1
|
Taskén AA, Berg EAR, Grenne B, Holte E, Dalen H, Stølen S, Lindseth F, Aakhus S, Kiss G. Automated estimation of mitral annular plane systolic excursion by artificial intelligence from 3D ultrasound recordings. Artif Intell Med 2023; 144:102646. [PMID: 37783546 DOI: 10.1016/j.artmed.2023.102646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
Perioperative monitoring of cardiac function is beneficial for early detection of cardiovascular complications. The standard of care for cardiac monitoring performed by trained cardiologists and anesthesiologists involves a manual and qualitative evaluation of ultrasound imaging, which is a time-demanding and resource-intensive process with intraobserver- and interobserver variability. In practice, such measures can only be performed a limited number of times during the intervention. To overcome these difficulties, this study presents a robust method for automatic and quantitative monitoring of cardiac function based on 3D transesophageal echocardiography (TEE) B-mode ultrasound recordings of the left ventricle (LV). Such an assessment obtains consistent measurements and can produce a near real-time evaluation of ultrasound imagery. Hence, the presented method is time-saving and results in increased accessibility. The mitral annular plane systolic excursion (MAPSE), characterizing global LV function, is estimated by landmark detection and cardiac view classification of two-dimensional images extracted along the long-axis of the ultrasound volume. MAPSE estimation directly from 3D TEE recordings is beneficial since it removes the need for manual acquisition of cardiac views, hence decreasing the need for interference by physicians. Two convolutional neural networks (CNNs) were trained and tested on acquired ultrasound data of 107 patients, and MAPSE estimates were compared to clinically obtained references in a blinded study including 31 patients. The proposed method for automatic MAPSE estimation had low bias and low variability in comparison to clinical reference measures. The method accomplished a mean difference for MAPSE estimates of (-0.16±1.06) mm. Thus, the results did not show significant systematic errors. The obtained bias and variance of the method were comparable to inter-observer variability of clinically obtained MAPSE measures on 2D TTE echocardiography. The novel pipeline proposed in this study has the potential to enhance cardiac monitoring in perioperative- and intensive care settings.
Collapse
Affiliation(s)
- Anders Austlid Taskén
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Høgskoleringen 1, 7491 Trondheim, Norway.
| | - Erik Andreas Rye Berg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Espen Holte
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
| | - Stian Stølen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Frank Lindseth
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Høgskoleringen 1, 7491 Trondheim, Norway.
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Gabriel Kiss
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Høgskoleringen 1, 7491 Trondheim, Norway.
| |
Collapse
|
2
|
Berger SG, Witczak BN, Reiseter S, Schwartz T, Andersson H, Hetlevik SO, Berntsen KS, Sanner H, Lilleby V, Gunnarsson R, Molberg Ø, Sjaastad I, Stokke MK. Cardiac dysfunction in mixed connective tissue disease: a nationwide observational study. Rheumatol Int 2023; 43:1055-1065. [PMID: 36933069 PMCID: PMC10126085 DOI: 10.1007/s00296-023-05308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
We aimed to identify cardiac function in patients with established mixed connective tissue disease (MCTD). This was a cross-sectional case-control study of well-characterised MCTD patients who had previously been included in a nationwide cohort. Assessments comprised protocol transthoracic echocardiography, electrocardiogram and blood samples. In patients only, we evaluated the findings of high-resolution pulmonary computed tomography and disease activity. We assessed 77 MCTD patients (mean age 50.5 ± 12.3 years) with a mean disease duration of 16.4 years, and 59 age- and sex-matched healthy controls (49.9 ± 11.7 years). By echocardiography, measures of left ventricular function, i.e. fractional shortening (38.1 ± 6.4% vs. 42.3 ± 6.6%, p < 0.001), mitral annulus plane systolic excursion (MAPSE) (13.7 ± 2.1 mm vs. 15.3 ± 2.3 mm, p < 0.001) and early diastolic velocity of the mitral annulus (e') (0.09 ± 0.02 m/s vs. 0.11 ± 0.03 m/s, p = 0.002) were subclinical and lower in patients than controls. Right ventricular dysfunction was found in patients assessed by tricuspid annular plane systolic excursion (TAPSE) (22.7 ± 4.0 mm vs. 25.5 ± 4.0 mm, p < 0.001). While cardiac dysfunction was not associated with pulmonary disease, e' and TAPSE were found to correlate with disease activity at baseline. In this cohort of MCTD patients, echocardiographic examinations demonstrated a higher frequency of cardiac dysfunction than in matched controls. Cardiac dysfunction was associated with disease activity at baseline, but was independent of cardiovascular risk factors and pulmonary disease. Our study indicates that cardiac dysfunction is part of the multi-organ affliction seen in MCTD.
Collapse
Affiliation(s)
- Simon Girmai Berger
- Institute for Experimental Medical Research, K. G. Jebsen Center for Cardiac Research, Oslo University Hospital Ullevål, University of Oslo, PB 4956 Nydalen, 0424, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Birgit Nomeland Witczak
- Institute for Experimental Medical Research, K. G. Jebsen Center for Cardiac Research, Oslo University Hospital Ullevål, University of Oslo, PB 4956 Nydalen, 0424, Oslo, Norway
| | | | - Thomas Schwartz
- Oslo New University College, Oslo, Norway
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Helena Andersson
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | | | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Oslo New University College, Oslo, Norway
| | - Vibke Lilleby
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, K. G. Jebsen Center for Cardiac Research, Oslo University Hospital Ullevål, University of Oslo, PB 4956 Nydalen, 0424, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, K. G. Jebsen Center for Cardiac Research, Oslo University Hospital Ullevål, University of Oslo, PB 4956 Nydalen, 0424, Oslo, Norway.
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| |
Collapse
|
3
|
User experience and image quality influence on performance of automated real-time quantification of left ventricular function by handheld ultrasound devices: a diagnostic accuracy study with data from general practitioners, nurses and cardiologists. Open Heart 2022; 9:openhrt-2022-002083. [PMID: 36270715 PMCID: PMC9594519 DOI: 10.1136/openhrt-2022-002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background and objectives Echocardiography is the cornerstone of heart failure (HF) diagnosis, but expertise is limited. Non-experts using handheld ultrasound devices (HUDs) challenge the clinical yield. Left ventricular (LV) ejection fraction (EF) is used for assessment and grading of HF. Mitral annular plane systolic excursion (MAPSE) reflects LV long-axis shortening. Automatic tools for quantification of EF (autoEF) and MAPSE (autoMAPSE) are available on HUDs. We aimed to explore the importance of user experience and image quality for autoEF and autoMAPSE on HUDs, and how image quality influences the feasibility, agreement and reliability in patients with suspected HF. Methods General practitioners, registered cardiac nurses and cardiologists represented the novice, intermediate and expert users, respectively, in this diagnostic accuracy study. 2543 images were evaluated by an external, blinded cardiologist by a five-parameter, prespecified score (four-chamber view, LV alignment, apical mispositioning, mitral annular assessment and number of visible endocardial segments) graded 0–6. Results Feasibility was higher with increasing image quality. In all recordings, irrespective of user, the average image quality score and the five prespecified scores were associated with the feasibility of autoEF and autoMAPSE (all p<0.001). Image quality was more important for the feasibility of autoMAPSE than autoEF. Image quality was not important for the agreement of autoEF (R2 2%) and autoMAPSE (R2 7%). Combining all user groups, the reliability was lower with larger within-patient variability in image quality of the repeated recordings (p≤0.005). Similar associations were not found in user group specific analyses (p≥0.16). Patients’ characteristics were only weakly associated with image quality score (R2≤4%). Discussion Image quality was important for feasibility but does not explain the low agreement with reference or the modest within-patient reliability of automatic decision-support software on HUDs for all user groups in patients with suspected HF.
Collapse
|
4
|
Hjorth-Hansen AK, Magelssen MI, Andersen GN, Graven T, Kleinau JO, Landstad B, Løvstakken L, Skjetne K, Mjølstad OC, Dalen H. Real-time automatic quantification of left ventricular function by hand-held ultrasound devices in patients with suspected heart failure: a feasibility study of a diagnostic test with data from general practitioners, nurses and cardiologists. BMJ Open 2022; 12:e063793. [PMID: 36229153 PMCID: PMC9562287 DOI: 10.1136/bmjopen-2022-063793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To evaluate the feasibility and reliability of hand-held ultrasound (HUD) examinations with real-time automatic decision-making software for ejection fraction (autoEF) and mitral annular plane systolic excursion (autoMAPSE) by novices (general practitioners), intermediate users (registered cardiac nurses) and expert users (cardiologists), respectively, compared to reference echocardiography by cardiologists in an outpatient cohort with suspected heart failure (HF). DESIGN Feasibility study of a diagnostic test. SETTING AND PARTICIPANTS 166 patients with suspected HF underwent HUD examinations with autoEF and autoMAPSE measurements by five novices, three intermediate-skilled users and five experts. HUD results were compared with a reference echocardiography by experts. A blinded cardiologist scored all HUD recordings with automatic measurements as (1) discard, (2) accept, but adjust the measurement or (3) accept the measurement as it is. PRIMARY OUTCOME MEASURE The feasibility of automatic decision-making software for quantification of left ventricular function. RESULTS The users were able to run autoEF and autoMAPSE in most patients. The feasibility for obtaining accepted images (score of ≥2) with automatic measurements ranged from 50% to 91%. The feasibility was lowest for novices and highest for experts for both autoEF and autoMAPSE (p≤0.001). Large coefficients of variation and wide coefficients of repeatability indicate moderate agreement. The corresponding intraclass correlations (ICC) were moderate to good (ICC 0.51-0.85) for intra-rater and poor (ICC 0.35-0.51) for inter-rater analyses. The findings of modest to poor agreement and reliability were not explained by the experience of the users alone. CONCLUSION Novices, intermediate and expert users were able to record four-chamber views for automatic assessment of autoEF and autoMAPSE using HUD devices. The modest feasibility, agreement and reliability suggest this should not be implemented into clinical practice without further refinement and clinical evaluation. TRIAL REGISTRATION NUMBER NCT03547076.
