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Ding W, Li L, Qiu J, Wang S, Huang L, Chen Y, Yang S, Zhuang X. Aligning Multi-Sequence CMR Towards Fully Automated Myocardial Pathology Segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:3474-3486. [PMID: 37347625 DOI: 10.1109/tmi.2023.3288046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Myocardial pathology segmentation (MyoPS) is critical for the risk stratification and treatment planning of myocardial infarction (MI). Multi-sequence cardiac magnetic resonance (MS-CMR) images can provide valuable information. For instance, balanced steady-state free precession cine sequences present clear anatomical boundaries, while late gadolinium enhancement and T2-weighted CMR sequences visualize myocardial scar and edema of MI, respectively. Existing methods usually fuse anatomical and pathological information from different CMR sequences for MyoPS, but assume that these images have been spatially aligned. However, MS-CMR images are usually unaligned due to the respiratory motions in clinical practices, which poses additional challenges for MyoPS. This work presents an automatic MyoPS framework for unaligned MS-CMR images. Specifically, we design a combined computing model for simultaneous image registration and information fusion, which aggregates multi-sequence features into a common space to extract anatomical structures (i.e., myocardium). Consequently, we can highlight the informative regions in the common space via the extracted myocardium to improve MyoPS performance, considering the spatial relationship between myocardial pathologies and myocardium. Experiments on a private MS-CMR dataset and a public dataset from the MYOPS2020 challenge show that our framework could achieve promising performance for fully automatic MyoPS.
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Cho Y, Ueda T, Kotani S, Okada K, Ozawa K, Shimura S, Shimizu H. AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure. Int J Cardiol 2023; 391:131277. [PMID: 37598910 DOI: 10.1016/j.ijcard.2023.131277] [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: 04/20/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.
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Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Thoshihiko Ueda
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sohsyu Kotani
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Kimiaki Okada
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Keisuke Ozawa
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichiro Shimura
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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3
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Hegeman RRMJJ, McManus S, van Kuijk JP, Harb SC, Swaans MJ, Klein P, Puri R. Inward Displacement: A Novel Method of Regional Left Ventricular Functional Assessment for Left Ventriculoplasty Interventions in Heart Failure with Reduced Ejection Fraction (HFrEF). J Clin Med 2023; 12:jcm12051997. [PMID: 36902783 PMCID: PMC10003768 DOI: 10.3390/jcm12051997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hybrid minimally invasive left ventricular reconstruction is used to treat patients with ischemic heart failure with reduced ejection fraction (HFrEF) and antero-apical scar. Pre- and post-procedural regional functional left ventricular assessment with current imaging techniques remains limited. We evaluated 'inward displacement' as a novel technique of assessing regional left ventricular function in an ischemic HFrEF population who underwent left ventricular reconstruction with the Revivent System. METHODS Inward displacement adopts three standard long-axis views obtained during cardiac MRI or CT and assesses the degree of inward endocardial wall motion towards the true left ventricular center of contraction. For each of the standard 17 left ventricular segments, regional inward displacement is measured in mm and expressed as a percentage of the maximal theoretical distance each segment can contract towards the centerline. The left ventricle was divided into three regions, obtaining the arithmetic average of inward displacement or speckle tracking echocardiographic strain at the left ventricular base (segments 1-6), mid-cavity (segments 7-12) and apex (segments 13-17). Inward displacement was measured using computed tomography or cardiac magnetic resonance imaging and compared pre- and post-procedurally in ischemic HFrEF patients who underwent left ventricular reconstruction with the Revivent System (n = 36). In a subset of patients who underwent baseline speckle tracking echocardiography, pre-procedural inward displacement was compared with left ventricular regional echocardiographic strain (n = 15). RESULTS Inward displacement of basal and mid-cavity left ventricular segments increased by 27% (p < 0.001) and 37% (p < 0.001), respectively, following left ventricular reconstruction. A significant overall decrease in both the left ventricular end systolic volume index and end diastolic volume index of 31% (p < 0.001) and 26% (p < 0.001), respectively, was detected, along with a 20% increase in left ventricular ejection fraction (p = 0.005). A significant correlation between inward displacement and speckle tracking echocardiographic strain was noted within the basal (R = -0.77, p < 0.001) and mid-cavity left ventricular segments (R = -0.65, p = 0.004), respectively. Inward displacement resulted in relatively larger measurement values compared to speckle tracking echocardiography, with a mean difference of absolute values of -3.33 and -7.41 for the left ventricular base and mid-cavity, respectively. CONCLUSIONS Obviating the limitations of echocardiography, inward displacement was found to highly correlate with speckle tracking echocardiographic strain to evaluate regional segmental left ventricular function. Significant improvements in basal and mid-cavity left ventricular contractility were demonstrated in ischemic HFrEF patients following left ventricular reconstruction of large antero-apical scars, consistent with the concept of reverse left ventricular remodeling at a distance. Inward displacement holds significant promise in the HFrEF population being evaluated pre- and post-left ventriculoplasty procedures.
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Affiliation(s)
- Romy R. M. J. J. Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
- Correspondence: ; Tel.: +31-(0)631-103-506
| | | | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Martin J. Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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4
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Govil S, Mauger C, Hegde S, Occleshaw CJ, Yu X, Perry JC, Young AA, Omens JH, McCulloch AD. Biventricular shape modes discriminate pulmonary valve replacement in tetralogy of Fallot better than imaging indices. Sci Rep 2023; 13:2335. [PMID: 36759522 PMCID: PMC9911768 DOI: 10.1038/s41598-023-28358-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Current indications for pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (rTOF) rely on cardiovascular magnetic resonance (CMR) image-based indices but are inconsistently applied, lead to mixed outcomes, and remain debated. This study aimed to test the hypothesis that specific markers of biventricular shape may discriminate differences between rTOF patients who did and did not require subsequent PVR better than standard imaging indices. In this cross-sectional retrospective study, biventricular shape models were customized to CMR images from 84 rTOF patients. A statistical atlas of end-diastolic shape was constructed using principal component analysis. Multivariate regression was used to quantify shape mode and imaging index associations with subsequent intervention status (PVR, n = 48 vs. No-PVR, n = 36), while accounting for confounders. Clustering analysis was used to test the ability of the most significant shape modes and imaging indices to discriminate PVR status as evaluated by a Matthews correlation coefficient (MCC). Geometric strain analysis was also conducted to assess shape mode associations with systolic function. PVR status correlated significantly with shape modes associated with right ventricular (RV) apical dilation and left ventricular (LV) dilation (p < 0.01), RV basal bulging and LV conicity (p < 0.05), and pulmonary valve dilation (p < 0.01). PVR status also correlated significantly with RV ejection fraction (p < 0.05) and correlated marginally with LV end-systolic volume index (p < 0.07). Shape modes discriminated subsequent PVR better than standard imaging indices (MCC = 0.49 and MCC = 0.28, respectively) and were significantly associated with RV and LV radial systolic strain. Biventricular shape modes discriminated differences between patients who did and did not require subsequent PVR better than standard imaging indices in current use. These regional features of cardiac morphology may provide insight into adaptive vs. maladaptive types of structural remodeling and point toward an improved quantitative, patient-specific assessment tool for clinical use.
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Affiliation(s)
- Sachin Govil
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Charlène Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | | | - Xiaoyang Yu
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - James C Perry
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Cardiology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.,Department of Biomedical Engineering, King's College London, London, UK
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, MC 0412, La Jolla, CA, 92093-0412, USA.
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Chuah SH, Md Sari NA, Chew BT, Tan LK, Chiam YK, Chan BT, Lim E, Abdul Aziz YF, Liew YM. Phenotyping of hypertensive heart disease and hypertrophic cardiomyopathy using personalized 3D modelling and cardiac cine MRI. Phys Med 2020; 78:137-149. [PMID: 33007738 DOI: 10.1016/j.ejmp.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 12/24/2022] Open
Abstract
Differential diagnosis of hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) is clinically challenging but important for treatment management. This study aims to phenotype HHD and HCM in 3D + time domain by using a multiparametric motion-corrected personalized modeling algorithm and cardiac magnetic resonance (CMR). 44 CMR data, including 12 healthy, 16 HHD and 16 HCM cases, were examined. Multiple CMR phenotype data consisting of geometric and dynamic variables were extracted globally and regionally from the models over a full cardiac cycle for comparison against healthy models and clinical reports. Statistical classifications were used to identify the distinctive characteristics and disease subtypes with overlapping functional data, providing insights into the challenges for differential diagnosis of both types of disease. While HCM is characterized by localized extreme hypertrophy of the LV, wall thickening/contraction/strain was found to be normal and in sync, though it was occasionally exaggerated at normotrophic/less severely hypertrophic regions during systole to preserve the overall ejection fraction (EF) and systolic functionality. Additionally, we observed that hypertrophy in HHD could also be localized, although at less extreme conditions (i.e. more concentric). While fibrosis occurs mostly in those HCM cases with aortic obstruction, only minority of HHD patients were found affected by fibrosis. We demonstrate that subgroups of HHD (i.e. preserved and reduced EF: HHDpEF & HHDrEF) have different 3D + time CMR characteristics. While HHDpEF has cardiac functions in normal range, dilation and heart failure are indicated in HHDrEF as reflected by low LV wall thickening/contraction/strain and synchrony, as well as much reduced EF.
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Affiliation(s)
- Shoon Hui Chuah
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nor Ashikin Md Sari
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Bee Teng Chew
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yin Kia Chiam
- Department of Software Engineering, Faculty of Computer Science and Information Technology, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia.
