scholarly journals P364 The first prospective study of non-compaction cardiomyopathy patients with preserved ejection fraction using cardiac magnetic resonance feature tracking

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Kiss ◽  
A Szucs ◽  
A Furak ◽  
Z S Gregor ◽  
M Horvath ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Apical Part ◽  
Left Ventricular ◽  
Functional Parameters ◽  
Significant Difference

Abstract Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement to reveal changes e.g. in noncompaction cardiomyopathy (NCMP) patients with good ejection fraction (EF). Our aim was to describe, first in the literature, the functional and CMR-FT strain values of NCMP patients with good EF and to compare them with their previous scans taken 4 years ago. At the Heart and Vascular Center of Semmelweis University 6743 CMR examinations were done between 2009-2015 and 232 NCMP patients were diagnosed. We followed up 27 patients, who had a previous examination at least 4 years ago, had no co-morbidities and whoes EF were above 50% (mean age: 37 ± 14.4 years, 18 males, mean follow up: 5.7 ± 1.5 years). Their parameters were compared to a matched control (C) group. The Medis Suite software was used for analysis, the MedCalc software for statistics, (p < 0.05). We compared the patient’s previous (PREV) and recent (REC) functional parameters but did not find significant changes. Comparing the global longitudinal and global circumferential strains (GLS, GCS) and rotation (R) no difference was found between the PREV and the REC values. The GCS showed significant difference between NCMP and C groups (-30.2 ± 5.0 vs -35.9 ± 4.5; p < 0.0001). We compared the segmental longitudinal and circumferential strain values of PREV vs. REC groups and NCMP vs C groups and found significant differences just in a few segments. The left ventricular (LV) apical part’s mean longitudinal strain value showed significant decrease on the REC scans compared to the PREV (PREV vs REC: -24.4 ± 7.7 vs -20.6 ± 5.1%; p < 0.05) and a non-significant decrease compared to the C (C vs REC: -22.8 ± 7.5 vs -20.6 ± 5.1%; p= n.s.). The ratio of the average longitudinal strain value of the apical and basal part of the left ventricle was significantly smaller in the REC group compared to the PREV but did not differ from the C subjects ( PREV vs. REC: 1.5 ± 0.8 vs 1.0 ±0.3; C vs REC: 1.5 ± 0.3 vs 1.2 ± 0.5; p < 0.05) We did not find worsening in the functional parameters of NCMP patients with good EF by the end of the follow up period. However, subclinical changes can be detected in the affected apical part of LV when using FT suggesting the need for follow up.

scholarly journals Feature-tracking cardiac magnetic resonance left ventricular global longitudinal strain improves 6 months after kidney transplantation associated with reverse remodeling, not myocardial tissue characteristics

2021 ◽  
Author(s):  
Maurício Fregonesi Barbosa ◽  
Mariana Moraes Contti ◽  
Luis Gustavo Modelli de Andrade ◽  
Alejandra del Carmen Villanueva Mauricio ◽  
Sergio Marrone Ribeiro ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Cardiac Magnetic Resonance ◽  
Feature Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Myocardial Tissue ◽  
Tissue Characteristics

AbstractTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling and myocardial tissue characteristics. This is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done up to 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. A total of 44 patients [mean age 50 ± 11 years-old, 27 (61.4%) male] completed the two CMR exams. LV GLS improved from − 13.4% ± 3.0 at baseline to − 15.2% ± 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (− 17.7% ± 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p = 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = − 0.429, p = 0.004), ejection fraction (r = − 0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = − 0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). In this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

3225Global longitudinal strain measured using feature-tracking cardiac magnetic resonance imaging is an independent predictor of all cause mortality in patients with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Romano ◽  
R Judd ◽  
R Kim ◽  
J Heitner ◽  
D Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Feature Tracking ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Regression Modeling ◽  
Preserved Ejection Fraction

