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Yao K, Deng W, He R, Gao H, Wang L, Zhao R, Yue X, Yu Y, Zhong L, Li X. Comparing Strain Assessment in Compressed Sensing and Conventional Cine MRI. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01040-x. [PMID: 38388867 DOI: 10.1007/s10278-024-01040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
The aim of this study is to assess the feasibility of compressed sensing (CS) acceleration methods compared to conventional segmented cine (Seg) cardiac magnetic resonance (CMR) for evaluating left ventricular (LV) function and strain by feature tracking (FT). In this prospective study, 45 healthy volunteers underwent CMR imaging used Seg, threefold (CS3), fourfold (CS4), and eightfold (CS8) CS acceleration. Cine images were scored for quality (1-5 scale). LV volumetric and functional parameters and global longitudinal (GLS), circumferential (GCS), and radial strains (GRS) were quantified. LV volumetric and functional parameters exhibited no differences between Seg and all CS cines (all P > 0.05). The strains were similar for Seg, CS3, and CS4 (all P > 0.05). Similarly, no significant differences were observed in GRS and GCS between Seg and CS8 (all P > 0.05), but the global longitudinal strain was significantly lower for CS8 versus Seg (P < 0.001). Image quality declined with CS acceleration, especially in long-axis views with CS8. CS cine MRI at acceleration factor 4 maintained good image quality and accurate measurements of LV function and strain, although there was a slight reduction in the quality of long-axis images and GLS with CS8. CS acceleration up to a factor of 4 enabled fast CMR evaluations, making it suitable for clinical use.
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Affiliation(s)
- Kaixuan Yao
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Wei Deng
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Rong He
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Hui Gao
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Linlin Wang
- Imaging Center, Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People's Republic of China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, China
| | | | - Yongqiang Yu
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Liang Zhong
- National Heart Centre Singapore, Duke NUS Medical School, National University of Singapore, Queenstown, Singapore.
| | - Xiaohu Li
- Research Center of Clinical Medical Imaging; Anhui Province Clinical Image Quality Control Center, Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China.
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Teira Calderón A, Levine M, Ruisánchez C, Serrano D, Catoya S, Llano M, Lerena P, Cuesta JM, Fernández-Valls M, González Vilchez F, de la Torre Hernández JM, García-García HM, Vazquez de Prada JA. Clinical comparison of a handheld cardiac ultrasound device for the assessment of left ventricular function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:55-64. [PMID: 37882957 DOI: 10.1007/s10554-023-02979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Recently developed handheld ultrasound devices (HHUD) represent a promising method to evaluate the cardiovascular abnormalities at the point of care. However, this technology has not been rigorously evaluated. The aim of this study was to explore the correlation and the agreement between the LVEF (Left Ventricular Ejection Fraction) visually assessed by a moderately experienced sonographer using an HHUD compared to the routine LVEF assessment performed at the Echocardiography Laboratory. METHODS This was a prospective single center study which enrolled 120 adult inpatients and outpatients referred for a comprehensive Echocardiography (EC). RESULTS The mean age of the patients was 69.9 ± 12.5 years. There were 47 females (39.2%). The R-squared was r 0.94 (p < 0.0001) and the ICC was 0.93 (IC 95% 0.91-0.95, p ≤ 0.0001). The Bland-Altman plot showed limits of agreement (LOA): Upper LOA 10.61 and Lower LOA - 8.95. The overall agreement on the LVEF assessment when it was stratified as "normal" or "reduced" was 89.1%, with a kappa of 0.77 (p < 0.0001). When the LVEF was classified as "normal", "mildly reduced", "moderately reduced", or "severely reduced," the kappa was 0.77 (p < 0.0001). The kappa between the HHUD EC and the comprehensive EC for the detection of RWMAs in the territories supplied by the LAD, LCX and RCA was 0.85, 0.73 and 0.85, respectively. CONCLUSION With current HHUD, an averagely experienced operator can accurately bedside visual estimate the LVEF. This may facilitate the incorporation of this technology in daily clinical practice improving the management of patients.
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Affiliation(s)
- Andrea Teira Calderón
- Hospital Universitari i Politécnic La Fe, Valencia (Valencia), España.
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España.
| | - Molly Levine
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Cristina Ruisánchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - David Serrano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Santiago Catoya
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Miguel Llano
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Piedad Lerena
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - José María Cuesta
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Mónica Fernández-Valls
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Francisco González Vilchez
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Jose María de la Torre Hernández
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
| | - Héctor M García-García
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States
| | - Jose Antonio Vazquez de Prada
- Grupo de Investigación Cardiovascular, Instituto de Investigación Valdecilla (IDIVAL), Santander (Cantabria), España
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008, Santander, Cantabria, España
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Shiraz Rizvi SM, Sunny S, Wani IA, Mahdi F, Zaidi ZH, Rajasekaran NS. Influence of electrolyte imbalance on regional wall motion abnormalities in STEMI patients of North Indian origin. Front Cardiovasc Med 2023; 10:1223954. [PMID: 38099220 PMCID: PMC10720728 DOI: 10.3389/fcvm.2023.1223954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023] Open
Abstract
Assessing regional wall motion abnormalities (RWMA) in the myocardium may provide early diagnosis and treat chronic remodeling in STEMI patients. We assessed RWMA in 217 subjects with anterior STEMI admitted to Era University Hospital in Lucknow, UP, India. Besides abnormalities in the LAD territory, sub-sets of patients exhibited diffuse regional myocardial dysfunction. Interestingly, variations in serum electrolytes, specifically sodium and potassium, significantly affected the distribution and frequency of RWMA. Notably, RWMA occurred in the basal septum, apical septum, apex, and lateral wall in the anterior STEMI group. Additionally, the rate of regional dysfunction varied with serum urea and creatinine levels. This suggests that anterior STEMI can manifest myocardial abnormalities beyond the LAD territory. These findings indicate that ST-segment elevation might not be specific, possibly influenced by electrolyte changes affecting cardiac rhythm. Therefore, diagnosing and correcting region-specific wall motion abnormalities and electrolyte imbalances may improve outcomes in STEMI patients.
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Affiliation(s)
- S. Mohd. Shiraz Rizvi
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Sini Sunny
- Cardiac Aging & Redox Signaling Laboratory, Molecular and Cellular Pathology, Department of Pathology, Birmingham, AL, United States
| | - Irshad A. Wani
- Department of Cardiology, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Farzana Mahdi
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Zeeshan H. Zaidi
- Department of Community Medicine, Era’s Lucknow Medical College & Hospital, Era University, Lucknow, India
| | - Namakkal S. Rajasekaran
- Cardiac Aging & Redox Signaling Laboratory, Molecular and Cellular Pathology, Department of Pathology, Birmingham, AL, United States
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
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Playford D, Stewart S, Harris SA, Chan Y, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12:e031243. [PMID: 37947119 PMCID: PMC10727298 DOI: 10.1161/jaha.123.031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. Methods and Results Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. Conclusions In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of MedicineThe University of Notre DameFremantleWestern AustraliaAustralia
| | - Simon Stewart
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Ann Harris
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
| | - Yih‐Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Geoff Strange
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- Heart Research InstituteSydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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Kandels J, Metze M, Hagendorff A, Marshall RP, Hepp P, Laufs U, Stöbe S. The impact of upright posture on left ventricular deformation in athletes. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1123-1131. [PMID: 36869240 DOI: 10.1007/s10554-023-02820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
Besides LV ejection fraction (LVEF), global longitudinal strain (GLS) and global myocardial work index (GWI) are increasingly important for the echocardiographic assessment of left ventricular (LV) function in athletes. Since exercise testing is frequently performed on a treadmill, we investigated the impact of upright posture on GLS and GWI. In 50 male athletes (mean age 25.7 ± 7.3 years) transthoracic echocardiography (TTE) and simultaneous blood pressure measurements were performed in upright and left lateral position. LVEF (59.7 ± 5.3% vs. 61.1 ± 5.5%; P = 0.197) was not affected by athletes' position, whereas GLS (- 11.9 ± 2.3% vs. - 18.1 ± 2.1%; P < 0.001) and GWI (1284 ± 283 mmHg% vs. 1882 ± 247 mmHg%; P < 0.001) were lower in upright posture. Longitudinal strain was most frequently reduced in upright posture in the mid-basal inferior, and/or posterolateral segments. Upright posture has a significant impact on LV deformation with lower GLS, GWI and regional LV strain in upright position. These findings need to be considered when performing echocardiography in athletes.
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Affiliation(s)
- J Kandels
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - M Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - A Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - R P Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120, Halle, Germany
| | - P Hepp
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - U Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - S Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Durr AJ, Korol AS, Hathaway QA, Kunovac A, Taylor AD, Rizwan S, Pinti MV, Hollander JM. Machine learning for spatial stratification of progressive cardiovascular dysfunction in a murine model of type 2 diabetes mellitus. PLoS One 2023; 18:e0285512. [PMID: 37155623 PMCID: PMC10166525 DOI: 10.1371/journal.pone.0285512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
Speckle tracking echocardiography (STE) has been utilized to evaluate independent spatial alterations in the diabetic heart, but the progressive manifestation of regional and segmental cardiac dysfunction in the type 2 diabetic (T2DM) heart remains understudied. Therefore, the objective of this study was to elucidate if machine learning could be utilized to reliably describe patterns of the progressive regional and segmental dysfunction that are associated with the development of cardiac contractile dysfunction in the T2DM heart. Non-invasive conventional echocardiography and STE datasets were utilized to segregate mice into two pre-determined groups, wild-type and Db/Db, at 5, 12, 20, and 25 weeks. A support vector machine model, which classifies data using a single line, or hyperplane, that best separates each class, and a ReliefF algorithm, which ranks features by how well each feature lends to the classification of data, were used to identify and rank cardiac regions, segments, and features by their ability to identify cardiac dysfunction. STE features more accurately segregated animals as diabetic or non-diabetic when compared with conventional echocardiography, and the ReliefF algorithm efficiently ranked STE features by their ability to identify cardiac dysfunction. The Septal region, and the AntSeptum segment, best identified cardiac dysfunction at 5, 20, and 25 weeks, with the AntSeptum also containing the greatest number of features which differed between diabetic and non-diabetic mice. Cardiac dysfunction manifests in a spatial and temporal fashion, and is defined by patterns of regional and segmental dysfunction in the T2DM heart which are identifiable using machine learning methodologies. Further, machine learning identified the Septal region and AntSeptum segment as locales of interest for therapeutic interventions aimed at ameliorating cardiac dysfunction in T2DM, suggesting that machine learning may provide a more thorough approach to managing contractile data with the intention of identifying experimental and therapeutic targets.
