The International Journal of Cardiovascular Imaging

Dengke, Zhang; Lan, Li; Xiangli, Shen; Shubin, Jiang

doi: 10.1007/s10554-018-1449-3pmid: 30178222

To investigate the effectiveness and safety of using the Ensite NavX three-dimensional (3D) mapping system during Radiofrequency catheter ablation (RFCA) of left accessory pathway (AP) disorders. A total of 227 patients having their left AP treated by RFCA, were classified into study group (n = 112) and the control group (n = 115). X-ray irradiation time and exposure doses during the course of the operations were recorded. Time taken to place the mapping catheter along with total duration of operations and procedural complications were compared. The X-ray irradiation time and exposure doses in the course of manipulating the ablation catheters were significantly lower in the study group compared to control (5.1 ± 2.3 min vs. 13.1 ± 3.1 min; P < 0.05 and 5.7 ± 2.6 mGy vs. 17.8 ± 4.3 mGy; P < 0.05, respectively). The total duration of operation was also significantly shorter in the study group compared to control (53.1 ± 18.8 min vs. 62.3 ± 20.6 min; P < 0.05). No procedural complications were reported in both groups. The irradiation time and exposure dose along with total operation duration was significantly reduced when the Ensite NavX mapping system was used during RFCA in comparison with traditional X-ray fluoroscopy method.

Fan, Lin; Luo, Yukun; Chen, Zhaoyang; Cai, Wei; Dong, Xianfeng; Lin, Chaogui; Chen, Lianglong

doi: 10.1007/s10554-018-1475-1pmid: 30386956

The present study aimed to evaluate the feasibility of low frame rate fluoroscopy during primary percutaneous coronary intervention (PPCI) for patients with acute ST elevation myocardial infarction (STEMI). From January 2016 to December 2017, 165 consecutive patients with STEMI who underwent PPCI were retrospectively divided into two groups: the 7.5-frame group (fluoroscopy at 7.5 frames/s) and the 15-frame group (fluoroscopy at 15 frames/s), according to the frame rate of fluoroscopy used in their treatment. Reduction of radiation and safety of fluoroscopy at 7.5 frames/s were compared by a method of propensity score matching (PSM) with fluoroscopy at 15 frames/s. After PSM, there were 56 patients in each group. There were no differences in patients’ baseline characteristics between two groups. The 7.5-frame protocol resulted in 48.9% reduction of DAP (9917 ± 5543 cGycm2 vs. 14766 ± 7272 cGycm2, P < 0.001) and 61.1% reduction of AK (1209 ± 562 mGy vs. 1948 ± 1105 mGy, P < 0.001) with comparable procedural time (38.1 ± 15.3 min vs. 38.8 ± 17.2 min, P = 0.830), fluoroscopy time (13.0 ± 7.2 min vs. 13.5 ± 8.1 min, P = 0.703) and contrast volume (122.3 ± 39.4 ml vs. 119.3 ± 49.4 ml, P = 0.725) to the 15-frame group. Meanwhile, this new protocol didn’t increase the incidence of contrast-induced nephropathy (23.2% vs. 25.0%, OR = 0.907, 95% CI 0.381–2.157, P = 0.825) and peri-PPCI cumulative adverse events (30.4% vs. 28.6%, OR = 1.090, 95% CI 0.483–2.456, P = 0.836). In conclusion, low frame rate fluoroscopy at 7.5 frames/s is a safe and feasible strategy for reducing radiation during PPCI.

Okuya, Yoshiyuki; Saito, Yuichi; Sakai, Yoshiaki; Ishibashi, Iwao; Kobayashi, Yoshio

doi: 10.1007/s10554-018-1465-3pmid: 30328026

Clinical impact of tissue protrusion (TP) after coronary stenting is still controversial, especially in patients with ST-segment elevation myocardial infarction (STEMI). A total of 104 STEMI patients without previous MI who underwent primary percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS)-guidance were included. Post-stenting grayscale IVUS analysis was performed, and the patients were classified according to the presence or absence of post-stenting TP on IVUS. Coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) with 99mTc tetrofosmin were analyzed. Major adverse cardiac events were defined as cardiovascular death, myocardial infarction, heart failure hospitalization, and target vessel revascularization. TP on IVUS was detected in 62 patients (60%). Post-PCI coronary flow was more impaired, and peak creatine kinase-myoglobin binding level was higher in patients with TP compared to those without. SPECT MPI was performed in 77 out of 104 patients (74%) at 35.4 ± 7.7 days after primary PCI. In patients with TP, left ventricular ejection fraction was significantly reduced (47.5 ± 12.0% vs. 57.6 ± 11.2%, p < 0.001), and infarct size was larger [17% (8–25) vs. 4% (0–14), p = 0.002] on SPECT MPI. During a median follow-up of 14 months after primary PCI, Kaplan–Meier analysis demonstrated a significantly higher incidence of major adverse cardiac events in patients with TP compared to those without. TP on IVUS after coronary stenting was associated with poor outcomes in patients with STEMI.

