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Zhong Y, Li C, Yu Y, Du Y, Bai Y, Wang X, Dai X, Fan G, Wang G. Evaluation the relationship between myocardial fibrosis and left ventricular torsion measured by cardiac magnetic resonance feature-tracking in hypertrophic cardiomyopathy patients with preserved ejection fraction. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03061-7. [PMID: 38448705 DOI: 10.1007/s10554-024-03061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
The relationship between left ventricular (LV) torsion and myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with preserved ejection fraction was still not well understood. New developments in cardiac magnetic resonance (CMR) enable a much fuller assessment of cardiac characteristics. This study sought to assess the impact of HCM on myocardial function as assessed by LV torsion and its relationship with MF. HCM (n = 79) and healthy controls (n = 40) underwent CMR. According to whether there was late gadolinium enhancement (LGE), patients were divided into LGE+ group and LGE- group. LV torsion and torsion rate were measured by CMR feature-tracking (CMR-FT). MF was quantitatively evaluated through LGE imaging. LGE was present in 44 patients (56%). Compared with healthy controls, torsion increased in the LGE- group (P < 0.001). Compared with LGE+ group, torsion was higher in the LGE- group (P < 0.001). There was no significant difference in torsion between LGE+ group and healthy controls. Correlation analysis showed that torsion was correlated with LGE% (r = - 0.443) and LGE mass (r = - 0.435) respectively. On multivariable logistic regression analysis, LV torsion was the only feature that was independently associated with the presence of LGE (OR 0.130; 95% CI 0.040 to 0.420, P = 0.01). The best torsion value associated with MF was 1.91 (sensitivity 60.0%, specificity 77.3%, AUC = 0.733). In HCM patients with preserved ejection fraction, CMR-FT derived LV torsion analysis holds promise for myocardial fibrosis detection.
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Affiliation(s)
- Ying Zhong
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ce Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Yu
- Department of Cardio-surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yaqi Du
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yun Bai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xinrui Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Guoguang Fan
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
| | - Guan Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
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Ishida M. Editorial for "Healthy Adult Left and Right Ventricular Torsion and Torsion Rates With MR-Feature Tracking". J Magn Reson Imaging 2024. [PMID: 38165087 DOI: 10.1002/jmri.29204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Masaki Ishida
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
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Zhang Z, Li G, Gao Y, Zhou S, Xie J, Liu S, Zhao Z, Zhu C, Ordovas K, Pohost GM, Sun K, Li K. Healthy Adult Left and Right Ventricular Torsion and Torsion Rates With MR-Feature Tracking. J Magn Reson Imaging 2023. [PMID: 38156373 DOI: 10.1002/jmri.29201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The clinical value of myocardial torsion quantification in prognostic assessment and risk stratification of various cardiovascular diseases is gradually being recognized. However, normal values of left and right ventricular (LV and RV) torsion and torsion rates (TRs) have not been fully determined, and their correlation with age and gender has not been well studied. PURPOSE To establish normal ranges of biventricular torsion, peak systolic and diastolic TRs using magnetic resonance feature tracking (MR-FT) technique based on a large sample of healthy adults, and further investigate their relationship with age and gender. STUDY TYPE Retrospective. POPULATION 566 Healthy adults (312 males, aged 43 ± 10 years; 254 females, aged 43 ± 11 years). FIELD STRENGTH/SEQUENCE 1.5T/gradient echo. ASSESSMENT Biventricular torsion, peak systolic, and diastolic TRs. STATISTICAL TESTS Shapiro-Wilk test, Student's t-test, Mann-Whitney-U test, linear regression, intraclass correlation coefficient, Bland-Altman analysis. Differences were regarded as statistically significant at P < 0.05. RESULTS Women demonstrated greater magnitudes of left ventricle (LV) torsion (1.23 ± 0.44 vs. 1.00 ± 0.42°/cm), peak systolic TR (9.69 ± 3.70 vs. 8.27 ± 3.73°/cm*sec), peak diastolic TR (-7.78 ± 2.82 vs. -6.06 ± 2.44°/cm*sec), and RV torsion (2.20 ± 1.23 vs. 1.65 ± 1.11°/cm*sec), peak systolic TR (16.07 ± 8.18 vs. 12.62 ± 7.08°/cm*sec), peak diastolic TR (-15.39 ± 6.53 vs. -11.70 ± 6.03°/cm*sec). For both genders, the magnitudes of LV and RV torsion, peak systolic, and diastolic TRs increased linearly with age. All the measurements of biventricular torsion, peak systolic and diastolic TRs achieved good to excellent intraobserver and interobserver reproducibility, with all intraclass correlation coefficients >0.70. DATA CONCLUSION The present study systematically provided age- and sex-stratified reference values for LV and RV torsion and TRs using MR-FT technique. Women and aging are associated with greater magnitudes of biventricular torsion, peak systolic, and diastolic TRs. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zhen Zhang
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
| | - Gengxiao Li
- Department of Radiology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yiyuan Gao
- The First School of Clinical Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shanshan Zhou
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
| | - Jianan Xie
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
| | - Shurong Liu
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
| | - Zhiwei Zhao
- Zhouxin Medical Imaging and Health Screening Center, Xiamen, Fujian, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Karen Ordovas
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gerald M Pohost
- Zhouxin Medical Imaging and Health Screening Center, Xiamen, Fujian, China
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kai Sun
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
| | - Kuncheng Li
- Department of Radiology, Medical imaging research institute of Longgang, the Third People's Hospital of Longgang District, Shenzhen, China
- Zhouxin Medical Imaging and Health Screening Center, Xiamen, Fujian, China
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Zlibut A, Cojocaru C, Onciul S, Agoston-Coldea L. Cardiac Magnetic Resonance Imaging in Appraising Myocardial Strain and Biomechanics: A Current Overview. Diagnostics (Basel) 2023; 13. [PMID: 36766658 DOI: 10.3390/diagnostics13030553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics.
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Schulz A, Schuster A. Visualizing diastolic failure: Non-invasive imaging-biomarkers in patients with heart failure with preserved ejection fraction. EBioMedicine 2022; 86:104369. [PMID: 36423377 PMCID: PMC9691917 DOI: 10.1016/j.ebiom.2022.104369] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction is an increasing challenge for modern day medicine and has been drawing more attention recently. Invasive right heart catheterization represents the mainstay for the diagnosis of diastolic dysfunction, however due to its attributable risk of an invasive procedure, other non-invasive clinical pathways are trying to approach this pathology in clinical practice. Diastolic failure is complex, and imaging is based on various parameters. In addition to transthoracic echocardiography, numerous novel imaging approaches, such as cardiac magnetic resonance imaging, computed tomography, positron emission (computed) tomography or single photon emission tomography techniques are being used to supplement deeper insights into causal pathology and might open targets for dedicated therapy options. This article provides insights into these sophisticated imaging techniques, their incremental value for the diagnosis of this poorly understood disease and recent promising results for an enhanced prognostication of outcome and therapy monitoring.
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Affiliation(s)
| | - Andreas Schuster
- Corresponding author. Department for Cardiology and Pneumology, University Medical Center, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
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Lai W, Chen-Xu Z, Jian-Xun D, Jie H, Ling-Cong K, Dong-Ao-Lei A, Bing-Hua C, Song D, Zheng L, Fan Y, Hu-Wen W, Jian-Rong X, Heng G, Jun P. Prognostic implications of left ventricular torsion measured by feature-tracking cardiac magnetic resonance in patients with ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2022; 24:785-795. [PMID: 36056877 DOI: 10.1093/ehjci/jeac177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/20/2022] [Accepted: 08/13/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The prognostic implication of left ventricular (LV) torsion on ST-elevation myocardial infarction (STEMI) is unclear. METHODS AND RESULTS We analysed cardiovascular magnetic resonance (CMR) findings of 420 patients from a registry study (NCT03768453). These patients received CMR examination within 1 week after timely primary percutaneous coronary intervention. LV torsion and other CMR indexes were measured. Compared with healthy control subjects, STEMI significantly decreased patients' LV torsion (1.04 vs. 1.63°/cm, P < 0.001). During follow-up (median, 52 months), the reduction of LV torsion was greater in patients with than without composite major adverse cardiac and cerebrovascular events (MACCEs, 0.79 vs. 1.08°/cm, P < 0.001). The risk of MACCEs would increase to 1.125- or 1.092-fold, and the risk of 1-year LV remodelling would increase to 1.110- or 1.082-fold for every 0.1°/cm reduction in LV torsion after adjustment for clinical or CMR parameters respectively. When divided dichotomously, patients with LV torsion≤ 0.802°/cm had significantly higher risk of MACCEs (40.2 vs. 12.3%, P < 0.001) and more remarkable LV remodelling (46.1 vs. 11.9%, P < 0.001) than patients with better LV torsion. The addition of LV torsion to conventional prognostic factors such as the LV ejection fraction and infarction size led to a better risk classification model of patients for both MACCEs and LV remodelling. Finally, tobacco use, worse post-PCI flow, and greater microvascular obstruction size were presumptive risk factors for reduced LV torsion. CONCLUSION LV torsion measured by CMR is closely associated with the prognosis of STEMI and would be a promising indicator to improve patients' risk stratification. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT03768453.
