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Baccouch W, Oueslati S, Solaiman B, Lahidheb D, Labidi S. Automatic left ventricle volume and mass quantification from 2D cine-MRI: Investigating papillary muscle influence. Med Eng Phys 2024; 127:104162. [PMID: 38692762 DOI: 10.1016/j.medengphy.2024.104162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Early detection of cardiovascular diseases is based on accurate quantification of the left ventricle (LV) function parameters. In this paper, we propose a fully automatic framework for LV volume and mass quantification from 2D-cine MR images already segmented using U-Net. METHODS The general framework consists of three main steps: Data preparation including automatic LV localization using a convolution neural network (CNN) and application of morphological operations to exclude papillary muscles from the LV cavity. The second step consists in automatically extracting the LV contours using U-Net architecture. Finally, by integrating temporal information which is manifested by a spatial motion of myocytes as a third dimension, we calculated LV volume, LV ejection fraction (LVEF) and left ventricle mass (LVM). Based on these parameters, we detected and quantified cardiac contraction abnormalities using Python software. RESULTS CNN was trained with 35 patients and tested on 15 patients from the ACDC database with an accuracy of 99,15 %. U-Net architecture was trained using ACDC database and evaluated using local dataset with a Dice similarity coefficient (DSC) of 99,78 % and a Hausdorff Distance (HD) of 4.468 mm (p < 0,001). Quantification results showed a strong correlation with physiological measures with a Pearson correlation coefficient (PCC) of 0,991 for LV volume, 0.962 for LVEF, 0.98 for stroke volume (SV) and 0.923 for LVM after pillars' elimination. Clinically, our method allows regional and accurate identification of pathological myocardial segments and can serve as a diagnostic aid tool of cardiac contraction abnormalities. CONCLUSION Experimental results prove the usefulness of the proposed method for LV volume and function quantification and verify its potential clinical applicability.
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Affiliation(s)
- Wafa Baccouch
- University of Tunis El Manar, Higher institute of Medical Technologies of Tunis, Research laboratory of Biophysics and Medical Technologies LR13ES07, Tunis, 1006, Tunisia.
| | - Sameh Oueslati
- University of Tunis El Manar, Higher institute of Medical Technologies of Tunis, Research laboratory of Biophysics and Medical Technologies LR13ES07, Tunis, 1006, Tunisia
| | - Basel Solaiman
- Image & Information Processing Department (iTi), IMT-Atlantique, Technopôle Brest Iroise CS 83818, 29238, Brest Cedex, France
| | - Dhaker Lahidheb
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Department of Cardiology, Military Hospital of Tunis, Tunis, Tunisia
| | - Salam Labidi
- University of Tunis El Manar, Higher institute of Medical Technologies of Tunis, Research laboratory of Biophysics and Medical Technologies LR13ES07, Tunis, 1006, Tunisia
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Cecere A, Cipriani A, De Lazzari M, Graziano F, Brunetti G, De Conti G, Motta R, Ravagnin A, Lorenzoni G, Gregori D, Basso C, Tona F, Lee YJ, Delling FN, Iliceto S, Marra MP. Left ventricular fibrosis in arrhythmic mitral valve prolapse: quantification and comparison of semi-automated techniques assessed by cardiac magnetic resonance. Int J Cardiovasc Imaging 2024; 40:275-285. [PMID: 38141098 PMCID: PMC10884156 DOI: 10.1007/s10554-023-03006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/03/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Left ventricular (LV) fibrosis has a key role in arrhythmogenesis in patients with mitral valve prolapse (MVP). Cardiac magnetic resonance identifies LV fibrosis by using late gadolinium enhancement (LGE) technique. LGE assessment and quantification in patients with MVP lacks of standardization protocols. METHODS 66 MVP patients with normal systolic function and without significant regurgitation were enrolled. Semi-automated gray-scale thresholding techniques using full width at half maximum (FWHM) and 2, 3 and 5 standard deviation (SD) above the remote myocardium were used and compared with the visual assessment, considered as the gold standard. RESULTS LGE was identified in 41 MVP patients (62%) and quantified. The mean quantity of LGE visually assessed was 2.40 ± 1.07% or 1.40 ± 0.82 g. With FWHM, LGE resulted 3.56 ± 1.23% or 1.99 ± 1.13 g. Using thresholding, the mean LGE quantity was 9.2 ± 3.1% or 4.82 ± 2.28 g for 2-SD, 5.72 ± 1.75% or 3.06 ± 1.47 g for 3-SD and 2.36 ± 0.99% or 1.29 ± 0.79 g for 5-SD. The 5-SD measurement in percentage demonstrated a good correlation with LGE quantification visually assessed (2.40 ± 1.07 vs. 2.363 ± 0.9909, p = 0.543). When compared with the gold standard, the 5-SD threshold quantification, both in percentage and in grams, revealed the least intra-observer (respectively, ICC: 0.976 and 0.966) and inter-observer variability (respectively ICC: 0.948 and 0.935). CONCLUSION The 5-SD gray-scale threshold technique in percentage revealed the best correlation with the visual assessment and an optimal reproducibility in MVP patient.
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Affiliation(s)
- Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Alberto Cipriani
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Manuel De Lazzari
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Francesca Graziano
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giulia Brunetti
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Raffaella Motta
- Department of Medicine, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Alberto Ravagnin
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Yoo Jin Lee
- Clinical Radiology, Cardiac and Pulmonary Imaging, University of California, San Francisco, CA, USA
| | - Francesca Nesta Delling
- Department of Medicine (Cardiovascular Division), University of California San Francisco, San Francisco, CA, USA
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy.