Collapse
Affiliation(s)
- Anna Katarina Hjorth-Hansen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Malgorzata Izabela Magelssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
| | - Garrett Newton Andersen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens Olaf Kleinau
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bodil Landstad
- Department of Research, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kyrre Skjetne
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Innherred Heart Clinic, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
| | - Havard Dalen
- Department of Internal medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
5
|
Xue H, Artico J, Davies RH, Adam R, Shetye A, Augusto JB, Bhuva A, Fröjdh F, Wong TC, Fukui M, Cavalcante JL, Treibel TA, Manisty C, Fontana M, Ugander M, Moon JC, Schelbert EB, Kellman P. Automated In-Line Artificial Intelligence Measured Global Longitudinal Shortening and Mitral Annular Plane Systolic Excursion: Reproducibility and Prognostic Significance. J Am Heart Assoc 2022; 11:e023849. [PMID: 35132872 PMCID: PMC9245823 DOI: 10.1161/jaha.121.023849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 12/25/2022]
Abstract
Background Global longitudinal shortening (GL-Shortening) and the mitral annular plane systolic excursion (MAPSE) are known markers in heart failure patients, but measurement may be subjective and less frequently reported because of the lack of automated analysis. Therefore, a validated, automated artificial intelligence (AI) solution can be of strong clinical interest. Methods and Results The model was implemented on cardiac magnetic resonance scanners with automated in-line processing. Reproducibility was evaluated in a scan-rescan data set (n=160 patients). The prognostic association with adverse events (death or hospitalization for heart failure) was evaluated in a large patient cohort (n=1572) and compared with feature tracking global longitudinal strain measured manually by experts. Automated processing took ≈1.1 seconds for a typical case. On the scan-rescan data set, the model exceeded the precision of human expert (coefficient of variation 7.2% versus 11.1% for GL-Shortening, P=0.0024; 6.5% versus 9.1% for MAPSE, P=0.0124). The minimal detectable change at 90% power was 2.53 percentage points for GL-Shortening and 1.84 mm for MAPSE. AI GL-Shortening correlated well with manual global longitudinal strain (R2=0.85). AI MAPSE had the strongest association with outcomes (χ2, 255; hazard ratio [HR], 2.5 [95% CI, 2.2-2.8]), compared with AI GL-Shortening (χ2, 197; HR, 2.1 [95% CI,1.9-2.4]), manual global longitudinal strain (χ2, 192; HR, 2.1 [95% CI, 1.9-2.3]), and left ventricular ejection fraction (χ2, 147; HR, 1.8 [95% CI, 1.6-1.9]), with P<0.001 for all. Conclusions Automated in-line AI-measured MAPSE and GL-Shortening can deliver immediate and highly reproducible results during cardiac magnetic resonance scanning. These results have strong associations with adverse outcomes that exceed those of global longitudinal strain and left ventricular ejection fraction.
Collapse
Affiliation(s)
- Hui Xue
- National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
| | - Jessica Artico
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- University Hospital and University of TriesteTriesteItaly
| | | | - Robert Adam
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Abhishek Shetye
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - João B. Augusto
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
| | - Anish Bhuva
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Fredrika Fröjdh
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstituteStockholmSweden
| | - Timothy C. Wong
- UPMC Cardiovascular Magnetic Resonance CenterUPMCPittsburghPA
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- Heart and Vascular InstituteUPMCPittsburghPA
- Clinical and Translational Science InstituteUniversity of PittsburghPittsburghPA
| | - Miho Fukui
- Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisMN
| | | | | | | | - Marianna Fontana
- University College LondonLondonUnited Kingdom
- Royal Free HospitalNHS TrustLondonUnited Kingdom
| | - Martin Ugander
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstituteStockholmSweden
- Kolling InstituteRoyal North Shore Hospital, and Charles Perkins CentreFaculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - James C. Moon
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Erik B. Schelbert
- Minneapolis Heart Institute, United HospitalSt. Paul, Minnesota and Abbott Northwestern HospitalMinneapolisMN
| | - Peter Kellman
- National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
| |
Collapse
|
6
|
Kavurt AV, Bağrul D, Gül AEK, Özdemiroğlu N, Ece İ, Çetin İİ, Özcan S, Uyar E, Emeksiz S, Çelikel E, Gülhan B. Echocardiographic Findings and Correlation with Laboratory Values in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol 2022; 43:413-425. [PMID: 34564734 PMCID: PMC8475320 DOI: 10.1007/s00246-021-02738-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/16/2021] [Indexed: 12/19/2022]
Abstract
Cardiac involvement is a common and serious problem in multisystem inflammatory syndrome in children (MIS-C). Echocardiographic evaluation of systolic and diastolic function by traditional, tissue Doppler and three-dimensional (3D) echocardiography was performed in consecutive 50 MIS-C patients during hospitalization and age-matched 40 healthy controls. On the day of worst left ventricular (LV) systolic function (echo-1), all left and right ventricular systolic function parameters were significantly lower (p < 0.001), E/A ratio was significantly lower, and averaged E/e' ratio was significantly higher (median 1.5 vs. 1.8, p < 0.05; 8.9 vs. 6.3, p < 0.001 respectively) in patients compared to control. Patients were divided into 2 groups according to 3D LV ejection fraction (LVEF) on the echo-1: Group 1; LVEF < 55%, 26 patients, and group 2; LVEF ≥ 55%, 24 patients. E/e' ratio was significantly higher in group 1 than group 2 and control at discharge (median 7.4 vs. 6.9, p = 0.005; 7.4 vs. 6.3, p < 0.001 respectively). Coronary ectasia was detected in 2 patients (z score: 2.53, 2.6 in the right coronary artery), and resolved at discharge. Compared with group 2, group 1 had significantly higher troponin-I (median 658 vs. 65 ng/L; p < 0.001), NT-pro BNP (median 14,233 vs. 1824 ng/L; p = 0.001), procalcitonin (median 10.9 vs. 2.1 µg/L; p = 0.009), ferritin (median 1234 vs. 308 µg/L; p = 0.003). The most common findings were ventricular systolic dysfunction recovering during hospitalization, and persisting LV diastolic dysfunction in the reduced LVEF group at discharge. Coronary artery involvement was rare in the acute phase of the disease. Also, in MIS-C patients, the correlation between LV systolic dysfunction and markers of inflammation and cardiac biomarkers should be considered.
Collapse
Affiliation(s)
- Ahmet Vedat Kavurt
- Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.
| | - Denizhan Bağrul
- Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nevin Özdemiroğlu
- Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - İbrahim Ece
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Intensive Care Unit, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Emel Uyar
- Department of Pediatric Intensive Care Unit, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care Unit, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Belgin Gülhan
- Division of Pediatric Infection, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
7
|
Berg J, Jablonowski R, Mohammad M, Solem K, Borgquist R, Ostenfeld E, Arheden H, Carlsson M. Ventricular longitudinal shortening is an independent predictor of death in heart failure patients with reduced ejection fraction. Sci Rep 2021; 11:20280. [PMID: 34645886 PMCID: PMC8514526 DOI: 10.1038/s41598-021-99613-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/14/2021] [Indexed: 01/07/2023] Open
Abstract
Reduced ventricular longitudinal shortening measured by atrioventricular plane displacement (AVPD) and global longitudinal strain (GLS) are prognostic markers in heart disease. This study aims to determine if AVPD and GLS with cardiovascular magnetic resonance (CMR) are independent predictors of cardiovascular (CV) and all-cause death also in heart failure with reduced ejection fraction (HFrEF). Patients (n = 287) were examined with CMR and AVPD, GLS, ventricular volumes, myocardial fibrosis/scar were measured. Follow-up was 5 years with cause of death retrieved from a national registry. Forty CV and 60 all-cause deaths occurred and CV non-survivors had a lower AVPD (6.4 ± 2.0 vs 8.0 ± 2.4 mm, p < 0.001) and worse GLS (− 6.1 ± 2.2 vs − 7.7 ± 3.1%, p = 0.001). Kaplan–Meier analyses displayed increased survival for patients in the highest AVPD- and GLS-tertiles vs. the lowest tertiles (AVPD: p = 0.001, GLS: p = 0.013). AVPD and GLS showed in univariate analysis a hazard ratio (HR) of 1.30 (per-mm-decrease) and 1.19 (per-%-decrease) for CV death. Mean AVPD and GLS were independent predictors of all-cause death (HR = 1.24 per-mm-decrease and 1.15 per-%-decrease), but only AVPD showed incremental value over age, sex, body-mass-index, EF, etiology and fibrosis/scar for CV death (HR = 1.33 per-mm-decrease, p < 0.001). Ventricular longitudinal shortening remains independently prognostic for death in HFrEF even after adjusting for well-known clinical risk factors.
Collapse
Affiliation(s)
- J Berg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Syntach AB, Lund, Sweden
| | - R Jablonowski
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - M Mohammad
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - R Borgquist
- Cardiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - E Ostenfeld
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - H Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - M Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| |
Collapse
|
8
|
An Intra-Cycle Optimal Control Framework for Ventricular Assist Devices Based on Atrioventricular Plane Displacement Modeling. Ann Biomed Eng 2021; 49:3508-3523. [PMID: 34549343 PMCID: PMC8671277 DOI: 10.1007/s10439-021-02848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022]
Abstract
A promising treatment for congestive heart failure is the implementation of a left ventricular assist device (LVAD) that works as a mechanical pump. Modern LVADs work with adjustable constant rotor speed and provide therefore continuous blood flow; however, recently undertaken efforts try to mimic pulsatile blood flow by oscillating the pump speed. This work proposes an algorithmic framework to construct and evaluate optimal pump speed policies with respect to generic objectives. We use a model that captures the atrioventricular plane displacement, which is a physiological indicator for heart failure. We employ mathematical optimization to adapt this model to patient specific data and to find optimal pump speed policies with respect to ventricular unloading and aortic valve opening. To this end, we reformulate the cardiovascular dynamics into a switched system and thereby reduce nonlinearities. We consider system switches that stem from varying the constant pump speed and that are state dependent such as valve opening or closing. As a proof of concept study, we personalize the model to a selected patient with respect to ventricular pressure. The model fitting results in a root-mean-square deviation of about 6 mmHg. The optimization that considers aortic valve opening and ventricular unloading results in speed modulation akin to counterpulsation. These in silico findings demonstrate the potential of personalized hemodynamical optimization for the LVAD therapy.
Collapse
|
9
|
Bach MBT, Grevsen JR, Kiely MAB, Willesen JL, Koch J. Detection of congestive heart failure by mitral annular displacement in cats with hypertrophic cardiomyopathy - concordance between tissue Doppler imaging-derived tissue tracking and M-mode. J Vet Cardiol 2021; 36:153-168. [PMID: 34298446 DOI: 10.1016/j.jvc.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The left ventricular systolic longitudinal function, traditionally measured by M-mode-derived mitral annular plane systolic excursion (MAPSE), is reduced in feline hypertrophic cardiomyopathy (HCM) and further reduced in cats with left-sided congestive heart failure (CHF). The objectives of this study were to compare longitudinal displacement measured by tissue tracking (TT-LD) and MAPSE in feline HCM and assess these methods' ability to differentiate CHF from preclinical HCM. A further objective was to provide preliminary reference intervals for TT-LD. ANIMALS Eighty-five client-owned cats. METHODS A retrospective case-control study. Anatomical M-mode was used to record MAPSE, and TT-LD was recorded by tissue tracking. RESULTS Reduced longitudinal displacement measured by either MAPSE or TT-LD was significantly associated with CHF in cats with HCM (p < 0.036). Receiver-operating characteristic analysis indicated that TT-LD (AUC: 92.9%-97.9%) was more sensitive and specific than MAPSE (AUC: 85.8%-89.1%) for the detection of CHF. A diagnostic cut-off of 2.89 mm for maximal TT-LD in the left ventricular septum resulted in a sensitivity and specificity of 100% and 83.3%, while a diagnostic cut-off of 2.41 mm in the left ventricular posterior wall resulted in a sensitivity of 100% and a specificity of 90%. CONCLUSIONS M-mode-derived mitral annular plane systolic excursion and TT-LD were strongly correlated, but not interchangeable. Longitudinal displacement measured by tissue tracking decreased more with disease severity than traditional MAPSE. Longitudinal displacement may help detect CHF in cats with HCM - with the maximal TT-LD of the left ventricular posterior wall achieving the highest AUC value.
