To assess a novel approach for automatic flow velocity computation in deriving quantitative flow ratio (QFR) from coronary angiography. QFR is a novel approach for assessment of functional significance of coronary artery stenosis without using pressure wire and induced hyperemia. Patient-specific coronary flow is estimated semi-automatically by frame count method, which is subjective and inconvenient in the workflow of QFR analysis. The vascular structures were automatically delineated from coronary angiogram. Subsequently, the centerline of the interrogated vessel was extracted from the delineated lumen on each image frame and the change in the length of centerline was used to compute the flow velocity, which provided patient-specific flow for computation of QFR (QFRauto). A parameter derived from the increase in centerline length was used to automatically quantify the stability of contrast flow. From the two angiographic image runs used for three-dimensional angiographic reconstruction, the one with better stability was used to compute QFRauto. QFRauto was assessed in all patients enrolled in the FAVOR II China study, and compared with the commercialized QFR computational method based on frame count (QFRcount), using pressure wire-based fractional flow reserve (FFR) as the reference standard. Out of 328 vessels with paired FFR data, QFRauto was successfully computed on 325 (99%) vessels with acceptable stability in filling of contrast flow. The flow velocity computed by the proposed approach had a weak to moderate correlation with the frame count method (r = 0.37, p < 0.001), with mean differences of − 0.02 ± 0.07 m/s (p < 0.001). QFRauto had good correlation (r = 0.96, p < 0.001) and agreement (mean difference: − 0.01 ± 0.04, p < 0.001) with QFRcount. Good correlation (r = 0.83, p < 0.001) and agreement (mean difference: 0.01 ± 0.06, p = 0.016) were also observed between QFRauto and FFR. Using FFR ≤ 0.80 to define functional significance of coronary stenosis, the overall diagnostic accuracy for QFRauto was 93.2% (95% CI 90.5–96.0%). The area under the receiver-operating characteristic curve did not differ significantly between QFRcount and QFRauto (difference: 0.00; 95% CI − 0.01 to 0.01; p = 0.529). Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for QFRauto were 92.4% (95% CI 86.0–96.5%), 93.7% (95% CI 89.5–96.6%), 14.7 (95% CI 8.7–25.0), and 0.1 (95% CI 0.0–0.2), respectively. Automatic computation of patient-specific coronary flow velocity based on coronary angiography is feasible. Assessment of QFR based on this novel approach had good diagnostic accuracy in determining the functional significance of coronary stenosis.

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Extreme negative remodeling of septal left anterior descending branch masquerading as a bifurcation lesion

Pillai, Ajith; Rangasamy, Sasinthar

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1484-0pmid: 30382476

We report a case of severe negative remodelling at the ostium of septal LAD artery. We deferred stenting to avoid the risk of rupture of the vessel and stent fracture

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LitStream Collection

First Presentation of Integration of Intravascular Optical Coherence Tomography and Computational Fractional Flow Reserve

Tian, Feng; Yu, Wei; Huang, Jiayue; Zhang, Tao; Chen, Yundai; Tu, Shengxian

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1491-1pmid: 30390169

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LitStream Collection

Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation

Sonaglioni, Andrea; Vincenti, Antonio; Baravelli, Massimo; Rigamonti, Elisabetta; Tagliabue, Elena; Bassi, Pietro; Nicolosi, Gian; Anzà, Claudio; Lombardo, Michele

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1485-zpmid: 30377893

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The added value of right ventricular longitudinal strain in patients with chronic thromboembolic pulmonary hypertension

Golu, Vlad; Nistor, Dan

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1486-ypmid: 30421353

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LitStream Collection

Effect of image quality on accuracy of two-dimensional strain echocardiography for diagnosing ischemic chest pain: a 2DSPER multicenter trial substudy

Shiran, Avinoam; Blondheim, David; Shimoni, Sara; Jabarren, Mohamed; Rosenmann, David; Sagie, Alex; Leibowitz, David; Leitman, Marina; Feinberg, Micha; Beeri, Ronen; Adawi, Salim; Asmer, Ihab; Ganaeem, Majdi; Friedman, Zvi; Liel-Cohen, Noah

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Drop-off in positivity rate of stress echocardiography based on regional wall motion abnormalities over the last three decades

Cortigiani, Lauro; Ramirez, Pamela; Coltelli, Maico; Bovenzi, Francesco; Picano, Eugenio

