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Papa A, Nussbaumer C, Goulouti E, Schwitz F, Wustmann K, Tobler D, Greutmann M, Schwerzmann M. Prognostic value of right ventricular dyssynchrony in adults with repaired tetralogy of Fallot. Open Heart 2024; 11:e002583. [PMID: 38242560 PMCID: PMC10806502 DOI: 10.1136/openhrt-2023-002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Residual sequelae after surgical repair of tetralogy of Fallot (rTOF) affect clinical outcome. We investigated the prognostic impact of right ventricular (RV) dyssynchrony in adults with rTOF years after the surgical repair. METHODS Patients from the Swiss Adult Congenital HEart disease Registry were included. NT-proBNP levels, echocardiography, exercise testing and MRI data were collected. An offline strain analysis to quantify RV-ventricular and interventricular dyssynchrony was performed. The standard deviation of the time-to-peak shortening (TTP) of six RV segments defined the RV Dyssynchrony Index (RVDI). Maximal difference of TTP between RV and left ventricular segments defined the interventricular shortening delay (IVSD). Predictors of a composite adverse event (arrhythmias, hospitalisation for heart failure and death) were identified by multivariate Cox regression analysis. Their median values were used to create a risk score. RESULTS Out of 285 included patients (mean age 34±14 years), 33 patients (12%) experienced an adverse event during a mean follow-up of 48±21 months. No correlation was found between RVDI, IVSD and clinical events. NT-proBNP, right atrial area and peak heart rate were independent predictors of outcomes. After 4 years-follow-up, no adverse events occurred in patients at low risk (score=0 points), while an adverse event occurred in 62% of patients at high risk (score=3 points, p<0.001). CONCLUSION In our cohort of adults with rTOF, surrogates of RV dyssynchrony did not correlate with outcomes. A multimodality approach was effective in predicting the risk for adverse events.
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Affiliation(s)
- Andrea Papa
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Clement Nussbaumer
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Eleni Goulouti
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Daniel Tobler
- University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Jacquemyn X, Kutty S, Manlhiot C. The Lifelong Impact of Artificial Intelligence and Clinical Prediction Models on Patients With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:440-452. [PMID: 38161675 PMCID: PMC10755786 DOI: 10.1016/j.cjcpc.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 01/03/2024]
Abstract
Medical advancements in the diagnosis, surgical techniques, perioperative care, and continued care throughout childhood have transformed the outlook for individuals with tetralogy of Fallot (TOF), improving survival and shifting the perspective towards lifelong care. However, with a growing population of survivors, longstanding challenges have been accentuated, and new challenges have surfaced, necessitating a re-evaluation of TOF care. Availability of prenatal diagnostics, insufficient information from traditional imaging techniques, previously unforeseen medical complications, and debates surrounding optimal timing and indications for reintervention are among the emerging issues. To address these challenges, the integration of artificial intelligence and machine learning holds great promise as they have the potential to revolutionize patient management and positively impact lifelong outcomes for individuals with TOF. Innovative applications of artificial intelligence and machine learning have spanned across multiple domains of TOF care, including screening and diagnosis, automated image processing and interpretation, clinical risk stratification, and planning and performing cardiac interventions. By embracing these advancements and incorporating them into routine clinical practice, personalized medicine could be delivered, leading to the best possible outcomes for patients. In this review, we provide an overview of these evolving applications and emphasize the challenges, limitations, and future potential for integrating them into clinical care.
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Affiliation(s)
- Xander Jacquemyn
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Shelby Kutty
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Pediatric and Congenital Heart Center, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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3
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Schäfer M, Mawad W. Advanced Imaging Technologies for Assessing Tetralogy of Fallot: Insights Into Flow Dynamics. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:380-392. [PMID: 38161669 PMCID: PMC10755841 DOI: 10.1016/j.cjcpc.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect requiring surgical repair. Although surgical interventions have significantly reduced mortality, postrepair complications, such as pulmonary valve regurgitation and stenosis, may lead to adverse outcomes, including right ventricular dysfunction and increased risks of morbidity and mortality. This review explores the potential of advanced imaging technologies, including 4-dimensional-flow magnetic resonance imaging and high-frame-rate echocardiography, in providing valuable insights into blood flow dynamics and energy parameters. Quantitative measures, such as energy loss and vorticity, along with qualitative flow analysis, can provide additional insights into adverse haemodynamics at a potentially earlier and more reversible stage. Furthermore, personalized patient-specific information from these imaging modalities aids in guiding treatment decisions and monitoring postoperative interventions effectively. By characterizing flow patterns, these advanced imaging techniques hold great promise in improving the assessment and management of tetralogy of Fallot, providing tailored insights. However, further research and longitudinal studies are required to fully establish their clinical utility and potential impact on patient care.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Wadi Mawad
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
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Kazijevs M, Samad MD. Deep imputation of missing values in time series health data: A review with benchmarking. J Biomed Inform 2023; 144:104440. [PMID: 37429511 PMCID: PMC10529422 DOI: 10.1016/j.jbi.2023.104440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
The imputation of missing values in multivariate time series (MTS) data is critical in ensuring data quality and producing reliable data-driven predictive models. Apart from many statistical approaches, a few recent studies have proposed state-of-the-art deep learning methods to impute missing values in MTS data. However, the evaluation of these deep methods is limited to one or two data sets, low missing rates, and completely random missing value types. This survey performs six data-centric experiments to benchmark state-of-the-art deep imputation methods on five time series health data sets. Our extensive analysis reveals that no single imputation method outperforms the others on all five data sets. The imputation performance depends on data types, individual variable statistics, missing value rates, and types. Deep learning methods that jointly perform cross-sectional (across variables) and longitudinal (across time) imputations of missing values in time series data yield statistically better data quality than traditional imputation methods. Although computationally expensive, deep learning methods are practical given the current availability of high-performance computing resources, especially when data quality and sample size are of paramount importance in healthcare informatics. Our findings highlight the importance of data-centric selection of imputation methods to optimize data-driven predictive models.
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Affiliation(s)
- Maksims Kazijevs
- Department of Computer Science, Tennessee State University, Nashville, TN 37209, United States
| | - Manar D Samad
- Department of Computer Science, Tennessee State University, Nashville, TN 37209, United States.
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Schäfer M, Mitchell MB, Frank BS, Barker AJ, Stone ML, Jaggers J, von Alvensleben JC, Hunter KS, Friesen RM, Ivy DD, Jacobsen R, Di Maria MV. Myocardial strain-curve deformation patterns after Fontan operation. Sci Rep 2023; 13:11912. [PMID: 37488167 PMCID: PMC10366156 DOI: 10.1038/s41598-023-39226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023] Open
Abstract
Myocardial deformation analysis by cardiac MRI (CMR) yielding global circumferential and longitudinal strain (GCS and GLS) is an increasingly utilized method to accurately quantify systolic function and predict clinical events in patients with Fontan circulation. The purpose of this study was to use principal component analysis (PCA) to investigate myocardial temporal deformation patterns derived from strain-time curves to learn about latent strain features beyond peak values. We conducted the study with specific attention to dominant single left or right ventricle (SLV and SRV) morphologies. Methods and Results: Patients remote from Fontan operation who underwent follow-up CMR were analyzed for standard volumetric and function hemodynamics including myocardial deformation parameters including GCS and GLS. We applied PCA to investigate in an unbiased fashion the strain-time curve morphology and to calculate patient specific shape scores. All variables were subjected to single variable Cox regression analysis to detect composite clinical outcome including death, heart transplant, protein losing enteropathy and plastic bronchitis. A total of 122 patients, (SLV = 67, SRV = 55) with a mean age of 12.7 years underwent comprehensive CMR analysis. The PCA revealed 3 primary modes of strain-curve variation regardless of single ventricle morphology and type of strain investigated. Principle components (PCs) described changes in (1) strain-time curve amplitude, (2) time-to-peak strain, and (3) post-systolic slope of the strain-time curve. Considering only SLV patients, GCS was only CMR variable predictive of clinical events (HR 1.46, p = 0.020). In the SRV group, significant CMR predictors of clinical events were derived indexed end-diastolic (HR 1.02, p = 0.023) and end-systolic (HR 1.03, p = 0.022) volumes, GCS (HR 1.91, p = 0.003) and its related first component score (HR 1.20, p = 0.005), GLS (HR 1.32, p = 0.029) and its third component score (HR 1.58, p = 0.017). CMR derived global strain measures are sensitive markers of clinical outcomes in patients with Fontan circulation, particularly in patients with the SRV morphology. Myocardial strain-time curve morphology specific to SLV and SRV patients inspired by unbiased PCA technique can further aid with predicting clinical outcomes.
