Rob J. van der Geest

Introduction The exact mechanism underlying myocardial maladaptive changes post-ST elevation myocardial infarction (STEMI) remains unclear. We aim to assess the impact of the tissue-flow interaction on the development of adverse cardiac remodelling 12 months (M) after acute STEMI. Materials and Methods 49 first STEMI patients (M:F= 36:13; mean age = 58 ± 10) prospectively underwent 3T CMR acutely, 3 and 12 M post-STEMI. The CMR protocol included LV cine-images, 4D flow, late gadolinium enhancement (LGE) imaging. The outcome measures at 3M included: LV flow kinetic energy (KE) and 4D flow parameters indexed to end-diastolic volume (KEiEDV ) and 4D FlowiEDV [LV-KEiEDV, Minimal-KEiEDV, In-plane-KEiEDV, Systolic-KEiEDV, Diastolic-KEiEDV, and Residual LV-VolumeiEDV, Retained LV-inflowiEDV, Delayed LV-ejection flowiEDV, Direct LV-flowiEDV); global radial, circumferential and …

MethodsConsecutive patients who underwent CMR for any indication between January 2022 and October 2022 at a single tertiary centre were included prospectively. For each case, short-axis CMR images were segmented by the AI tool and manually to yield volume, mass and ejection fraction measurements for both ventricles. Automated and manual measurements were compared for agreement and the quality of the automated contours was assessed visually by cardiac radiologists.Results462 CMR studies were included. No statistically significant difference was demonstrated between any automated and manual measurements (p> 0.05; independent T-test). Intraclass correlation coefficient and Bland-Altman analysis showed excellent agreement across all metrics (ICC> 0.85). The automated contours were evaluated visually in 251 cases, with agreement or minor disagreement in 229 cases (91.2%) and failed …

Introduction There is growing interest in identifying cardiovascular magnetic resonance (CMR) signatures in ageing due to their relevance to cardiovascular health.1 It also remains uncertain whether patients with heart failure with preserved ejection fraction (HFpEF) have disruptions in their aortic flow. This study aimed to explore sophisticated indicators of aortic flow disturbances in ageing and in HFpEF.Materials and Methods This study used two-dimensional phase-contrast CMR data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10).Results Differences were significant in mean age (P<0.001 …

Background4D flow MRI enables assessment of cardiac function and intra-cardiac blood flow dynamics from a single acquisition. However, due to the poor contrast between the chambers and surrounding tissue, quantitative analysis relies on the segmentation derived from a registered cine MRI acquisition. This requires an additional acquisition and is prone to imperfect spatial and temporal inter-scan alignment. Therefore, in this work we developed and evaluated deep learning-based methods to segment the left ventricle (LV) from 4D flow MRI directly.MethodsWe compared five deep learning-based approaches with different network structures, data pre-processing and feature fusion methods. For the data pre-processing, the 4D flow MRI data was reformatted into a stack of short-axis view slices. Two feature fusion approaches were proposed to integrate the features from magnitude and velocity images. The …

Validation of 2D Flow MRI for Helical and Vortical Flows Toggle navigation Login Toggle navigation Validation of 2D Flow MRI for Helical and Vortical Flows QMRO Home William Harvey Research Institute Centre for Cardiovascular Medicine and Devices Validation of 2D Flow MRI for Helical and Vortical Flows QMRO Home William Harvey Research Institute Centre for Cardiovascular Medicine and Devices Validation of 2D Flow MRI for Helical and Vortical Flows All of QMROCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects Login Most Popular ItemsStatistics by CountryMost Popular Authors Validation of 2D Flow MRI for Helical and Vortical Flows View/Open Accepted version Embargoed until: 2099-01-01 Reason: Not yet published. Publisher BMJ Publishing Group Journal Open Heart ISSN 2053-3624 Metadata Show full item record Authors Petersen, …

