Validation and clinical application of myocardial strain by echocardiography and cardiac magnetic resonance

Understanding and describing the functional complexity of the heart has prompted the development of imaging modalities aiming for a more in-depth characterization of left ventricular mechanics by non-invasively evaluating the myocardial deformation, i.e. strain. Over the years, deformation imaging techniques have become extremely popular and have been applied to numerous research questions. In the contemporary framework of evolving tissue tracking technology, the present thesis contributes to the current state-of-the-art by addressing part of the gaps in evidence of validation and clinical application of deformation imaging modalities. Accordingly, this research work was focused on validating a widely used deformation imaging modality, 2D and 3D speckle tracking echocardiography and on investigating the clinical value of a new and promising tissue tracking modality, feature tracking cardiac magnetic resonance. This research work is therefore lining up to the efforts of standardization of strain measurement proposed by the imaging societies and contributes to the advancement in the field of clinical implementation.(MED - Sciences médicales) -- UCL, 201

Cardiac myxoma: a contemporary multimodality imaging review.

Cardiac myxoma (CM) is by far the most common primary benign cardiac tumor, typically arising in the left atrium with an attachment point in the fossa ovalis region. Although the etiology of CM remains unclear, we know that this endocardial-based mass originates from undifferentiated mesenchymal cells. Continuous technical improvements in the field of echocardiography since the 1960s has profoundly changed the diagnostic approach by allowing a good tumor detection as well as the preoperative planning by providing crucial information concerning the attachment point location. However, echocardiography has its limitations among which lack of tissue characterization and restricted field of view can arise diagnosis difficulties in atypical presentations. With the widespread and routine use of echocardiography and chest computed tomography (CT), incidental detection of CM is not infrequent. As a consequence, it has become mandatory for cardiologists and radiologists evolving in a multimodality imaging world to be familiar with the wide range of presentations of this tumor. The authors present here a review of the common and less common aspects of CM using the main imaging modalities available: echocardiography, cardiovascular magnetic resonance imaging, CT, positron emission tomography and coronary angiography

Cardiac myxoma: a contemporary multimodality imaging review

Cardiac myxoma (CM) is by far the most common primary benign cardiac tumor, typically arising in the left atrium with an attachment point in the fossa ovalis region. Although the etiology of CM remains unclear, we know that this endocardial-based mass originates from undifferentiated mesenchymal cells. Continuous technical improvements in the field of echocardiography since the 1960s has profoundly changed the diagnostic approach by allowing a good tumor detection as well as the preoperative planning by providing crucial information concerning the attachment point location. However, echocardiography has its limitations among which lack of tissue characterization and restricted field of view can arise diagnosis difficulties in atypical presentations. With the widespread and routine use of echocardiography and chest computed tomography (CT), incidental detection of CM is not infrequent. As a consequence, it has become mandatory for cardiologists and radiologists evolving in a multimodality imaging world to be familiar with the wide range of presentations of this tumor. The authors present here a review of the common and less common aspects of CM using the main imaging modalities available: echocardiography, cardiovascular magnetic resonance imaging, CT, positron emission tomography and coronary angiography.status: publishe

How to improve tissue Doppler imaging sensitivity to detect the Pickelhaube sign

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Physiopathologie et prise en charge des insuffisances valvulaires aortiques et mitrales combinées

The combination of aortic and mitral regurgitation is a typical example of a frequent yet understudied multiple valve disease scenario. The aetiology is often rheumatic or degenerative; less frequently it can be induced by drugs or radiation, or caused by infective endocarditis or congenital valvular lesions. Aortic regurgitation resulting in secondary mitral regurgitation is also not uncommon. There are limited data to guide the management of combined aortic and mitral regurgitation. Left ventricular dysfunction is frequent at initial presentation, and even more so postoperatively, suggesting that surgical management should not be delayed, particularly when symptoms occur or when there is evidence of even subtle left ventricular dysfunction. The decision to operate on one or both valves not only depends on the severity of each lesion, but also on several other factors, including age, co-morbidities and frailty, the increased operative risk of double valve surgery, the increased risk of long-term thrombotic and bleeding complications with multiple mechanical valves, the risk of leaving one valve unoperated and the probability of requiring redo surgery. The role of a multidisciplinary heart valve team is critical in this setting to optimize management and outcomes. The role of transcatheter approaches is currently limited, but technological advances will probably soon change the management paradigm.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Right ventricular longitudinal fractional shortening: a substitute to right ventricular free wall longitudinal strain?

