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1
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Parker LE, Overbey DM, Kang L, Medina CK, Kurzlechner LM, Beckerman Z, Andersen ND, Schroder JN, Turek J. Use of microaxial flow pumps in adolescents. JTCVS Tech 2023; 21:188-194. [PMID: 37854848 PMCID: PMC10580165 DOI: 10.1016/j.xjtc.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives The Impella 5.5 has been successfully used in the adult population; however, safety and efficacy data in patients aged less than 18 years are limited. Methods Six pediatric patients, aged 13 to 16 years and weighing 45 to 113 kg, underwent axillary artery graft placement and attempted placement of the Impella 5.5 device at our institution between August 2020 and March 2023. Results Indications for implantation were heart failure secondary to myocarditis (2), rejection of prior orthotopic heart transplant, idiopathic dilated cardiomyopathy (2), and heart failure after transposition of the great arteries repair. Placement was unsuccessful in a 13.8-year-old female patient due to prohibitively acute angulation of the right subclavian artery, and venoarterial extracorporeal membrane oxygenation cannulation was performed via the axillary graft. In 5 patients with successful Impella 5.5 placement, median duration of support was 13.5 days (range, 7-42 days). One experienced cardiac arrest secondary to coagulation-associated device failure, requiring temporary HeartMate3 implantation. Four patients were bridged to transplant; 3 patients received a transplant directly from Impella 5.5, and 1 patient received a transplant after HeartMate3. The final patient received the HeartMate3 on Impella day 42 and is awaiting transplant. Conclusions Although exact size cutoffs and anatomy are still being determined, our experience provides a framework for use of the Impella 5.5 in adolescents.
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Affiliation(s)
- Lauren E. Parker
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Douglas M. Overbey
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lillian Kang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Cathlyn K. Medina
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Leonie M. Kurzlechner
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ziv Beckerman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Nicholas D. Andersen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jacob N. Schroder
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Joseph Turek
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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2
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Valentin S, Maurac A, Mandry D, Selton-Suty C, Huttin O, Cherifi A, Guillaumot A, Gomez E, Chabot F, Chaouat A. Place de l’IRM cardiaque dans l’hypertension artérielle pulmonaire et l’hypertension pulmonaire thrombo-embolique chronique. Rev Mal Respir 2022; 39:486-497. [DOI: 10.1016/j.rmr.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/14/2022] [Indexed: 01/26/2023]
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Cardinal MP, Blais S, Dumas A, Hamilton V, Larose E, LeBlanc S, Déry J, Grotenhuis H, Leiner T, Mawad W, Têtu C, Greenway SC, Dahl N, Patton D, Hussain A, Drolet C, Gahide G, Farand P, Schantz D, Dallaire F. Novel Z Scores to Correct Biases Due to Ventricular Volume Indexing to Body Surface Area in Adolescents and Young Adults. Can J Cardiol 2021; 37:417-424. [PMID: 32585324 DOI: 10.1016/j.cjca.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reference values for cardiac magnetic resonance imaging (cMRI) in children and young adults are scarce. This leads to risk stratification of patients with congenital heart diseases being based on volumes indexed to body surface area (BSA). We aimed to produce cMRI Z score equations for ventricular volumes in children and young adults and to test whether indexing to BSA resulted in an incorrect assessment of ventricular dilation according to sex, body composition, and growth. METHODS We retrospectively included 372 subjects aged < 26 years with either normal hearts or conditions with no impact on ventricular volumes (reference group), and 205 subjects with repaired tetralogy of Fallot (TOF) aged < 26 years. We generated Z score equations by means of multivariable regression modelling. Right ventricular dilation was assessed with the use of Z scores and compared with indexing to BSA in TOF subjects. RESULTS Ventricular volume Z scores were independent from age, sex, and anthropometric measurements, although volumes indexed to BSA showed significant residual association with sex and body size. In TOF subjects, indexing overestimated dilation in growing children and underestimated dilation in female compared with male subjects, and in overweight compared with lean subjects. CONCLUSIONS Indexed ventricular volumes measured with cMRI did not completely adjust for body size and resulted in a differential error in the assessment of ventricular dilation according to sex and body size. Our proposed Z score equations solved this problem. Future studies should evaluate if ventricular volumes expressed as Z scores have a better prognostic value than volumes indexed to BSA.
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Affiliation(s)
- Mikhail-Paul Cardinal
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Blais
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne Dumas
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Eric Larose
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Stéphanie LeBlanc
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Julie Déry
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Heynric Grotenhuis
- Wilhelmina Children's Hospital, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- University Medical Center Utrecht, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Wadi Mawad
- Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - Cassandre Têtu
- Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - Steven C Greenway
- Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Dahl
- Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David Patton
- Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arif Hussain
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christian Drolet
- Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Québec, Canada
| | - Gérald Gahide
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Paul Farand
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Daryl Schantz
- Children's Hospital of Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Frederic Dallaire
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec, Canada.
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Li YY, Zhang P, Rashid S, Cheng YJ, Li W, Schapiro W, Gliganic K, Yamashita AM, Grgas M, Haag E, Cao JJ. Real-time exercise stress cardiac MRI with Fourier-series reconstruction from golden-angle radial data. Magn Reson Imaging 2020; 75:89-99. [PMID: 33098934 DOI: 10.1016/j.mri.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Magnetic resonance imaging (MRI) can measure cardiac response to exercise stress for evaluating and managing heart patients in the practice of clinical cardiology. However, exercise stress cardiac MRI have been clinically limited by the ability of available MRI techniques to quantitatively measure fast and unstable cardiac dynamics during exercise. The presented work is to develop a new real-time MRI technique for improved quantitative performance of exercise stress cardiac MRI. This technique seeks to represent real-time cardiac images as a sparse Fourier-series along the time. With golden-angle radial acquisition, parallel imaging and compressed sensing can be integrated into a linear system of equations for resolving Fourier coefficients that are in turn used to generate real-time cardiac images from the Fourier-series representation. Fourier-series reconstruction from golden-angle radial data can effectively address data insufficiency due to MRI speed limitation, providing a real-time approach to exercise stress cardiac MRI. To demonstrate the feasibility, an exercise stress cardiac MRI experiment was run to investigate biventricular response to in-scanner biking exercise in a cohort of sixteen healthy volunteers. It was found that Fourier-series reconstruction from golden-angle radial data effectively detected exercise-induced increase in stroke volume and ejection fraction in a healthy heart. The presented work will improve the applications of exercise stress cardiac MRI in the practice of clinical cardiology.
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Affiliation(s)
- Yu Y Li
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Pengyue Zhang
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA
| | - Shams Rashid
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Yang J Cheng
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Wenhui Li
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA
| | - William Schapiro
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Kathleen Gliganic
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Ann-Marie Yamashita
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Marie Grgas
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - Elizabeth Haag
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
| | - J Jane Cao
- St. Francis Hospital, DeMatteis Center for Research and Education, Cardiac Imaging, 101 Northern Blvd, Greenvale, NY 11548, USA.