Collapse
Affiliation(s)
- M B T Bach
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark.
| | - J R Grevsen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark
| | - M A B Kiely
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark
| | - J L Willesen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark
| | - J Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 16, 1870, Frederiksberg, Denmark
| |
Collapse
|
10
|
Hyperparameter optimisation and validation of registration algorithms for measuring regional ventricular deformation using retrospective gated computed tomography images. Sci Rep 2021; 11:5718. [PMID: 33707527 PMCID: PMC7952400 DOI: 10.1038/s41598-021-84935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
Recent dose reduction techniques have made retrospective computed tomography (CT) scans more applicable and extracting myocardial function from cardiac computed tomography (CCT) images feasible. However, hyperparameters of generic image intensity-based registration techniques, which are used for tracking motion, have not been systematically optimised for this modality. There is limited work on their validation for measuring regional strains from retrospective gated CCT images and open-source software for motion analysis is not widely available. We calculated strain using our open-source platform by applying an image registration warping field to a triangulated mesh of the left ventricular endocardium. We optimised hyperparameters of two registration methods to track the wall motion. Both methods required a single semi-automated segmentation of the left ventricle cavity at end-diastolic phase. The motion was characterised by the circumferential and longitudinal strains, as well as local area change throughout the cardiac cycle from a dataset of 24 patients. The derived motion was validated against manually annotated anatomical landmarks and the calculation of strains were verified using idealised problems. Optimising hyperparameters of registration methods allowed tracking of anatomical measurements with a mean error of 6.63% across frames, landmarks, and patients, comparable to an intra-observer error of 7.98%. Both registration methods differentiated between normal and dyssynchronous contraction patterns based on circumferential strain (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p_1=0.0065$$\end{document}p1=0.0065, \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p_2=0.0011$$\end{document}p2=0.0011). To test whether a typical 10 temporal frames sampling of retrospective gated CCT datasets affects measuring cardiac mechanics, we compared motion tracking results from 10 and 20 frames datasets and found a maximum error of \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$8.51\pm 0.8\%$$\end{document}8.51±0.8%. Our findings show that intensity-based registration techniques with optimal hyperparameters are able to accurately measure regional strains from CCT in a very short amount of time. Furthermore, sufficient sensitivity can be achieved to identify heart failure patients and left ventricle mechanics can be quantified with 10 reconstructed temporal frames. Our open-source platform will support increased use of CCT for quantifying cardiac mechanics.
Collapse
|
11
|
Sharma JB, Deora S, Choudhary R, Kaushik A. Diagnostic utility of mitral annular displacement by speckle tracking echocardiography in predicting significant coronary artery disease in suspected chronic stable angina pectoris. Echocardiography 2020; 37:2010-2017. [DOI: 10.1111/echo.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | | | - Atul Kaushik
- Department of Cardiology AIIMS Jodhpur Jodhpur India
| |
Collapse
|
12
|
Seemann F, Berg J, Solem K, Jablonowski R, Arheden H, Carlsson M, Heiberg E. Quantification of left ventricular contribution to stroke work by longitudinal and radial force-length loops. J Appl Physiol (1985) 2020; 129:880-890. [PMID: 32816638 PMCID: PMC8285573 DOI: 10.1152/japplphysiol.00198.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Left ventricular (LV) stroke work (SW) is calculated from the pressure-volume (PV) loop. PV loops do not contain information on longitudinal and radial pumping, leaving their contributions to SW unknown. A conceptual framework is proposed to derive the longitudinal and radial contributions to SW, using ventricular force-length loops reflecting longitudinal and radial pumping. The aim of this study was to develop and validate this framework experimentally and to explore these contributions in healthy controls and heart failure patients. Thirteen swine underwent cardiovascular magnetic resonance (CMR) and LV pressure catheterization at baseline (n = 7) or 1 wk after myocardial infarction (n = 6). CMR and noninvasive PV loop quantification were performed on 26 human controls and 14 patients. Longitudinal and radial forces were calculated as LV pressure multiplied by the myocardial surface areas in the respective directions. Length components were defined as the atrioventricular plane and epicardial displacements, respectively. Contributions to SW were calculated as the area within the respective force-length loop. Summation of longitudinal and radial SW had excellent agreement with PV loop-derived SW (ICC = 0.95, R = 0.96, bias ± SD = −4.5 ± 5.4%) in swine. Longitudinal and radial contributions to SW were ~50/50% in swine and human controls, and 44/56% in patients. Longitudinal pumping required less work than radial to deliver stroke volume in swine (6.8 ± 0.8 vs. 8.7 ± 1.2 mJ/mL, P = 0.0002) and in humans (11 ± 2.1 vs. 17 ± 4.7 mJ/mL, P < 0.0001). In conclusion, longitudinal and radial pumping contribute ~50/50% to SW in swine and human controls and 44/56% in heart failure patients. Longitudinal pumping is more energy efficient than radial pumping in delivering stroke volume. NEW & NOTEWORTHY A novel method for quantifying the contributions of longitudinal and radial pumping to stroke work using global left ventricular force-length loops was proposed and validated, which can be quantified noninvasively using cardiovascular magnetic resonance and brachial cuff pressure. We found that longitudinal and radial pumping contributes equally to stroke work in controls and 44/56% in heart failure patients, and that the longitudinal pumping is more energy efficient in delivering stroke volume than radial pumping.
Collapse
Affiliation(s)
- Felicia Seemann
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Jonathan Berg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Syntach AB, Lund, Sweden
| | | | - Robert Jablonowski
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| |
Collapse
|
13
|
Teraguchi I, Hozumi T, Emori H, Takemoto K, Fujita S, Wada T, Kashiwagi M, Shiono Y, Shimamura K, Kuroi A, Tanimoto T, Kubo T, Tanaka A, Akasaka T. Prognostic value of tissue-tracking mitral annular displacement by speckle-tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction. J Echocardiogr 2020; 19:95-102. [PMID: 32970310 DOI: 10.1007/s12574-020-00490-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tissue-tracking mitral annular displacement (TMAD) by speckle-tracking echocardiography provides rapid and simple assessment of left ventricular (LV) longitudinal deformation. The purpose of this study was to evaluate the value of TMAD for the assessment of LV longitudinal deformation in patients with severe AS and preserved LV ejection fraction (LVEF). METHODS We studied 44 patients with severe AS preserved and LVEF in whom TMAD was assessed. Using TMAD analysis software, the base-to-apex displacement of automatically defined mid-point of mitral annular line in four-chamber view was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated. We investigated the association between %TMAD and the cardiac events including appearance of symptom (dyspnea on exertion and hospitalization due to heart failure), decreased LVEF (< 50%), and cardiac death. RESULTS During follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6, p = 0.002). The cardiac events were predicted by %TMAD (HR 0.68, 95% CI 0.54-0.85; p = 0.0012). CONCLUSIONS The present study suggests that TMAD easily and rapidly estimated by speckle-tracking echocardiography may be used as a simple method to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved LVEF.
Collapse
Affiliation(s)
- Ikuko Teraguchi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
14
|
Grue JF, Storve S, Dalen H, Mjølstad OC, Samstad SO, Eriksen-Volnes T, Torp H, Haugen BO. Automatic quantification of left ventricular function by medical students using ultrasound. BMC Med Imaging 2020; 20:29. [PMID: 32178639 PMCID: PMC7077164 DOI: 10.1186/s12880-020-00430-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Automatic analyses of echocardiograms may support inexperienced users in quantifying left ventricular (LV) function. We have developed an algorithm for fully automatic measurements of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic (S') and early diastolic (e') peak velocities. We aimed to study the influence of user experience of automatic measurements of these indices in echocardiographic recordings acquired by medical students and clinicians. METHODS We included 75 consecutive patients referred for echocardiography at a university hospital. The patients underwent echocardiography by clinicians (cardiologists, cardiology residents and sonographers), who obtained manual reference measurements of MAPSE by M-mode and of S' and e' by colour tissue Doppler imaging (cTDI). Immediately after, each patient was examined by 1 of 39 medical students who were instructed in image acquisition on the day of participation. Each student acquired cTDI recordings from 1 to 4 patients. All cTDI recordings by students and clinicians were analysed for MAPSE, S' and e' using a fully automatic algorithm. The automatic measurements were compared to the manual reference measurements. RESULTS Correct tracking of the mitral annulus was feasible in 50 (67%) and 63 (84%) of the students' and clinicians' recordings, respectively (p = 0.007). Image quality was highest in the clinicians' recordings. Mean difference ± standard deviation of the automatic measurements of the students' recordings compared to the manual reference was - 0.0 ± 2.0 mm for MAPSE, 0.3 ± 1.1 cm/s for S' and 0.6 ± 1.4 cm/s for e'. The corresponding intraclass correlation coefficients for MAPSE, S' and e' were 0.85 (good), 0.89 (good) and 0.92 (excellent), respectively. Automatic measurements from the students' and clinicians' recordings were in similar agreement with the reference when mitral annular tracking was correct. CONCLUSIONS In case of correct tracking of the mitral annulus, the agreement with reference for the automatic measurements was overall good. Low image quality reduced feasibility. Adequate image acquisition is essential for automatic analyses of LV function indices, and thus, appropriate education of the operators is mandatory. Automatic measurements may help inexperienced users of ultrasound, but do not remove the need for dedicated education and training.
Collapse
Affiliation(s)
- Jahn Frederik Grue
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway.
| | - Sigurd Storve
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
- Clinic of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
- Clinic of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein O Samstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
- Clinic of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torfinn Eriksen-Volnes
- Clinic of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| | - Bjørn Olav Haugen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway
| |
Collapse
|
15
|
Grue JF, Storve S, Støylen A, Torp H, Haugen BO, Mølmen HE, Dalen H. Normal ranges for automatic measurements of tissue Doppler indices of mitral annular motion by echocardiography. Data from the HUNT3 Study. Echocardiography 2019; 36:1646-1655. [PMID: 31544286 DOI: 10.1111/echo.14476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/31/2019] [Accepted: 08/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Automatic quantification of left ventricular (LV) function could enhance workflow for cardiologists and assist inexperienced clinicians who perform focused cardiac ultrasound. We have developed an algorithm for automatic measurements of the mitral annular plane systolic excursion (MAPSE) and peak velocities in systole (S') and early (e') and late (a') diastole. We aimed to establish normal reference values for the automatic measurements and to compare them with manual measurements. METHODS AND RESULTS Healthy participants (n = 1157, 52.5% women) from the HUNT3 cross-sectional population study in Norway were included. The mean age ± standard deviation (SD) was 49 ± 14 (range: 19-89) years. The algorithm measured MAPSE, S', e', and a' from apical 4-chamber color tissue Doppler imaging (cTDI) recordings. The manual measurements were obtained by two echocardiographers, who measured MAPSE by M-mode and the velocities by cTDI. For men and women, age-specific reference values were created for groups (mean ± 1.96SD) and by linear regression (mean, 95% prediction interval). Age was negatively correlated with MAPSE, S', and e' and positively correlated with a'. There were small differences between genders. Normal reference ranges were created. The coefficients of variation between automatic and manual measurements ranged from 5.5% (S') to 11.7% (MAPSE). CONCLUSION Normal reference values for automatic measurements of LV function indices are provided. The automatic measurements were in line with the manual measurements. Implementing automatic measurements and comparison with normal ranges in ultrasound scanners can allow for quick and precise interpretation of LV function.
