Effects of steady state free precession parameters on cardiac mass, function, and volumes

G0400444/Medical Research Council/United Kingdom Wellcome Trust/United Kingdo

Quantitative planar and volumetric cardiac measurements using 64 mdct and 3t mri vs. Standard 2d and m-mode echocardiography: does anesthetic protocol matter?

Cross‐sectional imaging of the heart utilizing computed tomography and magnetic resonance imaging (MRI) has been shown to be superior for the evaluation of cardiac morphology and systolic function in humans compared to echocardiography. The purpose of this prospective study was to test the effects of two different anesthetic protocols on cardiac measurements in 10 healthy beagle dogs using 64‐multidetector row computed tomographic angiography (64‐MDCTA), 3T magnetic resonance (MRI) and standard awake echocardiography. Both anesthetic protocols used propofol for induction and isoflourane for anesthetic maintenance. In addition, protocol A used midazolam/fentanyl and protocol B used dexmedetomedine as premedication and constant rate infusion during the procedure. Significant elevations in systolic and mean blood pressure were present when using protocol B. There was overall good agreement between the variables of cardiac size and systolic function generated from the MDCTA and MRI exams and no significant difference was found when comparing the variables acquired using either anesthetic protocol within each modality. Systolic function variables generated using 64‐MDCTA and 3T MRI were only able to predict the left ventricular end diastolic volume as measured during awake echocardiogram when using protocol B and 64‐MDCTA. For all other systolic function variables, prediction of awake echocardiographic results was not possible (P = 1). Planar variables acquired using MDCTA or MRI did not allow prediction of the corresponding measurements generated using echocardiography in the awake patients (P = 1). Future studies are needed to validate this approach in a more varied population and clinically affected dogs

Magnetic resonance imaging and its applicability in veterinary cardiology

Magnetic Resonance Imaging (MRI) is a technique whereby images are created by the manipulation of hydrogen atoms in magnetic fields; it is based on the principle of nuclear magnetic resonance (MR), which is non-invasive and non-ionising (Constantine, Shan, Flamm, & Sivananthan, 2004). Cardiac Magnetic Resonance Imaging (CMRI) uses the same principle: application of magnetic-field gradients that are adjusted to highlight desired tissue characteristics, producing a variety of sequences that allow detection of cardiac tissue and blood, and consequently anatomical and/or physiological abnormalities (Jeudy & White, 2008; Constantine et al., 2004). Basic pulse sequences used in CMRI are spin-echo and gradient-echo sequences, or their faster hybrids dark- or black-blood and bright-blood respectively (Constantine et al., 2004). CMRI is rapidly developing and is now an important diagnostic tool in human clinical cardiology (Gilbert, McConnell, Holden, Sivananthan, & Dukes-McEwan, 2010). In veterinary medicine the use of CMRI is still sporadic; its limitations in this field include the need for general anaesthesia, the cost and availability of the equipment, the steep learning curve to obtain and analyse the images, and the time needed to manually trace endocardial borders if semi-automated analysis is not available (MacDonald, Kittleson, Garcia-Nolen, Larson, & Wisner, 2006). CMRI was considered to be the reference method in many veterinary studies (Eskofier, Wefstaedt, Beyerbach, Nolte, & Hungerbuhler, 2015; Fattal et al., 2015; Sargent et al., 2015). Still, not many studies have been published or made available in this field. It is therefore essential to fully ascertain the clinical applications, advantages and limitations of CMRI in veterinary medicine. The aim of this review is to identify the potential applications of CMRI from a clinical point of view and compare it with echocardiography, which is still the gold standard in veterinary cardiology. We describe the principles and technique of MRI in small animal cardiology, and the diseases in which CMRI could be an important tool for diagnosis and prognosis

Robust Cardiac Motion Estimation using Ultrafast Ultrasound Data: A Low-Rank-Topology-Preserving Approach

