Right and left ventricular function and flow quantification in pediatric patients with repaired tetralogy of Fallot using four-dimensional flow magnetic resonance imaging

Abstract Background To assess the accuracy and reproducibility of right ventricular (RV) and left ventricular (LV) function and flow measurements in children with repaired tetralogy of Fallot (rTOF) using four-dimensional (4D) flow, compared with conventional two-dimensional (2D) magnetic resonance imaging (MRI) sequences. Methods Thirty pediatric patients with rTOF were retrospectively enrolled to undergo 2D balanced steady-state free precession cine (2D b-SSFP cine), 2D phase contrast (PC), and 4D flow cardiac MRI. LV and RV volumes and flow in the ascending aorta (AAO) and main pulmonary artery (MPA) were quantified. Pearson’s or Spearman’s correlation tests, paired t-tests, the Wilcoxon signed-rank test, Bland–Altman analysis, and intraclass correlation coefficients (ICC) were performed. Results The 4D flow scan time was shorter compared with 2D sequences (P < 0.001). The biventricular volumes between 4D flow and 2D b-SSFP cine had no significant differences (P > 0.05), and showed strong correlations (r > 0.90, P < 0.001) and good consistency. The flow measurements of the AAO and MPA between 4D flow and 2D PC showed moderate to good correlations (r > 0.60, P < 0.001). There was good internal consistency in cardiac output. There was good intraobserver and interobserver biventricular function agreement (ICC > 0.85). Conclusions RV and LV function and flow quantification in pediatric patients with rTOF using 4D flow MRI can be measured accurately and reproducibly compared to those with conventional 2D sequences.

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Measurements in Pediatric Patients with Cardiomyopathies: Comparison of Cardiac Magnetic Resonance Imaging and Echocardiography

Cardiology ◽

10.1159/000381418 ◽

2015 ◽

Vol 131 (4) ◽

pp. 245-250 ◽

Cited By ~ 6

Author(s):

Yuting Zhang ◽

Ling He ◽

Jinhua Cai ◽

Tiewei Lv ◽

Qijian Yi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Function ◽

Cardiac Magnetic Resonance Imaging ◽

Diastolic Function ◽

Pediatric Patients ◽

Left Ventricular ◽

Functional Score ◽

Resonance Imaging

Aims: Cardiomyopathies are common cardiovascular diseases in children. Cardiac magnetic resonance imaging (cMRI) and echocardiography (Echo) are routinely applied in the detection and diagnosis of pediatric cardiomyopathies. In this study, we compared and explored the correlation between these two measurements in pediatric patients with various cardiomyopathies. Methods and Results: A total of 53 pediatric patients with cardiomyopathy hospitalized during the recent 3 years in our hospital were analyzed. All of them and 22 normal controls were assessed by both cMRI and Echo. Cardiac function of the patients was graded according to the New York Heart Association functional classification. The cardiac function indexes measured with both cMRI and Echo included left-ventricular (LV) end-diastolic volume (EDV), end-systolic volume, ejection fraction and fractional shortening. These parameters were somehow lower in cMRI measurements than in Echo measurements. The index of diastolic function, such as peak filling rate (PFR) measured with cMRI, had a good correlation with the clinical cardiac functional score, while the index of the diastolic function (early/atrial filling ratio and isovolumic relaxation time) measured with Echo was not well correlated with the clinical cardiac function score. Significant systolic dysfunction was detected by cMRI in 34 patients with dilated cardiomyopathy, LV noncompaction or endocardial fibroelastosis. Significant diastolic dysfunction was detected by cMRI in 19 patients with hypertrophic cardiomyopathy or restrictive cardiomyopathy showing an alteration in PFR and EDV. Conclusion: Both cMRI and Echo are of great value in the diagnosis and assessment of cardiac function in pediatric patients with cardiomyopathy. cMRI could accurately display the characteristic morphological changes in the hearts affected with cardiomyopathies, and late gadolinium enhancement on cMRI may reveal myocardial fibrosis, which has obvious advantages over Echo measurements in diagnosis. Furthermore, cMRI can quantitatively determine ventricular function because it does not make invalid geometrical assumptions.