Purpose: Because of its diagnostic and prognostic value, right ventricular strain assessed by speckle-tracking imaging (RVS) has been incorporated into echocardiographic guidelines. However, it suffers from limitations including the need of good image quality and of dedicated software with inter-vendor variability. We hypothesized that RV free wall longitudinal fractional shortening (LFS) could be used as a substitute to RVS, without suffering from the aforementioned limitations. Methods: We aimed to establish in a series of non-selected consecutive patients in sinus rhythm the value of LFS, calculated as [-(TAPSE/RVdiastolic length)] and of several common echocardiographic and Doppler parameters to predict an abnormal RV function, defined as RVS > − 20.2%. Results: Among 144 consecutive patients, poor image quality precluded the assessment of RVS and of LFS in 31 and 4 patients, respectively (P = 0.0018), resulting in a final study group of 113 patients. The intraclass correlation coefficients for inter- and intra-observer variability were 0.97 (95% CI 0.92; 0.98) and 0.93 (CI 0.92; 0.98) for LFS and RVS, respectively. Among all tested RV function indices, LFS best correlated with RVS (R 0.97, 95% CI 0.81; 0.91). Bland–Altman analysis for the comparison between LFS and RVS showed no systematic bias. The area under the ROC-curve of the various RV function indices to detect abnormal RVS was best for LFS (0.97, 95% CI 0.94–1), with sensitivity, specificity, negative and positive predictive value of 83%, 96%, 96%, and 83%, respectively. Conclusion: LFS performs reasonably well to predict abnormal RVS and is more often feasible than RVS.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A multimodal spatiotemporal cardiac motion atlas from MR and ultrasound data

Cardiac motion atlases provide a space of reference in which the motions of a cohort of subjects can be directly compared. Motion atlases can be used to learn descriptors that are linked to different pathologies and which can subsequently be used for diagnosis. To date, all such atlases have been formed and applied using data from the same modality. In this work we propose a framework to build a multimodal cardiac motion atlas from 3D magnetic resonance (MR) and 3D ultrasound (US) data. Such an atlas will benefit from the complementary motion features derived from the two modalities, and furthermore, it could be applied in clinics to detect cardiovascular disease using US data alone. The processing pipeline for the formation of the multimodal motion atlas initially involves spatial and temporal normalisation of subjects' cardiac geometry and motion. This step was accomplished following a similar pipeline to that proposed for single modality atlas formation. The main novelty of this paper lies in the use of a multi-view algorithm to simultaneously reduce the dimensionality of both the MR and US derived motion data in order to find a common space between both modalities to model their variability. Three different dimensionality reduction algorithms were investigated: principal component analysis, canonical correlation analysis and partial least squares regression (PLS). A leave-one-out cross validation on a multimodal data set of 50 volunteers was employed to quantify the accuracy of the three algorithms. Results show that PLS resulted in the lowest errors, with a reconstruction error of less than 2.3 mm for MR-derived motion data, and less than 2.5  mm for US-derived motion data. In addition, 1000 subjects from the UK Biobank database were used to build a large scale monomodal data set for a systematic validation of the proposed algorithms. Our results demonstrate the feasibility of using US data alone to analyse cardiac function based on a multimodal motion atlas

Transcatheter edge-to-edge mitral valve repair as a bridge to optimal guideline-directed medical therapy

SCOPUS: ar.jinfo:eu-repo/semantics/publishe