Impact of the papillary muscles on cardiac magnetic resonance image analysis of important left ventricular parameters in hypertrophic cardiomyopathy

Gommans, D.H. Frank; Bakker, Jeannette; Cramer, G. Etienne; Verheugt, Freek W.A.; Brouwer, Marc A.; Kofflard, Marcel

doi:10.1007/s12471-016-0805-y

Cited by 12 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies report similar variations with the potential for clinically important differences in the assessment of relevant pathologies such as hypertrophic cardiomyopathy and Fabry’s disease. 42 , 43 Whilst other sources of technical variation do exist and perhaps have a cumulative effect, it does seem that contouring technique is the most important. Interestingly, a small study of variation of CMR derived LV measures from the use of different software packages demonstrated no significant variation from the software programmes with the application of a standardized contouring protocol and a single scanner vendor.…”

Section: Discussionmentioning

confidence: 99%

Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis

Raisi‐Estabragh

Kenawy

Aung

et al. 2020

European Heart Journal - Cardiovascular Imaging

View full text Add to dashboard Cite

Aims To determine population-related and technical sources of variation in cardiac magnetic resonance (CMR) reference ranges for left ventricular (LV) quantification through a formal systematic review and meta-analysis. Methods and results This study is registered with the International Prospective Register of Systematic Reviews (CRD42019147161). Relevant studies were identified through electronic searches and assessed by two independent reviewers based on predefined criteria. Fifteen studies comprising 2132 women and 1890 men aged 20–91 years are included in the analysis. Pooled LV reference ranges calculated using random effects meta-analysis with inverse variance weighting revealed significant differences by age, sex, and ethnicity. Men had larger LV volumes and higher LV mass than women [LV end-diastolic volume (mean difference = 6.1 mL/m2, P-value = 0.014), LV end-systolic volume (MD = 4 mL/m2, P-value = 0.033), LV mass (mean difference = 12 g/m2, P-value = 7.8 × 10−9)]. Younger individuals had larger LV end-diastolic volumes than older ages (20–40 years vs. ≥65 years: women MD = 14.0 mL/m2, men MD = 14.7 mL/m2). East Asians (Chinese, Korean, Singaporean-Chinese, n = 514) had lower LV mass than Caucasians (women: MD = 6.4 g/m2, P-value = 0.016; men: MD = 9.8 g/m2, P-value = 6.7 × 10−5). Between-study heterogeneity was high for all LV parameters despite stratification by population-related factors. Sensitivity analyses identified differences in contouring methodology, magnet strength, and post-processing software as potential sources of heterogeneity. Conclusion There is significant variation between CMR normal reference ranges due to multiple population-related and technical factors. Whilst there is need for population-stratified reference ranges, limited sample sizes and technical heterogeneity precludes derivation of meaningful unified ranges from existing reports. Wider representation of different populations and standardization of image analysis is urgently needed to establish such reference distributions.

show abstract

Section: Discussionmentioning

confidence: 99%

Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis

Raisi‐Estabragh

Kenawy

Aung

et al. 2020

European Heart Journal - Cardiovascular Imaging

View full text Add to dashboard Cite

show abstract

“…We have chosen to use a segmentation of the short axis that includes the papillary muscles. Indeed, recent papers show that these muscles have impact on the analysis of MR images (Gommans et al, 2016 ). However, this controversy is out of the scope of our work.…”

Section: Discussionmentioning

confidence: 99%

“…We simulated the CA dynamics on a short-axis slice of a human ventricle taken from an open repository (Koch et al, 2011 ) (see Figure 5 ). During the segmentation process, we have included the papillary muscles as part of the myocardium (Gommans et al, 2016 ). However, we note that the results presented in this work are not affect by this particular short-axis or segmentation.…”

Section: Numerical Methods and Experimentsmentioning

confidence: 99%

Simulation of the Perfusion of Contrast Agent Used in Cardiac Magnetic Resonance: A Step Toward Non-invasive Cardiac Perfusion Quantification

et al. 2019

View full text Add to dashboard Cite

This work presents a new mathematical model to describe cardiac perfusion in the myocardium as acquired by cardiac magnetic resonance (CMR) perfusion exams. The combination of first pass (or contrast-enhanced CMR) and late enhancement CMR is a widely used non-invasive exam that can identify abnormal perfused regions of the heart via the use of a contrast agent (CA). The exam provides important information to the diagnosis, management, and prognosis of ischemia and infarct: perfusion on different regions, the status of microvascular structures, the presence of fibrosis, and the relative volume of extracellular space. This information is obtained by inferring the spatiotemporal dynamics of the contrast in the myocardial tissue from the acquired images. The evaluation of these physiological parameters plays an important role in the assessment of myocardial viability. However, the nature of cardiac physiology poses great challenges in the estimation of these parameters. Briefly, these are currently estimated qualitatively via visual inspection of images and comparison of relative brightness between different regions of the heart. Therefore, there is a great urge for techniques that can help to quantify cardiac perfusion. In this work, we propose a new mathematical model based on multidomain flow in porous media. The model is based on a system of partial differential equations. Darcy's law is used to obtain the pressure and velocity distribution. CA dynamics is described by reaction-diffusion-advection equations in the intravascular space and in the interstitial space. The interaction of fibrosis and the CA is also considered. The new model treats the domains as anisotropic media and imposes a closed loop of intravascular flow, which is necessary to reproduce the recirculation of the CA. The model parameters were adjusted to reproduce clinical data. In addition, the model was used to simulate different scenarios: normal perfusion; endocardial ischemia due to stenosis in a coronary artery in the epicardium; and myocardial infarct. Therefore, the computational model was able to correlate anatomical features, stenosis and the presence of fibrosis, with functional ones, cardiac perfusion. Altogether, the results suggest that the model can support the process of non-invasive cardiac perfusion quantification.

show abstract

“…Threshold-based methods define the endocardial surface based on the different signal intensities of blood and myocardium; thus, the TPM are measured as part of the ventricular mass [ 9 ]. There is no consensus on which evaluation method is more reliable in the case of HCM [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

Dohy

Szabó

Tóth

et al. 2021

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

The prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

show abstract

Impact of the papillary muscles on cardiac magnetic resonance image analysis of important left ventricular parameters in hypertrophic cardiomyopathy

Cited by 12 publications

References 32 publications

Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis

Variation in left ventricular cardiac magnetic resonance normal reference ranges: systematic review and meta-analysis

Simulation of the Perfusion of Contrast Agent Used in Cardiac Magnetic Resonance: A Step Toward Non-invasive Cardiac Perfusion Quantification

Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

Contact Info

Product

Resources

About