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Affiliation(s)
- Andrya J Durr
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Anna S Korol
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Quincy A Hathaway
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Center for Inhalation Toxicology (iTOX), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Amina Kunovac
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Center for Inhalation Toxicology (iTOX), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Andrew D Taylor
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Saira Rizwan
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Mark V Pinti
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- West Virginia University School of Pharmacy, Morgantown, West Virginia, United States of America
- Department of Physiology and Pharmacology, West Virginia University School of Pharmacy, Morgantown, West Virginia, United States of America
| | - John M Hollander
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
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Li H, Chen Z, Kahn AM, Kligerman S, Narayan HK, Contijoch FJ. Deep learning automates detection of wall motion abnormalities via measurement of longitudinal strain from ECG-gated CT images. Front Cardiovasc Med 2022; 9:1009445. [PMID: 36588550 PMCID: PMC9797833 DOI: 10.3389/fcvm.2022.1009445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/28/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction 4D cardiac CT (cineCT) is increasingly used to evaluate cardiac dynamics. While echocardiography and CMR have demonstrated the utility of longitudinal strain (LS) measures, measuring LS from cineCT currently requires reformatting the 4D dataset into long-axis imaging planes and delineating the endocardial boundary across time. In this work, we demonstrate the ability of a recently published deep learning framework to automatically and accurately measure LS for detection of wall motion abnormalities (WMA). Methods One hundred clinical cineCT studies were evaluated by three experienced cardiac CT readers to identify whether each AHA segment had a WMA. Fifty cases were used for method development and an independent group of 50 were used for testing. A previously developed convolutional neural network was used to automatically segment the LV bloodpool and to define the 2, 3, and 4 CH long-axis imaging planes. LS was measured as the perimeter of the bloodpool for each long-axis plane. Two smoothing approaches were developed to avoid artifacts due to papillary muscle insertion and texture of the endocardial surface. The impact of the smoothing was evaluated by comparison of LS estimates to LV ejection fraction and the fractional area change of the corresponding view. Results The automated, DL approach successfully analyzed 48/50 patients in the training cohort and 47/50 in the testing cohort. The optimal LS cutoff for identification of WMA was -21.8, -15.4, and -16.6% for the 2-, 3-, and 4-CH views in the training cohort. This led to correct labeling of 85, 85, and 83% of 2-, 3-, and 4-CH views, respectively, in the testing cohort. Per-study accuracy was 83% (84% sensitivity and 82% specificity). Smoothing significantly improved agreement between LS and fractional area change (R 2: 2 CH = 0.38 vs. 0.89 vs. 0.92). Conclusion Automated LV blood pool segmentation and long-axis plane delineation via deep learning enables automatic LS assessment. LS values accurately identify regional wall motion abnormalities and may be used to complement standard visual assessments.
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Affiliation(s)
- Hui Li
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Zhennong Chen
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Andrew M. Kahn
- Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Seth Kligerman
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Hari K. Narayan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Francisco J. Contijoch
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
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Sharma R, Silverman S, Patel S, Schwamm LH, Sanborn DY. Frequency, predictors and cardiovascular outcomes associated with transthoracic echocardiographic findings during acute ischaemic stroke hospitalisation. Stroke Vasc Neurol 2022; 7:482-492. [PMID: 35697387 PMCID: PMC9811598 DOI: 10.1136/svn-2021-001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To characterise the clinical utility of transthoracic echocardiography (TTE) at the time of acute ischaemic stroke (AIS). BACKGROUND The utility of obtaining a TTE during AIS hospitalisation is uncertain. METHODS We studied AIS hospitalisations at a single centre (2002-2016). TTE abnormalities were classified as findings associated with: high stroke risk (Category I), cardiac events (Category II) and of unclear significance (Category III). We performed logistic regressions to predict Category I, II and III abnormalities. The odds of 1 year recurrent stroke hospitalisation captured by ICD 9 and 10 codes as a function of Category I, II and III abnormalities were assessed. Improvement in predictive capacity for 1 year recurrent ischaemic stroke hospitalisation beyond stroke risk factors was evaluated by net reclassification improvement. RESULTS There were 5523 AIS hospitalisations. Nearly 81% of admission TTEs were abnormal (18.7% Category I, 32.7% Category II, 72.8% Category III). Older patients with coronary artery disease, atrial fibrillation, hypertension, diabetes, and patent intracranial and extracranial vessels were likely to have an abnormal TTE. Category I finding was associated with lower odds of 1-year recurrent stroke hospitalisation (OR 0.54, 95% CI 0.30 to 0.96). Category I data significantly improved the predictive value for 1-year recurrent ischaemic stroke hospitalisation beyond stroke risk factors (net reclassification improvement 0.1563, 95% CI 0.0465 to 0.2661). CONCLUSIONS TTE abnormalities associated with stroke and cardiac event risk were commonly detected during AIS hospitalisation. Detection of Category I TTE findings reduced the risk of recurrent stroke, potentially due to neutralisation of the cardioembolic source by targeted therapy, indicating the clinical utility of TTE.
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Affiliation(s)
- Richa Sharma
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott Silverman
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shaun Patel
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Chen Z, Contijoch F, Colvert GM, Manohar A, Kahn AM, Narayan HK, McVeigh E. Detection of left ventricular wall motion abnormalities from volume rendering of 4DCT cardiac angiograms using deep learning. Front Cardiovasc Med 2022; 9:919751. [PMID: 35966529 PMCID: PMC9366190 DOI: 10.3389/fcvm.2022.919751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background The presence of left ventricular (LV) wall motion abnormalities (WMA) is an independent indicator of adverse cardiovascular events in patients with cardiovascular diseases. We develop and evaluate the ability to detect cardiac wall motion abnormalities (WMA) from dynamic volume renderings (VR) of clinical 4D computed tomography (CT) angiograms using a deep learning (DL) framework. Methods Three hundred forty-three ECG-gated cardiac 4DCT studies (age: 61 ± 15, 60.1% male) were retrospectively evaluated. Volume-rendering videos of the LV blood pool were generated from 6 different perspectives (i.e., six views corresponding to every 60-degree rotation around the LV long axis); resulting in 2058 unique videos. Ground-truth WMA classification for each video was performed by evaluating the extent of impaired regional shortening visible (measured in the original 4DCT data). DL classification of each video for the presence of WMA was performed by first extracting image features frame-by-frame using a pre-trained Inception network and then evaluating the set of features using a long short-term memory network. Data were split into 60% for 5-fold cross-validation and 40% for testing. Results Volume rendering videos represent ~800-fold data compression of the 4DCT volumes. Per-video DL classification performance was high for both cross-validation (accuracy = 93.1%, sensitivity = 90.0% and specificity = 95.1%, κ: 0.86) and testing (90.9, 90.2, and 91.4% respectively, κ: 0.81). Per-study performance was also high (cross-validation: 93.7, 93.5, 93.8%, κ: 0.87; testing: 93.5, 91.9, 94.7%, κ: 0.87). By re-binning per-video results into the 6 regional views of the LV we showed DL was accurate (mean accuracy = 93.1 and 90.9% for cross-validation and testing cohort, respectively) for every region. DL classification strongly agreed (accuracy = 91.0%, κ: 0.81) with expert visual assessment. Conclusions Dynamic volume rendering of the LV blood pool combined with DL classification can accurately detect regional WMA from cardiac CT.
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Affiliation(s)
- Zhennong Chen
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, CA, United States
| | - Francisco Contijoch
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, CA, United States
- Department of Radiology, UC San Diego School of Medicine, La Jolla, CA, United States
| | - Gabrielle M. Colvert
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, CA, United States
| | - Ashish Manohar
- Department of Mechanical and Aerospace Engineering, UC San Diego School of Engineering, La Jolla, CA, United States
| | - Andrew M. Kahn
- Department of Cardiology, UC San Diego School of Medicine, La Jolla, CA, United States
| | - Hari K. Narayan
- Department of Pediatrics, UC San Diego School of Medicine, La Jolla, CA, United States
| | - Elliot McVeigh
- Department of Bioengineering, UC San Diego School of Engineering, La Jolla, CA, United States
- Department of Radiology, UC San Diego School of Medicine, La Jolla, CA, United States
- Department of Cardiology, UC San Diego School of Medicine, La Jolla, CA, United States
- *Correspondence: Elliot McVeigh
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10
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Kaolawanich Y, Boonyasirinant T. Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance Imaging in Older Adults with Known or Suspected Coronary Artery Disease. Arq Bras Cardiol 2022; 119:97-106. [PMID: 35830106 PMCID: PMC9352122 DOI: 10.36660/abc.20210530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
Fundamento: Há dados limitados sobre o valor prognóstico da ressonância magnética cardíaca (RMC) em estresse em pacientes idosos. Objetivo: Determinar o valor prognóstico da RMC em estresse com adenosina em idosos com doença arterial coronariana (DAC) conhecida ou suspeita. Métodos: Entre 2010 e 2015, pacientes consecutivos com 65 anos ou mais encaminhados para RMC em estresse com adenosina foram acompanhados para a ocorrência de eventos cardíacos graves (morte cardíaca e infarto do miocárdio não-fatal) e eventos cardiovasculares adversos maiores (ECAM) que também incluíram hospitalização por insuficiência cardíaca e acidente vascular cerebral isquêmico. As análises univariadas e multivariadas foram realizadas para determinar o valor prognóstico da isquemia miocárdica, com valor de p <0,05 considerado estatisticamente significante. Resultados: Após um período médio de seguimento de 50,4 meses em 324 pacientes (48% do sexo masculino, 73±7 anos), ocorreram 21 eventos cardíacos graves e 52 ECAM. Pacientes com isquemia miocárdica (n=99) apresentaram taxas significantemente maiores de eventos cardíacos graves (HR 5,25 [IC 95% 2,11-13,04], p<0,001) e ECAM (HR 3,01 [IC 95% 1,75-5,20], p<0,001) do que aqueles sem isquemia. A análise multivariada determinou a isquemia como preditor independente de eventos cardíacos graves (HR 3,14 [IC 95% 1,22-8,07], p=0,02) e ECAM (HR 1,91 [IC 95% 1,02-3,59], p=0,04). A isquemia forneceu um valor prognóstico incremental sobre fatores clínicos e fração de ejeção do ventrículo esquerdo para predizer eventos cardíacos graves e ECAM (p<0,01 para ambos). Nenhum evento adverso grave ocorreu durante ou imediatamente após os exames de RMC. Conclusão: A RMC em estresse com adenosina é segura e demonstra valor prognóstico em idosos com DAC conhecida ou suspeita.
