Left ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography

Bellenger, Nicholas G.; Marcus, Neil; Davies, Ceri; Yacoub, Magdi H.; Banner, Nicholas R.; Pennell, Dudley J.

doi:10.1016/s1053-2498(00)00079-6

Cited by 64 publications

(26 citation statements)

References 29 publications

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“…Mass by CMR was obtained from 3D delineation of endo/epicardial contours, whereas echo-derived mass was obtained using a 1D linear formula that incorporates assumptions regarding LV geometry. Prior studies have shown that volumetric mass by CMR yields lower values than does linear-derived mass by echo 29,30 and that magnitude of difference between modalities is greatest in patients with LV remodeling. 31 It is important to recognize that although LV filling profiles add to the information obtained from routine CMR exams, approximately one fourth of patients with echoevidenced diastolic dysfunction were not identified by CMR indices.…”

Section: Discussionmentioning

confidence: 97%

Automated Segmentation of Routine Clinical Cardiac Magnetic Resonance Imaging for Assessment of Left Ventricular Diastolic Dysfunction

Kawaji

Codella

Prince

et al. 2009

Circ: Cardiovascular Imaging

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Background-Cardiac magnetic resonance (CMR) is established for assessment of left ventricular (LV) systolic function but has not been widely used to assess diastolic function. This study tested performance of a novel CMR segmentation algorithm (LV-METRIC) for automated assessment of diastolic function. Methods and Results-A total of 101 patients with normal LV systolic function underwent CMR and echocardiography (echo) within 7 days. LV-METRIC generated LV filling profiles via automated segmentation of contiguous short-axis images (204Ϯ39 images, 2:04Ϯ0:53 minutes). Diastolic function by CMR was assessed via early:atrial filling ratios, peak diastolic filling rate, time to peak filling rate, and a novel index-diastolic volume recovery (DVR), calculated as percent diastole required for recovery of 80% stroke volume. Using an echo standard, patients with versus without diastolic dysfunction had lower early:atrial filling ratios, longer time to peak filling rate, lower stroke volume-adjusted peak diastolic filling rate, and greater DVR (all PϽ0.05). Prevalence of abnormal CMR filling indices increased in relation to clinical symptoms classified by New York Heart Association functional class (Pϭ0.04) or dyspnea (Pϭ0.006). Among all parameters tested, DVR yielded optimal performance versus echo (area under the curve: 0.87Ϯ0.04, PϽ0.001). Using a 90% specificity cutoff, DVR yielded 74% sensitivity for diastolic dysfunction. In multivariate analysis, DVR (odds ratio, 1.82; 95% CI, 1.13 to 2.57; Pϭ0.02) was independently associated with echo-evidenced diastolic dysfunction after controlling for age, hypertension, and LV mass ( 2 ϭ73.4, PϽ0.001). Conclusions-Automated

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Section: Discussionmentioning

confidence: 97%

Automated Segmentation of Routine Clinical Cardiac Magnetic Resonance Imaging for Assessment of Left Ventricular Diastolic Dysfunction

Kawaji

Codella

Prince

et al. 2009

Circ: Cardiovascular Imaging

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“…Cine magnetic resonance imaging (MRI) is commonly used for the anatomic and functional assessment of the heart [6][7][8][9]. Nevertheless, while its accuracy and reproducibility have been widely demonstrated for the LV measurements [10][11][12], few studies have assessed the in vivo validity and reproducibility of the RV dimensions and function using routine cine-MRI methods.…”

Section: Introductionmentioning

confidence: 99%

Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study

Beygui

Furber

Delépine³

et al. 2004

Int J Cardiovasc Imaging

103

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Right ventricular (RV) dysfunction is a predictor of poor outcome in patients with heart disease. Conventional imaging modalities fail to assess RV volumes accurately. We sought to assess the accuracy and reproducibility of routine breath-hold gradient echo magnetic resonance imaging (MRI)-derived RV mass, volumes and function. We assessed: (1) The accuracy of in vivo MRI-derived RV mass in comparison to the RV weight in 9 minipigs. (2) Intra- and inter-observer reproducibility of RV mass, end-diastolic (EDV) and end-systolic (ESV) volumes and ejection fraction (EF) in 15 normal volunteers and 10 patients with heart disease. (3) Inter-study reproducibility of the former parameters in 25 coronary artery disease patients. (4) The correlation between right and left ventricular stroke volumes in the total population. Strong statistically significant correlations were found between: (1) MRI-derived RV mass and RV weight (r = 0.98, bias = 2.5 g), (2) Intra-observer measurements of RV mass (r = 0.96, bias = 0.5 g), EDV (r = 0.99, bias = -1.5 ml), ESV (r = 0.98, bias = 0.1 ml) and EF (r = 0.92, bias = -1.4%), (3) Inter-observer measurements of RV mass (r = 0.95, bias = 1.1 g), EDV (r = 0.98, bias = -1.1 ml), ESV (r = 0.98, bias = 1.2 ml) and EF (r = 0.87, bias = -1.9%), (4) Inter-study measurements of RV mass (r = 0.91, bias = -0.1 g), EDV (r = 0.96, bias = 3.8 ml), ESV (r = 0.98, bias = 0.3 ml) and EF (r = 0.90, bias = 0.9%), (5) MRI-derived right and left ventricular stroke volumes (r = 0.87). The assessment of the RV mass, volumes and function by routine breath-hold gradient echo MRI is accurate and highly reproducible. The correlation between left and RV MRI-derived stroke volumes indicates excellent coherence of simultaneous bi-ventricular volume measurements.

