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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2019

Open Access 01-12-2019 | Myocardial Infarction | Research

Right ventricular shape and function: cardiovascular magnetic resonance reference morphology and biventricular risk factor morphometrics in UK Biobank

Authors: Charlène Mauger, Kathleen Gilbert, Aaron M. Lee, Mihir M. Sanghvi, Nay Aung, Kenneth Fung, Valentina Carapella, Stefan K. Piechnik, Stefan Neubauer, Steffen E. Petersen, Avan Suinesiaputra, Alistair A. Young

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2019

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Abstract

Background

The associations between cardiovascular disease (CVD) risk factors and the biventricular geometry of the right ventricle (RV) and left ventricle (LV) have been difficult to assess, due to subtle and complex shape changes. We sought to quantify reference RV morphology as well as biventricular variations associated with common cardiovascular risk factors.

Methods

A biventricular shape atlas was automatically constructed using contours and landmarks from 4329 UK Biobank cardiovascular magnetic resonance (CMR) studies. A subdivision surface geometric mesh was customized to the contours using a diffeomorphic registration algorithm, with automatic correction of slice shifts due to differences in breath-hold position. A reference sub-cohort was identified consisting of 630 participants with no CVD risk factors. Morphometric scores were computed using linear regression to quantify shape variations associated with four risk factors (high cholesterol, high blood pressure, obesity and smoking) and three disease factors (diabetes, previous myocardial infarction and angina).

Results

The atlas construction led to an accurate representation of 3D shapes at end-diastole and end-systole, with acceptable fitting errors between surfaces and contours (average error less than 1.5 mm). Atlas shape features had stronger associations than traditional mass and volume measures for all factors (p < 0.005 for each). High blood pressure was associated with outward displacement of the LV free walls, but inward displacement of the RV free wall and thickening of the septum. Smoking was associated with a rounder RV with inward displacement of the RV free wall and increased relative wall thickness.

