Circulation Cardiovascular Imaging

Publisher: American Heart Association, Lippincott, Williams & Wilkins


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    Circulation / Cardiovascular imaging., Cardiovascular imaging
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Lippincott, Williams & Wilkins

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Publications in this journal

  • [show abstract] [hide abstract]
    ABSTRACT: -The aim of this study is to explore the differential impact of three-dimensional color Doppler echocardiography (3D-CDE) for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography (2D-CDE) based MR quantification has well-documented limitations. -We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-CDE in 211 patients (95.5%). The quantitative differences between the MR volumes obtained by 2D- and 3D-PISA were analyzed in various MR subgroups. In the validation cohort (N=52), MR volume obtained by 3D-PISA showed a better agreement with phase contrast cardiac magnetic resonance (PC-CMR) imaging than 2D-PISA (r= 0.97 vs. 0.84). In all 211 patients, 2D-PISA underestimated the MR volume compared to 3D-PISA (52.4 ± 19.6 vs. 59.5 ± 25.6 mL, p=0.005). 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having non-severe MR. In the subgroup analysis, the MR severity (OR: 6.96, 95%CI 3.04-15.94, p<0.001) and having an asymmetric orifice (OR: 11.48, 95%CI 3.72-35.4, p<0.001) and an eccentric jet (OR: 3.82, 95%CI, 1.27-11.48, p=0.017)were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods. -Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetric orifice. This paper demonstrates that 3D-CDE could be used as a valuable tool to confirm treatment strategy in patients with significant MR.
    Circulation Cardiovascular Imaging 04/2014;
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    ABSTRACT: -Little is known about the clinical value of stress imaging studies in asymptomatic patients post percutaneous coronary intervention (PCI). -Residents of Olmsted County, MN, who underwent PCI were followed for the occurrence of stress imaging (stress nuclear or stress echocardiography), coronary angiography, or coronary artery bypass grafting (CABG) (without angiography) as initial procedures after PCI. Patients whose first follow-up procedure was a stress imaging test were evaluated for their symptom status at the time of the study and whether they underwent angiography or revascularization (PCI or CABG) within 90 days. Of 1848 patients who underwent PCI during the study period, 710 (38%) had stress imaging as their initial procedure after PCI, and 241 (13% of the entire cohort) were asymptomatic at the time of testing. The majority (86%) of these 241 patients underwent PCI for acute myocardial infarction or unstable angina. Within 90 days of stress imaging, 16 of the 241 asymptomatic patients underwent angiography and two patients were revascularized. Stratified by timing after PCI, none of 138 asymptomatic patients tested within two years of PCI underwent revascularization. Two of 103 asymptomatic patients tested after two years from PCI underwent revascularization. Compared to patients who were asymptomatic at the time of stress imaging, patients who did not undergo any follow-up procedures (stress imaging, angiography, or CABG) after the index PCI were older, more likely to have co-morbidities, and had significantly greater all-cause mortality (p<0.001). -In a population-based sample of patients undergoing PCI primarily for acute coronary syndromes, 1 in 8 had subsequent stress imaging when they were asymptomatic. These stress imaging tests resulted in further revascularization in less than 1% of patients. The very low rate of downstream revascularization suggests that stress imaging in asymptomatic patients post PCI has low value.
