The Indo-American Journal of Pharma and Bio Sciences is an online international journal that publishes articles quarterly.It's important to note that the specific policies, guidelines, and the editorial board of IAJPB may change over time, so it's advisable to visit the journal's official website or contact the journal of the materials science journal.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
In non-cardioembolic stroke patients, the cardiac manifestations of elevated blood pressure are of particular interest. The value of LV geometry in the prediction of cardiovascular risk is controversial. Many reports detected that left ventricular hypertrophy is independently associated with risk of ischemic stroke. The primary objective of this study was to identify the frequency of different patterns of altered left ventricular geometry in patients with non cardioembolic stroke, and to assess whether a significant number of patients will miss the diagnosis of LV remodeling if the left ventricular relative wall thickness(RWT) is not evaluated or reported. 100 patients were referred within 48 hours after an acute non cardioembolic ischemic stroke for a transthoracic echocardiogram. The echocardiographic findings were analyzed. Mean age was 61.86 ± 12.59 years, 45 % men. Concentric remodeling carried the highest frequency (43%), followed by normal pattern (27%), concentric hypertrophy (22%), and eccentric hypertrophy (8%). The frequency of abnormal left ventricular RWT (61.4%) was significantly higher than that of abnormal LVMI.
Fragmented QRS Complex is associated with the Left Ventricular Remodeling in ...submissionclinmedima
A total of 140 patients with AMI were enrolled. Accoridng to the presence of fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital and 6-month follow-up period were collected.
FragmentedQRSComplexisassociatedwiththeLeftVentricular Remodeling in Patients...semualkaira
A total of 140 patients with AMI were enrolled. Accoridng to the presence of
fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital
and 6-month follow-up period were collected. The difference between two groups and the
influencing factors of left ventricular remodeling were analyzed.
Predictors of Ischaemia and Outcomes in Egyptian Patients with Diabetes Mellitus Referred for Perfusion Imaging. Samir Rafla*, Ahmed Abdel-Aaty, Mohamed Ahmed Sadaka, Aly Ahmed Abo Elhoda and Ahmed Mohamed Shams
Background: Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.
Methods: Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.
Results: Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.
Conclusions: In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
Early Detection of Left Ventricular Dysfunction in Type II Diabetic Patients ...Premier Publishers
To assess Left ventricular (LV) systolic dysfunction using 2D speckle tracking echocardiography (STE) in asymptomatic type II Diabetic patients. We acquired three LV short-axis, and three LV apical views in 100 asymptomatic diabetic patients with normal LV ejection fraction (EF) and 25 age-matched healthy volunteers. We measured end-systolic longitudinal strain (LS), radial strain (RS), and circumferential strain (CS) in 18 LV segments. There were no significant differences in LVEF between two groups. Diabetic patients had more advanced diastolic dysfunction and increased LV mass compared with controlled group. Basal, middle, and apical LSs were significantly lower in diabetic patients compared with control subjects, with 43% (43/100) of the diabetic patients showing abnormal global LS values (cut-off value: 217.2 mean 2SD in control subjects Conclusion: Detecting subclinical LV systolic dysfunction by using 2D speckle tracking echocardiography (STE) might provide useful information of the risk stratification in an asymptomatic diabetic population.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
In non-cardioembolic stroke patients, the cardiac manifestations of elevated blood pressure are of particular interest. The value of LV geometry in the prediction of cardiovascular risk is controversial. Many reports detected that left ventricular hypertrophy is independently associated with risk of ischemic stroke. The primary objective of this study was to identify the frequency of different patterns of altered left ventricular geometry in patients with non cardioembolic stroke, and to assess whether a significant number of patients will miss the diagnosis of LV remodeling if the left ventricular relative wall thickness(RWT) is not evaluated or reported. 100 patients were referred within 48 hours after an acute non cardioembolic ischemic stroke for a transthoracic echocardiogram. The echocardiographic findings were analyzed. Mean age was 61.86 ± 12.59 years, 45 % men. Concentric remodeling carried the highest frequency (43%), followed by normal pattern (27%), concentric hypertrophy (22%), and eccentric hypertrophy (8%). The frequency of abnormal left ventricular RWT (61.4%) was significantly higher than that of abnormal LVMI.
Fragmented QRS Complex is associated with the Left Ventricular Remodeling in ...submissionclinmedima
A total of 140 patients with AMI were enrolled. Accoridng to the presence of fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital and 6-month follow-up period were collected.
FragmentedQRSComplexisassociatedwiththeLeftVentricular Remodeling in Patients...semualkaira
A total of 140 patients with AMI were enrolled. Accoridng to the presence of
fQRS in presenting electrocardiogram. The patients were divided into fQRS group and NonfQRS group. Real-time three-dimensional echocardiograph parameters measured in-hospital
and 6-month follow-up period were collected. The difference between two groups and the
influencing factors of left ventricular remodeling were analyzed.
