Jérôme Caudron

Evaluation of Left Ventricular Diastolic Function with Cardiac MR Imaging

Assessment of left ventricular (LV) function with cardiac magnetic resonance (MR) imaging is often limited to evaluation of systolic function, including analysis of regional wall motion, measurement of mass and volume, and estimation of ejection fraction. However, diastolic dysfunction is present in various heart diseases, particularly in heart failure with preserved ejection fraction, which is increasingly prevalent and is associated with a poor prognosis. In daily practice, the assessment of diastolic function is mainly performed with transthoracic echocardiography. Evaluation of diastolic function with cardiac MR imaging is seldom performed in clinical practice. However, basic assessment of LV relaxation and stiffness abnormalities can be achieved with MR imaging by using a combination of left atrium size measurement and phase-contrast evaluation of transmitral flow. In addition, assessment of pulmonary venous flow and the LV filling curve can also be performed. Furthermore, MR imaging with late gadolinium enhancement sequences provides insight into the extent of myocardial fibrosis, which strongly influences LV stiffness. Finally, phase-contrast evaluation of tissue velocities, myocardial tagging, MR spectroscopy, and MR elastography are promising tools for a better understanding of LV diastolic function but require further evaluation.

Cardiac MRI assessment of right ventricular function in acquired heart disease: factors of variability.

RATIONALE AND OBJECTIVES To evaluate intra- and inter-observer variability of right ventricular (RV) functional parameters as evaluated by cardiac magnetic resonance imaging (MRI) in patients with acquired heart disease (AHD), and to identify factors associated with an increased variability. MATERIALS AND METHODS Sixty consecutive patients were enrolled. Right and left ventricular (LV) volumes, ejection fraction, and mass were determined from short-axis cine sequences. All analyzes were performed twice by three observers with various training-degree in cardiac MRI. Intra- and inter-observer variability was evaluated. The impact on variability of each of the following parameters was assessed: observers experience, basal and apical slices selection, end-systolic phase selection, and delineation. RESULTS Mean segmentation time ranged 9.8-19.0 minutes for RV and 6.4-9.2 minutes for LV. Variability of RV functional parameters measurement was strongly influenced by previous observers experience: it was two to three times superior to that of LV, even for the most experienced observer. High variability in the measurement of RV mass was observed. For both ventricles, selection of the basal slice and delineation were major determinants of variability. CONCLUSION As compared to LV, RV function assessment with cardiac MRI in AHD patients is much more variable and time-consuming. Observers experience, selection of basal slice, and delineation are determinant.

Automatic cardiac ventricle segmentation in MR images: a validation study.

AbstractPurposeSegmenting the cardiac ventricles in magnetic resonance (MR) images is required for cardiac function assessment. Numerous segmentation methods have been developed and applied to MR ventriculography. Quantitative validation of these segmentation methods with ground truth is needed prior to clinical use, but requires manual delineation of hundreds of images. We applied a well-established method to this problem and rigorously validated the results.MethodsAn automatic method based on active contours without edges was used for left and the right ventricle cavity segmentation. A large database of 1,920 MR images obtained from 59 patients who gave informed consent was evaluated. Two standard metrics were used for quantitative error measurement.ResultsSegmentation results are comparable to previously reported values in the literature. Since different points in the cardiac cycle and different slice levels were used in this study, a detailed error analysis is possible. Better performance was obtained at end diastole than at end systole, and on mid-ventricular slices than apical slices. Localization of segmentation errors were highlighted through a study of their spatial distribution.ConclusionsVentricular segmentation based on region-driven active contours provided satisfactory results in MRI, without the use of a priori knowledge. The study of error distribution allows identification of potential improvements in algorithm performance.

Diagnostic accuracy and variability of three semi-quantitative methods for assessing right ventricular systolic function from cardiac MRI in patients with acquired heart disease

ObjectivesTo evaluate the diagnostic accuracy and variability of 3 semi-quantitative (SQt) methods for assessing right ventricular (RV) systolic function from cardiac MRI in patients with acquired heart disease: tricuspid annular plane systolic excursion (TAPSE), RV fractional-shortening (RVFS) and RV fractional area change (RVFAC).MethodsSixty consecutive patients were enrolled. Reference RV ejection fraction (RVEF) was determined from short axis cine sequences. TAPSE, RVFS and RVFAC were measured on a 4-chamber cine sequence. All SQt analyses were performed twice by 3 observers with various degrees of training in cardiac MRI. Correlation with RVEF, intra- and inter-observer variability, and receiver operating characteristic (ROC) curve analysis were performed for each SQt method.ResultsCorrelation between RVFAC and RVEF was good for all observers and did not depend on previous cardiac MRI experience (R range = 0.716–0.741). Conversely, RVFS (R range = 0.534–0.720) and TAPSE (R range = 0.482–0.646) correlated less with RVEF and depended on previous experience. Intra- and inter-observer variability was much lower for RVFAC than for RVFS and TAPSE. ROC analysis demonstrated that RVFAC <41% could predict a RVEF <45% with 90% sensitivity and 94% specificity.ConclusionsRVFAC appears to be more accurate and reproducible than RVFS and TAPSE for SQt assessment of RV function by cardiac MRI.

Transapical aortic valve implantation in Rouen: four years' experience with the Edwards transcatheter prosthesis.