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7
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Hammouda K, Khalifa F, Abdeltawab H, Elnakib A, Giridharan GA, Zhu M, Ng CK, Dassanayaka S, Kong M, Darwish HE, Mohamed TMA, Jones SP, El-Baz A. A New Framework for Performing Cardiac Strain Analysis from Cine MRI Imaging in Mice. Sci Rep 2020; 10:7725. [PMID: 32382124 PMCID: PMC7205890 DOI: 10.1038/s41598-020-64206-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/13/2020] [Indexed: 01/17/2023] Open
Abstract
Cardiac magnetic resonance (MR) imaging is one of the most rigorous form of imaging to assess cardiac function in vivo. Strain analysis allows comprehensive assessment of diastolic myocardial function, which is not indicated by measuring systolic functional parameters using with a normal cine imaging module. Due to the small heart size in mice, it is not possible to perform proper tagged imaging to assess strain. Here, we developed a novel deep learning approach for automated quantification of strain from cardiac cine MR images. Our framework starts by an accurate localization of the LV blood pool center-point using a fully convolutional neural network (FCN) architecture. Then, a region of interest (ROI) that contains the LV is extracted from all heart sections. The extracted ROIs are used for the segmentation of the LV cavity and myocardium via a novel FCN architecture. For strain analysis, we developed a Laplace-based approach to track the LV wall points by solving the Laplace equation between the LV contours of each two successive image frames over the cardiac cycle. Following tracking, the strain estimation is performed using the Lagrangian-based approach. This new automated system for strain analysis was validated by comparing the outcome of these analysis with the tagged MR images from the same mice. There were no significant differences between the strain data obtained from our algorithm using cine compared to tagged MR imaging. Furthermore, we demonstrated that our new algorithm can determine the strain differences between normal and diseased hearts.
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Affiliation(s)
- K Hammouda
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - F Khalifa
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - H Abdeltawab
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - A Elnakib
- Electronics and Communications Engineering Department, Faculty of Engineeering, Mansoura University, Mansoura, Egypt
| | - G A Giridharan
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, USA
| | - M Zhu
- Department of Radiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - C K Ng
- Department of Radiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - S Dassanayaka
- Diabetes and Obesity Center, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - M Kong
- Department of Bioinformatics and Biostatistics, SPHIS, University of Louisville, Louisville, KY, USA
| | - H E Darwish
- Mathematics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - T M A Mohamed
- Diabetes and Obesity Center, Department of Medicine, University of Louisville, Louisville, KY, USA
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - S P Jones
- Diabetes and Obesity Center, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - A El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, KY, USA.
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8
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Obata JE, Horikoshi T, Nakamura T, Kugiyama K. Sustained endothelial dysfunction in the infarct-related coronary artery is associated with left ventricular adverse remodeling in survivors of ST-segment elevation myocardial infarction. J Cardiol 2019; 75:261-269. [PMID: 31447080 DOI: 10.1016/j.jjcc.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ischemia-reperfusion causes endothelial injury and dysfunction in the infarct-related coronary artery (IRA). Using serial assessment of coronary endothelial vasomotor function and left ventriculography (LVG), this study prospectively investigated the clinical impact of endothelial vasomotor dysfunction in the patent IRA on left ventricular (LV) remodeling in survivors of ST-elevation myocardial infarction (STEMI). METHODS This study included 78 patients with STEMI due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy with percutaneous coronary intervention. All of them had LV ejection fraction (LVEF) <55%. LVG and the vasomotor responses to acetylcholine (ACh) in the LAD were examined within 2 weeks (1st test) and 6 months (2nd test) after MI. Cut-off values for coronary vasomotor dysfunction in response to ACh were based on the lower 10% of the distribution of coronary vasomotor responses to ACh in 20 control subjects. RESULTS LV adverse remodeling, defined as a >10% increase in either LV end-diastolic volume index (LVEDVI) and/or end-systolic volume index (LVESVI) from the 1st to the 2nd test, occurred in 21 (70%) of 30 patients with sustained impairment of the coronary flow response to ACh at both the 1st and 2nd tests and 14 (29%) of 48 in the other coronary flow response group (p < 0.01). In multivariate logistic regression analysis, a >10% increase in LVEDVI and LVESVI was respectively associated with sustained impairment of the coronary diameter and flow responses to ACh (OR 4.9 and 3.5, 95% CI 1.7-14.1 and 1.1-10.9, p < 0.01 and p = 0.03, respectively), that was independent of hypertension, peak creatine phosphokinase, and the baseline coronary flow response to ACh at the 1st test. CONCLUSIONS Sustained endothelial vasomotor dysfunction in the IRA was associated with LV adverse remodeling in STEMI survivors with successful reperfusion therapy.
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Affiliation(s)
- Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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9
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Feldmann KJ, Goldstein JA, Marinescu V, Dixon SR, Raff GL. Disparate Impact of Ischemic Injury on Regional Wall Dysfunction in Acute Anterior vs Inferior Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:965-972. [PMID: 30611651 DOI: 10.1016/j.carrev.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute transmural ischemia should induce similar magnitude of wall motion abnormality (WMA) in both anterior myocardial infarction (AMI) and inferior (IMI). However, patients with AMI generally suffer more severe hemodynamic compromise. METHODS This retrospective study compared WMA's in ST segment elevation MI patients undergoing primary reperfusion and subsequent cardiac MRI. Regional systolic wall motion and thickening were assessed in all segments throughout the left ventricle (LV). RESULTS We analyzed 37 patients (AMI = 24 vs IMI = 13). Reperfusion success was achieved in all and there were no differences between groups in door-to-balloon time (AMI median 77 vs IMI 119 min, p = 0.085). Compared to IMI, in AMI LV ejection fraction was more depressed (37 ± 7.6% vs 51 ± 10.3%, P = 0.0006) and regional WMA more severe (total regional WMA score = 2.63 ± 0.53 vs IMI = 2.1 ± 0.52, P = 0.007). Regional dyskinesis was commonly observed in AMI patients but was rare in IMI (79% vs 7% of cases). Similarly, AMI manifested systolic thinning, whereas thickening was depressed but still present in IMI patients. Strikingly, WMA severity differed downstream relative to the origin of the infarct artery: In all AMI cases, WMA worsened from proximal anterior toward the distal apical zone; in IMI the pattern was reverse, with WMA consistently most severe in the basal segment of the inferior-posterior wall with preservation toward the apical distribution of the infarct vessel. CONCLUSION These results demonstrate a disparate impact of ischemic injury on mechanical performance of the anterior vs inferior-posterior walls. These findings may be attributable to differences between the walls in architecture, mechanics and coronary blood flow. These observations may have implications for myocardial salvage, remodeling and prognosis.
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Affiliation(s)
- Kyle J Feldmann
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - James A Goldstein
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA.
| | - Victor Marinescu
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - Gilbert L Raff
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
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10
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Khalid A, Lim E, Chan BT, Abdul Aziz YF, Chee KH, Yap HJ, Liew YM. Assessing regional left ventricular thickening dysfunction and dyssynchrony via personalized modeling and 3D wall thickness measurements for acute myocardial infarction. J Magn Reson Imaging 2018; 49:1006-1019. [PMID: 30211445 DOI: 10.1002/jmri.26302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Existing clinical diagnostic and assessment methods could be improved to facilitate early detection and treatment of cardiac dysfunction associated with acute myocardial infarction (AMI) to reduce morbidity and mortality. PURPOSE To develop 3D personalized left ventricular (LV) models and thickening assessment framework for assessing regional wall thickening dysfunction and dyssynchrony in AMI patients. STUDY TYPE Retrospective study, diagnostic accuracy. SUBJECTS Forty-four subjects consisting of 15 healthy subjects and 29 AMI patients. FIELD STRENGTH/SEQUENCE 1.5T/steady-state free precession cine MRI scans; LGE MRI scans. ASSESSMENT Quantitative thickening measurements across all cardiac phases were correlated and validated against clinical evaluation of infarct transmurality by an experienced cardiac radiologist based on the American Heart Association (AHA) 17-segment model. STATISTICAL TEST Nonparametric 2-k related sample-based Kruskal-Wallis test; Mann-Whitney U-test; Pearson's correlation coefficient. RESULTS Healthy LV wall segments undergo significant wall thickening (P < 0.05) during ejection and have on average a thicker wall (8.73 ± 1.01 mm) compared with infarcted wall segments (2.86 ± 1.11 mm). Myocardium with thick infarct (ie, >50% transmurality) underwent remarkable wall thinning during contraction (thickening index [TI] = 1.46 ± 0.26 mm) as opposed to healthy myocardium (TI = 4.01 ± 1.04 mm). For AMI patients, LV that showed signs of thinning were found to be associated with a significantly higher percentage of dyssynchrony as compared with healthy subjects (dyssynchrony index [DI] = 15.0 ± 5.0% vs. 7.5 ± 2.0%, P < 0.01). Also, a strong correlation was found between our TI and left ventricular ejection fraction (LVEF) (r = 0.892, P < 0.01), and moderate correlation between DI and LVEF (r = 0.494, P < 0.01). DATA CONCLUSION The extracted regional wall thickening and DIs are shown to be strongly correlated with infarct severity, therefore suggestive of possible practical clinical utility. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1006-1019.
