Quantification of Left Ventricular Function With Premature Ventricular Complexes Reveals Variable Hemodynamics

Contijoch, Francisco; Rogers, Kelly C.; Rears, Hannah; Shahid, Mohammed; Kellman, Peter; Gorman, Joseph H.; Gorman, Robert C.; Yushkevich, Paul A.; Zado, Erica S.; Supple, Gregory E.; Marchlinski, Francis E.; Witschey, Walter R.; Han, Yuchi

doi:10.1161/circep.115.003520

Cited by 21 publications

(14 citation statements)

References 29 publications

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“…An alternative approach to self‐gating is single‐shot (real‐time) MRI, which may provide high spatiotemporal resolution scenes of every heartbeat with much less data than would be required by the Nyquist sampling criteria . Based on the low variation of ventricular volume in the image‐based navigator in this work and in other reports , it is apparent that single‐shot MRI has sufficient spatiotemporal resolution to characterize beat‐to‐beat ventricular volumes with low bias compared with cine MRI . In addition, a compressed sensing reconstruction which incorporates a spatiotemporal total variation (TV) constraint can further improve image quality and is demonstrated in Sup Videos S7–S9 .…”

Section: Discussionmentioning

confidence: 90%

Self-gated MRI of multiple beat morphologies in the presence of arrhythmias

et al. 2016

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Purpose Develop self-gated MRI for distinct heartbeat morphologies in subjects with arrhythmias. Methods Golden angle radial data was obtained in 7 sinus and 8 arrhythmias subjects. An image-based cardiac navigator was derived from single-shot images, distinct beat types were identified and images were reconstructed for repeated morphologies. Image sharpness, contrast and volume variation were quantified and compared to self-gated MRI. Images were scored for image quality and artifacts. Hemodynamic parameters were computed for each distinct beat morphology in bigeminy and trigeminy subjects and for sinus beats in patients with infrequent premature ventricular contractions. Results Images of distinct beat types were reconstructed except for two patients with infrequent premature ventricular contractions. Image contrast and sharpness were similar to sinus self-gated images (Contrast = 0.45±0.13 and 0.43±0.15; Sharpness = 0.21±0.11 and 0.20±0.05). Visual scoring was highest in self-gated images (4.1±0.3) compared to real-time (3.9±0.4) and ECG-gated cine (3.4±1.5). ECG-gated cine had less artifacts than self-gating (2.3±0.7 and 2.1±0.2), but was affected by misgating in two subjects. Among arrhythmia subjects, post-extrasystole/sinus (58.1 ± 8.6 mL) and interrupted sinus (61.4 ± 5.9 mL) stroke volume was higher than extrasystole (32.0 ± 16.5 mL; p<0.02). Conclusion Self-gated imaging can reconstruct images during ectopy and allowed for quantification of hemodynamic function of different beat morphologies.

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Section: Discussionmentioning

confidence: 90%

Self-gated MRI of multiple beat morphologies in the presence of arrhythmias

et al. 2016

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“…As proposed by Contijoch et al, categorization of beats based on the duration of two consecutive RR intervals was used to quantify the prevalence of arrhythmia for each patient (Figure A). The RR duration of the loading beat RR i‐1 was plotted versus the RR duration of the current beat RR i allowing identification of the presence of distinct beat types in clusters.…”

Section: Methodsmentioning

confidence: 99%

Assessment of left ventricle magnetic resonance temperature stability in patients in the presence of arrhythmias

et al. 2019

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Background Magnetic resonance (MR) thermometry allows visualization of lesion formation in real‐time during cardiac radiofrequency (RF) ablation. The present study was performed to evaluate the precision of MR thermometry without RF heating in patients exhibiting cardiac arrhythmia in a clinical setting. The evaluation relied on quantification of changes in temperature measurements caused by noise and physiological motion. Methods Fourteen patients referred for cardiovascular magnetic resonance imaging underwent an extra sequence to test the temperature mapping stability during free‐breathing acquisition. Phase images were acquired using a multi‐slice, cardiac‐triggered, single‐shot echo planar imaging sequence. Temperature maps were calculated and displayed in real‐time while the electrocardiogram (ECG) was recorded. The precision of temperature measurement was assessed by measuring the temporal standard deviation and temporal mean of consecutive temperature maps over a period of three minutes. The cardiac cycle was analyzed from ECG recordings to quantify the impact of arrhythmia events on the precision of temperature measurement. Finally, two retrospective strategies were tested to remove acquisition dynamics related either to arrhythmia events or sudden breathing motion. Results ECG synchronization allowed categorization of inter‐beat intervals (RR) into distinct beat morphologies. Five patients were in stable sinus rhythm, while nine patients showed irregular RR intervals due to ectopic beats. An average temporal standard deviation of temperature of 1.6°C was observed in patients under sinus rhythm with a frame rate corresponding to the heart rate of the patient. The temporal standard deviation rose to 2.5°C in patients with arrhythmia. The retrospective rejection strategies increased the temperature precision measurement while maintaining a sufficient frame rate. Conclusions Our results indicated that real‐time cardiac MR thermometry shows good precision in patients under clinical conditions, even in the presence of arrhythmia. By providing real‐time visualization of temperature distribution within the myocardium during RF delivery, MR thermometry could prevent insufficient or excessive heating and thus improve safety and efficacy.

