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Article ; Online: Understanding right ventricular dyssynchrony: Its myriad determinants and clinical relevance.

Fraser, Alan G / Bijnens, Bart H / Friedberg, Mark K

2021 Volume 106, Issue 4, Page(s) 797–800

Language	English
Publishing date	2021-03-02
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	1016295-1
ISSN	1469-445X ; 0958-0670
ISSN (online)	1469-445X
ISSN	0958-0670
DOI	10.1113/EP089366
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Uc I Zs.102: Show issues

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Article ; Online: Right Ventricular Electromechanical Dyssynchrony and Its Relation to Right Ventricular Remodeling, Dysfunction, and Exercise Capacity in Ebstein Anomaly.

Akazawa, Yohei / Fujioka, Tao / Yazaki, Kana / Strbad, Martina / Hörer, Jürgen / Kühn, Andreas / Hui, Wei / Slorach, Cameron / Roehlig, Christoph / Mertens, Luc / Bijnens, Bart H / Vogt, Manfred / Friedberg, Mark K

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography

2023 Volume 36, Issue 6, Page(s) 634–643

Abstract: Background: Abnormal atrioventricular and intraventricular electrical conduction and dysfunction of the functional right ventricle (fRV) are common in Ebstein anomaly (EA). However, fRV mechanical dyssynchrony and its relation to fRV function are poorly ...

Abstract	Background: Abnormal atrioventricular and intraventricular electrical conduction and dysfunction of the functional right ventricle (fRV) are common in Ebstein anomaly (EA). However, fRV mechanical dyssynchrony and its relation to fRV function are poorly characterized. We evaluated fRV mechanical dyssynchrony in EA patients in relation to fRV remodeling, dysfunction, and exercise intolerance. Methods: We retrospectively analyzed data from nonoperated EA patients and age-matched controls who underwent echocardiography, cardiovascular magnetic resonance imaging, and cardiopulmonary exercise testing to quantify right ventricular (RV) remodeling, dysfunction, and exercise capacity. The relation of these to fRV dyssynchrony was retrospectively investigated. Right ventricular mechanical dyssynchrony was defined by early fRV septal activation (right-sided septal flash), RV lateral wall prestretch/late contraction, postsystolic shortening, and intra-RV delay using two-dimensional strain echocardiography. The SD of time to peak shortening among the fRV segments was calculated as a parameter of mechanical dispersion. Results: Thirty-five EA patients (10 of whom were <18 years of age) and 35 age-matched controls were studied. Ebstein anomaly patients had worse RV function and increased intra-RV dyssynchrony versus controls. Nineteen of 35 (54%) EA patients had early septal activation with simultaneous stretch and consequent late activation and postsystolic shortening of RV lateral segments. Intra-fRV mechanical delay correlated with fRV end-diastolic volume index (r = 0.43, P < .05) and fRV end-systolic volume index (r = 0.63, P < .001). The fRV ejection fraction was lower in EA with versus without right-sided septal flash (44.9 ± 11.0 vs 54.2 ± 8.2, P = .012). The fRV mechanical dispersion correlated with the percentage of predicted peak VO Conclusions: In EA, fRV mechanical dyssynchrony is associated with fRV remodeling, dysfunction, and impaired exercise capacity. Mechanical dyssynchrony as a therapeutic target in selected EA patients warrants further study.
MeSH term(s)	Humans ; Adult ; Heart Ventricles/diagnostic imaging ; Ebstein Anomaly/diagnosis ; Retrospective Studies ; Ventricular Remodeling ; Exercise Tolerance/physiology ; Ventricular Dysfunction, Right/diagnostic imaging ; Ventricular Function, Right/physiology
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1035622-8
ISSN	1097-6795 ; 0894-7317
ISSN (online)	1097-6795
ISSN	0894-7317
DOI	10.1016/j.echo.2023.02.013
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Zs.A 2638: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Artificial intelligence in medical device software and high-risk medical devices - a review of definitions, expert recommendations and regulatory initiatives.

Fraser, Alan G / Biasin, Elisabetta / Bijnens, Bart / Bruining, Nico / Caiani, Enrico G / Cobbaert, Koen / Davies, Rhodri H / Gilbert, Stephen H / Hovestadt, Leo / Kamenjasevic, Erik / Kwade, Zuzanna / McGauran, Gearóid / O'Connor, Gearóid / Vasey, Baptiste / Rademakers, Frank E

Expert review of medical devices

2023 Volume 20, Issue 6, Page(s) 467–491

Abstract: Introduction: Artificial intelligence (AI) encompasses a wide range of algorithms with risks when used to support decisions about diagnosis or treatment, so professional and regulatory bodies are recommending how they should be managed.: Areas covered! ...

