Ventricular Volume In Patients Research Articles

Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease.

Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.

Comparison And Agreement Between Cardiovascular Computed Tomography (cct) Derived Mid-diastolic Volume And End-diastolic Ventricular Volume In Patients With Congenital Heart Disease (chd)

Comparison And Agreement Between Cardiovascular Computed Tomography (cct) Derived Mid-diastolic Volume And End-diastolic Ventricular Volume In Patients With Congenital Heart Disease (chd)

Paradoxical increase in left atrial strains early after Covid-19 infection, a result of comprehensive recovery phase four-chamber strains study.

Cardiac consequences of Covid-19 infection have been mentioned in various studies as a serious risk factor for in-hospital mortality. However, the existence of residual cardiac dysfunction after the acute phase is seldom investigated especially in people without a history of specific medical disease.One hundred health care workers with positive reverse transcription-polymerase chain reaction test underwent comprehensive 2D and 3D echocardiography six to eight weeks after infection. Patients were classified into Mild, Moderate, and Severe groups based on their clinical characteristics of covid-19 infection, and all echocardiographic parameters were compared between the three groups. Left ventricular (LV) stroke volume index was reduced in all groups compared to normal ranges and was more prominent in the severe group (P-value < 0.05). 3D-derived LV global longitudinal strain (GLS) was significantly lower in the severe group in comparison to the mild group (- 19.3 ± 1 Vs. - 22.2 ± 2, P-value < 0.001) and correlated with highly sensitive CRP level at the acute phase. Left atrial (LA) strains, including LA peak strain, LA contraction strain, and LA reservoir strain, were considerably higher and LA volume index was significantly lower in the clinically severe covid patients. Analysis based on the extent of lung involvement showed significantly increased 3D-derived right ventricular volumes in patients who experienced severe pneumonia despite normalized strains. Conclusion: subclinical LV dysfunction as reduced stroke volume index and GLS exists in the early recovery phase of normal individuals with severe course of covid-19. LA function indicated by LA strains paradoxically increases in severe covid-19 infection in this phase.

Incremental prognostic value of myocardial strain over ventricular volume in patients with repaired tetralogy of Fallot.

The relative incremental predictive value of myocardial deformation over ventricular volume for future adverse events in patients with repaired tetralogy of Fallot (rTOF) remains unknown. We aimed to determine the incremental prognostic value of myocardial deformation over ventricular volume to predict adverse events in patients with rToF. We retrospectively included patients with rTOF who completed cardiac magnetic resonance (CMR) and follow-up in our hospital from January 2014 to October 2020, and stratified according to the presence or absence of adverse events during follow-up. The strain parameters of the right ventricular (RV) and left ventricular (LV) were obtained from CMR-derived feature tracking. Multivariable Cox proportional hazard models and net reclassification improvement analysis were used to analyze the prognostic information of biventricular strain and volume parameters in rTOF patients. Among 98 patients with rTOF, 54 (55.1%) experienced primary and/or secondary events during a median follow-up period of 27.0 months. Univariable analysis indicated that RV volume and strain were significantly associated with both primary events and all adverse events (all p < .01). Multivariable Cox regression and net reclassification improvement analyses achieved incremental global χ2 (all p < .001), C index (all p < .001), and overall correct reclassification by sequentially adding CMR-derived RV volume, RV strain and LV strain parameters to preexisting clinical factors in adverse events model analyses. RV and LV myocardial deformation provided incremental prognostic information and significant improvement for risk stratification over RV size and clinical variables and therefore can be combined to further enhance prognostication. • RV volume and strain were significantly associated with both primary events and all adverse events, whereas LV volume and strain were associated with primary events. • Ventricular myocardial deformation is a strong predictor of adverse outcomes of patients with repaired tetralogy of Fallot, providing increased prognostic information and significantly improved risk stratification over ventricular size.

