Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Pattern Analysis of Left Ventricular Remodeling Using Cardiac Computed Tomography in Children with Congenital Heart Disease: Preliminary Results

  • Hyun Woo Goo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sang-Hyub Park (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2019.09.14
  • Accepted : 2020.02.09
  • Published : 2020.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To assess left ventricular remodeling patterns using cardiac computed tomography (CT) in children with congenital heart disease and correlate these patterns with their clinical course. Materials and Methods: Left ventricular volume and myocardial mass were quantified in 17 children with congenital heart disease who underwent initial and follow-up end-systolic cardiac CT studies with a mean follow-up duration of 8.4 ± 9.7 months. Based on changes in the indexed left ventricular myocardial mass (LVMi) and left ventricular mass-volume ratio (LVMVR), left ventricular remodeling between the two serial cardiac CT examinations was categorized into one of four patterns: pattern 1, increased LVMi and increased LVMVR; pattern 2, decreased LVMi and decreased LVMVR; pattern 3, increased LVMi and decreased LVMVR; and pattern 4, decreased LVMi and increased LVMVR. Left ventricular remodeling patterns were correlated with unfavorable clinical courses. Results: Baseline LVMi and LVMVR were 65.1 ± 37.9 g/m2 and 4.0 ± 3.2 g/mL, respectively. LVMi increased in 10 patients and decreased in seven patients. LVMVR increased in seven patients and decreased in 10 patients. Pattern 1 was observed in seven patients, pattern 2 in seven, and pattern 3 in three patients. Unfavorable events were observed in 29% (2/7) of patients with pattern 1 and 67% (2/3) of patients with pattern 3, but no such events occurred in pattern 2 during the follow-up period (4.4 ± 2.7 years). Conclusion: Left ventricular remodeling patterns can be characterized using cardiac CT in children with congenital heart disease and may be used to predict their clinical course.