    Circulation Cardiovascular Imaging 03/2014;
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    ABSTRACT: -LGE CMR is a powerful method for characterizing MI, but the requisite gadolinium infusion is estimated to be contraindicated in nearly 20% of MI patients due to end-stage chronic kidney disease. The purpose of this study is to investigate whether T1 Cardiovascular-Magnetic-Resonance Imaging (CMR) obtained without contrast agents at 3T could be an alternative to Late-Gadolinium-Enhanced (LGE) CMR for characterizing chronic myocardial infarctions (MIs) using a canine model of MI. -Canines (n=29) underwent CMR at 7 days (acute, AMI) and 4 months (chronic, CMI) post-MI. Infarct location, size and transmurality measured using native T1 maps and LGE images at 1.5T and 3T were compared. Resolution of edema between AMI and CMI was examined with T2 maps. T1 maps overestimated infarct size and transmurality relative to LGE images in AMI (p=0.016 and p=0.007, respectively), which was not observed in CMI (p=0.49 and p=0.81, respectively), at 3T. T1 maps underestimated infarct size and transmurality relative to LGE images in AMI and CMI (p<0.001), at 1.5T. Relative to the remote territories, T1 of the infarcted myocardium was increased in CMI and AMI (p<0.05); and T2 of the infarcted myocardium was increased in AMI (p<0.001), but not in CMI (p >0.20) at both field strengths. Histology showed extensive replacement fibrosis within the CMI territories. CMI detection sensitivity and specificity of T1 CMR at 3T were 95% and 97%, respectively. -Native T1 maps at 3T can determine the location, size and transmurality of CMI with high diagnostic accuracy. Patient studies are necessary for clinical translation.
    Circulation Cardiovascular Imaging 03/2014;
  • [show abstract] [hide abstract]
    ABSTRACT: -Real-time vascular imaging that provides both anatomic and hemodynamic information could greatly facilitate the diagnosis of vascular diseases and provide accurate assessment of therapeutic effects. Here we have developed a novel fluorescence-based all-optical method, named near-infrared II (NIR-II) fluorescence imaging, to image murine hindlimb vasculature and blood flow in an experimental model of peripheral arterial disease, by exploiting fluorescence in the NIR-II region (1000-1400 nm) of photon wavelengths. -Owing to the reduced photon scattering of NIR-II fluorescence compared to traditional NIR fluorescence imaging and thus much deeper penetration depth into the body, we demonstrated that the mouse hindlimb vasculature could be imaged with higher spatial resolution than in vivo microCT. Furthermore, imaging over 26 days revealed a significant increase in hindlimb microvascular density in response to experimentally induced ischemia within the first 8 days of the surgery (P < 0.005), which was confirmed by histological analysis of microvascular density. Moreover, the tissue perfusion in the ischemic hindlimb could be quantitatively measured by the dynamic NIR-II method, revealing the temporal kinetics of blood flow recovery that resembled microbead-based blood flowmetry and laser Doppler blood spectroscopy. -The penetration depth of millimeters, high spatial resolution and fast acquisition rate of NIR-II imaging makes it a useful imaging tool for murine models of vascular disease.
    Circulation Cardiovascular Imaging 03/2014;
  • [show abstract] [hide abstract]
    ABSTRACT: -Angina, in the absence of obstructive CAD is more common in women, is associated with adverse cardiovascular morbidity and mortality, and is a major burden to the healthcare system. While advancements have been made to understand the mechanistic underpinning of this disease, the functional consequence remains unclear. -Cardiac magnetic resonance imaging was performed to assess left ventricular (LV) function in 20 women with signs and symptoms of ischemia, but no obstructive CAD (cases), and 15 age and body mass index-matched reference controls. Functional imaging included standard cinematic imaging to assess LV morphology and global function, along with tissue tagging to assess LV tissue deformation. Systolic function was preserved in both cases and controls, with no differences in ejection fraction (mean + SE: 63.1 + 8% vs. 65 + 2%), circumferential strain (-20.7+0.6 vs. -21.9+0.5%) or systolic circumferential strain rate (-105.9+6.1 vs. -109.0+3.8%/s), respectively. In contrast, we observed significant differences between cases and controls in diastolic function, as demonstrated by reductions in both diastolic circumferential strain rate (153.8 + 8.9 vs. 191.4 + 8.9 %/s, P < 0.05) and the peak rate of left ventricular untwisting (-99.4 + 8.0 vs. -129.4 + 12.8 °/s, P < 0.05), respectively. -Diastolic function is impaired in women with signs and symptoms of ischemia in the absence of CAD, as assessed by cardiac magnetic resonance tissue tagging. These results are hypothesis generating- larger studies are needed in order to define the exact mechanism(s) responsible, and to establish viable treatment strategies.
