RESUMEN
OBJECTIVES: Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes. DESIGN: Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE methods. Segmental wall thickness (SWT) was measured, while radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann-Whitney U test and McNemar's test (between and within groups). Bland-Altman analyses were used for intertechnique coherence, while interactions regarding TTE were tested using Spearman's coefficient. RESULTS: LVM decreased during recovery (p < 0.05), by MRI and one of the TTE methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared with MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence there between. The TEF data interacted partially with a demonstrated increase in radial strain. CONCLUSIONS: TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF method regarding LVM.
Asunto(s)
Ecocardiografía Doppler , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Imagen por Resonancia Cinemagnética , Cardiomiopatía de Takotsubo/diagnóstico , Anciano , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Contracción Miocárdica , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Cardiomiopatía de Takotsubo/diagnóstico por imagen , Cardiomiopatía de Takotsubo/patología , Cardiomiopatía de Takotsubo/fisiopatología , Factores de Tiempo , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Magnetic resonance (MR) imaging and echocardiography both allow assessment of aortic valve stenosis. In MR the aortic valve area (AvA) is measured using planimetry while in transthoracic echocardiography (TTE) AvA is usually calculated by applying the continuity equation. PURPOSE: To compare the measured stenotic aortic valve areas using five different MR-acquisition alternatives with the corresponding area values calculated by TTE. MATERIAL AND METHODS: The aortic valve was imaged in 14 patients, with diagnosed aortic valve stenosis, using balanced steady state free precession (bSSFP) gradient echo (GE) and phase contrast imaging (PC). Three adjacent slices were planned to encompass the aortic valve and the aortic valve area was measured using planimetry. The two sets of complex valued images generated by the PC sequence formed three kinds of images that could be used for aortic valve area measurements: the magnitude image (PC/Mag), the modulus (PCA/M), and phase difference (PCA/P) between the two complex images, respectively. The valve area from TTE was calculated using the continuity equation. A cut-off of <1.0 cm(2) was used as a criteria for severe stenosis. RESULTS: The mean area differences between the different MR acquisitions and TTE method were -0.05 ± 0.37 cm(2) (GE), -0.18 ± 0.46 cm(2) (bSSFP), 0.27 ± 0.43 cm(2) (PC/Mag), 0.15 ± 0.32 cm(2) (PCA/P), and 0.26 ± 0.27 cm(2) (PCA/M). The valve area was significantly overestimated using PCA/M that, in turn, implied a significant underestimation of the aortic valve stenosis severity compared to the assessments using TTE. CONCLUSION: The smallest area valve difference between TTE and an MR-acquisition alternative is obtained with gradient echo images. The use of PCA/M leads to significant differences in planimetry measurements of the aortic valve orifice and the gradation of the stenosis severity compared to TTE.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico , Ecocardiografía/métodos , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To investigate the accuracy of velocity measurements in patients with aortic valve stenosis using phase contrast (PC) imaging accelerated with SENSE (Sensitivity Encoding) and k-t BLAST (Broad-use Linear Acquisition Speed-up Technique). METHODS: Accelerated quantitative breath hold PC measurements, using SENSE and k-t BLAST, were performed in twelve patients whose aortic valve stenosis had been initially diagnosed using echocardiography. Stroke volume (SV) and peak velocity measurements were performed on each subject in three adjacent slices using both accelerating methods. RESULTS: The peak velocities measured with PC MRI using SENSE were -8.0±9.5% lower (p<0.01) compared to the peak velocities measured with k-t BLAST and the correlation was r=0.83. The stroke volumes when using SENSE were slightly higher 0.4±17.1 ml compared to the SV obtained using k-t BLAST but the difference was not significant (p>0.05). CONCLUSIONS: In this study higher peak velocities were measured in patients with aortic stenosis when combining k-t BLAST with PC MRI compared to PC MRI using SENSE. A probable explanation of this difference is the higher temporal resolution achieved in the k-t BLAST measurement. There was, however, no significant difference between calculated SV based on PC MRI using SENSE and k-t BLAST, respectively.