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Affiliation(s)
- Michal Schäfer
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA.
- Division of Cardiothoracic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
| | - Max B Mitchell
- Division of Cardiothoracic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin S Frank
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew L Stone
- Division of Cardiothoracic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - James Jaggers
- Division of Cardiothoracic Surgery, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Johannes C von Alvensleben
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Richard M Friesen
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
| | - D Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
| | - Roni Jacobsen
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
| | - Michael V Di Maria
- Division of Pediatric Cardiology, Children's Hospital Colorado, Heart Institute, University of Colorado Denver, Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA
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Ozden O, Unlu S, Kilic DI, Sherif SA, Opan S, Kemal HS, Ozmen E, Tuner H, Bingol G, Barutcu A, Nasifov M, Bakan S, Goktekin O. [The association between cardiac mr feature tracking strain and myocardial late gadolinium enhancement in patients with hypertrophic cardiomyopathy]. KARDIOLOGIIA 2023; 63:52-58. [PMID: 36880144 DOI: 10.18087/cardio.2023.2.n2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 03/08/2023]
Abstract
Aim Hypertrophic cardiomyopathy (HCM) is a relatively common, heritable cardiomyopathy, and cardiac magnetic resonance (CMR) studies have been performed previously to evaluate different aspects of the disease. However, a comprehensive study, including all four cardiac chambers and analysis of left atrial (LA) function, is missing in the literature. The aim of this retrospective study was to analyze CMR-feature tracking (CMR-FT) strain parameters and atrial function of HCM patients and to investigate the association of these parameters with the amount of myocardial late gadolinium enhancement (LGE).Material and Methods In this retrospective, cross-sectional study, we analyzed the CMR images (CMRI) of 58 consecutive patients, who from February 2020 to September 2022 were diagnosed with HCM at our tertiary cardiovascular center. Patients who were younger than 18 yrs or who had moderate or severe valvular heart disease, significant coronary artery disease, previous myocardial infarction, suboptimal image quality, or with contraindication to CMR were excluded. CMRI was performed at 1.5 T with a scanner, and all scans were assessed by an experienced cardiologist and then re-assessed by an experienced radiologist. SSFP 2-, 3- and 4‑chamber, short axis views were obtained and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were measured. LGE images were obtained using a PSIR sequence. Native T1 and T2 mapping and post-contrast T1 map sequences were performed and each patient's myocardial extracellular volume (ECV) was calculated. LA volume index (LAVI), LA ejection fraction (LAEF), LA coupling index (LACI) were calculated. The complete CMR analysis of each patient was performed with CVI 42 software (Circle CVi, Calgary, Canada), off-line.Results The patients were divided into two groups, HCM with LGE (n=37, 64 %) and HCM without LGE (n=21, 36 %). The average patient age in the HCM patients with LGE was 50.8±14 yrs and 47±12.9 yrs in the HCM patients without LGE. Maximum LV wall thickness and basal antero-septum thickness were significantly higher in the HCM with LGE group compared to the HCM without LGE group (14.8±3.5 mm vs 20.3±6.5 mm (p<0.001), 14.2±3.2 mm vs 17.3±6.1 mm (p=0.015), respectively). LGE was 21.9±31.7 g and 15.7±13.4 % in the HCM with LGE group. LA area (22.2±6.1 vs 28.8±11.2 cm2; p=0.015) and LAVI (28.9±10.2 vs 45.6±23.1; p-0.004) were significantly higher in the HCM with LGE group. LACI was doubled in the HCM with LGE group (0.2±0.1 vs 0.4±0.2; p<0.001). LA strain (30.4±13.2 vs 21.3±16.2; p-0.04) and LV strain (15.2±3 vs 12.2±4.5; p=0.012) were significantly decreased in the HCM with LGE group.Conclusion This study sheds light on the CMR-FT differences between HCM with and without LGE. We found a greater burden of LA volume but significantly lower LA and LV strain in the LGE patients. These findings highlight further the LA and LV remodeling in HCM. Impaired LA function appears to have physiological significance, being associated with greater LGE. While our CMR-FT findings support the progressive nature of HCM, beginning with sarcomere dysfunction to eventual fibrosis, further studies are needed to validate these results in larger cohorts and to evaluate their clinical relevance.
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Affiliation(s)
| | | | | | - Sara Abu Sherif
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust
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Zachos P, Nevras V, Milaras N, Karakosta M, Kalesi A, Kasinos N, Destounis A, Kelekis NL, Ikonomidis I, Niakas D. The value of myocardial strain imaging in the evaluation of patients with repaired Tetralogy of Fallot: a review of the literature. Heart Fail Rev 2023; 28:97-112. [PMID: 35286572 DOI: 10.1007/s10741-022-10223-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/07/2023]
Abstract
Tetralogy of Fallot (ToF) is considered to be the most common, complex, cyanotic congenital heart disease (CHD) representing 7-10% of all congenital heart defects, whereas the patients with ToF are the most frequently operated in their early infancy or childhood. Cardiac magnetic resonance (CMR) consists a valuable imaging technique for the diagnosis and serial follow-up of CHD patients. Furthermore, in recent years, advanced echocardiography imaging techniques have come to the fore, aiming to achieve a complete and more accurate evaluation of cardiac function using speckle tracking imaging modalities. We conducted a review of the literature in order to assess the myocardial deformation of patients with repaired ToF (rToF) using echocardiographic and CMR parameters. Patients with rToF have impaired myocardial strain parameters, that are well standardized either with the use of speckle tracking echocardiography or with the use of CMR imaging. Subclinical left ventricular dysfunction (low GLS) and myocardial dyssynchrony are commonly identified in rToF patients. Impaired left atrium (LA) and right atrium (RA) mechanics are, also, a common finding in this study population, but the studies using atrial strain are a lot fewer than those with LV and RV strain. No studies using myocardial work were identified in the literature, as far as rToF patients are concerned, which makes it an ideal field for further investigation.
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Affiliation(s)
- Panagiotis Zachos
- Department of Health Economics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece.