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Affiliation(s)
- Amirah Khalid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yang Faridah Abdul Aziz
- University Malaya Research Imaging Centre, Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine Building, University of Malaya, Kuala Lumpur, Malaysia
| | - Hwa Jen Yap
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
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11
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Tsuchida K, Nishida K, Soda S, Akiyama T, Hakamata T, Sudo K, Tanaka K, Hosaka Y, Takahashi K, Oda H. Impact of glycemic variability on myocardial infarct size in patients with ST-segment elevation myocardial infarction: quantitative assessment of left ventricular wall motion severity. Cardiovasc Interv Ther 2018; 34:122-130. [PMID: 29808351 DOI: 10.1007/s12928-018-0531-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/24/2018] [Indexed: 02/07/2023]
Abstract
Glycemic variability (GV) is relevant to impaired myocardial salvage in acute ST-elevation myocardial infarction (STEMI). Severity of hypokinesis at the infarct site as assessed from contrast left ventriculography can reportedly predict infarct size in STEMI. We prospectively studied 58 consecutive patients (mean age, 63 ± 11 years) with anterior or inferior STEMI who underwent successful reperfusion therapy. Mean amplitude of glucose excursion (MAGE) was obtained from continuous glucose monitoring system. Patients were divided into the upper tertile of MAGE as Group H, and the other two-thirds as Group L. Serial regional wall motion severity at the infarct site was computed postprocedure and at follow-up using a quantitative left ventricular analysis system. Impaired myocardial salvage was defined as severity recovery ratio < 20%. Significantly shorter onset-to-balloon time (196.9 vs. 279.0 min, p = 0.033) and relatively lower postprocedural wall motion severity (2.4 vs. 2.9, p = 0.096) were observed in Group H, but absolute severity recovery was significantly smaller in Group H (0.5 vs. 1.3, p = 0.017). Multivariate analysis showed higher MAGE as predictive of impaired myocardial salvage (OR, 406.10; 95% CI, 4.41-37,366.60; p = 0.009). Recovery of reginal wall motion severity at the infarct site was compromised in STEMI patients with higher MAGE. Our results suggest that final infarct size is potentially larger than expected in STEMI patients with higher GV.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan.
| | - Kota Nishida
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Satoshi Soda
- Department of Endocrinology and Metabolism, Niigata City General Hospital, Niigata, Japan
| | - Takumi Akiyama
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Takahiro Hakamata
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Koji Sudo
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Komei Tanaka
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Yukio Hosaka
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Kazuyoshi Takahashi
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan
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12
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Caresio C, Salvi M, Molinari F, Meiburger KM, Minetto MA. Fully Automated Muscle Ultrasound Analysis (MUSA): Robust and Accurate Muscle Thickness Measurement. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:195-205. [PMID: 27720522 DOI: 10.1016/j.ultrasmedbio.2016.08.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/01/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
Musculoskeletal ultrasound imaging allows non-invasive measurement of skeletal muscle thickness. Current techniques generally suffer from manual operator dependency, while all the computer-aided approaches are limited to be semi-automatic or specifically optimized for a single muscle. The aim of this study was to develop and validate a fully automatic method, named MUSA (Muscle UltraSound Analysis), for measurement of muscle thickness on longitudinal ultrasound images acquired from different skeletal muscles. The MUSA algorithm was tested on a database of 200 B-mode ultrasound images of rectus femoris, vastus lateralis, tibialis anterior and medial gastrocnemius. The automatic muscle thickness measurements were compared to the manual measurements obtained by three operators. The MUSA algorithm achieved a 100% segmentation success rate, with mean differences between the automatic and manual measurements in the range of 0.06-0.45 mm. MUSA performance was statistically equal to the operators and its measurement accuracy was independent of the muscle thickness value.
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Affiliation(s)
- Cristina Caresio
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Massimo Salvi
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
| | - Kristen M Meiburger
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Marco Alessandro Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy; Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
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13
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Comparison between a count-based and geometrical approach for the assessment of left ventricular dyssynchrony using myocardial perfusion scintigraphy. Nucl Med Commun 2016; 37:1125-35. [PMID: 27383191 DOI: 10.1097/mnm.0000000000000574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are two distinct approaches for the assessment of left ventricular (LV) dyssynchrony by myocardial perfusion scintigraphy (MPS). The aim of this study was to compare the performance of the count-based and geometrical approach in clinical data using gated single photon emission computed tomography MPS. MATERIAL AND METHODS Group 1 consisted of 113 patients (49 men, 64 women) with normal perfusion [summed rest score (SRS)≤3], normal LV ejection fraction (≥55%), and normal QRS duration (QRSd<120 ms). Group 2 consisted of 89 heart failure patients (79 men, 10 women) with no restriction for SRS, LV ejection fraction ≤35%, and QRSd ≥120 ms. All MPS parameters were obtained from the software Corridor4DM. Dyssynchrony parameters used were time to peak contraction, SD, and bandwidth (BW). RESULTS SD and BW were estimated higher (difference group 1: SD 3.0±2.3 and BW 11.3±9.3, P-values <0.001; difference group 2: SD 2.4±4.3 and BW 1.3±17.0, P-value <0.001 and 0.479 respectively) using the count-based approach in comparison with the geometrical method. A significant and good correlation was found between these two methods (R=0.763, 0.902, 0.896 for time to peak contraction, SD, and BW respectively, P-values ≤0.001). SD and BW in both approaches were equally good parameters for differentiating heart failure patients (area under the curve: 0.995-0.998), although using different cut-off values. CONCLUSION The count-based approach generally provides a wider phase distribution and subsequently greater SD and BW estimates compared with the geometrical algorithm. These differences result in clinically relevant deviations in normal and cut-off values that have to be recognized when evaluating patients.
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14
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Schwarz ER, Gupta R, Diep TP, Nowak B, Kostin S, Grohmann B, Uretsky BF, Schaper J. Carvedilol Improves Myocardial Contractility Compared With Metoprolol in Patients With Chronic Hibernating Myocardium After Revascularization. J Cardiovasc Pharmacol Ther 2016; 10:181-90. [PMID: 16211207 DOI: 10.1177/107424840501000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: We tested the hypothesis of whether carvedilol delays morphologic degeneration and improves functional outcome compared with metoprolol tartrate in patients with hibernating myocardium undergoing surgical revascularization. We have previously shown that patients with chronic hibernating myocardium undergo progressive cellular degeneration and fibrosis. Methods: Twenty patients with multivessel coronary artery disease revascularization and hibernating myocardium as assessed by technetium-99m perfusion scintigraphy and fluorine-18-fluorodeoxyglucose positron emission tomography were randomized to receive either carvedilol or metoprolol tartrate for at least 2 months before surgery, and this was continued for 7 months postoperatively. Left ventricular ejection fraction and regional wall motion abnormalities were assessed by left ventriculography at baseline and 7 months postoperatively. Intraoperative transmural needle biopsy samples were obtained for microscopic analysis. Results: Postoperatively, the ejection fraction increased from 31% ± 5% to 44% ± 4% ( P < .005) in the carvedilol group (n = 10), and from 30% ± 6% to 40% ± 6% in the metoprolol tartrate group ( P < .05 vs preoperatively and vs carvedilol). Wall motion abnormalities in the carvedilol group improved from -2.1 ± 0.4 to -0.6 ± 0.5 ( P < .05) and from -2.3 ± 0.5 to -1.6 ± 0.6 in the metoprolol tartrate group ( P < .05 vs preoperatively and vs carvedilol). Microscopic analysis after 72 ± 18 days of either treatment showed mild cardiomyocyte degeneration and moderate-to-severe fibrosis (28% ± 7%) in the carvedilol group compared with moderate cardiomyocyte degeneration and moderate-to-severe fibrosis (33% ± 6%) in the metoprolol tartrate group. Apoptosis, as assessed by the terminal deoxynucleotidyl transferase nick end labeling method, was observed in only 1 patient in each group. Conclusions: Carvedilol treatment of hibernating myocardium results in improved functional recovery after revascularization compared with metoprolol tartrate, and this might partially be related to reduced cardiomyocyte degeneration.
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Affiliation(s)
- Ernst R Schwarz
- Division of Cardiology, Department of Medicine, University of Texas Medical Branch, Galveston, TX 77555-0553, USA.
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15
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van Deel E, Ridwan Y, van Vliet JN, Belenkov S, Essers J. In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography. J Vis Exp 2016:53603. [PMID: 26967592 PMCID: PMC4828165 DOI: 10.3791/53603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of Micro-Computed Tomography (MicroCT) for in vivo studies of small animals as models of human disease has risen tremendously due to the fact that MicroCT provides quantitative high-resolution three-dimensional (3D) anatomical data non-destructively and longitudinally. Most importantly, with the development of a novel preclinical iodinated contrast agent called eXIA160, functional and metabolic assessment of the heart became possible. However, prior to the advent of commercial MicroCT scanners equipped with X-ray flat-panel detector technology and easy-to-use cardio-respiratory gating, preclinical studies of cardiovascular disease (CVD) in small animals required a MicroCT technologist with advanced skills, and thus were impractical for widespread implementation. The goal of this work is to provide a practical guide to the use of the high-speed Quantum FX MicroCT system for comprehensive determination of myocardial global and regional function along with assessment of myocardial perfusion, metabolism and viability in healthy mice and in a cardiac ischemia mouse model induced by permanent occlusion of the left anterior descending coronary artery (LAD).
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Affiliation(s)
- Elza van Deel
- Department of Genetics, Erasmus MC, Rotterdam; Department of Experimental Cardiology, Erasmus MC, Rotterdam
| | | | | | | | - Jeroen Essers
- Department of Genetics, Erasmus MC, Rotterdam; Department of Vascular Surgery, Erasmus MC, Rotterdam; Department of Radiation Oncology, Erasmus MC, Rotterdam;
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16
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Bickel C, Schnabel RB, Zeller T, Lackner KJ, Rupprecht HJ, Blankenberg S, Sinning C, Westermann D. Predictors of leptin concentration and association with cardiovascular risk in patients with coronary artery disease: results from the AtheroGene study. Biomarkers 2016; 22:210-218. [PMID: 26769430 DOI: 10.3109/1354750x.2015.1130745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT Leptin is produced in white adipose tissue, but also in human coronary atherosclerotic lesions. OBJECTIVE The aim of this study is to assess the prognostic value of leptin in patients with proven coronary artery disease (CAD) (N = 1907). METHODS AtheroGene is a contemporary CAD cohort study (N = 3229). Median follow-up time was 3.8 (Quartile 1/3 with 2.8/4.9) years. RESULTS Leptin concentration was associated with a hazard ratio (HR) for the fully adjusted model of HR = 1.32 in women but was not significant in men. The endpoint cardiovascular death and non-fatal myocardial infarction was observed in 167 patients. CONCLUSION In women with known CAD, increased leptin concentration is useful for predicting cardiovascular death and non-fatal myocardial infarction.