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Affiliation(s)
- Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok - Tailândia
| | - Thananya Boonyasirinant
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok - Tailândia
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11
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Espersen C, Modin D, Platz E, Jensen GB, Schnohr P, Prescott E, Gislason G, Møgelvang R, Biering-Sørensen T. Global and regional wall motion abnormalities and incident heart failure in the general population. Int J Cardiol 2022; 357:146-151. [PMID: 35304187 DOI: 10.1016/j.ijcard.2022.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Wall Motion Score Index (WMSI) is a simple method to quantify global and regional systolic function on echocardiography. We sought to investigate the prognostic importance of global and regional WMSI for the development of incident heart failure (HF) in the general population. METHODS We included adults without HF or ischemic heart disease from the 4th Copenhagen City Heart Study (2001-2003). At baseline, participants underwent an echocardiography and physical examination and completed a self-administered health questionnaire. WMSI was assessed by conventional echocardiography using a 16-segment model obtaining WMSI assessments for the anterior, lateral, inferior, septal, and posterior left ventricular (LV) walls and calculating a global WMSI. The primary endpoint was incident HF. RESULTS Among 3415 participants (mean age 58 years, 42% male, 45% with hypertension), 83 (2.4%) had hypo-, a-, or dyskinesia of at least one LV wall segment at baseline. During a median follow-up of 15.4 years, 297 (8.7%) participants developed HF. After adjusting for important clinical variables, LV ejection fraction and E/A, hypo-, a- or dyskinesia of at least one segment in any of the LV regional walls was associated with a higher risk of incident HF (HR 3.63, 95% CI 2.15-6.12, p < 0.001). Similarly, global WMSI was independently associated with a higher risk of HF (HR 1.38 per 0.1 increase, 95%CI 1.22-1.56, p < 0.001). CONCLUSION Wall motion abnormalities in any regional LV wall and global WMSI were associated with incident HF in this general population cohort independent of various baseline clinical data, LV ejection fraction and E/A.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.
| | - Daniel Modin
- Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Eva Prescott
- The Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Gunnar Gislason
- Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | | | - Tor Biering-Sørensen
- Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Zakeri A, Hokmabadi A, Ravikumar N, Frangi AF, Gooya A. A probabilistic deep motion model for unsupervised cardiac shape anomaly assessment. Med Image Anal 2021; 75:102276. [PMID: 34753021 DOI: 10.1016/j.media.2021.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Automatic shape anomaly detection in large-scale imaging data can be useful for screening suboptimal segmentations and pathologies altering the cardiac morphology without intensive manual labour. We propose a deep probabilistic model for local anomaly detection in sequences of heart shapes, modelled as point sets, in a cardiac cycle. A deep recurrent encoder-decoder network captures the spatio-temporal dependencies to predict the next shape in the cycle and thus derive the outlier points that are attributed to excessive deviations from the network prediction. A predictive mixture distribution models the inlier and outlier classes via Gaussian and uniform distributions, respectively. A Gibbs sampling Expectation-Maximisation (EM) algorithm computes soft anomaly scores of the points via the posterior probabilities of each class in the E-step and estimates the parameters of the network and the predictive distribution in the M-step. We demonstrate the versatility of the method using two shape datasets derived from: (i) one million biventricular CMR images from 20,000 participants in the UK Biobank (UKB), and (ii) routine diagnostic imaging from Multi-Centre, Multi-Vendor, and Multi-Disease Cardiac Image (M&Ms). Experiments show that the detected shape anomalies in the UKB dataset are mostly associated with poor segmentation quality, and the predicted shape sequences show significant improvement over the input sequences. Furthermore, evaluations on U-Net based shapes from the M&Ms dataset reveals that the anomalies are attributable to the underlying pathologies that affect the ventricles. The proposed model can therefore be used as an effective mechanism to sift shape anomalies in large-scale cardiac imaging pipelines for further analysis.
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Affiliation(s)
- Arezoo Zakeri
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK.
| | - Alireza Hokmabadi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Nishant Ravikumar
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Alejandro F Frangi
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK
| | - Ali Gooya
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing, University of Leeds, Leeds, UK.
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13
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Kamran S, Akhtar N, Singh R, Imam Y, Haroon KH, Amir N, Hussain S, Al Jerdi S, Ojha L, Own A, Muhammad A, Perkins JD. Association of Major Adverse Cardiovascular Events in Patients With Stroke and Cardiac Wall Motion Abnormalities. J Am Heart Assoc 2021; 10:e020888. [PMID: 34259032 PMCID: PMC8483461 DOI: 10.1161/jaha.121.020888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background The association of cardiac wall motion abnormalities (CWMAs) in patients with stroke who have major adverse cardiovascular events (MACE) remains unclear. The purpose of this study was to estimate the 50‐month risk of MACE, including stroke recurrence, acute coronary events, and vascular death in patients with stroke who have CWMAs. Methods and Results We performed a retrospective analysis of prospectively collected acute stroke data (acute stroke and transient ischemic attack) over 50 months by electronic medical records. Data included demographic and clinical information, vascular imaging, and echocardiography data including CWMAs and MACE. Of a total of 2653 patients with acute stroke/transient ischemic attack, CWMA was observed in 355 (13.4%). In patients with CWMAs, the embolic stroke of undetermined source (50.7%) was the most frequent index stroke subtype and stroke recurrences (P=0.001). In multivariate Cox regression after adjustment for demographics, traditional risk, and confounding factors, CWMA was independently associated with a higher risk of MACE (adjusted hazard ratio [HR], 1.74; 95% CI, 1.37–2.21 [P=0.001]). Similarly, CWMA independently conferred an increased risk for ischemic stroke recurrence (adjusted HR, 1.50; 95% CI, 1.01–2.17 [P=0.04]), risk of acute coronary events (aHR, 2.50; 95% CI, 1.83–3.40 [P=0.001]) and vascular death (adjusted HR, 1.57; 95% CI, 1.04–2.40 [P=0.03]), in comparison to the patients with stroke without CWMA. Conclusions In a multiethnic cohort of ischemic stroke with CWMA, CWMA was associated with 1.7‐fold higher risks of MACE independent of established risk factors. Embolic stroke of undetermined source was the most common stroke association with CWMA. Patients with stroke should be screened for CWMA to identify those at higher risk of MACE.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Naveed Akhtar
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Rajvir Singh
- Heart Hospital Hamad Medical Corporation Doha Qatar
| | - Yahya Imam
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | | | - Noman Amir
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Suhail Hussain
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | | | - Laxmi Ojha
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmed Own
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmad Muhammad
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medical School Doha Qatar
| | - Jonathan D Perkins
- Perception Movement Action Research Consortium University of Edinburgh United Kingdom
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14
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Seol H, Kim JS. Prevalence, Mechanisms, and Management of Ischemic Stroke in Heart Failure Patients. Semin Neurol 2021; 41:340-347. [PMID: 33851399 DOI: 10.1055/s-0041-1726329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heart failure (HF) and stroke, two of the major causes of death worldwide, are closely associated. Although atrial fibrillation (AF), which occurs in more than half of patients with HF, is a major risk factor for stroke, there is a great deal of evidence that HF itself increases the risk of stroke independent of AF. The main mechanism of stroke appears to be thromboembolism. However, previous studies have failed to demonstrate the benefit of warfarin in patients with HF without AF, as the benefit of stroke prevention was counteracted by the increased incidence of major bleeding. Recently, researchers have identified patients with HF at a particularly high risk for stroke who may benefit from anticoagulation therapy. Based on stroke-risk prediction models, it may be possible to make better stroke prevention decisions for patients with HF. Moreover, non-vitamin K oral anticoagulants have emerged as anticoagulants with a more favorable risk-benefit profile than warfarin. Future studies on selecting high-risk patients and using more appropriate antithrombotics will lead to improved management of patients with HF.