Predictors of Ischaemia and Outcomes in Egyptian Patients with Diabetes Mellitus Referred for Perfusion Imaging. Samir Rafla*, Ahmed Abdel-Aaty, Mohamed Ahmed Sadaka, Aly Ahmed Abo Elhoda and Ahmed Mohamed Shams
Background: Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.
Methods: Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.
Results: Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.
Conclusions: In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...Premier Publishers
The clinical presentation of acute coronary syndrome is variable Patients with suspected NSTE-ACS are a heterogeneous group. Coronary occlusion may or may not be present. To correlate 2D speckle tracking echocardiography with coronary angiography results in non-ST segment elevation myocardial infarction patients and test its ability to predict culprit lesion. It is a prospective study where 100 patients with non-ST elevation myocardial infarction were enrolled in the study where regional wall motion score index was obtained by echocardiography then 2D speckle tracking echocardiography was done and territorial longitudinal strain for each vessel was obtained and finally coronary angiography was done. By using the bull’s eye view of the territorial LS values obtained from the 17 myocardial segments to predict the culprit artery for each patient the sensitivity for prediction of culprit LAD was 93.3 %, specificity was 92.7 %, For LCX; sensitivity was 82.7 %, specificity was 92.9 % and for RCA; sensitivity was 84 %, specificity was 93.3 %. Longitudinal strain imaging by 2D speckle-tracking might help in the work-up of non-ST elevation myocardial infarction patients. In addition, it may be helpful to localize coronary artery stenosis in a given perfusion territory.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement
Authors: Andrew N. Rassi, Wael AlJaroudi, Sahar Naderi, M Chadi Alraies, Venu Menon, Leonardo Rodriguez, Richard Grimm, Brian Griffin, Wael A. Jaber
http://www.thecdt.org/article/view/2855
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
ISSN 2321 – 9602
It appears that you are providing information about the publication process of IAJAVS International Journal of Advanced Veterinary and Animal Science. it seems to prioritize a fast publication schedule while maintaining rigorous peer review of the journals in research.
Indo-American Journal of Agricultural and Veterinary Sciences appears to be a reputable journal that values both the speed of publication and the quality of research in the fields of agriculture and veterinary sciences. Researchers interested in submitting their work to this journal of the journalism research.
Abstract
Objective: The objective of this study is to determine the normal value of 3D left ventricular (LV) twist in subendocardial, mid-wall and subepicardial layers, as well as to study the effects of aging on 3D LV twist by tagged MR motion tracking techniques. Three dimensional motion detection based on 3D tagged MR images is robust to out-of-plane motion error; while 2D motion detection is inherently unable to analyze the 3D cardiac motion and may lead to inaccurate results.
Methods: The 3D LV volumetric images were acquired in 52 normal adult subjects (aged 21-82) and were analyzed by using 3D HARmonic phase (HARP) technique. HARP technique provided the 3D displacement fields and the displacements were utilized to compute the rotational values. LV twist was defined as apical rotation relative to the basal rotation, in the 3D coordinates. The LV twist values of subendocardial, midwall and subepicardial layers were analyzed separately. The measured parameters in this study were: peak apical rotation, peak basal rotation, and peak LV twist.
Result: Looking at the apex, the normal LV maintains a clockwise rotation in the LV basal plane and a counterclockwise rotation in the LV apical plane. In general, the apical and basal rotation values increase during the aging process, leading to an increased value of LV twist. Peak epicardial LV twist is (10.4±2.6 degrees) which is lower than the mid-wall LV twist (11.3±2.2 degrees) and endocardial LV twist (12.1±2.6 degrees) in the young group (21-35 years old). Also, peak epicardial LV twist is (12.2±2.6 degrees) which is lower than the mid-wall LV twist (14.4±2.8 degrees) and endocardial LV twist (14.7±2.5 degrees) in the middle aged group (21-35 years old). In a similar way, peak epicardial LV twist is (14.8±2.9 degrees) which is lower than the mid-wall LV twist (15.7±3.6 degrees) and endocardial LV twist (16.7±3.0 degrees) in the old group (50-65 years old). Regarding the older group (more than 65 years old), peak epicardial LV twist is (15.9±3.1 degrees) which is lower than the mid-wall LV twist (16.2±3.4 degrees) and endocardial LV twist (18.3±3.0 degrees).
Conclusions: It is feasible to measure the subepicardial, mid-wall and subendocardial twist in tagged MR images. The twist value gradually increases in the aging process. Outside layers have greater twist values compared to the inside layers.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
Exercise stress echocardiography in patients with aortic stenosis: impact of baseline diastolic dysfunction and functional capacity on mortality and aortic valve replacement
Authors: Andrew N. Rassi, Wael AlJaroudi, Sahar Naderi, M Chadi Alraies, Venu Menon, Leonardo Rodriguez, Richard Grimm, Brian Griffin, Wael A. Jaber
http://www.thecdt.org/article/view/2855
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
ISSN 2321 – 9602
It appears that you are providing information about the publication process of IAJAVS International Journal of Advanced Veterinary and Animal Science. it seems to prioritize a fast publication schedule while maintaining rigorous peer review of the journals in research.
