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Journal articles on the topic 'Scar imaging echocardiography'
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1
Gaibazzi, Nicola, Michele Bianconcini, Nicola Marziliano, Iris Parrini, Maria Rosa Conte, Carmine Siniscalchi, Giacomo Faden, et al. "Scar Detection by Pulse-Cancellation Echocardiography." JACC: Cardiovascular Imaging 9, no. 11 (November 2016): 1239–51. http://dx.doi.org/10.1016/j.jcmg.2016.01.021.
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Amundsen, Brage H., Anders Thorstensen, and Asbjørn Støylen. "Deformation Measurements by Echocardiography versus Late Enhancement Magnetic Resonance Imaging in Patients with Coronary Artery Disease." European Cardiology Review 8, no. 2 (2012): 101. http://dx.doi.org/10.15420/ecr.2012.8.2.101.
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The aim of this article is to discuss the present and future potential of deformation imaging by echocardiography and scar visualisation by magnetic resonance imaging (MRI) in patients with coronary artery disease (CAD). The two methods are clearly different: one is concerned with function, the other with morphology. Echocardiography, with its versatility of methods and high applicability, will continue to be the workhorse in cardiac imaging of patients with CAD. Important additional information can be extracted from deformation imaging methods, especially due to the high temporal resolution in tissue Doppler. Deformation measurements in 3D images are still limited by their lower resolution compared with 2D but will continue to improve. The standardisation of image analysis and the collaboration within the echocardiographic community to conduct larger studies will be important tasks in the attempt to establish evidence for the new methods. Late enhancement MRI is a method with unique properties and will continue to be an important alternative in selected patients and settings, as well as an invaluable research tool.
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Chaosuwannakit, Narumol, and Pattarapong Makarawate. "Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging." Tomography 7, no. 2 (May 12, 2021): 180–88. http://dx.doi.org/10.3390/tomography7020016.
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Objective: Cardiovascular magnetic resonance imaging (CMR) late gadolinium enhancement technique (LGE) detects thrombus rather than anatomical presence based on tissue properties and is theoretically highly accurate. The present study’s goal was to compare the diagnostic accuracy obtained with various CMR techniques and transthoracic echocardiography to diagnose left ventricular thrombus and evaluate the prevalence and perspectives of left ventricular (LV) thrombus among patients with impaired systolic left ventricular function. Methods: In a single academic referral center, a retrospective database review of all CMR assessments of the established left ventricular thrombus was carried out in 206 consecutive patients with reduced systolic function for five years. To assess thrombus risk factors, clinical and imaging parameters were analyzed. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), echocardiography, and cine-CMR sequence accuracy have been identified. LV structural parameters were quantified to detect markers for thrombus and predictors of the additive usefulness of contrast-enhanced thrombus imaging. Comparisons against LGE-CMR were made, which was used as the standard. Results: A 7.8 percent prevalence of left ventricular thrombus was identified by LGE-CMR. Cine-CMR increased the diagnostic efficiency for echocardiographic thrombus identification in this group, with sensitivity increasing from 50 percent by echocardiography to 75 percent by cine-CMR (p = 0.008). Dark blood CMR (DB-CMR) has better sensitivity and accuracy than echocardiography (p < 0.001), comparable to cine-CMR. The transmural infarct size was an independent marker for thrombus after correction for the LVEF and LV volume while considering only CMR parameters. There were significantly higher embolic events (HR = 71.33; CI 8.31–616.06, p < 0.0001) in LV thrombus patients detected by LGE-CMR. Conclusion: CMR imaging was more sensitive to left ventricular thrombi identification compared with transthoracic echocardiography. An additional parameter available from LGE-CMR and shown as an independent risk factor for left ventricular thrombus is the myocardial scar.
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Trivedi, Siddharth J., Timothy Campbell, Luke D. Stefani, Liza Thomas, and Saurabh Kumar. "Strain by speckle tracking echocardiography correlates with electroanatomic scar location and burden in ischaemic cardiomyopathy." European Heart Journal - Cardiovascular Imaging 22, no. 8 (February 15, 2021): 855–65. http://dx.doi.org/10.1093/ehjci/jeab021.
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Abstract Aims Ventricular tachycardia (VT) in ischaemic cardiomyopathy (ICM) originates from scar, identified as low-voltage areas with invasive high-density electroanatomic mapping (EAM). Abnormal myocardial deformation on speckle tracking strain echocardiography can non-invasively identify scar. We examined if regional and global longitudinal strain (GLS) can localize and quantify low-voltage scar identified with high-density EAM. Methods and results We recruited 60 patients, 40 ICM patients undergoing VT ablation and 20 patients undergoing ablation for other arrhythmias as controls. All patients underwent an echocardiogram prior to high-density left ventricular (LV) EAM. Endocardial bipolar and unipolar scar location and percentage were correlated with regional and multilayer GLS. Controls had normal GLS and normal bipolar and unipolar voltages. There was a strong correlation between endocardial and mid-myocardial longitudinal strain and endocardial bipolar scar percentage for all 17 LV segments (r = 0.76–0.87, P < 0.001) in ICM patients. Additionally, indices of myocardial contraction heterogeneity, myocardial dispersion (MD), and delta contraction duration (DCD) correlated with bipolar scar percentage. Endocardial and mid-myocardial GLS correlated with total LV bipolar scar percentage (r = 0.83; 0.82, P < 0.001 respectively), whereas epicardial GLS correlated with epicardial bipolar scar percentage (r = 0.78, P < 0.001). Endocardial GLS −9.3% or worse had 93% sensitivity and 82% specificity for predicting endocardial bipolar scar >46% of LV surface area. Conclusions Multilayer strain analysis demonstrated good linear correlations with low-voltage scar by invasive EAM. Validation studies are needed to establish the utility of strain as a non-invasive tool for quantifying scar location and burden, thereby facilitating mapping and ablation of VT.
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Badano, Luigi P., Karima Addetia, Gianluca Pontone, Camilla Torlasco, Roberto M. Lang, Gianfranco Parati, and Denisa Muraru. "Advanced imaging of right ventricular anatomy and function." Heart 106, no. 19 (July 3, 2020): 1469–76. http://dx.doi.org/10.1136/heartjnl-2019-315178.
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Right ventricular (RV) size and function are important predictors of cardiovascular morbidity and mortality in patients with various conditions. However, non-invasive assessment of the RV is a challenging task due to its complex anatomy and location in the chest. Although conventional echocardiography is widely used, its limitations in RV assessment are well recognised. New techniques such as three-dimensional and speckle tracking echocardiography have overcome the limitations of conventional echocardiography allowing a comprehensive, quantitative assessment of RV geometry and function without geometric assumptions. Cardiac magnetic resonance (CMR) and CT provide accurate assessment of RV geometry and function, too. In addition, tissue characterisation imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV that has clinical applications for diagnosis and prognosis in a broad range of cardiac conditions. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. Hybrid imaging, which is able to integrate anatomical information (usually obtained by CT or CMR) with physiological and molecular data (usually obtained with positron emission tomography), can provide optimal in vivo evaluation of Rv functional impairment. This review summarises the clinically useful applications of advanced echocardiography techniques, CMR and CT for comprehensive assessment of RV size, function and mechanics.
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Madanieh, Raef, Shawn Mathew, Pratik Shah, Satya K. Vatti, Abed Madanieh, Constantine E. Kosmas, and Timothy J. Vittorio. "Cardiac Magnetic Resonance Imaging Might Complement Two-Dimensional Echocardiography in the Detection of a Reversible Nonischemic Cardiomyopathy." Clinical Medicine Insights: Case Reports 8 (January 2015): CCRep.S26054. http://dx.doi.org/10.4137/ccrep.s26054.
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We report a case of reversible nonischemic dilated cardiomyopathy in a male in his 60s who presented with an acute heart failure syndrome. Both conventional two-dimensional echocardiography and cardiac magnetic resonance imaging (cMRI) demonstrated severe left ventricular systolic dysfunction; however, both modalities were devoid of significant valvular heart disease as well as the presence of fibrosis, infiltration, inflammation, and scar. After six months of aggressive neurohumoral modulation, there was complete reverse remodeling and normalization of left ventricular function, which highlights the role of cMRI as an adjunct to two-dimensional echocardiography in the detection of a potentially reversible nonischemic cardiomyopathy.
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Fazio, Giovanni, Federica Vernuccio, Emanuele Grassedonio, Giuseppe Grutta, Giuseppe Lo Re, and Massimo Midiri. "Ischemic and non-ischemic dilated cardiomyopathy." Open Medicine 9, no. 1 (February 1, 2014): 15–20. http://dx.doi.org/10.2478/s11536-013-0233-y.
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AbstractDilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.
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Cochet, Hubert, Xavier Iriart, Antoine Allain-Nicolaï, Claudia Camaioni, Soumaya Sridi, Hubert Nivet, Emmanuelle Fournier, et al. "Focal scar and diffuse myocardial fibrosis are independent imaging markers in repaired tetralogy of Fallot." European Heart Journal - Cardiovascular Imaging 20, no. 9 (April 16, 2019): 990–1003. http://dx.doi.org/10.1093/ehjci/jez068.
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Abstract Aims To identify the correlates of focal scar and diffuse fibrosis in patients with history of tetralogy of Fallot (TOF) repair. Methods and results Consecutive patients with prior TOF repair underwent electrocardiogram, 24-h Holter, transthoracic echocardiography, exercise testing, and cardiac magnetic resonance (CMR) including cine imaging to assess ventricular volumes and ejection fraction, T1 mapping to assess left ventricular (LV) and right ventricular (RV) diffuse fibrosis, and free-breathing late gadolinium-enhanced imaging to quantify scar area at high spatial resolution. Structural imaging data were related to clinical characteristics and functional imaging markers. Cine and T1 mapping results were compared with 40 age- and sex-matched controls. One hundred and three patients were enrolled (age 28 ± 15 years, 36% women), including 36 with prior pulmonary valve replacement (PVR). Compared with controls, TOF showed lower LV ejection fraction (LVEF) and RV ejection fraction (RVEF), and higher RV volume, RV wall thickness, and native T1 and extracellular volume values on both ventricles. In TOF, scar area related to LVEF and RVEF, while LV and RV native T1 related to RV dilatation. On multivariable analysis, scar area and LV native T1 were independent correlates of ventricular arrhythmia, while RVEF was not. Patients with history of PVR showed larger scars on RV outflow tract but shorter LV and RV native T1. Conclusion Focal scar and biventricular diffuse fibrosis can be characterized on CMR after TOF repair. Scar size relates to systolic dysfunction, and diffuse fibrosis to RV dilatation. Both independently relate to ventricular arrhythmias. The finding of shorter T1 after PVR suggests that diffuse fibrosis may reverse with therapy.
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Owashi, Kimi, Marion Taconné, Nicolas Courtial, Antoine Simon, Mireille Garreau, Alfredo Hernandez, Erwan Donal, Virginie Le Rolle, and Elena Galli. "Desynchronization Strain Patterns and Contractility in Left Bundle Branch Block through Computer Model Simulation." Journal of Cardiovascular Development and Disease 9, no. 2 (February 6, 2022): 53. http://dx.doi.org/10.3390/jcdd9020053.
