• Journal of Cardiovascular Imaging
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• v.30 no.4
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• pp.263-275
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• 2022

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS: Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0-3) based on coronary angiography. RESULTS: The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS: Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.131-142
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• 1973

Studies of cardiopulmonary function and acid-base balance were performed on 29 dogs during control period, during oligemic hypotension and following return of blood to the animals. Intravenous morphine and local anesthesia were used. Fifteen of the 29 animals survived the complete experiment. The 14 animals that failed to survive the experimental period died between 15 to 90 minutes after the onset of bleeding. The results were as follows. 1. The heart rate increased after the onset of bleeding and failed to return to control level following reinfusion. Stroke volume decreased markedly after bleeding and failed to recover after return of blood from the reservoir. Cardiac output also decreased during oligemic hypotension and was maintained at this level after re-infusion. Total peripheral resistance decreased significantly immediately after bleeding, however it increased soon over the pre-bleeding level. Central venous pressure decreased after the onset of bleeding and remained at lower level for the rest of the experimental period. Arterial blood pressure, clown to 40-45 mmHg by acute hemorrhage, was elevated near to control level. Left ventricular work decreased tremendously during oligemic hypotension and failed to return to control level with the re-infusion of blood. Hematocrit value showed no significant decrease after bleeding and increased after re-infusion. Hemoglobin decreased after the onset of bleeding and recovered to control value after re-infusion. 2. The respiratory rate fell rapidly after bleeding from 124 to 29 and remained at this lower level for the remainder of the experiment. The tidal volume increased after bleeding and was maintained at this level for the remainder of the experiment. The respiratory minute volume showed no significant changes throughout the experimental period. Oxygen consumption fell lightly in all animals during oligemic hypotension and returned to normal levels following re-infusion. Arterial oxygen content and arterial oxygen saturation decreased following bleeding and the values returned to normal levels after the return of blood from the reservoir The arterio-venous oxygen difference increased after the onset of bleeding. It failed to return to normal values following re-infusion. Arterial $Pco_2$ decreased in all animals after the beginning of the bleeding. Partial pressure of $Co_2$ continued to fall until re-infusion, after which the values returned toward normal. Animals became acidotic. The pH fell to lower level following bleeding. Lactic acid and lactate: pyruvate ratio also increased during same period. Arterial pH and lactic acid failed to return to control value and lactate: pyruvate ratio increased more after re-infusion. Sodium bicarbonate decreased after bleeding and returned to control value following re-infusion.

• Korean Journal of Radiology
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• v.23 no.12
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• pp.1251-1259
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• 2022

Objective: T1 mapping provides valuable information regarding cardiomyopathies. Manual drawing is time consuming and prone to subjective errors. Therefore, this study aimed to test a DL algorithm for the automated measurement of native T1 and extracellular volume (ECV) fractions in cardiac magnetic resonance (CMR) imaging with a temporally separated dataset. Materials and Methods: CMR images obtained for 95 participants (mean age ± standard deviation, 54.5 ± 15.2 years), including 36 left ventricular hypertrophy (12 hypertrophic cardiomyopathy, 12 Fabry disease, and 12 amyloidosis), 32 dilated cardiomyopathy, and 27 healthy volunteers, were included. A commercial deep learning (DL) algorithm based on 2D U-net (Myomics-T1 software, version 1.0.0) was used for the automated analysis of T1 maps. Four radiologists, as study readers, performed manual analysis. The reference standard was the consensus result of the manual analysis by two additional expert readers. The segmentation performance of the DL algorithm and the correlation and agreement between the automated measurement and the reference standard were assessed. Interobserver agreement among the four radiologists was analyzed. Results: DL successfully segmented the myocardium in 99.3% of slices in the native T1 map and 89.8% of slices in the post-T1 map with Dice similarity coefficients of 0.86 ± 0.05 and 0.74 ± 0.17, respectively. Native T1 and ECV showed strong correlation and agreement between DL and the reference: for T1, r = 0.967 (95% confidence interval [CI], 0.951-0.978) and bias of 9.5 msec (95% limits of agreement [LOA], -23.6-42.6 msec); for ECV, r = 0.987 (95% CI, 0.980-0.991) and bias of 0.7% (95% LOA, -2.8%-4.2%) on per-subject basis. Agreements between DL and each of the four radiologists were excellent (intraclass correlation coefficient [ICC] of 0.98-0.99 for both native T1 and ECV), comparable to the pairwise agreement between the radiologists (ICC of 0.97-1.00 and 0.99-1.00 for native T1 and ECV, respectively). Conclusion: The DL algorithm allowed automated T1 and ECV measurements comparable to those of radiologists.