We aimed to correlate left atrial appendage (LAA) structure and function with the history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation (AF). We analyzed the data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent cardiac computed tomography and transesophageal echocardiography before ablation. The LAA morphologies depicted by cardiac computed tomography were categorized into 4 groups: cauliflower, chicken wing, swan, and windsock shapes. The mean age was 61.3 ± 10.5 years, 33.9% were women. The prevalence of stroke/TIA was 7.1%. After adjustment for the main risk factors, the LAA flow velocity ≤35.3 cm/s (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.09 to 4.61, p = 0.033) and the swan LAA shape (OR 2.69, 95% CI 0.96 to 6.86, p = 0.047) independently associated with a higher risk of stroke/TIA, whereas the windsock LAA …

Aims To compare the novel 2D multi-velocity encoding (venc) and 4D flow acquisitions with the standard 2D flow acquisition for the assessment of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR) using cardiac magnetic resonance (CMR)-derived regurgitant fraction (RF). Methods and results In this prospective study, patients underwent CMR 1 month after TAVR for the assessment of PVR, for which 2D multi-venc and 4D flow were used, in addition to standard 2D flow. Scatterplots and Bland–Altman plots were used to assess correlation and visualize agreement between techniques. Reproducibility of measurements was assessed with intraclass correlation coefficients. The study included 21 patients (mean age ± SD 80 ± 5 years, 9 men). The mean RF was 11.7 ± 10.0% when standard 2D flow was used, 10.6 ± 7.0% when 2D multi-venc flow …

Background Left atrial (LA) assessment is an important marker of adverse cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) accurately quantifies LA volume and function based on biplane long-axis imaging. We aimed to validate single-plane-derived LA indices against the biplane method to simplify the post-processing of cine CMR. Methods In this study, 100 patients from Leeds Teaching Hospitals were used as the derivation cohort. Bias correction for the single plane method was applied and subsequently validated in 79 subjects. Results There were significant differences between the biplane and single plane mean LA maximum and minimum volumes and LA ejection fraction (EF) (all p < 0.01). After correcting for biases in the validation cohort, significant correlations in all LA indices were observed (0.89 to 0.98). The area under the curve (AUC) for the single plane to predict biplane cutoffs of LA maximum volume ≥ 112 mL was 0.97, LA minimum volume ≥ 44 mL was 0.99, LA stroke volume (SV) ≤ 21 mL was 1, and LA EF ≤ 46% was 1, (all p < 0.001). Conclusions LA volumetric and functional assessment by the single plane method has a systematic bias compared to the biplane method. After bias correction, single plane LA volume and function are comparable to the biplane method.

Cardiovascular Magnetic Resonance Imaging (CMRI) is widely utilized for diagnosing various heart diseases in routine clinical practice, providing information on heart morphology, function, and myocardial tissue characterization. Furthermore, CMRI demonstrates its capabilities in disease prognosis and guiding treatment planning, owing to its non-invasive and radiation-free features, making it applicable for follow-up studies. With the development of both MRI sequence techniques and image post-processing algorithms, CMRI has shifted its focus from conventional qualitative methods to novel quantitative approaches, offering fruitful advanced quantitative indexes, such as myocardial strain, T1/T2/T2* mapping, hemodynamics, and more. However, the reliability, accuracy, and, most importantly, the diagnostic and prognostic value of these advanced quantitative indexes obtained from CMRI still needs further improvement and exploration. Within the papers collected in this Research Collection, we see examples of technical/diagnostic/prognostic improvements of these quantitative methods, demonstrations of potential clinical applications and, reviews that highlight the current state-of-the-art in this field.Myocardial strain has proven to be a more sensitive index than Left Ventricular Ejection Fraction (LVEF) in capturing early changes in heart function (1). Among various strain analysis methods, Displacement Encoding with Stimulated Echoes (DENSE)(2) and Feature Tracking (FT)(1, 3) emerge as the two most promising approaches. Efforts have been dedicated to reducing the scan time of the DENSE sequence and simplifying its post-processing …

Background: Pulmonary Arterial Hypertension (PAH) has a poor prognosis and survival is determined primarily by right ventricular function. CMR is the gold standard technique for assessing bi-ventricular volumes and function. CMR is increasingly considered an endpoint in clinical studies and this study aims to quantify the change in CMR measurements pre-and post-treatment in PAH.Methods: Consecutive treatment-naïve patients with pulmonary arterial hypertension between 2010 and 2022 who had two CMR scans (at baseline prior to treatment and 12 months following treatment) were identified from the ASPIRE registry. CMR was performed with 1.5 Tesla MRI systems from GE. CMR measurements were obtained through an automated and validated segmentation tool. A dependent t-test between pre-and post-treatment was performed with a significance threshold of 0.05.Results: 254 patients with PAH were …

