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  • Ovid Technologies (Wolters Kluwer Health)  (16)
  • 1
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    Abstract 8928: Le Coeur En Sabot: Shape and Regional Function Predict Adverse Outcome in Patients with Repaired Tetralogy of Fallot
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: “Le Coeur en Sabot” (or the boot-shaped heart) is a radiological description of the appearance of the heart on a plain radiograph of a patient with Tetralogy of Fallot. This highlights the importance of the shape of the heart. Maladaptive remodeling is known to occur in patients with repaired Tetralogy of Fallot (rToF) due to residual lesions such as Pulmonary Regurgitant Fraction (PRF) Hypothesis: Shape and function analysis can reveal novel remodeling patterns associated with adverse events in patients with rToF Methods: Biventricular shape and function were studied in 192 patients with rToF (median age 15 years). Linear discriminative analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events (AE). AE included death, arrhythmias, and cardiac arrest (median follow-up 10 years) Results: LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular LV (decreased eccentricity), dilated (increased sphericity) LV base, increased RV apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.78). PRF did not add value, and shape changes associated with increased PRF were not predictive of AE. Conclusions: Remodeling patterns in patients with rToF are associated with AE, independent of PRF. Mechanisms leading to AE include LV basal dilation with a reduced RV apical ejection fraction. That is to say that the old descriptor, “Le Coeur en Sabot'' may also describe that shape that is adverse in rTOF. The toe of this boot would be the dilated and poorly contractile RV apex and the ankle would be the spherical LV base (Figure 1: Top Row Diastole. Middle Systole. Posterior projection (a), anatomical position (b) and superior (c). LV is green)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.8928
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Altered Dependence of Aortic Pulse Wave Velocity on Transmural Pressure in Hypertension Revealing Structural Change in the Aortic Wall
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Hypertension Vol. 65, No. 2 ( 2015-02), p. 362-369
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 65, No. 2 ( 2015-02), p. 362-369
    Abstract: Aortic pulse wave velocity (aPWV), a major prognostic indicator of cardiovascular events, may be augmented in hypertension as a result of the aorta being stretched by a higher distending blood pressure or by a structural change. We used a novel technique to modulate intrathoracic pressure and thus aortic transmural pressure (TMP) to examine the variation of intrathoracic aPWV with TMP in hypertensive (n=20; mean±SD age, 52.1±15.3 years; blood pressure, 159.6±21.2/92.0±15.9 mm Hg) and normotensive (n=20; age, 55.5±11.1 years; blood pressure, 124.5±11.9/72.6±9.1 mm Hg) subjects. aPWV was measured using dual Doppler probes to insonate the right brachiocephalic artery and aorta at the level of the diaphragm. Resting aPWV was greater in hypertensive compared with normotensive subjects (897±50 cm/s versus 784±43 cm/s; P 〈 0.05). aPWV was equal in hypertensive and normotensive subjects when measured at a TMP of 96 mm Hg. However, dependence of aPWV on TMP in normotensive subjects was greater than that in hypertensive subjects (9.6±1.6 versus 3.8±0.7 cm/s per mm Hg increase in TMP, respectively, means±SEM; P 〈 0.01). This experimental behavior was best explained by a theoretical model incorporating strain-induced recruitment of stiffer fibers in normotensive subjects and fully recruited stiffer fibers in hypertensive subjects. These results explain previous contradictory findings with respect to isobaric aPWV in hypertensive compared with normotensive subjects. They suggest that hypertension is associated with a profound change in aortic wall mechanical properties possibly because of destruction of elastin leading to less strain-induced stiffening and predisposition to aortic dissection.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.114.04370
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2094210-2
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  • 3
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    Noninvasive Quantification of Left-to-Right Shunt in Pediatric Patients : Phase-Contrast Cine Magnetic Resonance Imaging Compared With Invasive Oximetry
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Circulation Vol. 103, No. 20 ( 2001-05-22), p. 2476-2482
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 103, No. 20 ( 2001-05-22), p. 2476-2482
    Abstract: Background —Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease. Methods and Results —In 50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an atrial- or ventricular-level shunt, blood flow rate in the great vessels was determined by PC-MRI, and the ratio of pulmonary to aortic flow (Q̇p/Q̇s) was compared with Q̇p/Q̇s by oximetry. We found a difference of 2% and a range of −20% to +26% (limits of agreement, mean±2 SD). In another 7 children with congenital heart disease but no cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years), Q̇p/Q̇s by PC-MRI was 1.02 (SD ±0.06). No difference between systemic venous and aortic flow volumes was found (range −17% to +20%, n=37). Blood flow through a secundum atrial septal defect as assessed by PC-MRI (n=24) overestimated the shunt compared with the difference between pulmonary and aortic flows. The mean difference between 3 repeated PC-MRI measurements in each location was 5.3% (SD ±4.0%, n=522), demonstrating good precision. The interobserver variability was low. The accuracy of PC-MRI was confirmed by in vitro experiments. Conclusions —Determination of Q̇p/Q̇s by PC-MRI in children is quick, safe, and reliable compared with oximetry. Systemic venous flow can be quantified by PC-MRI, whereas through-plane shunt measurement within an atrial septal defect is inaccurate.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.103.20.2476
