1
|
Power Modulation Echocardiography to Detect and Quantify Myocardial Scar. J Am Soc Echocardiogr 2022; 35:1146-1155. [PMID: 35798123 DOI: 10.1016/j.echo.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/28/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Myocardial scar correlates with clinical outcomes. Traditionally, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is used to detect and quantify scar. In this prospective study using LGE CMR as reference, the authors hypothesized that nonlinear ultrasound imaging, namely, power modulation, can detect and quantify myocardial scar in selected patients with previous myocardial infarction. In addition, given the different histopathology between ischemic and nonischemic scar, a further aim was to test the diagnostic performance of this echocardiographic technique in unselected consecutive individuals with ischemic and nonischemic LGE or no LGE on CMR. METHODS Seventy-one patients with previous myocardial infarction underwent power modulation echocardiography following CMR imaging (group A). Subsequently, 101 consecutive patients with or without LGE on CMR, including individuals with nonischemic LGE, were scanned using power modulation echocardiography (group B). RESULTS In group A, echocardiography detected myocardial scar in all 71 patients, with good scar volume agreement with CMR (bias = -1.9 cm3; limits of agreement [LOA], -8.0 to 4.2 cm3). On a per-segment basis, sensitivity was 82%, specificity 97%, and accuracy 92%. Sensitivity was higher in the inferior and posterior segments and lower in the anterior and lateral walls. In group B, on a per-subject basis, the sensitivity of echocardiography was 62% (91% for ischemic and 30% for nonischemic LGE), with specificity and accuracy of 89% and 72%, respectively. The bias for scar volume between modalities was 5.9 cm3, with LOA of 34.6 to 22.9 cm3 (bias = -1.9 cm3 [LOA, -11.4 to 7.6 cm3] for ischemic LGE, and bias = 18.9 cm3 [LOA, -67.4 to 29.7.6 cm3] for nonischemic LGE). CONCLUSIONS Power modulation echocardiography can detect myocardial scar in both selected and unselected individuals with previous myocardial infarction and has good agreement for scar volume quantification with CMR. In an unselected cohort with nonischemic LGE, sensitivity is low.
Collapse
|
2
|
Appadurai V, Thomas JD. Detecting Scar in Echocardiography: Has the Power Shifted? J Am Soc Echocardiogr 2022; 35:1156-1158. [PMID: 36171153 DOI: 10.1016/j.echo.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois; School of Medicine, University of Queensland, St. Lucia, Queensland, Australia
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois.
| |
Collapse
|
3
|
Echocardiographic Advances in Dilated Cardiomyopathy. J Clin Med 2021; 10:jcm10235518. [PMID: 34884220 PMCID: PMC8658091 DOI: 10.3390/jcm10235518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Although the overall survival of patients with dilated cardiomyopathy (DCM) has improved significantly in the last decades, a non-negligible proportion of DCM patients still shows an unfavorable prognosis. DCM patients not only need imaging techniques that are effective in diagnosis, but also suitable for long-term follow-up with frequent re-evaluations. The exponential growth of echocardiography’s technology and performance in recent years has resulted in improved diagnostic accuracy, stratification, management and follow-up of patients with DCM. This review summarizes some new developments in echocardiography and their promising applications in DCM. Although nowadays cardiac magnetic resonance (CMR) remains the gold standard technique in DCM, the echocardiographic advances and novelties proposed in the manuscript, if properly integrated into clinical practice, could bring echocardiography closer to CMR in terms of accuracy and may certify ultrasound as the technique of choice in the follow-up of DCM patients. The application in DCM patients of novel echocardiographic techniques represents an interesting emergent research area for scholars in the near future.