Prognostic power of a new index of right ventricle-pulmonary artery coupling based on right ventricular volumes in patients with secondary tricuspid regurgitation

Abstract Background Although echocardiographic surrogates of right ventricular -arterial coupling (RVAC) have been reported to be associated with outcome in patients with moderate or severe secondary tricuspid regurgitation (STR), pulmonary artery systolic pressure (SPAP) is difficult to be estimated using echocardiography in patients with severe STR. Purpose Accordingly, we evaluated the predictive power of indexes of RVAC obtained using RV volumes measured using three-dimensional echocardiography (3DE). Methods We prospectively enrolled 180 patients with moderate or severe STR and complete two-dimensional, Doppler and 3DE data. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome. Results After a median follow up of 24 months (IQR: 2–48), 72 patients (40%) reached the primary endpoint. Most of the echocardiographic parameters of RV function were associated with outcomes. Among the different parameters of RVAC, the receiver operating curve (ROC) analysis selected the ratio between (RV stroke volume [SV]-RegVol)/ RV End-systolic volume (ESV) (i.e. the RV forward SV/ESV) as the best predictor of the combined endpoint (AUC 0.80 [IC 95% 0.73–087]), with a threshold value of 0.49. Event-free survival of patients with RV forward SV/ESV higher and lower 0.49 has been performed (Figure 1). Multivariable Cox proportional hazards models were constructed (Figure 2). Adding sequentially the 3D-RVEF, TAPSE/SPAP and the forward RV SV/RV ESV on top of a basal model made of TR severity, New York Heart Association (NYHA) functional class and tricuspid anulus plane systolic excursion (TAPSE), the χ2 of the model increased from 40 to 43 (p=0.13) by adding 3D RVEF, from 43 to 46 (p=0.04) by adding TAPSE/SPAP, and from 46 to 51 (p=0.02) by adding RV forward SV/ESV. Severe TR (HR 3.53 [CI 95%: 1.84–6.78], p&amp;lt;0.001) and RV forward SV/ESV &amp;lt;0.49 (HR 2.45 [CI 95% 1.16–5.18], p=0.02) were the only parameters independently associated with outcome. Conclusions The RV forward SV/ESV is an index of RVAC obtained by 3DE which is independent from SPAP and it is strongly associated with the occurrence of death or heart failure hospitalization in patients with STR. Funding Acknowledgement Type of funding sources: None.

The effect on brain volume in HIV-negative and non-transplant cryptococcal meningitis

To explore the brain volume (BV) changes of HIV-negative and non-transplant cryptococcal meningitis (CM) in 1 year after initial therapy. Case data were collected from 78 CM patients who underwent magnetic resonance imaging (MRI) scanning at least 3 times in 1-year interval after initial therapy. The assessment of BV was measured by a non-commercial software, uAI Research Portal. Linear mixed model was used to investigate the association between clinical characteristics and the changes in BV. Longitudinal study showed a decrease in total brain volume (-4.65 cm3, P=.005), regional brain volume including white matter (-2.86 cm3, P=.031) and basal ganglia (-0.25 cm3, P=.007), and increase in cerebrospinal fluid (CSF) volume (3.58 cm3, P=.013) in CM patients in 1 year after initial therapy. Ventricular volume in patients with ventriculoperitoneal shunts (VPS) was lower than that in patients without VPS (-7.5 cm3, P<.05). Ventricular volume in patients with post-infectious inflammatory response syndrome (PIIRS) was larger than that in patients without PIIRS (7.1 cm3, P<.01). In addition, temporal lobe atrophy was associated with corticosteroid therapy (-6.8 cm3, P<.01). The present study suggested that brain atrophy, especially regional BV decrease, could happen in HIV-negative and non-transplant CM patients over a 1-year interval.

Contouring techniques in cardiac magnetic resonance assessment of right ventricular volumes in repaired tetralogy of fallot