BackgroundVoltage mapping to detect ventricular scar is important for guiding catheter ablation, but the field-of-view of unipolar, bipolar, conventional, and microelectrodes as it relates to the extent of viable myocardium (VM) is not well defined.ObjectivesThe purpose of this study was to evaluate electroanatomic voltage-mapping (EAVM) with different-size electrodes for identifying VM, validated against high-resolution ex-vivo cardiac magnetic resonance (HR-LGE-CMR).MethodsA total of 9 swine with early-reperfusion myocardial infarction were mapped with the QDOT microcatheter. HR-LGE-CMR (0.3-mm slices) were merged with EAVM. At each EAVM point, the underlying VM in multisize transmural cylinders and spheres was quantified from ex vivo CMR and related to unipolar and bipolar voltages recorded from conventional and microelectrodes.ResultsIn each swine, 220 mapping points (Q1, Q3: 216, 260 …

PurposeCarotid intraplaque hemorrhage (IPH) on MRI predicts stroke. Magnetization-prepared rapid acquisition gradient (MP-RAGE) is widely used to detect IPH. CE-MRA is used routinely to assess stenosis. Initial studies indicated that IPH can be identified on mask images of CE-MRA, while Time-of-Flight (TOF) images were reported to have high specificity but lower sensitivity. We investigated the diagnostic accuracy of detecting IPH on mask images of CE-MRA and TOF.

PurposeWe hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes mellitus.BackgroundIncreased body weight and diabetes mellitus are both individually associated with a higher incidence of heart failure with preserved ejection fraction. However, it is unclear how increased myocardial steatosis and interstitial fibrosis interact to influence myocardial composition and function.MethodsA total of 100 subjects (27 healthy lean volunteers, 21 healthy but overweight volunteers, and 52 asymptomatic overweight patients with diabetes) were prospectively recruited to measure left ventricular (LV) myocardial steatosis (LV-myoFat) and interstitial fibrosis (by extracellular volume [ECV]) using magnetic resonance imaging, and then used to determine their combined impact on LV global longitudinal …

BackgroundRadial k-space sampling is compared with conventional Cartesian k-space sampling in small field-of-view respiratory-triggered Turbo Spin Echo (TSE) T2-weighted imagingof the pancreas regarding image quality and artifacts in a screening program for hereditary pancreatic cancer.MethodsSmall field-of-view radial and Cartesian k-space sampled respiratory triggered TSE images were acquired in 40 healthy mutation carriers undergoing annual screening for pancreatic cancer. Two radiologists evaluated images for motion artifacts, anatomical sharpness, pancreatic duct conspicuity and sharpness of vessels using a five-point Likert scale (1= very poor, 5= excellent) and reported their preferred sequence. Contiguousness between slices was quantified by segmentation of the superior mesenteric vein and determining the continuity of the vessel wall on consecutive slices by determining the deviation of the superior mesenteric vein center points.ResultsAll categories except in-plane motion artifacts yielded statistically significant differences (p< 0.001). Radial sampling performed better in slice contiguousness, anatomical sharpness and sharpness of vessel walls. Pancreatic duct conspicuity was higher on the Cartesian approach. Slice contiguousness had an average score of 4.53±0.71 for radial and 3.46±0.76 for Cartesian TSE. Radial sampling was preferred in 65 cases (81.3%). The average deviation of the superior mesenteric vein center points was 1.45 mm (interquartile range (IQR) 1.08–2.06) on radial TSE and 2.31 mm (IQR 1.65–3.30) on Cartesian TSE, p< 0.001.ConclusionRadial k-space sampling yields better overall image …