Collapse
|
4
|
Butter C, Georgi C, Stockburger M. Optimal CRT Implantation-Where and How To Place the Left-Ventricular Lead? Curr Heart Fail Rep 2021; 18:329-344. [PMID: 34495452 PMCID: PMC8484220 DOI: 10.1007/s11897-021-00528-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/28/2022]
Abstract
Purpose of Review Cardiac resynchronization therapy (CRT) represents a well-established and effective non-pharmaceutical heart failure (HF) treatment in selected patients. Still, a significant number of patients remain CRT non-responders. An optimal placement of the left ventricular (LV) lead appears crucial for the intended hemodynamic and hence clinical improvement. A well-localized target area and tools that help to achieve successful lead implantation seem to be of utmost importance to reach an optimal CRT effect. Recent Findings Recent studies suggest previous multimodal imaging (CT/cMRI/ECG torso) to guide intraprocedural LV lead placement. Relevant benefit compared to empirical lead optimization is still a matter of debate. Technical improvements in leads and algorithms (e.g., multipoint pacing (MPP), adaptive algorithms) promise higher procedural success. Recently emerging alternatives for ventricular synchronization such as conduction system pacing (CSP), LV endocardial pacing, or leadless pacing challenge classical biventricular pacing. Summary This article reviews current strategies for a successful planning, implementation, and validation of the optimal CRT implantation. Pre-implant imaging modalities offer promising assistance for complex cases; empirical lead positioning and intraoperative testing remain the cornerstone in most cases and ensure a successful CRT effect.
Collapse
Affiliation(s)
- Christian Butter
- Department of Cardiology, Heart Center Brandenburg, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Christian Georgi
- Department of Cardiology, Heart Center Brandenburg, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Martin Stockburger
- Department of Internal Medicine/Cardiology, Havelland Kliniken GmbH, Nauen, Germany
| |
Collapse
|
5
|
Almeida AG, Carpenter JP, Cameli M, Donal E, Dweck MR, Flachskampf FA, Maceira AM, Muraru D, Neglia D, Pasquet A, Plein S, Gerber BL. Multimodality imaging of myocardial viability: an expert consensus document from the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2021; 22:e97-e125. [PMID: 34097006 DOI: 10.1093/ehjci/jeab053] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
In clinical decision making, myocardial viability is defined as myocardium in acute or chronic coronary artery disease and other conditions with contractile dysfunction but maintained metabolic and electrical function, having the potential to improve dysfunction upon revascularization or other therapy. Several pathophysiological conditions may coexist to explain this phenomenon. Cardiac imaging may allow identification of myocardial viability through different principles, with the purpose of prediction of therapeutic response and selection for treatment. This expert consensus document reviews current insight into the underlying pathophysiology and available methods for assessing viability. In particular the document reviews contemporary viability imaging techniques, including stress echocardiography, single photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and computed tomography and provides clinical recommendations for how to standardize these methods in terms of acquisition and interpretation. Finally, it presents clinical scenarios where viability assessment is clinically useful.
Collapse
Affiliation(s)
- Ana G Almeida
- Faculty of Medicine, Lisbon University, University Hospital Santa Maria/CHLN, Portugal
| | - John-Paul Carpenter
- Cardiology Department, University Hospitals Dorset, NHS Foundation Trust, Poole Hospital, Longfleet Road, Poole, Dorset BH15 2JB, United Kingdom
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes 1, Rennes F-35000, France
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, The University of Edinburgh & Edinburgh Heart Centre, Chancellors Building Little France Crescent, Edinburgh EH16 4SB, United Kingdom
| | - Frank A Flachskampf
- Dept. of Med. Sciences, Uppsala University, and Cardiology and Clinical Physiology, Uppsala University Hospital, Akademiska, 751 85 Uppsala, Sweden
| | - Alicia M Maceira
- Cardiovascular Imaging Unit, Ascires Biomedical Group Colon St, 1, Valencia 46004, Spain; Department of Medicine, Health Sciences School, CEU Cardenal Herrera University, Lluís Vives St. 1, 46115 Alfara del Patriarca, Valencia, Spain
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, 20149, Milan, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio-Via G. Moruzzi 1, Pisa, Italy
