Numerous methods have been published to segment the infarct tissue in theleft ventricle, most of them either need manual work, post-processing, or suffer from poorreproducibility. We proposed an automatic segmentation...Numerous methods have been published to segment the infarct tissue in theleft ventricle, most of them either need manual work, post-processing, or suffer from poorreproducibility. We proposed an automatic segmentation method for segmenting the infarct tissue irleft ventricle with myocardial infarction. Cardiac images of a total of 60 diseased hearts (55 humanhearts and 5 porcine hearts) were used in this study. The epicardial and endocardial boundariesof the ventricles in every 2D slice of the cardiac magnetic resonance with late gadoliniumenhancement images were manually segmented. The subsequent pipeline of infarct tissuesegmentation is fully automatic. The segmentation results with the automatic algorithm proposed inthis paper were compared to the consensus ground truth. The median of Dice overlap between ourautomatic method and the consensus ground truth is 0.79. We also compared the automatic methodwith the consensus ground truth using different image sources from diferent centers with diferentscan parameters and different scan machines. The results showed that the Dice overlap with thepublic dataset was 0.83, and the overall Dice overlap was 0.79. The results show that our method isrobust with respect to different MRI image sources, which were scanned by different centers withdifferent image collection parameters. The segmentation accuracy we obtained is comparable toor better than that of the conventional semi-automatic methods. Our segmentation method may beuseful for processing large amount of dataset in clinic.展开更多
AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65...AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.展开更多
AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational ...AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.展开更多
Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is...Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.展开更多
A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mecha...A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mechanism by which these women have myocardial injury varies and is not usually clear by history and angiography alone.Additional imaging,including modalities such as cardiac MRI,intravascular imaging,and computed tomography may be helpful to clarify diagnoses and direct treatment.展开更多
Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary p...Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.展开更多
目的:探讨PTCA球囊封堵猪冠状动脉建立急性心肌梗死再灌注动物模型的实验方法并进行判定。方法:选用中华小型猪8只,将PTCA球囊放至冠状动脉左回旋支第一钝缘支,堵闭血流90 m in,再灌注60 m in后,用坏死特异性对比剂(EC-60)增强MR I在活...目的:探讨PTCA球囊封堵猪冠状动脉建立急性心肌梗死再灌注动物模型的实验方法并进行判定。方法:选用中华小型猪8只,将PTCA球囊放至冠状动脉左回旋支第一钝缘支,堵闭血流90 m in,再灌注60 m in后,用坏死特异性对比剂(EC-60)增强MR I在活体确定梗死区;离体标本进行氯化三苯基四氮唑(TTC)组化染色验证梗死区。结果:成功建立8只猪急性心肌梗死动物模型,活体EC III-60增强MR I高信号区与离体TTC染色所示梗死区部位与面积一致(P>0.05)。结论:应用PTCA球囊封堵猪冠状动脉可成功建立急性心肌梗死动物模型,这种模型具有重复性好、可控性强的优点,且创伤较小,接近临床病理生理过程,可作为急性心肌梗死研究的技术平台。展开更多
基金supported by the National Key Researchand Development Program of China(No.2016YFC1301002 to Jianzeng Dong)the National Natural Science Foundation of China(No.81901841 to Dongdong Deng,No.81671650 and No.81971569 to Yi He,No.61527811 to Ling Xia)+1 种基金the Key Research and Development Program of Zhejiang Province(No.2020C03016 to Ling Xia)Dongdong Deng also acknowledges support from Dalian University of Technology(No.DUT18RC(3)068)。
文摘Numerous methods have been published to segment the infarct tissue in theleft ventricle, most of them either need manual work, post-processing, or suffer from poorreproducibility. We proposed an automatic segmentation method for segmenting the infarct tissue irleft ventricle with myocardial infarction. Cardiac images of a total of 60 diseased hearts (55 humanhearts and 5 porcine hearts) were used in this study. The epicardial and endocardial boundariesof the ventricles in every 2D slice of the cardiac magnetic resonance with late gadoliniumenhancement images were manually segmented. The subsequent pipeline of infarct tissuesegmentation is fully automatic. The segmentation results with the automatic algorithm proposed inthis paper were compared to the consensus ground truth. The median of Dice overlap between ourautomatic method and the consensus ground truth is 0.79. We also compared the automatic methodwith the consensus ground truth using different image sources from diferent centers with diferentscan parameters and different scan machines. The results showed that the Dice overlap with thepublic dataset was 0.83, and the overall Dice overlap was 0.79. The results show that our method isrobust with respect to different MRI image sources, which were scanned by different centers withdifferent image collection parameters. The segmentation accuracy we obtained is comparable toor better than that of the conventional semi-automatic methods. Our segmentation method may beuseful for processing large amount of dataset in clinic.
