Pub Date : 2024-03-21eCollection Date: 2024-01-01DOI: 10.1093/ehjimp/qyae021
Dan M Dorobantu, Curtis A Wadey, Ben Berryman, Nurul H Amir, Lynsey Forsythe, A Graham Stuart, Guido E Pieles, Craig A Williams
Aims: The value of cardiopulmonary exercise testing (CPET) and exercise stress echocardiography (ESE) in managing cardiac disease is well known, but no standard CPET-ESE protocol is currently recommended. This pilot study aims to compare feasibility and cardiac function responses between a new high-intensity single-stage combined test (CPET-hiESE) and a standard maximal ESE (smESE).
Methods and results: After screening and maximal CPET, all volunteers (n = 21) underwent three ESE modalities: (i) based on the gas exchange threshold (hiESE-GET, 40% of peak-GET, 6 min), (ii) based on heart rate (HR) (hiESE-HR, 80% of peak HR, 6 min), and (iii) smESE (85% of predicted peak HR for age, 3 min). Speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) were measured at each step. There was superior image quality and data completeness for the right ventricle strain for both hiESE modalities compared with smESE (71.4 and 76.2 vs. 42.9%, P = 0.07). Left ventricular STE data completeness was similar for all three conditions. Despite systematically higher HR, work rate and levels of exertion in the smESE compared with hiESE, STE and TDI parameters were not systematically different. Concordance correlation coefficients ranged from 0.56 to 0.88, lowest for strain rate parameters and mean difference from -0.34 to 1.53, highest for TDI measurements.
Conclusion: The novel CPET-hiESE protocol allowed for better data completeness, at lower levels of exertion compared with smESE, without systematically different cardiac reserve measurements in healthy participants. This single-stage protocol can be individualized to clinical populations, which would provide practical advantages to standard testing.
{"title":"A new protocol for a single-stage combined cardiopulmonary and echocardiography exercise test: a pilot study.","authors":"Dan M Dorobantu, Curtis A Wadey, Ben Berryman, Nurul H Amir, Lynsey Forsythe, A Graham Stuart, Guido E Pieles, Craig A Williams","doi":"10.1093/ehjimp/qyae021","DOIUrl":"10.1093/ehjimp/qyae021","url":null,"abstract":"<p><strong>Aims: </strong>The value of cardiopulmonary exercise testing (CPET) and exercise stress echocardiography (ESE) in managing cardiac disease is well known, but no standard CPET-ESE protocol is currently recommended. This pilot study aims to compare feasibility and cardiac function responses between a new high-intensity single-stage combined test (CPET-hiESE) and a standard maximal ESE (smESE).</p><p><strong>Methods and results: </strong>After screening and maximal CPET, all volunteers (<i>n</i> = 21) underwent three ESE modalities: (i) based on the gas exchange threshold (hiESE-GET, 40% of peak-GET, 6 min), (ii) based on heart rate (HR) (hiESE-HR, 80% of peak HR, 6 min), and (iii) smESE (85% of predicted peak HR for age, 3 min). Speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) were measured at each step. There was superior image quality and data completeness for the right ventricle strain for both hiESE modalities compared with smESE (71.4 and 76.2 vs. 42.9%, <i>P</i> = 0.07). Left ventricular STE data completeness was similar for all three conditions. Despite systematically higher HR, work rate and levels of exertion in the smESE compared with hiESE, STE and TDI parameters were not systematically different. Concordance correlation coefficients ranged from 0.56 to 0.88, lowest for strain rate parameters and mean difference from -0.34 to 1.53, highest for TDI measurements.</p><p><strong>Conclusion: </strong>The novel CPET-hiESE protocol allowed for better data completeness, at lower levels of exertion compared with smESE, without systematically different cardiac reserve measurements in healthy participants. This single-stage protocol can be individualized to clinical populations, which would provide practical advantages to standard testing.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-16eCollection Date: 2024-01-01DOI: 10.1093/ehjimp/qyae012
Roberta Lo Giudice, Alessia Gimelli, Marianna Venditti
{"title":"Enhancing cardiovascular imaging department efficiency through robust quality systems and effective risk management.","authors":"Roberta Lo Giudice, Alessia Gimelli, Marianna Venditti","doi":"10.1093/ehjimp/qyae012","DOIUrl":"10.1093/ehjimp/qyae012","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-08eCollection Date: 2023-09-01DOI: 10.1093/ehjimp/qyad043
Amro Sehly, Albert He, Jacob Agris, John Konstantopoulos, Jack Joyner, Julien Flack, Simon Kwok, Benjamin J W Chow, Brian Ko, Michael Ridner, Abdul Rahman Ihdayhid, Girish Dwivedi
{"title":"Deep learning-based computed tomography quantification of left ventricular mass.","authors":"Amro Sehly, Albert He, Jacob Agris, John Konstantopoulos, Jack Joyner, Julien Flack, Simon Kwok, Benjamin J W Chow, Brian Ko, Michael Ridner, Abdul Rahman Ihdayhid, Girish Dwivedi","doi":"10.1093/ehjimp/qyad043","DOIUrl":"10.1093/ehjimp/qyad043","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-07eCollection Date: 2023-09-01DOI: 10.1093/ehjimp/qyad041
