Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study
ABSTRACT: Background: Deterioration of right ventricular (RV) function in repaired tetralogy of Fallot (rToF) is poorly understood. Cardiovascular magnetic resonance (CMR) is used for monitoring, but its analysis is user-dependent and time-consuming. We sought to automate the analysis of CMR using...
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Elsevier
2025-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664725000171 |
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| author | Elizabeth W. Thompson Ningiun J. Dong Jin-seo Kim Abhijit Bhattaru Phuong Vu Fengling Hu Russell T. Shinohara Sophia Swago Elizabeth Donnelly Xuemei Zhang Annefleur Loth Lipika Vuthuri Kristen Lanzilotta Kevin K. Whitehead Jeffrey Duda James Gee Laura Almasy Elizabeth Goldmuntz Mark A. Fogel Walter R. Witschey |
| author_facet | Elizabeth W. Thompson Ningiun J. Dong Jin-seo Kim Abhijit Bhattaru Phuong Vu Fengling Hu Russell T. Shinohara Sophia Swago Elizabeth Donnelly Xuemei Zhang Annefleur Loth Lipika Vuthuri Kristen Lanzilotta Kevin K. Whitehead Jeffrey Duda James Gee Laura Almasy Elizabeth Goldmuntz Mark A. Fogel Walter R. Witschey |
| author_sort | Elizabeth W. Thompson |
| collection | DOAJ |
| description | ABSTRACT: Background: Deterioration of right ventricular (RV) function in repaired tetralogy of Fallot (rToF) is poorly understood. Cardiovascular magnetic resonance (CMR) is used for monitoring, but its analysis is user-dependent and time-consuming. We sought to automate the analysis of CMR using machine learning and to identify imaging traits associated with adverse RV remodeling in the natural history of rToF. Methods: A longitudinal cohort of rToF patients underwent CMR at the Children’s Hospital of Philadelphia. The nnU-Net method was used to train a machine learning model to segment the left ventricular (LV) blood pool, LV myocardium, and RV blood pool from two-dimensional short-axis CMR images. Conventional and novel measures were calculated and studied in association with remodeling rates using multivariable linear regression. Remodeling rates were calculated as ((Variablescan2 − Variablescan1)/years between scans) for the variables end-diastolic volume index (EDVi), end-systolic volume index (ESVi), stroke volume index (SVi), ejection fraction (EF), and peak systolic dV/dt. Results: The cohort was comprised of 758 patients, of whom 152 had 2 analyzable scans. Thirty-six patients underwent pulmonic valve replacement (PVR) between scans. Compared to patients with no intervention (representing the natural history of rToF), patients with PVR had significantly lower remodeling rates for RVEDVi, RVESVi, RVSVi, and absolute peak systolic RV dV/dt, while RVEF and left-sided metrics did not differ between groups. In 116 patients without PVR between scans, RV remodeling rates were negatively associated with baseline LV mass index, LVEDVi, LVSVi, and absolute peak systolic LV dV/dt. Conclusion: We demonstrated that rToF patients with two CMR scans and PVR have significant differences in and opposite directions of RV remodeling rates compared to those with no intervention. We also showed that several left-sided measures of structure and function were associated with RV remodeling rates, indicating the importance of baseline LV measurements in characterizing future risk of adverse RV remodeling. |
| format | Article |
| id | doaj-art-166ea47a7d324c2e862279a5ff40a3a1 |
| institution | OA Journals |
| issn | 1097-6647 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-166ea47a7d324c2e862279a5ff40a3a12025-08-20T02:34:15ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127110185510.1016/j.jocmr.2025.101855Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot studyElizabeth W. Thompson0Ningiun J. Dong1Jin-seo Kim2Abhijit Bhattaru3Phuong Vu4Fengling Hu5Russell T. Shinohara6Sophia Swago7Elizabeth Donnelly8Xuemei Zhang9Annefleur Loth10Lipika Vuthuri11Kristen Lanzilotta12Kevin K. Whitehead13Jeffrey Duda14James Gee15Laura Almasy16Elizabeth Goldmuntz17Mark A. Fogel18Walter R. Witschey19Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corresponding author.Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USADepartment of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USAABSTRACT: Background: Deterioration of right ventricular (RV) function in repaired tetralogy of Fallot (rToF) is poorly understood. Cardiovascular magnetic resonance (CMR) is used for monitoring, but its analysis is user-dependent and time-consuming. We sought to automate the analysis of CMR using machine learning and to identify imaging traits associated with adverse RV remodeling in the natural history of rToF. Methods: A longitudinal cohort of rToF patients underwent CMR at the Children’s Hospital of Philadelphia. The nnU-Net method was used to train a machine learning model to segment the left ventricular (LV) blood pool, LV myocardium, and RV blood pool from two-dimensional short-axis CMR images. Conventional and novel measures were calculated and studied in association with remodeling rates using multivariable linear regression. Remodeling rates were calculated as ((Variablescan2 − Variablescan1)/years between scans) for the variables end-diastolic volume index (EDVi), end-systolic volume index (ESVi), stroke volume index (SVi), ejection fraction (EF), and peak systolic dV/dt. Results: The cohort was comprised of 758 patients, of whom 152 had 2 analyzable scans. Thirty-six patients underwent pulmonic valve replacement (PVR) between scans. Compared to patients with no intervention (representing the natural history of rToF), patients with PVR had significantly lower remodeling rates for RVEDVi, RVESVi, RVSVi, and absolute peak systolic RV dV/dt, while RVEF and left-sided metrics did not differ between groups. In 116 patients without PVR between scans, RV remodeling rates were negatively associated with baseline LV mass index, LVEDVi, LVSVi, and absolute peak systolic LV dV/dt. Conclusion: We demonstrated that rToF patients with two CMR scans and PVR have significant differences in and opposite directions of RV remodeling rates compared to those with no intervention. We also showed that several left-sided measures of structure and function were associated with RV remodeling rates, indicating the importance of baseline LV measurements in characterizing future risk of adverse RV remodeling.http://www.sciencedirect.com/science/article/pii/S1097664725000171CMRTetralogy of FallotRemodelingRight ventricle |
| spellingShingle | Elizabeth W. Thompson Ningiun J. Dong Jin-seo Kim Abhijit Bhattaru Phuong Vu Fengling Hu Russell T. Shinohara Sophia Swago Elizabeth Donnelly Xuemei Zhang Annefleur Loth Lipika Vuthuri Kristen Lanzilotta Kevin K. Whitehead Jeffrey Duda James Gee Laura Almasy Elizabeth Goldmuntz Mark A. Fogel Walter R. Witschey Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study Journal of Cardiovascular Magnetic Resonance CMR Tetralogy of Fallot Remodeling Right ventricle |
| title | Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study |
| title_full | Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study |
| title_fullStr | Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study |
| title_full_unstemmed | Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study |
| title_short | Cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of Fallot: A Single Center Outcomes Using cardiovascular magnetic resonance in Tetralogy of Fallot study |
| title_sort | cardiovascular magnetic resonance imaging traits associated with adverse right ventricular remodeling in repaired tetralogy of fallot a single center outcomes using cardiovascular magnetic resonance in tetralogy of fallot study |
| topic | CMR Tetralogy of Fallot Remodeling Right ventricle |
| url | http://www.sciencedirect.com/science/article/pii/S1097664725000171 |
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