Response by Jablonowski et al to Letter Regarding Article, “Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone: Comparison of Four Analysis Methods”

HomeCirculation: Cardiovascular ImagingVol. 11, No. 1Response by Jablonowski et al to Letter Regarding Article, "Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone: Comparison of Four Analysis Methods" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by Jablonowski et al to Letter Regarding Article, "Cardiovascular Magnetic Resonance to Predict Appropriate Implantable Cardioverter Defibrillator Therapy in Ischemic and Nonischemic Cardiomyopathy Patients Using Late Gadolinium Enhancement Border Zone: Comparison of Four Analysis Methods" Robert Jablonowski, MD, PhD Uzma Chaudhry, MBBS and Jesper van der Pals, MD, PhD Henrik Engblom, MD, PhD and Håkan Arheden, MD, PhD Einar Heiberg, PhD Katherine C. Wu, MD Rasmus Borgquist, MD, PhD Marcus Carlsson, MD, PhD Robert JablonowskiRobert Jablonowski Clinical Physiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Uzma ChaudhryUzma Chaudhry Cardiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden and Jesper van der PalsJesper van der Pals Cardiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Henrik EngblomHenrik Engblom Clinical Physiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden and Håkan ArhedenHåkan Arheden Clinical Physiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Einar HeibergEinar Heiberg Clinical Physiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Katherine C. WuKatherine C. Wu Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD Rasmus BorgquistRasmus Borgquist Cardiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Marcus CarlssonMarcus Carlsson Clinical Physiology, Department of Clinical Sciences, Lund University, Lund University Hospital, Lund, Sweden Originally published5 Jan 2018https://doi.org/10.1161/CIRCIMAGING.117.007333Circulation: Cardiovascular Imaging. 2018;11:e007333In Response:We thank Guaricci et al for their interest in our study1 to find a late gadolinium enhancement (LGE) cardiovascular magnetic resonance characteristic as a predictor of implantable cardioverter defibrillator therapy. Below, we have addressed the concerns raised about certain technical aspects of the study.Guaricci et al state that acquisition of LGE using different schemes (2-dimensional [2D] and 3D acquisition) in the current study1 should be considered a limitation. In this context, Guaricci et al discuss the result from a previous validation study2 from our group, and refer to the use of 8 SD from remote myocardium for infarct quantification as a problem. This previous validation study from 20132 included 2D phase sensitive inversion recovery (PSIR) and 3D-IR in patients with ischemic cardiomyopathy as well as experimentally induced infarction in a pig model, including high-resolution ex vivo T1-weighted imaging of infarction. Eight SD was used for infarct quantification in the high-resolution ex vivo images and not for the clinical in vivo analysis in patients, where a previously validated infarct quantification algorithm was used.3 For the in vivo infarct quantification an excellent agreement between the 2D- and 3D-LGE sequences was shown (r=0.94; bias, 0.16±2.0% scar), justifying pooling of 2D- and 3D-LGE data in the current study1 using the same 2D- and 3D-LGE sequences. In terms of LGE quantification in the current study,1 the weighted border zone algorithm3 was one of the 4 algorithms tested.Furthermore, Guaricci et al comment on the technical differences between IR and PSIR images in both 2D- and 3D-LGE sequences and how this may lead to variable quantification of LGE, possibly affecting our results. This was investigated in another validation paper from our group where Engblom et al4 validated the automatic LGE quantification algorithm EWA (expectation maximization, weighted intensity, a priori information) in multicenter, multivendor patient data and experimentally