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5
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Endovascular Repair of Blunt Thoracic Aortic Trauma is Associated With Increased Left Ventricular Mass, Hypertension, and Off-target Aortic Remodeling. Ann Surg 2020; 274:1089-1098. [PMID: 31904600 DOI: 10.1097/sla.0000000000003768] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic elasticity creates a cushion that protects the heart from pressure injury, and a recoil that helps perfuse the coronary arteries. TEVAR has become first-line therapy for many aortic pathologies including trauma, but stent-grafts stiffen the aorta and likely increase LV afterload. OBJECTIVE Test the hypothesis that trauma TEVAR is associated with LV mass increase and adverse off-target aortic remodeling. METHODS Computed Tomography Angiography (CTA) scans of 20 trauma TEVAR patients (17 M/3 F) at baseline [age 34.9 ± 18.5 (11.4-71.5) years] and 5.1 ± 3.1 (1.1-12.3) years after repair were used to measure changes in LV mass, LV mass index, and diameters and lengths of the ascending thoracic aorta (ATA). Measurements were compared with similarly-aged control patients without aortic repair (21 M/21 F) evaluated at similar follow-ups. RESULTS LV mass and LV mass index of TEVAR patients increased from 138.5 ± 39.6 g and 72.35 ± 15.17 g/m to 173.5 ± 50.1 g and 85.48 ± 18.34 g/m at the rate of 10.03 ± 12.79 g/yr and 6.25 ± 10.28 g/m/yr, whereas in control patients LV characteristics did not change. ATA diameters of TEVAR patients increased at a rate of 0.60 ± 0.80 mm/yr, which was 2.4-fold faster than in controls. ATA length in both TEVAR and control patients increased at 0.58 mm/yr. Half of TEVAR patients had hypertension at follow-up compared to only 5% at baseline. CONCLUSIONS TEVAR is associated with LV mass increase, development of hypertension, and accelerated expansile remodeling of the ascending aorta. Although younger trauma patients may adapt to these effects, these changes may be even more important in older patients with other aortic pathologies and diminished baseline cardiac function.
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Voges I, Giordano R, Koestenberg M, Marchese P, Scalese M, Ait-Ali L, Santoro G, Iervasi G, Valverde I, Kutty S, Cantinotti M. Nomograms for Cardiovascular Magnetic Resonance Measurements in the Pediatric Age Group: To Define the Normal and the Expected Abnormal Values in Corrected/Palliated Congenital Heart Disease: A Systematic Review. J Magn Reson Imaging 2019; 49:1222-1235. [DOI: 10.1002/jmri.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- Inga Voges
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Deparment of Advanced Biomedical Sciences, University of Naples "Federico II"; Italy
| | - Martin Koestenberg
- Division of Pediatric Cardiology, Department of Pediatrics; Medical University Graz; Austria
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
| | | | | | - Giuseppe Santoro
- University Hospital Schleswig-Holstein; Campus Kiel Kiel Germany
| | | | - Israel Valverde
- Hospital Virgen del Rocio & Institute of Biomedicine of Seville (IBIS); Seville Spain
- Guy's and St. Thomas' Hospital/Evelina Children's Hospital; London UK
| | - Shelby Kutty
- Division of Pediatric Cardiology; Johns Hopkins School of Medicine Bloomberg Children's Center; Baltimore Maryland USA
| | - Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana; Massa and Pisa Italy
- Institute of Clinical Physiology; Pisa Italy
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7
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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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8
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Stark VC, Huemmer M, Olfe J, Mueller GC, Kozlik-Feldmann R, Mir TS. The Pulmonary Artery in Pediatric Patients with Marfan Syndrome: An Underestimated Aspect of the Disease. Pediatr Cardiol 2018; 39:1194-1199. [PMID: 29696429 DOI: 10.1007/s00246-018-1880-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/04/2018] [Indexed: 01/16/2023]
Abstract
Aortic root dilatation and its complications are known to be the most important and life limiting features in patients with Marfan syndrome (MFS). Since monitoring of patients, preventive medical and surgical treatments are available nowadays, other MFS pathologies are becoming more relevant for the outcome of the disease. Main pulmonary artery (MPA) dilatation is a cardiac finding, which has not been fully investigated in children. Due to the similarities in tissue composition of the aortic and pulmonary root, MPA dilatation may cause complications and require treatment. In addition, it may be a predictor for severe connective tissue involvement. We retrospectively examined 135 pediatric patients with MFS. 8.1% showed MPA dilatation. MPA dilatation was associated with earlier occurrence of aortic dilatation, mitral valve prolapse, and systemic manifestations of MFS compared with patients without MPA dilatation (p < 0.05). The presence of MPA dilatation was also associated with a higher incidence of ectopia lentis (p < 0.05). Medical treatment was started earlier in MPA dilatation patients than in those without (p < 0.05). We conclude that MPA dilatation is a sign of more severe vascular and connective tissue involvement. Regular examination of the pulmonary artery is essential in MFS to avoid complications. As medical treatment of life threatening MFS events has improved, other features of MFS need to be investigated to improve quality of life.
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Affiliation(s)
- Veronika C Stark
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Michael Huemmer
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jakob Olfe
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Goetz C Mueller
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Thomas S Mir
- Pediatric Cardiology, University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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9
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Wong J, Chabiniok R, Tibby SM, Pushparajah K, Sammut E, Celermajer D, Giese D, Hussain T, Greil GF, Schaeffter T, Razavi R. Exploring kinetic energy as a new marker of cardiac function in the single ventricle circulation. J Appl Physiol (1985) 2018; 125:889-900. [PMID: 29369740 DOI: 10.1152/japplphysiol.00580.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ventricular volumetric ejection fraction (VV EF) is often normal in patients with single ventricle circulations despite them experiencing symptoms related to circulatory failure. We sought to determine if kinetic energy (KE) could be a better marker of ventricular performance. KE was prospectively quantified using four-dimensional flow MRI in 41 patients with a single ventricle circulation (aged 0.5-28 yr) and compared with 43 healthy volunteers (aged 1.5-62 yr) and 14 patients with left ventricular (LV) dysfunction (aged 28-79 yr). Intraventricular end-diastolic blood was tracked through systole and divided into ejected and residual blood components. Two ejection fraction (EF) metrics were devised based on the KE of the ejected component over the total of both the ejected and residual components using 1) instantaneous peak KE to assess KE EF or 2) summating individual peak particle energy (PE) to assess PE EF. KE EF and PE EF had a smaller range than VV EF in healthy subjects (97.9 ± 0.8 vs. 97.3 ± 0.8 vs. 60.1 ± 5.2%). LV dysfunction caused a fall in KE EF ( P = 0.01) and PE EF ( P = 0.0001). VV EF in healthy LVs and single ventricle hearts was equivalent; however, KE EF and PE EF were lower ( P < 0.001) with a wider range indicating a spectrum of severity. Those reporting the greatest symptomatic impairment (New York Heart Association II) had lower PE EF than asymptomatic subjects ( P = 0.0067). KE metrics are markers of healthy cardiac function. PE EF may be useful in grading dysfunction. NEW & NOTEWORTHY Kinetic energy (KE) represents the useful work of the heart in ejecting blood. This article details the utilization of KE indexes to assess cardiac function in health and a variety of pathophysiological conditions. KE ejection fraction and particle energy ejection fraction (PE EF) showed a narrow range in health and a lower wider range in disease representing a spectrum of severity. PE EF was altered by functional status potentially offering the opportunity to grade dysfunction.
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Affiliation(s)
- James Wong
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Radomir Chabiniok
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom.,Inria, Paris-Saclay University, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Paris-Saclay University, Palaiseau, France
| | - Shane M Tibby
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Eva Sammut
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - David Celermajer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Daniel Giese
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Gerald F Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
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10
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Dallaire F, Sarkola T. Growth of Cardiovascular Structures from the Fetus to the Young Adult. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:347-360. [PMID: 30051395 DOI: 10.1007/978-3-319-77932-4_22] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The size, hemodynamics, and function of cardiovascular structures change dramatically from the early fetal life to late adolescence. The principal determinants of cardiovascular dimensions are related to the blood flow needed to meet metabolic demands. This demand is in turn tightly related to body size and body composition, keeping in mind that various tissues may have different metabolic rates. There is no simple model that links cardiac dimensions with a single body size measurement. Consequently, despite abundant scientific literature, few studies have proposed pediatric reference values that efficiently and completely account for the effect of body size. Other factors influence cardiovascular size and function in children, including sex. The influence of sex is multifactorial and not fully understood, but differences in body size and body composition play an important role. We will first review the determinants of cardiovascular size and function in children. We then explore the evaluation and normalization of cardiovascular size and function in pediatric cardiology in relation to the growth of cardiovascular structures during childhood, with a particular focus on sex differences.
