Usefulness of strain cardiac magnetic resonance for the exposure of mild left ventricular systolic abnormalities in pectus excavatum

Rodríguez-Granillo, Gastón A.; Toselli, Luzia; Farina, Juan; Raggio, Ignacio; Diluca, Pablo; Fontana, Lucía; Valle-Anziani, Maxroxia; Bordoli, Ines; Bellía-Munzón, Gastón; Martı́nez-Ferro, Marcelo

doi:10.1016/j.jpedsurg.2021.09.008

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…These results indicate a purely mechanical problem in the absence of structural changes. In contrast, several small studies in patients with real PE found abnormal values for both LV and RV strain 14 , 54 , 55 , some of which were improved after surgical correction 56 . In addition, it is discussed whether the impairment of the strain is actually due to subclinical myocardial dysfunction or rather reflects intraventricular dyssynchrony due to the compression 57 .…”

Section: Discussionmentioning

confidence: 84%

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Hohneck

Ansari

Natale

et al. 2023

Sci Rep

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Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with thoracic constriction (defined as elevated Haller-Index > 3.25 determined by cardiac magnetic resonance imaging (CMR)) without visible evidence of PE, leading to similar complaints. Between January 2004 till June 2020, patients who underwent CMR for further evaluation of the heart, due to cardiac symptoms were enrolled and compared to controls. Biventricular global strain analysis was assessed using feature tracking (CMR-FT). ECG and/or Holter recordings were performed to detect rhythm events. Cardiac symptoms were evaluated in detail using a questionnaire. Finally, 88 patients (male 35, female 53) with elevated Haller-Index (3.9 ± 0.8) were included and compared to CMR data from 25 individuals with confirmed PE and 25 healthy controls (HC). Mean age at time of CMR was 35 ± 16 years. The most common symptoms at presentation were palpitations (41%), followed by dyspnea (24%) and atypical chest pain (14%). Three patients (3%) had atrial fibrillation or atrial flutter. Concomitant phenomena were pericardial effusion in 39% and mitral valve prolapse (MVP) in 27% of the study cohort. While there were no differences in left ventricular function or volumes, right ventricular function (RVEF) was significantly lower in patients with internal PE compared to HC (RVEF (%) 50 ± 5 vs 59 ± 4, p < 0.01). Strain analysis revealed only discrete changes in RV strain, implying a purely mechanical problem in the absence of structural changes. RV dimensions were negatively correlated with the size of thoracic indices (r = 0.41), reflecting the extent of thoracic constriction. MVP was more prevalent in patients with greater thoracic indices (r = 0.24). The described cohort, referred to as internal PE because of the absence of external changes, showed similar CMR morphologic findings as patients with real PE (especially altered dimensions of the right heart and a lower RVEF). In addition, there was a high incidence of rhythm disturbances, such as extrasystoles or arrhythmias. In one-third of the study cohort additional abnormalities such as pericardial effusion or MVP were present, with MVP being found more frequently in patients with larger thoracic indices, suggesting a possible common pathogenesis.Trial registration: ISRCTN registry, ISRCTN15355937, retrospectively registered 03.06.2022, https://www.isrctn.com/ISRCTN15355937?q=15355937&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10.

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Section: Discussionmentioning

confidence: 84%

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Hohneck

Ansari

Natale

et al. 2023

Sci Rep

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“…Conventional methods to evaluate myocardial function on MRI are through the assessment of wall motion abnormalities or ejection fraction. However, imaging of ventricular myocardial strain (i.e., fractional deformation of the myocardial wall throughout the cardiac cycle) has been shown to detect myocardial dysfunction at an earlier stage compared to conventional measures ( 50 - 52 ).…”

Section: Conventional Preoperative Imaging Methodsmentioning

confidence: 99%

“…In case of pectus excavatum, assessment of cardiac function is mainly focused on the right ventricle since the associated sternal depression usually deforms the right ventricular wall ( 53 ). To improve cardiac MRI assessment in patients with pectus excavatum, Rodriguez-Granillo et al [2022] evaluated systolic function of both the right and left ventricles using longitudinal cardiac strain and conventional ejection fraction analyses ( 50 ). The study demonstrated that right ventricular systolic dysfunction can be identified using conventional analyses, while subtle left ventricular systolic dysfunction could only be detected using longitudinal strain analysis and was overlooked by conventional assessment ( 50 ).…”

Section: Conventional Preoperative Imaging Methodsmentioning

confidence: 99%

“…To improve cardiac MRI assessment in patients with pectus excavatum, Rodriguez-Granillo et al [2022] evaluated systolic function of both the right and left ventricles using longitudinal cardiac strain and conventional ejection fraction analyses ( 50 ). The study demonstrated that right ventricular systolic dysfunction can be identified using conventional analyses, while subtle left ventricular systolic dysfunction could only be detected using longitudinal strain analysis and was overlooked by conventional assessment ( 50 ). Though, it must be remembered that these results are based on analyses of cardiac function of patients at rest and in supine position.…”