Indo-American Journal of Agricultural and Veterinary Sciences appears to be a reputable journal that values both the speed of publication and the quality of research in the fields of agriculture and veterinary sciences. Researchers interested in submitting their work to this journal of the journalism research.
ISSN 2347-2251
Manuscripts should be carefully checked for grammatical and punctuation errors. All papers undergo peer review. Please note that all articles published in this journal represent the opinions of the authors and do not necessarily reflect the official policy of the Journal of Indo-American Journal of Pharma and Bio Sciences of the journals to publish paper.
Scientific development is an ever-evolving journey, driven by the exchange of data and ideas among researchers across the globe.One such remarkable publication dedicated to facilitating this exchange within the fields of Pharmacy and Bio Sciences is the Indo-American Journal of Pharma and Bio Sciences of the published research.
It appears that you have provided information about the "Indo-American Journal of Agricultural and Veterinary Sciences" . This journal seems to be an international online publication in English, published quarterly. It emphasizes fast publication while maintaining a rigorous peer-review process of the published research.
It appears that you have provided information about the "Indo-American Journal of Agricultural and Veterinary Sciences" . This journal seems to be an international online publication in English, published quarterly. It emphasizes fast publication while maintaining a rigorous peer-review process of the published research.
The Indo-American Journal of Agricultural and Veterinary Sciences appears to be a scholarly journal focused on publishing research within the fields of agriculture and veterinary sciences of the journal publishers.
ISSN 2347-2251
Manuscripts should be carefully checked for grammatical and punctuation errors. All papers undergo peer review. Please note that all articles published in this journal represent the opinions of the authors and do not necessarily reflect the official policy of the Journal of Indo-American Journal of Pharma and Bio Sciences of the journal for research.
It seems like you're providing information about the publication process of the International Journal of Advanced Publication Practices. This information outlines the fast publication schedule and peer-review process by the journal of the appears to prioritize a fast and efficient publication process while maintaining the quality and integrity of the research it publishes of the original research papers.
Indo-American Journal of Agricultural and Veterinary Sciences .It sounds like the journal you're referring to has a broad scope covering various aspects of Agricultural Sciences and Veterinary Medicine. The topics listed indicate a comprehensive range of fields within these discipline and submitting manuscripts to this journal can explore research and review articles of the journalism research.
The Indo-American Journal of Pharma and Bio Sciences plays a crucial role in the scientific community by providing a platform for the exchange and dissemination of research findings in the fields of Pharmacy and Bio Sciences is the sscope and journal of the journal research paper.
It seems like you're providing information about the publication process of the International Journal of Advanced Publication Practices. This information outlines the fast publication schedule and peer-review process by the journal of the appears to prioritize a fast and efficient publication process while maintaining the quality and integrity of the research it publishes of the journal paper publication.
Scientific development is an ever-evolving journey, driven by the exchange of data and ideas among researchers across the globe.One such remarkable publication dedicated to facilitating this exchange within the fields of Pharmacy and Bio Sciences is the Indo-American Journal of Pharma and Bio Sciences of the journals to publish paper.
It appears that you have provided information about the "Indo-American Journal of Agricultural and Veterinary Sciences" . This journal seems to be an international online publication in English, published quarterly. It emphasizes fast publication while maintaining a rigorous peer-review process of the journal for research.
Indo-American Journal of Agricultural and Veterinary Sciences". It appears to be an international online journal that publishes research and review articles in English on topics related to agriculture and veterinary sciences is the journal of the research publish journal.
The Indo-American Journal of Agricultural and Veterinary Sciences appears to be a scholarly journal focused on publishing research within the fields of agriculture and veterinary sciences of the journals in research.
The Indo-American Journal of Pharma and Bio Sciences is an online international journal that publishes articles quarterly.It's important to note that the specific policies, guidelines, and the editorial board of IAJPB may change over time, so it's advisable to visit the journal's official website or contact the journal of the research on journaling.
ISSN 2347-2251
Manuscripts should be carefully checked for grammatical and punctuation errors. All papers undergo peer review. Please note that all articles published in this journal represent the opinions of the authors and do not necessarily reflect the official policy of the Journal of Indo-American Journal of Pharma and Bio Sciences of the all journal.
Indo-American Journal of Agricultural and Veterinary Sciences appears to be a reputable journal that values both the speed of publication and the quality of research in the fields of agriculture and veterinary sciences. Researchers interested in submitting their work to this journal of the journal research paper.
The Journal of Indo-American Journal of Pharma and Bio Sciences is the appears to have a broad scope covering various fields related to Pharmaceutical Sciences and Biological Sciences of the journal publishes various types of content, including research articles, reviews, and short communications of the journals public.
