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Kaya Ç, Gürdoğan M. Comparison of myocardial perfusion scintigraphy and strain echocardiography in patients undergoing coronary angiography. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2025; 71:e20241806. [PMID: 40332276 PMCID: PMC12051942 DOI: 10.1590/1806-9282.20241806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 12/08/2024] [Indexed: 05/08/2025]
Abstract
OBJECTIVE Myocardial perfusion scintigraphy is a common non-invasive method for assessing ischemic burden, though artifacts can affect accuracy. Speckle-tracking strain echocardiography improves left ventricular function assessment, and global longitudinal strain correlates well with coronary artery disease. The aim of this study was to compare myocardial perfusion scintigraphy with global longitudinal strain in stable angina pectoris patients. METHODS A total of 133 suspected coronary artery disease patients who underwent myocardial perfusion scintigraphy and coronary angiography were prospectively enrolled and classified as myocardial perfusion scintigraphy true positives or false positives based on coronary angiography results. Global longitudinal strain values for the epicardium, endocardium, and myocardium (avg) were calculated. RESULTS Ischemic percentages of myocardial perfusion scintigraphy>12% and mid-wall global longitudinal strain<-18.4% correlated with true positive coronary angiography results. Left ventricular ejection fraction/global longitudinal strain mid ratio positively correlated with coronary artery disease presence and severity. Higher ischemic percentages of myocardial perfusion scintigraphy showed a negative correlation (r: -0.2606, p: 0.002) with global longitudinal strain, indicating a greater likelihood of coronary artery disease (OR 0.25, 95%CI 0.08-0.73, p: 0.012). Female sex was linked to fewer true positive myocardial perfusion scintigraphy results. CONCLUSION The GLS value of the Left Ventricle obtained by two-dimentional strain echocardiography offers sensitivity and specificity similar to myocardial perfusion scintigraphy in the detection of coronary artery disease.. An elevated left ventricular ejection fraction/global longitudinal strain ratio is a significant predictor of the presence and severity of coronary artery disease.
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Affiliation(s)
- Çağlar Kaya
- Trakya University, Department of Cardiology – Edirne, Turkey
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Gandhi S, Sweeney HL, Hart CC, Han R, Perry CGR. Cardiomyopathy in Duchenne Muscular Dystrophy and the Potential for Mitochondrial Therapeutics to Improve Treatment Response. Cells 2024; 13:1168. [PMID: 39056750 PMCID: PMC11274633 DOI: 10.3390/cells13141168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disease caused by mutations to the dystrophin gene, resulting in deficiency of dystrophin protein, loss of myofiber integrity in skeletal and cardiac muscle, and eventual cell death and replacement with fibrotic tissue. Pathologic cardiac manifestations occur in nearly every DMD patient, with the development of cardiomyopathy-the leading cause of death-inevitable by adulthood. As early cardiac abnormalities are difficult to detect, timely diagnosis and appropriate treatment modalities remain a challenge. There is no cure for DMD; treatment is aimed at delaying disease progression and alleviating symptoms. A comprehensive understanding of the pathophysiological mechanisms is crucial to the development of targeted treatments. While established hypotheses of underlying mechanisms include sarcolemmal weakening, upregulation of pro-inflammatory cytokines, and perturbed ion homeostasis, mitochondrial dysfunction is thought to be a potential key contributor. Several experimental compounds targeting the skeletal muscle pathology of DMD are in development, but the effects of such agents on cardiac function remain unclear. The synergistic integration of small molecule- and gene-target-based drugs with metabolic-, immune-, or ion balance-enhancing compounds into a combinatorial therapy offers potential for treating dystrophin deficiency-induced cardiomyopathy, making it crucial to understand the underlying mechanisms driving the disorder.
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Affiliation(s)
- Shivam Gandhi
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - H. Lee Sweeney
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL 32610, USA; (H.L.S.); (C.C.H.)
- Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Cora C. Hart
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL 32610, USA; (H.L.S.); (C.C.H.)
- Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Renzhi Han
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Christopher G. R. Perry
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
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Werner O, Martins D, Bertini F, Bennati E, Collia D, Olivotto I, Spaziani G, Baruteau AE, Pedrizzetti G, Raimondi F. Comparative analysis of left ventricle function and deformation imaging in short and long axis plane in cardiac magnetic resonance imaging. Front Cardiovasc Med 2024; 11:1388171. [PMID: 38756751 PMCID: PMC11097778 DOI: 10.3389/fcvm.2024.1388171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Background Advancements in cardiac imaging have revolutionized our understanding of ventricular contraction. While ejection fraction (EF) is still the gold standard parameter to assess left ventricle (LV) function, strain imaging (SI) has provided valuable insights into ventricular mechanics. The lack of an integrative method including SI parameters in a single, validated formula may limit its use. Our aim was to compare different methods for evaluating global circumferential strain (GCS) and their relationship with global longitudinal strain (GLS) and EF in CMR and how the different evaluations fit in the theoretical relationship between EF and global strain. Methods Retrospective monocenter study. Inclusion of every patient who underwent a CMR during a 15 months period with various clinical indication (congenital heart defect, myocarditis, cardiomyopathy). A minimum of three LV long-axis planes and a stack of short-axis slices covering the LV using classical steady-state free precession cine sequences. A single assessment of GLS on long axis (LAX) slices and a double assessment of GCS and EF with both short axis (SAX) and LAX slices were made by a single experienced CMR investigator. Results GCS-SAX and GCS-LAX were correlated (r = 0.77, P < 0.001) without being interchangeable with a high reproducibility for GCS, GLS and EF. EF calculated from LAX images showed an overestimation compared to EF derived from SAX images of 7%. The correlation between calculated EF and theoretical EF derived from SI was high (r = 0.88 with EF-SAX, 0.95 with EF-LAX). Data conclusion This study highlights the need to integrate strain imaging techniques into clinical by incorporating strain parameters into EF calculations, because it gives a deeper understanding of cardiac mechanics.
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Affiliation(s)
- Oscar Werner
- Pediatric Cardiology Unit, University Hospital Meyer, Florence, Italy
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
| | - Duarte Martins
- Pediatric and Adult Congenital Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Bertini
- Pediatric Radiology Department, University Hospital Meyer, Florence, Italy
| | - Elena Bennati
- Pediatric Cardiology Unit, University Hospital Meyer, Florence, Italy
| | - Dario Collia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Iacopo Olivotto
- Pediatric Cardiology Unit, University Hospital Meyer, Florence, Italy
| | - Gaia Spaziani
- Pediatric Cardiology Unit, University Hospital Meyer, Florence, Italy
| | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Francesca Raimondi
- Pediatric Cardiology Unit, University Hospital Meyer, Florence, Italy
- Pediatric and Adult Congenital Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Kong H, Cao J, Zhang L, An J, Wu X, He Y. Myocardial deformation characteristics assessed by cardiovascular magnetic resonance feature tracking in a healthy Chinese population. Heliyon 2024; 10:e28341. [PMID: 38623204 PMCID: PMC11016585 DOI: 10.1016/j.heliyon.2024.e28341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To explore global/regional myocardial deformation across various layers, vascular distributions, specific levels and distinct walls in healthy individuals using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods We selected a cohort of 55 healthy participants and CMR cine images were used to obtain the left ventricular (LV) peak longitudinal, circumferential, radial strains (LS, CS, RS). The characteristics of normal LV strain in various layers (endocardium, myocardium, epicardium), territories [left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA)], levels (basal, middle, apical) and walls (anterior, septum, inferior, lateral) were compared. Results The absolute values of the LV global LS and CS gradually decreased from endocardium to epicardium. The absolute LV global RS (65.7 ± 47.7%) was maximum relative to LS (-22.0 ± 10.8%) and CS (-22.8 ± 7.7%). The absolute values of the LCX territorial strain were the largest compared with the LAD and RCA territorial strains. Regional RS, endo-CS and endo-LS gradually increased from the basal to the apical level. The LV lateral walls had the highest strain values (CS, LS, and RS). Conclusions Variations in normal LV strain values across various layers, territories, levels, and walls were observed, suggesting the necessity for careful clinical interpretation of these strain values. These findings also partially revealed the complexity of normal cardiac mechanics.
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Affiliation(s)
- Huihui Kong
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiaxin Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance, MR Collaboration NE Asia, Shenzhen, China
| | - Xiaohua Wu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Zheng Y, Liu H, Zhao L, Guan S, Huo H, Li H, Guo J, Peng X, Hao Y, Jin S, Hou Y, Dai X, Liu T, Zhang X. Serial Cardiac MRI for Quantification of the Dynamics of Anthracycline-Induced Subclinical Myocardial Injury. J Magn Reson Imaging 2023; 58:1533-1541. [PMID: 36912379 DOI: 10.1002/jmri.28667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Anthracyclines are known to be associated with chemotherapy-induced cardiotoxicity. Limited data focus on dynamic myocardial injury during the course of chemotherapy in patients with breast cancer. PURPOSE To investigate the variation of tissue characterization and myocardial deformation derived by cardiac MRI during anthracycline chemotherapy. STUDY TYPE Prospective. POPULATION Fifty-eight female breast cancer patients (mean age: 52.82 ± 2.61 years) were enrolled. FIELD STRENGTH/SEQUENCE A 3.0-T, cardiac MRI including cine balanced steady-state free precession, a modified Looker-Locker inversion recovery (MOLLI), and a fast spin echo (FSE) T2-weighted sequences were performed. ASSESSMENT Cardiac MRI was performed baseline and after two, four, and six cycles of chemotherapy. Assessment of global longitudinal strain (GLS), global circumstance strain (GCS), global radial strain (GRS), and strain rate (GLS-s, GCS-s, GRS-s) and T1, T2 and T2* were accomplished by CVI42. The anthracycline dose and risk factors were also collected before each cardiac MRI. STATISTICAL TESTS Analysis of variance (ANOVA) for repeated measures was used to compare the changes in LVEF cardiac function, strain and T1/T2/T2* parameters over time. Pearson correlation analyses were performed to estimate the potential associations between differences in myocardial characteristics (∆) and the chemotherapy cycle. A P value <0.05 was considered statistically significant. RESULTS LVEF was not significantly different from pretreatment MRI regarding each cycle of chemotherapy (P = 0.54). Compared with baseline, patients had significantly lower GLS (-15.85% ± 0.83%, -14.50% ± 0.88%, -12.34% ± 1.01% vs. -18.82% ± 0.92%) and GLS-s (-0.71% ± 0.07%, -0.65% ± 0.05%, -0.64% ± 0.04% vs. -0.95 ± 0.06%) and increased T2 values (57.21 ± 4.27 msec, 58.60 ± 3.93 msec, 58.10 ± 3.17 msec vs. 43.88 ± 3.28 msec) at two, four and six cycles of chemotherapy treatment. ∆GLS and ∆GLS-s were significantly associated with the chemotherapy cycle (correlation coefficients for GLS = 0.75, GLS-s = 0.75). DATA CONCLUSION Cardiac MRI can precisely detect the dynamic changes of anthracycline-induced subclinical myocardial injury that is represented as a gradually decrease in GLS and GLS-s. These parameters may provide new insight for monitoring risk and therapy in patients with breast cancer. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Yue Zheng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shu Guan
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jie Guo
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xin Peng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yuetong Hao
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shiqi Jin
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xinfeng Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
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Simon J, Fung K, Raisi-Estabragh Z, Aung N, Khanji MY, Zsarnóczay E, Merkely B, Munroe PB, Harvey NC, Piechnik SK, Neubauer S, Leeson P, Petersen SE, Maurovich-Horvat P. Association between subclinical atherosclerosis and cardiac structure and function-results from the UK Biobank Study. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad010. [PMID: 37822973 PMCID: PMC10563379 DOI: 10.1093/ehjimp/qyad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 10/13/2023]
Abstract
Aims Heart failure (HF) is a major health problem and early diagnosis is important. Atherosclerosis is the main cause of HF and carotid intima-media thickness (IMT) is a recognized early measure of atherosclerosis. This study aimed to investigate whether increased carotid IMT is associated with changes in cardiac structure and function in middle-aged participants of the UK Biobank Study without overt cardiovascular disease. Methods and results Participants of the UK Biobank who underwent CMR and carotid ultrasound examinations were included in this study. Patients with heart failure, angina, atrial fibrillation, and history of myocardial infarction or stroke were excluded. We used multivariable linear regression models adjusted for age, sex, physical activity, body mass index, body surface area, hypertension, diabetes, smoking, ethnicity, socioeconomic status, alcohol intake, and laboratory parameters. In total, 4301 individuals (61.6 ± 7.5 years, 45.9% male) were included. Multivariable linear regression analyses showed that increasing quartiles of IMT was associated with increased left and right ventricular (LV and RV) and left atrial volumes and greater LV mass. Moreover, increased IMT was related to lower LV end-systolic circumferential strain, torsion, and both left and right atrial ejection fractions (all P < 0.05). Conclusion Increased IMT showed an independent association over traditional risk factors with enlargement of all four cardiac chambers, decreased function in both atria, greater LV mass, and subclinical LV dysfunction. There may be additional risk stratification that can be derived from the IMT to identify those most likely to have early cardiac structural/functional changes.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
