Cvi42

Manufactured by Circle Cardiovascular Imaging

Sourced in Canada, Germany

Cvi42 is a comprehensive cardiovascular imaging and analysis software suite developed by Circle Cardiovascular Imaging. It provides tools for the visualization, quantification, and interpretation of cardiovascular imaging data.

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Circle CVI42 (27 citations) Cvi42 v5.11 (13 citations) Cvi42 post-processing software (11 citations) CVI42 Tissue Tracking software (4 citations) CVI42®, version 5.2.1, (4 citations) Cvi42 postprocessing tool (3 citations) Cvi42 image analysis software (3 citations) Circle cvi42 v5.16 (2 citations)

291 protocols using cvi42

Cardiac Imaging Protocol for Myocardial Assessment

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LV function, global LV mass and maximal segmental LV wall thickness were analyzed using commercially available software (CVI42, version 4.1.8, Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada) according to standardized methods [25 (link)]. All the indices were corrected for body surface area. Hypertrophy was defined by an end-diastolic wall thickness equal or greater than 15 mm [1 (link)].
Two independent observers judged the presence of fibrosis visually and recorded LGE in terms of standard LV segments. Using commercially-available software, according to standardized methods, areas of scar were measured [26 (link)] (CVI42, version 4.1.8, Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada). A threshold of six standard deviations above the average signal of a remote and non-enhanced region was used to define overt scar [26 (link)].

Villa A.D., Sammut E., Zarinabad N., Carr-White G., Lee J., Bettencourt N., Razavi R., Nagel E, & Chiribiri A. (2016). Microvascular ischemia in hypertrophic cardiomyopathy: new insights from high-resolution combined quantification of perfusion and late gadolinium enhancement. Journal of Cardiovascular Magnetic Resonance, 18, 4.

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Cardiac MRI Reporting and Analysis Protocol

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Images were analysed using cvi42 (Circle Cardiovascular Imaging Inc., Version 5.11.4–1559, Calgary, Canada) with a provided typically 3-month ongoing licence to participating centres (two centres had pre-existing cvi42 licences). Scans were reported the same day by the local doctor, supported, and reviewed by the international visiting experts (final report signed-off by a doctor with a Level 2 or 3 CMR EACVI—ESC certification or equivalent).^{20 (link)} After the onsite intervention, the participating centres used other software (e.g. Osirix, ARGUS, and free online post-procession software for cardiac and iron T2* analysis—http://www.isodense.com/mcdcm/mviewer.html). Reporting was used as a training exercise during the educational conference, where indications for the scan and the anonymized images were shown and discussed with the attendees after the patients’ consent. Reports were translated into the local language where needed and incorporated into local medical records.

Menacho K.D., Ramirez S., Perez A., Dragonetti L., Perez de Arenaza D., Katekaru D., Illatopa V., Munive S., Rodriguez B., Shimabukuro A., Cupe K., Bansal R., Bhargava V., Rodriguez I., Seraphim A., Knott K., Abdel-Gadir A., Guerrero S., Lazo M., Uscamaita D., Rivero M., Amaya N., Sharma S., Peix A., Treibel T., Manisty C., Mohiddin S., Litt H., Han Y., Fernandes J., Jacob R., Westwood M., Ntusi N., Herrey A., Walker J.M, & Moon J. (2022). Improving cardiovascular magnetic resonance access in low- and middle-income countries for cardiomyopathy assessment: rapid cardiovascular magnetic resonance. European Heart Journal, 43(26), 2496-2507.

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Evaluating Biventricular Strain Reproducibility

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Sixty subjects were randomly selected from the study populations, and interobserver reproducibility of biventricular strain metrics assessed by both CMR-FT software packages (cvi⁴², Circle Cardiovascular Imaging and Medis Medical Imaging) was evaluated by two independent experienced researchers (GXL and YYG, with more than 3 and 5 years of experience in CMR, respectively). To assess intraobserver reproducibility, the datasets were measured by a researcher (GXL) for the second time using the same method with a time interval of more than a month. In addition, we further examined the reproducibility of biventricular global strain measurements assessed by the manual contouring method used in the present study and the automatic contouring method provided by cvi⁴² software.
To assess the inter-scanner reproducibility of strain measurements, we re-recruited 20 healthy individuals to determine whether the obtained reference values were dependent on CMR scanner. Written informed consent was provided by all subjects. Each of the subjects underwent CMR examinations on the same day with the two CMR scanners using the same protocols as described. GRS, GCS, and GLS of both ventricles were measured by the first author (G.X. L) using cvi⁴² software (Circle Cardiovascular Imaging) based on the same method described above.

