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Open Access 01-12-2019 | Computed Tomography | Research article

Cardiac left ventricular myocardial tissue density, evaluated by computed tomography and autopsy

Authors: Alexandra G. Gheorghe, Andreas Fuchs, Christina Jacobsen, Klaus F. Kofoed, Rasmus Møgelvang, Niels Lynnerup, Jytte Banner

Published in: BMC Medical Imaging | Issue 1/2019

Abstract

Background

Left ventricular mass (LVM) is an independent risk factor for the prediction of cardiac events. Its assessment is a clinically important diagnostic procedure in cardiology and may be performed by Computed Tomography (CT). The aim of this study was to assess the correlation between the cardiac left ventricular shell volume (LVShV) determined by postmortem Computed Tomography (PMCT) and the anatomic LVM obtained at autopsy and to calculate the myocardial tissue density.

Methods

A total of 109 deceased individuals were examined with a 64-slice CT scanner and LVShV was determined. At autopsy, the left ventricle was dissected and weighted. The correlation between LVShV and the anatomic LVM was analysed. Asymmetric left ventricular (LV) hypertrophy was recorded. Inter-observer variability was evaluated, and a density value for myocardial tissue was calculated.

Results

The mean age of the deceased was 55 ± 16 years, and 58% was men. We found 30 cases of asymmetric LV hypertrophy. A highly positive correlation existed between LVShV and anatomic LVM (r = 0.857; p < 0.0001), regardless of hypertrophy, asymmetric hypertrophy and gender. The mean difference in the inter-observer variability for LVShV assessment was - 4.4 ml (95% CI: -26.4; 17.6). A linear regression analysis was performed, resulting in a value of 1.265 g/ml for myocardial tissue density. Applying the hitherto used myocardial tissue density of 1.055 g/ml underestimated the anatomic LVM by 18.1% (p < 0.0001).

Conclusion

PMCT is a helpful tool for the assessment of LVM, and LVShV is highly correlated with LVM as assessed by subsequent autopsy. The correlation between the two was independent of gender, hypertrophy and LV asymmetric hypertrophy. We found a higher myocardial tissue density of 1.265 g/ml compared to previous studies. We show that PMCT combined with autopsy may contribute not only to anatomical but also clinical knowledge.

Hoang K, Zhao Y, Gardin JM, Carnethon M, Mukamal K, Yanez D, et al. LV mass as a predictor of CVD events in older adults with and without metabolic syndrome and diabetes. JACC Cardiovasc Imaging. 2015;8:1007–15. https://doi.org/10.1016/j.jcmg.2015.04.019.CrossRefPubMedPubMedCentral

Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JAC. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging. 2012;5:837–48. https://doi.org/10.1016/j.jcmg.2012.06.003.CrossRefPubMedPubMedCentral

Litwin SE. Cardiac “Morphomics.”. JACC Cardiovasc Imaging. 2015;8:1016–8. https://doi.org/10.1016/j.jcmg.2015.06.008.CrossRefPubMed

Celebi AS, Yalcin H, Yalcin F. Current cardiac imaging techniques for detection of left ventricular mass. Cardiovasc Ultrasound. 2010;8:19.CrossRef

Udelson JE. Left ventricular shape. JACC: Heart Failure. 2017;5:179–81. https://doi.org/10.1016/j.jchf.2017.01.005.CrossRefPubMed

Emanuel R, Marcomichelakis J, Withers R, O’Brien K. Asymmetric septal hypertrophy and hypertrophic cardiomyopathy. Br Heart J. 1983;49:309.CrossRef

Losi M-A, Nistri S, Galderisi M, Betocchi S, Cecchi F, Olivotto I, et al. Echocardiography in patients with hypertrophic cardiomyopathy: usefulness of old and new techniques in the diagnosis and pathophysiological assessment. Cardiovasc Ultrasound. 2010;8:7.CrossRef

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. 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. 2005;18:1440–63. https://doi.org/10.1016/j.echo.2005.10.005.CrossRefPubMed

Fuchs A, Kühl JT, Lønborg J, Engstrøm T, Vejlstrup N, Køber L, et al. Automated assessment of heart chamber volumes and function in patients with previous myocardial infarction using multidetector computed tomography. Journal of Cardiovascular Computed Tomography. 2012;6:325–34. https://doi.org/10.1016/j.jcct.2012.01.006.CrossRefPubMed

10.