Asunto(s)
Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Angiografía por Resonancia Magnética/métodos , Adulto , Anciano de 80 o más Años , Femenino , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Short-axis (SA) magnetic resonance (MR) images are commonly planned parallel to the left atrioventricular valve. This orientation leads to oblique slices of the right ventricle (RV) with subsequent difficulties in separating the RV from the right atrium in the SA images. The insertion points of the tricuspid valve (TV) in the myocardium can be clearly identified in the right ventricle long axis (RVLA) and four-chamber (4CH) views. The purpose of this study was to develop a method that transfers the position of the tricuspid plane, as seen in the RVLA and 4CH views, to the SA images to facilitate the separation of the RV from the atrium. This methodology, termed Dissociating the Right Atrium from the Ventricle Volume (DRAW), was applied in 20 patients for calculations of right ventricular stroke volume (RVSV). The RVSV using DRAW (RVSV(DRAW)) was compared to left ventricular stroke volumes (LVSV) obtained from flow measurements in the ascending aorta. The RVSV was also determined using the conventional method (RVSV(CONV)) where the stack of images from the SA views are summarized, and a visual decision is made of the most basal slice to be included in the RV. The mean difference between RVSV(DRAW) and LVSV was 0·1 ± 12·7 ml, while the mean difference between RVSV(CONV) and LVSV was 0·33 ± 14·3 ml. Both the intra- and interobserver variability were small using the DRAW methodology, 0·6 ± 3·5 and 1·7 ± 2·7 ml, respectively. In conclusion, the DRAW method can be used to facilitate the separation of the RV and the atrium.
Asunto(s)
Cardiopatías/diagnóstico , Ventrículos Cardíacos/patología , Imagen por Resonancia Magnética , Volumen Sistólico , Válvula Tricúspide/patología , Función Ventricular Derecha , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Atrios Cardíacos/patología , Atrios Cardíacos/fisiopatología , Cardiopatías/patología , Cardiopatías/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Suecia , Válvula Tricúspide/fisiopatología , Adulto JovenRESUMEN
BACKGROUND: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined. METHODS: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Åsberg depression rating scale, self rated version, MADRS-S). RESULTS: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01). CONCLUSIONS: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.
Asunto(s)
Corazón/fisiopatología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/fisiopatología , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/fisiopatología , Anciano , Sistema Nervioso Autónomo/fisiopatología , Depresión , Ecocardiografía , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos por Estrés Postraumático/complicaciones , Encuestas y Cuestionarios , Cardiomiopatía de Takotsubo/complicacionesRESUMEN
The purpose of this work was to develop a visualization method for concurrent observation of both velocity and magnitude data obtained from through-plane velocity measurements using phase-contrast magnetic resonance imaging. Magnitude and velocity images were combined using an opacity transfer function (OTF) where the opacity was a function of a velocity range defined by the velocity encoding (v (enc)) parameter. Measured velocities were color-coded according to a predefined color scale and then combined into one image with the gray-scale magnitude image according to the OTF. In the combined images, simultaneous information of velocity and anatomy was presented. The proposed visualization method facilitated the understanding of how the measured blood flow was related to the underlying anatomy. Results are shown where the method is used to visualize blood flow measurements in the ascending aorta and the aortic valve. Adjustments of the OTF render possible identification of the peak velocities and their localization. Forward and backward blood flow is easily shown when applying appropriate OTF and color-coding. An advantage when using the proposed method is the ability of developing standardized protocol settings since the velocity information is quantitative and not relative as is the case for data obtained from the magnitude images. The intended application of the visualization method is the analysis of common flow studies used in the diagnosis of different cardiovascular diseases.
Asunto(s)
Aorta/anatomía & histología , Válvula Aórtica/anatomía & histología , Imagen por Resonancia Magnética/métodos , Flujo Pulsátil , Velocidad del Flujo Sanguíneo , Circulación Coronaria , Humanos , Imagenología Tridimensional/métodosRESUMEN
Short axis (SA) images obtained from cardiac magnetic resonance imaging are used to advantage in the calculation of important clinical parameters such as the ejection fraction and stroke volume (SV). A prerequisite for these calculations is the separation of the left ventricle and the left atrium. When only using the information seen in the SA images this separation can be a source of error due to the through-plane motion of the basal part of the left ventricle. In this study a method is proposed where the separation of the left ventricle and the atrium is performed by identifying the intersections of the atrioventricular plane in the SA images. The equation of the atrioventricular plane was determined in both systole and diastole using long axis and four chamber image views. Stroke volumes were measured in 20 patients using SA images where the endocardium had been delineated. The SV obtained using the new method was compared with quantitative flow measurements and the conventional technique for calculation of SV from SA images, respectively. The agreement of SV was, according to Bland-Altman analysis, 2.0 ml (95% CI -12.0 to 15.9 ml) in comparison with the flow measurements and 2.2 ml (95% CI -9.2 to 13.6 ml) compared to the conventional method. Inter- and intra-observer variability, when using the new proposed method, was small. This study shows that the identification of the left atrioventricular plane in SA images can be used in the separation of the left atrium and ventricle.