- Pediatric Cardiology and Adult Congenital Heart Disease Department, General Hospital of Karditsa, 43100, Karditsa, Tavropou (Terma), Greece.
| | - Vasilios Nevras
- Cardiology Department, General Hospital of Karditsa, 43100, Karditsa, Tavropou (Terma), Greece
| | - Nikias Milaras
- Cardiology Department, General Hospital of Karditsa, 43100, Karditsa, Tavropou (Terma), Greece
| | - Maria Karakosta
- Echocardiography Training Center "D. Beldekos," Cardiology Department, Tzaneio General Hospital of Pireaus, Zanni & 1 Afentouli Ave, 18536, Piraeus, Attica, Greece
| | - Alkistis Kalesi
- Echocardiography Training Center "D. Beldekos," Cardiology Department, Tzaneio General Hospital of Pireaus, Zanni & 1 Afentouli Ave, 18536, Piraeus, Attica, Greece
| | - Nearchos Kasinos
- Echocardiography Training Center "D. Beldekos," Cardiology Department, Tzaneio General Hospital of Pireaus, Zanni & 1 Afentouli Ave, 18536, Piraeus, Attica, Greece
| | - Antonios Destounis
- Echocardiography Training Center "D. Beldekos," Cardiology Department, Tzaneio General Hospital of Pireaus, Zanni & 1 Afentouli Ave, 18536, Piraeus, Attica, Greece
| | - Nikolaos L Kelekis
- Research Unit of Radiology and Medical Imaging/2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Street, Haidari, 12462, Athens, Greece
| | - Ignatios Ikonomidis
- Echocardiography and Preventive Cardiology Laboratories/2nd Cardiology Department, National and Kapodistrian University of Athens - Attikon University Hospital, 1 Rimini Street, Haidari, 12462, Athens, Greece
| | - Dimitrios Niakas
- Department of Health Economics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27, Athens, Greece
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Massarella D, Alonso-Gonzalez R. Updates in the management of congenital heart disease in adult patients. Expert Rev Cardiovasc Ther 2022; 20:719-732. [PMID: 36128784 DOI: 10.1080/14779072.2022.2125870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Adults with congenital heart disease represent a highly diverse, ever-growing population. Optimal approaches to management of problems such as arrhythmia, sudden cardiac death, heart failure, transplant, application of advanced therapies and unrepaired shunt lesions are incompletely established. Efforts to strengthen our understanding of these complex clinical challenges and inform evidence-based practices are ongoing. AREAS COVERED This narrative review summarizes evidence underpinning current approaches to congenital heart disease management while highlighting areas requiring further investigation. A search of literature published in 'Medline,' 'EMBASE,' and 'PubMed' using search terms 'congenital heart disease,' 'arrhythmia,' 'sudden cardiac death,' 'heart failure,' 'heart transplant,' 'advanced heart failure therapy,' 'ventricular assist device (VAD),' 'mechanical circulatory support (MSC),' 'intracardiac shunt' and combinations thereof was undertaken. EXPERT OPINION Application of novel technologies in the diagnosis and management of arrhythmia has and will continue to improve outcomes in this population. Sudden death remains a prevalent problem with many persistent unknowns. Heart failure is a leading cause of morbidity and mortality. Improved access to specialist care, advanced therapies and cardiac transplant is needed. The emerging field of cardio-obstetrics will continue to define state-of-the-art care for the reproductive health of women with heart disease.
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Affiliation(s)
- Danielle Massarella
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
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Ke S, Weng K, Chang M, Wu M, Li Y, Chien K, Lin C, Hsieh K, Chang M, Pan J, Peng H. Differential Adaptation of Biventricular Myocardial Kinetic Energy in Patients With Repaired Tetralogy of Fallot Assessed by
MR
Tissue Phase Mapping. J Magn Reson Imaging 2022; 57:1492-1504. [PMID: 36094105 DOI: 10.1002/jmri.28420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The myocardial kinetic energy (KE) and its association with pulmonary regurgitation (PR) have yet to be investigated in repaired tetralogy of Fallot (rTOF) patients. PURPOSE To evaluate the adaptation of myocardial KE in rTOF patients by tissue phase mapping (TPM). STUDY TYPE Prospective. POPULATION A total of 49 rTOF patients (23 ± 5 years old; male = 32), 47 normal controls (22 ± 1 year old; male = 29). FIELD STRENGTH/SEQUENCE 3-T/2D dark-blood three-directional velocity-encoded gradient-echo sequence. ASSESSMENT Left and right ventricle (LV, RV) myocardial KE in radial (KEr ), circumferential (KEø ), longitudinal (KEz ) directions. The proportions of KE in each direction to the sum of all KE (KErøz ): %KEr , %KEø , %KEz . PR fraction. STATISTICAL TEST Student's t test, multivariable regression. Statistical significance: P < 0.05. RESULTS In rTOF group, LV KEz remained normal in systole (P = 0.565) and diastole (P = 0.210), whereas diastolic LV %KEz (62% ± 14% vs. 72% ± 7%) and systolic LV %KEø (9% ± 6% vs. 20% ± 7%) were significantly decreased. The KEr and %KEr of both ventricles significantly increased in the rTOF group (RV in diastole: 6 ± 3 vs. 3 ± 1 μJ and 54% ± 13% vs. 27% ± 7%). The rTOF group exhibited significantly higher RV/LV ratios of %KEr (systole: 1.3 ± 0.3 vs. 1.0 ± 0.3) and %KEø (systole: 1.6 ± 0.8 vs. 1.0 ± 0.3) and significantly lower ratios of %KEz in systole (0.7 ± 0.2 vs. 1.0 ± 0.1) and diastole (0.5 ± 0.2 vs. 0.9 ± 0.1). In multivariable regression analysis, the RV peak systolic KErøz , RV systolic KEz , and LV diastolic %KEø were independently associated with PR fraction in the rTOF group (adjusted R2 = 0.479). DATA CONCLUSION In rTOF patients, the adaptation of the KE proportion occurred earlier than that of the KE amplitude, and the biventricular balance of %KE was disrupted. PR may cause differential KE adaptation in RV and LV. TPM-derived KE may be useful in investigation of myocardial adaptation in rTOF patients. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Shi‐Ying Ke
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ken‐Pen Weng
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Meng‐Chu Chang
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ming‐Ting Wu
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Institute of Clinical Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Yi‐He Li
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kuang‐Jen Chien
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Chu‐Chuan Lin
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kai‐Sheng Hsieh
- Department of Pediatrics China Medical University Children's Hospital Taichung Taiwan
| | - Ming‐Hua Chang
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Jun‐Yen Pan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Department of Cardiovascular Surgery Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Hsu‐Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
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Zhuang B, Yu S, Feng Z, He F, Jiang Y, Zhao S, Lu M, Li S. Left ventricular strain derived from cardiac magnetic resonance can predict outcomes of pulmonary valve replacement in patients with repaired tetralogy of Fallot. Front Cardiovasc Med 2022; 9:917026. [PMID: 36061553 PMCID: PMC9433663 DOI: 10.3389/fcvm.2022.917026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSeveral adults with repaired tetralogy of Fallot (rToF) undergo pulmonary valve replacement (PVR) to reduce the right ventricular volume and retain right ventricular function. However, there is currently no consensus on the ideal time for PVR surgery in asymptomatic patients with rTOF with pulmonary regurgitation (PR). Clinical outcomes after PVR are also indeterminate. Recently, myocardial strain and strain rate derived from cardiac magnetic resonance (CMR) feature tracking were found to be more sensitive to right ventricular dysfunction than conventional parameters and therefore may add prognostic value in patients with rToF. We aimed to analyze whether pre-PVR left ventricular (LV) strain and strain rate detected by CMR feature tracking are associated with midterm outcomes after PVR in patients with rToF.MethodsSeventy-eight asymptomatic patients with rToF who required PVR due to moderate or severe PR were prospectively enrolled between January 2014 and June 2020. CMR cine sequences were obtained, and feature tracking parameters were measured preoperatively. Adverse events were documented during the follow-up. Receiver operating characteristic analysis was performed to determine the cutoff value. Kaplan–Meier curves were drawn with log-rank statistics; moreover, univariate and multivariate Cox proportional hazards regression analyses and Harrel C-indices were analyzed.ResultsDuring 3.6 ± 1.8 years of follow-up, 25 adverse events were recorded. Kaplan–Meier survival curves and univariate Cox analysis verified that patients with significantly reduced radial strain (RS), circumferential strain (CS), longitudinal strain (LS), RS rate at systole and diastole (RSRs and RSRe), and circumferential and LS rates at diastole (CSRe and LSRe) had worse event-free survival. After multivariate correction, only LS and LSRe remained significantly associated with adverse outcomes (hazard ratio = 1.243 [1.083–1.428] and 0.067 [0.017–0.258], respectively, all p < 0.05). The cutoff values of LS and LSRe were −12.30 (%) and 1.07 (s–1), respectively.ConclusionThe LV strain and strain rate prior to PVR are important prognostic factors for adverse events after PVR in rToF.
