Farrar Genevieve, Suinesiaputra Avan, Gilbert Kathleen, Perry James C, Hegde Sanjeet, Marsden Alison, Young Alistair A, Omens Jeffrey H, McCulloch Andrew D
Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ.
Prog Pediatr Cardiol. 2016 Dec;43:61-69. doi: 10.1016/j.ppedcard.2016.07.010. Epub 2016 Aug 18.
Congenital heart disease is associated with abnormal ventricular shape that can affect wall mechanics and may be predictive of long-term adverse outcomes. Atlas-based parametric shape analysis was used to analyze ventricular geometries of eight adolescent or adult single-ventricle CHD patients with tricuspid atresia and Fontans. These patients were compared with an "atlas" of non-congenital asymptomatic volunteers, resulting in a set of z-scores which quantify deviations from the control population distribution on a patient-by-patient basis. We examined the potential of these scores to: (1) quantify abnormalities of ventricular geometry in single ventricle physiologies relative to the normal population; (2) comprehensively quantify wall motion in CHD patients; and (3) identify possible relationships between ventricular shape and wall motion that may reflect underlying functional defects or remodeling in CHD patients. CHD ventricular geometries at end-diastole and end-systole were individually compared with statistical shape properties of an asymptomatic population from the Cardiac Atlas Project. Shape analysis-derived model properties, and myocardial wall motions between end-diastole and end-systole, were compared with physician observations of clinical functional parameters. Relationships between altered shape and altered function were evaluated correlations between atlas-based shape and wall motion scores. Atlas-based shape analysis identified a diverse set of specific quantifiable abnormalities in ventricular geometry or myocardial wall motion in all subjects. Moreover, this initial cohort displayed significant relationships between specific shape abnormalities such as increased ventricular sphericity and functional defects in myocardial deformation, such as decreased long-axis wall motion. These findings suggest that atlas-based ventricular shape analysis may be a useful new tool in the management of patients with CHD who are at risk of impaired ventricular wall mechanics and chamber remodeling.
先天性心脏病与异常的心室形状有关,这种异常形状会影响心室壁力学,并且可能预示着长期不良后果。基于图谱的参数形状分析被用于分析8名患有三尖瓣闭锁和Fontan手术的青少年或成年单心室先天性心脏病患者的心室几何形状。将这些患者与非先天性无症状志愿者的“图谱”进行比较,得出一组z分数,这些分数逐患者量化了与对照人群分布的偏差。我们研究了这些分数的潜力,以:(1)相对于正常人群量化单心室生理状态下心室几何形状的异常;(2)全面量化先天性心脏病患者的心室壁运动;(3)识别心室形状与心室壁运动之间可能反映先天性心脏病患者潜在功能缺陷或重塑的关系。将舒张末期和收缩末期的先天性心脏病心室几何形状分别与心脏图谱项目中无症状人群的统计形状特性进行比较。将形状分析得出的模型特性以及舒张末期和收缩末期之间的心肌壁运动与医生对临床功能参数的观察结果进行比较。通过基于图谱的形状和壁运动分数之间的相关性评估形状改变与功能改变之间的关系。基于图谱的形状分析在所有受试者中识别出了一组多样的、可量化的心室几何形状或心肌壁运动的特定异常。此外,这一初始队列显示出特定形状异常(如心室球形度增加)与心肌变形功能缺陷(如长轴壁运动减少)之间存在显著关系。这些发现表明,基于图谱的心室形状分析可能是管理有心室壁力学受损和心室重塑风险的先天性心脏病患者的一种有用的新工具。