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
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  • 4
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    Sex-Specific Pediatric Percentiles for Ventricular Size and Mass as Reference Values for Cardiac MRI : Assessment by Steady-State Free-Precession and Phase-Contrast MRI Flow
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation: Cardiovascular Imaging Vol. 3, No. 1 ( 2010-01), p. 65-76
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 1 ( 2010-01), p. 65-76
    Abstract: Background— Cardiac MRI is important in the treatment of children with congenital heart disease, but sufficient normative data are lacking. For ventricular volumes and mass, we sought to deliver reference centiles and to investigate sex effects. Methods and Results— We included 114 healthy children and adolescents, uniformly distributed spanning an age range of 4 to 20 years, as required by the Lambda-Mu-Sigma method to achieve a percentile distribution, thus avoiding arbitrary age categories. Subjects underwent axial volumetry (1.5-T scanner) using standardized 2D steady-state free-precession and flow protocols. Percentiles were computed for age 8 to 20 years (99 subjects) because breath-holds were more consistent in this group. When indexed for body surface area or height, the centile curves of ventricular volumetric parameters showed allometric increase until adolescence, when a plateau was reached, with values comparable to published adult reference data. In contrast, ventricular mass centiles increased without plateau. There was a significant sex difference, with centiles reflecting larger values in boys than in girls ( P 〈 0.05) when ventricular volumes were indexed to body surface area or height but not when indexed to weight (exception: mass). There was excellent agreement of axial and short-axis volumetry and of volumetric and flow-derived stroke volumes. Conclusions— Percentiles for ventricular volumes and mass in healthy children have been established to serve as reference values in pediatric heart disease. Significant sex differences were noted when indexing volumes to body surface area or height. Unisex centiles related to weight may be considered for chamber volumes albeit not for mass.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.109.859074
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 5
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    Rapid Left-to-Right Shunt Quantification in Children by Phase-Contrast Magnetic Resonance Imaging Combined With Sensitivity Encoding (SENSE)
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Circulation Vol. 108, No. 11 ( 2003-09-16), p. 1355-1361
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 108, No. 11 ( 2003-09-16), p. 1355-1361
    Abstract: Background— Parallel imaging by sensitivity encoding (SENSE) may considerably reduce scan time in MRI. For rapid flow quantification in children with congenital heart disease, we evaluated phase-contrast MRI (PC-MRI) techniques combined with SENSE. Methods and Results— In 22 pediatric patients (mean age, 7.2±6.2 years) with cardiac left-to-right shunt, blood flow rate in the pulmonary artery (Q p ) and ascending aorta (Q s ) and flow ratio Q p /Q s were determined by PC-MRI with SENSE reduction-factor 2 and 3 (SF-2 and SF-3). Additionally, we used PC-MRI with higher spatial in-plane resolution (1.6×2.1 versus 2.3×3.1 mm) with and without SF-3. Results were compared with a recently validated standard PC-MRI protocol and tested in vitro using a pulsatile flow phantom. Reduction of signal averages from 2 to 1 and application of SENSE accelerated flow measurements by a factor of 3.5 (5.2) using PC-MRI with SF-2 (SF-3) compared with standard PC-MRI. For blood flow rate through the pulmonary artery and aorta, as well as for the Q p /Q s ratio we found negligible differences of ±3%, lower limits of agreement (mean±2 SD) of −7% to −18%, and upper limits of agreement (mean±2 SD) of +3 to +24%, demonstrating good agreement with standard PC-MRI. Mean Q p /Q s ratio by standard PC-MRI was 1.69±0.45 (range, 1.27 to 2.79). Interobserver variability was low, and high accuracy was confirmed in vitro for all protocols. Conclusions— PC-MRI for flow quantitation may be combined with SENSE to achieve a substantive reduction of scanning time. In children with left-to-right shunt, Q p /Q s quantification is possible by PC-MRI+SF-3 in 〈 60 seconds. Use of higher in-plane resolution did not improve measurement results.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000087603.97036.C2
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 6
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    Pediatric cirrhotic cardiomyopathy: Impact on liver transplant outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Liver Transplantation Vol. 24, No. 6 ( 2018-06), p. 820-830
    Details
    In: Liver Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 24, No. 6 ( 2018-06), p. 820-830
