Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction

To assess agreement between two semi-automatic, three-dimensional (3D) computed tomography (CT) ventricular volumetry methods with different user interactions in patients with congenital heart disease. In 30 patients with congenital heart disease (median age 8 years, range 5 days–33 years; 20 men), dual-source, multi-section, electrocardiography-synchronized cardiac CT was obtained at the end-systolic (n = 22) and/or end-diastolic (n = 28) phase. Nineteen left ventricle end-systolic (LV ESV), 28 left ventricle end-diastolic (LV EDV), 22 right ventricle end-systolic (RV ESV), and 28 right ventricle end-diastolic volumes (RV EDV) were successfully calculated using two semi-automatic, 3D segmentation methods with different user interactions (high in method 1, low in method 2). The calculated ventricular volumes of the two methods were compared and correlated. A P value <0.05 was considered statistically significant. LV ESV (35.95 ± 23.49 ml), LV EDV (88.76 ± 61.83 ml), and RV ESV (46.87 ± 47.39 ml) measured by method 2 were slightly but significantly smaller than those measured by method 1 (41.25 ± 26.94 ml, 92.20 ± 62.69 ml, 53.61 ± 50.08 ml for LV ESV, LV EDV, and RV ESV, respectively; P ≤ 0.02). In contrast, no statistically significant difference in RV EDV (122.57 ± 88.57 ml in method 1, 123.83 ± 89.89 ml in method 2; P = 0.36) was found between the two methods. All ventricular volumes showed very high correlation (R = 0.978, 0.993, 0.985, 0.997 for LV ESV, LV EDV, RV ESV, and RV EDV, respectively; P < 0.001) between the two methods. In patients with congenital heart disease, 3D CT ventricular volumetry shows good agreement and high correlation between the two methods, but method 2 tends to slightly underestimate LV ESV, LV EDV, and RV ESV.     

Early detection of myocardial dysfunction in children with beta-thalassaemia major

To evaluate left and right ventricular myocardial performance using pulsed-tissue Doppler imaging (TDI) and its relation to BNP levels in patients with beta-thalassaemia major (ß-TM). We enrolled 36 thalassaemic patients (21 male, 15 female; mean age: 14.2 ± 4.1 years) with normal left ventricular systolic and diastolic functions with conventional echocardiography and 30 healthy control subjects (18 male, 12 female, and 12.5 ± 4.2 years). Myocardial performance indexes (MPI) of left ventricular (LV) lateral wall, interventricular septum (IVS) and right ventricular (RV) lateral wall were calculated with TDI. Plasma BNP levels were measured in all patients. MPIs and other echocardiographic parameters of patients with ß-TM were compared with control group. All the patients’ plasma BNP levels were within normal limits. There were no differences between conventional echocardiographic parameters of patients and control group. MPI of LV, IVS, and RV of patients were significantly higher than control group (P = 0.01, and P < 0.01, and P < 0.001, respectively). Our study confirms that MPI obtained by TDI seems to be an early sensitive parameter of cardiac dysfunction in ß-TM. We concluded that MPI obtained by TDI may be an adjunctive parameter to conventional echocardiography for detecting early myocardial damage.     

The relationship between electrocardiographic changes and CMR features in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy

To investigate the relationship between electrocardiographic (ECG) abnormalities and left ventricular (LV) segmental hypertrophy and myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy (HCM). 118 asymptomatic or mildly symptomatic patients with HCM were examined with late gadolinium enhancement (LGE) CMR, 12-lead ECG, and echocardiography. The distribution and magnitude of LV segmental hypertrophy and LGE were assessed and analyzed in relation to ECG abnormalities. Abnormal electrocardiograms were found in 113 of 118 (95 %) patients. Negative T waves were associated with greater apical septal thickness (P = 0.009) and an increased ratio of LV septum to free wall thickness (P = 0.01). Giant negative T waves (GNT) were found in 19 patients (16 %), and were associated with apical HCM (P < 0.001), greater apical thickness (P = 0.004), and increased ratio of LV apical to basal wall thickness (P < 0.001). However, no significant association was demonstrated between GNT and apical LGE (P = 0.71). Abnormal Q waves were associated with greater basal anteroseptal thickness (P = 0.001), maximal basal thickness (P = 0.004), and more segments with extensive LGE (>75 % wall thickness involved) (P = 0.001). LV hypertrophy was related to greater LV mass (P = 0.002) and LV end diastolic volume (P = 0.002). In addition, a modest but significant correlation was observed between maximum LV wall thickness and the Romhilt-Estes score (r = 0.41, P < 0.001). GNT were associated with apical HCM and an increased ratio of LV apical to basal wall thickness. Abnormal Q waves were related to basal anteroseptal hypertrophy and segmental extensive LGE.     