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Affiliation(s)
- Christoph Bickel
- a Department of Internal Medicine , Federal Armed Forces Central Hospital , Koblenz , Germany
| | - Renate B Schnabel
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Tanja Zeller
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Karl J Lackner
- c Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz , Mainz , Germany
| | - Hans J Rupprecht
- d Department of Medicine II , GPR Rüsselsheim , Rüsselsheim , Germany
| | - Stefan Blankenberg
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Christoph Sinning
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
| | - Dirk Westermann
- b Department of General and Interventional Cardiology , University Heart Center Hamburg , Hamburg , Germany
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17
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Kaneko H, Suzuki S, Uejima T, Kano H, Matsuno S, Takai H, Oikawa Y, Yajima J, Aizawa T, Yamashita T. Functional mitral regurgitation and left ventricular systolic dysfunction in the recent era of cardiovascular clinical practice, an observational cohort study. Hypertens Res 2014; 37:1082-7. [PMID: 25164208 DOI: 10.1038/hr.2014.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 11/09/2022]
Abstract
Functional mitral regurgitation (MR) is frequently associated with left ventricular systolic dysfunction (LVSD). Ventricular volume overload that occurs in patients with MR may lead to a progression of myocardial dysfunction. However, the prevalence and clinical outcomes of functional MR in Japanese patients with LVSD remain unclear. The aim of the present study is to clarify the prevalence and prognosis of functional MR in Japanese LVSD patients in the contemporary era. We followed patients with LVSD (LV ejection fraction (LVEF) ⩽ 40%) who were listed within a single, hospital-based cohort in the Shinken Database from 2004 to 2011, which was composed of all new patients (n = 17,517) who visited the Cardiovascular Institute. A total of 506 patients were included: 86 FMR (moderate-to-severe functional MR) patients and 420 non-FMR (none or mild functional MR) patients. FMR patients were older, had lower rates of hypertension and ischemic heart disease but had higher rates of chronic kidney disease, dilated cardiomyopathy and New York Heart Association III/IV classification. FMR patients had higher brain natriuretic peptide levels and lower LVEF. The Kaplan-Meier curves revealed that the incidence of all-cause death, cardiovascular death and heart failure (HF) admission was significantly higher in FMR patients. The presence of FMR was independently associated with a significantly higher risk of composite end point, including all-cause death and/or HF admission (hazard ratio 1.551, 95% confidence interval 1.045-2.303, P = 0.029). FMR was common in Japanese patients with LVSD and was associated with adverse long-term outcomes. Future study is warranted to establish the optimal therapeutic strategy for FMR and LVSD.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hideaki Takai
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tadanori Aizawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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18
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Matsumoto M, Yasuda S, Miyazaki S, Kataoka Y, Hosoda H, Nagaya N, Noguchi T, Morii I, Ogawa H, Kangawa K. Decreased serum ghrelin levels in patients with acute myocardial infarction. TOHOKU J EXP MED 2014; 231:235-42. [PMID: 24240664 DOI: 10.1620/tjem.231.235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ghrelin is a novel growth hormone-releasing peptide isolated from the stomach and possesses various cardioprotective effects, including energy balance improvement and regulation of autonomic nervous system activity. We investigated the changes in serum ghrelin levels and its association with cardiac function and myocardial infarct size in patients with acute myocardial infarction (AMI). Forty-seven consecutive patients were divided into the following 4 groups: 16 patients with AMI, 12 patients with unstable angina pectoris (UAP), 13 patients with stable angina pectoris (SAP), and 6 control patients. Serum levels were measured with the ELISA kit. Compared to the control (72 ± 26 fmol/mL), SAP (69 ± 47 fmol/mL), and UAP (72 ± 31 fmol/mL) groups, serum ghrelin levels on admission were significantly lower in the AMI group (27 ± 12 fmol/mL, P < 0.01). After admission, the serum ghrelin level gradually increased (30 ± 15 fmol/mL on day 2 and 39 ± 18 fmol/mL on day 7) and became significantly higher on day 14 (49 ± 28 fmol/mL, P < 0.01), compared to the level on admission. In patients with AMI, the ratio of day 14 to admission serum ghrelin levels, an index of AMI-related acute changes in ghrelin, correlated positively with peak creatine phosphokinase levels (R = 0.72, P < 0.01) and the double products (R = 0.60, P < 0.01) and inversely with left ventricular ejection fraction (R = -0.53, P < 0.05). In conclusion, serum ghrelin levels are significantly decreased in association with myocardial infarct size and cardiac function.
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Affiliation(s)
- Manabu Matsumoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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19
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Fransson H, Ljungberg M, Carlsson M, Engblom H, Arheden H, Heiberg E. Validation of an automated method to quantify stress-induced ischemia and infarction in rest-stress myocardial perfusion SPECT. J Nucl Cardiol 2014; 21:503-18. [PMID: 24532031 DOI: 10.1007/s12350-014-9863-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial perfusion SPECT (MPS) is one of the frequently used methods for quantification of perfusion defects in patients with known or suspected coronary artery disease. This article describes open access software for automated quantification in MPS of stress-induced ischemia and infarction and provides phantom and in vivo validation. METHODS AND RESULTS A total of 492 patients with known or suspected coronary artery disease underwent both stress and rest MPS. The proposed perfusion analysis algorithm (Segment) was trained in 140 patients and validated in the remaining 352 patients using visual scoring in MPS by an expert reader as reference standard. Furthermore, validation was performed with simulated perfusion defects in an anthropomorphic computer model. Total perfusion deficit (TPD, range 0-100), including both extent and severity of the perfusion defect, was used as the global measurement of the perfusion defects. Mean bias ± SD between TPD by Segment and the simulated TPD was 3.6 ± 3.8 (R(2) = 0.92). Mean bias ± SD between TPD by Segment and the visual scoring in the patients was 1.2 ± 2.9 (R (2)= 0.64) for stress-induced ischemia and -0.3 ± 3.1 (R(2) = 0.86) for infarction. CONCLUSION The proposed algorithm can detect and quantify perfusion defects in MPS with good agreement to expert readers and to simulated values in a computer phantom.
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Affiliation(s)
- Helen Fransson
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund University Hospital, 221 85, Lund, Sweden,
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20
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Adhyapak SM, Parachuri VR. Stroke volume paradox in heart failure: mathematical validation. Asian Cardiovasc Thorac Ann 2014; 22:288-95. [PMID: 24585904 DOI: 10.1177/0218492313483583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In some patients with ischemic cardiomyopathy, despite large increases in ventricular size with decreased cardiac output, the paradox of preserved stroke volume has been observed. Following surgical ventricular restoration, despite marked improvements clinically and in ventricular volumes and ejection fraction, a decrease in stroke volume was observed. METHODS 101 consecutive patients with postinfarction left ventricular aneurysms were studied by 2-dimensional echocardiography and contrast ventriculography at baseline, and 57 of these patients at 1.7 to 2.2 years (mean 1.95 ± 0.44 years) after surgical ventricular restoration. RESULTS Surgical ventricular restoration resulted in a decrease in end-diastolic volume index of 40.2 mL (95% confidence interval: 33.6-46.7) and stroke volume index of 10.0 mL (95% confidence interval: 6.6-13.5), and an increase in ejection fraction of 6.7% (95% confidence interval: 5.5-7.9). The stroke volume index had a significant linear relationship with the end-diastolic volume index at rest in patients with end-diastolic volume index < 150 mL (r = 0.64, p < 0.001). In patients with end-diastolic volume index >150 mL, this linear relationship was not seen. The change in end-diastolic volume index and stroke volume index had a significant linear relationship (r = 0.72, p < 0.001) that persisted at 1.95 years after surgery. CONCLUSIONS In ischemic cardiomyopathy, stroke volume increases linearly with increases in end-diastolic volume up to a certain magnitude of end-diastolic volume, beyond which it decreases. Hence, following surgical ventricular restoration, decreases in stroke volume are not a reflection of impaired cardiac function.
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Zhao XY, Hu SJ, Li J, Mou Y, Bian K, Sun J, Zhu ZH. rAAV-asPLB transfer attenuates abnormal sarcoplasmic reticulum Ca2+-ATPase activity and cardiac dysfunction in rats with myocardial infarction. Eur J Heart Fail 2014; 10:47-54. [PMID: 18096433 DOI: 10.1016/j.ejheart.2007.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 08/22/2007] [Accepted: 10/19/2007] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xiao-Yan Zhao
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
| | - Shen-Jiang Hu
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
- E-Institute of Shanghai Universities, Division of Nitric Oxide and Inflammatory Medicine; China
| | - Jiang Li
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
| | - Yun Mou
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
| | - Ka Bian
- Department of Integrative Biology and Pharmacology; The University of Texas-Houston Medical School; 6431 Fannin Houston TX 77030 USA
- E-Institute of Shanghai Universities, Division of Nitric Oxide and Inflammatory Medicine; China
| | - Jian Sun
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
| | - Zhao-Hui Zhu
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University; 79 Qingchun Road Hangzhou 310003 China
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The shape and function of the left ventricle in Ebstein's anomaly. Int J Cardiol 2013; 171:404-12. [PMID: 24411210 DOI: 10.1016/j.ijcard.2013.12.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/17/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Left ventricular (LV) failure is common in Ebstein's anomaly, though remains poorly understood. We investigated whether shape deformity impacts LV function. METHODS Three-dimensional models of the right ventricle (RV) and LV from 29 adult Ebstein's patients and nine normal subjects were generated from cardiac magnetic resonance image tracings. LV end diastolic (ED) shape, systolic function, septal motion and ventricular interaction were analyzed. RESULTS LV ED volume index was normal in Ebstein's (75 ± 19 vs. 78 ± 11 ml/m(2) in normals, p=0.50) but the LV was basally narrowed and modestly dilated apically. LV function was reduced globally (ejection fraction (EF) 41 ± 7 vs. 57 ± 5% in normals, p<0.0001) and regionally (decreased mean segment displacement at end systole (ES) in 12/16 segments, basal Z-scores -2.1 to -1.0). Septal dyskinesis was suggested by outward mean segment displacement in at least one basal septal segment in 25 patients (86%) but refuted by septal thickening in 14 (48%), normal septal curvature at ED and ES, and by visually evident basal LV anterior translation in 27 patients (93%). LV EF correlated better with normalized tricuspid annular plane systolic excursion (r=0.70) than with RV EF (r=0.42) or RVEDVI (r=0.18). CONCLUSIONS Although the Ebstein's LV has preserved volume, it exhibits basal narrowing, modest apical dilation and global hypokinesis. The apparent basal septal dyskinesis observed in most patients is likely attributable to anterior cardiac translation rather than true paradoxical motion. LV EF is unaffected by RV volume, correlating well instead with RV longitudinal shortening.