Abstract Introduction Ejection fraction is the principal measure used clinically to assess cardiac mechanics and provides significant prognostic information. However, echocardiographic strain imaging has shown significant abnormalities of myocardial deformation can be present despite preserved ejection fraction, which maybe associated with adverse prognosis. Cardiac-Magnetic-Resonance (CMR) feature-tracking techniques now allow assessment of strain from routine cine-images, without specialized pulse sequences. Whether abnormalities of strain measured using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown. Purpose To evaluate the prognostic value of CMR feature-tracking derived global longitudinal strain (GLS) in a large multicenter population of patients with preserved ejection fraction. Methods Consecutive patients with preserved ejection fraction (EF ≥50%) and a clinical indication for CMR at four US medical centers were included in this study. Feature-tracking GLS was calculated from 3 long-axis-cine-views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models. Results Of the 1274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (−20%) had significantly reduced event free survival compared to those with GLS < median (log-rank p<0.001) (Figure, top panel). The continuous relationship between GLS and the hazard of death is shown in the cubic spline (Figure, lower panel). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 23.6% increased risk-of-death after adjustment for clinical and imaging risk factors (HR=1.236 per %; p<0.001). Addition of GLS in this model resulted in significant-improvement in the global-chi-square (67 to 168; p<0.0001) and Harrel's C-statistic (0.716 to 0.825; p<0.0001). Conclusions CMR feature-tracking derived GLS is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.

P5266Renal denervation improves diastolic dysfunction in patients with HFpEF - initial results of a multicenter CMR study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Zamani ◽  
F Mahfoud ◽  
L Stoiber ◽  
M Boehm ◽  
B Pieske ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Cine Mri ◽  
Preserved Ejection Fraction

Abstract Introduction Renal denervation (RDN) significantly reduces blood pressure (BP) and improves myocardial function in patients with resistant hypertension. Purpose This multicenter study aimed to investigate the intermediate term effect of RDN on left ventricular global longitudinal strain (GLS), a surrogate for diastolic myocardial function in RDN patients with proven heart failure with preserved ejection fraction (HFpEF), assessed by cardiac magnetic resonance imaging (CMR). Methods We analyzed data from 22 patients with resistant hypertension (mean age 68±6 years). 16 patients underwent renal denervation (RDN) and 6 matched control patients received optimal medical therapy (OMT). Both groups had diastolic dysfunction defined by preserved ejection fraction (EF ≥50%) and pathologically elevated GLS at baseline (GLS >−18%) quantified by cardiac magnetic resonance (CMR). A standardized CMR protocol was performed at baseline (BL) and 6 months follow-up (FU). Left ventricular mass index (LVMI) was quantified in end-diastolic and end-systolic endo- and epicardial contouring in short axis cine-MRI images. GLS was measured by end-diastolic and end-systolic endocardial contouring in 2-, 3- and 4-chamber view cine-MRI images. MRI-Images have been analyzed with Medis, Netherlands. Results GLS following RDN patients significantly improved after 6 months by 21% (−14.21% ±3.19 vs. −17.17%± 3.1; p=0.007). In control patients with OMT, no significant change in GLS was detected (−14.77% ±3.05 vs. −17.39% ± 4.49; p=0.327). LVMI was numerically reduced in the RDN group at follow-up but did not reach statistical significance (58.55 g/m2±11.37 vs. 55.46 g/m2±12.76; p=0.085). There was no such effect in control patients with OMT (49.25 g/m2±8.2 vs. 50.18 g/m2±7.27; p=0.665). (See also: Figure A and B). Conclusions We found significantly improved diastolic function (GLS) in patients with HFpEF and resistant hypertension undergoing RDN. Future studies are needed to determine whether RDN represents a treatment option in patients with HFpEF.

scholarly journals Measurement of Ejection Fraction by Cardiac Magnetic Resonance Imaging and Echocardiography to Monitor Doxorubicin-Induced Cardiotoxicity

2019 ◽  
Vol 29 (01) ◽  
pp. 045-051 ◽  
Author(s):  
Tahir Tak ◽  
Camilla M. Jaekel ◽  
Shahyar M. Gharacholou ◽  
Marshall W. Dworak ◽  
Scott A. Marshall
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Magnetic Resonance Imaging ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Resonance Imaging ◽  
Significant Difference

AbstractDoxorubicin is a standard treatment option for breast cancer, lymphoma, and leukemia, but its benefits are limited by its potential for cardiotoxicity. The primary objective of this study was to compare cardiac magnetic resonance imaging (CMRI) versus echocardiography (ECHO) to detect a reduction in left ventricular ejection function, suggestive of doxorubicin cardiotoxicity. We studied eligible patients who were 18 years or older, who had breast cancer or lymphoma, and who were offered treatment with doxorubicin with curative intent dosing of 240 to 300 mg/m2 body surface area between March 1, 2009 and October 31, 2013. Patients underwent baseline CMRI and ECHO. Both imaging studies were repeated after four cycles of treatment. Ejection fraction (EF) calculated by both methods was compared and analyzed with the inferential statistical Student's t test. Twenty-eight eligible patients were enrolled. Two patients stopped participating in the study before undergoing baseline CMRI; 26 patients underwent baseline ECHO and CMRI. Eight of those 26 patients declined posttreatment studies, so the final study population was 18 patients. There was a significant difference in EF pre- and posttreatment in the CMRI group (p = 0.009) versus the ECHO group that showed no significant differences in EF (p = NS). It appears that CMRI is superior to ECHO for detecting doxorubicin-induced reductions in cardiac systolic function. However, ECHO is less expensive and more convenient for patients because of its noninvasive character and bedside practicality. A larger study is needed to confirm these findings.

