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Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking

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Abstract

Right ventricular (RV) dysfunction is known to be highly correlated with mortality and morbidity; nevertheless, imaging-based assessment of RV anatomy and physiology lags far behind that of the left ventricle. In this study, we advance RV imaging using cardiac magnetic resonance (CMR) to accomplish the following aims: (i) track the motion of six tricuspid annular (TA) sites using a semi-automatic tracking system; (ii) extract clinically important TA measurements—systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), and TA plane systolic excursion (TAPSE)—for each TA site and compare these CMR-derived measurements in healthy subjects vs. patients with heart failure, repaired tetralogy of Fallot, pulmonary hypertension, and hypertrophic cardiomyopathy; (iii) investigate how the TA motion related measurements compare with information provided by invasive right heart catheterization (RHC); (iv) evaluate the rate of change in surface area swept out by the reconstructed tricuspid annulus over time and (v) assess the reproducibility of this CMR-based technique. Results indicate that TA motion parameter data obtained in three dimensions using the proposed CMR-based systematic methodology achieve superior diagnostic performance (Sm: AUC = 0.957; TAPSE: AUC = 0.981) compared to two-dimensional CMR imaging. Both Sm and TAPSE from CMR correlated positively with dP/dt max/IP from RHC (Sm: r = 0.621, p < 0.01; TAPSE: r = 0.648, p < 0.01). Our highly reproducible and robust methodology holds potential for extending CMR imaging to characterization of TA morphology and dynamic behaviour, eventually leading to deeper understanding of RV function and improved diagnostic capability.

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Abbreviations

3D:

Three dimensional

Am:

Peak tricuspid annular velocity during atrial contraction

CMR:

Cardiac magnetic resonance

EF:

Ejection fraction

Em:

Peak tricuspid annular velocity during early diastolic filling

HCM:

Hypertrophic cardiomyopathy

HF:

Heart failure

PH:

Pulmonary hypertension

rTOF:

Repaired tetralogy of Fallot

RHC:

Right heart catheterization

RV:

Right ventricular

Sm:

Peak tricuspid annular systolic velocity

SSA:

Sweep surface area

SSAV:

Sweep surface area velocity

TA:

Tricuspid annular

TAPSE:

Tricuspid annular plane systolic excursion

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Acknowledgments

This work was funded by Biomedical Research Council under Singapore-China Joint Research Programme (BMRC 14/1/32/24/0002 for LZ) and the Goh Cardiovascular Research Grant (Duke-NUS-GCR/2013/0009 for LZ). The authors appreciate the support and medical editing assistance from Duke-NUS/SingHealth Academic Medicine Research Institute.

Conflict of interest

The author(s) have no conflicts of interest, financial or otherwise.

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    Authors and Affiliations

    1. National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore

      Shuang Leng, Xiao-Dan Zhao, Ju-Le Tan, Ru-San Tan & Liang Zhong

    2. Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People’s Republic of China

      Meng Jiang & Ben He

    3. Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore

      John Carson Allen, Ru-San Tan & Liang Zhong

    4. California Medical Innovations Institute, San Diego, CA, 92121, USA

      Ghassan S. Kassab

    5. Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People’s Republic of China

      Rong-Zhen Ouyang

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    1. Shuang Leng
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    Correspondence to Ben He or Liang Zhong.

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    Associate Editor Estefanía Peña oversaw the review of this article.

    Co-first authors Shuang Leng and Meng Jiang have equally contributed to this work.

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    Leng, S., Jiang, M., Zhao, XD. et al. Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking. Ann Biomed Eng 44, 3522–3538 (2016). https://doi.org/10.1007/s10439-016-1695-2

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