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Taimouri V, Hua J. Visualization of shape motions in shape space. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2013; 19:2644-2652. [PMID: 24051831 DOI: 10.1109/tvcg.2013.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Analysis of dynamic object deformations such as cardiac motion is of great importance, especially when there is a necessity to visualize and compare the deformation behavior across subjects. However, there is a lack of effective techniques for comparative visualization and assessment of a collection of motion data due to its 4-dimensional nature, i.e., timely varying three-dimensional shapes. From the geometric point of view, the motion change can be considered as a function defined on the 2D manifold of the surface. This paper presents a novel classification and visualization method based on a medial surface shape space, in which two novel shape descriptors are defined, for discriminating normal and abnormal human heart deformations as well as localizing the abnormal motion regions. In our medial surface shape space, the geodesic distance connecting two points in the space measures the similarity between their corresponding medial surfaces, which can quantify the similarity and disparity of the 3D heart motions. Furthermore, the novel descriptors can effectively localize the inconsistently deforming myopathic regions on the left ventricle. An easy visualization of heart motion sequences on the projected space allows users to distinguish the deformation differences. Our experimental results on both synthetic and real imaging data show that this method can automatically classify the healthy and myopathic subjects and accurately detect myopathic regions on the left ventricle, which outperforms other conventional cardiac diagnostic methods.
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Affiliation(s)
- Vahid Taimouri
- Wayne State University and Children's Hospital Boston, Harvard Medical School
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Morcos M, Sheehan FH. Regional right ventricular wall motion in tetralogy of fallot: a three dimensional analysis. Int J Cardiovasc Imaging 2013; 29:1051-8. [PMID: 23292150 DOI: 10.1007/s10554-012-0178-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/29/2012] [Indexed: 11/25/2022]
Abstract
We observed an abnormal contraction pattern in the right ventricle (RV) in postoperative tetralogy of Fallot (TOF) patients when measuring the regional contribution to global stroke volume (rSV) of 20 RV slices from apex to base. We compared the rSV method's performance with the centersurface method which offers greater flexibility in defining regions of interest. We reconstructed the RV in 3D from manually traced borders in 20 repaired TOF patients and nine normal subjects from cardiac magnetic resonance images. Wall motion was measured as the local orthogonal distance between the RV endocardium at end diastole and end systole. The RV was divided into septum, conus, and 10 free wall regions. For comparison with the rSV method the free wall regions were grouped into apical, mid, and basal levels. The RV was also divided into two other 3-part models for comparison. Both rSV and centersurface methods showed that TOF patients have diminished function at the base and increased function at the apex compared to normal. The other 3-part models were less informative because large region size obscured local function abnormalities. Septal and free wall motion differed between the groups. Two analysis methods agreed that patients with TOF have a pattern of relatively increased wall motion at the apex and diminished function at the base compared to normal. The centersurface analysis showed that characterization of the RV's complex pattern of regional function requires more than three RV subdivisions.
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Affiliation(s)
- Michael Morcos
- Cardiovascular Research and Training Center, University of Washington, Box 356422, Seattle, WA 98195-6422, USA
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Turan RG, Bozdag-T I, Turan CH, Ortak J, Akin I, Kische S, Schneider H, Rauchhaus M, Rehders TC, Kleinfeldt T, Belu C, Amen S, Hermann T, Yokus S, Brehm M, Steiner S, Chatterjee T, Sahin K, Nienaber CA, Ince H. Enhanced mobilization of the bone marrow-derived circulating progenitor cells by intracoronary freshly isolated bone marrow cells transplantation in patients with acute myocardial infarction. J Cell Mol Med 2012; 16:852-64. [PMID: 21707914 PMCID: PMC3822854 DOI: 10.1111/j.1582-4934.2011.01358.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Autologous bone marrow cell transplantation (BMCs-Tx) is a promising novel option for treatment of cardiovascular disease. We analysed in a randomized controlled study the influence of the intracoronary autologous freshly isolated BMCs-Tx on the mobilization of bone marrow–derived circulating progenitor cells (BM-CPCs) in patients with acute myocardial infarction (AMI). Sixty-two patients with AMI were randomized to either freshly isolated BMCs-Tx or to a control group without cell therapy. Peripheral blood (PB) concentrations of CD34/45+- and CD133/45+-circulating progenitor cells were measured by flow cytometry in 42 AMI patients with cell therapy as well as in 20 AMI patients without cell therapy as a control group on days 1, 3, 5, 7, 8 and 3, 6 as well as 12 months after AMI. Global ejection fraction (EF) and the size of infarct area were determined by left ventriculography. We observed in patients with freshly isolated BMCs-Tx at 3 and 12 months follow up a significant reduction of infarct size and increase of global EF as well as infarct wall movement velocity. The mobilization of CD34/45+ and CD133/45+ BM-CPCs significantly increased with a peak on day 7 as compared to baseline after AMI in both groups (CD34/45+: P < 0.001, CD133/45+: P < 0.001). Moreover, this significant mobilization of BM-CPCs existed 3, 6 and 12 months after cell therapy compared to day 1 after AMI. In control group, there were no significant differences of CD34/45+ and CD133/45+ BM-CPCs mobilization between day 1 and 3, 6 and 12 months after AMI. Intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system in patients with AMI may enhance and prolong the mobilization of CD34/45+ and CD133/45+ BM-CPCs in PB and this might increase the regenerative potency after AMI.
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Affiliation(s)
- R G Turan
- Division of Cardiology, Department of Internal Medicine, University Hospital Rostock, Rostock, Germany.
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Cho Y, Ueda T, Inoue Y, Shimura S, Aki A, Furuya H, Okada K, Tanaka C. Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation. Eur J Cardiothorac Surg 2012; 42:462-9. [DOI: 10.1093/ejcts/ezs363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bozdag-Turan I, Turan RG, Ludovicy S, Akin I, Kische S, Schneider H, Rehders TC, Turan CH, Arsoy NS, Hermann T, Paranskaya L, Ortak J, Kohlschein P, Bastian M, Sahin K, Nienaber CA, Ince H. Intra coronary freshly isolated bone marrow cells transplantation improve cardiac function in patients with ischemic heart disease. BMC Res Notes 2012; 5:195. [PMID: 22534049 PMCID: PMC3436745 DOI: 10.1186/1756-0500-5-195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 04/05/2012] [Indexed: 01/14/2023] Open
Abstract
Background Autologous bone marrow cell transplantation (BMCs-Tx) is a promising novel option for treatment of cardiovascular disease. In this study we analyzed whether intracoronary autologous freshly isolated BMCs-Tx have beneficial effects on cardiac function in patients with ischemic heart disease (IHD). Results In this prospective nonrandomized study we treated 12 patients with IHD by freshly isolated BMCs-Tx by use of point of care system and compared them with a representative 12 control group without cell therapy. Global ejection fraction (EF) and infarct size area were determined by left ventriculography. Intracoronary transplantation of autologous freshly isolated BMCs led to a significant reduction of infarct size (p < 0.001) and an increase of global EF (p = 0.003) as well as infarct wall movement velocity (p < 0.001) after 6 months follow-up compared to control group. In control group there were no significant differences of global EF, infarct size and infarct wall movement velocity between baseline and 6 months after coronary angiography. Furthermore, we found significant decrease in New York Heart Association (NYHA) as well as significant decrease of B-type natriuretic peptide (BNP) level 6 months after intracoronary cell therapy (p < 0.001), whereas there were no significant differences in control group 6 months after coronary angiography. Conclusions These results demonstrate that intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system is safe and may lead to improvement of cardiac function in patients with IHD. Trial registration Registration number: ISRCTN54510226
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Affiliation(s)
- Ilkay Bozdag-Turan
- Department of Internal Medicine, Division of Cardiology, Rostock-University, Ernst Hydemann Str 6, Rostock 18055, Germany
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Petersen JW, Forder JR, Thomas JD, Moyé LA, Lawson M, Loghin C, Traverse JH, Baraniuk S, Silva G, Pepine CJ. Quantification of myocardial segmental function in acute and chronic ischemic heart disease and implications for cardiovascular cell therapy trials: a review from the NHLBI-Cardiovascular Cell Therapy Research Network. JACC Cardiovasc Imaging 2012; 4:671-9. [PMID: 21679903 DOI: 10.1016/j.jcmg.2011.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/11/2011] [Accepted: 02/10/2011] [Indexed: 12/01/2022]
Abstract
Global left ventricular (LV) ejection fraction (LVEF) has been used as a measure of improvement in LV function following cell therapy. Although the impact of cell therapy on LVEF in short- and long-term follow-up has been generally positive, there is concern that research evaluating regional therapeutics (e.g., cell or gene therapy) may require analysis of regional LV function localized to the site of intervention. Regional LV assessment is traditionally performed with qualitative or quantitative analysis of wall thickening within 16 myocardial segments, but advances in noninvasive imaging permit an increasingly more detailed and accurate evaluation of LV function. Wall-thickness measurements can now include evaluation of over 1,000 myocardial segments. In addition to higher resolution measures of wall thickening, automated assessments of myocardial segment deformation, such as strain imaging, exist. Strain imaging allows for direct evaluation of the mechanical properties that may improve following regional therapeutic intervention. Improvements in regional LV function may also be assessed by determining regional ejection fraction (EF). Regional EF offers the advantage of summarizing the end result of all of the complex deformations in the adjacent myocardial segments. Although regional EF and strain imaging, as compared with wall thickening, enhance detection of improvement in complex measures of regional myocardial function, it remains unclear whether such measures are better able to predict meaningful improvement in clinical outcomes.