YuZhi Phuah, Ying Xin Tan, Sheref Zaghloul, Sharmaine Sim, Joshua Wong, Saba Usmani, Lily Snell, Karish Thavabalan, Carmen Lucia García-Pérez, Niraj S Kumar, Hannah Glatzel, Reubeen Rashid Ahmad, Luciano Candilio, Jonathan J H Bray, Mahmood Ahmed, Rui Providencia
Transthoracic echocardiography (TTE) is the most commonly used imaging modality to diagnose left ventricular thrombus (LVT), however, cardiac magnetic resonance (CMR) remains the gold standard investigation. A comparison of the diagnostic performance between two modalities is needed to inform guidelines on a diagnostic approach towards LVT. We performed a systematic review and meta-analysis to investigate the diagnostic performance of three methods of TTE (non-contrast, contrast, and apical wall motion scoring) for the detection of LVT compared to CMR as a reference test. Studies comprising 2113 patients investigated for LVT using both TTE and CMR were included in the meta-analysis. For non-contrast TTE, pooled sensitivity and specificity were 47% [95% confidence interval (CI): 32-62%], and 98% (95% CI: 96-99%), respectively. In contrast, TTE pooled sensitivity and specificity values were 58% (95% CI: 46-69%), and 98% (95% CI: 96-99%), respectively. Apical wall motion scoring on non-contrast TTE yielded a sensitivity of 100% [95% CI: 93-100%] and a specificity of 54% (95% CI: 42-65%). The area under the curve (AUC) values from our summary receiver operating characteristic curve (SROC) for non-contrast and contrast TTE were 0.87 and 0.86 respectively, with apical wall motion studies having the highest AUC of 0.93. Despite high specificity, routine contrast and non-contrast TTE are likely to miss a significant number of LVT, making it a suboptimal screening tool. The addition of apical wall motion scoring provides a promising method to reliably identify patients requiring further investigations for LVT, whilst excluding others from unnecessary testing.
{"title":"A systematic review and meta-analysis of transthoracic echocardiogram vs. cardiac magnetic resonance imaging for the detection of left ventricular thrombus.","authors":"YuZhi Phuah, Ying Xin Tan, Sheref Zaghloul, Sharmaine Sim, Joshua Wong, Saba Usmani, Lily Snell, Karish Thavabalan, Carmen Lucia García-Pérez, Niraj S Kumar, Hannah Glatzel, Reubeen Rashid Ahmad, Luciano Candilio, Jonathan J H Bray, Mahmood Ahmed, Rui Providencia","doi":"10.1093/ehjimp/qyad041","DOIUrl":"10.1093/ehjimp/qyad041","url":null,"abstract":"<p><p>Transthoracic echocardiography (TTE) is the most commonly used imaging modality to diagnose left ventricular thrombus (LVT), however, cardiac magnetic resonance (CMR) remains the gold standard investigation. A comparison of the diagnostic performance between two modalities is needed to inform guidelines on a diagnostic approach towards LVT. We performed a systematic review and meta-analysis to investigate the diagnostic performance of three methods of TTE (non-contrast, contrast, and apical wall motion scoring) for the detection of LVT compared to CMR as a reference test. Studies comprising 2113 patients investigated for LVT using both TTE and CMR were included in the meta-analysis. For non-contrast TTE, pooled sensitivity and specificity were 47% [95% confidence interval (CI): 32-62%], and 98% (95% CI: 96-99%), respectively. In contrast, TTE pooled sensitivity and specificity values were 58% (95% CI: 46-69%), and 98% (95% CI: 96-99%), respectively. Apical wall motion scoring on non-contrast TTE yielded a sensitivity of 100% [95% CI: 93-100%] and a specificity of 54% (95% CI: 42-65%). The area under the curve (AUC) values from our summary receiver operating characteristic curve (SROC) for non-contrast and contrast TTE were 0.87 and 0.86 respectively, with apical wall motion studies having the highest AUC of 0.93. Despite high specificity, routine contrast and non-contrast TTE are likely to miss a significant number of LVT, making it a suboptimal screening tool. The addition of apical wall motion scoring provides a promising method to reliably identify patients requiring further investigations for LVT, whilst excluding others from unnecessary testing.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11240154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27eCollection Date: 2023-09-01DOI: 10.1093/ehjimp/qyad040
Sigbjorn Sabo, David Pasdeloup, Hakon Neergaard Pettersen, Erik Smistad, Andreas Østvik, Sindre Hellum Olaisen, Stian Bergseng Stølen, Bjørnar Leangen Grenne, Espen Holte, Lasse Lovstakken, Havard Dalen
Aims: Impaired standardization of echocardiograms may increase inter-operator variability. This study aimed to determine whether the real-time guidance of experienced sonographers by deep learning (DL) could improve the standardization of apical recordings.
