Sefa UNAL, Burak AÇAR, Çağrı YAYLA, Ahmet Göktuğ ERTEM, Omac TUFEKCIOGLU, Dursun ARAS

İzole sol ventrikül noncompaction olan hastalarda miyokard dokusunun analizi

Amaç: Videodensitometrik miyokardiyal doku analizi (VMTA), çeşitli kardiyak hastalıklarda sol ventrikül (LV) disfonksiyonunu araştırmak için yaygın olarak kullanılmıştır. İzole sol ventrikül noncompaction (IVNC) olan hastalar LV fonksiyonunda dalgalı bir düşüş yaşarlar. Bu çalışmanın amacı, bu hasta grubunda LV fonksiyonunun bozulmasını değerlendirmek için VMTA değerini değerlendirmektir. Gereç ve Yöntemler: IVNC'li 25 hasta (10 asemptomatik [korunmuş LV fonksiyonu], 12 semptomatik [LV disfonksiyon]) ve 12 sağlıklı kontrol olacak şekilde değerlendirildi. Sistol sonunda ve diyastolde orta bazal LV duvarının 2 bölgesi (interventriküler septum [IVS] ve arka duvar [PW]) için arka plan düzeltmeli ortalama gri seviyelerini (BC-MGL) kaydetmek için videodensitometri kullanıldı. Her bölge için siklik varyasyon (CV) indeksi, formül CV'ye göre hesaplandı, CV indeksi, % = ([[BC-MGLend-diastol - BC-MGL end-sistol]] ÷ BC- MGLend-diastol) × 100. Bulgular: Semptomatik IVNC grubundaki ortalama IVS-CV indeksi (% 12.3 ± 4.9), asemptomatik IVNC grubundaki (% 32.3 ± 14.8; p <0.05) ve kontrol grubundaki (% 36.6 ± 12.1) karşılık gelen bulgulardan anlamlı olarak düşüktü (p <0.001). Semptomatik gruptaki ortalama PW-CV indeksi (% 15.1 ± 5.5), asemptomatik (27.0 ± 10.4; p <0.05) ve kontrol gruplarındaki (28.8 ± 10.9; p <0.001) karşılık gelen değerlerden anlamlı olarak düşüktü. Sonuç: VMTA, IVNC'li hastalarda LV miyokardiyumu değerlendirmek için konvansiyonel ekokardiyografiye pratik ve faydalı bir yardımcıdır. Azaltılmış CV indeks değerlerinin tespiti, bu grupta LV bozulmasının erken aşamalarını öngörebilir.

Anahtar Kelimeler:

videodensitometrik miyokardiyal doku analizi, izole sol ventrikül noncompaction kardiyomiyopati, kalp yetmezliği;, non-invaziv kalp görüntüleme

Analysis of myocardial texture in patients with isolated left ventricular noncompaction

Aim: Videodensitometric myocardial texture analysis (VMTA) has been widely used to investigate left ventricular (LV) dysfunction in various cardiac disorders. Patients with isolated left ventricular noncompaction (IVNC) experience an undulating decline in LV function. The aim of this study was to assess the value of VMTA for evaluating deterioration of LV function in this patient group.Material and Methods: Twenty-two patients with IVNC (10 asymptomatic [preserved LV function], 12 symptomatic [LV dysfunction]) and 12 healthy controls were evaluated. Videodensitometry was used to record background-corrected mean gray levels (BC-MGL) for 2 regions of the mid-basal LV wall (the interventricular septum [IVS] and the posterior wall [PW]) at end-systole and end-diastole. The cyclic variation (CV) index for each region was calculated according to the formula, CV index % = ([BC-MGLend-diastole – BC-MGLend-systole] ÷ BC-MGLend-diastole) × 100. Results: The mean IVS-CV index in the symptomatic IVNC group (12.3 ± 4.9%) was significantly lower than the corresponding findings in the asymptomatic IVNC group (32.3 ± 14.8%, p < 0.05) and control group (36.6 ± 12.1%, p < 0.001). The mean PW-CV index in the symptomatic group (15.1 ± 5.5%) was also significantly lower than the corresponding values in the asymptomatic (27.0 ± 10.4%, p < 0.05) and control groups (28.8 ± 10.9%, p < 0.001). Conclusion: VMTA is a practical, useful adjunct to conventional echocardiography for assessing LV myocardium in patients with IVNC. Detection of reduced CV index values might predict the early stages of LV deterioration in this group.

