An accurate and time-efficient deep learning-based system for automated segmentation and reporting of cardiac magnetic resonance-detected ischemic scar

Background and objectives: Myocardial infarction scar (MIS) assessment by cardiac magnetic resonance provides prognostic information and guides patients' clinical management. However, MIS segmentation is time-consuming and not performed routinely. This study presents a deep-learning-based computational workflow for the segmentation of left ventricular (LV) MIS, for the first time performed on state-of-the-art dark-blood late gadolinium enhancement (DB-LGE) images, and the computation of MIS transmurality and extent.Methods: DB-LGE short-axis images of consecutive patients with myocardial infarction were acquired at 1.5T in two centres between Jan 1, 2019, and June 1, 2021. Two convolutional neural network (CNN) mod-els based on the U-Net architecture were trained to sequentially segment the LV and MIS, by processing an incoming series of DB-LGE images. A 5-fold cross-validation was performed to assess the performance of the models. Model outputs were compared respectively with manual (LV endo-and epicardial border) and semi-automated (MIS, 4-Standard Deviation technique) ground truth to assess the accuracy of the segmentation. An automated post-processing and reporting tool was developed, computing MIS extent (expressed as relative infarcted mass) and transmurality.Results: The dataset included 1355 DB-LGE short-axis images from 144 patients (MIS in 942 images). High performance (> 0.85) as measured by the Intersection over Union metric was obtained for both the LV and MIS segmentations on the training sets. The performance for both LV and MIS segmentations was 0.83 on the test sets.Compared to the 4-Standard Deviation segmentation technique, our system was five times quicker ( <1 min versus 7 +/- 3 min), and required minimal user interaction. Conclusions: Our solution successfully addresses different issues related to automatic MIS segmentation, including accuracy, time-effectiveness, and the automatic generation of a clinical report.(c) 2022 Elsevier B.V. All rights reserved

Review of Journal of Cardiovascular Magnetic Resonance 2015

There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication

Shockwave for abrogation of heart failure in ischaemia-reperfusion injury

BACKGROUND: Although reperfusion of STEMI has markedly improved acute patients’ survival, more patients are living with heart failure. Theoretically, more myocardial tissue is salvageable if reperfusion injury could be alleviated, limiting the risk of developing heart failure. AIM: To assess the combination shockwave treatment with DPP4-inhibitor as a treatment adjunct for cardiac IR injury. HYPOTHESIS: Shockwave provides cardioprotection from IR injury, improves cardiac function and cell-homing, and when shockwave used in conjunction with DPP4-inhibitor, the effects are augmented. METHOD: In-vivo: Surgical IR-rat models imaged using Bruker-BioSpec-9.4T. Multi-sequence CMR similar to clinical multi-planar acquisition using: (a) FLASH-CINE, (b) INTRAGATE-CINE, (c) MESE-T2-map, (d) T2-star, and (e) IR-LGE; in experimental groups: (1) Healthy versus IR-MI [a,b,c,e]; (2) Healthy versus Healthy-SW [a,b] ; (3) Healthy-SW versus Healthy-SW-inhibitor [a]; (4) IR-MI versus IR-MI-SW versus IR-MI-SW-inhibitor [a,b,c,e]; (5) iron pretreament then shockwave [c]; and (6) shockwave BOLD [d]. Segment(Medviso) post-processing to derive EDV, ESV, SV, CO, EF, T2-maps and T2star-maps; and Image-Arena(Tomtec) to derive GLS, GCS, GRS and segmental-strains; (6)multi-colour-flow-cytometry CD45-CD90+ and CD45+CD34+ on PBMC after shockwave. In-vitro: (7) Shockwave-treated HCF, HVT, HUVEC, and cardiomyocytes qPCR-assessed for SDF1. (8) Shockwave or SDF1-spiking treatment on oxygen-deprived cardiomyocytes and assessed for viability. RESULTS: (1) Segmental-strains distinguished phenotypes of Healthy, AAR and Infarction; global-strains detected IR-MI better than EF. (2) Shockwave induced inotropy. (3) DPP4-inhibitor prolonged shockwave-inotropic effect. (4) Smaller infarction in shockwave group; reduced transmurality with DPP4-inhibitor; stronger GLS, GCS, GRS in IR-MI-SW than IR-MI; stronger GLS and GRS in IR-MI-SW-inhibitor had than IR-MI-SW while GCS was unchanged. (5) Shockwave reduced T2, signifying cell-homing. (6) Shockwave increased BOLD signifying angiogenesis. (7) SDF1 expression increased in HCF, HVT, HUVEC but not in cardiomyocytes. (8) Shockwave and SDF1-spiking improved cardiomyocytes viability. CLINICAL CONTEXT: Shockwave with DPP4-inhibitor treatment in reperfused-STEMI could limit infarct size and improve cardiac function.Open Acces