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Intra-Left Ventricular Hemodynamics Assessed with 4D Flow Magnetic Resonance Imaging in Patients with Left Ventricular Thrombus

International Heart Journal ◽

10.1536/ihj.20-792 ◽

2021 ◽

Vol 62 (6) ◽

pp. 1287-1296

Author(s):

Tomoaki Sakakibara ◽

Kenichiro Suwa ◽

Takasuke Ushio ◽

Tetsuya Wakayama ◽

Marcus Alley ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Resonance Imaging ◽

4D Flow ◽

Ventricular Thrombus

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Abstract 4556: Magnetic Resonance Imaging in Evaluating Left Ventricular Rotation and Synchronization in Patients with Congenital Single Ventricle Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_910 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Xiaokui Li ◽

Craig S Broberg ◽

Mary E Joyce ◽

Helene Houle ◽

Muhammad Ashraf ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Papillary Muscle ◽

Single Ventricle ◽

Cardiac Mechanics ◽

Left Ventricular ◽

Resonance Imaging ◽

Ssfp Cine ◽

Ventricular Mechanics ◽

Mri Study

Rotational motion of the left ventricular (LV) myocardium has recently received attention as an index of ventricular function. Echocardiographic methods for evaluation of ventricular mechanics are limited by image quality. We developed a method for evaluating cardiac mechanics on gradient cine magnetic resonance imaging (MRI) studies. Twelve adult single ventricle (SV) patients were retroactively selected to compare with 11 randomly selected relatively normal patients who had undergone cardiac MRI study. Detailed SSFP cine images were acquired at several levels in short axis views using Philips and GE MRI systems. Images from each study were evaluated at the apex and papillary muscle levels using VVI (Siemens) for degree of rotation and circumferential strain rate (CSR). Maximal time difference between each segment was recorded as well as the average degree of rotation. When compared with normal patients, SV patients had less rotation at both apex and papillary muscle levels and more dispersion of peak rotation: average rotation: 1.79° ± 0.81° vs. 3.60° ± 1.38°, p < 0.0001, peak rotation: 3.10° ± 1.25° vs 5.71°± 2.63°, p < 0.0001. In contrast, maximum wall motion delay between the segments of each level for data obtained from both rotation and CSR was greater for SV pathology than normals: rotational segment delay, 181.55 ± 76.06 ms vs. 66.86 ± 47.11 ms, p < 0.0001; CSR delay, 90.73 ± 61.98 ms vs. 44.23 ± 37.14 ms, p = 0.004. Average CSR for SV was −8.87 ± 7.30 s −1 and for normals, −18.02 ± 7.31 s −1 . Our MRI mechanics study showed decreased CSR in SVs compared to normal LVs, and also a marked decrease in and segmental dyssynchrony of rotation.

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Left and right ventricular hemodynamic forces in healthy volunteers and elite athletes assessed with 4D flow magnetic resonance imaging

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00583.2016 ◽

2017 ◽

Vol 312 (2) ◽

pp. H314-H328 ◽

Cited By ~ 17

Author(s):

Per M. Arvidsson ◽

Johannes Töger ◽

Marcus Carlsson ◽

Katarina Steding-Ehrenborg ◽

Gianni Pedrizzetti ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Blood Flow ◽