Cardiac motion estimation is an important diagnostic tool to detect heart diseases and it has been explored with modalities such as MRI and conventional ultrasound (US) sequences. US cardiac motion estimation still presents challenges because of the complex motion patterns and the presence of noise. In this work, we propose a novel approach to estimate the cardiac motion using ultrafast ultrasound data. -- Our solution is based on a variational formulation characterized by the L2-regularized class. The displacement is represented by a lattice of b-splines and we ensure robustness by applying a maximum likelihood type estimator. While this is an important part of our solution, the main highlight of this paper is to combine a low-rank data representation with topology preservation. Low-rank data representation (achieved by finding the k-dominant singular values of a Casorati Matrix arranged from the data sequence) speeds up the global solution and achieves noise reduction. On the other hand, topology preservation (achieved by monitoring the Jacobian determinant) allows to radically rule out distortions while carefully controlling the size of allowed expansions and contractions. Our variational approach is carried out on a realistic dataset as well as on a simulated one. We demonstrate how our proposed variational solution deals with complex deformations through careful numerical experiments. While maintaining the accuracy of the solution, the low-rank preprocessing is shown to speed up the convergence of the variational problem. Beyond cardiac motion estimation, our approach is promising for the analysis of other organs that experience motion.Comment: 15 pages, 10 figures, Physics in Medicine and Biology, 201

Retrospective study of the association between neutering status and changes secondary to degenerative mitral valve disease

Dissertação de Mestrado Integrado em Medicina VeterináriaMyxomatous mitral valve disease is the most common cardiovascular disease reported in dogs. Although many patients may remain asymptomatic, some of them progress to left-sided congestive heart failure and develop clinical signs. Little has yet been published regarding the possible influence of the neutering status on changes secondary to myxomatous mitral valve disease. This study aims to assess a possible correlation between neutering status and myxomatous mitral valve disease. A retrospective study was conducted and included all the cases diagnosed with myxomatous mitral valve disease, consulted at the Cardiology service of the University of Liverpool. To help assess the association between neutering status and cardiac remodelling, dogs were categorized into four groups: FE (female entire), FN (female neutered), ME (male entire) and MN (male neutered). Retrospective review of echocardiographic data, signalment, and underlying diseases were performed. Echocardiographic measurements were made through offline analysis. Echocardiographic measurements were then compared between groups. Five hundred and eighty-two dogs (n = 582) were included: female entire (n = 24), female neutered (n = 235), male entire (n = 115) and male neutered (n = 208). Left ventricular internal diameter at end diastole (LVIDd), left atrial dimension to the aortic root diameter (LA:Ao) and left atrium maximal dimension to the aortic root dimension (LAmax:Ao) were significantly different between ME and MN, with ME dogs presenting higher mean values for LVIDd and higher median LA:Ao and LAmax:Ao measurements. Left ventricular internal diameter at end systole (LVIDs) was not significantly different between ME and MN. There were no significant differences between FE and FN groups. This study shows that neutering status may influence the development of myxomatous mitral valve disease in male dogs and that entire male dogs could be at higher risk of developing cardiac remodelling secondary to myxomatous mitral valve disease. On the other hand, neutering status doesn’t seem to have an influence on disease progression in female dogs.RESUMO - Estudo retrospetivo da associação entre a esterilização e alterações secundárias à doença mixomatosa da válvula mitral - A doença mixomatosa da válvula mitral é a doença cardiovascular mais prevalente em cães. Apesar da maior parte dos pacientes permanecerem assintomáticos, alguns podem progredir para insuficiência cardíaca esquerda e desenvolver sinais clínicos. Até hoje, existem poucas publicações sobre o possível efeito que a esterilização possa ter no desenvolvimento da doença mixomatosa da válvula mitral. O objetivo deste estudo é avaliar se existe de facto uma relação entre a esterilização e a doença mixomatosa da válvula mitral. Foi realizado um estudo retrospetivo que incluiu todos os casos diagnosticados com doença mixomatosa da válvula mitral consultados no serviço de Cardiologia da Universidade de Liverpool. Para avaliar a relação entre a esterilização e a presença de remodelação cardíaca, os cães foram categorizados em quatro grupos: FE (fêmeas inteiras), FN (fêmeas esterilizadas), ME (machos inteiros) e MN (machos castrados). A história pregressa e os dados ecocardiográficos dos animais foram revistos retrospetivamente e as medidas ecocardiográficas foram obtidas por medição offline. Estas medições foram depois comparadas entre os diferentes grupos. Quinhentos e oitenta e dois cães (n = 582) foram incluídos: fêmeas inteiras (n = 24), fêmeas esterilizadas (n = 235), machos inteiros (n = 115) e machos castrados (n = 208). Nos resultados obtidos, o diâmetro interno do ventrículo esquerdo no final da diástole (LVIDd), o rácio átrio esquerdo-aorta (LA:Ao) e o rácio diâmetro máximo do átrio esquerdo-aorta (LAmax:Ao) foram estatisticamente significativos entre machos inteiros e machos castrados. Os machos inteiros apresentaram não só um LVIDd médio superior, como também uma mediana de LA:Ao e LAmax:Ao superior aos machos castrados. Ao mesmo tempo, o diâmetro interno do ventrículo esquerdo no final da sístole (LVIDs) não mostrou ser estatisticamente significativo entre machos inteiros e machos castrados e nenhum dos parâmetros ecocardiográficos anteriormente referidos revelou ser estatisticamente significativo entre fêmeas inteiras e fêmeas esterilizadas. Este estudo demonstra que a esterilização poderá influenciar o desenvolvimento da doença mixomatosa da válvula mitral e que os cães machos inteiros poderão apresentar um maior risco de desenvolver remodelação cardíaca secundária a esta doença. No entanto, a esterilização não aparenta influenciar a progressão desta doença em cadelas.N/

