scholarly journals The Total Right/Left-Volume Index: A New and Simplified Cardiac Magnetic Resonance Measure to Evaluate the Severity of Ebstein Anomaly of the Tricuspid Valve

2014 ◽  
Vol 7 (4) ◽  
pp. 601-609 ◽  
Author(s):  
Olga Hösch ◽  
Jan Martin Sohns ◽  
Thuy-Trang Nguyen ◽  
Peter Lauerer ◽  
Christina Rosenberg ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Tricuspid Valve ◽  
Volume Index ◽  
Ebstein Anomaly

scholarly journals Incremental value of feature-tracking cardiac magnetic resonance imaging in detecting myocardial dysfunction in patients with idiopathic ventricular arrhythmias

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Nikolaidou ◽  
C Kotanidis ◽  
J Leal-Pelado ◽  
K Kouskouras ◽  
VP Vassilikos ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Feature Tracking ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Subjects ◽  
Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging can identify the underlying substrate in patients with ventricular arrhythmias (VAs) and normal echocardiography. Myocardial strain has emerged as a superior index of systolic performance compared to ejection fraction (EF), with an incremental prognostic value in many cardiac diseases. Purpose To assess myocardial deformation using 2-D feature-tracking CMR strain imaging (CMR-FT) in patients with frequent VAs (≥500 ventricular premature contractions (VPC)/24 hours; and/or non-sustained ventricular tachycardia), and structurally normal hearts on echocardiography without evidence of coronary artery disease. Methods Sixty-eight consecutive patients (mean age 46 ± 16 years; 54% female) and 72 healthy controls matched for age and body surface area were included in the study. CMR imaging was performed on a 1.5T Magnetom Avanto (Siemens, Erlangen, Germany) scanner using a standard cardiac protocol. Results CMR showed normal findings in 30 patients (44%), while 16 (24%) had previous myocarditis, 6 (9%) had a diagnosis of non-ischaemic cardiomyopathy (NICM), 15 (22%) were diagnosed with VPC-related cardiomyopathy, and 1 patient had subendocardial infarction [excluded from strain analysis]. Mean left ventricular EF (LVEF) in patients was 62% ± 6% and right ventricular EF 64% ± 6% (vs. 65% ± 3% and 66% ± 4% in controls, respectively). Compared to control subjects, patients with VAs had impaired peak LV global radial strain (GRS) (28.88% [IQR: 25.87% to 33.97%] vs. 36.65% [IQR:33.19% to 40.2%], p < 0.001) and global circumferential strain (GCS) (-17.73% [IQR: -19.8% to -16.33%] vs. -20.66% [IQR: -21.72% to -19.6%], p < 0.001, Panel A). Peak LV GRS could differentiate patients with previous myocarditis from patients with NICM and those with VPC-related cardiomyopathy (Panel B). Peak LV GCS could differentiate patients with previous myocarditis from patients with NICM (Panel C). Peak LV GRS showed excellent diagnostic accuracy in detecting patients from control subjects (Panel D). In a multivariable regression model, subjects with a low GRS (<29.91%-determined by the Youden’s index) had 5-fold higher odds of having VAs (OR:4.99 [95%CI: 1.2-21.95]), after adjusting for LVEF, LV end-diastolic volume index, age, sex, BMI, smoking, hypertension, and dyslipidaemia. Peak LV global longitudinal strain (GLS) and RV strain indices were not statistically different between patients and controls. Conclusion Peak LV GRS and GCS are impaired in patients with frequent idiopathic VAs and can detect myocardial contractile dysfunction in patients with different underlying substrates. Our findings suggest that LV strain indices on CMR-FT constitute independent markers of myocardial dysfunction on top and independently of EF. Abstract Figure.