Fuchs A, Mejdahl MR, Kühl JT, Stisen ZR, Nilsson EJP, Køber LV, et al. Normal values of left ventricular mass and cardiac chamber volumes assessed by 320-detector computed tomography angiography in the Copenhagen general population study. Eur Heart J Cardiovasc Imaging. 2016;17:1009–17. https://doi.org/10.1093/ehjci/jev337.CrossRefPubMed

11.

Hindsø L, Fuchs A, Kühl JT, Nilsson EJP, Sigvardsen PE, Køber L, et al. Normal values of regional left ventricular myocardial thickness, mass and distribution-assessed by 320-detector computed tomography angiography in the Copenhagen general population study. Int J Card Imaging. 2017;33:421–9. https://doi.org/10.1007/s10554-016-1015-9.CrossRef

12.

Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.CrossRef

13.

Jackowski C, Schweitzer W, Thali M, Yen K, Aghayev E, Sonnenschein M, et al. Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI. Forensic Sci Int. 2005;149:11–23. https://doi.org/10.1016/j.forsciint.2004.05.019.CrossRefPubMed

14.

Masshoff W, Scheidt D, Reimers HF. Quantitative Bestimmung des Fett-und Myokardgewebes im Leichenherzen. Virchows Arch. 1967;342:184–9.CrossRef

15.

Stolzmann P, Scheffel H, Leschka S, Schertler T, Frauenfelder T, Kaufmann PA, et al. Reference values for quantitative left ventricular and left atrial measurements in cardiac computed tomography. Eur Radiol. 2008;18:1625–34. https://doi.org/10.1007/s00330-008-0939-4.CrossRefPubMed

16.

Lakatta EG, Mitchell JH, Pomerance A, Rowe GG. Human aging: changes in structure and function. J Am Coll Cardiol. 1987;10:42A–7A.CrossRef

17.

Reichek N, Devereux RB. Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings. Circulation. 1981;63:1391–8. https://doi.org/10.1161/01.CIR.63.6.1391.CrossRefPubMed

18.

Snyder WS, Cook MJ, Nasset ES, Karhausen LR, Howells GP. Tipton IH. Report of the Task Group on Reference Man. n.d.:112–7.

19.

Bardeen CR. Determination of the size of the heart by means of the x-rays. Dev Dyn. 1918;23:423–87.

20.

Bai R, Yu X, Wang D, Lv J, Xu G, Lai X. The densities of visceral organs and the extent of pathologic changes. Am J Forensic Med Pathol. 2009;30:148–51. https://doi.org/10.1097/PAF.0b013e3181875ab2.CrossRefPubMed

21.

Friedman CE. Heart volume, myocardial volume and total capacity of the heart cavities in certain chronic heart diseases; a clinic, roentgenologic and patho-anatomic investigation of the problem of cardiac hypertrophy and dilatation and amount of residual blood of the heart. Acta Medica Scand Suppl. 1951;257:1–100.

22.

de la Grandmaison GL, Clairand I, Durigon M. Organ weight in 684 adult autopsies: new tables for a Caucasoid population. Forensic Sci Int. 2001;119:149–54.CrossRef

23.

Gandy SJ, Waugh SA, Nicholas RS, Simpson HJ, Milne W, Houston JG. Comparison of the reproducibility of quantitative cardiac left ventricular assessments in healthy volunteers using different MRI scanners: a multicenter simulation. J Magn Reson Imaging. 2008;28:359–65. https://doi.org/10.1002/jmri.21401.CrossRefPubMed

24.