BACKGROUND The first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department. AIMS To report 4-year outcomes of transapical implantation with the Edwards transcatheter bioprosthesis. METHODS We prospectively evaluated consecutive patients who underwent transapical implantation with an Edwards transcatheter bioprosthesis between July 2007 and October 2011. Patients were not suitable for conventional surgery (due to severe comorbidities) or transfemoral implantation (due to poor femoral access). RESULTS Among 61 patients (59.0% men), mean logistic EuroSCORE was 27.5 ± 14.9% and mean age was 81.0 ± 6.8 years. Successful valve implantation was achieved in 59/61 patients (96.7%) of patients. The other two patients required conversion to conventional surgery due to prosthesis embolization and died. Six additional patients died in the postoperative period. Causes of perioperative death were two septic shocks (one of peritonitis), two multi-organ failure, one ventricular fibrillation and one respiratory insufficiency. Intraprocedural stroke was not observed in any patient. The actuarial survival rates at 1, 2 and 4 years were 73.8%, 67.2% and 41.0%. During this 4-year period, four patients died of cardiovascular events, but no impairment of transprosthesis gradient was observed. CONCLUSION Our series of 61 patients who underwent transapical implantation of the Edwards transcatheter bioprosthesis shows satisfactory results, similar to other reports, considering the high level of severity of patients referred for this method. Transapical access is a reliable alternative method for patients that cannot benefit from a transfemoral approach.

Diagnosis and follow-up of Wegener's granulomatosis by cardiac magnetic resonance

A 46-year-old woman was referred to our institution for chest pain and dyspnea. Wegeners granulomatosis (WG) had recently been diagnosed based on typical chest and sinus CT findings. Clinical examination was normal. ECG disclosed an acute episode of atrial fibrillation. Troponin level was moderately increased at 3.25 µg/L. There was a marked inflammatory syndrome (Erythrocyte sedimentation rate 116 mm; C-reative protein …

Cardiac multislice computed tomography after transcatheter aortic valve implantation: Features after “valve-in-valve” implantation for degenerative stented aortic bioprosthesis

MOTS CLES An 86-year-old woman complained of gradually increasing dyspnoea (New York Heart Association stage III). Ten years previously she had surgical aortic valve replacement with a stented bioprosthesis (21 mm Carpentier-Edwards; Edwards Lifesciences, Irvine, CA, USA) for severe symptomatic aortic stenosis. At the same time, a triple coronary bypass graft was performed. Five years after surgery, a permanent pacemaker was implanted. Follow-up transthoracic echocardiography demonstrated severe stenosis of the aortic bioprosthesis (maximal pressure gradient 80 mmHg; aortic valve area 0.6 cm2). Surgery was contraindicated (logistic EuroSCORE greater than 20%). The patient was referred to our centre for transcatheter aortic valve implantation (TAVI). Preimplantation multislice computed tomography (MSCT)-angiography confirmed

Cardiac computed tomography in right-sided carcinoid heart disease

MOTS CLÉS Valvulopathie ; Cardiopathie carcinoïde ; Scanner cardiaque Ileal carcinoid neoplasm with liver metastasis (Panel A, arrows) was diagnosed recently in this 38-year-old man. Surgical treatment had been scheduled, combining ileo-colectomy and liver transplantation. As the patient complained of dyspnoea on exertion, transthoracic echocardiography (TTE) was performed, which revealed massive pulmonary and tricuspid regurgitation. Left ventricular ejection fraction and left-sided valves were normal. Dose-modulated cardiac computed tomography (CT) (VCT Light Speed 64, General Electric, Milwaukee, WI, USA) was performed to eliminate coronary artery disease before surgery (Fig. 1). Coronary arteries were normal. Multiplanar multiphase reconstruction showed enlarged right cavities, and thickening and retraction of the tricuspid valve and subvalvular apparatus, including chordae and papillary muscles (Panels B, C and D). Tricuspid valve closure was incomplete during systole (Panel C, arrow; Video 1). The pulmonary valve was also thickened and non-coapting at diastole (Panels E, F; Video 2). Moderate cardiac effusion was visible (Panel D, arrow). Although the impact of CT was limited for planning the treatment of cardiac carcinoid disease, it provided a comprehensive depiction of the anatomy of the right-sided cavities and pulmonary valve. The limits of CT must be acknowledged: it cannot assess or quantify valve regurgitation, pulmonary artery pressure or patent foramen ovale (PFO). Also, the temporal resolution of CT does not allow detailed assessment of valve motion compared with TTE.

Multimodality cardiac magnetic resonance imaging of cardiac mass.

An 84-year-old man presented with a 1-month history of dyspnoea and constrictive chest pain on exertion, relieved by nitroglycerin administration. His main medical history included aortic valve replacement (AVR) with a bioprosthetic valve, coronary artery bypass graft (CABG) and post-transfusion chronic hepatitis C. Physical examination was normal except for a grade 2 ejection systolic murmur audible in the aortic area and bilateral leg oedema. Electrocardiogram demonstrated sinus rhythm at 75/min and T-wave inversion in the inferior leads. Moderately elevated troponin concentration was noted (0.79 g/L). The patient was transferred to the intensive care unit with a preliminary diagnosis of acute coronary syndrome. Transthoracic echocardiography (TTE) revealed a hyperechogenic and heterogeneous motionless mass infiltrating the lateral wall of the right ventricle and atrium (Fig. 1, Panel A, black arrow) without intracavitary extension. Left ventricular ejection fraction was normal.

Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial.

Unfortunately, there is a mistake in the sectionResults, Clinical safety. While the text states that Bno severe AEs were reported^, in fact one severe AE was reported in the iomeprol group (one severe injection site pain assessed as possibly related to contrast agent), as shown in Table 5. In addition, the name of the author Jean-François Paul was rendered incorrectly in the original publication but has since been corrected. The authors apologize for these mistakes.