IntroductionRight ventricular size and function on cardiac MRI provides thresholds for referral for pulmonary valve intervention in repaired Tetralogy of Fallot (RTOF). However, different contouring techniques are available to calculate right ventricular volumes and ejection fraction. It is not known whether these contouring techniques impact on threshold triggers for intervention. MethodsRight ventricular volumes on cardiac MRI for 24 consecutive subjects with RTOF were measured by two independent, experienced observers using three contouring techniques: smooth, detailed manual and detailed with semi-automated thresholding. ResultsEnd-diastolic and end-systolic volumes were significantly different between contouring techniques: largest for smooth contours, intermediate for thresholding and smallest for manual (EDV: smooth 233 ml, SD 105 ml; thresholding 215 ml, SD 95 ml; manual 206 ml, SD 94 ml; ESV: smooth 122 ml, SD 71 ml; thresholding 113 ml, SD 67 ml; manual 103 ml, SD 64 ml; p < 0.001 for all comparisons). Stroke volume from contours by thresholding correlated most strongly with velocity mapping (r = 0.87, p < 0.001). Interobserver agreement was strongest for smooth (end-diastolic volume ICC = 1.0 (confidence interval (CI):0.999–1.0, p < 0.001); end-systolic volume ICC = 0.999 (CI:0.994–1.0, p < 0.001) and weakest for manual contours ((end-diastolic volume ICC = 0.89 (CI:0.33–0.99, p = 0.01); end-diastolic volume ICC = 0.88 (CI:0.30–0.99, p = 0.01). Intra-observer agreement was uniformly high (ICC≥0.996, p < 0.001 for all). In 4/24 cases, contouring technique altered threshold triggers for pulmonary valve intervention. ConclusionsDifferences in contouring technique for measuring right ventricular volumes in patients with RTOF can affect thresholds triggering referral for pulmonary valve intervention. Standardisation of right ventricular measurement is needed in congenital cardiac MRI practice.

Relationship Between Automated Pupillometry Measurements and Ventricular Volume in Patients With Aneurysmal Subarachnoid Hemorrhage.

INTRODUCTION: Pupillometry allows for a standardized assessment of the pupillary light reflex. Acute hydrocephalus (HCP) is a common complication in patients with aneurysmal subarachnoid hemorrhage (aSAH). HCP may affect the pupillary light reflex because of increased intracranial pressure or dilation of the rostral aqueduct. The association between the pupillary light reflex and HCP in aSAH patients has not been clearly established. The objective of this study is to analyze the correlation between the Neurological Pupil index (NPi) and the degree of HCP in aSAH patients. METHODS: The Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care Registry is a prospectively collected database of pupillometry readings in patients admitted to 4 different neurological intensive care units. Patients in the registry with aSAH who had pupillometry assessments within 6 hours of a brain computed tomography were studied. The degree of HCP was quantified using the HCP score, and the relationship between the NPi and HCP was analyzed after controlling for confounders. RESULTS: A total of 43 patients were analyzed (mean age, 54 ± 15 years; 53.2% male; mean HCP score, 5.3 ± 3.8). Thirty-eight patients had HCP. Mean NPi for the right eye was 4.02 (±1.2), and that for the left eye was 3.7 (±1.5). After adjusting for age, sex, race, and sedation, there was no significant correlation between HCP and NPi (right eye: r = 0.12, P = .44; left eye: r = 0.04, P = .8). CONCLUSION: In patients with aSAH, NPi was not correlated with HCP score. A small sample size could be a limitation of this study. Additional studies are needed to characterize the clinical significance of pupillometry in the evaluation of patients with aSAH and HCP.

Assessment of the left ventricular volume of tetralogy of Fallot by electrocardiogram.

Sufficient left ventricular volume is required for patients with tetralogy of Fallot (TOF) who are going to have biventricular repair. In this study, we investigated the utility of the electrocardiogram to evaluate left ventricular volume in patients with TOF. Patients whose left ventricular (LV) end-diastolic volume was lower than 80% of normal were defined as having a small LV. Seven patients with TOF who had to undergo Blalock-Taussig shunt surgery because of a small LV were assigned to group S. Twenty patients with TOF who had sufficient LV volume were assigned to group G. The amplitudes of the Q wave of V5-7 leads (QV5-QV7), the S wave of V1 lead, and the R wave of the II, III, aVf, and V5-7 leads of the electrocardiogram were evaluated. The amplitude of QV5 was 0 mV in all cases in group S, which was significantly smaller than that in group G (0 vs 0.01 mV, P = 0.028). The frequency of absent QV5 was significantly higher in group S than in group G (100% vs 50%, P = 0.026). Absent QV5 showed 100% sensitivity, 50% specificity, and a negative predictive value of 100% for a small LV. In TOF, the amplitude of the septal Q wave reflects LV volume. In particular, the absence of QV5 suggests a small LV end-diastolic volume, which is lower than 80% of normal.

The Reliability of Automated Three-Dimensional Echocardiography-HeartModelA.I. Versus 2D Echocardiography Simpson Methods in Evaluation of Left Ventricle Volumes and Ejection Fraction in Patients With Left Ventricular Dysfunction.

