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Zhu Y, Imbrie-Moore AM, Wilkerson RJ, Paulsen MJ, Park MH, Woo YJ. Ex vivo biomechanical analysis of flexible versus rigid annuloplasty rings in mitral valves using a novel annular dilation system. BMC Cardiovasc Disord 2022; 22:73. [PMID: 35219298 PMCID: PMC8882272 DOI: 10.1186/s12872-022-02515-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background Mitral annuloplasty rings restore annular dimensions to increase leaflet coaptation, serving a fundamental component in mitral valve repair. However, biomechanical evaluations of annuloplasty rings are lacking. We aim to biomechanically analyze flexible and rigid annuloplasty rings using an ex vivo mitral annular dilation model. Methods Juvenile porcine mitral valves (n = 4) with intercommissural distance of 28 mm were dilated to intercommissural distances of 40 mm using a 3D-printed dilator and were sewn to an elastic mount. Fiber bragg grating sensors were anchored to native chordae to measure chordal forces. The valves were repaired using size 28 rigid and flexible annuloplasty rings in a random order. Hemodynamic data, echocardiography, and chordal force measurements were collected.
Results Mitral annular dilation resulted in decreased leaflet coaptation height and increased mitral regurgitation fraction. Both the flexible and rigid annuloplasty rings effectively increased leaflet coaptation height compared to that post dilation. Rigid ring annuloplasty repair significantly decreased the mitral regurgitation fraction. Flexible annuloplasty ring repair reduced the chordal rate of change of force (7.1 ± 4.4 N/s versus 8.6 ± 5.9 N/s, p = 0.02) and peak force (0.6 ± 0.5 N versus 0.7 ± 0.6 N, p = 0.01) compared to that from post dilation. Rigid annuloplasty ring repair was associated with higher chordal rate of change of force (9.8 ± 5.8 N/s, p = 0.0001) and peak force (0.7 ± 0.5 N, p = 0.01) compared to that after flexible ring annuloplasty repair. Conclusions Both rigid and flexible annuloplasty rings are effective in increasing mitral leaflet coaptation height. Although the rigid annuloplasty ring was associated with slightly higher chordal stress compared to that of the flexible annuloplasty ring, it was more effective in mitral regurgitation reduction. This study may help direct the design of an optimal annuloplasty ring to further improve patient outcomes.
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McCutcheon K, Manga P. Left ventricular remodelling in chronic primary mitral regurgitation: implications for medical therapy. Cardiovasc J Afr 2019; 29:51-65. [PMID: 29582880 PMCID: PMC6002796 DOI: 10.5830/cvja-2017-009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 01/12/2017] [Indexed: 01/07/2023] Open
Abstract
Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.
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Affiliation(s)
- Keir McCutcheon
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Heart failure remains the most common cause of morbidity and mortality in adults with congenital heart disease (CHD). Although gender-specific outcomes are not robust, it seems that women with CHD may be more affected by late heart failure (HF) than men. A specialized and experienced adult CHD team is required to care for these women as they age, including assessment for reversible causes of HF and in the management of pregnancy, labor, and delivery.
