Walter R. T. Witschey, PhD, Francisco Contijoch, MS, Jeremy R

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Presentation transcript:

Real-Time Magnetic Resonance Imaging Technique for Determining Left Ventricle Pressure-Volume Loops Walter R.T. Witschey, PhD, Francisco Contijoch, MS, Jeremy R. McGarvey, MD, Victor A. Ferrari, MD, Michael S. Hansen, PhD, Madonna E. Lee, MD, Satoshi Takebayashi, MD, Chikashi Aoki, MD, Julio A. Chirinos, MD, Paul A. Yushkevich, PhD, Joseph H. Gorman, MD, James J. Pilla, PhD, Robert C. Gorman, MD The Annals of Thoracic Surgery Volume 97, Issue 5, Pages 1597-1603 (May 2014) DOI: 10.1016/j.athoracsur.2014.01.010 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Method for real-time magnetic resonance (MR) measurement of left ventricular (LV) pressure volume (PV) loops. (A) Time-varying LV volume; 4 chamber (ch) and 2 chamber views of the segmentation (red) are overlaid on a cine images. (B) single-slice real-time MR image at mid-ventricle. (C) One-dimensional (1D) profile intersecting the septum. A white line indicates the location of the 1D projection in (B). The occlusion time is indicated with a black bar in (C) and (D). (D)The LV pressure is matched synchronously to each radiofrequency pulse. (E) The ratio of the slice volume in (B) to the global LV volume in (A). The time-varying error in the slice to volume ratio is shown in red. Peak error is labeled in green. (F) The PV loop, derived from 2D real-time MRI and scaled to LV volumes using ratio in (E). (ED = end-diastolic; ES = end-systolic.) The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Dependence of measured heart function on exposure time (Te) under rest and stress physiology. (A) End-diastolic volume (EDV) was the lower-right corner of the pressure-volume (PV) loop. (B) The end systolic volume (ESV) was the upper-left corner of the PV loop. (C) Ejection fraction was calculated from (A) and (B). (D) Time-varying volume under stress conditions for Te = 72.8, 162.4 and 560 ms and with continuous breathing. (E) The PV loops for cine and real-time acquisitions for Te = 72.8 and 560 ms. (F) and (G) Image frames at end-diastole and at end-systole with segmented volume overlay for Te = 72.8 and 560 ms. Error is the SD across 10 end-expiratory heartbeats. Solid black lines indicate cine data. The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Dependence of observed end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) on temporal resolution (Tr) under rest and stress physiology. (A) The EDV was the lower-right of the PV loop. (B) The ESV was the upper-left corner of the PV loop. (C) The EF was calculated from (A) and (B). Error is the standard deviation across 10 end-expiratory heartbeats. Solid black lines indicate cine data. The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Real-time pressure-volume (PV) loops from a swine under rest and stress physiology. (A) The PV loops were measured at rest and during continuous dobutamine infusion. Left ventricular (LV) pressure obtained with an intraventricular catheter was synchronized with each radiofrequency pulse. (B) Time-varying LV pressure, and (C) LV volume during 12 seconds of continuous acquisition. The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Real-time pressure-volume (PV) loops from a swine under rest and stress conditions during a preload reduction experiment. (A) Time-varying left ventricular (LV) pressure and (B) LV volume during 12 seconds of continuous acquisition throughout the preload reduction experiment. (C) The PV loops were measured at rest and at increased inotropic state. The end-systolic pressure volume relationship (ESPVR) was fit with a quadratic function (solid red line) through ES points (green points). (D) One-dimensional (1D) projection intersecting the LV parallel to the LV outflow tract. (E) 1D profile (magnetic resonance m-mode image) of LV, right ventricle, and septum from the projection of the real-time data in (D). Occlusion and release times are indicated with white lines. (EDPVR = end-diastolic pressure-volume relationship.) The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Myocardial stroke work under rest and stress conditions during a preload reduction experiment. (A) Time-varying stroke work during transient reduction in end-diastolic volume (EDV) and release. (B) Relationship between stroke work and EDV (preload-recruitable stroke work). (C) Relationship between stroke work, EDV, and inotropic state. The Annals of Thoracic Surgery 2014 97, 1597-1603DOI: (10.1016/j.athoracsur.2014.01.010) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions