Purpose: We hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes... Show morePurpose: We hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes mellitus. Background: Increased body weight and diabetes mellitus are both individually associated with a higher incidence of heart failure with preserved ejection fraction. However, it is unclear how increased myocardial steatosis and interstitial fibrosis interact to influence myocardial composition and function. Methods: A total of 100 subjects (27 healthy lean volunteers, 21 healthy but overweight volunteers, and 52 asymptomatic overweight patients with diabetes) were prospectively recruited to measure left ventricular (LV) myocardial steatosis (LV-myoFat) and interstitial fibrosis (by extracellular volume [ECV]) using magnetic resonance imaging, and then used to determine their combined impact on LV global longitudinal strain (GLS) analysis by 2-dimensional (2D) speckle tracking echocardiography on the same day. Results: On multivariable analysis, both increased body mass index and diabetes were independently associated with increased LV-myoFat. In turn, increased LV-myoFat was independently associated with increased LV ECV. Both increased LV-myoFat and LV ECV were independently associated with impaired 2D LV GLS. Conclusion: Patients with increased body weight and patients with diabetes display excessive myocardial steatosis, which is related to a greater burden of myocardial interstitial fibrosis. LV myocardial contractile function was determined by both the extent of myocardial steatosis and interstitial fibrosis, and was independent of increasing age. Further study is warranted to determine how weight loss and improved diabetes management can improve myocardial composition and function. Show less
Simon, J.; Mahdiui, M. el; Smit, J.M.; Szaraz, L.; Rosendael, A.R. van; Herczeg, S.; ... ; Merkely, B. 2021
Introduction There are no consistently confirmed predictors of atrial fibrillation (AF) recurrence after catheter ablation. Therefore, we aimed to study whether left atrial appendage volume (LAAV)... Show moreIntroduction There are no consistently confirmed predictors of atrial fibrillation (AF) recurrence after catheter ablation. Therefore, we aimed to study whether left atrial appendage volume (LAAV) and function influence the long-term recurrence of AF after catheter ablation, depending on AF type. Methods AF patients who underwent point-by-point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis. LAAV and LAA orifice area were measured by CT. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence. Results In total, 561 AF patients (61.9 +/- 10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 (9.3-43.1) months. Patients with persistent AF had significantly higher body surface area-indexed LAV, LAAV, and LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment left ventricular ejection fraction (LVEF) <50% (HR = 2.17; 95% CI = 1.38-3.43; p < .001) and LAAV (HR = 1.06; 95% CI = 1.01-1.12; p = .029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF. Conclusion The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF. Show less
Background: There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains... Show moreBackground: There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined.Objective: To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies.Methods: Thirty-five patients with MR were recruited (primary MR = 12, secondary MR = 10 and MVR = 13). Patients underwent CMR, including cines and four-dimensional flow (4D flow). Four methods were evaluated: MRStandard (left ventricular stroke volume-aortic forward flow by phase contrast), MRLVRV (left ventricular stroke volume - right ventricular stroke volume), MRJet (direct jet quantification by 4D flow) and MRMVAV (mitral forward flow by 4D flow - aortic forward flow by 4D flow). For all cases and MR types, 520 MR volumes were recorded by these 4 methods for intra-/inter-observer tests.Results: In primary MR, MRMVAV and MRLVRV were comparable to MRStandard (P > 0.05). MRJet resulted in significantly higher MR volumes when compared to MRStandard (P < 0.05) In secondary MR and MVR cases, all methods were comparable. In intra-observer tests, MRMVAV demonstrated least bias with best limits of agreement (bias = -0.1 ml,-8 ml to 7.8 ml, P = 0.9) and best concordance correlation coefficient (CCC = 0.96, P < 0.01). In inter-observer tests, for primary MR and MVR, least bias and highest CCC were observed for MRMVAV. For secondary MR, bias was lowest for MRJet (-0.1 ml, P=NS).Conclusion: CMR methods of MR quantification demonstrate agreement in secondary MR and MVR. In primary MR, this was not observed. Across all types of MR, MRMVAV quantification demonstrated the highest reproducibility and consistency. (C) 2021 The Author(s). Published by Elsevier B.V. Show less
Mahdiui, M. el; Simon, J.; Smit, J.M.; Kuneman, J.H.; Rosendael, A.R. van; Steyerberg, E.W.; ... ; Maurovich-Horvat, P. 2021