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Leng S, Zhang S, Jiang M, Zhao X, Wu R, Allen J, He B, Tan RS, Zhong L. Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking. Sci Rep 2018; 8:81. [PMID: 29311562 PMCID: PMC5758818 DOI: 10.1038/s41598-017-18354-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022] Open
Abstract
Feature tracking in cine cardiac magnetic resonance (CMR) is a quantitative technique to assess heart structure and function. We investigated 4-dimensional (4D) dynamics and morphology of the mitral annulus (MA) using a novel tracking system based on radially rotational long-axis cine CMR series. A total of 30 normal controls and patients with mitral regurgitation were enrolled. The spatiotemporal changes of the MA were characterized by an in-house developed program. Dynamic and morphological parameters extracted from all 18 radial slices were used as references and were compared with those from subsequently generated sub-datasets with different degrees of sparsity. An excellent agreement was found among all datasets including routine 2-, 3- and 4-chamber views for MA dynamics such as peak systolic velocity (Sm) and mitral annular plane systolic excursion (MAPSE). MA morphology for size and shape was addressed adequately by as few as 6 radial slices, but poorly by only three routine views. Patients with regurgitation showed significantly reduced mitral dynamics and mild annular deformation, which was consistent between three routine views and 18 reference slices. In conclusion, feature tracking cine CMR provided a comprehensive and distinctive profile for 4D MA dynamics and morphology, which may help in studying different cardiac diseases.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Shuo Zhang
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Philips Healthcare, 622 Lorong 1, Toa Payoh, 319763, Singapore, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Rui Wu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - John Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Sahoo D, Kapoor A, Sinha A, Khanna R, Kumar S, Garg N, Tewari S, Goel P. Targeting the sympatho-adrenergic link in chronic rheumatic mitral regurgitation: assessing the role of oral beta-blockers. Cardiovasc Ther 2017; 34:261-7. [PMID: 27219616 DOI: 10.1111/1755-5922.12196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Chronic mitral regurgitation (MR) is characterized by adverse ventricular remodeling and progressive LV dysfunction leading to heart failure (HF). Beta-blockers (BB) improve LV remodeling and prognosis in patients with HF. As chronic severe MR results in neuroendocrine activation similar to HF, it is likely that BB may also exert favorable effects in these patients. No study has assessed the role of oral BB therapy in chronic rheumatic MR. AIMS A total of 100 patients of chronic rheumatic MR (mean age 30±13.48 years, NYHA 2.2±0.5) were randomized to BB (Metoprolol, 37±13.5 mg, n=48) vs no BB (n=52) in addition to standard therapy. RESULTS Baseline BNP and echocardiographic parameters were comparable in the two groups. At 3 months, BB therapy resulted in significantly lower NYHA class (1.97 vs 2.35), BNP (141 vs 207 pg/mL), LV end-systolic (35.89 vs 51.30) and LV end-diastolic volumes (101 vs 128 mL/m(2) ), LV end-systolic stress (81.1 vs 93.3 dyn/cm(2) ), LV mass (122 vs 154 gm/m(2) ), and LV work (737.02 vs 952.82 mm Hg L/min, all P significant). Therapy with BB resulted in a -15.6%, -10.4%,-12.1%, and -7.3% reduction in LV end-systolic and end-diastolic dimensions and LVESVi and LVEDVi, respectively. Following BB therapy, BNP levels, end-systolic stress, indexed LV mass, and LV work also reduced significantly by 27.3%, 15.6%, 8.7%, and 28%, respectively. The control group had no significant change. The MR grade reduced from severe to moderate in 11% of those on BB (controls: no change). At 6 months, the BB group had further improvement in all echocardiographic parameters ranging from +9.1 to -18.2%. CONCLUSION In this first study of BB in rheumatic MR, targeting the sympatho-adrenergic axis exerted favorable effects on NYHA class, LV volumes, LV end-systolic stress, and LV work. Further studies are required to elucidate the role of BB in rheumatic MR.