Regional contribution to ventricular stroke volume is affected on the left side,but not on the right in patients with pulmonary hypertension

To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (RV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMR). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (RHC) and CMR. CMR from 33 healthy adults (13 females) were used as controls. Left ventricular (LV) atrioventricular plane displacement (AVPD) and corresponding longitudinal contribution to LVSV was lower in patients (10.8?±?3.2 mm and 51?±?12?%) compared to controls (16.6?±?1.9 mm and 59?±?9?%, p?<?0.0001 and p?<?0.01, respectively). This decrease did not differ in patient with ejection fraction (EF) >50?% and <50?% (p?=?0.5) and was compensated for by increased LV lateral contribution to LVSV in patients (49?±?13?% vs. 37?±?7?%, p?=?0.001). Septal motion contributed less to LVSV in patients (5?±?8?%) compared to controls (8?±?4?%, p?=?0.05). RV AVPD was lower in patients (12.0?±?3.6 mm vs. 21.8?±?2.2 mm, p?<?0.0001) but longitudinal and lateral contribution to RVSV did not differ between patients (78?±?17?% and 29?±?16?%) and controls (79?±?9?% and 31?±?6?% p?=?0.7 for both) explained by increased RV cross sectional area in patients. LV function is affected in patients with PH despite preserved global LV function. The decreased longitudinal contribution and increased lateral contribution to LVSV was not seen in the RV, contrary to previous findings in patients with volume loaded RVs.     

Echocardiographic assessment of right ventricular functions in patients with proximal right coronary artery chronic total occlusion

To assess right ventricular functions by echocardiography in patients with proximal right coronary artery (RCA) CTO and correlating it with clinical and angiographic variables. We studied 60 consecutive patients with CTO of the proximal RCA and no other significant lesions in the left coronary system. Echocardiography was performed in order to measure left ventricular (LV) dimensions, LVEF, RV end diastolic area (RVEDA), RV end systolic area (RVESA), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), Doppler myocardial performance index (MPI), trans-tricuspid E and A waves, E/A ratio, S′, e′ and a′. Grades of coronary collaterals was assessed. Doppler MPI showed negative correlation with TAPSE (r = ?0.8997, p < 0.0001) and RVFAC (r = ?0.928, p < 0.0001). Positive correlation with trans-tricuspid E/A ratio (r = 0.893, p < 0.0001) and E/e′ ratio (r = 0.783, p < 0.0001). Patients with no evidence of MI had more well-developed (grade 3) coronary collaterals (83.8 vs. 17.4 %). Patients with evidence of MI had lower RVFAC 38.13 ± 5.39 versus 45.08 ± 4.99 % (p < 0.0001), lower TAPSE 20.17 ± 3.85 versus 25.35 ± 3.46 mm (p < 0.0001), higher MPI 0.4 ± 0.08 versus 0.31 ± 0.05 (p < 0.0001), higher trans-tricuspid E/A ratio 1.79 ± 0.38 versus 1.13 ± 0.36 (p < 0.0001) and E/e′ ratio 5.23 ± 1.02 versus 3.61 ± 0.88 (p < 0.0001). Patients with poorly developed collaterals had lower TAPSE and RVFAC and a higher MPI (p < 0.0001 for each). Patients with proximal RCA CTOs and evidence of inferior wall MI have significant impairment of RV functions in addition to poorly developed coronary collaterals. Those with proximal RCA CTOs and well-developed coronary collaterals have better RV functions.     