| | - Agnès Pasquet
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, and Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Av Hippocrate 10, B-1200 Brussels, Belgium
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
| | - Bernhard L Gerber
- Department of Biomedical Imaging Science, Leeds, Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom
| | | | | | | |
Collapse
|
6
|
Gaibazzi N, Tuttolomondo D, Guaricci AI, Di Giannuario G. Pulse-Cancellation Echocardiography for Clinical Evaluation of Myocardial Scar Burden. Curr Cardiol Rep 2021; 23:100. [PMID: 34196815 DOI: 10.1007/s11886-021-01532-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Echocardiography has been completely abandoned as far as myocardial tissue characterization is concerned, but recently, the possibility to detect scarred myocardial tissue has been revived. We review the most recent studies aiming to assess the presence of myocardial fibrosis or scar using echocardiography. RECENT FINDINGS The use of a simple and clinically available ultrasound, such as method pulse-cancellation, is a promising add-on to standard echocardiography for the detection of scarred myocardial tissue, mostly, but not only, in the setting of post-myocardial infarction patients. Pulse-cancellation technique, available since at least 20 years ago on commercial ultrasound machines, is reasonably accurate to detect myocardial scar tissue caused by recent or prior myocardial infarction, the accuracy varying depending on the spatial distribution of myocardial scars in the left ventricle. Severe myocardial fibers disarray, as found in hypertrophic cardiomyopathy, can also be detected by this ultrasound method.
Collapse
Affiliation(s)
- Nicola Gaibazzi
- Azienda Ospedaliero-Universitaria di Parma, Viale Antonio Gramsci 14, 43126, Parma, Italy.
| | - Domenico Tuttolomondo
- Azienda Ospedaliero-Universitaria di Parma, Viale Antonio Gramsci 14, 43126, Parma, Italy
| | - Andrea Igoren Guaricci
- Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | | |
Collapse
|
7
|
Papachristidis A, Queirós S, Theodoropoulos KC, D'hooge J, Rafter P, Masoero G, Zidros S, Pagnano G, Huang M, Dancy L, Sado D, Shah AM, Murgatroyd FD, Monaghan MJ. The Impact of Vendor-Specific Ultrasound Beam-Forming and Processing Techniques on the Visualization of In Vitro Experimental "Scar": Implications for Myocardial Scar Imaging Using Two-Dimensional and Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2021; 34:1095-1105.e6. [PMID: 34082020 DOI: 10.1016/j.echo.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myocardial scar appears brighter compared with normal myocardium on echocardiography because of differences in tissue characteristics. The aim of this study was to test how different ultrasound pulse characteristics affect the brightness contrast (i.e., contrast ratio [CR]) between tissues of different acoustic properties, as well as the accuracy of assessing tissue volume. METHODS An experimental in vitro "scar" model was created using overheated and raw pieces of commercially available bovine muscle. Two-dimensional and three-dimensional ultrasound scanning of the model was performed using combinations of ultrasound pulse characteristics: ultrasound frequency, harmonics, pulse amplitude, steady pulse (SP) emission, power modulation (PM), and pulse inversion modalities. RESULTS On both two-dimensional and three-dimensional imaging, the CR between the "scar" and its adjacent tissue was higher when PM was used. PM, as well as SP ultrasound imaging, provided good "scar" volume quantification. When tested on 10 "scars" of different size and shape, PM resulted in lower bias (-9.7 vs 54.2 mm3) and narrower limits of agreement (-168.6 to 149.2 mm3 vs -296.0 to 404.4 mm3, P = .03). The interobserver variability for "scar" volume was better with PM (intraclass correlation coefficient = 0.901 vs 0.815). Two-dimensional and three-dimensional echocardiography with PM and SP was performed on 15 individuals with myocardial scar secondary to infarction. The CR was higher on PM imaging. Using cardiac magnetic resonance as a reference, quantification of myocardial scar volume showed better agreement when PM was used (bias, -645 mm3; limits of agreement, -3,158 to 1,868 mm3) as opposed to SP (bias, -1,138 mm3; limits of agreement, -5,510 to 3,233 mm3). CONCLUSIONS The PM modality increased the CR between tissues with different acoustic properties in an experimental in vitro "scar" model while allowing accurate quantification of "scar" volume. By applying the in vitro findings to humans, PM resulted in higher CR between scarred and healthy myocardium, providing better scar volume quantification than SP compared with cardiac magnetic resonance.