Abstract	Introduction: Artificial intelligence (AI) encompasses a wide range of algorithms with risks when used to support decisions about diagnosis or treatment, so professional and regulatory bodies are recommending how they should be managed. Areas covered: AI systems may qualify as standalone medical device software (MDSW) or be embedded within a medical device. Within the European Union (EU) AI software must undergo a conformity assessment procedure to be approved as a medical device. The draft EU Regulation on AI proposes rules that will apply across industry sectors, while for devices the Medical Device Regulation also applies. In the CORE-MD project (Coordinating Research and Evidence for Medical Devices), we have surveyed definitions and summarize initiatives made by professional consensus groups, regulators, and standardization bodies. Expert opinion: The level of clinical evidence required should be determined according to each application and to legal and methodological factors that contribute to risk, including accountability, transparency, and interpretability. EU guidance for MDSW based on international recommendations does not yet describe the clinical evidence needed for medical AI software. Regulators, notified bodies, manufacturers, clinicians and patients would all benefit from common standards for the clinical evaluation of high-risk AI applications and transparency of their evidence and performance.
MeSH term(s)	Humans ; Artificial Intelligence ; Software ; Algorithms ; European Union ; Surveys and Questionnaires
Language	English
Publishing date	2023-05-08
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2250857-0
ISSN	1745-2422 ; 1743-4440
ISSN (online)	1745-2422
ISSN	1743-4440
DOI	10.1080/17434440.2023.2184685
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Article ; Online: Machine-learning-based exploration to identify remodeling patterns associated with death or heart-transplant in pediatric-dilated cardiomyopathy.

Garcia-Canadilla, Patricia / Sanchez-Martinez, Sergio / Martí-Castellote, Pablo M / Slorach, Cameron / Hui, Wei / Piella, Gemma / Aguado, Ainhoa M / Nogueira, Mariana / Mertens, Luc / Bijnens, Bart H / Friedberg, Mark K

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2021 Volume 41, Issue 4, Page(s) 516–526

Abstract: Aims: We investigated left ventricular (LV) remodeling, mechanics, systolic and diastolic function, combined with clinical characteristics and heart-failure treatment in association to death or heart-transplant (DoT) in pediatric idiopathic, genetic or ... ...

Abstract	Aims: We investigated left ventricular (LV) remodeling, mechanics, systolic and diastolic function, combined with clinical characteristics and heart-failure treatment in association to death or heart-transplant (DoT) in pediatric idiopathic, genetic or familial dilated cardiomyopathy (DCM), using interpretable machine-learning. Methods and results: Echocardiographic and clinical data from pediatric DCM and healthy controls were retrospectively analyzed. Machine-learning included whole cardiac-cycle regional longitudinal strain, aortic, mitral and pulmonary vein Doppler velocity traces, age and body surface area. We used unsupervised multiple kernel learning for data dimensionality reduction, positioning patients based on complex conglomerate information similarity. Subsequently, k-means identified groups with similar phenotypes. The proportion experiencing DoT was evaluated. Pheno-grouping identified 5 clinically distinct groups that were associated with differing proportions of DoT. All healthy controls clustered in groups 1 to 2, while all, but one, DCM subjects, clustered in groups 3 to 5; internally validating the algorithm. Cluster-5 comprised the oldest, most medicated patients, with combined systolic and diastolic heart-failure and highest proportion of DoT. Cluster-4 included the youngest patients characterized by severe LV remodeling and systolic dysfunction, but mild diastolic dysfunction and the second-highest proportion of DoT. Cluster-3 comprised young patients with moderate remodeling and systolic dysfunction, preserved apical strain, pronounced diastolic dysfunction and lowest proportion of DoT. Conclusions: Interpretable machine-learning, using full cardiac-cycle systolic and diastolic data, mechanics and clinical parameters, can potentially identify pediatric DCM patients at high-risk for DoT, and delineate mechanisms associated with risk. This may facilitate more precise prognostication and treatment of pediatric DCM.
MeSH term(s)	Cardiomyopathy, Dilated ; Child ; Diastole ; Humans ; Machine Learning ; Retrospective Studies ; Ventricular Dysfunction, Left ; Ventricular Function, Left
Language	English
Publishing date	2021-12-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2021.11.020
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Article ; Online: Characterization of myocardial motion patterns by unsupervised multiple kernel learning.