BACKGROUND: Atrial fibrillation (AF) recurrence following catheter ablation remains high. Recent studies have shown a relation between epicardial adipose tissue and AF. epicardial adipose tissue... Show moreBACKGROUND: Atrial fibrillation (AF) recurrence following catheter ablation remains high. Recent studies have shown a relation between epicardial adipose tissue and AF. epicardial adipose tissue secretes several proinflammatory and anti-inflammatory adipokines that directly interact with the adjacent myocardium. The aim of the current study was to evaluate whether posterior left atrial (LA) adipose tissue attenuation, as marker of inflammation, is related to AF recurrences after catheter ablation.METHODS: Consecutive patients with symptomatic AF referred for first AF catheter ablation who underwent computed tomography were included. The total epicardial adipose tissue and posterior LA adipose tissue were manually traced and adipose tissue was automatically recognized as tissue with Hounsfield units (HU) between -195 and -45. The attenuation value of the posterior LA adipose tissue was assessed, and the population was divided according to the mean HU value (-96.4 HU).RESULTS: In total, 460 patients (66% male, age 61 +/- 10 years) were included in the analysis. After a median follow-up of 18 months (interquartile range, 6-32), 168 (37%) patients had AF recurrence. Patients with higher attenuation (>=-96.4 HU) of the posterior LA adipose tissue showed higher AF recurrence rates compared with patients with lower attenuation (P=0.046). Univariate analysis showed an association between AF recurrence and higher posterior LA adipose tissue attenuation (>=-96.4 HU; P<0.05). On multivariable analysis, posterior LA adipose tissue attenuation (hazard ratio, 1.26 [95% CI, 0.90-1.76]; P=0.181) remained a promising predictor of AF recurrence following catheter ablation.CONCLUSIONS: Posterior LA adipose tissue attenuation is a promising predictor of AF recurrence in patients who undergo catheter ablation. Higher adipose tissue attenuation might signal increased local inflammation and serve as an imaging biomarker of increased risk of AF recurrence.GRAPHIC ABSTRACT: A is available for this article. Show less
Ng, A.C.T.; Strudwick, M.; Geest, R.J. van der; Ng, A.C.C.; Gillinder, L.; Goo, S.Y.; ... ; Bax, J.J. 2018
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
Taxis, C.F.B.V.H. van; Wijnmaalen, A.P.; Geest, R.J. van der; Schuijf, J.D.; Bax, J.J.; Schalij, M.J.; Zeppenfeld, K. 2011
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
Brandts, A.; Bertini, M.; Dijk, E.J. van; Delgado, V.; Marsan, N.A.; Geest, R.J. van der; ... ; Westenberg, J.J.M. 2011
Purpose: To compare parameters describing left ventricular (LV) diastolic function obtained with three-dimensional (3D) three-directional velocity-encoded (VE) MRI with retrospective valve tracking... Show morePurpose: To compare parameters describing left ventricular (LV) diastolic function obtained with three-dimensional (3D) three-directional velocity-encoded (VE) MRI with retrospective valve tracking and two-dimensional (2D) one-directional VE MRI in patients with ischemic heart failure. Second, to compare classification of LV diastolic function, and in particular for discriminating restrictive filling patterns, with both MRI techniques versus Doppler echocardiography. Materials and Methods: The 3D and 2D VE ME! early (E) and atrial (A) peak flow rate indices, determined from transmitral waveform analyses, were compared. Also, net forward flow volume per cycle and transmitral regurgitation fraction were determined. Agreement in classifying diastolic filling patterns between 3D and 2D VE MRI versus Doppler echocardiography was evaluated using kappa statistics. Results: The 3D three-directional VE MRI with retrospective valve tracking was statistically significantly different from 2D one-directional VE MRI for net forward flow volume and regurgitation fraction through the mitral valve and all parameters describing the diastolic waveform filling pattern, except for the E deceleration time and E/A filling ratio. Kappa-agreement between 3D three-directional VE MRI with retrospective valve tracking and echocardiography for classifying diastolic filling patterns was superior to 2D one-directional VE MRI and echocardiography (i.e., kappa = 0.91 versus kappa = 0.79, respectively). Conclusion: The 3D three-directional VE MRI with retrospective valve tracking better describes LV diastolic function as compared to 2D one-directional VE MRI in patients with ischemic heart failure. Show less
Background. Surgical ventricular reconstruction has been proposed as a treatment option in heart failure patients with left ventricular (LV) aneurysm. The feasibility of this procedure has some... Show moreBackground. Surgical ventricular reconstruction has been proposed as a treatment option in heart failure patients with left ventricular (LV) aneurysm. The feasibility of this procedure has some limitations, and extensive preoperative evaluation is necessary to give the correct indication. For this purpose, magnetic resonance imaging (MRI) is currently considered the gold standard, providing accurate quantification of LV shape, size, and global and regional function together with the assessment of myocardial scar and mitral regurgitation severity. The aim of this study was to evaluate the accuracy of real-time three-dimensional echocardiography (RT3DE) as a potential alternative to MRI for this evaluation. Methods. A total of 52 patients with ischemic cardiomyopathy and LV aneurysm underwent a comprehensive analysis with two-dimensional echocardiography, RT3DE, and MRI. Results. Excellent correlation (r = 0.97, p < 0.001) and agreement were found between RT3DE and MRI for quantification of LV volumes, ejection