Collapse
Affiliation(s)
- Alexandros Papachristidis
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom.
| | - Sandro Queirós
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Lab on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Jan D'hooge
- Lab on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Giovanni Masoero
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Spyridon Zidros
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Gianpiero Pagnano
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Marilou Huang
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Luke Dancy
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Daniel Sado
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Ajay M Shah
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Francis D Murgatroyd
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| | - Mark J Monaghan
- Cardiology Department, King's College Hospital, London, United Kingdom; King's College London, British Heart Foundation Centre, London, United Kingdom
| |
Collapse
|
8
|
Houard L, Amzulescu MS, Colin G, Langet H, Militaru S, Rousseau MF, Ahn SA, Vanoverschelde JLJ, Pouleur AC, Gerber BL. Prognostic Value of Pulmonary Transit Time by Cardiac Magnetic Resonance on Mortality and Heart Failure Hospitalization in Patients With Advanced Heart Failure and Reduced Ejection Fraction. Circ Cardiovasc Imaging 2021; 14:e011680. [PMID: 33438438 DOI: 10.1161/circimaging.120.011680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary transit time (PTT) from first-pass perfusion imaging is a novel parameter to evaluate hemodynamic congestion by cardiac magnetic resonance (cMR). We sought to evaluate the additional prognostic value of PTT in heart failure with reduced ejection fraction over other well-validated predictors of risk including the Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. METHODS We prospectively followed 410 patients with chronic heart failure with reduced ejection fraction (61±13 years, left ventricular (LV) ejection fraction 24±7%) who underwent a clinical cMR to assess the prognostic value of PTT for a primary endpoint of overall mortality and secondary composite endpoint of cardiovascular death and heart failure hospitalization. Normal reference values of PTT were evaluated in a population of 40 asymptomatic volunteers free of cardiovascular disease. Results PTT was significantly increased in patients with heart failure with reduced ejection fraction as compared to controls (9±6 beats and 7±2 beats, respectively, P<0.001), and correlated not only with New York Heart Association class, cMR-LV and cMR-right ventricular (RV) volumes, cMR-RV and cMR-LV ejection fraction, and feature tracking global longitudinal strain, but also with cardiac output. Over 6-year median follow-up, 182 patients died and 200 reached the secondary endpoint. By multivariate Cox analysis, PTT was an independent and significant predictor of both endpoints after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Importantly in multivariable analysis, PTT in beats had significantly higher additional prognostic value to predict not only overall mortality (χ2 to improve, 12.3; hazard ratio, 1.35 [95% CI, 1.16-1.58]; P<0.001) but also the secondary composite endpoints (χ2 to improve=20.1; hazard ratio, 1.23 [95% CI, 1.21-1.60]; P<0.001) than cMR-LV ejection fraction, cMR-RV ejection fraction, LV-feature tracking global longitudinal strain, or RV-feature tracking global longitudinal strain. Importantly, PTT was independent and complementary to both pulmonary artery pressure and reduced RV ejection fraction<42% to predict overall mortality and secondary combined endpoints. CONCLUSIONS Despite limitations in temporal resolution, PTT derived from first-pass perfusion imaging provides higher and independent prognostic information in heart failure with reduced ejection fraction than clinical and other cMR parameters, including LV and RV ejection fraction or feature tracking global longitudinal strain. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03969394.