Collapse
Affiliation(s)
- Jahn Frederik Grue
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sigurd Storve
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Cardiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørn Olav Haugen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Harald Edvard Mølmen
- Morbid Obesity Centre, Division of Medicine, Department of Endocrinology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinic of Cardiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| |
Collapse
|
16
|
Teraguchi I, Hozumi T, Takemoto K, Ota S, Kashiwagi M, Shimamura K, Shiono Y, Kuroi A, Yamano T, Yamaguchi T, Matsuo Y, Ino Y, Kitabata H, Kubo T, Tanaka A, Akasaka T. Assessment of decreased left ventricular longitudinal deformation in asymptomatic patients with organic mitral regurgitation and preserved ejection fraction using tissue‐tracking mitral annular displacement by speckle‐tracking echocardiography. Echocardiography 2019; 36:678-686. [DOI: 10.1111/echo.14290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/17/2019] [Accepted: 01/28/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ikuko Teraguchi
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Takeshi Hozumi
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Kazushi Takemoto
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Shingo Ota
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Akio Kuroi
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Takashi Yamano
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Tomoyuki Yamaguchi
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Yasushi Ino
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Hironori Kitabata
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Takashi Kubo
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Atsushi Tanaka
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| | - Takashi Akasaka
- Department of Cardiovascular MedicineWakayama Medical University Wakayama Japan
| |
Collapse
|
17
|
Huang H, Shu Z, Song B, Ji L, Zhu N. Modeling left ventricular dynamics using a switched system approach based on a modified atrioventricular piston unit. Med Eng Phys 2018; 63:42-49. [PMID: 30554979 DOI: 10.1016/j.medengphy.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
The contribution of the longitudinal atrioventricular plane displacement to ventricular pumping has drawn more and more attentions. In this paper, differential equations of the left ventricle (LV) are derived via the atrioventricular piston concept. The contribution of left ventricular radial function to blood flow was converted to an equivalent coefficient. A systemic circulatory model incorporating the modified atrioventricular piston unit was developed on a switched system form by adding some state-dependent switching planes. Simulation results prove that the end-systolic pressure volume relationship of the model with a changing systemic arterial resistance is approximately linear and insensitive to perturbations in afterload. Then the LV model was validated using a data fitting method. A pressure-volume loop from a patient undergoing routine diagnostic cardiac catheterization with LV angiography was used as measurements. Model parameters and the trapezoidal profile of contraction forces were adjusted by a trial method. The root mean squared error between the measured and estimated LV pressure is 2.99 mmHg. The LV compliance is 0.34 ml/mmHg. The ratio between left ventricular and left atrial cross-section is 1.8. Therefore, parameter values used in the modified LV model match physiological data. The model can reproduce the realistic pressure-flow relationship in the LV chamber.
Collapse
Affiliation(s)
- Huan Huang
- School of Electrical Engineering and Automation, Jiangsu Normal University, Xuzhou, Jiangsu, China
| | - Zhan Shu
- School of Electrical Engineering and Automation, Jiangsu Normal University, Xuzhou, Jiangsu, China; Electro-Mechanical Group, Faculty of Engineering and the Environment, University of Southampton, Southampton SO17 1BJ, UK.
| | - Bo Song
- School of Electrical Engineering and Automation, Jiangsu Normal University, Xuzhou, Jiangsu, China
| | - Liya Ji
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Nan Zhu
- School of Electrical Engineering and Automation, Jiangsu Normal University, Xuzhou, Jiangsu, China
| |
Collapse
|
18
|
The importance of the pericardium for cardiac biomechanics: from physiology to computational modeling. Biomech Model Mechanobiol 2018; 18:503-529. [DOI: 10.1007/s10237-018-1098-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
|
19
|
Zhang H, He W, Wang X, Chao Y, Zhang L, Zhu R, Yin W, Liu L, Wu J, Liu D. Physicians' Ability to Visually Estimate Left Ventricular Ejection Fraction, Right Ventricular Enlargement, and Paradoxical Septal Motion After a 2-Day Focused Cardiac Ultrasound Training Course. J Cardiothorac Vasc Anesth 2018; 33:1912-1918. [PMID: 30442519 DOI: 10.1053/j.jvca.2018.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Focused cardiac ultrasound (FCU) can provide useful information for the management of shock and acute respiratory distress syndrome. This study aimed to determine whether a 2-day focused cardiac ultrasound training course could enable critical care physicians to interpret ultrasound images in terms of left ventricular ejection fraction (LVEF), ratio of right ventricular end-diastolic area to left ventricular end-diastolic area (R/LVEDA), and septal kinetics. DESIGN A prospective analysis of an image test score. SETTING Ultrasound training programs in 7 regions across China. PARTICIPANTS Two hundred forty-seven critical care physicians. INTERVENTIONS All participants received a 2-day FCU training, including 4 sessions of basic heart function appraisal, 3 sessions of hands-on practice, and 1 session of image interpretation. MEASUREMENTS AND MAIN RESULTS The post-training total scores were considerably higher than those of pretraining (75.6% v 58.9%, respectively, p < 0.001). After the course, the trainees obtained considerably higher scores on images with LVEF <30% than on images with LVEF 30% to 54% and LVEF ≥55% (100% v 60.0% and 60.0%, respectively, p < 0.001). The trainees obtained considerably higher scores on images with R/LVEDA >1 than on images with R/LVEDA 0.6 to 1 and R/LVEDA <0.6 (90.0% v 80.0% and 80.0%, p = 0.042 and p < 0.001, respectively). The trainees obtained considerably higher scores on images with paradoxical septal movement (PSM) than on images without PSM (100% v 75.0%, respectively, p < 0.001). CONCLUSION The physicians' abilities to assess LVEF, RV enlargement, and PSM improved after the training course, and they demonstrated more accurate estimations of the most obviously abnormal images.
Collapse
Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangong Chao
- Department of Critical Care Medicine, The First Hospital of Tsing Hua University, Beijing, China
| | - Lina Zhang
- Department of Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, Hu Nan, China
| | - Ran Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liao Ning, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Si Chuan University, Chengdu, China
| | - Lixia Liu
- Department of Critical Care Medicine, Fourth Hospital of He Bei Medical University, China
| | - Jun Wu
- Department of Critical Care Medicine, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
20
|
Mitral Annular Plane Systolic Excursion as a Predictor of Mortality in Children With Septic Shock. Pediatr Crit Care Med 2018; 19:e486-e494. [PMID: 30024571 DOI: 10.1097/pcc.0000000000001661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Myocardial dysfunction is well recognized in severe sepsis and septic shock. Echocardiography provides rapid, noninvasive, and bedside evaluation of cardiac function in patients with hemodynamic instability. Mitral annular plane systolic excursion is an M-mode-derived echocardiographic variable used to assess longitudinal left ventricular systolic function. No data are available about the uses of mitral annular plane systolic excursion in children with septic shock. Therefore, we aimed to assess the prognostic significance of mitral annular plane systolic excursion in children with septic shock and to correlate it with the most commonly used measures of left ventricular systolic function and myocardial injury. DESIGN A prospective cohort study. SETTING The study carried out at the PICU of Menoufia University Hospital in the period from March 2015 to September 2016. PATIENTS We serially enrolled 50 children with septic shock. INTERVENTIONS Complete diagnostic workup was performed for each patient including calculation of Pediatric Risk of Mortality III score. Transthoracic echocardiography was done to obtain mitral annular plane systolic excursion and the left ventricular ejection fraction measurement within 24 hours of inclusion then repeated on third and fifth days. Patients were followed up until hospital discharge or death. The predictive power of mitral annular plane systolic excursion was determined using the receiver operating characteristic curve. MEASUREMENTS AND MAIN RESULTS Mitral annular plane systolic excursion was significantly lower in nonsurvivors compared with survivors (p < 0.001). Receiver operating characteristic curve analysis showed an area under the curve of 0.892 for mitral annular plane systolic excursion on day 1. The cut-off point was 7.9 mm with 82.76% sensitivity and 80.95% specificity. Furthermore, follow-up of the patient's systolic function showed that mitral annular plane systolic excursion was significantly lower in nonsurvivors compared with survivors on days of follow-up, whereas left ventricular ejection fraction was not significantly different between survivors and nonsurvivors at any day. Mitral annular plane systolic excursion was positively correlated with left ventricular ejection fraction (p = 0.044) and duration of hospital stay (p < 0.001) and negatively correlated with Pediatric Risk of Mortality III score (p < 0.001) and cardiac troponin I level (p < 0.001). CONCLUSIONS Measurement of mitral annular plane systolic excursion at admission added a prognostic value in septic shock children. Compared with the left ventricular ejection fraction, longitudinal systolic function might be more sensitive in the detection of myocardial dysfunction in critically ill children and should receive more attention.
Collapse
|
21
|
Magdy G, Hamdy E, Elzawawy T, Ragab M. Value of mitral annular plane systolic excursion in the assessment of contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization. Indian Heart J 2018; 70:373-378. [PMID: 29961453 PMCID: PMC6034018 DOI: 10.1016/j.ihj.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/26/2017] [Accepted: 11/05/2017] [Indexed: 12/02/2022] Open
Abstract
Background Mitral annular plane systolic excursion (MAPSE) is an M-mode derived echocardiographic marker of left ventricular longitudinal function, the aim of this study is to evaluate the value of MAPSE in assessment of contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization. Methods The study included 50 patients with ischemic cardiomyopathy with ejection fraction (EF) ≤35%, the patients presented to echocardiography laboratory for dobutamine stress echocardiography (DSE) to assess viability and contractile reserve before revascularization, patients with primary valvular disease, and those with significant mitral annular calcifications were excluded from the study. A low dose DSE was done to all patients using standardized incremental infusions of 5, 10, and 20 μg/kg/min and the following parameters were measured at both baseline and peak dose, (EF, wall motion score index(WMSI) and MAPSE). Contractile reserve was measured as the difference between the low dose and baseline values of the EF and WMSI. Results The study included 50 patients aged 55.08 ± 7.15 years, 94% were males, the DSE protocol was complete in all patients without serious side effects. A total of eight hundred segments were analyzed, at baseline 65% were dysfunctional including 31.2% hypokinetic, 28.8% were akinetic, and 5% were dyskinetic. At low dose study 70% of the dysfunctional myocardium showed viability, EF increased significantly from 30.84 ± 4.56 to 42.24 ± 8.15%, p < 0.001, the WMSI reduced significantly from 1.92 ± 0.33 to 1.47 ± 0.39, and MAPSE increased significantly from 1.02 ± 0.23 to 1.30 ± 0.30 mm. MAPSE showed a significant positive correlation with EF at both baseline and low dose study (r = 0.283, p = 0.046 & r = 0.348, p = 0.013) respectively and a significant negative correlation with WMSI at both baseline and low dose study (r = −0.3, p = 0.034 & r = −0.409, p = 0.003), respectively. By ROC curve analysis we found that Δ MAPSE ≥2 mm can predict contractile reserve at Δ EF >10% (AUC = 0.6, sensitivity 67.86, specificity 59.09), and Δ MAPSE ≥1.8 mm can predict contractile reserve at ΔWMSI ≤0.20 (AUC = 0.61, sensitivity 65.5, specificity 75.6). Conclusions MAPSE is a rapid simple quantitative echocardiographic method that can asses contractile reserve in patients with ischemic cardiomyopathy before cardiac revascularization.
