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Leng S, Zhao XD, Huang FQ, Wong JI, Su BY, Allen JC, Kassab GS, Tan RS, Zhong L. Automated quantitative assessment of cardiovascular magnetic resonance-derived atrioventricular junction velocities. Am J Physiol Heart Circ Physiol 2015; 309:H1923-35. [PMID: 26408537 DOI: 10.1152/ajpheart.00284.2015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/23/2015] [Indexed: 11/22/2022]
Abstract
The assessment of atrioventricular junction (AVJ) deformation plays an important role in evaluating left ventricular systolic and diastolic function in clinical practice. This study aims to demonstrate the effectiveness and consistency of cardiovascular magnetic resonance (CMR) for quantitative assessment of AVJ velocity compared with tissue Doppler echocardiography (TDE). A group of 145 human subjects comprising 21 healthy volunteers, 8 patients with heart failure, 17 patients with hypertrophic cardiomyopathy, 52 patients with myocardial infarction, and 47 patients with repaired Tetralogy of Fallot were prospectively enrolled and underwent TDE and CMR scan. Six AVJ points were tracked with three CMR views. The peak systolic velocity (Sm1), diastolic velocity during early diastolic filling (Em), and late diastolic velocity during atrial contraction (Am) were extracted and analyzed. All CMR-derived septal and lateral AVJ velocities correlated well with TDE measurements (Sm1: r = 0.736; Em: r = 0.835; Am: r = 0.701; Em/Am: r = 0.691; all p < 0.001) and demonstrated excellent reproducibility [intrastudy: r = 0.921-0.991, intraclass correlation coefficient (ICC): 0.918-0.991; interstudy: r = 0.900-0.970, ICC: 0.887-0.957; all p < 0.001]. The evaluation of three-dimensional AVJ motion incorporating measurements from all views better differentiated normal and diseased states [area under the curve (AUC) = 0.918] and provided further insights into mechanical dyssynchrony diagnosis in HF patients (AUC = 0.987). These findings suggest that the CMR-based method is feasible, accurate, and consistent in quantifying the AVJ deformation, and subsequently in diagnosing systolic and diastolic cardiac dysfunction.
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Affiliation(s)
| | | | - Fei-Qiong Huang
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
| | | | - Bo-Yang Su
- National Heart Centre Singapore, Singapore
| | | | | | - Ru-San Tan
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
| | - Liang Zhong
- National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School Singapore, Singapore; and
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Saba SG, Chung S, Bhagavatula S, Donnino R, Srichai MB, Saric M, Katz SD, Axel L. A novel and practical cardiovascular magnetic resonance method to quantify mitral annular excursion and recoil applied to hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2014; 16:35. [PMID: 24886666 PMCID: PMC4041905 DOI: 10.1186/1532-429x-16-35] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/02/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We have developed a novel and practical cardiovascular magnetic resonance (CMR) technique to evaluate left ventricular (LV) mitral annular motion by tracking the atrioventricular junction (AVJ). To test AVJ motion analysis as a metric for LV function, we compared AVJ motion variables between patients with hypertrophic cardiomyopathy (HCM), a group with recognized systolic and diastolic dysfunction, and healthy volunteers. METHODS We retrospectively evaluated 24 HCM patients with normal ejection fractions (EF) and 14 healthy volunteers. Using the 4-chamber view cine images, we tracked the longitudinal motion of the lateral and septal AVJ at 25 time points during the cardiac cycle. Based on AVJ displacement versus time, we calculated maximum AVJ displacement (MD) and velocity in early diastole (MVED), velocity in diastasis (VDS) and the composite index VDS/MVED. RESULTS Patients with HCM showed significantly slower median lateral and septal AVJ recoil velocities during early diastole, but faster velocities in diastasis. We observed a 16-fold difference in VDS/MVED at the lateral AVJ [median 0.141, interquartile range (IQR) 0.073, 0.166 versus 0.009 IQR -0.006, 0.037, P < 0.001]. Patients with HCM also demonstrated significantly less mitral annular excursion at both the septal and lateral AVJ. Performed offline, AVJ motion analysis took approximately 10 minutes per subject. CONCLUSIONS Atrioventricular junction motion analysis provides a practical and novel CMR method to assess mitral annular motion. In this proof of concept study we found highly statistically significant differences in mitral annular excursion and recoil between HCM patients and healthy volunteers.
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Affiliation(s)
- Shahryar G Saba
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Current affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sohae Chung
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Sharath Bhagavatula
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Robert Donnino
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
| | - Monvadi B Srichai
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
- Current affiliation: Medstar Heart Institute, Medstar Georgetown University Hospital, Washington DC 20007, USA
| | - Muhamed Saric
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Stuart D Katz
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Leon Axel
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
- Department of Radiology, Center for Biomedical Imaging, New York University Langone Medical Center, 660 First Avenue, Room 411, New York, NY 10016, USA
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