Exploring the left ventricular chamber dynamics in echocardiography images

Abstract Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

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Assessment of the Left Ventricular Chamber Stiffness in Athletes

Echocardiography ◽

10.1111/j.1540-8175.2010.01311.x ◽

2010 ◽

Vol 28 (3) ◽

pp. 276-287 ◽

Cited By ~ 7

Author(s):

Dejana Popovic ◽

Miodrag C. Ostojic ◽

Milan Petrovic ◽

Bosiljka Vujisic-Tesic ◽

Bojana Popovic ◽

...

Keyword(s):

Left Ventricular ◽

Left Ventricular Chamber

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Left ventricular diastolic function of remodeled myocardium in dogs with pacing-induced heart failure

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.274.3.h945 ◽

1998 ◽

Vol 274 (3) ◽

pp. H945-H954 ◽

Cited By ~ 6

Author(s):

Steven B. Solomon ◽

Srdjan D. Nikolic ◽

Stanton A. Glantz ◽

Edward L. Yellin

Keyword(s):

Heart Failure ◽

Elastic Properties ◽

Diastolic Pressure ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Diastolic Filling ◽

Elastic Recoil ◽

Systolic Volume ◽

Left Ventricular Chamber ◽

Volume Relation

In patients with heart failure, decreased contractility resulting in high end-diastolic pressures and a restrictive pattern of left ventricular filling produces a decrease in early diastolic filling, suggesting a stiff ventricle. This study investigated the elastic properties of the myocardium and left ventricular chamber and the ability of the heart to utilize elastic recoil to facilitate filling during pacing-induced heart failure in the anesthetized dog. Elastic properties of the myocardium were determined by analyzing the myocardial stress-strain relation. Left ventricular chamber properties were determined by analyzing the pressure-volume relation using a logarithmic approach. Elastic recoil was characterized using a computer-controlled mitral valve occluder to prevent transmitral flow during diastole. We conclude that, during heart failure, the high end-diastolic pressures suggestive of a stiff ventricle are due not to stiffer myocardium but to a ventricle whose chamber compliance characteristics are changed due to geometric remodeling of the myocardium. The restrictive filling pattern is a result of the ventricle being forced to operate on the stiff portion of the diastolic pressure-volume relation to maintain cardiac output. Slowed relaxation and decreased contractility result in an inability of the heart to contract to an end-systolic volume below its diastolic equilibrium volume. Thus the left ventricle cannot utilize elastic recoil to facilitate filling during heart failure.

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Abstract 224: A Deep Learning Approach to Left-Ventricular Chamber Quantification for Fully Automated Three Dimensional Strain Analysis in Cardiotoxicity

Circulation Research ◽

10.1161/res.127.suppl_1.224 ◽

2020 ◽

Vol 127 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Bryant M Baldwin ◽

Shane Joseph ◽

Xiaodong Zhong ◽

Ranya Kakish ◽

Cherie Revere ◽

...

Keyword(s):

Deep Learning ◽

Interpolation Method ◽

Three Dimensional ◽

Strain Analysis ◽

Correlation Coefficients ◽

Semantic Segmentation ◽

Left Ventricular ◽

Breast Cancer Patients ◽

Left Ventricular Chamber ◽

Longitudinal Strains

This study investigated MRI and semantic segmentation-based deep-learning (SSDL) automation for left-ventricular chamber quantifications (LVCQ) and low longitudinal strain (LLS) determination, thus eliminating user-bias by providing an automated tool to detect cardiotoxicity (CT) in breast cancer patients treated with antineoplastic agents. Displacement Encoding with Stimulated Echoes-based (DENSE) myocardial images from 26 patients were analyzed with the tool’s Convolution Neural Network with underlying Resnet-50 architecture. Quantifications based on the SSDL tool’s output were for LV end-diastolic diameter (LVEDD), ejection fraction (LVEF), and mass (LVM) (see figure for phase sequence). LLS was analyzed with Radial Point Interpolation Method (RPIM) with DENSE phase-based displacements. LVCQs were validated by comparison to measurements obtained with an existing semi-automated vendor tool (VT) and strains by 2 independent users employing Bland-Altman analysis (BAA) and interclass correlation coefficients estimated with Cronbach’s Alpha (C-Alpha) index. F1 score for classification accuracy was 0.92. LVCQs determined by SSDL and VT were 4.6 ± 0.5 vs 4.6 ± 0.7 cm (C-Alpha = 0.93 and BAA = 0.5 ± 0.5 cm) for LVEDD, 58 ± 5 vs 58 ± 6 % (0.90, 1 ± 5%) for LVEF, 119 ± 17 vs 121 ± 14 g (0.93, 5 ± 8 g) for LV mass, while LLS was 14 ± 4 vs 14 ± 3 % (0.86, 0.2 ± 6%). Hence, equivalent LV dimensions, mass and strains measured by VT and DENSE imaging validate our unique automated analytic tool. Longitudinal strains in patients can then be analyzed without user bias to detect abnormalities for the indication of cardiotoxicity and the need for therapeutic intervention even if LVEF is not affected.

