Tirza Springeling

Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands

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Publications (19)73.35 Total impact

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    ABSTRACT: Our current understanding is that left ventricular (LV) remodeling after acute myocardial infarction (AMI) is caused by expansion of the infarcted myocardium with thinning of the wall and eccentric hypertrophy of the remote myocardium. To study the geometric changes in the remodeling process after reperfused AMI we used cardiac magnetic resonance imaging (CMR). Nine juvenile swine underwent a 120-min occlusion of the left circumflex coronary artery followed by reperfusion. CMR was performed at 3 and 36days post-infarction. Global and regional LV remodeling was assessed including geometric changes of infarcted and remote myocardium; infarct longitudinal length (mm), mean circumferential length (mm), total infarct surface (mm(2)), end-diastolic wall thickness (EDWT) (mm) and transmural extent of infarction (TEI). From 3days to 36days post-infarction end-diastolic volume increased by 43% (p<0.01). Infarct mass decreased by 36% (p<0.01), mainly by reduction of EDWT with 26%, while mean infarct circumferential length and longitudinal infarct length did not change. Remote myocardial mass increased by 23%, which was the result of an increase in its circumferential length from 95±10mm to 113±11mm (p<0.01), with no change in its EDWT. In contrast, EDWT in the infarct, peri-infarct and border zone decreased. Contrary to the widely held view the present, using CMR measurements, shows that post-infarction remodeling was not associated with expansion of the infarcted myocardium. These findings suggest that eccentric hypertrophy of the remote myocardium, but not expansion of the infarct region, is responsible for left ventricular dilatation after AMI.
    International journal of cardiology 10/2013; · 6.18 Impact Factor
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    ABSTRACT: Despite achievement of optimal epicardial coronary flow in the majority of patients treated for ST-segment elevation myocardial infarction (STEMI) by primary percutaneous coronary intervention (PPCI), myocardial no-reflow is a common phenomenon occurring in 5 to 50% of patients. The no-reflow phenomenon is a predictor of infarct size and an independent predictor of mortality both in the short and long term. Prevention of no-reflow is therefore a crucial step in improving prognosis of patients with STEMI. Several strategies including pharmacological and mechanical ones have been developed to improve microvascular perfusion in the setting of a myocardial infarction. Prevention starts by conservation of the microvascular reserve especially in patients at high risk of acute coronary syndromes such as diabetes patients. Optimal glycaemic control and the use of statins have been shown to reduce no-reflow in this context. Reducing ischaemic time by shortening door to balloon times, administration of intracoronary GP IIb/IIIa antagonists during PPCI and the use of manual aspiration thrombectomy have been shown to result in better myocardial perfusion and improved clinical outcome in major trials. In this review we discuss some of these major trials and studies of other therapeutic options that aim to prevent the no-reflow phenomenon.
    Current Vascular Pharmacology 03/2013; 11(2):263-277. · 2.91 Impact Factor
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    ABSTRACT: Background: Primary percutaneous coronary intervention (PPCI) preserves function and improves survival. The late effects of PPCI on left ventricular remodeling, however, have not yet been investigated on cardiac magnetic resonance imaging (CMRI). Methods and Results: Twenty-five patients with acute myocardial infarction (AMI) treated with PPCI underwent CMRI within 10 days, at 4 months and at 5 years. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume were quantified on cine images. Infarct mass and transmural extent of infarction were quantified on contrast-enhanced imaging. In all patients EDV increased significantly in the early phase (192±40ml to 211±49ml, P≤0.01) and LVEF improved significantly (42±9% to 46±9%, P=0.02). In the late phase (>4 months) no significant changes were observed (LVEF 44±9%, P=0.07; EDV 216±68ml, P=0.38). Three different groups could be identified. One-third (32%) had no dilatation at all; one-third (32%) had limited dilatation at 4 months without progression later; and 36% had progressive dilatation both at 4 months and at late follow-up. This third group had an average increase in EDV of 20% in the acute phase followed by an additional 13%. The strongest predictor for progressive dilatation was infarct mass. Conclusions: Even in the era of PPCI for AMI followed by optimal medical therapy, one-third of patients had progressive dilatation, which was best predicted by infarct mass.