fraction, and sphericity index; in a segment-to-segment comparison, RT3DE was shown to be accurate also for the analysis of wall motion abnormalities (k = 0.62) and LV regional thickness (k = 0.56) as a marker of myocardial scar. In contrast, two-dimensional echocardiography significantly underestimated these variables. Furthermore, mitral regurgitant volume assessed by RT3DE showed excellent correlation (r = 0.93) with regurgitant volume measured by MRI, without significant bias (= -0.7 mL/beat). Conclusions. In the management of heart failure patients with LV aneurysm, RT3DE provides an accurate and comprehensive assessment, including quantification of LV size, shape, global systolic function, regional wall motion, and myocardial scar together with precise evaluation of the severity of mitral regurgitation. (Ann Thorac Surg 2011;91:113-22) (C) 2011 by The Society of Thoracic Surgeons Show less
Wijnmaalen, A.P.; Geest, R.J. van der; Taxis, C.F.B.V. van; Siebelink, H.M.J.; Kroft, L.J.M.; Bax, J.J.; ... ; Zeppenfeld, K. 2011
Aims Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging ... Show moreAims Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. Methods and results Fifteen patients without implantable cardiac defibrillator (14 males, 64 +/- 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 +/- 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. Conclusion Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients. Show less
Wijnmaalen, A.P.; Geest, R.J. van der; Taxis, C.F.B.V. van; Siebelink, H.M.J.; Kroft, L.J.M.; Bax, J.J.; ... ; Zeppenfeld, K. 2011
AIMS Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging ... Show moreAIMS Substrate-based ablation of ventricular tachycardia (VT) relies on electroanatomical voltage mapping (EAVM). Integration of scar information from contrast-enhanced magnetic resonance imaging (CE-MRI) with EAVM may provide supplementary information. This study assessed the relation between electrogram voltages and CE-MRI scar characteristics using real-time integration and reversed registration. METHODS AND RESULTS Fifteen patients without implantable cardiac defibrillator (14 males, 64 ± 9 years) referred for VT ablation after myocardial infarction underwent CE-MRI. Contours of the CE-MRI were used to create three-dimensional surface meshes of the left ventricle (LV), aortic root, and left main stem (LM). Real-time integration of CE-MRI-derived scar meshes with EAVM of the LV and aortic root was performed using the LM and the CARTO surface registration algorithm. Merging of CE-MRI meshes with EAVM was successful with a registration error of 3.8 ± 0.6 mm. After the procedure, voltage amplitudes of each mapping point were superimposed on the corresponding CE-MRI location using the reversed registration matrix. Infarcts on CE-MRI were categorized by transmurality and signal intensity. Local bipolar and unipolar voltages decreased with increasing scar transmurality and were influenced by scar heterogeneity. Ventricular tachycardia reentry circuit isthmus sites were correlated to CE-MRI scar location. In three patients, VT isthmus sites were located in scar areas not identified by EAVM. CONCLUSION Integration of MRI-derived scar maps with EAVM during VT ablation is feasible and accurate. Contrast-enhanced magnetic resonance imaging identifies non-transmural scars and infarct grey zones not detected by EAVM according to the currently used voltage criteria and may provide important supplementary substrate information in selected patients. Show less
Westenberg, J.J.M.; Roos, A. de; Grotenhuis, H.B.; Steendijk, P.; Hendriksen, D.; Boogaard, P.J. van den; ... ; Reiber, J.H.C. 2010
Purpose: To evaluate the accuracy and reproducibility of aortic pulse wave velocity (PWV) assessment by in-plane velocity-encoded magnetic resonance imaging (MRI). Materials and Methods: In 14... Show morePurpose: To evaluate the accuracy and reproducibility of aortic pulse wave velocity (PWV) assessment by in-plane velocity-encoded magnetic resonance imaging (MRI). Materials and Methods: In 14 patients selected for cardiac catheterization on suspicion of coronary artery disease and 15 healthy volunteers, PWV was assessed with multislice two-directional in-plane velocity-encoded MRI (PWVi.p.) and compared with conventionally assessed PWV from multisite one-directional through-plane velocity-encoded MRI (PWVt.p.). In patients, PWV was also obtained from intraarterially acquired pressure-time curves (PWVpressure), which is considered the gold standard reference method. In volunteers, PWVi.p. and PWVt.p. were obtained in duplicate in the same examination to test reproducibility. Results: In patients, PWVi.p. showed stronger correlation and similar variation with PWVpressure than PWVt.p.). (Pearson correlation r = 0.75 vs. r = 0.58, and coefficient of variation [COV] = 10% vs. COV = 12%, respectively). In volunteers, repeated PWVi.p. assessment showed stronger correlation and less variation than repeated PWVt.p. (proximal aorta: r = 0.97 and COV = 10% vs. r = 0.69 and COV = 17%; distal aorta: r = 0.94 and COV = 12% vs. r = 0.90 and COV = 16%; total aorta: r = 0.97 and COV = 7% vs. r = 0.90 and COV = 13%). Conclusion: PWVi.p. is an improvement over conventional PWVt.p. by showing higher agreement as compared to the gold standard (PWVpressure) and higher reproducibility for repeated MRI assessment. Show less