• Clinical and Experimental Pediatrics
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• v.58 no.6
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• pp.218-223
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• 2015

Purpose: Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. Methods: Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thoracic-dominant scoliosis (group A, n=78) and lumbar-dominant scoliosis (group B, n=12) groups. Scoliosis severity was evaluated using the Cobb method. In each group, relationships between Cobb angles and cardiopulmonary markers such as forced vital capacity (FVC), forced expiratory volume in one second ($FEV_1$), $FEV_1$/FVC, left ventricular ejection fraction, pulmonary artery flow velocity, and tissue Doppler velocities (E/E', E'/A') were analyzed by correlation analysis linear regression. Results: In group A, 72 patients (92.3%) underwent pulmonary function tests (PFTs), and 41 (52.6%) underwent echocardiography. In group B, 9 patients (75.0%) underwent PFT and 8 (66.7%) underwent echocardiography. Cobb angles showed a significant negative correlation with FVC and $FEV_1$ in group A (both P<0.05), but no such correlation in group B, and a significant negative correlation with mitral E/A ratio (P<0.05) and tissue Doppler E'/A' (P<0.05) in group A, with a positive correlation with mitral E/A ratio (P<0.05) in group B. Conclusion: Pulmonary and cardiac function was significantly correlated with the degree of scoliosis in patients with thoracic-dominant scoliosis. Myocardial diastolic function might be impaired in patients with the most severe scoliosis.

• Journal of Biomedical Engineering Research
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• v.13 no.3
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• pp.225-234
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• 1992

In order to use a low cost polymer valve in our total artificial heart and ventricular assist device, we have developed a slit-type bileaflet polymer valve[BPV 1. The aim of this study is to determine the hydrodynamic effectiveness of the newly-designed BPV and its feasibility for temporary use in the blood pumps. For hydrodynamic comparison, we investigated in-vitro the pressure drop across the valve, the leakage volume, the flow rate and the flow pattern of the BPV, two mechanical valves and a trileaflet polymer valve. We employed the ventriculo-pulmonary bypassing method for in-vivo tests of the BPV's together vilh our electrohydraulic left venIn ricular assist device in mongrel dogs. The BPV showed adquate gydrodynamic performances and in the preliminary animal bests, there was no xvi dence of thrombus formation on the valve leaflets and around the struts. Detailed results obtained from the animal tests will be separately reported. This report involves the design criteria, fabrication and hydrodynamic charateristics of she BPV, and the basic merits and demerits of the valve are dis- cussed from the hydrodynamic point of view.

• The Korean Journal of Nuclear Medicine
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• v.39 no.6
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• pp.430-437
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• 2005