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Affiliation(s)
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Archana Sinha
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
| | - Pravin Goel
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP, India
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Schenone E, Collin A, Gerbeau JF. Numerical simulation of electrocardiograms for full cardiac cycles in healthy and pathological conditions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02744. [PMID: 26249327 DOI: 10.1002/cnm.2744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
This work is dedicated to the simulation of full cycles of the electrical activity of the heart and the corresponding body surface potential. The model is based on a realistic torso and heart anatomy, including ventricles and atria. One of the specificities of our approach is to model the atria as a surface, which is the kind of data typically provided by medical imaging for thin volumes. The bidomain equations are considered in their usual formulation in the ventricles, and in a surface formulation on the atria. Two ionic models are used: the Courtemanche-Ramirez-Nattel model on the atria and the 'minimal model for human ventricular action potentials' by Bueno-Orovio, Cherry, and Fenton in the ventricles. The heart is weakly coupled to the torso by a Robin boundary condition based on a resistor-capacitor transmission condition. Various electrocardiograms (ECGs) are simulated in healthy and pathological conditions (left and right bundle branch blocks, Bachmann's bundle block, and Wolff-Parkinson-White syndrome). To assess the numerical ECGs, we use several qualitative and quantitative criteria found in the medical literature. Our simulator can also be used to generate the signals measured by a vest of electrodes. This capability is illustrated at the end of the article. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elisa Schenone
- Sorbonne Universités UPMC, Paris, France
- Inria Paris-Rocquencourt, Paris, France
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Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
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White BM, Vennarini S, Lin L, Freedman G, Santhanam A, Low DA, Both S. Accuracy of Routine Treatment Planning 4-Dimensional and Deep-Inspiration Breath-Hold Computed Tomography Delineation of the Left Anterior Descending Artery in Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 91:825-31. [DOI: 10.1016/j.ijrobp.2014.11.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/23/2022]
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White BM, Santhanam A, Thomas D, Min Y, Lamb JM, Neylon J, Jani S, Gaudio S, Srinivasan S, Ennis D, Low DA. Modeling and incorporating cardiac-induced lung tissue motion in a breathing motion model. Med Phys 2014; 41:043501. [PMID: 24694158 DOI: 10.1118/1.4866888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this work is to develop a cardiac-induced lung motion model to be integrated into an existing breathing motion model. METHODS The authors' proposed cardiac-induced lung motion model represents the lung tissue's specific response to the subject's cardiac cycle. The model is mathematically defined as a product of a converging polynomial function h of the cardiac phase (c) and the maximum displacement y(X0) of each voxel (X0) among all the cardiac phases. The function h(c) was estimated from cardiac-gated MR imaging of ten healthy volunteers using an Akaike Information Criteria optimization algorithm. For each volunteer, a total of 24 short-axis and 18 radial planar views were acquired on a 1.5 T MR scanner during a series of 12-15 s breath-hold maneuvers. Each view contained 30 temporal frames of equal time-duration beginning with the end-diastolic cardiac phase. The frames in each of the planar views were resampled to create a set of three-dimensional (3D) anatomical volumes representing thoracic anatomy at different cardiac phases. A 3D multiresolution optical flow deformable image registration algorithm was used to quantify the difference in tissue position between the end-diastolic cardiac phase and the remaining cardiac phases. To account for image noise, voxel displacements whose maximum values were less than 0.3 mm, were excluded. In addition, the blood vessels were segmented and excluded in order to eliminate registration artifacts caused by blood-flow. RESULTS The average cardiac-induced lung motions for displacements greater than 0.3 mm were found to be 0.86 ± 0.74 and 0.97 ± 0.93 mm in the left and right lungs, respectively. The average model residual error for the ten healthy volunteers was found to be 0.29 ± 0.08 mm in the left lung and 0.38 ± 0.14 mm in the right lung for tissue displacements greater than 0.3 mm. The relative error decreased with increasing cardiac-induced lung tissue motion. While the relative error was > 60% for submillimeter cardiac-induced lung tissue motion, the relative error decreased to < 5% for cardiac-induced lung tissue motion that exceeded 10 mm in displacement. CONCLUSIONS The authors' studies implied that modeling and including cardiac-induced lung motion would improve breathing motion model accuracy for tissues with cardiac-induced motion greater than 0.3 mm.
