Shape Of Ventricle Research Articles

Lateral ventricle morphology analysis via mean latitude axis.

Statistical shape analysis has emerged as an insightful method for evaluating brain structures in neuroimaging studies, however most shape frameworks are surface based and thus directly depend on the quality of surface alignment. In contrast, medial descriptions employ thickness information as alignment-independent shape metric. We propose a joint framework that computes local medial thickness information via a mean latitude axis from the well-known spherical harmonic (SPHARM-PDM) shape framework. In this work, we applied SPHARM derived medial representations to the morphological analysis of lateral ventricles in neonates. Mild ventriculomegaly (MVM) subjects are compared to healthy controls to highlight the potential of the methodology. Lateral ventricles were obtained from MRI scans of neonates (9-144 days of age) from 30 MVM subjects as well as age- and sex-matched normal controls (60 total). SPHARM-PDM shape analysis was extended to compute a mean latitude axis directly from the spherical parameterization. Local thickness and area was straightforwardly determined. MVM and healthy controls were compared using local MANOVA and compared with the traditional SPHARM-PDM analysis. Both surface and mean latitude axis findings differentiate successfully MVM and healthy lateral ventricle morphology. Lateral ventricles in MVM neonates show enlarged shapes in tail and head. Mean latitude axis is able to find significant differences all along the lateral ventricle shape, demonstrating that local thickness analysis provides significant insight over traditional SPHARM-PDM. This study is the first to precisely quantify 3D lateral ventricle morphology in MVM neonates using shape analysis.

Segmentation by retrieval with guided random walks: Application to left ventricle segmentation in MRI

In this paper, a new segmentation framework with prior knowledge is proposed and applied to the left ventricles in cardiac Cine MRI sequences. We introduce a new formulation of the random walks method, coined as guided random walks, in which prior knowledge is integrated seamlessly. In comparison with existing approaches that incorporate statistical shape models, our method does not extract any principal model of the shape or appearance of the left ventricle. Instead, segmentation is accompanied by retrieving the closest subject in the database that guides the segmentation the best. Using this techniques, rare cases can also effectively exploit prior knowledge from few samples in training set. These cases are usually disregarded in statistical shape models as they are outnumbered by frequent cases (effect of class population). In the worst-case scenario, if there is no matching case in the database to guide the segmentation, performance of the proposed method reaches to the conventional random walks, which is shown to be accurate if sufficient number of seeds is provided. There is a fast solution to the proposed guided random walks by using sparse linear matrix operations and the whole framework can be seamlessly implemented in a parallel architecture. The method has been validated on a comprehensive clinical dataset of 3D+t short axis MR images of 104 subjects from 5 categories (normal, dilated left ventricle, ventricular hypertrophy, recent myocardial infarction, and heart failure). The average segmentation errors were found to be 1.54 mm for the endocardium and 1.48 mm for the epicardium. The method was validated by measuring different algorithmic and physiologic indices and quantified with manual segmentation ground truths, provided by a cardiologist.

Novel Indices for Left-Ventricular Dyssynchrony Characterization Based on Highly Automated Segmentation From Real-Time 3-D Echocardiography

Cardiac resynchronization therapy (CRT) using a biventricular pacemaker is an invasive and expensive treatment option for left ventricular mechanical dyssynchrony (LVMD). The CRT candidate selection is a crucial issue due to the unreliability of the current standard CRT indicators. Real-time three-dimensional (3-D) echocardiography (RT3DE) provides four-dimensional (4-D) (3-D+time) information about the LV and is suitable for LVMD assessment. In this article, the complex left ventricle (LV) shape and motion of 50 RT3DE datasets are represented by novel 4-D descriptors — 4-D sphericity, volume and shape, from which novel indices were derived by principal component analysis (PCA) and subsequently analyzed by a support vector machine (SVM) classifier to assess their capability of LVMD characterization and CRT outcome prediction. These novel indices outperformed clinical indices and have promising capabilities in disease characterization and great potential in CRT outcome prediction. To enable efficient quantitative RT3DE analysis, a segmentation method was developed to combine the powers of active shape models and optimal graph search. Various aspects of the method were designed to handle varying RT3DE image quality among datasets and LV segments. An application with graphical user interface was developed to provide the user with simple and intuitive control. The developed method was robust to inter-observer variability and produced very good accuracy — 3.2±1.1 mm absolute surface positioning error, <1 mm mean signed error and <5% mean volume difference. The computer method’s classification performance was compared with the independent standard, showing that the 4-D shape modal indices were not only the most capable of all tested options when employed for disease characterization but also the least sensitive to segmentation imperfections.