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Liu J, Tan T, Wei P, Ma J, Zhong L, Qiu H, Wang S, Zhuang J, Zhu W, Guo H, Chen J. Anomalous papillary muscle insertion into the mitral valve leaflet in hypertrophic obstructive cardiomyopathy: a lip nevus sign in echocardiography. Front Cardiovasc Med 2023; 10:1292142. [PMID: 38124897 PMCID: PMC10731039 DOI: 10.3389/fcvm.2023.1292142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background Anomalous papillary muscle (APM) insertion into the mitral valve leaflet is rare but clinically important in hypertrophic obstructive cardiomyopathy (HOCM). In this study, we report the detection rate of APM insertion into the mitral valve using preoperative imaging modalities and the surgical outcomes of the patients. Methods By retrospectively reviewing the clinical records of patients with HOCM who underwent surgical treatment by a single operation group at our center from January 2020 to June 2023, patients with APM insertion into the mitral valve leaflet were identified. Baseline data, image characteristics, and surgical outcomes were analyzed. Results The incidence of APM insertion into the mitral valve leaflet was 5.1% (8/157). The insertion site was located at A3 in six cases, which was more common than at A2 (n = 2). Preoperative echocardiography was used to identify two patients (25%) with APM insertion. We observed a particular echocardiographic feature for APM in HOCM patients, which was noted as a "lip nevus sign", with a higher detection rate (62.5%). All patients successfully underwent septal myectomy with concomitant APM excision or mitral valve replacement via the transaortic (n = 5) or transmitral (n = 3) approach. The mean age was 49.0 ± 17.4 years and seven patients (87.5%) were female. Interventricular septum thickness (17.0 mm vs. 13.3 mm, P = 0.012) and left ventricular outflow gradient (117.5 mmHg vs. 7.5 mmHg, P = 0.012) were significantly decreased after surgery. Residual outflow obstruction, systolic anterior motion, and ≥3+ mitral regurgitation were negative. During the follow-up of 26.2 ± 12.2 months, there were no reported operations, adverse events, mitral regurgitation aggravations, recurrences of outflow obstruction, or instances of SAM. Conclusions Papillary muscles inserted into the mitral valve leaflet are a subtype of subvalvular malformation in HOCM that requires surgical correction. The lip nevus sign on echocardiography is a characteristic of APM insertion in HOCM and may improve the preoperative detection rate. Adequate myectomy with anomalous papillary muscle excision has achieved good results in reducing the outflow gradient and eliminating mitral regurgitation, with good outcomes at short-to-intermediate follow-up.
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Affiliation(s)
- Jian Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Tong Tan
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Peijian Wei
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Jianrui Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Lishan Zhong
- Division of Adult Echocardiography, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Hailong Qiu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Shengwen Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Wei Zhu
- Division of Adult Echocardiography, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
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Li S, Fang L, Wu W, Zhang Z, Ji L, Sun Z, He L, Wang Z, Fu W, Li F, Xie M, Yang Y. Echocardiographic diagnosis of rupture of mitral valve papillary muscle. Int J Cardiol 2023; 391:131273. [PMID: 37598909 DOI: 10.1016/j.ijcard.2023.131273] [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: 05/20/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To explore the value of echocardiography in diagnosing papillary muscle rupture (PMR) of the mitral valve, and summarize the characteristic echocardiographic features of different types. METHODS Echocardiograms of 13 PMR patients confirmed by surgery in Wuhan Union Hospital between January 2009 and December 2022 were retrospectively analyzed and their preoperative transthoracic echocardiography (TTE) was compared with surgical findings. RESULTS A total of 9020 patients underwent mitral valve repair or replacement surgery during the study period including 13 (0.14%) for PMR. Of the 13 PMRs, 8 cases were partial PMR(P-PMR), 5 cases were complete PMR(C-PMR); 3 cases were anterolateral PMR, and 10 were posteromedial PMR. The diagnostic accuracy, sensitivity, and specificity of the preoperative TTE were 99.9%, 53.8% and 99.9% respectively. Echocardiographic features of 10 patients (5-C-PMR and 5 P-PMR) with detailed TTE and intraoperative transesophageal echocardiography (TEE) data included: both anterior and posterior leaflets prolapse (C-PMR 60% vs P-PMR 60%); flail leaflet (C-PMR100% vs P-PMR 40%); All C-PMRs and P-PMRs have severe, eccentric and lateral regurgitation; flail attachment (chordae tendinae and ruptured PM) at the tip of prolapsed leaflet (C-PMR100% vs P-PMR 60%); high-echo masses resembled "champagne glasses" in 100% of the C-PMR; high-echo masses resembled "lotus-seedpod" in 60% and "dumbbell-shaped" torn PM in remaining 40% of the P-PMR. CONCLUSIONS Different PMR subtypes have different echocardiographic characteristics. Combining TTE and TEE can accurately identify the typical features of PMR such as ipsilateral hemipetal leaflet prolapse, high-echoic mass at the tip of the leaflet, massive eccentricity and lateral regurgitation.