The world of search engine optimization (SEO) is buzzing with discussions after Google confirmed that around 2,500 leaked internal documents related to its Search feature are indeed authentic. The revelation has sparked significant concerns within the SEO community. The leaked documents were initially reported by SEO experts Rand Fishkin and Mike King, igniting widespread analysis and discourse. For More Info:- https://news.arihantwebtech.com/search-disrupted-googles-leaked-documents-rock-the-seo-world/
India Orthopedic Devices Market: Unlocking Growth Secrets, Trends and Develop...Kumar Satyam
According to TechSci Research report, “India Orthopedic Devices Market -Industry Size, Share, Trends, Competition Forecast & Opportunities, 2030”, the India Orthopedic Devices Market stood at USD 1,280.54 Million in 2024 and is anticipated to grow with a CAGR of 7.84% in the forecast period, 2026-2030F. The India Orthopedic Devices Market is being driven by several factors. The most prominent ones include an increase in the elderly population, who are more prone to orthopedic conditions such as osteoporosis and arthritis. Moreover, the rise in sports injuries and road accidents are also contributing to the demand for orthopedic devices. Advances in technology and the introduction of innovative implants and prosthetics have further propelled the market growth. Additionally, government initiatives aimed at improving healthcare infrastructure and the increasing prevalence of lifestyle diseases have led to an upward trend in orthopedic surgeries, thereby fueling the market demand for these devices.
As a business owner in Delaware, staying on top of your tax obligations is paramount, especially with the annual deadline for Delaware Franchise Tax looming on March 1. One such obligation is the annual Delaware Franchise Tax, which serves as a crucial requirement for maintaining your company’s legal standing within the state. While the prospect of handling tax matters may seem daunting, rest assured that the process can be straightforward with the right guidance. In this comprehensive guide, we’ll walk you through the steps of filing your Delaware Franchise Tax and provide insights to help you navigate the process effectively.
Accpac to QuickBooks Conversion Navigating the Transition with Online Account...PaulBryant58
This article provides a comprehensive guide on how to
effectively manage the convert Accpac to QuickBooks , with a particular focus on utilizing online accounting services to streamline the process.
Personal Brand Statement:
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materials science journal
1.
2. Indo-Am. J. Pharm & Bio. Sc., 2019 ISSN 2347-2251 www.iajpb.com
Ischemic and Non-Ischemic Heart Disease: A Patient-Specific Approach to
Scar Detection Using Cardiac MRI
B.Padmasri1
, P. Banujirao2
, V. Anil Kumar3
, R. Kalyani4
Abstract
The purpose of this research was to examine the use of cardiac magnetic resonance (CMR) feature tracking for scar identification in
a population of patients with varying degrees of ischemic and non-ischemic heart disease.
A total of 89 individuals with chronic ischemia and non-ischemic heart disease (IHD+) and 65 patients with ischemic scars
exclusively (IHD) had their cardiac magnetic resonance imaging (CMR) studies retrospectively analyzed. In all cases, original cine
pictures were processed using specialized software (Segment CMR, Medviso) to extract global (GCS) and segmental (SCS)
circumferential strain. Segmental values from GCSmedian percentage plots were associated with corresponding myocardial
segments in late gadolinium enhancement (LGE) after patient-specific median GCS (GCSmedian) was calculated.
Overall, the results showed a range of -3.5% to -19.8% in GCS, with a significantly lower average GCS in IHD+ compared to IHD
(p 0.05). The percentage of infarcted myocardial segments was 19% in IHD and 16% in IHD+. 6.7% of IHD+ segments also showed
evidence of non-ischemic LGE. GCSmedian percentage plots correlated with LGE to reveal that below a cut- off of 39.5%
GCSmedian (87.5% sensitivity, 86.3% specificity, AUC 0.907), the presence of ischemic scar tissue in a myocardial segment was
very probable.95% CI 0.875-0.938, p < 0.05).Ischemic scar tissue in the myocardium may be suspected using patient-specific
GCSmedian percentage plots computed from native cine pictures, as shown in the conclusion.
Keywords: Cardiac Magnetic Resonance; Feature Tracking; IschemicHeart Disease
List of Abbreviations: AHA- American Heart Association; AUC- Area Under The Curve; CMP- Cardiomyopathy; CMR-
Cardiac Magnetic Resonance; GCS- Global Circumferential Strain; GCSmedian- Patient-Specific Median Global Circumferential
Strain; HHD- Hypertensive Heart Disease; ICC- Intraclass Correlation Coefficient; IHD/IHD+- Chronic Ischemic Heart Disease/
Chronic Ischemic Heart Disease and Concomitant Non-Ischemic Heart Disease; LGE- Late Gadolinium Enhancement; LV- Left
Ventricle/ Left-Ventricular: LV-EDV- Left Ventricular End-Diastolic Volume; LV-EF- Left Ventricular Ejection Fraction; ROC-
Receiver Operating Characteristics;SCS- Segmental Circumferential Strain; SSFP- Steady- State Free Precession; T- Tesla
Introduction
Imaging scar tissue in ischemic heart disease has
progressed to the point where late gadolinium
enhancement (LGE) on cardiac magnetic resonance
(CMR) is a need [1]. Reduced diagnostic capability of
CMR scans in patients with ischemic heart disease and
contraindications to gadolinium mean that clinically
validated native approaches for identification of ischemia
scarring remain inadequate. By keeping tabs on previously
recorded voxels during the cardiac cycle, CMR feature
tracking detects myocardial deformation and gives
information on global and segmental strain from regularly
collected native cine sequences [2-4]. Reduced tissue
deformation characteristics in infarcts compared to strain
values of surrounding healthy myocardium led researchers
to conclude that segmental circumferential strain has great
potential for separating scar tissue from distant
myocardium [5-8]. Strain impairment is not exclusive to
ischemia damage; other cardiac illnesses, such as
cardiomyopathies and non-ischemic heart diseases, may
also affect strain values [9]. Furthermore, owing to inter-
individual heterogeneity in global strain levels, it is
difficult to define universally appropriate criteria for
infarcted and remote myocardium in heterogeneous patient
groups. This work thus explores a patient-specific method
to scar recognition, using a threshold based on median
global circumferential strain
1. B.Padmasri, Associate professor, Department of pharmaceutical Technology,
,Etcherla, Srikakulam.Email:padmasripharma@gmail.com
2.P. Banujirao, Assistant professor, Department of pharmacy Practice, Sri Venkateswara
College of pharmacy, Etcherla, Srikakulam.