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Chronic inhibition of fatty acid oxidation: new model of diastolic dysfunction

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1990.258.1.h51 ◽

1990 ◽

Vol 258 (1) ◽

pp. H51-H56 ◽

Cited By ~ 1

Author(s):

S. E. Litwin ◽

T. E. Raya ◽

R. G. Gay ◽

J. B. Bedotto ◽

J. J. Bahl ◽

...

Keyword(s):

Fatty Acid ◽

Fatty Acid Oxidation ◽

Weight Ratio ◽

Left Ventricular ◽

Chain Fatty Acid ◽

Acid Oxidation ◽

Long Chain Fatty Acid ◽

Ventricular Relaxation ◽

Left Ventricular Chamber ◽

Long Chain

This study was designed to determine the changes in the heart that result from inhibition of long-chain fatty acid oxidation with 2-tetradecylglycidic acid (TDGA). Male Sprague-Dawley rats (n = 64) were treated with TDGA (20 mg.kg-1.day-1) or a comparable volume of vehicle by gavage feeding for 7 or 21 days. In conscious rats TDGA produced no changes in heart rate, left ventricular systolic or end-diastolic pressures, left ventricular pressure development (dP/dt), or the time constant of left ventricular relaxation. Left ventricular developed pressure was not changed at 21 days. TDGA increased left ventricular weight, left ventricular weight-to-body weight ratio, and total heart weight-to-body weight ratio. Left ventricular endocardial and epicardial myocyte volumes were increased by 53 and 65%, respectively. Myocardial triglyceride content was increased threefold. Left ventricular chamber stiffness constants between end-diastolic pressures of 0 and 30 mmHg were increased, and left ventricular end-diastolic volumes at operating end-diastolic pressures were decreased at both 7 and 21 days. The myocardial stiffness constant was also increased at 7 and 21 days. Thus inhibition of long-chain fatty acid oxidation with TDGA increased left ventricular mass and altered left ventricular chamber and muscle stiffness without changing left ventricular relaxation or systolic function. We conclude that inhibition of long-chain fatty acid oxidation produced an unusual model of left ventricular hypertrophy and diastolic dysfunction characterized by abnormalities of passive-elastic properties but preserved relaxation.

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Loss of Endogenously Cycling Adult Cardiomyocytes Worsens Myocardial Function

Circulation Research ◽

10.1161/circresaha.120.318277 ◽

2020 ◽

Author(s):

Leigh A Bradley ◽

Alexander Young ◽

Hongbin Li ◽

Helen O Billcheck ◽

Matthew J Wolf

Keyword(s):