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Affiliation(s)
- John W Petersen
- University of Florida College of Medicine, Gainesville, Florida, USA
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Uchida Y, Ichimiya S, Ishii H, Kanashiro M, Watanabe J, Yoshikawa D, Takeshita K, Sakai S, Amano T, Matsubara T, Murohara T. Impact of plaque burden in the left main coronary artery determined by intravascular ultrasound on cardiovascular events in a Japanese population undergoing percutaneous coronary intervention. Am J Cardiol 2012; 109:352-8. [PMID: 22071210 DOI: 10.1016/j.amjcard.2011.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 09/29/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
Abstract
The left main coronary artery (LMCA) is a particularly important target of atherosclerotic plaque accumulation. The aim of this study was to investigate the connection between subclinical plaque burden in the LMCA measured by intravascular ultrasound and future cardiovascular events. Two hundred eighteen consecutive patients underwent percutaneous coronary intervention for the left anterior descending coronary artery or the left circumflex coronary artery under intravascular ultrasound guidance. Plaque burden in the LMCA was analyzed for these patients, and major adverse cardiac events were also evaluated. Data were analyzed by grouping the patients into tertiles according to plaque burden values; tertile 1, <32% area stenosis; tertile 2, 32% to 45% area stenosis; and tertile 3, >45% area stenosis. During a 3-year follow-up period (average 16.1 months), 12% of tertile 1, 18% of tertile 2, and 40% of tertile 3 experienced major adverse cardiac events, mostly due to repeat revascularization (p <0.001). On Cox multivariate analysis, plaque burden in the LMCA (per percentage) detected by intravascular ultrasound remained an independent significant predictor of major adverse cardiac events (hazard ratio 1.04, 95% confidence interval 1.02 to 1.07) and future revascularization (hazard ratio 1.05, 95% confidence interval 1.02 to 1.07) (p <0.001). In conclusion, plaque burden in the LMCA is useful as an indicator of coronary atherosclerosis and may be a significant predictor of cardiovascular events, especially revascularization.
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New automated Markov-Gibbs random field based framework for myocardial wall viability quantification on agent enhanced cardiac magnetic resonance images. Int J Cardiovasc Imaging 2011; 28:1683-98. [PMID: 22160668 DOI: 10.1007/s10554-011-9991-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
Abstract
A novel automated framework for detecting and quantifying viability from agent enhanced cardiac magnetic resonance images is proposed. The framework identifies the pathological tissues based on a joint Markov-Gibbs random field (MGRF) model that accounts for the 1st-order visual appearance of the myocardial wall (in terms of the pixel-wise intensities) and the 2nd-order spatial interactions between pixels. The pathological tissue is quantified based on two metrics: the percentage area in each segment with respect to the total area of the segment, and the trans-wall extent of the pathological tissue. This transmural extent is estimated using point-to-point correspondences based on a Laplace partial differential equation. Transmural extent was validated using a simulated phantom. We tested the proposed framework on 14 datasets (168 images) and validated against manual expert delineation of the pathological tissue by two observers. Mean Dice similarity coefficients (DSC) of 0.90 and 0.88 were obtained for the observers, approaching the ideal value, 1. The Bland-Altman statistic of infarct volumes estimated by manual versus the MGRF estimation revealed little bias difference, and most values fell within the 95% confidence interval, suggesting very good agreement. Using the DSC measure we documented statistically significant superior segmentation performance for our MGRF method versus established intensity-based methods (greater DSC, and smaller standard deviation). Our Laplace method showed good operating characteristics across the full range of extent of transmural infarct, outperforming conventional methods. Phantom validation and experiments on patient data confirmed the robustness and accuracy of the proposed framework.
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Grover S, Srinivasan G, Selvanayagam JB. Evaluation of myocardial viability with cardiac magnetic resonance imaging. Prog Cardiovasc Dis 2011; 54:204-14. [PMID: 22014488 DOI: 10.1016/j.pcad.2011.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Assessment of myocardial viability is of clinical and scientific significance. Traditionally, the detection of myocardial viability (either stunning or hibernation) has been used in aiding diagnosis before revascularization, especially in high-risk patients. There is a considerable body of observational evidence showing substantial improvement after revascularization in patients with significant left ventricular dysfunction and myocardial viability. Recent randomized evidence has questioned the benefit of viability testing but must be interpreted with caution. Dobutamine stress echocardiography, nuclear imaging, and cardiovascular magnetic resonance are the mainstays of viability testing and provide information on contractile function, cellular metabolism, and myocardial fibrosis, respectively. Larger, multicenter trials with outcome data are needed to define the nature of viability testing and, particularly, cardiovascular magnetic resonance in moderate-to-severe ischemic cardiomyopathy.
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Affiliation(s)
- Suchi Grover
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia
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van der Veen BJ, Al Younis I, Ajmone-Marsan N, Westenberg JJM, Bax JJ, Stokkel MPM, de Roos A. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study. Eur J Nucl Med Mol Imaging 2011; 39:421-9. [PMID: 22113618 PMCID: PMC3276773 DOI: 10.1007/s00259-011-1991-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/02/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Left ventricular dyssynchrony may predict response to cardiac resynchronization therapy and may well predict adverse cardiac events. Recently, a geometrical approach for dyssynchrony analysis of myocardial perfusion scintigraphy (MPS) was introduced. In this study the feasibility of this geometrical method to detect dyssynchrony was assessed in a population with a normal MPS and in patients with documented ventricular dyssynchrony. METHODS For the normal population 80 patients (40 men and 40 women) with normal perfusion (summed stress score ≤2 and summed rest score ≤2) and function (left ventricular ejection fraction 55-80%) on MPS were selected; 24 heart failure patients with proven dyssynchrony on MRI were selected for comparison. All patients underwent a 2-day stress/rest MPS protocol. Perfusion, function and dyssynchrony parameters were obtained by the Corridor4DM software package (Version 6.1). RESULTS For the normal population time to peak motion was 42.8 ± 5.1% RR cycle, SD of time to peak motion was 3.5 ± 1.4% RR cycle and bandwidth was 18.2 ± 6.0% RR cycle. No significant gender-related differences or differences between rest and post-stress acquisition were found for the dyssynchrony parameters. Discrepancies between the normal and abnormal populations were most profound for the mean wall motion (p value <0.001), SD of time to peak motion (p value <0.001) and bandwidth (p value <0.001). CONCLUSION It is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM.
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Turan RG, Bozdag-T I, Ortak J, Kische S, Akin I, Schneider H, Turan CH, Rehders TC, Rauchhaus M, Kleinfeldt T, Belu C, Brehm M, Yokus S, Steiner S, Sahin K, Nienaber CA, Ince H. Improved functional activity of bone marrow derived circulating progenitor cells after intra coronary freshly isolated bone marrow cells transplantation in patients with ischemic heart disease. Stem Cell Rev Rep 2011; 7:646-56. [PMID: 21188654 PMCID: PMC3137778 DOI: 10.1007/s12015-010-9220-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives There is growing evidence that intracoronary autologous bone marrow cells transplantation (BMCs-Tx) in patients with chronic myocardial infarction beneficially affects postinfarction remodelling. In this randomized controlled study we analyzed the influence of intracoronary autologous freshly isolated bone marrow cells transplantation by use of point of care system on cardiac function and on the functional activity of bone marrow derived circulating progenitor cells (BM-CPCs) in patients with ischemic heart disease (IHD). Methods 56 patients with IHD were randomized to either received freshly isolated BMC-Tx or a control group that did not receive cell therapy. The functional activity of BM-CPCs in peripheral blood (PB) was measured by migration assay and colony forming unit assay pre- and 3, 6 as well as 12 months after procedure. Global ejection fraction (EF) and infarct size area were determined by left ventriculography. Results Intracoronary transplantation of autologous freshly isolated BMCs led to a significant reduction of infarct size and an increase of global EF as well as infarct wall movement velocity after 3 and 12 months follow-up compared to control group. The colony-forming capacity of BM-CPCs significantly increased 3, 6 and 12 months after cell therapy compared to pre BMCs-Tx and control group (CFU-E: p < 0.001, CFU-GM: p < 0.001). Likewise, we found significant increase of migratory response to stromal cell-derived factor 1 (SDF-1) and vascular endothelial growth factor (VEGF) after cell therapy compared to pre BMCs-Tx (SDF-1: p < 0.001, VEGF: p < 0.001) and to control (SDF-1: p < 0.001, VEGF: p < 0.001). There was no significant difference of migratory- and colony forming capacity between pre- and 3, 6, 12 months after coronary angiography in control group without cell therapy. Conclusions Intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system may lead to improvement of BM-CPCs functional activity in peripheral blood, which might increase the regenerative potency in patients with IHD.
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Affiliation(s)
- R Goekmen Turan
- Department of Internal Medicine, Division of Cardiology, Rostock-University, Ernst Hydemann Str 6, 18055, Rostock, Germany.
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Eicosapentaenoic acid reduces ischemic ventricular fibrillation via altering monophasic action potential in pigs. J Mol Cell Cardiol 2011; 51:329-36. [DOI: 10.1016/j.yjmcc.2011.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/13/2011] [Accepted: 05/23/2011] [Indexed: 11/22/2022]
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Wang XF, Zhang JY, Li L, Zhao XY, Tao HL, Zhang L. Metformin improves cardiac function in rats via activation of AMP-activated protein kinase. Clin Exp Pharmacol Physiol 2011; 38:94-101. [PMID: 21143620 DOI: 10.1111/j.1440-1681.2010.05470.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
1. Metformin is one of the most commonly used drugs for the treatment of Type 2 diabetes. Accumulating evidence suggests that metformin also has cardioprotective effects. In the present study, we investigated the cardioprotective effects of metformin and the mechanisms involved. 2. A rat model of chronic heart failure was established by permanent left coronary artery occlusion. Heart failure rats were randomly divided into four groups: (i) a saline-treated group given 4 mL/kg day via intragastric gavage; (ii) a metformin-treated group, given 100 mg/kg metformin once daily via intragastric gavage; (iii) a group treated with 5 mg/kg 5'-aminoimidazole-4-carboxyamide-ribonucleoside (AICAR), an AMP-activated protein kinase (AMPK) agonist, every second day; and (iv) a group treated with 100 mg/kg per day metformin + 20 mg/kg, i.p., compound C (an AMPK antagonist). After 4 weeks treatment, echocardiography was used to assess left ventricular (LV) dimensions and function. Expression of AMPK, endothelial nitric oxide synthase (eNOS) and transforming growth factor (TGF)-β1 was determined by reverse transcription-polymerase chain reaction and western blot analysis. 3. Metformin administration significantly improved cardiac function and LV remodelling, as evidenced by increases in LV systolic pressure and LV ejection fraction and decreases in LV end-diastolic diameter and LV end-systolic diameter. These beneficial effects of metformin were associated with increased AMPK and eNOS phosphorylation, as well as reductions in insulin, TGF-β1, basic fibroblast growth factor and tumour necrosis factor-α levels in the circulation and/or myocardium. 4. The results indicate that chronic low-dose metformin confers significant cardioprotective effects against chronic heart failure by activating the AMPK-eNOS pathway.