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Affiliation(s)
- Shiying Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lingyun Fang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Ziming Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhenxing Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Zhen Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenpei Fu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Fangya Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - Yali Yang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Crean AM, Small GR, Saleem Z, Maharajh G, Ruel M, Chow BJW. Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 205:481-492. [PMID: 37683571 DOI: 10.1016/j.amjcard.2023.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy is a common inherited cardiac condition in which regional myocardial thickening and scarring can lead to a range of symptoms including breathlessness, dizziness, chest pain, and collapse with loss of consciousness. It is vital to be able to understand the mechanisms behind these epiphenomena and to be able to distinguish, for example, between syncope because of arrhythmia versus syncope because of mechanical outflow tract obstruction. Therefore, we require a technique that can characterize anatomy, physiology, and myocardial substrate. Traditionally, this role has been the preserve of cardiac magnetic resonance (CMR) imaging. This review makes the case for cardiac computed tomography (CT) as an alternative imaging method. We review the use of functional CT to identify the components of outflow tract obstruction (and obstruction at other levels, which may be simultaneous), and as an aid to interventional and surgical planning. We demonstrate the added value of multiplanar isotropic reformats in this condition, particularly in cases where the diagnosis may be more challenging or where complications (such as early apical aneurysm) may be difficult to recognize with 2-dimensional techniques. In conclusion, our aim is to convince readers that cardiac CT is a highly valuable and versatile tool, which deserves wider usage and greater recognition in those caring for patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Andrew M Crean
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zain Saleem
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gyaandeo Maharajh
- Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
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Gaidulis G, Padala M. Computational Modeling of the Subject-Specific Effects of Annuloplasty Ring Sizing on the Mitral Valve to Repair Functional Mitral Regurgitation. Ann Biomed Eng 2023; 51:1984-2000. [PMID: 37344691 PMCID: PMC10826925 DOI: 10.1007/s10439-023-03219-9] [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: 12/21/2022] [Accepted: 04/21/2023] [Indexed: 06/23/2023]
Abstract
Surgical repair of functional mitral regurgitation (FMR) that occurs in nearly 60% of heart failure (HF) patients is currently performed with undersizing mitral annuloplasty (UMA), which lacks short- and long-term durability. Heterogeneity in valve geometry makes tailoring this repair to each patient challenging, and predictive models that can help with planning this surgery are lacking. In this study, we present a 3D echo-derived computational model, to enable subject-specific, pre-surgical planning of the repair. Three computational models of the mitral valve were created from 3D echo data obtained in three pigs with HF and FMR. An annuloplasty ring model in seven sizes was created, each ring was deployed, and post-repair valve closure was simulated. The results indicate that large annuloplasty rings (> 32 mm) were not effective in eliminating regurgitant gaps nor in restoring leaflet coaptation or reducing leaflet stresses and chordal tension. Smaller rings (≤ 32 mm) restored better systolic valve closure in all investigated cases,but excessive valve tethering and restricted motion of the leaflets were still present. This computational study demonstrates that for effective correction of FMR, the extent of annular reduction differs between subjects, and overly reducing the annulus has deleterious effects on the valve.
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Affiliation(s)
- Gediminas Gaidulis
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, USA.
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA.
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Yildiz C, Koyuncu A, Ocal L, Gursoy MO, Oflar E, Kahveci G. Assessment of papillary muscle free strain in hypertrophic cardiomyopathy and hypertension-induced left ventricular hypertrophy. Cardiovasc J Afr 2023; 34:169-174. [PMID: 36947167 PMCID: PMC10658726 DOI: 10.5830/cvja-2022-070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/12/2022] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients. METHODS Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients. RESULTS Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP. CONCLUSIONS Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.
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Affiliation(s)
- Cennet Yildiz
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey.
| | - Atilla Koyuncu
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Lutfi Ocal
- Department of Cardiology, Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gursoy
- Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Ersan Oflar
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Istinye University, Liv Hospital, Istanbul, Turkey
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8
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Aquaro GD, De Gori C, Grilli G, Licordari R, Barison A, Todiere G, Ianni U, Parollo M, Grigoratos C, Restivo L, De Luca A, Faggioni L, Cioni D, Sinagra G, Di Bella G, Neri E. Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance. Eur Radiol 2023; 33:4621-4636. [PMID: 36692598 PMCID: PMC10289986 DOI: 10.1007/s00330-023-09400-x] [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: 08/23/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. METHODS A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered. RESULTS Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02). CONCLUSIONS In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. KEY POINTS • Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction. • Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. • Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia.
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Affiliation(s)
- Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
| | - Carmelo De Gori
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | | | - Roberto Licordari
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | | | | | | | - Matteo Parollo
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | | | | | | | - Lorenzo Faggioni
- Academic Radiology Unit, Department of Translational research and of new technology in medicine and Surgery, University of Pisa, Pisa, Italy
| | - Dania Cioni
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | | | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy
| | - Emanuele Neri
- Academic Radiology Unit, Department of Translational research and of new technology in medicine and Surgery, University of Pisa, Pisa, Italy
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9
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Wu W, Ching S, Sabin P, Laurence DW, Maas SA, Lasso A, Weiss JA, Jolley MA. The effects of leaflet material properties on the simulated function of regurgitant mitral valves. J Mech Behav Biomed Mater 2023; 142:105858. [PMID: 37099920 PMCID: PMC10199327 DOI: 10.1016/j.jmbbm.2023.105858] [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: 02/09/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
Advances in three-dimensional imaging provide the ability to construct and analyze finite element (FE) models to evaluate the biomechanical behavior and function of atrioventricular valves. However, while obtaining patient-specific valve geometry is now possible, non-invasive measurement of patient-specific leaflet material properties remains nearly impossible. Both valve geometry and tissue properties play a significant role in governing valve dynamics, leading to the central question of whether clinically relevant insights can be attained from FE analysis of atrioventricular valves without precise knowledge of tissue properties. As such we investigated (1) the influence of tissue extensibility and (2) the effects of constitutive model parameters and leaflet thickness on simulated valve function and mechanics. We compared metrics of valve function (e.g., leaflet coaptation and regurgitant orifice area) and mechanics (e.g., stress and strain) across one normal and three regurgitant mitral valve (MV) models with common mechanisms of regurgitation (annular dilation, leaflet prolapse, leaflet tethering) of both moderate and severe degree. We developed a novel fully-automated approach to accurately quantify regurgitant orifice areas of complex valve geometries. We found that the relative ordering of the mechanical and functional metrics was maintained across a group of valves using material properties up to 15% softer than the representative adult mitral constitutive model. Our findings suggest that FE simulations can be used to qualitatively compare how differences and alterations in valve structure affect relative atrioventricular valve function even in populations where material properties are not precisely known.
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Affiliation(s)
- Wensi Wu
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA
| | - Stephen Ching
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA
| | - Patricia Sabin
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA
| | - Devin W Laurence
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA
| | - Steve A Maas
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, UT, USA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, Canada
| | - Jeffrey A Weiss
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, UT, USA
| | - Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA; Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, 19104, PA, USA.