Assessment of pulmonary arterial stiffness in obstructive sleep apnea

Pulmonary hypertension (PH) is one of the major complications of obstructive sleep apnea syndrome (OSAS). Pulmonary arterial stiffness (PAS) can be used in determination of PH. The aim of the present study was to evaluate the PAS and cardiac function of patients with OSAS and analyses the relationship between OSAS severity and PAS. Sixty newly diagnosed patients with OSAS (mean age 49.6 ± 11.7 years) and 30 healthy controls (mean age 46.4 ± 14 years) were enrolled. Right ventricle (RV) and left ventricle (LV) echocardiographic parameters and PAS values of study groups were compared. There were no significant differences in terms of LV ejection fraction, LV Tei-index and tricuspid annular plane systolic excursion. PAS, mean pulmonary arterial pressure (PAP) and RV Tei-index were significantly higher but tricuspid annulus early diastolic myocardial velocity was lower in patients with OSAS than control subjects (respectively p < 0.001, p < 0.001, p = 0.001, p = 0.001). Moreover, we found a higher PAS in OSAS patients without PH compared to controls (p < 0.001). When we investigated the relationship between polysomnographic variables and echocardiographic parameters, we found positive correlations between apnea hypopnea index and total oxygen desaturation with PAS and mean PAP (r = 0.384, p < 0.001; r = 0.404, p < 0.001; r = 0.36, p < 0.001; r = 0.349, p = 0.001 respectively). PAS and mean PAP were increased in patients with OSAS. Pulmonary vascular bed may be affected due to the fluctuation of PAP during day and night time. Therefore, assessment of PAS can be more useful than PAP in OSAS patients.     

Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values

Pulmonary hypertension (PH) is a progressively fatal disease having a significant impact on right ventricular (RV) function, a major determinant of long-term outcome in PH patients. In our clinic we frequently noticed the combination of PH and reduced RV function, but with discordant Tricuspid Annular Plane Systolic Excursion (TAPSE) values. The present study focuses on whether RV free wall strain measured using 2-dimensional speckle-tracking echocardiography is able to predict mortality in this subgroup of PH patients. 57 patients with PH and RV dysfunction (visual echocardiographic assessment of ≥2) and pseudo-normalized TAPSE values (defined as ≥16 mm) were retrospectively evaluated. Patients were divided by RV free ?20 % as cut-off value. Follow-up data on all-cause mortality were registered after a median follow-up time of 27.9 ± 1.7 months. RV free of ≥?20 % was predictive of all-cause mortality after a median follow-up time of 27.9 ± 1.7 months (HR 3.76, 95 % CI 1.02–13.92, p = 0.05). RV free ≥?20 % remained a significant predictor of all-cause mortality (HR 4.30, 95 % CI 1.11–16.61, p = 0.04) after adjusting for PH-specific treatment. On the contrary, TAPSE was not a significant predictor of all-cause mortality. RV free wall strain provides prognostic information in patients with PH and RV dysfunction, but with normal TAPSE values. Future studies with larger cohorts, longer follow-up periods and inclusion of more echocardiographic parameters measuring LV and RV function could confirm the strength of RV free ≥?20 % as a predictor of mortality for this subgroup of patients with PH.     

Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile

Regional right ventricular (RV) dysfunction (RRVD) is an echocardiographic feature in acute pulmonary embolism (PE), primarily reported in patients with moderate-to-severe RV dysfunction. This study investigated the clinical importance of RRVD by assessing its relationship with clot burden and biomarkers. We identified consecutive patients admitted to the emergency department between 1999 and 2014 who underwent computed tomographic angiography, echocardiography, and biomarker testing (troponin and NT-proBNP) for suspected acute PE. RRVD was defined as normal excursion of the apex contrasting with hypokinesis of the mid-free wall segment. RV assessment included measurements of ventricular dimensions, fractional area change, free-wall longitudinal strain and tricuspid annular plane systolic excursion. Clot burden was assessed using the modified Miller score. Of 82 patients identified, 51 had acute PE (mean age 66 ± 17 years, 43 % male). No patient had RV myocardial infarction. RRVD was present in 41 % of PEs and absent in all patients without PE. Among patients with PE, 86 % of patients with RRVD had central or multi-lobar PE. Patients with RRVD had higher prevalence of moderate-to-severe RV dilation (81 vs. 30 %, p < 0.01) and dysfunction (86 vs. 23 %, p < 0.01). There was a strong trend for higher troponin level in PE patients with RRVD (38 vs. 13 % in PE patients without RRVD, p = 0.08), while there was no significant difference for NT-proBNP (67 vs. 73 %, p = 0.88). RRVD showed good concordance between readers (87 %). RRVD is associated with an increased clot burden in acute PE and is more prevalent among patients with moderate-to-severe RV enlargement and dysfunction.     