    Circulation Cardiovascular Imaging 03/2014;
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    ABSTRACT: -Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. -Patients with surgically-confirmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared to patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: 1) respiration-related ventricular septal shift; 2) variation in mitral inflow E velocity; 3) medial mitral annular e' velocity; 4) ratio of medial mitral annular e' to lateral e'; and 5) hepatic vein expiratory diastolic reversal ratio. All five principal variables differed significantly between the groups. In patients with atrial fibrillation or flutter (n=29), all but mitral inflow velocity remained significantly different. Three variables were independently associated with constrictive pericarditis: 1) ventricular septal shift, 2) medial mitral e'; and 3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e' ≥ 9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥ 0.79 corresponded to a desirable combination of sensitivity (87%) and specificity (91%). The specificity increased to 97% when all three factors were present but the sensitivity decreased to 64%. -Echocardiography may allow differentiation of constrictive pericarditis from heart failure due to restrictive myocardial disease or severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic flow reversals are independently associated with the diagnosis of constrictive pericarditis.
    Circulation Cardiovascular Imaging 03/2014;
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    ABSTRACT: -Several clinical risk factors for death and heart transplantation have been identified in patients with Fontan circulation. It is unknown whether cardiac magnetic resonance (CMR) measurements of ventricular size and function are independently associated with these outcomes and further improve risk stratification. -Data on Fontan patients who had a CMR study from 1/2002 to 1/2011 were retrospectively reviewed. The endpoint was time to death or listing for heart transplantation after the CMR study. The median age of the 215 patients was 18.3 years [25(th), 75(th) percentiles: 14, 26] with a median age at Fontan of 3.6 years [2.3, 7.1]. Over a median post-CMR follow-up period of 4.1 years [2.6, 6.2], 24 patients (11%) reached the endpoint: 20 deaths, 3 transplants, and 1 transplant listing. In a multivariable Cox regression model with clinical parameters only, protein losing enteropathy (PLE) was associated with transplant-free survival. A multivariable model including clinical and CMR parameters showed that in addition to PLE, ventricular end-diastolic volume (EDVi) >125 mL/BSA(1.3) was associated with transplant-free survival. A likelihood-ratio test comparing the 2 models showed that the addition of EDVi resulted in a significantly improved endpoint prediction (P<0.001) - C-index increased from 0.63 to 0.79. -CMR-derived ventricular EDVi is an independent predictor of transplant-free survival late after the Fontan operation and adds incremental value over clinical symptoms alone for risk stratification.
    Circulation Cardiovascular Imaging 03/2014;
  • Circulation Cardiovascular Imaging 03/2014; 7(2):412.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):398-408.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):217-219.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):414.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):379-389.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):390-397.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):220-221.
  • Circulation Cardiovascular Imaging 03/2014; 7(2):409-411.
  • [show abstract] [hide abstract]
    ABSTRACT: -Right ventricular (RV) diastolic dysfunction influences outcomes in pulmonary arterial hypertension (PAH); but echocardiographic parameters have not been investigated in relation to invasive reference standards in pediatric PAH. We investigated echocardiographic parameters of RV diastolic function in children with PAH in relation to simultaneously measured invasive reference measures. -We prospectively recruited children undergoing a clinically indicated cardiac catheterization for evaluation of PAH and/ or pulmonary vasoreactivity testing. Echocardiography was performed simultaneously with invasive reference measurements by high-fidelity micro-manometer catheter. For analysis, patients were divided into shunt and non-shunt groups. 16 children were studied. In the group as a whole, significant correlations were found between tau and tricuspid deceleration time, E', E/E', TimeE-E', A-wave velocity and global early and late diastolic strain rate. dp/dt minimum correlated significantly with late diastolic tricuspid annular velocity (A'), TDI derived S:D ratio and global late diastolic strain rate. EDP correlated significantly with TDI derived S:D ratio. On multivariate analysis, tricuspid deceleration time, TimeE-E' and global early diastolic strain rate were independent predictors of tau, while TDI derived S:D ratio was an independent predictor of dp/dt minimum. In general, correlations between echocardiographic and invasive parameters were better in the shunt group than in the non-shunt group. -Echocardiography correlates with invasive reference measures of RV diastolic function in children with PAH, although does not differentiate between early versus late diastolic abnormalities. Newer echocardiographic techniques may have added value to assess RV diastolic dysfunction in this population.