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Affiliation(s)
| | - Taisto Sarkola
- University of Helsinki, the Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
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11
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Horriat NL, Deatsman SL, Stelter J, Frommelt PC, Hill GD. Variable Myocardial Response to Load Stresses in Infants with Single Left Ventricular Anatomy: Influence of Initial Physiology and Surgical Palliative Strategy. Pediatr Cardiol 2016; 37:1569-1574. [PMID: 27554256 DOI: 10.1007/s00246-016-1471-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
Initial surgical strategies in neonates with single left ventricular (LV) anatomy vary based on adequacy of pulmonary and systemic blood flow. Differing myocardial responses to these strategies, as reflected in indices of systolic function, ventricular size, and mass have not been well defined. We sought to evaluate single LV myocardial response to varied physiology and initial palliation and determine whether the response is consistent and predictable. Infants with single LV physiology were divided based on neonatal palliation: no palliation/PA band (NO); BT shunt only (BT); or Norwood procedure (NP). Echo measures were obtained at presentation, early post-bidirectional Glenn (BDG), late post-BDG follow-up, and post-Fontan procedure. Measures included ejection fraction, LV mass indexed to height2.7 and end diastolic volume indexed to body surface area, and mass/volume ratio. The cohort included 38 children (13 NO, 13 BT, 12 NP). Ejection fraction was similar but depressed in all groups at all stages. LV mass was higher in the NP group than the BT group at early post-BDG (p = 0.03) and higher than both BT and NO groups (p < 0.01) at late post-BDG, but the difference was resolved by post-Fontan follow-up. The NP group had the most remarkable remodeling in LV size from BDG to Fontan, suggesting that volume unloading is most valuable in this subgroup. Ventricular remodeling can be identified by echocardiography in children with single LV physiology, despite variable initial surgical palliative strategies. Importantly, these initial surgical strategies do not result in significant differences after Fontan palliation during early childhood.
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Affiliation(s)
- Narges L Horriat
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Sara L Deatsman
- Department of Obstetrics and Gynecology, University of Florida, PO Box 100294, Gainesville, FL, 32610, USA
| | - Jessica Stelter
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Peter C Frommelt
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Garick D Hill
- Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA. .,Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.
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12
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Whitlock MC, Hundley WG. Noninvasive Imaging of Flow and Vascular Function in Disease of the Aorta. JACC Cardiovasc Imaging 2016; 8:1094-1106. [PMID: 26381770 DOI: 10.1016/j.jcmg.2015.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/03/2015] [Accepted: 08/06/2015] [Indexed: 02/06/2023]
Abstract
With advancements in technology and a better understanding of human cardiovascular physiology, research as well as clinical care can go beyond dimensional anatomy offered by traditional imaging and investigate aortic functional properties and the impact disease has on this function. Linking the knowledge of the histopathological changes with the alterations in aortic function observed on noninvasive imaging results in a better understanding of disease pathophysiology. Translating this to clinical medicine, these noninvasive imaging assessments of aortic function are proving to be able to diagnose disease, better predict risk, and assess response to therapies. This review is designed to summarize the various hemodynamic measures that can characterize the aorta, the various noninvasive techniques, and applications for various disease states.
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Affiliation(s)
- Matthew C Whitlock
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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13
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Restrictive right ventricular performance assessed by cardiac magnetic resonance after balloon valvuloplasty of critical pulmonary valve stenosis. Cardiol Young 2016; 26:556-68. [PMID: 26095337 DOI: 10.1017/s1047951115000724] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little data are published about right ventricular diastolic performance in patients with critical pulmonary valve stenosis after balloon pulmonary valvuloplasty thus far. METHODS A total of 44 patients with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with haemodynamic recordings were enrolled to the study; 33 patients who came for follow-up underwent further imaging by echocardiography after 6 months and their right ventricular functional parameters were compared with 33 control patients of the same age and sex. Out of 33 patients, 21 underwent cardiac MRI with late gadolinium enhancement to assess the presence of right ventricular fibrosis. RESULTS The right ventricular systolic pressure (p<0.0001) and right ventricular outflow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. During follow-up, M-mode left ventricular end diastolic dimension (p<0.001) and end systolic dimension increased (p<0.001), whereas right ventricular end diastolic dimension decreased (p<0.001). Compared with controls, patients (n=33) had significantly reduced tricuspid annular Ea and higher E/Ea (p<0.001). Right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (p<0.001). Late gadolinium enhancement was demonstrated in 13 out of 21 patients with restrictive physiology, which involves the anterior right ventricular outflow tract, anterior wall, and inferior wall. The right ventricular late gadolinium enhancement score correlated positively with age (r=0.7, p<0.001) and right ventricular mass index (r=0.52, p<0.001). CONCLUSION The persistence of right ventricular diastolic dysfunction after relief of chronic pressure overload of critical pulmonary valve stenosis suggests that a factor - other than increase in afterload - is involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.
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Mitchell FM, Prasad SK, Greil GF, Drivas P, Vassiliou VS, Raphael CE. Cardiovascular magnetic resonance: Diagnostic utility and specific considerations in the pediatric population. World J Clin Pediatr 2016; 5:1-15. [PMID: 26862497 PMCID: PMC4737683 DOI: 10.5409/wjcp.v5.i1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/10/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field.
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15
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Wong J, Chabiniok R, deVecchi A, Dedieu N, Sammut E, Schaeffter T, Razavi R. Age-related changes in intraventricular kinetic energy: a physiological or pathological adaptation? Am J Physiol Heart Circ Physiol 2016; 310:H747-55. [PMID: 26747496 PMCID: PMC4867343 DOI: 10.1152/ajpheart.00075.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 01/08/2016] [Indexed: 11/22/2022]
Abstract
Measuring intracardiac kinetic energy using four-dimensionl flow cardiac magnetic resonance provides important information on the decline in the early diastolic kinetic energy of blood with aging. The decline is comparable with that seen in those with heart failure and may be a marker of cardiac function. Aging has important deleterious effects on the cardiovascular system. We sought to compare intraventricular kinetic energy (KE) in healthy subjects of varying ages with subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. Four-dimensional flow MRI was acquired in 35 healthy subjects (age: 1–67 yr) and 10 patients with left ventricular (LV) dysfunction (age: 28–79 yr). Healthy subjects were divided into age quartiles (1st quartile: <16 yr, 2nd quartile: 17–32 yr, 3rd quartile: 33–48 yr, and 4th quartile: 49–64 yr). KE was measured in the LV throughout the cardiac cycle and indexed to ventricular volume. In healthy subjects, two large peaks corresponding to systole and early diastole occurred during the cardiac cycle. A third smaller peak was seen during late diastole in eight adults. Systolic KE (P = 0.182) and ejection fraction (P = 0.921) were preserved through all age groups. Older adults showed a lower early peak diastolic KE compared with children (P < 0.0001) and young adults (P = 0.025). Subjects with LV dysfunction had reduced ejection fraction (P < 0.001) and compared with older healthy adults exhibited a similar early peak diastolic KE (P = 0.142) but with the addition of an elevated KE in diastasis (P = 0.029). In healthy individuals, peak diastolic KE progressively decreases with age, whereas systolic peaks remain constant. Peak diastolic KE in the oldest subjects is comparable to those with LV dysfunction. Unique age-related changes in ventricular diastolic energetics might be physiological or herald subclinical pathology.