Serial assessment of arterial structure and function in patients with coarctation of the aorta undergoing stenting

Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8–39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs. 74.39 ± 22.07 g/m², p < 0.0001) values did not normalize. There was no significant change in FMD, NMD, PWV and CC or RSCA IMT. In patients with CoA, arterial reactivity is impaired and LV mass, arterial stiffness and thickness are increased. Although stenting is successful to relieve the obstruction resulting in better LV function and mass reduction, arterial structure and function remains abnormal after 1 year of follow-up.     

Evaluation of ventricular dysfunction using semi-automatic longitudinal strain analysis of four-chamber cine MR imaging

The aim of this study was to evaluate ventricular dysfunction using the longitudinal strain analysis in 4-chamber (4CH) cine MR imaging, and to investigate the agreement between the semi-automatic and manual measurements in the analysis. Fifty-two consecutive patients with ischemic, or non-ischemic cardiomyopathy and repaired tetralogy of Fallot who underwent cardiac MR examination incorporating cine MR imaging were retrospectively enrolled. The LV and RV longitudinal strain values were obtained by semi-automatically and manually. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff of the minimum longitudinal strain value for the detection of patients with cardiac dysfunction. The correlations between manual and semi-automatic measurements for LV and RV walls were analyzed by Pearson coefficient analysis. ROC analysis demonstrated the optimal cut-off of the minimum longitudinal strain values (ε_{L_min}) for diagnoses the LV and RV dysfunction at a high accuracy (LV ε_{L_min} = ?7.8 %: area under the curve, 0.89; sensitivity, 83 %; specificity, 91 %, RV ε_{L_min} = ?15.7 %: area under the curve, 0.82; sensitivity, 92 %; specificity, 68 %). Excellent correlations between manual and semi-automatic measurements for LV and RV free wall were observed (LV, r = 0.97, p < 0.01; RV, r = 0.79, p < 0.01). Our semi-automatic longitudinal strain analysis in 4CH cine MR imaging can evaluate LV and RV dysfunction with simply and easy measurements. The strain analysis could have extensive application in cardiac imaging for various clinical cases.     

Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1–11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (?17.1 ± 2.3 vs. ?20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = ?0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction.     

Assessment of aortic stiffness among patients with systemic lupus erythematosus and rheumatoid arthritis by magnetic resonance imaging

To evaluate aortic stiffness by MRI in female patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) in comparison to controls. We measured aortic strain, distensibility and pulse wave velocity (PWV) by MRI in 30 SLE patients, 31 RA patients and 53 matched controls. Mean PWV in SLE and RA patients were higher in comparison to controls (9.2 ± 4.4 vs. 7.6 ± 3.0 m/s, p = 0.04) and (6.2 ± 2.3 vs. 5.4 ± 1.7, p = 0.04) respectively. Aortic distensibility among RA patients was significantly lower in comparison to controls (4.4 ± 4.6 vs. 5.8 ± 4.9 kPa^?1 × 10^?3, p = 0.04). A significant correlation was found between PWV and age (r = 0.67, p < 0.001), Framingham risk score (r = 0.61, p < 0.001), waist to hip ratio (r = 0.45, p < 0.001), systolic blood pressure (r = 0.37, p = 0.01), diabetes (r = 0.32, p = 0.001) and dyslipidemia (r = 0.32, p = 0.001). In multivariate analysis for the prediction of PWV, variables which were found significant included: RA (p = 0.01), age (p < 0.001) and hypertension (p = 0.01) for patients with RA and SLE (p = 0.02), waist to hip ratio (p < 0.001) and total cholesterol (p < 0.001) for patients with SLE. Arterial stiffness, characterized by metrics of aortic distensibility and pulse wave velocity derived from MRI, is increased in SLE and RA female patients.     

Left Atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy

Background

Impaired left atrial (LA) function is an early marker of cardiac dysfunction and predictor of adverse cardiac events. Herein, we assess LA structure and function in hypertrophy in hypertrophic cardiomyopathy (HCM) sarcomere mutation carriers with and without left ventricular hypertrophy (LVH).

Method

Seventy-three participants of the HCMNet study who underwent cardiovascular magnetic resonance (CMR) imaging were studied, including mutation carriers with overt HCM (n =?34), preclinical mutation carriers without HCM (n =?24) and healthy, familial controls (n =?15).