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Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiqin Yu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengpu He
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Yong Jiang
- Department of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Echocardiography, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Minjie Lu,
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Shoujun Li,
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Leczycki P, Banach M, Maciejewski M, Bielecka-Dabrowa A. Heart Failure Risk Predictions and Prognostic Factors in Adults With Congenital Heart Diseases. Front Cardiovasc Med 2022; 9:692815. [PMID: 35282364 PMCID: PMC8907450 DOI: 10.3389/fcvm.2022.692815] [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: 04/09/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
In recent decades the number of adults with congenital heart diseases (ACHD) has increased significantly. This entails the need for scrupulous evaluation of the current condition of these patients. The ACHD population is one of the most challenging in contemporary medicine, especially as well-known scales such as the NYHA classification have very limited application. At the moment, there is a lack of universal parameters or scales on the basis of which we can easily capture the moment of deterioration of our ACHD patients' condition. Hence it is crucial to identify factors that are widely available, cheap and easy to use. There are studies showing more and more potential prognostic factors that may be of use in clinical practice: thorough assessment with echocardiography and magnetic resonance imaging (e.g., anatomy, ventricular function, longitudinal strain, shunt lesions, valvular defects, pericardial effusion, and pulmonary hypertension), cardiopulmonary exercise testing (e.g., peak oxygen uptake, ventilatory efficiency, chronotropic incompetence, and saturation) and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, growth-differentiation factor 15, high-sensitivity troponin T, red cell distribution width, galectin-3, angiopoietin-2, asymmetrical dimethylarginine, and high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess patients with specific congenital heart diseases.
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Affiliation(s)
- Patryk Leczycki
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- *Correspondence: Patryk Leczycki
| | - Maciej Banach
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łodź, Poland
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
| | - Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute, Łodź, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łodź, Poland
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12
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Karali K, Makedou K, Kallifatidis A, Didagelos M, Giannakoulas G, Davos CH, Karamitsos TD, Ziakas A, Karvounis H, Hadjimiltiades S. The Interplay between Myocardial Fibrosis, Strain Imaging and Collagen Biomarkers in Adults with Repaired Tetralogy of Fallot. Diagnostics (Basel) 2021; 11:diagnostics11112101. [PMID: 34829449 PMCID: PMC8621125 DOI: 10.3390/diagnostics11112101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: We sought to assess the interplay between right ventricle (RV) fibrosis, biventricular dysfunction based on global longitudinal strain (GLS) analysis, and biomarkers such as Galectin-3 (Gal-3), procollagen type III (PCIII), and NTproBNP. Methods: We studied 35 adult patients with rToF. All patients underwent a cardiac magnetic resonance (CMR) scan including feature tracking for deformation imaging. Blood biomarkers were measured. Results: LGE RV was detected in all patients, mainly at surgical sites. Patients with the highest RV LGE scoring had greater RV dilatation and dysfunction whereas left ventricular (LV) function was preserved. LV GLS correlated with RV total fibrosis score (p = 0.007). A LV GLS value of −15.9% predicted LGE RV score > 8 (AUC 0.754 (p = 0.02)). Neither RV GLS nor biomarker levels were correlated with the extent of RV fibrosis. A cut-off value for NTproBNP of 145.25 pg/mL predicted LGE RV score > 8 points (AUC 0.729, (p = 0.03)). A cut-off value for Gal-3 of 7.42 ng/mL predicted PR Fraction > 20% [AUC 0.704, (p = 0.05)]. Conclusions: A significant extent of RV fibrosis was mainly detected at surgical sites of RV, affecting RV performance. CMR-FT reveals subtle LV dysfunction in rToF patients, due to decreased performance of the fibrotic RV. Impaired LV function and elevated NTproBNP in rToF reflect a dysfunctional fibrotic RV.
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Affiliation(s)
- Konstantina Karali
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
- Correspondence: ; Tel.: +30-6945543674 or +30-23102553558
| | - Kali Makedou
- Laboratory of Biochemistry, AHEPA General Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece;
| | - Alexandros Kallifatidis
- Department of Radiology, Cardiovascular Imaging Unit, St. Luke’s Hospital, 55236 Thessaloniki, Greece;
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
| | - Constantinos H. Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, 11527 Athens, Greece;
| | - Theodoros D. Karamitsos
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
| | - Stavros Hadjimiltiades
- First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece; (M.D.); (G.G.); (T.D.K.); (A.Z.); (H.K.); (S.H.)
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Carruth ED, Fielden SW, Nevius CD, Fornwalt BK, Haggerty CM. 3D-Encoded DENSE MRI with Zonal Excitation for Quantifying Biventricular Myocardial Strain During a Breath-Hold. Cardiovasc Eng Technol 2021; 12:589-597. [PMID: 34244904 DOI: 10.1007/s13239-021-00561-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Right ventricular (RV) function is increasingly recognized for its prognostic value in many disease states. As with the left ventricle (LV), strain-based measurements may have better prognostic value than typical chamber volumes or ejection fraction. Complete functional characterization of the RV requires high-resolution, 3D displacement tracking methods, which have been prohibitively challenging to implement. Zonal excitation during Displacement ENcoding with Stimulated Echoes (DENSE) magnetic resonance imaging (MRI) has helped reduce scan time for 2D LV strain quantification. We hypothesized that zonal excitation could alternatively be used to reproducibly acquire higher resolution, 3D-encoded DENSE images for quantification of bi-ventricular strain within a single breath-hold. METHODS We modified sequence parameters for a 3D zonal excitation DENSE sequence to achieve in-plane resolution < 2 mm and acquired two sets of images in eight healthy adult male volunteers with median (IQR) age 32.5 (32.0-33.8) years. We assessed the inter-test reproducibility of this technique, and compared computed strains and torsion with previously published data. RESULTS Data for one subject was excluded based on image artifacts. Reproducibility for LV (CoV: 6.1-9.0%) and RV normal strains (CoV: 6.3-8.2%) and LV torsion (CoV = 7.1%) were all very good. Reproducibility of RV torsion was lower (CoV = 16.7%), but still within acceptable limits. Computed global strains and torsion were within reasonable agreement with published data, but further studies in larger cohorts are needed to confirm. CONCLUSION Reproducible acquisition of 3D-encoded biventricular myocardial strain data in a breath-hold is feasible using DENSE with zonal excitation.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Samuel W Fielden
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,Medical and Health Physics, Geisinger, Danville, PA, USA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA.,The Heart Institute, Geisinger, Danville, PA, USA.,Department of Radiology, Geisinger, Danville, PA, USA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA. .,The Heart Institute, Geisinger, Danville, PA, USA.
