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Changes in left ventricular shape and morphology in the presence of heart failure: a four-dimensional quantitative and qualitative analysis

  • Helen O’GradyEmail author
  • Khalid Mostafa
  • Haroon Zafar
  • Derek Lohan
  • Liam Morris
  • Faisal Sharif
Original Article
  • 79 Downloads

Abstract

Purpose

The presence and progression of heart failure (HF) are associated with cardiac remodelling, defined as cellular, molecular and interstitial changes which occur after injury and manifest as changes in left ventricular (LV) size, mass, geometry and function. This research study was designed to investigate the changes to LV morphology and shape which occur in the presence of heart failure using three-dimensional (3D) modelling and analysis of cardiac-gated CT scans from both healthy individuals and patients classified with HF.

Methods

A number of quantitative and qualitative strategies were applied to cardiac CT scans of HF patients and healthy controls (n = 7) in order to analyse changes to LV size, shape and structure and to examine LV remodelling in the different classes of HF. Three-dimensional wireframe representations of endocardial and epicardial borders were created, three-dimensional computer stereolithography models of the inner LV cavity and myocardial wall segments were generated and three-dimensionally printed and a number of clinical LV dimension and shape indices were measured. All data were analysed using one-way ANOVA with post hoc Tukey method for multiple comparisons for significant variables.

Results

Results of most significance included abnormalities in LV mass and end-systolic dimensions and significantly increased septal wall thickness among mid-range ejection fraction cases. Also of importance were significant increases in both dimension-based and volumetric sphericity index measures in all HF cases. Three-dimensional printed models provided qualitative information as to changes in inner LV cavity and myocardial wall morphology across the cardiac cycle for healthy and HF cases and validated quantitative findings.

Conclusion

Findings from this study can successfully be applied to motivate the research and development of new HF treatment strategies and devices as well as for the development of a realistic cardiac simulator system.

Keywords

Left ventricular morphology Left ventricular shape Left ventricular sphericity Dimensional sphericity index Volumetric sphericity index Heart failure Three-dimensional printing Four-dimensional analysis Cardiovascular engineering Cardiac CT scans 

