Left Ventricular Motion Abnormalities Research Articles

Association between Native Myocardial T1 Mapping and Cardiac Function and Macroscopic Fibrosis in Thalassemia Major

Background.Cardiovascular magnetic resonance (CMR) is the only available technique for the non-invasive quantification of MIO. The native T1 mapping has recently been proposed as an alternative to the universally adopted T2* technique, due to the higher sensitivity for detection of changes associated with mild or early iron overload. Objective.To study the association between T1 values and left ventricular (LV) function in thalassemia major (TM) and to evaluate for the first time if T1 measurements quantifying MIO are influenced by macroscopic myocardial fibrosis. Methods.146 TM patients (87 females, 38.7±11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network underwent CMR. Native T1 values were obtained by Modified Look-Locker Inversion recovery (MOLLI) sequence in all 16 myocardial segments and the global value was the mean. LV function parameters were quantified by cine images. Late gadolinium enhancement (LGE) technique was used to detect macroscopic myocardial fibrosis. Results.No correlation was detected between global heart T1 values and LV volume indexes, LV mass index, or LV ejection fraction. Foourteen (9.6%) patients had an abnormal LV motion (13 hypokinesia and 1 dyskinesia) and they showed significantly lower global heart T1 values than patients without LV motion abnormalities (883.8±139.7 ms vs 959.0±91.3 ms; P=0.049). LGE images were acquired in 88 patients (60.3%) and macroscopic myocardial fibrosis was detected in 36 patients (40.9%). The 72.2% of patients had two or more foci of fibrosis. Patients with macroscopic myocardial fibrosis had significantly lower global heart T1 values (921.3±100.3 ms vs 974.5±72.7 ms; P=0.027) (Figure 1A). Data about the LGE was present for 1408 segments (88 patients x 16 segments) and 105 (7.5%) were positive. Segments with LGE had significantly lower T1 values than segments LGE-negative (905.6±110.6 ms vs 956.9±103.8 ms; P<0.0001) (Figure 1B). Conclusion.No correlation between T1 values and LV function parameters was detected, probably because the majority of the patients had normal or mild abnormal LV parameters. TM patients with macroscopic myocardial fibrosis showed significantly lower T1 values suggesting that T1 measurements for quantifying MIO are not influenced by macroscopic myocardial fibrosis and an association between myocardial iron and macroscopic fibrosis, previously detected only in pediatric TM patients. Figure Disclosures Pepe: Chiesi Farmaceutici S.p.A.:Other: no profit support and speakers' honoraria;Bayer:Other: no profit support;ApoPharma Inc.:Other: no profit support.Pistoia:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

Identifying the anomaly in LV wall motion using eigenspace

In this paper, we have experimented left ventricular (LV) wall motion abnormalities using eigen LV space. We employ three phases of operations in order to perform efficient identification of LV motion abnormalities. In the first phase, LV border detection technique was used to detect LV area. In the second phase, eigen LV spaces of six abnormalities are to be converged as the search space. In the third phase, query is projected on this search space which leads matching of closest disease. The results proved using receiver operating characteristic (ROC) curve show that the proposed architecture provides high contribute to computer-aided diagnosis. Experiments were made on a set of 20 abnormal and 20 normal cases. We trained with eight normal and eight abnormal cases and yielded an accuracy of 88.8% for the proposed works and 75.81% and 79% respectively for earlier works. Our empirical evaluation has a superior diagnosis performance when compared to the performance of other recent works.

Identifying the anomaly in LV wall motion using eigenspace

In this paper, we have experimented left ventricular (LV) wall motion abnormalities using eigen LV space. We employ three phases of operations in order to perform efficient identification of LV motion abnormalities. In the first phase, LV border detection technique was used to detect LV area. In the second phase, eigen LV spaces of six abnormalities are to be converged as the search space. In the third phase, query is projected on this search space which leads matching of closest disease. The results proved using receiver operating characteristic (ROC) curve show that the proposed architecture provides high contribute to computer-aided diagnosis. Experiments were made on a set of 20 abnormal and 20 normal cases. We trained with eight normal and eight abnormal cases and yielded an accuracy of 88.8% for the proposed works and 75.81% and 79% respectively for earlier works. Our empirical evaluation has a superior diagnosis performance when compared to the performance of other recent works.