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1501-3pmid: 30460582

Previous studies have suggested a decline in positivity of stress cardiac imaging based on regional wall motion abnormalities (RWMA). To assess the rate of RWMA positivity of stress echocardiography (SE) over 3 decades in the same primary care SE lab. We retrospectively assessed the rate of SE positivity in 7626 SE tests (dipyridamole in 5053, dobutamine in 2496, exercise in 77) in consecutive patients with known or suspected coronary artery disease and /or heart failure who performed SE in a primary care referral center from April 1991 to May 2018. Starting April 2005, SE based on RWMA was complemented by assessment of coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery. Starting October 2016, we added left ventricular contractile reserve (LVCR). Starting October 2016, we also added B-lines by lung ultrasound. There was a progressive decline over time in the rate of SE positivity based on RWMA from 24% (1991–1999) to 10% (2000–2009) down to 4% (2010–2018) (p < 0.0001). Positivity rate was 29% with CFVR, 16% with LVCR, and 12% with B-lines. Over three decades, we observed a dramatic decline in SE positivity rate based on classical RWMA. In the last decade, the positivity rate rose sharply thanks to the stepwise introduction of CFVR, LVCR and B-lines as additional positivity criteria in integrated quadruple SE.

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Left atrial functional response after a marathon in healthy amateur volunteers

Hirata, Yukina; Kusunose, Kenya; Yamada, Hirotsugu; Morita, Sae; Torii, Yuta; Nishio, Susumu; Zheng, Robert; Saijo, Yoshihito; Fukuda, Daiju; Yagi, Shusuke; Soeki, Takeshi; Sata, Masataka

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1502-2

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Open Access Collection

Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair?

Velu, J.; Baan Jr, J.; Bruin-Bon, H.; Mourik, M.; Nassif, M.; Koch, K.; Vis, M.; Brink, R.; Boekholdt, S.; Piek, J.; Bouma, B.

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1507-xpmid: 30499057

The aim of the current study was to investigate whether stress echocardiography improves selection of patients who might have clinical benefit from percutaneous mitral valve repair with the MitraClip. In total, 39 patients selected for MitraClip implantation underwent preprocedural low-dose stress (dobutamine or handgrip) echocardiography from which stroke volume, ejection fraction and MR grade were measured. Outcome after MitraClip implantation was determined by New York Heart Association classification and Quality of Life questionnaires. Clinical benefit from MitraClip treatment was defined as survival and NYHA class I–II at 6 months follow-up. In total, 36 patients with a technically successful procedure were included in the analysis (mean age 79 ± 8 years, 47% male, 50% functional MR). Clinical benefit was achieved in 18 patients. All seven patients with MR decreasing during stress remained in NYHA III–IV or died within 6 months, while 62% (18 out of 29) of the patients with stable or increased MR during stress had clinical benefit (p = 0.008). Significant increase in Quality of Life on 4/8 subscales of the RAND Short Form-36 questionnaire was observed: Physical Functioning (p < 0.001), Social Functioning (p < 0.001), Mental Health (p = 0.022) and Vitality (p = 0.026) was seen in patients with an increase in stroke volume during stress echocardiography. Patients with a decreased MR during preprocedural stress echocardiography remained more symptomatic than patients with a stable or increased MR during stress. Stress echocardiography may support patient selection for percutaneous mitral valve repair.

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LitStream Collection

Early diastolic strain rate measurements by cardiac MRI in breast cancer patients treated with trastuzumab: a longitudinal study

Gong, Inna; Ong, Geraldine; Brezden-Masley, Christine; Dhir, Vinita; Deva, Djeven; Chan, Kelvin; Graham, John; Chow, Chi-Ming; Thavendiranathan, Paaladinesh; Dai, Day; Ng, Ming-Yen; Barfett, Joseph; Connelly, Kim; Yan, Andrew

2018

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Prognostic stratification of acute ischemic stroke (AIS) patients without atrial fibrillation (AF) remains a challenge. Two-dimensional speckle tracking echocardiography (2D-STE) has recently been introduced for dynamic evaluation of left atrial function. However only few data are actually available regarding the application of 2D-STE in AIS patients. The aim of our study was to assess the prognostic role of global left atrial peak strain (GLAPS), measured by 2D-STE, in AIS patients without AF history. Eighty-five AIS patients (mean age 74.1 ± 12.1 years, 49 males) with normal sinus rhythm on ECG and without AF history were enrolled in the prospective study. All patients underwent a complete echocardiographic study with 2D-STE. At 1 year follow-up, we evaluated the occurrence of a composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations. GLAPS was markedly reduced in AIS patients (15.71 ± 4.70%), without any statistically significant difference between the stroke subtypes. At 1-year follow-up, 14 deaths and 17 hospital readmissions were detected in AIS subjects. On a multivariate Cox model, variables independently associated with the occurrence of the composite endpoint were the “Rankin in” Scale (HR 1.69, p = 0.001), GFR (HR 0.98, p = 0.03) and the GLAPS value (HR 0.78, p < 0.0001). A GLAPS value ≤ 15.5% predicted the composite endpoint with sensitivity of 100% and specificity of 80%. A GLAPS value ≤ 15.5% reflects a more advanced atrial cardiomyopathy and might provide a reliable and useful prognostic risk stratification of AIS patients without AF history.