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“…Noninvasive assessments of blood flow and distensibility in the pulmonary arteries can be made [9][10][11], as well as estimates of stroke volume and cardiac output [10]. Changes in right ventricular mass (RVM), function and pulmonary artery blood flow have been observed following lung transplantation [12][13][14][15] and MRI has been shown to be far more accurate than ECHO in monitoring changes in left ventricular mass (LVM) [16].Several investigators have attempted to use MRI as a noninvasive means of estimating MPAP but none have reported any advantages over ECHO. Right ventricular end-diastolic wall thickness has been shown to correlate well with MPAP in primary Eur Respir J…”

mentioning

confidence: 99%

Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure

Saba¹,

Foster²,

Cockburn³

et al. 2002

Eur Respir J

167

116

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Magnetic resonance imaging (MRI) can provide accurate anatomical measurements of the cardiac ventricles. This study investigated whether a calculated ventricular mass index (VMI) would provide an accurate means of estimating pulmonary artery pressure noninvasively, and compared the results with conventional Doppler echocardiography and invasive measurement.A total of 26 subjects referred for investigation of pulmonary hypertension were studied by MRI and echocardiography within 2 weeks of cardiac catheterisation. The correlations for mean pulmonary artery pressure were as follows: VMI (ratio of right ventricular mass over left ventricular mass) r=0.81; pulmonary artery systolic pressure (echocardiography) r=0.77. The confidence intervals for the VMI were narrower than for echocardiography. Sensitivity and specificity for pulmonary hypertension were 84 and 71% respectively for the VMI compared with 89 and 57% for echocardiography.The calculated ventricular mass index provides an accurate and practical means of estimating pulmonary artery pressure noninvasively in pulmonary hypertension and may provide a more accurate estimate than Doppler echocardiography. This may be because it reflects the right ventricular response to sustained pulmonary hypertension over a long period and is not influenced by short-term physiological variables affecting echocardiography, such as heart rate, posture, hydration status and oxygen supplementation. Pulmonary arterial hypertension (PAHT) is a rare disorder characterised by high pulmonary vascular resistance. Prognosis is related to mean pulmonary artery pressure (MPAP) measured at right heart catheterisation (RHC) [1], and repeated measurements are often necessary to assess disease progression and the response to treatment. The most widely used noninvasive technique, Doppler echocardiography (ECHO) [2] is safe and widely available, but has several limitations. Firstly, it cannot measure MPAP and only provides an estimate of pulmonary artery systolic pressure (PASP). Secondly, it depends upon the presence of detectable tricuspid regurgitation and has a significant failure rate in some patient groups [3]. Finally, measurements are somewhat operatordependent, and influenced by physiological variables such as heart rate, hydration status and posture, limitations that also affect the accepted gold standard method of RHC [4].Magnetic resonance imaging (MRI) is an attractive modality for studying the complex geometry of the right ventricle and pulmonary vasculature since no assumptions need to be made about the shape or location of the structure being studied. It provides three-dimensional anatomical measurements of right ventricular morphology that are unaffected by physiological variables and more likely to be reproducible than dynamic, planar measurements made at ECHO. Furthermore, these anatomical variables assess the right ventricular response to chronic pulmonary vascular disease and may provide a more clinically relevant assessment of disease severity.MRI has been extensi...

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Left ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography

Cited by 64 publications

References 29 publications

Automated Segmentation of Routine Clinical Cardiac Magnetic Resonance Imaging for Assessment of Left Ventricular Diastolic Dysfunction

Automated Segmentation of Routine Clinical Cardiac Magnetic Resonance Imaging for Assessment of Left Ventricular Diastolic Dysfunction

Routine breath-hold gradient echo MRI-derived right ventricular mass, volumes and function: accuracy, reproducibility and coherence study

Ventricular mass index using magnetic resonance imaging accurately estimates pulmonary artery pressure

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