Localized basal left ventricular dyssynchrony induced by manifest accessory pathway: Successful differentiation from cardiac involvement of sarcoidosis with administration of flecainide acetate

We present a patient with non-cardiac sarcoidosis complicated with manifest ventricular preexcitation. Initially, cardiac involvement of sarcoidosis was suspected from the echocardiographic findings showing localized hypokinesia at the left ventricular basal inferior wall. We, however, considered that the hypokinesia was a preexcitation-induced mechanical dyssynchrony rather than cardiac sarcoidosis, because polarities of the delta-waves indicated a left ventricular inferior accessory pathway. Temporal administration of oral flecainide acetate eliminated the basal left ventricular motion abnormality. Accordingly, we could successfully differentiate the mechanism of hypokinesia. In this context, we could rule out cardiac sarcoidosis, and initiation of glucocorticoid therapy was reasonably withheld.

Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation

BackgroundCardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality. ObjectiveThe aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation. MethodsThe proposed method uses a recent image processing tool called “monogenic signal” to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy). ResultsThe results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively. ConclusionAccuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.

Presence of diastolic dysfunction after biphasic synchronized transthoracic shocks in a porcine model evaluated with CMR

Background Defibrillation and cardioversion are often used as lifesaving measures in cases of cardiac arrest and arrhythmias. Previous studies in humans with cardioversion of arrhythmias, found a decrease in ejection fraction but no significant changes in preload, afterload and heart rate. However, it is not clear whether the underlying cardiac condition may have contributed to these findings. This study aimed to observe the effects of biphasic synchronized shocks on left-ventricular function parameters over a 5-hour period in a porcine model. Methods Ten pigs received five consecutive biphasic synchronized shocks of 200J. Six pigs served as healthy controls and underwent the identical anesthesia and imaging protocol. Images were acquired with a clinical 3T MRI scanner (Siemens Magnetom Skyra). Routine functional cine imaging was completed for all pigs at baseline by acquiring a short-axis stack (7-10 slices) of the left ventricle. This imaging protocol was repeated hourly for 5 hours. All MR images were analyzed for cardiac function parameters (cardiac output, stroke volume, ejection fraction, end-diastolic and end-systolic volume) and in addition to assess left ventricular motion abnormalities. T2 maps were acquired at each time point to evaluate the presence of myocardial edema following the shock series. Results

Segmental left ventricular hypokinesis is associated with embolic signals in transcranial Doppler

Global left ventricular (LV) hypokinesis is considered to be the cause of stroke, while the significance of segmental wall motion abnormalities is still unknown. The aim of the study was to determine the frequency of embolic signals in the middle cerebral artery in patients with segmental LV wall hypokinesis in the course of coronary artery disease (CAD) with and without stroke. The study included 68 patients (aged 21-87 years) with segmental LV wall hypokinesis (33 patients without and 35 with stroke). The reference group comprised 30 patients (aged 43-76 years) with atherosclerotic risk factors; the control group comprised 37 healthy volunteers (aged 41-71 years). All subjects underwent echocardiography and carotid and transcranial Doppler ultrasound with the detection of microembolic signals. Embolic signals were observed significantly more often in patients with segmental LV wall hypokinesis than in the control and reference groups. In patients with CAD and stroke, an increased number of embolic signals (≥3) was observed significantly more often compared with patients without stroke. Compared with other locations, interventricular septum and apex hypokinesis was associated with a higher frequency of embolic signals in the middle cerebral arteries. Segmental LV motion abnormalities in the form of hypokinesis in patients with CAD are associated with the presence of embolic signals in the middle cerebral arteries, which may have clinical significance as a risk factor for stroke.

Normal left ventricular twist in patients with non-compaction cardiomyopathy, or in normal subjects with hypertrabeculation?