Keywords:

videodensitometric myocardial texture analysis, isolated left ventricular noncompaction, cardiomyopathy, non-invasive cardiac imaging,

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1. Richardson P, McKenna W, Bristow M et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996; 93: 841–42.
2. Sedmera D, Pexieder T, Vuillemin M, Thompson RP, Anderson RH. Developmental patterning of the myocardium. Anat Rec 2000; 258: 319-37.
3. Jenni R, Goebel N, Tartini R, Schneider J, Arbenz U, Oelz O. Persisting myocardial sinusoids of both ventricles as an isolated anomaly: echocardiographic, angiographic, and pathologic anatomical findings. Cardiovasc Intervent Radiol 1986; 9: 127-31.
4. Chin TK, Perloff JK, Williams RG, Jue K, Mohrmann R. Isolated noncompaction of left ventricular myocardium: a study of eight cases. Circulation 1990; 82: 507-13.
5. Oechslin EN, Attenhofer Jost CH, Rojas JR, Kaufmann PA, Jenni R. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36: 493-500.
6. Jenni R, Oechslin E, Schneider J, Attenhofer Jost C, Kaufmann PA. Attenhofer Jost C, Kaufmann PA. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy. Heart 2001; 86: 666-71.
7. Pignatelli RH, McMahon CJ, Dreyer WJ et al. Clinical characterization of left ventricular noncompaction in children: a relatively common form of cardiomyopathy. Circulation. 2003; 108: 2672-28.
8. Aras D, Tufekcioglu O, Topaloglu S et al. Preserved systolic function with isolated left ventricular noncompaction in an elderly patient. Eur J Echocardiogr 2006; 7: 71-74.
9. Sengupta PP, Mohan JC, Mehta V et al. Comparison of echocardiographic features of noncompaction of the left ventricle in adults versus idiopathic dilated cardiomyopathy in adults. Am J Cardiol 2004; 94: 389-91.
10. Picano E, Faletra F, Marini C et al. Increased echodensity of transiently asynergic myocardium in humans: a novel echocardiographic sign of myocardial ischemia. J Am Coll Cardiol 1993; 21: 199-207.
11. Marini C, Picano E, Varga A, Marzullo P, Pingitore A, Paterni M. Cyclic variation in myocardial gray level as a marker of viability in man. A videodensitometric study. Eur Heart J 1996; 17: 472-79.
12. Di Bello V, Pedrinelli R, Giorgi D et al. Ultrasonic videodensitometric analysis of two different models of left ventricular hypertrophy. Athlete's heart and hypertension. Hypertension 1997; 29: 937-44.
13. Di Bello V, Pedrinelli R, Giorgi D et al.Ultrasonic myocardial texture versus Doppler analysis in hypertensive heart: a preliminary study. Hypertension 1999; 33: 66-73.
14. Zoni A, Regolisti G, Aschieri D, Borghetti A. Myocardial ultrasonic tissue characterization in patients with different types of left ventricular hypertrophy: a videodensitometric approach. J Am Soc Echocardiogr 1997; 10: 74-82.
15. Dagdeviren B, Akdemir O, Eren M et al. Prognostic implication of myocardial texture analysis in idiopathic dilated cardiomyopathy. Eur J Heart Fail 2002; 4: 41-48.
16. Jenni R, Vieli A, Hess O, Anliker M, Krayenbuehl HP. Estimation of left ventricular volume from apical orthogonal 2-D echocardiograms. Eur Heart J 1981; 2: 217 - 25.
17. Lasserre R, Gosse P, Mansour S. Myocardial Tissue Characterization in Echocardiography with Videodensitometry: Evaluation of a New Semi-automatic Software Applied on a Population of Hypertensive Patients. Eur J Echocardiogr 2003; 4: 292-99.
18. Stamou SC, Lefrak EA, Athari FC, Burton NA, Massimiano PS. Heart transplantation in a patient with isolated noncompaction of the left ventricular myocardium. Ann Thorac Surg 2004; 77: 1806-8.
19. Burke A, Mont E, Kutys R, Virmani R. Left ventricular noncompaction: a pathological study of 14 cases. Hum Pathol 2005; 36: 403-11.
20. Skorton DJ, Melton HE Jr, Pandian NG et al. Detection of acute myocardial infarction in closed-chest dogs by analysis of regional two-dimensional echocardiographic gray-level distributions. Circ Res 1983; 52: 36-44.
21. Hoyt RM, Skorton DJ, Collins SM, Melton HE Jr. Ultrasonic backscatter and collagen in normal ventricular myocardium. Circulation 1984; 69: 775-82.
22. Bello VD, Giorgi D, Viacava P et al. Severe aortic stenosis and myocardial function diagnostic and prognostic usefulness of ultrasonic integrated backscatter analysis. Circulation 2004; 110: 849-55.
23. Rossi Gp, Di Bello V, Ganzaroli C et al. Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism. Hypertension 2002; 40: 23-27.
24. Williams RI, Masani ND, Buchalter MB, Fraser AG. Abnormal myocardial strain rate in noncompaction of the left ventricle. J Am Soc Echocardiogr 2003; 16:293-96.
25. Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre arthitecture in man. Br Heart J 1981; 45: 248-63.
26. Dagdeviren B, Akdemir O, Bolca O, Eren M, Gürlertop Y, Tezel T. Myocardial texture analysis in idiopathic dilated cardiomyopathy: prediction of contractile reserve on dobutamine echocardiography. J Am Soc Echocardiogr 2002; 15: 36-42.
27. Aras D, Tufekcioglu O, Ergun K et al. Clinical features of isolated ventricular noncompaction in adults long-term clinical course, echocardiographic properties, and predictors of left ventricular failure J Card Fail 2006; 12: 726-33.
28. Bennett CE, Freudenberger R. The Current Approach to Diagnosis and Management of Left Ventricular Noncompaction Cardiomyopathy: Review of the Literature. Cardiol Res Pract 2016; 2016: 5172308