Background:Two-dimensional echocardiography (2DE) Simpson methods is the most frequently used imaging modality to assess Left ventricular ejection fraction (LVEF). LVEF is an important predictor of morbidity and mortality in a wide range of patients and clinical scenarios. Despite its importance in prognosis and clinical decision making, most echocardiography laboratories currently determine EF primarily by visual estimation, which is highly experience-dependent and sensitive to intra- and inter-observer variability and suboptimal accuracy and repeatability. Over the last decade, 3-dimensional echocardiography (3DE) has become increasingly implemented in clinical practice. The automated 3D HeartModelA.I. tracks every frame over the cardiac cycle using 3D speckle technology. HeartModelA.I. is a fully automated program that simultaneously detects LA and LV endocardial surfaces using an adaptive analytics algorithm that consists of knowledge-based identification of initial global shape and orientation followed by patient-specific adaptation.Objective:The objective of the study was to compare the automated 3D HeartModelA.I echocardiography and 2D Simpson methods echocardiography in evaluation of the left ventricular ejection fraction and left ventricular volumes in patients with left heart dysfunction.Methods:The study prospectively enrolled 165 patients with symptoms of LV dysfunction (ischemic or nonischemic) and New York Heart Association (NYHA) functional class I-III, referred for an echocardiographic study to evaluate the LV volumes and LV ejection fraction (LVEF) during the period from March 2020 to March 2022. Echocardiographic images were acquired by experienced echocardiographers using a commercially available Philips EPIQ machine (Koninklijke Philips Ultrasound, USA) equipped with X5-1 Matrix probe for 2DE and DHM 3DE acquisitions, respectively.Results:2D Simpson methods echocardiography results for estimated LVEF were 38.43 ± 1.70 in patients with NYHA class I-II, 30.53 ± 1.60 in patients with NYHA class III. Using 3D Heart Model, LVEF were 38.23 ± 1.71 in patients with NYHA class I-II and 30.27 ± 1.50 in patients with NYHA class III. The results of 2D Simpson methods echocardiography for estimated LVEDVi in NYHA class I-II and NYHA class III were 99.06 ± 6.36 ml/m2, 121.96 ± 2.93 ml/m2 respectively, LVESVi were 60.91 ± 3.91 ml/m2, 84.74 ± 2.70 ml/m2 respectively, for 3D Heart Model, LVEDVi in NYHA class I-II and NYHA class III were 100.07 ± 6.72, 121.38 ± 3.01 ml/m2 respectively, LVESVi were 61.75 ± 3.94 ml/m2, 84.73 ± 2.33 ml/m2 respectively. 2DE measurement of LV volumes and EF was completed in 6.1 ± 0.8 min. per patient. 3DE HeartModelA.I acquisition and analysis in most patients was completed in <3.2 min., an average time of 2.9 ± 1.3 min. per patient. The result of our study shows that the 3D HeartModelA.I. is a reliable and robust method for LVEF and LV volume analysis, which has similar results to 2D echocardiography performed by experienced sonographers. In this study, we found that 3DE DHM fully automated tool is also significantly faster than 2DE analysis and thus can help overcome the time-consuming nature and its present a strong argument for its incorporation into the clinical workflow. In this study, we found that 3DE DHM fully automated tool is also significantly faster than 2DE analysis and thus can help overcome the time-consuming nature and its present a strong argument for its incorporation into the clinical workflow.Conclusion:3D DHM provides fast and accurate LV volumes and LVEF quantitation, as it avoids geometric assumptions and left ventricular foreshortening, has better reproducibility and has incremental value to predict adverse outcomes in comparison with conventional 2DE. In the future major benefit of AI in echocardiography is expected from improvements in automated analysis and interpretation to reduce workload and improve clinical outcome.

Usefulness of a New Transthoracic Echocardiography Score to Assess Right Ventricular Volumes in Patients with Repaired Tetralogy of Fallot.