Sanchez-Martinez, Sergio / Duchateau, Nicolas / Erdei, Tamas / Fraser, Alan G / Bijnens, Bart H / Piella, Gemma

Medical image analysis

2017 Volume 35, Page(s) 70–82

Abstract: We propose an independent objective method to characterize different patterns of functional responses to stress in the heart failure with preserved ejection fraction (HFPEF) syndrome by combining multiple temporally-aligned myocardial velocity traces at ... ...

Abstract	We propose an independent objective method to characterize different patterns of functional responses to stress in the heart failure with preserved ejection fraction (HFPEF) syndrome by combining multiple temporally-aligned myocardial velocity traces at rest and during exercise, together with temporal information on the occurrence of cardiac events (valves openings/closures and atrial activation). The method builds upon multiple kernel learning, a machine learning technique that allows the combination of data of different nature and the reduction of their dimensionality towards a meaningful representation (output space). The learning process is kept unsupervised, to study the variability of the input traces without being conditioned by data labels. To enhance the physiological interpretation of the output space, the variability that it encodes is analyzed in the space of input signals after reconstructing the velocity traces via multiscale kernel regression. The methodology was applied to 2D sequences from a stress echocardiography protocol from 55 subjects (22 healthy, 19 HFPEF and 14 breathless subjects). The results confirm that characterization of the myocardial functional response to stress in the HFPEF syndrome may be improved by the joint analysis of multiple relevant features.
MeSH term(s)	Case-Control Studies ; Echocardiography ; Exercise/physiology ; Exercise Test ; Heart/diagnostic imaging ; Heart/physiology ; Heart Failure/diagnostic imaging ; Heart Failure/physiopathology ; Humans ; Motion ; Movement ; Reproducibility of Results ; Rest/physiology ; Sensitivity and Specificity ; Unsupervised Machine Learning
Language	English
Publishing date	2017
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1356436-5
ISSN	1361-8423 ; 1361-8431 ; 1361-8415
ISSN (online)	1361-8423 ; 1361-8431
ISSN	1361-8415
DOI	10.1016/j.media.2016.06.007
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Zs.A 5206: Show issues

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Article ; Online: A Novel Three-Dimensional Approach Towards Evaluating Endomyocardial Biopsies for Follow-Up After Heart Transplantation: X-Ray Phase Contrast Imaging and Its Agreement With Classical Histopathology.

Planinc, Ivo / Ilic, Ivana / Dejea, Hector / Garcia-Canadilla, Patricia / Gasparovic, Hrvoje / Jurin, Hrvoje / Milicic, Davor / Skoric, Bosko / Stampanoni, Marco / Bijnens, Bart / Bonnin, Anne / Cikes, Maja

Transplant international : official journal of the European Society for Organ Transplantation

2023 Volume 36, Page(s) 11046

Abstract: Endomyocardial biopsies are the gold standard for surveillance of graft rejection following heart transplantation, and are assessed by classical histopathology using a limited number of previously stained slices from several biopsies. Synchrotron ... ...

Abstract	Endomyocardial biopsies are the gold standard for surveillance of graft rejection following heart transplantation, and are assessed by classical histopathology using a limited number of previously stained slices from several biopsies. Synchrotron propagation-based X-ray phase contrast imaging is a non-destructive method to image biological samples without tissue preparation, enabling virtual 2D and 3D histopathology. We aimed to show the feasibility of this method to assess acute cellular rejection and its agreement to classical histopathology. Right ventricular biopsies were sampled from 23 heart transplantation recipients (20 males, mean age 54±14 years) as part of standard follow-up. The clinical diagnosis of potential rejection was made using classical histopathology. One additional study sample was harvested and imaged by X-ray phase contrast imaging, producing 3D datasets with 0.65 μm pixel size, and up to 4,320 images per sample. An experienced pathologist graded both histopathological and X-ray phase contrast images in a blinded fashion. The agreement between methods was assessed by weighted kappa, showing substantial agreement (kappa up to 0.80,
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; Aged ; Follow-Up Studies ; X-Rays ; Heart Transplantation ; Biopsy ; Graft Rejection/diagnostic imaging ; Graft Rejection/pathology ; Imaging, Three-Dimensional
Language	English
Publishing date	2023-01-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	639435-8
ISSN	1432-2277 ; 0934-0874
ISSN (online)	1432-2277
ISSN	0934-0874
DOI	10.3389/ti.2023.11046
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Article ; Online: Feasibility and safety of synchrotron-based X-ray phase contrast imaging as a technique complementary to histopathology analysis.