Myocardial Infarction ◽

Cell Cycle ◽

Myocardial Function ◽

Cultured Cells ◽

Left Ventricular ◽

Left Ventricular Chamber ◽

Adult Cardiomyocytes ◽

Border Zones ◽

And Function ◽

Chamber Size

Rationale: Endogenously cycling adult cardiomyocytes (CMs) increase after myocardial infarction (MI) but remain scare, and are generally thought not to contribute to myocardial function. However, this broadly held assumption has not been tested, mainly because of the lack of transgenic reporters that restrict Cre expression to adult CMs that reenter the cell cycle. Objective: We created and validated a new transgenic mouse, αMHC-MerDreMer-Ki67p-RoxedCre::Rox-Lox-tdTomato-eGFP (denoted αDKRC) that restricts Cre expression to cycling adult CMs and uniquely integrates spatial and temporal adult CM cycling events based on the DNA specificities of orthologous Dre- and Cre recombinases. We then created mice that expressed an inducible Diphtheria toxin (DTA), αDKRC::DTA mice, in adult cycling CMs and examined the effects of ablating these endogenously cycling CMs on myocardial function after Ischemic-Reperfusion (I/R) MI. Methods and Results: A tandem αDKRC transgene was designed, validated in cultured cells, and used to make transgenic mice. The αDKRC transgene integrated between MYH6 and MYH7 and did not disrupt expression of the surrounding genes. Compared to controls, αDKRC::RLTG mice treated with Tamoxifen expressed tdTomato+ in CMs with rare Bromodeoxyuridine (BrdU)+, eGFP+ CMs, consistent with reentry of the cell cycle. We then pre-treated αDKRC::RLTG mice with Tamoxifen to activate the reporter before sham or reperfusion (I/R) myocardial infarction (MI) surgeries. Compared to Sham surgery, the I/R MI group had increased single and paired eGFP+ CMs predominantly in the border zones (5.8 {plus minus} 0.5 vs. 3.3 {plus minus} 0.3 CMs per ten-micron section, N = 8-9 mice per group, n = 16-24 sections per mouse), indicative of cycled CMs. The single to paired eGFP+ CM ratio was ~9 to 1 (5.2 {plus minus} 0.4 single vs. 0.6 {plus minus} 0.2 paired CMs) in the I/R MI group after MI, suggesting that cycling CMs were more likely to undergo polyploidy than replication. The ablation of endogenously cycling adult CMs in αDKRC::DTA mice caused progressive worsening left ventricular chamber size and function after I/R MI, compared to controls. Conclusions: Although scarce, endogenously cycling adult CMs contribute to myocardial function after injury, suggesting that these cells may be physiologically relevant.

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Blood Pressure Control and Left Ventricular Hypertrophy in Long-Term Capd and Hemodialysis Patients: A Cross-Sectional Study

Peritoneal Dialysis International ◽

10.1177/089686080302300608 ◽

2003 ◽

Vol 23 (6) ◽

pp. 563-567 ◽

Cited By ~ 15

Author(s):

Ali Ihsan Günal ◽

Erdogan Ilkay ◽

Ercan Kirciman ◽

Ilgin Karaca ◽

Ayhan Dogukan ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular Hypertrophy ◽

Wall Thickness ◽

Left Atrial ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Volume Control ◽

Left Ventricular Chamber ◽

Significant Difference

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.

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Novel method to estimate ventricular contractility using intraventricular pulse wave velocity

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1999.277.6.h2409 ◽

1999 ◽

Vol 277 (6) ◽

pp. H2409-H2415 ◽

Cited By ~ 2

Author(s):

Toshiaki Shishido ◽

Masaru Sugimachi ◽

Osamu Kawaguchi ◽

Hiroshi Miyano ◽

Toru Kawada ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Volume Measurement ◽

Left Ventricular ◽

Ventricular Contractility ◽

Left Ventricular Chamber ◽

Novel Method ◽

Volume Pulse ◽

Late Systole

We developed a novel technique for estimating ventricular contractility using intraventricular pulse wave velocity (PWV). In eight isolated, cross-circulated canine hearts, we used a fast servo pump to inject a volume pulse into the base of the left ventricular chamber at late diastole and at late systole. We measured the transit time of the volume pulse wave as it traversed the distance from base to apex and calculated the intraventricular PWV. The intraventricular PWV increased from diastole (2.3 ± 0.4 m/s) to systole (11.7 ± 2.4 m/s, P < 0.0001 vs. diastole). The square of the intraventricular PWV at late systole correlated linearly with the left ventricular end-systolic elastance ( r = 0.939, P < 0.0001) and with the end-systolic Young's modulus ( r = 0.901, P < 0.0001). Moreover, the intraventricular PWV was insensitive to preload. We conclude that the intraventricular PWV at late systole reflects left ventricular end-systolic elastance reasonably well. The fact that estimation of PWV does not require volume measurement or load manipulation makes this technique an attractive means of assessing ventricular contractility.

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