- Barts Health NHS Trust, Newham University Hospital, Glen Road, Plaistow, London E1 1BB, United Kingdom
| | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Stefan K Piechnik
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Stefan Neubauer
- National Institute for Health Research, Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 1, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London EC1M 6BQ, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United Kingdom
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Üllői út 78, H-1082 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary, Városmajor u 68, H-1122 Budapest, Hungary
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Chen W, Jiao Z, Li W, Han R. Two-dimensional speckle tracking echocardiography, a powerful method for the evaluation of anthracyclines induced left ventricular insufficiency. Medicine (Baltimore) 2022; 101:e31084. [PMID: 36281099 PMCID: PMC9592473 DOI: 10.1097/md.0000000000031084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anthracyclines have been one of the most important therapeutic methods in breast cancer therapy for decades. However, serious long-term toxicities, especially cardiotoxicity limits the continuous usage of anthracyclines, hence affects long term prognosis. Early detection of myocardial dysfunction during treatment is critical but challenging. Two-dimensional speckle tracking echocardiography (2D-STE) is a non-Doppler technique that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. This study aims to compare the sensitivity and precision between 2D-STE and traditional echocardiography on monitoring the left ventricular function in patients with breast cancer after anthracyclines therapy, which is the key indicator for evaluating myocardial changes. Thirty-three patients with breast cancer were recruited from February 2019 to December 2019. All patients were treated with 4 cycles anthracycline. 2D-STE and conventional echocardiography were performed on each patient. Two-dimensional echocardiographic examination was used to collect data interventricular septum diameter (IVSD), end-diastolic left ventricular posterior wall diameter (LVPWD), left ventricular end-diastolic diameter (LVEDD) and left ventricular systole on the parasternal left ventricular long axis view. The final diameter (left ventricular end-systolic diameter [LVESD]) and the left ventricular short axis shortening rate (LVFS) was measured by M-type. The two-plane Simpson's method was used to measure left ventricular end-diastolic volume (LVEDV) and end-systolic volume (left ventricular end-systolic volume [LVESV]) to obtain left ventricular ejection fraction (LVEF). Two-dimensional speckle tracking imaging technical indicator includes left ventricular global longitudinal strain (LVGLS), subendocardial myocardial longitudinal strain (LVGLS-Endo) and epicardial myocardial longitudinal strain (LVGLS-Epi). The correlation between 2-dimensional speckle tracking imaging and conventional ultrasound parameters were analyzed. Compared with baseline (T0), the systolic function parameter LVEF was significantly changed after four cycle chemotherapy (T4) (P < .05). However, the conventional echocardiographic parameters including IVSD, LVPWD, LVEDD, LVESD, LVEDV, and LVESV were not statistically significant (P > .05). Meanwhile, the two-dimensional strain parameters LVGLS, LVGLS-Endo, and LVGLS-Epi were statistically significant after T2 and T4 cycle chemotherapy (P < .01).The two-dimensional strain parameter GLS has higher accuracy and sensitivity for monitoring left ventricular insufficiency caused by anthracycline therapy when compared with traditional echocardiography.
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Affiliation(s)
- Wei Chen
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ziyi Jiao
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Wenjie Li
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ruoling Han
- The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- *Correspondence: Ruoling Han, Department of Ultrasound, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China (e-mail: )
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Sciatti E, Mohseni Z, Orabona R, Mulder EG, Prefumo F, Lorusso R, Frusca T, Ghossein-Doha C, Spaanderman ME. Maternal myocardial dysfunction after hemolysis, elevated liver enzymes, and low platelets syndrome: a speckle-tracking study. J Hypertens 2021; 39:1956-1963. [PMID: 34173798 PMCID: PMC10231931 DOI: 10.1097/hjh.0000000000002901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Pregnancy complicated by pre-eclampsia (PE) and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is associated with an increased risk of cardiovascular (CV) diseases later in life. Subclinical cardiac alterations precede eminent CV diseases. Speckle-tracking echocardiography (STE) is an effective method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to investigate the prevalence of subclinical myocardial dysfunction in former PE patients (with and without HELLP syndrome) compared to normotensive women affected by HELLP syndrome. METHODS In this cross-sectional retrospective study, women with a history of normotensive HELLP (n = 32), PE without HELLP (n = 59), and PE with HELLP (n = 101) underwent conventional and STE as part of the clinical CV work-up after their complicated pregnancies from 6 months to 4 years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. RESULTS Women with a history of PE with HELLP syndrome were characterized by a higher prevalence of altered left ventricular circumferential and global longitudinal two-dimensional (2D) strain (74 and 20%, respectively), altered right ventricular longitudinal 2D strain (37%), and left atrial (LA) 2D strain (57%). Moreover, a higher proportion of alterations of biventricular and LA strains was also present in former PE without HELLP as well as in the normotensive HELLP group. CONCLUSIONS In the first years after a pregnancy complicated by HELLP syndrome, irrespective of whether there was concomitant PE, a higher rate of abnormal STE myocardial function is observed. Therefore, these women may benefit from CV risk management.
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Affiliation(s)
- Edoardo Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
| | - Zenab Mohseni
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Eva G. Mulder
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tiziana Frusca
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
- Department of Obstetrics and Gynecology, University of Parma, Italy
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
- Department of Cardiology, Heart & Vascular Centre, Maastricht University Medical Center (MUMC), The Netherlands
| | - Marc E.A. Spaanderman
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC), The Netherlands
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Loecher M, Perotti LE, Ennis DB. Using synthetic data generation to train a cardiac motion tag tracking neural network. Med Image Anal 2021; 74:102223. [PMID: 34555661 DOI: 10.1016/j.media.2021.102223] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/15/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
A CNN based method for cardiac MRI tag tracking was developed and validated. A synthetic data simulator was created to generate large amounts of training data using natural images, a Bloch equation simulation, a broad range of tissue properties, and programmed ground-truth motion. The method was validated using both an analytical deforming cardiac phantom and in vivo data with manually tracked reference motion paths. In the analytical phantom, error was investigated relative to SNR, and accurate results were seen for SNR>10 (displacement error <0.3 mm). Excellent agreement was seen in vivo for tag locations (mean displacement difference = -0.02 pixels, 95% CI [-0.73, 0.69]) and calculated cardiac circumferential strain (mean difference = 0.006, 95% CI [-0.012, 0.024]). Automated tag tracking with a CNN trained on synthetic data is both accurate and precise.
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Affiliation(s)
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, USA; Cardiovascular Institute, Stanford University, USA; Center for Artificial Intelligence in Medicine & Imaging, Stanford University, USA
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10
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Larsen CK, Aalen JM, Stokke C, Fjeld JG, Kongsgaard E, Duchenne J, Degtiarova G, Gheysens O, Voigt JU, Smiseth OA, Hopp E. Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: a feasibility study in left bundle branch block. Eur Heart J Cardiovasc Imaging 2021; 21:143-153. [PMID: 31599327 DOI: 10.1093/ehjci/jez231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/08/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Regional myocardial work may be assessed by pressure-strain analysis using a non-invasive estimate of left ventricular pressure (LVP). Strain by speckle tracking echocardiography (STE) is not always accessible due to poor image quality. This study investigated the estimation of regional myocardial work from strain by feature tracking (FT) cardiac magnetic resonance (CMR) and non-invasive LVP. METHODS AND RESULTS Thirty-seven heart failure patients with reduced ejection fraction, left bundle branch block (LBBB), and no myocardial scar were compared to nine controls without LBBB. Circumferential strain was measured by FT-CMR in a mid-ventricular short-axis cine view, and longitudinal strain by STE. Segmental work was calculated by pressure-strain analysis. Twenty-five patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography. Segmental values were reported as percentages of the segment with maximum myocardial FDG uptake. In LBBB patients, net CMR-derived work was 51 ± 537 (mean ± standard deviation) in septum vs. 1978 ± 1084 mmHg·% in the left ventricular (LV) lateral wall (P < 0.001). In controls, however, there was homogeneous work distribution with similar values in septum and the LV lateral wall (non-significant). Reproducibility was good. Segmental CMR-derived work correlated with segmental STE-derived work and with segmental FDG uptake (average r = 0.71 and 0.80, respectively). CONCLUSION FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.
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Affiliation(s)
- Camilla Kjellstad Larsen
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John M Aalen
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Jan Gunnar Fjeld
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Erik Kongsgaard
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Einar Hopp
- Center for Cardiological Innovation, Oslo University Hospital, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway
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11
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Polacin M, Karolyi M, Eberhard M, Gotschy A, Baessler B, Alkadhi H, Kozerke S, Manka R. Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images. Sci Rep 2021; 11:12376. [PMID: 34117271 PMCID: PMC8195981 DOI: 10.1038/s41598-021-90283-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/26/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate whether segmental strain is noticeably affected in chronic infarcts and thus can be potentially used for infarct detection based on routinely acquired non-contrast cine images in patients with known coronary artery disease (CAD). Forty-six patients with known CAD and chronic scars in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age-matched controls with normal cardiac MRI (2 female, mean age 47 ± 13 years) were retrospectively enrolled. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual wall motion assessment of short axis cine images as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient and control were presented in random order to two independent blinded readers, which should localize potentially infarcted segments in those datasets blinded to LGE images and patient information. Global strain values were impaired in patients compared to controls (GPCS p = 0.02; GPLS p = 0.04; GPRS p = 0.01). Patients with preserved ejection fraction showed also impeded GPCS compared to healthy individuals (p = 0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5.4% ± 2) and in transmurally infarcted segments (- 1.2% ± 3) compared to remote myocardium (- 12.9% ± 3, p = 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut-off value for SPCS for discriminating infarcted from remote myocardium of - 7.2% with a sensitivity of 89.4% and specificity of 85.7%. Mean SPRS was impeded in transmurally infarcted segments (15.9% ± 6) compared to SPRS of remote myocardium (31.4% ± 5; p = 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16.6% with a sensitivity of 83.3% and specificity of 76.5%. 80.3% of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Global strain parameters are impaired in patients with chronic infarcts compared to controls. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected due to wall motion abnormalities in visual wall motion assessment. Analysis of segmental circumferential strain shows a promising method for detection of chronic scars in routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.
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Affiliation(s)
- M Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - M Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - M Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - A Gotschy
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - B Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland
| | - R Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092, Zurich, Switzerland.
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12
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Samaan AA, Said K, Aroussy WE, Hassan M, Romeih S, El Sawy A, Fawzy ME, Yacoub M. Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study. Front Cardiovasc Med 2021; 8:674435. [PMID: 34150869 PMCID: PMC8212956 DOI: 10.3389/fcvm.2021.674435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45-69) %, LVEDVI of 74 (44-111) ml/m2 and LVESVI of 31 (14-57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (-16.4 vs. -13.8, p < 0.001) and global circumferential strain (GCS) (-17.8 vs. -15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (-17.9 vs. -16.4, p = 0.008) and GCS (-19.4 vs. -17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.