Quantification of right ventricular (RV) volumes is essential in the follow-up of patients with a repaired tetralogy of Fallot (TOF). Cardiac magnetic resonance imaging (MRI) is the gold standard for RV assessment. However, given its cost and availability, the systematic use of MRI for serial longitudinal follow-up is limited. Herein, we examined the utility of a new two-dimensional (2D) transthoracic echocardiography (TTE) score (the RVDi score), which includes a compilation of 2D RV dimensions indexed to the body surface area, for predicting MRI-derived RV end-diastolic volume (RVEDV) in patients with a repaired TOF. Using our congenital heart clinic database, we retrospectively included 29 adult patients with a repaired TOF between February 2015 and July 2019. The 2D TTE RVDi score was compared with the MRI-derived RVEDV. Sensitivity and specificity values for predicting an RVEDVi > 150ml/m2 were calculated. The TTE RVDi score was highly correlated (r = 0.944) with MRI RVEDVi. A cut-off RVDi score set at 120mm/m2 predicted an RVEDVi > 150ml/m2 with a sensitivity of 83% and specificity of 94%. Use of a simple echocardiographic score based on indexed RV dimensions from 2D standard TTE imaging may complement the assessment of RV volumes in TOF patients.

Automated CT registration tool improves sensitivity to change in ventricular volume in patients with shunts and drains.

CT is the mainstay imaging modality for assessing change in ventricular volume in patients with ventricular shunts or external ventricular drains (EVDs). We evaluated the performance of a novel fully automated CT registration and subtraction method to improve reader accuracy and confidence compared with standard CT. In a retrospective evaluation of 49 ventricular shunt or EVD patients who underwent sequential head CT scans with an automated CT registration tool (CT CoPilot), three readers were assessed on their ability to discern change in ventricular volume between scans using standard axial CT images versus reformats and subtraction images generated by the registration tool. The inter-rater reliability among the readers was calculated using an intraclass correlation coefficient (ICC). Bland-Altman tests were performed to determine reader performance compared to semi-quantitative assessment using the bifrontal horn and third ventricular width. McNemar's test was used to determine whether the use of the registration tool increased the reader's level of confidence. Inter-rater reliability was higher when using the output of the registration tool (single measure ICC of 0.909 with versus 0.755 without the tool). Agreement between the readers' assessment of ventricular volume change and the semi-quantitative assessment improved with the registration tool (limits of agreement 4.1 vs 4.3). Furthermore, the tool improved reader confidence in determining increased or decreased ventricular volume (p < 0.001). Automated CT registration and subtraction improves the reader's ability to detect change in ventricular volume between sequential scans in patients with ventricular shunts or EVDs. Our automated CT registration and subtraction method may serve as a promising generalizable tool for accurate assessment of change in ventricular volume, which can significantly affect clinical management.

The REDUCE FMR Trial: A Randomized Sham-Controlled Study of Percutaneous Mitral Annuloplasty in Functional Mitral Regurgitation

ObjectivesThis study sought to evaluate the effects of the Carillon device on mitral regurgitation severity and left ventricular remodeling. BackgroundFunctional mitral regurgitation (FMR) complicates heart failure with reduced ejection fraction and is associated with a poor prognosis. MethodsIn this blinded, randomized, proof-of-concept, sham-controlled trial, 120 patients receiving optimal heart failure medical therapy were assigned to a coronary sinus-based mitral annular reduction approach for FMR or sham. The pre-specified primary endpoint was change in mitral regurgitant volume at 12 months, measured by quantitative echocardiography according to an intention-to-treat analysis. ResultsPatients (69.8 ± 9.5 years of age) were randomized to either the treatment (n = 87) or the sham-controlled (n = 33) arm. There were no significant differences in baseline characteristics between the groups. In the treatment group, 73 of 87 (84%) had the device implanted. The primary endpoint was met, with a statistically significant reduction in mitral regurgitant volume in the treatment group compared to the control group (decrease of 7.1 ml/beat [95% confidence interval [CI]: −11.7 to −2.5] vs. an increase of 3.3 ml/beat [95% CI: −6.0 to 12.6], respectively; p = 0.049). Additionally, there was a significant reduction in left ventricular volumes in patients receiving the device versus those in the control group (left ventricular end-diastolic volume decrease of 10.4 ml [95% CI: −18.5 to −2.4] vs. an increase of 6.5 ml [95% CI: −5.1 to 18.2]; p = 0.03 and left ventricular end-systolic volume decrease of 6.2 ml [95% CI: −12.8 to 0.4] vs. an increase of 6.1 ml [95% CI: −1.42 to 13.6]; p = 0.04). ConclusionsThe Carillon device significantly reduced mitral regurgitant volume and left ventricular volumes in symptomatic patients with functional mitral regurgitation receiving optimal medical therapy. (Carillon Mitral Contour System for Reducing Functional Mitral Regurgitation [REDUCE FMR]; NCT02325830)