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Affiliation(s)
- Wei Lai
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Zhao Chen-Xu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Dong Jian-Xun
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - He Jie
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Kong Ling-Cong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - An Dong-Ao-Lei
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Chen Bing-Hua
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Ding Song
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Li Zheng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Yang Fan
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Wang Hu-Wen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing Street, Sha Tin, Hong Kong Special Administrative Region 999077, China
| | - Xu Jian-Rong
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Ge Heng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
| | - Pu Jun
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New Area, Shanghai 200127, China
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Lau C, Elshibly MMM, Kanagala P, Khoo JP, Arnold JR, Hothi SS. The role of cardiac magnetic resonance imaging in the assessment of heart failure with preserved ejection fraction. Front Cardiovasc Med 2022; 9:922398. [PMID: 35924215 PMCID: PMC9339656 DOI: 10.3389/fcvm.2022.922398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) is a major cause of morbidity and mortality worldwide. Current classifications of HF categorize patients with a left ventricular ejection fraction of 50% or greater as HF with preserved ejection fraction or HFpEF. Echocardiography is the first line imaging modality in assessing diastolic function given its practicality, low cost and the utilization of Doppler imaging. However, the last decade has seen cardiac magnetic resonance (CMR) emerge as a valuable test for the sometimes challenging diagnosis of HFpEF. The unique ability of CMR for myocardial tissue characterization coupled with high resolution imaging provides additional information to echocardiography that may help in phenotyping HFpEF and provide prognostication for patients with HF. The precision and accuracy of CMR underlies its use in clinical trials for the assessment of novel and repurposed drugs in HFpEF. Importantly, CMR has powerful diagnostic utility in differentiating acquired and inherited heart muscle diseases presenting as HFpEF such as Fabry disease and amyloidosis with specific treatment options to reverse or halt disease progression. This state of the art review will outline established CMR techniques such as transmitral velocities and strain imaging of the left ventricle and left atrium in assessing diastolic function and their clinical application to HFpEF. Furthermore, it will include a discussion on novel methods and future developments such as stress CMR and MR spectroscopy to assess myocardial energetics, which show promise in unraveling the mechanisms behind HFpEF that may provide targets for much needed therapeutic interventions.
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Affiliation(s)
- Clement Lau
- Department of Cardiology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Mohamed M. M. Elshibly
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Prathap Kanagala
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust and Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Jeffrey P. Khoo
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jayanth Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Sandeep Singh Hothi
- Department of Cardiology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Kawakubo M, Nagao M, Yamamoto A, Nakao R, Matsuo Y, Kaneko K, Watanabe E, Sakai A, Sasaki M, Sakai S. 13 N-ammonia PET-derived right ventricular longitudinal strain and myocardial flow reserve in right coronary artery disease. Eur J Nucl Med Mol Imaging 2021; 49:1870-1880. [PMID: 34897553 DOI: 10.1007/s00259-021-05647-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We developed a feature-tracking algorithm for use with electrocardiography-gated high-resolution 13 N-ammonia positron emission tomography (PET) imaging, and we hypothesized it could be used to clarify the association between right ventricular (RV) longitudinal strain (LS) and right coronary artery (RCA) ischemia. The aim of this study was to investigate the association between the reduction of regional myocardial flow reserve (MFR) in RCA territories and PET-derived LS of the RV free wall. METHODS Ninety-three patients with coronary artery stenosis > 50%, diagnosed by coronary computed tomography angiography, and 10 controls were retrospectively analyzed. RV-LS in the free wall was measured by a feature-tracking technique on the resting and stressed 13 N-ammonia PET images of horizontal long axis slices. The patients were sub-grouped according to regional MFR values at the territories of RCA, left anterior descending artery (LAD), and left circumflex coronary artery (LCx): RCA-MFR < 2.0 [n = 34], RCA-MFR ≥ 2.0 but MFR < 2.0 at LAD or LCx territories [n = 11], and MFR ≥ 2.0 for all territories [n = 48]. Stress and resting RV-LS were compared in each of the four groups. Multiple comparisons of RV-LS among the four groups were performed in the stress and resting state. RESULTS Decreased stress RV-LS in patients with an RCA-MFR < 2.0 was observed. In the patients with MFR ≥ 2.0 for all territories, the stressed RV-LS was significantly increased compared to that in the resting state. Significantly decreased RV free wall LS during adenosine stress in patients with RCA-MFR < 2.0 was observed in the other three groups. CONCLUSIONS We measured RV myocardial LS using feature tracking in cine imaging of 13 N-ammonia PET. The results of this study suggest that PET-derived stressed RV-LS is useful for detecting reduced RV myocardial motion due to ischemia in the RCA territory.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Kaneko
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Eri Watanabe
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Ibrahim ESH, Dennison J, Frank L, Stojanovska J. Diastolic Cardiac Function by MRI-Imaging Capabilities and Clinical Applications. Tomography 2021; 7:893-914. [PMID: 34941647 PMCID: PMC8706325 DOI: 10.3390/tomography7040075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 02/05/2023] Open
Abstract
Most cardiac studies focus on evaluating left ventricular (LV) systolic function. However, the assessment of diastolic cardiac function is becoming more appreciated, especially with the increasing prevalence of pathologies associated with diastolic dysfunction like heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction is an indication of abnormal mechanical properties of the myocardium, characterized by slow or delayed myocardial relaxation, abnormal LV distensibility, and/or impaired LV filling. Diastolic dysfunction has been shown to be associated with age and other cardiovascular risk factors such as hypertension and diabetes mellitus. In this context, cardiac magnetic resonance imaging (MRI) has the capability for differentiating between normal and abnormal myocardial relaxation patterns, and therefore offers the prospect of early detection of diastolic dysfunction. Although diastolic cardiac function can be assessed from the ratio between early and atrial filling peaks (E/A ratio), measuring different parameters of heart contractility during diastole allows for evaluating spatial and temporal patterns of cardiac function with the potential for illustrating subtle changes related to age, gender, or other differences among different patient populations. In this article, we review different MRI techniques for evaluating diastolic function along with clinical applications and findings in different heart diseases.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Correspondence:
| | - Jennifer Dennison
- Department of Medicine, Medical College of Wisconsin, Wausau, WI 54401, USA;
| | - Luba Frank
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
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Ochs A, Riffel J, Ochs MM, Arenja N, Fritz T, Galuschky C, Schuster A, Bruder O, Mahrholdt H, Giannitsis E, Frey N, Katus HA, Buss SJ, André F. Myocardial mechanics in dilated cardiomyopathy: prognostic value of left ventricular torsion and strain. J Cardiovasc Magn Reson 2021; 23:136. [PMID: 34852822 PMCID: PMC8638178 DOI: 10.1186/s12968-021-00829-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT). METHODS CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome. RESULTS GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p < 0.001). The primary endpoint occurred in 59 (18.7%) patients [median follow-up 4.2 (2.0-5.6) years]. In the univariate analyses all strain parameters showed a significant prognostic value (p < 0.05). In the multivariate model, LV strain parameters, particularly GLS provided an incremental prognostic value compared to established CMR parameters like LV ejection fraction and late gadolinium enhancement. A scoring model including six categorical variables of standard CMR and strain parameters differentiated further risk subgroups. CONCLUSION LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.
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Affiliation(s)
- Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Marco M. Ochs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Nisha Arenja
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Department of Cardiology, Solothurner Spitäler AG, Kantonsspital Olten, Olten, Switzerland
| | - Thomas Fritz
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | | | | | | | | | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
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11
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Abstract
Purpose of Review Cardiac magnetic resonance-feature-tracking (CMR-FT)-based deformation analyses are key tools of cardiovascular imaging and applications in heart failure (HF) diagnostics are expanding. In this review, we outline the current range of application with diagnostic and prognostic implications and provide perspectives on future trends of this technique. Recent Findings By applying CMR-FT in different cardiovascular diseases, increasing evidence proves CMR-FT-derived parameters as powerful diagnostic and prognostic imaging biomarkers within the HF continuum partly outperforming traditional clinical values like left ventricular ejection fraction. Importantly, HF diagnostics and deformation analyses by CMR-FT are feasible far beyond sole left ventricular performance evaluation underlining the holistic nature and accuracy of this imaging approach. Summary As an established and continuously evolving technique with strong prognostic implications, CMR-FT deformation analyses enable comprehensive cardiac performance quantification of all cardiac chambers.