Collapse
Affiliation(s)
- Laura Houard
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Mihaela S Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Geoffrey Colin
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Helene Langet
- Philips Clinical Research Board, Suresnes, France (H.L.)
| | - Sebastian Militaru
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Michel F Rousseau
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Sylvie A Ahn
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Jean-Louis J Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc (L.H., M.S.A., G.C., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.).,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium (L.H., M.S.A., S.M., M.F.R., S.A.A., J.-L.J.V., A.-C.P., B.L.G.)
| |
Collapse
|
9
|
Lin K, Sarnari R, Pathrose A, Gordon D, Blaisdell J, Markl M, Carr JC. Cine MRI detects elevated left heart pressure in pulmonary hypertension. J Magn Reson Imaging 2021; 54:275-283. [PMID: 33421234 DOI: 10.1002/jmri.27504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/25/2022] Open
Abstract
Cine magnetic resonance imaging (MRI) is an emerging modality for evaluating left ventricular (LV) motion/deformation patterns, which may have potential to identify LV dysfunctions underlying postcapillary pulmonary hypertension (PH). The aim of this study was to test the hypothesis that cine MRI-derived LV motion/deformation indices can be used to identify an elevated left heart pressure in PH. This was a retrospective study, which included 26 precapillary and 28 postcapillary PH patients (23 males, 58.9 ± 13.5 years old). All patients underwent right heart catheterization (the "reference standard") and cardiac MRI. Balanced steady-state free precession cine sequence acquired at 1.5 T was used. Cine MRI datasets were analyzed by using heart deformation analysis. LV motion/deformation indices were measured through 25 phases within a cardiac cycle. Peak LV displacement, velocity, strain, and strain rates at systole, early and late diastole were compared between the two patient groups using t-tests. The Pearson correlation coefficient (r) was used to investigate the association between cine MRI-derived indices and pulmonary capillary wedge pressure (PCWP). Multivariable linear and logistic regression models were applied to assess the ability of MRI-derived parameters to predict PCWP and postcapillary PH. Compared to 26 precapillary PH patients, the 28 postcapillary PH patients had lower peak late radial diastolic displacement (0.43 ± 0.19 cm vs. 0.64 ± 0.18 cm) and velocity (12.2 ± 5.8 mm/s vs. 18.9 ± 5.6 mm/s) and peak late radial (52.1 ± 32.7%/s vs. 97.1 ± 38%/s) and circumferential (38 ± 19.8%/s vs. 63.1 ± 22.9%/s) strain rates. PCWP was correlated with peak late radial diastolic displacement (r = -0.54) and velocity (r = -0.57) and peak late radial (r = -0.63) and circumferential diastolic (r = -0.63) strain rates. Peak late radial strain rate could predict PCWP (β = -0.09) and postcapillary PH (β = -0.036). All p < 0.05. Cine MRI-derived LV late diastolic motion/deformation properties can be used to estimate elevated left heart pressure in PH. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 1.
Collapse
Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Roberto Sarnari
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Daniel Gordon
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Julie Blaisdell
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
10
|
Ganguly A, Lapa M, Saba SG. Fatty Metaplasia within a Chronic Myocardial Infarction: Multimodality Correlation between Echocardiography and Computed Tomography. CASE 2020; 4:399-400. [PMID: 33117937 PMCID: PMC7581643 DOI: 10.1016/j.case.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Correlative imaging shows a chronic myocardial infarction with fatty metaplasia. Hyperechoic, akinetic myocardium may indicate infarction with fatty metaplasia. A hyperechoic zone with normal function in the septum represents a normal finding. Myocardial hyperechogenicity may indicate underlying tissue pathology.