基金Supported by Grant from the Agency for Healthcare Research and Quality,No.K12HS019473
文摘AIM:To investigate diagnostic accuracy of high,low and mixed voltage dual energy computed tomography(DECT) for detection of prior myocardial infarction(MI).METHODS:Twenty-four consecutive patients(88% male,mean age 65 ± 11 years old) with clinically documented prior MI(】 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI.Computed tomography(CT) examinations were performed using a dual source CT system(64-slice Definition or 128-slice Definition FLASH,Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions.Using the 17-segment model,regional systolic function was analyzed using first pass CT as normal or abnormal(hypokinetic,akinetic,dyskinetic).Regions with abnormal systolic function were identified as infarct segments.Late phase DE scans were reconstructed into:140 kVp,100 kVp,mixed(120 kVp) images and iodine-only datasets.Using the same 17-segment model,each dataset was evaluated for possible(grade 2) or definite(grade 3) late phase myocardial enhancement abnormalities.Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores.RESULTS:All patients reported prior history of documented myocardial infarction,with most occurring more than 5 years prior(n = 18;75% of cohort).Fiftyfive of 408(13%) segments demonstrated abnormal wall motion and were classified as infarct.The remaining 353 segments were classified as non-infarcted segments.A total of 1692 segments were analyzed for late phase enhancement abnormalities,with 91(5.5%) segments not interpretable due to artifact.Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated.Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy(87%;95%CI:80%-90%),sensitivity(86%-93%;95%CI:54%-78%) and specificity(90%;95%CI:86%-93%) compared to the other reconstructions.For sensitivity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.0005),100 kVp vs mixed(P【0.0001),and 100 kVp vs iodine only(P【0.005) using combined grade 2 and grade 3 perfusion abnormalities.For specificity,there were significant differences noted between 100 kVp vs 140 kVp(P【0.005),and 100 kVp vs mixed(P【0.01) using combined grades 2 and 3 perfusion abnormalities.CONCLUSION:Low voltage acquisition CT,100 kVp in this study,demonstrates superior diagnostic performance when compared to higher and mixed voltage acquisitions for detection of prior MI.
基金Supported by The French Federation of Cardiology(Fédération francaise de Cardiologie)
文摘AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and nonobstructive coronary arteries(MINOCA)with normal ejection fraction(EF).METHODS This is an observational analysis of 131 MINOCA patients with normal EF.Three cardiac magnetic resonance(CMR)diagnosis classes were recognized according to the late gadolinium enhancement(LGE)pattern:Myocardial infarction(MI)(n=34),myocarditis(n=47),and"no LGE"(n=50).Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.RESULTS Ventricular arrhythmia was observed in 18(13.8%)patients during hospitalization.The"no LGE"patients experienced fewer ventricular events than the MI and myocarditis patients[4.0%vs 26.5%and 14.9%,respectively(P=0.013)].There was no significant difference between the MI and myocarditis groups.On multivariate analysis,LGE transmural extent[OR=1.52(1.08-2.15),P=0.017]and ST-segment elevation[OR=4.65(1.61-13.40),P=0.004]were independent predictors of ventricular arrhythmic events,irrespective of the diagnosis class.Finally,no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events,irrespective of the CMR diagnosis class.LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.
文摘Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.
文摘A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mechanism by which these women have myocardial injury varies and is not usually clear by history and angiography alone.Additional imaging,including modalities such as cardiac MRI,intravascular imaging,and computed tomography may be helpful to clarify diagnoses and direct treatment.
文摘Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.
文摘目的:探讨PTCA球囊封堵猪冠状动脉建立急性心肌梗死再灌注动物模型的实验方法并进行判定。方法:选用中华小型猪8只,将PTCA球囊放至冠状动脉左回旋支第一钝缘支,堵闭血流90 m in,再灌注60 m in后,用坏死特异性对比剂(EC-60)增强MR I在活体确定梗死区;离体标本进行氯化三苯基四氮唑(TTC)组化染色验证梗死区。结果:成功建立8只猪急性心肌梗死动物模型,活体EC III-60增强MR I高信号区与离体TTC染色所示梗死区部位与面积一致(P>0.05)。结论:应用PTCA球囊封堵猪冠状动脉可成功建立急性心肌梗死动物模型,这种模型具有重复性好、可控性强的优点,且创伤较小,接近临床病理生理过程,可作为急性心肌梗死研究的技术平台。