Collapse
Affiliation(s)
- Gehan Magdy
- Cardiology department, Faculty of medicine, Alexandria University, Egypt
| | - Ebtihag Hamdy
- Cardiology department, Faculty of medicine, Alexandria University, Egypt
| | - Tarek Elzawawy
- Cardiology department, Faculty of medicine, Alexandria University, Egypt
| | - Maher Ragab
- Cardiology department, Faculty of medicine, Alexandria University, Egypt
| |
Collapse
|
22
|
Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
Collapse
Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
23
|
Aurich M, Fuchs P, Müller-Hennessen M, Uhlmann L, Niemers M, Greiner S, Täger T, Hirschberg K, Ehlermann P, Meder B, Frankenstein L, Giannitsis E, Katus HA, Mereles D. Unidimensional Longitudinal Strain: A Simple Approach for the Assessment of Longitudinal Myocardial Deformation by Echocardiography. J Am Soc Echocardiogr 2018; 31:733-742. [DOI: 10.1016/j.echo.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 12/20/2022]
|
24
|
Hensel KO, Roskopf M, Wilke L, Heusch A. Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children. PLoS One 2018; 13:e0196614. [PMID: 29746603 PMCID: PMC5944962 DOI: 10.1371/journal.pone.0196614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/15/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mitral annular plane systolic excursion (MAPSE) is an increasingly used echocardiography technique to assess left ventricular (LV) function. However, reproducibility and dependence on echocardiographic image quality for MAPSE in pediatric patients have not been studied to date. METHODS We analyzed 284 transthoracic echocardiograms performed on consecutive normotensive children without structural heart disease (mean age 12.6±3.1 years, 50.4% female). B-mode and M-mode derived MAPSE measurements were performed and analyzed regarding inter- and intraobserver reliability and the influence of echocardiographic image quality. RESULTS Overall, MAPSE measurements were highly reproducible with only minor bias. Both inter- and intraobserver reliability were significantly better for M-mode derived MAPSE (p<0.001). Echocardiographic image quality did not significantly influence M-mode MAPSE reproducibility (p>0.235). In contrast, B-mode lateral MAPSE was significantly better reproducible in optimal image quality (-0.07±1.04) when compared to suboptimal echocardiographic images (0.42±1.59, p<0.001). Moreover, poor quality images yielded significantly lower M-mode MAPSE values (14.3±2 mm) than near-optimal (15.2±1.9 mm, p<0.001) or optimal images (15.1±2.2 mm, p = 0.006). CONCLUSION Echocardiographic image quality essentially has a negligible effect on MAPSE reproducibility and measurements. Consequently, MAPSE is a robust echocardiographic parameter with convincing reproducibility for the assessment of LV function in children-even in patients with substandard imaging conditions.
Collapse
Affiliation(s)
- Kai O. Hensel
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
- University of Cambridge, Addenbrooke’s University Hospital, Department of Pediatrics, Cambridge, United Kingdom
- * E-mail:
| | - Markus Roskopf
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Lucia Wilke
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Andreas Heusch
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| |
Collapse
|
25
|
El-Battrawy I, Ansari U, Lang S, Fastner C, Zhou X, Borggrefe M, Akin I. Risk stratification in Takotsubo syndrome: a role of mitral annular plane systolic excursion. QJM 2018; 111:231-236. [PMID: 29346679 DOI: 10.1093/qjmed/hcy003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/14/2022] Open
Abstract
AIM Takotsubo syndrome (TTS) patients have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised mitral annular plane systolic excursion (MAPSE) on hospital admission. METHODS AND RESULTS Our institutional database constituted a collective of 53 patients diagnosed with TTS between 2003 and 2016. The patients were classified into two groups based on the MAPSE, with those presenting with an MAPSE <1 cm on admission categorized into one group (n = 20, 38%) and those presenting with MAPSE ≥1 cm (n = 33, 62%) categorized into another group. Preliminary results indicated that patients with an MAPSE < 1 cm had a greater risk of developing thromboembolic events. The long-term mortality was significantly higher in TTS patients with an MAPSE < 1 cm. In the multivariate Cox regression analysis, cardiogenic shock (hazard ratio 3.5; 95% confidence interval: 1.2-10.7; P = 0.02) and MAPSE < 1 cm (hazard ratio 5.1; 95% confidence interval: 1.3-19.2; P = 0.01) figured as independent predictors of the mortality. CONCLUSION Although the short-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admission were as similar as without reduced MAPSE, the long-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high-risk TTS patients.
Collapse
Affiliation(s)
- I El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (GermanCenter for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - U Ansari
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - S Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (GermanCenter for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - C Fastner
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - X Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (GermanCenter for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - M Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (GermanCenter for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - I Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (GermanCenter for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| |
Collapse
|
26
|
Støylen A, Mølmen HE, Dalen H. Relation between Mitral Annular Plane Systolic Excursion and Global longitudinal strain in normal subjects: The HUNT study. Echocardiography 2018; 35:603-610. [DOI: 10.1111/echo.13825] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Asbjørn Støylen
- Faculty of medicine; Department of Medical Imaging and Circulation; Norwegian University of Science and Technology; Trondheim Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
| | - Harald E. Mølmen
- Morbid Obesity Center; Division of Medicine; Department of Endocrinology; Vestfold Hospital Trust; Tønsberg Norway
- Asgardstrand General Practice; Horten Norway
| | - Håvard Dalen
- Faculty of medicine; Department of Medical Imaging and Circulation; Norwegian University of Science and Technology; Trondheim Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
- Department of Medicine; Levanger Hospital; Nord-Trøndelag Hospital Trust; Levanger Norway
| |
Collapse
|
27
|
Kopic S, Stephensen SS, Heiberg E, Arheden H, Bonhoeffer P, Ersbøll M, Vejlstrup N, Søndergaard L, Carlsson M. Isolated pulmonary regurgitation causes decreased right ventricular longitudinal function and compensatory increased septal pumping in a porcine model. Acta Physiol (Oxf) 2017; 221:163-173. [PMID: 28580611 PMCID: PMC5655773 DOI: 10.1111/apha.12904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
Aim Longitudinal ventricular contraction is a parameter of cardiac performance with predictive power. Right ventricular (RV) longitudinal function is impaired in patients with free pulmonary regurgitation (PR) following corrective surgery for Tetralogy of Fallot (TOF). It remains unclear whether this is a consequence of the surgical repair, or whether it is inherent to PR. The aim of this study was to assess the relationship between longitudinal, lateral and septal pumping in a porcine model of isolated PR. Methods Piglets were divided into a control (n = 8) group and a treatment (n = 12) group, which received a stent in the pulmonary valve orifice, inducing PR. After 2–3 months, animals were subjected to cardiac magnetic resonance imaging. A subset of animals (n = 6) then underwent percutaneous pulmonary valve replacement (PPVR) with follow‐up 1 month later. Longitudinal, lateral and septal contributions to stroke volume (SV) were quantified by measuring volumetric displacements from end‐diastole to end‐systole in the cardiac short axis and long axis. Results PR resulted in a lower longitudinal contribution to RV stroke volume, compared to controls (60.0 ± 2.6% vs. 73.6 ± 3.8%; P = 0.012). Furthermore, a compensatory increase in septal contribution to RVSV was observed (11.0 ± 1.6% vs. −3.1 ± 1.5%; P < 0.0001). The left ventricle (LV) showed counter‐regulation with an increased longitudinal LVSV. Changes in RV longitudinal function were reversed by PPVR. Conclusion These findings suggest that PR contributes to decreased RV longitudinal function in the absence of scarring from cardiac surgery. Measurement of longitudinal RVSV may aid risk stratification and timing for interventional correction of PR in TOF patients.
Collapse
Affiliation(s)
- S. Kopic
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | - S. S. Stephensen
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | - E. Heiberg
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
- Department of Biomedical Engineering; Faculty of Engineering; Lund University; Lund Sweden
| | - H. Arheden
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - M. Ersbøll
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - N. Vejlstrup
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - L. Søndergaard
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - M. Carlsson
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| |
Collapse
|
28
|
Szokol M, Priksz D, Bombicz M, Varga B, Kovacs A, Fulop GA, Csipo T, Posa A, Toth A, Papp Z, Szilvassy Z, Juhasz B. Long Term Osmotic Mini Pump Treatment with Alpha-MSH Improves Myocardial Function in Zucker Diabetic Fatty Rats. Molecules 2017; 22:molecules22101702. [PMID: 29023410 PMCID: PMC6151765 DOI: 10.3390/molecules22101702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/03/2017] [Indexed: 01/20/2023] Open
Abstract
The present investigation evaluates the cardiovascular effects of the anorexigenic mediator alpha-melanocyte stimulating hormone (MSH), in a rat model of type 2 diabetes. Osmotic mini pumps delivering MSH or vehicle, for 6 weeks, were surgically implanted in Zucker Diabetic Fatty (ZDF) rats. Serum parameters, blood pressure, and weight gain were monitored along with oral glucose tolerance (OGTT). Echocardiography was conducted and, following sacrifice, the effects of treatment on ischemia/reperfusion cardiac injury were assessed using the isolated working heart method. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity was measured to evaluate levels of oxidative stress, and force measurements were performed on isolated cardiomyocytes to determine calcium sensitivity, active tension and myofilament co-operation. Vascular status was also evaluated on isolated arterioles using a contractile force measurement setup. The echocardiographic parameters ejection fraction (EF), fractional shortening (FS), isovolumetric relaxation time (IVRT), mitral annular plane systolic excursion (MAPSE), and Tei-index were significantly better in the MSH-treated group compared to ZDF controls. Isolated working heart aortic and coronary flow was increased in treated rats, and higher Hill coefficient indicated better myofilament co-operation in the MSH-treated group. We conclude that MSH improves global heart functions in ZDF rats, but these effects are not related to the vascular status.