    Circulation Journal 09/2012; · 3.58 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of this study was to evaluate the natural progression of aortic dilatation and its association with aortic valve stenosis (AoS) in patients with bicuspid aortic valve (BAV). METHODS: Prospective study of aorta dilatation in patients with BAV and AoS using cardiac magnetic resonance (CMR). Aortic root, ascending aorta, aortic peak velocity, left ventricular systolic and diastolic function and mass were assessed at baseline and at 3-year follow-up. RESULTS: Of the 33 enrolled patients, 5 needed surgery, while 28 patients (17 male; mean age: 31 ± 8 years) completed the study. Aortic diameters significantly increased at the aortic annulus, sinus of Valsalva and tubular ascending aorta levels (P < 0.050). The number of patients with dilated tubular ascending aortas increased from 32 % to 43 %. No significant increase in sino-tubular junction diameter was observed. Aortic peak velocity, ejection fraction and myocardial mass significantly increased while the early/late filling ratio significantly decreased at follow-up (P < 0.050). The progression rate of the ascending aorta diameter correlated weakly with the aortic peak velocity at baseline (R (2) = 0.16, P = 0.040). CONCLUSION: BAV patients with AoS showed a progressive increase of aortic diameters with maximal expression at the level of the tubular ascending aorta. The progression of aortic dilatation correlated weakly with the severity of AoS. KEY POINTS: • Bicuspid aortic valve (BAV) is the most common congenital heart defect. • BAV patients have an increased risk of developing aortic valve stenosis (AoS). • BAV patients have an increased risk of developing thoracic aorta dilatation. • The severity of aortic stenosis is correlated to the progression of aortic dilatation. • Cardiac magnetic resonance can rapidly assess patients with a bicuspid aortic valve.
    European Radiology 09/2012; · 4.34 Impact Factor
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    Journal of the American College of Cardiology 01/2012; 59(5):539-40. · 14.09 Impact Factor
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    ABSTRACT: Tagged magnetic resonance imaging (tMRI) is a well-known noninvasive method for studying regional heart dynamics. It offers great potential for quantitative analysis of a variety of kine(ma)tic parameters, but its clinical use has so far been limited, in part due to the lack of robustness and accuracy of existing tag tracking algorithms in dealing with low (and intrinsically time-varying) image quality. In this paper, we evaluate the performance of four frequently used concepts found in the literature (optical flow, harmonic phase (HARP) magnetic resonance imaging, active contour fitting, and non-rigid image registration) for cardiac motion analysis in 2D tMRI image sequences, using both synthetic image data (with ground truth) and real data from preclinical (small animal) and clinical (human) studies. In addition we propose a new probabilistic method for tag tracking that serves as a complementary step to existing methods. The new method is based on a Bayesian estimation framework, implemented by means of reversible jump Markov chain Monte Carlo (MCMC) methods, and combines information about the heart dynamics, the imaging process, and tag appearance. The experimental results demonstrate that the new method improves the performance of even the best of the four previous methods. Yielding higher consistency, accuracy, and intrinsic tag reliability assessment, the proposed method allows for improved analysis of cardiac motion.
    Medical image analysis 09/2011; 16(1):301-24. · 3.09 Impact Factor
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    ABSTRACT: There are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during mid and late pregnancy using cardiovascular magnetic resonance (CMR). Healthy non-pregnant women, pregnant women at 20th week of gestation and at 32nd week of gestation without history of cardiac disease were recruited to the study and underwent CMR in supine and left lateral positions. Cardiac hemodynamic parameters and dimensions were measured and compared between both positions. Five non-pregnant women, 6 healthy pregnant women at mid pregnancy and 8 healthy pregnant women at late pregnancy were enrolled in the study. In the group of non-pregnant women left ventricular (LV) cardiac output (CO) significantly decreased by 9% (p=0.043) and right ventricular (RV) end-diastolic volume (EDV) significantly increased by 5% (p=0.043) from the supine to the left lateral position. During mid pregnancy LV ejection fraction (EF), stroke volume (SV), left atrium lateral diameter and left atrial supero-inferior diameter increased significantly from the supine position to the left lateral position: 8%, 27%, 5% and 11%, respectively (p<0.05). RV EDV, SV and right atrium supero-inferior diameter significantly increased from the supine to the left lateral position: 25%, 31% and 13% (p<0.05), respectively. During late pregnancy a significant increment of LV EF, EDV, SV and CO was observed in the left lateral position: 11%, 21%, 35% and 24% (p<0.05), respectively. Left atrial diameters were significantly larger in the left lateral position compared to the supine position (p<0.05). RV CO was significantly increased in the left lateral position compared to the supine position (p<0.05). During pregnancy positional changes affect significantly cardiac hemodynamic parameters and dimensions. Pregnant women who need serial studies by CMR should be imaged in a consistent position. From as early as 20 weeks the left lateral position should be preferred on the supine position because it positively affects venous return, SV and CO.