Li, Kan Yan Chloe / Dejea, Hector / De Winne, Koen / Bonnin, Anne / D'Onofrio, Valentino / Cox, Janneke A / Garcia-Canadilla, Patricia / Lammens, Martin / Cook, Andrew C / Bijnens, Bart / Dendooven, Amélie

Histochemistry and cell biology

2023 Volume 160, Issue 5, Page(s) 377–389

Abstract: X-ray phase contrast imaging (X-PCI) is a powerful technique for high-resolution, three-dimensional imaging of soft tissue samples in a non-destructive manner. In this technical report, we assess the quality of standard histopathological techniques ... ...

Abstract	X-ray phase contrast imaging (X-PCI) is a powerful technique for high-resolution, three-dimensional imaging of soft tissue samples in a non-destructive manner. In this technical report, we assess the quality of standard histopathological techniques performed on formalin-fixed, paraffin-embedded (FFPE) human tissue samples that have been irradiated with different doses of X-rays in the context of an X-PCI experiment. The data from this study demonstrate that routine histochemical and immunohistochemical staining quality as well as DNA and RNA analyses are not affected by previous X-PCI on human FFPE samples. From these data we conclude it is feasible and acceptable to perform X-PCI on FFPE human biopsies.
MeSH term(s)	Humans ; X-Rays ; Synchrotrons ; Feasibility Studies ; Percutaneous Coronary Intervention ; Imaging, Three-Dimensional ; Paraffin Embedding ; Formaldehyde ; Tissue Fixation
Chemical Substances	Formaldehyde (1HG84L3525)
Language	English
Publishing date	2023-07-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1222930-1
ISSN	1432-119X ; 0301-5564 ; 0948-6143
ISSN (online)	1432-119X
ISSN	0301-5564 ; 0948-6143
DOI	10.1007/s00418-023-02220-6
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Article ; Online: Volumetric parcellation of the cardiac right ventricle for regional geometric and functional assessment.

Bernardino, Gabriel / Hodzic, Amir / Langet, Hélène / Legallois, Damien / De Craene, Mathieu / González Ballester, Miguel Ángel / Saloux, Éric / Bijnens, Bart

Medical image analysis

2021 Volume 71, Page(s) 102044

Abstract: 3D echocardiography is an increasingly popular tool for assessing cardiac remodelling in the right ventricle (RV). It allows quantification of the cardiac chambers without any geometric assumptions, which is the main weakness of 2D echocardiography. ... ...

Abstract	3D echocardiography is an increasingly popular tool for assessing cardiac remodelling in the right ventricle (RV). It allows quantification of the cardiac chambers without any geometric assumptions, which is the main weakness of 2D echocardiography. However, regional quantification of geometry and function is limited by the lower spatial and temporal resolution and the scarcity of identifiable anatomical landmarks, especially within the ventricular cavity. We developed a technique for regionally assessing the volume of 3 relevant RV volumetric regions: apical, inlet and outflow. The proposed parcellation method is based on the geodesic distances to anatomical landmarks that are easily identifiable in the images: the apex and the tricuspid and pulmonary valves, each associated to a region. Based on these distances, we define a partition in the endocardium at end-diastole (ED). This partition is then interpolated to the blood cavity using the Laplace equation, which allows to compute regional volumes. For obtaining an end-systole (ES) partition, the endocardial partition is transported from ED to ES using a commercial image-based tracking software, and then the interpolation process is repeated. We assessed the intra- and inter-observer reproducibility using a 10-subjects dataset containing repeated quantifications of the same images, obtaining intra- and inter- observer errors (7-12% and 10-23% respectively). Finally, we propose a novel synthetic mesh generation algorithm that deforms a template mesh imposing a user-defined strain to a template mesh. We used this method to create a new dataset for involving distinct types of remodelling that were used to assess the sensitivity of the parcellation method to identify volume changes affecting different parts. We show that the parcellation method is adequate for capturing local circumferential and global circumferential and longitudinal RV remodelling, which are the most clinically relevant cases.
MeSH term(s)	Echocardiography ; Echocardiography, Three-Dimensional ; Heart Ventricles/diagnostic imaging ; Humans ; Reproducibility of Results ; Ventricular Dysfunction, Right ; Ventricular Function, Right
Language	English
Publishing date	2021-04-06
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1356436-5
ISSN	1361-8423 ; 1361-8431 ; 1361-8415
ISSN (online)	1361-8423 ; 1361-8431
ISSN	1361-8415
DOI	10.1016/j.media.2021.102044
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Article ; Online: Assessment of wall elasticity variations on intraluminal haemodynamics in descending aortic dissections using a lumped-parameter model.