Tenekecioglu, Erhan; Torii, Ryo; Katagiri, Yuki; Chichareon, Ply; Asano, Taku; Miyazaki, Yosuke; Takahashi, Kuniaki; Modolo, Rodrigo; Al-Lamee, Rasha; Al-Lamee, Kadem; Colet, Carlos; Reiber, Johan; Pekkan, Kerem; Geuns, Robert; Bourantas, Christos; Onuma, Yoshinobu; Serruys, Patrick

Rausch, Karen; Shiino, Kenji; Putrino, Anthony; Lam, Alfred; Scalia, Gregory; Chan, Jonathan

doi: 10.1007/s10554-018-1453-7pmid: 30229344

Left atrial (LA) strain is an emerging technique with potential applications including arrhythmia prediction in atrial fibrillation and early identification of atrial dysfunction. The aim of this study was to evaluate reproducibility of LA strain and strain rate (SR) using multi-vendor analysis software between novice and expert. For LA strain to be a reliable tool, the technique must be reproducible by observers with variable experience. Use of multi-vendor analysis software allows serial strain assessment when echocardiographic images are acquired using different vendors. Fifty subjects underwent 2D-Speckle tracking echocardiographic (STE) derived LA strain and SR analysis measured from apical four and two-chamber views. Three strain parameters of LA function were assessed: reservoir (S-LAs, SR-LAs), contractile (S-LAa, SR-LAa) and conduit (S-LAs–S-LAa, SR-LAe). Strain analyses were performed by 2 independent, blinded novice and expert observers using multi-vendor analysis software. Intraobserver and interobserver analyses were performed using intra class correlation coefficients (ICC) and Bland–Altman analysis. LA strain and SR measured by novice observer demonstrated excellent intraobserver reproducibility (ICC for all strain and SR values > 0.88). There was good interobserver agreement of LA strain values between novice and expert (S-LAs:ICC 0.81, S-LAe:ICC 0.82, S-LAa:ICC 0.74). SR values also demonstrated good interobserver agreement (SR-LAs:ICC 0.83, SR-LAe:ICC 0.79, SR-LAa:ICC 0.86). Of all parameters, SR-LAa had the best interobserver and intraobserver agreement (ICC 0.86, 0.96). Global LA strain and SR values were highly reproducible by novice strain reader using multi-vendor analysis software. Interobserver reproducibility between novice and experts were good and acceptable within limits of agreement.

Lin, Mingjie; Hao, Li; Cao, Yuan; Xie, Fei; Han, Wenqiang; Rong, Bing; Zhao, Yachao; Zhong, Jingquan

doi: 10.1007/s10554-018-1457-3pmid: 30293193

Dissipative energy loss (EL), an index of inefficient blood flow, has not been studied in patients with atrial fibrillation (AF). We therefore assessed the effect of AF and of successful catheter ablation on left ventricular (LV) EL and global longitudinal strain (GLS) to explore the effect of inefficient blood flow on LV remodeling. In 53 patients undergoing catheter ablation for AF (AF group), LV EL (in mW/m) was evaluated by vector flow mapping (VFM) during systole (ELsys), early diastole (ELed) and atrial contraction phase (ELac), and GLS was calculated by two-dimensional tissue tracking (2DTT). Of the 53 patients, 37 patients who sustained sinus rhythm and completed echocardiographic evaluation at baseline and at 3 and 6 months follow-up were examined for change in EL and GLS. The latter parameters also were assessed in 44 age- and sex-matched controls. At baseline in AF group, ELsys and ELed were significantly higher (3.97 ± 2.29 vs. 3.14 ± 1.01; and 9.22 ± 5.01 vs. 3.89 ± 1.51; both P < 0.05, respectively), and GLS was lower (− 16.66 ± 3.50 vs. − 19.95 ± 2.40, P < 0.05) than in controls. During follow-up after catheter ablation, ELsys and ELed significantly improved at 3 months, and almost normalized at 6 months (both P < 0.05); GLS also improved significantly (P < 0.05). In multivariate logistic regression analysis, ELed was the only independent predictor for maintenance of sinus rhythm at 1-year follow-up (hazard ratio, 1.254; 95% confidence interval 1.073–1.467). VFM and 2DTT revealed impaired LV EL and GLS in patients with AF. Successful catheter ablation appeared to ameliorate impairment in intraventricular flow and mechanics.