We read with great interest the article by Pacileo et al. ,1 recently published in the European Journal of Echocardiography. The authors described normal left ventricular (LV) twist in 14 patients with non-compaction cardiomyopathy (NCCM). This finding is in sharp contrast to severely impaired LV twist described in larger series by us2,3 and others.4 Also, an abnormal LV motion pattern called ‘rigid body …

Detection of Left Ventricular Motion Abnormality Via Information Measures and Bayesian Filtering

We present an original information theoretic measure of heart motion based on the Shannon's differential entropy (SDE), which allows heart wall motion abnormality detection. Based on functional images, which are subject to noise and segmentation inaccuracies, heart wall motion analysis is acknowledged as a difficult problem, and as such, incorporation of prior knowledge is crucial for improving accuracy. Given incomplete, noisy data and a dynamic model, the Kalman filter, a well-known recursive Bayesian filter, is devised in this study to the estimation of the left ventricular (LV) cavity points. However, due to similarity between the statistical information of normal and abnormal heart motions, detecting and classifying abnormality is a challenging problem, which we investigate with a global measure based on the SDE. We further derive two other possible information theoretic abnormality detection criteria, one is based on Rényi entropy and the other on Fisher information. The proposed methods analyze wall motion quantitatively by constructing distributions of the normalized radial distance estimates of the LV cavity. Using 269 x 20 segmented LV cavities of short-axis MRI obtained from 30 subjects, the experimental analysis demonstrates that the proposed SDE criterion can lead to a significant improvement over other features that are prevalent in the literature related to the LV cavity, namely, mean radial displacement and mean radial velocity.

Usefulness of contrast echocardiography for assessment of intracardiac masses

Conventional echocardiography is not a reliable method for characterizing tissue patterns of intracardiac masses. To assess the ability of contrast echocardiography to characterize intracardiac masses. Thirty-one consecutive patients with an intracardiac mass were included in this prospective study. All patients underwent conventional and contrast echocardiographic examinations. Analysis of characteristics by contrast agent allowed classification of intracardiac masses as follows: complete lack of enhancement, suggesting thrombus; partial and/or incomplete enhancement, suggesting myxoma; complete enhancement, suggesting intracardiac tumor. Tissue characteristics of intracardiac masses were also analyzed using at least one of the following techniques: cardiac magnetic resonance, pathology of intracardiac mass and/or mass resolved after anticoagulation during follow-up. Using contrast echocardiography, an accurate diagnosis was made in all patients by an experienced investigator and in all patients except one (97%), by a physician trainee (p=0.31). Among patients with a history of tumor, echocardiography allowed accurate diagnosis of the nature of the mass in all patients; 50% of these patients presented with a secondary cardiac tumor and the others had a thrombus. Of the 14patients with a thrombus located in the left ventricle, 12 (86%) presented with left ventricular motion abnormalities using conventional echocardiography, whereas wall motion abnormalities were observed in all 14patients (100%) using contrast agent. In these patients, 91 and 99% of left ventricular segments were well visualized using conventional and contrast echocardiography, respectively (p<0.0001). Contrast echocardiography may be useful for the tissue characterization of intracardiac masses.

Atypical Stunned Myocardium Caused by Severe Pulmonary Dysfunction

We present the case of a 71-year-old Japanese man suffering from severe dyspnea who showed abnormal left ventricular motion in cardiac echogram with ST-T elevation in electrocardiogram, which at first was misdiagnosed as an acute myocardial infarction. Coronary angiography showed neither coronary obstructions nor spasms. The symptoms were transient and the patient soon recovered. We speculate that it is a specific type of atypical stunned myocardium caused by the great stress of severe pulmonary dysfunction.

A typical Stunned Myocardium Caused by Severe Pulmonary Dysfunction

We present the case of a 71-year-old Japanese man suffering from severe dyspnea who showed abnormal left ventricular motion in cardiac echogram with ST-T elevation in electrocardiogram, which at first was misdiagnosed as an acute myocardial infarction. Coronary angiography showed neither coronary obstructions nor spasms. The symptoms were transient and the patient soon recovered. We speculate that it is a specific type of atypical stunned myocardium caused by the great stress of severe pulmonary dysfunction.