Introduction As the life expectancy of children with congenital heart disease (CHD) is rapidly increasing and the adult population with CHD is growing, there is an unmet need to improve clinical workflow and efficiency of analysis. Cardiovascular magnetic resonance (CMR) is a noninvasive imaging modality for monitoring patients with CHD. CMR exam is based on multiple breath-hold 2-dimensional (2D) cine acquisitions that should be precisely prescribed and is expert and institution dependent. Moreover, 2D cine images have relatively thick slices, which does not allow for isotropic delineation of ventricular structures. Thus, development of an isotropic 3D cine acquisition and automatic segmentation method is worthwhile to make CMR workflow straightforward and efficient, as the present work aims to establish. Methods Ninety-nine patients with many types of CHD were imaged using a non-angulated 3D cine CMR sequence covering the whole-heart and great vessels. Automatic supervised and semi-supervised deep-learning-based methods were developed for whole-heart segmentation of 3D cine images to separately delineate the cardiac structures, including both atria, both ventricles, aorta, pulmonary arteries, and superior and inferior vena cavae. The segmentation results derived from the two methods were compared with the manual segmentation in terms of Dice score, a degree of overlap agreement, and atrial and ventricular volume measurements. Results The semi-supervised method resulted in a better overlap agreement with the manual segmentation than the supervised method for all 8 structures (Dice score 83.23 ± 16.76% vs …

Objectives:Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction.Methods:In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3–6–12 months). Effect modification was studied for baseline ultrasound carotid–femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables …

ObjectivesCarotid atherosclerosis plays an essential role in the occurrence of ischemic stroke. This study aimed to investigate whether a larger burden of napkin-ring sign (NRS) plaques on cervicocerebral computed tomography angiography (CTA) increased the risk of acute ischemic stroke (AIS).MethodsThis retrospective, single-center, cross-sectional study enrolled patients with NRS plaques identified in the subclavian arteries, brachiocephalic trunk, carotid arterial system, and vertebrobasilar circulation on contrast-enhanced cervicocerebral CTA. Patients were divided into AIS and non-AIS groups based on imaging within 12 h of symptom onset. Univariate and multivariate logistic regression analyses were performed to determine the risk factor of AIS occurrence.ResultsA total of 202 patients (66.72 years ± 8.97, 157 men) were evaluated. Plaques with NRS in each subject of the AIS group (N = 98) were …

Introduction Cardiac MRI (CMR) is the gold standard technique to assess bi-ventricular volumes and function and is increasingly being considered as an end-point in clinical studies. Currently, with the exception of right ventricle (RV) stroke volume, there are no minimally important differences (MIDs) reported for CMR metrics in pulmonary arterial hypertension (PAH). Our study aimed to identify MIDs for CMR metrics that reflect how a patient feels and functions.Materials and Methods Consecutive treatment-naive patients with PAH between 2010 and 2021 who had two CMR scans (at baseline and at 12 months following treatment) were identified from the ASPIRE registry. The MID in CMR metrics was determined using an anchor-based method combining how a patient “feels” (emPHasis-10 questionnaire) and “functions” (incremental shuttle walking test). RV ejection fraction (RVEF) and RV and left ventricle (LV) end …

There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SVMVP) and without (LV SVstandard) MVP left ventricular doming volume, using 4D flow (LV SV4DF) as the reference value. Significant differences were observed when comparing LV SVstandard and LV SVMVP (p < 0.001), and between LV SVstandard and LV SV4DF (p = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SVMVP and LV SV4DF (ICC = 0.86, p < 0.001) but only moderate repeatability between LV SVstandard and LV SV4DF (ICC = 0.75, p < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and …

Aims Increased blood flow eccentricity in the aorta has been associated with aortic (AO) pathology, however, its association with exercise capacity has not been investigated. This study aimed to assess the relationships between flow eccentricity parameters derived from 2-dimensional (2D) phase-contrast (PC) cardiovascular magnetic resonance (CMR) imaging and aging and cardiopulmonary exercise test (CPET) in a cohort of healthy subjects. Methods and Results One hundred and sixty-nine healthy subjects (age 44 ± 13 years, M/F: 96/73) free of cardiovascular disease were recruited in a prospective study (NCT03217240) and underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET (cycle ergometer) within one week. The following AO flow parameters were derived: AO forward and backward flow indexed to body surface area …