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Left bundle branch block (LBBB) is associated with specific septal-to-lateral wall activation patterns which are strongly influenced by the intrinsic left ventricular (LV) contractility and myocardial scar localization. The objective of this study was to propose a computational-model-based interpretation of the different patterns of LV contraction observed in the case of LBBB and preserved contractility or myocardial scarring. Two-dimensional transthoracic echocardiography was used to obtain LV volumes and deformation patterns in three patients with LBBB: (1) a patient with non-ischemic dilated cardiomyopathy, (2) a patient with antero-septal myocardial scar, and (3) a patient with lateral myocardial scar. Scar was confirmed by the distribution of late gadolinium enhancement with cardiac magnetic resonance imaging (cMRI). Model parameters were evaluated manually to reproduce patient-derived data such as strain curves obtained from echocardiographic apical views. The model was able to reproduce the specific strain patterns observed in patients. A typical septal flash with pre-ejection shortening, rebound stretch, and delayed lateral wall activation was observed in the case of non-ischemic cardiomyopathy. In the case of lateral scar, the contractility of the lateral wall was significantly impaired and septal flash was absent. In the case of septal scar, septal flash and rebound stretch were also present as previously described in the literature. Interestingly, the model was also able to simulate the specific contractile properties of the myocardium, providing an excellent localization of LV scar in ischemic patients. The model was able to simulate the electromechanical delay and specific contractility patterns observed in patients with LBBB of ischemic and non-ischemic etiology. With further improvement and validation, this technique might be a useful tool for the diagnosis and treatment planning of heart failure patients needing CRT.
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Rammos, Aidonis, Vasileios Meladinis, Georgios Vovas, and Dimitrios Patsouras. "Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment—A Systematic Review." Radiology Research and Practice 2017 (2017): 1–14. http://dx.doi.org/10.1155/2017/2874902.
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Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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Catalano, Oronzo, Guido Moro, Giorgio Cannizzaro, Renato Mingrone, Cristina Opasich, Mariarosa Perotti, Felice Rognone, Mauro Frascaroli, Maurizia Baldi, and Roberto Tramarin. "Scar Detection by Contrast-Enhanced Magnetic Resonance Imaging in Chronic Coronary Artery Disease: A Comparison with Nuclear Imaging and Echocardiography." Journal of Cardiovascular Magnetic Resonance 7, no. 4 (July 1, 2005): 639–47. http://dx.doi.org/10.1081/jcmr-200065602.
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Umnov, I. N., A. L. Bobrov, and M. N. Alekhin. "Contrast Echocardiography with a Quantitative Assessment of Myocardial Perfusion in Patients with Previous Q-Wave Myocardial Infarction." Kardiologiia 60, no. 2 (March 5, 2020): 17–23. http://dx.doi.org/10.18087/cardio.2020.2.n817.
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Objective. To assess possibilities of contrast echocardiography with quantitative evaluation of myocardial perfusion in patients with previous Q-wave myocardial infarction.Materials and Methods. We examined 15 men (42-72 years) with coronary artery disease and previous myocardial infarction, and pathological Q-wave in 2 or more ECG leads. Quantification of left ventricular (LV) myocardial perfusion was performed by calculating of the ultrasound signal tissue intensity from the LV myocardial segments during intravenous administration of the ultrasound contrast agent (SonoVue). The Tissue intensive curve (TIC) analysis was done in the end-diastolic period before and on the fourth cardiac cycle after applying the "flash". Changes in the intensity of myocardial perfusion (A4, dB) was estimated as the difference between the intensity values of the ultrasound signal in the myocardial segment during the period of filling the contrast bubbles on 4-th cardiac cycle and before applying the «flash». Measurements were performed in 16 segments of the LV. A contrast cardiac magnetic resonance imaging (contrast MRI) was performed in order to verify the LV scar. Fibrotic changes of 50% of myocardial wall or more were considered as signs of post-infarction scar.Results. The dynamics of perfusion and scar presence in 240 myocardial segments were evaluated. The median A4 was 1 dB (range, -20 to 10 dB). MRI revealed 82 of 240 segments with the large-focal scar. The effectiveness of the diagnostic test (quantitative contrast perfusion echocardiography with A4 assessment) to detect myocardial scar was investigated. ROC curve analysis showed good model quality, AUC=0,787 (0,730-0,837); sensitivity 82.9%; specificity 75.3%; p<0.01. The cut-off point for A4 was -1.Conclusion. A new approach to quantitative contrast assessment of perfusion allows to identify perfusion disorders with high efficiency in patients with previous Q-wave myocardial infarction.
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Ha, Francis J., Sharad Agarwal, Katharine Tweed, Sonny C. Palmer, Heath S. Adams, Muhunthan Thillai, and Lynne Williams. "Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge." Current Cardiology Reviews 16, no. 2 (May 19, 2020): 90–97. http://dx.doi.org/10.2174/1573403x15666190725121246.
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Cardiac Sarcoidosis (CS) represents a unique diagnostic dilemma. Guidelines have been recently revised to reflect the established role of sophisticated imaging techniques. Trans-thoracic Echocardiography (TTE) is widely adopted for initial screening of CS. Contemporary TTE techniques could enhance detection of subclinical Left Ventricular (LV) dysfunction, particularly LV global longitudinal strain assessment which predicts event-free survival (meta-analysis of 5 studies, hazard ratio 1.28, 95% confidence interval 1.18-1.37, p < 0.0001). However, despite the wide availability of TTE, it has limited sensitivity and specificity for CS diagnosis. Cardiac Magnetic resonance Imaging (CMR) is a crucial diagnostic modality for suspected CS. Presence of late gadolinium enhancement signifies myocardial scar and enables risk stratification. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) coupled with myocardial perfusion imaging can identify active CS and guide immunosuppressant therapy. Gallium scintigraphy may be considered although FDG-PET is often preferred. While CMR and FDG-PET provide complementary information in CS evaluation, current guidelines do not recommend which imaging modalities are essential in suspected CS and if so, which modality should be performed first. The utility of hybrid imaging combining both advanced imaging modalities in a single scan is currently being explored, although not yet widely available. In view of recent, significant advances in cardiac imaging techniques, this review aims to discuss changes in guidelines for CS diagnosis, the role of various cardiac imaging modalities and the future direction in CS.
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Mazur, O. A., L. M. Hrubyak, O. V. Kupchynskyi, and N. V. Bankovska. "Case Study: Using 3D Speckle Tracking Echocardiography for Left Ventricular Aneurysm Diagnosis." Ukrainian journal of cardiovascular surgery, no. 4 (41) (December 16, 2020): 90–95. http://dx.doi.org/10.30702/ujcvs/20.4112/061090-095/073.7.
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Nowadays magnetic resonance imaging (MRI) is a gold standard for diagnosing abnormalities of left ventricular geometry and function, however, it is not universally accessible. Furthermore, MRI is not compatible with pacemakers and similar devices. 3D speckle tracking echocardiography (3D STE) is a cutting-edge echocardiography imaging technique for myocardial deformation assessment. As such, 3D STE looks very promising for diagnosing structural complications of myocardial infarction (MI) and choosing the optimal surgical techniques.
In this case study, we used 3D STE to assess left ventricular function in a patient with left ventricular aneurysm.
The patient was admitted to National Amosov Institute of Cardiovascular Surgery three weeks after having a second MI (the first MI was reported 4 years ago). His coronary angiography showed diffuse coronary artery disease. 2D echocardiography (performed on Toshiba Artida) results: end-diastolic volume (EDV) 206 ml, end-systolic volume (ESV) 141 ml, ejection fraction (EF) (Simpson’s method) 31%. An object sized 2.2*1.6 cm was discovered in the apical region (left ventricular thrombus). 3D STE results: EDV 209 ml, ESV 182 ml, EF 13%. Global area strain (GAS) was considerably decreased (–13.7 %) showing the pattern of ischemic cardiomyopathy with multivessel disease. Due to several reasons, it was impossible to obtain an MRI scan, so a CT coronary angiography was performed (Toshiba Aquilion One). The results of multi-slice computed tomography (MSCT) were consistent with those of echocardiography.
According to the results, the initial plan to resect the apical akinesia region was ruled out. The patient underwent coronary artery bypass grafting (CABG) (4 shunts), the removal of thrombi from the left ventricle (additional fresh thrombi were discovered during the surgical intervention), and left ventricular aneurysm repair under cardiopulmonary bypass. Post-treatment 3D STE results: EDV dropped to 135 ml, EF rose from 13% to 32%. GAS increased up to –20.4 %, while the strains of all segments increased to subnormal levels. The overall dynamics was positive, and the patient was discharged to undergo postoperative rehabilitation.
The case shows that 3D STE data is consistent with CT data in patients with abnormal ventricular remodeling. 3D STE is a good method for differentiation between akinetic scar tissue and a dyskinetic left ventricular aneurysm.
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Hegeman, Romy R. M. J. J., Sean McManus, Jan-Peter van Kuijk, Serge C. Harb, Martin J. Swaans, Patrick Klein, and Rishi Puri. "Inward Displacement: A Novel Method of Regional Left Ventricular Functional Assessment for Left Ventriculoplasty Interventions in Heart Failure with Reduced Ejection Fraction (HFrEF)." Journal of Clinical Medicine 12, no. 5 (March 2, 2023): 1997. http://dx.doi.org/10.3390/jcm12051997.
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Background: Hybrid minimally invasive left ventricular reconstruction is used to treat patients with ischemic heart failure with reduced ejection fraction (HFrEF) and antero-apical scar. Pre- and post-procedural regional functional left ventricular assessment with current imaging techniques remains limited. We evaluated ‘inward displacement’ as a novel technique of assessing regional left ventricular function in an ischemic HFrEF population who underwent left ventricular reconstruction with the Revivent System. Methods: Inward displacement adopts three standard long-axis views obtained during cardiac MRI or CT and assesses the degree of inward endocardial wall motion towards the true left ventricular center of contraction. For each of the standard 17 left ventricular segments, regional inward displacement is measured in mm and expressed as a percentage of the maximal theoretical distance each segment can contract towards the centerline. The left ventricle was divided into three regions, obtaining the arithmetic average of inward displacement or speckle tracking echocardiographic strain at the left ventricular base (segments 1–6), mid-cavity (segments 7–12) and apex (segments 13–17). Inward displacement was measured using computed tomography or cardiac magnetic resonance imaging and compared pre- and post-procedurally in ischemic HFrEF patients who underwent left ventricular reconstruction with the Revivent System (n = 36). In a subset of patients who underwent baseline speckle tracking echocardiography, pre-procedural inward displacement was compared with left ventricular regional echocardiographic strain (n = 15). Results: Inward displacement of basal and mid-cavity left ventricular segments increased by 27% (p < 0.001) and 37% (p < 0.001), respectively, following left ventricular reconstruction. A significant overall decrease in both the left ventricular end systolic volume index and end diastolic volume index of 31% (p < 0.001) and 26% (p < 0.001), respectively, was detected, along with a 20% increase in left ventricular ejection fraction (p = 0.005). A significant correlation between inward displacement and speckle tracking echocardiographic strain was noted within the basal (R = −0.77, p < 0.001) and mid-cavity left ventricular segments (R = −0.65, p = 0.004), respectively. Inward displacement resulted in relatively larger measurement values compared to speckle tracking echocardiography, with a mean difference of absolute values of −3.33 and −7.41 for the left ventricular base and mid-cavity, respectively. Conclusions: Obviating the limitations of echocardiography, inward displacement was found to highly correlate with speckle tracking echocardiographic strain to evaluate regional segmental left ventricular function. Significant improvements in basal and mid-cavity left ventricular contractility were demonstrated in ischemic HFrEF patients following left ventricular reconstruction of large antero-apical scars, consistent with the concept of reverse left ventricular remodeling at a distance. Inward displacement holds significant promise in the HFrEF population being evaluated pre- and post-left ventriculoplasty procedures.
