Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ...Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion.The patients were divided into the anterior wall myocardial infarction(AWMI)and nonanterior wall myocardial infarction(NAWMI)groups.Infarct characteristics were assessed by late gadolinium enhancement.Global and regional strains and associated strain rates in the radial,circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images.The associations of infarct size,regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.Results There were 44 patients in the AWMI group and 51 in the NAWMI group.The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group(24.47±11.89,21.06±12.08%LV;t=3.928,P=0.008).In infarct zone analysis,strains in the radial,circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group(z=-20.873,-20.918,-10.357,all P<0.001).The volume(end-systolic volume index),total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group(all P<0.001).Conclusion In STEMI patients treated by percutaneous coronary intervention,myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.展开更多
BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden ...BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.展开更多
Deep neural networks(DNNs)have been extensively studied in medical image segmentation.However,existing DNNs often need to train shape models for each object to be segmented,which may yield results that violate cardiac...Deep neural networks(DNNs)have been extensively studied in medical image segmentation.However,existing DNNs often need to train shape models for each object to be segmented,which may yield results that violate cardiac anatomical structure when segmenting cardiac magnetic resonance imaging(MRI).In this paper,we propose a capsulebased neural network,named Seg-CapNet,to model multiple regions simultaneously within a single training process.The Seg-CapNet model consists of the encoder and the decoder.The encoder transforms the input image into feature vectors that represent objects to be segmented by convolutional layers,capsule layers,and fully-connected layers.And the decoder transforms the feature vectors into segmentation masks by up-sampling.Feature maps of each down-sampling layer in the encoder are connected to the corresponding up-sampling layers,which are conducive to the backpropagation of the model.The output vectors of Seg-CapNet contain low-level image features such as grayscale and texture,as well as semantic features including the position and size of the objects,which is beneficial for improving the segmentation accuracy.The proposed model is validated on the open dataset of the Automated Cardiac Diagnosis Challenge 2017(ACDC 2017)and the Sunnybrook Cardiac Magnetic Resonance Imaging(MRI)segmentation challenge.Experimental results show that the mean Dice coefficient of Seg-CapNet is increased by 4.7%and the average Hausdorff distance is reduced by 22%.The proposed model also reduces the model parameters and improves the training speed while obtaining the accurate segmentation of multiple regions.展开更多
Cardiovascular magnetic resonance (CMR) has become a reference standard for the measure-ment of cardiac volumes, function, and mass. This study aims to reconstruct three dimen-sional modeling of the left ventricle (LV...Cardiovascular magnetic resonance (CMR) has become a reference standard for the measure-ment of cardiac volumes, function, and mass. This study aims to reconstruct three dimen-sional modeling of the left ventricle (LV) in pa-tients with heart failure (HF) using CMRtools and thereby derive the LV functional indices. CMR images were acquired in 41 subjects (6 females) with heart failure (HF) and 12 normal controls (4 females). Five comparisons were made (i) nor-mal and dilated heart failure subjects, (ii) male and female normal heart, (iii) male and female dilated heart, (iv) male normal and dilated heart failure and (v) female normal and dilated heart failure. In HF, a significant higher values of EDV (320 刡 79 vs. 126 刡 22 ml, P&amp;amp;amp;amp;lt;0.0001), ESV (255 刡 68 vs. 54 刡 12 ml, P&amp;amp;amp;amp;lt;0.00001) and lower values of EF (20 刡 7 vs. 58 刡 5 %) were found compared that of normal control. There were significant difference on LV EDV and ESV between sex in both normal and HF subjects.展开更多
Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diag-nosis of primitive myocardial disorders, identification of ...Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diag-nosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evalu-ation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.展开更多
BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true a...BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.展开更多
The aim of this work is to develop an improved region based active contour and dynamic programming based method for accurate segmentation of left ventricle (LV) from multi-slice cine short axis cardiac magnetic reso...The aim of this work is to develop an improved region based active contour and dynamic programming based method for accurate segmentation of left ventricle (LV) from multi-slice cine short axis cardiac magnetic resonance (MR) images. Intensity inhomogeneity and weak object boundaries present in MR images hinder the segmentation accuracy. The proposed active contour model driven by a local Gaussian distribution fitting (LGDF) energy and an auxiliary global intensity fitting energy improves the accuracy of endocardial boundary detection. The weightage of the global energy fitting term is dynamically adjusted using a spatially varying weight function. Dynamic programming scheme proposed for the segmentation of epicardium considers the myocardium probability map and a distance weighted edge map in the cost matrix. Radial distance weighted technique and conical geometry are employed for segmenting the basal slices with left ventricle outflow tract (LVOT) and most apical slices. The proposed method is validated on a public dataset comprising 45 subjects from medical image computing and computer assisted interventions (MICCAI) 2009 segmentation challenge. The average percentage of good endocardial and epicardial contours detected is about 99%, average perpendicular distance of the detected good contours from the manual reference contours is 1.95 mm, and the dice similarity coefficient between the detected contours and the reference contours is 0.91. Correlation coefficient and the coefficient of determination between the ejection fraction measurements from manual segmentation and the automated method are respectively 0.9781 and 0.9567, for LV mass these values are 0.9249 and 0.8554. Statistical analysis of the results reveals a good agreement between the clinical parameters determined manually and those estimated using the automated method.展开更多
目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic re...目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic resonance,CMR)在评估PH-LHF患者中的应用价值。材料与方法回顾性分析2018年9月至2020年9月期间215例确诊为左心衰(left heart failure,LHF)患者的临床和CMR参数,根据心脏超声测量的收缩期肺动脉压将患者分为两组,即LHF组(n=129)和PH-LHF组(n=86)。比较两组的基线资料和CMR参数包括心血管形态参数、心室容积功能参数以及心室心房应变参数。通过单因素及多因素logistic回归分析CMR参数中PH-LHF的独立预测因子,并绘制受试者工作特征(receiver operating characteristics,ROC)曲线评估CMR参数的诊断价值。结果PH-LHF患者组左右心室舒张末期容积指数、收缩末期容积指数、右心室心肌质量指数、室间隔角、左心房最大直径及面积、初始T1值均高于LHF组,而左右心室射血分数、右心室每搏输出量指数、右心室心脏指数低于LHF组。PH-LHF组左心室整体纵向应变、整体周向应变以及应变率、右心室整体周向应变、左心房主动应变、被动应变、总应变均不同程度下降。多因素logistic回归分析显示CMR参数中右心室射血分数,左心室整体周向应变,左心房主动应变和左心房最大直径是PH-LHF的独立预测因子。ROC曲线分析结果显示临床模型、CMR模型、联合模型诊断PH-LHF的AUC值分别为0.773、0.777、0.828,并且DeLong检验显示当加入CMR参数后,临床模型诊断效能提升(0.773 vs.0.828,P<0.05)。结论基于CMR-FT技术的心肌应变参数可以定量评估心室心房应变,反映PH-LHF患者的心肌功能以及运动情况,多参数CMR在诊断评估LHF是否合并PH中具有较好的临床增益价值。展开更多
The left atrium(LA) acts as a modulator of left ventricular(LV) filling. Although there is considerable evidence to support the use of LA maximum and minimum volumes for disease prediction,theoretical considerations a...The left atrium(LA) acts as a modulator of left ventricular(LV) filling. Although there is considerable evidence to support the use of LA maximum and minimum volumes for disease prediction,theoretical considerations and a growing body of literature suggest to focus on the quantification of the three basic LA functions:(1) Reservoir function:collection of pulmonary venous return during LV systole;(2) Conduit function:passage of blood to the left ventricle during early LV diastole; and(3) Contractile booster pump function(augmentation of ventricular filling during late LV diastole. Tremendous advances in our ability to non-invasively characterize all three elements of atrial function include speckle tracking echocardiography(STE),and more recently cardiovascular magnetic resonance myocardial feature tracking(CMR-FT). Corresponding imaging biomarkers are increasingly recognized to have incremental roles in determining prognosis and risk stratification in cardiac dysfunction of different origins. The current editorial introduces the role of STE and CMR-FT for the functional assessment of LA deformation as determined by strain and strain rate imaging and provides an outlook of how this exciting field may develop in the future.展开更多