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Affiliation(s)
- Amir Anwar Samaan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Karim Said
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Wafaa El Aroussy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Soha Romeih
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Amr El Sawy
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Mohammed Eid Fawzy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Magdi Yacoub
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
- Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom
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13
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Loecher M, Hannum AJ, Perotti LE, Ennis DB. Arbitrary Point Tracking with Machine Learning to Measure Cardiac Strains in Tagged MRI. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2021; 12738:213-222. [PMID: 34590079 PMCID: PMC8478357 DOI: 10.1007/978-3-030-78710-3_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cardiac tagged MR images allow for deformation fields to be measured in the heart by tracking the motion of tag lines throughout the cardiac cycle. Machine learning (ML) algorithms enable accurate and robust tracking of tag lines. Herein, the use of a massive synthetic physics-driven training dataset with known ground truth was used to train an ML network to enable tracking any number of points at arbitrary positions rather than anchored to the tag lines themselves. The tag tracking and strain calculation methods were investigated in a computational deforming cardiac phantom with known (ground truth) strain values. This enabled both tag tracking and strain accuracy to be characterized for a range of image acquisition and tag tracking parameters. The methods were also tested on in vivo volunteer data. Median tracking error was <0.26mm in the computational phantom, and strain measurements were improved in vivo when using the arbitrary point tracking for a standard clinical protocol.
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Affiliation(s)
| | | | - Luigi E Perotti
- Dept. of Mechanical and Aerospace Engineering, University of Central Florida
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14
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Sandhu P, Ong JP, Garg V, Altaha M, Bello O, Singal SR, Verma S, Yan AT, Connelly KA. The effects of saxagliptin on cardiac structure and function using cardiac MRI (SCARF). Acta Diabetol 2021; 58:633-641. [PMID: 33483855 DOI: 10.1007/s00592-020-01661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE A recent large cardiovascular outcome trial in patients with type 2 diabetes (T2DM) demonstrated excess heart failure hospitalization with saxagliptin. We sought to evaluate the impact of saxagliptin on cardiac structure and function using cardiac magnetic resonance imaging (CMR) in patients with T2DM without pre-existing heart failure. METHODS In this prospective study, patients with T2DM without heart failure were prescribed saxagliptin as part of routine guideline-directed management. Clinical assessment, CMR imaging and biomarkers were assessed in a blinded fashion and compared following 6 months of continued treatment. The primary outcome was the change in left ventricular (LV) ejection fraction (LVEF) after 6 months of therapy. Key secondary outcomes included changes in LV and right ventricular (RV) end-diastolic volume, ventricular mass, LV global strain and cardiac biomarkers [N terminal pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP)] over 6 months. RESULTS The cohort (n = 16) had a mean age of 59.9 years with 69% being male. The mean hemoglobin A1c (HbA1c) was 8.3%. Mean baseline LVEF was 57% ± 3.4, with no significant change over 6 months (- 0.2%, 95% CI - 2.5, 2.1, p = 0.86). Detailed CMR analyses that included LV/RV volumes, LV mass, and feature tracking-derived strain showed no significant change (all p > 0.50). NT-proBNP and hsCRP levels did not significantly change (p > 0.20). CONCLUSIONS In this cohort of stable ambulatory patients with T2DM without heart failure, saxagliptin treatment was not associated with adverse ventricular remodeling over 6 months as assessed using CMR and biomarkers.
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Affiliation(s)
- Paul Sandhu
- Division of Cardiology, Queen's University, Kingston, ON, Canada
| | - Jann P Ong
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Vinay Garg
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Mustafa Altaha
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Olubenga Bello
- Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Sewa R Singal
- Department of Medicine, Humber River Hospital, Toronto, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B1M8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, ON, Canada.
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 193 Yonge St, Toronto, ON, M5B1M8, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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15
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Mella H, Mura J, Wang H, Taylor MD, Chabiniok R, Tintera J, Sotelo J, Uribe S. HARP-I: A Harmonic Phase Interpolation Method for the Estimation of Motion From Tagged MR Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1240-1252. [PMID: 33434127 DOI: 10.1109/tmi.2021.3051092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We proposed a novel method called HARP-I, which enhances the estimation of motion from tagged Magnetic Resonance Imaging (MRI). The harmonic phase of the images is unwrapped and treated as noisy measurements of reference coordinates on a deformed domain, obtaining motion with high accuracy using Radial Basis Functions interpolations. Results were compared against Shortest Path HARP Refinement (SP-HR) and Sine-wave Modeling (SinMod), two harmonic image-based techniques for motion estimation from tagged images. HARP-I showed a favorable similarity with both methods under noise-free conditions, whereas a more robust performance was found in the presence of noise. Cardiac strain was better estimated using HARP-I at almost any motion level, giving strain maps with less artifacts. Additionally, HARP-I showed better temporal consistency as a new method was developed to fix phase jumps between frames. In conclusion, HARP-I showed to be a robust method for the estimation of motion and strain under ideal and non-ideal conditions.
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16
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Lee S, Lee M, Hor KN. The role of imaging in characterizing the cardiac natural history of Duchenne muscular dystrophy. Pediatr Pulmonol 2021; 56:766-781. [PMID: 33651923 DOI: 10.1002/ppul.25227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 01/11/2023]
Abstract
Duchene muscular dystrophy (DMD) is a rare but devastating disease resulting in progressive loss of ambulation, respiratory failure, DMD-associated cardiomyopathy (DMD-CM), and premature death. The use of corticosteroids and supportive respiratory care has improved outcomes, such that DMD-CM is now the leading cause of death. Historically, most programs have focused on skeletal myopathy with less attention to the cardiac phenotype. This omission is rather astonishing since patients with DMD possess an absolute genetic risk of developing cardiomyopathy. Unfortunately, heart failure signs and symptoms are vague due to skeletal muscle myopathy leading to limited ambulation. Traditional assessment of cardiac symptoms by the New York Heart Association American College of Cardiology/American Heart Association Staging (ACC/AHA) classification is of limited utility, even in advanced stages. Echocardiographic assessment can detect cardiac dysfunction late in the disease course, but this has proven to be a poor surrogate marker of early cardiovascular disease and an inadequate predictor of DMD-CM. Indeed, one explanation for the paucity of cardiac therapeutic trials for DMD-CM has been the lack of a suitable end-point. Improved outcomes require a better proactive treatment strategy; however, the barrier to treatment is the lack of a sensitive and specific tool to assess the efficacy of treatment. The use of cardiac imaging has evolved from echocardiography to cardiac magnetic resonance imaging to assess cardiac performance. The purpose of this article is to review the role of cardiac imaging in characterizing the cardiac natural history of DMD-CM, highlighting the prognostic implications and an outlook on how this field might evolve in the future.
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Affiliation(s)
- Simon Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Marc Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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17
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Kido T, Hirai K, Ogawa R, Tanabe Y, Nakamura M, Kawaguchi N, Kurata A, Watanabe K, Schmidt M, Forman C, Mochizuki T, Kido T. Comparison between conventional and compressed sensing cine cardiovascular magnetic resonance for feature tracking global circumferential strain assessment. J Cardiovasc Magn Reson 2021; 23:10. [PMID: 33618722 PMCID: PMC7898736 DOI: 10.1186/s12968-021-00708-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feature tracking (FT) has become an established tool for cardiovascular magnetic resonance (CMR)-based strain analysis. Recently, the compressed sensing (CS) technique has been applied to cine CMR, which has drastically reduced its acquisition time. However, the effects of CS imaging on FT strain analysis need to be carefully studied. This study aimed to investigate the use of CS cine CMR for FT strain analysis compared to conventional cine CMR. METHODS Sixty-five patients with different left ventricular (LV) pathologies underwent both retrospective conventional cine CMR and prospective CS cine CMR using a prototype sequence with the comparable temporal and spatial resolution at 3 T. Eight short-axis cine images covering the entire LV were obtained and used for LV volume assessment and FT strain analysis. Prospective CS cine CMR data over 1.5 heartbeats were acquired to capture the complete end-diastolic data between the first and second heartbeats. LV volume assessment and FT strain analysis were performed using a dedicated software (ci42; Circle Cardiovasacular Imaging, Calgary, Canada), and the global circumferential strain (GCS) and GCS rate were calculated from both cine CMR sequences. RESULTS There were no significant differences in the GCS (- 17.1% [- 11.7, - 19.5] vs. - 16.1% [- 11.9, - 19.3; p = 0.508) and GCS rate (- 0.8 [- 0.6, - 1.0] vs. - 0.8 [- 0.7, - 1.0]; p = 0.587) obtained using conventional and CS cine CMR. The GCS obtained using both methods showed excellent agreement (y = 0.99x - 0.24; r = 0.95; p < 0.001). The Bland-Altman analysis revealed that the mean difference in the GCS between the conventional and CS cine CMR was 0.1% with limits of agreement between -2.8% and 3.0%. No significant differences were found in all LV volume assessment between both types of cine CMR. CONCLUSION CS cine CMR could be used for GCS assessment by CMR-FT as well as conventional cine CMR. This finding further enhances the clinical utility of high-speed CS cine CMR imaging.
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Affiliation(s)
- Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kuniaki Hirai
- Department of Radiology, Uwajima City Hospital, Uwajima, Japan
| | - Ryo Ogawa
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masashi Nakamura
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kouki Watanabe
- Department of Cardiology, Saiseikai Matsuyama Hospital, Matsuyama, Japan
| | | | | | - Teruhito Mochizuki
- Department of Radiology, Yoshino Hospital, Imabari, Japan
- Department of Radiology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Hitsukawa, Toon, Ehime, 791-0295, Japan
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18
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Kim MY, Park EA, Lee W, Lee SP. Cardiac Magnetic Resonance Feature Tracking in Aortic Stenosis: Exploration of Strain Parameters and Prognostic Value in Asymptomatic Patients with Preserved Ejection Fraction. Korean J Radiol 2020; 21:268-279. [PMID: 32090519 PMCID: PMC7039715 DOI: 10.3348/kjr.2019.0441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022] Open
Abstract
Objective To determine the most valuable cardiac magnetic resonance feature tracking (CMR-FT) parameters for evaluating aortic stenosis (AS) and determine whether they can predict the prognosis in asymptomatic AS patients with preserved ejection fraction (pEF). Materials and Methods A prospective cohort of 123 moderate to severe AS patients (60 males, 68.6 ± 9.2 years) and 32 control subjects (14 males, 67.9 ± 4.4 years) underwent echocardiography and 3T CMR imaging from 2011–2015. CMR cine images were analyzed using CMR-FT to assess the left ventricular radial, circumferential, and longitudinal peak strain (PS) in 2- and 3-dimensions. The primary endpoints were clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development. For statistical analysis, logistic regression and log-rank tests were used. Results Global PSs differed between AS patients and controls and between severe and moderate AS patients (p < 0.05). Two-dimensional (2D) global radial and longitudinal PSs changed gradually with the severity of AS groups (p < 0.001). Twenty-two of 67 asymptomatic AS patients with pEF experienced CCEs during the follow-up (median: 31.1 months). 2D global longitudinal PS (GLPS) was the single risk factor for CCE (p = 0.017). The relative risk for CCE was 3.9 (p = 0.016, 95% confidence interval: 1.2–11.9) based on 2D GLPS with a cutoff of −17.9% according to receiver operating characteristic curve analysis. Survival analysis demonstrated that asymptomatic AS patients with pEF having impaired 2D GLPS experienced worse event-free survival than the others (p = 0.041). Conclusion 2D global longitudinal and radial PSs may reflect cardiac dysfunction according to the degree of AS. 2D GLPS might be a prognostic predictor of CCEs in asymptomatic AS patients with pEF.