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Romano, Minna M. D., Henrique T. Moreira, André Schmidt, Benedito Carlos Maciel, and José Antônio Marin-Neto. "Imaging Diagnosis of Right Ventricle Involvement in Chagas Cardiomyopathy." BioMed Research International 2017 (2017): 1–14. http://dx.doi.org/10.1155/2017/3820191.
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Right ventricle (RV) is considered a neglected chamber in cardiology and knowledge about its role in cardiac function was mostly focused on ventricular interdependence. However, progress on the understanding of myocardium diseases primarily involving the RV led to a better comprehension of its role in health and disease. In Chagas disease (CD), there is direct evidence from both basic and clinical research of profound structural RV abnormalities. However, clinical detection of these abnormalities is hindered by technical limitations of imaging diagnostic tools. Echocardiography has been a widespread and low-cost option for the study of patients with CD but, when applied to the RV assessment, faces difficulties such as the absence of a geometrical shape to represent this cavity. More recently, the technique has evolved to a focused guided RV imaging and myocardial deformation analysis. Also, cardiac magnetic resonance (CMR) has been introduced as a gold standard method to evaluate RV cavity volumes. CMR advantages include precise quantitative analyses of both LV and RV volumes and its ability to perform myocardium tissue characterization to identify areas of scar and edema. Evolution of these cardiac diagnostic techniques opened a new path to explore the pathophysiology of RV dysfunction in CD.
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Abou, Rachid, Edgard A. Prihadi, Laurien Goedemans, Rob van der Geest, Mohammed El Mahdiui, Martin J. Schalij, Nina Ajmone Marsan, Jeroen J. Bax, and Victoria Delgado. "Left ventricular mechanical dispersion in ischaemic cardiomyopathy: association with myocardial scar burden and prognostic implications." European Heart Journal - Cardiovascular Imaging 21, no. 11 (July 30, 2020): 1227–34. http://dx.doi.org/10.1093/ehjci/jeaa187.
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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 < 0.001), total scar burden (r = 0.497, P < 0.001), and border zone (r = 0.298, P = 0.003). In total, 14 patients (15%) reached the combined endpoint. Patients with LV MD >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.
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Kansal, M. M., P. M. Panse, H. Abe, G. Caracciolo, S. Wilansky, A. J. Tajik, B. K. Khandheria, and P. P. Sengupta. "Relationship of contrast-enhanced magnetic resonance imaging-derived intramural scar distribution and speckle tracking echocardiography-derived left ventricular two-dimensional strains." European Heart Journal - Cardiovascular Imaging 13, no. 2 (October 1, 2011): 152–58. http://dx.doi.org/10.1093/ejechocard/jer163.
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Atabekov, Tariel A., Mikhail S. Khlynin, Anna I. Mishkina, Roman E. Batalov, Svetlana I. Sazonova, Sergey N. Krivolapov, Victor V. Saushkin, Yuliya V. Varlamova, Konstantin V. Zavadovsky, and Sergey V. Popov. "The Value of Left Ventricular Mechanical Dyssynchrony and Scar Burden in the Combined Assessment of Factors Associated with Cardiac Resynchronization Therapy Response in Patients with CRT-D." Journal of Clinical Medicine 12, no. 6 (March 8, 2023): 2120. http://dx.doi.org/10.3390/jcm12062120.
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Background: Cardiac resynchronization therapy (CRT) improves the outcome in patients with heart failure (HF). However, approximately 30% of patients are nonresponsive to CRT. The aim of this study was to determine the role of the left ventricular (LV) mechanical dyssynchrony (MD) and scar burden as predictors of CRT response. Methods: In this study, we included 56 patients with HF and the left bundle-branch block with QRS duration ≥ 150 ms who underwent CRT-D implantation. In addition to a full examination, myocardial perfusion imaging and gated blood-pool single-photon emission computed tomography were performed. Patients were grouped based on the response to CRT assessed via echocardiography (decrease in LV end-systolic volume ≥15% or/and improvement in the LV ejection fraction ≥5%). Results: In total, 45 patients (80.3%) were responders and 11 (19.7%) were nonresponders to CRT. In multivariate logistic regression, LV anterior-wall standard deviation (adjusted odds ratio (OR) 1.5275; 95% confidence interval (CI) 1.1472–2.0340; p = 0.0037), summed rest score (OR 0.7299; 95% CI 0.5627–0.9469; p = 0.0178), and HF nonischemic etiology (OR 20.1425; 95% CI 1.2719–318.9961; p = 0.0331) were the independent predictors of CRT response. Conclusion: Scar burden and MD assessed using cardiac scintigraphy are associated with response to CRT.
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Giollo, Alessandro, Giulia Vinco, Giovanni Cioffi, Francesca Frizzera, Anna Quinternetto, Corinna Bergamini, Marta Dal Porto, et al. "Subclinical Myocardial Fibrosis in Systemic Lupus Erythematosus as Assessed by Pulse-Cancellation Echocardiography: A Pilot Study." Journal of Clinical Medicine 11, no. 16 (August 16, 2022): 4788. http://dx.doi.org/10.3390/jcm11164788.
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The aim of this study was to examine whether scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) can detect subclinical myocardial involvement in systemic lupus erythematosus (SLE). We consecutively recruited SLE patients and controls matched for age, sex, and cardiovascular risk factors. Participants with cardiac symptoms or a prior history of heart disease were excluded. All participants underwent eSCAR and speckle tracking echocardiography (STE) with global longitudinal strain (GLS) assessment. SLE patients were assessed for disease activity and were followed up for 12 months. Myocardial scars by eSCAR were observed in 19% of SLE patients, almost exclusively localized at the inferoseptal myocardial segments, and in none of the controls. GLS was significantly lower in most myocardial segments of SLE patients compared with the controls, especially in the inferoseptal segments. eSCAR-positive SLE patients received a higher cumulative and current dose of prednisone, and had significantly higher levels of anti-dsDNA antibodies (p = 0.037). eSCAR-positive patients were at higher risk of having SLE flares over follow-up (hazard ratio: 4.91; 95% CI 1.43–16.83; p = 0.0001). We identified inferoseptal myocardial scars by eSCAR in about one-fifth of SLE patients. Subclinical myocardial involvement was associated with glucocorticoid use and anti-dsDNA antibodies.
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Nakachi, Tatsuya, Shingo Kato, Naka Saito, Kazuki Fukui, Tae Iwasawa, Tsutomu Endo, Masami Kosuge, Daisuke Utsunomiya, Kazuo Kimura, and Kouichi Tamura. "Non-Invasive Evaluation of Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion." Journal of Clinical Medicine 10, no. 20 (October 14, 2021): 4712. http://dx.doi.org/10.3390/jcm10204712.
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Background: As percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) gains wider acceptance as a therapeutic option for coronary artery disease, the importance of appropriate patient selection has increased. Although cardiovascular magnetic resonance imaging (MRI) allows segmental and quantitative analyses of myocardial ischemia and scar transmurality, it has limitations, including contraindications, cost, and accessibility. This study established a non-invasive method to evaluate patients undergoing CTO-PCI using two-dimensional speckle-tracking echocardiography (2D-STE). Methods: Overall, we studied 55 patients who underwent successful CTO-PCI. Cardiovascular MRI and 2D-STE were performed before and 8 ± 2 months after CTO-PCI. Segmental findings of strain parameters were compared with those obtained with late gadolinium enhancement and stress-perfusion MRI. Results: With a cutoff of −10.7, pre-procedural circumferential strain (CS) showed reasonable sensitivity (71%) and specificity (73%) for detecting segments with transmural scar. The discriminatory ability of longitudinal strain (LS) for segments with transmural scar significantly improved during follow-up after successful CTO-PCI in the territory of the recanalized artery (area under the curve (AUC) 0.70 vs. 0.80, p < 0.001). LS accuracy was lower than that of CS at baseline (AUC 0.70 vs. 0.79, p = 0.048), and was increased at follow-up (AUC 0.80 vs. 0.82, p = 0.81). Changes in myocardial perfusion reserve from baseline to follow-up were significantly associated with those in LS but not in CS. Conclusions: Use of 2D-STE may allow the non-invasive evaluation of patients undergoing CTO-PCI to assess the indication before the procedure and treatment effects at follow-up.
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Nakachi, Tatsuya, Shingo Kato, Naka Saito, Kazuki Fukui, Tae Iwasawa, Tsutomu Endo, Masami Kosuge, Daisuke Utsunomiya, Kazuo Kimura, and Kouichi Tamura. "Non-Invasive Evaluation of Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion." Journal of Clinical Medicine 10, no. 20 (October 14, 2021): 4712. http://dx.doi.org/10.3390/jcm10204712.
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Background: As percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) gains wider acceptance as a therapeutic option for coronary artery disease, the importance of appropriate patient selection has increased. Although cardiovascular magnetic resonance imaging (MRI) allows segmental and quantitative analyses of myocardial ischemia and scar transmurality, it has limitations, including contraindications, cost, and accessibility. This study established a non-invasive method to evaluate patients undergoing CTO-PCI using two-dimensional speckle-tracking echocardiography (2D-STE). Methods: Overall, we studied 55 patients who underwent successful CTO-PCI. Cardiovascular MRI and 2D-STE were performed before and 8 ± 2 months after CTO-PCI. Segmental findings of strain parameters were compared with those obtained with late gadolinium enhancement and stress-perfusion MRI. Results: With a cutoff of −10.7, pre-procedural circumferential strain (CS) showed reasonable sensitivity (71%) and specificity (73%) for detecting segments with transmural scar. The discriminatory ability of longitudinal strain (LS) for segments with transmural scar significantly improved during follow-up after successful CTO-PCI in the territory of the recanalized artery (area under the curve (AUC) 0.70 vs. 0.80, p < 0.001). LS accuracy was lower than that of CS at baseline (AUC 0.70 vs. 0.79, p = 0.048), and was increased at follow-up (AUC 0.80 vs. 0.82, p = 0.81). Changes in myocardial perfusion reserve from baseline to follow-up were significantly associated with those in LS but not in CS. Conclusions: Use of 2D-STE may allow the non-invasive evaluation of patients undergoing CTO-PCI to assess the indication before the procedure and treatment effects at follow-up.