Methods and results: Patients (n = 88) in sinus rhythm referred for echocardiography were included. All participants underwent three examinations, whereof two were performed by sonographers and the third by cardiologists. In the first study period (Period 1), the sonographers were instructed to provide echocardiograms for the analyses of the left ventricular function. Subsequently, after brief training, the DL guidance was used in Period 2 by the sonographer performing the second examination. View standardization was quantified retrospectively by a human expert as the primary endpoint and the DL algorithm as the secondary endpoint. All recordings were scored in rotation and tilt both separately and combined and were categorized as standardized or non-standardized. Sonographers using DL guidance had more standardized acquisitions for the combination of rotation and tilt than sonographers without guidance in both periods (all P ≤ 0.05) when evaluated by the human expert and DL [except for the apical two-chamber (A2C) view by DL evaluation]. When rotation and tilt were analysed individually, A2C and apical long-axis rotation and A2C tilt were significantly improved, and the others were numerically improved when evaluated by the echocardiography expert. Furthermore, all, except for A2C rotation, were significantly improved when evaluated by DL (P < 0.01).
Conclusion: Real-time guidance by DL improved the standardization of echocardiographic acquisitions by experienced sonographers. Future studies should evaluate the impact with respect to variability of measurements and when used by less-experienced operators.
{"title":"Real-time guidance by deep learning of experienced operators to improve the standardization of echocardiographic acquisitions.","authors":"Sigbjorn Sabo, David Pasdeloup, Hakon Neergaard Pettersen, Erik Smistad, Andreas Østvik, Sindre Hellum Olaisen, Stian Bergseng Stølen, Bjørnar Leangen Grenne, Espen Holte, Lasse Lovstakken, Havard Dalen","doi":"10.1093/ehjimp/qyad040","DOIUrl":"10.1093/ehjimp/qyad040","url":null,"abstract":"<p><strong>Aims: </strong>Impaired standardization of echocardiograms may increase inter-operator variability. This study aimed to determine whether the real-time guidance of experienced sonographers by deep learning (DL) could improve the standardization of apical recordings.</p><p><strong>Methods and results: </strong>Patients (<i>n</i> = 88) in sinus rhythm referred for echocardiography were included. All participants underwent three examinations, whereof two were performed by sonographers and the third by cardiologists. In the first study period (Period 1), the sonographers were instructed to provide echocardiograms for the analyses of the left ventricular function. Subsequently, after brief training, the DL guidance was used in Period 2 by the sonographer performing the second examination. View standardization was quantified retrospectively by a human expert as the primary endpoint and the DL algorithm as the secondary endpoint. All recordings were scored in rotation and tilt both separately and combined and were categorized as standardized or non-standardized. Sonographers using DL guidance had more standardized acquisitions for the combination of rotation and tilt than sonographers without guidance in both periods (all <i>P</i> ≤ 0.05) when evaluated by the human expert and DL [except for the apical two-chamber (A2C) view by DL evaluation]. When rotation and tilt were analysed individually, A2C and apical long-axis rotation and A2C tilt were significantly improved, and the others were numerically improved when evaluated by the echocardiography expert. Furthermore, all, except for A2C rotation, were significantly improved when evaluated by DL (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Real-time guidance by DL improved the standardization of echocardiographic acquisitions by experienced sonographers. Future studies should evaluate the impact with respect to variability of measurements and when used by less-experienced operators.</p><p><strong>Clinicaltrialsgov identifier: </strong>NCT04580095.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amélie Marang, Marc Bonnet, Thomas Rees, Jonathan Bentz, Sébastien Gerelli
{"title":"An unusual cause of reversible complete heart block: Right sinus of Valsalva rupture and compressive pseudo- aneurysm","authors":"Amélie Marang, Marc Bonnet, Thomas Rees, Jonathan Bentz, Sébastien Gerelli","doi":"10.1093/ehjimp/qyad038","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad038","url":null,"abstract":"","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135430058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xu Wang, Steele C Butcher, Rinchyenkhand Myagmardorj, Sophie IE Liem, Victoria Delgado, Jeroen J Bax, Jeska K De Vries-Bouwstra, Nina Ajmone Marsan