P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hinojar Baydes ◽  
A Garcia Martin ◽  
A Gonzalez-Gomez ◽  
G Alonso-Salinas ◽  
M Plaza-Martin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Regurgitant Fraction ◽  
End Point ◽  
Tricuspid Valve Surgery ◽  
Poor Outcomes

Abstract Background Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown. Purpose Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all). Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01 Conclusion Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.

scholarly journals Biventricular pacing during cardiac magnetic resonance imaging

EP Europace ◽  
2019 ◽  
Author(s):  
Hajnalka Vago ◽  
Csilla Czimbalmos ◽  
Roland Papp ◽  
Liliana Szabo ◽  
Attila Toth ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Circumferential Strain ◽  
Biventricular Pacing ◽  
Radial Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Resonance Imaging

Abstract Aims We aimed to assess the effect of cardiac resynchronization on left ventricular (LV) function, volumes, geometry, and mechanics in order to demonstrate reverse remodelling using cardiac magnetic resonance (CMR) with resynchronization on. Methods and results New York Heart Association (NYHA) Class II–III patients on optimal medical therapy with LV ejection fraction (LVEF) ≤35%, and complete LBBB with broad QRS (>150 ms) were prospectively recruited. Cardiac magnetic resonance examination was performed at baseline and at 6-month follow-up, applying both biventricular and AOO pacing. The following data were measured: conventional CMR parameters, remodelling indices, global longitudinal, circumferential, radial strain, global dyssynchrony [mechanical dispersion (MD) defined as the standard deviation of time to peak longitudinal/circumferential strain in 16 LV segments], and regional dyssynchrony (maximum differences in time between peak septal and lateral transversal displacement). Thirteen patients (64 ± 7 years, 38% male) were enrolled. Comparing the baseline and follow-up CMR parameters measured during biventricular pacing, significant increase in LVEF, and decrease in LV end-diastolic volume index (LVEDVi) and LV end-systolic volume index (LVESVi) were found. Left ventricular remodelling indices, global longitudinal, circumferential, and radial strain values showed significant improvement. Circumferential MD decreased (20.5 ± 5.5 vs. 13.4 ± 3.4, P < 0.001), while longitudinal MD did not change. Regional dyssynchrony drastically improved (362 ± 96 vs. 104 ± 66 ms, P < 0.001). Applying AOO pacing resulted in an immediate deterioration in LVEF, LVESVi, circumferential strain, global and regional dyssynchrony. Conclusion Cardiac magnetic resonance imaging during biventricular pacing is feasible and enables a more precise quantification of LV function, morphology, and mechanics. As a result, it may contribute to a better understanding of the effects of resynchronization therapy and might improve responder rate in the future.

Abstract 12145: Cardiac Magnetic Resonance Late Gadolinium Enhancement is Associated With Ventricular Elastance That May Predict Latent Ventricular Dysfunction After Fontan Procedure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michihiro Okuyama ◽  
Shuta Ishigami ◽  
Daiki Ousaka ◽  
Junko Kobayashi ◽  
Sadahiko Arai ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Circumferential Strain ◽  
Fontan Procedure ◽  
Volume Index ◽  
Gadolinium Enhancement ◽  
Global Circumferential Strain ◽  
Ventricular Elastance

Backgrounds: Systemic right ventricular circulation after Fontan procedures is known to have late hemodynamic complications. Although a number of studies have investigated the factors that may impact on survival, postoperative outcomes after palliations remain to be elucidated. Objective: The purpose of this study is to investigate the prognostic value of myocardial fibrosis identified by cardiac magnetic resonance imaging (cMRI) in patients with single ventricular physiology. Methods: Consecutive 23 patients undergoing Fontan procedures were prospectively scheduled to have cMRI study with late gadolinium enhancement (LGE) imaging and ventricle circumferential strain measurement before and 4 months after Fontan operation. Results: Of 23 patients (mean age 3.3±0.9 years), 7 were positive for LGE (LGE+) and median percent LGE was 3.0% (interquartile range 3.0% to 7.5%). Pre-Fontan examinations revealed that patients with LGE+ showed an increase in end-diastolic volume index (139.7±26.8 ml/BSA vs. 113.3±20.9 ml/BSA; P=0.02) and end-systolic volume index (ESVI: 99.9±32.2 ml/BSA vs. 70.8±20.0 ml/BSA; P=0.01) compared with those without LGE (LGE-). In contrast to LGE- group, LGE+ patients showed lower global circumferential strain (4.1±2.3% vs. 7.9±2.7%, P=0.006), decreased ejection fraction (EF: 29±9.1% vs. 38±8.7%; P=0.04), and reduced end-systolic elastance (1.1±0.3 mm Hg/ml/m2 vs. 1.7±0.5 mm Hg/ml/m2). In addition, LGE+ group had higher levels of BNP (91.0±72.4 pg/ml vs. 30.9±44.0 pg/ml, P=0.02) and New York University Pediatric Heart Failure Index (10.9±3.3 vs. 7.8±1.1, P=0.02) than LGE- group. This was validated by positive correlations between the area of LGE versus ESVI (r=0.85, P=0.01) and BNP levels (r=0.82, P=0.02), respectively. At 4 months after Fontan procedure, LGE- group showed higher EF (37.5±8.6% vs. 24.0±8.9%, P=0.02) compared with those in LGE+ patients, and increased global circumferential strain (6.5±2.0% to 7.4±2.7%, P=0.04). Conclusion: LGE identified by cMRI before operation may be associated with lower ventricular elastance that resulted in poorer functional recovery after staged palliation. This novel strategy may provide a prognostic value of latent myocardial dysfunction after Fontan procedure.