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Bauer, Brenton S., Anthony Li, and Jason S. Bradfield. "Arrhythmogenic Inflammatory Cardiomyopathy: A Review." Arrhythmia & Electrophysiology Review 7, no. 3 (2018): 181. http://dx.doi.org/10.15420/aer.2018.26.2.
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Arrhythmogenic inflammatory cardiomyopathy is a recent clinical description of a subgroup of patients with non-ischaemic cardiomyopathy who are referred to electrophysiologists for evaluation and management of ventricular arrhythmias and are found to have evidence of active cardiac inflammation. The identification of these patients is key, since the aetiology of their arrhythmic burden is likely both related to scar-mediated and direct inflammatory mechanisms, which may have different treatment approaches. Evaluation of these patients starts with a full clinical history and physical examination along with echocardiography, as with most patients with cardiomyopathy, however, additional imaging with fluorodeoxyglucose PET-CT and cardiac MRI is crucial. Medical treatment is aimed at targeting traditional neurohumeral mediators to achieve recovery of ejection fraction, in addition to immunosuppressant medication to directly treat inflammation. While medical treatment alone is successful in many patients, some will require further invasive management with electrophysiologic study and radiofrequency catheter ablation.
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Gaibazzi, Nicola, Sergio Suma, Valentina Lorenzoni, Daniele Sartorio, Gregg Pressman, Carmine Siniscalchi, and Silvia Garibaldi. "Myocardial Scar by Pulse-Cancellation Echocardiography Is Independently Associated with Appropriate Defibrillator Intervention for Primary Prevention after Myocardial Infarction." Journal of the American Society of Echocardiography 33, no. 9 (September 2020): 1123–31. http://dx.doi.org/10.1016/j.echo.2020.04.020.
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Gürdoğan, Muhammet, Fethi Emre Ustabaşıoğlu, Osman Kula, and Selçuk Korkmaz. "Cardiac Magnetic Resonance Imaging and Transthoracic Echocardiography: Investigation of Concordance between the Two Methods for Measurement of the Cardiac Chamber." Medicina 55, no. 6 (June 9, 2019): 260. http://dx.doi.org/10.3390/medicina55060260.
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Background and objectives: Cardiac magnetic resonance (CMR) imaging is the gold standard method for the detection of ventricular volumes and myocardial edema/scar. Transthoracic echocardiography (TTE) imaging is primarily used in the evaluation of cardiac functions and chamber dimensions. This study aims to investigate whether the chamber diameter measurements are concordant with each other in the same patient group who underwent TTE and CMR. Materials and Methods: The study included 41 patients who underwent TTE and CMR imaging. Ventricular and atrial diameter measurements from TTE-derived standard parasternal long axis and apical four-chamber views and CMR-derived three- and four-chamber views were recorded. The concordance between the two methods was compared using intra-class correlation coefficients (ICC) and Bland–Altman plots. Results: Of the patients, 25 (61%) were male and the mean age was 48.12 ± 16.79. The mean ICC for LVDD between CMR observers was 0.957 (95% CI: 0.918–0.978), while the mean ICC between CMR and TTE measurements were 0.849 (95% CI: 0.709–0.922) and 0.836 (95% CI: 0.684–0.915), respectively. The mean ICC for the right ventricle between CMR observers was 0.985 (95% CI: 0.971–0.992), while the mean ICC between CMR and TTE measurements were 0.869 (95% CI: 0.755–0.930) and 0.892 (95% CI: 0.799–0.942), respectively. Passing–Bablok Regression and Bland–Altman plots indicated high concordance between the two methods. Conclusions: TTE and CMR indicated high concordance in chamber diameter measurements for which the CMR should be considered in patients for whom optimal evaluation with TTE could not be performed due to their limitations.
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Muser, Daniele, Pasquale Santangeli, Joseph B. Selvanayagam, and Gaetano Nucifora. "Role of Cardiac Magnetic Resonance Imaging in Patients with Idiopathic Ventricular Arrhythmias." Current Cardiology Reviews 15, no. 1 (December 11, 2018): 12–23. http://dx.doi.org/10.2174/1573403x14666180925095923.
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Ventricular Arrhythmias (VAs) may present with a wide spectrum of clinical manifestations ranging from mildly symptomatic frequent premature ventricular contractions to lifethreatening events such as sustained ventricular tachycardia, ventricular fibrillation and sudden cardiac death. Myocardial scar plays a central role in the genesis and maintenance of re-entrant arrhythmias which are commonly associated with Structural Heart Diseases (SHD) such as ischemic heart disease, healed myocarditis and non-ischemic cardiomyopathies. However, the arrhythmogenic substrate may remain unclear in up to 50% of the cases after a routine diagnostic workup, comprehensive of 12-lead surface ECG, transthoracic echocardiography and coronary angiography/ computed tomography. Whenever any abnormality cannot be identified, VAs are referred as to “idiopathic”. In the last decade, Cardiac Magnetic Resonance (CMR) imaging has acquired a growing role in the identification and characterization of myocardial arrhythmogenic substrate, not only being able to accurately and reproducibly quantify biventricular function, but, more importantly, providing information about the presence of myocardial structural abnormalities such as myocardial fatty replacement, myocardial oedema, and necrosis/ fibrosis, which may otherwise remain unrecognized. Moreover, CMR has recently demonstrated to be of great value in guiding interventional treatments, such as radiofrequency ablation, by reliably identifying VA sites of origin and improving long-term outcomes. In the present manuscript, we review the available data regarding the utility of CMR in the workup of apparently “idiopathic” VAs with a special focus on its prognostic relevance and its application in planning and guiding interventional treatments.
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Liu, Hailei, Mingfang Li, Chengzong Li, Zhirong Wang, Qi Lu, Zhoushan Gu, Xiangqian Qi, et al. "Nonatrial Fibrillation Patients With Complete P Wave Disappearance." Stroke 52, no. 3 (March 2021): 1074–78. http://dx.doi.org/10.1161/strokeaha.120.031666.
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Background and Purpose: Complete P wave disappearance (CPWD) in patients without atrial fibrillation is an uncommon clinical phenomenon. We aimed to study the relationship between CPWD and thromboembolism. Methods: Between July 2007 and December 2018, consecutive patients with CPWD on surface ECG and 24-hour Holter recording were recruited into the study from 4 centers in China. All recruited patients underwent transesophageal echocardiography or cardiac computed tomography to screen for atrial thrombus. Atrial electrical activity and scar were assessed by electrophysiological study (EPS) and 3-dimensional electroanatomic mapping. Cardiac structure and function were assessed by multimodality cardiac imaging. Results: Twenty-three consecutive patients (8 male; mean age 48.5±14.7 years) with CPWD were included. Only 3 patients demonstrated complete atrial electrical silence with atrial noncapture. Thirteen patients who had invasive atrial endocardial mapping demonstrated extensive scar. Pulse-wave mitral inflow Doppler demonstrated absent and dampened A waves in 18 and 5 patients, respectively. Pulse-wave tricuspid inflow Doppler showed absent and dampened A waves in 19 and 4 patients, respectively. Upon recruitment, 8 patients had previous stroke and 3 patients had atrial thrombus. Warfarin was prescribed to all patients. During median follow-up of 42.0 months, 2 patients developed massive ischemic stroke due to warfarin discontinuation. Conclusions: Our study suggested that CPWD reflects extensive atrial electrical silence and significantly impaired atrial mechanical function. It was strongly associated with thromboembolism and the clinical triad of CPWD-atrial paralysis-stroke was proposed. Anticoagulation should be recommended in such patients.
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Giollo, A., G. Vinco, G. Orsolini, G. Cioffi, G. Adami, A. Fassio, L. Idolazzi, et al. "AB1094 SCAR IMAGING ECHOCARDIOGRAPHY WITH ULTRASOUND MULTI-PULSE SCHEME [eSCAR] FOR THE DETECTION OF MYOCARDIAL FIBROSIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: PRELIMINARY RESULTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1836.2–1836. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5006.
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Background:Myocardial fibrosis is a severe complication of immune-mediated diseases, occurring in up to 30% of systemic lupus erythematosus (SLE) patients. Cardiovascular magnetic resonance imaging allows myocardial scar detection in SLE patients, but it is costly, time consuming, and unfit for patients with renal disease. Scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) is a novel and promising technique that proved to be effective in detecting ischemic myocardial scars in patients with coronary artery disease (CAD).Objectives:To evaluate if the eSCAR technique is feasible and to better characterize SLE patients with cardiac involvement by eSCAR.Methods:We recruited consecutive patients with SLE classified according to the 2019 EULAR/ACR recommendations. Patients with diabetes mellitus, obesity, prior cardiovascular (CV) disease or anti-phospholipid (aPL) syndrome were excluded. Eligible participants underwent a thorough clinical assessment and a full echocardiography examination, including the eSCAR technique. Data on clinical variables were collected; disease activity was estimated by the SLE Disease Activity Index (SLEDAI) score. Lupus flare was defined as new/worse clinical signs and symptoms and/or lab measurements and a change/increase in treatment. Patients were compared according to the presence or absence of eSCAR. In this preliminary report, only descriptive analyses are provided. Continuous data are reported as median [25th; 75thpercentile].Results:We enrolled fifteen patients diagnosed with SLE (age 45 years [36; 47], disease duration 14 years [12; 20]), 13 (87%) were females. Median SLEDAI was 5 [2; 8]. The most frequent disease involvement included arthritis (73%), skin and mucous membranes (60%), lupus nephritis (47%) and cytopenias (47%). Patients had received treatment for lupus with 5 drugs [5; 8]. Cumulative prednisone dosage was 25 g [20; 44], whilst the current daily dosage of prednisone was 4 mg [0.0; 5.0]. Hypertension was present in 4 (27%) and hypercholesterolemia in 2 (13%) subjects; 4 patients (27%) were current or past smokers. The eSCAR technique was feasible in all participants with no adverse effects. Myocardial scars were detected in 2 patients (eSCAR-positive 13%; figure and table); eSCAR positive patients were females and had no history of cardiovascular involvement (including pericarditis); they had at least one relapse within the prior 12 months before enrollment; at least one cardiovascular risk factor was found in both patients (one was a smoker and the other one had hypertension); none received prior treatment with cyclophosphamide or rituximab; they had no renal involvement; arthritis and cytopenia were the prominent features of disease; anti-dsDNA titer was higher than eSCAR-negative patients.Conclusion:Echocardiography allowed detection of myocardial scars in patients with SLE. Our preliminary data show that eSCAR is feasible and well tolerated in a SLE population. Further data from this ongoing study will help investigate whether eSCAR might improve risk stratification, by identifying myocardial involvement in SLE patients with a more active disease.eSCAR positivePatient 1eSCAR positivePatient 2eSCAR negativeSLE patients (n=13)Age, years324545SexFemaleFemale11 F / 2 MESR mm/h29715CRP mg/L30.62Anti-dsDNA (IF)PositivePositivePositive 7 (47)Anti-dsDNA (CLIA)10514934 [7; 66]C3 (mg/L)618085 [70; 94]C4 (mg/L)41310 [9; 16]P-Cr (mg/dL)0.60.80.7 [0.6; 0.7]aPLPositiveNegative7 (47)Disease duration, years152814 [12; 15]SLEDAI1205 [2; 8]Lupus flare in the past 12 monthsyesyes5 (33)Cumulative prednisone dosage (g)606124 [19, 32]Previous use of cyclophosphamideNoNo3 (20)Previous use of rituximabNoNo1 (1)Acknowledgments:This study was granted by Gruppo LES Italia OnlusDisclosure of Interests:Alessandro Giollo: None declared, Giulia Vinco: None declared, Giovanni Orsolini: None declared, Giovanni Cioffi: None declared, Giovanni Adami: None declared, Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work., Luca Idolazzi: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Flavio Luciano Ribichini: None declared, Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB, Ombretta Viapiana: None declared
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Tayal, Bhupendar, Maan Malahfji, John M. Buergler, Dipan J. Shah, and Sherif F. Nagueh. "Hemodynamic determinants of left atrial strain in patients with hypertrophic cardiomyopathy: A combined echocardiography and CMR study." PLOS ONE 16, no. 2 (February 10, 2021): e0245934. http://dx.doi.org/10.1371/journal.pone.0245934.
