scholarly journals Aortic regurgitation and left ventricle remodeling in cardiac magnetic resonance and transthoracic echocardiography

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
M Haberka ◽  
M Balys ◽  
Z Gasior
Keyword(s):  
Magnetic Resonance ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Imaging Modality ◽  
Public Institution ◽  
Funding Sources ◽  
Left Ventricle Remodeling ◽  
Lv Remodeling ◽  
Severity Grading

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Medical University of SIlesia Background Transthoracic echocardiography (TTE) is the main imaging modality used to assess patients with chronic aortic regurgitation (AR). However, it is not possible to provide a precise quantification in all patients. Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling. Methods A total of 51 consecutive patients with isolated AR in TTE were enrolled into the study and finally forty nine individuals (age: 57.1 (14); 61% males) underwent a non-contrast CMR (2 pts excluded for CMR contraindications). AR severity grading and LV remodeling were assessed according to the current ASE guidelines, including a semi-quantitative and quantitative parameters. All CMR studies were obtained on ecg-gated cine images acquired on 1.5T system (GE Optima MR450w, GE Healthcare, Wisconsin, USA) with a dedicated cardiac coil using a non-contrast protocol, including a quantitative approach (phase-contrast velocity  encoded imaging). Results Most of the study patients showed mild symptoms (NYHA I/II/III – 55%/38%/7%; CCS 0/I/II/III/IV – 79%/2%/12%/6%) and typical cardiovascular risk factors: hypertension (83%), dyslipidemia (91%), diabetes (12%) and obesity (16%). Twenty patients (40%) showed combined AV disease and 14 patients (28,5%) had a bicuspid AV. The AR jets were central (53%) or eccentric (47%) and multiple in 7 cases (14%). The inter-modality agreement (TTE-CMR) in AR grading was high in mild AR (91%) and low in mild-to-moderate (12%), moderate-to-severe (10%) and severe (20%) AR. The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed a significant association with CMR parameters (AR vol: r = 0.75; p < 0.001 and RF: r = 0.55; p < 0.01). Moreover, CMR revealed significantly larger LV end-diastolic volumes (EDV) (185,5 ± 61ml vs 158,4 ± 61ml; p = 0.03) and a trend towards higher left ventricle ejection fraction (59 ± 8 vs 56 ± 8%; p = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; p < 0.0001) compared to TTE (r = 0.6; p = 0.001). Conclusions CMR provides a comprehensive assessment of AR severity and LV remodeling with a moderate agreement with TTE.

scholarly journals Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Ming-Kui Zhang ◽  
Li-Na Li ◽  
Hui Xue ◽  
Xiu-Jie Tang ◽  
He Sun ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Left Ventricle Remodeling ◽  
Lv Remodeling ◽  
Chronic Aortic Regurgitation

Abstract Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. Methods We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m2. The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. Results Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6–12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. Conclusions The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.

scholarly journals Right Ventricle Involvement in Hypertrophic Cardiomyopathy and Role of Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy: Review Article

2021 ◽  
Vol 24 (4) ◽  
pp. E746-E750
Author(s):  
Weihao Ding ◽  
Sandeep Bhushan ◽  
Chen Ma ◽  
Yifan Yan ◽  
Zongwei Xiao
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Complex Geometry ◽  
Imaging Modality ◽  
Phenotypic Expression ◽  
The Right ◽  
And Function

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease, and its main characteristic is symmetrical or asymmetrical hypertrophy of the left ventricle and/or right ventricle. Most previous studies mainly include the left ventricle for definition of HCM, thus neglecting the right ventricle. But recently, many studies have reported the right ventricular involvement in HCM. Histopathological results showed that similar pathogenic changes in both the right and left ventricles, which suggests common myopathic processes and sarcomere genetic mutations. Cardiovascular magnetic resonance (CMR) is a gold standard imaging modality to assess heart anatomy and function and provides highly accurate and reproducible measurements. CMR is very useful in characterizing the various phenotypes of right and left ventricles in HCM. CMR also can be useful in detecting early and dominant phenotypic expression of HCM. Due to the complex geometry of the right ventricle and its retrosternal position, echocardiography may not provide accurate measurements. CMR also provides more accurate and repeatable right ventricular measurements. Thus, right ventricle evaluation along with left ventricle should routinely be done for better assessment of HCM patients.

