163 research outputs found
Supplemental material for Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy
No full textSupplemental Figure for Preoperative CT of cardiac veins for planning left ventricular lead placement in cardiac resynchronization therapy by Hanna Markstad, Zoltan Bakos, Ellen Ostenfeld, Mats Geijer, Marcus Carlsson and Rasmus Borgquist in Acta Radiologica</p
Imaging the Right Heart-Pulmonary Circulation Unit : The Role of MRI and Computed Tomography
No full textThe different components of the right heart pulmonary circulation unit can be investigated by MRI and computed tomography. MRI has clear advantages over echocardiography for accurate definition of right heart function and structure and to derive functional information regarding the pulmonary vasculature. Computed tomography is superior for the assessment of parenchymal and vascular pathologies of the lung with indications in the diagnostic work-up of pulmonary hypertension, but with more limited capability to evaluate right ventricular function and in deriving pulmonary hemodynamics. Recent technical developments with these imaging modalities could allow a better evaluation of the right heart pulmonary circulation unit
Three-dimensional assessment of cardiac function; When right is wrong
No full textAssessment of the right side of the heart is important in patients with heart disease; especially in patient with elevated pressure in the lung circulation. Decreased right ventricular function and elevated pressure in the right atrium are of poor prognostic value. Two-dimensional echocardiography (ultrasound of the heart) is the most commonly used method to assess the hearts function, but the right ventricle is hard to assess with this method. This is partly due to a 2-dimensional method has intrinsic problems to assess a 3-dimensional complex structure such as the right side of the heart. Magnetic resonance imaging of the heart and 3-dimensional (3D) echocardiography can be used for imaging in three dimensions. The aim of this thesis is to assess how 3D echocardiography and magnetic resonance imaging of the heart can be used to determine the right heart function; and due to this determine how the heart pump physiology is altered by elevated right atrial and pulmonary pressure. In this thesis, echocardiography and magnetic resonance imaging is used with 2D and 3D technique. Study I showed how to acquire 3D echocardiography for volume assessment of both atria and ventricles in adult cardiac patients. Acquisition from the apex of the heart, with at times an 'off-axis' approach, should be used for volumetric assessment with 3D echocardiography. While the atria and the left ventricle were well visualized, the right ventricle was a challenge. Study II aimed to validated right ventricular volumes and function, in a population of adult cardiac patients, with 3D echocardiography using magnetic resonance imaging as a reference. The study showed the difficulty to asses right ventricular volumes and function, even when using 3D echocardiography in a clinically unselected population. Furthermore, the study showed the importance of manual corrections to achieve reasonably valid measurements, when compared to magnetic resonance imaging. Study III assessed elevated right atrial pressure by quantifying right atrial volumes with 3D echocardiography in patients with elevated pressure in the lung circulation. The volumes were compared to invasively measured pressure values and magnetic resonance imaging. The study showed that 3D as well as 2D echocardiographic volume assessment of the right atrium were better than the conventional echocardiographic methods to determine elevated right atrial pressure. This was despite a substantial underestimation of the 3D echocardiographic volumes compared to magnetic resonance imaging. Study IV examined the different contributions to right and left ventricular stroke volume in patients with elevated pressure in the lung circulation; and compared to those of healthy adults. Magnetic resonance imaging was used given the results of study II and pressure was quantified by right sided catheterization. The study showed that longitudinal and lateral contribution to left ventricular stroke volume was altered in patients with elevated pressure in the lung circulation compared to the control group. Right ventricular longitudinal and lateral contribution to stroke volume did not differ between patients and controls. The septum moved to the left in both groups, however less in patients than in healthy adults. In patients with elevated pressure in the lung circulation and hence pressure loaded right ventricles, the different components of pump function are altered in a different compared to volume loaded right ventricles. This is new information that helps understand the hearts physiology
Are biventricular and biatrial function truly preserved after arterial switch operation?