Collapse
Affiliation(s)
- Miklos Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Daniel Priksz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Mariann Bombicz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Balazs Varga
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Arpad Kovacs
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Gabor Aron Fulop
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Tamas Csipo
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Aniko Posa
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, H-6720 Szeged, Hungary.
| | - Attila Toth
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Szilvassy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Bela Juhasz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| |
Collapse
|
29
|
High sensitivity troponin T and I reflect mitral annular plane systolic excursion being assessed by cardiac magnetic resonance imaging. Eur J Med Res 2017; 22:38. [PMID: 28978339 PMCID: PMC5628434 DOI: 10.1186/s40001-017-0281-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/22/2017] [Indexed: 01/13/2023] Open
Abstract
Purpose This study aims to evaluate the association between high sensitivity troponins (hsTn) and mitral annular plane systolic excursion (MAPSE) in patients undergoing cardiac magnetic resonance imaging (cMRI). Methods Patients undergoing cMRI were prospectively enrolled. Patients with right ventricular dysfunction (< 50%) were excluded. Blood samples for measurements of hsTn and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were collected at the time of cMRI. Results 84 patients were included. Median left ventricular ejection fraction was 59% (IQR 51–64%). HsTn were correlated inversely with MAPSE within multivariable linear regression models (hsTnI: Beta − 0.19; T − 1.96; p = 0.05; hsTnT: Beta − 0.26; T − 3.26; p = 0.002). HsTn increased significantly according to decreasing stages of impaired MAPSE (p < 0.003). HsTn discriminated patients with impaired MAPSE < 11 mm (hsTnT: AUC = 0.67; p = 0.008; hsTnI: AUC = 0.64; p = 0.03) and < 8 mm (hsTnT: AUC = 0.79; p = 0.0001; hsTnI: AUC = 0.75; p = 0.001) and were still significantly associated in multivariable logistic regression models with impaired MAPSE < 11 mm (hsTnT: OR = 4.71; p = 0.002; hsTnI: OR = 4.22; p = 0.009). Conclusions This study demonstrates that hsTn are able to reflect MAPSE being assessed by cMRI. Electronic supplementary material The online version of this article (doi:10.1186/s40001-017-0281-x) contains supplementary material, which is available to authorized users.
Collapse
|
30
|
Seemann F, Pahlm U, Steding-Ehrenborg K, Ostenfeld E, Erlinge D, Dubois-Rande JL, Jensen SE, Atar D, Arheden H, Carlsson M, Heiberg E. Time-resolved tracking of the atrioventricular plane displacement in Cardiovascular Magnetic Resonance (CMR) images. BMC Med Imaging 2017; 17:19. [PMID: 28241751 PMCID: PMC5330030 DOI: 10.1186/s12880-017-0189-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Atrioventricular plane displacement (AVPD) is an indicator for systolic and diastolic function and accounts for 60% of the left ventricular, and 80% of the right ventricular stroke volume. AVPD is commonly measured clinically in echocardiography as mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE), but has not been applied widely in cardiovascular magnetic resonance (CMR). To date, there is no robust automatic algorithm available that allows the AVPD to be measured clinically in CMR with input in a single timeframe. This study aimed to develop, validate and provide a method that automatically tracks the left and right ventricular AVPD in CMR images, which can be used in the clinical setting or in applied cardiovascular research in multi-center studies. Methods The proposed algorithm is based on template tracking by normalized cross-correlation combined with a priori information by principal component analysis. The AVPD in each timeframe is calculated for the left and right ventricle separately using CMR long-axis cine images of the 2, 3, and 4-chamber views. The algorithm was developed using a training set (n = 40), and validated in a test set (n = 113) of healthy subjects, athletes, and patients after ST-elevation myocardial infarction from 10 centers. Validation was done using manual measurements in end diastole and end systole as reference standard. Additionally, AVPD, peak emptying velocity, peak filling velocity, and atrial contraction was validated in 20 subjects, where time-resolved manual measurements were used as reference standard. Inter-observer variability was analyzed in 20 subjects. Results In end systole, the difference between the algorithm and the reference standard in the left ventricle was (mean ± SD) -0.6 ± 1.9 mm (R = 0.79), and −0.8 ± 2.1 mm (R = 0.88) in the right ventricle. Inter-observer variability in end systole was −0.6 ± 0.7 mm (R = 0.95), and −0.5 ± 1.4 mm (R = 0.95) for the left and right ventricle, respectively. Validation of peak emptying velocity, peak filling velocity, and atrial contraction yielded lower accuracy than the displacement measures. Conclusions The proposed algorithm show good agreement and low bias with the reference standard, and with an agreement in parity with inter-observer variability. Thus, it can be used as an automatic method of tracking and measuring AVPD in CMR. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0189-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Felicia Seemann
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Numerical Analysis, Faculty of Engineering, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
| |
Collapse
|
31
|
Riffel JH, Keller MGP, Rost F, Arenja N, Andre F, Aus dem Siepen F, Fritz T, Ehlermann P, Taeger T, Frankenstein L, Meder B, Katus HA, Buss SJ. Left ventricular long axis strain: a new prognosticator in non-ischemic dilated cardiomyopathy? J Cardiovasc Magn Reson 2016; 18:36. [PMID: 27268238 PMCID: PMC4897821 DOI: 10.1186/s12968-016-0255-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/27/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Long axis strain (LAS) has been shown to be a fast assessable parameter representing global left ventricular (LV) longitudinal function in cardiovascular magnetic resonance (CMR). However, the prognostic value of LAS in cardiomyopathies with reduced left ventricular ejection fraction (LVEF) has not been evaluated yet. METHODS AND RESULTS In 146 subjects with non-ischemic dilated cardiomyopathy (NIDCM, LVEF ≤45 %) LAS was assessed retrospectively from standard non-contrast SSFP cine sequences by measuring the distance between the epicardial border of the left ventricular apex and the midpoint of a line connecting the origins of the mitral valve leaflets in end-systole and end-diastole. The final values were calculated according to the strain formula. The primary endpoint of the study was defined as a combination of cardiac death, heart transplantation or aborted sudden cardiac death and occurred in 24 subjects during follow-up. Patients with LAS values > -5 % showed a significant higher rate of cardiac events independent of the presence of late gadolinium enhancement (LGE). The multivariate Cox regression analysis revealed that LVEDV/BSA (HR: 1.01, p < 0.05), presence of LGE (HR: 2.51, p < 0.05) and LAS (HR: 1.28, p < 0.05) were independent predictors for cardiac events. In a sequential cox regression analysis LAS offered significant incremental information (p < 0.05) for the prediction of outcome in addition to LGE and LVEDV/BSA. Using a dichotomous three point scoring model for risk stratification, including LVEF <35 %, LAS > -10 % and the presence of LGE, patients with 3 points had a significantly higher risk for cardiac events than those with 2 or less points. CONCLUSION Assessment of long axis function with LAS offers significant incremental information for the prediction of cardiac events in NIDCM and improves risk stratification beyond established CMR parameters.
Collapse
MESH Headings
- Adult
- Aged
- Biomechanical Phenomena
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/surgery
- Chi-Square Distribution
- Contrast Media/administration & dosage
- Death, Sudden, Cardiac/etiology
- Female
- Heart Transplantation
- Humans
- Kaplan-Meier Estimate
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mitral Valve/diagnostic imaging
- Mitral Valve/physiopathology
- Multivariate Analysis
- Observer Variation
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Reproducibility of Results
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Function, Left
Collapse
Affiliation(s)
- Johannes H Riffel
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Marius G P Keller
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Franziska Rost
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Nisha Arenja
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Florian Andre
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Thomas Fritz
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Tobias Taeger
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site, Heidelberg, Germany
| | - Sebastian J Buss
- Department of Cardiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
32
|
Rangarajan V, Chacko SJ, Romano S, Jue J, Jariwala N, Chung J, Farzaneh-Far A. Left ventricular long axis function assessed during cine-cardiovascular magnetic resonance is an independent predictor of adverse cardiac events. J Cardiovasc Magn Reson 2016; 18:35. [PMID: 27266262 PMCID: PMC4897936 DOI: 10.1186/s12968-016-0257-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular pump function requires a complex interplay involving myocardial fibers orientated in the longitudinal, oblique and circumferential directions. Long axis dysfunction appears to be an early marker for a number of pathological states. We hypothesized that mitral annular plane systolic excursion (MAPSE) measured during cine-cardiovascular magnetic resonance (CMR) reflects changes in long axis function and may be an early marker for adverse cardiovascular outcomes. The aims of this study were therefore: 1) To assess the feasibility and reproducibility of MAPSE measurements during routine cine-CMR; and 2) To assess whether MAPSE, as a surrogate for long axis function, is a predictor of major adverse cardiovascular events (MACE). METHODS Four hundred consecutive patients undergoing CMR were prospectively enrolled. MAPSE was measured in the 4-chamber cine view. Patients were prospectively followed for major adverse cardiac events (MACE) - death, non-fatal myocardial infarction, hospitalization for heart failure or unstable angina, and late revascularization. Cox proportional hazards regression modeling was used to identify factors independently associated with MACE. Net reclassification improvement (NRI) was calculated to assess whether addition of MAPSE resulted in improved risk reclassification of MACE. RESULTS Seventy-two MACE occurred during a median follow-up of 14.5 months. By Kaplan-Meier analysis, patients with lateral MAPSE <1.11 cm (median) experienced significantly higher incidence of MACE than patients with a MAPSE ≥1.11 cm (p = 0.027). After adjustment for established clinical risk factors which were univariate predictors (age, diabetes, hypertension, NYHA class, LV mass), lateral MAPSE remained a significant independent predictor of MACE (HR = 4.384 per cm decrease or 1.344 per 2 mm decrease; p = 0.020). Incorporation of lateral MAPSE into this risk model resulted in a net reclassification improvement (NRI) of 0.18 (p = 0.006). CONCLUSIONS Reduced long axis function assessed with lateral MAPSE during cine-CMR is an independent predictor of MACE.
Collapse
Affiliation(s)
- Vibhav Rangarajan
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Satish Jacob Chacko
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Simone Romano
- Department of Medicine, University of Verona, Verona, Italy
| | - Jennifer Jue
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Nikhil Jariwala
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Jaehoon Chung
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA
| | - Afshin Farzaneh-Far
- Department of Medicine, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920S, Chicago, IL, 60612, USA.