scholarly journals Solitary neurofibroma of the heart

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091317
Author(s):  
Pei Jing Li ◽  
Jing Ping Sun ◽  
Xiao Yan Wang ◽  
Chun Li ◽  
Zheng Liu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Transthoracic Echocardiography ◽  
Contrast Echocardiography ◽  
Histopathologic Examination ◽  
Resonance Imaging ◽  
Solitary Neurofibroma

Solitary neurofibroma of the heart is extremely unusual. Few reports of neurofibroma in the left ventricle have been published. In this case report, we present the results of transthoracic echocardiography, myocardial contrast echocardiography, cardiac magnetic resonance imaging, and histopathologic examination of a patient with a neurofibroma of the heart. The patient had no evidence of any other metastasis or primary tumor in other organs, which is clinically rare.

scholarly journals Predicting the need of aortic valve surgery in patients with chronic aortic regurgitation: a comparison between cardiovascular magnetic resonance imaging and transthoracic echocardiography

2021 ◽  
Author(s):  
M. Faber ◽  
C. Sonne ◽  
S. Rosner ◽  
H. Persch ◽  
W. Reinhard ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Magnetic Resonance Tomography ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Cardiac Magnetic Resonance Tomography ◽  
Chronic Aortic Regurgitation

AbstractTo compare the ability of cardiac magnetic resonance tomography (CMR) and transthoracic echocardiography (TTE) to predict the need for valve surgery in patients with chronic aortic regurgitation on a mid-term basis. 66 individuals underwent assessment of aortic regurgitation (AR) both in CMR and TTE between August 2012 and April 2017. The follow-up rate was 76% with a median of 5.1 years. Cox proportional hazards method was used to assess the association of the time-to-aortic-valve-surgery, including valve replacement and reconstruction, and imaging parameters. A direct comparison of most predictive CMR and echocardiographic parameters was performed by using nested-factor-models. Sixteen patients (32%) were treated with aortic valve surgery during follow-up. Aortic valve insufficiency parameters, both of echocardiography and CMR, showed good discriminative and predictive power regarding the need of valve surgery. Within all examined parameters AR gradation derived by CMR correlated best with outcome [χ2 = 27.1; HR 12.2 (95% CI: 4.56, 36.8); (p < 0.0001)]. In direct comparison of both modalities, CMR assessment provided additive prognostic power beyond echocardiographic assessment of AR but not vice versa (improvement of χ2 from 21.4 to 28.4; p = 0.008). Nested model analysis demonstrated an overall better correlation with outcome by using both modalities compared with using echo alone with the best improvement in the moderate to severe AR range with an echo grade II out of III and a regurgitation fraction of 32% in CMR. This study corroborates the capability of CMR in direct quantification of AR and its role for guiding further treatment decisions particularly in patients with moderate AR in echocardiography.

scholarly journals Ischemic mitral regurgitation: modern evidence based echocardiography diagnosis, quantification and risks stratification review

2019 ◽  
pp. 9-16
Author(s):  
S. A. Rudenko ◽  
S. V. Potashev ◽  
L. M. Hrubiak ◽  
O. A. Mazur ◽  
O. K. Gogayeva ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Ischemic Cardiomyopathy ◽  
Ischemic Mitral Regurgitation ◽  
Evidence Based ◽  
Lv Remodeling ◽  
Major Coronary Artery ◽  
Severity Grading ◽  
Underlying Mechanisms ◽  
Main Factor