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10
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Liu Q, Lu Q, Chai Y, Tao Z, Wu Q, Jiang M, Pu J. Papillary-Muscle-Derived Radiomic Features for Hypertrophic Cardiomyopathy versus Hypertensive Heart Disease Classification. Diagnostics (Basel) 2023; 13:diagnostics13091544. [PMID: 37174935 PMCID: PMC10177511 DOI: 10.3390/diagnostics13091544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose: This study aimed to assess the value of radiomic features derived from the myocardium (MYO) and papillary muscle (PM) for left ventricular hypertrophy (LVH) detection and hypertrophic cardiomyopathy (HCM) versus hypertensive heart disease (HHD) differentiation. Methods: There were 345 subjects who underwent cardiovascular magnetic resonance (CMR) examinations that were analyzed. After quality control and manual segmentation, the 3D radiomic features were extracted from the MYO and PM. The data were randomly split into training (70%) and testing (30%) datasets. Feature selection was performed on the training dataset. Five machine learning models were evaluated using the MYO, PM, and MYO+PM features in the detection and differentiation tasks. The optimal differentiation model was further evaluated using CMR parameters and combined features. Results: Six features were selected for the MYO, PM, and MYO+PM groups. The support vector machine models performed best in both the detection and differentiation tasks. For LVH detection, the highest area under the curve (AUC) was 0.966 in the MYO group. For HCM vs. HHD differentiation, the best AUC was 0.935 in the MYO+PM group. Comparing the radiomics models to the CMR parameter models for the differentiation tasks, the radiomics models achieved significantly improved the performance (p = 0.002). Conclusions: The radiomics model with the MYO+PM features showed similar performance to the models developed from the MYO features in the detection task, but outperformed the models developed from the MYO or PM features in the differentiation task. In addition, the radiomic models performed better than the CMR parameters' models.
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Affiliation(s)
- Qiming Liu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Qifan Lu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Yezi Chai
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Zhengyu Tao
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Qizhen Wu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Meng Jiang
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
| | - Jun Pu
- Department of Cardiology, RenJi Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200120, China
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11
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Pambianchi G, Giannetti M, Marchitelli L, Cundari G, Maestrini V, Mancone M, Francone M, Catalano C, Galea N. Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain. J Clin Med 2023; 12:jcm12041497. [PMID: 36836032 PMCID: PMC9963367 DOI: 10.3390/jcm12041497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; p-value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; p < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Giannetti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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12
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Tao J, Duan F, Long J, Meng Q, Zhang B, Zhu Z, Wang H. The Role of the Submitral Apparatus in Hypertrophic Obstructive Cardiomyopathy. J Am Soc Echocardiogr 2023; 36:133-145. [PMID: 36191671 DOI: 10.1016/j.echo.2022.09.018] [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: 04/28/2022] [Revised: 07/14/2022] [Accepted: 09/25/2022] [Indexed: 02/06/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, is characterized by unexplained hypertrophy of any myocardial segment, and has a prevalence of 0.2% to 0.5% among the general population. As one of the phenotypes of hypertrophic cardiomyopathy, left ventricular outflow tract obstruction (LVOTO) is associated with high morbidity and mortality, including cardiac death. The integration of various factors, including septal hypertrophy, malformation of the mitral valve apparatus, and an anomalous mitral subvalvular apparatus, may contribute to the occurrence of LVOTO. Previous studies have thoroughly discussed the role of the mitral valve in the mechanisms of systolic anterior motion and LVOTO. Recent studies have shown the importance of determining the potential mechanism of the submitral apparatus in inducing systolic anterior motion and LVOTO. The authors review recent advances in knowledge regarding the submitral apparatus of patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Jia Tao
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fujian Duan
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jili Long
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinglong Meng
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Zhang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenhui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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13
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Wengrofsky P, Akivis Y, Bukharovich I. Cardiac Multimodality Imaging in Hypertrophic Cardiomyopathy: What to Look for and When to Image. Curr Cardiol Rev 2023; 19:1-18. [PMID: 36927425 PMCID: PMC10518881 DOI: 10.2174/1573403x19666230316103117] [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: 12/02/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM), now recognized as a common cardiomyopathy of complex genomics and pathophysiology, is defined by the presence of left ventricular hypertrophy of various morphologies and severity, significant hemodynamic consequences, and diverse phenotypic, both structural and clinical, profiles. Advancements in cardiac multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, with and without angiography have greatly improved the diagnosis of HCM, and enable precise measurements of cardiac mass, volume, wall thickness, function, and physiology. Multimodality imaging provides comprehensive and complementary information and hasemerged as the bedrock for the diagnosis, clinical assessment, serial monitoring, and sudden cardiac death risk stratification of patients with HCM. This review highlights the role of cardiac multimodality imaging in the modern diagnosis and management of HCM.
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Affiliation(s)
- Perry Wengrofsky
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Yonatan Akivis
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Inna Bukharovich
- Division of Cardiology, Department of Medicine, NYC Health and & Hospitals, Kings County, Brooklyn, NY 11203, USA
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14
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Occlusion of the os of the left coronary artery by dysplastic aortic valve tissue presenting as progressive mitral insufficiency and cardiac arrest. Cardiol Young 2022; 33:824-826. [PMID: 36102120 DOI: 10.1017/s104795112200292x] [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: 11/05/2022]
Abstract
Mitral regurgitation in the neonatal period is relatively rare. It can be secondary to a congenital malformation of the valve apparatus or mitral valve dysfunction and deformation secondary to myocardial dysfunction or volume load of the left ventricle. Less commonly, it can be due to coronary artery abnormalities leading to mitral valve papillary muscle ischaemia and subsequent dysfunction. Such coronary artery abnormalities include anomalous left coronary artery from pulmonary artery, left main coronary artery atresia, or a thromboembolic phenomenon. In this study, we describe a newborn with a dysplastic aortic valve causing obstruction of the os of the left coronary artery leading to progressive mitral insufficiency.