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Affiliation(s)
- Moon Young Kim
- Department of Radiology, Cardiology Division, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, SNU-SMG Boramae Medical Center, Seoul, Korea
| | - Eun Ah Park
- Department of Radiology, Cardiology Division, Seoul National University Hospital, Seoul, Korea.
| | - Whal Lee
- Department of Radiology, Cardiology Division, Seoul National University Hospital, Seoul, Korea
| | - Seung Pyo Lee
- Department of Internal Medicine, Cardiology Division, Seoul National University Hospital, Seoul, Korea
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Abstract
There is a well-established yet unexplained high prevalence of cardiovascular morbidity and mortality in individuals with end-stage kidney disease receiving dialysis. Potential causes include changes in cardiac structure and function, with increased left ventricular mass index as the best established cardiac structural change associated with this increase in mortality. However, in recent years, new echocardiographic and cardiac magnetic resonance imaging techniques have emerged that may provide novel markers that may better explain the mechanisms underlying the cardiovascular morbidity and mortality observed in end-stage kidney disease. This review outlines advances in cardiac imaging and the current status of imaging modalities, including echocardiography, cardiac magnetic resonance imaging, and cardiac positron emission tomography, to identify dialysis patients at high risk for cardiovascular mortality.
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Affiliation(s)
- Jeff Kott
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Nathaniel Reichek
- Cardiac Imaging Program and Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY
- Department of Biomedical Engineering, School of Engineering and Applied Mathematics, Stony Brook University, Stony Brook, NY
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Leonard Arbeit
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Sandeep K. Mallipattu
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
- Renal Section, Northport VA Medical Center, Northport, NY
- Address for Correspondence: Sandeep K. Mallipattu, MD, Department of Medicine/Nephrology, Stony Brook University, 100 Nicolls Rd, HSCT16-080E, Stony Brook, NY 11794-8176.
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20
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Are all left bundle branch blocks the same? Myocardial mechanical implications by cardiovascular magnetic resonance. Int J Cardiol 2020; 324:221-226. [PMID: 32941866 DOI: 10.1016/j.ijcard.2020.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
AIMS Left bundle branch block (LBBB) is usually associated with structural myocardial diseases progressively leading to left ventricular (LV) dysfunction. We sought to determine the mechanical implications of LBBB (as defined based on Strauss' criteria) by Cardiovascular Magnetic Resonance (CMR). METHOD AND RESULTS We included consecutive patients referred to CMR to assess the structural cause of LBBB. CMR scans consisted of cine, stress perfusion, and late gadolinium enhancement (LGE) sequences. Myocardial deformation was assessed by tissue tracking analysis; LGE was quantified using the full width at half maximum method. We included 86 patients [63% male, 70 years (60-72)] with mean QRS duration 150 ± 13 msec. A structural disease was identified on CMR in 53% of patients (ischemic heart disease, IHD, 31%; non-ischemic heart disease, NIHD, 22%), while LBBB-related septal dyssynchrony (SD) was the only abnormality in 47%. LGE was found in 42% of patients. LVEF and myocardial deformation were impaired. Despite similar ECG characteristics, myocardial strain differed significantly between IHD, NIHD and SD patients, and patients with SD showed less impaired myocardial deformation. Indexed LV end-systolic volume and LGE extent were independently associated with impaired strain. CONCLUSIONS Patients with LBBB show different structural and mechanical properties, and LGE extent has an unfavourable effect on myocardial mechanics.
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21
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He J, Sirajuddin A, Li S, Zhuang B, Xu J, Zhou D, Wu W, Sun X, Fan X, Ji K, Chen L, Zhao S, Arai AE, Lu M. Heart Failure With Preserved Ejection Fraction in Hypertension Patients: A Myocardial MR Strain Study. J Magn Reson Imaging 2020; 53:527-539. [PMID: 32896042 DOI: 10.1002/jmri.27313] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite current recommendations for heart failure with preserved ejection fraction (HFpEF), few studies have demonstrated the ability of MRI to identify subtle functional differences between HFpEF with essential hypertension (HFpEF-HTN) patients and hypertension patients (HTN). PURPOSE This study aimed to detect and evaluate HFpEF in patients with HTN using feature-tracking (FT) and to ascertain optimal strain cutoffs for the diagnosis of HFpEF-HTN. STUDY TYPE Retrospective study. POPULATION Three groups (84 with HFpEF-HTN; 72 with HTN; and 70 healthy controls). FIELD STRENGTH 1.5T, steady-state free precession (SSFP), and half-Fourier single-shot turbo spin-echo (HASTE) sequences. ASSESSMENT All patients underwent laboratory testing and imaging protocols (echocardiography and MRI). FT-derived left ventricular (LV) strain and strain rate (SR) were measured and compared among the three groups with adjustment for confounding factors. STATISTICAL TESTS Kolmogorov-Smirnov's test, independent-sample t-tests, one-way analysis of variance (ANOVA), Pearson's correlation coefficient, area under the receiver-operator characteristic (ROC) curve (AUC), and logistic regression. RESULTS Compared to 72 HTN patients and 70 healthy controls, HFpEF-HTN patients (84 patients) demonstrated significantly impaired LV strains (except for global peak systolic radial strain, GRS, P < 0.05 for all). Only LV global peak systolic longitudinal strain (GLS) was significantly impaired in HTN patients vs. controls (P < 0.05). The global peak systolic circumferential SR (sGCSR) showed the highest diagnostic value for the differentiation of HFpEF-HTN patients from HTN patients (AUC, 0.731; cutoff value, -1.11/s; sensitivity, 56.0%; specificity, 84.7%). Only global peak early diastolic longitudinal SR (eGLSR) remained independently associated with a diagnosis of HFpEF-HTN in multilogistic analysis. The major strain parameters significantly correlated with LV ejection fraction, end-systolic volume index, and N-terminal pro-brain natriuretic peptide (P < 0.05 for all) and also demonstrated differences between NYHA functional class. DATA CONCLUSION HFpEF-HTN patients suffer from both systolic and diastolic cardiac dysfunction. FT-derived strain parameters have potential value for the diagnosis and risk stratification of HFpEF-HTN patients. Level of Evidence 3. Technical Efficacy Stage 2.
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Affiliation(s)
- Jian He
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- Department of Health and Human Services (DHHS), National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Shuang Li
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Xu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Zhou
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weichun Wu
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China.,Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keshan Ji
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andrew E Arai
- Department of Health and Human Services (DHHS), National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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22
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Ferdian E, Suinesiaputra A, Fung K, Aung N, Lukaschuk E, Barutcu A, Maclean E, Paiva J, Piechnik SK, Neubauer S, Petersen SE, Young AA. Fully Automated Myocardial Strain Estimation from Cardiovascular MRI-tagged Images Using a Deep Learning Framework in the UK Biobank. Radiol Cardiothorac Imaging 2020; 2:e190032. [PMID: 32715298 PMCID: PMC7051160 DOI: 10.1148/ryct.2020190032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/19/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To demonstrate the feasibility and performance of a fully automated deep learning framework to estimate myocardial strain from short-axis cardiac MRI-tagged images. MATERIALS AND METHODS In this retrospective cross-sectional study, 4508 cases from the U.K. Biobank were split randomly into 3244 training cases, 812 validation cases, and 452 test cases. Ground truth myocardial landmarks were defined and tracked by manual initialization and correction of deformable image registration using previously validated software with five readers. The fully automatic framework consisted of (a) a convolutional neural network (CNN) for localization and (b) a combination of a recurrent neural network (RNN) and a CNN to detect and track the myocardial landmarks through the image sequence for each slice. Radial and circumferential strain were then calculated from the motion of the landmarks and averaged on a slice basis. RESULTS Within the test set, myocardial end-systolic circumferential Green strain errors were -0.001 ± 0.025, -0.001 ± 0.021, and 0.004 ± 0.035 in the basal, mid-, and apical slices, respectively (mean ± standard deviation of differences between predicted and manual strain). The framework reproduced significant reductions in circumferential strain in participants with diabetes, hypertensive participants, and participants with a previous heart attack. Typical processing time was approximately 260 frames (approximately 13 slices) per second on a GPU with 12 GB RAM compared with 6-8 minutes per slice for the manual analysis. CONCLUSION The fully automated combined RNN and CNN framework for analysis of myocardial strain enabled unbiased strain evaluation in a high-throughput workflow, with similar ability to distinguish impairment due to diabetes, hypertension, and previous heart attack.Published under a CC BY 4.0 license. Supplemental material is available for this article.
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Affiliation(s)
- Edward Ferdian
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Avan Suinesiaputra
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Kenneth Fung
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Nay Aung
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Elena Lukaschuk
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Ahmet Barutcu
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Edd Maclean
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Jose Paiva
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Stefan K. Piechnik
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Stefan Neubauer
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Steffen E. Petersen
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
| | - Alistair A. Young
- From the Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand (E.F., A.S., A.A.Y.); William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, England (K.F., N.A., E.M., J.P., S.E.P.); and Oxford NIHR Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, England (E.L., A.B., S.K.P., S.N.); Department of Biomedical Engineering, King’s College London, 5th Floor Becket House, 1 Lambeth Palace Rd, London SE1 7EU, England (A.A.Y.)
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Liu H, Wang J, Pan Y, Ge Y, Guo Z, Zhao S. Early and Quantitative Assessment of Myocardial Deformation in Essential Hypertension Patients by Using Cardiovascular Magnetic Resonance Feature Tracking. Sci Rep 2020; 10:3582. [PMID: 32107428 PMCID: PMC7046638 DOI: 10.1038/s41598-020-60537-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/13/2020] [Indexed: 01/19/2023] Open
Abstract
The aims of the study were to identify subclinical global systolic function abnormalities and evaluate influencing factors associated with left ventricular (LV) strain parameters in hypertensive subjects using cardiovascular magnetic resonance imaging feature tracking (CMR-FT). The study enrolled 57 patients with essential hypertension (mean age: 43.04 ± 10.90 years; 35 males) and 26 healthy volunteers (mean age: 38.69 ± 10.44 years; 11 males) who underwent clinical evaluation and CMR examination. Compared with controls, hypertensive patients had significantly impaired myocardial strain values while ejection fraction (EF) did not differ. After multivariate regression analyses adjustment for confounders, the global radial strains (GRS) was independently associated with the mean arterial pressure (MAP) and left ventricular mass index (LVMI) (β = -0.219, p = 0.009 and β = -0.224, p = 0.015, respectively; Adjusted R2 = 0.4); the global circumferential strains (GCS) was also independently associated with the MAP and LVMI (β = 0.084, p = 0.002 and β = 0.073, p = 0.01, respectively; Adjusted R2 = 0.439); the global longitudinal strains (GLS) was independently associated with the Age and MAP (β = 0.065, p = 0.021 and β = 0.077, p = 0.009, respectively; Adjusted R2 = 0.289). Myocardial strain can early detect the myocardial damage and may be an appropriate target for preventive strategies before abnormalities of EF.