No full textImaging the right heart pulmonary circulation unit : Insights from advanced ultrasound techniques
No full textThe right heart pulmonary circulation unit (RH-PCU) is a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for pulmonary hemodynamic assessment, a comprehensive cardiovascular ultrasound approach is an essential step in the diagnostic-prognostic clinical pathway of patients with suspect or overt pulmonary hypertension. The exponential development of advanced ultrasound techniques (strain, 3-dimensional echocardiography and lung ultrasound) has led to new insights into the evaluation of RH-PCU structure and function, overcoming some limitations of standard Doppler echocardiography. In the near future, exercise Doppler echocardiography may become a useful technique for detecting a latent stage of pulmonary hypertension and for evaluating right ventricular contractile reserve
Three-dimensional assessment of cardiac function; When right is wrong
No full textPopular Abstract in Swedish Bedömning av höger sida av hjärtat är viktig hos patienter med hjärtsjukdom; i synnerhet hos patienter med förhöjt tryck i lungkretsloppet. Sänkt högerkammarfunktion och förhöjt tryck i höger förmak har visats vara prognostiskt dåligt. Två-dimensionellt ultraljud av hjärtat (ekokardiografi) är den vanligaste metoden för att bedöma hjärtats funktion, men högerkammaren är svår att värdera med denna metod. Detta beror delvis på att en 2-dimensionell metod har inneboende problem att värdera en 3-dimensionellt komplicerad struktur som den högra sidan av hjärtat. Magnetresonans av hjärtat och 3-dimensionell (3D) ekokardiografi kan användas för avbildning i tre dimensioner. Syftet med denna avhandling är att värdera hur 3D-ekokardiografi och magnetresonans av hjärtat kan användas för att bestämma höger hjärthalvas funktion; och även bestämma hur hjärtats pumpfysiologi påverkas vid förhöjt tryck i höger förmak och förhöjt tryck i lungkretsloppet. I avhandlingen används för utvärdering både 2D och 3D teknik med ekokardiografi samt magnetresonans. Delarbete I visade hur man bäst utför och samlar in 3D-ekokardiografiska data för volymbedömning av både förmak och kammare. Studien visade att en insamlingsteknik från spetsen av hjärtat (apikal teknik) bör användas vid volymbedömning med 3D-ekokardiografi, och att man ibland behöver en justerad vinkel jämfört med 2D. Medan förmaken och vänster kammare visualiserades väl, var höger kammare en utmaning. Delarbete II validerade högerkammarens volymer och funktion hos en vuxen kardiologisk population med 3D-ekokardiografi där magnetresonans var referensmetod. Studien visade hur svårt det är att använda 3D-ekokardiografi för på högerkammarvärdering i en kliniskt oselekterad population. Dessutom visade studien att relativt många manuella korrektioner måste göras för att få värden som är någorlunda hållbara, när man jämför mätningarna med magnetresonans. Delarbete III bedömde förhöjt höger förmakstryck genom att kvantifiera höger förmaksvolymer med 3D-ekokardiografi hos patienter med förhöjt tryck i lungkretsloppet. Volymerna jämfördes med invasivt mätta tryckvärden och mot magnetresonans. Studien visade att 3D-ekokardiografi men även 2D- ekokardiografiska estimat av höger förmaksvolymer var bättre än gängse ekokardiografiska metoder för att bedöma förhöjt medeltryck i höger förmak, även om ekokardiografi underskattade volymerna väsentligen jämfört med magnetresonans. Delarbete IV undersökte bidraget till slagvolym från longitudinell, lateral och septal pumpfunktion i höger och vänster kammares hos patienter med förhöjda tryck i lungkretsloppet. De olika komponenterna jämfördes med en frisk normalpopulation. Magnetresonans användes med tanke på resultaten i delarbete II och trycket mättes med en kateter i höger hjärthalva. Studien visade att den longitudinella (längsgående) och det laterala (kramande) tillskottet till vänster kammares slagvolym är påverkade hos patienter med förhöjt tryck i lungkretsloppet jämfört med friska. Höger kammares längsgående och kramande tillskott till slagvolymen skiljer sig dock inte mellan patienter och friska. Skiljeväggen mellan kamrarna (septum) rör sig i båda grupperna mot vänster, men i lägre grad hos patienterna än friska. De olika komponenterna till pumpfunktion skiljer sig hos patienter med förhöjt tryck i lungkretsloppet jämfört med patienter med volymbelastad högerkammare. Detta ger ny information för att förstå