Background:The right ventricle to pulmonary artery conduit(RVPAC)may impair right ventricular(RV)function in patients with functional single right ventricles.Modification of the RVPAC using a ring-reinforced end with ...Background:The right ventricle to pulmonary artery conduit(RVPAC)may impair right ventricular(RV)function in patients with functional single right ventricles.Modification of the RVPAC using a ring-reinforced end with dunked insertion into the RV through a limited ventriculotomy may reduce the impact on RV function.We compared RV segmental strain between patients with a traditional RVPAC and ring-reinforced RVPAC using feature tracking cardiovascular magnetic resonance(CMR)imaging.Methods:Patients with CMR examinations after Stage I operation with RVPAC between 2000 and 2018 were reviewed.Ventricular mass,volumes,late gadolinium enhancement(LGE),and peak radial and circumferential strain of the 4 segments near the RVPAC insertion site were analyzed.Results:The study included 71 CMR examinations in 61 patients(30 traditional RVPAC,31 ring-reinforced RVPAC).Prior to Stage II,the ring-reinforced RVPAC group had better peak radial strain and circumferential strain in 1 of 4 segments proximal to the RVPAC insertion site compared to the traditional RVPAC group.Prior to Stage III operation,the ring-reinforced group had better peak radial and circumferential strain in 2 of 4 segments.LGE at the RVPAC insertion site was observed in 97%of patients before Stage II and 95%of patients before Stage III.RVPAC type and regional strain were not associated with transplant-free survival during a median follow-up of 6.3 years.Conclusions:Compared to a traditional RVPAC,the ring-reinforced RVPAC is associated with improved regional mechanics at the conduit insertion site.Further investigation of long-term outcomes after ring-reinforced RVPAC is warranted.展开更多
文摘Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion.The patients were divided into the anterior wall myocardial infarction(AWMI)and nonanterior wall myocardial infarction(NAWMI)groups.Infarct characteristics were assessed by late gadolinium enhancement.Global and regional strains and associated strain rates in the radial,circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images.The associations of infarct size,regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.Results There were 44 patients in the AWMI group and 51 in the NAWMI group.The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group(24.47±11.89,21.06±12.08%LV;t=3.928,P=0.008).In infarct zone analysis,strains in the radial,circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group(z=-20.873,-20.918,-10.357,all P<0.001).The volume(end-systolic volume index),total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group(all P<0.001).Conclusion In STEMI patients treated by percutaneous coronary intervention,myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.
文摘BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.
基金This work was supported by the Collaborative Innovation Major Project of Zhengzhou under Grant No.20XTZX06013the National Natural Science Foundation of China under Grant No.61932014.
文摘Deep neural networks(DNNs)have been extensively studied in medical image segmentation.However,existing DNNs often need to train shape models for each object to be segmented,which may yield results that violate cardiac anatomical structure when segmenting cardiac magnetic resonance imaging(MRI).In this paper,we propose a capsulebased neural network,named Seg-CapNet,to model multiple regions simultaneously within a single training process.The Seg-CapNet model consists of the encoder and the decoder.The encoder transforms the input image into feature vectors that represent objects to be segmented by convolutional layers,capsule layers,and fully-connected layers.And the decoder transforms the feature vectors into segmentation masks by up-sampling.Feature maps of each down-sampling layer in the encoder are connected to the corresponding up-sampling layers,which are conducive to the backpropagation of the model.The output vectors of Seg-CapNet contain low-level image features such as grayscale and texture,as well as semantic features including the position and size of the objects,which is beneficial for improving the segmentation accuracy.The proposed model is validated on the open dataset of the Automated Cardiac Diagnosis Challenge 2017(ACDC 2017)and the Sunnybrook Cardiac Magnetic Resonance Imaging(MRI)segmentation challenge.Experimental results show that the mean Dice coefficient of Seg-CapNet is increased by 4.7%and the average Hausdorff distance is reduced by 22%.The proposed model also reduces the model parameters and improves the training speed while obtaining the accurate segmentation of multiple regions.