Magnetic Resonance ◽

Right Ventricular ◽

Healthy Subjects ◽

Elite Athletes ◽

Left Ventricular ◽

Resonance Imaging ◽

4D Flow ◽

Hemodynamic Forces

Intracardiac blood flow is driven by hemodynamic forces that are exchanged between the blood and myocardium. Previous studies have been limited to 2D measurements or investigated only left ventricular (LV) forces. Right ventricular (RV) forces and their mechanistic contribution to asymmetric redirection of flow in the RV have not been measured. We therefore aimed to quantify 3D hemodynamic forces in both ventricles in a cohort of healthy subjects, using magnetic resonance imaging 4D flow measurements. Twenty five controls, 14 elite endurance athletes, and 2 patients with LV dyssynchrony were included. 4D flow data were used as input for the Navier-Stokes equations to compute hemodynamic forces over the entire cardiac cycle. Hemodynamic forces were found in a qualitatively consistent pattern in all healthy subjects, with variations in amplitude. LV forces were mainly aligned along the apical-basal longitudinal axis, with an additional component aimed toward the aortic valve during systole. Conversely, RV forces were found in both longitudinal and short-axis planes, with a systolic force component driving a slingshot-like acceleration that explains the mechanism behind the redirection of blood flow toward the pulmonary valve. No differences were found between controls and athletes when indexing forces to ventricular volumes, indicating that cardiac force expenditures are tuned to accelerate blood similarly in small and large hearts. Patients’ forces differed from controls in both timing and amplitude. Normal cardiac pumping is associated with specific force patterns for both ventricles, and deviation from these forces may be a sensitive marker of ventricular dysfunction. Reference values are provided for future studies.NEW & NOTEWORTHY Biventricular hemodynamic forces were quantified for the first time in healthy controls and elite athletes (n = 39). Hemodynamic forces constitute a slingshot-like mechanism in the right ventricle, redirecting blood flow toward the pulmonary circulation. Force patterns were similar between healthy subjects and athletes, indicating potential utility as a cardiac function biomarker.

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Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.674435 ◽

2021 ◽

Vol 8 ◽

Author(s):

Amir Anwar Samaan ◽

Karim Said ◽

Wafaa El Aroussy ◽

Mohammed Hassan ◽

Soha Romeih ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Mitral Stenosis ◽

Left Ventricular ◽

Lv Function ◽

Resonance Imaging ◽

Gadolinium Enhancement ◽

Mitral Valvuloplasty ◽

Rheumatic Mitral Stenosis

Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied.Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function.Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated.Results: At baseline, patients had median EF of 57 (range: 45–69) %, LVEDVI of 74 (44–111) ml/m2 and LVESVI of 31 (14–57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (−16.4 vs. −13.8, p < 0.001) and global circumferential strain (GCS) (−17.8 vs. −15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (−17.9 vs. −16.4, p = 0.008) and GCS (−19.4 vs. −17.8 p = 0.03).Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.

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Usefulness of Cardiac Magnetic Resonance Imaging in Aortic Stenosis

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.010356 ◽

2020 ◽

Vol 13 (5) ◽

Author(s):

Yohann Bohbot ◽

Cédric Renard ◽

Alain Manrique ◽

Franck Levy ◽

Sylvestre Maréchaux ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Stenosis ◽

Left Ventricular ◽

Flow Quantification ◽

Low Flow ◽

Left Ventricular Volumes ◽

Resonance Imaging ◽

And Function

The objective of this review is to provide an overview of the role of cardiac magnetic resonance (CMR) in aortic stenosis (AS). Although CMR is undeniably the gold standard for assessing left ventricular volume, mass, and function, the assessment of the left ventricular repercussions of AS by CMR is not routinely performed in clinical practice, and its role in evaluating and quantifying AS is not yet well established. CMR is an imaging modality integrating myocardial function and disease, which could be particularly useful in a pathology like AS that should be considered as a global myocardial disease rather than an isolated valve disease. In this review, we discuss the emerging potential of CMR for the diagnosis and prognosis of AS. We detail its utility for studying all aspects of AS, including valve anatomy, flow quantification, left ventricular volumes, mass, remodeling, and function, tissue mapping, and 4-dimensional flow magnetic resonance imaging. We also discuss different clinical situations where CMR could be useful in AS, for example, in low-flow low-gradient AS to confirm the low-flow state and to understand the reason for the left ventricular dysfunction or when there is a suspicion of associated cardiac amyloidosis.

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