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Background Left atrial (LA) strain is associated with symptomatic status and atrial fibrillation in patients with hypertrophic cardiomyopathy (HCM). However, hemodynamic determinants of LA reservoir (LARS), conduit, and pump strains have not been examined and data are needed on the relation of LA strain with exercise tolerance in HCM. Methods Fifty HCM patients with echocardiographic and CMR imaging within 30 days were included. Left ventricular (LV) volumes, mass, EF, scar extent, extracellular volume fraction (ECV), and LA maximum volume were measured by CMR. Echo studies were analyzed for mitral inflow, pulmonary vein flow, mitral annulus tissue Doppler velocities, LV global longitudinal strain, and LA strain. Twenty six patients able and willing to exercise underwent cardiopulmonary stress testing for peak oxygen consumption (MVO2), and VE/VCO2 slope. Patients were followed for clinical events. Findings LARS was significantly associated with indices of LA systolic function, LV GLS, and LV filling pressures (P<0.05). Conduit strain was significantly associated with mitral annulus early diastolic velocity and ECV, whereas LA pump strain was determined by LA systolic function and indices of LV end diastolic pressure (all P<0.05). LARS and conduit strain were significantly higher in patients who achieved ≥80% of MVO2. LARS, conduit, and pump strains were significantly associated with atrial fibrillation (P<0.05). Conclusions LV structure, systolic and diastolic function, and LA systolic function determine the 3 components of LA strain. LA strain is associated with exercise tolerance and clinical events in patients with HCM.
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Kydd, Anna, Fakhar Khan, Liam McCormick, Deepa Gopalan, Munmohan Virdee, and David Dutka. "ASSESSING GLOBAL SCAR BURDEN USING ECHOCARDIOGRAPHY IN PATIENTS UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY: A COMPARISON OF 2D AND 3D SPECKLE TRACKING WITH CARDIAC MAGNETIC RESONANCE IMAGING." Journal of the American College of Cardiology 59, no. 13 (March 2012): E914. http://dx.doi.org/10.1016/s0735-1097(12)60915-2.
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Elvas, Luis B., Ana G. Almeida, Luís Rosario, Miguel Sales Dias, and João C. Ferreira. "Calcium Identification and Scoring Based on Echocardiography. An Exploratory Study on Aortic Valve Stenosis." Journal of Personalized Medicine 11, no. 7 (June 24, 2021): 598. http://dx.doi.org/10.3390/jpm11070598.
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Currently, an echocardiography expert is needed to identify calcium in the aortic valve, and a cardiac CT-Scan image is needed for calcium quantification. When performing a CT-scan, the patient is subject to radiation, and therefore the number of CT-scans that can be performed should be limited, restricting the patient’s monitoring. Computer Vision (CV) has opened new opportunities for improved efficiency when extracting knowledge from an image. Applying CV techniques on echocardiography imaging may reduce the medical workload for identifying the calcium and quantifying it, helping doctors to maintain a better tracking of their patients. In our approach, a simple technique to identify and extract the calcium pixel count from echocardiography imaging, was developed by using CV. Based on anonymized real patient echocardiographic images, this approach enables semi-automatic calcium identification. As the brightness of echocardiography images (with the highest intensity corresponding to calcium) vary depending on the acquisition settings, echocardiographic adaptive image binarization has been performed. Given that blood maintains the same intensity on echocardiographic images—being always the darker region—blood areas in the image were used to create an adaptive threshold for binarization. After binarization, the region of interest (ROI) with calcium, was interactively selected by an echocardiography expert and extracted, allowing us to compute a calcium pixel count, corresponding to the spatial amount of calcium. The results obtained from these experiments are encouraging. With this technique, from echocardiographic images collected for the same patient with different acquisition settings and different brightness, obtaining a calcium pixel count, where pixel values show an absolute pixel value margin of error of 3 (on a scale from 0 to 255), achieving a Pearson Correlation of 0.92 indicating a strong correlation with the human expert assessment of calcium area for the same images.
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Talay, Süreyya, and Nahide Belgit Talay. "F18-FDG Cardiac PET/CT: An alternative tool for myocardial viability determination prior to coronary revascularization decision in severe ventricular dysfunction." Acta Medica 51, no. 1 (March 28, 2020): 21–31. http://dx.doi.org/10.32552/0.actamedica.415.
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Purposes: The aim of the present study was to evaluate clinical value and accuracy of Fludeoxyglucose Cardiac Positron Emission Tomography Computerized Tomography (FDG C-PET/CT) as an alternative tool for myocardial viability determination prior to coronary revascularization decision in lower left ventricular ejection fraction (LVEF) patients. We accepted lower LVEF as 35% or less for the study. FDG C-PET/CT is reported to be the gold standart for myocardial viability detection among other techniques such as thallium-201 rest-redistribution scintigraphy myocardial perfusion imaging and dobutamine stress echocardiography.
Materials and Methods: Between the dates of 01.01.2010 and 10.07.2019, 191 consecutive patients (mean age 64±9.1 years) underwent CABG operations with severe LVEF dysfunction with 35% or less. These impaired LVEF patients were calculated as the 4.4% total CABG cases. Myocardial viability was also studied and elaborated by F18-FDG C-PET/CT for all cases. Elaboration was detailed as viable myocardial tissue, hibernated myocardial tissue or necrosis areas (scars, nonviable tissue) via segmentally images of the heart. Final surgical decision was primarily depended on F18-FDG C-PET/CT for the majority of cases.
Results: 191 CABG operations were performed. Perioperative deaths occured in 18 (9.4%) cases. Mortality reasons were prolonged CPB in 4 (2%) cases, severe and unmanageable ventricular arrhytmias in 5 (2.6%) cases, MOD with prolonged intubation in 6 (3.1%) cases and major neurological complication in 2 (1%) cases. Our mean coronary graft number was 3.5±0.8. LIMA was used in the majority of cases (n=176, 92.1%). LIMA was anastomosed to LAD for each case. IABP insertions were applied in 81(42.4%, 43 cases intraoperatively, 38 cases at ICU) patients. 236 patients with impaired LVEF and severe coronary artery disease were evaluated by F18-FDG C-PET/CT prior to operation. 191 cases (80.9%) were accepted as canditates for revascularization with multiple viable segments.45 cases (19.1%) presented transmural scar tissue (non-viable) images by FDG uptake analysis. This group cases were considered to be with non-beneficial results from revascularization. Thus, these patients were referred to medical treatments. Mean number of viable segments on F18-FDG C-PET/CT were calculated as 5.2±1.4 for each patient.
Conclusions: The presence of myocardial viability is crucial to define reasonable canditates for revascularization in cases with lower LVEF. Among other preoperative viability detection techniques such as dobutamin echocardiography and myocardial perfusion scintigraphies, F18 FDG cardiac PET/CT is accepted as the ‘Gold Standart’ for segmental analysis on basis of distinguishing scar tissue from viable components. We strongly advocate F18-FDG cardiac PET/CT to be a suitable and effective tool to evaluate CABG indications in severe ventricular dysfunction.
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YUDA, Satoshi, Leanne SHORT, Rodel LEANO, and Thomas H. MARWICK. "Myocardial abnormalities in hypertensive patients with normal and abnormal left ventricular filling: a study of ultrasound tissue characterization and strain." Clinical Science 103, no. 3 (August 19, 2002): 283–93. http://dx.doi.org/10.1042/cs1030283.
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Abnormal left ventricular (LV) filling is common, but not universal, in hypertensive LV hypertrophy (LVH). We sought to elucidate the relative contributions of myocardial structural changes, loading and hypertrophy to LV dysfunction in 113 patients: 85 with hypertensive LVH and 28 controls without LVH and with normal filling. Patients with normal dobutamine stress echocardiography and no history of coronary artery disease were selected, in order to exclude a contribution from ischaemia or scar. Abnormal LV filling was identified in 65 LVH patients, based on Doppler measurement of transmitral filling and annular velocities. All patients underwent grey-scale and colour tissue Doppler imaging from three apical views, which were stored and analysed off line. Integrated backscatter (IB) and strain rate imaging were used to detect changes in structure and function; average cyclic variation of IB, strain rate and peak systolic strain were calculated by averaging each segment. Calibrated IB intensity, corrected for pericardial IB intensity, was measured in the septum and posterior wall from the parasternal long-axis view. Patients with LVH differed significantly from controls with respect to all backscatter and strain parameters, irrespective of the presence or absence of abnormal LV filling. LVH patients with and without abnormal LV filling differed with regard to age, LV mass and incidence of diabetes mellitus, but also showed significant differences in cyclic variation (P<0.01), calibrated IB in the posterior wall (P<0.05) and strain rate (P<0.01), although blood pressure, heart rate and LV systolic function were similar. Multivariate logistic regression analysis demonstrated that age, LV mass index and calibrated IB in the posterior wall were independent determinants of abnormal LV filling in patients with LVH. Thus structural and functional abnormalities can be detected in hypertensive patients with LVH with and without abnormal LV filling. In addition to age and LVH, structural (not functional) abnormalities are likely to contribute to abnormal LV filling, and may be an early sign of LV damage. IB is useful for the detection of myocardial abnormalities in patients with hypertensive LVH.
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Shlevkov, N. B., A. A. Zhambeev, A. Z. Gasparyan, V. N. Shitov, and O. V. Stukalova. "Characteristic of fibrotic myocardial lesions associated with life-threatening ventricular tachyarrhythmias in patients with ischemic and non-ischemic cardiomyopathies." Terapevticheskii arkhiv 90, no. 9 (September 15, 2018): 42–47. http://dx.doi.org/10.26442/terarkh201890942-47.