Li G., Zhang Z., Gao Y., Zhu C., Zhou S., Cao L., Zhao Z., Zhao J., Ordovas K., Lou M., Li K, & Pohost G.M. (2022). Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study. Journal of Cardiovascular Magnetic Resonance, 24, 63.

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Benchmarking Cardiac MRI Segmentation Precision

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Scan-rescan precision was measured using an independent dataset intended for benchmarking segmentations (we make these freely available at www.thevolumesresource.com) obtained on 109 subjects who were scanned, then removed from the scanner before being scanned again. The dataset contains multiple pathologies (32 myocardial infarctions, 17 LV hypertrophy, 17 cardiomyopathy, 8 cardio-oncology patients, 5 with chronic kidney disease, 30 healthy subjects), scanned at two field strengths at five institutions, as previously described [13 (link)].
A benchmark for human precision was obtained from segmentations performed by clinicians. First, all scan and rescan studies were combined into a single pool and presented in a randomized order to two trainees (YY, CL, 1–2 years CMR experience) and one expert (JCM, > 15 years CMR experience) who segmented each one using cvi42 software (version 5.3.8, Circle Cardiovascular Imaging)—using the semi-automated threshold tool with freehand correction and the mitral valve plane correction option enabled [13 (link)]. A further benchmark was obtained from the fully automated deep learning tool from a commercial software package (cvi42, version 5.11, Circle Cardiovascular Imaging).

Davies R.H., Augusto J.B., Bhuva A., Xue H., Treibel T.A., Ye Y., Hughes R.K., Bai W., Lau C., Shiwani H., Fontana M., Kozor R., Herrey A., Lopes L.R., Maestrini V., Rosmini S., Petersen S.E., Kellman P., Rueckert D., Greenwood J.P., Captur G., Manisty C., Schelbert E, & Moon J.C. (2022). Precision measurement of cardiac structure and function in cardiovascular magnetic resonance using machine learning. Journal of Cardiovascular Magnetic Resonance, 24, 16.

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Quantitative Cardiac MRI Analysis

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CMR analysis was performed quantitatively offline by a single operator (CS) blinded to clinical data and scanning order. Analysis was performed using commercially available software (Cvi42, Circle Cardiovascular Imaging, Calgary, Canada). LV volumes and LVEF were calculated by the summation of discs method^{15 (link)}.
LGE images were visually reviewed for the presence or absence of LGE by at least two observers blinded to clinical data (CS/LB/SP/PS, Figure 2). Presence of ischaemic and non-ischaemic patterns of myocardial fibrosis was assessed according to previously published work^{17 (link)}. Semi-automated quantification of LGE was then performed using a threshold of 5 standard deviations (5SD) of signal intensity of the remote myocardium^{18 (link)}. Strain parameters were calculated using feature tracking software (Cvi42, Circle Cardiovascular Imaging, Calgary, Canada) and used to determine a mechanical dyssynchrony index (MDI) (Data Supplement).

Saunderson C.E., Paton M.F., Brown L.A., Gierula J., Chew P.G., Das A., Sengupta A., Craven T.P., Chowdhary A., Koshy A., White H., Levelt E., Dall’Armellina E., Garg P., Witte K.K., Greenwood J.P., Plein S, & Swoboda P.P. (2021). Detrimental Immediate- and Medium-Term Clinical Effects of Right Ventricular Pacing in Patients With Myocardial Fibrosis. Circulation. Cardiovascular Imaging, 14(5), e012256.

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Cardiac MRI Protocol for Right Ventricular Assessment

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All study MRIs are performed at a core MRI facility on a single Siemens 1.5T Aera with full Advanced Cardiac Package and XQ Gradients (45 mT/m @ 200 T/m/s) regularly used for research grade imaging. All MRI measurements are made using commercially available cardiac MRI software (CVI42, Circle Cardiovascular Imaging). Longitudinal and circumferential strain will be determined using standard cine imaging and Tissue Tracking (Strain) software (Tissue Tracking plugin—CVI42, circle cardiovascular imaging) at study completion to avoid batch effects. In addition to RV longitudinal strain, we will measure RV fibrosis with T1 mapping as well as standard measures of RV function including RV ejection fraction (RVEF), RV end-diastolic mass, and volumes (stroke volume, end-systolic volume, end-diastolic volume). After study visits with MRI, a single expert reader performs quality assurance/quality control (QA/QC) on image acquisition. The same single expert reader blinded to participant and study visits will read studies for the primary end point (RV longitudinal strain) and fibrosis (on T1 images) in randomly sequenced batches at the study’s conclusion. Ten percent of the MRI studies will be reassessed by a second expert reader for intra-reader and inter-reader reliability estimates of all measured parameters.