Section: Conventional Preoperative Imaging Methodsmentioning

confidence: 99%

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Advancements in preoperative imaging of pectus excavatum: a comprehensive review

Coorens,

Janssen,

Daemen

et al. 2024

J Thorac Dis

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Pectus excavatum, the most common pectus deformity, varies in severity and has been associated with cardiopulmonary impairment and psychological distress. Since its initial documentation, a multitude of imaging techniques for preoperative evaluation (i.e., diagnosis, severity classification, functional assessment, and surgical planning) have been reported. Conventional imaging techniques encompass computed tomography (CT), chest radiography, magnetic resonance imaging (MRI), echocardiography and medical photography, while three dimensional (3D) optical surface imaging is a promising emerging technique in the preoperative assessment of pectus excavatum. This narrative review explores the current insights and advancements of these imaging modalities. CT imaging allows for the calculation of pectus indices and evaluation of cardiac compression and displacement. Recent developments focus on automated calculations, minimizing radiation exposure and improving surgical planning. Chest radiography offers a radiation-reducing alternative for pectus index measurement, but is unsuitable for disproportionally asymmetric chest deformations. MRI is a radiation-free imaging method, and allows for the calculation of pectus indices as well as the assessment of cardiac function. Real-time MRI provides dynamic insights, while exercise MRI shows promise for comprehensive evaluation of cardiac function but requires additional developments. Using echocardiography, structural cardiac changes can be identified, but its use in evaluating cardiac function in pectus excavatum patients is limited. Medical photography combined with caliper measurements complements other imaging methods for qualitative and quantitative documentation of pectus excavatum. Emerging as an innovative technique, 3D optical surface imaging offers a rapid, radiation-free assessment of the deformity which correlates with conventional pectus indices. Potential applications include quantifying other morphological features and predicting cardiac compression. However, standardization and validation are needed for its widespread use. This review provides an overview of preoperative imaging of pectus excavatum, highlighting the current developments in conventional methods and the potential of the emerging 3D optical surface imaging technique. These advancements hold promise for the future of the assessment and surgical planning of pectus excavatum.

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Adolescent Reference Values for MR‐Derived Biventricular Strain Obtained Using Feature‐Tracking and Myocardial Tagging

Real,

Párraga,

González‐Calvo

et al. 2024

Magnetic Resonance Imaging

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BackgroundMyocardial strain is a promising marker for the detection of early left or right ventricular (LV or RV) dysfunction in pediatric populations. The reference standard for MR strain measurement is myocardial tagging (MT); however, MT has limited clinical utility because the additional acquisitions needed are time‐consuming. In contrast, MR‐feature tracking (FT) allows strain quantification from routinely acquired cine sequences. Studies providing reference values obtained with both FT and MT for adolescents are lacking.PurposeTo use MR‐FT and MT to define sex‐specific LV and RV strain reference values for adolescents.Study TypeCross‐sectional, prospective.PopulationOne hundred twenty‐three adolescents aged 15–18 years (52% girls) without known cardiovascular disease.Field Strength/SequenceBalanced steady‐state free‐precession sequence for FT analysis and a spatial modulation of magnetization hybrid TFE‐EPI sequence for MT acquisitions at 3.0‐T.AssessmentSegment Medviso software was used to obtain longitudinal (LS) and circumferential (CS) strain for both ventricles, and radial strain (RS) for LV.Statistical TestsThe Student t‐test was used for between‐sex comparisons of continuous variables. Sex‐specific percentiles were calculated using the weighted average method. Intraobserver and interobserver agreement was assessed in 30 randomly selected studies using intraclass correlation coefficients (ICC). A P‐value <0.05 was considered statistically significant.ResultsFT‐derived LVLS and LVCS were significantly higher in girls than in boys (−19.8% vs. −17.8% and −22.2% vs. −21.0%, respectively), as they were with MT (LVLS: −18.1% vs. −16.8%; LVCS: −20.8% vs. −19.7%). FT‐LVRS was higher in girls than in boys (44.8% vs. 35.1%), while MT‐LVRS was the opposite (18.6% vs. 22.7%). FT‐RVLS was higher in girls (−23.4% vs. −21.3%), but there were no between‐sex differences in MT‐derived RVLS or RVCS. ICC values for intraobserver agreement were ≥0.89, whereas for interobserver agreement were <0.80 for MT‐LVRS and ≥0.80 for all remaining parameters.Data ConclusionThis study provides sex‐specific reference biventricular strain values obtained with MR‐MT and MR‐FT for adolescents aged 15–18 years. MR‐FT may be a valid method for obtaining strain values in pediatric populations.Evidence Level1Technical EfficacyStage 3

show abstract

Usefulness of strain cardiac magnetic resonance for the exposure of mild left ventricular systolic abnormalities in pectus excavatum

Cited by 4 publications

References 20 publications

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Advancements in preoperative imaging of pectus excavatum: a comprehensive review

Adolescent Reference Values for MR‐Derived Biventricular Strain Obtained Using Feature‐Tracking and Myocardial Tagging

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