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Affiliation(s)
- Hyeyoung Seol
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Jong S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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15
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Kido T, Hirai K, Ogawa R, Tanabe Y, Nakamura M, Kawaguchi N, Kurata A, Watanabe K, Schmidt M, Forman C, Mochizuki T, Kido T. Comparison between conventional and compressed sensing cine cardiovascular magnetic resonance for feature tracking global circumferential strain assessment. J Cardiovasc Magn Reson 2021; 23:10. [PMID: 33618722 PMCID: PMC7898736 DOI: 10.1186/s12968-021-00708-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feature tracking (FT) has become an established tool for cardiovascular magnetic resonance (CMR)-based strain analysis. Recently, the compressed sensing (CS) technique has been applied to cine CMR, which has drastically reduced its acquisition time. However, the effects of CS imaging on FT strain analysis need to be carefully studied. This study aimed to investigate the use of CS cine CMR for FT strain analysis compared to conventional cine CMR. METHODS Sixty-five patients with different left ventricular (LV) pathologies underwent both retrospective conventional cine CMR and prospective CS cine CMR using a prototype sequence with the comparable temporal and spatial resolution at 3 T. Eight short-axis cine images covering the entire LV were obtained and used for LV volume assessment and FT strain analysis. Prospective CS cine CMR data over 1.5 heartbeats were acquired to capture the complete end-diastolic data between the first and second heartbeats. LV volume assessment and FT strain analysis were performed using a dedicated software (ci42; Circle Cardiovasacular Imaging, Calgary, Canada), and the global circumferential strain (GCS) and GCS rate were calculated from both cine CMR sequences. RESULTS There were no significant differences in the GCS (- 17.1% [- 11.7, - 19.5] vs. - 16.1% [- 11.9, - 19.3; p = 0.508) and GCS rate (- 0.8 [- 0.6, - 1.0] vs. - 0.8 [- 0.7, - 1.0]; p = 0.587) obtained using conventional and CS cine CMR. The GCS obtained using both methods showed excellent agreement (y = 0.99x - 0.24; r = 0.95; p < 0.001). The Bland-Altman analysis revealed that the mean difference in the GCS between the conventional and CS cine CMR was 0.1% with limits of agreement between -2.8% and 3.0%. No significant differences were found in all LV volume assessment between both types of cine CMR. CONCLUSION CS cine CMR could be used for GCS assessment by CMR-FT as well as conventional cine CMR. This finding further enhances the clinical utility of high-speed CS cine CMR imaging.
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Affiliation(s)
- Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kuniaki Hirai
- Department of Radiology, Uwajima City Hospital, Uwajima, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masashi Nakamura
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kouki Watanabe
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | | | - Teruhito Mochizuki
- Department of Radiology, Yoshino Hospital, Imabari, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
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16
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Ramasamy S, Yaghi S, Salehi Omran S, Lerario MP, Devereux R, Okin PM, Gupta A, Navi BB, Kamel H, Merkler AE. Association Between Left Ventricular Ejection Fraction, Wall Motion Abnormality, and Embolic Stroke of Undetermined Source. J Am Heart Assoc 2020; 8:e011593. [PMID: 31057030 PMCID: PMC6512092 DOI: 10.1161/jaha.118.011593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It is uncertain whether there is an association between left ventricular (LV) ejection fraction (LVEF) or LV wall motion abnormality and embolic stroke of undetermined source (ESUS). Methods and Results We performed a retrospective, cross‐sectional study of patients with acute ischemic stroke enrolled in the CAESAR (Cornell Acute Stroke Academic Registry) from 2011 to 2016. We restricted this study to patients with ESUS and, as controls, those with small‐ and large‐artery ischemic strokes. LVEF had to be above 35% to be considered ESUS. In a secondary analysis, we excluded patients with ESUS who had any evidence of ipsilateral carotid atherosclerosis. Multiple logistic regression was used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS. We performed a confirmatory study at another tertiary‐care center. We identified 885 patients with ESUS (n=503) or small‐ or large‐artery strokes (n=382). Among the entire cohort, LVEF was not associated with ESUS (odds ratio per 5% decrement in LVEF, 1.0; 95% CI, 1.0–1.1) and LV wall motion abnormality was not associated with ESUS (odds ratio, 0.9; 95% CI, 0.5–1.6). The results were identical in our confirmatory study. In our secondary analysis excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, there was an association between LVEF and ESUS (odds ratio per 5% decrement in LVEF, 1.2; 95% CI, 1.0–1.5; P=0.04). Conclusions Among the entire cohort, no association existed between LVEF or LV wall motion abnormality and ESUS; however, after excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, lower LVEF appeared to be associated with ESUS.
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Affiliation(s)
- Shobana Ramasamy
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Shadi Yaghi
- 5 Department of Neurology Warren Alpert Medical School of Brown University Providence RI
| | - Setareh Salehi Omran
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Michael P Lerario
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Richard Devereux
- 3 Department of Medicine Weill Cornell Medical College New York NY
| | - Peter M Okin
- 3 Department of Medicine Weill Cornell Medical College New York NY
| | - Ajay Gupta
- 4 Department of Radiology Weill Cornell Medical College New York NY
| | - Babak B Navi
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Hooman Kamel
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Alexander E Merkler
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
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17
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Kamran S, Akhtar N, George P, Singh R, Imam Y, Salam A, Babu B, Burke P, Own A, Vattoth S, Perkins J, Parray A, Qadri S, Hamid T. Embolic Pattern of Stroke Associated with Cardiac Wall Motion Abnormalities; Narrowing the Embolic Stroke of Undetermined Source Category. J Stroke Cerebrovasc Dis 2020; 29:104509. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/29/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
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18
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Cardiac wall motion abnormality as a predictor for undetermined stroke with embolic lesion-pattern. Clin Neurol Neurosurg 2020; 191:105677. [PMID: 31958700 DOI: 10.1016/j.clineuro.2020.105677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/28/2019] [Accepted: 01/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Several strokes of potential embolism do not clearly meet the definitions of embolic stroke with unknown source, cryptogenic stroke, or cardioembolic (CE) stroke. Considering the high mortality and recurrence of CE strokes, it is very important to detect treatable cardiac sources of embolism. Although regional wall motion abnormality (RWMA) of the left ventricle (LV) seems to be related to CE stroke, association between cerebral embolic risk and RWMA remains unclear. The purpose of this study was to investigate the influence of RWMA on undetermined stroke with embolic lesion-pattern (USELP). PATIENTS AND METHODS Among a total of 2327 patients with acute ischemic stroke, we excluded 148 patients without a transthoracic echocardiography (TTE). According to a stepwise approach, we excluded patients without an embolic lesion-pattern. Finally, we divided patients into two groups (USELP, 119, and non-embolic stroke, 1237). We classified patients' RWMAs into three major arterial territories according to the standard 17-segment model of TTE. RESULTS Among the included 1356 patients, those with USELP had larger internal dimension at diastole and systole in LV, reduced LV ejection fraction, increased E/A ratios, mitral valve disease, and RWMA. After adjusting for multiple variables, binary logistic regression revealed that RWMA was significantly associated with USELP (OR 7.02, 95 % CI: 3.51-14.01, p<0.001). CONCLUSION This study provides significant information to support that RWMA can be a predictor for undetermined embolic stroke. In this regard, RWMA were highly correlated with patients whose imaging supported an embolic source compared to those without this radiographic pattern.
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19
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Vestberg D, Johansson MC, Letho A, Pivodic A, Hallström S, Ólafsdóttir AF, Rosengren A, Lind M. Investigation of early signs of systolic and diastolic dysfunction among persons with type 1 diabetes. Open Heart 2020; 6:e001020. [PMID: 31908811 PMCID: PMC6927507 DOI: 10.1136/openhrt-2019-001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/20/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
Background Persons with type 1 diabetes have a higher risk to develop heart failure than the general population, and the mechanism behind the increased risk is unclear. In epidemiological studies with hospitalisation for heart failure as endpoint HbA1c, body mass index and decreased kidney function are significant risk factors, but it is unclear how these risk factors influence the development of heart failure. Methods In this study, we investigated early signs of systolic and diastolic dysfunction with transthoracic echocardiography. Statistical analysis on correlation of risk factors and early signs of diastolic and systolic dysfunction was made. Results In this study population of 287 persons with type 1 diabetes, 160 were men and 127 were women with a mean age of 53.8 (SD 11.6) years and a mean diabetes duration of 36.2 (SD 13.5) years. There were 23 (8.2%) persons who fulfilled the definition of systolic dysfunction (ejection fraction <50% or regional wall motion abnormalities) and 24 persons (9%) the definition for diastolic dysfunction. When comparing the groups with either systolic or diastolic dysfunction to the rest of the population, the only significant risk factor was age in both groups and previous myocardial infarction in the systolic group. Conclusion In our study population with type 1 diabetes, we found signs of diastolic dysfunction in 9% and systolic dysfunction in 8.2%. Compared with published data from the general population, this rate is somewhat higher in a younger population. Only age was a significant risk factor in the study.
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Affiliation(s)
- Daniel Vestberg
- Department of Medicine, NU-hospital Group, Trollhattan/Uddevalla, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden
| | - Magnus Carl Johansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Goteborg, Sweden
| | - Anette Letho
- Department of Medicine, NU-hospital Group, Trollhattan/Uddevalla, Sweden
| | | | - Sara Hallström
- Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Arndís Finna Ólafsdóttir
- Department of Medicine, NU-hospital Group, Trollhattan/Uddevalla, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden.,Department of Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Marcus Lind
- Department of Medicine, NU-hospital Group, Trollhattan/Uddevalla, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborg, Sweden
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Yaghi S, Chang AD, Ricci BA, MacGrory B, Cutting S, Burton T, Dakay K, McTaggart R, Jayaraman MV, Merkler AE, Reznik M, Lerario M, Gupta A, Mehanna E, Song C, Seiffge DJ, De Marchis GM, Paciaroni M, Kamel H, Elkind MSV, Furie KL. Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation. Journal of Neurology, Neurosurgery and Psychiatry 2019. [DOI: 10.1136/jnnp-2018-320219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.