Abstract 17788: Association of Left Atrial Function and Left Atrial Fibrosis in Patients with Atrial Fibrillation: a Cardiac Magnetic Resonance Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammadali Habibi ◽  
Joao Lima ◽  
Irfan Khurram ◽  
Stefan L Zimmerman ◽  
Vadim Zipunnikov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Feature Tracking ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Physiological Importance

Introduction: Atrial fibrillation (AF) is associated with left atrial (LA) electrical, structural, and contractile remodeling. Cardiac magnetic resonance (CMR), late gadolinium enhancement (LGE) and feature tracking are capable of noninvasive quantification of LA fibrosis and myocardial motion, respectively. Hypothesis: Increased LA fibrosis measured with LGE is associated with worsening of the phasic LA function measured with feature tracking CMR. Methods: The cohort included 90 patients (age 61 ± 10 years, 76% male) with symptomatic drug-resistant AF referred for ablation. Peak global longitudinal LA strain (PLAS), LA systolic strain rate (SR-s), and early (SR-ed) and late diastolic (SR-ld) strain rates were measured using cine-CMR images acquired during sinus rhythm. The degree of LGE was quantified using normalized image intensity. Results: Compared to patients with paroxysmal AF (60% of cohort), those with persistent AF had larger maximum LA volume index (LAVImax, 56 ± 17ml/m2 versus 49 ± 13ml/m2 p=0.036), and increased LGE (27.1± 11.7% versus 36.8 ± 14.8% p<0.001). Aside from LA active emptying fraction, all LA parameters (passive emptying fraction, PLAS, SR-s, SR-ed and SR-ld) were lower in patients with persistent AF (p< 0.05 for all). Increased LA fibrosis was associated with lower LA passive emptying fraction, PLAS, SR-s, SR-ed, and SR-ld after adjusting for age, sex, hypertension, heart failure, left ventricular ejection fraction, type of AF, and LA volume (p<0.05 for all). Conclusions: Increased LA fibrosis is associated with decreased LA reservoir, conduit, and booster pump functions. Phasic measurement of LA function using feature-tracking CMR is feasible and may add important information regarding the physiological importance of LA fibrosis.

scholarly journals Assessment of flow pattern of right ventricle outflow and pulmonary arteries in surgically corrected tetralogy of Fallot patients by four-dimensional cardiac magnetic resonance flow

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mahmoud Shaaban ◽  
Mai Salama ◽  
Ayman Alsaied ◽  
Raghda Elsheikh ◽  
Magdy Elmasry
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Pulmonary Arteries ◽  
Pulmonary Regurgitation ◽  
Peak Systolic Velocity ◽  
Volume Index ◽  
Flow Measurements ◽  
Good Agreement