Purpose: The objectives of this study were - First, to determine the normal range of left ventricular end diastolic volume (EDV), end systolic volume (ESV) and election fraction (EF) from gated myocardial perfusion SPECT for Quantitative Gated SPECT (QGS) and 4D-MSPECT (4DM), respectively. Second, to evaluate the relationships between values produced by both software packages. Materials & Methods: Tc-99m MIBI gated myocardial perfusion SPECT were performed for 77 patients (mean age: $49.6{\pm}13.7y$, n=37(M), 40(F)) with a low likelihood (<10%) of coronary artery disease (CAD) using dual head gamma camera (E.CAM, Siemens, USA). Left ventricular EDV, ESV and EF were automatically measured by means of QGS and 4DM, respectively. Results: in QGS, the mean EDV, ESV and EF for all patients were $78.2{\pm}25.2ml,\;27.4{\pm}12.9ml\;and\;66.6{\pm}8.0%$ at stress test respectively, not different from rest test (p>0.05). In 4DM, the mean EDV, ESV and EF for all patients were $89.1{\pm}26.4ml,\;29.1{\pm}12.8ml\;and\;68.5{\pm}6.7%$ at stress test. Most cases in 4DM, there was no significant difference statistically between stress and rest test (p>0.05). But statistically significant difference was found in EF ($68.5{\pm}6.7%$ at stress vs $70.9{\pm}8.0%$ at rest, p<0.05). Correlation coefficients between the methods for EDV, ESV and EF were comparatively high (0.95, 0.93, 0.71 at stress test and 0.95, 0.90, 0.69 at rest test, respectively). However, Bland-Altman plots showed a large range of the limit value of agreement for EDV, ESV and EF between both methods ($-30ml{\sim}10ml,\;-12ml{\sim}8ml,\;-14%{\sim}11%$ at stress test and $-32ml{\sim}5ml,\;-13ml{\sim}13ml,\;-18%{\sim}12%$ at rest test). Conclusion: We found the normal ranges of EDV, ESV and EF for patients with a low likelihood of CAD in both methods. We expect these values will be a good reference to interpret gated myocardial perfusion SPECT. Although good correlation was observed between both methods, they should not be used interchangeably. Therefore, when both programs are used at the same site, it will be important to apply normal limits specific to each method.

• Journal of the Korean Society of Radiology
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• v.8 no.5
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• pp.231-240
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• 2014

The purpose of this study were to analyze that the Seoul neuropsychological screening battery (SNSB) for the evaluating cognitive assessment of the Parkinson's disease patients with mild cognitive impairment (PD-MCI) and the changes of the cerebral ventricle volume in the brain magnetic resonance imaging (MRI), and we has been bring forward the guideline to determine the diagnostic criteria for the PD-MCI. To achieve this, we was diagnosed with Parkinson's disease patients (PD-MCI group: 34 patients; Parkinson's disease with normal cognition, PD-NC group: 34 patients) to perform the SNSB test for the attention, language, memory, visuospatial, and frontal/executive functions and the brain MRI. Additionally, to compared the change of the cerebral ventricle volume, we performed the brain MRI for the 32 normal control (NC) group. The volumetric analysis for a specific cerebral ventricle performed by using Freesurfer Ver. 5.1 (Massachusetts general Hospital, Boston MA, USA). As a results, compared to the PD-NC group, the PD-MCI group were statistically significant reduction in the ability to perform the memory and the visuospatial function (p<0.05). The volumetric changes for a specific cerebral ventricle were statistically significant variation in the left and right lateral ventricle, left and right inferior lateral ventricle, and 3rd ventricle. Although, in order to compared the objectification, the normalized percentage applied to the volumetric changes showed to extend the PD-MCI group than the PD-NC group. Specially, the left and right ventricle extension for the PD-MCI patients conspicuously had showed a quantitative linear relationship between the memory and the visuospatial function for the SNSB (r>0.5, p<0.05). Therefore, we were able to judge the diagnostic criteria of the PD-MCI through that can observe the volumetric variation of the specific cerebral ventricle by using Freesurfer in brain MRI, and to analyze the correlation between the SNSB.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.200-206
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• 2013

Purpose : To assess the effect of applying an automated heart model based measurements of left ventricle (LV) and compare with manual and semi-automated measurements at Cardiovascular MR Imaging. Materials and Methods: Sixty-two patients who underwent cardiac 1.5T MR imaging were included. Steady state free precession cine images of 20 phases per cardiac cycle were obtained in short axis views and both 2-chamber and 4-chamber views. Epicardial and endocardial contours were drawn in manual, automated, and semi-automated ways. Based on these acquired contour sets, the end-diastolic (ED) and end-systolic (ES) volumes, ejection fraction (EF), systolic volume (SV) and LV mass were calculated and compared. Results: In EDV and ESV, the differences among three measurement methods were not statistically significant (P = .399 and .145, respectively). However, in EF, SV, and LV mass, the differences were statistically significant (P=.001, <001, <001, respectively) and the measured value from automated method tend to be consistently higher than the values from other two methods. Conclusion: An automatic heart model-based method grossly overestimate EF, SV and LV mass compared with manual or semi-automated methods. Even though the method saves a considerable amount of efforts, further manual adjustment should be considered in critical clinical cases.