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21
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Choi JY, Cha J, Jung JM, Seo WK, Oh K, Cho KH, Yu S. Left ventricular wall motion abnormality is associated with cryptogenic stroke. Int J Stroke 2019; 15:188-196. [PMID: 30982433 DOI: 10.1177/1747493019834181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Left ventricular wall motion abnormality (LVWMA) unrelated to known cardiac risk factors is an uncertain risk for stroke. AIMS We evaluated whether LVWMA was associated with cryptogenic stroke. METHODS This retrospective, observational study included 4316 acute ischemic stroke patients, and the association between cryptogenic stroke and LVWMA was examined in comparison with other stroke subtypes. RESULTS The prevalence of LVWMA was 10.0% in the study population. In a fully adjusted, binary logistic regression, LVWMA was independently associated with cryptogenic stroke compared with stroke from large artery atherosclerosis (odds ratio = 1.627, 95% confidence interval = 1.129-2.345), small vessel occlusion (odds ratio = 1.948, 95% confidence interval = 1.261-3.010), or other causes (odds ratio = 4.950, 95% confidence interval = 1.145-21.412). Meanwhile, the association of LVWMA with cryptogenic stroke was similar to the associations of LVWMA with cardioembolic stroke (odds ratio = 0.758, 95% confidence interval = 0.525-1.094) and stroke with two or more causes (odds ratio = 0.992, 95% confidence interval = 0.609-1.615). In multinomial regression, LVWMA had the strongest association with cardioembolic stroke, followed by cryptogenic stroke and stroke from two or more causes. The strength of the associations with LVWMA then decreased sequentially in patients with large artery atherosclerosis, small vessel occlusion, and other causes. CONCLUSIONS The association of LVWMA with cryptogenic stroke was comparable to that of LVWMA with cardioembolic stroke but stronger than that of LVWMA with non-cardioembolic stroke. LVWMA unrelated to known cardiac risk factors could be considered an independent risk factor for cryptogenic stroke.
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Affiliation(s)
- Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Sicari R, Cortigiani L, Arystan AZ, Fettser DV. [The Clinical use of Stress Echocardiography in Ischemic Heart Disease Cardiovascular Ultrasound (2017)15:7. Translation authors: Arystan A.Zh., Fettser D.V.]. ACTA ACUST UNITED AC 2019; 59:78-96. [PMID: 30990145 DOI: 10.18087/cardio.2019.3.10244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 01/08/2023]
Abstract
Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows detecting myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependence on operator expertise, the lack of outcome data (a widespread problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.
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Affiliation(s)
| | | | - A Zh Arystan
- Medical Centre Hospital of President's Affairs Administration of the RK, Astana
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23
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Mehta A. Cardiac calcification on echocardiograms: Taking a closer look at this marker of adverse outcomes. Eur J Prev Cardiol 2019; 26:1188-1190. [PMID: 30857426 DOI: 10.1177/2047487319834388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA
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24
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Miles JA, Garber L, Ghosh S, Spevack DM. Association of Transthoracic Echocardiography Findings and Long-Term Outcomes in Patients Undergoing Workup of Stroke. J Stroke Cerebrovasc Dis 2018; 27:2943-2950. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/31/2018] [Accepted: 06/17/2018] [Indexed: 11/15/2022] Open
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25
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Medina‐Lezama J, Narvaez‐Guerra O, Herrera‐Enriquez K, Morey‐Vargas OL, Bolaños‐Salazar JF, Abugattas JP, Zea‐Diaz H, Chirinos‐Revilla JL, Fernandez‐Sivincha JG, Delgado‐Lazo V, Chirinos DA, Townsend RR, Chirinos JA. Hemodynamic Patterns Identified by Impedance Cardiography Predict Mortality in the General Population: The PREVENCION Study. J Am Heart Assoc 2018; 7:e009259. [PMID: 30371205 PMCID: PMC6222967 DOI: 10.1161/jaha.118.009259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
Background Blood pressure is determined by the interactions between the heart and arterial properties, and subjects with identical blood pressure may have substantially different hemodynamic determinants. Whether arterial hemodynamic indices quantified by impedance cardiography ( ICG ), a simple operator-independent office procedure, independently predict all-cause mortality in adults from the general population, and specifically among those who do not meet criteria for American College of Cardiology/American Heart Association stage 2 hypertension, is currently unknown. Methods and Results We studied 1639 adults aged 18 to 80 years from the general population. We used ICG to measure hemodynamic parameters and metrics of cardiac function. We assessed the relationship between hemodynamic parameters measured at baseline and all-cause mortality over a mean follow-up of 10.9 years. Several ICG parameters predicted death. The strongest predictors were total arterial compliance index (standardized hazard ratio=0.38; 95% confidence interval=0.31-0.46; P<0.0001) and indices of cardiac contractility: velocity index (standardized hazard ratio=0.45; 95% confidence interval=0.37-0.55; P<0.0001) and acceleration index (standardized hazard ratio=0.44; 95% confidence interval=0.35-0.55; P<0.0001). These remained independently predictive of death after adjustment for multiple confounders, as well as systolic and diastolic blood pressure. Among subjects without stage 2 hypertension (n=1563), indices of cardiac contractility were independently predictive of death and identified a subpopulation (25% of non-stage-2 hypertensives) that demonstrated a high 10-year mortality risk, equivalent to that of stage 2 hypertensives. Conclusions Hemodynamic patterns identified by ICG independently predict mortality in the general population. The predictive value of ICG applies even in the absence of American College of Cardiology/American Heart Association stage 2 hypertension and identifies higher-risk individuals who are in earlier stages of the hypertension continuum.
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Affiliation(s)
- Josefina Medina‐Lezama
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Offdan Narvaez‐Guerra
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Karela Herrera‐Enriquez
- PREVENCION Research InstituteArequipaPeru
- Universidad Catolica de Santa Maria School of MedicineArequipaPeru
| | - Oscar L. Morey‐Vargas
- Department of MedicineSanford University of South Dakota
Medical CenterBrusselsBelgium
| | - Juan Francisco Bolaños‐Salazar
- Department of Cardiology, Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel‐Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 JetteBrusselsBelgium
| | - Juan P. Abugattas
- Department of Cardiology, Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel‐Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 JetteBrusselsBelgium
| | | | | | | | | | | | - Raymond R. Townsend
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of PennsylvaniaPhiladelphiaPA
| | - Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of PennsylvaniaPhiladelphiaPA
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Motion-Corrected Real-Time Cine Magnetic Resonance Imaging of the Heart: Initial Clinical Experience. Invest Radiol 2018; 53:35-44. [PMID: 28857861 DOI: 10.1097/rli.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Free-breathing real-time (RT) imaging can be used in patients with difficulty in breath-holding; however, RT cine imaging typically experiences poor image quality compared with segmented cine imaging because of low resolution. Here, we validate a novel unsupervised motion-corrected (MOCO) reconstruction technique for free-breathing RT cardiac images, called MOCO-RT. Motion-corrected RT uses elastic image registration to generate a single heartbeat of high-quality data from a free-breathing RT acquisition. MATERIALS AND METHODS Segmented balanced steady-state free precession (bSSFP) cine images and free-breathing RT images (Cartesian, TGRAPPA factor 4) were acquired with the same spatial/temporal resolution in 40 patients using clinical 1.5 T magnetic resonance scanners. The respiratory cycle was estimated using the reconstructed RT images, and nonrigid unsupervised motion correction was applied to eliminate breathing motion. Conventional segmented RT and MOCO-RT single-heartbeat cine images were analyzed to evaluate left ventricular (LV) function and volume measurements. Two radiologists scored images for overall image quality, artifact, noise, and wall motion abnormalities. Intraclass correlation coefficient was used to assess the reliability of MOCO-RT measurement. RESULTS Intraclass correlation coefficient showed excellent reliability (intraclass correlation coefficient ≥ 0.95) of MOCO-RT with segmented cine in measuring LV function, mass, and volume. Comparison of the qualitative ratings indicated comparable image quality for MOCO-RT (4.80 ± 0.35) with segmented cine (4.45 ± 0.88, P = 0.215) and significantly higher than conventional RT techniques (3.51 ± 0.41, P < 0.001). Artifact and noise ratings for MOCO-RT (1.11 ± 0.26 and 1.08 ± 0.19) and segmented cine (1.51 ± 0.90, P = 0.088 and 1.23 ± 0.45, P = 0.182) were not different. Wall motion abnormality ratings were comparable among different techniques (P = 0.96). CONCLUSIONS The MOCO-RT technique can be used to process conventional free-breathing RT cine images and provides comparable quantitative assessment of LV function and volume measurements to conventional segmented cine imaging while providing improved image quality and less artifact and noise. The free-breathing MOCO-RT reconstruction method may have considerable clinical utility in cardiac magnetic resonance imaging for patients with difficulty breath-holding.
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Pordel S, Sajedi Khanian M, Karimi MH, Nikoo H, Doroudchi M. Plasma CXCL1 levels and TRAF3IP2 variants in patients with myocardial infarction. J Clin Lab Anal 2018; 32:e22402. [PMID: 29430728 DOI: 10.1002/jcla.22402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND IL-17A plays an important role in inflammatory responses in myocardial infarction (MI). IL-17A signals through its receptor, for which, Act1 (TRAF3IP2) functions as a key upstream adaptor in the pathway. AIM To compare frequencies of functional polymorphisms of TRAF3IP2 (rs13210247, rs33980500) between patients with MI and healthy controls. METHODS The selected SNPs were studied in 201 Iranian MI patients and 201 healthy blood donors from Fars Province by PCR-RFLP in association with clinicopathologic criteria of patients. CXCL1 plasma levels in 126 MI patients and 50 normal subjects were measured by ELISA. RESULTS A significant increase in the mutant (T) allele of TRAF3IP2 rs33980500 in patients with diastolic dysfunction of the heart (P = .01) was observed. The highest correlation, however, was observed between the TRAF3IP2 rs33980500 TT genotype and T allele with left main coronary artery stenosis (P = .01, P < .001; OR = 31.03). T allele of TRAF3IP2 rs33980500 was also associated with female gender, family history of cardiovascular disease, and mechanical complications of heart (P = .04, P = .02, and P = .01, respectively). Moreover, TRAF3IP2 rs13210247 (G) correlated with mechanical complications of the heart (P = .01). A significant increase in the plasma levels of CXCL1 chemokine in patients (P = .0006) associated with TT genotype of TRAF3IP2 (rs33980500) was observed (P = .04). CONCLUSION The gene variants of Act1 adaptor are associated with correlates of poor outcome in patients with MI and plasma CXCL1 levels.
