Feature tracking computed tomography-derived left ventricular global longitudinal strain in patients with aortic stenosis: a comparative analysis with echocardiographic measurements.
- 作者列表："Gegenava T","van der Bijl P","Hirasawa K","Vollema EM","van Rosendael A","van der Kley F","de Weger A","Hautemann DJ","Reiber JHC","Ajmone Marsan N","Bax JJ","Delgado V
BACKGROUND:Left ventricular (LV) systolic function is a prognostic factor in patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired retrospectively, LV systolic function can be assessed. Novel software permits assessment of LV global longitudinal strain (GLS) from MDCT data. OBJECTIVES:The present study investigated the feasibility of feature tracking MDCT-derived LV GLS and its agreement with echocardiographic LV GLS in patients treated with TAVI. METHODS:LV GLS was measured on transthoracic echocardiography using speckle tracking analysis and on dynamic MDCT using feature tracking technology. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis. RESULTS:A total of 214 patients (51% male, mean age: 80 ± 7 years) were analysed. Mean LV GLS on echocardiography was -13.91 ± 4.32%, whereas mean feature tracking MDCT-derived GLS was -12.46 ± 3.97%. Correlation of measurements between feature tracking MDCT-derived LV GLS and echocardiographic LV GLS demonstrated a large effect size (r = 0.791, p < 0.001). On Bland-Altman analysis, feature tracking MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement -3.85% - 6.73%). CONCLUSIONS:Assessment of LV GLS on dynamic feature tracking MDCT data is feasible in TAVI patients. Compared to speckle tracking echocardiography, feature tracking MDCT underestimates the value of LV GLS.
背景: 左心室收缩功能是严重主动脉瓣狭窄 (AS) 患者的预后因素。多探测器行计算机断层扫描 (MDCT) 数据是评估接受经导管主动脉瓣植入术 (TAVI) 的患者的关键，当回顾性获得时，可以评估LV收缩功能。新型软件允许从MDCT数据评估LV整体纵向应变 (GLS)。 目的: 本研究探讨了特征跟踪MDCT衍生的LV GLS的可行性及其与TAVI治疗患者超声心动图LV GLS的一致性。 方法: 在经胸超声心动图上使用斑点追踪分析测量LV GLS，在动态MDCT上使用特征追踪技术测量LV GLS。使用Bland-Altman分析评估两种不同模式的测量结果之间的一致性。 结果: 共分析了214例患者 (51% 例男性，平均年龄: 80 ± 7岁)。超声心动图上的平均LV GLS为-13.91 ± 4.32%，而平均特征跟踪MDCT衍生的GLS为-12.46 ± 3.97%。特征跟踪MDCT衍生的LV GLS和超声心动图LV GLS之间的测量结果的相关性显示出大的效应大小 (r = 0.791，p <0.001)。在Bland-Altman分析中，与超声心动图相比，特征跟踪MDCT衍生的应变分析低估了LV GLS，平均差异为1.44% (95% 协议极限-3.85%-6.73%)。 结论: 动态特征跟踪MDCT数据评估LV GLS在TAVI患者中是可行的。与斑点追踪超声心动图相比，特征追踪MDCT低估了LV GLS的价值。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.