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Affiliation(s)
- James Wong
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Radomir Chabiniok
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom; Inria and Paris-Saclay University, Palaiseau, France
| | - Adelaide deVecchi
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Nathalie Dedieu
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Eva Sammut
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Tobias Schaeffter
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom;
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17
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Abstract
The aims of this study were to assess the development of heart failure in patients with congenitally corrected transposition of the great arteries in a medium-term follow-up, to identify the impact of tricuspid regurgitation on the development of heart failure, and to determine the most reliable marker for its identification. The prospective 6-year follow-up study included 19 adult patients. All patients were evaluated clinically by the determination of N-terminal pro-hormone brain natriuretic peptide levels, exercise stress testing, echocardiography magnetic resonance, or CT. Among them, two patients died of heart failure. There was a decline in exercise capacity and systolic systemic ventricular function (p=0.011). Systemic ventricular ejection fraction decreased (48.3±13.7 versus 42.7±12.7%, p=0.001). Tissue Doppler imaging showed a decline in peak tricuspid systolic annular velocity (10.3±2.0 versus 8.3±2.5 cm/second, p=0.032) and peak tricuspid early diastolic annular velocity (14.6±4.3 versus 12.0±4.5 cm/second, p=0.048). The tricuspid regurgitation did not increase significantly. N-terminal pro-hormone brain natriuretic peptide levels increased (127.0 ng/L(82.3-305.8) versus 226.0 ng/L(112.5-753.0), p=0.022). Progressive exercise intolerance in congenitally corrected transposition of the great arteries appears to be driven mainly by a progression in systemic right ventricular dysfunction. Tricuspid regurgitation is likely to play a role, especially in patients with structural abnormalities of the tricuspid valve - Ebstein anomaly. The N-terminal pro-hormone brain natriuretic peptide levels and tissue Doppler parameters appear sensitive in detecting changes over time and may guide management.
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18
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Marterer R, Hongchun Z, Tschauner S, Koestenberger M, Sorantin E. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters. Eur Radiol 2015; 25:3528-35. [DOI: 10.1007/s00330-015-3788-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 11/29/2022]
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19
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Cools B, Brown SC, Heying R, Jansen K, Boshoff DE, Budts W, Gewillig M. Percutaneous pulmonary valve implantation for free pulmonary regurgitation following conduit-free surgery of the right ventricular outflow tract. Int J Cardiol 2015; 186:129-35. [DOI: 10.1016/j.ijcard.2015.03.108] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/14/2015] [Accepted: 03/07/2015] [Indexed: 11/24/2022]
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20
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Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, Plein S, Tee M, Eng J, Bluemke DA. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson 2015; 17:29. [PMID: 25928314 PMCID: PMC4403942 DOI: 10.1186/s12968-015-0111-7] [Citation(s) in RCA: 521] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/06/2015] [Indexed: 01/17/2023] Open
Abstract
Morphological and functional parameters such as chamber size and function, aortic diameters and distensibility, flow and T1 and T2* relaxation time can be assessed and quantified by cardiovascular magnetic resonance (CMR). Knowledge of normal values for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. In this review, we present normal reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques and sequences.
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Affiliation(s)
- Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Loestrasse 170, 7000, Chur, Switzerland.
| | - Alicia Maceira
- Cardiac Imaging Unit, Eresa Medical Center, C/Marqués de San Juan s/n, 46015, Valencia, Spain.
| | | | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, OE 8220, Carl-Neuberg-Str 1, 30625, Hannover, Germany.
| | - Evrim B Turkbey
- Radiology and Imaging Sciences/ Clinical Image Processing Service, Clinical Center, NIH, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Rupert Williams
- The Rayne Institute, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, LS2 9JT, UK.
| | - Michael Tee
- Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, 10 Center Drive, Bethesda, MD, 20892-1074, USA.
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, 10 Center Drive, Bethesda, MD, 20892-1074, USA.
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21
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Laser KT, Houben BA, Körperich H, Haas NA, Kelter-Klöpping A, Barth P, Burchert W, DallaPozza R, Kececioglu D, Herberg U. Calculation of Pediatric Left Ventricular Mass: Validation and Reference Values Using Real-Time Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2015; 28:275-83. [DOI: 10.1016/j.echo.2014.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Indexed: 02/08/2023]
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Punithakumar K, Noga M, Ben Ayed I, Boulanger P. Right ventricular segmentation in cardiac MRI with moving mesh correspondences. Comput Med Imaging Graph 2015; 43:15-25. [PMID: 25733395 DOI: 10.1016/j.compmedimag.2015.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/27/2014] [Accepted: 01/09/2015] [Indexed: 11/25/2022]
Abstract
This study investigates automatic propagation of the right ventricle (RV) endocardial and epicardial boundaries in 4D (3D+time) magnetic resonance imaging (MRI) sequences. Based on a moving mesh (or grid generation) framework, the proposed algorithm detects the endocardium and epicardium within each cardiac phase via point-to-point correspondences. The proposed method has the following advantages over prior RV segmentation works: (1) it removes the need for a time-consuming, manually built training set; (2) it does not make prior assumptions as to the intensity distributions or shape; (3) it provides a sequence of corresponding points over time, a comprehensive input that can be very useful in cardiac applications other than segmentation, e.g., regional wall motion analysis; and (4) it is more flexible for congenital heart disease where the RV undergoes high variations in shape. Furthermore, the proposed method allows comprehensive RV volumetric analysis over the complete cardiac cycle as well as automatic detections of end-systolic and end-diastolic phases because it provides a segmentation for each time step. Evaluated quantitatively over the 48-subject data set of the MICCAI 2012 RV segmentation challenge, the proposed method yielded an average Dice score of 0.84±0.11 for the epicardium and 0.79±0.17 for the endocardium. Further, quantitative evaluations of the proposed approach in comparisons to manual contours over 23 infant hypoplastic left heart syndrome patients yielded a Dice score of 0.82±0.14, which demonstrates the robustness of the algorithm.
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Affiliation(s)
- Kumaradevan Punithakumar
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
| | - Michelle Noga
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Ismail Ben Ayed
- GE Healthcare, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Pierre Boulanger
- Servier Virtual Cardiac Centre, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
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23
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Quantitative magnetic resonance imaging of pulmonary hypertension: a practical approach to the current state of the art. J Thorac Imaging 2014; 29:68-79. [PMID: 24552882 DOI: 10.1097/rti.0000000000000079] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulmonary hypertension is a condition of varied etiology, commonly associated with poor clinical outcome. Patients are categorized on the basis of pathophysiological, clinical, radiologic, and therapeutic similarities. Pulmonary arterial hypertension (PAH) is often diagnosed late in its disease course, with outcome dependent on etiology, disease severity, and response to treatment. Recent advances in quantitative magnetic resonance imaging (MRI) allow for better initial characterization and measurement of the morphologic and flow-related changes that accompany the response of the heart-lung axis to prolonged elevation of pulmonary arterial pressure and resistance and provide a reproducible, comprehensive, and noninvasive means of assessing the course of the disease and response to treatment. Typical features of PAH occur primarily as a result of increased pulmonary vascular resistance and the resultant increased right ventricular (RV) afterload. Several MRI-derived diagnostic markers have emerged, such as ventricular mass index, interventricular septal configuration, and average pulmonary artery velocity, with diagnostic accuracy similar to that of Doppler echocardiography. Furthermore, prognostic markers have been identified with independent predictive value for identification of treatment failure. Such markers include large RV end-diastolic volume index, low left ventricular end-diastolic volume index, low RV ejection fraction, and relative area change of the pulmonary trunk. MRI is ideally suited for longitudinal follow-up of patients with PAH because of its noninvasive nature and high reproducibility and is advantageous over other biomarkers in the study of PAH because of its sensitivity to change in morphologic, functional, and flow-related parameters. Further study on the role of MRI image based biomarkers in the clinical environment is warranted.
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24
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Swift AJ, Rajaram S, Campbell MJ, Hurdman J, Thomas S, Capener D, Elliot C, Condliffe R, Wild JM, Kiely DG. Prognostic Value of Cardiovascular Magnetic Resonance Imaging Measurements Corrected for Age and Sex in Idiopathic Pulmonary Arterial Hypertension. Circ Cardiovasc Imaging 2014; 7:100-6. [DOI: 10.1161/circimaging.113.000338] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background—
There are limited data on the prognostic value of cardiovascular magnetic resonance measurements in idiopathic pulmonary arterial hypertension, with no studies investigating the impact of correction of cardiovascular magnetic resonance indices for age and sex on prognostic value.