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Affiliation(s)
- Benjamin M White
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - Anand Santhanam
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - David Thomas
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - Yugang Min
- Department of Radiation Oncology, University of California, Los Angeles, California 90095
| | - James M Lamb
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - Jack Neylon
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - Shyam Jani
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
| | - Sergio Gaudio
- Department of Radiation Oncology, University of California, Los Angeles, California 90095
| | - Subashini Srinivasan
- Biomedical Engineering IDP, University of California, Los Angeles, California 90095 and Department of Radiological Sciences, University of California, Los Angeles, California 90095
| | - Daniel Ennis
- Biomedical Physics IDP, University of California, Los Angeles, California 90095; Biomedical Engineering IDP, University of California, Los Angeles, California 90095; and Department of Radiological Sciences, University of California, Los Angeles, California 90095
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, California 90095 and Biomedical Physics IDP, University of California, Los Angeles, California 90095
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Wu V, Chyou JY, Chung S, Bhagavatula S, Axel L. Evaluation of diastolic function by three-dimensional volume tracking of the mitral annulus with cardiovascular magnetic resonance: comparison with tissue Doppler imaging. J Cardiovasc Magn Reson 2014; 16:71. [PMID: 25242199 PMCID: PMC4169226 DOI: 10.1186/s12968-014-0071-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/26/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Measurement of mitral annulus (MA) dynamics is an important component of the evaluation of left ventricular (LV) diastolic function; MA velocities are commonly measured using tissue Doppler imaging (TDI). This study aimed to examine the clinical potential of a semi-automated cardiovascular magnetic resonance (CMR) technique for quantifying global LV diastolic function, using 3D volume tracking of the MA with conventional cine-CMR images. METHODS 124 consecutive patients with normal ejection fraction underwent both clinically indicated transthoracic echocardiography (TTE) and CMR within 2 months. Interpolated 3D reconstruction of the MA over time was performed with semi-automated atrioventricular junction (AVJ) tracking in long-axis cine-CMR images, producing an MA sweep volume over the cardiac cycle. CMR-based diastolic function was evaluated, using the following parameters: peak volume sweep rates in early diastole (PSRE) and atrial systole (PSRA), PSRE/PSRA ratio, deceleration time of sweep volume (DTSV), and 50% diastolic sweep volume recovery time (DSVRT50); these were compared with TTE diastolic measurements. RESULTS Patients with TTE-based diastolic dysfunction (n = 62) showed significantly different normalized MA sweep volume profiles compared to those with TTE-based normal diastolic function (n = 62), including a lower PSRE (5.25 ± 1.38 s-1 vs. 7.72 ± 1.7 s-1), a higher PSRA (6.56 ± 1.99 s-1 vs. 4.67 ± 1.38 s-1), a lower PSRE/PSRA ratio (0.9 ± 0.44 vs. 1.82 ± 0.69), a longer DTSV (144 ± 55 ms vs. 96 ± 37 ms), and a longer DSVRT50 (25.0 ± 11.0% vs. 15.6 ± 4.0%) (all p < 0.05). CMR diastolic parameters were independent predictors of TTE-based diastolic dysfunction after adjusting for left ventricular hypertrophy, hypertension, and coronary artery disease. Good correlations were observed between CMR PSRE/PSRA and early-to-late diastolic annular velocity ratios (e'/a') measured by TDI (r = 0.756 to 0.828, p < 0.001). CONCLUSIONS 3D MA sweep volumes generated by semi-automated AVJ tracking in routinely acquired CMR images yielded diastolic parameters that were effective in identifying patients with diastolic dysfunction when correlated with TTE-based variables.