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Affiliation(s)
- Safoora Pordel
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Sajedi Khanian
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Doroudchi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim W, Kim EJ. Heart Failure as a Risk Factor for Stroke. J Stroke 2018; 20:33-45. [PMID: 29402070 PMCID: PMC5836579 DOI: 10.5853/jos.2017.02810] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) is one of the major causes of death worldwide. Despite the high incidence of stroke in patients with HF, there has been a controversy as to whether HF itself is a risk factor for stroke. Recently, there is a great deal of evidence that HF itself increases the risk of stroke. In previous studies, the benefit of warfarin for stroke prevention in patients with HF was offset by the risk of bleeding. In the era of non-vitamin K antagonist oral anticoagulants with low bleeding profiles, we can expect a more effective stroke prevention in patients with HF by selective anticoagulation. The purpose of this review is to describe the relationship between stroke and HF, which could be an unconventional risk factor and a potential intervention target for stroke prevention.
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Affiliation(s)
- Woohyeun Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Mechano-electrical feedback in the clinical setting: Current perspectives. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:365-375. [DOI: 10.1016/j.pbiomolbio.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/13/2022]
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Seo WK, Jung JM, Kim JH, Koh SB, Bang OY, Oh K. Free Fatty Acid Is Associated with Thrombogenicity in Cardioembolic Stroke. Cerebrovasc Dis 2017; 44:160-168. [DOI: 10.1159/000478895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/20/2017] [Indexed: 01/15/2023] Open
Abstract
Background: Recently, the role of free fatty acids (FFAs) in thromboembolism has re-emerged in the context of cardioembolic stroke. Therefore, we attempted to determine the role of FFAs in embolic risk in various potential sources of cardioembolism (PSCE). We hypothesized that if elevated FFA levels in stroke patients are associated with thrombogenesis, then patients with a well-known high risk of embolic sources would have high FFA levels. Methods: Data collected from 2 hospital-based stroke registries were analyzed to investigate the association between FFA and PSCE. Results: A total of 2,770 acute stroke patients, including 539 with cardioembolic stroke, were selected for analysis. FFA was an independent predictor for cardioembolism (OR 2.755, 95% CI 2.221-3.417, p < 0.001). Among the PSCE, FFA levels were significantly associated with high risk of atrial fibrillation (AF), valvular heart disease, congestive heart failure with low ejection fraction, left atrial thrombus, left ventricular thrombus, left atrial smoke, and ventricular wall motion abnormality. FFA levels increased with the number of PSCE per patient without interaction with the presence of AF. Conclusions: Among acute stroke patients, FFA levels increased in groups with higher risk of cardioembolic stroke irrespective of the presence of AF. These results suggest that enhanced thrombogenicity could be the main mechanism to explain the elevated FFA levels in patients with cardioembolic stroke.
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The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:1561-1569. [PMID: 28421305 PMCID: PMC5676834 DOI: 10.1007/s10554-017-1138-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/09/2017] [Indexed: 12/28/2022]
Abstract
Prior myocardial infarction (MI) is associated with increased mortality and is prevalent in certain high risk patient groups. Electrocardiogram may be used in diagnosis, however, sensitivity is limited, thus non-invasive imaging techniques may improve diagnosis. We investigated whether global longitudinal strain (GLS) and longitudinal strain parameters are reduced in patients with prior MI but preserved left ventricular ejection fraction (LVEF). The study included 40 clinical patients with prior MI occurring >3 months previously (defined as subendocardial hyperenhancement on late Gadolinium enhancement imaging) with LVEF ≥ 55% and 40 controls matched for age and LVEF. GLS, global longitudinal strain rate (GLSR) and early diastolic longitudinal strain rate (GLSRe) were measured from cine imaging feature tracking analysis. Presence of wall motion abnormality (WMA) and minimum systolic wall thickening (SWT) were calculated from cine imaging. GLS was −17.3 ± 3.7% in prior MI versus −19.3 ± 1.9% in controls (p = 0.012). GLSR was −88.0 ± 33.7%/s in prior MI versus −103.3 ± 26.5%/s in controls (p = 0.005). GLSRe was 76.4 ± 28.4%/s in prior MI versus 95.5 ± 26.0%/s in controls (p = 0.001). GLS accurately identified prior MI [AUC 0.662 (95% CI 0.54–0.785) p = 0.012] whereas WMA [AUC 0.500 (95% CI 0.386–0.614) p = 1.0] and minimum SWT [AUC 0.609 (95% CI 0.483–0.735) p = 0.093] did not. GLS, GLSR and GLSRe are reduced in prior MI with preserved LVEF. Normal LVEF and lack of WMA cannot exclude prior MI. Prior MI should be considered when reduced GLS, GLSR or GLSRe are detected by non-invasive imaging.
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De Marco M, Gerdts E, Mancusi C, Roman MJ, Lønnebakken MT, Lee ET, Howard BV, Devereux RB, de Simone G. Influence of Left Ventricular Stroke Volume on Incident Heart Failure in a Population With Preserved Ejection Fraction (from the Strong Heart Study). Am J Cardiol 2017; 119:1047-1052. [PMID: 28159195 DOI: 10.1016/j.amjcard.2016.12.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
At a given level of left ventricular (LV) systolic function, LV pump performance (assessed by stroke index [SVi]) may differ, depending on LV size. We evaluated whether low SVi may be considered a marker of risk for incident congestive heart failure (HF), independent of LV geometry and systolic function, assessed by ejection fraction (EF) or midwall fractional shortening (MFS), in a large population-based sample with normal EF. Clinical and echocardiographic data from the second Strong Heart Study (SHS) examination, including 2,885 American Indians (59 ± 8 years; 63% women) with normal EF (EF ≥51% in men and EF ≥55% in women) and without prevalent HF or significant valve disease, were analyzed. Low SVi was defined as SVi ≤22 ml/m2.04. Low SVi was more common among men and associated with lower body mass index, systolic blood pressure, LV mass index, left atrial dimension, EF, and MFS and with higher relative wall thickness. During a mean 12-year follow-up, 209 participants developed HF and 246 had acute myocardial infarction. In Cox regression analysis, low SVi was associated with higher risk of incident HF (hazard ratio 1.38; 95% confidence interval 1.06 to 1.80), independently of age, gender, body mass index, heart rate, hypertension, prevalent cardiovascular disease, left atrial dimension index, LV mass index, LV concentric geometry, EF or MFS, and abnormal wall motion, also accounting for myocardial infarction as a competing risk event. In conclusion, in the SHS, low SVi was associated with higher incident rate of HF, independently of LV geometry and systolic function and other major confounders.
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Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovasc Ultrasound 2017; 15:7. [PMID: 28327159 PMCID: PMC5361820 DOI: 10.1186/s12947-017-0099-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/15/2017] [Indexed: 12/18/2022] Open
Abstract
Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.
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Affiliation(s)
- Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124, Pisa, Italy.
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Bloomfield GS, DeLong AK, Akwanalo CO, Hogan JW, Carter EJ, Aswa DF, Binanay C, Koech M, Kimaiyo S, Velazquez EJ. Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya. Glob Heart 2017; 11:97-107. [PMID: 27102027 DOI: 10.1016/j.gheart.2015.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although risk factors for heart failure are increasingly common worldwide, the contribution of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown. OBJECTIVE This study assessed the association between atherosclerotic risk factors and heart failure in a developing country. METHODS We performed a case-control study of heart failure in rural Kenya. We assessed the risk factors for heart failure by using international criteria based on electrocardiogram (ECG), echocardiogram, physical examination findings, and laboratory testing. Atherosclerotic risk factors were determined by ECG, echocardiogram, ankle-brachial index (ABI), and lipid testing. We described the relationship of wall motion abnormalities on echocardiogram, ABI <0.9, and ischemic pattern on ECG with the presence of heart failure with multivariable logistic regression adjusting for age and sex and using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS There were 125 cases and 191 controls (n = 316); 49% were male. The mean age was 60 (SD = 13) years. Most patients had hypertension (53%), and 16% had human immunodeficiency virus infection. Lipids were in the normal range for all. Cases were older than controls (62 years vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common cause in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%; AOR: 1.99; 95% CI: 1.19 to 3.32), ischemia or infarct on ECG (68% vs. 43%; AOR: 3.01; 95% CI: 1.43 to 6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%; AOR: 7.00; 95% CI: 3.95 to 12.39). CONCLUSIONS Ischemic heart failure is more common in Kenya than previously recognized. Noninvasive markers of atherosclerosis are routinely found among patients with heart failure. Treatment and prevention of heart failure in sub-Saharan Africa must consider many causes including those related to atherosclerosis.
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Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Allison K DeLong
- Center for Statistical Science, School of Public Health, Brown University, Providence, RI, USA
| | | | - Joseph W Hogan
- Department of Biostatistics and Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - E Jane Carter
- Division of Infectious Diseases, Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Pulmonary Medicine, Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Daniel F Aswa
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Cynthia Binanay
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Myra Koech
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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Lin K, Meng L, Collins JD, Chowdhary V, Markl M, Carr JC. Heart deformation analysis: the distribution of regional myocardial motion patterns at left ventricle. Int J Cardiovasc Imaging 2016; 33:351-359. [PMID: 27783187 DOI: 10.1007/s10554-016-1005-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022]
Abstract
The aim of the present study was to test the hypothesis that heart deformation analysis (HDA) is able to discriminate regional myocardial motion patterns on the left ventricle (LV). Totally 21 healthy volunteers (15 men and 6 women) without documented cardiovascular diseases were recruited. Cine MRI was performed on those subjects at four-chamber, two-chamber, and short-axis views. The variations of segmental myocardial motion indices of the LV, which were measured with the HDA tool, were investigated. Regional displacement, velocity, strain and strain rate were compared between lateral wall and septal wall using t tests. There are significant variations (CoV = 18.0-72.4%) of myocardial motion indices (average over 21 subjects) among 16 myocardial segments. There are significant differences (p < 0.05) between displacement, velocity, strain and strain rate measured at lateral and septal areas of the LV. In conclusion, HDA is able to present different regional LV motion patterns from multiple aspects in healthy volunteers.