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15
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The Role of Multimodality Imaging and 3D Printing in Ventricular Cone Constriction. JACC Case Rep 2022; 4:1160-1161. [PMID: 36213877 PMCID: PMC9537099 DOI: 10.1016/j.jaccas.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Yang C, Xu H, Qiao S, Jia R, Jin Z, Yuan J. Papillary and Trabecular Muscles Have Substantial Impact on Quantification of Left Ventricle in Patients with Hypertrophic Obstructive Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12082029. [PMID: 36010378 PMCID: PMC9407152 DOI: 10.3390/diagnostics12082029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Patients with obstructive hypertrophic cardiomyopathy (HOCM) have large papillary and trabecular muscles (PTMs), which are myocardial tissue. PTMs are usually excluded from the myocardium and included in the left ventricular (LV) cavity when determining LV mass (LVM) and volumes using cardiac magnetic resonance (CMR). This conventional method may result in large distortion of LVM and other indices. We investigated 74 patients with HOCM undergoing CMR imaging. LV short-axis cine images were obtained. LV contours were drawn using two different methods: (1) the conventional method, where PTMs were included in the LV cavity; and (2) the mask method, which includes the TPMs in the LV myocardium. The LV end-diastolic volume (LV-EDV), LV end-systolic volume (LV-ESV), LV ejection fraction (LVEF), and the LVM were then calculated. Fasting NT-proBNP and CK-MB levels were measured with ELISA. In patients with HOCM, mass of PTMs (MOPTM) was 47.9 ± 18.7 g, which represented 26.9% of total LVM. Inclusion of PTMs with the mask method resulted in significantly greater LVM and LVM index (both p < 0.0001) in comparison with those measured with the conventional method. In addition, the mask method produced a significant decrease in LV-EDV and LV-ESV. LVEF was significantly increased with the mask method (64.3 ± 7.9% vs. 77.2 ± 7.1%, p < 0.0001). MOPTM was positively correlated with BMI, septal wall thickness, LVM, LV-EDV, and LV-ESV. LVEF was inversely correlated with MOPTM. In addition, MOPTM correlated positively with NT-proBNP (r = 0.265, p = 0.039) and CK-MB (r = 0.356, p = 0.002). In conclusion, inclusion of PTMs in the myocardium has a substantial impact on quantification of the LVM, LV-EDV, LV-ESV, and LVEF in patients with HOCM. The effects of the PTMs in women was greater than that in men. Furthermore, the MOPTM was positively associated with NT-proBNP and CK-MB. The PTMs might be included in the myocardium when measuring the LV volumes and mass of patients with HOCM. At present, the clinical and prognostic meaning and relevance of the PTMs is not clear and should be further studied.
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Affiliation(s)
- Chengzhi Yang
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Haobo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ruofei Jia
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China
- Correspondence: (Z.J.); (J.Y.)
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Z.J.); (J.Y.)
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17
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Kawel-Boehm N, Bremerich J. Dark-Blood Late Gadolinium Enhancement: A Major Advance for Cardiac MRI. Radiology 2022; 305:339-340. [PMID: 35880984 DOI: 10.1148/radiol.221435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nadine Kawel-Boehm
- From the Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000 Chur, Switzerland (N.K.B.); and Department of Radiology, University of Basel Hospital, Basel, Switzerland (J.B.)
| | - Jens Bremerich
- From the Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000 Chur, Switzerland (N.K.B.); and Department of Radiology, University of Basel Hospital, Basel, Switzerland (J.B.)
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18
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Tuberculosis of the Heart: A Diagnostic Challenge. Tomography 2022; 8:1649-1665. [PMID: 35894002 PMCID: PMC9326682 DOI: 10.3390/tomography8040137] [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: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis of the heart is relatively rare and presents a significant diagnostic difficulty for physicians. It is the leading cause of death from infectious illness. It is one of the top 10 leading causes of death worldwide, with a disproportionate impact in low- and middle-income nations. The radiologist plays a pivotal role as CMR is a non-invasive radiological method that can aid in identifying potential overlap and differential diagnosis between tuberculosis, mass lesions, pericarditis, and myocarditis. Regardless of similarities or overlap in observations, the combination of clinical and certain particular radiological features, which are also detected by comparison to earlier and follow-up CMR scans, may aid in the differential diagnosis. CMR offers a significant advantage over echocardiography for detecting, characterizing, and assessing cardiovascular abnormalities. In conjunction with clinical presentation, knowledge of LGE, feature tracking, and parametric imaging in CMR may help in the early detection of tuberculous myopericarditis and serve as a surrogate for endomyocardial biopsy resulting in a quicker diagnosis and therapy. This article aims to explain the current state of cardiac tuberculosis, the diagnostic utility of CMR in tuberculosis (TB) patients, and offer an overview of the various imaging and laboratory procedures used to detect cardiac tuberculosis.
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Awasthi N, Vermeer L, Fixsen LS, Lopata RGP, Pluim JPW. LVNet: Lightweight Model for Left Ventricle Segmentation for Short Axis Views in Echocardiographic Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2115-2128. [PMID: 35452387 DOI: 10.1109/tuffc.2022.3169684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lightweight segmentation models are becoming more popular for fast diagnosis on small and low cost medical imaging devices. This study focuses on the segmentation of the left ventricle (LV) in cardiac ultrasound (US) images. A new lightweight model [LV network (LVNet)] is proposed for segmentation, which gives the benefits of requiring fewer parameters but with improved segmentation performance in terms of Dice score (DS). The proposed model is compared with state-of-the-art methods, such as UNet, MiniNetV2, and fully convolutional dense dilated network (FCdDN). The model proposed comes with a post-processing pipeline that further enhances the segmentation results. In general, the training is done directly using the segmentation mask as the output and the US image as the input of the model. A new strategy for segmentation is also introduced in addition to the direct training method used. Compared with the UNet model, an improvement in DS performance as high as 5% for segmentation with papillary (WP) muscles was found, while showcasing an improvement of 18.5% when the papillary muscles are excluded. The model proposed requires only 5% of the memory required by a UNet model. LVNet achieves a better trade-off between the number of parameters and its segmentation performance as compared with other conventional models. The developed codes are available at https://github.com/navchetanawasthi/Left_Ventricle_Segmentation.