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Affiliation(s)
- Vincent Wu
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Janice Y Chyou
- />Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY USA
| | - Sohae Chung
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Sharath Bhagavatula
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
| | - Leon Axel
- />Department of Radiology, Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, 660 First Avenue, Room 411, New York, NY 10016 USA
- />Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY USA
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Medrano-Gracia P, Cowan BR, Ambale-Venkatesh B, Bluemke DA, Eng J, Finn JP, Fonseca CG, Lima JAC, Suinesiaputra A, Young AA. Left ventricular shape variation in asymptomatic populations: the Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Magn Reson 2014; 16:56. [PMID: 25160814 PMCID: PMC4145340 DOI: 10.1186/s12968-014-0056-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/15/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although left ventricular cardiac geometric indices such as size and sphericity characterize adverse remodeling and have prognostic value in symptomatic patients, little is known of shape distributions in subclinical populations. We sought to quantify shape variation across a large number of asymptomatic volunteers, and examine differences among sub-cohorts. METHODS An atlas was constructed comprising 1,991 cardiovascular magnetic resonance (CMR) cases contributed from the Multi-Ethnic Study of Atherosclerosis baseline examination. A mathematical model describing regional wall motion and shape was used to establish a coordinate map registered to the cardiac anatomy. The model was automatically customized to left ventricular contours and anatomical landmarks, corrected for breath-hold mis-registration between image slices. Mathematical techniques were used to characterize global shape distributions, after removal of translations, rotations, and scale due to height. Differences were quantified among ethnicity, sex, smoking, hypertension and diabetes sub-cohorts. RESULTS The atlas construction process yielded accurate representations of global shape (errors between manual and automatic surface points in 244 validation cases were less than the image pixel size). After correction for height, the dominant shape component was associated with heart size, explaining 32% of the total shape variance at end-diastole and 29% at end-systole. After size, the second dominant shape component was sphericity at end-diastole (13%), and concentricity at end-systole (10%). The resulting shape components distinguished differences due to ethnicity and risk factors with greater statistical power than traditional mass and volume indices. CONCLUSIONS We have quantified the dominant components of global shape variation in the adult asymptomatic population. The data and results are available at cardiacatlas.org. Shape distributions were principally explained by size, sphericity and concentricity, which are known correlates of adverse outcomes. Atlas-based global shape analysis provides a powerful method for quantifying left ventricular shape differences in asymptomatic populations. TRIAL REGISTRATION ClinicalTrials.gov NCT00005487.
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Affiliation(s)
- Pau Medrano-Gracia
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Bharath Ambale-Venkatesh
- The Donald W. Reynolds Cardiovascular Clinical Research Center, The Johns Hopkins University, Baltimore, USA
| | - David A Bluemke
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, USA
| | - John Eng
- The Donald W. Reynolds Cardiovascular Clinical Research Center, The Johns Hopkins University, Baltimore, USA
| | - John Paul Finn
- Department of Radiology, University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Carissa G Fonseca
- Department of Radiology, University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Joao AC Lima
- The Donald W. Reynolds Cardiovascular Clinical Research Center, The Johns Hopkins University, Baltimore, USA
| | - Avan Suinesiaputra
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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Muller DWM, Jansz P. A clip in time--selecting interventions for severe mitral valve regurgitation. Heart Lung Circ 2014; 23:493-5. [PMID: 24810159 DOI: 10.1016/j.hlc.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
Affiliation(s)
- David W M Muller
- Cardiology and Cardiothoracic Surgery Depts, St Vincent's Hospital, Victoria St, Darlinghurst, NSW 2010, Australia.
| | - Paul Jansz
- Cardiology and Cardiothoracic Surgery Depts, St Vincent's Hospital, Victoria St, Darlinghurst, NSW 2010, Australia
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15
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Pu M, Gao Z, Pu DK, Davidson WR. Effects of early, late, and long-term nonselective β-blockade on left ventricular remodeling, function, and survival in chronic organic mitral regurgitation. Circ Heart Fail 2013; 6:756-62. [PMID: 23580745 DOI: 10.1161/circheartfailure.112.000196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mitral regurgitation (MR) produces sympathetic nervous system activation which is detrimental in other causes of heart failure. However, whether β-blockade is beneficial in MR has not been determined. METHODS AND RESULTS Eighty-seven rats with significant organic MR were randomized to the β-blockade group (n=43) or the control group (n=44). Carvedilol was started in week 2 post MR induction and given for 23 to 35 weeks in the β-blockade group. Echocardiography was performed at baseline and at weeks 2, 6, 12, 24, 30, and 36 after MR induction. After 23 weeks of β-blockade, heart rates were significantly reduced by carvedilol (308 ± 25 versus 351 ± 31 beats per minute; P<0.001). Left ventricular end-diastolic (2.2 ± 0.7 versus 1.59 ± 0.6 mL; P<0.001), end-systolic volumes (0.72 ± 0.42 versus 0.40 ± 0.19 mL; P<0.001), and mass index (2.40 ± 0.55 versus 2.06 ± 0.62 g/kg; P<0.001) were significantly higher, and left ventricular fraction shortening (33 ± 7% versus 38 ± 7%; P<0.001) and ejection fraction (69 ± 11% versus 75 ± 7%; P<0.001) were significantly lower in the β-blockade group than in the control group. Systolic blood pressure was lower in the β-blockade group than in the control group (114 ± 10 versus 93 ± 12 mm Hg; P<0.005). Survival probability was significantly lower in the early β-blockade group than in the control group (88% versus 96%; P=0.03). CONCLUSIONS Early and long-term nonselective β-blockade was associated with adverse left ventricular remodeling, systolic dysfunction, and a reduction in survival in the experimental rat model of organic MR.