Methods and Results—
Consecutive patients with idiopathic pulmonary arterial hypertension underwent cardiovascular magnetic resonance imaging at 1.5T. Steady-state free precession cardiac volumes and mass measurements were corrected for age, sex, and body surface area according to reference data and prognostic significance assessed. A total of 80 patients with idiopathic pulmonary arterial hypertension were identified, and 23 patients died during the mean follow-up of 32±14 months. Corrected for age, sex, and body surface area, right ventricular end-systolic volume (
P
=0.004) strongly predicted mortality, independent of World Health Organization functional class, mean right atrial pressure, cardiac index, and mixed venous oxygen saturations.
Conclusions—
Consideration should be given to correcting cardiovascular magnetic resonance measures for age, sex, and body surface area, particularly given the changing demographics of patients with idiopathic pulmonary arterial hypertension. Corrected right ventricular end-systolic volume is a strong prognostic marker in idiopathic pulmonary arterial hypertension, independent of invasively derived measurements, mean right atrial pressure cardiac index, and mixed venous oxygen saturations.
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Affiliation(s)
- Andrew J. Swift
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Smitha Rajaram
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael J. Campbell
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judith Hurdman
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steve Thomas
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dave Capener
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charlie Elliot
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M. Wild
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David G. Kiely
- From the Unit of Academic Radiology (A.J.S., D.C., J.M.W.) and Design, Trials & Statistics (M.J.C.), The School of Health and Related Research, University of Sheffield, Sheffield, UK; and Sheffield Pulmonary Vascular Disease Unit (J.H., C.E., R.C., D.G.K.), and Radiology Department (S.R., S.T.), Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Zhong YM, Jaffe RB, Liu JF, Sun AM, Gao W, Wang Q, Zhu M, Qiu HS, Berdon WE. Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve. Pediatr Radiol 2014; 44:803-9. [PMID: 24706163 PMCID: PMC4061480 DOI: 10.1007/s00247-014-2898-z] [Citation(s) in RCA: 7] [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: 08/25/2013] [Revised: 12/12/2013] [Accepted: 01/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression. OBJECTIVE To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions. MATERIALS AND METHODS We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated. RESULTS Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study. CONCLUSION Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.
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Affiliation(s)
- Yu-Min Zhong
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Richard B. Jaffe
- Department of Medical Imaging, Primary Children’s Medical Center, Salt Lake City, UT USA
| | - Jin-Fen Liu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, No.1678 Dong Fang Road, Shanghai, 200127 China
| | - Ai-Min Sun
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Qian Wang
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Hai-Sheng Qiu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Walter E. Berdon
- Department of Radiology, Children’s Hospital of New York, New York, NY USA
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O'Byrne ML, Mercer-Rosa L, Zhao H, Zhang X, Yang W, Cassedy A, Fogel MA, Rychik J, Tanel RE, Marino BS, Paridon S, Goldmuntz E. Morbidity in children and adolescents after surgical correction of truncus arteriosus communis. Am Heart J 2013; 166:512-8. [PMID: 24016501 DOI: 10.1016/j.ahj.2013.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of outcome after operative correction of truncus arteriosus communis (TA) have focused on mortality and rates of reintervention. We sought to investigate the clinical status of children and adolescents with surgically corrected TA. METHODS AND RESULTS A cross-sectional study of subjects with TA was performed. Subjects underwent concurrent genetic testing, electrocardiogram, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and completed questionnaires assessing health status and health-related quality of life. Review of their medical history provided retrospective information on cardiac reintervention and use of medical care. Twenty-five subjects with a median age of 11.8 (8.1-18.99) years were enrolled. The prevalence of 22q11.2 deletion was 32%. Incidence of hospitalization, cardiac reintervention, and noncardiac operations was highest in the first year of life. Combined catheter-based and operative reintervention rates were 52% on the conduit and 56% on the pulmonary arteries. Right ventricular ejection fraction and end-diastolic volume were normal. Moderate or greater truncal valve insufficiency was seen in 11% of subjects, and truncal valve replacement occurred in 8% of subjects. Maximal oxygen consumption (P = .0002), maximal work (P < .0001), and forced vital capacity (P < .0001) were all lower than normal for age and sex. Physical health status and health-related quality of life were both severely diminished. CONCLUSION Patients with TA demonstrate significant comorbid disease throughout childhood, significant burden of operative and catheter-based reintervention, and deficits in exercise performance, functional status, and health-related quality of life.
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Affiliation(s)
- Michael L O'Byrne
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Bell A, Rawlins D, Bellsham-Revell H, Miller O, Razavi R, Simpson J. Assessment of right ventricular volumes in hypoplastic left heart syndrome by real-time three-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2013; 15:257-66. [PMID: 23946284 DOI: 10.1093/ehjci/jet145] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate assessment of right ventricular (RV) volumes and function is important in patients with hypoplastic left heart syndrome (HLHS). We prospectively sought to determine the reproducibility of three-dimensional (3D) echocardiography and its agreement with cardiac magnetic resonance imaging (CMR) in HLHS. METHODS AND RESULTS Twenty-eight patients underwent CMR followed immediately by transthoracic 3D echocardiography under general anaesthesia. Semi-automated border detection software was used to determine echocardiographic RV volumes. Inter- and intra-observer variability, correlation and levels of agreement between techniques were determined. The median age was 0.37 years (0.18-9.28 years) and weight 6.24 kg (3.42-32.50 kg). Intra- and inter-observer variability was excellent for both techniques. Median (range) measurements for 3D echocardiography and CMR were; end-diastolic volume (EDV) 23.6 mL (6.5-63.2) and 30.6 mL (11.8-87.9), end-systolic volume (ESV) 12.6 mL (3.7-37.0) and 14.9 mL (5.8-33.9), stroke volume (SV) 11.2 mL (2.8-33.0) and 17.1 mL (6.0-54.1), ejection fraction (EF) 48.2% (31.2-64.9), and 56.5% (42.7-72.2). Correlation coefficients were r = 0.85, 0.84, 0.83, and 0.74, respectively (P < 0.01 for all). Volumetric data were expressed as a percentage of the echocardiographic volume to CMR volume. When compared with CMR, 3D echocardiography underestimated EDV, ESV and SV by 26.7% (SD ± 20.2), 10.6% (±28.1), and 37.5% (±20.1), respectively. The difference in volume appeared largest at low ventricular volumes. EF was 8.3% (±7.3) lower by 3D echocardiography compared with CMR. CONCLUSION Both 3D echocardiography and CMR volumes appear highly reproducible. Measurements obtained by 3D echocardiography are significantly lower than those obtained by CMR, with wide limits of agreement such that these two methods cannot be used interchangeably.