Results

LA volumes were similar between preclinical, control and overt HCM cohorts after covariate adjustment. However, there was evidence of impaired LA function with decreased LA total emptying function in both preclinical (64?±?8%) and overt HCM (59?±?10%), compared with controls (70?±?7%; p =?0.002 and p =?0.005, respectively). LA passive emptying function was also decreased in overt HCM (35?±?11%) compared with controls (47?±?10%; p =?0.006). Both LAtotal emptying function and LA passive emptying function were inversely correlated with the extent of late gadolinium enhancement (LGE; p?=?0.005 and p <?0.05, respectively), LV mass (p =?0.02 and p <?0.001) and interventricular septal thickness (p?<?0.001 for both) and serum NT-proBNP levels (p?<?0.001 for both).

Conclusion

LA dysfunction is detectable by CMR in preclinical HCM mutation carriers despite non-distinguishable LV wall thickness and LA volume. LA function appears most impaired in subjects with overt HCM and a greater extent of LV fibrosis.

     

Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve

In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB?, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB? patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m², p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m², p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m², p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m², p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB? groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = ?0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.     

Real-time three-dimensional left ventricular contraction in patients with diastolic dysfunction

Purpose

Systolic alterations in left ventricular (LV) myocardial function have been reported previously in patients with diastolic dysfunction (DD). Recent advances in real-time three-dimensional echocardiography (3DE) enable the measurement of a set of parameters previously difficult to obtain with standard two-dimensional echocardiography (2DE). The aim of this study was to evaluate global 3DE LV contraction in patients with and without DD who had normal ejection fraction (EF).

Methods

Sixty-five patients (average age 56 ± 6 years; 31 females and 34 males) with normal EF (>50 %) referred to echocardiographic examination for the evaluation of DD were included. In addition to measuring conventional echocardiographic parameters, they were also evaluated with 3DE. End diastolic volume, end systolic volume, EF, corrected standard deviation (SD) of time to minimal systolic volume for 16 segments its dispersion, average excursion of the segments and the SD of segmental motion (excursion-SD) were recorded.

Results

When we tested the differences among three groups of diastolic function (normal, Grade 1, and Grade 2), the results showed that coronary artery disease, left atrial volume, septum, posterior wall, E, A, E/A, deceleration time, E′ septum, E′ lateral, and excursion-SD were significantly different. An ordered logistic regression analysis revealed that excursion-SD (p < 0.001) and septum (p < 0.001) measurements were statistically significant for predicting DD grade.

Conclusion

In our patient population, a decline in excursion-SD values was observed with increasing DD grade. In other words, the amount of segmental difference in terms of excursion was reduced.

     

The washout rate of <Superscript>123</Superscript>I-BMIPP and the evolution of left ventricular function in patients with successfully reperfused ST-segment elevation myocardial infarction: comparisons with the echocardiography

The evolution of the oxidative metabolism of ¹¹C acetate parallels the recovery of left ventricular (LV) contraction following acute myocardial infarction (AMI). This study was designed to unravel, for the first time, the impact of the global washout rate (WR) of ¹²³I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) on the recovery of LV function following AMI, as evidenced from conventional echocardiography. Twenty consecutive patients (age: 58 ± 13 years; 16 males and 4 females) with ST-segment elevation myocardial infarction (STEMI) were enrolled and all of them underwent successful percutaneous coronary intervention (PCI). ¹²³I-BMIPP cardiac scintigraphy was performed at 7 ± 3 days after admission. The WR was calculated from the polar map and the regional BMIPP defect score was calculated using a 17 segment model. Echocardiography was performed within 24 h of admission and at 3 months to record the ejection fraction (EF), the wall motion score index (WMSI), the ratio of the mitral inflow velocity to the early diastolic velocity (E/E′) and the myocardial performance index (MPI). The mean global WR of the BMIPP was 22.12 ± 7.22%, and it was significantly correlated with the improvement of the WMSI (r = 0.61, P < 0.004). However, the relative changes of the EF, E/E′ and MPI were not correlated with the WR. The BMIPP defect score (18 ± 10) was significantly correlated with the WMSI on admission (r = 0.74, P = 0.0002), but the defect score was not correlated with the relative changes of any of the echocardiographic parameters. We proved that the WR of the BMIPP is a promising indicator of improvement of the LV wall motion (WMSI) following ST-segment elevation myocardial infarction and successful reperfusion.     