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Aim. To identify the features of myocardial scar and fibrosis associated with the occurrence of malignant ventricular tachyarrhythmias (VTs) in high-risk patients with ischemic (ICMP) and non-ischemic cardiomyopathy (NICMP). Materials and methods. This prospective study included 50 patients (41 men, 9 women), age = 60 ± 13 years, 30 patients of them with ICMP and 20 patients with NICMP, who underwent echocardiography (Echo) and contrast magnetic resonance imaging (MRI) of the heart followed by implantation of cardioverter-defibrillators (ICD) or resynchronizing devices with defibrillator (CPTD) to prevent sudden cardiac death. Results. Sustained VTs were reported in 20/30 (67%) patients with ICMP and in 5/20 (25%) patients with NICMP on follow-up [26 (22-37) months]. Successive univariate and ROC-analyses of Echo and MRI-indices between patients with and without recurrence of VTs found different results for ICMP and NICMP patients groups. In ICMP patients the VTs were associated with wide transmural fibrosis on contrast MRI that covered 3 or more segments of left ventricular. These segments were preferably localized in the middle parts of the inferior and inferolateral segments of the left ventricle. The independent predictors of VTs in NICMP patients were non-transmural fibrosis at 4.5% of the left ventricular mass by contrast MRI as well as low left ventricular ejection fraction (less than 26%) by Echo. Conclusion. To determine the indications for implantation of the ICD and CRTD for primary prevention of sudden cardiac death, it is advisable to take into account not only the value of ejection fraction of left ventricular, but also the features of the fibrosis of the left ventricle by contrast MRI of the heart.
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Ahmed, Iftikhar, Asif Nadeem, Nazish Saeed, Syed Ali Shiram, Zahid Hussain, Muhammad Naeem Tariq, Javeria Kamran, Attiya Mustafa, Naseem Azad, and Syed Khurram Shahzad. "Comparison of Left Ventricular Ejection Fraction in Heart Failure Patients on Echocardiography, Cardiac Magnetic Resonance Imaging and Single Photon Emission Computed Tomography." Pakistan Armed Forces Medical Journal 72, SUPPL-3 (November 22, 2022): S461–66. http://dx.doi.org/10.51253/pafmj.v72isuppl-3.9534.
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Objective: To compare the left ventricular ejection fraction on echocardiograph, cardiac magnetic resonance imaging and single-photon emission computed tomography scan in heart failure patients.
Study Design: This was a prospective cross-sectional study.
Place and Duration of Study: Tertiary Cardiac Care Center of Rawalpindi, Pakistan, from Nov 2021 to Apr 2022.
Methodology: This was a prospective cross-sectional study conducted from November 2021 to April 2022 at a tertiary cardiac care center of Rawalpindi. Thirty (n=30) heart failure patients of either gender with reduced ejection fraction were selected by consecutive sampling technique and were analyzed to quantify their left ventricular ejection fraction (LVEF) using Echo, CMR and SPECT scan. All three modalities were used to measure LVEF in these patients and were compared accordingly.
Results: The LVEF measured by Cardiac Magnetic Resonance Imaging, Single Photon Emission Computed Tomography Scan and Echocardiography was in the range of 15% to 67%. The mean LVEF was 37.2±14.2 by CMR, 37.17±14.1 by SPECT and 38±12.3 by Echo. The mean LVEF determined by SPECT was slightly lower while that determined by Echocardiography was slightly higher. The measured p-value of LVEF by the three modalities, however, indicated statistically difference (p-value <0.05).
Conclusion: Although the literature shows diversity in results of these modalities, CMR is considered the standard reference for assessment of LVEF when interpreted by an expert observer. We in our study found that all three modalities are complimentary to each other and can be used interchangeably depending upon the availability of the equipment and reporting expertise of the observers.
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Kazakauskaite, Egle, Donatas Vajauskas, Ruta Unikaite, Ieva Jonauskiene, Agneta Virbickiene, Diana Zaliaduonyte, Tomas Lapinskas, and Renaldas Jurkevicius. "Comparative Analysis of Myocardial Viability Multimodality Imaging in Patients with Previous Myocardial Infarction and Symptomatic Heart Failure." Medicina 58, no. 3 (March 1, 2022): 368. http://dx.doi.org/10.3390/medicina58030368.
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Background and Objectives: To compare the accuracy of multimodality imaging (myocardial perfusion imaging with single-photon emission computed tomography (SPECT MPI), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), and cardiovascular magnetic resonance (CMR) in the evaluation of left ventricle (LV) myocardial viability for the patients with the myocardial infarction (MI) and symptomatic heart failure (HF). Materials and Methods: 31 consecutive patients were included in the study prospectively, with a history of previous myocardial infarction, symptomatic HF (NYHA) functional class II or above, reduced ejection fraction (EF) ≤ 40%. All patients had confirmed atherosclerotic coronary artery disease (CAD), but conflicting opinions regarding the need for percutaneous intervention due to the suspected myocardial scar tissue. All patients underwent transthoracic echocardiography (TTE), SPECT MPI, 18F-FDG PET, and CMR with late gadolinium enhancement (LGE) examinations. Quantification of myocardial viability was assessed in a 17-segment model. All segments that were described as non-viable (score 4) by CMR LGE and PET were compared. The difference of score between CMR and PET we named reversibility score. According to this reversibility score, patients were divided into two groups: Group 1, reversibility score > 10 (viable myocardium with a chance of functional recovery after revascularization); Group 2, reversibility score ≤ 10 (less viable myocardium when revascularisation remains questionable). Results: 527 segments were compared in total. A significant difference in scores 1, 2, 3 group, and score 4 group was revealed between different modalities. CMR identified “non-viable” myocardium in 28.1% of segments across all groups, significantly different than SPECT in 11.8% PET in 6.5% Group 1 (viable myocardium group) patients had significantly higher physical tolerance (6 MWT (m) 3892 ± 94.5 vs. 301.4 ± 48.2), less dilated LV (LVEDD (mm) (TTE) 53.2 ± 7.9 vs. 63.4 ± 8.9; MM (g) (TTE) 239.5 ± 85.9 vs. 276.3 ± 62.7; LVEDD (mm) (CMR) 61.7 ± 8.1 vs. 69.0 ± 6.1; LVEDDi (mm/m2) (CMR) 29.8 ± 3.7 vs. 35.2 ± 3.1), significantly better parameters of the right heart (RV diameter (mm) (TTE) 33.4 ± 6.9 vs. 38.5 ± 5.0; TAPSE (mm) (TTE) 18.7 ± 2.0 vs. 15.2 ± 2.0), better LV SENC function (LV GLS (CMR) −14.3 ± 2.1 vs. 11.4 ± 2.9; LV GCS (CMR) −17.2 ± 4.6 vs. 12.7 ± 2.6), smaller size of involved myocardium (infarct size (%) (CMR) 24.5 ± 9.6 vs. 34.8 ± 11.1). Good correlations were found with several variables (LVEDD (CMR), LV EF (CMR), LV GCS (CMR)) with a coefficient of determination (R2) of 0.72. According to the cut-off values (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26%, and LV GCS (CMR) < −15.8), we performed prediction of non-viable myocardium (reversibility score < 10) with the overall percentage of 80.6 (Nagelkerke R2 0.57). Conclusions: LGE CMR reveals a significantly higher number of scars, and the FDG PET appears to be more optimistic in the functional recovery prediction. Moreover, using exact imaging parameters (LVEDV (CMR) > 330 mL, infarct size (CMR) > 26% and LV GCS (CMR) < −15.8) may increase sensitivity and specificity of LGE CMR for evaluation of non-viable myocardium and lead to a better clinical solution (revascularization vs. medical treatment) even when viability is low in LGE CMR, and FDG PET is not performed.
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Steeds, Richard P., Craig E. Stiles, Vishal Sharma, John B. Chambers, Guy Lloyd, and William Drake. "Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology." Echo Research and Practice 6, no. 1 (March 2019): G1—G8. http://dx.doi.org/10.1530/erp-18-0069.
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This is a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology on the role of echocardiography in monitoring patients receiving dopamine agonist (DA) therapy for hyperprolactinaemia. (1) Evidence that DA pharmacotherapy causes abnormal valve morphology and dysfunction at doses used in the management of hyperprolactinaemia is extremely limited. Evidence of clinically significant valve pathology is absent, except for isolated case reports around which questions remain. (2) Attributing change in degree of valvular regurgitation, especially in mild and moderate tricuspid regurgitation, to adverse effects of DA in hyperprolactinaemia should be avoided if there are no associated pathological changes in leaflet thickness, restriction or retraction. It must be noted that even where morphological change in leaflet structure and function may be suspected, grading is semi-quantitative on echocardiography and may vary between different machines, ultrasound settings and operators. (3) Decisions regarding discontinuation of medication should only be made after review of serial imaging by an echocardiographer experienced in analysing drug-induced valvulopathy or carcinoid heart disease. (4) A standard transthoracic echocardiogram should be performed before a patient starts DA therapy for hyperprolactinaemia. Repeat transthoracic echocardiography should then be performed at 5 years after starting cabergoline in patients taking a total weekly dose less than or equal to 2 mg. If there has been no change on the 5-year scan, repeat echocardiography could continue at 5-yearly intervals. If a patient is taking more than a total weekly dose of 2 mg, then annual echocardiography is recommended.
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Oye, Monique, Aaron Richardson, Edin Sadic, Ahmad Alkhasawneh, and Gladys Velarde. "Cardiac Amyloidosis Presenting as Biventricular Systolic Heart Failure." Case Reports in Cardiology 2021 (April 1, 2021): 1–6. http://dx.doi.org/10.1155/2021/6671469.
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A previously healthy octogenarian presented with new onset heart failure symptoms. Comprehensive multimodality imaging including complete echocardiography with longitudinal strain analysis, cardiac magnetic resonance imaging (cMRI), nuclear medicine pyrophosphate (99-mcTcPYP) scan along with biomarker, monoclonal protein analysis, and fat pad biopsy confirmed diagnosis of transthyretin cardiac amyloidosis.
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Nizar, Muhammad Hanif Ahmad, Chow Khuen Chan, Azira Khalil, Ahmad Khairuddin Mohamed Yusof, and Khin Wee Lai. "Real-time Detection of Aortic Valve in Echocardiography using Convolutional Neural Networks." Current Medical Imaging Formerly Current Medical Imaging Reviews 16, no. 5 (May 28, 2020): 584–91. http://dx.doi.org/10.2174/1573405615666190114151255.
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Background: Valvular heart disease is a serious disease leading to mortality and increasing medical care cost. The aortic valve is the most common valve affected by this disease. Doctors rely on echocardiogram for diagnosing and evaluating valvular heart disease. However, the images from echocardiogram are poor in comparison to Computerized Tomography and Magnetic Resonance Imaging scan. This study proposes the development of Convolutional Neural Networks (CNN) that can function optimally during a live echocardiographic examination for detection of the aortic valve. An automated detection system in an echocardiogram will improve the accuracy of medical diagnosis and can provide further medical analysis from the resulting detection. Methods: Two detection architectures, Single Shot Multibox Detector (SSD) and Faster Regional based Convolutional Neural Network (R-CNN) with various feature extractors were trained on echocardiography images from 33 patients. Thereafter, the models were tested on 10 echocardiography videos. Results: Faster R-CNN Inception v2 had shown the highest accuracy (98.6%) followed closely by SSD Mobilenet v2. In terms of speed, SSD Mobilenet v2 resulted in a loss of 46.81% in framesper- second (fps) during real-time detection but managed to perform better than the other neural network models. Additionally, SSD Mobilenet v2 used the least amount of Graphic Processing Unit (GPU) but the Central Processing Unit (CPU) usage was relatively similar throughout all models. Conclusion: Our findings provide a foundation for implementing a convolutional detection system to echocardiography for medical purposes.
