Left ventricular and atrial strain imaging with cardiac computed tomography: Validation against echocardiography.
- 作者列表："Szilveszter B","Nagy AI","Vattay B","Apor A","Kolossváry M","Bartykowszki A","Simon J","Drobni ZD","Tóth A","Suhai FI","Merkely B","Maurovich-Horvat P
BACKGROUND:Data on left ventricular (LV) deformation imaging using CT angiography (CTA) are scarce and the feasibility of atrial deformation analysis by CT has not been addressed. We aimed to compare 2D echocardiographic and CT derived LV and left atrial (LA) global longitudinal strain (GLS) obtained by using a novel feature tracking algorithm in patients following transcatheter aortic valve implantation. METHODS:Twenty-eight patients were included who underwent retrospectively-gated 256-slice CTA and speckle-tracking echocardiography (STE) on the same day. CT datasets in 10% increments were reconstructed throughout the cardiac cycle. LV GLS and LA global peak reservoir strain (LA GS) was measured. RESULTS:Median absolute values for LV GLS were 19.9 [14.8-22.4] vs. 19.9 [16.8-24.7], as measured by CT vs STE, respectively (p = 0.017). We found good inter-modality correlation for LV GLS (ρ = 0.78, p < 0.05) with a mean bias of -1.6. Regarding atrial measurements, the median LA GS was 19.0 [13.5-27.3] for CT vs. 28.0 [17.5-32.6] for STE (p < 0.001) with a mean bias of -5.6 between CT and STE and a correlation coefficient of ρ = 0.87, p < 0.001. CT measurements were highly reproducible: intra-observer intra-class correlation coefficient was 0.96 for LV GLS and 0.95 for LA GS. CONCLUSION:We detected good correlation between CTA and echocardiography-based LV and LA longitudinal strain parameters. CTA provides accurate strain measurements with high reproducibility. Feature tracking-based deformation analysis could provide a clinically important addition to CT examinations by complementing anatomical information with functional data.
背景: 利用CT血管造影 (CTA) 进行左心室 (LV) 变形成像的数据很少，并且利用CT进行心房变形分析的可行性尚未得到解决。我们的目的是比较在经导管主动脉瓣植入术后患者中使用一种新的特征跟踪算法获得的二维超声心动图和CT衍生的LV和左心房 (LA) 全局纵向应变 (GLS)。 方法: 28例患者于同日接受回顾性门控256层CTA和斑点追踪超声心动图 (STE) 检查。在整个心动周期中以10% 增量重建CT数据集。测量LV GLS和LA全局峰值储层应变 (LA GS)。 结果: 通过CT和STE分别测量，LV GLS的中值绝对值分别为19.9 [14.8-22.4] 和19.9 [16.8-24.7] (p = 0.017)。我们发现LV GLS具有良好的模态间相关性 (ρ = 0.78，p <0.05)，平均偏倚为-1.6。关于心房测量，CT的中位LA GS为19.0 [13.5-27.3]，STE为28.0 [17.5-32.6] (p <0.001)，CT和STE之间的平均偏差为-5.6，相关系数 ρ = 0.87，p <0.001。CT测量是高度可重复的: 对于lvgls，观察者内类内相关系数为0.96，对于lags，为0.95。 结论: CTA与基于超声心动图的LV和LA纵向应变参数之间具有良好的相关性。CTA提供具有高再现性的精确应变测量。通过用功能数据补充解剖信息，基于特征跟踪的变形分析可以为ct检查提供临床上重要的补充。
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.