Quantitative assessment of left ventricular mechanical dyssynchrony using cine cardiovascular magnetic resonance imaging: Inter-study reproducibility

Kowallick, Johannes T.; Morton, Geraint; Lamata, Pablo; Jogiya, Roy; Kutty, Shelby; Hasenfuß, Gerd; Lotz, Joachim; Chiribiri, Amedeo; Nagel, Eike; Schuster, Andreas

doi:10.1177/2048004017710142

Cited by 14 publications

(12 citation statements)

References 33 publications

(77 reference statements)

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“…A possible explanation is that septal movement in patients with LBBB has both active and passive components, and delayed contraction of the LV free wall thus has a more marked effect on the apical segments of the septum than on its basal segments ( 32 , 33 ). The data of the present study suggest that qualitative assessment of dyssynchrony (i.e., “septal flash” and “apical rocking”) already during CINE imaging can help to identify “patients at risk” while strain analysis with SDI septal could further assist in identifying those patients prone to artefacts, the latter also with respect to the comparatively short computing time and a sufficiently good inter-study reproducibility ( 21 ). Consideration must be given to the fact that strain analysis by MRI is not widely used in institutions.…”

Section: Discussionmentioning

confidence: 83%

“…Whenever manual correction of the contours was necessary, it was performed by consensus by the readers. The global SDI (SDI global ), defined as the standard deviation of the segmental time to maximum strain for segments 1–16 normalised to the length of the cardiac cycle and given in time percentage, was used to determine the severity of LV dyssynchrony and to correlate dyssynchrony with the frequency of artefacts identified in LGE imaging ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

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Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Petersen

Nagel²,

Hamm³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundLeft bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images.Materials and methodsFifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash).ResultsThirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44–20.44%); LBBB without artefact: 6.82% (-2.18–15.83%); controls: 4.38% (1.38–7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05).ConclusionPatients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.

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Section: Discussionmentioning

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Petersen

Nagel²,

Hamm³

et al. 2022

Front. Cardiovasc. Med.

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“…CURE has been shown to identify a greater magnitude of dyssynchrony (lower CURE values) in patients with non-ischemic cardiomyopathy compared to healthy controls (0.79 ± 0.14 vs 0.97 ± 0.02) [36]. In a different study, CURE in healthy controls volunteers has been shown to be 0.87 ± 0.07 [37]. The current study shows that patients with severely reduced LVEF and normal QRS duration have some degree of mechanical dyssynchrony even in the absence of scar (median CURE 0.79).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of left ventricular mechanical dyssynchrony indices for mechanical characteristics of left bundle branch block using cardiovascular magnetic resonance feature tracking

Loewenstein

Wieslander

Heiberg

et al. 2022

Preprint

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Background: Cardiac imaging-based indices of left ventricular (LV) mechanical dyssynchrony have limited accuracy for predicting the response to cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the diagnostic performance of mechanical dyssynchrony indices in a study population of patients with severely reduced ejection fraction and no LV myocardial scar assessed by cardiovascular magnetic resonance (CMR), and either left bundle branch block (LBBB) or normal QRS duration. Methods: We retrospectively identified 80 patients from three centers, with LV ejection fraction ≤35%, no scar by CMR late gadolinium enhancement, and either normal electrocardiographic QRS duration (<120ms) and normal frontal plane electrical axis (-30 to +90 degrees) (control, n=36), or LBBB by Strauss' criteria (LBBB, n=44). The CMR image data from these subjects is made publicly available as part of this publication. CMR feature tracking was used to derive circumferential strain in a midventricular short-axis cine image. Using circumferential strain, mechanical dyssynchrony was quantified as the circumferential uniformity ratio estimate (CURE) and the systolic stretch index (SSI), respectively. Results: Both CURE and SSI resulted in measures of mechanical dyssynchrony that were more severe (lower CURE, higher SSI) in LBBB compared to controls (CURE, median [interquartile range], 0.63 [0.54-0.75] vs 0.79 [0.69-0.86], p<0.001; SSI 9.4 [7.4-12.7] vs 2.2 [1.2-3.6], p<0.001). SSI outperformed CURE in the ability to discriminate between LBBB and controls (area under the receiver operating characteristics curve [95% confidence interval] 0.98 [0.95-1.00] vs 0.77 [0.66-0.86], p<0.001; sensitivity 93 [84-100] vs 75 [61-86] %, p=0.02; specificity 97 [92-100] vs 67 [50-81] %, p=0.003). Conclusions: The ability to discriminate between LBBB and normal QRS duration among patients with severely reduced ejection fraction and no scar was fair for CURE and excellent for SSI.

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“…Besides LV strain evaluations, CMR-FT also has been shown to enable measurement of LV tissue velocity, rotational mechanics (calculating angular movements of a tracked point between systole and diastole with regard to the centre of gravity) or circumferential and radial uniformity ratio estimates quantifying synchrony of myocardial deformation by plotting strain against spatial position and measuring oscillations as an expression of myocardial dyssynchrony [16][17][18][19] (Fig. 3).…”

Section: Techniques Basic Principles and Measurement Capabilitiesmentioning

confidence: 99%

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

Lange

Schuster

2021

Curr Heart Fail Rep

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Purpose of Review Cardiac magnetic resonance-feature-tracking (CMR-FT)-based deformation analyses are key tools of cardiovascular imaging and applications in heart failure (HF) diagnostics are expanding. In this review, we outline the current range of application with diagnostic and prognostic implications and provide perspectives on future trends of this technique. Recent Findings By applying CMR-FT in different cardiovascular diseases, increasing evidence proves CMR-FT-derived parameters as powerful diagnostic and prognostic imaging biomarkers within the HF continuum partly outperforming traditional clinical values like left ventricular ejection fraction. Importantly, HF diagnostics and deformation analyses by CMR-FT are feasible far beyond sole left ventricular performance evaluation underlining the holistic nature and accuracy of this imaging approach. Summary As an established and continuously evolving technique with strong prognostic implications, CMR-FT deformation analyses enable comprehensive cardiac performance quantification of all cardiac chambers.

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Quantitative assessment of left ventricular mechanical dyssynchrony using cine cardiovascular magnetic resonance imaging: Inter-study reproducibility

Cited by 14 publications

References 33 publications

Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Accuracy of left ventricular mechanical dyssynchrony indices for mechanical characteristics of left bundle branch block using cardiovascular magnetic resonance feature tracking

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

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