Growth in a Turing Model of Cortical Folding

The brain's cerebral cortex is folded into many gyri (hills) and sulci (valleys). Little is known about how the cortex folds or why the folds are located where they are. We have developed a spatio-temporal mathematical model of cortical folding to address this question. Our model utilizes a Turing reaction-diffusion system on an exponentially growing prolate spheroidal domain. This domain approximates the shape of the lateral ventricle (LV) during cortical development. The Intermediate Progenitor Model (IPM) of cortical folding states that regional patterning of self-amplication of intermediate progenitor cells (IPCs) in the subventricular zone of the LV corresponds with the formation of cortical folding. As self-amplication of IPCs is genetically controlled via chemical gradients, a Turing system is a logical choice to create a mathematical representation of the IPM. A growing domain model of cortical folding may be more realistic than previous static domain models of cortical folding since it incorporates the growth that naturally occurs as the brain develops. By comparing patterns generated by our growing prolate spheroid Turing system with those generated by a static prolate spheroid Turing system, we show that the addition of growth causes a significant change in system behavior; the system produces transient patterns instead of converging to one final pattern. Our model illustrates the importance of including growth in a model of cortical folding and can be utilized to explain certain human diseases of cortical folding.

Periventricular nodular heterotopia is related to severity of the hindbrain deformity in Chiari II malformation

Knowledge of the occurrence of malformations of cortical development (MCDs) and its relationship to hindbrain deformity in Chiari II malformation (CIIM) is limited. To assess malformations of cortical development and its relationship to hindbrain deformity regarding Chiari II malformation. Brain and cervical spinal MRI from 66 children (age range, 1-256days; mean age, 22.3days) with Chiari II malformation were retrospectively reviewed. If present, the type, number and location of malformations of cortical development were recorded. Hindbrain deformity was assessed for the level of the medullary kink, the descent of the pons and the shape of the fourth ventricle; these parameters were compared in children with and without malformations of cortical development. Twenty children with malformations of cortical development were identified. Only periventricular nodular heterotopia was noted. The median level of the medullary kink was significantly lower in children with malformations of cortical development compared with children without it (P = 0.037). A low pontomesencephalic junction was identified more frequently in children with malformations of cortical development (65.0%), relative to children without malformations of cortical development (34.8%) (P = 0.045). The fourth ventricular shape was not significantly different in children with or without malformations of cortical development (P = 0.684). Periventricular nodular heterotopia was seen in a relatively high proportion of children with Chiari II malformation, suggesting that it may be associated with severe hindbrain deformity.

The shape and function of the right ventricle in Ebstein's anomaly

BackgroundEbstein's anomaly involves both the right ventricle (RV) and tricuspid valve. MethodsThe functional RV and tricuspid orifice were traced from magnetic resonance images in 29 adult Ebstein patients and 9 normal subjects and reconstructed for visualization and measurement of regional RV size, function, and shape at 20 cross sections, and inlet and outflow tract ejection fractions (EFs). ResultsThe RV in Ebstein's had RV dilation (end diastolic volume index 179±69 vs. 84±22ml/m2 in normals, p<0.001) and global dysfunction (EF 45±8 vs. 55±5% in normals, p<0.001). Longitudinal contraction was preserved (26±13 vs. 26±4mm in normals) and correlated more weakly with EF than short axis fractional shortening (r=0.44 vs. r=0.71, p<0.05 for both). The apical region in Ebstein's RV was enlarged, rounded and contributed more than normal to the global stroke volume. However this contribution correlated inversely with global EF. In contrast slices in the basal region had normal cross sectional area and their function correlated directly with global EF. Inlet EF was depressed (46±8% vs. 55±6 in normals, p=.002); outflow tract EF was even more depressed (39±14, p=0.019). ConclusionThe three dimensional shape of the RV in adult Ebstein patients was demonstrated. The Ebstein's RV remodels in diverse regional patterns rather than following a shape continuum. Changes at the apex and base had opposing effects on function. Global EF was supported more by short axis than longitudinal contraction.