3. V. Anil Kumar, Assistant professor, Department of pharmaceutical Technology, Sri
Venkateswara college of pharmacy, Etcherla, Srikakulam.
4. R. Kalyani, Assistant professor, Department of pharmacuetical Technology, Sri
Venkateswara college of pharmacy, Etcherla, Srikakulam
3. (
GCSmedian), in patients with ischemia and with both
ischemic and non- ischemic heart disease.
Methods
Study Population
The institutional review board and the local ethics
committee both gave their permission to this retrospective
investigation, and all patients who participated gave their
written informed consent. Between September 2017 and
January 2020, patients who visited our clinic for a CMR
check were analyzed for this research. Eighty-nine
individuals ("ischemic heart disease+" [IHD+]); Figure 1
out of 181 with chronic ischemic and non-ischemic heart
disease were included. These 89 individuals with ischemic
heart disease also had diagnoses of hypertension in an
additional 28, hypertrophy in an additional 23, LV
dilatation in an additional 26, and amyloidosis in an
additional 12 [10, 12]. Also recruited (Table 1) were 65
individuals from the same time period who had been
diagnosed with one of 85 chronic ischemic scars but no
other non-ischemic cardiac diseases ("ischemic heart
disease"/IHD). Patients who had recently had symptoms or
signs (acute chest pain, abnormal EKG, increased cardiac
enzymes, significant coronary stenosis on invasive
angiography) of a life-threatening cardiac disease were not
eligible for CMR.
89 patients with chronic ischemic and non-ischemic heart
disease were enrolled in the IHD+ group after 92 patients
were deemed ineligible due to exclusion criteria. This
group included 28 patients with hypertensive heart disease,
26 patients with severe left ventricular dilatation
(dilatative cardiomyopathy), 23 patients with hypertrophic
cardiomyopathy, and 12 patients with amyloidosis.
CMR Data Acquisition
All CMR exams were conducted on a clinical 1.5T
MR (Achieva, Philips Healthcare). Cine balanced
steady-state free precession (bSSFP) images in long-
axis geometries (2-, 3- and 4- chamber view) as well as
in short axis orientation covering the left ventricle
(LV) (field of view: 350 × 350
Figure 1: IHD+ group profile.
After exclusion of 92 patients, 89 patients with both chronic
ischemic and non-ischemic heart disease were enrolled in
IHD+ group: 28 patients with hypertensive heart disease, 26
patients with severe left ventricular dilatation (dilatative
cardiomyopathy), 23 patients with hypertrophic
cardiomyopathy and 12 patients with amyloidosis.
CMP: Cardiomyopathy; ED: End-Diastole/End-Diastolic; IHD+:
Patients with Concomitant Chronic Ischemic and Non-
Ischemic Heart Disease; LGE: Late Gadolinium
Enhancement; LV: Left Ventricle/Left-Ventricular; LV-EDV:
Left Ventricular End-Diastolic Volume; LV-EF: Left Ventricular
Ejection Fraction
mm2
; repetition time/echo time: 3.0/1.5 ms;
spatial resolutionSubsequently, percentages of
GCS
1.2 × 1.2 x 8 mm3
; number of cardiac phases: 50) were
acquired for functional LV assessment. After acquisition of
cine images,
Gadolinium (0.2 mmol gadobutrol [Gadovist; Bayer
Schering Pharma, Zurich, Switzerland] per kilogram
body weight) was applied for LGE sequences (inversion
recovery gradient-echo sequence; field of view: 350 × 350
mm2
; repetition time/echo time: 3.5/1.7 ms; spatial
resolution
1.2 × 1.2 x 8 mm3
; inversion time: 205–250 ms;
flip angle: 15°) in short axis orientation and in
2-,3- and 4 chamber view.