scholarly journals Correlation between cardiac magnetic resonance feature tracking derived left ventricular strain and morphological characteristics of non-ischemic dilated cardiomyopathy at baseline and follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Pozo Osinalde ◽  
J Urmeneta Ulloa ◽  
J L Rodriguez Hernandez ◽  
L Perez De Isla ◽  
H Martinez Fernandez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Feature Tracking ◽  
Systolic Function ◽  
Morphological Characteristics ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Morphological Parameters ◽  
Non Ischemic Dilated Cardiomyopathy

Abstract Background Left ventricular (LV) strain from echocardiography is a known useful predictor of LVEF recovery in non-ischemic dilated cardiomyopathy (NIDCM). More recently, feature tracking (FT) has allowed LV myocardial deformation analysis using conventional cardiac magnetic resonance (CMR) cine sequences. Purpose Our aim is to establish the correlation between LV strain values from CMR-FT at diagnosis and morphological parameters at baseline and during follow-up. Methods Consecutive patients with NIDCM who underwent CMR were retrospectively collected. All the studies were performed in a 1.5 Tesla magnet following a standard acquisition protocol of conventional SSFP cine sequences in long and short axis. Global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained with a dedicated FT software. Correlation with CMR morphological parameters at baseline were evaluated. Likewise, in the cases with follow-up echocardiogram association between FT LV strain and evolution of morphofunctional variables was explored. Results CMR-FT strain analysis was performed in 98 patients (age 68±13 years, 72% males) with NIDCM. They showed severe LV dilatation (LVEDVi= 133.6±33.4 mL/m2) and systolic dysfunction (LVEF= 29.5±9.6%) at baseline. Myocardial fibrosis was detected in 38.8% of the patients with late gadolium enhancement (LGE) sequence. All the basal CMR morphological characteristics were significantly correlated with FT strain analysis (Table), even more markedly for GCS. However, there was no association of baseline morphofunctional parameters with LGE. An echocardiogram was performed in 85.7% of the patients during the follow-up (2.4 [1.8–3.4] years), with an LVEF &gt;50% in the 25.5% of the cases. These patients with preserved LVEF in the evolution showed better GCS (−9 vs −7.1%; p=0.019) at baseline, with no differences in the other FT LV strain parameters. Despite less fibrosis in LGE (16.1% vs 37.7%; p=0.037), none of the baseline morphofunctional CMR parameters (LVEF, LVEDVi...) were associated with systolic function restoration. In multivariate analysis, GCS was the only independent predictor (OR 1.16; p=0.045) of LVEF recovery among imaging variables. Conclusions All the FT derived LV strain values were correlated with the degree of basal morphofunctional involvement in NIDCM. Furthermore, GCS emerged as an independent imaging predictor of LV systolic function restoration in our series. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Correlation between myocardial deformation values by feature tracking and morphofunctional variables in basal CMR.

scholarly journals 154 Can we improve the accuracy and reproducibility of left ventricular ejection fraction from 2D echocardiography using artificial intelligence? A validation against cardiac magnetic resonance

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Popoff ◽  
H Langet ◽  
P Piro ◽  
C Ropert ◽  
P Allain ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Image Quality ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Objective Assessment ◽  
Left Ventricular ◽  
Lv Volumes