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Morales KRDP, Romero CVE, Guacho WRL, Jaya DAS, Fonseca EKUN. Mid-ventricular obstruction in a patient with hypertrophic cardiomyopathy. EINSTEIN-SAO PAULO 2022; 20:eAI6672. [PMID: 35476079 PMCID: PMC9018060 DOI: 10.31744/einstein_journal/2022ai6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
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Single cardiomyocytes from papillary muscles show lower preload-dependent activation of force compared to cardiomyocytes from the left ventricular free wall. J Mol Cell Cardiol 2022; 166:127-136. [DOI: 10.1016/j.yjmcc.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/05/2022] [Accepted: 02/22/2022] [Indexed: 01/21/2023]
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22
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Rosu RO, Lupsor A, Necula A, Cismaru G, Cainap SS, Iacob D, Lazea C, Cismaru A, Negru AG, Pop D, Gusetu G. Anatomical-MRI Correlations in Adults and Children with Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12020489. [PMID: 35204578 PMCID: PMC8870875 DOI: 10.3390/diagnostics12020489] [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: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the disease’s natural course may be developed in the future. CMR has been validated as a technique with high sensitivity and specificity, very few contraindications, a low risk of side effects, and is overall a good tool to be employed in the management of HCM patients. The goal of this review is to evaluate the magnetic resonance features of HCM, starting with distinct phenotypic variants of the disease and progressing to differential diagnoses of athlete’s heart, hypertension, and infiltrative cardiomyopathies. HCM in children has its own section in this review, with possible risk factors that are distinct from those in adults; delayed enhancement in children may play a role in risk stratification in HCM. Finally, a number of teaching points for general cardiologists who recommend CMR for patients with HCM will be presented.
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Affiliation(s)
- Radu Ovidiu Rosu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Ana Lupsor
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Alexandru Necula
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Correspondence: (A.L.); (G.C.); Tel.: +40-004-072-192-6230 (G.C.)
| | - Simona Sorana Cainap
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 2nd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Daniela Iacob
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 3rd Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- 1st Pediatric Department, Mother and Child Department, Emergency Clinical Hospital for Children, 400370 Cluj-Napoca, Romania
| | - Andrei Cismaru
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, 400337 Cluj-Napoca, Romania
| | - Alina Gabriela Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Dana Pop
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
| | - Gabriel Gusetu
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, 400347 Cluj-Napoca, Romania; (R.O.R.); (D.P.); (G.G.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.N.); (S.S.C.); (D.I.); (C.L.); (A.C.)
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Nussinovitch U, Wang P, Narayan S, Viswanathan M, Badhwar N, Zheng L, Sauer WH, Nguyen DT. Perpendicular Catheter Orientation During Papillary Muscle Ablation Results in Larger, Deeper Lesions. J Cardiovasc Electrophysiol 2022; 33:690-695. [PMID: 35133050 DOI: 10.1111/jce.15408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Ablation of papillary muscles (PM) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting. METHODS Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 grams. Ablation lesions were sectioned and underwent quantitative morphometric analysis. RESULTS A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared to ablation with the catheter parallel to PM tissue (75.26±8.40 mm3 vs. 34.04±2.91 mm3 , p<0.001) and (3.33±0.18 mm vs. 2.24±0.10 mm, p<0.001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33±0.28°C vs. 40.28±0.24°C, p=0.003), yet, there were no steam pops in either group. CONCLUSION For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Udi Nussinovitch
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Paul Wang
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Sanjiv Narayan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Mohan Viswanathan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women's Hospital, Boston, MA
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
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Tumenas A, Tamkeviciute L, Arzanauskiene R, Arzanauskaite M. Multimodality Imaging of the Mitral Valve: Morphology, Function, and Disease. Curr Probl Diagn Radiol 2021; 50:905-924. [DOI: 10.1067/j.cpradiol.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
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25
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Mamalakis M, Garg P, Nelson T, Lee J, Wild JM, Clayton RH. MA-SOCRATIS: An automatic pipeline for robust segmentation of the left ventricle and scar. Comput Med Imaging Graph 2021; 93:101982. [PMID: 34481237 DOI: 10.1016/j.compmedimag.2021.101982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Multi-atlas segmentation of cardiac regions and total infarct scar (MA-SOCRATIS) is an unsupervised automatic pipeline to segment left ventricular myocardium and scar from late gadolinium enhanced MR images (LGE-MRI) of the heart. We implement two different pipelines for myocardial and scar segmentation from short axis LGE-MRI. Myocardial segmentation has two steps; initial segmentation and re-estimation. The initial segmentation step makes a first estimate of myocardium boundaries by using multi-atlas segmentation techniques. The re-estimation step refines the myocardial segmentation by a combination of k-means clustering and a geometric median shape variation technique. An active contour technique determines the unhealthy and healthy myocardial wall. The scar segmentation pipeline is a combination of a Rician-Gaussian mixture model and full width at half maximum (FWHM) thresholding, to determine the intensity pixels in scar regions. Following this step a watershed method with an automatic seed-points framework segments the final scar region. MA-SOCRATIS was evaluated using two different datasets. In both datasets ground truths were based on manual segmentation of short axis images from LGE-MRI scans. The first dataset included 40 patients from the MS-CMRSeg 2019 challenge dataset (STACOM at MICCAI 2019). The second is a collection of 20 patients with scar regions that are challenging to segment. MA-SOCRATIS achieved robust and accurate performance in automatic segmentation of myocardium and scar regions without the need of training or tuning in both cohorts, compared with state-of-the-art techniques (intra-observer and inter observer myocardium segmentation: 81.9% and 70% average Dice value, and scar (intra-observer and inter observer segmentation: 70.5% and 70.5% average Dice value).