    Journal of Cardiovascular Magnetic Resonance 06/2011; 13:31. · 4.44 Impact Factor
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    ABSTRACT: To evaluate additional adenosine magnetic resonance perfusion (MRP) imaging in the diagnostic workup of patients with suspected stable angina with computed tomography coronary angiography (CTCA) as first-line diagnostic modality. Two hundred and thirty symptomatic patients (male, 52%; age, 56 year) with suspected stable angina underwent CTCA. In patients with a stenosis of >50% as visually assessed, MRP was performed and the quantitative myocardial perfusion reserve index (MPRI) was calculated. Coronary flow reserve (CFR) using invasive coronary flow measurements served as the standard of reference. CTCA showed non-significant CAD in 151/230 (66%) patients and significant CAD in 79/230 patients (34%), of whom 50 subsequently underwent MRP and CFR. MRP showed reduced perfusion in 32 patients (64%), which was confirmed by CFR in 27 (84%). All 18 cases of normal MRP (36%) were confirmed by CFR. The positive likelihood ratio of MRP for the presence of functional significant disease in patients with a lesion on CTCA was 4.49 (95% confidence interval [CI] 2.12-9.99). The negative likelihood ratio was 0.05 (95%CI 0.01-0.34). CTCA as first-line diagnostic modality excluded coronary artery disease in a high percentage of patients referred for diagnostic workup of suspected stable angina. MRP made a significant contribution to the detection of functional significant lesions in patients with a positive CTCA.
    Circulation Journal 06/2011; 75(7):1678-84. · 3.58 Impact Factor
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    ABSTRACT: To optimize the predictive value of cardiac magnetic resonance imaging (MRI) for improvement of myocardial dysfunction prior to percutaneous coronary intervention (PCI). We performed cardiac MRI in 72 patients (male 87%, age 60 years) before and 6 months after successful PCI (43/72) or unsuccessful PCI (29/72) of a chronic total coronary occlusion (CTO). Before PCI, 5 viability parameters were evaluated: transmural extent of infarction (TEI), contractile reserve during dobutamine, end diastolic wall thickness, unenhanced rim thickness and segmental wall thickening of the unenhanced rim (SWTur). Multivariate analysis was performed and based on the regression coefficient (RC) a predictive score was constructed. Diagnostic performance to predict improvement in myocardial function for each parameter and for the viability score was determined. The predictive value of a combination of contractile reserve, SWTur and TEI was incremental to TEI alone (AUROC 0.91 vs. 0.77; p<0.001). A viability score of ≥ 5 based on contractile reserve (RC=4), SWTur (RC=1) and TEI (RC=2) was 91% sensitive and 84% specific in predicting improvement of myocardial function. Combining viability parameters results in a better prediction of improvement of dysfunctional myocardial segments after a successful PCI.