Abstract Aims Epicardial adipose tissue (EAT) has emerged as a mediator between systemic inflammatory disorders and cardiovascular disease, and may therefore play a role in the pathophysiology of cardiac involvement in systemic sclerosis (SSc). The aim of this study was to assess the correlation between EAT and left ventricular (LV) function, and to determine the prognostic value of EAT in patients with SSc. Methods and results Consecutive patients with SSc who underwent non-contrast thorax computed tomography and echocardiography were included. EAT mass was quantified using dedicated software. The study endpoint was all-cause mortality. A total of 230 SSc patients [age 53±15 years, 14% male] were included. The median value of EAT mass was 67g (IQR: 45-101g). Patients with increased EAT mass (≥67g) showed more impaired LV diastolic function as compared to patients with less EAT mass (<67g), and even after adjusting for age and comorbidities, EAT mass was independently associated with LV diastolic function parameters. During a median follow-up of 8 years, 42 deaths occurred. Kaplan-Meier analysis showed that patients with increased EAT mass had higher all-cause mortality rate as compared to patients with less EAT mass (29% vs 7 %; P<0.001). In the multivariable analysis, EAT was independently associated with all-cause mortality after adjusting for important covariates (HR:1.006; 95%CI:1.001-1.010). Conclusion In patients with SSc, EAT is independently associated with LV diastolic dysfunction and higher mortality rate.
摘要目的心外膜脂肪组织(EAT)已成为全身性炎症性疾病和心血管疾病之间的中介,因此可能在系统性硬化症(SSc)中心脏受累的病理生理学中发挥作用。本研究的目的是评估EAT与左心室(LV)功能的相关性,并确定EAT在SSc患者中的预后价值。方法和结果对连续行胸部ct和超声心动图检查的SSc患者进行分析。使用专用软件定量EAT质量。研究终点为全因死亡率。共纳入230例SSc患者,年龄53±15岁,男性占14%。EAT质量中位数为67g (IQR: 45-101g)。与EAT质量较低(<67g)的患者相比,EAT质量增加(≥67g)的患者左室舒张功能受损更严重,即使在调整年龄和合共病后,EAT质量与左室舒张功能参数独立相关。在平均8年的随访期间,发生了42例死亡。Kaplan-Meier分析显示,与EAT体积较小的患者相比,EAT体积增大的患者具有更高的全因死亡率(29% vs 7%;P&肝移植;0.001)。在多变量分析中,在调整重要协变量后,EAT与全因死亡率独立相关(HR:1.006;95%置信区间:1.001—-1.010)。结论在SSc患者中,EAT与左室舒张功能障碍和较高的死亡率独立相关。
{"title":"Epicardial adipose tissue in patients with systemic sclerosis","authors":"Xu Wang, Steele C Butcher, Rinchyenkhand Myagmardorj, Sophie IE Liem, Victoria Delgado, Jeroen J Bax, Jeska K De Vries-Bouwstra, Nina Ajmone Marsan","doi":"10.1093/ehjimp/qyad037","DOIUrl":"https://doi.org/10.1093/ehjimp/qyad037","url":null,"abstract":"Abstract Aims Epicardial adipose tissue (EAT) has emerged as a mediator between systemic inflammatory disorders and cardiovascular disease, and may therefore play a role in the pathophysiology of cardiac involvement in systemic sclerosis (SSc). The aim of this study was to assess the correlation between EAT and left ventricular (LV) function, and to determine the prognostic value of EAT in patients with SSc. Methods and results Consecutive patients with SSc who underwent non-contrast thorax computed tomography and echocardiography were included. EAT mass was quantified using dedicated software. The study endpoint was all-cause mortality. A total of 230 SSc patients [age 53±15 years, 14% male] were included. The median value of EAT mass was 67g (IQR: 45-101g). Patients with increased EAT mass (≥67g) showed more impaired LV diastolic function as compared to patients with less EAT mass (&lt;67g), and even after adjusting for age and comorbidities, EAT mass was independently associated with LV diastolic function parameters. During a median follow-up of 8 years, 42 deaths occurred. Kaplan-Meier analysis showed that patients with increased EAT mass had higher all-cause mortality rate as compared to patients with less EAT mass (29% vs 7 %; P&lt;0.001). In the multivariable analysis, EAT was independently associated with all-cause mortality after adjusting for important covariates (HR:1.006; 95%CI:1.001-1.010). Conclusion In patients with SSc, EAT is independently associated with LV diastolic dysfunction and higher mortality rate.","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135874668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-25eCollection Date: 2023-09-01DOI: 10.1093/ehjimp/qyad035
Per M Arvidsson, Peregrine G Green, William D Watson, Mayooran Shanmuganathan, Einar Heiberg, Giovanni Luigi De Maria, Håkan Arheden, Neil Herring, Oliver J Rider
Aims: Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans.