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Affiliation(s)
- Huina Liu
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China
| | - Jiajia Wang
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China
| | - Yukun Pan
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China
| | - Yinghui Ge
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China.
| | - Zhiping Guo
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China.
| | - Shihua Zhao
- Department of Cardiac MR, Fuwai Hospital, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, People's Republic of China
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24
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Karthikeyan B, Sonkawade SD, Pokharel S, Preda M, Schweser F, Zivadinov R, Kim M, Sharma UC. Tagged cine magnetic resonance imaging to quantify regional mechanical changes after acute myocardial infarction. Magn Reson Imaging 2019; 66:208-218. [PMID: 31668928 DOI: 10.1016/j.mri.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE The conventional volumetric approaches of measuring cardiac function are load-dependent, and are not able to discriminate functional changes in the infarct, transition and remote myocardium. We examined phase-dependent regional mechanical changes in the infarct, transition and remote regions after acute myocardial infarction (MI) in a preclinical mouse model using cardiovascular magnetic resonance imaging (CMR). METHODS We induced acute MI in six mice with left anterior descending coronary artery ligation. We then examined cardiac (infarct, transition and remote-zone) morphology and function utilizing 9.4 T high field CMR before and 2 weeks after the induction of acute MI. Myocardial scar tissue was evaluated by using CMR with late gadolinium enhancement (LGE). After determining global function through volumetric analysis, regional wall motion was evaluated by measuring wall thickening and radial velocities. Strain rate imaging was performed to assess circumferential contraction and relaxation at the myocardium, endocardium, and epicardium. RESULTS There was abnormal LGE in the anterior walls after acute MI suggesting a successful MI procedure. The transition zone consisted of a mixed signal intensity, while the remote zone contained viable myocardium. As expected, the infarct zone had demonstrated severely decreased myocardial velocities and strain rates, suggesting reduced contraction and relaxation function. Compared to pre-infarct baseline, systolic and diastolic velocities (vS and vD) were significantly reduced at the transition zone (vS: -1.86 ± 0.16 cm/s vs -0.68 ± 0.13 cm/s, P < 0.001; vD: 1.86 ± 0.17 cm/s vs 0.53 ± 0.06 cm/s, P < 0.001) and remote zone (vS: -1.86 ± 0.16 cm/s vs -0.65 ± 0.12 cm/s, P < 0.001; vD: 1.86 ± 0.16 cm/s vs 0.51 ± 0.04 cm/s, P < 0.001). Myocardial peak systolic and diastolic strain rates (SRS and SRD) were significantly lower in the transition zone (SRS: -4.2 ± 0.3 s-1 vs -1.3 ± 0.2 s-1, P < 0.001; SRD: 3.9 ± 0.3 s-1 vs 1.3 ± 0.2 s-1, P < 0.001) and remote zone (SRS: -3.8 ± 0.3 s-1 vs -1.4 ± 0.3 s-1, P < 0.001; SRD: 3.5 ± 0.2 s-1 vs 1.5 ± 0.4 s-1, P = 0.006). Endocardial and epicardial SRS and SRD were similarly reduced in the transition and remote zones compared to baseline. CONCLUSIONS This study, for the first time, utilized state-of-the art high-field CMR algorithms in a preclinical mouse model for a comprehensive and controlled evaluation of the regional mechanical changes in the transition and remote zones, after acute MI. Our data demonstrate that CMR can quantitatively monitor dynamic post-MI remodeling in the transition and remote zones, thereby serving as a gold standard tool for therapeutic surveillance.
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Affiliation(s)
- Badri Karthikeyan
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Swati D Sonkawade
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Saraswati Pokharel
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Marilena Preda
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Ferdinand Schweser
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Robert Zivadinov
- Center for Biomedical Imaging at the Clinical and Translational Science Institute, University at Buffalo, Buffalo, NY, United States of America
| | - Minhyung Kim
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Umesh C Sharma
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America.
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Prasad SK, Lota AS. Improving Risk Stratification by Cardiac Magnetic Resonance Imaging in Heart Failure: Is Strain the Missing Link? JACC Cardiovasc Imaging 2019; 11:1430-1432. [PMID: 30286906 DOI: 10.1016/j.jcmg.2017.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/28/2022]
Affiliation(s)
- Sanjay K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.
| | - Amrit S Lota
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
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Jensen MT, Fung K, Aung N, Sanghvi MM, Chadalavada S, Paiva JM, Khanji MY, de Knegt MC, Lukaschuk E, Lee AM, Barutcu A, Maclean E, Carapella V, Cooper J, Young A, Piechnik SK, Neubauer S, Petersen SE. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy. Circ Cardiovasc Imaging 2019; 12:e009476. [PMID: 31522551 PMCID: PMC7099857 DOI: 10.1161/circimaging.119.009476] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
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Affiliation(s)
- Magnus T. Jensen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
- Department of Cardiology, Copenhagen University Hospital Herlev- Gentofte, Hellerup, Denmark (M.T.J.)
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark (M.T.J.)
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Sucharitha Chadalavada
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Martina C. de Knegt
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Elena Lukaschuk
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Aaron M. Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
| | - Ahmet Barutcu
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Edd Maclean
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Valentina Carapella
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
| | - Alistair Young
- Department of Biomedical Engineering, King’s College London, United Kingdom (A.Y.)
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom (E.L., A.B., V.C., S.K.P., S.N.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., E.M., J.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (M.T.J., K.F., N.A., M.M.S., S.C., J.M.P., M.Y.K., M.C.d.K., A.M.L., S.E.P.)
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Cardiac magnetic resonance-tissue tracking for the early prediction of adverse left ventricular remodeling after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2019; 35:2095-2102. [DOI: 10.1007/s10554-019-01659-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/26/2019] [Indexed: 01/20/2023]
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Parajuli N, Lu A, Ta K, Stendahl J, Boutagy N, Alkhalil I, Eberle M, Jeng GS, Zontak M, O'Donnell M, Sinusas AJ, Duncan JS. Flow network tracking for spatiotemporal and periodic point matching: Applied to cardiac motion analysis. Med Image Anal 2019; 55:116-135. [PMID: 31055125 PMCID: PMC6939679 DOI: 10.1016/j.media.2019.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/16/2019] [Accepted: 04/17/2019] [Indexed: 12/15/2022]
Abstract
The accurate quantification of left ventricular (LV) deformation/strain shows significant promise for quantitatively assessing cardiac function for use in diagnosis and therapy planning. However, accurate estimation of the displacement of myocardial tissue and hence LV strain has been challenging due to a variety of issues, including those related to deriving tracking tokens from images and following tissue locations over the entire cardiac cycle. In this work, we propose a point matching scheme where correspondences are modeled as flow through a graphical network. Myocardial surface points are set up as nodes in the network and edges define neighborhood relationships temporally. The novelty lies in the constraints that are imposed on the matching scheme, which render the correspondences one-to-one through the entire cardiac cycle, and not just two consecutive frames. The constraints also encourage motion to be cyclic, which an important characteristic of LV motion. We validate our method by applying it to the estimation of quantitative LV displacement and strain estimation using 8 synthetic and 8 open-chested canine 4D echocardiographic image sequences, the latter with sonomicrometric crystals implanted on the LV wall. We were able to achieve excellent tracking accuracy on the synthetic dataset and observed a good correlation with crystal-based strains on the in-vivo data.
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Affiliation(s)
- Nripesh Parajuli
- Department of Electrical Engineering, Yale University, New Haven, CT 06520, USA.
| | - Allen Lu
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Kevinminh Ta
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - John Stendahl
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Nabil Boutagy
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Imran Alkhalil
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Melissa Eberle
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA
| | - Geng-Shi Jeng
- Department of Bioengineering, Washington University, Seattle 98195, WA, USA
| | - Maria Zontak
- College of Computer and Information Science, Northeastern University, Seattle 98195, WA, USA
| | - Matthew O'Donnell
- Department of Bioengineering, Washington University, Seattle 98195, WA, USA
| | - Albert J Sinusas
- Department of Internal Medicine, Yale University, New Haven, CT 06520, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT 06520, USA
| | - James S Duncan
- Department of Electrical Engineering, Yale University, New Haven, CT 06520, USA; Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT 06520, USA
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29
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Kar J, Cohen MV, McQuiston SA, Figarola MS, Malozzi CM. Can post-chemotherapy cardiotoxicity be detected in long-term survivors of breast cancer via comprehensive 3D left-ventricular contractility (strain) analysis? Magn Reson Imaging 2019; 62:94-103. [PMID: 31254595 DOI: 10.1016/j.mri.2019.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE This study applied a novel and automated contractility analysis tool to investigate possible cardiotoxicity-related left-ventricular (LV) dysfunction in breast cancer patients following treatment with anti-neoplastic chemotherapy agents (CTA). Subclinical dysfunction otherwise undetected via LV ejection fraction (LVEF) was determined. METHODS Deformation data were acquired with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence on 16 female patients who had CTA-based treatment. The contractility analysis tool consisting of image quantization-based boundary detection and the meshfree Radial Point Interpolation Method was used to compare chamber quantifications, 3D regional strains and torsion between patients and healthy subjects (N = 26 females with N = 14 age-matched). Quantifications of patient LVEFs from DENSE and Steady-State Free Precession (SSFP) acquisitions were compared, Bland-Altman interobserver agreements measured on their strain results and differences in contractile parameters with healthy subjects determined via Student's t-tests. RESULTS A significant difference was not found between DENSE and SSFP-based patient LVEFs at 58 ± 7% vs 57 ± 9%, p = 0.6. Bland-Altman agreements were - 0.01 ± 0.05 for longitudinal strain and 0.1 ± 1.3° for torsion. Differences in basal diameter indicating enlargement, 5.2 ± 0.5 cm vs 4.5 ± 0.5 cm, p < 0.01, and torsion, 4.7 ± 1.0° vs 8.1 ± 1.1°, p < 0.001 in the mid-ventricle and 5.9 ± 1.2° vs 10.2 ± 0.9°, p < 0.001 apically, were seen between patients and age-matched healthy subjects and similarly in longitudinal strain, but not in LVEF. CONCLUSIONS Results from the statistical analysis reveal the likelihood of LV remodeling in this patient subpopulation otherwise not indicated by LVEF measurements.
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Affiliation(s)
- Julia Kar
- Departments of Mechanical Engineering and Pharmacology, University of South Alabama, 150 Jaguar Drive, Mobile, AL 36688, United States of America.
| | - Michael V Cohen
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
| | - Samuel A McQuiston
- Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, United States of America
| | - Maria S Figarola
- Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive, Mobile, AL 36617, United States of America
| | - Christopher M Malozzi
- Department of Cardiology, College of Medicine, University of South Alabama, 1700 Center Street, Mobile, AL 36604, United States of America
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Ong JP, Wald R, Goldstein MB, Leipsic J, Kiaii M, Deva DP, Kirpalani A, Jimenez‐Juan L, Bello O, Azizi PM, Wald RM, Wright GA, Harel Z, Connelly KA, Yan AT. Left ventricular strain analysis using cardiac magnetic resonance imaging in patients undergoing in‐centre nocturnal haemodialysis. Nephrology (Carlton) 2019; 24:557-563. [DOI: 10.1111/nep.13404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jann P Ong
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Ron Wald
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Marc B Goldstein
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Jonathon Leipsic
- Department of Radiology and Division of CardiologySt. Paul’s Hospital, University of British Columbia Vancouver British Columbia Canada
| | - Mercedeh Kiaii
- Division of NephrologySt. Paul’s Hospital, University of British Columbia Vancouver British Columbia Canada
| | - Djeven P Deva
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSt. Michael’s Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto Ontario Canada
| | - Anish Kirpalani
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSt. Michael’s Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto Ontario Canada
| | - Laura Jimenez‐Juan
- University of Toronto Toronto Ontario Canada
- Department of Medical ImagingSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Olugbenga Bello
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
| | | | - Rachel M Wald
- University of Toronto Toronto Ontario Canada
- Division of CardiologyToronto General Hospital Toronto Ontario Canada
| | - Graham A Wright
- University of Toronto Toronto Ontario Canada
- Schulich Heart Program and the Sunnybrook Research InstituteSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Ziv Harel
- University of Toronto Toronto Ontario Canada
- Division of NephrologySt Michael’s Hospital, and Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Ontario Canada
| | - Kim A Connelly
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Andrew T Yan
- Division of CardiologySt. Michael’s Hospital Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
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31
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Cameli M, Mandoli GE, Sciaccaluga C, Mondillo S. More than 10 years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice? Echocardiography 2019; 36:958-970. [DOI: 10.1111/echo.14339] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
| | - Giulia E. Mandoli
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
| | | | - Sergio Mondillo
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
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Rajakumar AP, Ravikumar MS, Palanisamy V, Raman K, Mohanraj A, Jamesraj J, Kurian VM, Ajit M, Sethuratnam R. Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial. Indian J Thorac Cardiovasc Surg 2019; 35:175-185. [PMID: 33061002 DOI: 10.1007/s12055-018-0748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022] Open
Abstract
Objective To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM). Methods Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed. Results Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively. Conclusion Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.