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12
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Kihlberg J, Gupta V, Haraldsson H, Sigfridsson A, Sarvari SI, Ebbers T, Engvall JE. Clinical validation of three cardiovascular magnetic resonance techniques to measure strain and torsion in patients with suspected coronary artery disease. J Cardiovasc Magn Reson 2020; 22:83. [PMID: 33280612 PMCID: PMC7720468 DOI: 10.1186/s12968-020-00684-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several cardiovascular magnetic resonance (CMR) techniques can measure myocardial strain and torsion with high accuracy. The purpose of this study was to compare displacement encoding with stimulated echoes (DENSE), tagging and feature tracking (FT) for measuring circumferential and radial myocardial strain and myocardial torsion in order to assess myocardial function and infarct scar burden both at a global and at a segmental level. METHOD 116 patients with a high likelihood of coronary artery disease (European SCORE > 15%) underwent CMR examination including cine images, tagging, DENSE and late gadolinium enhancement (LGE) in the short axis direction. In total, 97 patients had signs of myocardial disease and 19 had no abnormalities in terms of left ventricular (LV) wall mass index, LV ejection fraction, wall motion, LGE or a history of myocardial infarction. Thirty-four patients had myocardial infarct scar with a transmural LGE extent (transmurality) that exceeded 50% of the wall thickness in at least one segment. Global circumferential strain (GCS) and global radial strain (GRS) was analyzed using FT of cine loops, deformation of tag lines or DENSE displacement. RESULTS DENSE and tagging both showed high sensitivity (82% and 71%) at a specificity of 80% for the detection of segments with > 50% LGE transmurality, and receiver operating characteristics (ROC) analysis showed significantly higher area under the curve-values (AUC) for DENSE (0.87) than for tagging (0.83, p < 0.001) and FT (0.66, p = 0.003). GCS correlated with global LGE when determined with DENSE (r = 0.41), tagging (r = 0.37) and FT (r = 0.15). GRS had a low but significant negative correlation with LGE; DENSE r = - 0.10, FT r = - 0.07 and tagging r = - 0.16. Torsion from DENSE and tagging had a weak correlation (- 0.20 and - 0.22 respectively) with global LGE. CONCLUSION Circumferential strain from DENSE detected segments with > 50% scar with a higher AUC than strain determined from tagging and FT at a segmental level. GCS and torsion computed from DENSE and tagging showed similar correlation with global scar size, while when computed from FT, the correlation was lower.
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Affiliation(s)
- Johan Kihlberg
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Vikas Gupta
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Haraldsson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Andreas Sigfridsson
- Department of Clinical Physiology & Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Sebastian I Sarvari
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0316, Oslo, Norway
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan E Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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13
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Zhang Y, Li SY, Xie JJ, Wu Y. Twist/untwist parameters are promising evaluators of myocardial mechanic changes in heart failure patients with preserved ejection fraction. Clin Cardiol 2020; 43:587-593. [PMID: 32212277 PMCID: PMC7298990 DOI: 10.1002/clc.23353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/20/2019] [Accepted: 02/19/2020] [Indexed: 12/01/2022] Open
Abstract
Background This study aimed to evaluate the twist/untwist parameters of the left ventricle (LV) in patients with heart failure with preserved ejection fraction (HFpEF) measured by ultrasonic two‐dimensional speckle tracking echocardiography (STE) and to examine the correlations between twist parameters and serum N‐terminal pro b‐type natriuretic peptide (NT‐proBNP) as well as conventional two‐dimensional echocardiography (2DE) indexes. Hypothesis Changes in twist/untwist parameters can be used to evaluate LV function in HFpEF patients. Methods In 63 HFpEF patients and 40 healthy controls, we analyzed LV twist/untwist parameters by STE, cardiac function by 2DE, and serum NT‐proBNP by enzyme‐linked immunosorbent assay (ELISA). The correlations between twist/untwist parameters and 2DE parameters and serum NT‐proBNP were examined by Pearson correlation analysis. Results Left ventricular end diastolic inner diameter and ejection fraction in HFpEF patients were within the normal range, whereas other 2DE parameters including left ventricular posterior wall end diastolic thickness, interventricular septal thickness, left atrial volume index, E, E/A, and E/e' differed significantly between HFpEF patients and control subjects. The twist/untwist parameters such as peak apical rotation (Par), peak untwisting velocity (PUWV), and isovolumic diastole untwisting percentage (Iutw%) were significantly decreased in HFpEF patients compared with control participants. Positive correlations between PUWV/Iutw% and E/A/E/e' and a significant negative correlation between PUWV/Iutw% and left atrial volume index (LAVI) were observed. The plasma NT‐proBNP concentration was positively correlated with LAVI, but negatively correlated with PUWV and Iutw%. Conclusions Changes in twist/untwist parameters correlate well with conventional 2DE parameters and plasma levels of NT‐proBNP, and can be used to evaluate LV function in HFpEF patients. Par is sensitive to the LV myocardial function damage.
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Affiliation(s)
- Yi Zhang
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Shen-Yi Li
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Juan-Juan Xie
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
| | - Yuan Wu
- Department of Ultrasonography, People's Hospital of Hunan Province, Changsha, China
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14
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Dreisbach JG, Mathur S, Houbois CP, Oechslin E, Ross H, Hanneman K, Wintersperger BJ. Cardiovascular magnetic resonance based diagnosis of left ventricular non-compaction cardiomyopathy: impact of cine bSSFP strain analysis. J Cardiovasc Magn Reson 2020; 22:9. [PMID: 31996239 PMCID: PMC6990516 DOI: 10.1186/s12968-020-0599-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Investigation of the myocardial strain characteristics of the left ventricular non-compaction (LVNC) phenotype with cardiovascular magnetic resonance (CMR) feature tracking. METHODS CMR cine balanced steady-state free precession data sets of 59 retrospectively identified LVNC phenotype patients (40 years, IQR: 28-50 years; 51% male) and 36 healthy subjects (39 years, IQR: 30-47 years; 44% male) were evaluated for LV volumes, systolic function and mass. Hypertrabeculation in patients and healthy subjects was evaluated against established CMR diagnostic criteria. Global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS) were evaluated with feature-tracking software. Subgroup analyses were performed in patients (n = 25) and healthy subjects (n = 34) with normal LV volumetrics, and with healthy subjects (n = 18) meeting at least one LVNC diagnostic criteria. RESULTS All LVNC phenotype patients, as well as a significant proportion of healthy subjects, met morphology-based CMR diagnostic criteria: non-compacted (NC): compacted myocardial diameter ratio > 2.3 (100% vs. 19.4%), NC mass > 20% (100% vs. 44.4%) and > 25% (100% vs. 13.9%), and NC mass indexed to body surface area > 15 g/m2 (100% vs. 41.7%). LVNC phenotype patients demonstrated reduced GRS (26.4% vs. 37.1%; p < 0.001), GCS (- 16.5% vs. -20.5%; p < 0.001) and GLS (- 14.6% vs. -17.1%; p < 0.001) compared to healthy subjects, with statistically significant differences persisting on subgroup comparisons of LVNC phenotype patients with healthy subjects meeting diagnostic criteria. GCS also demonstrated independent and incremental diagnostic value beyond each of the morphology-based CMR diagnostic criteria. CONCLUSIONS LVNC phenotype patients demonstrate impaired strain by CMR feature tracking, also present on comparison of subjects with normal LV volumetrics meeting diagnostic criteria. The high proportion of healthy subjects meeting morphology-based CMR diagnostic criteria emphasizes the important potential complementary diagnostic value of strain in differentiating LVNC from physiologic hypertrabeculation.
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Affiliation(s)
- John G. Dreisbach
- Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, Toronto, M5G 2N5 Ontario Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Shobhit Mathur
- Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, Toronto, M5G 2N5 Ontario Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Christian P. Houbois
- Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, Toronto, M5G 2N5 Ontario Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Erwin Oechslin
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Heather Ross
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Kate Hanneman
- Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, Toronto, M5G 2N5 Ontario Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
| | - Bernd J. Wintersperger
- Department of Medical Imaging, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, 585 University Avenue, Toronto, M5G 2N5 Ontario Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario Canada
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15
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Sardana M, Konda P, Hashmath Z, Oldland G, Gaddam S, Miller R, Satija V, Ansari B, Lee J, Mustafa A, Akers SR, Chirinos JA. Usefulness of Left Ventricular Strain by Cardiac Magnetic Resonance Feature-Tracking to Predict Cardiovascular Events in Patients With and Without Heart Failure. Am J Cardiol 2019; 123:1301-8. [PMID: 30717885 DOI: 10.1016/j.amjcard.2019.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 01/09/2023]
Abstract
There is controversy regarding the utility of left ventricular (LV) mechanics assessed by feature-tracking steady-state free-precession (FT-SSFP), a readily implementable technique in clinical practice. In particular, whether LV mechanics assessed by FT-SSFP predicts outcomes in subjects with heart failure (HF) with reduced ejection fraction (HFrEF), with preserved ejection fraction (HFpEF), or without HF is unknown. We aimed to assess whether LV mechanics measured with FT-SSFP cine magnetic resonance imaging (MRI) predicts adverse outcomes. We prospectively enrolled 612 adults without HF (n = 402), with HF with reduced ejection fraction (HFrEF; n = 113), or HFpEF (n = 97) and assessed LV strain using FT-SSFP cine MRI. Over a median follow-up of 39.5 months, 75 participants had an HF admission, and 85 died. In Cox proportional hazards models, lower global longitudinal (Standardized hazard ratio 1.56, 95% confidence interval [CI] 1.22 to 2.00, p = 0.0004), circumferential (Standardized HR 1.46, 95% CI 1.08 to 1.95, p = 0.0123), and radial strain (Standardized HR 0.59, 95% CI 0.43 to 0.83, p = 0.0019) were independently associated with the composite endpoint, after adjustment for HF status, LV ejection fraction (LVEF), age, sex, ethnicity, body mass index, systolic and diastolic blood pressure, hypertension, diabetes, coronary artery disease, and glomerular filtration rate. Furthermore, global longitudinal strain stratified the risk of adverse outcomes across tertiles better than LVEF. In analyses that included only participants with a preserved LVEF, systolic radial, circumferential and longitudinal strain were independently predictive of adverse outcomes. We conclude that LV longitudinal, circumferential and radial strain measured using FT-SSFP cine MRI (a readily implementable technique in clinical practice) predict the risk of adverse events, independently of LVEF.