Diagnosis of grey matter heterotopia on cerebral ultrasound in a newborn: lessons from a case report for daily clinical practice

Grey matter heterotopias result from premature arrest of neuronal migration from the germinal matrix in the lateral ventricular wall to the developing cortex. To date, heterotopias have been exclusively diagnosed on magnetic resonance imaging (MRI). We present a case of heterotopia primarily detected with transfontanellar cranial ultrasonography (CUS) and review the literature for sonographic signs to suggest the presence of this pathological entity. Transfontanellar CUS evaluation of a preterm twin revealed a prominent rectangular-shaped left lateral ventricle. Subsequent angled views identified an abnormally increased echogenicity within the ipsilateral cortex. MRI confirmed subependymal and possibly subcortical heterotopia. A literature review using the search words ‘grey matter heterotopia’ was undertaken and further refined for specific information related to imaging criteria on MRI or sonography. Neuroradiologists classify heterotopias on MRI by location and appearance into three types: subependymal, subcortical and band types. Signs of subependymal heterotopia on CUS include ventricular wall irregularity, hyperechoic periventricular band and isolated hyperechoic periventricular nodules protruding into the ventricle. They are rarely associated with cortical lesions. CUS signs of subcortical heterotopia include abnormal hyperechoic regions in the white matter. Our sonographic imaging revealed an irregular shape of the left ventricle suggestive of subependymal heterotopia. Other abnormalities described with subependymal heterotopia were not found. A hyperechoic structure in the left cortical region next to the affected lateral ventricle could represent enfolded cortex as is seen in subcortical heterotopia. We propose an extended search for cerebral lesions outside the usual field of view (i.e. white matter and cortex) using angled coronal and parasagittal CUS views to display frontal, occipital and lateral cortices as optimally as can be achieved whenever an angular or irregular lateral ventricle shape is encountered. The differential diagnoses including haemorrhagic, ischaemic and structural parenchymal lesions should be extended to include grey matter heterotopia.

Takotsubo syndrome in a patient after renal transplantation

SummaryBackgroundTakotsubo syndrome (TTS) is a transient cardiomyopathy of unknown origin, clinically manifesting as acute coronary syndrome (ACS). This syndrome mainly occurs in postmenopausal women and has a temporary relationship with emotional or physical stress.Case ReportTTS occurred in 46-year-old female patient on the first day after renal transplantation. The predominant symptoms were connected with ACS, performed with low grade troponin elevation and characteristic shape of left ventricle depicted in echocardiography. Taking into consideration the risk of the development of contrast-induced nephropathy, coronary angiography (CA) was delayed; myocardial perfusion scintigraphy and iodine-123 metaiodobenzylguanidine (123I-mIBG) myocardial uptake were performed to confirm the clinical suspicion. Myocardial perfusion scintigraphy (MPS) performed in rest condition showed normal perfusion but myocardial uptake of 123I-mIBG was impaired. Within 6 months after surgery, full recovery of all biochemical and functional parameters of the left ventricle were observed. At that time CA was done, depicting normal coronary arteries.ConclusionsTTS could be diagnosed by the use of non-nephrotoxic tests – 123I-mIBG myocardial scintigraphy, MPS and echocardiography.