Relationship of basal-septal fibrosis with LV outflow tract obstruction in hypertrophic cardiomyopathy: insights from cardiac magnetic resonance analysis

Myocardial fibrosis is frequently observed and may be associated with the prognosis in patients with hypertrophic cardiomyopathy (HCM); however, the clinical pathophysiological features, particularly in terms of fibrosis, of hypertrophic obstructive cardiomyopathy (HOCM) remain unclear. This study aimed to determine a role of local fibrosis in HOCM using cardiac magnetic resonance (CMR). 108 consecutive HCM patients underwent CMR. HOCM was defined as a left ventricular outflow tract (LVOT) pressure gradient ≥30 mmHg at rest. Myocardial mass and fibrosis mass by late gadolinium-enhancement CMR (LGE-CMR) were calculated and the distribution/pattern was analyzed using the AHA 17-segment model. LV ejection fraction (LVEF) was significantly higher in patients with HOCM (n = 19) than in those with nonobstructive HCM (n = 89) (P < 0.05). Both total myocardial and fibrosis masses in LV were similar in the two groups (P = 0.385 and P = 0.859, respectively). However, fibrosis in the basal septum was significantly less frequent in the HOCM group than in the nonobstructive HCM group (P < 0.01). The LVOT pressure gradient was significantly higher in the basal-septal non-fibrosis group than in the fibrosis group (23.6 ± 37.3 vs. 4.8 ± 11.4 mmHg, P < 0.01). Multivariate analysis revealed that basal-septal fibrosis was an independent negative predictor of LVOT obstruction in addition to the local wall thickness and LVEF as positive predictors in HCM patients. In conclusion, a significant association was observed between LVOT obstruction and basal septal fibrosis by LGE-CMR in HCM patients. In addition to negative impact of basal-septal fibrosis, basal-septal hypertrophy and preserved global LV contractility may be associated with the pathophysiological features of LVOT obstruction.     

Left ventricular synchrony,torsion, and recoil mechanics in Ebstein’s anomaly: insights from cardiovascular magnetic resonance

Background

Disease progression and heart failure development in Ebstein’s Anomaly (EA) of the tricuspid valve is characterized by both right and left ventricular (LV) deterioration. The mechanisms underlying LV dysfunction and their role in heart failure development are incompletely understood. We hypothesized that LV dyssynchrony and impaired torsion and recoil mechanics induced by paradoxical movement of the basal septum may play a role in heart failure development.

Methods

31 EA patients and 31 matched controls underwent prospective cardiovascular magnetic resonance (CMR). CMR feature tracking (CMR-FT) was performed on apical, midventricular and basal short-axis and 4D–volume analysis was performed using three long-axis views and a short axis cine stack employing dedicated software. Circumferential uniformity ratio estimates (CURE) time-to-peak-based circumferential systolic dyssynchrony index (C-SDI), 4D volume analysis derived SDI (4D–SDI), torsion (Tor) and systolic (sysTR) and diastolic torsion rate (diasTR) were calculated for the LV. QRS duration, brain natriuretic peptide, NYHA and Total R/L-Volume Index (R/L Index) were obtained.

Results

EA patients (31.5 years; controls 31.4 years) had significantly longer QRS duration (123.35 ms?±?26.36 vs. 97.33 ms ±?11.89 p <?0.01) and showed more LV dyssynchrony (4D–SDI 7.60%?±?4.58 vs. 2.54%?±?0.62, p <?0.001; CURE 0.77?±?0.05 vs. 0.86?±?0.03, p?<?0.001; C-SDI 7.70?±?3.38 vs. 3.80?±?0.91, p =?0.001). There were significant associations of LV dyssynchrony with heart failure parameters and QRS duration. Although torsion and recoil mechanics did not differ significantly (p >?0.05) there was an association of torsion and recoil mechanics with dyssynchrony parameters CURE (sysTR r =??0.426; p =?0.017, diasTR r =?0.419; p =?0.019), 4D–SDI (sysTR r =?0.383; p =?0.044) and C-SDI (diasTR r =??0.364; p?=?0.044).

Conclusions

EA is characterized by LV intra-ventricular dyssynchrony, which is associated with heart failure and disease severity parameters. Markers of dyssynchrony can easily be quantified from CMR-FT, and may have a role in the assessment of altered cardiac function, carrying potential management implications for EA patients.