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16
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Burkhardt BEU, Kellenberger CJ, Franzoso FD, Geiger J, Oxenius A, Valsangiacomo Buechel ER. Right and Left Ventricular Strain Patterns After the Atrial Switch Operation for D-Transposition of the Great Arteries-A Magnetic Resonance Feature Tracking Study. Front Cardiovasc Med 2019; 6:39. [PMID: 31024933 PMCID: PMC6465947 DOI: 10.3389/fcvm.2019.00039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/21/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Adult survivors of the atrial switch operation for transposition of the great arteries present with a systemic morphologic right ventricle and a subpulmonary morphologic left ventricle. This physiology can be considered a model for the effects of long-term right ventricular pressure overload and of decreased left ventricular afterload. We aimed to determine the impact of these chronically altered loading conditions on myocardial deformation of the ventricles. Materials and methods: Two-dimensional steady state free precession cine images of 29 patients after atrial repair (age 29 ± 7 years) and 19 controls (24 ± 10 years; n.s.) were post-processed with feature tracking software (TomTec 2D CPA). Volumes, ejection fractions, global and free wall longitudinal and circumferential strains of both ventricles were compared between both groups. Results: Systemic right ventricular global longitudinal strain was decreased in patients compared to controls (−12.9 ± 3.3% vs. −18.9 ± 4.6%, p < 0.001), while right ventricular circumferential strain was unchanged (−15.8 ± 3.4% vs. −15.1 ± 5%; n.s.). Left ventricular longitudinal strain was similar in both groups (−17 ± 5.6% vs. −17.5 ± 4.6%; n.s.), but global left ventricular circumferential strain was lower in patients (−20.7 ± 4.1% vs. −27.3 ± 4.5%, p < 0.001). The systemic right ventricle, compared to the systemic left ventricle, showed decreased global longitudinal (p < 0.001) and circumferential strain (p < 0.001). The subpulmonary left ventricle, compared to the subpulmonary right ventricle, demonstrated similar longitudinal (p = 0.223) but higher circumferential strain (p < 0.001). Conclusions: In patients after atrial switch repair for transposition of the great arteries, the systemic right ventricle shows poor longitudinal strain, but maintains normal right ventricular circumferential strain. The left ventricle shows higher circumferential strain than the right ventricle, in both systemic and subpulmonary positions.
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Affiliation(s)
- Barbara Elisabeth Ursula Burkhardt
- Department of Surgery, Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christian Johannes Kellenberger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Francesca Daniela Franzoso
- Department of Surgery, Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Julia Geiger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland
| | - Angela Oxenius
- Department of Surgery, Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Emanuela Regina Valsangiacomo Buechel
- Department of Surgery, Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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17
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Kheyfets V, Truong U, Ivy D, Shandas R. Structural and Biomechanical Adaptations of Right Ventricular Remodeling - in Pulmonary Arterial Hypertension - Reduces Left Ventricular Rotation During Contraction: A Computational Study. J Biomech Eng 2019; 141:2724083. [PMID: 30714069 DOI: 10.1115/1.4042682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 11/08/2022]
Abstract
Pulmonary hypertension (PH) is a degenerative disease characterized by progressively increased right ventricular (RV) afterload that leads to ultimate functional decline [1]. Recent observational studies have documented a decrease in left ventricular (LV) torsion during ejection, with preserved LV ejection fraction (EF) in pediatric and adult PH patients [2-4]. The objective of this study was to develop a computational model of the bi-ventricular heart and use it to evaluate changes in LV torsion mechanics in response to mechanical, structural, and hemodynamic changes in the RV free-wall. The heart model revealed that LV apex rotation and torsion were decreased when increasing RV mechanical rigidity and during re-orientation of RV myocardial fibers. Furthermore, structural changes to the RV appear to have a notable impact on RV EF, but little influence on LV EF. Finally, RV pressure overload exponentially increased LV myocardial stress. The computational results found in this study are consistent with clinical observations in adult and pediatric PH patients, which reveal a decrease in LV torsion with preserved LV EF [3, 4]. Furthermore, discovered causes of decreased LV torsion are consistent with RV structural adaptations seen in PH rodent studies [5], which might also explain suspected stress-induced changes in LV myocardial gene/protein expression.
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Affiliation(s)
- Vitaly Kheyfets
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado
| | - Uyen Truong
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado
| | - Dunbar Ivy
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado
| | - Robin Shandas
- University of Colorado Anschutz Medical Campus, Children's Hospital Colorado
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18
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Lamata P, Uhlig J, Kowallick JT, Raaz U, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Temporal changes within mechanical dyssynchrony and rotational mechanics in Takotsubo syndrome: A cardiovascular magnetic resonance imaging study. Int J Cardiol 2018; 273:256-262. [PMID: 30195843 PMCID: PMC6236127 DOI: 10.1016/j.ijcard.2018.04.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. METHODS This multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed. RESULTS CURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074). CONCLUSION Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Uwe Raaz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Joachim Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany; Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia.
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19
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Zhang X, Liu ZQ, Singh D, Powell DK, Chung CS, Campbell KS, Wenk JF. Differential Effects of Isoproterenol on Regional Myocardial Mechanics in Rat using 3D cine DENSE Cardiovascular Magnetic Resonance. J Biomech Eng 2018; 141:2696750. [PMID: 30098173 DOI: 10.1115/1.4041042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/03/2023]
Abstract
The present study assessed the acute effects of isoproterenol on left ventricular (LV) mechanics in healthy rats with the hypothesis that ß-adrenergic stimulation influences the mechanics of different myocardial regions of the LV wall in different ways. To accomplish this, magnetic resonance images were obtained in the LV of healthy rats with or without isoproterenol infusion. The LV contours were divided into basal, mid-ventricular, and apical regions. Additionally, the mid-ventricular myocardium was divided into three transmural layers with each layer partitioned into four segments (i.e., septal, inferior, lateral, and anterior). Peak systolic strains and torsion were quantified for each region. Isoproterenol significantly increased peak systolic radial strain and circumferential-longitudinal shear strain, as well as ventricular torsion, throughout the basal, mid-ventricle, and apical regions. In the mid-ventricle, isoproterenol significantly increased peak systolic radial strain, and induced significant increases in peak systolic circumferential strain and longitudinal strain in the septum. Isoproterenol consistently increased peak systolic circumferential-longitudinal shear strain in all mid-ventricular segments. Ventricular torsion was significantly increased in nearly all segments except the inferior sub-endocardium. The effects of isoproterenol on LV systolic mechanics (i.e., 3D strains and torsion) in healthy rats depend on the region. This region-dependency is also strain component-specific. These results provide insight into the regional response of LV mechanics to ß-adrenergic stimulation in rats, and could act as a baseline for future studies on subclinical abnormalities associated with the inotropic response in heart disease.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
| | - Zhan-Qiu Liu
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
| | - Dara Singh
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Department of Anatomy and Neurobiology, University of Kentucky, Lexington, KY, USA
| | - Charles S Chung
- Department of Physiology, Wayne State University, Detroit, MI, USA; Department of Physiology, University of Kentucky, Lexington, KY, USA
| | | | - Jonathan F Wenk
- Department of Surgery, University of Kentucky, Lexington, KY, USA
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20
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Abstract
BACKGROUND Hypertension is common in patients with coarctation of the aorta (CoA), even after successful repair. Increased aortic stiffness has been implicated in the pathology of CoA-associated hypertension. This study aimed to investigate aortic vascular function and its relationship with hypertension in well-repaired CoA-patients at long-term follow-up. Furthermore, we assessed the additive effect of hypertension to adverse arterioventricular coupling associated with increased aortic stiffness. METHODS Twenty-two CoA-patients (age 30 ± 10.6 years) with successful surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) between 3 months and 16 years of age with a follow-up of >10 years and 22 healthy controls underwent cardiac magnetic resonance imaging (CMR), at mean follow-up of 29.3 years, to study aortic pulse wave velocity (PWV), aortic distensibility, global left ventricular (LV) function, LV dimensions, and LV myocardial deformation. RESULTS CoA-patients had significantly increased aortic arch PWV (5.6 ± 1.9 m/s vs. 4.5 ± 1.0 m/s, P = .02) and decreased distensibility (4.5 ± 1.8 × 10-3 mmHg-1 vs. 5.8 ± 1.8 × 10-3 mmHg-1, P = .04) compared to controls. Significant differences in aortic arch PWV were found between hypertensive patients, normotensive patients and controls (6.1 ± 1.8 m/s vs. 4.9 ± 1.9 m/s and 4.5 ± 1.0 m/s, respectively, P = .03). Aortic arch PWV and distensibility were correlated with systolic blood pressure (R = 0.37 and R = -0.37, respectively, P = .03 for both). Global LV function, LV mass, LV dimensions and myocardial deformation were similar in CoA-patients when compared to controls. CONCLUSIONS Central aortic stiffness is significantly increased in well-repaired CoA-patients long-term after repair, and is associated with hypertension. Global LV function, myocardial deformation indices and LV dimensions are however preserved.
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Affiliation(s)
- Elles J Dijkema
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, The University of Utrecht, Utrecht, The Netherlands.