Collapse
|
11
|
Siniscalchi C, Gaibazzi N. Early detection of fibrotic areas in anterior STEMI by echocardiography. A case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020077. [PMID: 32921773 PMCID: PMC7716985 DOI: 10.23750/abm.v91i3.8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
We describe the case of a patient admitted to our ward for dyspnea and chest pain. Acutely performed electrocardiogram confirms the clinical suspect of myocardial infarction by showing ST-elevation in the anterior leads (STEMI). Primary percutaneous coronary intervention (PCI) was performed, with normal final coronary artery flow. At 6-month cardiac magnetic resonance (CMR) late Gadolinium enhancement (CMR-LGE) was present in the entire left anterior descending coronary artery territory. We also performed a standard echocardiogram on day 1 after primary angioplasty, as expected showing akinesia in the STEMI territory. Interesting, using a new echocardiographic setting, we have been able to very early detect fibrotic tissue in an easy and cost-effective way.
Collapse
|
12
|
Gaibazzi N, Suma S, Lorenzoni V, Sartorio D, Pressman G, Siniscalchi C, Garibaldi S. Myocardial Scar by Pulse-Cancellation Echocardiography Is Independently Associated with Appropriate Defibrillator Intervention for Primary Prevention after Myocardial Infarction. J Am Soc Echocardiogr 2020; 33:1123-1131. [DOI: 10.1016/j.echo.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/29/2023]
|
13
|
Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
Collapse
Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
14
|
Marwick TH, Taylor AJ. Contrast-Specific Imaging Without Contrast: An Echocardiographic Technique for the Detection of Myocardial Scar. JACC Cardiovasc Imaging 2018; 9:1252-1254. [PMID: 27832899 DOI: 10.1016/j.jcmg.2016.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/11/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Andrew J Taylor
- Baker-IDI Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
15
|
Pasquet A, Gerber B, Vanoverschelde JLJ. Assessing Myocardial Viability: Principles and the Role of Echocardiography. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
16
|
Gaibazzi N, Bianconcini M, Marziliano N, Parrini I, Conte MR, Siniscalchi C, Faden G, Faggiano P, Pigazzani F, Grassi F, Albertini L. Scar Detection by Pulse-Cancellation Echocardiography: Validation by CMR in Patients With Recent STEMI. JACC Cardiovasc Imaging 2016; 9:1239-1251. [PMID: 27236531 DOI: 10.1016/j.jcmg.2016.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/14/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This study sought to assess an echocardiographic approach (scar imaging echocardiography with ultrasound multipulse scheme [eSCAR]), based on existing multipulse ultrasound scheme, as a marker of myocardial scar in humans, compared with cardiac magnetic resonance assessing late gadolinium enhancement (CMR-LGE). BACKGROUND The detection of myocardial scar impacts patient prognosis and management in coronary artery disease and other types of cardiac disease. The clinical experience with echocardiography suggests that the reflected ultrasound signal is often significantly enhanced in infarcted myocardial segments. METHODS Twenty patients with a recent ST-segment elevation myocardial infarction (STEMI) (cases) and 15 patients with absent CMR-LGE (negative controls) were imaged with both the eSCAR pulse-cancellation echocardiography and CMR-LGE to assess their potential association. RESULTS Scar was detectable at CMR-LGE in 19 of 20 STEMI patients (91%), whereas all (100%) demonstrated eSCAR at echocardiography. In the 19 STEMI patients in whom CMR-LGE was detected, regional matching between eSCAR and CMR-LGE was total, although the segmental extent of detected scar was not always superimposable, particularly in the most apical segments, a region in which eSCAR demonstrated undersensitivity for the true extent of scar. CONCLUSIONS A 2-dimensional multipulse echocardiography allows detection of myocardial scar, reliably matching the presence and site of CMR-LGE at 30 days after STEMI, or its absence in negative controls.