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Affiliation(s)
- Min Pu
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Lee APW, Hsiung MC, Salgo IS, Fang F, Xie JM, Zhang YC, Lin QS, Looi JL, Wan S, Wong RHL, Underwood MJ, Sun JP, Yin WH, Wei J, Tsai SK, Yu CM. Quantitative analysis of mitral valve morphology in mitral valve prolapse with real-time 3-dimensional echocardiography: importance of annular saddle shape in the pathogenesis of mitral regurgitation. Circulation 2012; 127:832-41. [PMID: 23266859 DOI: 10.1161/circulationaha.112.118083] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few data exist on the relation of the 3-dimensional morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse. METHODS AND RESULTS Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 112 subjects, including 36 patients with mitral valve prolapse and significant MR (≥3+; MR+ group), 32 patients with mitral valve prolapse but no or mild MR (≤2+; MR- group), 12 patients with significant MR resulting from nonprolapse pathologies (nonprolapse group), and 32 control subjects. The 3-dimensional geometry of mitral valve apparatus was measured with dedicated quantification software. Compared with the normal and MR- groups, the MR+ group had more dilated mitral annulus (P<0.0001), a reduced annular height to commissural width ratio (AHCWR) (P<0.0001) indicating flattening of annular saddle shape, redundant leaflet surfaces (P<0.0001), greater leaflet billow volume (P<0.0001) and billow height (P<0.0001), longer lengths from papillary muscles to coaptation (P<0.0001), and more frequent chordal rupture (P<0.0001). Prevalence of chordal rupture increased progressively with annulus flattening (7% versus 24% versus 42% for AHCWR >20%, 15%-20%, and <15%, respectively; P=0.004). Leaflet billow volume increased exponentially with decreasing AHCWR in patients without chordal rupture (r(2)=0.66, P<0.0001). MR severity correlated strongly with leaflet billow volume (r(2)=0.74, P<0.0001) and inversely with AHCWR (r(2)=0.44, P<0.0001). In contrast, annulus dilatation but not flattening occurred in nonprolapse MR patients. An AHCWR <15% (odds ratio=7.1; P=0.0004) was strongly associated with significant MR in mitral valve prolapse. CONCLUSION Flattening of the annular saddle shape is associated with progressive leaflet billowing and increased frequencies of chordal rupture and may be important in the pathogenesis of MR in mitral valve prolapse.
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Affiliation(s)
- Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR
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Circulation: Cardiovascular Imaging
Editors' Picks. Circ Cardiovasc Imaging 2011. [DOI: 10.1161/circimaging.111.968867] [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 articles are being highlighted as part of
Circulation: Cardiovascular Imaging's
Topic Review. This series summarizes the most important articles, as selected by the editors, that have published in the
Circulation
portfolio. The studies included in this article represent the most significant research in the area of structural heart disease, cardiac function, aortic disease, and molecular imaging.
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