against triphenyltetrazolium-chloride staining and high-resolution T1-weighted images. The study showed that in multicenter patient data, infarct size by the EWA algorithm showed a bias to expert delineation of −2 ± 6% LVM in IR images (n=124) and 0±5% LVM in PSIR images (n=49). In the experimental validation part, infarct size by the EWA algorithm in vivo in pigs showed a bias to ex vivo triphenyltetrazolium-chloride of −1±4% LVM in IR and −2±3% LVM in PSIR images. Thus, from our experience from multicenter, multivendor data, and in vivo experimental data LGE quantification using the EWA algorithm in both IR and PSIR LGE images yield similar LGE size. The EWA algorithm was 1 of the 4 algorithms tested in the current study.1In summary, 2D- and 3D-LGE sequences used in the current study1 have been validated in previous study and shown good agreement, facilitating the design of the study.Robert Jablonowski, MD, PhDClinical Physiology, Department of Clinical Sciencesund University, Lund University HospitalLund, SwedenUzma Chaudhry, MBBSJesper van der Pals, MD, PhDCardiology, Department of Clinical SciencesLund University, Lund University HospitalLund, SwedenHenrik Engblom, MD, PhDHåkan Arheden, MD, PhDClinical Physiology, Department of Clinical SciencesLund University, Lund University HospitalLund, SwedenEinar Heiberg, PhDClinical Physiology, Department of Clinical SciencesLund University, Lund University HospitalLund, SwedenKatherine C. Wu, MDDivision of Cardiology, Department of MedicineJohns Hopkins Medical InstitutionsBaltimore, MDRasmus Borgquist, MD, PhDCardiology, Department of Clinical SciencesLund University, Lund University HospitalLund, SwedenMarcus Carlsson, MD, PhDClinical Physiology, Department of Clinical SciencesLund University, Lund University HospitalLund, SwedenDisclosuresDr Heiberg is founder and owner of Medviso AB producing the Segment software for medical image analysis. Dr Arheden is stockholder of Imacor AB. Drs Engblom and Carlsson have received consultancy fees from Imacor AB. The other authors report no conflicts.References1. Jablonowski R, Chaudhry U, van der Pals J, Engblom H, Arheden H, Heiberg E, Wu KC, Borgquist R, Carlsson M. Cardiovascular magnetic resonance to predict appropriate implantable cardioverter defibrillator therapy in ischemic and nonischemic cardiomyopathy patients using late gadolinium enhancement border zone: comparison of four analysis methods.Circ Cardiovasc Imaging. 2017; 10:e006105. doi: 10.1161/CIRCIMAGING.116.006105.LinkGoogle Scholar2. Jablonowski R, Nordlund D, Kanski M, Ubachs J, Koul S, Heiberg E, Engblom H, Erlinge D, Arheden H, Carlsson M. Infarct quantification using 3D inversion recovery and 2D phase sensitive inversion recovery; validation in patients and ex vivo.BMC Cardiovasc Disord. 2013; 13:110. doi: 10.1186/1471-2261-13-110.CrossrefMedlineGoogle Scholar3. Heiberg E, Ugander M, Engblom H, Götberg M, Olivecrona GK, Erlinge D, Arheden H. Automated quantification of myocardial infarction from MR images by accounting for partial volume effects: animal, phantom, and human study.Radiology. 2008; 246:581–588. doi: 10.1148/radiol.2461062164.CrossrefMedlineGoogle Scholar4. Engblom H, Tufvesson J, Jablonowski R, Carlsson M, Aletras AH, Hoffmann P, Jacquier A, Kober F, Metzler B, Erlinge D, Atar D, Arheden H, Heiberg E. A new automatic algorithm for quantification of myocardial infarction imaged by late gadolinium enhancement cardiovascular magnetic resonance: experimental validation and comparison to expert delineations in multi-center, multi-vendor patient data.J Cardiovasc Magn Reson. 2016; 18:27. doi: 10.1186/s12968-016-0242-5.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails January 2018Vol 11, Issue 1 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.117.007333PMID: 29305351 Originally publishedJanuary 5, 2018 PDF download Advertisement SubjectsCatheter Ablation and Implantable Cardioverter-DefibrillatorImagingMagnetic Resonance Imaging (MRI)