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Affiliation(s)
- Michail Mamalakis
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK.
| | - Pankaj Garg
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Tom Nelson
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Jim M Wild
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Polaris, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Richard H Clayton
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK
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Axelsson E, Ljungvall I, Bhoumik P, Conn LB, Muren E, Ohlsson Å, Olsen LH, Engdahl K, Hagman R, Hanson J, Kryvokhyzha D, Pettersson M, Grenet O, Moggs J, Del Rio-Espinola A, Epe C, Taillon B, Tawari N, Mane S, Hawkins T, Hedhammar Å, Gruet P, Häggström J, Lindblad-Toh K. The genetic consequences of dog breed formation-Accumulation of deleterious genetic variation and fixation of mutations associated with myxomatous mitral valve disease in cavalier King Charles spaniels. PLoS Genet 2021; 17:e1009726. [PMID: 34473707 PMCID: PMC8412370 DOI: 10.1371/journal.pgen.1009726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Selective breeding for desirable traits in strictly controlled populations has generated an extraordinary diversity in canine morphology and behaviour, but has also led to loss of genetic variation and random entrapment of disease alleles. As a consequence, specific diseases are now prevalent in certain breeds, but whether the recent breeding practice led to an overall increase in genetic load remains unclear. Here we generate whole genome sequencing (WGS) data from 20 dogs per breed from eight breeds and document a ~10% rise in the number of derived alleles per genome at evolutionarily conserved sites in the heavily bottlenecked cavalier King Charles spaniel breed (cKCs) relative to in most breeds studied here. Our finding represents the first clear indication of a relative increase in levels of deleterious genetic variation in a specific breed, arguing that recent breeding practices probably were associated with an accumulation of genetic load in dogs. We then use the WGS data to identify candidate risk alleles for the most common cause for veterinary care in cKCs–the heart disease myxomatous mitral valve disease (MMVD). We verify a potential link to MMVD for candidate variants near the heart specific NEBL gene in a dachshund population and show that two of the NEBL candidate variants have regulatory potential in heart-derived cell lines and are associated with reduced NEBL isoform nebulette expression in papillary muscle (but not in mitral valve, nor in left ventricular wall). Alleles linked to reduced nebulette expression may hence predispose cKCs and other breeds to MMVD via loss of papillary muscle integrity. As a consequence of selective breeding, specific disease-causing mutations have become more frequent in certain dog breeds. Whether the breeding practice also resulted in a general increase in the overall number of disease-causing mutations per dog genome is however not clear. To address this question, we compare the amount of harmful, potentially disease-causing, mutations in dogs from eight common breeds that have experienced varying degrees of intense selective breeding. We find that individuals belonging to the breed affected by the most intense breeding—cavalier King Charles spaniel (cKCs)—carry more harmful variants than other breeds, indicating that past breeding practices may have increased the overall levels of harmful genetic variation in dogs. The most common disease in cKCs is myxomatous mitral valve disease (MMVD). To identify variants linked to this disease we next characterize mutations that are common in cKCs, but rare in other breeds, and then investigate if these mutations can predict MMVD in dachshunds. We find that variants that regulate the expression of the gene NEBL in papillary muscles may increase the risk of the disease, indicating that loss of papillary muscle integrity could contribute to the development of MMVD.
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Affiliation(s)
- Erik Axelsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Priyasma Bhoumik
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Laura Bas Conn
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Eva Muren
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Åsa Ohlsson
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Lisbeth Høier Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ragnvi Hagman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jeanette Hanson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Dmytro Kryvokhyzha
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mats Pettersson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Olivier Grenet
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jonathan Moggs
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Christian Epe
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Bruce Taillon
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Nilesh Tawari
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Shrinivas Mane
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Troy Hawkins
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Åke Hedhammar
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
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Vadi SK, Sood A, Panda P, Debi U, Arafath MY, Parmar M, Bahl A, Mittal BR. Reversible perfusion pattern in hypertrophied papillary muscles evident on myocardial perfusion imaging with CZT-based cardiac-specific camera. J Nucl Cardiol 2021; 28:320-327. [PMID: 32895858 DOI: 10.1007/s12350-020-02333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Shelvin Kumar Vadi
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India.
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Uma Debi
- Department of Radiology and Imaging, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Mohamed Yaser Arafath
- Department of Radiology and Imaging, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Madan Parmar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector -12, Chandigarh, 160012, India
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De Lazzari M, Zorzi A, Bettella N, Cipriani A, Pilichou K, Cason M, Vessella T, Sarto P, Gualea MR, Chianura F, Tardini L, Ricci G, Mazzanti I, Ricci F, Motta R, Perazzolo Marra M, Corrado D. Papillary Muscles Abnormalities in Athletes With Otherwise Unexplained T-Wave Inversion in the ECG Lateral Leads. J Am Heart Assoc 2021; 10:e019239. [PMID: 33496187 PMCID: PMC7955426 DOI: 10.1161/jaha.120.019239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Papillary muscles (PMs) abnormalities may be associated with ECG repolarization abnormalities. We aimed to evaluate the relation between lateral T‐wave inversion (TWI) and PMs characteristics in a cohort of athletes with no clinically demonstrable cardiac disease. Methods and Results We included 53 athletes (median age, 20 years; 87% men) with lateral TWI and no evidence of heart disease on clinical and cardiac magnetic resonance evaluation. A group of healthy athletes with normal ECG served as controls. We evaluated the PMs dimensions, such as diameters, area, volume, mass, and ratio between PMs and left ventricular mass, and the prevalence of PMs apical displacement. Compared with controls, athletes with TWI showed PMs hypertrophy with significantly increased PMs diameters, area, volume, and mass. The ratio between PMs and left ventricular mass was 4.4% in athletes with TWI and 3.0% in controls (P<0.001). A PMs/left ventricular mass ratio >3.5% showed 85% sensitivity and 76% specificity for differentiating between athletes with TWI and controls. Apical displacement of PMs was found in 25 (47%) athletes with TWI versus 9 (17%) controls (P=0.001). At multivariable analysis, PMs/left ventricular mass ratio and apical displacement remained independent predictors of TWI. Clinical outcome of the athletes with TWI and PMs abnormalities was uneventful despite continuation of their sports activity. Conclusions PMs hypertrophy and apical displacement may underlie otherwise unexplained lateral TWI in the athlete. Lateral TWI associated with PMs abnormalities appears as a distinct anatomo‐clinical condition characterized by a favorable outcome.
