scholarly journals Reproducibility of non-invasive VT substrate characterization: finding the same paths

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Silva Garcia ◽  
D Villanueva ◽  
W Delgado ◽  
A Berruezo ◽  
D Soto-Iglesias ◽  
...  
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Observer Agreement ◽  
Border Zone ◽  
Tissue Mass ◽  
Non Invasive ◽  
Funding Sources ◽  
Inter Observer Variability ◽  
The Mean

Abstract Background Delayed enhancement gadolinium MRI is a useful technique to identify myocardial scar. The objective of this study is compare the reproducibility of the scar quantification and characterization based on cardiac MRI. Methods 10 patients with ischemic ethology underwent to 1,5T DE-MRI acquisition for myocardial scar analysis. Images were processed using a commercial software (ADAS3D-Galgo Medical) and different parameters from scar tissue (mass of the scar, core of scar and border zone expressed in grams) were analysed. Conducting channels evaluation was obtained by the number of corridors and the mass of the border zone of those corridors. To perform this analysis, 2 experienced and 1 non experienced users segmented DE-MRI acquisition in order to evaluate the inter observer variability. Bland-Altman analysis was employed to evaluate the comparison between the measurements. Results Inter observer agreement between experienced users was high (table). The mean and the standard deviation of the differences between two measurements for the scar mass was −3,9±14,66 gr. Analysing the scar tissue divided in core and border zone, the mass of these volume tissues were very similar (−3,51±4,56gr and −0,4±12,87gr respectively. Regarding conducting channels characteristics, the mean of the differences was 0±2 for the number of channels and 1,71±7,76 gr for the mass on the border zone of the corridors. Comparing the measurements between one of the experienced users and the beginner user, results were similar but significant differences were found on the mass of the core and the number of channels, with a variability of ±2 channels (table). Conclusions Left ventricular scar size and characteristics derived from late gadolinium enhanced post-processed images are highly reproducible between experienced observers. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Scar analysis performed by 3 users

scholarly journals Does age at aortic coarctation repair have an impact on left ventricle size and function?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Cardoso Torres ◽  
CX Resende ◽  
PG Diogo ◽  
P Araujo ◽  
RA Pinto ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
Surgical Repair ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Negative Relationship ◽  
Late Complications ◽  
Left Ventricular ◽  
Funding Sources ◽  
The Mean ◽  
Clinical Records

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Adults with repaired aortic coarctation (CoA) require lifelong follow-up due to late complications, including left ventricular (LV) myocardial dysfunction. Age at the time of CoA repair is an important prognostic factor in these patients (pts). Purpose To evaluate LV size, ejection fraction (EF) and global longitudinal strain (GLS) values using 2D speckle tracking echocardiography (STE) in a population of adult pts with repaired CoA and to assess the relationship between these echocardiographic parameters and age at the time of CoA repair. Methods Retrospective analysis of adult pts with repaired CoA, followed in a Grown Up Congenital Heart Disease Centre. Pts with hemodynamically significant concomitant cardiac lesions were ruled out. Epidemiologic and clinical data were obtained from clinical records. Transthoracic echocardiograms were reviewed in order to assess GLS using 2DSTE (Echopac Software, GE). Results The study population consisted of 63 pts (61.9% male), with a mean age of 35.3 years at the time of the echocardiographic evaluation. The mean age at the time of the CoA repair was 117 months (95% CI 89.8-144.1 months). Surgical repair was performed in 46 pts (73%): resection with subclavian artery flap aortoplasty (n = 21); patch aortoplasty (n = 15) and head-to-head anastomosis (n = 10). In 10 pts there was no data regarding the type of surgical repair. Seven pts (11.1%) were submitted to percutaneous intervention (6 with aortic stent implantation and 1 with balloon aortic angioplasty). Mean LVEF was 63.4% (CI 95% 55.6 – 71.2%) and mean LV end-diastolic diameter (LVEDD) was 50mm (CI 95% 43-57mm). Mean GLS was - 17.3 (CI 95% 14.8- 19.8), which is inferior to the mean normal values reported for the software used. Age at the time of CoA repair had a statistically significant positive linear relationship with LVEDD (r= 0.282; p= 0.026) and a linear negative relationship with both GLS (r= -0,29; p= 0.022) and LVEF (r= -0.33; p= 0.05). Conclusion Older age at the time of CoA repair was associated with increased LVEDD and decreased GLS and LVEF. Also, GLS may be an important tool for the identification of subclinical LV dysfunction in adult pts with repaired CoA.