    International journal of cardiology 03/2011; 159(3):192-7. · 6.18 Impact Factor
  • International journal of cardiology 02/2011; 147(1):184-6. · 6.18 Impact Factor
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    Journal of Cardiovascular Magnetic Resonance 01/2011; · 4.44 Impact Factor
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    Journal of Cardiovascular Magnetic Resonance 01/2011; · 4.44 Impact Factor
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    ABSTRACT: PURPOSE There are physiological reasons for the effects of positioning on hemodynamic variables and cardiac dimensions, related to altered intra-abdominal and intra-thoracic pressures. This problem is especially evident in pregnant women due to the additional aorto-caval compression by the enlarged uterus. The purpose of this study was to investigate the effect of postural changes on cardiac dimensions and function during the second and third trimester of pregnancy using MRI. METHOD AND MATERIALS Fourteen healthy pregnant women at mid (20th week of gestation; n=6) and late pregnancy (32th week of gestation; n=8) and ten no pregnant women with no history of cardiac disease underwent cardiac MRI in supine and left lateral positions. Heart rate (HR), ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and cardiac output (CO) were compared in both positions. Lateral and supero-inferior left atrial diameters were measured at the end of ventricular systole on a 4-chamber view. RESULTS Heart rate was 81±13 bpm in the supine position and it decreased to 74±9 in the left lateral position (p-value=0.09). EDV, EF, SV and CO increased significantly from supine position to left lateral position: 10%, 19%, 31% and 14%, respectively. Cardiac left atrium dimensions increased significantly from supine position to left lateral position (p-value<0.05). ESV did not change significantly between the two recumbent positions. During late pregnancy left ventricle CO significantly increased between supine and left lateral position; the percentage of increment at 32 weeks was 24.3%. No changes between the two recumbent positions were present at 20 gestational weeks. In no pregnant women no significant differences were found between supine and left lateral position. CONCLUSION Positional changes affect cardiovascular performance especially at longer duration of gestation. To correctly investigate the cardiac workload in pregnant women with congenital heart disease cardiovascular MRI should be performed in the lateral position. CLINICAL RELEVANCE/APPLICATION Magnetic resonance imaging is the gold standard for the evaluation of cardiac dimensions and function outside pregnancy but no normal values are available during pregnancy.
    Journal of Cardiovascular Magnetic Resonance 11/2010; 12:1-1. · 4.44 Impact Factor
  • Interventional Cardiology. 06/2010; 2(3):327-339.
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    ABSTRACT: The aim of this study was to investigate the effect of complete, incomplete, and unsuccessful revascularization by percutaneous coronary intervention (PCI) on left ventricular ejection fraction (EF) in patients with multivessel disease and impaired left ventricular function and assess the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) for improvement in EF. The effect of PCI for multivessel coronary artery disease on long-term myocardial function and the predictive value of cardiac MRI on global function are incompletely investigated. Cardiac MRI was performed in patients with multivessel disease before and 6 months after complete revascularization (n = 34) or incomplete revascularization (n = 22) or in patients without successful revascularization (n = 15). For the prediction of recovery of EF, wall thickening was quantified on cine images at rest and during 5- and 10-microg/kg/min dobutamine. The transmural extent of infarction was quantified on delayed enhancement cardiac MRI. The EF improved significantly after complete revascularization (46 +/- 12% to 51 +/- 13%; p < 0.0001) but did not change after incomplete (49 +/- 11% to 49 +/- 10%; p = 0.88) or unsuccessful revascularization (49 +/- 13% to 47 +/- 13%; p = 0.11). Sensitivity, specificity, positive and negative predictive value for the prediction of improvement in EF of >4% after PCI were 100%, 75%, 74%, and 100%, respectively, for dobutamine-cardiac MRI and 70%, 77%, 70%, and 77%, respectively, for delayed enhancement-cardiac MRI. Complete revascularization for multivessel coronary artery disease improves EF, whereas EF did not change in patients after incomplete or unsuccessful revascularization. Improvement in EF can be predicted by performing cardiac MRI before PCI.