Abstract Background The most common post-surgical complication of tetralogy of Fallot (TOF) is pulmonary regurgitation (PR) which can lead to right ventricle (RV) dysfunction/failure. Cardiac magnetic resonance (CMR) is the imaging modality of choice to follow-up a repaired TOF. However, the conventional two-dimensional phase-contrast (2D-PC) flow usually underestimates PR as well as the pulmonary peak systolic velocity (PSV). Recently, four-dimensional (4D) CMR flow is introduced for more accurate quantitative flow assessment. This work aimed to compare between 4D-CMR and 2D-PC flow across the main (MPA), right (RPA), and left (LPA) pulmonary arteries (PAs) in surgically corrected TOF patients. Results This study was conducted on 20 repaired TOF patients (range 3–9 years, 50% males). All patients had CMR exam on 1.5T scanner. 4D-CMR and 2D-PC flows were obtained at the proximal segments of the MPA, RPA, and LPA. The stroke volume index (SVI), regurgitation fraction (RF), and PSV measured by 4D-CMR were compared to 2D-PC flow. The SVI across the PAs was nearly similar between both methods (P = 0.179 for MPA, 0.218 for RPA, and 0.091 for LPA). However, the RF was significantly higher by 4D-CMR in comparison to 2D-PC flow (P = 0.027 for MPA, 0.039 for RPA, and 0.046 for LPA). The PSV as well was significantly higher by 4D-CMR flow (P = 0.003 for MPA, < 0.001 for RPA, and 0.002 for LPA). The Bland-Altman plots showed a good agreement between 4D-CMR and 2D-PC flow for the SVI, RF, and PSV across the pulmonary arteries. Conclusion A good agreement existed between the two studied methods regarding pulmonary flow measurements. Because of its major advantage of performing a comprehensive flow assessment in a shorter time, 4D-CMR flow plays an important role in the assessment of patients with complex CHD especially in the pediatric group.

scholarly journals Left atrial volumes evaluation by cardiac magnetic resonance - time to revise the grading severity cut off values

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
RC Rimbas ◽  
AI Nicula ◽  
AV Marinescu ◽  
SI Visoiu ◽  
S Mihaila-Baldea ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Pathological Condition ◽  
Volume Index ◽  
Complete Analysis ◽  
P Value ◽  
Maximal Volume ◽  
2D Echocardiography ◽  
Severity Grading

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant of Ministery of Research and Innovation, CNCS-UEFISCDI, project number grant 5/2018 and 83/2018 and PN-III-P1-1-TE-2016-0669, within PNCDI III Background Left atrial maximal volume (LAVmax) assessed by 2D echocardiography (2DE) is incorporated in new scoring system (2019) of heart failure with preserved ejection fraction (HFpEF), using well established cut-off values for grading severity. These values have strong evidence for diagnosis and prognosis. Moreover, cardiac magnetic resonance (CMR) is also included in the structural evaluation of HFpEF. However, cut-off values for LAVmax evaluated by CMR are higher. This might generate a different classification for LA dilation by CMR, potentially including patients in another risk class. We aimed to evaluate LAVi by 2DE and CMR in a group of HFpEF patients, in order to test the agreement between these two methods, regarding severity grading. Methods.  We prospectively enrolled 74 HFpEF patients (68 ± 9 yrs), and evaluate them by 2DE and CMR. Conventional 2DE was used to define anatomy and function of the left ventricle (LV). NTproBNP was done in all patients. We assessed biplane LAVmax index (LAVimax) and LA minimal volume index (LAVimin), from 4C and 2C views, and reported as a mean value, by eco and CMR (area–length method). Cohen"s k of agreement was evaluated to determine if there was an agreement between eco and CMR, using the cut off values for LAVimax by CMR and eco, provided by the guidelines (Figure) Results. Feasibility of the complete analysis was 95% (70 pts). LVEF was 60 ± 5.7%. LAVimax and LAVimin by eco and CMR were highly correlated (all R &gt; 0.7, p &lt; 0.001) (Table). However, CMR diagnosed a high percent of patients as having normal LAVimax values, by comparison with echo (59 vs. 5.7 %, p &lt; 0.001) (Figure). There was no agreement between these two evaluation methods (Cohen"s k of agreement = 0.000), suggesting that CMR evaluation provides completely  different severity grading. NTproBNP significantly correlated only with LAVimin by CMR (R = 0.4, p = 0.04). Conclusions. We suggest that there is need for a future update of the grading cut-offs for LAV by CMR with larger reference range studies, and also with prognosis studies, as 2DE already provided. The present CMR grading severity might generate misclassification in certain pathological condition, such as HFpEF. We also suggest that LAVi min, instead of LAVi max should be used in the future study for assessment of prognosis. LA volumes evaluation by CMR and 2D echo LAVimax LAVimin ECO (ml/m2) 47 ± 11 23 ± 9 CMR (ml/m2) 51 ± 15 26 ± 12 R coefficient 0.7 0.74 P value &lt;0.001 &lt;0.001 Abstract Figure.

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