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Rost, Christian, Marie-Charlotte Rost, Ole A. Breithardt, Michael Schmid, Lutz Klinghammer, Christian Stumpf, Werner G. Daniel, and Frank A. Flachskampf. "Relation of Functional Echocardiographic Parameters to Infarct Scar Transmurality by Magnetic Resonance Imaging." Journal of the American Society of Echocardiography 27, no. 7 (July 2014): 767–74. http://dx.doi.org/10.1016/j.echo.2014.02.004.
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Kjellstad Larsen, C., E. Galli, J. Duchenne, J. M. Aalen, C. Stokke, G. Degtiarova, J. G. Fjeld, et al. "P975 Echocardiography and nuclear medicine imaging techniques are insufficient for scar detection in patients referred for cardiac resynchronization therapy." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.605.
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Abstract Funding Acknowledgements The study was supported by Center for Cardiological Innovation Background Many patients referred for cardiac resynchronization therapy (CRT) do not respond to the treatment. Scar either in septum or the left ventricular (LV) lateral wall, as well as global scar burden, influence the outcome negatively. Preoperative scar assessment is therefore recommended in this patient group. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is considered reference standard for scar detection, but is not always available. Purpose To investigate the ability of advanced echocardiographic and nuclear imaging techniques to detect septal and left ventricular (LV) lateral wall scar in patients referred for CRT, compared to late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR). Methods Scar was quantified as percentage segmental LGE in 131 patients (age 66 ± 10, 66% male, QRS-width 164 ± 17ms) referred for CRT, 92% with left bundle branch block (LBBB). Longitudinal strain was assessed by speckle tracking echocardiography in 130 patients (641 septal and 630 LV lateral wall segments). Wall motion score index (WMSI) was assessed visually in all patients by an experienced operator, and graded from one to four. Glucose metabolism was assessed by 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) in 52 patients. Perfusion was assessed in 46 patients by either 13N-ammonia PET (n = 32) or Single Photon Emission Computed Tomography (SPECT) (n = 14). Metabolism and perfusion were reported as percentages of the segment with maximum tracer uptake. The ability of each parameter to identify scar was evaluated with receiver operating characteristic (ROC) curves with calculation of area under the curve (AUC) and 95% confidence interval (CI). AUC≥0.800 was considered reasonable agreement with LGE. Results Scar was present in 574 of total 2090 interpretable segments (79% ischemic etiology). Globally, perfusion (AUC = 0.845, 95% CI 0.777-0.914) and glucose metabolism (AUC = 0.807, 95% CI 0.758-0.855) adequately detected transmural scars, but not smaller scars (all AUC < 0.800). Echocardiographic parameters failed to detect global scars irrespective of size (all AUC < 0.800). However, the associations between echocardiographic/nuclear parameters and scars were highly dependent on myocardial region. In the LV lateral wall, glucose metabolism precisely detected transmural scars (AUC = 0.958, 95% CI 0.902-1.00) and WMSI proved reasonable agreement (AUC = 0.812, 95% CI 0.737-0.887), while the rest of the parameters did not (all AUC < 0.800). Smaller scars in this region was not detected by any parameter tested (all AUC < 0.800). No parameter adequately detected septal scars, not even those with transmural involvement (all AUC < 0.800) (Figure). Conclusions Neither echocardiographic nor nuclear imaging techniques can replace LGE-CMR in scar assessment prior to CRT. Septum is especially challenging, explained by LBBB-induced reduction in strain, metabolism and perfusion in this region. Abstract P975 Figure. Detection of transmural septal scar
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Appadurai, Vinesh, and James D. Thomas. "Detecting Scar in Echocardiography: Has the Power Shifted?" Journal of the American Society of Echocardiography, September 2022. http://dx.doi.org/10.1016/j.echo.2022.09.001.
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Papachristidis, Alexandros, Konstantinos C. Theodoropoulos, Apostolia Marvaki, Sandro Queirós, Jan D’hooge, Giovanni Masoero, Gianpiero Pagnano, et al. "Power Modulation Echocardiography to Detect and Quantify Myocardial Scar." Journal of the American Society of Echocardiography, July 2022. http://dx.doi.org/10.1016/j.echo.2022.06.009.
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Duchenne, J., M. Cvijic, C. K. Larsen, E. Galli, J. M. Aalen, G. Voros, A. S. Beela, et al. "160 Echocardiographic assessment of CRT candidates. Does additional scar evaluation by MRI improve prediction of response?" European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.038.
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Abstract Background Myocardial scar presence and extent, has a considerable influence on response to cardiac resynchronization therapy (CRT). Apical rocking (ApRock) and septal flash (SF) are associated with favourable outcome after CRT. Little is known however to which extent visual assessment of mechanical dyssynchrony by ApRock, SF and scar predicts CRT response. We therefore investigated, if additional scar assessment by cardiac magnetic resonance imaging (MRI) adds to the predictive value of the visual evaluation of echocardiographic images in CRT candidates. Methods A total of 201 unselected patients referred for CRT, who fulfil the contemporary guidelines for CRT implantation, were enrolled in this prospective multicentre study. Two experienced observers visually assessed echocardiographic images before CRT implantation, focussing on the presence of ApRock, SF and location and extent of scar segments of the left ventricle (LV), resulting in a CRT response prediction (i.e. Integrative Prediction). A third observer provided a consensus reading in case of disagreement. All observers were blinded to all patient information other than the ischaemic aetiology of heart failure. Independent from that, segmental myocardial scar burden was objectified by late gadolinium enhancement (LGE) cardiac MRI (LGE > 50%). CRT response was defined as ≥15% reduction in LV end-systolic volume on echocardiography, one year after device implantation. Results Overall, 69 (34%) patients had an ischaemic aetiology of heart failure. Before CRT, ApRock and SF were present in 129 (64%) and 136 (68%) patients, respectively. ApRock and SF alone predicted CRT response with an area under the curve (AUC) of 0.85 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.77-0.91) (Figure A), while the echocardiographic Integrative Prediction had an AUC of 0.90 (95% CI: 0.84-0.95), with a sensitivity of 93% and a specificity of 87% for the prediction of CRT response (Figure B) (p < 0.05 vs. ApRock and SF alone). When combining information on ApRock, SF and the number of scarred segments on MRI in a statistical model, the AUC was comparable to the echocardiographic Integrative Prediction [0.90 (95% CI: 0.84-0.96)] as was sensitivity and specificity (91% and 83%, respectively, p = N.S. vs. Integrative Prediction) (Figure C). Conclusions An integrative visual assessment of LV function has an excellent predictive value for CRT response. Our data show, that the echocardiographic estimation of scar burden is sufficiently accurate and cannot be further improved by an additional MRI scar assessment. Abstract 160 Figure.
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Angelini, G., M. Bonanni, VL Paiocchi, LA Leo, S. Schlossbauer, E. Pasotti, G. Pedrazzini, et al. "Multimodality imaging in the evaluation of left ventricle myocardial deformation determined by edema and scar in acute myocarditis." European Heart Journal - Cardiovascular Imaging 23, Supplement_1 (February 1, 2022). http://dx.doi.org/10.1093/ehjci/jeab289.439.
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Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION acute myocarditis (aMY) is characterized by the presence of edema and myocardial scar detected by cardiovascular magnetic resonance (CMR). Aim of our study is to investigate the diagnostic value of two-dimensional (2D) speckle tracking echocardiography and Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) in detecting edema and myocardial scar in aMY. METHODS all consecutive patients with clinically suspected aMY were enrolled in our study. Inclusion criteria were: 1) new ECG abnormalities 2) myocardial cytolysis markers and 3) absence of angiographically detectable coronary artery disease. Exclusion criteria included poor cine image quality caused by respiratory motion and arrhythmia. All patients underwent transthoracic echocardiography and cardiac function was evaluated by a comprehensive assessment of LV function, including 2D speckle-tracking echocardiography (2D STE). CMR was performed in all patients in a 3T scanner. Extension of edema and myocardial scar were respectively evaluated on T2 mapping and on Late Gadolinium Enhancement sequences considering numbers of segments involved according to 17-segment model (AHA). FT analysis of the left ventricle (LV) was performed using the Tissue Tracking Module to obtain LV strain data. RESULTS 52 patients were included in the study, mean age was 36± 17 years, three patients were female (6%). Mean LVEF was 56,2 ± 7,2 % and mean end diastolic volume index (EDVi) was 62,52 ± 19,02 ml/m2. 10 patients (19,2%) had impaired EF with mean values of 44,6 ± 6,15%. aMY was confirmed in all patients with the presence of myocardial edema and subepicardial late gadolinium enhancement (LGE). Inferior segments were involved in 28 patients (53,8%), lateral segment in 19 patients (36,5%), septal segments in 7 patients (13,5%) and anterior segments in 15 patients (28,8%). 2D STE LV GLS was -16.41± 5,47% while CMR-FT LV GLS was -19,07 ± 4,65%, showing a good agreement between the two methods (r = 0,5; p < 0,001). The univariate analysis showed a significant correlation between 2D STE LV GLS and CMR-FT LV GLS with the extension of myocardial edema assessed by CMR (r= 0,43; p= 0,002 and r = 0.47; p = 0,002 respectively). The univariate analysis did not show a significant correlation between 2D STE LV and the extension of myocardial scar assessed by CMR (r= 0.2; p= 0.155) while a significant correlation was found between CMR-FT LV GLS and myocardial scar (r = 0.4; p = 0.01). CONCLUSIONS in patients with aMY, good correlation was found between CMR-FT and 2D STE in the evaluation of GLS. 2D STE LV GLS and CMR-FT LV GLS proved to have a good correlation with the extension of myocardial edema, while only CMR-FT LV GLS proved to be associated with myocardial scar extension.
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Kawamura, Iwanari, Vivek Y. Reddy, Carlos G. Santos-Gallego, Bingyan J. Wang, Hina W. Chaudhry, Eric D. Buck, George Mavroudis, et al. "Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine." Circulation: Arrhythmia and Electrophysiology, January 3, 2023. http://dx.doi.org/10.1161/circep.122.011369.
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BACKGROUND: Pulsed field ablation (PFA) has recently been shown to penetrate ischemic scar, but details on its efficacy, risk of arrhythmias, and imaging insights are lacking. In a porcine model of myocardial scar, we studied the ability of ventricular PFA to penetrate scarred tissue, induce ventricular arrhythmias, and assess the influence of QRS gating during pulse delivery. METHODS: Of a total of 6 swine, 5 underwent coronary occlusion and 1 underwent radiofrequency ablation to create infarct scar and iatrogenic scar models, respectively. Two additional swine served as healthy controls. An 8 Fr focal PFA catheter was used to deliver bipolar, biphasic PFA (2.0 kV) lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography over both scarred and healthy myocardium. Swine underwent magnetic resonance imaging 2–7 days post-PFA. RESULTS: PFA successfully penetrated scar without significant difference in lesion depth between lesion at the infarct border (5.9±1.0 mm, n=41) and healthy myocardium (5.7±1.3 mm, n=26; P =0.53). PFA penetration of both infarct and iatrogenic radiofrequency abalation scar was observed in all examined sections. Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated applications, whereas no ventricular arrhythmias occurred during gated PFA applications (0 of 64 [0%]). Dark-blood late-gadolinium–enhanced sequences allowed for improved endocardial border detection as well as lesion boundaries compared with conventional bright-blood late-gadolinium–enhanced sequences. CONCLUSIONS: PFA penetrates infarct and iatrogenic scar successfully to create deep lesions. Gated delivery eliminates the occurrence of ventricular arrhythmias observed with ungated porcine PFA. Optimized magnetic resonance imaging sequences can be helpful in detecting lesion boundaries.