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“…In previous reports, decreased PVC SV could be involved in symptoms. [22][23][24] The mechanism of the hemodynamic changes caused by PVCs has been suggested as (1) a decrease in PVC SV, (2) insufficient LV filling because of the short diastolic phase immediately before the appearance of a PVC, and (3) an increase in SV in the sinus beat following PVC caused by a decrease in LV filling at the time of the PVC.…”

Section: Mechanism Of Pvc-related Symptomsmentioning

confidence: 99%

Left Ventricular Inflow Velocity Pattern in Patients With Symptomatic Premature Ventricular Contraction

Takahashi

Mine

Ashida

et al. 2019

Circ J

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remature ventricular contractions (PVCs) are a common arrhythmia, even in people without structural heart disease, and has been reported at an incidence rate of approximately 1% on standard 12-lead ECGs and 40-75% on routine 24-h Holter ECG. 1,2 PVCs in a structurally normal heart are almost idiopathic, but multiform PVCs, high PVC burden, or the presence of non-sustained ventricular tachycardia (VT) are associated with inverse clinical outcomes such as death, heart failure and cardiovascular hospitalization. 3-5 Many previous reports show that PVCs can develop into cardiomyopathy and that risk factors include PVC frequency, PVC origin, short PVC coupling interval (CI), and VT. 6-9 Some patients have symptoms that were seemingly associated with PVCs and require treatment such as antiarrhythmic drugs 10-12 or catheter ablation, 13-15 which have been reported as effective. PVC-related symptoms include pulse deficit, palpitations, shortness of breath, malaise and syncope. Yet no explicit relationship between the presence of symptoms and the frequency of PVCs has been observed. 16 The mechanism of symptomatic PVCs is still unknown, although the PVC CI is associated with symptoms. 17 There have been few reports on the relationship between PVCs and these symptoms, and the cause of symptomatic PVCs remains unclear. Therefore, we investigated the hemodynamic features that could cause symptomatic PVCs. Methods Patients We enrolled 189 consecutive patients with frequent monomorphic PVCs on standard 12-lead or 24-h Holter ECG who visited Hyogo College of Medicine for examination of PVCs between November, 2016 and January, 2018. We defined frequent PVC when ≥2 beats of PVC were recorded on 12-lead ECG during a 10-s period more than twice. Of the patients, 27 who had structural heart disease (11 cases of ischemic heart disease, 2 of hypertrophic cardiomyopathy, 4 of hypertensive heart disease, 1 case each of dilated cardiomyopathy and severe aortic valve regurgitation, 5 other cases) or rhythm abnormality (3 cases of atrial fibrillation, 2 cases of pacemaker rhythm) were excluded. Among the remaining 162 patients, 1 case of bigeminy of PVCs, one of unstable interval of preceding R wave and PVC, and 7 cases of an unclear relationship between PVCs and symptoms were also excluded. Patients with polymorphic PVCs on standard 12-lead or 24-h Holter ECG were not included. Another 44 cases of patients who did not have PVCs recorded during echocardiography were also excluded, and the remaining 109 patients were studied. All patients underwent standard 12-lead ECG, 24-h Holter ECG and echocardiography. Blood samples for atrial natriuretic peptide (ANP) and B-type natriuretic pep

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Quantification of Left Ventricular Function With Premature Ventricular Complexes Reveals Variable Hemodynamics

Cited by 21 publications

References 29 publications

Self-gated MRI of multiple beat morphologies in the presence of arrhythmias

Self-gated MRI of multiple beat morphologies in the presence of arrhythmias

Assessment of left ventricle magnetic resonance temperature stability in patients in the presence of arrhythmias

Left Ventricular Inflow Velocity Pattern in Patients With Symptomatic Premature Ventricular Contraction

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