2018 The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1495-xpmid: 30430326

Few data exist regarding the effect of image quality on measurements of two-dimensional longitudinal strain (2DLS). In the 2DLS for Diagnosing Chest Pain in the Emergency Room (2DSPER) multicenter study, 2DLS was not useful for ruling out acute coronary syndromes (ACS) in the emergency department (ED). The aim of this substudy was to determine the effect of 2D image quality on the diagnostic accuracy of 2DLS for ACS. We reviewed apical views used for 2DLS analysis in all 605 patients included in the 2DSPER study. Studies with the best image quality (HighQ, n = 177), were compared to the lower quality group (LowQ, n = 428). Abnormal 2DLS was defined as PSS20% > − 17% (PSS20% being the peak left ventricular systolic strain value identifying the 20% worst strain values). Global longitudinal strain (GLS) and PSS20% were significantly worse in LowQ compared to HighQ patients. LowQ independently predicted abnormal 2DLS (OR 1.9, 95% CI 1.3–2.9, P = 0.003). The sensitivity of PSS20% > − 17% for ACS was 85% for LowQ vs. 73% for HighQ (P = 0.2), specificity 22% vs. 38% (P < 0.0001) and overall accuracy 29% vs. 44% (P = 0.0004). Despite better overall accuracy in the HighQ group there was no significant difference between the receiver operating characteristic curves of either GLS or PSS20% in the two groups and abnormal 2DLS did not predict ACS even in HighQ patients (OR 1.7, 95% CI 0.7–4.3, P = 0.3). LowQ echo is associated with worse 2DLS. Abnormal 2DLS was not clinically useful for excluding ACS in the ED even in patients with optimal 2D image quality.

pmid:

30470971

Middle-aged marathon runners have an increased risk of developing atrial fibrillation (AF). A previous study described that repetitive marathon running was associated with left atrial (LA) dysfunction. However, whether this change is common in marathon runners and which runners are at risk of LA dysfunction remain unknown. The purpose of this study was to determine which factors could predict LA dysfunction. We prospectively examined 12 healthy amateur volunteers (9 males, 31 ± 8 years old) who participated in a full marathon. All echocardiographic measurements and speckle-tracking echocardiography were performed before and after the marathon. The endpoint was defined as reduced LA reservoir strain 1 day after the marathon (non-responder group). Seven participants were in the non-responder group. Age (35 ± 9 vs. 26 ± 2 years, p = 0.020), augmentation index (76 ± 12 vs. 55 ± 8, p = 0.002), and diastolic blood pressures (83 ± 11 vs. 70 ± 7 mmHg, p = 0.021) in the non-responder group were significantly higher compared with the responder group. In multivariate linear regression analysis, only the augmentation index was an independent predictor of reduced LA reservoir function after the marathon (β = − 0.646, p = 0.023). The augmentation index was a predictive marker for reduction in LA reservoir function after a marathon in healthy amateur volunteers.

The International Journal of Cardiovascular Imaging

doi: 10.1007/s10554-018-1482-2pmid: 30390170

We evaluated temporal changes in early diastolic strain rates by cardiovascular magnetic resonance (CMR) as an early detector of trastuzumab-induced ventricular dysfunction. We conducted a prospective, multi-centre, longitudinal observational study of 41 trastuzumab-treated breast cancer women who underwent serial CMR (baseline, 6, 12, and 18 months). Two blinded readers independently measured left ventricular ejection fraction (LVEF), peak systolic strain parameters (global longitudinal strain [GLS] and global circumferential strain [GCS]), and early diastolic strain rate parameters (global longitudinal diastolic strain rate [GLSR-E], global circumferential diastolic strain rate [GCSR-E], and global radial diastolic strain rate [GRSR-E]), by feature tracking (FT-CMR) using CMR42. There was a significant decline in peak systolic strain GLS and GCS at 6 months (p = 0.024 and p < 0.001, respectively) and 12 months (p = 0.002 and p < 0.001, respectively), followed by recovery at 18 months, which paralleled decline in LVEF at 6 months (p = 0.034) and 12 months (p = 0.012). Conversely, early diastolic strain rates GLSR-E and GCSR-E did not significantly change over 18 months (p > 0.10), while GRSR-E was marginally significant at 12 months (p = 0.021). There was no significant correlation between changes at 6 months in LVEF and GLSR-E or GRSR-E (p > 0.10), and a marginally significant weak correlation between LVEF and GCSR-E (p = 0.046). Among trastuzumab-treated patients without overt cardiotoxicity, there was no consistent temporal change in FT-CMR-derived diastolic strain rate parameters up to 18 months, in contrast to decline in systolic strain and LVEF. Systolic strains by FT-CMR are likely more useful than diastolic strain rates for monitoring subclinical trastuzumab-related myocardial dysfunction.