STUDY ON THE CORRELATION BETWEEN PLASMA NT-PROBNP CONCENTRATION AND STRUCTURAL CHANGE AND DYSFUNCTION OF LEFT VENTRICLE IN DIABETIC TYPE 2 PATIENTS

Objectives: 1.To measure plasma NT- proBNP levels, shape and function of left ventricle of diabetic type 2 patients, and (2) To explore the correlation between plasma NT-proBNP levels and the shape and function of the left ventricle, and heart failure according to Framingham, NYHA, and ACC/AHA criteria. Materials and Methods: Cross-sectional and descriptive study on 104 diabetic type 2 patients through the measurements of plasma NT-proBNP levels, ECG and Doppler echocardiography. Results: Average plasma NT-proBNP level: 142.17 ± 186.95 pg/ml. The results highlighted that: (1) Plasma NT-proBNP level significantly increases with age, the detection time, the severity of clinical heart failure, left ventricle hypertrophy, and diastolic-systolic dysfunction of left ventricle (p &lt;0.05), and (2) Plasma NT-proBNP level significantly correlates with heart failure based on Framingham criteria (r = 0.66; p &lt; 0.001), functional heart failure based on NYHA classification (r = 0.676; p &lt; 0.001), the stage of heart failure based on the ACC/AHA guidelines (r = 0.709; p &lt; 0.001), left ventricle hypertrophy based on Sokolow-Lyon (r = 0.346; QTc (r = 0.471; p &lt; 0.001), LVMI (r = 0,701; p &lt; 0,001), diastolic dysfunction grades (r = 0.604; p &lt; 0.001), DTE (r = 0.437; p &lt; 0.001), IVRT (r = 0.29; p = 0.003), EF (r = - 0.414; p &lt; 0.001), and systolic dysfunction grades (r = 0.502; p &lt; 0.001). Conclusion : At the cut-point of 125 pg/ml, plasma NT-proBNP level has the prognostic value of left ventricle hypertrophy, and diastolic-systolic dysfunction of left ventricle in diabetic type 2 patients.

Neuroendoscopic treatment of different types of quadrigeminal cistern arachnoid cysts

To evaluate the method, strategy and efficacy of treating different types of quadrigeminal cistern arachnoid cysts (QCAC) with neuroendoscope. A retrospective analysis was conducted for 12 QCAC patients with obstructive hydrocephalus. They were classified into 3 types and underwent neuroendoscopic operation at our hospital between November 2005 and November 2009. Their surgical approaches, complications and efficacy were analyzed. The mean age of first diagnosis was 3.7 years old. There were 7 type II cases and 5 type III cases with a varying level of symptoms. The follow-up period was 6 - 24 months. Cine-MRI (magnetic resonance imaging) examination was performed both preoperatively and post-operatively. Among them, 12 patients recovered well without any occurrence of hemorrhage, paralysis, lower cranial nerve injury, cerebrospinal fluid leakage, infection or death. Subdural effusion occurred in 3 cases, but disappeared within 6 months. Seven feverish cases recovered after a symptomatic treatment. The shapes of cysts and ventricles almost returned to a normal level in 8 cases. Three cases of arachnoid cyst had a slight change. In accordance with the QCAC patient types, different neuroendoscopic approaches can fully reconstruct the cerebrospinal fluid circulation. And the use of frameless navigation makes it more precise and safe.

Left ventricular wall stress compendium

Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

A bovine pericardium rigid prosthesis for left ventricle restoration: 12 years of follow-up

Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ± 20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.

Deficiency of Biglycan Causes Cardiac Fibroblasts to Differentiate into a Myofibroblast Phenotype

Myocardial infarction (MI) is followed by extracellular matrix (ECM) remodeling, which is on the one hand required for the healing response and the formation of stable scar tissue. However, on the other hand, ECM remodeling can lead to fibrosis and decreased ventricular compliance. The small leucine-rich proteoglycan (SLRP), biglycan (bgn), has been shown to be critically involved in these processes. During post-infarct remodeling cardiac fibroblasts differentiate into myofibroblasts which are the main cell type mediating ECM remodeling. The aim of the present study was to characterize the role of bgn in modulating the phenotype of cardiac fibroblasts. Cardiac fibroblasts were isolated from hearts of wild-type (WT) versus bgn(-/0) mice. Phenotypic characterization of the bgn(-/0) fibroblasts revealed increased proliferation. Importantly, this phenotype of bgn(-/0) fibroblasts was abolished to the WT level by reconstitution of biglycan in the ECM. TGF-β receptor II expression and phosphorylation of SMAD2 were increased. Furthermore, indicative of a myofibroblast phenotype bgn(-/0) fibroblasts were characterized by increased α-smooth muscle actin (α-SMA) incorporated into stress fibers, increased formation of focal adhesions, and increased contraction of collagen gels. Administration of neutralizing antibodies to TGF-β reversed the pro-proliferative, myofibroblastic phenotype. In vivo post-MI α-SMA, TGF-β receptor II expression, and SMAD2 phosphorylation were markedly increased in bgn(-/0) mice. Collectively, the data suggest that bgn deficiency promotes myofibroblast differentiation and proliferation in vitro and in vivo likely due to increased responses to TGF-β and SMAD2 signaling.