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, USA.
| |
Collapse
|
33
|
Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:153-163. [DOI: 10.1093/ehjqcco/qcw026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 12/15/2022]
|
34
|
Kuwata S, Yoneyama K, Suzuki K, Izumo M, Mizukoshi K, Koyama K, Ishibashi Y, Mitarai T, Kamijima R, Kongoji K, Harada T, Akashi YJ. Aortic annulus displacement assessed by contrast left ventriculography during invasive coronary angiography as a predictor of adverse events. J Cardiol 2016; 69:442-448. [PMID: 26896307 DOI: 10.1016/j.jjcc.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND We propose the use of aortic annulus displacement (AAD) detected on contrast left ventriculography (LVG) during invasive coronary angiography as a marker of left ventricular (LV) long-axis shortening. In the present study, we aimed to investigate whether AAD is associated with adverse events in patients who underwent coronary angiography because of suspected coronary artery disease. METHODS In this retrospective study, we evaluated the medical records of 998 consecutive patients who underwent invasive coronary angiography and LVG. LV lengths were measured from the apex to the aortic valve insertion by using LVG images. AAD (%) was calculated as [(LV end-diastolic length-LV end-systolic length)/LV end-diastolic length]×100. RESULTS The participants' median age was 67 years. Ninety-six adverse events (composite events; all-cause death, 39; congestive heart failure, 21; late revascularization, 34; and myocardial infarction, 2) were observed during a median follow-up period of 3.1 years. In multivariate Cox regression analysis, adverse events were associated with lower AAD (hazard ratio, 0.703; p=0.002), after adjusting for traditional risk factors and coronary artery stenosis. The area under the curve of AAD for predicting adverse events was greater than that of LV ejection fraction (0.656 vs. 0.541, p<0.05). CONCLUSIONS AAD was superior to LV ejection fraction as a predictor of adverse events in patients with and without coronary arterial stenosis. AAD may be the optimal method for assessing longitudinal LV systolic function in the catheter laboratory.
Collapse
Affiliation(s)
- Shingo Kuwata
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Koyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
| |
Collapse
|
35
|
Gjesdal O, Yoneyama K, Mewton N, Wu C, Gomes AS, Hundley G, Prince M, Shea S, Liu K, Bluemke DA, Lima JAC. Reduced long axis strain is associated with heart failure and cardiovascular events in the multi-ethnic study of Atherosclerosis. J Magn Reson Imaging 2016; 44:178-85. [PMID: 26731196 DOI: 10.1002/jmri.25135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/02/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To propose long axis strain (LAS), a novel index of global left ventricle (LV) function, as a sensitive and powerful predictor of hard cardiovascular events and heart failure in the Multi-Ethnic Study of Atherosclerosis (MESA). MATERIALS AND METHODS Strain is an index of relative myocardial deformation, and enables normalization for differences in heart size. Measurement of strain conventionally requires dedicated software and protocols for image acquisition. LAS, however, can be analyzed using a caliper tool from conventional LV long axis magnetic resonance imaging (MRI) cine loops, reflecting the average myocardial contraction in the longitudinal direction. In all, 1651 participants (53% men) of the MESA study, without a history of myocardial infarction or heart failure, were assessed using conventional cine MR images. LV lengths were assessed at end-diastole (EDL ) and end-systole (ESL ), and LAS was calculated as 100*(EDL -ESL )/EDL . Participants were followed for 6.8 ± 1.8 years for a composite endpoint of congestive heart failure or hard cardiovascular events, and the predictive ability of LAS was tested, unadjusted and adjusted for established cardiovascular risk factors. RESULTS A total of 114 events were observed. Mean LAS was 11.7 ± 2.5% and 10.0 ± 2.7% in participants without and with events, respectively (P < 0.001). Increased LAS reduced the hazard ratio to 0.75 for univariate, and 0.88 for multivariate assessments, respectively (both P < 0.001). CONCLUSION Assessment of long axis LV deformation by LAS is feasible and reproducible. Moreover, LAS predicts hard cardiovascular events and congestive heart failure in a multi-ethnic population without overt cardiovascular disease at inclusion. J. Magn. Reson. Imaging 2016;44:178-185.
Collapse
Affiliation(s)
- Ola Gjesdal
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA.,Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - Kihei Yoneyama
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
| | - Nathan Mewton
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
| | - Colin Wu
- National Heart, Lung and Blood Institute, Office of Biostatistics Research, Bethesda, Maryland, USA
| | - Antoinette S Gomes
- UCLA School of Medicine, Department of Radiology, Los Angeles, California, USA
| | - Gregory Hundley
- Wake Forest University Health Sciences, Department of Cardiology, Winston-Salem, North Carolina, USA
| | - Martin Prince
- Columbia University, Department of Radiology, New York, New York, USA
| | - Steven Shea
- Columbia University, Departments of Medicine and Epidemiology, New York, New York, USA
| | - Kiang Liu
- Northwestern University Medical School, Department of Preventive Medicine, Chicago, Illinois, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - Joao A C Lima
- Johns Hopkins University, Department of Cardiology, Baltimore, Maryland, USA
| |
Collapse
|
36
|
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]
|
37
|
Esposito R, Sorrentino R, Galderisi M. The use of transthoracic echocardiography for the assessment of left ventricular systolic and diastolic function in patients with suspected or ascertained chronic heart failure. Expert Rev Cardiovasc Ther 2015; 14:37-50. [PMID: 26559428 DOI: 10.1586/14779072.2016.1111760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Roberta Esposito
- a Laboratory of Standard and Advanced Echocardiography , Federico II University Hospital , Naples , Italy
- b Laboratory of Standard and Advanced Echocardiography, Department of Translational Medical Sciences , Federico II University Hospital , Naples , Italy
| | - Regina Sorrentino
- a Laboratory of Standard and Advanced Echocardiography , Federico II University Hospital , Naples , Italy
- c Laboratory of Standard and Advanced Echocardiography, Department of Advanced Biomedical Sciences , Federico II University Hospital , Naples , Italy
| | - Maurizio Galderisi
- a Laboratory of Standard and Advanced Echocardiography , Federico II University Hospital , Naples , Italy
- c Laboratory of Standard and Advanced Echocardiography, Department of Advanced Biomedical Sciences , Federico II University Hospital , Naples , Italy
| |
Collapse
|
38
|
Riffel JH, Andre F, Maertens M, Rost F, Keller MGP, Giusca S, Seitz S, Kristen AV, Müller M, Giannitsis E, Korosoglou G, Katus HA, Buss SJ. Fast assessment of long axis strain with standard cardiovascular magnetic resonance: a validation study of a novel parameter with reference values. J Cardiovasc Magn Reson 2015; 17:69. [PMID: 26253220 PMCID: PMC4529700 DOI: 10.1186/s12968-015-0171-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/16/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Assessment of longitudinal function with cardiovascular magnetic resonance (CMR) is limited to measurement of systolic excursion of the mitral annulus (MAPSE) or elaborate strain imaging modalities. The aim of this study was to develop a fast assessable parameter for the measurement of long axis strain (LAS) with CMR. METHODS 40 healthy volunteers and 125 patients with different forms of cardiomyopathy were retrospectively analyzed. Four different approaches for the assessment of LAS with CMR measuring the distance between the LV apex and a line connecting the origins of the mitral valve leaflets in enddiastole and endsystole were evaluated. Values for LAS were calculated according to the strain formula. RESULTS LAS derived from the distance of the epicardial apical border to the midpoint of the line connecting the mitral valve insertion points (LAS-epi/mid) proved to be the most reliable parameter for the assessment of LAS among the different approaches. LAS-epi/mid displayed the highest sensitivity (81.6 %) and specificity (97.5 %), furthermore showing the best correlation with feature tracking (FTI) derived transmural longitudinal strain (r = 0.85). Moreover, LAS-epi/mid was non-inferior to FTI in discriminating controls from patients (Area under the curve (AUC) = 0.95 vs. 0.94, p = NS). The time required for analysis of LAS-epi/mid was significantly shorter than for FTI (67 ± 8 s vs. 180 ± 14 s, p < 0.0001). Additionally, LAS-epi/mid performed significantly better than MAPSE (Delta AUC = 0.09; p < 0.005) and the ejection fraction (Delta AUC = 0.11; p = 0.0002). Reference values were derived from 234 selected healthy volunteers. Mean value for LAS-epi/mid was -17.1 ± 2.3 %. Mean values for men were significantly lower compared to women (-16.5 ± 2.2 vs. -17.9 ± 2.1 %; p < 0.0001), while LAS decreased with age. CONCLUSIONS LAS-epi/mid is a novel and fast assessable parameter for the analysis of global longitudinal function with non-inferiority compared to transmural longitudinal strain.
Collapse
Affiliation(s)
- Johannes H Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Florian Andre
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Malte Maertens
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Franziska Rost
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Marius G P Keller
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Sorin Giusca
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Sebastian Seitz
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Arnt V Kristen
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Matthias Müller
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Grigorios Korosoglou
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany.
| | - Sebastian J Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| |
Collapse
|
39
|
Hashimoto I, Watanabe K. Z-Value of Mitral Annular Plane Systolic Excursion Is a Useful Indicator to Predict Left Ventricular Stroke Volume in Children: Comparing Longitudinal and Radial Contractions. Echocardiography 2015; 33:290-8. [DOI: 10.1111/echo.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ikuo Hashimoto
- Department of Pediatrics; Toyama City Hospital; Toyama Japan
| | | |
Collapse
|
40
|
Doesch C, Sperb A, Sudarski S, Lossnitzer D, Rudic B, Tülümen E, Heggemann F, Schimpf R, Schoenberg SO, Borggrefe M, Papavassiliu T. Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Arch Cardiovasc Dis 2015; 108:356-66. [PMID: 25863428 DOI: 10.1016/j.acvd.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/13/2014] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) causes various degrees of fibrosis resulting in left ventricular function impairment, which can be measured using mitral annular plane systolic excursion (MAPSE). AIMS To determine the values for septal, lateral and average MAPSE using cardiovascular magnetic resonance (CMR) in healthy controls and patients with HCM; and to investigate whether MAPSE correlated with the extent of fibrosis. METHODS Patients with HCM and healthy controls underwent CMR. RESULTS In 50 healthy controls, septal and lateral MAPSE were comparable and showed excellent intra- and inter-observer reliability. Patients with HCM had significantly reduced septal, lateral and average MAPSE compared to healthy controls. Furthermore, in patients with HCM, septal MAPSE measurements were significantly reduced compared to lateral ones. Correspondingly, the septal myocardial segments showed significantly more late gadolinium enhancement (LGE) than lateral ones. No significant differences were found between echocardiographic and CMR MAPSE measurements in healthy controls and patients with HCM. Patients who suffered a major adverse cardiac event or stroke revealed a significantly reduced MAPSE and a significantly greater LGE extent compared to event-free patients with HCM. CONCLUSIONS MAPSE measurement using CMR is feasible, reproducible and comparable to echocardiography in healthy controls and patients with HCM. The asymmetric and mainly septal distribution of myocardial hypertrophy and fibrosis detected by LGE in patients with HCM was reflected by significantly reduced septal versus lateral MAPSE. Therefore, reduced MAPSE seems to be an easily determinable marker of fibrosis accumulation leading to left ventricular mechanical dysfunction and also seems to have a prognostic implication.