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Affiliation(s)
- Anjith Prakash Rajakumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mithun Sundararaaja Ravikumar
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Vijayanand Palanisamy
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Karthik Raman
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Anbarasu Mohanraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Jacob Jamesraj
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Valikapthalil Mathew Kurian
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Mullasari Ajit
- Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
| | - Rajan Sethuratnam
- Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India
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Anqi Y, Yu Z, Mingjun X, Xiaoli K, Mengmeng L, Fangfang L, Mei Z. Use of echocardiography to monitor myocardial damage during anthracycline chemotherapy. Echocardiography 2019; 36:495-502. [PMID: 30636342 DOI: 10.1111/echo.14252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anthracycline-related cardiotoxicity has a poor prognosis; therefore, early detection of any change in LV function is critical. OBJECTIVE The aim of this study was to evaluate the two-dimensional speckle tracking technique for the early detection of cardiac toxicity after low-dose anthracycline chemotherapy in the Chinese population. METHODS Forty breast cancer patients were treated by chemotherapy using anthracycline for 4-6 cycles. Patients were examined by echocardiography before chemotherapy (T0) and after the second (T2), fourth (T4), and sixth (T6) cycle. LV ejection fraction (LVEF), LV global longitudinal strain (GLS) and endocardium, mid-myocardium, and epicardium global longitudinal strain (GLS-Endo, GLS-Mid, and GLS-Epi). Additionally, global circumferential strain (GCS), RV global longitudinal strain (RVGLS), and LA global longitudinal strain (LAGLS) were evaluated. RESULTS Left ventricular ejection fraction was significantly reduced at T4 (P < 0.05). Compared with T0, GLS, GLS-Endo, GLS-Mid, and GLS-Epi were significantly reduced at T2, T4, and T6 (P < 0.05 for all), the apical septum wall (AS) was also reduced significantly at T2 (P < 0.05), and the apical anterior wall (AA) and the basal anterior wall (BA) longitudinal strains were significantly reduced at T4 (P < 0.05). GCS, RVGLS, and LAGLS were not significantly changed after treatment (P > 0.05). CONCLUSIONS LV stratified strains and strain of the segments supplied by the left anterior descending coronary artery are more sensitive to the cardiac toxicity of anthracycline.
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Affiliation(s)
- Yang Anqi
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Yu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xu Mingjun
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kong Xiaoli
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Li Mengmeng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Liu Fangfang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Mei
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
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Magrath P, Maforo N, Renella P, Nelson SF, Halnon N, Ennis DB. Cardiac MRI biomarkers for Duchenne muscular dystrophy. Biomark Med 2018; 12:1271-1289. [PMID: 30499689 PMCID: PMC6462870 DOI: 10.2217/bmm-2018-0125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a fatal inherited genetic disorder that results in progressive muscle weakness and ultimately loss of ambulation, respiratory failure and heart failure. Cardiac MRI (MRI) plays an increasingly important role in the diagnosis and clinical care of boys with DMD and associated cardiomyopathies. Conventional cardiac MRI biomarkers permit measurements of global cardiac function and presence of fibrosis, but changes in these measures are late manifestations. Emerging MRI biomarkers of myocardial function and structure include the estimation of rotational mechanics and regional strain using MRI tagging; T1-mapping; and T2-mapping, a marker of inflammation, edema and fat. These emerging biomarkers provide earlier insights into cardiac involvement in DMD, improving patient care and aiding the evaluation of emerging therapies.
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Affiliation(s)
- Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Nyasha Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, Department of Human Genetics, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, University of California, Los Angeles, CA 90024, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
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Muser D, Castro SA, Santangeli P, Nucifora G. Clinical applications of feature-tracking cardiac magnetic resonance imaging. World J Cardiol 2018; 10:210-221. [PMID: 30510638 PMCID: PMC6259029 DOI: 10.4330/wjc.v10.i11.210] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/04/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diagnosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evaluation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.
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Affiliation(s)
- Daniele Muser
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Simon A Castro
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Gaetano Nucifora
- NorthWest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, United Kingdom.
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Grattan M, Mertens L, Grosse-Wortmann L, Friedberg MK, Cifra B, Dragulescu A. Ventricular Torsion in Young Patients With Single-Ventricle Anatomy. J Am Soc Echocardiogr 2018; 31:1288-1296. [PMID: 30340887 DOI: 10.1016/j.echo.2018.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND In normal left ventricles, clockwise basal rotation and counterclockwise apical rotation result in systolic torsion. Torsion is important for contractile efficiency and may be especially important in single-ventricle (SV) physiology. However, little is known about torsion in patients with SVs. The aim of this study was to measure torsion in SVs and to determine its relationship with other measures of ventricular function. The hypothesis was that torsion would be decreased in all SVs, most significantly in single right ventricles, and that it would correlate with other measures of ventricular function. METHODS A prospective cross-sectional study was performed in 61 patients with SVs undergoing pre- or post-Fontan cardiac catheterization and 30 matched control subjects. Echocardiography, catheterization, and cardiac magnetic resonance imaging were performed under the same anesthetic. Torsion and strain were measured using speckle-tracking echocardiography. Intracardiac pressures, pulmonary vascular resistance, and cardiac magnetic resonance imaging-derived ventricular volume and ejection fraction were measured. RESULTS Thirty-five patients were left ventricular dominant, 15 were right ventricular dominant, 10 were codominant, and one had indeterminate morphology. Thirty-seven patients were pre-Fontan and 24 were post-Fontan. Patients with SVs had similar overall torsion as control subjects (median, 1.7°/cm vs 1.65°/cm; P = NS); however, they had decreased or reversed basal rotation (-0.32°/cm vs -0.93°/cm, P < .0001) and increased apical rotation (1.45°/cm vs 1.06°/cm, P = .0065). There were no differences on the basis of ventricular dominance or palliative stage. Torsion did not significantly correlate with other echocardiographic, catheter-based, or cardiac magnetic resonance imaging measures of cardiac function. CONCLUSIONS Single left and right ventricles exhibit preserved torsion, mainly because of preserved or increased apical rotation. Possible mechanisms of torsion in single right ventricles include myofiber remodeling and altered ventricular-ventricular interactions. Understanding myocardial deformation in SVs will improve the ability to interpret ventricular function in this precarious population.
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Affiliation(s)
- Michael Grattan
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, LHSC Children's Hospital, University of Western Ontario, London, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark K Friedberg
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Cifra
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andreea Dragulescu
- Department of Paediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Kang Y, Xiao F, Chen H, Wang W, Shen L, Zhao H, Shen X, Chen F, He B. Subclinical Anthracycline-Induced Cardiotoxicity in the Long - Term Follow-Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis. Arq Bras Cardiol 2018; 110:219-228. [PMID: 29694546 PMCID: PMC5898770 DOI: 10.5935/abc.20180042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background Anthracycline generates progressive left ventricular dysfunction associated
with a poor prognosis. Objectives The purpose of this study was to evaluate whether layer-specific strain
analysis could assess the subclinical left ventricular dysfunction after
exposure to anthracycline. Methods Forty-two anthracycline-treated survivors of large B-cell non-Hodgkin
lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27
healthy volunteers, aged 51.39 ± 13.40 years (control group) were
enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67
± 71.71mg/m2. The time from last dose of epirubicin to the
echocardiographic examination was 52.92 ± 22.32 months. Global
longitudinal (GLS), circumferential (GCS) and radial strain (GRS),
subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO,
LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values
were analyzed. Transmural strain gradient was calculated as differences in
peak systolic strain between the subendocardial and subepicardial layers. A
value of p < 0.05 was considered significant. Results Conventional parameters of systolic and diastolic function showed no
significant difference between two groups. Compared with controls, patients
had significantly lower GCS and GLS. Multi-layer speckle tracking analysis
showed significant reduction of circumferential strain of subendocardial
layer, transmural CS gradient and longitudinal strain of all three layers.
In contrast, the two groups did not differ in transmural longitudinal strain
gradient and radial strains. Conclusions It proved the preferential impairment of subendocardial deformation in
long-term survivors after exposure to anthracycline. Multi-layer speckle
tracking echocardiography might facilitate the longitudinal follow-up of
this at-risk patient cohort.
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Affiliation(s)
- Yu Kang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fei Xiao
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, China
| | - Wei Wang
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lijing Shen
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hang Zhao
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xuedong Shen
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fangyuan Chen
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ben He
- Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Zamirian M, Samiee E, Moaref A, Abtahi F, Tahamtan M. Assessment of Subclinical Myocardial Changes in Non-Alcoholic Fatty Liver Disease: A Case-Control Study Using Speckle Tracking Echocardiography. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:466-472. [PMID: 30214098 PMCID: PMC6123551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Considering the association between cardiac abnormalities and non-alcoholic fatty liver disease (NAFLD), the present study aimed to evaluate the relationship between biopsy-proven NAFLD and functional echocardiographic parameters, including left ventricular (LV) global longitudinal strain (GLS) in asymptomatic individuals. METHODS Thirty asymptomatic patients with liver biopsy-proven NAFLD and the same number with no evidence of fatty liver in ultrasonography were enrolled in the study as cases and controls, respectively. The measured echocardiographic parameters included LV ejection fraction (LVEF), LV end-systolic and end-diastolic dimensions (ESD, EDD), LV end-systolic and end-diastolic volumes (ESV, EDV), E/e' ratio (early-diastolic mitral inflow velocity/early-diastolic myocardial velocity), E/A ratio (early-diastolic mitral inflow velocity/late-diastolic mitral inflow velocity), and GLS. Data were analyzed using the SPSS statistical software (version 18.0) by performing the independent t test, Chi-square, and non-parametric Mann-Whitney U tests. P values <0.05 were considered statistically significant. RESULTS A significant difference in ESD (32.1±1.4 mm vs. 34±1.8 mm), EDD (41.9±1.7 mm vs. 45.2±3.1 mm), and E/e' ratio (8.4±0.8 vs. 7.4±1.2) was detected among individuals with NAFLD compared with those without NAFLD (P<0.001 for the first two parameters and P=0.002 for the last one). GLS was also significantly lower in NAFLD patients than in controls, but within normal levels (19.3%±2.0 vs. 21.2%±1.4, P<0.001). CONCLUSION The findings support the presence of subclinical cardiovascular structural and functional changes in patients affected by NAFLD. It also indicates that the use of GLS is more sensitive than LVEF for the detection of LV systolic dysfunction in NAFLD patients.
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The comparison of short-term prognostic value of T1 mapping with feature tracking by cardiovascular magnetic resonance in patients with severe dilated cardiomyopathy. Int J Cardiovasc Imaging 2018; 35:171-178. [DOI: 10.1007/s10554-018-1444-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
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Kar J, Zhong X, Cohen MV, Cornejo DA, Yates-Judice A, Rel E, Figarola MS. Introduction to a mechanism for automated myocardium boundary detection with displacement encoding with stimulated echoes (DENSE). Br J Radiol 2018; 91:20170841. [PMID: 29565646 PMCID: PMC6221787 DOI: 10.1259/bjr.20170841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Displacement ENcoding with Stimulated Echoes (DENSE) is an MRI technique developed to encode phase related to myocardial tissue displacements, and the displacement information directly applied towards detecting left-ventricular (LV) myocardial motion during the cardiac cycle. The purpose of this study is to present a novel, three-dimensional (3D) DENSE displacement-based and magnitude image quantization-based, semi-automated detection technique for myocardial wall motion, whose boundaries are used for rapid and automated computation of 3D myocardial strain. Methods: The architecture of this boundary detection algorithm is primarily based on pixelwise spatiotemporal increments in LV tissue displacements during the cardiac cycle and further reinforced by radially searching for pixel-based image gradients in multithreshold quantized magnitude images. This spatiotemporal edge detection methodology was applied to all LV partitions and their subsequent timeframes that lead to full 3D LV reconstructions. It was followed by quantifications of 3D chamber dimensions and myocardial strains, whose rapid computation was the primary motivation behind developing this algorithm. A pre-existing two-dimensional (2D) semi-automated contouring technique was used in parallel to validate the accuracy of the algorithm and both methods tested on DENSE data acquired in (N = 14) healthy subjects. Chamber quantifications between methods were compared using paired t-tests and Bland–Altman analysis established regional strain agreements. Results: There were no significant differences in the results of chamber quantifications between the 3D semi-automated and existing 2D boundary detection techniques. This included comparisons of ejection fractions, which were 0.62 ± 0.04 vs 0.60 ± 0.06 (p = 0.23) for apical, 0.60 ± 0.04 vs 0.59 ± 0.05 (p = 0.76) for midventricular and 0.56 ± 0.04 vs 0.58 ± 0.05 (p = 0.07) for basal segments, that were quantified using the 3D semi-automated and 2D pre-existing methodologies, respectively. Bland–Altman agreement between regional strains generated biases of 0.01 ± 0.06, –0.01 ± 0.01 and 0.0 ± 0.06 for the radial, circumferential and longitudinal directions, respectively. Conclusion: A new, 3D semi-automated methodology for contouring the entire LV and rapidly generating chamber quantifications and regional strains is presented that was validated in relation to an existing 2D contouring technique. Advances in knowledge: This study introduced a scientific tool for rapid, semi-automated generation of clinical information regarding shape and function in the 3D LV.