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Affiliation(s)
- Xiao-Fang Wang
- Department of Cardiology, First Affiliated Hospital, College of Medicine, Zhengzhou University, Zhengzhou, China
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TZOU WENDYS, ZADO ERICAS, LIN DAVID, CALLANS DAVIDJ, DIXIT SANJAY, COOPER JOSHUAM, BALA RUPA, GARCIA FERMIN, HUTCHINSON MATHEWD, RILEY MICHAELP, DEO RAJAT, GERSTENFELD EDWARDP, MARCHLINSKI FRANCISE. Sinus Rhythm ECG Criteria Associated with Basal-Lateral Ventricular Tachycardia Substrate in Patients with Nonischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2011; 22:1351-8. [DOI: 10.1111/j.1540-8167.2011.02129.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brown SB, Raina A, Katz D, Szerlip M, Wiegers SE, Forfia PR. Longitudinal Shortening Accounts for the Majority of Right Ventricular Contraction and Improves After Pulmonary Vasodilator Therapy in Normal Subjects and Patients With Pulmonary Arterial Hypertension. Chest 2011; 140:27-33. [DOI: 10.1378/chest.10-1136] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J Thorac Cardiovasc Surg 2011; 141:905-16, 916.e1-4. [DOI: 10.1016/j.jtcvs.2010.10.026] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 10/11/2010] [Accepted: 10/16/2010] [Indexed: 11/21/2022]
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The first clinical pilot study of intravenous adrenomedullin administration in patients with acute myocardial infarction. J Cardiovasc Pharmacol 2011; 56:413-9. [PMID: 20930593 DOI: 10.1097/fjc.0b013e3181f15b45] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adrenomedullin (AM) is a 52-amino-acid vasodilator peptide that was originally isolated from human pheochromocytoma. In the previous experimental study with rat ischemia/reperfusion model, AM reduced infarct size and inhibited myocyte apoptosis. AM also suppressed the production of oxygen-free radicals. The present study was designed to evaluate the feasibility of intravenous administration of AM in patients with acute myocardial infarction. We studied 10 patients with first acute myocardial infarction [male to female ratio: 9 to 1, age: 65 ± 9 (mean ± SD) years, peak creatine phosphokinase level: 4215 ± 1933 (SD) U/L], who were hospitalized within 12 hours of symptom onset. Proceeding reperfusion therapy, AM infusion was initiated and continued at concentration of 0.0125-0.025 μg·kg·min for 12 hours. Follow-up coronary angiography and left ventriculography were performed at 3 months. Cardiac magnetic resonance was examined at 1 month and 3 months after AM therapy. During infusion of AM, hemodynamics kept stable except 2 patients. Wall motion index in the infarct area at 3 months was significantly improved compared with that at baseline, and infarct size evaluated by cardiac magnetic resonance was significantly decreased at 3 months. In conclusion, intravenous administration of AM, which possesses a variety of potential cardiovascular protective actions, can be adjunctive to percutaneous coronary intervention.
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Turan RG, Bozdag-Turan I, Ortak J, Akin I, Kische S, Schneider H, Rehders TC, Turan CH, Rauchhaus M, Kleinfeldt T, Chatterjee T, Sahin K, Nienaber CA, Ince H. Improvement of cardiac function by intracoronary freshly isolated bone marrow cells transplantation in patients with acute myocardial infarction. Circ J 2011; 75:683-91. [PMID: 21266786 DOI: 10.1253/circj.cj-10-0817] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We analyzed in the present study the influence of intracoronary autologous freshly isolated bone marrow cells transplantation (BMCs-Tx) on cardiac function in patients with acute myocardial infarction (AMI). METHODS AND RESULTS The 32 patients with AMI were enrolled in this prospective nonrandomized study to either freshly isolated BMC-Tx or to a control group without cell therapy. Global left ventricular ejection fraction (LVEF) and the size of infarct area were determined by left ventriculography. We observed in patients with autologous freshly isolated BMCs-Tx at 6 months follow up a significant reduction of infarct size as compared to control group. Moreover, we found a significant increase of LVEF as well as infarct wall movement velocity at 6 months follow up in cell therapy group as compared to control group. In the control group there was no significant difference of LVEF, infarct size and infarct wall movement velocity between baseline and 6 months after AMI. CONCLUSIONS These results demonstrate for the first time that intracoronary transplantation of autologous freshly isolated BMCs by use of a point of care system is safe, and may lead to improvement of cardiac function in patients with AMI.
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Affiliation(s)
- Ramazan Gökmen Turan
- Department of Internal Medicine, Division of Cardiology, Rostock-University, Ernst Hydemann Str 6, 18055 Rostock, Germany.
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Gao JY, Yasuda S, Tsuburaya R, Ito Y, Shiroto T, Hao K, Aizawa K, Kikuchi Y, Ito K, Shimokawa H. Long-Term Treatment With Eicosapentaenoic Acid Ameliorates Myocardial Ischemia-Reperfusion Injury in Pigs In Vivo - Involvement of Rho-Kinase Pathway Inhibition -. Circ J 2011; 75:1843-51. [DOI: 10.1253/circj.cj-11-0209] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jun Yi Gao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Ryuji Tsuburaya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoshitaka Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kentaro Aizawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoku Kikuchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Turan RG, Bozdag-Turan I, Ortak J, Akin I, Kische S, Schneider H, Turan CH, Rehders TC, Rauchhaus M, Kleinfeldt T, Adolph E, Brehm M, Yokus S, Steiner S, Sahin K, Nienaber CA, Ince H. Improved mobilization of the CD34(+) and CD133(+) bone marrow-derived circulating progenitor cells by freshly isolated intracoronary bone marrow cell transplantation in patients with ischemic heart disease. Stem Cells Dev 2010; 20:1491-501. [PMID: 21190450 DOI: 10.1089/scd.2010.0373] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cell therapy is a promising novel option for treatment of cardiovascular disease. Because the role of bone marrow-derived circulating progenitor cells (BM-CPCs) after cell therapy is less clear, we analyzed in this randomized, controlled study the influence of intracoronary autologous freshly isolated bone marrow cell transplantation (BMC-Tx) by using a point-of-care system on cardiac function and on the mobilization of BM-CPCs in patients with ischemic heart disease (IHD). Fifty-six patients with IHD were randomized to either receive freshly isolated BMC-Tx or a control group that did not receive cell therapy. Peripheral blood concentrations of CD34/45(+) and CD133/45(+) CPCs were measured by flow cytometry pre-, immediately post-, and at 3, 6, and 12 months postprocedure in both groups. Global ejection fraction and the size of infarct area were determined by left ventriculography. We observed in patients with IHD after intracoronary transplantation of autologous freshly isolated BMCs-Tx at 3 and 12 months follow-up a significant reduction of the size of infarct area and increase of global ejection fraction as well as infarct wall movement velocity. The mobilization of CD34/45(+) and CD133/45(+) BM-CPCs significantly increased at 3, 6, and 12 months after cell therapy when compared with baseline in patients with IHD, although no significant changes were observed between pre- and immediately postintracoronary cell therapy administration. In the control group without cell therapy, there was no significant difference of CD34/45(+) and CD133/45(+) BM-CPCs mobilization between pre- and at 3, 6, and 12 months postcoronary angiography. Intracoronary transplantation of autologous freshly isolated BMCs by using a point-of-care system in patients with IHD may enhance and prolong the mobilization of CD34/45(+) and CD133/45(+) BM-CPCs in peripheral blood and this might increase the regenerative potency in IHD.
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Affiliation(s)
- Ramazan Gökmen Turan
- Division of Cardiology, Department of Internal Medicine, Rostock-University, Rostock, Germany.
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Steigen TK, Buller CE, Mancini GBJ, Jorapur V, Cantor WJ, Rankin JM, Thomas B, Webb JG, Kronsberg SS, Atchison DJ, Lamas GA, Hochman JS, Džavík V. Myocardial perfusion grade after late infarct artery recanalization is associated with global and regional left ventricular function at one year: analysis from the Total Occlusion Study of Canada-2. Circ Cardiovasc Interv 2010; 3:549-55. [PMID: 21062997 DOI: 10.1161/circinterventions.109.918722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether myocardial perfusion grade (MPG) following late recanalization of infarct-related arteries (IRAs) predicts left ventricular (LV) function recovery beyond the acute phase of myocardial infarction (MI) is unknown. METHODS AND RESULTS The Total Occlusion Study of Canada-2 enrolled stable patients with a persistently occluded IRA beyond 24 hours and up to 28 days post-MI. We studied the relationship between the initial MPG and changes in LV function and volume as well as the change in MPG from immediate post-percutaneous coronary intervention (PCI) to 1 year in 139 PCI patients with thrombolysis in myocardial infarction grade 3 epicardial flow post-PCI and with paired values grouped into impaired or good MPG groups (MPG 0/1 or MPG 2/3). MPG 0/1 patients were more likely to have received thrombolytic therapy and to have a left anterior descending IRA. They had lower blood pressure and LV ejection fraction (LVEF) and a higher heart rate and systolic sphericity index at baseline. Changes in the MPG 0/1 and MPG 2/3 groups from baseline to 1 year were LVEF, 3.3±9.0% and 4.8±8.9% (P=0.42); LV end-systolic volume index (LVESVI), -1.1±9.2 and -4.7±12.3 mL/m(2) (P=0.25); LV end-diastolic volume index (LVEDVI), 0.08±19.1 and -2.4±22.2 mL/m(2) (P=0.67); and SDs/chord for infarct zone wall motion index (WMI), 0.38±0.70 and 0.84±1.11 (P=0.01). By covariate-adjusted analysis, post-PCI MPG 0/1 predicted lower WMI (P<0.001), lower LVEF (P<0.001), and higher LVESVI (P<0.01) but not LVEDVI at 1 year. Of the MPG 0/1 patients, 60% were MPG 2 or 3 at 1 year. CONCLUSIONS Preserved MPG is present in a high proportion of patients following late PCI of occluded IRAs post-MI. Poor MPG post-PCI frequently improves MPG over 1 year. MPG graded after IRA recanalization undertaken days to weeks post MI is associated with LV recovery, indicating that MPG determined in the subacute post-MI period remains a marker of viability. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00025766.