Ischemic mitral regurgitation (IMR) is a frequent complication in the patients after acute myocardial infarction (AMI) or in ischemic cardiomyopathy (ICM), associated with significant prognosis worsening. Mitral valve (MV) involvement may be primary (organic MR) or secondary (functional MR). Primary MR develops because of mitral subvalvular apparatus rupture as an AMI complication. Secondary IMR develops in the conditions of normal MV cusps and chords structure because of balance impairment between MV closure and tension forces secondary to left ventricle (LV) geometry alterations. According to evidence data both scenarios of IMR are associated with at least one major coronary artery critical stenosis (>70%). Secondary IMR is the most frequent consequence of ischemic cardiomyopathy. IMR diagnosis is associated with elevated patients mortality compared to those without it. It has been shown, that survival within patients with IMR after AMI down to 40% in case of moderate-to-severe IMR, compared to 62% in the patients with mild IMR or 84% in the patients without IMR at all. Pathophysiological mechanisms of IMR are not fully understood, but it is well known, that IMR is a complex entity, having left chambers, especially left ventricle (LV) remodeling as a key cause. Echocardiography (EchoCG) significantly contributes to understanding the underlying mechanisms of IMR. The aim of this review is to summarize modern evidence based data about IMR mechanisms and analysis of contemporary EchoCG indices for diagnosis, evaluation and risks stratification in the patients with IMR. IMR develops in approximately 20% of patients after AMI with increasing occurrence over past years, significantly influencing patients’ prognosis. IMR is a complex and dynamic entity, where LV remodeling is the main factor of MV dysfunction. EchoCG plays the clue role in IMR diagnosis giving the detailed information about its mechanisms and severity grading. Comprehensive EchoCG in the patients with coronary arteries disease (CAD) allows a better and comprehensive approach in risks stratification and optimal surgical IMR treatment planning.

scholarly journals Assessment of aortic regurgitation mechanism with cardiac magnetic resonance: an echocardiography comparative study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Richardson ◽  
N Raad ◽  
A Coisne ◽  
H Ridon ◽  
AS Polge ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Regurgitation ◽  
Integrated Approach ◽  
Aortic Dilatation ◽  
Surgical Decision ◽  
Funding Sources ◽  
Type 3

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic regurgitation (AR) quantification still remains challenging and requires an integrated approach. AR mechanism is one key parameter to take into account to assess its severity and repairability, and thus help to guide surgical decision. Although Cardiac Magnetic Resonance (CMR) has a growing interest in AR quantification, its performance to identify aortic AR mechanism has never been studied. Purpose We intended to define CMR Performance in this setting, by using echocardiography as reference. Methods AR mechanism was systematically evaluated in sixty-seven patients (81% male, mean age 46 ± 20 years) with chronic AR using CMR, and compared to transthoracic (TTE) and transesophageal (TEE) echocardiography as gold standard. AR were categorized as follows: type 1, aortic dilatation; type 2, Cusp prolapse; type 3, restrictive cusp motion. Jet direction, number of cusps and calcification (1 = no calcification, 2 = spots, 3 = big calcification interfering with cusp motion and 4 = Extensive with restricted cusp motion) were also evaluated. Results At TTE/TEE, mechanisms of AR were type 1 in 56 (83.5%), type 2 in 33 (49.2%), type 3 in 24 (35%). Agreement between TTE/TEE and CMR was modest, with respectively 74.6% (k= 0.4), 79.1% (k = 0.58) and 74.6% (k = 0.44). Bicuspid aortic valve was found in 44 (65.7%) patients at TTE/TEE, agreement with CMR was excellent, 98.5% (k = 0.97).  Jet was directed to the mitral valve in 42 (62.7%), at the inter ventricular septum in 12 (17.9%), and central in 13 (19.4%). Agreement with CMR was correct, respectively 80% (k = 0,6), 88% (k = 0.62) and 83.5% (K= 0.52). Calcification extension was 1 in 26 (38.8%), 2 in 25 (37.3%), 3 in 11 (16.4%) and 4 in 5 (7.5%). Agreement with CMR was poor, 44.7% (K= 0.28). Conclusion Accuracy between CMR and TTE/TEE to evaluate chronic AR mechanism and repairability was modest, with lower performance to define calcification extension. Abstract Figure. AR classification TTE/TEE vs CMR