Collapse
Affiliation(s)
- Christina Doesch
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany.
| | - Amelie Sperb
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Sonja Sudarski
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Boris Rudic
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Felix Heggemann
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Rainer Schimpf
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| |
Collapse
|
41
|
Riffel JH, Mereles D, Emami M, Korosoglou G, Kristen AV, Aurich M, Voss A, Schonland SO, Hegenbart U, Hardt SE, Katus HA, Buss SJ. Prognostic significance of semiautomatic quantification of left ventricular long axis shortening in systemic light-chain amyloidosis. Amyloid 2015; 22:45-53. [PMID: 25492308 DOI: 10.3109/13506129.2014.992515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To assess left ventricular long axis shortening (LAS) in patients with AL amyloidosis as a potential predictor for outcome. METHODS AND RESULTS We performed a de novo echocardiographic analysis of LAS in 120 patients with biopsy-proven AL amyloidosis evaluated at first presentation before specific treatment. Additionally, 47 control subjects were analyzed retrospectivly. LAS was measured using a semiautomatic tissue motion annular displacement software algorithm (TMAD). LAS was significantly better than ejection fraction (EF) (p < 0.0001) and M-mode-derived mitral annular plane systolic excursion (MAPSE) (p < 0.05) discriminating AL patients from control subjects, while being non-inferior compared to tissue Doppler-derived peak systolic mitral annular velocity. One year outcome analysis in patients with AL amyloidosis showed that LAS remained the only significant echocardiographic parameter (HR:0.76; p < 0.005) in a multivariable Cox regression model of echocardiographic values. In a comprehensive clinical model, LAS (HR:0.72, p < 0.0001), cardiac troponin-T (HR:2.86, p < 0.01) and free light chain difference (HR:1.00; p < 0.05) were independently associated with the outcome. Assessment of LAS led to a significant integrated discrimination improvement and offered incremental information compared to EF and biomarkers. The cut-off value for LAS discriminating the endpoint was 5.8%. CONCLUSION LAS was an independent predictor of survival within the first year and offers incremental information in patients with AL amyloidosis evaluated prior to specific treatment.
Collapse
|
42
|
Longitudinal systolic left ventricular function in preterm and term neonates: reference values of the mitral annular plane systolic excursion (MAPSE) and calculation of z-scores. Pediatr Cardiol 2015; 36:20-6. [PMID: 25077661 DOI: 10.1007/s00246-014-0959-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
The mitral annular plane systolic excursion (MAPSE) is a quick and reliable echocardiographic tool for assessing longitudinal left ventricular (LV) systolic function in children and adults. Because this parameter is affected by the LV longitudinal dimension, pediatric and adult normal values are not suitable for preterm and term neonates. A prospective study investigated a large group of preterm and term neonates [gestational age (GA), 26/0-6 to 40/0-6; birth weight (BW), 670-4,140 g]. The growth- and BW-related changes in MAPSE were determined to establish normal z-score values for preterm and term neonates. The MAPSE ranged from a mean of 0.36 ± 0.05 cm in preterm neonates with a GA of 26/0-6 to 0.56 ± 0.08 cm in term neonates with a GA of 40/0-6. The findings showed MAPSE, GA, and BW to be moderately correlated. Pearson's correlation coefficient was 0.56 for GA (MAPSE; p < 0.001) and 0.58 for BW (MAPSE; p < 0.001). The normal MAPSE values did not differ significantly between females and males (p = 0.946). The absolute values and z-scores of normal MAPSE values in healthy preterm and term neonates within the first 48 h of life were calculated, and percentile charts were established. Determination of LV function using MAPSE might be useful for vulnerable infants for whom a prolonged examination is inappropriate and for neonates with suboptimal visualization of the endocardium.
Collapse
|
43
|
Wenzelburger FW, Tan YT, Choudhary FJ, Lee ES, Leyva F, Sanderson JE. Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction. Eur J Heart Fail 2014; 13:953-60. [DOI: 10.1093/eurjhf/hfr081] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Frauke W.G. Wenzelburger
- Department of Cardiovascular Medicine; University of Birmingham; Birmingham UK
- University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University; Staffordshire UK
| | - Yu Ting Tan
- Department of Cardiovascular Medicine; University of Birmingham; Birmingham UK
| | - Ferrah J. Choudhary
- University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University; Staffordshire UK
| | - Eveline S.P. Lee
- University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University; Staffordshire UK
| | - Francisco Leyva
- Department of Cardiovascular Medicine; University of Birmingham; Birmingham UK
| | - John E. Sanderson
- Department of Cardiovascular Medicine; University of Birmingham; Birmingham UK
- University Hospital of North Staffordshire and Institute for Science and Technology in Medicine, Keele University; Staffordshire UK
| |
Collapse
|
44
|
Koestenberger M, Nagel B, Ravekes W, Avian A, Cvirn G, Rehak T, Gamillscheg A. Reference values of the mitral annular peak systolic velocity (Sm) in 690 healthy pediatric patients, calculation of Z-score values, and comparison to the mitral annular Plane systolic excursion (MAPSE). Echocardiography 2014; 31:1122-30. [PMID: 25271547 DOI: 10.1111/echo.12541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The mitral annular peak systolic velocity (Sm) is an echocardiographic measurement using tissue Doppler imaging to assess longitudinal left ventricular (LV) systolic function in children and adults. We determined growth-related changes in Sm to establish reference values for the entire pediatric age group. METHODS AND RESULTS A prospective study was conducted in a group of 690 healthy pediatric patients (age: 1 day-18 years). We determined the effects of age, sex, and body surface area (BSA) on the Sm values. Regression analysis was used to estimate Sm from age, BSA, and sex. In addition, a correlation of normal Sm with normal age-matched values of the M-mode parameter mitral annular plane systolic excursion (MAPSE) was measured. The Sm ranged from a mean of 5.8 cm/sec (Z-score ±2: 3.6-8.0 cm/sec) in the newborn to 11.8 cm/sec (Z-score ±2: 8.5-15.1 cm/sec) in the 18-year-old adolescent. The Sm values showed a positive correlation with age and BSA with a nonlinear course. There was no significant difference in Sm values between females and males. A significant correlation was found between Sm and MAPSE values. CONCLUSION Z-scores of Sm values were calculated and percentile charts were established to serve as reference data in patients with congenital heart diseases.
Collapse
Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
| | | | | | | | | | | | | |
Collapse
|
45
|
Whalley GA, Wasywich CA, Walsh H, Doughty RN. Role of echocardiography in the contemporary management of chronic heart failure. Expert Rev Cardiovasc Ther 2014; 3:51-70. [PMID: 15723575 DOI: 10.1586/14779072.3.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Echocardiography is an excellent noninvasive tool for the assessment of ventricular size and both systolic and diastolic function, and it is routinely used in patients with heart failure. This review will discuss the role of echocardiography in heart failure diagnosis, prognostic assessment and in the management of heart failure patients.
Collapse
Affiliation(s)
- Gillian A Whalley
- University of Auckland, Department of Medicine, Private Bag 92019, Auckland, New Zealand.
| | | | | | | |
Collapse
|
46
|
Gjesdal O, Almeida ALC, Hopp E, Beitnes JO, Lunde K, Smith HJ, Lima JAC, Edvardsen T. Long axis strain by MRI and echocardiography in a postmyocardial infarct population. J Magn Reson Imaging 2013; 40:1247-51. [PMID: 24214923 DOI: 10.1002/jmri.24485] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 09/21/2013] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare long axis strain (LAS) by magnetic resonance imaging (MRI) and echocardiography in a postinfarct patient population. Long axis left ventricle (LV) function is a sensitive index of incipient heart failure by echocardiography, but is less well established in MRI. LAS is an index of global LV function, which is easily assessed in cine loops provided by most cardiac MRI protocols. MATERIALS AND METHODS In all, 116 patients (57 ± 9 years) were studied the same day using echocardiography and MRI 7.4 ± 4.1 months after a first myocardial infarction. LV length was measured in end diastole and end systole in conventional cine images with a temporal resolution of 50 msec or less, and LAS (%) was calculated as the change in LV length, relative to end diastole. Infarct mass was assessed by contrast-enhanced MRI. RESULTS LAS was progressively reduced in patients with larger infarcts, and demonstrated good correlations with infarct mass (r = 0.55, P < 0.01). There was a good agreement between LAS assessed by echocardiography and MRI (r = 0.77, P < 0.01), and between LAS by MRI and speckle tracking strain by echocardiography (r = 0.74, P < 0.01). CONCLUSION LAS is an index that allows measurement of LV long axis function by conventional cine MRI.
Collapse
Affiliation(s)
- Ola Gjesdal
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Cardiology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Simulation of the contraction of the ventricles in a human heart model including atria and pericardium. Biomech Model Mechanobiol 2013; 13:627-41. [PMID: 23990017 DOI: 10.1007/s10237-013-0523-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
During the contraction of the ventricles, the ventricles interact with the atria as well as with the pericardium and the surrounding tissue in which the heart is embedded. The atria are stretched, and the atrioventricular plane moves toward the apex. The atrioventricular plane displacement (AVPD) is considered to be a major contributor to the ventricular function, and a reduced AVPD is strongly related to heart failure. At the same time, the epicardium slides almost frictionlessly on the pericardium with permanent contact. Although the interaction between the ventricles, the atria and the pericardium plays an important role for the deformation of the heart, this aspect is usually not considered in computational models. In this work, we present an electromechanical model of the heart, which takes into account the interaction between ventricles, pericardium and atria and allows to reproduce the AVPD. To solve the contact problem of epicardium and pericardium, a contact handling algorithm based on penalty formulation was developed, which ensures frictionless and permanent contact. Two simulations of the ventricular contraction were conducted, one with contact handling of pericardium and heart and one without. In the simulation with contact handling, the atria were stretched during the contraction of the ventricles, while, due to the permanent contact with the pericardium, their volume increased. In contrast to that, in the simulations without pericardium, the atria were also stretched, but the change in the atrial volume was much smaller. Furthermore, the pericardium reduced the radial contraction of the ventricles and at the same time increased the AVPD.
Collapse
|
48
|
Lisi M, Henein M, Cameli M, Ballo P, Reccia R, Bennati E, Chiavarelli M, Maccherini M, Mondillo S. Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain. Int J Cardiol 2013; 167:1450-5. [DOI: 10.1016/j.ijcard.2012.04.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/18/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
|
49
|
D’Ascenzi F, Cameli M, Henein M, Iadanza A, Reccia R, Lisi M, Curci V, Sinicropi G, Torrisi A, Pierli C, Mondillo S. Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study. Int J Cardiovasc Imaging 2013; 29:1717-24. [DOI: 10.1007/s10554-013-0265-z] [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: 05/19/2013] [Accepted: 07/04/2013] [Indexed: 12/01/2022]
|
50
|
Koestenberger M, Ravekes W, Nagel B, Avian A, Heinzl B, Fritsch P, Sorantin E, Cvirn G, Rehak T, Gamillscheg A. Longitudinal systolic ventricular interaction in pediatric and young adult patients with TOF: a cardiac magnetic resonance and M-mode echocardiographic study. Int J Cardiovasc Imaging 2013; 29:1707-15. [DOI: 10.1007/s10554-013-0261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
|