Atrio-ventricular deformation and heart failure in Ebstein's Anomaly — A cardiovascular magnetic resonance study

Steinmetz, Michael; Broder, Marike; Hösch, Olga; Lamata, Pablo; Kutty, Shelby; Kowallick, Johannes T.; Staab, Wieland; Ritter, Christian; Hasenfuß, Gerd; Paul, Thomas; Lotz, Joachim; Schuster, Andreas

doi:10.1016/j.ijcard.2017.11.097

Cited by 25 publications

(19 citation statements)

References 30 publications

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“…The reported experience of using FT-CMR LA strain parameter assessment for clinical diagnosis is quite recent, and encompasses cohorts of patients undergoing atrial fibrillation catheter ablation [ 8 , 47 , 48 ], implantable cardioverter-defibrillator implant [ 47 , 49 ], community volunteers without cardiovascular disease at baseline [ 50 , 51 ], patients with acute myocarditis [ 45 ], obesity [ 52 ], and Ebstein’s anomaly [ 53 ]. These studies established the feasibility and validity of LA strain parameter measurement using CMR; and in [ 51 ] found negative correlation between LA strain and LA fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Leng

Tan

Zhao

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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BackgroundAbnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain.MethodsWe studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain εs and strain rate SRs), conduit function (conduit strain εe and strain rate SRe) and booster pump function (booster strain εa and strain rate SRa).ResultsThere was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for εs, 18.1 ± 4.3% for εe, 17.2 ± 3.5% for εa, and 1.8 ± 0.4, − 2.0 ± 0.5, − 2.3 ± 0.6 s− 1 for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller εs, SRs, εe and SRe than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS).ConclusionsNovel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0496-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Leng

Tan

Zhao

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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“…CMR-FT is extensively used in cardiovascular research and increasingly in clinical practice. It allows for comprehensive and reliable assessments of cardiac function [5–10] and has been applied to a broad range of cardiovascular diseases such as patients with dilated [11, 12] or ischemic [13] cardiomyopathy, after myocardial infarction [14–16] and in patients with complex cardiac malformations such as Ebstein’s Anomaly [17]. Raising evidence points towards incremental additional value of myocardial deformation assessment for clinical decision making beyond established markers for cardiovascular risk including left ventricular ejection fraction (LVEF) [10–12, 14, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility

et al. 2019

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BackgroundCardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software.MethodsIntra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers.ResultsTraining improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance.ConclusionObserver experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.

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“…Studies have proved that Ebstein's anomaly is not a simple tricuspid valve abnormality and is associated with LV or left atrial dysfunction. 19,20 However, it is not easy to present standardized indicators in clinical practice. It is known than hemodynamic indicators determined by cardiac MRI can be used as relatively objective indicators because there are several limitations in evaluating RV function and TR using echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Recent Surgical Outcomes of Ebstein’s Anomaly: A Focus on Changes in Outcomes Due to Cone Repair

Choi¹,

Kim²,

Kim³

et al. 2020

Preprint

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Background: Ebstein’s anomaly exhibits a wide variety of clinical features, and therefore, proposing a standardized treatment for it is difficult. This study was conducted to determine whether Cone repair, which has been implemented in our hospital since 2008, is more effective than conventional repair.Methods: We retrospectively analyzed the clinical information of patients with Ebstein’s anomaly who were followed-up at the hospital from 2000 to 2019. A total of 61 patients who had undergone tricuspid valve repair after 2000 were divided into the conventional and Cone repair groups and their clinical outcomes were compared.Results: Of the 170 patients, 82 (48.2%) patients received surgical treatment for the tricuspid valve, whereas 75 patients received only medical treatment. The median follow-up duration was 5.89 years. After surgery, tricuspid valve regurgitation decreased and aortic stroke volume increased in both the Cone and conventional repair groups. In the Cone repair group, no mortality and postoperative complete atrioventricular block occurred and significantly fewer cases of moderate to severe tricuspid valve regurgitation were noted after surgery compared with the conventional repair group.Conclusions: Cone repair is thought to be a method with less mortality and less occurrence of complete atrioventricular block than conventional repair.

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Atrio-ventricular deformation and heart failure in Ebstein's Anomaly — A cardiovascular magnetic resonance study

Cited by 25 publications

References 30 publications

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility

Recent Surgical Outcomes of Ebstein’s Anomaly: A Focus on Changes in Outcomes Due to Cone Repair

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