Prediction of left ventricular remodelling by radionuclide imaging

Left ventricular remodelling is a complex process by which mechanical, neurohormonal and genetic factors alter ventricular structure and function leading to reduced mechanical performance, electrical instability and sudden death [1]. It is an important aspect of heart failure progression, characterized by dilatation and change of shape of the left ventricle (LV) as well as alterations in the ventricular wall which include hypertrophy, loss of myocytes and increased interstitial fibrosis [2]. At the molecular level, it is characterized by a regression to the fetal pattern, i.e. increase of β-myosin heavy chain, α-actin, atrial natriuretic peptide overexpression, sarco/endoplasmic reticulum CaATPase activity decrease and a shift of myocardial metabolism towards glucose utilization [3, 4]. Acute myocardial infarction (MI) is a common cause of LV remodelling. It is estimated that despite primary percutaneous coronary intervention (PCI) and standard current therapy, around 30% of anterior MIs will develop remodelling. The three major biomechanical mechanisms contributing to the increase of LV volumes over time after MI are: (1) expansion of the infarct in the subacute phase [5], (2) subsequent non-ischaemic infarct extension into the adjacent non-infarcted region [6, 7] and (3) hypertrophy and dilatation of non-infarcted myocardium in the chronic phase [8–10]. The main factors associated with remodelling are size of infarction, anterior location and late or unsuccessful (or absence of) reperfusion therapy both at the epicardial vessel level and at the microvasculature level. LV remodelling, however, is a potentially reversible or even possibly preventable process. Regression is manifested as a return to a more normal ventricular size and shape and appears to be a good predictor of a reduction in morbidity and mortality [2, 11]. Several trials on post acute MI patients have demonstrated that this can be achieved by a combination of treatment regimes [12]. This is understandable considering that the three aforementioned mechanisms operate in different regions of the LV and during different time frames after MI, thus making it unlikely for any single drug to be completely effective in addressing all three mechanisms [12]. A major determinant to the selection of the appropriate treatment is the propensity of the underlying MI to result in LV remodelling. Therefore, accurate monitoring of post acute MI patients to identify those who are likely to develop LV remodelling is of great importance. Based on the mechanistic rationale described above, monitoring is performed with non-invasive imaging and usually includes assessment of heart size, shape and mass, ejection fraction (EF), end-diastolic and end-systolic volumes and regional contractility. Cardiac magnetic resonance (CMR) is the gold standard to assess these parameters as well microvascular obstruction and infarct size. A consistent finding from the CMR literature in the post acute MI setting is that scar size is a key determinant of long-term LV remodelling. Moreover, there are distinct time-dependent patterns of infarct healing and LV remodelling which suggest that the timing of CMR performance is important for assessment of infarct size and prediction of C. D. Anagnostopoulos (*) Nuclear Medicine Division, PET/CT Department, Clinical Research Center, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou St., 115 27 Athens, Greece e-mail: cdanagnostopoulos@bioacademy.gr

Impact of surgical ventricular restoration on ventricular shape, wall stress, and function in heart failure patients