Role of D3 dopamine receptors in modulating neuroanatomical changes in response to antipsychotic administration

Clinical research has shown that chronic antipsychotic drug (APD) treatment further decreases cortical gray matter and hippocampus volume, and increases striatal and ventricular volume in patients with schizophrenia. D2-like receptor blockade is necessary for clinical efficacy of the drugs, and may be responsible for inducing these volume changes. However, the role of other D2-like receptors, such as D3, remains unclear. Following our previous work, we undertook a longitudinal study to examine the effects of chronic (9-week) typical (haloperidol (HAL)) and atypical (clozapine (CLZ)) APDs on the neuroanatomy of wild-type (WT) and dopamine D3-knockout (D3KO) mice using magnetic resonance imaging (MRI) and histological assessments in a sub-region of the anterior cingulate cortex (the prelimbic [PL] area) and striatum. D3KO mice had larger striatal volume prior to APD administration, coupled with increased glial and neuronal cell density. Chronic HAL administration increased striatal volume in both WT and D3KO mice, and reduced PL area volume in D3KO mice both at trend level. CLZ increased volume of the PL area of WT mice at trend level, but decreased D3KO PL area glial cell density. Both typical and atypical APD administration induced neuroanatomical remodeling of regions rich in D3 receptor expression, and typically altered in schizophrenia. Our findings provide novel insights on the role of D3 receptors in structural changes observed following APD administration in clinical populations.

Remodeling classification system considering left ventricular volume in patients with aortic valve stenosis: Association with adverse cardiovascular outcomes.

To assess prevalence and clinical implications of left ventricular (LV) remodeling considering: LV volume, mass and relative wall thickness at the time of aortic valve stenosis diagnosis. We retrospectively analyzed 343 patients (age 79.2±9.5years, 48.1% males) with functional aortic valve area (AVA)≤1.5cm2 . LV geometric patterns and clinical outcomes (combined death, cardiac hospitalization, aortic valve replacement [AVR]) were evaluated. According to the new LV remodeling classification, 4.9% had normal geometry, 7.5% concentric remodeling, 39.3% concentric hypertrophy (LVH), 22.4% mixed LVH, 12.5% dilated LVH, 3.2% eccentric LVH and 4.3% eccentric remodeling, 5.5% had not classifiable LVH. Indexed stroke volume (SVi) was higher in patients with concentric LVH (40.3±11.9mL/m2 ) and mixed LVH (41.6±13.4mL/m2 ) and lower in patients with eccentric LVH (24.9±7.7mL/m2 ), concentric (36.6±12.7mL/m2 ) and eccentric remodeling (34.9±9.5mL/m2 ), P=0.003. During a median follow-up of 2.2years, 260 (75.8%) had the combined end point. A significant association between the combined end point and LV dilation (P=0.010) or LV remodeling patterns (P=0.0001) was found. After multivariable adjustment for AVR, concentric remodeling (HR 3.12, IC 95% 1.14-8.55; P=0.02) and dilated LVH (HR 3.48, IC 95% 1.31-9.27; P=0.01) were strongly associated with death or cardiac hospitalizations. In patients with AVA≤1.5cm2 , when the new LV remodeling classification system is applied, only a minority had normal geometry and less than half had "classic" concentric LVH or remodeling. LV volume dilatation is frequent and associated with adverse outcome. Concentric remodeling, eccentric remodeling, dilated LVH had the worst noninvasive hemodynamic profile and prognosis.

Computed Tomography and Magnetic Resonance Imaging Can Replace Cardiac Catheterization for Measuring Ventricular Volume in Patients with Congenital Heart Disease

Computed Tomography and Magnetic Resonance Imaging Can Replace Cardiac Catheterization for Measuring Ventricular Volume in Patients with Congenital Heart Disease

New classification of geometric patterns considering left ventricular volume in patients with chronic aortic valve regurgitation: Prevalence and association with adverse cardiovascular outcomes.