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Petryka-Mazurkiewicz J, Ziolkowska L, Mazurkiewicz Ł, Kowalczyk-Domagała M, Boruc A, Śpiewak M, Marczak M, Brzezinska-Rajszys G. Right-ventricular mechanics assessed by cardiovascular magnetic resonance feature tracking in children with hypertrophic cardiomyopathy. PLoS One 2021; 16:e0248725. [PMID: 33735278 PMCID: PMC7971555 DOI: 10.1371/journal.pone.0248725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although hypertrophic cardiomyopathy (HCM) is considered a disease of the left ventricle (LV), right ventricular (RV) abnormalities have also been reported on. Cardiovascular magnetic resonance feature tracking (CMR-FT) accurately and reproducibly quantifies RV myocardial deformation. Aim To investigate RV deformation disorders in childhood HCM using CMR-FT. Material and methods Consecutive subjects aged <18 years with echocardiographic evidence of HCM were enrolled. Cardiovascular magnetic resonance (CMR) was performed including RV volumetric and functional assessment, and late gadolinium enhancement (LGE) imaging. Results We included 54 children (37 males, 68.5%) with HCM, of which 28 patients (51.8%; mean extent of 2.18 ± 2.34% of LV mass) had late gadolinium enhancement. LV outflow tract obstruction (LVOTO) was detected in 19 subjects (35.2%). In patients with LVOTO, RV global longitudinal strain (RVGLS) (-16.1±5.0 vs. -20.7±5.3, p<0.01), RVGLS rate (-1.05±0.30 vs. -1.26±0.40, p = 0.03), RV radial strain (RVR) (15.8±7.7 vs. 22.1±7.0, p<0.01) and RVR rate (0.95±0.35 vs. 1.6±0.44, p<0.01) were lower than in patients without LVOTO. The RVR rate (p<0.01) was lower in patients with LGE in comparison to patients without LGE. Conclusions Children with HCM, especially with LVOTO, have significantly reduced indices of RV mechanics despite normal RV systolic function. It seems that the degree of LVOT obstruction is responsible for compromising the RV dynamics, rather than either mass or the amount of LV fibrosis.
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Affiliation(s)
- Joanna Petryka-Mazurkiewicz
- Magnetic Resonance Unit, National Institute of Cardiology, Warsaw, Poland
- Department of Coronary and Structural Heart Disease, National Institute of Cardiology, Warsaw, Poland
| | - Lidia Ziolkowska
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
- * E-mail:
| | - Łukasz Mazurkiewicz
- Magnetic Resonance Unit, National Institute of Cardiology, Warsaw, Poland
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | | | - Agnieszka Boruc
- Department of Pediatric Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Mateusz Śpiewak
- Magnetic Resonance Unit, National Institute of Cardiology, Warsaw, Poland
| | - Magdalena Marczak
- Magnetic Resonance Unit, National Institute of Cardiology, Warsaw, Poland
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15
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Monti CB, Secchi F, Capra D, Guarnieri G, Lastella G, Barbaro U, Carminati M, Sardanelli F. Right ventricular strain in repaired Tetralogy of Fallot with regards to pulmonary valve replacement. Eur J Radiol 2020; 131:109235. [PMID: 32919263 DOI: 10.1016/j.ejrad.2020.109235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess right ventricular (RV) myocardial strain both globally and segmentally through feature-tracking cardiac magnetic resonance (CMR) in patients with Tetralogy of Fallot (ToF), with regards to pulmonary valve replacement (PVR). METHODS After Ethics Committee approval, we retrospectively included 46 consecutive ToF patients who had two CMR examinations performed at our institution between March 2014 and June 2019. We divided patients into those who had not undergone PVR between the two CMR examinations (Group-0), and those who had (Group-1). Ventricular volumes were quantified on cine sequences, and strain was calculated through feature-tracking, using the previously traced segmentations. RV longitudinal and radial strain were assessed both globally and separately for the septum and free wall. Variations were normalized for intercurrent years, differences were appraised with t-tests or Mann-Whitney U. RESULTS 30 patients belonged to Group-0 and 16 to Group-1. Median age was 22 years (interquartile range [IQR] 17-29 years) in Group-0, and 21 years (IQR 16-29 years) in Group-1. No significant differences were reported in RV strain between groups (p ≥ 0.254) except for RV septal radial strain, significantly higher (p = 0.010) in Group-0 (24.2 %, IQR 10.1-52.4 %) than in Group-1 (6.0 %, IQR -3.3-23.3 %) at the second CMR. Both global and segmental RV strains decreased over time in both groups, and yearly variations did not differ significantly (p ≥ 0.081) between groups. CONCLUSIONS While PVR performed at the appropriate timing eases the burden on the RV allowing for a reduction in volumes, RV strain seems to continuously deteriorate as in patients who do not undergo PVR.
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Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Gianluca Guarnieri
- Corso di Laurea in Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
| | - Giulia Lastella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
| | - Ugo Barbaro
- Department of Radiology, IRCCS Centro Neurolesi "Bonino Pulejo", Viale Europa 45, 98124, Messina, Italy.
| | - Mario Carminati
- Department of Pediatric and Adult Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
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16
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Left ventricular strain and fibrosis in adults with repaired tetralogy of Fallot: A case-control study. Int J Cardiol 2020; 323:34-39. [PMID: 32882293 DOI: 10.1016/j.ijcard.2020.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left ventricular (LV) systolic dysfunction and myocardial fibrosis have prognostic implications in repaired tetralogy of Fallot (rTOF), but their relationship with myocardial strain is not well understood. We evaluated systolic strain and fibrosis (extracellular volume fraction, ECV) of the left ventricle (LV) using feature tracking with magnetic resonance and determine their association with each other and clinical outcome. METHOD Adults with rTOF and age-matched controls underwent CMR to measure LV-ECV. Feature-tracking was used to quantify radial, circumferential, and longitudinal strain in both 2 and 3 dimensions. Clinical events (death, arrhythmia and heart-failure hospitalization) were obtained through chart review. Associations between strain, ECV and clinical events were explored. RESULTS 48 rTOF subjects (age 40.5 ± 14.3, 42% female) and 20 healthy controls were included. Both LV 2D and 3D global circumferential strain (GCS) and global longitudinal strain (GLS) were lower in rTOF subjects (p ≤0.01 for all). There was no association between strain and LV-ECV. Strain parameters correlated with ventricular volumes and function. After a median follow-up of 8.5 years (range 1-10.9 years) there were 5 deaths, 6 hospitalizations and 9 new arrhythmias. By multivariate Cox-regression, GLS was an independent predictor of both hospitalization and death, whereas LV-ECV was an independent predictor of arrhythmia. CONCLUSION While both LV strain abnormalities and fibrosis are present in rTOF, they are associated with different types of clinical outcome, and not to each other. The findings suggest that these measures reflect different long-term adverse adaptations to abnormal hemodynamics.
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17
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Ventricular Myocardial Deformation Imaging of Patients with Repaired Tetralogy of Fallot. J Am Soc Echocardiogr 2020; 33:788-801. [PMID: 32624088 DOI: 10.1016/j.echo.2020.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/22/2022]
Abstract
In patients with repaired tetralogy of Fallot (TOF), dysfunction of the right and left ventricles remains an important issue. Adverse right ventricular (RV) remodeling has been related to RV dilation secondary to pulmonary regurgitation, electromechanical dyssynchrony, and myocardial fibrosis. Left ventricular (LV) dysfunction is attributed among other factors to altered ventricular-ventricular interaction. Advancements in echocardiography and cardiac magnetic resonance imaging have enabled direct interrogation of myocardial deformation of both ventricles in terms of myocardial strain and strain rate. Emerging evidence suggests that myocardial deformation imaging may provide incremental information for clinical use. In children and adults with repaired TOF, there is a growing body of literature on the use of myocardial deformation imaging in the assessment of ventricular mechanics and its clinical and prognostic values. The present review aims to provide an overview of impairment in RV and LV mechanics, associations between RV and LV deformation, changes in ventricular deformation after pulmonary valve replacement, and associations between measures of RV and LV deformation and outcomes and to highlight the clinical translational potential of myocardial deformation imaging in patients with repaired TOF.
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Sjöberg P, Ostenfeld E, Hedström E, Arheden H, Gustafsson R, Nozohoor S, Carlsson M. Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot. Am J Physiol Heart Circ Physiol 2020; 318:H345-H353. [PMID: 31886724 DOI: 10.1152/ajpheart.00417.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients (n = 12) with rToF and PR > 35% before and after PVR and in healthy controls (n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls (P < 0.0001; P < 0.01) and decreased after PVR (P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls (P < 0.05) and decreased after PVR (P < 0.01). Left ventricular GLS did not differ between patients and controls (P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls (r = 0.93; P < 0.0001) and patients before PVR (r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.
