The total right/left-volume index

A new and simplifed cardiac magnetic resonance measure to evaluate the severity of Ebstein anomaly of the tricuspid valve: A comparison with heart failure markers from various modalities

Olga Hösch, Jan Martin Sohns, Thuy Trang Nguyen, Peter Lauerer, Christina Rosenberg, Johannes Tammo Kowallick, Shelby Kutty, Christina Unterberg, Andreas Schuster, Martin Faßhauer, Wieland Staab, Thomas Paul, Joachim Lotz, Michael Steinmetz

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background-The classifcation of clinical severity of Ebstein anomaly still remains a challenge. The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically-supposedly-normal left heart and to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of Ebstein anomaly. Methods and Results-Twenty-fve patients at a mean age of 26±14 years with unrepaired Ebstein anomaly were examined in a prospective study. Disease severity was classifed using CMR volumes and functional measurements in comparison with heart failure markers from clinical data, ECG, laboratory and cardiopulmonary exercise testing, and echocardiography. All examinations were completed within 24 hours. A total right/left-volume index was defned from end-diastolic volume measurements in CMR: total right/left-volume index=(RA+aRV+fRV)/(LA+LV). Mean total right/ left-volume index was 2.6±1.7 (normal values: 1.1±0.1). This new total right/left-volume index correlated with almost all clinically used biomarkers of heart failure: brain natriuretic peptide (r=0.691; P=0.0003), QRS (r=0.432; P=0.039), peak oxygen consumption/kg (r=-0.479; P=0.024), ventilatory response to carbon dioxide production at anaerobic threshold (r=0.426; P=0.048), the severity of tricuspid regurgitation (r=0.692; P=0.009), tricuspid valve offset (r=0.583; P=0.004), and tricuspid annular plane systolic excursion (r=0.554; P=0.006). Previously described severity indices ([RA+aRV]/ [fRV+LA+LV]) and fRV/LV end-diastolic volume corresponded only to some parameters. Conclusions-In patients with Ebstein anomaly, the easily acquired index of right-sided to left-sided heart volumes from CMR correlated well with established heart failure markers. Our data suggest that the total right/left-volume index should be used as a new and simplifed CMR measure, allowing more accurate assessment of disease severity than previously described scoring systems.

Original languageEnglish (US)
Pages (from-to)601-609
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume7
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Ebstein Anomaly
Tricuspid Valve
Magnetic Resonance Spectroscopy
Heart Failure
Biomarkers
Anaerobic Threshold
Tricuspid Valve Insufficiency
Cardiac Volume
Brain Natriuretic Peptide
Carbon Dioxide
Oxygen Consumption
Echocardiography
Electrocardiography
Reference Values
Prospective Studies
Exercise

Keywords

  • Congenital
  • Heart failure
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

The total right/left-volume index : A new and simplifed cardiac magnetic resonance measure to evaluate the severity of Ebstein anomaly of the tricuspid valve: A comparison with heart failure markers from various modalities. / Hösch, Olga; Sohns, Jan Martin; Nguyen, Thuy Trang; Lauerer, Peter; Rosenberg, Christina; Kowallick, Johannes Tammo; Kutty, Shelby; Unterberg, Christina; Schuster, Andreas; Faßhauer, Martin; Staab, Wieland; Paul, Thomas; Lotz, Joachim; Steinmetz, Michael.

In: Circulation: Cardiovascular Imaging, Vol. 7, No. 4, 01.01.2014, p. 601-609.

Research output: Contribution to journalArticle

Hösch, Olga ; Sohns, Jan Martin ; Nguyen, Thuy Trang ; Lauerer, Peter ; Rosenberg, Christina ; Kowallick, Johannes Tammo ; Kutty, Shelby ; Unterberg, Christina ; Schuster, Andreas ; Faßhauer, Martin ; Staab, Wieland ; Paul, Thomas ; Lotz, Joachim ; Steinmetz, Michael. / The total right/left-volume index : A new and simplifed cardiac magnetic resonance measure to evaluate the severity of Ebstein anomaly of the tricuspid valve: A comparison with heart failure markers from various modalities. In: Circulation: Cardiovascular Imaging. 2014 ; Vol. 7, No. 4. pp. 601-609.
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AU - Sohns, Jan Martin

AU - Nguyen, Thuy Trang

AU - Lauerer, Peter

AU - Rosenberg, Christina

AU - Kowallick, Johannes Tammo

AU - Kutty, Shelby

AU - Unterberg, Christina

AU - Schuster, Andreas

AU - Faßhauer, Martin

AU - Staab, Wieland

AU - Paul, Thomas

AU - Lotz, Joachim

AU - Steinmetz, Michael

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N2 - Background-The classifcation of clinical severity of Ebstein anomaly still remains a challenge. The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically-supposedly-normal left heart and to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of Ebstein anomaly. Methods and Results-Twenty-fve patients at a mean age of 26±14 years with unrepaired Ebstein anomaly were examined in a prospective study. Disease severity was classifed using CMR volumes and functional measurements in comparison with heart failure markers from clinical data, ECG, laboratory and cardiopulmonary exercise testing, and echocardiography. All examinations were completed within 24 hours. A total right/left-volume index was defned from end-diastolic volume measurements in CMR: total right/left-volume index=(RA+aRV+fRV)/(LA+LV). Mean total right/ left-volume index was 2.6±1.7 (normal values: 1.1±0.1). This new total right/left-volume index correlated with almost all clinically used biomarkers of heart failure: brain natriuretic peptide (r=0.691; P=0.0003), QRS (r=0.432; P=0.039), peak oxygen consumption/kg (r=-0.479; P=0.024), ventilatory response to carbon dioxide production at anaerobic threshold (r=0.426; P=0.048), the severity of tricuspid regurgitation (r=0.692; P=0.009), tricuspid valve offset (r=0.583; P=0.004), and tricuspid annular plane systolic excursion (r=0.554; P=0.006). Previously described severity indices ([RA+aRV]/ [fRV+LA+LV]) and fRV/LV end-diastolic volume corresponded only to some parameters. Conclusions-In patients with Ebstein anomaly, the easily acquired index of right-sided to left-sided heart volumes from CMR correlated well with established heart failure markers. Our data suggest that the total right/left-volume index should be used as a new and simplifed CMR measure, allowing more accurate assessment of disease severity than previously described scoring systems.

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