hjärtats pumpfysiologi.Assessment of the right side of the heart is important in patients with heart disease; especially in patient with elevated pressure in the lung circulation. Decreased right ventricular function and elevated pressure in the right atrium are of poor prognostic value. Two-dimensional echocardiography (ultrasound of the heart) is the most commonly used method to assess the hearts function, but the right ventricle is hard to assess with this method. This is partly due to a 2-dimensional method has intrinsic problems to assess a 3-dimensional complex structure such as the right side of the heart. Magnetic resonance imaging of the heart and 3-dimensional (3D) echocardiography can be used for imaging in three dimensions. The aim of this thesis is to assess how 3D echocardiography and magnetic resonance imaging of the heart can be used to determine the right heart function; and due to this determine how the heart pump physiology is altered by elevated right atrial and pulmonary pressure. In this thesis, echocardiography and magnetic resonance imaging is used with 2D and 3D technique. Study I showed how to acquire 3D echocardiography for volume assessment of both atria and ventricles in adult cardiac patients. Acquisition from the apex of the heart, with at times an 'off-axis' approach, should be used for volumetric assessment with 3D echocardiography. While the atria and the left ventricle were well visualized, the right ventricle was a challenge. Study II aimed to validated right ventricular volumes and function, in a population of adult cardiac patients, with 3D echocardiography using magnetic resonance imaging as a reference. The study showed the difficulty to asses right ventricular volumes and function, even when using 3D echocardiography in a clinically unselected population. Furthermore, the study showed the importance of manual corrections to achieve reasonably valid measurements, when compared to magnetic resonance imaging. Study III assessed elevated right atrial pressure by quantifying right atrial volumes with 3D echocardiography in patients with elevated pressure in the lung circulation. The volumes were compared to invasively measured pressure values and magnetic resonance imaging. The study showed that 3D as well as 2D echocardiographic volume assessment of the right atrium were better than the conventional echocardiographic methods to determine elevated right atrial pressure. This was despite a substantial underestimation of the 3D echocardiographic volumes compared to magnetic resonance imaging. Study IV examined the different contributions to right and left ventricular stroke volume in patients with elevated pressure in the lung circulation; and compared to those of healthy adults. Magnetic resonance imaging was used given the results of study II and pressure was quantified by right sided catheterization. The study showed that longitudinal and lateral contribution to left ventricular stroke volume was altered in patients with elevated pressure in the lung circulation compared to the control group.Right ventricular longitudinal and lateral contribution to stroke volume did not differ between patients and controls. The septum moved to the left in both groups, however less in patients than in healthy adults. In patients with elevated pressure in the lung circulation and hence pressure loaded right ventricles, the different components of pump function are altered in a different compared to volume loaded right ventricles. This is new information that helps understand the hearts physiology
Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?
No full textPurpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH
Assessment of right ventricular volumes and ejection fraction by echocardiography: from geometric approximations to realistic shapes. [Elektronisk resurs]
No full textRight ventricular volumes and ejection fraction are challenging to assess by echocardiography, but are well established as functional and prognostic parameters. Three-dimensional (3D) echocardiography has become widespread and relatively easy to use, making calculation of these parameters feasible in the large majority of patients. We review past attempts to estimate right ventricular volumes, current strengths and weaknesses of 3D echocardiography for this task, and compare with corresponding data from magnetic resonance imaging
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