文摘Cardiovascular magnetic resonance (CMR) has become a reference standard for the measure-ment of cardiac volumes, function, and mass. This study aims to reconstruct three dimen-sional modeling of the left ventricle (LV) in pa-tients with heart failure (HF) using CMRtools and thereby derive the LV functional indices. CMR images were acquired in 41 subjects (6 females) with heart failure (HF) and 12 normal controls (4 females). Five comparisons were made (i) nor-mal and dilated heart failure subjects, (ii) male and female normal heart, (iii) male and female dilated heart, (iv) male normal and dilated heart failure and (v) female normal and dilated heart failure. In HF, a significant higher values of EDV (320 刡 79 vs. 126 刡 22 ml, P&amp;amp;amp;amp;lt;0.0001), ESV (255 刡 68 vs. 54 刡 12 ml, P&amp;amp;amp;amp;lt;0.00001) and lower values of EF (20 刡 7 vs. 58 刡 5 %) were found compared that of normal control. There were significant difference on LV EDV and ESV between sex in both normal and HF subjects.
文摘Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diag-nosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evalu-ation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.
文摘BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.
基金supported by Department of Science and Technology, Ministry of Science and Technology, India (No. DST/TSG/ICT/2010/08)
文摘The aim of this work is to develop an improved region based active contour and dynamic programming based method for accurate segmentation of left ventricle (LV) from multi-slice cine short axis cardiac magnetic resonance (MR) images. Intensity inhomogeneity and weak object boundaries present in MR images hinder the segmentation accuracy. The proposed active contour model driven by a local Gaussian distribution fitting (LGDF) energy and an auxiliary global intensity fitting energy improves the accuracy of endocardial boundary detection. The weightage of the global energy fitting term is dynamically adjusted using a spatially varying weight function. Dynamic programming scheme proposed for the segmentation of epicardium considers the myocardium probability map and a distance weighted edge map in the cost matrix. Radial distance weighted technique and conical geometry are employed for segmenting the basal slices with left ventricle outflow tract (LVOT) and most apical slices. The proposed method is validated on a public dataset comprising 45 subjects from medical image computing and computer assisted interventions (MICCAI) 2009 segmentation challenge. The average percentage of good endocardial and epicardial contours detected is about 99%, average perpendicular distance of the detected good contours from the manual reference contours is 1.95 mm, and the dice similarity coefficient between the detected contours and the reference contours is 0.91. Correlation coefficient and the coefficient of determination between the ejection fraction measurements from manual segmentation and the automated method are respectively 0.9781 and 0.9567, for LV mass these values are 0.9249 and 0.8554. Statistical analysis of the results reveals a good agreement between the clinical parameters determined manually and those estimated using the automated method.