Surgical ventricular restoration (SVR) was designed to treat patients with aneurysms or large akinetic walls and dilated ventricles. Yet, crucial aspects essential to the efficacy of this procedure like optimal shape and size of the left ventricle (LV) are still debatable. The objective of this study is to quantify the efficacy of SVR based on LV regional shape in terms of curvedness, wall stress, and ventricular systolic function. A total of 40 patients underwent magnetic resonance imaging (MRI) before and after SVR. Both short-axis and long-axis MRI were used to reconstruct end-diastolic and end-systolic three-dimensional LV geometry. The regional shape in terms of surface curvedness, wall thickness, and wall stress indexes were determined for the entire LV. The infarct, border, and remote zones were defined in terms of end-diastolic wall thickness. The LV global systolic function in terms of global ejection fraction, the ratio between stroke work (SW) and end-diastolic volume (SW/EDV), the maximal rate of change of pressure-normalized stress (dσ*/dt(max)), and the regional function in terms of surface area change were examined. The LV end-diastolic and end-systolic volumes were significantly reduced, and global systolic function was improved in ejection fraction, SW/EDV, and dσ*/dt(max). In addition, the end-diastolic and end-systolic stresses in all zones were reduced. Although there was a slight increase in regional curvedness and surface area change in each zone, the change was not significant. Also, while SVR reduced LV wall stress with increased global LV systolic function, regional LV shape and function did not significantly improve.

Double-patch sandwich repair for left ventricular free wall rupture

We present a case of a patient with left ventricular free wall rupture who successfully underwent emergency surgical repair using the double-patch sandwich technique. This technique has already been used for the treatment of left ventricular aneurysm and retains the proper shape and size of the left ventricle. Multislice computed tomography was fast and non-invasive in the detection of a ventricular rupture.

087 Left ventricle shape and trabeculations in idiopathic dilated cardiomyopathy assessed by cardiac magnetic resonance imaging

Idiopathic dilated cardiomyopathies (IDC) frequently develop left ventricle (LV) hypertrabeculation which bring to doubt about the diagnostic of LV non compaction (LVNC). The high spatial resolution of cardiac magnetic resonance imaging (CMR) allows distinguishing myocardial trabeculations explaining the exponential rise in the number of reports describing LVNC. To study the correlation between the LV shape and myocardial trabeculations regarding the BNP level in a population of IDC. Between November 2007 and November 2009, 48 IDC were prospectively assessed by CMR. Patients with echocardiographic LV ejection fraction (LVEF) > 45%, severe valvulopathy or usual criteria of LVNC were excluded. Patients with significant coronary artery disease (coronary stenosis > 50%) at the angiogram or subendocardium gadolinium delayed enhancement at the CMR were considered as ischemic cardiomyopathy and were excluded. LV end-diastolic volume (EDV) and end-systolic volume were measured by summing cine-CMR LV short axis slice. Sphericity index (SI) was defined as the ratio of LV end-diastolic diameter (EDD) on LV length measured respectively in midventricular short axis and midventricular 4 chambers cine-CMR views. LV trabeculation index (LVTI) was defined as the ratio of trabeculated on compacted layers thickness in a 16-segment model excluding apex. BNP was measured for each patient. Mean age was 52 ± 14 years with 29 (60%) men. Mean LVEF was 25 ± 10% with a mean indexed EDD of 37 ± 5 mm/m 2 and EDV of 135 ± 45 ml/m 2 . LVTI was not correlate with indexed EDV (r = 0.14; p = 0.34) and LVEF (r = 0.02, p = 0.9) but it was linearly correlated with SI (r = 0.26; p = 0.046) and had a tendency to have a negative correlation with BNP level (r = −0.26; p = 0.07). These results suggest that LV myocardial trabeculation thickness increases linearly with the LV shape sphericity and has a tendency to decrease with the rise of LV pressure regime assessed by BNP level.

Assessment of shape and function of right ventricle in heart transplantation patients by single beat real-time three-dimensional echocardiography

Objective To investigate the shape and function of right ventricles in patients received heart transplantation(HT). Methods Sixty healthy volunteers(control group) and 31 HT patients(HT group) were enrolled, and the HT group was further divided into the nonrejected(HTn) group and the rejected(HTp) group based on the endomyocardial biopsy(EMB) results. All the participants received routine echocardiography. Single beat real-time three-dimensional echocardiography (sRT-3DE) was performed in all to evaluate parameters concerning modality and systolic function of participants' right ventricles. Results 1) Right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were significantly different among the groups[RVSV: control group vs HTn group vs HTp group was (56.18 ± 23.72)ml vs (36.08 ± 10.94)ml vs (26.22 ± 9.84)ml, P ＜0.0001; RVEF:control group vs HTn group vs HTp group was (62.09± 7.18)% vs (51.04 ± 7.58) vs (35.86 ± 9.86)%, P ＜0.00001＝.2＝ When taking the influence of rejection into consideration,RVEF was proved to be a stable and sensitive indicator. Conclusions sRT-3DE can quickly assess shape and systolic function of right ventricle.RVEF was the most stableand sensitive among all the RV-related indicators and is a promising indicator in the clinic follow-up of HT patients. Key words: Echocardiography, real-time three-dimensional; Heart transplantation; Ventricularfunction, right