• Journal of Cardiovascular Imaging
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• v.31 no.2
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• pp.85-95
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• 2023

BACKGROUND: The prognostic utility of follow-up transthoracic echocardiography (FU-TTE) in patients with hypertrophic cardiomyopathy (HCM) is unclear, specifically in terms of whether changes in echocardiographic parameters in routine FU-TTE parameters are associated with cardiovascular outcomes. METHODS: From 2010 to 2017, 162 patients with HCM were retrospectively enrolled in this study. Using echocardiography, HCM was diagnosed based on morphological criteria. Patients with other diseases that cause cardiac hypertrophy were excluded. TTE parameters at baseline and FU were analyzed. FU-TTE was designated as the last recorded value in patients who did not develop any cardiovascular event or the latest exam before event development. Clinical outcomes were acute heart failure, cardiac death, arrhythmia, ischemic stroke, and cardiogenic syncope. RESULTS: Median interval between the baseline TTE and FU-TTE was 3.3 years. Median clinical FU duration was 4.7 years. Septal trans-mitral velocity/mitral annular tissue Doppler velocity (E/e'), tricuspid regurgitation velocity, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) at baseline were recorded. LVEF, LAVI, and E/e' values were associated with poor outcomes. However, no delta values predicted HCM-related cardiovascular outcomes. Logistic regression models incorporating changes in TTE parameters had no significant findings. Baseline LAVI was the best predictor of a poor prognosis. In survival analysis, an already enlarged or increased size LAVI was associated with poorer clinical outcomes. CONCLUSIONS: Changes in echocardiographic parameters extracted from TTE did not assist in predicting clinical outcomes. Cross-sectionally evaluated TTE parameters were superior to changes in TTE parameters between baseline and FU at predicting cardiovascular events.

• Clinical and Experimental Pediatrics
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• v.57 no.5
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• pp.232-239
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• 2014

Purpose: Mitochondrial disease (MD) and Duchenne muscular dystrophy (DMD) are often associated with cardiomyopathy, but the myocardial variability has not been isolated to a specific characteristic. We evaluated the left ventricular (LV) mass by echocardiography to identify the general distribution and functional changes of the myocardium in patients with MD or DMD. Methods: We retrospectively evaluated the echocardiographic data of 90 children with MD and 42 with DMD. Using two-dimensional echocardiography, including time-motion (M) mode and Doppler measurements, we estimated the LV mass, ratio of early to late mitral filling velocities (E/A), ratio of early mitral filling velocity to early diastolic mitral annular velocity (E/Ea), stroke volume, and cardiac output. A "z score" was generated using the lambda-mu-sigma method to standardize the LV mass with respect to body size. Results: The LV mass-for-height z scores were significantly below normal in children with MD ($-1.02{\pm}1.52$, P<0.001) or DMD ($-0.82{\pm}1.61$, P =0.002), as were the LV mass-for-lean body-mass z scores. The body mass index (BMI)-for-age z scores were far below normal and were directly proportional to the LV mass-for-height z scores in both patients with MD (R =0.377, P<0.001) and those with DMD (R =0.330, P=0.033). The LV mass-for-height z score correlated positively with the stroke volume index (R =0.462, P<0.001) and cardiac index (R =0.358, P<0.001). Conclusion: LV myocardial atrophy is present in patients with MD and those with DMD and may be closely associated with low BMI. The insufficient LV mass for body size might indicate deterioration of systolic function in these patients.