文摘目的基于心脏磁共振特征追踪(cardiac magnetic resonance feature tracking,CMR-FT)技术定量分析左心衰合并肺高压(pulmonary hypertension due to left heart failure,PH-LHF)患者的心肌应变参数并探讨心脏磁共振(cardiac magnetic resonance,CMR)在评估PH-LHF患者中的应用价值。材料与方法回顾性分析2018年9月至2020年9月期间215例确诊为左心衰(left heart failure,LHF)患者的临床和CMR参数,根据心脏超声测量的收缩期肺动脉压将患者分为两组,即LHF组(n=129)和PH-LHF组(n=86)。比较两组的基线资料和CMR参数包括心血管形态参数、心室容积功能参数以及心室心房应变参数。通过单因素及多因素logistic回归分析CMR参数中PH-LHF的独立预测因子,并绘制受试者工作特征(receiver operating characteristics,ROC)曲线评估CMR参数的诊断价值。结果PH-LHF患者组左右心室舒张末期容积指数、收缩末期容积指数、右心室心肌质量指数、室间隔角、左心房最大直径及面积、初始T1值均高于LHF组,而左右心室射血分数、右心室每搏输出量指数、右心室心脏指数低于LHF组。PH-LHF组左心室整体纵向应变、整体周向应变以及应变率、右心室整体周向应变、左心房主动应变、被动应变、总应变均不同程度下降。多因素logistic回归分析显示CMR参数中右心室射血分数,左心室整体周向应变,左心房主动应变和左心房最大直径是PH-LHF的独立预测因子。ROC曲线分析结果显示临床模型、CMR模型、联合模型诊断PH-LHF的AUC值分别为0.773、0.777、0.828,并且DeLong检验显示当加入CMR参数后,临床模型诊断效能提升(0.773 vs.0.828,P<0.05)。结论基于CMR-FT技术的心肌应变参数可以定量评估心室心房应变,反映PH-LHF患者的心肌功能以及运动情况,多参数CMR在诊断评估LHF是否合并PH中具有较好的临床增益价值。
基金Supported by The DZHK(German Centre for Cardiovascular Research)the BMBF(German Ministry of Education and Research)the Research program of the Faculty of Medicine of the Georg-August-University in G ttingen,Germany
文摘The left atrium(LA) acts as a modulator of left ventricular(LV) filling. Although there is considerable evidence to support the use of LA maximum and minimum volumes for disease prediction,theoretical considerations and a growing body of literature suggest to focus on the quantification of the three basic LA functions:(1) Reservoir function:collection of pulmonary venous return during LV systole;(2) Conduit function:passage of blood to the left ventricle during early LV diastole; and(3) Contractile booster pump function(augmentation of ventricular filling during late LV diastole. Tremendous advances in our ability to non-invasively characterize all three elements of atrial function include speckle tracking echocardiography(STE),and more recently cardiovascular magnetic resonance myocardial feature tracking(CMR-FT). Corresponding imaging biomarkers are increasingly recognized to have incremental roles in determining prognosis and risk stratification in cardiac dysfunction of different origins. The current editorial introduces the role of STE and CMR-FT for the functional assessment of LA deformation as determined by strain and strain rate imaging and provides an outlook of how this exciting field may develop in the future.
基金This study was supported by Evan’s Heart Fund(RH Rathod).
文摘Background:The right ventricle to pulmonary artery conduit(RVPAC)may impair right ventricular(RV)function in patients with functional single right ventricles.Modification of the RVPAC using a ring-reinforced end with dunked insertion into the RV through a limited ventriculotomy may reduce the impact on RV function.We compared RV segmental strain between patients with a traditional RVPAC and ring-reinforced RVPAC using feature tracking cardiovascular magnetic resonance(CMR)imaging.Methods:Patients with CMR examinations after Stage I operation with RVPAC between 2000 and 2018 were reviewed.Ventricular mass,volumes,late gadolinium enhancement(LGE),and peak radial and circumferential strain of the 4 segments near the RVPAC insertion site were analyzed.Results:The study included 71 CMR examinations in 61 patients(30 traditional RVPAC,31 ring-reinforced RVPAC).Prior to Stage II,the ring-reinforced RVPAC group had better peak radial strain and circumferential strain in 1 of 4 segments proximal to the RVPAC insertion site compared to the traditional RVPAC group.Prior to Stage III operation,the ring-reinforced group had better peak radial and circumferential strain in 2 of 4 segments.LGE at the RVPAC insertion site was observed in 97%of patients before Stage II and 95%of patients before Stage III.RVPAC type and regional strain were not associated with transplant-free survival during a median follow-up of 6.3 years.Conclusions:Compared to a traditional RVPAC,the ring-reinforced RVPAC is associated with improved regional mechanics at the conduit insertion site.Further investigation of long-term outcomes after ring-reinforced RVPAC is warranted.