Etiology of mitral regurgitation in secundum atrial septal defect.

Non-rheumatic mitral regurgitation was found in 9.1% (27 patients) of all patients with secundum atrial septal defect (298 patients) who were operated on during a 13-year period at the Mitsui Memorial Hospital. This combined lesion was more frequent in female (12.3%, 19 patients) than male (5.6%, 8 patients), and the incidence tended to increase with age. Inspection at operation revealed a marked fibrous thickening of the anterior and posterior mitral valve leaflets with a localized bulging into the left atrium in the posteromedial commissural area. Similar, but less prominent change was found in nearly all patients above 20 years of age with mitral regurgitation, although the small area where the commissural chordae were attached was not involved. A friction between anterior and posterior mitral leaflets due to abnormal left ventricular motion secondary to the right ventricular volume overload might be responsible to the genesis of this lesion. Mitral annuloplasty was performed on 21 of 27 patients with a satisfactory result without operative mortality. Except one case of early death from cerebral thromboembolism they were all restored to a functional status of class I by NYHA standard within one year after operation, and there were no late death during a follow-up period of as long as 12 years. We propose a new entity "ASD, MR complex" for this combined lesion, as it demonstrates a specific pathophysiology, and necessitates a different procedure for surgical correction from that of a secundum atrial septal defect without other anomalies.

Augmentation of left ventricular contraction pattern in coronary artery disease by an inotropic catecholamine. The epinephrine ventriculogram.

In order to assess potential improvement in abnormal left ventricular (LV) wall motion, eighteen subjects — sixteen with obstructive coronary artery disease and LV asynergy and two with no evidence of organic heart disease — were studied by cardiac catheterization and cineangiography. Ventriculograms were performed at rest and during a constant infusion of l-epinephrine (EPI) at 1-4 µg/min after an average of nine minutes steady state. EPI infusion induced augmentation of LV contraction pattern in both normal subjects and in all normal zones in the sixteen subjects with asynergy, and in no instance was contraction in a normal zone rendered abnormal. Eleven of sixteen patients showed improved contraction in previously asynergic areas, two of whom also demonstrated paradoxical motion in an abnormal zone. Of a total of forty-four resting asynergic zones, twenty-three exhibited an improved contraction pattern with EPI, one showed depressed contraction, two demonstrated both an increase and deterioration in the same zone (paradoxical motion), and eighteen showed no change. Quantitative motion analysis generally corroborated these qualitative ventriculographic observations. Heart rate, LV systolic pressure and LV end-diastolic pressure increased slightly with EPI, but were not significantly changed from control values. While there was wide variation in end-diastolic volume in the subjects with asynergy, EPI resulted in an increase in both stroke volume and ejection fraction, the latter significantly ( P &lt; 0.05). In the four subjects who subsequently underwent aneurysmectomy, preoperative lack of improvement with EPI correlated with a pathologic diagnosis of fibrosis. Other than angina pectoris of brief duration in two subjects, EPI provoked no untoward reactions, arrhythmias or complications. It is concluded that LV motion abnormalities can be improved or changed in certain cases by the inotropic stimulus of EPI, suggesting residual contractile ability; the agent may differentiate between zones of potentially functional cardiac muscle and frank fibrosis.