scholarly journals Evaluation of Inter-System Variability in Liver Stiffness Measurements

2018 ◽  
Vol 40 (01) ◽  
pp. 64-75 ◽  
Author(s):  
Giovanna Ferraioli ◽  
Annalisa De Silvestri ◽  
Raffaella Lissandrin ◽  
Laura Maiocchi ◽  
Carmine Tinelli ◽  
...  
Keyword(s):  
Shear Wave ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Mean Difference ◽  
Observer Agreement ◽  
Concordance Correlation ◽  
Limits Of Agreement ◽  
Inter Observer Variability ◽  
System Variability ◽  
The Mean

Abstract Aim The primary aim of this study was to determine the inter-system variability of liver stiffness measurements (LSMs) in patients with varying degrees of liver stiffness. The secondary aim was to determine the inter-observer variability of measurements. Materials and Methods 21 individuals affected by chronic hepatitis C and 5 healthy individuals were prospectively enrolled. The assessment of LSMs was performed using six ultrasound (US) systems, four of which with point shear wave elastography (p-SWE) and two with 2 D shear wave elastography (2D-SWE) systems. The Fibroscan (Echosens, France) was used as the reference standard. Four observers performed the measurements in pairs (A-B, C-D). The agreement between different observers or methods was calculated using Lin’s concordance correlation coefficient. The Bland-Altman limits of agreement (LOA) were calculated as well. Results There was agreement above 0.80 for all pairs of systems. The mean difference between the values of the systems with 2D-SWE technique was 1.54 kPa, whereas the maximum mean difference between the values of three out of four systems with the pSWE technique was 0.79 kPa. The intra-patient concordance for all systems was 0.89 (95 % CI: 0.83 – 0.94). Inter-observer agreement was 0.96 (95 % CI: 0.94 – 0.98) for the pair of observers A-B and 0.93 (95 % CI: 0.89 – 0.96) for the pair of observers C-D. Conclusion The results of this study show that the agreement between LSMs performed with different US systems is good to excellent and the overall inter-observer agreement in “ideal conditions” is above 0.90 in expert hands.

Chronic infarction decreases maximum cardiac work and sensitivity of heart to extracellular calcium

1985 ◽  
Vol 249 (1) ◽  
pp. H80-H87 ◽  
Author(s):  
E. Fellenius ◽  
C. A. Hansen ◽  
O. Mjos ◽  
J. R. Neely
Keyword(s):  
Adenine Nucleotides ◽  
Creatine Phosphate ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Compensatory Hypertrophy ◽  
Tissue Mass ◽  
Pressure Development ◽  
Whole Heart

Rat hearts were infarcted in vivo by ligation of the left ventricular coronary artery to cause an initial 40% loss of viable tissue by weight. Due to compensatory hypertrophy of the surviving myocardium and progression of the infarct to scar tissue, the infarct represented approximately 25% by weight of the whole heart after 1 wk. After 1 or 3 wk, these infarcted hearts were removed and perfused in vitro by the working hearts technique. Ventricular pressure development and positive dP/dt were lower in infarcted hearts compared with sham-operated ones. O2 consumption and glucose utilization by viable tissue per unit pressure development was the same in normal and infarcted hearts. Levels of creatine phosphate and free creatine were decreased, but ATP and total adenine nucleotides were well maintained. The inotropic response to decreases in extracellular [Ca2+] was much greater in infarcted hearts than in sham controls. Prenalterol increased ventricular function proportionally more in infarcted than in the sham-operated hearts, suggesting that down regulation of beta receptors was not a problem. The infarcted hearts were much more sensitive to verapamil than control hearts. It is concluded that the depressed function of the noninfarcted tissue of chronically infarcted hearts is due in part to loss of functioning tissue mass and in part to decreased sensitivity to extracellular Ca2+.