Left ventricular (LV) remodeling due to aortic regurgitation (AR) often leads to maladaptive responses. We assessed the prevalence and clinical implications of LV remodeling considering LV volume, mass, and relative wall thickness at the time of AR diagnosis. Between 2008 and 2017, 370 consecutive patients (mean age 67.3±16.1years, 56.5% males), with moderate or severe AR, were retrospectively analyzed. LV geometric patterns and clinical outcomes (cardiovascular death, hospitalization for heart failure, or aortic valve replacement) were evaluated. LV dilatation (LV end-diastolic volume >75mL/m2 ) was present in 228 patients (61.6%). Applying the new LV remodeling classification system, 40 (10.8%) patients had normal geometry, 14 (3.8%) concentric remodeling, 43 (11.6%) concentric hypertrophy (LVH), 45 (12.2%) indeterminate LVH, 38 (10.3%) mixed LVH, 93 (25.1%) dilated LVH, 54 (14.6%) eccentric LVH, and 43 (11.6%) eccentric remodeling. During a median follow-up of 3.48years (25th-75th percentile 0.91-5.57), 97 (26.2%) had the combined endpoint. LV dilation (P<0.001), LVH (P<0.001), and LV remodeling patterns were significantly associated with the combined endpoint. After multivariable adjustment for age, EF, aortic stenosis, CAD history, and moderate mitral regurgitation, dilated LVH (HR 7.61, IC 95% 1.82-31.80; P=0.005) and eccentric LVH (HR 7.91, IC 95% 1.82-34.38; P=0.006) were associated with adverse outcome compared to eccentric remodeling, that showed the best event-free survival rate. In a contemporary cohort of patients with AR, applying the new LV remodeling classification system, only a minority had normal geometry. Dilated LVH and eccentric LVH showed distinct outcome penalty after adjustment for confounders.

Central Atrophy Early in Multiple Sclerosis: Third Ventricle Volumetry versus Planimetry.

Cerebral atrophy has been suggested to be a reliable magnetic resonance imaging (MRI) predictor of subsequent disability in all stages of multiple sclerosis (MS). However, no accepted methodology for routine clinical use exists to date. We sought an easy to apply and fast technique to evaluate cerebral ventricular volume in patients with MS with similar accuracy as a semiautomatic volumetric method. The study included 104 patients, 61 diagnosed with MS and 43 with clinically isolated syndrome. In addition, 30 healthy controls were enrolled. Physical disability was assessed with the expanded disability status scale and cognitive disability with the Multiple Sclerosis Inventory Cognition (MUSIC) test. All subjects received standardized 3-dimensional (3D) MR-imaging on a 3 T scanner. Third ventricle volume (3VV) was obtained from 3D T1-weighted images using a semiautomated technique, and compared against planimetric assessment of the width of the third ventricle aligned (a3VW) and unaligned (u3VW) to anatomical landmarks. a3VW was obtained within seconds with excellent intra- and interrater agreement, and outperformed volumetric measurements regarding the differentiation of MS patients from healthy controls. a3VW had the strongest correlations with 3VV (r = .78, P < .001) and showed moderate inverse correlation with MUSIC cognition score (r = -.310, P < .005). a3VW is a time-effective and robust biomarker that has strong correlations with volumetric measurements and can be established as standard in the MRI quantification of central brain atrophy in patients with early MS.

Reverse remodelling in systolic heart failure: A puzzle yet to be solved?

In the setting of systolic heart failure (sHF), left ventricular reverse remodelling (LVRR) has been regarded as an auspicious sign associated with better outcomes [1]. LVRR is generally defined as a gradual improvement in left ventricular systolic functions as measured with a significant and time-dependent increase in left ventricular ejection fraction (LVEF) along with a reduction in left ventricular volumes in patients with sHF [2]. In patients with sHF, even though LVRR might occur spontaneously (under optimal medical therapy) [1], it is more likely to emerge after relief of underlying hemodynamic stress including correction of aortic valvular regurgitation [2,3] or initiation of certain invasive therapeutic regimens including cardiac resynchronization therapy (CRT) [4].

Chronic Phase Effect of Landiolol about Left Ventricular Volume in Patients with Acute Myocardial Infarction after Primary Percutaneous Coronary Intervention

Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study is to investigate the long-term effect of landiolol therapy in very acute phase of AMI.