    Abstract: In adults, cirrhotic cardiomyopathy (CCM) has a significant incidence and impact on liver transplantation. For pediatric liver transplantation (pLT), data on liver‐induced cardiac changes are scarce, and in particular, the comparison between cirrhotic and noncirrhotic liver disease has not been investigated. We retrospectively evaluated cardiac changes associated with CCM by echocardiography and 12‐lead electrocardiogram in 198 pLT‐candidates (median age 4.1 years) 4.2 before and 12 months after pLT. Results were correlated with the stage of liver fibrosis and cholestasis before transplantation. The left ventricular end‐diastolic diameter (LVIDd) z score, left ventricular mass z score, and left ventricular mass index were significantly higher in cirrhotic patients (‐0.10 versus 0.98, P   〈  0.001; ‐1.55 versus ‐0.42, P  = 0.001; 78.99 versus 125.64 g/m 2 , P  = 0.001, respectively) compared with children with noncirrhotic liver disease. Pathological z scores ( 〉 2SDS) for the LVIDd occurred more frequently in cirrhotic patients compared with patients with noncirrhotic liver disease (31/169 versus 1/29; P  = 0.03) and were significantly associated with cholestasis. All observed cardiac changes were reversible 1 year after pLT. Pathological LVIDd z scores correlated highly with intensive care unit (ICU) stay (9.6 days versus 17.1 days, respectively, P  = 0.002) but not with patient survival pre‐LT or post‐LT. In contrast to other studies, prolonged QTc time was not associated with liver cirrhosis in our patients. In conclusion, CCM‐associated cardiac changes in pLT candidates with cirrhotic liver disease are frequent, mild, and associated with cholestasis and reversible after pLT. They may impact peritransplant care and posttransplant hospitalization time. Further prospective evaluation is warranted. In particular, for QTc time prolongation etiological factors, possible protective effects of ursodeoxycholic acid treatment and the use as a screening parameter for CCM should be verified. Liver Transplantation 24 820–830 2018 AASLD.
    Type of Medium: Online Resource
    ISSN: 1527-6465 , 1527-6473
    URL: Article
    DOI: 10.1002/lt.25076
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 7
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    Cardiovascular Magnetic Resonance Myocardial Feature Tracking : Concepts and Clinical Applications
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation: Cardiovascular Imaging Vol. 9, No. 4 ( 2016-04)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 4 ( 2016-04)
    Abstract: Heart failure–induced cardiovascular morbidity and mortality constitute a major health problem worldwide and result from diverse pathogeneses, including coronary artery disease, nonischemic cardiomyopathies, and arrhythmias. Assessment of cardiovascular performance is important for early diagnosis and accurate management of patients at risk of heart failure. During the past decade, cardiovascular magnetic resonance myocardial feature tracking has emerged as a useful tool for the quantitative evaluation of cardiovascular function. The method allows quantification of biatrial and biventricular mechanics from measures of deformation: strain, torsion, and dyssynchrony. The purpose of this article is to review the basic principles, clinical applications, accuracy, and reproducibility of cardiovascular magnetic resonance myocardial feature tracking, highlighting the prognostic implications. It will also provide an outlook on how this field might evolve in the future.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.115.004077
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 8
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    Ascending Aortic and Main Pulmonary Artery Areas Derived From Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Circulation: Cardiovascular Imaging Vol. 5, No. 5 ( 2012-09), p. 644-651
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 5 ( 2012-09), p. 644-651
    Abstract: Cardiac magnetic resonance (CMR) imaging is an important clinical tool for serial follow-up of patients with congenital heart disease, but normative data for great vessel dimensions in pediatric subjects are scarce. We investigated the ascending aortic (AO) and main pulmonary artery dimensions in normal children and young adults in comparison with a cohort of patients with repaired tetralogy of Fallot (TOF). Methods and Results— Subjects were prospectively enrolled for cardiac magnetic resonance after a standardized protocol in 14 participating centers of the German Competence Network for Congenital Heart Defects. All studies were performed in 1.5-T scanners and used single-slice multiphase acquisitions steady-state free precession and velocity-encoded cine. AO and main pulmonary artery areas were measured. The cohort consisted of 483 subjects: 105 normal controls (55 men; 50 women; and median age, 14 years) and 378 patients with repaired TOF (210 men; 168 women; and median age, 16 years). Among TOF, 35 (9%) had pulmonary atresia, 98 (26%) had a palliative procedure before repair, the mean age at repair was 2.9 years, and 82 (23%) used a transannular patch repair. Great vessel areas correlated well with body surface area and age in controls and reference Z-score values were derived. Z scores for ascending AO areas were larger in TOF compared with controls (mean Z score =1.95, P =0.001). In TOF, pulmonary atresia ( P =0.003), male sex ( P =0.01) and previous palliations ( P =0.046) were associated with larger AO areas. Main pulmonary artery area Z scores in surgically modified TOF were smaller on an average than controls (mean Z score =−0.293 P =0.001) but not small to the same extent as the AO was large. Conclusions— This study provides cardiac magnetic resonance reference Z scores for great vessel areas in normal children and adolescents in comparison with a large contemporary cohort of repaired TOF. Male sex, pulmonary atresia, and previous palliations emerged as predictors for larger AO dimensions in TOF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00266188.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.112.973073