Takeuchi M, Nishikage T, Mor-Avi V, Sugeng L, Weinert L, Nakai H, et al. Measurement of left ventricular mass by real-time three-dimensional echocardiography: validation against magnetic resonance and comparison with two-dimensional and m-mode measurements. J Am Soc Echocardiogr. 2008;21:1001–5. https://doi.org/10.1016/j.echo.2008.07.008.CrossRefPubMed

25.

Banner J. SURVIVE: let the dead help the living—an autopsy-based cohort study for mapping risk markers of death among those with severe mental illnesses. Scandinavian journal of forensic science n.d.; 24/2018:7–17. https://doi.org/10.2478/sjfs-2018-0002.CrossRef

26.

Basso C, Burke M, Fornes P, Gallagher PJ, De Gouveia RH, Sheppard M, et al. Guidelines for autopsy investigation of sudden cardiac death. Pathologica. 2010;102:391–404.PubMed

27.

Bove KE, Rowlands DT, Scott RC. Observations on the assessment of cardiac hypertrophy utilizing a chamber partition technique. Circulation. 1966;33:558–68.CrossRef

28.

Lucena J, Garcia-Pavia P, Pulpon LA. Clinico-pathological atlas of cardiovascular diseases. vol. 2015. Springer International Publishing, Switzerland. 362 pages. page 210-215. ISBN 13:978-3319111452.

29.

Schiller NB, Skiôldebrand CG, Schiller EJ, Mavroudis CC, Silverman NH, Rahimtoola SH, et al. Canine left ventricular mass estimation by two-dimensional echocardiography. Circulation. 1983;68:210–6.CrossRef

30.

Manning WJ, Wei JY, Fossel ET, Burstein D. Measurement of left ventricular mass in rats using electrocardiogram-gated magnetic resonance imaging. Am J Phys Heart Circ Phys. 1990;258:H1181–6.

31.

Wyatt HL, Heng MK, Meerbaum S, Hestenes JD, Cobo JM, Davidson RM, et al. Cross-sectional echocardiography. I. Analysis of mathematic models for quantifying mass of the left ventricle in dogs. Circulation. 1979;60:1104–13.CrossRef

32.

Ward SR, Lieber RL. Density and hydration of fresh and fixed human skeletal muscle. J Biomech. 2005;38:2317–20. https://doi.org/10.1016/j.jbiomech.2004.10.001.CrossRefPubMed

33.

Juergens KU, Fischbach R. Left ventricular function studied with MDCT. Eur Radiol. 2006;16:342–57. https://doi.org/10.1007/s00330-005-2888-5.CrossRefPubMed

34.

Dykun I, Mahabadi AA, Lehmann N, Bauer M, Moebus S, Jöckel K-H, et al. Left ventricle size quantification using non-contrast-enhanced cardiac computed tomography--association with cardiovascular risk factors and coronary artery calcium score in the general population: the Heinz Nixdorf recall study. Acta Radiol. 2015;56:933–42. https://doi.org/10.1177/0284185114542996.CrossRefPubMed

35.

Zilg B, Thelander G, Giebe B, Druid H. Postmortem blood sampling-comparison of drug concentrations at different sample sites. Forensic Sci Int. 2017;278:296–303. https://doi.org/10.1016/j.forsciint.2017.07.006.CrossRefPubMed

36.

Penttilä A, Laiho K. Autolytic changes in blood cells of human cadavers. II. Morphological studies. Forensic Sci Int. 1981;17:121–32.CrossRef

Title: Cardiac left ventricular myocardial tissue density, evaluated by computed tomography and autopsy
Authors: Alexandra G. Gheorghe
Andreas Fuchs
Christina Jacobsen
Klaus F. Kofoed
Rasmus Møgelvang
Niels Lynnerup
Jytte Banner
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Computed Tomography
Autopsy
Computed Tomography
Published in: BMC Medical Imaging / Issue 1/2019
Electronic ISSN: 1471-2342
DOI: https://doi.org/10.1186/s12880-019-0326-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cardiac left ventricular myocardial tissue density, evaluated by computed tomography and autopsy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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