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Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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Lumens J, Fan CPS, Walmsley J, Yim D, Manlhiot C, Dragulescu A, Grosse-Wortmann L, Mertens L, Prinzen FW, Delhaas T, Friedberg MK. Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. J Am Heart Assoc 2020; 8:e010903. [PMID: 30651018 PMCID: PMC6497336 DOI: 10.1161/jaha.118.010903] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The relative impact of right ventricular ( RV ) electromechanical dyssynchrony versus pulmonary regurgitation ( PR ) on exercise capacity and RV function after tetralogy of Fallot repair is unknown. We aimed to delineate the relative effects of these factors on RV function and exercise capacity. Methods and Results We retrospectively analyzed 81 children with tetralogy of Fallot repair using multivariable regression. Predictor parameters were electrocardiographic QRS duration reflecting electromechanical dyssynchrony and PR severity by cardiac magnetic resonance. The outcome parameters were exercise capacity (percentage predicted peak oxygen consumption) and cardiac magnetic resonance ejection fraction (RV ejection fraction). To understand the relative effects of RV dyssynchrony versus PR on exercise capacity and RV function, virtual patient simulations were performed using a closed-loop cardiovascular system model (CircAdapt), covering a wide spectrum of disease severity. Eighty-one patients with tetralogy of Fallot repair (median [interquartile range { IQR} ] age, 14.48 [11.55-15.91] years) were analyzed. All had prolonged QRS duration (median [IQR], 144 [123-152] ms), at least moderate PR (median [IQR], 40% [29%-48%]), reduced exercise capacity (median [IQR], 79% [68%-92%] predicted peak oxygen consumption), and reduced RV ejection fraction (median [IQR], 48% [44%-52%]). Longer QRS duration, more than PR , was associated with lower oxygen consumption and lower RV ejection fraction. In a multivariable regression analysis, oxygen consumption decreased with both increasing QRS duration and PR severity. CircAdapt modeling showed that RV dyssynchrony exerts a stronger limiting effect on exercise capacity and on RV ejection fraction than does PR , regardless of contractile function. Conclusions In both patient data and computer simulations, RV dyssynchrony, more than PR , appears to be associated with reduced exercise capacity and RV systolic dysfunction in patients after TOF repair.
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Affiliation(s)
- Joost Lumens
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands.,3 IHU LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Pessac France
| | - Chun-Po Steve Fan
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - John Walmsley
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Deane Yim
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Cedric Manlhiot
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Andreea Dragulescu
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Lars Grosse-Wortmann
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Luc Mertens
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Frits W Prinzen
- 4 Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Tammo Delhaas
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Mark K Friedberg
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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Ylitalo P, Lehmonen L, Lauerma K, Holmström M, Pitkänen-Argillander O, Jokinen E. Severe pulmonary regurgitation in adolescents with tetralogy of Fallot leads to increased longitudinal strain. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:309-316. [PMID: 31583488 PMCID: PMC7109171 DOI: 10.1007/s10334-019-00780-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
Objectives Postoperative patients with tetralogy of Fallot (TOF) are often compromised by chronic pulmonary regurgitation and chronic right ventricular volume load. We sought to determine whether pulmonary regurgitation (PR) would affect right and left ventricle (RV and LV) strain. Materials and methods This cross-sectional analysis included 40 patients who had TOF with surgical repair, with an average follow-up period of 11.8 ± 3.0 years. Altogether, 44 healthy volunteers with similar age and gender distribution were recruited. A cardiovascular magnetic resonance imaging study with feature tracking analysis was performed on all patients and controls. Results RV peak longitudinal strain was increased in TOF patients with PR > 30 ml/m2 when compared to those with PR < 30 ml/m2 (− 22.5% ± 2.7% vs − 19.7% ± 3.5%, p = 0.018) and controls (p = 0.007). PR volume correlated with peak RV longitudinal strain (R = − 0.37, p = 0.030) and peak RV longitudinal strain rate (systolic: R = 0.37, p = 0.03; diastolic: R = 0.39, p = 0.021). The peak RV circumferential strain, from base to apex, increased more than in healthy controls (apex-base difference 7.6% ± 4.2% vs 3.3% ± 2.4%, p < 0.0001). Conclusions Pediatric patients with TOF and a severe pulmonary regurgitation show an enhanced longitudinal strain when compared to patients with milder regurgitation or to control subjects. In addition, mean RV circumferential strain of the patients is significantly enhanced compared to healthy individuals.
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Affiliation(s)
- Pekka Ylitalo
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Lehmonen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Kirsi Lauerma
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miia Holmström
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Eero Jokinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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van der Ven JP, van den Bosch E, Bogers AJ, Helbing WA. Current outcomes and treatment of tetralogy of Fallot. F1000Res 2019; 8:F1000 Faculty Rev-1530. [PMID: 31508203 PMCID: PMC6719677 DOI: 10.12688/f1000research.17174.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.
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Affiliation(s)
- Jelle P.G. van der Ven
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Eva van den Bosch
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ad J.C.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology, Radboud UMC - Amalia Children's Hospital, Nijmegen, The Netherlands
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Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations. J Thorac Cardiovasc Surg 2019; 158:509-517. [DOI: 10.1016/j.jtcvs.2019.02.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/18/2022]
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23
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van Grootel RW, van den Bosch AE, Baggen VJ, Menting ME, Baart SJ, Cuypers JA, Witsenburg M, Roos-Hesselink JW. The Prognostic Value of Myocardial Deformation in Adult Patients With Corrected Tetralogy of Fallot. J Am Soc Echocardiogr 2019; 32:866-875.e2. [DOI: 10.1016/j.echo.2019.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/25/2022]
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Impact of age and cardiac disease on regional left and right ventricular myocardial motion in healthy controls and patients with repaired tetralogy of fallot. Int J Cardiovasc Imaging 2019; 35:1119-1132. [PMID: 30715669 DOI: 10.1007/s10554-019-01544-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022]
Abstract
The assessment of both left (LV) and right ventricular (RV) motion is important to understand the impact of heart disease on cardiac function. The MRI technique of tissue phase mapping (TPM) allows for the quantification of regional biventricular three-directional myocardial velocities. The goal of this study was to establish normal LV and RV velocity parameters across a wide range of pediatric to adult ages and to investigate the feasibility of TPM for detecting impaired regional biventricular function in patients with repaired tetralogy of Fallot (TOF). Thirty-six healthy controls (age = 1-75 years) and 12 TOF patients (age = 5-23 years) underwent cardiac MRI including TPM in short-axis locations (base, mid, apex). For ten adults, a second TPM scan was used to assess test-retest reproducibility. Data analysis included the calculation of biventricular radial, circumferential, and long-axis velocity components, quantification of systolic and diastolic peak velocities in an extended 16 + 10 LV + RV segment model, and assessment of inter-ventricular dyssynchrony. Biventricular velocities showed good test-retest reproducibility (mean bias ≤ 0.23 cm/s). Diastolic radial and long-axis peak velocities for LV and RV were significantly reduced in adults compared to children (19-61%, p < 0.001-0.02). In TOF patients, TPM identified significantly reduced systolic and diastolic LV and RV long-axis peak velocities (20-50%, p < 0.001-0.05) compared to age-matched controls. In conclusion, tissue phase mapping enables comprehensive analysis of global and regional biventricular myocardial motion. Changes in myocardial velocities associated with age underline the importance of age-matched controls. This pilot study in TOF patients shows the feasibility to detect regionally abnormal LV and RV motion.