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Affiliation(s)
- Aaron Bell
- Paediatric Cardiology, Evelina London Children's Hospital, 6th Floor, Evelina Children's Hospital, 1 Westminster Bridge Road, London SE1 7EH, UK
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Koestenberger M, Ravekes W, Nagel B, Avian A, Heinzl B, Fritsch P, Sorantin E, Cvirn G, Rehak T, Gamillscheg A. Longitudinal systolic ventricular interaction in pediatric and young adult patients with TOF: a cardiac magnetic resonance and M-mode echocardiographic study. Int J Cardiovasc Imaging 2013; 29:1707-15. [DOI: 10.1007/s10554-013-0261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
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Ylänen K, Poutanen T, Savikurki-Heikkilä P, Rinta-Kiikka I, Eerola A, Vettenranta K. Cardiac Magnetic Resonance Imaging in the Evaluation of the Late Effects of Anthracyclines Among Long-Term Survivors of Childhood Cancer. J Am Coll Cardiol 2013; 61:1539-47. [DOI: 10.1016/j.jacc.2013.01.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 12/21/2012] [Accepted: 01/08/2013] [Indexed: 12/27/2022]
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Bellsham-Revell HR, Simpson JM, Miller OI, Bell AJ. Subjective evaluation of right ventricular systolic function in hypoplastic left heart syndrome: how accurate is it? J Am Soc Echocardiogr 2012; 26:52-6. [PMID: 23098782 PMCID: PMC3548410 DOI: 10.1016/j.echo.2012.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Indexed: 11/28/2022]
Abstract
Background The geometry and heterogeneity of the right ventricle in hypoplastic left heart syndrome makes objective echocardiographic assessment of systolic function challenging. Consequently, subjective echocardiographic assessment of right ventricular (RV) function is still routinely undertaken. The aims of this study were to compare this with magnetic resonance imaging (MRI), investigate the impact of experience and training on the accuracy of subjective assessment, and critically analyze the role of echocardiography to detect impaired systolic function. Methods A retrospective analysis of prospectively acquired data was performed. Children with hypoplastic left heart syndrome underwent routine preoperative cardiac MRI and echocardiography under the same general anesthetic. Echocardiograms were reviewed, and members of the congenital heart disease team with differing echocardiography experience subjectively graded RV systolic function (good, moderate, or poor). This was compared with MRI-derived ejection fraction. Results Twenty-eight patients at different palliative stages were included. Twenty-eight observers were divided into five experience categories (congenital heart disease junior trainees to attending cardiologists). Median agreement was 47.6% (range, 31.4%–58.2%), with the lowest agreement among junior trainees and the highest among attending cardiologists. When used as a screening test for poor RV systolic function, the median sensitivity of echocardiography was 0.89 (range, 0.86–0.96), and median specificity was 0.45 (range, 0.26–0.55). The highest sensitivity was observed among junior trainees but with the lowest specificity. The highest specificity was observed among attending cardiologists (0.55). Conclusions Agreement between echocardiographic and MRI RV ejection fraction improves with experience but remains suboptimal. When used as a screening test for poor RV function, echocardiography is sensitive, but specificity is heavily influenced by operator experience.
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Affiliation(s)
- Hannah R Bellsham-Revell
- Department of Paediatric Cardiology, Level 6 Evelina Children's Hospital, London, United Kingdom.
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31
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Left and right ventricular function and volume assessment in young thalassemia major patients with no related myocardial iron overload. Ann Hematol 2012; 91:1839-44. [DOI: 10.1007/s00277-012-1543-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/26/2012] [Indexed: 12/16/2022]
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Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fandl A, Rehak T, Sorantin E, Cvirn G, Gamillscheg A. Tricuspid annular peak systolic velocity (S') in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases, and in those with repaired tetralogy of Fallot: echocardiography and MRI data. J Am Soc Echocardiogr 2012; 25:1041-9. [PMID: 22763086 DOI: 10.1016/j.echo.2012.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tricuspid annular peak systolic velocity (S'), as an echocardiographic index to assess right ventricular (RV) systolic function, has not been investigated thoroughly in children and young adults with repaired tetralogy of Fallot (TOF) and pulmonary artery hypertension secondary to congenital heart disease (PAH-CHD). METHODS S' values in patients with TOF (n = 183) and PAH-CHD (n = 55) were compared with those in normal subjects. S' values were compared with RV ejection fraction and RV end-diastolic volume index (RVEDVi) determined by magnetic resonance imaging. RESULTS S' values became significantly reduced in PAH-CHD patients after 10.4 years of age and after 13.6 years of age in patients with TOF compared with the lower boundary of the ±2-SD interval of normal subjects. Significant positive correlations between S' and RV ejection fraction were seen in patients with TOF (r = 0.66, P < .001) and those with PAH-CHD (r = 0.82, P < .001). Significant negative correlations between S' and RVEDVi were also seen in patients with repaired TOF (r = -0.29, P = .002) and in those with PAH-CHD (r = -0.59, P < .001). CONCLUSIONS Although initially preserved, in this prospective study, impaired S' values with increasing age were found in patients with repaired TOF and PAH-CHD. Persistent pressure overload in patients with PAH-CHD as well as volume overload in those with repaired TOF might lead to systolic RV functional impairment and increased RVEDVi. The validity of S' data was supported by magnetic resonance imaging data (RVEDVi and RV ejection fraction).
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 34/2, Graz, Austria.
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Koestenberger M, Nagel B, Avian A, Ravekes W, Sorantin E, Cvirn G, Beran E, Halb V, Gamillscheg A. Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. CONGENIT HEART DIS 2012; 7:250-8. [PMID: 22494699 DOI: 10.1111/j.1747-0803.2012.00655.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The tricuspid annular plane systolic excursion (TAPSE), as echocardiographic index to assess right ventricular (RV) systolic function, has not been investigated thoroughly in children and young adults with tetralogy of Fallot (TOF) and pulmonary artery hypertension secondary to congenital heart disease (PAH-CHD). PATIENTS TAPSE values of 49 patients with PAH-CHD and 156 patients with TOF were compared with age-matched normal subjects. TAPSE values were also compared with RV ejection fraction (RVEF) and RV indexed end-diastolic volume (RVEDVi) determined by magnetic resonance imaging in PAH-CHD and TOF patients. RESULTS Patients with a PAH-CHD showed a positive correlation between TAPSE with RVEF (r= 0.81; P < 0.001) and a negative correlation between TAPSE with RVEDVi (r=-0.67; P < 0.001). Similarly, in our TOF patients, a positive correlation between TAPSE with RVEF (r= 0.65; P < 0.001) and a negative correlation between TAPSE with RVEDVi (r=-0.42; P < 0.001) was seen. CONCLUSIONS Significant pressure overload in PAH-CHD patients and volume overload in TOF patients lead to a decreased systolic RV function, determined by TAPSE and magnetic resonance imaging and to increased RVEDVi values, determined by MRI, with time.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 34/2, Graz, Austria.
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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35
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Kwon EN, Mussatto K, Simpson PM, Brosig C, Nugent M, Samyn MM. Children and adolescents with repaired tetralogy of fallot report quality of life similar to healthy peers. CONGENIT HEART DIS 2011; 6:18-27. [PMID: 21269409 DOI: 10.1111/j.1747-0803.2010.00481.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study aims to evaluate and compare self-reported and parent proxy-reported quality of life (QOL) in pediatric patients with repaired tetralogy of Fallot (TOF) and determine relationships with residual disease. DESIGN QOL was prospectively evaluated in children/adolescents with repaired TOF and parents' proxy report using the Pediatric Quality of Life Inventory Generic Core and Cardiac Module scales. The scores were compared with published self and parent proxy-reported normative data for children considered healthy, chronically ill, and with congenital heart disease. Recent clinical data were reviewed for correlations between QOL and residual disease severity. RESULTS Twenty child-parent pairs were assessed at median age of 10.9 years (range 8.4-18.7 years). Self-report was higher than parent proxy report. Compared with peers, self-reported QOL was higher than for chronically ill children (overall QOL 85 vs. 77, P= 0.007) and similar to healthy children (85 vs. 83, P= 0.44), while proxy report by parent was similar to parents of chronically ill children (overall QOL 77 vs. 74, P= 0.035). Despite moderate pulmonary regurgitation (mean 35%) and right ventricular dilation (mean 114 mL/m(2) ), 76% had a New York Heart Association class of 1, normal B-natriuretic peptide (24 pg/mL), reasonable exercise tolerance VO(2) max% predicted (mean 77%), and preserved right ventricular ejection fraction (mean 58%, range 44-80%). Overall QOL positively correlated with child's VO(2) max% predicted, when reported by child (r = 0.47, P < 0.05) and parent proxy (r = 0.63, P < 0.05). CONCLUSIONS QOL in children/adolescents with repaired TOF is not proportional to the severity of their residual disease. Self-reported QOL appears similar to healthy peers while parent proxy reported lower QOL. For both children and parents, QOL positively correlated with the child's exercise capacity. Therefore, comprehensive follow-up should include cardiac rehabilitation and psychosocial evaluation to ensure an active lifestyle, improve health perception, and prevent later acquired heart disease.
