Purpose: To compare four-dimensional flow MRI with automated valve tracking to manual valve tracking in patients with acquired or congenital heart disease and healthy volunteers.Materials and... Show morePurpose: To compare four-dimensional flow MRI with automated valve tracking to manual valve tracking in patients with acquired or congenital heart disease and healthy volunteers.Materials and Methods: In this retrospective study, data were collected from 114 patients and 46 volunteers who underwent four-dimensional flow MRI at 1.5 T or 3.0 T from 2006 through 2017. Among the 114 patients, 33 had acquired and 81 had congenital heart disease (median age, 17 years; interquartile range [IQR], 13-49 years), 51 (45%) were women, and 63 (55%) were men. Among the 46 volunteers (median age, 28 years; IQR, 22-36 years), there were 19 (41%) women and 27 (59%) men. Two orthogonal cine views of each valve were used for valve tracking. Wilcoxon signed-rank test was used to compare analysis times, net forward volumes (NFVs), and regurgitant fractions. Intra-and interobserver variability was tested by using intraclass correlation coefficients (ICCs).Results: Analysis time was shorter for automated versus manual tracking (all patients, 14 minutes [IQR, 12-15 minutes] vs 25 minutes [IQR, 20-25 minutes]; P<.001). Although overall differences in NFV and regurgitant fraction were comparable between both methods, NFV variation over four valves was smaller for automated versus manual tracking (all patients, 4.9% [IQR, 3.3%-6.7%] vs 9.8% [IQR, 5.1%-14.7%], respectively; P<.001). Regurgitation severity was discordant for seven pulmonary valves, 22 mitral valves, and 21 tricuspid valves. Intra-and interobserver agreement for automated tracking was excellent for NFV assessment (intra-and interobserver, ICC >= 0.99) and strong to excellent for regurgitant fraction assessment (intraobserver, ICC >= 0.94; interobserver, ICC >= 0.89).Conclusion: Automated valve tracking reduces analysis time and improves reliability of valvular flow quantification with four-dimensional flow MRI in patients with acquired or congenital heart disease and in healthy volunteers. (c) RSNA, 2018 Show less
Diabetes mellitus type 1 (DM1) is associated with aortic stiffening and left ventricular (LV) diastolic dysfunction, however the relationship between aortic stiffness and LV diastolic dysfunction... Show moreDiabetes mellitus type 1 (DM1) is associated with aortic stiffening and left ventricular (LV) diastolic dysfunction, however the relationship between aortic stiffness and LV diastolic dysfunction in DM1 patients is still largely unknown. The purpose of this study was to evaluate whether an increased aortic stiffness, expressed by increased aortic pulse wave velocity (PWV), is associated with subclinical LV diastolic dysfunction and decreased left atrial (LA) compliance as assessed with speckle tracking strain analysis in patients with DM1. Aortic PWV was assessed with cardiovascular magnetic resonance in 41 DM1 patients. Patients underwent echocardiography for assessment of conventional LV diastolic function indices and LV and LA longitudinal strain and strain rate (SR) assessed with speckle tracking strain analysis. LV SR during the isovolumic relaxation period (SRIVR) and LA strain were recorded and the E-wave velocity to SRIVR velocity ratio (E/SRIVR) was calculated. Independent samples t test and multivariate linear regression analyses were used for statistical analyses. Aortic PWV significantly correlated with SRIVR (β = -0.71, p < 0.001), E/SRIVR (β = 0.61, p = 0.002) and LA strain (β = -0.47, p = 0.014), but not with conventional echocardiographic markers of diastolic function (all p > 0.10). In DM1 patients, aortic stiffness is inversely associated with sensitive markers of LV diastolic function and decrease in LA compliance as measured with echocardiographic speckle tracking strain analysis. Show less