Collapse
|
17
|
Mele D, Agricola E, Monte AD, Galderisi M, D'Andrea A, Rigo F, Citro R, Chiodi E, Marchese G, Valentina PD, Calabrese A, Ferrari R. Pacing transmural scar tissue reduces left ventricle reverse remodeling after cardiac resynchronization therapy. Int J Cardiol 2013; 167:94-101. [DOI: 10.1016/j.ijcard.2011.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/22/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
|
18
|
Echocardiographic Evaluation of Left Ventricular Structure and Function: New Modalities and Potential Applications in Clinical Trials. J Card Fail 2012; 18:159-72. [DOI: 10.1016/j.cardfail.2011.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/10/2011] [Accepted: 10/28/2011] [Indexed: 12/17/2022]
|
19
|
Imaging in the Management of Ischemic Cardiomyopathy. J Am Coll Cardiol 2012; 59:359-70. [DOI: 10.1016/j.jacc.2011.08.076] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/18/2011] [Accepted: 08/02/2011] [Indexed: 11/17/2022]
|
20
|
Mele D, Ascione L, Caso P, Manuppelli V, Martiniello AR, Nipote C. Ruolo attuale dell’ecocardiografia nella terapia di resincronizzazione cardiaca. J Cardiovasc Echogr 2011. [DOI: 10.1016/j.jcecho.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
|
21
|
Abstract
The prevalence of heart failure due to coronary artery disease continues to increase, and it portends a worse prognosis than non-ischemic cardiomyopathy. Revascularization improves prognosis in these high-risk patients who have evidence of viability; therefore, optimal assessment of myocardial viability remains essential. Multiple imaging modalities exist for differentiating viable myocardium from scar in territories with contractile dysfunction. Given the multiple modalities available, choosing the best modality for a specific patient can be a daunting task. In this review, the physiology of myocardial hibernation and stunning will be reviewed. All the current methods available for assessing viability including echocardiography, cardiac magnetic resonance imaging, nuclear imaging with single photon emission tomography and positron emission tomography imaging and cardiac computed tomography will be reviewed. The effectiveness of the various techniques will be compared, and the limitations of the current literature will be discussed.
Collapse
Affiliation(s)
- Sara L Partington
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology), Brigham and Women's Hospital, 70 Francis Street, Floor 5, Room 128, Boston, MA 02115, USA
| | | | | |
Collapse
|
22
|
Circulation: Cardiovascular Imaging
Editors' Picks. Circ Cardiovasc Imaging 2011. [DOI: 10.1161/circimaging.111.967299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The following are highlights from the new series,
Circulation: Cardiovascular Imaging
Topic Review. This series summarizes the most important articles, as selected by the editors, that have been published in the
Circulation
portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important articles that are relevant to the imaging and general cardiology audience. The studies included in this article represent the most significant research in the area of coronary artery disease.
Collapse
|
23
|
Link MS, Exner DV, Anderson M, Ackerman M, Al-Ahmad A, Knight BP, Markowitz SM, Kaufman ES, Haines D, Asirvatham SJ, Callans DJ, Mounsey JP, Bogun F, Narayan SM, Krahn AD, Mittal S, Singh J, Fisher JD, Chugh SS. HRS policy statement: clinical cardiac electrophysiology fellowship curriculum: update 2011. Heart Rhythm 2011; 8:1340-56. [PMID: 21699868 DOI: 10.1016/j.hrthm.2011.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
- Mark S Link
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Nihoyannopoulos P, Vanoverschelde JL. Myocardial ischaemia and viability: the pivotal role of echocardiography. Eur Heart J 2011; 32:810-9. [PMID: 21297129 DOI: 10.1093/eurheartj/ehr002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Echocardiography has a central role for the diagnosis and management of patients with known or suspected coronary artery disease. Besides the fact that it provides an essential role in the differential diagnosis of patients presenting with chest pain in the emergency department, echocardiography provides a comprehensive non-invasive haemodynamic and functional assessment of those patients. Stress echocardiography in many institutions is now the preferred stress modality associated with imaging as it is cost-effective and does not use ionizing radiation. It is used for assessing patients with known or suspected coronary artery disease, risk stratification and for assessing myocardial viability. The recent introductions of ultrasound contrast agents as well as deformation imaging techniques have eliminated the last limitations of stress echocardiography such as image quality and quantification, respectively.
Collapse
|