4. CMR Data Analysis
CMR feature tracking: Global (GCS) and segmental
(SCS) circumferential strain was derived from native cine
short axis stacks (anonymized data) using a specific software
(Segment CMR v3.0, Medviso; Figure 2) as previously
described [7] with both readers (M.P. and T.H.) being
blinded to each other, to patient information and to LGE
sequences. In every patient, patient- specific median GCS
(GCSmedian) was calculated from the segmental
circumferential strain values.
an individualized polar plot map (Figure 2d) and
segmental values were correlated with corresponding
myocardial segments in LGE short axis (reference
standard) [13].
Assessment of LV Function and LGE Images:
For the radiological report, ventricular volumes and
function were calculated using IntelliSpace Portal
(Philips, Version 8.0.3). LGE was classified as
“ischemic LGE” (subendocardial or transmural LGE
with accompanying regional wall motion abnormality)
or “non-ischemic LGE” (LGE in a midmyocardial,
epicardial or circular subendocardial/diffuse
distribution without concomitant wall motion
pathology). In ischemic LGE, segments with infarct
transmurality above 50% wall thickness were
considered “non-viable” [14]. Every CMR report was
revised by a EACVI level III cardiologist with > 20
years of experience in CMR (R.M.).
Statistical Analyses
Statistical analyses were conducted using commercially
available software (IBM SPSS Statistics, release 25.0;
Figure 2: 55-year-old male patient with chronic LAD infarction.
2a: Ischemic LGE in AHA segment 7,8,13 and 14 (red
arrows) in a 55-year-old patient with chronic ischemic heart
disease. 2b: Endo- and epicardial contouring of
corresponding cine short axis slices preceding strain
calculation (demonstrated by a basal, midventricular and
apical slice). 2c: Circumferential strain calculation with a
polar plot map depicting segmental values; mean GCS in
this patient is -6.6%. 2d: Based
on segmental strain values, patient-specific median GCS
(GCSmedian) was calculated and individual GCSmedian
percentage polar plot maps were generated. The resulting
percentage value of GCSmedian of every segment was
correlated with corresponding myocardial segment in LGE
short axis.
AHA- American Heart Association; GCS/SCS-
Global/Segmental Circumferential Strain; LAD- Left
Anterior Descending Coronary Artery; LGE- Late
Gadolinium Enhancement
6. BSA- Body Surface Area; BMI- Body Mass Index; GCS/SCS-
Global/Segmental Circumferential Strain; LAD- Left Anterior
Descending Coronary Artery; LCX- Left Circumflex Artery;
LGE- Late Gadolinium Enhancement; LV-EDV- Left Ventricular
End-Diastolic Volume; LV-EF- Left Ventricular Ejection
Fraction; LV-SV- Left Ventricular Stroke Volume; RCA- Right
Coronary Artery
Figure 3: ROC curve for distinguishing infarcted and non-
infarcted myocardium based on percentage values of GCSmedian.
In segments with values below 39.5% patient-specific
median GCS (GCSmedian), ischemic scar can be assumed with
87.5 % sensitivity and 86.3% specificity (AUC 0.907 [95%
CI: 0.875 – 0.938, p < 0.05], Youden`s index 0.74). Infarcted
segments in LGE short axis stacks served as gold standard.
AUC- Area Under The Curve; GCS- Global
Circumferential Strain; GCSmedian- Patient-Specific Median
Global Circumferential Strain; LGE- Late Gadolinium
Enhancement; ROC- Receiver Operating Characteristics
SPSS, Armonk, NY). Categorical variables were expressed
as frequencies or percentages, continuous variables were
expressed as means ± standard deviations. Global and
segmental circumferential strain values were compared using
two-tailed paired t-tests or Wilcoxon signed rank tests. To
measure interobserver agreement, the intraclass
correlation coefficient (ICC) was used; ICC = 0.50- 0.75
was consideredmoderate, ICC = 0.75- 0.9 was
considered good and ICC
> 0.9 was considered excellent agreement [15]. Receiver
operating characteristics (ROC) were calculated and the
area
under the curve (AUC) was determined for the percentage of
Infarct Detection with GCSmedian Percentage Plots in
IHD and IHD+: Analysis of percentage plots of GCSmedian
calculated for every patient (IHD and IHD+) revealed a
cut- off value of 39.5% below the presence of ischemic
LGE in a segment had a sensitivity of 87.5% and
specificity of 86.3% (AUC 0.907, 95% CI 0.875-0.938, p
< 0.05; Figure 3, 4).
In segments with values below 39.5% patient-
specific median GCS (GCSmedian), ischemic scar
can be assumed with
87.5 % sensitivity and 86.3% specificity (AUC 0.907 [95%
CI: 0.875 – 0.938, p < 0.05], Youden`s index 0.74).
Infarcted
GCS to differentiate infarcted from remote
myocardium;segments in LGE short axis stacks
served as gold standard.optimal cut-off was
defined by the Youden’s index. A two-In some
IHD+ patients with GCS
below - 7%
sided p-value < 0.05 indicated statistical significance.