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Affiliation(s)
- Elena N Kwon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Geiger J, Markl M, Jung B, Grohmann J, Stiller B, Langer M, Arnold R. 4D-MR flow analysis in patients after repair for tetralogy of Fallot. Eur Radiol 2011; 21:1651-7. [PMID: 21720942 DOI: 10.1007/s00330-011-2108-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 01/27/2011] [Accepted: 02/04/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Comprehensive analysis of haemodynamics by 3D flow visualisation and retrospective flow quantification in patients after repair of tetralogy of Fallot (TOF). METHODS Time-resolved flow-sensitive 4D MRI (spatial resolution ~ 2.5 mm, temporal resolution = 38.4 ms) was acquired in ten patients after repair of TOF and in four healthy controls. Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP) and left (lPA) and right (rPA) pulmonary arteries by 3D blood flow visualisation using particle traces, and quantitative measurements of flow velocity. RESULTS 3D visualisation of whole heart haemodynamics provided a comprehensive overview on flow pattern changes in TOF patients, mainly alterations in flow velocity, retrograde flow and pathological vortices. There was consistently higher blood flow in the rPA of the patients (rPA/lPA flow ratio: 2.6 ± 2.5 vs. 1.1 ± 0.1 in controls). Systolic peak velocity in the TP was higher in patients (1.9 m/s ± 0.7 m/s) than controls (0.9 m/s ± 0.1 m/s). CONCLUSIONS 4D flow-sensitive MRI permits the comprehensive evaluation of blood flow characteristics in patients after repair of TOF. Altered flow patterns for different surgical techniques in the small patient cohort may indicate its value for patient monitoring and potentially identifying optimal surgical strategies.
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Affiliation(s)
- J Geiger
- Department of Radiology, Medical Physics, University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
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Gurwitz A, Rosner J, Narine B, Anderson V. External aortic diameter ratios: a reliable method to diagnose preductal aortic coarctation. Fetal Pediatr Pathol 2011; 30:286-95. [PMID: 21609160 DOI: 10.3109/15513815.2011.572957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aortic Coarctation (AC) is associated with sudden infantile death. Current pathological diagnosis depends on absolute vessel size which is prone to errors due to different rates of development. This study explores the use of ratios of the external diameter between the aortic isthmus (AI), ascending aorta (AA) and the descending aortas (DA). Our study found that while the vessel diameter increased with gestational age, the ratios remained constant and are therefore preferable than absolute size. This simple and highly reproducible method will allow more cases of AC that may be misdiagnosed to get a proper pathological diagnosis.
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Affiliation(s)
- Avrahom Gurwitz
- Department of Pediatrics, New York University Langone Medical Center, New York, NY 10016, USA.
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Systolic Right Ventricular Function in Pediatric and Adolescent Patients with Tetralogy of Fallot: Echocardiography versus Magnetic Resonance Imaging. J Am Soc Echocardiogr 2011; 24:45-52. [DOI: 10.1016/j.echo.2010.10.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Indexed: 11/19/2022]
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Koestenberger M, Nagel B, Ravekes W, Everett AD, Stueger HP, Heinzl B, Sorantin E, Cvirn G, Gamillscheg A. Tricuspid annular plane systolic excursion and right ventricular ejection fraction in pediatric and adolescent patients with tetralogy of Fallot, patients with atrial septal defect, and age-matched normal subjects. Clin Res Cardiol 2010; 100:67-75. [DOI: 10.1007/s00392-010-0213-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 08/19/2010] [Indexed: 11/24/2022]
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Lin JH, Shih CH, Kaphle K, Wu LS, Tseng WY, Chiu JH, Lee TC, Wu YL. Acupuncture effects on cardiac functions measured by cardiac magnetic resonance imaging in a feline model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 7:169-76. [PMID: 18955311 PMCID: PMC2862935 DOI: 10.1093/ecam/nem187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 12/18/2007] [Indexed: 02/01/2023]
Abstract
The usefulness of acupuncture (AP) as a complementary and/or alternative therapy in animals is well established but more research is needed on its clinical efficacy relative to conventional therapy, and on the underlying mechanisms of the effects of AP. Cardiac magnetic resonance imaging (CMRI), an important tool in monitoring cardiovascular diseases, provides a reliable method to monitor the effects of AP on the cardiovascular system. This controlled experiment monitored the effect electro-acupuncture (EA) at bilateral acupoint Neiguan (PC6) on recovery time after ketamine/xylazine cocktail anesthesia in healthy cats. The CMRI data established the basic feline cardiac function index (CFI), including cardiac output and major vessel velocity. To evaluate the effect of EA on the functions of the autonomic nervous and cardiovascular systems, heart rate, respiration rate, electrocardiogram and pulse rate were also measured. Ketamine/xylazine cocktail anesthesia caused a transient hypertension in the cats; EA inhibited this anesthetic-induced hypertension and shortened the post-anesthesia recovery time. Our data support existing knowledge on the cardiovascular benefits of EA at PC6, and also provide strong evidence for the combination of anesthesia and EA to shorten post-anesthesia recovery time and counter the negative effects of anesthetics on cardiac physiology.
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Affiliation(s)
- Jen-Hsou Lin
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Chen-Haw Shih
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Krishna Kaphle
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Leang-Shin Wu
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Weng-Yih Tseng
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Jen-Hwey Chiu
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Tzu-chi Lee
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
| | - Ying-Ling Wu
- Department of Animal Science Technology, Department of Veterinary Medicine, National Taiwan University, Center for Optoelectronic Biomedicine, National Taiwan University Medical College, Department of Traditional Medicine, National Yang-Ming University and Institute of Public Health, Kaohsiung Medical University, Taiwan
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Abolmaali N, Koch A, Götzelt K, Hahn G, Fitze G, Vogelberg C. Lung volumes, ventricular function and pulmonary arterial flow in children operated on for left-sided congenital diaphragmatic hernia: long-term results. Eur Radiol 2010; 20:1580-9. [DOI: 10.1007/s00330-010-1723-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/23/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
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Prakash A, Powell AJ, Geva T. Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease. Circ Cardiovasc Imaging 2010; 3:112-25. [PMID: 20086225 DOI: 10.1161/circimaging.109.875021] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ashwin Prakash
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Andrew J. Powell
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Tal Geva
- From the Department of Cardiology, Children’s Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, Mass
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Hughes ML, Muthurangu V, Taylor AM. Cardiovascular MR imaging — Indications, techniques and protocols. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sarikouch S, Peters B, Gutberlet M, Leismann B, Kelter-Kloepping A, Koerperich H, Kuehne T, Beerbaum P. Sex-specific pediatric percentiles for ventricular size and mass as reference values for cardiac MRI: assessment by steady-state free-precession and phase-contrast MRI flow. Circ Cardiovasc Imaging 2009; 3:65-76. [PMID: 19820203 DOI: 10.1161/circimaging.109.859074] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac MRI is important in the treatment of children with congenital heart disease, but sufficient normative data are lacking. For ventricular volumes and mass, we sought to deliver reference centiles and to investigate sex effects. METHODS AND RESULTS We included 114 healthy children and adolescents, uniformly distributed spanning an age range of 4 to 20 years, as required by the Lambda-Mu-Sigma method to achieve a percentile distribution, thus avoiding arbitrary age categories. Subjects underwent axial volumetry (1.5-T scanner) using standardized 2D steady-state free-precession and flow protocols. Percentiles were computed for age 8 to 20 years (99 subjects) because breath-holds were more consistent in this group. When indexed for body surface area or height, the centile curves of ventricular volumetric parameters showed allometric increase until adolescence, when a plateau was reached, with values comparable to published adult reference data. In contrast, ventricular mass centiles increased without plateau. There was a significant sex difference, with centiles reflecting larger values in boys than in girls (P<0.05) when ventricular volumes were indexed to body surface area or height but not when indexed to weight (exception: mass). There was excellent agreement of axial and short-axis volumetry and of volumetric and flow-derived stroke volumes. CONCLUSIONS Percentiles for ventricular volumes and mass in healthy children have been established to serve as reference values in pediatric heart disease. Significant sex differences were noted when indexing volumes to body surface area or height. Unisex centiles related to weight may be considered for chamber volumes albeit not for mass.
