and strain were calculated in a finite element analysis during the inflation of left ventricles of different shape, ranging from an elongated ellipsoid to a sphere, but keeping the initial cavity and wall volume constant. The passive myocardium was described by an incompressible hyperelastic material law with transverse isotropic symmetry along the muscle fiber directions. A realistic transmural gradient in fiber orientation was assumed. While compliance was not altered, the transmural distribution of both passive fiber stress and strain was highly dependent on ventricular shape, where more spherical ventricles exhibited a higher subendocardial gradient in both quantities.
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Affiliation(s)
- Hon Fai Choi
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Diseases, Catholic University Leuven, Leuven, Belgium
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Sitia S, Tomasoni L, Turiel M. Speckle tracking echocardiography: A new approach to myocardial function. World J Cardiol 2010; 2:1-5. [PMID: 21160657 PMCID: PMC2999040 DOI: 10.4330/wjc.v2.i1.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 01/13/2010] [Accepted: 01/15/2010] [Indexed: 02/06/2023] Open
Abstract
Echocardiography is the most common diagnostic method for assessing cardiac function but some limitations affect this technique. Until now, visual assessment of wall motion and thickening has allowed only a subjective evaluation of myocardial function and requires long-term training. Recently, new echocardiographic techniques have been introduced to evaluate myocardial mechanics. Tissue Doppler imaging (TDI) technique is limited by angle-dependency such that only deformation along the ultrasound beam can be derived from velocities, while myocardium deforms simultaneously in three dimensions. Speckle tracking echocardiography (STE) is a more recent technique that provides a global approach to left ventricular myocardial mechanics, giving information about the three spatial dimensions of cardiac deformation. In this editorial, we describe the physical and pathophysiological concepts of STE, discussing the differences compared to TDI and underlining the pitfalls of this new technique.
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Affiliation(s)
- Simona Sitia
- Simona Sitia, Livio Tomasoni, Maurizio Turiel, Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, Università di Milano, 20161 Milan, Italy
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Frank LH, Yu Q, Francis R, Tian X, Samtani R, Sahn DJ, Leatherbury L, Lo CW. Ventricular rotation is independent of cardiac looping: a study in mice with situs inversus totalis using speckle-tracking echocardiography. J Am Soc Echocardiogr 2010; 23:315-23. [PMID: 20097527 DOI: 10.1016/j.echo.2009.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors conducted an ultrasound interrogation of a mutant mouse model with a Dnah5 mutation to determine whether cardiac mechanics may be affected by reversal of cardiac situs. This mutant is a bona fide model of primary ciliary dyskinesia, with surviving homozygous mice showing either situs solitus (SS) or situs inversus totalis (SI). METHODS High-frequency ultrasound interrogations of 27 neonatal and infant Dnah5 mutant mice, 16 with SS and 11 with SI, were conducted using an ultra-high-frequency biomicroscope. Electrocardiographic and respiratory gating were used to reconstruct high-resolution two-dimensional cines at 1,000 Hz, with speckle-tracking echocardiography used to further analyze midchamber and apical rotation. RESULTS All SS mice exhibited the expected counterclockwise apical rotation as viewed caudocranially, and surprisingly, the same counterclockwise motion was also observed in SI mice. Speckle-tracking analysis confirmed counterclockwise systolic rotation in both SS and SI mice, and this increased in magnitude from the subepicardium to the endocardium and from the papillary muscles to the apex. The magnitude of apical endocardial rotation was not different for SS and SI mice (5.64+/-0.75 degrees and 5.76+/-1.90 degrees, respectively, P=.93). The anatomic segments responsible for the largest components of apical endocardial systolic rotation differed between the SS and SI hearts (P=.004). In both, the two largest contributors to rotation were offset 180 degrees from each other, but the anatomic regions differed between them. In SS hearts, maximal regional rotation occurred at the anterior mid-septum and posterolateral free wall, while in SI hearts, it was derived from the posterior septum and the anterolateral free wall. Analysis by episcopic fluorescence image capture histology of representative SI and SS mice showed normal intracardiac and segmental anatomy ({S,D,S} or {I,L,I}) without intracardiac defects. CONCLUSIONS These results show that mirror-image cardiac looping did not result in mirror-image rotation of the morphologic left ventricle. These findings suggest that further studies are warranted to evaluate whether fiber orientation and cardiac mechanics may be abnormal in individuals with reversal of cardiac situs. The results of this study indicate that cardiac looping and myofiber orientation may be independently regulated.
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Affiliation(s)
- Lowell H Frank
- Laboratory of Developmental Biology, Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Abstract
Patients with chronic kidney disease are well recognized to develop a wide range of cardiac structural and functional abnormalities. These changes may be progressive and relate directly to a grossly aggravated risk of cardiovascular events and reduced survival. Although conventional methods of cardiac assessment have been shown to be useful, they are limited by insufficient sensitivity and specificity, to fully appreciate the overall degree of myocardial distress that is common in these patients. This article aims to review the use of established and emerging cardiac imaging tools and, in particular, their application in patients with chronic kidney disease.
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