Rudenick, Paula A / Bijnens, Bart H / Segers, Patrick / García-Dorado, David / Evangelista, Arturo

PloS one

2015 Volume 10, Issue 4, Page(s) e0124011

Abstract: Descending aortic dissection (DAD) is associated with high morbidity and mortality rates. Aortic wall stiffness is a variable often altered in DAD patients and potentially involved in long-term outcome. However, its relevance is still mostly unknown. To ... ...

Abstract	Descending aortic dissection (DAD) is associated with high morbidity and mortality rates. Aortic wall stiffness is a variable often altered in DAD patients and potentially involved in long-term outcome. However, its relevance is still mostly unknown. To gain more detailed knowledge of how wall elasticity (compliance) might influence intraluminal haemodynamics in DAD, a lumped-parameter model was developed based on experimental data from a pulsatile hydraulic circuit and validated for 8 clinical scenarios. Next, the variations of intraluminal pressures and flows were assessed as a function of wall elasticity. In comparison with the most rigid-wall case, an increase in elasticity to physiological values was associated with a decrease in systolic and increase in diastolic pressures of up to 33% and 63% respectively, with a subsequent decrease in the pressure wave amplitude of up to 86%. Moreover, it was related to an increase in multidirectional intraluminal flows and transition of behaviour as 2 parallel vessels towards a vessel with a side-chamber. The model supports the extremely important role of wall elasticity as determinant of intraluminal pressures and flow patterns for DAD, and thus, the relevance of considering it during clinical assessment and computational modelling of the disease.
MeSH term(s)	Aorta/physiology ; Computer Simulation ; Elasticity ; Hemodynamics ; Humans ; Models, Cardiovascular
Language	English
Publishing date	2015-04-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0124011
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Article ; Online: False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements.

Rudenick, Paula A / Segers, Patrick / Pineda, Victor / Cuellar, Hug / García-Dorado, David / Evangelista, Arturo / Bijnens, Bart H

PloS one

2017 Volume 12, Issue 1, Page(s) e0170888

Abstract: Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal ... ...

Abstract	Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal variations on FL flow patterns, as measured in a cross-section by phase-contrast magnetic resonance imaging (PC-MRI), could be used to infer integrated information on these features. In 33 patients with chronic descending AD, instantaneous flow profiles were quantified in the FL at diaphragm level by PC-MRI. We used a lumped-parameter model to assess the changes in flow profiles induced by wall stiffness, tear size/location, and the presence of abdominal side branches arising from the FL. Four characteristic FL flow patterns were identified in 31/33 patients (94%) based on the direction of flow in systole and diastole: BA = systolic biphasic flow and primarily diastolic antegrade flow (n = 6); BR = systolic biphasic flow and primarily diastolic retrograde flow (n = 14); MA = systolic monophasic flow and primarily diastolic antegrade flow (n = 9); MR = systolic monophasic flow and primarily diastolic retrograde flow (n = 2). In the computational model, the temporal variation of flow directions within the FL was highly dependent on the position of assessment along the aorta. FL flow patterns (especially at the level of the diaphragm) showed their characteristic patterns due to variations in the cumulative size and the spatial distribution of the communicating tears, and the incidence of visceral side branches originating from the FL. Changes in wall stiffness did not change the temporal variation of the flows whereas it importantly determined intraluminal pressures. FL flow patterns implicitly codify morphological information on key determinants of aortic expansion in ADs. This data might be taken into consideration in the imaging protocol to define the predictive value of FL flows.
MeSH term(s)	Adult ; Aged ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/physiopathology ; Aortic Aneurysm/diagnostic imaging ; Aortic Aneurysm/physiopathology ; Blood Flow Velocity/physiology ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Models, Cardiovascular ; Vascular Stiffness/physiology
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0170888
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