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Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA.
| | - Leng Meng
- Department of Radiology, Anzhen Hospital, Capital Medical University, Anzhen Li, Chaoyang District, Beijing, 100029, China
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Varun Chowdhary
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
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Lin K, Meng L, Collins JD, Chowdhary V, Markl M, Carr JC. Reproducibility of cine displacement encoding with stimulated echoes (DENSE) in human subjects. Magn Reson Imaging 2016; 35:148-153. [PMID: 27569367 DOI: 10.1016/j.mri.2016.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/27/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To test the hypothesis that two-dimensional (2D) displacement encoding via stimulated echoes (DENSE) is a reproducible technique for the depiction of segmental myocardial motion in human subjects. MATERIALS AND METHODS Following the approval of the institutional review board (IRB), 17 healthy volunteers without documented history of cardiovascular disease were recruited. For each participant, 2D DENSE were performed twice (at different days) and the images were obtained at basal, midventricular and apical levels of the left ventricle (LV) with a short-axis view. The radial thickening strain (Err), circumferential strain (Ecc), twist and torsion were calculated. The intra-, inter-observer and inter-study variations of DENSE-derived myocardial motion indices were evaluated using coefficient of variation (CoV) and intra-class correlation coefficient (ICC). RESULTS In total, there are 272 pairs of myocardial segments (data points) for comparison. There is good intra- and inter-observer reproducibility for all DENSE-derived measures in 17 participants. There is good inter-study reproducibility for peak Ecc (CoV=19.64%, ICC=0.8896, p<0.001), twist (CoV=33.11%, ICC=0.9135, p<0.001) and torsion (CoV=13.96%, ICC=0.8684, p<0.001). There is moderate inter-study reproducibility for Err (CoV=38.89%, ICC=0.7022, p<0.001). CONCLUSION DENSE is a reproducible technique for characterizing LV regional systolic myocardial motion on a per-segment basis in healthy volunteers.
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Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Leng Meng
- Department of Radiology, Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Varun Chowdhary
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL 60611
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Lin K, Collins JD, Chowdhary V, Markl M, Carr JC. Heart deformation analysis: measuring regional myocardial velocity with MR imaging. Int J Cardiovasc Imaging 2016; 32:1103-11. [PMID: 27076222 DOI: 10.1007/s10554-016-0879-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
The aim of the present study was to test the hypothesis that heart deformation analysis (HDA) may serve as an alternative for the quantification of regional myocardial velocity. Nineteen healthy volunteers (14 male and 5 female) without documented cardiovascular diseases were recruited following the approval of the institutional review board (IRB). For each participant, cine images (at base, mid and apex levels of the left ventricle [LV]) and tissue phase mapping (TPM, at same short-axis slices of the LV) were acquired within a single magnetic resonance (MR) scan. Regional myocardial velocities in radial and circumferential directions acquired with HDA (Vrr and Vcc) and TPM (Vr and VФ) were measured during the cardiac cycle. HDA required shorter processing time compared to TPM (2.3 ± 1.1 min/case vs. 9.5 ± 3.7 min/case, p < 0.001). Moderate to good correlations between velocity components measured with HDA and TPM could be found on multiple myocardial segments (r = 0.460-0.774) and slices (r = 0.409-0.814) with statistical significance (p < 0.05). However, significant biases of velocity measures at regional myocardial areas between HDA and TPM were also noticed. By providing comparable velocity measures as TPM does, HDA may serve as an alternative for measuring regional myocardial velocity with a faster image processing procedure.
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Affiliation(s)
- Kai Lin
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA.
| | - Jeremy D Collins
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Varun Chowdhary
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA
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Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2016; 28:727-54. [PMID: 26140936 DOI: 10.1016/j.echo.2015.05.002] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK
| | | | - Jose L Zamorano
- University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
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Iyngkaran P, Thomas M. Bedside-to-Bench Translational Research for Chronic Heart Failure: Creating an Agenda for Clients Who Do Not Meet Trial Enrollment Criteria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:121-32. [PMID: 26309418 PMCID: PMC4527366 DOI: 10.4137/cmc.s18737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/09/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
Abstract
Congestive heart failure (CHF) is a chronic condition usually without cure. Significant developments, particularly those addressing pathophysiology, mainly started at the bench. This approach has seen many clinical observations initially explored at the bench, subsequently being trialed at the bedside, and eventually translated into clinical practice. This evidence, however, has several limitations, importantly the generalizability or external validity. We now acknowledge that clinical management of CHF is more complicated than merely translating bench-to-bedside evidence in a linear fashion. This review aims to help explore this evolving area from an Australian perspective. We describe the continuation of research once core evidence is established and describe how clinician-scientist collaboration with a bedside-to-bench view can help enhance evidence translation and generalizability. We describe why an extension of the available evidence or generating new evidence is occasionally needed to address the increasingly diverse cohort of patients. Finally, we explore some of the tools used by basic scientists and clinicians to develop evidence and describe the ones we feel may be most beneficial.
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Affiliation(s)
- P Iyngkaran
- Flinders University, NT Medical School, Darwin, Australia
| | - M Thomas
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Stankovic I, Putnikovic B, Cvjetan R, Milicevic P, Panic M, Kalezic-Radmili T, Mandaric T, Vidakovic R, Cvorovic V, Neskovic AN. Visual assessment vs. strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction. Eur Heart J Cardiovasc Imaging 2014; 16:402-9. [PMID: 25336543 DOI: 10.1093/ehjci/jeu206] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought to determine the prevalence of overt and subclinical LV dysfunction in patients with critical left anterior descending coronary artery (LAD) stenosis but without a history of myocardial infarction and to compare diagnostic value of routine echocardiographic parameters with myocardial strain analysis for detection of critical LAD stenosis. METHODS AND RESULTS We retrospectively studied 269 patients with suspected coronary artery disease (CAD)-209 consecutive patients with critical LAD stenosis and 60 consecutive patients with atypical chest pain and without CAD. Conventional visual assessment of LV asynergy in the LAD territory was compared with global, regional, and segmental peak systolic longitudinal strain (PSLS) parameters derived by two-dimensional speckle tracking echocardiography (2D STE). Wall motion abnormalities in the LAD territory were found in 41% of patients with critical LAD stenosis, whereas, depending on the cut-off value, global longitudinal strain (GLS) was impaired in 42-69% of patients. GLS with an area under the receiver operating characteristic curve (AUC) of 0.85 showed better discriminative power for detecting critical LAD stenosis than conventional wall motion score index (AUC 0.73, P < 0.05, for the difference between the AUCs). PSLS values were significantly lower in basal and midventricular segments supplied by critically narrowed LAD, particularly if they also appeared dysfunctional on visual assessment. CONCLUSIONS Detection of subclinical LV dysfunction by 2D STE might improve identification of patients with critical LAD stenosis, although visually apparent regional LV dysfunction in the LAD territory is not uncommon finding in this subset of patients.
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Affiliation(s)
- Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Biljana Putnikovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosava Cvjetan
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Predrag Milicevic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Milos Panic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Kalezic-Radmili
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Mandaric
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Vojkan Cvorovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
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Yeh F, Dixon AE, Best LG, Marion SM, Lee ET, Ali T, Yeh J, Rhoades ER, Howard BV, Devereux RB. Lung function and heart disease in American Indian adults with high frequency of metabolic abnormalities (from the Strong Heart Study). Am J Cardiol 2014; 114:312-9. [PMID: 24878118 DOI: 10.1016/j.amjcard.2014.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 01/20/2023]
Abstract
The associations of pulmonary function with cardiovascular disease (CVD) independent of diabetes mellitus (DM) and metabolic syndrome have not been examined in a population-based setting. We examined prevalence and incidence CVD in relation to lower pulmonary function in the Strong Heart Study second examination (1993 to 1995) in 352 CVD and 2,873 non-CVD adults free of overt lung disease (mean age 60 years). Lung function was assessed by standard spirometry. Participants with metabolic syndrome or DM with or without CVD had lower pulmonary function than participants without these conditions after adjustment for hypertension, age, gender, abdominal obesity, smoking, physical activity index, and study field center. CVD participants with DM had significantly lower forced vital capacity than participants with CVD alone. Significant associations were observed between reduced pulmonary function, preclinical CVD, and prevalent CVD after adjustment for multiple CVD risk factors. During follow-up (median 13.3 years), pulmonary function did not predict CVD incidence, it predicted CVD mortality. Among 3,225 participants, 412 (298 without baseline CVD) died from CVD by the end of 2008. In models adjusted for multiple CVD risk factors, DM, metabolic syndrome, and baseline CVD, compared with highest quartile of lung function, lower lung function predicted CVD mortality (relative risk up to 1.5, 95% confidence interval 1.1 to 2.0, p<0.05). In conclusion, a population with a high prevalence of DM and metabolic syndrome and lower lung function was independently associated with prevalent clinical and preclinical CVD, and its impairment predicted CVD mortality. Additional research is needed to identify mechanisms linking metabolic abnormalities, low lung function, and CVD.
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Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study. J Hypertens 2014; 31:2060-8. [PMID: 23838656 DOI: 10.1097/hjh.0b013e328362bbd6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients. METHODS AND RESULTS Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05). CONCLUSION The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
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Zhu M, Streiff C, Panosian J, Zhang Z, Song X, Sahn DJ, Ashraf M. Regional strain determination and myocardial infarction detection by three-dimensional echocardiography with varied temporal resolution. Echocardiography 2014; 32:339-48. [PMID: 24815184 DOI: 10.1111/echo.12632] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Three-dimensional echocardiography (3DE) is a promising method for strain determination; however, there are temporal resolution concerns. This study aims to evaluate the feasibility and accuracy of 3DE on longitudinal and circumferential strain (LS, CS) determination and infarction detection under variable frame rates (FR) and "heart rates" (stroke rates [SR]) conditions. METHODS Latex balloons were sewn into the left ventricle (LV) of 20 freshly harvested pig hearts which were then passively driven by a pulsatile pump apparatus at stroke volumes (SV) 30-70 mL. The hearts were pumped at 2 normal limits of human heart rate. Full-volume data were acquired before and after a simulated myocardial infarction (MI) at the 2 most commonly used FRs. LS and CS values were evaluated against sonomicrometry. RESULTS Longitudinal strain and CS derived from high FR acquisitions showed statistically superior correlations with sonomicrometry data (LS: R(2) = 0.85, CS: R(2) = 0.84) than strain values from low FR (LS: R(2) = 0.78, CS: R(2) = 0.76) (all P < 0.01). After MI induction, LS and CS at different FRs were significantly decreased while maintaining excellent correlations with sonomicrometry data (all P < 0.001). There is no statistical difference of strain values between different SR acquisitions. CONCLUSION Three-dimensional wall-motion tracking has the ability to accurately determine regional myocardial deformation and detect MI. Different heart rates within a physiologically relevant range have no effect on 3D strain accuracy. Strain values calculated from higher frame rate acquisitions were found to have a slightly better accuracy.
