Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to quantify myocardial strain on the subendocardial and epicardial layers of the left ventricle (LV) using tagged cardiovascular magnetic resonance (CMR) and to investigate the transmural degree of contractile impairment in the chronic ischemic myocardium.</p> <p>Methods</p> <p>3T tagged CMR was performed at rest in 12 patients with severe coronary artery disease who had been scheduled for coronary artery bypass grafting. Circumferential strain (C-strain) at end-systole on subendocardial and epicardial layers was measured using the short-axis tagged images of the LV and available software (Intag; Osirix). The myocardial segment was divided into stenotic and non-stenotic segments by invasive coronary angiography, and ischemic and non-ischemic segments by stress myocardial perfusion scintigraphy. The difference in C-strain between the two groups was analyzed using the Mann-Whitney U-test. The diagnostic capability of C-strain was analyzed using receiver operating characteristics analysis.</p> <p>Results</p> <p>The absolute subendocardial C-strain was significantly lower for stenotic (-7.5 ± 12.6%) than non-stenotic segment (-18.8 ± 10.2%, p < 0.0001). There was no difference in epicardial C-strain between the two groups. Use of cutoff thresholds for subendocardial C-strain differentiated stenotic segments from non-stenotic segments with a sensitivity of 77%, a specificity of 70%, and areas under the curve (AUC) of 0.76. The absolute subendocardial C-strain was significantly lower for ischemic (-6.7 ± 13.1%) than non-ischemic segments (-21.6 ± 7.0%, p < 0.0001). The absolute epicardial C-strain was also significantly lower for ischemic (-5.1 ± 7.8%) than non-ischemic segments (-9.6 ± 9.1%, p < 0.05). Use of cutoff thresholds for subendocardial C-strain differentiated ischemic segments from non-ischemic segments with sensitivities of 86%, specificities of 84%, and AUC of 0.86.</p> <p>Conclusions</p> <p>Analysis of tagged CMR can non-invasively demonstrate predominant impairment of subendocardial strain in the chronic ischemic myocardium at rest.</p

Patients with Diabetes and Significant Epicardial Coronary Artery Disease have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest

Objective The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction. Design A prospective observational study. Setting Diagnosis of epicardial CAD in patients with diabetes. Patients and Methods Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. Main Outcome Measures Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography. Results Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001). Conclusions Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest

Machine learning applications in cardiac computed tomography: a composite systematic review

Artificial intelligence and machine learning (ML) models are rapidly being applied to the analysis of cardiac computed tomography (CT). We sought to provide an overview of the contemporary advances brought about by the combination of ML and cardiac CT. Six searches were performed in Medline, Embase, and the Cochrane Library up to November 2021 for (i) CT-fractional flow reserve (CT-FFR), (ii) atrial fibrillation (AF), (iii) aortic stenosis, (iv) plaque characterization, (v) fat quantification, and (vi) coronary artery calcium score. We included 57 studies pertaining to the aforementioned topics. Non-invasive CT-FFR can accurately be estimated using ML algorithms and has the potential to reduce the requirement for invasive angiography. Coronary artery calcification and non-calcified coronary lesions can now be automatically and accurately calculated. Epicardial adipose tissue can also be automatically, accurately, and rapidly quantified. Effective ML algorithms have been developed to streamline and optimize the safety of aortic annular measurements to facilitate pre-transcatheter aortic valve replacement valve selection. Within electrophysiology, the left atrium (LA) can be segmented and resultant LA volumes have contributed to accurate predictions of post-ablation recurrence of AF. In this review, we discuss the latest studies and evolving techniques of ML and cardiac CT