Heart valve disease: investigation by cardiovascular magnetic resonance

Cardiovascular magnetic resonance (CMR) has become a valuable investigative tool in many areas of cardiac medicine. Its value in heart valve disease is less well appreciated however, particularly as echocardiography is a powerful and widely available technique in valve disease. This review highlights the added value that CMR can bring in valve disease, complementing echocardiography in many areas, but it has also become the first-line investigation in some, such as pulmonary valve disease and assessing the right ventricle. CMR has many advantages, including the ability to image in any plane, which allows full visualisation of valves and their inflow/outflow tracts, direct measurement of valve area (particularly for stenotic valves), and characterisation of the associated great vessel anatomy (e.g. the aortic root and arch in aortic valve disease). A particular strength is the ability to quantify flow, which allows accurate measurement of regurgitation, cardiac shunt volumes/ratios and differential flow volumes (e.g. left and right pulmonary arteries). Quantification of ventricular volumes and mass is vital for determining the impact of valve disease on the heart, and CMR is the 'Gold standard' for this. Limitations of the technique include partial volume effects due to image slice thickness, and a low ability to identify small, highly mobile objects (such as vegetations) due to the need to acquire images over several cardiac cycles. The review examines the advantages and disadvantages of each imaging aspect in detail, and considers how CMR can be used optimally for each valve lesion

Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of fallot and healthy controls

Background: Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature racking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. Methods: Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steadystate- free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). Results: Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P<0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO2-slope. Conclusions: Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its interobserver reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. ‘Global strain’ calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study

Elusive left ventricular thrombus: Diagnostic role of cardiac magnetic resonance imaging-A case report and review of the literature

Identification of left ventricular mural thrombus (LVT) may be challenging depending on the imaging modality used. We present a case of LVT which was incidentally identified on cine cardiac magnetic resonance imaging (CMR). A sixty-four years old female presented with worsening dyspnea on exertion with troponin elevation. Transthoracic echocardiography (TTE) revealed a dilated left ventricle (LV) and ejection fraction (EF 30%) with thinning and akinesis of inferior/inferolateral wall was noted with basal and mid inferior wall aneurysm, and thrombus was not identified. CMR done to ascertain viability of myocardium revealed a mural thrombus within basal inferior aneurysm. This was not visualized on transthoracic echocardiography with and without use of contrast. She underwent coronary artery bypass grafting, bioprosthetic mitral valve replacement, resection and plication of posterior left ventricular aneurysm with removal of mural thrombus, and was started on anticoagulation with warfarin post-operatively for the apical thrombi. Cardiac magnetic resonance is a well suited imaging modality in detecting LVT due to its high resolution images and is more reproducible than TTE. In our patient, conventional TTE despite administration of echo-contrast agents failed to diagnose the presence of LVT in the basal inferior aneurysm as well as the apical thrombi. Delayed-enhancement CMR provides the greatest sensitivity for detection of left ventricular thrombus, superior to standard transthoracic and contrast-enhanced transthoracic echocardiography