Non-Invasive Measurement of Stroke Volume and Left Ventricular Ejection Fraction

1988 ◽  
Vol 29 (2) ◽  
pp. 175-178 ◽  
Author(s):  
H. Kelbæk ◽  
J. H. Svendsen ◽  
J. Aldershvile ◽  
K. Folke ◽  
S. L. Nielsen
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Mean Difference ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Non Invasive ◽  
The Mean

The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was −1 ml (SED 3.1) with a correlation coefficient of 0.83 (p<0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements, r=0.93 (p<0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p<0.001). These findings suggest that radionuclide determinations of SV and LVEF are reliable. The discrepancy between the non-invasive and invasive LVEF values raises the question, whether LVEF is overestimated by cardioangiography or underestimated by radionuclide cardiography.

scholarly journals Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Ribeyrolles ◽  
J L Monin ◽  
A Rohnean ◽  
C Diakov ◽  
C Caussin ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Transthoracic Echocardiography ◽  
Validation Cohort ◽  
Left Ventricular ◽  
Observer Agreement ◽  
4D Flow ◽  
Funding Sources ◽  
4D Flow Cmr ◽  
Optimal Thresholds ◽  
Initial Cohort

Abstract Background Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR. Purpose To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR. Methods We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. Results We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94). Conclusion We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification. FUNDunding Acknowledgement Type of funding sources: None. Quantification of MR using 4D Flow CMR

scholarly journals Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Pieter C. Geervliet ◽  
Jore H. Willems ◽  
Inger N. Sierevelt ◽  
Cornelis P. J. Visser ◽  
Arthur van Noort
Keyword(s):  
Observer Agreement ◽  
Post Surgery ◽  
Orthopedic Surgeons ◽  
Institutional Review ◽  
Inter Observer Variability ◽  
Significant Difference ◽  
The Mean ◽  
The Difference ◽  
End Stage ◽  
Shoulder Angle

Abstract Purpose Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure. Methods Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients. Results The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19–3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure. Conclusion The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm. Trial registration Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

scholarly journals Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
S Ribeyrolles ◽  
JL Monin ◽  
A Rohnean ◽  
C Diakov ◽  
C Caussin ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Transthoracic Echocardiography ◽  
Validation Cohort ◽  
Left Ventricular ◽  
Observer Agreement ◽  
4D Flow ◽  
Funding Sources ◽  
4D Flow Cmr ◽  
Optimal Thresholds ◽  
Initial Cohort

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR. OBJECTIVES To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR. METHODS  We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016-2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. RESULTS  We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95%CI, 0.8-1) and 20% and 37% for RF (κ=0.90; 95%CI, 0.7-0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95%CI, 0.61-0.94). CONCLUSION We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.

scholarly journals Left ventricular mechanical dispersion in ischaemic cardiomyopathy: association with myocardial scar burden and prognostic implications

2020 ◽  
Vol 21 (11) ◽  
pp. 1227-1234 ◽  
Author(s):  
Rachid Abou ◽  
Edgard A Prihadi ◽  
Laurien Goedemans ◽  
Rob van der Geest ◽  
Mohammed El Mahdiui ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Border Zone ◽  
Infarct Core ◽  
Scar Burden ◽  
St Segment Elevation ◽  
Mechanical Dispersion ◽  
Prognostic Implications ◽  
Event Rates