Results
Late Gadolinium Enhancement in IHD and
IHD+Ischemic Heart Disease (IHD): In IHD, 210 out of
1105segments(19%) had ischemic LGE; 194 of 210
infarcted segments (92.4%) were non-viable.
Concomitant Ischemic and Non-Ischemic Heart
Disease (IHD+): In IHD+, 251 out of 1513 (16.6%)
segments had ischemic LGE with mostly non-viable
infarcts (94%, 236 out of 251). Furthermore, 101
segments (6.7%) showed non- ischemic LGE. In patients
with hypertensive heart disease, 3 segments showed
midmyocardial LGE antero-/inferoseptal basal and 4
segments showed epicardial LGE at the basal RV
junction. In patients with dilatative cardiomyopathy, 15
segments show midmyocardial septal LGE.
Midmyocardial fibrosis was also found in 9 patients with
hypertrophic cardiomyopathy and 70 segments showed
circular/diffuseLGE in amyloidosis patients (Table 1).
Global Circumferential Strain
Among all patients (IHD and IHD+), individual GCS
ranged widely between -3.5% to -19.8%. IHD+ patients
had significantly lower average GCS than IHD patients (-
12.9% vs. -16%, p < 0.05; ICC 0.898, 95%CI: 0.832-
0.941). The lowest GCS was measured in patients with
cardiac amyloidosis (average GCS -9.7%, range from -
3.5% to -13.9%). Average GCS was higher in women
than in men(-15.4% vs. -14%, p < 0.05).
Segmental Circumferential Strain
Segmental Circumferential Strain in IHD and
IHD+: In IHD, average SCS was -17.4% (range -11.5 %
to -22.8%) in segments free of ischemic LGE, and -5.9%
(range: -2.3% to -7.3%) for ischemic LGE segments;
inter-reader agreement was extremely strong (ICC: 0.881,
95% CI: 0.823-0.932). SCS was on average -16.6%
(range: -6.5% to -19.1%) in IHD+ episodes without LGE.
Myocardial segments with ischemia LGE had a SCS of -
5.4% (range: 0.4% to -9.1%), whereas non-ischemic LGE
segments had a SCS of -11.8% (range: -2.4% to -21.3%).
We found a high level of agreement across readers (ICC
0.852, 95% CI 0.794-0.917).Eight infarcted segments had
values greater than the recommended threshold of 40%
GCSmedian (Figure 4), including three patients (2 with
amyloidosis and 1 with significant LV dilatation). Six of
the subendocardial scars that were still functional had
strain values greater than the
All of the segments were detectable in patients having
at least one segment below the 40% GCSmedian criterion.
Segment 17 was left out of the GCS calculation, making a
diagnosis of apical infarction impossible for 9 individuals.
Seven segments had ischemic LGE according to
GCSmedian criteria but showed no scar tissue on LGE
pictures; additional examination showed that strain
impairment in four of these segments was caused by an
LV diverticulum.
7. myocardial hibernation was most likely indicated by
the akinesia in 3 segments observed in short axis cine
without wall weakening. Finally, low values in 10
segments imply ischemia scar due to local aberrations in
the cine pictures, but there is no matching LGE or wall
motion abnormalities.
Discussion
Patients with chronic ischemia and non-ischemic heart
disease were included in this research to examine a patient-
specific strategy to employing CMR feature tracking for
native scar diagnosis. Ischemic scar tissue in a cardiac
segment could be identified with a sensitivity of 88% and a
specificity of 86% at a threshold of 40% patient-specific
median global circumferential strain (GCSmedian). CMR
feature tracking depicts global and segmental myocardial
deformation [16], and it is derived from regularly obtained
original cine pictures. Originating in echocardiography, this
technique is finding growing use in clinical CMR as a
means of gaining insight into the heart beyond what can be
gleaned from a visual assessment of wall motion [17].
Recent studies confirmed that local tissue destruction in
ischemic scars leads to significant local circumferential
strain impairment in contrast to adjacent
remote tissue, allowing to distinguish remote and infarcted
myocardium [5,6,18]. This is based on the premise that most
LV myocardial fibers are circumferentially orientated and
thus contribute to circumferential strain. As a result, this
method has the potential to increase the reliability of in-
house CMR tests for patients with ischemic heart disease
who cannot receive Gadolinium. However,
Figure 4: Influence of ischemic scar on segmental strain in IHD+
patients.
tic power of native CMR exams in patients who
decline contrast or have contraindications for
gadolinium. Hypertrophic cardiomyopathy (HCM) in a 53-
year-old female patient, showing diffuse mild
midmyocardial LGE in the anteroseptal basal and
inferoseptal midventricular regions (yellow arrows), as well
as transmural infarction in AHA segments 13-15. Infarcted
segments with GCSmedian values below 40% (15%, 17%,
and 18%, respectively), with the overall value being -17.7%.
A 65-year-old man patient was diagnosed with Dilated
Cardiomyopathy (DCM) based on his left ventricular
dilatation, decreased LV- EF (37%), and midmyocardial
septal thickening.