BACKGROUND Diabetic patients have increased interstitial myocardial fibrosis on histological examination. Magnetic resonance imaging (MRI) T(1) mapping is a previously validated imaging technique... Show moreBACKGROUND Diabetic patients have increased interstitial myocardial fibrosis on histological examination. Magnetic resonance imaging (MRI) T(1) mapping is a previously validated imaging technique that can quantify the burden of global and regional interstitial fibrosis. However, the association between MRI T(1) mapping and subtle left ventricular (LV) dysfunction in diabetic patients is unknown. METHODS AND RESULTS Fifty diabetic patients with normal LV ejection fraction (EF) and no underlying coronary artery disease or regional macroscopic scar on MRI delayed enhancement were prospectively recruited. Diabetic patients were compared with 19 healthy controls who were frequency matched in age, sex and body mass index. There were no significant differences in mean LV end-diastolic volume index, end-systolic volume index and LVEF between diabetic patients and healthy controls. Diabetic patients had significantly shorter global contrast-enhanced myocardial T(1) time (425±72 ms vs. 504±34 ms, P<0.001). There was no correlation between global contrast-enhanced myocardial T(1) time and LVEF (r=0.14, P=0.32) in the diabetic patients. However, there was good correlation between global contrast-enhanced myocardial T(1) time and global longitudinal strain (r=-0.73, P<0.001). Global contrast-enhanced myocardial T(1) time was the strongest independent determinant of global longitudinal strain on multivariate analysis (standardized β=-0.626, P<0.001). Similarly, there was good correlation between global contrast-enhanced myocardial T(1) time and septal E' (r=0.54, P<0.001). Global contrast-enhanced myocardial T(1) time was also the strongest independent determinant of septal E' (standardized β=0.432, P<0.001). CONCLUSIONS A shorter global contrast-enhanced myocardial T(1) time was associated with more impaired longitudinal myocardial systolic and diastolic function in diabetic patients. Show less
Chen, W.J.Y.; Greulich, S.; Rijzewijk, L.J.; Jonker, J.T.; Meer, R.W. van der; Lamb, H.J.; ... ; Diamant, M. 2011
Purpose: To correlate an automated regional wall motion abnormality (RWMA) detection method based on combined rest and dobutamine-stress cardiac MRI with the assessment of myocardial infarction... Show morePurpose: To correlate an automated regional wall motion abnormality (RWMA) detection method based on combined rest and dobutamine-stress cardiac MRI with the assessment of myocardial infarction from contrast-enhanced MRI (CE-MRI), and to demonstrate that adding stress data improves the detection of scar segments compared with rest data alone. Materials and Methods: An automated RWMA detection method was built based on a statistical model of normokinetic myocardium from 41 healthy volunteers. The method was adapted to detect changes in RWMA from rest to stress. Twelve patients with myocardial infarction were included in the experiment. The correlation with CE-MRI was performed on two measurements: infarct transmurality and scar detection. Results: Compared with infarct transmurality, the probability of normokinetic motion decreased progressively as Infarct transmurality increased. These probability values were 0.59 for non-scar segments, for <25% transmurality was 0.4 (SE = 0.04), for 25-50% was 0.33 (SE = 0.03), for 50-75% was 0.21 (SE = 0.03) and for >= 75% was 0.10 (SE = 0.03). For scar tissue detection, adding stress data significantly improved the performance (P < 0.001, confidence interval = 99.9%). The sensitivity, specificity, and accuracy increased by 34%, 30%, and 32%, respectively. The area under the receiver operating characteristics curve was 0.63 when rest-only data was used, but it was improved to 0.87 when stress data was added. Conclusion: The presented automated RWMA assessment was capable of detecting wall motion improvements from rest to stress. The method correlated well with infarct transmurality from CE-MRI. Detection of scar regions was more accurate when rest and stress data were combined compared with rest data alone. Show less