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Affiliation(s)
- Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Natascia Bettella
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Marco Cason
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | | | - Patrizio Sarto
- Center for Sports Medicine ULSS2 Marca Trevigiana Treviso Italy
| | - Maria Rita Gualea
- Interdipartimental Center for Biology and Sports Medicine University of Pavia Italy
| | | | | | | | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences University of Chieti-Pescara Chieti Scalo Italy
| | - Raffaella Motta
- Department of Medicine, Radiology Unit University of Padova Padova Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
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Nakou ES, Theodoropoulos KC, Shaikh H, Amin‐Youssef G, Monaghan MJ, Papachristidis A. Isolated papillary muscle rupture with nonobstructive coronary artery disease, minimal myocardial infarction, and normal wall motion. Echocardiography 2020; 37:1855-1859. [DOI: 10.1111/echo.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Eleni S. Nakou
- Department of Cardiology King’s College Hospital London UK
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30
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Kohnken R, Weber A. Characterization of Spontaneous Vascular Findings in the Papillary Muscles of Beagle Dogs. Toxicol Pathol 2020; 48:899-904. [PMID: 33094690 DOI: 10.1177/0192623320963020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standard histology trimming practices for toxicity studies in dogs include preparation of a section of the papillary muscle associated with the left ventricular free wall-the anteriolateral or anterior muscle. In contrast, the posteromedial or posterior papillary muscle, associated with the interventricular septum, is not commonly evaluated. In humans, the posterior papillary muscle is more often affected in ischemic myocardial disease, in large part due to the absence of collateral circulation, in contrast to the anterior muscle. Due to the differential vascular supply to the papillary muscles, we sought to determine whether there is a higher incidence of spontaneous coronary vascular changes in the posterior papillary muscle versus the anterior muscle in dogs. The hearts of 30 vehicle-treated or untreated beagle dogs that were euthanized for other purposes were collected and sectioned in a consistent manner to include both papillary muscles for histologic evaluation. The posterior muscle consistently had higher incidences of intramural coronary arteries affected by vascular medial hypertrophy, medial arteriosclerosis, intimal hyperplasia, and/or disruption or loss of the internal elastic lamina. This observation may have significant implications for the evaluation and characterization of spontaneous and xenobiotic-induced cardiovascular lesions in dogs.
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Affiliation(s)
| | - Angella Weber
- Preclinical Safety, 359181AbbVie, North Chicago, IL, USA
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Ünlü S, Özden Tok Ö, Avcı Demir F, Papadopoulos K, Monaghan MJ. Differential diagnosis of apical hypertrophic cardiomyopathy and apical displacement of the papillary muscles: a multimodality imaging point of view. Echocardiography 2020; 38:103-113. [PMID: 33067903 DOI: 10.1111/echo.14895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022] Open
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) and apical displacement of papillary muscles (ADPM) are two different pathologies with a number of similar imaging findings that may hamper adequate diagnosis. While ApHCM is associated with increased rate of mortality, ADPM commonly presents with a benign course and differential diagnosis is of great importance. Clinical assessment and 2D echocardiography cannot sufficiently differentiate these conditions, however, and advanced echocardiographic methods may facilitate diagnosis. Although echocardiography is the first-line imaging method in the diagnostic algorithm, cardiac magnetic resonance imaging (CMRI) is the gold standard for evaluating patients due to good spatial resolution and myocardial tissue characterization abilities. When CMRI is contraindicated, cardiac computed tomography may be an alternative reliable method that can also give information about the coronary anatomy. Nuclear imaging may also provide supplementary data regarding hypertrophy and coronary arteries when there is a suspicion of ischemia.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey
| | - Özge Özden Tok
- Cardiology Department, Memorial Bahçelievler Hospital, İstanbul, Turkey
| | - Fulya Avcı Demir
- Cardiology Department, Private Antalya Anatolia Hospital, Antalya, Turkey
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Kaewkes D, Ochiai T, Flint N, Patel V, Mahani S, Raschpichler M, Yoon SH, Skaf S, Singh S, Chakravarty T, Nakamura M, Cheng W, Makkar R. Outcomes of Patients with Severe Aortic Stenosis and Left Ventricular Obstruction Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 133:105-115. [PMID: 32811649 DOI: 10.1016/j.amjcard.2020.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
Scarce data exist on clinical features and prognosis of patients with severe aortic stenosis (AS), concomitant with left ventricular obstruction (LVO). We aimed to evaluate the prevalence, characteristics, and outcomes in patients with severe AS and LVO undergoing transcatheter aortic valve implantation (TAVI). Consecutive patients with severe AS undergoing TAVI between January 2013 to December 2017 at our institution were included. Significant LVO was defined as resting peak left ventricular (LV) systolic gradient ≥30 mm Hg on pre-TAVI echocardiography. We analyzed the primary composite outcome of all-cause mortality and rehospitalization for heart failure (HHF) at 1-year in patients with LVO and those without LVO in the overall and propensity-matched populations. Among 1,729 patients who underwent TAVI, significant LVO was observed in 31 (1.8%) patients. This group was more likely to be female, had smaller aortic annulus and LV cavity, and received a smaller size of the transcatheter heart valve. The most common phenotype of LV hypertrophy causing LVO was concentric LV hypertrophy (58%), and mid-LV obstruction was more common than LV outflow tract obstruction (77% vs 23%, respectively). After adjustment for baseline differences, the primary outcome was not significantly different between patients with LVO and those without LVO (15% vs 16%, respectively; hazard ratio: 0.83; 95% confidence interval: 0.19 to 3.72; p = 0.809). In conclusion, in patients undergoing TAVI, concomitant LVO was relatively uncommon and occurred more often at mid-LV. The presence of pre-TAVI LVO was not associated with worse outcomes defined as increase all-cause mortality or HHF at 1-year.
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Rrapo Kaso E, Kramer CM. Multimodality Imaging for Hypertrophic Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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