Abstract Funding Acknowledgements Philips BACKGROUND Accurate and reproducible echocardiographic measurements are paramount for objective assessment and follow-up of the cardiac function. However, manual contouring – e.g., for determining left ventricular (LV) volumes and ejection fraction (EF) – is limited by image quality and operator experience. Meanwhile, despite the wider availability of (semi-)automated tools, strong multimodal validation is still lacking for their widespread and safe use in the clinical routine. PURPOSE To evaluate the accuracy and reproducibility of an Artificial Intelligence (AI)-based semi-automated tool to compute LV volumes and EF, in comparison with manual contouring, using cardiac magnetic resonance (cMR) as reference. METHODS Manual and AI measurements from echocardiography were compared to measurements from cMR in a retrospective two-centre study. One hundred fourteen patients in sinus rhythm were included; among those, 85 had abnormal LV function (56 dilated and 29 hypertrophic). Three successive cardiac cycles were available for apical 4- and 2-chamber views. Two senior (A1 and B1) and one junior (A2) cardiologists contoured the ED and ES endocardial borders in the cardiac cycle of their choice, while blinded to quantitative outcomes. For AI analysis, a deep convolutional neural networks model was used to segment the LV cavity on the frames selected by the three observers. This model was trained using ED and ES manual contouring from senior cardiologist A1 on an independent single-centre dataset that consisted of 700 apical 4- and 2-chamber views. The same biplane Simpson’s method was used to compute all LV volumes and EF. RESULTS Despite challenging image quality (poor: 6%; fair: 33%; high: 61%, as rated by observers), the majority of the AI segmentations were deemed acceptable (75% in total; 80% for images of high quality). Overall, inter-observer agreement was better by AI than by manual contouring (ICC = 0.99 vs. 0.89, 1.00 vs. 0.95 and 0.95 vs. 0.89 for LVED, LVES and LVEF respectively, all p &lt; 0.001). For LVED and LVES, agreement vs. cMR was higher by AI (80.95 ± 39.09; -46.42 ± 38.29) than by manual contouring for junior observer A2 (-81.47 ± 43; -51.88 ± 40.43), although still lower than by manual contouring for the best senior observer (-54.71 ± 31.44; -32.75 ± 32.80), see upper part in figure below. LVEF bias was reduced near to zero by AI, with slightly higher variability than by manual contouring ([-0.91; -0.05] ± [8.47; 10.17] vs. [-0.19; 5.44] ± [7.75; 8.79]), see lower part in figure below. CONCLUSION The AI model generalized well to different sites, observers and image quality. Compared to manual contouring, LV volumes and EF by AI showed comparable or improved accuracy and higher reproducibility. These findings demonstrate the value of AI-based tools, with potential for full automation, for objective assessment and follow-up of the cardiac function. Abstract 154 Figure.

scholarly journals Myocardial Inflammation and Dysfunction in COVID-19–Associated Myocardial Injury

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ludwig T. Weckbach ◽  
Adrian Curta ◽  
Stephanie Bieber ◽  
Angelina Kraechan ◽  
Johannes Brado ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Longitudinal Strain ◽  
Myocardial Injury ◽  
Tissue Injury ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Elevated Troponin ◽  
Lymphocytic Myocarditis

Background: Myocardial injury, defined by elevated troponin levels, is associated with adverse outcome in patients with coronavirus disease 2019 (COVID-19). The frequency of cardiac injury remains highly uncertain and confounded in current publications; myocarditis is one of several mechanisms that have been proposed. Methods: We prospectively assessed patients with myocardial injury hospitalized for COVID-19 using transthoracic echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy. Results: Eighteen patients with COVID-19 and myocardial injury were included in this study. Echocardiography revealed normal to mildly reduced left ventricular ejection fraction of 52.5% (46.5%–60.5%) but moderately to severely reduced left ventricular global longitudinal strain of −11.2% (−7.6% to −15.1%). Cardiac magnetic resonance showed any myocardial tissue injury defined by elevated T1, extracellular volume, or late gadolinium enhancement with a nonischemic pattern in 16 patients (83.3%). Seven patients (38.9%) demonstrated myocardial edema in addition to tissue injury fulfilling the Lake-Louise criteria for myocarditis. Combining cardiac magnetic resonance with speckle tracking echocardiography demonstrated functional or morphological cardiac changes in 100% of investigated patients. Endomyocardial biopsy was conducted in 5 patients and revealed enhanced macrophage numbers in all 5 patients in addition to lymphocytic myocarditis in 1 patient. SARS-CoV-2 RNA was not detected in any biopsy by quantitative real-time polymerase chain reaction. Finally, follow-up measurements of left ventricular global longitudinal strain revealed significant improvement after a median of 52.0 days (−11.2% [−9.2% to −14.7%] versus −15.6% [−12.5% to −19.6%] at follow-up; P =0.041). Conclusions: In this small cohort of COVID-19 patients with elevated troponin levels, myocardial injury was evidenced by reduced echocardiographic left ventricular strain, myocarditis patterns on cardiac magnetic resonance, and enhanced macrophage numbers but not predominantly lymphocytic myocarditis in endomyocardial biopsies.

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