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Affiliation(s)
- Julia Kar
- 1 Departments of Mechanical Engineering and Pharmacology, University of South Alabama , Mobile, AL , USA
| | - Xiaodong Zhong
- 2 MR R&D Collaborations, Siemens Healthcare Inc. , Atlanta, GA , USA
| | - Michael V Cohen
- 3 Department of Physiology, College of Medicine, University of South Alabama , Mobile, Al , USA
| | - Daniel Auger Cornejo
- 4 Department of Biomedical Engineering, University of Virginia , Charlottesville, VA , USA
| | - Angela Yates-Judice
- 5 Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive , Mobile, AL , USA
| | - Eduardo Rel
- 5 Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive , Mobile, AL , USA
| | - Maria S Figarola
- 5 Department of Radiology, University of South Alabama, 2451 USA Medical Center Drive , Mobile, AL , USA
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Abstract
The objective assessments of left ventricular (LV) and right ventricular (RV) ejection fractions (EFs) are the main important tasks of routine cardiovascular magnetic resonance (CMR). Over the years, CMR has emerged as the reference standard for the evaluation of biventricular morphology and function. However, changes in EF may occur in the late stages of the majority of cardiac diseases, and being a measure of global function, it has limited sensitivity for identifying regional myocardial impairment. On the other hand, current wall motion evaluation is done on a subjective basis and subjective, qualitative analysis has a substantial error rate. In an attempt to better quantify global and regional LV function; several techniques, to assess myocardial deformation, have been developed, over the past years. The aim of this review is to provide a comprehensive compendium of all the CMR techniques to assess myocardial deformation parameters as well as the application in different clinical scenarios.
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Affiliation(s)
- A Scatteia
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.,Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy
| | - A Baritussio
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - C Bucciarelli-Ducci
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
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Feisst A, Kuetting DLR, Dabir D, Luetkens J, Homsi R, Schild HH, Thomas D. Influence of observer experience on cardiac magnetic resonance strain measurements using feature tracking and conventional tagging. IJC HEART & VASCULATURE 2018; 18:46-51. [PMID: 29876503 PMCID: PMC5988487 DOI: 10.1016/j.ijcha.2018.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
Abstract
Aim CMR quantitative myocardial strain analysis is increasingly being utilized in clinical routine. CMR feature tracking (FT) is now considered an alternative to the reference standard for strain assessment -CMR tagging. The impact of observer experience on the validity of FT results has not yet been investigated. The aim of this study was therefore to evaluate the observer experience-dependency of CMR FT and to compare results with the reference standard. Methods CSPAMM and SSFP-Cine sequences were acquired in 38 individuals (19 patients with HFpEF,19 controls) in identical midventricular short-axis locations. Global peak systolic circumferential strain (PSCS) together with LV ejection fraction (EF) and volumes were assessed by three observers (5,3 and 0 years of CMR-strain experience). Intermodality, intra- as well inter-observer variability were assessed. Results Correlation between tagging and FT derived PSCS depended on observer experience (r = 0.69, r = 0.58 and r = 0.53). For the inexperienced observer tagging and FT derived PSCS differed significantly (p = 0.0061). Intra-observer reproducibility of tagging derived PSCS were similar for all observers (coefficient of variation (CV): 6%, 6.8% and 4.9%) while reproducibility of FT derived PSCS (CV: 7.4%, 9.4% and 15.8%) varied depending on observer experience. Inter-observer reproducibility of tagging derived PSCS for observer 1 and 2 as well as 1 and 3 for tagging (CV: 6.17%, 9.18%) was superior in comparison to FT (CV: 11.8%, 16.4%). Conclusions Reliability and accuracy of FT based strain analysis, more than tagging based strain analysis, is dependent on reader experience. CMR strain experience or dedicated training in strain evaluation is necessary for FT to deliver accurate strain data, comparable to that of CMR tagging.
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Affiliation(s)
- Andreas Feisst
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Daniel L R Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Darius Dabir
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Rami Homsi
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
| | - Daniel Thomas
- Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany
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Prediction of infarct size and adverse cardiac outcomes by tissue tracking-cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction. Eur Radiol 2018; 28:3454-3463. [PMID: 29450717 DOI: 10.1007/s00330-017-5296-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/03/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated whether quantification of global left ventricular (LV) strain by tissue tracking-CMR (TT-CMR) can estimate the infarct size and clinical outcomes in patients with acute myocardial infarction (MI). METHODS We retrospectively registered 247 consecutive patients (58 ± 12 years; male, 81%) who underwent 1.5-T CMR within 1 month after ST-segment elevation MI (median, 4 days; interquartile range, 3-6 days), and 20 age- and sex-matched controls (58 ± 11 years; male, 80%). TT-CMR analysis was applied to cine-images to measure global LV radial, circumferential and longitudinal peak strains (GRS, GCS and GLS, respectively). Adverse cardiac events were defined as cardiac death and hospitalization for heart failure. RESULTS During the follow-up (median, 7.8 years), 20 patients (8.1%) experienced adverse events. LV myocardial deformation was significantly decreased in MI patients compared to controls and closely related to the infarct size. The GRS, GCS and GLS were all significant predictors of adverse cardiac events. In particular, a GLS > -14.1% was independently associated with a > 5-fold increased risk for adverse events, even after adjustment for the LV ejection fraction and infarct size. CONCLUSIONS TT-CMR-derived LV strain is significantly related to the infarct size and adverse events. GLS measurement provides strong prognostic information in MI patients. KEY POINTS • TT-CMR provides reliable quantification of LV strain in MI patients. • TT-CMR allows prediction of the infarct size and adverse events. • In particular, GLS by TT-CMR had independent prognostic value in MI patients.
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Mahjoob MP, Alipour Parsa S, Mazarei A, Safi M, Khaheshi I, Esmaeeli S. Rest 2D speckle tracking echocardiography may be a sensitive but nonspecific test for detection of significant coronary artery disease. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:457-461. [PMID: 29350660 PMCID: PMC6166178 DOI: 10.23750/abm.v88i4.5445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
AIMS To detect the significance of coronary artery disease in the patients, who are suspected, was assumed to be one of the advantages of 2D STE, as a novel non-invasive imaging modality with acceptable accuracy. METHODS In this study, 216 patients who were suspected to have coronary artery disease and candidate for coronary angiography, underwent rest two-dimensional speckle tracking echocardiography (2D STE) and negative global systolic longitudinal strain was evaluated. RESULTS Negative global systolic left ventricular longitudinal strain under 18% in rest 2D-STE was significantly prevalent in patients with significant CAD in coronary angiography (P value<0.0001).Our results revealed sensitivity of 91.1%, specificity of 63.0%, positive predictive value of 80.4%, negative predictive value of 81.0% and accuracy of 80.5% for rest 2D-STE in detection of significant CAD. CONCLUSION Here in we showed that rest Two-dimensional speckle tracking echocardiography could be a sensitive but nonspecific imaging modality to determine significant coronary artery disease. Future studies with large size will reveal more detailed findings.
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Affiliation(s)
- Mohammad Parsa Mahjoob
- Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Cai J, Bryant JA, Le TT, Su B, de Marvao A, O’Regan DP, Cook SA, Chin CWL. Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese. J Cardiovasc Magn Reson 2017; 19:102. [PMID: 29241460 PMCID: PMC5729602 DOI: 10.1186/s12968-017-0413-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/23/2017] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Left ventricular (LV) non-compaction (LVNC) is defined by extreme LV trabeculation, but is measured variably. Here we examined the relationship between quantitative measurement in LV trabeculation and myocardial deformation in health and disease and determined the clinical utility of semi-automated assessment of LV trabeculations. METHODS Cardiovascular magnetic resonance (CMR) was performed in 180 healthy Singaporean Chinese (age 20-69 years; males, n = 91), using balanced steady state free precession cine imaging at 3T. The degree of LV trabeculation was assessed by fractal dimension (FD) as a robust measure of trabeculation complexity using a semi-automated technique. FD measures were determined in healthy men and women to derive normal reference ranges. Myocardial deformation was evaluated using feature tracking. We tested the utility of this algorithm and the normal ranges in 10 individuals with confirmed LVNC (non-compacted/compacted; NC/C ratio > 2.3 and ≥1 risk factor for LVNC) and 13 individuals with suspected disease (NC/C ratio > 2.3). RESULTS Fractal analysis is a reproducible means of assessing LV trabeculation extent (intra-class correlation coefficient: intra-observer, 0.924, 95% CI [0.761-0.973]; inter-observer, 0.925, 95% CI [0.821-0.970]). The overall extent of LV trabeculation (global FD: 1.205 ± 0.031) was independently associated with increased indexed LV end-diastolic volume and mass (sβ = 0.35; p < 0.001 and sβ = 0.13; p < 0.01, respectively) after adjusting for age, sex and body mass index. Increased LV trabeculation was independently associated with reduced global circumferential strain (sβ = 0.17, p = 0.013) and global diastolic circumferential and radial strain rates (sβ = 0.25, p < 0.001 and sβ = -0.15, p = 0.049, respectively). Abnormally high FD was observed in all patients with a confirmed diagnosis of LVNC. Five out of 13 individuals with suspected LVNC had normal FD, despite NC/C > 2.3. CONCLUSION This study defines the normal range of LV trabeculation in healthy Chinese that can be used to make or refute a diagnosis of LVNC using the fractal analysis tool, which we make freely available. We also show that increased myocardial trabeculation is associated with higher LV volumes, mass and reduced myocardial strain.
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Affiliation(s)
- Jiashen Cai
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jennifer Ann Bryant
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Thu-Thao Le
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Boyang Su
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | | | | | - Stuart A. Cook
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- MRC London Institute of Medical Sciences, London, UK
| | - Calvin Woon-Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
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Vural MG, Çetin S, Keser N, Firat H, Akdemir R, Gunduz H. Left ventricular torsion in patients with obstructive sleep apnoea before and after continuous positive airway pressure therapy: assessment by two-dimensional speckle tracking echocardiography. Acta Cardiol 2017; 72:638-647. [PMID: 28660792 DOI: 10.1080/00015385.2017.1315257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate how obstructive sleep apnoea (OSA) influences left ventricular (LV) torsion and whether nasal continuous positive airway pressure (CPAP) therapy has any impact on LV torsion in OSA patients with established cardiovascular risk factors. METHODS LV torsion was assessed by two-dimensional speckle tracking echocardiography (STE) in 162 participants without overt cardiovascular disease. The participants were categorized according to the apnoea-hypopnea index (AHI) as controls and mild, moderate and severe OSA patients. Forty-three patients with AHI greater than 30 were enrolled to receive CPAP therapy for 24 weeks. Twenty-eight patients received CPAP therapy effectively (compliance: 65%). After completion of CPAP therapy, STE was repeated to evaluate LV torsion. RESULTS LV torsion was decreased in the severe OSA group compared to mild and moderate OSA but was similar to controls as a result of predominant decrease in apical rotation. AHI had no correlation with LV torsion in moderate OSA but a significant and mild negative correlation with LV torsion in severe OSA. When adjusted for potential confounding variables such as left ventricular mass index, diastolic dysfunction and the presence of hypertension, AHI and E/E' remained significant predictors of LV torsion in OSA patients. LV apical rotation tended to increase after effective CPAP therapy. On the other hand, LV basal rotation decreased significantly. CONCLUSIONS LV torsion was altered in OSA patients with varying degrees according to the disease severity. Furthermore, there was no significant change of torsion after 24 weeks of CPAP therapy.