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 9
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    Poorer Right Ventricular Systolic Function and Exercise Capacity in Women After Repair of Tetralogy of Fallot : A Sex Comparison of Standard Deviation Scores Based on Sex-Specific Reference Values in Healthy Control Subjects
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation: Cardiovascular Imaging Vol. 6, No. 6 ( 2013-11), p. 924-933
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 6 ( 2013-11), p. 924-933
    Abstract: In repaired congenital heart disease, there is increasing evidence of sex differences in cardiac remodeling, but there is a lack of comparable data for specific congenital heart defects such as in repaired tetralogy of Fallot. Methods and Results— In a prospective multicenter study, a cohort of 272 contemporary patients (158 men; mean age, 14.3±3.3 years [range, 8–20 years]) with repaired tetralogy of Fallot underwent cardiac magnetic resonance for ventricular function and metabolic exercise testing. All data were transformed to standard deviation scores according to the Lambda–Mu–Sigma method by relating individual values to their respective 50th percentile (standard deviation score, 0) in sex-specific healthy control subjects. No sex differences were observed in age at repair, type of repair conducted, or overall hemodynamic results. Relative to sex-specific controls, repaired tetralogy of Fallot in women had larger right ventricular end-systolic volumes (standard deviation scores: women, 4.35; men, 3.25; P =0.001), lower right ventricular ejection fraction (women, −2.83; men, −2.12; P =0.011), lower right ventricular muscle mass (women, 1.58; men 2.45; P =0.001), poorer peak oxygen uptake (women, −1.65; men, −1.14; P 〈 0.001), higher VE/VCO 2 (ventilation per unit of carbon dioxide production) slopes (women, 0.88; men 0.58; P =0.012), and reduced peak heart rate (women, −2.16; men −1.74; P =0.017). Left ventricular parameters did not differ between sexes. Conclusions— Relative to their respective sex-specific healthy control subjects, derived standard deviation scores in repaired tetralogy of Fallot suggest that women perform poorer than men in terms of right ventricular systolic function as tested by cardiac magnetic resonance and exercise capacity. This effect cannot be explained by selection bias. Further outcome data are required from longitudinal cohort studies. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00266188.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.112.000195
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 10
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    Functional Analysis of the Components of the Right Ventricle in the Setting of Tetralogy of Fallot
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Circulation: Cardiovascular Imaging Vol. 1, No. 2 ( 2008-09), p. 141-147
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 1, No. 2 ( 2008-09), p. 141-147
    Abstract: Background— Anatomic and functional observations suggest that the right ventricle (RV) can be analyzed in terms of its inlet, apical trabecular, and outlet components. Our study was designed to evaluate the regional adaptation of these components to different conditions of loading, with additional analysis of the surgical techniques used for primary repair. Methods and Results— We studied prospectively 45 patients with tetralogy of Fallot (age, 20.5�8.1 years) and 24 control subjects (age, 20.1�5.8 years). All subjects were studied by using cardiac MRI. End-diastolic (EDV), end-systolic (ESV), stroke volumes (SV), and ejection fraction (EF) were determined for the overall RV and separately for its inlet, apical trabecular, and outlet components. The patients had pulmonary regurgitant fractions of 33.2�11.1%, and RV peak-systolic pressures of 40.7�16.1 mm Hg. In controls, the apical trabecular component EDV was 51.5�11.1 mL/m 2 (54.3�6.8% of the total RV EDV), ESV was 19.2�6.3 mL/m 2 (47.6�10.5% of RV ESV), and SV was 32.3�6.9 mL/m 2 (58.9�6.6% of RV SV), resulting in an EF of 63.1�7.7%. When considering all patients, the apical trabecular component took up the greatest part of the overload, having an EDV of 76.5�18.1 mL/m 2 , and an ESV of 31.6�12.8 mL/m 2 , reflecting an increase of 49 and 67% over controls, respectively ( P 〈 0.001). EF was 59.7�10.7%, and was maintained at control levels ( P =0.132). In controls, the outlet had considerable ejecting force, with an EF of 54.8�9.1%, whereas it was decreased in the patients with tetralogy (EF=28.5�11.9%). There was significant increase of ESV ( P 〈 0.001), but not of EDV, with EF decreased by 45% ( P 〈 0.001). The inlet was not significantly affected by overload. The surgical technique did not significantly affect any measured parameter for any component. Conclusions— In patients with tetralogy of Fallot, subsequent to surgical correction, the individual components of the RV respond in characteristic fashion to RV overload.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.108.783795
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
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