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Affiliation(s)
- Samir Sarikouch
- Department of Heart, Thoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Qualitative echocardiographic assessment of aortic valve regurgitation with quantitative cardiac magnetic resonance: a comparative study. Pediatr Cardiol 2009; 30:971-7. [PMID: 19636486 DOI: 10.1007/s00246-009-9490-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/21/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Abstract
This study examined the correlation of echocardiography (ECHO) and Cardiac Magnetic Resonance (CMR) in the assessment of aortic valve regurgitation (AR) in children and young adults with congenital heart disease. We hypothesized that qualitative ECHO assessment correlates insufficiently with quantitative CMR data and compared subjective ECHO evaluations with objective measurement of regurgitant fractions (RF) by CMR. Patients who had both ECHO and CMR assessments of AR within 60 days of each other were included. The qualitative ECHO assessment (mild, moderate, severe) of AR and left ventricular dimension at end diastole were recorded. RF was quantified by CMR using phase-contrast velocity mapping. Repeat ECHO review and grading of AR was performed by a blinded single reader in a randomly chosen subgroup of patients. In 43 patients studied, statistical significance was observed in the CMR-RF between mild and moderate, and between mild and severe ECHO grades. There was significant overlap of objective RF between subjective grades. Mild ECHO AR corresponded to an RF (%) of 0-29, moderate 1-40, and severe 5-58. Overlap was more significant at moderate and severe grades. Results were similar in the group in whom a single reader interpreted the ECHO assessment. In conclusion, results derived from a real-life multiple-reader ECHO laboratory showed inconsistencies in ECHO grading of AR, with a wide range of objectively measured RF within a given ECHO grade. ECHO is less reliable in identifying more severe AR, often overestimating severity. Quantitative CMR is a potentially useful supplement to ECHO for management decisions and assessments of medical and surgical therapies in children and young adults with AR.
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Margossian R, Schwartz ML, Prakash A, Wruck L, Colan SD, Atz AM, Bradley TJ, Fogel MA, Hurwitz LM, Marcus E, Powell AJ, Printz BF, Puchalski MD, Rychik J, Shirali G, Williams R, Yoo SJ, Geva T. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study). Am J Cardiol 2009; 104:419-28. [PMID: 19616678 DOI: 10.1016/j.amjcard.2009.03.058] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/17/2009] [Accepted: 03/17/2009] [Indexed: 01/07/2023]
Abstract
Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (kappa = 0.42) and weak for right ventricular (RV) morphology (kappa = 0.12). For quantitative assessment, high intraclass correlation coefficients were found for echocardiographic interobserver agreement (LV 0.87 to 0.92, RV 0.82 to 0.85) of systolic and diastolic volumes, respectively. In contrast, intraclass correlation coefficients for LV and RV mass were moderate (LV 0.78, RV 0.72). The corresponding intraclass correlation coefficients by CMR were high (LV 0.96, RV 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility for the EF was similar for the 2 modalities. Although the absolute mean difference between modalities for the EF was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2-dimensional echocardiography underestimate CMR measurements, but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility, whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR.
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Koskenvuo JW, Järvinen V, Pärkkä JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging 2009; 29:229-40. [DOI: 10.1111/j.1475-097x.2009.00865.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buechel EV, Kaiser T, Jackson C, Schmitz A, Kellenberger CJ. Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:19. [PMID: 19545393 PMCID: PMC2718870 DOI: 10.1186/1532-429x-11-19] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/21/2009] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Quantification of ventricular volume by steady state free precession (SSFP) cardiovascular magnetic resonance is accurate and reproducible. Normal values exist for adults, but are lacking for children.We sought to establish normal values for left and right ventricular volumes, mass and function in healthy children by using SSFP. METHODS AND RESULTS Fifty children (27 females, 23 males) without cardiovascular disease were evaluated. Median age was 11 years (range 7 months - 18 years), weight 35 kg (range 7-77 kg), height 146 cm (range 66-181 cm). Thirty-six examinations were performed with breath holding, 14 in freely breathing sedated children.Ventricular volumes and mass were measured in the end systolic and end diastolic phase on SSFP cine images acquired in a short axis plane as a stack of 12 contiguous slices covering full length of both ventricles. Regression analysis showed an exponential relationship between body surface area (BSA) and ventricular volumes and mass (normal value = a*BSAb). Normative curves for males and females are presented in relation to BSA for the end-diastolic volume, end-systolic volume and mass of both ventricles. Intra- and interobserver variability of the measurements was within the limits of 2% and 7% respectively, except for right ventricular mass (10%). CONCLUSION The exponential equation for calculation of normal values for each ventricular parameter and graphical display of normative curves for data acquired in healthy children by SSFP cardiovascular magnetic resonance are provided.
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Affiliation(s)
| | - Thomas Kaiser
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Clare Jackson
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | - Achim Schmitz
- Division of Anesthesiology, University Children's Hospital, Zurich, Switzerland
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Robbers-Visser D, Boersma E, Helbing WA. Normal biventricular function, volumes, and mass in children aged 8 to 17 years. J Magn Reson Imaging 2009; 29:552-9. [PMID: 19243036 DOI: 10.1002/jmri.21662] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To assess normal values for biventricular function, volumes, and mass with current cardiovascular magnetic resonance (CMR) imaging sequences in children. MATERIALS AND METHODS Included in the study were 60 healthy children aged 8-17 years. A short axis set of contiguous slices was acquired with CMR imaging employing steady-state free precession. Biventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were determined. Uni- and multivariate linear regression analyses were performed to study the interrelation of age, gender, and body surface area (BSA) on biventricular volumes and mass. The coefficient of variation was calculated for intra- and interobserver variability. RESULTS EF did not differ between boys and girls (mean LV-EF 69+/-(SD) 5%, mean RV-EF 65+/-5%). BSA had good (EDV, mass) and modest (ESV) correlation with biventricular measurements. Gender appeared a significant modifier of these relations, whereas age had no independent contribution. The intra- and interobserver coefficient of variation was in the range 2.1%-13.9% for biventricular EDV, ESV, and mass. CONCLUSION This study reveals gender-specific normative data for biventricular function, volumes, and mass in children age 8-17 years that can be used as reference data in the follow-up of pediatric cardiac patients.
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Affiliation(s)
- Daniëlle Robbers-Visser
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Abstract
OBJECTIVES To assess neurohormonal activation of cardiac failure in adults with congenitally corrected transposition, and to determine the most sensitive marker for recognition of the cardiac failure. BACKGROUND The onset of morphologically right ventricular dysfunction is unpredictable in patients with congenitally corrected transposition, the combination of discordant atrioventricular and ventriculo-arterial connections, and its markers are unknown. METHODS We measured amino terminal pro brain natriuretic peptide in 19 patients, aged 35 plus or minus 13.1 years, and in 19 control subjects. Morhologically right ventricular function was assessed by echocardiography, including tissue Doppler echocardiography and magnetic resonance imaging or multislice computed tomography. RESULTS The patients showed a highly significant increase in the levels of amino terminal pro brain natriuretic peptide, the levels being significantly elevated even in asymptomatic patients. Left atrial dimensions were larger in patients, and significantly lower tissue Doppler echocardiographic velocities were measured at the lateral site of the tricuspid annulus and at the basal segment of the interventricular septum. The ejection fraction of the morphologically right ventricle correlated significantly with the levels of brain natriuretic peptide, and with left atrial dimensions. CONCLUSIONS Neurohormonal activation is present in patients with congenitally corrected transposition even when they are asymptomatic. It is correlated with left atrial dimensions and tissue Doppler echocardiographic parameters. Levels of brain natriuretic peptide, and peak tricuspid early diastolic annular velocity, are the earliest and most sensitive markers of morphologically right ventricular dysfunction.
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