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Affiliation(s)
- Meihua Zhu
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon
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Wu L, Germans T, Güçlü A, Heymans MW, Allaart CP, van Rossum AC. Feature tracking compared with tissue tagging measurements of segmental strain by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2014; 16:10. [PMID: 24450803 PMCID: PMC3926943 DOI: 10.1186/1532-429x-16-10] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 01/13/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Left ventricular segmental wall motion analysis is important for clinical decision making in cardiac diseases. Strain analysis with myocardial tissue tagging is the non-invasive gold standard for quantitative assessment, however, it is time-consuming. Cardiovascular magnetic resonance myocardial feature-tracking (CMR-FT) can rapidly perform strain analysis, because it can be employed with standard CMR cine-imaging. The aim is to validate segmental peak systolic circumferential strain (peak SCS) and time to peak systolic circumferential strain (T2P-SCS) analysed by CMR-FT against tissue tagging, and determine its intra and inter-observer variability. METHODS Patients in whom both cine CMR and tissue tagging has been performed were selected. CMR-FT analysis was done using endocardial (CMR-FTendo) and mid-wall contours (CMR-FTmid). The Intra Class Correlation Coefficient (ICC) and Pearson correlation were calculated. RESULTS 10 healthy volunteers, 10 left bundle branch block (LBBB) and 10 hypertrophic cardiomyopathy patients were selected. With CMR-FT all 480 segments were analyzable and with tissue tagging 464 segments.Significant differences in mean peak SCS values of the total study group were present between CMR-FTendo and tissue tagging (-23.8 ± 9.9% vs -13.4 ± 3.3%, p<0.001). Differences were smaller between CMR-FTmid and tissue tagging (-16.4 ± 6.1% vs -13.4 ± 3.3%, p=0.001). The ICC of the mean peak SCS of the total study group between CMR-FTendo and tissue tagging was low (0.19 (95%-CI-0.10-0.49), p=0.02). Comparable results were seen between CMR-FTmid and tissue tagging. In LBBB patients, mean T2P-SCS values measured with CMR-FTendo and CMR-FTmid were 418 ± 66 ms, 454 ± 60 ms, which were longer than with tissue tagging, 376 ± 55 ms, both p<0.05. ICC of the mean T2P-SCS between CMR-FTendo and tissue tagging was 0.64 (95%-CI-0.36-0.81), p<0.001, this was better in the healthy volunteers and LBBB group, whereas the ICC between CMR-FTmid and tissue tagging was lower.The intra and inter-observer agreement of segmental peak SCS with CMR-FTmid was lower compared with tissue tagging; similar results were seen for segmental T2P-SCS. CONCLUSIONS The intra and inter-observer agreement of segmental peak SCS and T2P-SCS is substantially lower with CMR-FTmid compared with tissue tagging. Therefore, current segmental CMR-FTmid techniques are not yet applicable for clinical and research purposes.
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Affiliation(s)
- LiNa Wu
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
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Kilcullen NM, Uthamalingam S, Gurm GS, Gregory SA, Picard MH. The Prognostic Significance of Resting Regional Left Ventricular Function in Patients With Varying Degrees of Myocardial Ischemia. Cardiol Res 2013; 4:178-185. [PMID: 28352442 PMCID: PMC5358306 DOI: 10.4021/cr240w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/21/2022] Open
Abstract
Background Our aim was to determine whether regional left ventricular (LV) function on a resting transthoracic echo (TTE) provides prognostic information in patients with varying degrees of ischemia on myocardial perfusion imaging. Methods Between 2004 - 2009, we identified 503 patients (mean age 69 (SD 11); 79% male) with reversible ischemia on a myocardial SPECT scan who had a TTE within 30 days. We evaluated the rate of subsequent revascularization and death for all patients. Results Following the SPECT scan and TTE, 246/503(49%) patients underwent revascularization, 64/503 (13%) patients died, 369 (73%) patients had a normal left ventricular ejection fraction (LVEF), 242 (48%) patients had a resting wall motion abnormality (WMA), 21/261 (8%) with no WMA died compared to 43/242 (18%) in patients with a WMA. In patients with a WMA (n = 242) there was no significant difference in mortality when comparing patients with small (< 6 segments) and large (> 6 segments) WMA (P = 0.44). In patients with moderate/severe ischemia, the presence of a resting WMA was associated with a higher mortality rate (18% v 7%; P = 0.005). In a multivariable model, LVEF (< 50%) was associated with a hazard ratio of 2.2 (P = 0.002, 95% CI 1.34 - 3.68) however, WMA and number of abnormal segments did not reach statistical significance. Conclusion A resting wall motion abnormality in patients with moderate/severe ischemia is associated with a higher mortality compared to patients with mild ischemia on myocardial perfusion imaging. Regional left ventricular dysfunction unlike LVEF was not an independent predictor of mortality.
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Transient Myocardial Tissue and Function Changes During a Marathon in Less Fit Marathon Runners. Can J Cardiol 2013; 29:1269-76. [DOI: 10.1016/j.cjca.2013.04.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/20/2013] [Accepted: 04/20/2013] [Indexed: 11/22/2022] Open
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Vigili de Kreutzenberg S, Avogaro A. The limited clinical value of a specific diabetic cardiomyopathy. Nutr Metab Cardiovasc Dis 2013; 23:599-605. [PMID: 23725770 DOI: 10.1016/j.numecd.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 01/29/2013] [Accepted: 03/30/2013] [Indexed: 02/07/2023]
Abstract
AIMS Diabetic patients show a higher likelihood of developing heart failure (HF), independently of the atherosclerotic process, than their nondiabetic counterparts. This suggests the presence of an intrinsic vulnerability of the heart in patients with diabetes mellitus. DATA SYNTHESIS A cardiomyopathy specific to the diabetic patient was first hypothesized by Rubler and co-workers, in 1972 and recognized as a nosologic entity by the World Health Organization (WHO) in 1995. All patients falling under Rubler's definition had ascertained diabetic glomerusclerosis, but were unaffected by major coronary artery disease (CAD). Notably, the mean plasma glucose in those patients was 417 ± 209 mg/dl. Since then, several studies conducted in both animals and in humans have focused on pathogenetic mechanisms, clinical manifestations, diagnostic as well as therapeutic approaches utilized for the treatment of diabetic cardiomyopathy (DCM). Despite the large body of literature available, the clinical entity and significance of this diabetic complication continue to be elusive. CONCLUSIONS In the present report, recent pathophysiological findings and diagnostic strategies to treat DCM are reviewed. Particular attention is dedicated to the clinical manifestation of DCM, that is to heart failure (HF), and to the implications of co-morbidities and metabolic control on its evolution.
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Do Echocardiographic Parameters Predict Mortality in Patients With End-Stage Renal Disease? Transplantation 2013; 95:1225-32. [DOI: 10.1097/tp.0b013e31828dbbbe] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoon YE, Kitagawa K, Kato S, Nakajima H, Kurita T, Dohi K, Ito M, Sakuma H. Prognostic value of unrecognised myocardial infarction detected by late gadolinium-enhanced MRI in diabetic patients with normal global and regional left ventricular systolic function. Eur Radiol 2013; 23:2101-8. [PMID: 23553584 DOI: 10.1007/s00330-013-2817-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/31/2013] [Accepted: 02/12/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine whether the detection of unrecognised myocardial infarction (MI) using late gadolinium-enhanced (LGE)-magnetic resonance imaging (MRI) can provide prognostic information in diabetic patients with normal ECG as well as normal global and regional left ventricular (LV) function. METHODS From 449 diabetic patients who had complete cine- and LGE-MRI, 321 patients with histories of CAD, ischaemic ECG changes and abnormal cine MRI findings (LV ejection fraction <50 % or presence of regional wall motion abnormality) were excluded. The presence and extent of LGE were determined in the remaining 128 patients. Follow-up information was obtained for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, acute MI, heart failure, unstable angina and significant ventricular arrhythmias in 120 patients. RESULTS Of 120 patients, 18 (15 %) had LGE. During follow-up (median, 27 months), six patients with LGE (33.3 %) and four patients without LGE (3.9 %) experienced MACE, resulting in an annualised event rate of 7.7 % and 0.9 %, respectively (log-rank P <0.001). The presence of LGE was associated with an eight-fold increased hazard for MACE (HR, 8.84; P = 0.001). CONCLUSIONS LGE-MRI can detect unrecognised MI and may improve the risk stratification of diabetic patients with no CAD history, normal ECG and normal LV systolic function. KEY POINTS • Late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) can identify subtle myocardial abnormalities. • LGE-MRI can detect myocardial infarction missed by ECG and cine-MRI. • Unrecognised MI detected by LGE-MRI was associated with adverse cardiac events. • LGE-MRI helps clinicians to assess diabetic patients with unrecognised MI.
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Affiliation(s)
- Yeonyee E Yoon
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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Coller J, Campbell D, Krum H, Prior D. Early Identification of Asymptomatic Subjects at Increased Risk of Heart Failure and Cardiovascular Events: Progress and Future Directions. Heart Lung Circ 2013; 22:171-8. [DOI: 10.1016/j.hlc.2012.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 11/25/2022]
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