preliminary clinical evaluation of the ASTRA4D algorithm

Objectives. To propose and evaluate a four-dimensional (4D) algorithm for joint motion elimination and spatiotemporal noise reduction in low-dose dynamic myocardial computed tomography perfusion (CTP). Methods. Thirty patients with suspected or confirmed coronary artery disease were prospectively included und underwent dynamic contrast-enhanced 320-row CTP. The presented deformable image registration method ASTRA4D identifies a low-dimensional linear model of contrast propagation (by principal component analysis, PCA) of the ex-ante temporally smoothed time-intensity curves (by local polynomial regression). Quantitative (standard deviation, signal-to-noise ratio (SNR), temporal variation, volumetric deformation) and qualitative (motion, contrast, contour sharpness; 1, poor; 5, excellent) measures of CTP quality were assessed for the original and motion-compensated volumes (without and with temporal filtering, PCA/ASTRA4D). Following visual myocardial perfusion deficit detection by two readers, diagnostic accuracy was evaluated using 1.5T magnetic resonance (MR) myocardial perfusion imaging as the reference standard in 15 patients. Results. Registration using ASTRA4D was successful in all 30 patients and resulted in comparison with the benchmark PCA in significantly (p<0.001) reduced noise over time (-83%, 178.5 vs 29.9) and spatially (-34%, 21.4 vs 14.1) as well as improved SNR (+47%, 3.6 vs 5.3) and subjective image quality (motion, contrast, contour sharpness: +1.0, +1.0, +0.5). ASTRA4D resulted in significantly improved per-segment sensitivity of 91% (58/64) and similar specificity of 96% (429/446) compared with PCA (52%, 33/64; 98%, 435/446; p=0.011) and the original sequence (45%, 29/64; 98%, 438/446; p=0.003) in the visual detection of perfusion deficits. Conclusions. The proposed functional approach to temporal denoising and morphologic alignment was shown to improve quality metrics and sensitivity of 4D CTP in the detection of myocardial ischemia.Zielsetzung. Die Entwicklung und Bewertung einer Methode zur simultanen Rauschreduktion und Bewegungskorrektur für niedrig dosierte dynamische CT Myokardperfusion. Methoden. Dreißig prospektiv eingeschlossene Patienten mit vermuteter oder bestätigter koronarer Herzkrankheit wurden einer dynamischen CT Myokardperfusionsuntersuchung unterzogen. Die präsentierte Registrierungsmethode ASTRA4D ermittelt ein niedrigdimensionales Modell des Kontrastmittelflusses (mittels einer Hauptkomponentenanalyse, PCA) der vorab zeitlich geglätteten Intensitätskurven (mittels lokaler polynomialer Regression). Quantitative (Standardabweichung, Signal-Rausch-Verhältnis (SNR), zeitliche Schwankung, räumliche Verformung) und qualitative (Bewegung, Kontrast, Kantenschärfe; 1, schlecht; 5, ausgezeichnet) Kennzahlen der unbearbeiteten und bewegungskorrigierten Perfusionsdatensätze (ohne und mit zeitlicher Glättung PCA/ASTRA4D) wurden ermittelt. Nach visueller Beurteilung von myokardialen Perfusionsdefiziten durch zwei Radiologen wurde die diagnostische Genauigkeit im Verhältnis zu 1.5T Magnetresonanztomographie in 15 Patienten ermittelt. Resultate. Bewegungskorrektur mit ASTRA4D war in allen 30 Patienten erfolgreich und resultierte im Vergleich mit der PCA Methode in signifikant (p<0.001) verringerter zeitlicher Schwankung (-83%, 178.5 gegenüber 29.9) und räumlichem Rauschen (-34%, 21.4 gegenüber 14.1) sowie verbesserter SNR (+47%, 3.6 gegenüber 5.3) und subjektiven Qualitätskriterien (Bewegung, Kontrast, Kantenschärfe: +1.0, +1.0, +0.5). ASTRA4D resultierte in signifikant verbesserter segmentweiser Sensitivität 91% (58/64) und ähnlicher Spezifizität 96% (429/446) verglichen mit der PCA Methode (52%, 33/64; 98%, 435/446; p=0.011) und dem unbearbeiteten Perfusionsdatensatz (45%, 29/64; 98%, 438/446; p=0.003) in der visuellen Beurteilung von myokardialen Perfusionsdefiziten. Schlussfolgerungen. Der vorgeschlagene funktionale Ansatz zur simultanen Rauschreduktion und Bewegungskorrektur verbesserte Qualitätskriterien und Sensitivität von dynamischer CT Perfusion in der visuellen Erkennung von Myokardischämie