The value of exercise tests in patients with abnormal resting electrocardiograms

Resting int’racardiac pressures and cardiac output were normal. Response to exercise demonstrated an increase in st#roke volume and cardiac output by 370/,, and the left ventricular end-diastolic pressure increased only slightly, while the left vemricular dp/dt, increased moderately. It now appears possible to reverse episodes of acute rejection, if they are detected early, in the majority of cases. In our patients, no evidence of myocardial ischemia or late funct.ional impairment of the transplanted heart has been demonstrat.ed. The Value of Exercise Tests in Patients with Abnormal Resting Electrocardiograms PETER F. COHN, MD/HARVEY G. KEMP, MD and RICHARD GORLIN, MD, FACC Boston, Massachusetts To investigate the usefulness of exercise tests in patients with abnormal resting electrocardiograms, 60 subjects who had undergone selective coronary cinearteriography were exercised with the standard double Master’s two step test and their electrocardiographic responses compared with their coronary anatomy. These subjects were suspected clinically of having coronary artery disease uncomplicated by other forms of heart disease; they were not receiving digitalis or beta adrenergic blockers, and had resting electrocardiograms demonstrating stable minor or major ST-T abnormalities and/or evidence of old transmural myocardial infarction. Subjects presenting with conduction disturbances and arrhythmias in the resting electrocardiogram were not included in this study. The exercise tests were interpreted as positive when the S-T segment showed an initial or further depression of at least 1 mm. No negative tests were included if post-exercise heart rate was less than 110 beats/min. Result,s are as follows : 44 Patients 16 Patients With Coronary Without Coronary Artery Disease Artery Disease Master’s test positive 35 (30%) 4 (25%) Master’s test negative 9 (20%) I2 (75%) ConverseIy, of the subjects with positive tests, 90% had anatomic coronary artery disease ; of the group with negative tests, 500/, had coronary artery disease. Subjects with three vessel disease had 90% positivity; those with two vessel disease, 75% positivity; and those with one vessel disease, 0%. Of the subjects with S-T segment depression of 2 mm or more, 96 percent had anatomic coronary artery disease. The anterior zonal leads were clearly more sensitive than the inferior ones in showing electrocardiographic abnormalit,ies. No fatalities or serious complications were observed. Abnormal Heart Sounds and Apexcardiographic A Waves in Patients with Coronary Artery Disease PETER F. COHN, MDjPANTEL S. VOKONAS, MD/RICHARD WILLIAMS, MD MICHAEL V. HERMAN, MD and RICHARD GORLIN. MD, FACC Boston, Massachusetts Despite numerous reports of an increased incidence of abnormal heart sounds and apexcardiographic A waves in patients wit,h coronary artery disease, correlations of these clinical findings with both hemodynamic and anatomic data have been lacking. Forty subjects underwent cardiac catheterization, selective coronary cinearteriography and left ventriculography, and were found to have coronary artery disease uncomplicated by other forms of heart disease. They were also studied with the phonocardiogram (PCG) and/or apexcardiagram (ACG) to document the presence or absence of a third or fourth sound or abnormal A wave. Results are shown in the table at right. The vast majority of patients with abnormal PCG-ACG studies had either three vessel disease, abnormal ventriculograms or elevated left ventricular end-diastolic pressure. Conversely, no subject presenting with normal PCGACG studies had combined three vessel disease, abnormal left ventricular motion study, and elevated LVEDP. Of the three PCG-ACG parameters, the abnormal A wave was the most sensitive single index of an elevat,ed left ventricular end-diastolic pressure and of an abnormal ventriculogram, but was one third less reliable than all three parameters taken together. No accurate prediction of three vessel disease could be made from any single parameter. 22 Subjects 18 Subjects With Without PCGACG PCGACG Abnormalities Abnormalities Three vessel disease Abnormal ventriculogram Left ventricular end-diastolic pressure above 12 mm Hg All of the above Cardiac index below 3.0 liters/min 36% 34%

The Ventricular Pulsations in Myocardial Infarction; a Fluoroscopic and Kymographic Study

Cardiac fluoroscopy and kymography give important information in the study of the patient with myocardial infarction. The observation of marked localized diminution of pulsation of the left ventricular border or of complete or partial reversal of pulsation is indicative of a circumscribed area of myocardial damage, usually as a result of previous myocardial infarction. Such findings may be observed in the absence of other typical clinical findings of previous myocardial infarction. Careful examination of left ventricular border motion should be a routine part of every chest fluoroscopy. The incidence, location, duration, clinical significance, differential diagnosis and physiologic basis for abnormal left ventricular motion in myocardial infarction is reviewed.