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25
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Manning WJ. Journal of Cardiovascular Magnetic Resonance 2017. J Cardiovasc Magn Reson 2018; 20:89. [PMID: 30593280 PMCID: PMC6309095 DOI: 10.1186/s12968-018-0518-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023] Open
Abstract
There were 106 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2017, including 92 original research papers, 3 reviews, 9 technical notes, and 1 Position paper, 1 erratum and 1 correction. The volume was similar to 2016 despite an increase in manuscript submissions to 405 and thus reflects a slight decrease in the acceptance rate to 26.7%. The quality of the submissions continues to be high. The 2017 JCMR Impact Factor (which is published in June 2018) was minimally lower at 5.46 (vs. 5.71 for 2016; as published in June 2017), which is the second highest impact factor ever recorded for JCMR. The 2017 impact factor means that an average, each JCMR paper that were published in 2015 and 2016 was cited 5.46 times in 2017.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in continuus fashion and in the chronologic order of acceptance, with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or theme, so that readers can view areas of interest in a single article in relation to each other and other contemporary JCMR articles. In this publication, the manuscripts are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought within the journal. In addition, I have elected to use this format to convey information regarding the editorial process to the readership.I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your very best, high quality manuscripts to JCMR for consideration. I thank our very dedicated Associate Editors, Guest Editors, and Reviewers for their efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the forefront journal of our field. And finally, I thank you for entrusting me with the editorship of the JCMR as I begin my 3rd year as your editor-in-chief. It has been a tremendous learning experience for me and the opportunity to review manuscripts that reflect the best in our field remains a great joy and highlight of my week!
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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26
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Samad MD, Wehner GJ, Arbabshirani MR, Jing L, Powell AJ, Geva T, Haggerty CM, Fornwalt BK. Predicting deterioration of ventricular function in patients with repaired tetralogy of Fallot using machine learning. Eur Heart J Cardiovasc Imaging 2018; 19:730-738. [PMID: 29538684 PMCID: PMC6012881 DOI: 10.1093/ehjci/jey003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 12/23/2022] Open
Abstract
Aims Previous studies using regression analyses have failed to identify which patients with repaired tetralogy of Fallot (rTOF) are at risk for deterioration in ventricular size and function despite using common clinical and cardiac function parameters as well as cardiac mechanics (strain and dyssynchrony). This study used a machine learning pipeline to comprehensively investigate the predictive value of the baseline variables derived from cardiac magnetic resonance (CMR) imaging and provide models for identifying patients at risk for deterioration. Methods and results Longitudinal deterioration for 153 patients with rTOF was categorized as 'none', 'minor', or 'major' based on changes in ventricular size and ejection fraction between two CMR scans at least 6 months apart (median 2.7 years). Baseline variables were measured at the time of the first CMR. An exhaustive variable search with a support vector machine classifier and five-fold cross-validation was used to predict deterioration and identify the most useful variables. For predicting any deterioration (minor or major) vs. no deterioration, the mean area under the curve (AUC) was 0.82 ± 0.06. For predicting major deterioration vs. minor or no deterioration, the AUC was 0.77 ± 0.07. Baseline left ventricular (LV) ejection fraction, LV circumferential strain, and pulmonary regurgitation were most useful for achieving accurate predictions. Conclusion For the prediction of deterioration in patients with rTOF, a machine learning pipeline uncovered the utility of baseline variables that was previously lost to regression analyses. The predictive models may be useful for planning early interventions in patients with high risk.
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Affiliation(s)
- Manar D Samad
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Gregory J Wehner
- Department of Biomedical Engineering, University of Kentucky, 522 Robotics and Manufacturing Building, Lexington, 40506-0108 KY, USA
| | - Mohammad R Arbabshirani
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, 02115 MA, USA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation, Center for Health Research, Geisinger Clinic, 100 North Academy Avenue, Danville, 17822-4400 PA, USA
- Department of Radiology, Geisinger, 100 North Academy Ave, Danville, 17822 PA, USA
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27
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Gao Y, Yang ZG, Shi K, Diao KY, Xu HY, Guo YK. Computed tomography for evaluating right ventricle and pulmonary artery in pediatric tetralogy of Fallot: correlation with post-operative pulmonary regurgitation. Sci Rep 2018; 8:7515. [PMID: 29760475 PMCID: PMC5951817 DOI: 10.1038/s41598-018-25868-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/14/2018] [Indexed: 02/05/2023] Open
Abstract
Pulmonary regurgitation (PR) is the most common complication after tetralogy of Fallot (TOF) surgical repair, and long-term PR might result in cardiovascular events. The aim of this study was to assess the influence of pre-operative right ventricle (RV) and pulmonary artery (PA) parameters assessed by dual-source computed tomography on post-operative PR. A total of 41 TOF patients who underwent trans-valve surgical repair were retrospectively recruited. The RV and PA parameters evaluated by pre-operative DSCT were compared between the PR and non-PR groups. Our result revealed that the PA parameters (McGoon ratio, Nakata index, and LPA diameter) and RV parameters (RV length diameter and RV short diameter) all showed significant differences between the two groups (all p < 0.05). There was a significant correlation between PR and LPA diameter (r = 0.361), McGoon ratio (r = 0.413), and Nakata index (r = 0.482). Receiver operating characteristic analysis also revealed a moderate sensitivity and specificity of LPA (66.33%; 82.60%), McGoon ratio (83.33%, 56.52%), and Nakata index (83.33%; 60.87%) for predicting the occurrence of PR. This study indicated that these pre-operative indices calculated by DSCT are associated with post-operative PR and that these pre-operative PA and RV parameters may serve as novel predictors of the risk of PR.
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Affiliation(s)
- Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan, 610041, China.
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Kalaitzidis P, Orwat S, Kempny A, Robert R, Peters B, Sarikouch S, Beerbaum P, Baumgartner H, Diller GP. Biventricular dyssynchrony on cardiac magnetic resonance imaging and its correlation with myocardial deformation, ventricular function and objective exercise capacity in patients with repaired tetralogy of Fallot. Int J Cardiol 2018; 264:53-57. [PMID: 29673853 DOI: 10.1016/j.ijcard.2018.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/09/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrical dyssynchrony and prolonged QRS duration are common in patients with repaired tetralogy of Fallot (ToF). It has been linked to increased risk of sudden cardiac death and right ventricular (RV) dysfunction. We investigated myocardial dyssynchrony using cardiac magnetic resonance imaging (CMR) and feature tracking analysis (FT) in this setting and compared it to myocardial deformation, conventional parameters of ventricular dysfunction and clinical parameters. METHODS AND RESULTS Patients underwent standardized CMR investigations as part of a nationwide study. We prospectively assessed myocardial deformation and analysed regional wall motion abnormalities of the RV and the left ventricle (LV) using CMR-FT. The main measure of dyssynchrony was the maximal time difference (wall motion delay) of the regional strain as a parameter of mechanical biventricular dyssynchrony. In addition, clinical parameters and measures of cardiopulmonary exercise capacity were available. Overall 345 patients were included. Parameters of biventricular wall motion delay correlated significantly with global FT-strain parameters (p < 0.0001 for all imaging planes assessed). Furthermore, we found a significant correlation between circumferential RV motion delay and QRS duration (p = 0.006). Higher LV and RV wall motion delay parameters were also associated with lower peak oxygen consumption (p < 0.05) and a worse LV and RV ejection fraction (p < 0.02). CONCLUSIONS Assessment of mechanical dyssynchrony is feasible using CMR-FT in ToF patients. Parameters of mechanical dyssynchrony correlate with electrical dyssynchrony, biventricular function and objective exercise capacity in this setting. Due to the weak degree of correlation, however, the clinical significance of these findings remains to be clarified by further studies.