New echocardiographic and translational tools in valvular and ischemic heart disease

The advent of new methodologies applied to echocardiography, such as tissue Doppler imaging, 2D speckle tracking for myocardial deformation, and myocardial work assessment, has provided additional tools, capable of finer and earlier diagnosis of myocardial dysfunction. In addition, the ability to evaluate endothelial function and measure platelet aggregation has allowed to identify patients at increased risk for cardiovascular events and potential target of pharmacological treatment. In this research project we explored the role of these innovative and advanced tools, like strain parameters, myocardial work indices, and percentage of platelet aggregation, in the diagnosis of physiopathological mechanism underlying valvular and ischemic heart disease. Furthermore, we evaluated the prognostic value of speckle tracking echocardiography in aortic stenosis patients, from asymptomatic status to transcatheter aortic valve implantation, and its accuracy in the prediction of coronary artery disease. Finally, we investigated how factors such as hyperglycemia, hypercholesterolemia and uremia affect endothelial and platelet function, detecting new compounds able to counteract their pathological effects. To date, most of these investigated methodologies are mainly used for research purpose; further and larger studies are needed to definitely attest their adding value, in order to include their use in the routine clinical practice

Respiratory organ motion in interventional MRI : tracking, guiding and modeling

Respiratory organ motion is one of the major challenges in interventional MRI, particularly in interventions with therapeutic ultrasound in the abdominal region. High-intensity focused ultrasound found an application in interventional MRI for noninvasive treatments of different abnormalities. In order to guide surgical and treatment interventions, organ motion imaging and modeling is commonly required before a treatment start. Accurate tracking of organ motion during various interventional MRI procedures is prerequisite for a successful outcome and safe therapy. In this thesis, an attempt has been made to develop approaches using focused ultrasound which could be used in future clinically for the treatment of abdominal organs, such as the liver and the kidney. Two distinct methods have been presented with its ex vivo and in vivo treatment results. In the first method, an MR-based pencil-beam navigator has been used to track organ motion and provide the motion information for acoustic focal point steering, while in the second approach a hybrid imaging using both ultrasound and magnetic resonance imaging was combined for advanced guiding capabilities. Organ motion modeling and four-dimensional imaging of organ motion is increasingly required before the surgical interventions. However, due to the current safety limitations and hardware restrictions, the MR acquisition of a time-resolved sequence of volumetric images is not possible with high temporal and spatial resolution. A novel multislice acquisition scheme that is based on a two-dimensional navigator, instead of a commonly used pencil-beam navigator, was devised to acquire the data slices and the corresponding navigator simultaneously using a CAIPIRINHA parallel imaging method. The acquisition duration for four-dimensional dataset sampling is reduced compared to the existing approaches, while the image contrast and quality are improved as well. Tracking respiratory organ motion is required in interventional procedures and during MR imaging of moving organs. An MR-based navigator is commonly used, however, it is usually associated with image artifacts, such as signal voids. Spectrally selective navigators can come in handy in cases where the imaging organ is surrounding with an adipose tissue, because it can provide an indirect measure of organ motion. A novel spectrally selective navigator based on a crossed-pair navigator has been developed. Experiments show the advantages of the application of this novel navigator for the volumetric imaging of the liver in vivo, where this navigator was used to gate the gradient-recalled echo sequence

Algorithms and mathematical methods for extraction of functional information from magnetic resonance images of the heart

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