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21
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Gertz RJ, Lange T, Kowallick JT, Backhaus SJ, Steinmetz M, Staab W, Kutty S, Hasenfuß G, Lotz J, Schuster A. Inter-vendor reproducibility of left and right ventricular cardiovascular magnetic resonance myocardial feature-tracking. PLoS One 2018. [PMID: 29538467 PMCID: PMC5851552 DOI: 10.1371/journal.pone.0193746] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Since cardiovascular magnetic resonance feature-tracking (CMR-FT) has been demonstrated to be of incremental clinical merit we investigated the interchangeability of global left and right ventricular strain parameters between different CMR-FT software solutions. MATERIAL AND METHODS CMR-cine images of 10 patients without significant reduction in LVEF and RVEF and 10 patients with a significantly impaired systolic function were analyzed using two different types of FT-software (TomTec, Germany; QStrain, Netherlands). Global longitudinal strains (LV GLS, RV GLS), global left ventricular circumferential (GCS) and radial strains (GRS) were assessed. Differences in intra- and inter-observer variability within and between software types based on single and up to three repeated and subsequently averaged measurements were evaluated. RESULTS Inter-vendor agreement was highest for GCS followed by LV GLS. GRS and RV GLS showed lower inter-vendor agreement. Variability was consistently higher in healthy volunteers as compared to the patient group. Intra-vendor reproducibility was excellent for GCS, LV GLS and RV GLS, but lower for GRS. The impact of repeated measurements was most pronounced for GRS and RV GLS on an intra-vendor level. CONCLUSION Cardiac pathology has no influence on CMR-FT reproducibility. LV GLS and GCS qualify as the most robust parameters within and between individual software types. Since both parameters can be interchangeably assessed with different software solutions they may enter the clinical arena for optimized diagnostic and prognostic evaluation of cardiovascular morbidity and mortality in various pathologies.
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Affiliation(s)
- Roman Johannes Gertz
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Johannes Tammo Kowallick
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Sören Jan Backhaus
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Wieland Staab
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, United States of America
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
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22
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Dijkema EJ, Slieker MG, Breur JMPJ, Leiner T, Grotenhuis HB. Preserved Myocardial Deformation after Successful Coarctation Repair: A CMR Feature-Tracking Study. Pediatr Cardiol 2018; 39:555-64. [PMID: 29209744 DOI: 10.1007/s00246-017-1788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
Arterial vasculopathy and residual aortic obstruction can lead to left ventricular (LV) dysfunction in patients with coarctation of the aorta (CoA) related to adverse ventriculo-arterial coupling. This study aimed to investigate potential differences in LV myocardial deformation indices between repaired CoA patients and healthy controls. Twenty-two CoA patients (age 30 ± 10.6 years) after surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) without residual stenosis, between 3 months and 16 years of age with > 10 years follow-up were compared to 22 healthy age- and gender-matched controls (age 30 ± 3.8 years). Cardiac magnetic resonance feature tracking (CMR-FT) was used for LV longitudinal-, circumferential-, and rotational deformation indices. Global systolic LV function was preserved in CoA patients (LV ejection fraction 58 ± 4.8 vs. 60 ± 6.8%, p = 0.56) when compared to controls, with normal LV dimensions and mass (p > 0.05). Twelve CoA patients (55%) were hypertensive, of whom 4 were on anti-hypertensive medication. LV global longitudinal strain was preserved in the four-chamber (- 18 ± 4.4 vs. - 16 ± 4.7%, p = 0.06) and two-chamber (- 22 ± 5.1 vs. - 20 ± 6.0%, p = 0.22) orientations in CoA patients. Global circumferential strain was preserved at basal (- 29 ± 4.1 vs. - 28 ± 4.8%, p = 0.43), mid-ventricular (- 27 ± 4.2 vs. - 25 ± 3.0%, p = 0.09), and apical levels (- 35 ± 7.8 vs. - 32 ± 34.9%, p = 0.32). No differences were found in global torsion (2.4 ± 1.3° vs. 2.0 ± 1.4°/cm, p = 0.28), twist (14 ± 5.8° vs. 12 ± 6.3°, p = 0.34), and recoil rate (- 17 ± 9.7° vs. - 17 ± 7.1°/cm s, p = 0.97). Analysis of intra-observer variability demonstrated good reproducibility for all CMR deformation indices. Global and rotational myocardial deformation indices are preserved in CoA patients long-term after repair without residual stenosis, despite a high incidence of hypertension.
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23
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Steinmetz M, Usenbenz S, Kowallick JT, Hösch O, Staab W, Lange T, Kutty S, Lotz J, Hasenfuß G, Paul T, Schuster A. Left ventricular synchrony, torsion, and recoil mechanics in Ebstein's anomaly: insights from cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:101. [PMID: 29237468 PMCID: PMC5729283 DOI: 10.1186/s12968-017-0414-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/23/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disease progression and heart failure development in Ebstein's Anomaly (EA) of the tricuspid valve is characterized by both right and left ventricular (LV) deterioration. The mechanisms underlying LV dysfunction and their role in heart failure development are incompletely understood. We hypothesized that LV dyssynchrony and impaired torsion and recoil mechanics induced by paradoxical movement of the basal septum may play a role in heart failure development. METHODS 31 EA patients and 31 matched controls underwent prospective cardiovascular magnetic resonance (CMR). CMR feature tracking (CMR-FT) was performed on apical, midventricular and basal short-axis and 4D-volume analysis was performed using three long-axis views and a short axis cine stack employing dedicated software. Circumferential uniformity ratio estimates (CURE) time-to-peak-based circumferential systolic dyssynchrony index (C-SDI), 4D volume analysis derived SDI (4D-SDI), torsion (Tor) and systolic (sysTR) and diastolic torsion rate (diasTR) were calculated for the LV. QRS duration, brain natriuretic peptide, NYHA and Total R/L-Volume Index (R/L Index) were obtained. RESULTS EA patients (31.5 years; controls 31.4 years) had significantly longer QRS duration (123.35 ms ± 26.36 vs. 97.33 ms ± 11.89 p < 0.01) and showed more LV dyssynchrony (4D-SDI 7.60% ± 4.58 vs. 2.54% ± 0.62, p < 0.001; CURE 0.77 ± 0.05 vs. 0.86 ± 0.03, p < 0.001; C-SDI 7.70 ± 3.38 vs. 3.80 ± 0.91, p = 0.001). There were significant associations of LV dyssynchrony with heart failure parameters and QRS duration. Although torsion and recoil mechanics did not differ significantly (p > 0.05) there was an association of torsion and recoil mechanics with dyssynchrony parameters CURE (sysTR r = -0.426; p = 0.017, diasTR r = 0.419; p = 0.019), 4D-SDI (sysTR r = 0.383; p = 0.044) and C-SDI (diasTR r = -0.364; p = 0.044). CONCLUSIONS EA is characterized by LV intra-ventricular dyssynchrony, which is associated with heart failure and disease severity parameters. Markers of dyssynchrony can easily be quantified from CMR-FT, and may have a role in the assessment of altered cardiac function, carrying potential management implications for EA patients.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Simon Usenbenz
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Johannes Tammo Kowallick
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Olga Hösch
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
| | - Wieland Staab
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- University of Nebraska Medical Center/ Children’s Hospital and Medical Center, Omaha, NE USA
| | - Joachim Lotz
- Institute for Diagostic and Interventional Radiology, Georg-August-University Göttingen, University Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, University Medical Center, Robert-Koch-Str. 40, D-37099 Götttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
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24
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Li L, Craft M, Hsu HH, Zhang M, Klas B, Danford DA, Kutty S. Left Ventricular Rotational and Twist Mechanics in the Human Fetal Heart. J Am Soc Echocardiogr 2017; 30:773-780.e1. [DOI: 10.1016/j.echo.2017.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 10/19/2022]
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25
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Wandelt LK, Kowallick JT, Schuster A, Wachter R, Stümpfig T, Unterberg-Buchwald C, Steinmetz M, Ritter CO, Lotz J, Staab W. Quantification of left atrial volume and phasic function using cardiovascular magnetic resonance imaging-comparison of biplane area-length method and Simpson's method. Int J Cardiovasc Imaging 2017; 33:1761-1769. [PMID: 28523471 DOI: 10.1007/s10554-017-1160-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/06/2017] [Indexed: 11/26/2022]
Abstract
Left atrial (LA) enlargement and dysfunction are markers of chronic diastolic dysfunction and an important predictor of adverse cardiovascular and cerebrovascular outcomes. Accordingly, accurate quantification of left atrial volume (LAV) and function is needed. In routine clinical cardiovascular magnetic resonance (CMR) imaging the biplane area-length method (Bi-ALM) is frequently applied due to time-saving image acquisition and analysis. However, given the varying anatomy of the LA we hypothesized that the diagnostic accuracy of the Bi-ALM is not sufficient and that results would be different from a precise volumetric assessment of transversal multi-slice cine images using Simpson's method. Thirty one patients of the FIND-AFRANDOMISED-study with status post acute cerebral ischemia (mean age 70.5 ± 6.2 years) received CMR imaging at 3T. The study protocol included cine SSFP sequences in standard 2- and 4 CV and a stack of contiguous slices in transversal orientation. Total, passive and active LA emptying fractions were calculated from LA maximal volume, minimal volume and volume prior to atrial contraction. Intra- and inter-observer variability was assessed in ten patients. Significant differences were found for LA volume and phasic function. The Bi-ALM significantly underestimated LA volume and overestimated LA function in comparison to Simpson's method (Bi-ALM vs. Simpson's method: LAVmax: 80.18 vs. 98.80 ml; LAVpre-ac: 61.09 vs. 80.41 ml; LAVmin: 36.85 vs. 52.66 ml; LAEFTotal: 55.17 vs. 47.85%; LAEFPassive: 23.96 vs. 19.15%; LAEFBooster: 40.87 vs. 35.64%). LA volumetric and functional parameters were reproducible on an intra- and inter-observer levels for both methods. Intra-observer agreement for LA function was better for Simpson's method (Bi-ALM vs. Simpson's method; ICC LAEFTotal: 0.84 vs. 0.96; ICC LAEFPassive: 0.74 vs. 0.92; ICC LAEFBooster: 0.86 vs. 0.89). The Bi-ALM is based on geometric assumptions that do not reflect the complex individual LA geometry. The assessment of transversal slices covering the left atrium with Simpson's method is feasible and might be more suitable for an accurate quantification of LA volume and phasic function.