Abstract Aims Left ventricular (LV) mechanical dispersion (MD) may result from heterogeneous electrical conduction and is associated with adverse events. The present study investigated (i) the association between LV MD and the extent of LV scar as assessed with contrast-enhanced cardiac magnetic resonance (CMR) and (ii) the prognostic implications of LV MD in patients after ST-segment elevation myocardial infarction. Methods and results LV MD was calculated by echocardiography and myocardial scar was analysed on CMR data retrospectively. Infarct core and border zone were defined as ≥50% and 35–50% of maximal signal intensity, respectively. Patients were followed for the occurrence of the combined endpoint (all-cause mortality and appropriate implantable cardioverter-defibrillator therapy). In total, 96 patients (87% male, 57 ± 10 years) were included. Median LV MD was 53.5 ms [interquartile range (IQR) 43.4–62.8]. On CMR, total scar burden was 11.4% (IQR 3.8–17.1%), infarct core tissue 6.2% (IQR 2.0–12.7%), and border zone was 3.5% (IQR 1.5–5.7%). Correlations were observed between LV MD and infarct core (r = 0.517, P &lt; 0.001), total scar burden (r = 0.497, P &lt; 0.001), and border zone (r = 0.298, P = 0.003). In total, 14 patients (15%) reached the combined endpoint. Patients with LV MD &gt;53.5 ms showed higher event rates as compared to their counterparts. Finally, LV MD showed the highest area under the curve for the prediction of the combined endpoint. Conclusion LV MD is correlated with LV scar burden. In addition, patients with prolonged LV MD showed higher event rates. Finally, LV MD provided the highest predictive value for the combined endpoint when compared with other parameters.

scholarly journals Prospective validation of a non-invasive method to estimate myocardial work in aortic stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
KP Owashi ◽  
V Le Rolle ◽  
A Hernandez ◽  
E Galli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Heart Catheterization ◽  
Aortic Valve Area ◽  
Non Invasive ◽  
Funding Sources ◽  
Invasive Method

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): ANR - Maestro project Background Stratification of aortic stenosis patients remains challenging and robust indices are required. Myocardial work assessment is a new afterload independent alternative to evaluate left ventricular function. Although, this method was developed in patients with normal aortic valve. We previously developed an integrated cardiovascular system simulated by a computational model to estimate non-invasively myocardial work in aortic stenosis patients* (figure 1A). In the present study, we tested our model in a prospective population of AS patients. Method and results 9 patients with severe AS (aortic valve area &lt; 1cm2) were included. A complete trans-thoracic echocardiography with a non-invasive blood pressure by brachial artery cuff were realized immediately before a left heart catheterization to have an invasive left ventricular pressure. Myocardial work is then calculated with non-invasive and invasive LV pressure combined to LV strain curves. For constructive and wasted work, root mean squared between invasive and estimated measures were respectively r2 = 0.92 and r2 = 0.94 (figure 1B) Conclusion The proposed model is efficient to estimate non-invasively myocardial work indices in AS-patients. These afterload independent indices could permit in future to better stratify this population.  *Owashi KP, Hubert A and al. Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PlosOne 2020. Mar 3;15(3):e0229609 Abstract Figure 1

scholarly journals Modalities for Detection of LV Dysfunction

2016 ◽  
Vol 01 (04) ◽  
pp. 045-055
Author(s):  
A. Patnaik ◽  
Johann Christopher
Keyword(s):  
Low Cost ◽  
Three Dimensional ◽  
Daily Practice ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Radionuclide Studies ◽  
Ventricular Ejection Fraction ◽  
Non Invasive ◽  
Lv Dysfunction ◽  
Inter Observer Variability

AbstractThe left ventricular ejection fraction (LVEF) assessed by trans-thoracic Echocardiogram (TTE) remains the most common parameter of LV performance that is used in clinical practice. Three-dimensional / volumetric methods are more accurate, but are cumbersome to be performed in every case. The measures of myocardial contractility are more sensitive, reliable and with lesser inter observer variability but their place in daily practice is limited. Two-dimensional echocardiogram has the advantages of easy availability, low cost, portability, lack of radiation and non-invasive nature. Radionuclide studies, SPECT, cardiac CT and cardiac MRI are available only in a few centers and have more specific indication to be performed. The choice of a modality depends on the information sought by the clinician and the availability of expertise. Additional cost, radiation and limited access are important limitations of these special imaging modalities. The invasive methods which were popular a few decades back are by and large relegated to academic exercise.

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