Background: Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor receptor superfamily, is linked to cardiovascular disease. Negative associations exist between circulating OPG and... Show moreBackground: Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor receptor superfamily, is linked to cardiovascular disease. Negative associations exist between circulating OPG and cardiac function. The adipocytokine adiponectin (ADPN) is downregulated in type 2 diabetes mellitus (T2DM) and coronary artery disease and shows an inverse correlation with insulin sensitivity and cardiovascular disease risk. We assessed the relationship of plasma OPG and ADPN and arterial function, cardiac function and myocardial glucose metabolism in T2DM. Methods: We included 78 asymptomatic men with uncomplicated, well-controlled T2DM, without inducible ischemia, assessed by dobutamine-stress echocardiography, and 14 age-matched controls. Cardiac function was measured by magnetic resonance imaging, myocardial glucose metabolism (MMRglu) by 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography. OPG and ADPN levels were measured in plasma. Results: T2DM patients vs. controls showed lower aortic distensibility, left ventricular (LV) volumes, impaired LV diastolic function and MMRglu (all P < 0.05). In T2DM men vs. controls, OPG levels were higher (P = 0.02), whereas ADPN concentrations were decreased (P = 0.04). OPG correlated inversely with aortic distensibility, LV volumes and E/A ratio (diastolic function), and positively with LV mass/volume ratio (all P < 0.05). Regression analyses showed the associations with aortic distensibility and LV mass/volume ratio to be independent of age-, blood pressure-and glycated hemoglobin (HbA1c). However, the associations with LV volumes and E/A ratio were dependent of these parameters. ADPN correlated positively with MMRglu (P < 0.05), which, in multiple regression analysis, was dependent of whole-body insulin sensitivity, HbA1c and waist. Conclusions: OPG was inversely associated with aortic distensibility, LV volumes and LV diastolic function, while ADPN was positively associated with MMRglu. These findings indicate that in asymptomatic men with uncomplicated T2DM, OPG and ADPN may be markers of underlying mechanisms linking the diabetic state to cardiac abnormalities. Show less
Background-The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with chronic... Show moreBackground-The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with chronic myocardial ischemia. Methods and Results-In a total of 50 patients, diastolic function was evaluated before and 3 months after bone marrow cell injection using standard echocardiography and strain analysis. In addition, MRI-derived transmitral flow measurements were obtained in a subset of 36 patients. Left ventricular ejection fraction increased from 50 +/- 5% to 54 +/- 7% in the bone marrow cell group, which was a significant improvement as compared with the placebo group (52 +/- 5% versus 51 +/- 7%, P=0.001). Filling pressure estimate E/E' ratio improved from 14 +/- 5 at baseline to 12 +/- 4 at 3 months in the bone marrow cell group, whereas no improvement was observed in the placebo group (13 +/- 4 versus 13 +/- 5). The improvement in E/E' ratio was significantly larger in the bone marrow cell group (P=0.008). Furthermore, the E/A peak flow ratio as assessed by MRI showed a significant increase in the bone marrow cell group as compared with the placebo group (+0.16 +/- 0.25 versus -0.04 +/- 0.21, P=0.01), which was mainly related to an increase in the early (E) peak flow rate in the bone marrow cell group (from 407 +/- 96 mL/s to 468 +/- 110 mL/s, P=0.009 as compared with the placebo group). Conclusions-The current study demonstrates that intramyocardial bone marrow cell injection is associated with a beneficial effect on myocardial relaxation and filling pressures in patients with chronic myocardial ischemia. Show less
OBJECTIVES This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography... Show moreOBJECTIVES This study aimed to demonstrate the feasibility of multidetector row computed tomography (CT) for assessment of diastolic function in comparison with 2-dimensional (2D) echocardiography using tissue Doppler imaging (TDI). BACKGROUND Diastolic left ventricular (LV) function plays an important role in patients with cardiovascular disease. 