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Affiliation(s)
- Laura Kristin Wandelt
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.
| | - Johannes Tammo Kowallick
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Andreas Schuster
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Rolf Wachter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Thomas Stümpfig
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- Department of Paediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- Department of Paediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Christian Oliver Ritter
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
| | - Wieland Staab
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Charnigo RJ, Fornwalt BK. Using a respiratory navigator significantly reduces variability when quantifying left ventricular torsion with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:25. [PMID: 28245864 PMCID: PMC5331707 DOI: 10.1186/s12968-017-0338-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Left ventricular (LV) torsion is an important indicator of cardiac function that is limited by high inter-test variability (50% of the mean value). We hypothesized that this high inter-test variability is partly due to inconsistent breath-hold positions during serial image acquisitions, which could be significantly improved by using a respiratory navigator for cardiovascular magnetic resonance (CMR) based quantification of LV torsion. METHODS We assessed respiratory-related variability in measured LV torsion with two distinct experimental protocols. First, 17 volunteers were recruited for CMR with cine displacement encoding with stimulated echoes (DENSE) in which a respiratory navigator was used to measure and then enforce variability in end-expiratory position between all LV basal and apical acquisitions. From these data, we quantified the inter-test variability of torsion in the absence and presence of enforced end-expiratory position variability, which established an upper bound for the expected torsion variability. For the second experiment (in 20 new, healthy volunteers), 10 pairs of cine DENSE basal and apical images were each acquired from consecutive breath-holds and consecutive navigator-gated scans (with a single acceptance position). Inter-test variability of torsion was compared between the breath-hold and navigator-gated scans to quantify the variability due to natural breath-hold variation. To demonstrate the importance of these variability reductions, we quantified the reduction in sample size required to detect a clinically meaningful change in LV torsion with the use of a respiratory navigator. RESULTS The mean torsion was 3.4 ± 0.2°/cm. From the first experiment, enforced variability in end-expiratory position translated to considerable variability in measured torsion (0.56 ± 0.34°/cm), whereas inter-test variability with consistent end-expiratory position was 57% lower (0.24 ± 0.16°/cm, p < 0.001). From the second experiment, natural respiratory variability from consecutive breath-holds translated to a variability in torsion of 0.24 ± 0.10°/cm, which was significantly higher than the variability from navigator-gated scans (0.18 ± 0.06°/cm, p = 0.02). By using a respiratory navigator with DENSE, theoretical sample sizes were reduced from 66 to 16 and 26 to 15 as calculated from the two experiments. CONCLUSIONS A substantial portion (22-57%) of the inter-test variability of LV torsion can be reduced by using a respiratory navigator to ensure a consistent breath-hold position between image acquisitions.
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Affiliation(s)
- Sean M. Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, KY USA
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
| | - Christopher M. Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Jonathan D. Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
| | - Gregory J. Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | | | - David K. Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Richard J. Charnigo
- Departments of Biostatistics and Statistics, University of Kentucky, Lexington, KY USA
| | - Brandon K. Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY USA
- Department of Imaging Science and Innovation, Geisinger Health System, Danville, PA USA
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA USA
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY USA
- Departments of Physiology and Medicine, University of Kentucky, Lexington, KY USA
- Department of Radiology, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-4400 USA
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27
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Hamlet SM, Haggerty CM, Suever JD, Wehner GJ, Andres KN, Powell DK, Zhong X, Fornwalt BK. Optimal configuration of respiratory navigator gating for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. J Magn Reson Imaging 2016; 45:786-794. [PMID: 27458823 DOI: 10.1002/jmri.25389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine the optimal respiratory navigator gating configuration for the quantification of left ventricular strain using spiral cine displacement encoding with stimulated echoes (DENSE) MRI. MATERIALS AND METHODS Two-dimensional spiral cine DENSE was performed on a 3 Tesla MRI using two single-navigator configurations (retrospective, prospective) and a combined "dual-navigator" configuration in 10 healthy adults and 20 healthy children. The adults also underwent breathhold DENSE as a reference standard for comparisons. Peak left ventricular strains, signal-to-noise ratio (SNR), and navigator efficiency were compared. Subjects also underwent dual-navigator gating with and without visual feedback to determine the effect on navigator efficiency. RESULTS There were no differences in circumferential, radial, and longitudinal strains between navigator-gated and breathhold DENSE (P = 0.09-0.95) (as confidence intervals, retrospective: [-1.0%-1.1%], [-7.4%-2.0%], [-1.0%-1.2%]; prospective: [-0.6%-2.7%], [-2.8%-8.3%], [-0.3%-2.9%]; dual: [-1.6%-0.5%], [-8.3%-3.2%], [-0.8%-1.9%], respectively). The dual configuration maintained SNR compared with breathhold acquisitions (16 versus 18, P = 0.06). SNR for the prospective configuration was lower than for the dual navigator in adults (P = 0.004) and children (P < 0.001). Navigator efficiency was higher (P < 0.001) for both retrospective (54%) and prospective (56%) configurations compared with the dual configuration (35%). Visual feedback improved the dual configuration navigator efficiency to 55% (P < 0.001). CONCLUSION When quantifying left ventricular strains using spiral cine DENSE MRI, a dual navigator configuration results in the highest SNR in adults and children. In adults, a retrospective configuration has good navigator efficiency without a substantial drop in SNR. Prospective gating should be avoided because it has the lowest SNR. Visual feedback represents an effective option to maintain navigator efficiency while using a dual navigator configuration. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:786-794.
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Affiliation(s)
- Sean M Hamlet
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Christopher M Haggerty
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jonathan D Suever
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gregory J Wehner
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Kristin N Andres
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - David K Powell
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, GA, USA
| | - Brandon K Fornwalt
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA.,Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania, USA.,Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky, USA.,Department of Physiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S. Cardiovascular Magnetic Resonance Myocardial Feature Tracking: Concepts and Clinical Applications. Circ Cardiovasc Imaging 2016; 9:e004077. [PMID: 27009468 DOI: 10.1161/circimaging.115.004077] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/29/2016] [Indexed: 12/14/2022]
Abstract
Heart failure-induced cardiovascular morbidity and mortality constitute a major health problem worldwide and result from diverse pathogeneses, including coronary artery disease, nonischemic cardiomyopathies, and arrhythmias. Assessment of cardiovascular performance is important for early diagnosis and accurate management of patients at risk of heart failure. During the past decade, cardiovascular magnetic resonance myocardial feature tracking has emerged as a useful tool for the quantitative evaluation of cardiovascular function. The method allows quantification of biatrial and biventricular mechanics from measures of deformation: strain, torsion, and dyssynchrony. The purpose of this article is to review the basic principles, clinical applications, accuracy, and reproducibility of cardiovascular magnetic resonance myocardial feature tracking, highlighting the prognostic implications. It will also provide an outlook on how this field might evolve in the future.
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Affiliation(s)
- Andreas Schuster
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.).
| | - Kan N Hor
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Johannes T Kowallick
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Philipp Beerbaum
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
| | - Shelby Kutty
- From the Department of Cardiology and Pneumology (A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K.), University Medical Centre Göttingen, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany (A.S., J.T.K.); Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, KCL, London, United Kingdom (A.S.); The Heart Center at Nationwide Children's Hospital, The Ohio State University, Columbus (K.N.H.); Department of Paediatric Cardiology and Critical Care Medicine, Children's Hospital, Hannover Medical School, Hannover, Germany (P.B.); and Division of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha (S.K.)