Methods and results: Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R2 = 0.96, P < 0.0001, bias 4.6%), potential energy (R2 = 0.83, P = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R2 = 0.89, P = 0.0004, bias 5.8%), ventricular efficiency (R2 = 0.98, P < 0.0001, bias 0.8%), arterial elastance (R2 = 0.88, P = 0.0006, bias -8.0%), mean external power (R2 = 0.92, P = 0.0002, bias 4.4%), and energy per ejected volume (R2 = 0.89, P = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (P > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters.
Conclusion: Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.
目的:左心室(LV)压力-容积(PV)环路提供了金标准的生理信息,但需要侵入性测量心室腔内压力,限制了临床和研究应用。最近提出了一种从磁共振成像和臂袖血压计算PV环的无创方法。在这里,我们评估了非侵入性PV算法对人类侵入性左室压力的保真度。方法和结果:4例EF < 35%且左室不同步的心力衰竭患者行心血管磁共振(CMR)成像,随后行左室导管置管,并顺序给予两种不同的静脉代谢底物输注(胰岛素/葡萄糖和脂质乳),产生不同血流动力学状态的8个数据集。根据CMR容积计算压力-容积循环,并结合(i)按肱血压缩放的时变弹性函数,并暂时拉伸以匹配容积数据,或(ii) 19至30次采样心跳的平均侵入性压力。方法采用线性回归和Bland-Altman分析进行比较。方法推导出光伏循环参数表现出高度的相关性和低偏差相比,中风的入侵数据工作(R2 = 0.96, P < 0.0001,偏差4.6%),势能(R2 = 0.83, P = 0.001,偏差1.5%),收缩末期压力-容积关系(R2 = 0.89, P = 0.0004,偏差5.8%)、心室效率(R2 = 0.98, P < 0.0001,偏差0.8%),动脉倒电容(R2 = 0.88, P = 0.0006,偏差-8.0%),意思是外部力量(R2 = 0.92, P = 0.0002,偏差4.4%),和每喷射体积能量(R2 = 0.89, P = 0.0001,偏差3.7%)。估计舒张末期压的变化对结果没有显著影响(P < 0.05)。一年后的观察者内部分析显示,左室容积法的偏差为0.9-3.4%,PV环路衍生参数的偏差为0.2-5.4%。结论:通过CMR成像和肱袖带血压可以精确计算出压力-容积环。
{"title":"Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements.","authors":"Per M Arvidsson, Peregrine G Green, William D Watson, Mayooran Shanmuganathan, Einar Heiberg, Giovanni Luigi De Maria, Håkan Arheden, Neil Herring, Oliver J Rider","doi":"10.1093/ehjimp/qyad035","DOIUrl":"10.1093/ehjimp/qyad035","url":null,"abstract":"<p><strong>Aims: </strong>Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans.</p><p><strong>Methods and results: </strong>Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R<sup>2</sup> = 0.96, <i>P</i> < 0.0001, bias 4.6%), potential energy (R<sup>2</sup> = 0.83, <i>P</i> = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R<sup>2</sup> = 0.89, <i>P</i> = 0.0004, bias 5.8%), ventricular efficiency (R<sup>2</sup> = 0.98, <i>P</i> < 0.0001, bias 0.8%), arterial elastance (R<sup>2</sup> = 0.88, <i>P</i> = 0.0006, bias -8.0%), mean external power (R<sup>2</sup> = 0.92, <i>P</i> = 0.0002, bias 4.4%), and energy per ejected volume (R<sup>2</sup> = 0.89, <i>P</i> = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (<i>P</i> > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters.</p><p><strong>Conclusion: </strong>Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.</p>","PeriodicalId":94317,"journal":{"name":"European heart journal. Imaging methods and practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}