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Soneson H, Engblom H, Hedström E, Bouvier F, Sörensson P, Pernow J, Arheden H, Heiberg E. An automatic method for quantification of myocardium at risk from myocardial perfusion SPECT in patients with acute coronary occlusion. J Nucl Cardiol 2010; 17:831-40. [PMID: 20440591 DOI: 10.1007/s12350-010-9237-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/15/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND In order to determine myocardial salvage, accurate quantification of myocardium at risk (MaR) is necessary. We present a validated novel automatic segmentation algorithm for quantification of MaR by myocardial perfusion SPECT (MPS) in patients with acute coronary occlusion. METHODS AND RESULTS Twenty-nine patients with coronary occlusion were injected with a perfusion tracer before reperfusion, and underwent rest MPS within 4 hours. The MaR was quantified using the proposed algorithm (Segment software), the software Quantitative Perfusion SPECT (QPS) and by manual segmentation. The Segment MaR algorithm used a threshold of 55% of maximal counts and an a priori model based on normal coronary artery perfusion territories. The MaR was 30 ± 10% left ventricular mass (%LVM) by manual segmentation, 31 ± 12%LVM by Segment, and 36 ± 14%LVM by QPS. There was a good agreement between automatic and manual segmentation for both of the algorithms with a lower bias for Segment (.8 ± 4.0%LVM) than for QPS (5.8 ± 5.8%LVM) when compared to manual segmentation. CONCLUSIONS The Segment MaR algorithm can be used to correctly assess MaR from MPS images in patients with acute coronary occlusion without access to tracer-specific normal database. The MaR in relation to final infarct size enables determination of myocardial salvage.
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Affiliation(s)
- Helen Soneson
- Department of Clinical Physiology, Skåne University Hospital, Lund University, 221 85 Lund, Sweden
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Strauer BE, Yousef M, Schannwell CM. The acute and long-term effects of intracoronary Stem cell Transplantation in 191 patients with chronic heARt failure: the STAR-heart study. Eur J Heart Fail 2010; 12:721-9. [PMID: 20576835 DOI: 10.1093/eurjhf/hfq095] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Despite accumulated evidence that intracoronary bone marrow cell (BMC) therapy may be beneficial in acute myocardial infarction, there are only limited data available on the effectiveness of BMC's in chronic heart failure. The aim of this study was to quantitatively investigate ventricular haemodynamics, geometry, and contractility as well as the long-term clinical outcome of BMC treated patients with reduced left ventricular ejection fraction (LVEF) due to chronic ischaemic cardiomyopathy. METHODS AND RESULTS Patients with chronic heart failure (n = 391 LVEF <or=35%) due to ischaemic cardiomyopathy were enrolled in the present study. Of these, 191 patients (mean NYHA class 3.22) underwent intracoronary BMC therapy. The control group (mean NYHA class 3.06) consisted of 200 patients with comparable LVEF. Assessments of haemodynamics at rest and exercise, quantitative ventriculography, spiroergometry, 24 h Holter ECG, late potentials, and heart rate variability were analysed. Over 3 months to 5 years after intracoronary BMC therapy there was a significant improvement in haemodynamics (e.g. LVEF, cardiac index), exercise capacity, oxygen uptake, and LV contractility. Importantly, there was a significant decrease in long-term mortality in the BMC treated patients compared with the control group. CONCLUSION Intracoronary BMC therapy improves ventricular performance, quality of life and survival in patients with heart failure. These effects were present when BMC were administered in addition to standard therapeutic regimes. No side effects were observed.
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Affiliation(s)
- Bodo-Eckehard Strauer
- Department of Medicine, Division of Cardiology, Pneumology and Angiology, Heinrich-Heine-University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany.
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Abstract
OBJECTIVES To develop a simple method to assess right ventricular function by angiography. BACKGROUND Conventional methods of evaluating right ventricular function are inaccurate, cumbersome, and expensive. METHODS We analyzed biplane right ventricular angiograms taken in the posterior-anterior and lateral projections using software to measure right ventricular volumes and regional wall motion in 78 patients with normal hearts (n = 29), atrial septal defects (ASD n = 13), pulmonary valve stenosis (PVS n = 21), and postoperative atrial switch patients (n = 15). We also measured the shortening fraction (SF) from the midtricuspid annulus to the septum and correlated various angiographic measurements with the right ventricular (RV) ejection fraction. RESULTS The volume-overloaded patients (ASD) had larger end diastolic volumes and increased SF compared with normal patients, while the pressure-loaded patients (PVS) had normal volumes and SF. The postoperative atrial switch patients had decreased systolic function and increased end diastolic volume. The SF for all of the patients correlated with the ejection fraction (r= 0.785, P<or= .0001). CONCLUSIONS A simple measurement of the end diastolic and end systolic distance from the midtricuspid annulus to the septum (SF) provides a good index of RV function by angiography and correlates well with RV ejection fraction.
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Affiliation(s)
- Michael R Nihill
- Department of Pediatrics, Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA.
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48
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Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson 2010; 12:35. [PMID: 20525337 PMCID: PMC2901360 DOI: 10.1186/1532-429x-12-35] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 06/04/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Longitudinal wall motion of the right ventricle (RV), generally quantified as tricuspid annular systolic excursion (TAPSE), has been well studied in pulmonary hypertension (PH). In contrast, transverse wall motion has been examined less. Therefore, the aim of this study was to evaluate regional RV transverse wall motion in PH, and its relation to global RV pump function, quantified as RV ejection fraction (RVEF). METHODS In 101 PH patients and 29 control subjects cardiovascular magnetic resonance was performed. From four-chamber cine imaging, RV transverse motion was quantified as the change of the septum-free-wall (SF) distance between end-diastole and end-systole at seven levels along an apex-to-base axis. For each level, regional absolute and fractional transverse distance change (SFD and fractional-SFD) were computed and related to RVEF. Longitudinal measures, including TAPSE and fractional tricuspid-annulus-apex distance change (fractional-TAAD) were evaluated for comparison. RESULTS Transverse wall motion was significantly reduced at all levels compared to control subjects (p < 0.001). For all levels, fractional-SFD and SFD were related to RVEF, with the strongest relation at mid RV (R(2) = 0.70, p < 0.001 and R(2) = 0.62, p < 0.001). For TAPSE and fractional-TAAD, weaker relations with RVEF were found (R(2) = 0.21, p < 0.001 and R(2) = 0.27, p < 0.001). CONCLUSIONS Regional transverse wall movements provide important information of RV function in PH. Compared to longitudinal motion, transverse motion at mid RV reveals a significantly stronger relationship with RVEF and thereby might be a better predictor for RV function.
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Affiliation(s)
- Taco Kind
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert-Jan Mauritz
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Nico Westerhof
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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Prasad M, Ramesh A, Kavanagh P, Tamarappoo BK, Nakazato R, Gerlach J, Cheng V, Thomson LEJ, Berman DS, Germano G, Slomka PJ. Quantification of 3D regional myocardial wall thickening from gated magnetic resonance images. J Magn Reson Imaging 2010; 31:317-27. [PMID: 20099344 DOI: 10.1002/jmri.22033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To develop 3D quantitative measures of regional myocardial wall motion and thickening using cardiac magnetic resonance imaging (MRI) and to validate them by comparison to standard visual scoring assessment. MATERIALS AND METHODS In all, 53 consecutive subjects with short-axis slices and mid-ventricular 2-chamber/4-chamber views were analyzed. After correction for breath-hold-related misregistration, 3D myocardial boundaries were fitted to images and edited by an imaging cardiologist. Myocardial thickness was quantified at end-diastole and end-systole by computing the 3D distances using Laplace's equation. 3D thickening was represented using the standard 17-segment polar coordinates. 3D thickening was compared with 3D wall motion and with expert visual scores (6-point visual scoring of wall motion and wall thickening; 0 = normal; 5 = greatest abnormality) assigned by imaging cardiologists. RESULTS Correlation between ejection fraction and thickening measurements was (r = 0.84; P < 0.001) compared to correlation between ejection fraction and motion measurements (r = 0.86; P < 0.001). Good negative correlation between summed visual scores and global wall thickening and motion measurements were also obtained (r(thick) = -0.79; r(motion) = -0.74). Additionally, overall good correlation between individual segmental visual scores with thickening/wall motion (r(thick) = -0.69; r(motion) = -0.65) was observed (P < 0.0001). CONCLUSION 3D quantitative regional thickening and wall motion measures obtained from MRI correlate strongly with expert clinical scoring.
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Affiliation(s)
- Mithun Prasad
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Jorapur V, Lamas GA, Sadowski ZP, Reynolds HR, Carvalho AC, Buller CE, Rankin JM, Renkin J, Steg PG, White HD, Vozzi C, Balcells E, Ragosta M, Martin CE, Srinivas VS, Wharton Iii WW, Abramsky S, Mon AC, Kronsberg SS, Hochman JS. Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction. World J Cardiol 2010; 2:13-8. [PMID: 20885993 PMCID: PMC2946261 DOI: 10.4330/wjc.v2.i1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 01/24/2010] [Accepted: 01/25/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF). METHODS Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF. RESULTS Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m(2)) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181). CONCLUSION A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF.
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Affiliation(s)
- Vinod Jorapur
- Vinod Jorapur, Gervasio A Lamas, Ana C Mon, Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL 33140, United States
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