Conclusion

Morphometric relationships between biventricular shape and cardiovascular risk factors in a large cohort show complex interactions between RV and LV morphology. These can be quantified by z-scores, which can be used to study the morphological correlates of disease.
Appendix
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Literature
1.
Dawber TR, Meadors GF, Moore FE Jr. Epidemiological approaches to heart disease: the Framingham study. Am J Public Health Nations Health. 1951;41:279–81.CrossRef
2.
Rosamond WD, Chambless LE, Folsom AR. Survival trends, coronary event rates, and the MONICA project. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999;354:864–5.CrossRef
3.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.CrossRef
4.
Chahal H, Johnson C, Tandri H, Jain A, Hundley WG, Barr RG, Kawut SM, Lima JA, Bluemke DA. Relation of cardiovascular risk factors to right ventricular structure and function as determined by magnetic resonance imaging (results from the multi-ethnic study of atherosclerosis). Am J Cardiol. 2010;106:110–6.CrossRef
5.
Chahal H, McClelland RL, Tandri H, Jain A, Turkbey EB, Hundley WG, Barr RG, Kizer J, Lima JA, Bluemke DA, Kawut SM. Obesity and right ventricular structure and function: the MESA-right ventricle study. Chest. 2012;141:388–95.CrossRef
6.
Petersen SE, Sanghvi MM, Aung N, Cooper JA, Paiva JM, Zemrak F, Fung K, Lukaschuk E, Lee AM, Carapella V, et al. The impact of cardiovascular risk factors on cardiac structure and function: insights from the UK biobank imaging enhancement study. PLoS One. 2017;12:e0185114.CrossRef
7.
Elzinga G, Piene H, de Jong JP. Left and right ventricular pump function and consequences of having two pumps in one heart. A study on the isolated cat heart. Circ Res. 1980;46:564–74.CrossRef
8.
Elzinga G, van Grondelle R, Westerhof N, van den Bos GC. Ventricular interference. Am J Phys. 1974;226:941–7.CrossRef
9.
Medrano-Gracia P, Cowan BR, Ambale-Venkatesh B, Bluemke DA, Eng J, Finn JP, Fonseca CG, Lima JAC, Suinesiaputra A, Young AA. Left ventricular shape variation in asymptomatic populations: the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson. 2014;16:56.CrossRef
10.
Gilbert K, Bai W, Mauger C, Medrano-Gracia P, Suinesiaputra A, Lee AM, Sanghvi MM, Aung N, Piechnik SK, Neubauer S, et al. Independent left ventricular morphometric atlases show consistent relationships with cardiovascular risk factors: a UK biobank study. Sci Rep. 2019;9:1130.CrossRef
11.
Zhang X, Cowan BR, Bluemcke DA, Finn JP, Fonseca CG, Kadish AH, Lee DC, Lima JAC, Suinesiaputra A, Young AA, Medrano-Gracia P. Atlas-based quantification of cardiac remodeling due to myocardial infarction. PLoS One. 2014;9:e110243.CrossRef
12.
Corden B, de Marvao A, Dawes TJ, Shi W, Rueckert D, Cook SA, O'Regan DP. Relationship between body composition and left ventricular geometry using three dimensional cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2016;18:32.CrossRef
13.
de Marvao A, Dawes TJ, Shi W, Durighel G, Rueckert D, Cook SA, O'Regan DP. Precursors of hypertensive heart phenotype develop in healthy adults: a high-resolution 3D MRI study. JACC Cardiovasc Imaging. 2015;8:1260–9.CrossRef
14.
Kawut SM, Barr RG, Lima JA, Praestgaard A, Johnson WC, Chahal H, Ogunyankin KO, Bristow MR, Kizer JR, Tandri H, Bluemke DA. Right ventricular structure is associated with the risk of heart failure and cardiovascular death: the multi-ethnic study of atherosclerosis (MESA)--right ventricle study. Circulation. 2012;126:1681–8.CrossRef
15.
Leary PJ, Kurtz CE, Hough CL, Waiss MP, Ralph DD, Sheehan FH. Three-dimensional analysis of right ventricular shape and function in pulmonary hypertension. Pulm Circ. 2012;2:34–40.CrossRef
16.
Morcos M, Sheehan FH. Regional right ventricular wall motion in tetralogy of fallot: a three dimensional analysis. Int J Cardiovasc Imaging. 2013;29:1051–8.CrossRef
17.
Dawes TJW, de Marvao A, Shi W, Fletcher T, Watson GMJ, Wharton J, Rhodes CJ, Howard L, Gibbs JSR, Rueckert D, et al. Machine learning of three-dimensional right ventricular motion enables outcome prediction in pulmonary hypertension: a cardiac MR imaging study. Radiology. 2017;283:381–90.CrossRef