Transmural infarction in segments 10 and 15 and a low-grade
astrocytoma (LGE; yellow arrow) at the base. Infarcted segments
have values
of 11% and 8% of the median GCS below 40%.
Concentric left ventricular hypertrophy, extensive LGE in
the anterolateral and basal regions (yellow arrow), and a
significant ischemic scar in segments 7,8,13, and 14 are all
hallmarks of HHD in this 55-year-old male patient.
GCSmedian values in scar tissue are 23.0%, 19.0%, 29.0%,
and 27.0%.
This 62-year-old male patient has amyloidosis (yellow
arrow), which is characterized by widespread LGE, a very
low GCSmedian (-6.8%), and a tiny scar inferior lateral (red
arrow) with a GCSmedian percentage value of 47%, which is
higher than the suggested criterion of 40% GCSmedian.
GCS stands for global circumferential strain; PSGCS stands
for patient-specific median global circumferential strain;
AHA stands for the American Heart Association.
abbreviations for Left Ventricular Ejection Fraction (LV-EF) and
Late Gadolinium Enhancement (LGE)
Segmental circumferential strain has low specificity for scar
detection in the general population because it is affected by a
wide variety of conditions besides myocardial infarction,
such as inflammatory changes, cardiomyopathies, cardiac
infiltrative disease, and states like hibernating myocardium
[19–21]. With this in mind, we set out to identify a threshold
based on individual strain values, beyond which ischemia
scars might be predicted with high likelihood in patients with
chronic ischemic (IHD) and simultaneous ischemic and non-
ischemic heart disease (IHD+). No patient-specific studies
using CMR feature tracking for scar identification have been
published as of yet, to the best of our knowledge. When
looking at the complete sample, the average global
circumferential strain (GCS) was lower in IHD+ than in IHD
[16], but values varied from pathologically low (-3.5%,
patient with amyloidosis and infarction) to normal (-19.8%,
patient with modest ischemic scar). Interestingly, both
groups showed comparably low average segmental strain
values in infarcted segments. Local circumferential strain
was less severely impaired in non-ischemic LGE in IHD+
than in segments bearing ischemic scars. This is due to the
greater degree of LV wall damage induced by non-viable,
ischemic scars than by non-ischemic LGE, which has
generally intact wall integrity. GCSmedian % polar plots
may be readily created using patient-specific median GCS
(GCSmedian), which is more resilient to outliers than mean
GCS, and segmental circumferential strain data. A criterion
below 40% GCSmedian was shown to have 88% sensitivity
and 82% specificity in identifying the existence of ischemia
scar in a diverse patient population with a variety of heart
diseases using segment-wise correlation of the derived polar
plot values with LGE pictures. Only a small percentage of
infarcted regions had values greater than the recommended
threshold, and this was mostly seen in individuals with
substantially impaired GCS (below -7% GCS), such as those
with amyloidosis. Amyloidosis patients may have trouble
using LGE imaging to locate ischemia scars because diffuse
LGE might obscure otherwise visible lesions. Furthermore,
several functional infarcts produced false negative findings
with levels greater than the suggested cutoff. Due to identical
signal intensities between scar and surrounding myocardium
and relatively mild wall motion disturbance [22], viable scars
8. may be difficult to identify even in LGE. Additional capture
and assessment of T1 mapping, with likely greater local
values in infarcted tissue relative to surrounding distant
myocardium [23,24], might be one method to solving this
problem. Only a small number of false positives were
discovered, and those were mostly attributable to regional
anomalies. Apical infarction (section 17 of the AHA) could
not be determined in this study.
However, in cine long axis, SCS manifests as apical akinesia
or dyskinesia due to ischemia in the apex. To confirm that
the 40% GCSmedian threshold also applies to data computed
with other commercially available CMR feature tracking
tools, more research is needed as only one program was
utilized to generate global and segmentalcircumferential
strain. The suggested feature tracking approach might be
readily used in a prospective clinical scenario in patients with
known or suspected ischemic heart disease since cine
pictures are routinely obtained before contrast application.
Possible benefits include less gadolinium use in future CMR
tests and better diagnostic accuracy.
Conclusion
A threshold below 40% patient-specific median
global circumferential strain (GCSmedian) indicates
chronic scars in myocardial segments with a sensitivity
of 88% and a specificity of 86%. Since alternatives for
detecting scar tissue from native CMR exams are
limited, this patient-specific cine-based method could
help to improve diagnostic power of native CMR
exams
in patients with contraindication to Gadolinium.
However, in patients with severely reduced GCS, this
method might be not sensitive enough to detect
ischemic scars and additional use of tissue
characterization techniques should be considered.
Authors’ Contributions
M.P. provided the study concept. M.P. and O.M.
provided patient data and images. M.P. and T.H.
performed data analysis.
M.P. wrote the manuscript. H.A., S.K. and R.M. proofread
the manuscript.
Acknowledgements
Not applicable.
Source of Funding :
M.P. is financially supported by a grant
from thePromedica Foundation.
Competing Interests
The authors declare they have no competing interests.
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