Asunto(s)
Atrios Cardíacos/anatomía & histología , Ventrículos Cardíacos/anatomía & histología , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Cinemagnética/métodos , Volumen Sistólico , Función Ventricular Izquierda , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/anatomía & histología , Válvula Mitral/fisiología , Variaciones Dependientes del Observador , Función VentricularRESUMEN
OBJECTIVE: To compare echocardiographic M-mode measurements of tricuspid annulus motion (TAM) with angiographic M-mode measurements of right coronary artery motion (RAM). DESIGN: Twenty-four patients were included and examined by echocardiography before the angiographic examination. The amplitudes and the velocities of TAM and the atrial contribution to the total amplitude of TAM were measured. The obtained values were compared with angiographic M-mode measurements of RAM at a proximal and a distal site of the second segment of the right coronary artery. RESULTS: There was no significant difference between several of the echocardiographic M-mode measurements of TAM and the angiographic M-mode measurements of RAM. However, the agreement was rather poor for some variables. CONCLUSION: Different parameters obtained from echocardiographic TAM are not interchangeable with values from angiographic RAM. If measurements of RAM are to be used in the assessment of right ventricular (RV) function further studies are needed to examine the correlation and agreement between RAM and different methods of measuring RV function, i.e. radionuclide angiography or magnetic resonance imaging.
Asunto(s)
Angiografía Coronaria/métodos , Vasos Coronarios/fisiología , Ecocardiografía Doppler de Pulso/métodos , Válvula Tricúspide/diagnóstico por imagen , Adulto , Anciano , Análisis de Varianza , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica , Sensibilidad y Especificidad , Volumen Sistólico/fisiología , Función Ventricular Derecha/fisiologíaRESUMEN
This article describes a simple yet effective method to catheterize the coronary arteries when the ascending aorta is very dilated. Two catheters are used in a coaxial fashion. It was possible to catheterize a patient with a 9 cm wide ascending aorta.
Asunto(s)
Aorta/patología , Cateterismo Cardíaco , Enfermedad de la Arteria Coronaria/diagnóstico , Anciano , Angioplastia Coronaria con Balón , Aorta/cirugía , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/terapia , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/terapia , Dilatación Patológica/diagnóstico , Dilatación Patológica/terapia , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate the usefulness of M-mode measurement of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. DESIGN: Seventy-two patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and systolic and diastolic parameters of CAM were measured by M-mode from coronary angiography. Twenty-three patients, examined by echocardiography of mitral annulus motion (MAM) within 24 h before the angiographic examination, formed a subgroup for comparison between angiographic M-mode of CAM and echocardiographic M-mode of MAM. RESULTS: In addition to previous reported CAM amplitude and longitudinal fractional shortening (FSL) the maximal systolic velocity of CAM can be reliably recorded by M-mode. The diastolic indices, atrial contribution to the total amplitude and maximal early and late diastolic velocities, are also well monitored by M-mode of CAM in comparison with echocardiographic MAM. CONCLUSION: LV systolic and diastolic function can be assessed by M-mode of CAM.
Asunto(s)
Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Función Ventricular Izquierda , Adulto , Anciano , Circulación Coronaria/fisiología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Diástole/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiología , Sístole/fisiología , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the usefulness of circumflex artery motion (CAM) for assessment of left ventricular (LV) function. DESIGN: Seventy-three consecutive patients referred for coronary angiography and LV angiography were included. Ejection fraction (EF) was calculated from LV angiography and CAM was measured from coronary angiography. RESULTS: The ratio between CAM and the end-diastolic length of the ventricle, which can be denominated long-axis fractional shortening (FS(L)), was found to be a better index of LV function than CAM per se. There was a significant linear correlation between EF and FS(L) (r = 0.81, SEE = 8.2, p < 0.001). When values of FS(L) > or =10% were selected to define a normal EF (> or =50%) there was a sensitivity of 95% and a specificity of 93%. Visual estimation of EF from CAM was not as good as the use of calculated FS(L) but may me useful as a fast screening method. CONCLUSION: LV systolic function can be assessed by studying CAM recorded by coronary angiography.