Computed Tomography-Estimated Right Ventricular Function and Exercise Capacity in Patients with Continuous-Flow Left Ventricular Assist Devices.
- 作者列表："Mirza KK","Jung MH","Sigvardsen PE","Kofoed KF","Elming MB","Rossing K","Gustafsson F
:Using four-dimensional (4D) cardiac computed tomography (CCT) scans at rest and immediately after exercise, we examined the right heart chamber sizes and systolic function and its association with exercise capacity in left ventricular assist device (LVAD) recipients. Fifteen patients with HeartMate (HM) II or 3 underwent echocardiography and maximal cardiopulmonary exercise test. Subsequently, contrast-enhanced CCT scans were performed at rest and immediately after two minutes of supine 25 Watt ergometer bike exercise. Patients were (60 ± 12 years of age) 377 ± 347 days postimplant. Peak oxygen uptake (pVO2) was 15 ± 5 ml/kg/min. LV ejection fraction measured by echocardiography was 15 ± 9%. Pump speed was 9500 ± 258 in HM II and 5518 ± 388 rpm in HM 3 recipients. Resting right atrial ejection fraction (RAEF) was 18 ± 9%, and right ventricular ejection fraction (RVEF) was 36 ± 8%. During stress, RAEF was 19 ± 10%, and RVEF was 37 ± 8%. RAEF and RVEF did not correlate significantly with pVO2 at rest or during stress. Resting-RAEF and stress RAEF correlated significantly: r = 0.87, p < 0.01 as did resting RVEF and stress RVEF: r = 0.76, p < 0.01. In conclusion, resting-EF predicted stress-EF for both RA and RV in patients with an LVAD. Neither RVEF nor RAEF correlated with pVO2.
: 使用四维 (4D) 心脏计算机断层扫描 (CCT) 在静息和运动后立即扫描，我们检查了左心室辅助装置 (LVAD) 接受者的右心腔大小和收缩功能及其与运动能力的关系。15例HeartMate (HM) II或3例患者行超声心动图和最大心肺运动试验。随后，在休息时和仰卧25瓦测力计自行车运动两分钟后立即进行对比增强CCT扫描。患者为 (60 ± 12岁) 植入后377 ± 347天。峰值摄氧量 (pVO2) 为15 ± 5 ml ml/kg/min。超声心动图测定左室射血分数为15 ± 9%。HM II的泵速为9500 ± 258，HM 3受体为5518 ± 388 rpm。静息右心房射血分数 (RAEF) 为18 ± 9%，右心室射血分数 (RVEF) 为36 ± 8%。应激期间，RAEF为19 ± 10%，RVEF为37 ± 8%。RAEF和RVEF与静息或应激时的pVO2无显著相关性。静息-RAEF和应激RAEF显著相关: r = 0.87，p <0.01，静息RVEF和应激RVEF显著相关: r = 0.76，p <0.01。总之，静息EF预测LVAD患者RA和RV的应力EF。RVEF和RAEF都与pv02不相关。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.