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Duchenne, J., O. Mirea, G. Degtiarova, S. Unlu, AS Beela, M. Cvijic, I. Stankovic, et al. "Localizing myocardial scar on echocardiography. How good does it work in the presence of conduction delays?" European Heart Journal - Cardiovascular Imaging 22, Supplement_1 (January 1, 2021). http://dx.doi.org/10.1093/ehjci/jeaa356.043.
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Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation - Flanders (FWO) Introduction Myocardial scar detection with echocardiography in patients with ischemic heart disease typically relies on semi-quantitative evaluation of regional systolic wall thickening. In patients scheduled for cardiac resynchronization therapy (CRT) however, such echo scar estimation is complicated by the presence of dyssynchronous contraction and differential regional remodelling. Visual assessment of myocardial shortening during systole may be an alternative approach. We tested this against cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients without and with conduction delay. Methods 122 patients with ischemic heart disease were included (n = 58 without, and n = 64 with conduction delay). Scar burden of the LV was determined in all patients on a segmental level in both CMR and echo. Reading of echo was blinded for CMR data and vice versa. Myocardial scar was defined as LGE > 50% of transmural thickness. On echo, scar was assessed visually, and defined as thin, echogenic myocardium with no visible shortening during systole. Analysis was performed per segment (18 segment model), and per region (6 walls with basal and mid segment and the apex region consisting of all apical segments). An additional analysis was performed with a tolerance of one adjacent segment in order to account for potential image misalignment between modalities. Results 2196 segments were available for comparison between echo and CMR. On CMR, 548 of those segments were defined as having >50% transmural scar. In echo, 565 segments were detected as having scar. On a segmental level, no difference was found for the correct assignment of segments by echo as having scar or not between patients without or with conduction delay (AUC 0.79 vs. 0.79; p = 0.968) (Figure, top panels). See Figure for sensitivity and specificity. If one segment tolerance was allowed, segments were correctly assigned with equal accuracy in both patient groups (AUC 0.98 vs. 0.96; p = 0.999) (see Figure; w. tolerance). Agreement on the level of LV regions was comparable. 295 regions had a scar on CMR while 286 regions were identified by echo. Echo correctly identified a scar in the same LV wall or apex as compared to CMR similarly in patients without or with conduction delay (AUC 0.79 vs. 0.77; p = 0.698). If one segment tolerance was allowed, correct identification improved further and was not different between both groups (AUC 0.93 vs. 0.91; p = 0.999). The extent of a scar was slightly underestimated (9%) by echocardiography in comparison to CMR in patients without, and slightly overestimated (3%) in patients with conduction delays. Conclusions Scars can be localized on echocardiography with good agreement to CMR-LGE as gold standard. The match between echo and CMR was similar for patients with and without conduction delay. Our findings demonstrate that echo can provide a valid impression of localization and extent of myocardial scar, even in the presence of conduction delays. Abstract Figure.
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Strachinaru, Mihai, Johan G. Bosch, Arend F. L. Schinkel, Michelle Michels, Lida Feyz, Nico de Jong, Marcel L. Geleijnse, and Hendrik J. Vos. "Local myocardial stiffness variations identified by high frame rate shear wave echocardiography." Cardiovascular Ultrasound 18, no. 1 (September 29, 2020). http://dx.doi.org/10.1186/s12947-020-00222-1.
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Abstract Background Shear waves are generated by the closure of the heart valves. Significant differences in shear wave velocity have been found recently between normal myocardium and disease models of diffusely increased muscle stiffness. In this study we correlate in vivo myocardial shear wave imaging (SWI) with presence of scarred tissue, as model for local increase of stiffness. Stiffness variation is hypothesized to appear as velocity variation. Methods Ten healthy volunteers (group 1), 10 hypertrophic cardiomyopathy (HCM) patients without any cardiac intervention (group 2), and 10 HCM patients with prior septal reduction therapy (group 3) underwent high frame rate tissue Doppler echocardiography. The SW in the interventricular septum after aortic valve closure was mapped along two M-mode lines, in the inner and outer layer. Results We compared SWI to 3D echocardiography and strain imaging. In groups 1 and 2, no change in velocity was detected. In group 3, 8/10 patients showed a variation in SW velocity. All three patients having transmural scar showed a simultaneous velocity variation in both layers. Out of six patients with endocardial scar, five showed variations in the inner layer. Conclusion Local variations in stiffness, with myocardial remodeling post septal reduction therapy as model, can be detected by a local variation in the propagation velocity of naturally occurring shear waves.
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Dal Porto, M., C. Dematte", M. Maines, C. Giovanelli, G. Vinco, E. Setti, C. Cemin, et al. "Left atrial functional remodeling assessed by echocardiography in patients undergoing ablation for atrial fibrillation: correlation with the presence of fibrosis and invasive atrial pressure." European Heart Journal - Cardiovascular Imaging 23, Supplement_1 (February 1, 2022). http://dx.doi.org/10.1093/ehjci/jeab289.103.
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Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency catheter ablation of pulmonary veins has become a common procedure for treatment of atrial fibrillation (AF). Nevertheless, the procedure is characterized by an extremely variable success rate, which reflects a great heterogeneity of factors implicated in AF recurrence and AF burden. Purpose We focused on the role of left atrium (LA) in patients with paroxysmal and persistent AF who underwent catheter pulmonary veins ablation procedure. In particular we paid attention to three factors: echocardiographic evaluation of LA function, LA scar evaluated by electroanatomic mapping and LA pressures (LAP) during ablation procedure. The aim of the study was to investigate the correlation between echocardiographic parameters indicating atrial dysfunction (LA volume indexed, E/E’, LAA contraction velocity, LA stiffness and LA longitudinal strain during reservoir phase (LASr)) and intraprocedural parameters (such as LAPpeak and the amount of fibrosis). Methods The study included 25 patients; mean age was 63 ± 8 years; nineteen patients (76%) had paroxysmal AF, eighteen patients (72%) were in sinus rhythm at the time of ablation. The population was divided into two subgroups according to the amount of fibrosis evaluated by electroanatomic mapping: patients with fibrosis ≥ 5% of the total LA volume were considered as having an atrial scar. All patients underwent a comprehensive transthoracic echocardiography and a transesophageal echocardiography before the ablation procedure. Intraprocedural data regarding LAPpeak and electroanatomic mapping were collected. Measurements were acquired during both sinus rhythm (SR) and AF. Results Patients with atrial scar had similar LA volume compared to patients without scar (44 ml vs 37.4 ml, p = 0.108) , but presented a trend towards higher LAPpeak (24.3 mmHg vs 15.9 mmHg, p = 0.053) and had higher E/E’ (11 vs 7, p = 0.037) and consequently increased LA stiffness (0.72 vs 0.23, p= 0.006). Still, they had lower LASr (16.6% vs 33.2%, p = 0.013) and tended to have reduced LAA contraction velocity (0.4 m/sec vs 0.7 m/sec, p= 0.005). Conclusions The present findings suggest that functional remodeling of the LA, more than morphological changes, are correlated with the presence of atrial fibrosis and elevated atrial pressure detected during ablation procedures. These parameters may represent potential criteria to guide patients’ selection for ablation procedure and deserve dedicated studies to be confirmed. Abstract Figure.
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Doltra, A., Y. Bertolani, M. Linhart, J. Acosta, J. M. Tolosana, L. L. Mont, A. Berruezo, and M. Sitges. "P1427 Mechanical dispersion assessed with echocardiography versus scar characterization with cardiac magnetic resonance to predict malignant arrhythmia in cardiac resynchronization therapy patients." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.856.
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Abstract Background Recent data have shown that scar characterization with late gadolinium enhancement magnetic resonance (LGE-CMR) is useful to predict malignant arrhythmic events in a cardiac resynchronization therapy (CRT) population. On the other hand, echocardiography 2D strain parameters (such as mechanical dispersion – MD) have been recently suggested as a predictor of ventricular arrhythmia (VA). Purpose To compare the usefulness of strain echocardiography and MR scar parameters to predict VA and sudden cardiac death (SCD) in CRT patients (pa). Methods 110 pa undergoing CRT implant were included. A 2D strain echo and a 3D LGE-CMR were performed before the implant. In the echocardiographic exam, left ventricle ejection fraction (LVEF), global longitudinal strain (GLS), mechanical dispersion (MD) and delta contraction time were quantified. Regarding LGE-CMR, scar mass, border zone (BZ) mass and the presence of BZ channels were assessed with specific software. The primary endpoint was the presence of SCD or appropriate implantable cardioverter-defibrillator therapy at long-term follow-up (FU). Results The primary outcome occurred in 23 pa (20.9%) during a mean FU of 53.5 ± 10.4 months. In these pa, MD was significantly increased (130.3 ± 55.5ms vs. 102.0 ± 45.1ms, p < 0.05) whereas LVEF, GLS and delta contraction time were not significantly different. All LGE-CMR parameters were significantly increased in PA with events. At multivariate analysis, both MD and LGE-CMR parameters were independent predictors of malignant arrhythmia (table). The MD cut-off value for prediction of VA was 80.88 ms, with 91.3% sensitivity and 36.8% specificity. The figure shows the Kaplan-Meier curves. Regarding LGE-CMR parameters, the cut-off value, sensitivity, and specificity were 13.8g/82.6%/81.6% for scar mass, 5.54g/85.7%/81.8% for BZ mass, and 90.9%/82.1% for presence of BZ channels. Conclusions MD and LGE-CMR scar parameters are independent predictors of VA and SCD in CRT. Due to its high sensitivity, MD could be used to identify pa at high arrhythmic risk that could benefit from a more complex and specific LGE-CMR study. Multivariate analysis Model 1 Model 2 Model 3 HR (95% CI) p HR (95% CI) p HR (95% CI) p Basal LVEF 1.01 (0.94-1.09) 0.731 1 (0.93-1.07) 0.974 1.04 (0.97-1.11) 0.273 MD (ms) 1.01 (1.00-1.02) 0.043 1.01 (1.00-1.02) 0.017 1.01 (1.00-1.02) 0.003 BZ mass (g) 1.08 (1.05-1.11) <0.001 Presence of BZ channels 18.39 (4.26-79.51) <0.001 Scar mass (g) 1.06 (1.04-1.08) <0.001 LVEF: left ventricle ejection fraction; MD:mechanical dispersion; BZ:border zone Abstract P1427 Figure. Kaplan-Meier curves