Notes

Compliance with ethical standards

Conflict of interest

Helen O’ Grady declares that she has no conflict of interest. Khalid Mostafa declares that he has no conflict of interest. Haroon Zafar declares that he has no conflict of interest. Derek Lohan declares that he has no conflict of interest. Liam Morris declares that he has no conflict of interest. Faisal Sharif declares that he has no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Buckberg GD (2002) Basic science review: the helix and the heart. J Thorac Cardiovasc Surg 124(5):863–883CrossRefGoogle Scholar
  2. 2.
    Buckberg G, Hoffman J, Mahajan A, Saleh S, Coghlan C (2008) Cardiac mechanics revisited: the relationship of cardiac architecture to ventricular function. Circulation 118(24):2571–2587CrossRefGoogle Scholar
  3. 3.
    Cohn JN, Ferrari R, Sharpe N (2000) Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol 35(3):569–582CrossRefGoogle Scholar
  4. 4.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200CrossRefGoogle Scholar
  5. 5.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS, American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. Circulation 105(4):539CrossRefGoogle Scholar
  6. 6.
    Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, Schiller NB, Stein JH, Weissman NJ, American Society of Echocardiography (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17(10):1086–1119Google Scholar
  7. 7.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463Google Scholar
  8. 8.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of echocardiography and the European Association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 16(3):233–271CrossRefGoogle Scholar
  9. 9.
    de Simone G, Devereux RB, Roman MJ, Ganau A, Saba PS, Alderman MH, Laragh JH (1994) Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol 23(6):1444–1451CrossRefGoogle Scholar
  10. 10.
    Biton Y, Goldenberg I, Kutyifa V, Baman JR, Solomon S, Moss AJ, Szepietowska B, McNitt S, Polonsky B, Zareba W, Barsheshet A (2016) Relative wall thickness and the risk for ventricular tachyarrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol 67(3):303–312CrossRefGoogle Scholar
  11. 11.
    Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55(4):613CrossRefGoogle Scholar
  12. 12.
    Tomlinson CW (1987) Left ventricular geometry and function in experimental heart failure. Can J Cardiol 3(6):305–310Google Scholar
  13. 13.
    Choi JO, Daly RC, Lin G, Lahr BD, Wiste HJ, Beaver TM, Iacovoni A, Malinowski M, Friedrich I, Rouleau JL, Favaloro RR, Sopko G, Lang IM, White HD, Milano CA, Jones RH, Lee KL, Velazquez EJ, Oh JK (2015) Impact of surgical ventricular reconstruction on sphericity index in patients with ischemic cardiomyopathy: follow-up from the STICH trial. Eur J Heart Fail 17(4):453–463CrossRefGoogle Scholar
  14. 14.
    Ambale-Venkatesh B, Yoneyama K, Sharma RK, Ohyama Y, Wu CO, Burke GL, Shea S, Gomes AS, Young AA, Bluemke DA, Lima JA (2017) Left ventricular shape predicts different types of cardiovascular events in the general population. Heart 103(7):499–507CrossRefGoogle Scholar
  15. 15.
    Nakamori S, Ismail H, Ngo LH, Manning WJ, Nezafat R (2017) Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction: a comprehensive cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 19(1):79CrossRefGoogle Scholar
  16. 16.
    Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Gomez De Diego JJ, Hagendorff A, Henri C, Hristova K, Lopez T, Magne J, De La Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, Salustri A, Van De Veire N, Von Bardeleben RS, Vinereanu D, Voigt JU, Zamorano JL, Donal E, Lang RM, Badano LP, Lancellotti P (2014) Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging 15(6):680–690Google Scholar
  17. 17.
    Hellawell JL, Margulies KB (2012) Myocardial reverse remodeling. Cardiovasc Ther 30(3):172–181CrossRefGoogle Scholar
  18. 18.
    Buckberg GD, Coghlan HC, Hoffman JI, Torrent-Guasp F (2001) The structure and function of the helical heart and its buttress wrapping. VII. Critical importance of septum for right ventricular function. Semin Thorac Cardiovasc Surg 13(4):402–416CrossRefGoogle Scholar
  19. 19.
    Murphy JG (2006) Mayo Clinic cardiology: concise textbook. Taylor & Francis, LondonCrossRefGoogle Scholar
  20. 20.
    Mann DL, Bogaev R, Buckberg GD (2010) Cardiac remodelling and myocardial recovery: lost in translation? Eur J Heart Fail 12(8):789–796CrossRefGoogle Scholar
  21. 21.
    Mann DL, Barger PM, Burkhoff D (2012) Myocardial recovery and the failing heart: myth, magic or molecular target? J Am Coll Cardiol 60(24):2465–2472CrossRefGoogle Scholar
  22. 22.
    Vukicevic M, Mosadegh B, Min JK, Little SH (2017) Cardiac 3D printing and its future directions. JACC Cardiovasc Imaging 10(2):171–184CrossRefGoogle Scholar

Copyright information

© CARS 2019

Authors and Affiliations

  1. 1.Department of Mechanical and Industrial Engineering, Galway Medical Technology Centre (GMedTech)Galway Mayo Institute of TechnologyGalwayIreland
  2. 2.Cardiovascular Research CentreNational University of Ireland GalwayGalwayIreland
  3. 3.Department of CardiologyUniversity Hospital GalwayGalwayIreland
  4. 4.Lambe Institute for Translational ResearchNational University of Ireland GalwayGalwayIreland
  5. 5.College of Engineering and InformaticsNational University of Ireland GalwayGalwayIreland
  6. 6.Department of RadiologyGalway ClinicDoughiska, GalwayIreland
  7. 7.CÚRAM, SFI Centre for Research in Medical DevicesGalwayIreland
  8. 8.BioInnovate IrelandGalwayIreland

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