scholarly journals Left Ventricle Intramuscular Haemangioma

2021 ◽  
Vol 21 (2) ◽  
pp. e316-319
Author(s):  
Rashid S Al Umairi ◽  
Said Sabek
Keyword(s):  
Magnetic Resonance ◽  
Left Ventricle ◽  
Imaging Modality ◽  
Left Ventricle Mass ◽  
Cardiac Tumours ◽  
Heart Neoplasms ◽  
Cardiology Clinic ◽  
History Of ◽  
Intramuscular Haemangioma ◽  
The Stability

Cardiac haemangiomas are rare cardiac tumours that are usually asymptomatic and detected incidentally while imaging the heart with echocardiogram. Cardiovascular magnetic resonance (CMR) is a non-ionising imaging modality that allows the diagnosis of cardiac haemangiomas prior to surgery. We report a 36-year old male patient who was referred to the Adult Cardiology Clinic at the Royal Hospital, Muscat, Oman, in 2006 with a history of a left ventricle mass detected on echocardiogram. Further assessment of the mass by CMR revealed that the mass within the left ventricle apical septum contained features that were consistent with a cardiac haemangioma. Due to the surgical risk of ventricular septal defect and the stability of the mass, the patient was managed conservatively and upon followup the patient’s condition remained stable. Keywords: Heart Neoplasms; Hemangioma; Heart, Neoplasm; Magnetic Resonance Imaging; Cardiovascular; Left Ventricle; Coronary Angiography; Case Report; Oman.

scholarly journals Left ventricular hypertrabeculation in Ebstein anomaly – a clinically significant or irrelevant problem?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Cieplucha ◽  
O Trojnarska ◽  
J Rajewska-Tabor ◽  
A Katarzynska-Szymanska ◽  
P Mitkowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Ebstein Anomaly ◽  
Funding Sources ◽  
Peak Vo2 ◽  
And Function

Abstract Background Ebstein anomaly (EA) is characterized by anomalous tricuspid valve resulting in the whole right heart's distorted anatomy. Heart failure is the most frequent complication in adults with EA. Recently more attention is also paid to the left ventricle. Some limited echocardiographic data suggest a markedly increased occurrence of the left ventricular hypertrabeculation, by some authors called a non-compacted myocardium. Currently, cardiac magnetic resonance (CMR) is a gold standard in the evaluation of hypertrabeculation. However, different diagnostic criteria and discrepancies in the study outcomes make the clinical interpretation of this phenomenon questionable and challenging. Purpose To determine the frequency of the left ventricular hypertrabeculation among adults with EA; to assess its association with the ventricular size and function and the markers of heart failure. Methods Study group consisted of 35 unoperated adults (mean age 41.9±14.8 years) with Ebstein anomaly. The study protocol included: a) cardiac magnetic resonance (CMR) with the assessment of the left ventricle (LV) and functional right ventricle (fRV), including ejection fraction (EF), end-diastolic, end-systolic, and stroke volumes indexed by body surface area (respectively: EDVind, ESVind, SVind), and presence of hypertrabeculation defined according to Jacquier (1) as trabeculation mass &gt;20% of the LV mass; b) cardiopulmonary tests with the assessment of peak oxygen consumption (peak VO2, % of predicted peak VO2), ventilation/carbon dioxide slope (VE/VCO2 slope) c) brain natriuretic peptide (BNP). Results Left ventricular hypertrabeculation was present in 13 (37.1%) patients. We demonstrated no difference between patients with and without LV hypertrabeculation regarding: s Conclusions Left ventricular hypertrabeculation demonstrated by cardiac magnetic resonance is a phenomenon frequently occurring among adults with Ebstein anomaly. However, its presence is not associated with both ventricles' worse function nor with reduced exercise capacity. Therefore, the clinical relevance of left ventricular hypertrabeculation in this population remains questionable and requires further prospective studies. FUNDunding Acknowledgement Type of funding sources: None.

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