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Bogarapu S, Puchalski MD, Everitt MD, Williams RV, Weng HY, Menon SC. Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) Analysis for Detection of Myocardial Fibrosis in Pediatric Hypertrophic Cardiomyopathy. Pediatr Cardiol 2016; 37:663-73. [PMID: 26833321 DOI: 10.1007/s00246-015-1329-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/15/2015] [Indexed: 12/16/2022]
Abstract
Myocardial fibrosis is a risk factor for sudden cardiac death in hypertrophic cardiomyopathy (HCM) and is conventionally identified by cardiac magnetic resonance imaging (CMR) using late gadolinium enhancement (LGE). This study evaluates utility of a novel 16-segment CMR feature tracking (CMR-FT) technique for measuring left ventricular (LV) strain (S) and strain rate (SR) on non-contrast cine images to detect myocardial fibrosis in pediatric HCM. We hypothesized that CMR-FT-derived S and SR will accurately differentiate HCM patients with and without myocardial fibrosis. Consecutive children with HCM who underwent CMR with LGE at our institution from 2006 to 2014 were included. Global and regional longitudinal, radial and circumferential S and SR of the LV in 2D and 3D were obtained using a CMR-FT software. Comparisons were made between HCM patients with (+LGE) and without (-LGE) delayed enhancement. Of the 29 HCM patients (mean age 13.5 ± 6.1 years; 52 % males), 11 (40 %) patients (mean age 17.5 ± 8.4 years) had +LGE. Global longitudinal, circumferential and radial S and SR were lower in +LGE compared to -LGE patients, in both 2D and 3D. Regional analysis revealed lower segmental S and SR in the septum with fibrosis compared to free wall without fibrosis. A global longitudinal S of ≤ -12.8 had 91 % sensitivity and 89 % specificity for detection of LGE. In pediatric HCM patients with myocardial fibrosis, global LV longitudinal, circumferential and radial S and SR were reduced, specifically in areas of fibrosis. A global longitudinal S of ≤ -12.8 detected patients with fibrosis with high degree of accuracy. This novel CMR-FT technique may be useful to identify myocardial fibrosis and risk-stratify pediatric HCM without use of contrast agents.
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Affiliation(s)
- Soujanya Bogarapu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
| | - Michael D Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
| | - Melanie D Everitt
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Richard V Williams
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA
| | - Hsin-Yi Weng
- Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
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30
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van der Graaf AWM, Bhagirath P, Scheffer MG, de Medina RR, Götte MJW. MR feature tracking in patients with MRI-conditional pacing systems: The impact of pacing. J Magn Reson Imaging 2016; 44:964-71. [PMID: 26990922 DOI: 10.1002/jmri.25229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To develop feature tracking (FT) software to perform strain analysis on conventional (nontagged) cardiac magnetic resonance imaging (MRI) function images. With the advent of MRI-conditional pacemaker systems, effects of cardiac pacing on myocardial strain can be studied using MR. In this study the impact of pacing on left ventricular (LV) strain was investigated using MR-FT in patients with an MRI-conditional cardiac implantable electronic device (CIED). MATERIALS AND METHODS FT was performed on 32 1.5T MR studies (16 patients with an MRI-conditional CIED and 16 control patients with normal scans). Short- and long-axis steady state free precession (SSFP) cines were used for the FT analysis. Strain was assessed using CVI(42) software (Circle Cardiovascular Imaging, Alberta, Canada). In addition, the intra- and interobserver variability was determined using the intraclass correlation coefficient. RESULTS Of the 16 patients with an MRI-conditional CIED, five patients were paced during the MRI exam. Despite the occasional presence of susceptibility artifacts induced by the CIED, radial, circumferential, and longitudinal strain parameters could be derived for all patients. Peak radial strain and peak circumferential strain were reduced during pacing when compared to the control group; for radial strain: 20.1 ± 4.7% vs. 33.1 ± 6.9%, P < 0.001, and for circumferential strain -7.5 ± 3.5% vs. -14.9 ± 3.2%, P < 0.05. Peak strain parameters were reproducible on an intra- and interobserver level. CONCLUSION MR-FT is feasible in patients with an MRI-conditional CIED and can be used to quantify regional wall motion. J. MAGN. RESON. IMAGING 2016;44:964-971.
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Affiliation(s)
| | - Pranav Bhagirath
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mike G Scheffer
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.,Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Marco J W Götte
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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31
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Sampaio F, Pimenta J. Left ventricular function assessment in cirrhosis: Current methods and future directions. World J Gastroenterol 2016; 22:112-125. [PMID: 26755864 PMCID: PMC4698479 DOI: 10.3748/wjg.v22.i1.112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/29/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.
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32
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Schuster A, Stahnke VC, Unterberg-Buchwald C, Kowallick JT, Lamata P, Steinmetz M, Kutty S, Fasshauer M, Staab W, Sohns JM, Bigalke B, Ritter C, Hasenfuß G, Beerbaum P, Lotz J. Cardiovascular magnetic resonance feature-tracking assessment of myocardial mechanics: Intervendor agreement and considerations regarding reproducibility. Clin Radiol 2015; 70:989-98. [PMID: 26139384 PMCID: PMC4683162 DOI: 10.1016/j.crad.2015.05.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/30/2015] [Accepted: 05/18/2015] [Indexed: 12/31/2022]
Abstract
Aim To assess intervendor agreement of cardiovascular magnetic resonance feature tracking (CMR-FT) and to study the impact of repeated measures on reproducibility. Materials and methods Ten healthy volunteers underwent cine imaging in short-axis orientation at rest and with dobutamine stimulation (10 and 20 μg/kg/min). All images were analysed three times using two types of software (TomTec, Unterschleissheim, Germany and Circle, cvi42, Calgary, Canada) to assess global left ventricular circumferential (Ecc) and radial (Err) strains and torsion. Differences in intra- and interobserver variability within and between software types were assessed based on single and averaged measurements (two and three repetitions with subsequent averaging of results, respectively) as determined by Bland–Altman analysis, intraclass correlation coefficients (ICC), and coefficient of variation (CoV). Results Myocardial strains and torsion significantly increased on dobutamine stimulation with both types of software (p<0.05). Resting Ecc and torsion as well as Ecc values during dobutamine stimulation were lower measured with Circle (p<0.05). Intra- and interobserver variability between software types was lowest for Ecc (ICC 0.81 [0.63–0.91], 0.87 [0.72–0.94] and CoV 12.47% and 14.3%, respectively) irrespective of the number of analysis repetitions. Err and torsion showed higher variability that markedly improved for torsion with repeated analyses and to a lesser extent for Err. On an intravendor level TomTec showed better reproducibility for Ecc and torsion and Circle for Err. Conclusions CMR-FT strain and torsion measurements are subject to considerable intervendor variability, which can be reduced using three analysis repetitions. For both vendors, Ecc qualifies as the most robust parameter with the best agreement, albeit lower Ecc values obtained using Circle, and warrants further investigation of incremental clinical merit. This is the first comparison of two types of CMR-FT software resulting in clinically valuable inter-vendor agreement data. Assessment of myocardial strain and torsion is feasible with both types of software at rest and with dobutamine stimulation. For both vendors, Ecc qualifies as the most robust parameter with the lowest variability.
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Affiliation(s)
- A Schuster
- Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Germany; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK.
| | - V-C Stahnke
- Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - C Unterberg-Buchwald
- Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - J T Kowallick
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - P Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, UK; Department of Computer Science, University of Oxford, Oxford, UK
| | - M Steinmetz
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - S Kutty
- Children's Hospital and Medical Center Joint Division of Pediatric Cardiology, University of Nebraska / Creighton University, Omaha, NE, USA
| | - M Fasshauer
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - W Staab
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - J M Sohns
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - B Bigalke
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - C Ritter
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - G Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Germany
| | - P Beerbaum
- Department of Paediatric Cardiology, Hannover Medical School, Hannover, Germany
| | - J Lotz
- DZHK (German Centre for Cardiovascular Research), Germany; Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
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Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Lotz J, Hasenfuß G, Nagel E, Chiribiri A, Schuster A. Inter-study reproducibility of left ventricular torsion and torsion rate quantification using MR myocardial feature tracking. J Magn Reson Imaging 2015; 43:128-37. [PMID: 26114731 DOI: 10.1002/jmri.24979] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To determine the inter-study reproducibility of MR feature tracking (MR-FT) derived left ventricular (LV) torsion and torsion rates for a combined assessment of systolic and diastolic myocardial function. METHODS Steady-state free precession (SSFP) cine LV short-axis stacks were acquired at 9:00 (Exam A), 9:30 (Exam B), and 14:00 (Exam C) in 16 healthy volunteers at 3 Tesla. SSFP images were analyzed offline using MR-FT to assess rotational displacement in apical and basal slices. Global peak torsion, peak systolic and peak diastolic torsion rates were calculated using different definitions ("twist", "normalized twist" and "circumferential-longitudinal (CL) shear angle"). Exam A and B were compared to assess the inter-study reproducibility. Morning and afternoon scans were compared to address possible diurnal variation. RESULTS The different methods showed good inter-study reproducibility for global peak torsion (intraclass correlation coefficient [ICC]: 0.90-0.92; coefficient of variation [CoV]: 19.0-20.3%) and global peak systolic torsion rate (ICC: 0.82-0.84; CoV: 25.9-29.0%). Conversely, global peak diastolic torsion rate showed little inter-study reproducibility (ICC: 0.34-0.47; CoV: 40.8-45.5%). Global peak torsion as determined by the CL shear angle showed the best inter-study reproducibility (ICC: 0.90;CoV: 19.0%). MR-FT results were not measurably affected by diurnal variation between morning and afternoon scans (CL shear angle: 4.8 ± 1.4°, 4.8 ± 1.5°, and 4.1 ± 1.6° for Exam A, B, and C, respectively; P = 0.21). CONCLUSION MR-FT based derivation of myocardial peak torsion and peak systolic torsion rate has high inter-study reproducibility as opposed to peak diastolic torsion rate. The CL shear angle was the most reproducible parameter independently of cardiac anatomy and may develop into a robust tool to quantify cardiac rotational mechanics in longitudinal MR-FT patient studies.
