EVALUATION OF THE ROLE OF 3 TESLA MRI AND ECHOCARDIOGRAPHY IN ASSESSING FUNCTIONAL LEFT VENTRICULAR PARAMETERS IN PATIENTS WITH CHRONIC ISCHEMIC CARDIOMYOPATHY

Background Multiple imaging modalities are available to assess dysfunctional yet viable myocardium; these include Echocardiography, Single Photon Emission Computed Tomography (SPECT) Imaging, Positron Emission Tomography (PET) and Cardiac Magnetic Resonance Imaging (CMRI). The aim of this study is to evaluate the role of 3T CMRI and Echocardiography in the evaluation of patients with Ischemic Cardiomyopathy for left ventricular function at both regional and global levels including the calculation of ejection fraction and segmental wall motion abnormalities based on the 17-segment model of the American Heart Association (AHA). Material and Methods This was a Hospital Based Cross Sectional Observational Study, conducted in Department of Cardiology and Department of Radiology, Advanced Cardiac Institute, PT J N M Medical College and Dr. B R A M Hospital between July 2017 to September 2018 in 24 patients with known Ischemic Cardiomyopathy, assessed by Echocardiography and 3T CMRI for Left Ventricular Functions. Results The study showed that the mean LVEF by CMRI was 34.08% and the mean LVEF by Echocardiography was 33.27% with a mean difference of 2.89%, standard deviation of bias was of 0.856 and 95% limits of agreement were 1.212-4.568. A poor to fair level of agreement was noted using Cohen’s Kappa (r) is 0.375, Standard Error (SE) of r is 0.035, P value of < 0.0005. The results showed that CMRI had a sensitivity of 94.7%, specificity of 44.1%, Positive Predictive value (PPV) of 65.5% and Negative Predictive value (NPV) of 88.2%. The Echocardiography had a sensitivity of 80%, specificity of 32.4%, with a PPV of 52.8% and a NPV of 63.2%. CMRI has an Excellent Negative Predictive Value of 88.2% which means that 88.2% of the Vascular Territories without SWMA on CMRI did not have a scar. Conclusions CMRI and Echocardiography are comparable for assessing Global Left Ventricular functions. There is only a fair degree of agreement between CMRI and Echocardiography for analysis of segmental wall motion abnormalities. CMRI may be more accurate in ruling out a scarred myocardium as compared to Echocardiography, owing to High Negative Predictive value.

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A Fully Automated Echocardiography Software Can Accurately Quantify Left Ventricular Ejection Fraction in Patients with Segmental Wall Motion Abnormalities

10.26226/morressier.5ebc4ac6ffea6f735881a42c ◽

2020 ◽

Author(s):

Ashton Lai

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Wall Motion ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Segmental Wall Motion ◽

Segmental Wall ◽

Wall Motion Abnormalities

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Abstract 15086: Transendocardial CD34+ Cell Transplantation Improves Left Ventricular Segmental Wall Motion in Patients With Ischemic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.15086 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Gregor Poglajen ◽

Gregor Zemljic ◽

Matjaz Sever ◽

Mojca Bervar ◽

Marko Cukjati ◽

...

Keyword(s):

Clinical Response ◽

Cell Transplantation ◽

Ischemic Cardiomyopathy ◽

Longitudinal Strain ◽

Wall Motion ◽

Myocardial Strain ◽

Left Ventricular ◽

Segmental Wall Motion ◽

Segmental Wall ◽

Cd34 Cells

Introduction: We investigated the effects of transendocardial transplantation of CD34+ stem cells on left ventricular segmental wall motion in patients with ischemic cardiomyopathy (ICM). Methods: We performed transendocardial CD34+ cell transplantation in 31 ICM patients with NYHA class III heart failure and LVEF <40%. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of hibernating myocardium as defined by electromechanical mapping (unipolar voltage ≥9 mV and linear shortening <6%). Left ventricular segmental wall motion analysis was evaluated with TomTec software using a 17-segment model of the left ventricle. Of 31 patients enrolled, 85% were male, their age was 57±6 years; their creatinine, bilirubin and NT-proBNP levels were 89±22 μmol/L, 17±9 μmol/L, and 3,322±3,411 pg/mL respectively. The average Syntax score was 27.9±10.5 and the average number of injected CD34+ cells was 90.6±7.5 million. Patients were followed for 6 months and good clinical response was defined as an increase of left ventricular ejection fraction (LVEF) ≥5%. Results: During follow-up, we found a significant improvement in LVEF (from 27.1±6,6% to 34.7±10.9%; P=0.001), left ventricular end-systolic diameter (from 5.3±0.7 cm to 4.9±0.9 cm; P=0.04), and left ventricular end-systolic volume (from 152±45 mL to 135±44 mL; P=0.03). Left ventricular segmental wall motion analysis showed significantly improved myocardial longitudinal strain in injected segmentes as opposed to noninjected segments (2.4±8.3 vs. -0.9±6.1; P=0.05). We also established a correlation between improvement in myocardial strain and clinical response to cell therapy: responders demonstrated a significant improvement in longitudinal strain in injected segments, but non-responders did not (6.29±8.1 vs. -3.4±5.1; P=0.007). No difference was seen between responders and nonresponders with regards to myocardial strain of noninjected segments (2.4±8.4 vs. -0.97±6.1; P=0.59). Conclusions: Intramyocardial CD 34+ cell transplantation appears to improve left ventricular segmental wall motion in patients with ischemic cardiomyopathy.

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