Pasqua, A.; Esposito, Claudia; Milewski, Priscilla; Ciliberti, Paolo; Chinali, Marcello; Secinaro, Aurelio; Rinelli, Gabriele

doi: 10.1007/s10554-018-1459-1pmid: 30298426

Smith, Aaron; Megaly, Michael; Madsen, Melissa; Waska, Amy; Bart, Bradley; Herzog, Charles

doi: 10.1007/s10554-018-1463-5pmid: 30288665

Wang, Yi-Dan; Li, Yi-Dan; Ding, Xue-Yan; Wu, Xiao-Peng; Li, Cheng; Guo, Di-Chen; Shi, Yan-Ping; Lu, Xiu-Zhang

doi: 10.1007/s10554-018-1468-0pmid: 30350115

Pulmonary arterial hypertension (PAH) is more prevalent in females. Paradoxically, female patients have better right ventricular (RV) function and higher survival rates than males. However, the effects of 17β-estradiol (E2) on RV function in PAH has not been studied. Twenty-four male rats were exposed to monocrotaline (MCT) to induce experimental PAH, while treated with E2 or vehicle respectively. Together with eight control rats, thirty-two rats were examined by echocardiography 4 weeks after drug administration. Echocardiographic measurement of RV function included: tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC) and tricuspid annular systolic velocity (s′). RV free wall longitudinal strain (RVLSFW) and RV longitudinal shortening fraction (RVLSF) were also used to quantify RV function. RV morphology was determined by echocardiographic and histological analysis. TAPSE, RVFAC and s′ were reduced, and RIMP was elevated in the MCT-treated group and vehicle-treated group, when compared with control group (P < 0.01). TAPSE, RVFAC and s′ in the E2 group were higher, while RIMP was lower than those in the MCT-treated group and vehicle-treated group (P < 0.01). Myocardial functional parameters (RVLSFW and RVLSF) were also higher in the E2 group. Enhanced serum E2 levels were closely correlated with the improvement in RV functional parameters and enhancement of serum BNP levels (P < 0.01 for all groups). RV function decreased significantly in male rats with MCT-induced PAH, while E2 exhibited a protective effect on RV function, suggesting that E2 is a critical modulator of sex differences in PAH.

Chen, Yilin; Li, Zheng; Shen, Xuedong; Wang, Wei; Kang, Yu; Qiao, Zhiqing; Wang, Xinhua; Pu, Jun

doi: 10.1007/s10554-018-1470-6pmid: 30413910

This study aimed to evaluate left atrial (LA) remodeling and fibrosis in paroxysmal atrial fibrillation (AF) using speckle tracking echocardiography (STE) based on the findings with radiofrequency catheter ablation (RFCA) so as to predict atrial remodeling prior to ablation. A total of 40 patients with paroxysmal AF were enrolled and divided into two groups based on LA bipolar voltage detected during RFCA: those with low-voltage zone (LVZ) (LV group, n = 19) and those without LVZ (non-LV group, n = 21). The segmental and global LA reservoir, conduit and contractile strain (εs, εe, εa) were analyzed using two-dimensional STE before RFCA. The segmental and global εs, εe, εa (%) decreased in the LV group. Especially, the εs in anteroseptal upper (18.32 ± 7.94 vs. 31.61 ± 9.39) and lower segments (16.60 ± 7.23 vs. 29.23 ± 9.81), posteroseptal upper (22.24 ± 6.65 vs. 32.23 ± 10.57) and lower segments (18.24 ± 6.49 vs. 26.40 ± 7.12), and the global εs (23.85 ± 6.74 vs. 30.48 ± 8.67) significantly decreased in the LV group than in the non-LV group (all P < 0.05). The εs ≤ 24.07 in the anteroseptal upper segment was an effective parameter to differentiate the LV group (sensitivity, 84%; specificity, 81%, P < 0.001). Besides, global εs tended to be an independent determinant of the LVZ (odds ratio 1.347, P = 0.046). STE enables a noninvasive method to evaluate LA remodeling prior ablation.