    JACC. Cardiovascular Interventions 04/2010; 3(4):392-400. · 1.07 Impact Factor
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    ABSTRACT: PURPOSE Non surgical septal myocardial reduction by coil embolization (CE) has been proposed as a feasible option with less adverse events compared to alcohol septal ablation (ASA) in drug resistant symptomatic patients with hypertrophic obstructive cardiomyopathy. The aim of this study was to compare myocardial infarction induced by both techniques. METHOD AND MATERIALS Nineteen patients underwent non-surgical myocardial septal reduction, 13 by ASA and 6 by CE. All patients underwent MRI before and 3 days after successful procedure. LVOT gradient reduction was measured during the procedure. Ejection fraction (EF), End-diastlioc volume (EDV), end systolic volume (ESV), Peak filling rate (PFR), Peak ejection rate (PER) and infarct size were quantified on cine and delayed enhancement images. RESULTS The LVOT gradient was reduced in both groups (ASA 127 ± 50 to 45 ±34 mmHg, p=<.01; CE 120 ± 36 to 57 ± 48 mmHg, p=<.01) during the procedure. Infarct size was smaller in the CE compared to the patients who underwent ASA 8,6 ± 5,6 and 12,4 ± 3,4 gram, (p=.01) respectively. EF decreased significantly in ASA group from 58 ± 8 to 51 ± 11%, (p=<.01) in contrast with the CE group (51 ± 12 to 49 ± 10%, p=.49). EDV decreased in the ASA group (82 ± 13 to 72 ± 9 ml, p=<.01) but not in the CE group (92 ± 22 to 93 ± 23 ml, p=.08). There was no significant difference at follow up for the ESV in both groups (ASA 34 ± 7 to 35 ± 8 ml, p=.35; CE 46 ± 17 to 48 ± 20 ml, p=.37). PER and PFR did not change in both groups (ASA: 3.1 ± 0.9 to 3.6 ± 0.7 ml/s p=.08; 2.6 ± 0.7 to 2.3 ± 0.8 ml/s and CE: 2.9 ± 0.9 to 3.0 ± 0.9 ml/s, p=.74; 2.1± 0.6 2.2± 0.5 p=.76 respectively) The induced infarct mass correlates significantly with EF, EDV and PFR (r= 0.68; 0.83; 0.53, p=<.01; <.01; .04 respectively). There was no correlation with the reduction of LVOT gradient. CONCLUSION Both techniques reduce the LVOT gradient sufficiently during the procedure. The infarct size is smaller in patients with CE. Infarct size correlates good with LVEF, EDV and PFR but not with the LVOT gradient reduction. It is unclear if the smaller infarct size will be sufficient in the long term after the effect of the stunning is diminished and remodelling will take place. CLINICAL RELEVANCE/APPLICATION Cardiac MRI is a accurate clinical tool to evaluate the effect of different treatments in patients with hypertrophic obstructive cardiomyopathy
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    ABSTRACT: PURPOSE/AIM The aim of this educational poster is to discuss why, when and how to assess myocardial iron overload and cardiac function in patients with hemochromatosis using MR imaging. CONTENT ORGANIZATION 1. Introduction on the pathophysiology of iron storage diseases with emphasis on cardiac iron deposition and its effect on ventricular function 2. When and why to assess iron overload and ventricular function with MR imaging 3. Choosing and optimizing cardiac MR pulse sequences 4. Challenges in T2*-weighted imaging and its correlation with iron concentration 5. Clinical cases 6. Summary 7. References SUMMARY Iron-induced cardiomyopathy is the leading cause of mortality is patients with hemochromatosis. Cardiac MR imaging can quantitatively evaluate cardiac iron concentrations and cardiac function, both useful in primary assessment and follow-up of patients with iron overload.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 11/2009
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    ABSTRACT: PURPOSE/AIM Dual Energy CT may improve contrast resolution between normal myocardium and infarcted area. The purpose of this poster is to demonstrate the feasibility of myocardial perfusion and delayed enhancement imaging in acute and chronic infarcts using Dual Energy CT. CONTENT ORGANIZATION A) Description of: - Dual Energy CT acquisition technique for perfusion and delayed enhancement imaging - Dual Energy CT post-processing, display and analysis of the images - Radiation dose associated with Dual Energy cardiac CT protocols B) Examples of enhancement patterns of acute and chronic myocardial infarcts with Dual Energy CT compared to Cardiac Magnetic Resonance (CMR). SUMMARY Acute myocardial infarct size is a predictor of long-term left ventricular function and clinical outcome in patients after acute myocardial infarction. Dual Energy CT is an emerging technique for the evaluation of viable myocardium and it permits identification and quantification of myocardial infarction size.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 11/2009
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    Journal of Cardiovascular Magnetic Resonance 01/2009; · 4.44 Impact Factor