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Affiliation(s)
- Mustafa Gökhan Vural
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Süha Çetin
- Cardiology Clinic, Kudret International Private Hospital, Ankara, Turkey
| | - Nurgül Keser
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hikmet Firat
- Department of Chest Diseases and Sleep Disorders, Ministry of Health Anakara Diskapi Education and Research Hospital, Ankara, Turkey
| | - Ramazan Akdemir
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Huseyin Gunduz
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
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Hwang JW, Kim SM, Park SJ, Cho EJ, Kim EK, Chang SA, Lee SC, Choe YH, Park SW. Assessment of reverse remodeling predicted by myocardial deformation on tissue tracking in patients with severe aortic stenosis: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 2017; 19:80. [PMID: 29061184 PMCID: PMC5654100 DOI: 10.1186/s12968-017-0392-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The technique of tissue tracking with balanced steady-state free precession cine sequences was introduced, and allowed myocardial strain to be derived directly, offering advantages over traditional myocardial tagging. The aim of this study was to evaluate the correlation between reverse remodeling as an outcome and left ventricular strain using cardiovascular magnetic resonance imaging (CMR) tissue tracking, and to evaluate prediction of reverse remodeling by myocardial deformation in patients with severe aortic stenosis (AS). METHODS We enrolled 63 patients with severe AS and normal left ventricular (LV) systolic function (ejection fraction > 60%), who underwent both CMR and transthoracic echocardiography (Echo) before surgical aortic valve replacement (AVR). CMR at 1.5 T, including non and post-contrast T1 mapping for extracellular volume (ECV), was carried out to define the amount of myocardial fibrosis. Cardiac Performance Analysis software was used to derive myocardial deformation as strain parameters from three short-axis cine views (basal, mid and apical levels) and apical 2, 3, and 4 chamber views. The primary outcome was reverse remodeling, as evaluated by regression of left ventricular mass index (LVMI). RESULTS Median follow-up was 28.8 months (interquartile range 11.3-38.3 months). As evaluated by LVMI between baseline and follow-up, mass regression was significantly improved after AVR (baseline 145.9 ± 37.0 [g/m2] vs. follow-up 97.7 ± 22.2[g/m2], p < 0.001). Statistically significant Pearson's correlations with LVMI regression were observed for longitudinal global strain (r = -0.461, p < 0.001), radial strain (r = 0.391, p = 0.002), and circumferential strain (r = -0.334, p = 0.009). A simple linear regression analysis showed that all strain parameters could predict the amount of LVMI regression (P < 0.05), as well as non-contrast T1 value (beta = -0.314, p < 0.001) and ECV (beta = -2.546, p = 0.038). However, ECV had the lowest predictive power (multiple r2 = 0.071). Multiple regression analysis showed strain could independently predict the amount of LVMI regression and the longitudinal global strain (beta = -3.335, p < 0.001). CONCLUSION Longitudinal global strain measured by CMR tissue tracking as a technique was correlated with reverse remodeling as LVMI regression and was predictive of this outcome. As a simple and practical method, tissue tracking is promising to assess strain and predict reverse remodeling in severe AS, especially in patients with suboptimal Echo image quality.
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Affiliation(s)
- Ji-won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, 10380 South Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Eun Jeong Cho
- Division of Cardiology, Department of Medicine, National Cancer Center, Goyang, 10408 South Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 South Korea
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Tyrankiewicz U, Olkowicz M, Skórka T, Jablonska M, Orzylowska A, Bar A, Gonet M, Berkowicz P, Jasinski K, Zoladz JA, Smolenski RT, Chlopicki S. Activation pattern of ACE2/Ang-(1-7) and ACE/Ang II pathway in course of heart failure assessed by multiparametric MRI in vivo in Tgαq*44 mice. J Appl Physiol (1985) 2017; 124:52-65. [PMID: 28970203 DOI: 10.1152/japplphysiol.00571.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Here, we analyzed systemic (plasma) and local (heart/aorta) changes in ACE/ACE-2 balance in Tgαq*44 mice in course of heart failure (HF). Tgαq*44 mice with cardiomyocyte-specific Gαq overexpression and late onset of HF were analyzed at different age for angiotensin pattern in plasma, heart, and aorta using liquid chromatography/mass spectrometry, for progression of HF by in vivo magnetic resonance imaging under isoflurane anesthesia, and for physical activity by voluntary wheel running. Six-month-old Tgαq*44 mice displayed decreased ventricle radial strains and impaired left atrial function. At 8-10 mo, Tgαq*44 mice showed impaired systolic performance and reduced voluntary wheel running but exhibited preserved inotropic reserve. At 12 mo, Tgαq*44 mice demonstrated a severe impairment of basal cardiac performance and modestly compromised inotropic reserve with reduced voluntary wheel running. Angiotensin analysis in plasma revealed an increase in concentration of angiotensin-(1-7) in 6- to 10-mo-old Tgαq*44 mice. However, in 12- to 14-mo-old Tgαq*44 mice, increased angiotensin II was noted with a concomitant increase in Ang III, Ang IV, angiotensin A, and angiotensin-(1-10). The pattern of changes in the heart and aorta was also compatible with activation of ACE2, followed by activation of the ACE pathway. In conclusion, mice with cardiomyocyte Gαq protein overexpression develop HF that is associated with activation of the systemic and the local ACE/Ang II pathway. However, it is counterbalanced by a prominent ACE2/Ang-(1-7) activation, possibly allowing to delay decompensation. NEW & NOTEWORTHY Changes in ACE/ACE-2 balance were analyzed based on measurements of a panel of nine angiotensins in plasma, heart, and aorta of Tgαq*44 mice in relation to progression of heart failure (HF) characterized by multiparametric MRI and exercise performance. The early stage of HF was associated with upregulation of the ACE2/angiotensin-(1-7) pathway, whereas the end-stage HF was associated with downregulation of ACE2/angiotensin-(1-7) and upregulation of the ACE/Ang II pathway. ACE/ACE-2 balance seems to determine the decompensation of HF in this model.
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Affiliation(s)
- Urszula Tyrankiewicz
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Mariola Olkowicz
- Department of Biochemistry, Medical University of Gdansk , Gdansk , Poland.,Department of Biotechnology, Poznan University of Life Sciences , Poznan , Poland
| | - Tomasz Skórka
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Magdalena Jablonska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Anna Orzylowska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Anna Bar
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Michal Gonet
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Piotr Berkowicz
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Krzysztof Jasinski
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Jerzy A Zoladz
- Department of Muscle Physiology, University School of Physical Education , Krakow , Poland
| | | | - Stefan Chlopicki
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland.,Chair of Pharmacology, Jagiellonian University Medical College , Krakow , Poland
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Luo R, Cui H, Huang D, Li G. Early assessment of the left ventricular function by epirubicin-induced cardiotoxicity in postoperative breast cancer patients. Echocardiography 2017; 34:1601-1609. [PMID: 28895191 DOI: 10.1111/echo.13693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Epirubicin (Epi) is a potent and effective drug for many malignant cancers with serious cardiotoxicity. Therefore, layer-specific two-dimensional speckle tracking echocardiography (2D-STE) was used to evaluate the longitudinal and circumferential systolic function of the left ventricular for the early detection of cardiotoxicity in this retrospective work. METHODS Overall, 130 female patients with postoperative breast cancer who did not receive radiotherapy were classified into three groups: Group A (control group, n = 40) without any chemotherapy; Group B (n = 44) administered Epi at 180 ~ 240 mg/m2 ; and Group C (n = 46) administered Epi at ≥360 mg/m2 . Peak and global systolic longitudinal strains (GLS) in the total and endocardium, mid-myocardium, and epicardium were measured and calculated from apical four-chamber, apical two-chamber, and left ventricular long-axis views, respectively. Peak and global circumferential strains (GCS) in the total and endocardium, mid-myocardium, and epicardium were measured and calculated from mitral annulus, papillary muscle, and apical levels of the short-axis view, respectively. RESULTS The total GLS and GLS of the endocardium in every view were significantly reduced in group C compared with both groups A and B (P < .05), but there was no significant difference between groups A and B (P > .05). The GLS of the epicardium and mid-myocardium in groups B and C were not significantly reduced (P > .05). There were no significant differences in the total GCS and layer-specific GCS of endocardium, mid-myocardium, and epicardium among the three groups (P > .05). CONCLUSIONS Left ventricular longitudinal systolic dysfunction was detected. Moreover, an impaired endocardium was also detected in an early assessment by layer-specific 2DSTE.
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Affiliation(s)
- Runlan Luo
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongyan Cui
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dongmei Huang
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guangsen Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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50
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Grotenhuis HB, Nyns ECA, Kantor PF, Dipchand AI, Greenway SC, Yoo SJ, Tomlinson G, Chaturvedi RR, Grosse-Wortmann L. Abnormal Myocardial Contractility After Pediatric Heart Transplantation by Cardiac MRI. Pediatr Cardiol 2017; 38:1198-1205. [PMID: 28555404 PMCID: PMC5514218 DOI: 10.1007/s00246-017-1642-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
Acute cellular rejection (ACR) compromises graft function after heart transplantation (HTX). The purpose of this study was to describe systolic myocardial deformation in pediatric HTX and to determine whether it is impaired during ACR. Eighteen combined cardiac magnetic resonance imaging (CMR)/endomyocardial biopsy (EMBx) examinations were performed in 14 HTX patients (11 male, age 13.9 ± 4.7 years; 1.2 ± 1.3 years after HTX). Biventricular function and left ventricular (LV) circumferential strain, rotation, and torsion by myocardial tagging CMR were compared to 11 controls as well as between patients with and without clinically significant ACR. HTX patients showed mildly reduced biventricular systolic function when compared to controls [LV ejection fraction (EF): 55 ± 8% vs. 61 ± 3, p = 0.02; right ventricular (RV) EF: 48 ± 7% vs. 53 ± 6, p = 0.04]. Indexed LV mass was mildly increased in HTX patients (67 ± 14 g/m2 vs. 55 ± 13, p = 0.03). LV myocardial deformation indices were all significantly reduced, expressed by global circumferential strain (-13.5 ± 2.3% vs. -19.1 ± 1.1%, p < 0.01), basal strain (-13.7 ± 3.0% vs. -17.5 ± 2.4%, p < 0.01), mid-ventricular strain (-13.4 ± 2.7% vs. -19.3 ± 2.2%, p < 0.01), apical strain (-13.5 ± 2.8% vs. -19.9 ± 2.0%, p < 0.01), basal rotation (-2.0 ± 2.1° vs. -5.0 ± 2.0°, p < 0.01), and torsion (6.1 ± 1.7° vs. 7.8 ± 1.1°, p < 0.01). EMBx demonstrated ACR grade 0 R in 3 HTX cases, ACR grade 1 R in 11 HTX cases and ACR grade 2 R in 4 HTX cases. When comparing clinically non-significant ACR (grades 0-1 R vs. ACR 2 R), basal rotation, and apical rotation were worse in ACR 2 R patients (-1.4 ± 1.8° vs. -4.2 ± 1.4°, p = 0.01 and 10.2 ± 2.9° vs. 2.8 ± 1.9°, p < 0.01, respectively). Pediatric HTX recipients demonstrate reduced biventricular systolic function and decreased myocardial contractility. Myocardial deformation indices by CMR may serve as non-invasive markers of graft function and, perhaps, rejection in pediatric HTX patients.
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Affiliation(s)
- Heynric B Grotenhuis
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Emile C A Nyns
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Paul F Kantor
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Anne I Dipchand
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Steven C Greenway
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Departments of Paediatrics and Cardiac Sciences, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Shi-Joon Yoo
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, Toronto General Hospital and Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rajiv R Chaturvedi
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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