Left ventricular strain-volume loops and myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy

Background: The left ventricular strain–volume loop (SVL) combines changes in global longitudinal strain (GLS) and LV volume across a cardiac cycle, providing insight into cardiac dynamics. This study explored the association between left ventricular SVL and presence of fibrosis, assessed with late gadolinium enhancement, in patients with Duchenne muscular dystrophy (DMD). Methods and results: 34 pediatric patients with DMD were included. Feature tracking analysis was used to assess endocardial GLS and volumetric measurements to construct the SVL. Mean age at the time of assessment was 14 ± 3 and 11 ± 2 years old (p < 0.01) in the group with (n = 18) versus without fibrosis (n = 16), respectively. Left ventricular ejection fraction was not significantly different between groups (fibrosis: 56.4 ± 3.8% versus without fibrosis: 54.0 ± 6.3%, p = 0.18). After adjusting for age, the late diastolic slope of the SVL was significantly associated with presence of fibrosis (OR 0.39 [95% CI 0.18–0.85]; area under the receiver operating characteristic curve: 0.83 [95% CI 0.70–0.97]) No significant association was observed for peak strain and fibrosis (OR 1.15 [95% CI 0.86–1.546]). Conclusion: A lower late diastolic slope of the left ventricular SVL, related to the interplay between longitudinal deformation and volume changes late in diastole, is associated with presence of myocardial fibrosis in pediatric patients with DMD

Left ventricular deformation and myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy

Background: Left ventricular (LV) strain and rotation are emerging functional markers for early detection of LV dysfunction and have been associated with the burden of myocardial fibrosis in several disease states. This study examined the association between LV deformation (i.e., LV strain and rotation) and extent and location of LV myocardial fibrosis in pediatric patients with Duchenne muscular dystrophy (DMD). Methods and results: 34 pediatric patients with DMD underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) to assess LV myocardial fibrosis. Offline CMR feature-tracking analysis was used to assess global and segmental longitudinal and circumferential LV strain, and LV rotation. Patients with fibrosis (n = 18, 52.9%) were older than those without fibrosis (14 ± 3 years (yrs) vs 11 ± 2 yrs., p = 0.01). There was no significant difference in LV ejection fraction (LVEF) between subjects with and without fibrosis (54 ± 6% vs 56 ± 4%, p = 0.18). However, lower endocardial global circumferential strain (GCS), but not LV rotation, was associated with presence of fibrosis (adjusted Odds Ratio 1.25 [95% CI 1.01–1.56], p = 0.04). Both GCS and global longitudinal strain correlated with the extent of fibrosis (r =.52, p = 0.03 and r =.75, p < 0.01, respectively). Importantly, segmental strain did not seem to correspond to location of fibrosis. Conclusion: A lower global, but not segmental, strain is associated with presence and extent of LV myocardial fibrosis in pediatric DMD patients. Therefore, strain parameters might detect structural myocardial alterations, however currently more research is needed to evaluate its value (e.g., prognostic) in clinical practice

Review: Hydraulic head measurements - New technologies, classic pitfalls

The hydraulic head is one of the most important metrics in hydrogeology as it underlies the interpretation of groundwater flow, the quantification of aquifer properties and the calibration of flow models. Heads are determined based on water-level measurements in wells and piezometers. Despite the importance of hydraulic head data, standard textbooks used in groundwater curricula provide relatively little discussion of the appropriate measurement procedures. This paper presents a review of the literature dealing with the determination of hydraulic heads, and aims to provide quantitative guidance on the likely sources of error and when these can be expected to become important. The most common measurement procedures are discussed and the main sources of error are identified, i.e. those related to (1) the measurement instruments, (2) the conversion from pressure to heads, (3) time lag effects, and (4) observation well defects. It is argued that heads should be determined following welldefined guidelines, and that it should become standard practice in hydrogeology to provide quantitative estimates of the measurement error.Water ManagementCivil Engineering and Geoscience