Structural pathology underlying neuroendocrine dysfunction in schizophrenia

Polydipsic hyponatremic schizophrenic (PHS) patients exhibit altered neuroendocrine activity that has been linked to their life-threatening water imbalance, as well as to impaired function and reduced volume of the anterior hippocampus. Polydipsic patients without hyponatremia (polydipsic normonatremic schizophrenics: PNS) exhibit similar, albeit less marked, changes in neuroendocrine activity and anterior hippocampal function, but not reduced anterior hippocampal volume. Indeed, reduced anterior hippocampal volume is seen in patients with normal water balance (nonpolydipsic normonatremic schizophrenics: NNS) whose neuroendocrine activity and anterior hippocampal function differ markedly from those with polydipsia. In an effort to reconcile these findings we measured hippocampal, amygdala and 3rd ventricle shapes in 26 schizophrenic patients (10 PNS, 7 PHS, 9 NNS) and 12 healthy controls matched for age and gender. Bilateral inward deformations were localized to the anterior lateral hippocampal surface (part of a neurocircuit which modulates neuroendocrine responses to psychological stimuli) in PHS and to a lesser extent in PNS, while deformations in NNS were restricted to the medial surface. Proportional deformations of the right medial amygdala, a key segment of this neurocircuit, were seen in both polydipsic groups, and correlated with the volume of the 3rd ventricle, which lies adjacent to the neuroendocrine nuclei. Finally, these structural findings were most marked in those with impaired hippocampal-mediated stress responses. These results reconcile previously conflicting data, and support the view that anterior lateral hippocampal pathology disrupts neuroendocrine function in polydipsic patients with and without hyponatremia. The relationship of these findings to the underlying mental illness remains to be established.

Right ventricular–left ventricular interaction in adults with Tetralogy of Fallot: A combined cardiac magnetic resonance and echocardiographic speckle tracking study

Objectives To assess ventricular dysfunction and ventricular interaction after repair of Tetralogy of Fallot (ToF) employing echocardiography speckle-tracking and cardiac magnetic resonance imaging (CMR). Background Severe pulmonary regurgitation and right ventricular (RV) dysfunction are common after repair of ToF and may also affect the shape and function of the left ventricle (LV). Recent studies suggest that LV dysfunction may be of particular prognostic value. Methods and results Twenty-one consecutive adults with repaired ToF (15 male, mean age 38 ± 11 years, 7 with severe PR) underwent a comprehensive echocardiographic exam including speckle-tracking analysis, CMR and cardiopulmonary exercise testing. Twenty-one subjects without relevant heart disease served as controls. Echocardiographically measured RV diameters correlated with RV volumes obtained from CMR ( r = 0.63; p = 0.006). In addition, a close correlation was found between RV and LV function on CMR ( r = 0.74, p = 0.002), speckle-tracking LV and RV peak longitudinal 2D strain ( r = 0.66, p = 0.003) and mitral and tricuspid annular plain systolic excursion ( r = 0.71, p = 0.0003). While LV ejection fraction was normal in the majority of patients and not different from controls, LV longitudinal strain was significantly reduced in ToF patients (− 16.5 ± 3.3 vs. -20.5 ± 2.7%, p = 0.0001). Conclusion Left and right ventricular function both by CMR and speckle-tracking is interrelated in adults with repaired ToF. Despite normal LV ejection fraction, 2D longitudinal strain is significantly reduced in ToF patients, suggesting subclinical LV myocardial damage. Considering the potential prognostic value of LV dysfunction in ToF, this measurement may gain importance and should be included in future outcome studies.