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Affiliation(s)
- Pantelis Kalaitzidis
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Stefan Orwat
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Radke Robert
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Brigitte Peters
- Institute for Biometry and Medical Informatics, University of Magdeburg, Germany
| | - Samir Sarikouch
- Department of Heart-, Thoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care, Hannover Medical School, Germany
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
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29
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Advanced Cardiovascular Magnetic Resonance Techniques in Grown-Up Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Manning WJ. Review of Journal of Cardiovascular Magnetic Resonance (JCMR) 2015-2016 and transition of the JCMR office to Boston. J Cardiovasc Magn Reson 2017; 19:108. [PMID: 29284487 PMCID: PMC5747150 DOI: 10.1186/s12968-017-0423-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
The Journal of Cardiovascular Magnetic Resonance (JCMR) is the official publication of the Society for Cardiovascular Magnetic Resonance (SCMR). In 2016, the JCMR published 93 manuscripts, including 80 research papers, 6 reviews, 5 technical notes, 1 protocol, and 1 case report. The number of manuscripts published was similar to 2015 though with a 12% increase in manuscript submissions to an all-time high of 369. This reflects a decrease in the overall acceptance rate to <25% (excluding solicited reviews). The quality of submissions to JCMR continues to be high. The 2016 JCMR Impact Factor (which is published in June 2016 by Thomson Reuters) was steady at 5.601 (vs. 5.71 for 2015; as published in June 2016), which is the second highest impact factor ever recorded for JCMR. The 2016 impact factor means that the JCMR papers that were published in 2014 and 2015 were on-average cited 5.71 times in 2016.In accordance with Open-Access publishing of Biomed Central, the JCMR articles are published on-line in the order that they are accepted with no collating of the articles into sections or special thematic issues. For this reason, over the years, the Editors have felt that it is useful to annually summarize the publications into broad areas of interest or themes, so that readers can view areas of interest in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes with previously published JCMR papers to guide continuity of thought in the journal. In addition, I have elected to open this publication with information for the readership regarding the transition of the JCMR editorial office to the Beth Israel Deaconess Medical Center, Boston and the editorial process.Though there is an author publication charge (APC) associated with open-access to cover the publisher's expenses, this format provides a much wider distribution/availability of the author's work and greater manuscript citation. For SCMR members, there is a substantial discount in the APC. I hope that you will continue to send your high quality manuscripts to JCMR for consideration. Importantly, I also ask that you consider referencing recent JCMR publications in your submissions to the JCMR and elsewhere as these contribute to our impact factor. I also thank our dedicated Associate Editors, Guest Editors, and reviewers for their many efforts to ensure that the review process occurs in a timely and responsible manner and that the JCMR continues to be recognized as the leading publication in our field.
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Affiliation(s)
- Warren J Manning
- From the Journal of Cardiovascular Magnetic Resonance Editorial Office and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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31
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Haggerty CM, Suever JD, Pulenthiran A, Mejia-Spiegeler A, Wehner GJ, Jing L, Charnigo RJ, Fornwalt BK, Fogel MA. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19:100. [PMID: 29228952 PMCID: PMC5724335 DOI: 10.1186/s12968-017-0410-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patients with repaired tetralogy of Fallot (TOF) have progressive, adverse biventricular remodeling, leading to abnormal contractile mechanics. Defining the mechanisms underlying this dysfunction, such as diffuse myocardial fibrosis, may provide insights into poor long-term outcomes. We hypothesized that left ventricular (LV) diffuse fibrosis is related to impaired LV mechanics. METHODS Patients with TOF were evaluated with cardiac magnetic resonance in which modified Look-Locker (MOLLI) T1-mapping and spiral cine Displacement encoding (DENSE) sequences were acquired at three LV short-axis positions. Linear mixed modeling was used to define the association between regional LV mechanics from DENSE based on regional T1-derived diffuse fibrosis measures, such as extracellular volume fraction (ECV). RESULTS Forty patients (26 ± 11 years) were included. LV ECV was generally within normal range (0.24 ± 0.05). For LV mechanics, peak circumferential strains (-15 ± 3%) and dyssynchrony indices (16 ± 8 ms) were moderately impaired, while peak radial strains (29 ± 8%) were generally normal. After adjusting for patient age, sex, and regional LV differences, ECV was associated with log-adjusted LV dyssynchrony index (β = 0.67) and peak LV radial strain (β = -0.36), but not LV circumferential strain. Moreover, post-contrast T1 was associated with log-adjusted LV diastolic circumferential strain rate (β = 0.37). CONCLUSIONS We observed several moderate associations between measures of fibrosis and impaired mechanics, particularly the LV dyssynchrony index and peak radial strain. Diffuse fibrosis may therefore be a causal factor in some ventricular dysfunction in TOF.
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Affiliation(s)
- Christopher M. Haggerty
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Jonathan D. Suever
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Arichanah Pulenthiran
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Abba Mejia-Spiegeler
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | - Gregory J. Wehner
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Linyuan Jing
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
| | | | - Brandon K. Fornwalt
- Department of Imaging Science and Innovation, Geisinger, 100 North Academy Avenue, Danville, PA 17822-4400 USA
- Biomedical and Translational Informatics Institute, Geisinger, Danville, PA USA
- Department of Radiology, Geisinger, Danville, PA USA
| | - Mark A. Fogel
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
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Chang MC, Wu MT, Weng KP, Su MY, Menza M, Huang HC, Peng HH. Left ventricular regional myocardial motion and twist function in repaired tetralogy of Fallot evaluated by magnetic resonance tissue phase mapping. Eur Radiol 2017; 28:104-114. [PMID: 28677054 DOI: 10.1007/s00330-017-4908-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/20/2017] [Accepted: 05/23/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to characterise regional myocardial motion and twist function in the left ventricles (LV) in patients with repaired tetralogy of Fallot (rTOF) and preserved LV global function. METHODS We recruited 47 rTOF patients and 38 age-matched normal volunteers. Tissue phase mapping (TPM) was performed for evaluating the LV myocardial velocity in longitudinal, radial, and circumferential (Vz, Vr, and VØ) directions in basal, middle, and apical slices. The VØ peak-to-peak (PTP) during systolic phases, the rotation angle of each slice, and VØ inconsistency were computed for evaluating LV twist function and VØ dyssynchrony. RESULTS As compared to the controls, the rTOF patients presented decreased RV ejection fraction (RVEF) (p = 0.002) and preserved global LV ejection fraction (LVEF). They also demonstrated decreased systolic and diastolic Vz in several LV segments and higher diastolic Vr in the septum (all p < 0.05). A lower VØ PTP, higher VØ inconsistency, and reduced peak net rotation angle (all p < 0.05) were observed. The aforementioned indices demonstrated an altered LV twist function in rTOF patients in an early disease stage. CONCLUSIONS MR TPM could provide information about early abnormalities of LV regional motion and twist function in rTOF patients with preserved LV global function. KEY POINTS • Patients with rTOF presented significantly reduced systolic and diastolic Vz in the LV. • rTOF patients demonstrated significantly increased diastolic Vr in the septum. • Abnormal characteristics of the segmental dynamic velocity evolution were shown in rTOF. • rTOF patients presented altered circumferential rotation and velocity inconsistency in early stage.
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Affiliation(s)
- Meng-Chu Chang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No.101, Sec. 2, Kuang-Fu Rd., BMES Building, R415, Hsinchu, 300, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ken-Pen Weng
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Mao-Yuan Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Marius Menza
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hung-Chieh Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, No.101, Sec. 2, Kuang-Fu Rd., BMES Building, R415, Hsinchu, 300, Taiwan.
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Ghonim S, Voges I, Gatehouse PD, Keegan J, Gatzoulis MA, Kilner PJ, Babu-Narayan SV. Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease. Front Cardiovasc Med 2017; 4:30. [PMID: 28589126 PMCID: PMC5440586 DOI: 10.3389/fcvm.2017.00030] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/28/2017] [Indexed: 01/15/2023] Open
Abstract
Congenital heart disease (CHD) is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.
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Affiliation(s)
- Sarah Ghonim
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK.,Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Inga Voges
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK.,Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Peter D Gatehouse
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Jennifer Keegan
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Philip J Kilner
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Sonya V Babu-Narayan
- Adult Congenital Heart Unit, Royal Brompton Hospital, London, UK.,Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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