    Circulation Cardiovascular Imaging 02/2014;
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    ABSTRACT: -Although age and sex distributions of calcified plaque (CCP) have been well described in the general population, noncalcified plaque (NCP) distributions remain unknown. This is important because NCP is a putative precursor for clinical CAD and could serve as a sentinel for aggressive primary prevention, especially in higher risk populations. We examined the distributions of NCP and CCP in healthy 30-74 year old individuals from families with early-onset coronary artery disease (CAD). -Participants in the GeneSTAR family study (N=805), mean age 51.1 ± 10.8 years, 56% female, were screened for CAD risk factors and for coronary plaque using dual-source CT angiography. Plaque volumes (mm(3)) were quantified using a validated automated method. The prevalence of coronary plaque was 57.8% in males and 35.8% in females (p<0.0001). NCP volume increased with age (p<0.001) and was higher in males than females (p<0.001). Although NCP, as a percent of total plaque, was inversely related to age (p<0.01), NCP accounted for most of the total plaque volume at all ages, especially in males and females <55 years (>70% and >80%, respectively). Higher Framingham risk was associated with the number of affected vessels (p<0.01) but 44% of males and 20.8% of females considered intermediate risk had left main and/or 3-vessel disease involvement. -The majority of coronary plaque was noncalcified, particularly in younger individuals. These findings support the importance of assessing family history and suggest that early primary prevention interventions may be warranted at younger ages in families with early onset CAD.
    Circulation Cardiovascular Imaging 02/2014;
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    ABSTRACT: -Tagged cardiac magnetic resonance (CMR) provides detailed information on regional myocardial function and mechanical behavior. T1 mapping by CMR allows non-invasive quantification of myocardial extracellular expansion (ECE) which has been related to interstitial fibrosis in previous clinical and sub-clinical studies. We assessed gender associated differences in the relation of ECE to LV remodeling and myocardial systolic and diastolic deformation in a large community based multi-ethnic population. -Mid-ventricular mid-wall peak circumferential shortening and early diastolic strain rate (EDSR); LV torsion and torsional recoil rate were determined using CMR tagging. Mid ventricular short axis T1 maps were acquired in the same examination pre and post-contrast injection using Modified Look-Locker Inversion Recovery sequence (MOLLI). Multivariable linear regression (B= estimated regression coefficient) was used to adjust for risk factors and sub-clinical disease measures. Of 1230 participants, 114 participants had visible myocardial scar by late gadolinium enhancement. Participants without visible myocardial scar (n=1116) had no previous history of clinical events. In the latter group, multivariable linear regression demonstrated that lower post-contrast T1 times, reflecting greater ECE were associated with lower circumferential shortening (B=-0.1, p=0.0001), lower end diastolic volume index (LVEDVi) (B=0.6, p=0.0001) and lower LV end diastolic mass index (LVMi) (B=0.4, p=0.0001). In addition, lower post-contrast T1 times were associated with lower EDSR (B=0.01, p=0.03) in women only; and lower LV torsion (B=0.005, p=0.03) a lower LV ejection fraction (B=0.2, p=0.01) in men only. -Greater ECE is associated with reduced LVEDVi and LVMi in a large multi-ethnic population without history of previous cardiovascular events. In addition, greater ECE is associated with reduced circumferential shortening, lower EDSR, and a preserved ejection fraction in women; while in men, greater ECE is associated with greater LV dysfunction manifested as reduced circumferential shortening, reduced LV Torsion and reduced ejection fraction.
    Circulation Cardiovascular Imaging 02/2014;

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