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Affiliation(s)
- Johannes T Kowallick
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom.,Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Geraint Morton
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom.,Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Roy Jogiya
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, Nebraska, USA
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Gerd Hasenfuß
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, United Kingdom.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
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34
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Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Hasenfuß G, Lotz J, Nagel E, Chiribiri A, Schuster A. Quantification of atrial dynamics using cardiovascular magnetic resonance: inter-study reproducibility. J Cardiovasc Magn Reson 2015; 17:36. [PMID: 25982348 PMCID: PMC4434799 DOI: 10.1186/s12968-015-0140-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/01/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) offers quantification of phasic atrial functions based on volumetric assessment and more recently, on CMR feature tracking (CMR-FT) quantitative strain and strain rate (SR) deformation imaging. Inter-study reproducibility is a key requirement for longitudinal studies but has not been defined for CMR-based quantification of left atrial (LA) and right atrial (RA) dynamics. METHODS Long-axis 2- and 4-chamber cine images were acquired at 9:00 (Exam A), 9:30 (Exam B) and 14:00 (Exam C) in 16 healthy volunteers. LA and RA reservoir, conduit and contractile booster pump functions were quantified by volumetric indexes as derived from fractional volume changes and by strain and SR as derived from CMR-FT. Exam A and B were compared to assess the inter-study reproducibility. Morning and afternoon scans were compared to address possible diurnal variation of atrial function. RESULTS Inter-study reproducibility was within acceptable limits for all LA and RA volumetric, strain and SR parameters. Inter-study reproducibility was better for volumetric indexes and strain than for SR parameters and better for LA than for RA dynamics. For the LA, reservoir function showed the best reproducibility (intraclass correlation coefficient (ICC) 0.94-0.97, coefficient of variation (CoV) 4.5-8.2%), followed by conduit (ICC 0.78-0.97, CoV 8.2-18.5%) and booster pump function (ICC 0.71-0.95, CoV 18.3-22.7). Similarly, for the RA, reproducibility was best for reservoir function (ICC 0.76-0.96, CoV 7.5-24.0%) followed by conduit (ICC 0.67-0.91, CoV 13.9-35.9) and booster pump function (ICC 0.73-0.90, CoV 19.4-32.3). Atrial dynamics were not measurably affected by diurnal variation between morning and afternoon scans. CONCLUSIONS Inter-study reproducibility for CMR-based derivation of LA and RA functions is acceptable using either volumetric, strain or SR parameters with LA function showing higher reproducibility than RA function assessment. Amongst the different functional components, reservoir function is most reproducibly assessed by either technique followed by conduit and booster pump function, which needs to be considered in future longitudinal research studies.
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Affiliation(s)
- Johannes T Kowallick
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | | | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
- Department of Computer Science, University of Oxford, Oxford, UK.
| | - Roy Jogiya
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, NE, USA.
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Eike Nagel
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
- Division of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research (DZHK, partner site Rhine-Main), Frankfurt, Germany.
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
| | - Andreas Schuster
- Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St Thomas' Hospital, King's College London, London, UK.
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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35
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Schuster A, Paul M, Bettencourt N, Hussain ST, Morton G, Kutty S, Bigalke B, Chiribiri A, Perera D, Nagel E, Beerbaum P. Myocardial feature tracking reduces observer-dependence in low-dose dobutamine stress cardiovascular magnetic resonance. PLoS One 2015; 10:e0122858. [PMID: 25848764 PMCID: PMC4388729 DOI: 10.1371/journal.pone.0122858] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/15/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine whether quantitative wall motion assessment by CMR myocardial feature tracking (CMR-FT) would reduce the impact of observer experience as compared to visual analysis in patients with ischemic cardiomyopathy (ICM). METHODS 15 consecutive patients with ICM referred for assessment of hibernating myocardium were studied at 3 Tesla using SSFP cine images at rest and during low dose dobutamine stress (5 and 10 μg/kg/min of dobutamine). Conventional visual, qualitative analysis was performed independently and blinded by an experienced and an inexperienced reader, followed by post-processing of the same images by CMR-FT to quantify subendocardial and subepicardial circumferential (Eccendo and Eccepi) and radial (Err) strain. Receiver operator characteristics (ROC) were assessed for each strain parameter and operator to detect the presence of inotropic reserve as visually defined by the experienced observer. RESULTS 141 segments with wall motion abnormalities at rest were eligible for the analysis. Visual scoring of wall motion at rest and during dobutamine was significantly different between the experienced and the inexperienced observer (p<0.001). All strain values (Eccendo, Eccepi and Err) derived during dobutamine stress (5 and 10 μg/kg/min) showed similar diagnostic accuracy for the detection of contractile reserve for both operators with no differences in ROC (p>0.05). Eccendo was the most accurate (AUC of 0.76, 10 μg/kg/min of dobutamine) parameter. Diagnostic accuracy was worse for resting strain with differences between operators for Eccendo and Eccepi (p<0.05) but not Err (p>0.05). CONCLUSION Whilst visual analysis remains highly dependent on operator experience, quantitative CMR-FT analysis of myocardial wall mechanics during DS-CMR provides diagnostic accuracy for the detection of inotropic reserve regardless of operator experience and hence may improve diagnostic robustness of low-dose DS-CMR in clinical practice.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pulmonology, Georg-August-University and German Center for Cardiovascular Research (DZHK, Partner Site), Göttingen, Germany
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
- * E-mail:
| | - Matthias Paul
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
| | - Nuno Bettencourt
- Cardiology Department—Centro Hospitalar de Gaia/Espinho, Porto, Portugal
| | - Shazia T. Hussain
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
| | - Geraint Morton
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
| | - Shelby Kutty
- Joint Division of Pediatric Cardiology, University of Nebraska/Creighton University, Children’s Hospital and Medical Center, Omaha, Nebraska, United States of America
| | - Boris Bigalke
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
- Department of Cardiology, Campus Benjamin Franklin, Charité Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Amedeo Chiribiri
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
| | - Divaka Perera
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
- King's College London BHF Centre of Excellence, NIHR Biomedical Research Centre and Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Eike Nagel
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
| | - Philipp Beerbaum
- King's College London British Heart Foundation (BHF) Centre of Excellence; National Institute of Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust; Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC) Medical Engineering Centre; Division of Imaging Sciences and Biomedical Engineering; The Rayne Institute, St. Thomas´ Hospital, London, United Kingdom
- Department of Paediatric Cardiology, Hannover Medical School, Hannover, Germany
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Hösch O, Ngyuen TT, Lauerer P, Schuster A, Kutty S, Staab W, Unterberg-Buchwald C, Sohns JM, Paul T, Lotz J, Steinmetz M. BNP and haematological parameters are markers of severity of Ebstein's anomaly: correlation with CMR and cardiopulmonary exercise testing. Eur Heart J Cardiovasc Imaging 2015; 16:670-5. [PMID: 25736309 DOI: 10.1093/ehjci/jeu312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/13/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS Ebstein's anomaly (EA) involves a displaced and dysplastic tricuspid valve resulting in an atrialized portion of the right ventricle and an enlargement of the functional right ventricle and right atrium. Biomarkers targeting heart failure such as brain natriuretic peptide (BNP) or haematological parameters [haemoglobin (Hb) and haematocrit (Hct)] are upregulated in states of pulmonary hypoperfusion. We hypothesized that decreased pulmonary perfusion dependent on the stage of right heart failure is a possible mechanism in EA, and that it can be correlated with cardiac magnetic resonance (CMR) parameters. The aim of this study was to investigate the relationship between BNP and haematological parameters with functional parameters from CMR and exercise testing in patients with EA. METHODS AND RESULTS Twenty-five patients with non-corrected EA were studied prospectively (mean age 26 ± 14 years). BNP level was increased (74 ± 127 ng/L), and in 16% markedly above the heart failure cut-off level of 100 ng/L. Hb and Hct were increased above normal levels in 20 and 24% of patients, respectively. BNP and Hct/Hb correlated with CMR [total right/left (R/L)-Volume-Index, right atrium-end-diastolic volume index (EDVi), functional right ventricle (fRV)-EDVi, fRV-ejection fraction (EF), tricuspid regurgitation, pulmonary artery flow, and left ventricular EF] and exercise testing [workload/kg, oxygen uptake (VO2), ventilatory response to carbon dioxide production (VE/VCO2), oxygen (O2) pulse, and heart rate reserve]. The higher BNP and haematological parameters, the higher was the disease severity and the more limited was the physical exercise capacity. CONCLUSION In this EA cohort, BNP levels and haematological parameters correlated well with functional data from CMR and exercise testing. The total R/L-Volume-Index and BNP, and to some extent hematological parameters, may be useful as prognostic markers in patients with EA.
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Affiliation(s)
- Olga Hösch
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Thuy-Trang Ngyuen
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Peter Lauerer
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University Göttingen, Göttingen, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA
| | - Wieland Staab
- Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | | | - Jan M Sohns
- DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany Institution for Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University Göttingen, Heart Center, Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Heart Center, UMG, German Center for Cardiovascular Research, partner site Goettingen, DZHK, Robert-Koch-Str. 40, Göttingen 37075, Germany DZHK, German Center for Heart Research, partner site Göttingen, Göttingen, Germany
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Affiliation(s)
- Johannes Tammo Kowallick
- Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Göttingen, Germany; German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany; Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, St. Thomas' Hospital, King's College London, London, United Kingdom; and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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