2D echocardiography using TDI has been used most commonly to evaluate diastolic LV function. Although the role of cardiac CT imaging for evaluation of coronary atherosclerosis has been explored extensively, its feasibility to evaluate diastolic function has not been studied. METHODS Patients who had undergone 64-multidetector row CT and 2D echocardiography with TDI were enrolled. Diastolic function was evaluated using early (E) and late (A) transmitral peak velocity (cm/s) and peak mitral septal tissue velocity (Ea; cm/s). Peak transmitral velocity (cm/s) was calculated by dividing peak diastolic transmitral flow (ml/s) by the corresponding mitral valve area (cm(2)). Mitral septal tissue velocity was calculated from changes in LV length per cardiac phase. Subsequently, the estimation of LV filling pressures (E/Ea) was determined. RESULTS Seventy patients (46 men; mean age 55 +/- 11 years) who had undergone cardiac CT and 2D echocardiography with TDI were included. Good correlations were observed between cardiac CT and 2D echocardiography for assessment of E (r = 0.73; p < 0.01), E/A (r = 0.87; p < 0.01), Ea (r = 0.82; p < 0.01), and E/Ea (r = 0.81; p < 0.01). Moreover, a good diagnostic accuracy (79%) was found for detection of diastolic dysfunction using cardiac CT. Finally, the study showed a low intraobserver and interobserver variability for assessment of diastolic function on cardiac CT. CONCLUSIONS Cardiac CT imaging showed good correlations for transmitral velocity, mitral septal tissue velocity, and estimation of LV filling pressures when compared with 2D echocardiography. Additionally, cardiac CT and 2D echocardiography were comparable for assessment of diastolic dysfunction. Accordingly, cardiac CT may provide information on diastolic dysfunction. (J Am Coll Cardiol Img 2011;4:246-56) (C) 2011 by the American College of Cardiology Foundation Show less
Diabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension Its underlying etiology is likely to be... Show moreDiabetic heart disease is currently defined as left ventricular dysfunction that occurs independently of coronary artery disease and hypertension Its underlying etiology is likely to be multifactorial, acting synergistically together to cause myocardial dysfunction Multimodality cardiac imaging, such as echocardiography, nuclear, computed tomography, and magnetic resonance imaging, can provide invaluable insight into different aspects of the disease process, from imaging at the cellular level for altered myocardial metabolism to microvascular and endothelial dysfunction, autonomic neuropathy, coronary atherosclerosis, and finally, interstitial fibrosis with scar formation Furthermore, cardiac imaging is pivotal in diagnosing diabetic heart disease Thus, the aim of the present review is to illustrate the role of multimodality cardiac imaging in elucidating the underlying pathophysiologic mechanisms of diabetic heart disease (Curr Probl Cardiol 2011,36 9-47) Show less
BACKGROUND: -The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with... Show moreBACKGROUND: -The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with chronic myocardial ischemia. METHODS AND RESULTS: -In a total of 50 patients, diastolic function was evaluated before and 3 months after bone marrow cell injection using standard echocardiography and strain analysis. In addition, magnetic resonance imaging-derived transmitral flow measurements were obtained in a subset of 36 patients. Left ventricular ejection fraction increased from 50±5% to 54±7% in the bone marrow cell group, which was a significant improvement as compared to the placebo group (52±5% vs. 51±7%, P=0.001). Filling pressure estimate E/E' ratio improved from 14±5 at baseline to 12±4 at 3 months in the bone marrow cell group, whereas no improvement was observed in the placebo group (13±4 vs. 13±5). The improvement in E/E' ratio was significantly larger in the bone marrow cell group (P=0.008). Furthermore, the E/A peak flow ratio as assessed by MRI showed a significant increase in the bone marrow cell group as compared to the placebo group (+0.16±0.25 vs. -0.04±0.21, P=0.01), which was mainly related to an increase in the early (E) peak flow rate in the bone marrow cell group (from 407±96 mL/sec to 468±110 mL/sec, P=0.009 as compared to placebo group). CONCLUSIONS: -The current study demonstrates that intramyocardial bone marrow cell injection is associated with a beneficial effect on myocardial relaxation and filling pressures in patients with chronic myocardial ischemia. Clinical Trial Registration-URL: http://www.trialregister.nl. Unique identifier: NTR400/ISRCTN58194927. Show less