Keywords

References

  1. Stevens SM, Reinier K, Chugh SS. Increased left ventricular mass as a predictor of sudden cardiac death: is it time to put it to the test? Circ Arrhythm Electrophysiol 2013;6:212-217  https://doi.org/10.1161/CIRCEP.112.974931
  2. Lamb HJ, Beyerbacht HP, de Roos A, van der Laarse A, Vliegen HW, Leujes F, et al. Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol 2002;40:2182-2188  https://doi.org/10.1016/S0735-1097(02)02604-9
  3. Villa E, Troise G, Cirillo M, Brunelli F, Tomba MD, Mhagna Z, et al. Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview. Cardiovasc Ultrasound 2006;4:25 
  4. Yarbrough WM, Mukherjee R, Ikonomidis JS, Zile MR, Spinale FG. Myocardial remodeling with aortic stenosis and after aortic valve replacement: mechanisms and future prognostic implications. J Thorac Cardiovasc Surg 2012;143:656-664  https://doi.org/10.1016/j.jtcvs.2011.04.044
  5. Boutin C, Jonas RA, Sanders SP, Wernovsky G, Mone SM, Colan SD. Rapid two-stage arterial switch operation. Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries. Circulation 1994;90:1304-1309  https://doi.org/10.1161/01.CIR.90.3.1304
  6. Myers PO, del Nido PJ, Geva T, Bautista-Hernandez V, Chen P, Mayer JE Jr, et al. Impact of age and duration of banding on left ventricular preparation before anatomic repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg 2013;96:603-610  https://doi.org/10.1016/j.athoracsur.2013.03.096
  7. Moodley S, Balasubramanian S, Tacy TA, Chan F, Hanley FL, Punn R. Echocardiography-derived left ventricular outflow tract gradient and left ventricular posterior wall thickening are associated with outcomes for anatomic repair in congenitally corrected transposition of the great arteries. J Am Soc Echocardiogr 2017;30:807-814  https://doi.org/10.1016/j.echo.2017.03.019
  8. Dweck MR, Joshi S, Murigu T, Gulati A, Alpendurada F, Jabbour A, et al. Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012;14:50 
  9. Han Y, Osborn EA, Maron MS, Manning WJ, Yeon SB. Impact of papillary and trabecular muscles on quantitative analyses of cardiac function in hypertrophic cardiomyopathy. J Magn Reson Imaging 2009;30:1197-1202  https://doi.org/10.1002/jmri.21958
  10. Miller CA, Jordan P, Borg A, Argyle R, Clark D, Pearce K, et al. Quantification of left ventricular indices from SSFP cine imaging: impact of real-world variability in analysis methodology and utility of geometric modeling. J Magn Reson Imaging 2013;37:1213-1222  https://doi.org/10.1002/jmri.23892
  11. Varga-Szemes A, Muscogiuri G, Schoepf UJ, Wichmann JL, Suranyi P, De Cecco CN, et al. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method. Eur Radiol 2016;26:1503-1511  https://doi.org/10.1007/s00330-015-3952-4
  12. Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, et al. Multimodality comparison of quantitative volumetric analysis of the right ventricle. JACC Cardiovasc Imaging 2010;3:10-18  https://doi.org/10.1016/j.jcmg.2009.09.017
  13. Kim HJ, Goo HW, Park SH, Yun TJ. Left ventricle volume measured by cardiac CT in an infant with a small left ventricle: a new and accurate method in determining uni- or biventricular repair. Pediatr Radiol 2013;43:243-246  https://doi.org/10.1007/s00247-012-2464-5
  14. Goo HW, Park SH. Semiautomatic three-dimensional CT ventricular volumetry in patients with congenital heart disease: agreement between two methods with different user interaction. Int J Cardiovasc Imaging 2015;31 Suppl 2:223-232  https://doi.org/10.1007/s10554-015-0751-6
  15. Goo HW. Serial changes in anatomy and ventricular function on dual-source cardiac computed tomography after the Norwood procedure for hypoplastic left heart syndrome. Pediatr Radiol 2017;47:1776-1786  https://doi.org/10.1007/s00247-017-3972-0
  16. Goo HW, Park SH. Computed tomography-based ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle: preliminary results. Korean J Radiol 2018;19:1042-1052  https://doi.org/10.3348/kjr.2018.19.6.1042
  17. Goo HW. Semiautomatic three-dimensional threshold-based cardiac computed tomography ventricular volumetry in repaired tetralogy of Fallot: comparison with cardiac magnetic resonance imaging. Korean J Radiol 2019;20:102-113  https://doi.org/10.3348/kjr.2018.0237
  18. Goo HW. Technical feasibility of semiautomatic three-dimensional threshold-based cardiac computed tomography quantification of left ventricular mass. Pediatr Radiol 2019;49:318-326  https://doi.org/10.1007/s00247-018-4303-9
  19. Goo HW, Suh DS. Tube current reduction in pediatric non-ECG-gated heart CT by combined tube current modulation. Pediatr Radiol 2006;36:344-351  https://doi.org/10.1007/s00247-005-0105-y
  20. Goo HW. State-of-the-art CT imaging techniques for congenital heart disease. Korean J Radiol 2010;11:4-18  https://doi.org/10.3348/kjr.2010.11.1.4
  21. Goo HW. Individualized volume CT dose index determined by cross-sectional area and mean density of the body to achieve uniform image noise of contrast-enhanced pediatric chest CT obtained at variable kV levels and with combined tube current modulation. Pediatr Radiol 2011;41:839-847  https://doi.org/10.1007/s00247-011-2121-4
  22. Goo HW. Is it better to enter a volume CT dose index value before or after scan range adjustment for radiation dose optimization of pediatric cardiothoracic CT with tube current modulation? Korean J Radiol 2018;19:692-703  https://doi.org/10.3348/kjr.2018.19.4.692
  23. Goo HW. Comparison of chest pain protocols for electrocardiography-gated dual-source cardiothoracic CT in children and adults: the effect of tube current saturation on radiation dose reduction. Korean J Radiol 2018;19:23-31  https://doi.org/10.3348/kjr.2018.19.1.23
  24. Hong SH, Goo HW, Maeda E, Choo KS, Tsai IC; Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group. User-friendly vendor-specific guideline for pediatric cardiothoracic computed tomography provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: part 1. Imaging techniques. Korean J Radiol 2019;20:190-204  https://doi.org/10.3348/kjr.2018.0571
  25. Tricarico F, Hlavacek AM, Schoepf UJ, Ebersberger U, Nance JW Jr, Vliegenthart R, et al. Cardiovascular CT angiography in neonates and children: image quality and potential for radiation dose reduction with iterative image reconstruction techniques. Eur Radiol 2013;23:1306-1315  https://doi.org/10.1007/s00330-012-2734-5
  26. Lee KB, Goo HW. Quantitative image quality and histogram-based evaluations of an iterative reconstruction algorithm at low-to-ultralow radiation dose levels: a phantom study in chest CT. Korean J Radiol 2018;19:119-129  https://doi.org/10.3348/kjr.2018.19.1.119
  27. Goo HW. Combined prospectively electrocardiography- and respiratory-triggered sequential cardiac computed tomography in free-breathing children: success rate and image quality. Pediatr Radiol 2018;48:923-931  https://doi.org/10.1007/s00247-018-4114-z
  28. Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol 2012;13:1-11  https://doi.org/10.3348/kjr.2012.13.1.1
  29. Lee E, Goo HW, Lee JY. Age- and gender-specific estimates of cumulative CT dose over 5 years using real radiation dose tracking data in children. Pediatr Radiol 2015;45:1282-1292  https://doi.org/10.1007/s00247-015-3331-y
  30. Gaasch WH, Carroll JD, Levine HJ, Criscitiello MG. Chronic aortic regurgitation: prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio. J Am Coll Cardiol 1983;1:775-782  https://doi.org/10.1016/S0735-1097(83)80190-9
  31. Krieger EV, Clair M, Opotowsky AR, Landzberg MJ, Rhodes J, Powell AJ, et al. Correlation of exercise response in repaired coarctation of the aorta to left ventricular mass and geometry. Am J Cardiol 2013;111:406-411  https://doi.org/10.1016/j.amjcard.2012.09.037
  32. Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 2011;13:9 
  33. Fine NM, Tandon S, Kim HW, Shah DJ, Thompson T, Drangova M, et al. Validation of sub-segmental visual scoring for the quantification of ischemic and nonischemic myocardial fibrosis using late gadolinium enhancement MRI. J Magn Reson Imaging 2013;38:1369-1376  https://doi.org/10.1002/jmri.24116
  34. Broberg CS, Chugh SS, Conklin C, Sahn DJ, Jerosch-Herold M. Quantification of diffuse myocardial fibrosis and its association with myocardial dysfunction in congenital heart disease. Circ Cardiovasc Imaging 2010;3:727-734  https://doi.org/10.1161/CIRCIMAGING.108.842096
  35. Goo HW. Myocardial delayed-enhancement CT: initial experience in children and young adults. Pediatr Radiol 2017;47:1452-1462 https://doi.org/10.1007/s00247-017-3889-7