18.
Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, Downey P, Elliott P, Green J, Landray M, et al. UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 2015;12:e1001779.CrossRef
19.
Petersen SE, Matthews PM, Francis JM, Robson MD, Zemrak F, Boubertakh R, Young AA, Hudson S, Weale P, Garratt S, et al. UK Biobank's cardiovascular magnetic resonance protocol. J Cardiovasc Magn Reson. 2016;18:8.CrossRef
20.
Petersen SE, Aung N, Sanghvi MM, Zemrak F, Fung K, Paiva JM, Francis JM, Khanji MY, Lukaschuk E, Lee AM, et al. Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK biobank population cohort. J Cardiovasc Magn Reson. 2017;19:18.CrossRef
21.
Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson. 2013;15:35.CrossRef
22.
Mauger C, Gilbert K, Suinesiaputra A, Pontre B, Omens J, McCulloch A, Young A. An iterative diffeomorphic algorithm for registration of subdivision surfaces: application to congenital heart disease. Conf Proc IEEE Eng Med Biol Soc. 2018;2018:596–9.PubMed
23.
Catmull E, Clark J. Recursively generated B-spline surfaces on arbitrary topological meshes. Comput Aided Des. 1978;10:350–5.CrossRef
24.
DeRose T, Kass M, Truong T. Subdivision surfaces in character animation. In: SIGGRAPH ‘98 proceedings of the 25th annual conference on computer graphics and interactive techniques; 1998. p. 85–94.CrossRef
25.
Hubka M, Bolson EL, McDonald JA, Martin RW, Munt B, Sheehan FH. Three-dimensional echocardiographic measurement of left and right ventricular mass and volume: in vitro validation. Int J Cardiovasc Imaging. 2002;18:111–8.CrossRef
26.
Prakash R. Determination of right ventricular wall thickness in systole and diastole. Echocardiographic and necropsy correlation in 32 patients. Br Heart J. 1978;40:1257–61.CrossRef
27.
Gilbert K, Cowan BR, Suinesiaputra A, Occleshaw C. Young AA: rapid D-affine biventricular cardiac function with polar prediction. In: Medical Image Computing and Computer-Assisted Intervention vol. LNCS 8674. Boston: Springer; 2014. p. 546–53.
28.
Jolliffe I. Principal component analysis. Hoboken: Wiley; 2005.
29.
Zou H, Hastie T. Regularization and variable selection via the elastic net. J R Stat Soc Ser B Methodol. 2005;67:301–20.CrossRef
30.
Davis J, Goadrich M. The relationship between precision-recall and ROC curves. In: Proceedings of the 23rd international conference on machine learning; 2006. p. 233–40.
31.
Saito T, Rehmsmeier M. The precision-recall plot is more informative than the ROC plot when evaluating binary classifiers on imbalanced datasets. PLoS One. 2015;10:e0118432.CrossRef
32.
Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. Hoboken: Wiley; 2013.
33.
Fluss R, Faraggi D, Reiser B. Estimation of the Youden index and its associated cutoff point. Biom J. 2005;47:458–72.CrossRef
34.
Kim HK, Kim YJ, Park JS, Kim KH, Kim KB, Ahn H, Sohn DW, Oh BH, Park YB, Choi YS. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol. 2006;98:236–42.CrossRef
35.
Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF. An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol. 1985;5:918–27.CrossRef
36.
Izumo M, Lancellotti P, Suzuki K, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Nobuoka S, et al. Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. Eur J Echocardiogr. 2009;10:961–7.CrossRef
37.
38.
Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC, Muller M. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77.CrossRef
39.
McLeish K, Hill DL, Atkinson D, Blackall JM, Razavi R. A study of the motion and deformation of the heart due to respiration. IEEE Trans Med Imaging. 2002;21:1142–50.CrossRef
40.
Kawut SM, Lima JA, Barr RG, Chahal H, Jain A, Tandri H, Praestgaard A, Bagiella E, Kizer JR, Johnson WC, et al. Sex and race differences in right ventricular structure and function: the multi-ethnic study of atherosclerosis-right ventricle study. Circulation. 2011;123:2542–51.CrossRef
41.
Yoneyama K, Venkatesh BA, Bluemke DA, McClelland RL, Lima JAC. Cardiovascular magnetic resonance in an adult human population: serial observations from the multi-ethnic study of atherosclerosis. J Cardiovasc Magn Reson. 2017;19:52.CrossRef