Incremental value of advanced cardiac imaging modalities for diagnosis and patient management : focus on real-time three-dimensional echocardiography and magnetic resonance imaging

Advanced cardiac imaging modalities play a crucial role in the diagnostic process and clinical management of patients with different cardiac diseases, including heart failure, valvular heart disease, myocardial infarction and atrial fibrillation. RT3DE has made an important transition from a research tool to a clinically applicable imaging technique and has been demonstrated to provide important advantages over conventional 2D echocardiography, such as a more accurate quantification of cardiac chamber size and function and the possibility of unlimited image plane orientations for better understanding of valvular heart diseases. Contrast-enhanced echocardiography should be performed in every patient with suboptimal acoustic window, especially with RT3DE. Importantly, in patients underwent primary percutaneous coronary intervention, perfusion analysis can provide an accurate estimate of myocardial infarction size, which is crucial information for the patient management, together with more sophisticated assessment of LV mechanics. Myocardial deformation imaging has witnessed an enormous development in the last years and is now considered an accurate tool for a more sensitive assessment of LV regional and global function and for a more detailed assessment of LV mechanics and dyssynchrony. CMR represents the reference imaging modality for the quantification of LV volumes and function and for the identification of myocardial scar/fibrosis. It should be therefore considered for a comprehensive evaluation of heart failure patients, including more novel and sophisticated assessments of transvalvular flow and LV dyssynchrony. Advanced cardiac imaging modalities can be applied in heart failure patients referred for CRT to explore novel physiopathological aspects, such as the effect on LV rotation mechanics, on functional mitral regurgitation and cerebral blood flow.Philips Healthcare, Meda Pharma, Boehringer Ingelheim, Roche, Servier, Biotronik, Boston Scientific Nederland BV and ServierUBL - phd migration 201

MRI methods for predicting response to cardiac resynchronization therapy

Cardiac Resynchronization Therapy (CRT) is a treatment option for heart failure patients with ventricular dyssynchrony. CRT corrects for dyssynchrony by electrically stimulating the septal and lateral walls of the left ventricle (LV), forcing synchronous con- traction and improving cardiac output. Current selection criteria for CRT rely upon the QRS duration, measured from a surface electrocardiogram, as a marker of electrical dyssynchrony. Unfortunately, 30-40% of patients undergoing CRT fail to benefit from the treatment. A multitude of studies have shown that presence of mechanical dyssynchrony in the LV is an important factor in determining if a patient will benefit from CRT. Furthermore, recent evidence suggests that patient response can be improved by placing the LV pacing lead in the most dyssynchronous or latest contracting segment. The overall goal of this project was to develop methods that allow for accurate assessment and display of regional mechanical dyssynchrony throughout the LV and at the site of the LV pacing lead. To accomplish this goal, we developed a method for quantifying regional dyssynchrony from standard short-axis cine magnetic resonance (MR) images. To assess the effects of LV lead placement, we developed a registration method that allows us to project the LV lead location from dual-plane fluoroscopy onto MR measurements of cardiac function. By applying these techniques in patients undergoing CRT, we were able to investigate the relationship between regional dyssynchrony, LV pacing lead location, and CRT response.Ph.D