Sonntag, Juli 31, 2022
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Optimization of the strategy of measuring left ventricular end-diastolic diameter in cardiac magnetic resonance as a predictor of left ventricular enlargement


The analysis has been carried out in compliance with the ideas of Good Medical Observe and Declaration of Helsinki. Ethics Committee of Wroclaw Medical College authorised the experimental protocol (protocol code KB-414/2021). The written knowledgeable consent has been obtained from all of the sufferers participating within the analysis. All knowledge collected from the sufferers have been anonymized.

The retrospective research included 78 consecutive sufferers who got here to the MRI Laboratory of the Wroclaw Medical College for CMR within the interval from November 15, 2020 to March 15, 2021. The imply age of the sufferers was 55.28 ± 17.18 years, the youngest affected person was 22 years outdated, and the oldest was 87 years outdated. Within the research group, 65.4% have been males and 34.6% have been ladies. The medical indications constituting the rationale why sufferers have been referred for MRI included: coronary heart failure (42 sufferers), cardiomyopathy (49) [including hypertrophic cardiomyopathy (16), dilated cardiomyopathy (26), arrhythmogenic right ventricular cardiomyopathy (2), left ventricular noncompaction (5)], myocarditis (9), coronary artery illness (15), arrhythmias (1), cardiac involvement in the midst of systemic ailments (3) and pericardial pathologies (1). The traits of the research group are offered in Desk 1.

Desk 1 Medical traits of the studied group of sufferers (n = 78).

To think about age and gender to optimize the strategy of LVEDD measuring in CMR as a predictor of LVEDV, subgroups have been distinguished. Primarily based on the gender criterion, a male subgroup (n = 51) and a feminine subgroup (n = 27) have been established, whereas based mostly on the age median (Me = 58 years), a gaggle of sufferers aged < median (< 58 years, n = 37) and a gaggle of sufferers aged ≥ median (≥ 58 years, n = 41) have been established.

CMR was carried out utilizing one 1.5 T Signa Hdx MRI (Common Electrical Medical Methods, USA) machine. CMR was carried out based on a typical protocol. ECG gating and breath maintain throughout the gating have been used. The research protocol included finding sequences, low-resolution single-shot black blood lookup sequences (Single Shot FSE), CINE steady-state free precession sequences (SSFP), T2 fats saturation sequences (T2fs), and late gadolinium enhancement sequences (IRPrepFGRE). The research protocol consisted of a bolus injection of gadobutrol (Gadovist, Bayer Healthcare, Germany) within the quantity of 0.2 mmol/kg physique mass by the ulnar fossa veins.

CMR photos obtained throughout the research have been assessed utilizing the GE ReportCARD Package deal (Common Electrical Medical Methods, USA), a typical software for CMR post-processing evaluation offered by the MRI producer. The usual evaluation of CMR included the preliminary evaluation of the mediastinal anatomy within the Single Shot FSE sequences, the evaluation of the size and quantity of the guts chambers within the CINE sequences recorded within the quick axis of the left ventricle and within the lengthy axis within the 2-chamber, 3-chamber and 4-chamber views, and the evaluation of morphological adjustments of the left ventricular myocardium (oedema and fibrosis) in T2fs and LGE sequences. In the usual CMR analysis, the left atrium (LA) and the aortic root (Ao) dimensions have been measured within the 3-chamber view; within the quick axis view, the left ventricular end-diastolic diameter (LVEDD), anterior interventricular septum diastolic dimension (aIVSDD) and posterior wall diastolic dimension (PWDD) have been measured within the basal-middle layers. Primarily based on CINE photos within the quick axis of the left ventricle, the purposeful parameters of the left ventricle have been measured utilizing the volumetric technique. Outlines of the epicardium and endocardium have been made in successive layers of the quick axis of the left ventricle in diastole and systole. Left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV) have been calculated by summing the consecutive left ventricular lumen areas from the successive layers multiplied by the thickness of the layers. Left ventricular ejection fraction (LVEF) was calculated based on the mathematical components: LVEF = (LVEDV − LVESV)/LVEDV × 100%. The applying, contemplating the adopted normal myocardial density, estimated the left ventricular mass (LVM) based mostly on the overall quantity of the left ventricular myocardium. Commonplace evaluation of CMR was carried out every time by one among two radiology and imaging diagnostics specialists with expertise within the efficiency and interpretation of CMR reaching as much as 150 examinations interpreted yearly during the last 5–10 years.

The CINE SSFP photos obtained throughout CMR have been used to retrospectively carry out further measurements of the left ventricular dimensions in diastole. Along with LVEDD measured within the basal-middle layers within the quick axis view, measurements of LVEDD have been made within the lengthy axis within the 2-chamber, 3-chamber and 4-chamber views. LVEDD within the lengthy axis views was measured at 1/3 of the proximal distance of the mitral valve from the apex (Fig. 1). For the needs of the current research, further measurements of the left ventricle dimensions have been carried out independently by two radiologists: one with nearly 10 years {of professional} expertise within the analysis of CMR (researcher A), the opposite throughout coaching within the evaluation of CMR (researcher B).

Determine 1
figure 1

The strategy of measuring the left ventricular end-diastolic diameter in CMR: (A) within the quick axis, (B) within the lengthy axis within the 2-chamber view, (C) within the lengthy axis within the 3-chamber view, (D) within the lengthy axis within the 4-chamber view.

To evaluate the repeatability of the measurements of the left ventricular dimensions in diastole, secondary parametric variables have been calculated, being the resultant of the measurement of LVEDD measured by researcher A and the measurement of the analogous diameter measured by researcher B. The calculated secondary variables and the formulation used to calculate them are as follows: imply measurement (imply, X): X = (measurement A + measurement B)/2; normal deviation of the measurement (normal deviation, SD): SD = √(((measurement A − X measurement)2) + ((measurement B − X measurement)2))/2); absolute distinction (AD): AD =|A measurement − B measurement|; relative distinction (RD): RD = AD of measurement/X of measurement; and the coefficient of variation (CV): CV = (SD of measurement/X of measurement) × 100%.

The statistical analysis of the outcomes was carried out with using the “Dell Statistica 13” program (Dell Inc., USA). Quantitative variables have been characterised by arithmetic means and normal deviations. The outcomes for the qualitative variables have been characterised by share values. The Shapiro–Wilk W check was used to evaluate the distribution of variables. In comparative analyses, the check for unrelated variables (within the case of regular distribution of variables) or the Mann–Whitney U check (within the absence of regular distribution of variables) was used to check the hypotheses. To find out the correlations between the studied variables, the Pearson or Spearman correlation evaluation and the univariate regression evaluation have been carried out. Furthermore, the sensitivity and specificity evaluation have been carried out with using ROC (Receiver Working Attribute) curve evaluation. The outcomes on the ranges p < 0.05 have been thought-about statistically important.

Ethics approval and consent to take part

All procedures carried out in research involving human contributors have been in accordance with the moral requirements of the Ethics Committee of Wroclaw Medical College (protocol code KB-414/2021) and with the 1964 Helsinki declaration and its later amendments or comparable moral requirements.

Consent for participation

Knowledgeable consent was obtained from all particular person contributors included within the research.

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