42.
Bove AA, Santamore WP. Ventricular interdependence. Prog Cardiovasc Dis. 1981;23:365–88.CrossRef
43.
Young AA, Orr R, Smaill BH, Dell'Italia LJ. Three-dimensional changes in left and right ventricular geometry in chronic mitral regurgitation. Am J Phys. 1996;271:H2689–700.
44.
Bai W, Shi W, de Marvao A, Dawes TJ, O'Regan DP, Cook SA, Rueckert D. A bi-ventricular cardiac atlas built from 1000+ high resolution MR images of healthy subjects and an analysis of shape and motion. Med Image Anal. 2015;26:133–45.CrossRef
45.
Frangi AF, Rueckert D, Schnabel JA, Niessen WJ. Automatic construction of multiple-object three-dimensional statistical shape models: application to cardiac modeling. IEEE Trans Med Imaging. 2002;21:1151–66.CrossRef
46.
Lorenzo-Valdés M, Sanchez-Ortiz GI, Mohiaddin R, Rueckert D. Atlas-based segmentation and tracking of 3D cardiac MR images using non-rigid registration. In: International conference on medical image computing and computer-assisted intervention. Berlin: Springer; 2002. p. 642–50.
47.
Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, Nikitin NP, Dubois-Rande JL, Hittinger L, Clark AL, Cleland JG. Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012;18:216–25.CrossRef
48.
Ambale-Venkatesh B, Yoneyama K, Sharma RK, Ohyama Y, Wu CO, Burke GL, Shea S, Gomes AS, Young AA, Bluemke DA, Lima JA. Left ventricular shape predicts different types of cardiovascular events in the general population. Heart. 2017;103:499–507.CrossRef
49.
Heckbert SR, Post W, Pearson GD, Arnett DK, Gomes AS, Jerosch-Herold M, Hundley WG, Lima JA, Bluemke DA. Traditional cardiovascular risk factors in relation to left ventricular mass, volume, and systolic function by cardiac magnetic resonance imaging: the Multiethnic Study of Atherosclerosis. J Am Coll Cardiol. 2006;48:2285–92.CrossRef
50.
Kaul S, Hopkins JM, Shah PM. Chronic effects of myocardial infarction on right ventricular function: a noninvasive assessment. J Am Coll Cardiol. 1983;2:607–15.CrossRef
51.
Fujii J, Yazaki Y, Sawada H, Aizawa T, Watanabe H, Kato K. Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two-dimensional Doppler echocardiographic method. J Am Coll Cardiol. 1985;5:1155–60.CrossRef
52.
Kono T, Sabbah HN, Rosman H, Alam M, Jafri S, Goldstein S. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol. 1992;20:1594–8.CrossRef
53.
Wong SP, French JK, Lydon AM, Manda SO, Gao W, Ashton NG, White HD. Relation of left ventricular sphericity to 10-year survival after acute myocardial infarction. Am J Cardiol. 2004;94:1270–5.CrossRef
54.
McLeod K, Wall S, Leren IS, Saberniak J, Haugaa KH. Ventricular structure in ARVC: going beyond volumes as a measure of risk. J Cardiovasc Magn Reson. 2016;18:73.CrossRef
55.
Bai W, Sinclair M, Tarroni G, Oktay O, Rajchl M, Vaillant G, Lee AM, Aung N, Lukaschuk E, Sanghvi MM, et al. Automated cardiovascular magnetic resonance image analysis with fully convolutional networks. J Cardiovasc Magn Reson. 2018;20:65.CrossRef
56.
Aung N, Sanghvi MM, Zemrak F, Cooper JA, Paiva JM, Thomson RJ, Fung K, Lukaschuk E, Lee A, Carapella V, et al. The Effect of Statin Therapy on Ventricular Structure and Functionas Assessed by Cardiovascular Magnetic Resonance (CMR): Insights from the UK Biobank. In: Sormani PAE, Varrenti M, Ranieri C, Spezzano T, Wu M, Briguglia D, Quattrocchi G, Milazzo A, Cipriani M, Oliva F, editors. QUICK FIRE ABSTRACTS-SESSION III European Heart Journal-Cardiovascular Imaging 2017 May 1;18(suppl_2):ii39–46; 2017.
Metadata
Title
Right ventricular shape and function: cardiovascular magnetic resonance reference morphology and biventricular risk factor morphometrics in UK Biobank
Authors
Charlène Mauger
Kathleen Gilbert
Aaron M. Lee
Mihir M. Sanghvi
Nay Aung
Kenneth Fung
Valentina Carapella
Stefan K. Piechnik
Stefan Neubauer
Steffen E. Petersen
Avan Suinesiaputra
Alistair A. Young
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2019
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-019-0551-6

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