     

Assessment of global function of left ventricle with dual-source CT in patients with severe arrhythmia: a comparison with the use of two-dimensional transthoracic echocardiography

To evaluate the agreement between dual-source computed tomography (DSCT) and two-dimensional transthoracic echocardiography (2D-TTE) with respect to the assessment of global left ventricular (LV) function in patients with severe arrhythmia. With 2D-TTE serving as the reference method, we performed both DSCT and 2D-TTE, at an interval of less than 2 days, in 54 patients with severe arrhythmia (average heart rate difference >30 beats per min) before open heart surgery for evaluation of valvular heart disease (VHD) and coronary artery disease. DSCT was performed using retrospective electrocardiography (ECG) without dose modulation. Ten phases of the cardiac cycle were analyzed for identification of end-diastolic and end-systolic phases with ECG-editing. Pearson’s correlation coefficient (r) and Bland–Altman analysis were used to determine agreement for parameters of LV global function. Correlation between DSCT and 2D-TTE measurements was good or excellent in terms of the values of the LV ejection fraction (51.0 ± 11.4% vs. 55.8 ± 11.6%; r = 0.8), LV end-diastolic volume (179.5 ± 98.6 ml vs. 152.1 ± 73.8 ml; r = 0.95), LV end-systolic volume (90.7 ± 60.7 ml vs. 69.1 ± 46.8 ml; r = 0.90), and LV stroke volume (89.0 ± 48.1 ml vs. 82.9 ± 37.3 ml; r = 0.89). Left ventricular ejection fraction measured using DSCT was less than that measured using 2D-TTE by an average of ?4.8 ± 7.3%. Dual-source CT with ECG editing can provide results comparable to those of 2D-TTE for assessment of LV global function in patients with severe arrhythmia.     

Diagnostic and prognostic significance of cardiovascular magnetic resonance native myocardial T1 mapping in patients with pulmonary hypertension

Background

Native T1 may be a sensitive, contrast-free, non-invasive cardiovascular magnetic resonance (CMR) marker of myocardial tissue changes in patients with pulmonary artery hypertension. However, the diagnostic and prognostic value of native T1 mapping in this patient group has not been fully explored. The aim of this work was to determine whether elevation of native T1 in myocardial tissue in pulmonary hypertension: (a) varies according to pulmonary hypertension subtype; (b) has prognostic value and (c) is associated with ventricular function and interaction.

Methods

Data were retrospectively collected from a total of 490 consecutive patients during their clinical 1.5 T CMR assessment at a pulmonary hypertension referral centre in 2015. Three hundred sixty-nine patients had pulmonary hypertension [58?±?15 years; 66% female], an additional 39 had pulmonary hypertension due to left heart disease [68?±?13 years; 60% female], 82 patients did not have pulmonary hypertension [55?±?18; 68% female]. Twenty five healthy subjects were also recruited [58 ±4 years); 51% female]. T1 mapping was performed with a MOdified Look-Locker Inversion Recovery (MOLLI) sequence. T1 prognostic value in patients with pulmonary arterial hypertension was assessed using multivariate Cox proportional hazards regression analysis.

Results

Patients with pulmonary artery hypertension had elevated T1 in the right ventricular (RV) insertion point (pulmonary hypertension patients: T1?=?1060?±?90 ms; No pulmonary hypertension patients: T1?=?1020?±?80 ms p <?0.001; healthy subjects T1?=?940?±?50 ms p <?0.001) with no significant difference between the major pulmonary hypertension subtypes. The RV insertion point was the most successful T1 region for discriminating patients with pulmonary hypertension from healthy subjects (area under the curve?=?0.863) however it could not accurately discriminate between patients with and without pulmonary hypertension (area under the curve?=?0.654). T1 metrics did not contribute to prediction of overall mortality (septal: p =?0.552; RV insertion point: p =?0.688; left ventricular free wall: p =?0.258). Systolic interventricular septal angle was a significant predictor of T1 in patients with pulmonary hypertension (p <?0.001).

Conclusions

Elevated myocardial native T1 was found to a similar extent in pulmonary hypertension patient subgroups and is independently associated with increased interventricular septal angle. Native T1 mapping may not be of additive value in the diagnostic or prognostic evaluation of patients with pulmonary artery hypertension.