Walsh T.P., Baird G.L., Atalay M.K., Agarwal S., Arcuri D., Klinger J.R., Mullin C.J., Morreo H., Normandin B., Shiva S., Whittenhall M, & Ventetuolo C.E. (2021). Experimental design of the Effects of Dehydroepiandrosterone in Pulmonary Hypertension (EDIPHY) trial. Pulmonary Circulation, 11(2), 2045894021989554.

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Unblinded Analysis of Cardiac MRI Data

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PSR performed unblinded analysis of all the CMR data using commercially available software [cvi42, Circle Cardiovascular Imaging, version 5.11.2 (1497)]. Semi-automated, artificial intelligence assisted endocardial and epicardial left ventricular (LV) and right ventricular (RV) borders were traced at end-systole and end-diastole to determine LV volumes and mass. Papillary muscles were excluded from the LV blood pool. Body surface area was calculated using the Mosteller formula [square root of (height (cm) x weight (kg)/3600)]. LV wall thickness was measured at the heart base in short axis. The LV sphericity index (SI) was calculated to evaluate the LV geometry [19 (link)] as follows: Midventricular length (A) divided by longitudinal length (B) (Fig. 1). The average SI from these two imaging planes were calculated. The midventricular level was determined by halving the measurement from the middle of the annular plane to the apex.Fig. 1

Measurements used to calculate the sphericity index in the 4 chamber (left) and 2 chamber (right) imaging planes

MAT re-read 10% of the cohort (n = 15) in a random and blinded fashion to assess the inter-reader variability within the study. PGH supervised the CMR analysis and reviewed key findings and measurements. He was blinded to the clinical information. PSR and MAT both have 3 years and PGH has 7 years’ experience in formal CMR analysis.

Robbertse P.P., Doubell A.F., Steyn J., Lombard C.J., Talle M.A, & Herbst P.G. (2022). Altered cardiac structure and function in newly diagnosed people living with HIV: a prospective cardiovascular magnetic resonance study after the initiation of antiretroviral treatment. The International Journal of Cardiovascular Imaging, 39(1), 169-182.

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Left Atrial Function Assessment Protocol

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Total LA‐EF is divided into two parts⁸:

Conduit EF: passive atrial emptying starts with atrioventricular‐valve opening.

Booster pump EF: active contractile atrial emptying (which is lost in AF), ends with atrioventricular‐valve closure.

Left atrial chamber evaluation was performed offline on a remote workstation with commercially available software (cvi42, Circle Cardiovascular Imaging Inc, Calgary, Alberta, Canada). The LA endocardial border and long axis diameter were drawn in a four‐chamber and two‐chamber view.¹¹, ¹⁴ The maximum volume, minimum volume, and the volume before LA contraction (if in SR), each indexed for the body surface area (LAVi) and consecutive conduit; booster pump; and total LA‐EF were then calculated using the biplane area‐length formula. This process was repeated three times, and average values were calculated for further analysis.

Schönbauer R., Kammerlander A.A., Duca F., Aschauer S., Koschutnik M., Dona C., Nitsche C., Loewe C., Hengstenberg C, & Mascherbauer J. (2021). Prognostic impact of left atrial function in heart failure with preserved ejection fraction in sinus rhythm vs. persistent atrial fibrillation. ESC Heart Failure, 9(1), 465-475.

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Assessing LV Dyssynchrony and Artefacts in LGE Imaging

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Semi-automatic analysis of circumferential strain was performed using cvi42^® [Release 5.13.5 (2190), Circle Cardiovascular Imaging, Alberta, Canada]. The endocardial and epicardial contours were automatically registered by the software on short-axis CINE images covering the left ventricle. All contours were checked by two experienced readers. Whenever manual correction of the contours was necessary, it was performed by consensus by the readers. The global SDI (SDI_global), defined as the standard deviation of the segmental time to maximum strain for segments 1–16 normalised to the length of the cardiac cycle and given in time percentage, was used to determine the severity of LV dyssynchrony and to correlate dyssynchrony with the frequency of artefacts identified in LGE imaging (21 (link)).
To further account for LV dyssynchrony due to delayed free wall contraction and associated septal deformation due to stretching in early systole, we investigated two additional new SDI:
The time required for strain analysis was less than 5 min and did not differ between patients and controls.

Petersen A., Nagel S.N., Hamm B., Elgeti T, & Schaafs L.A. (2022). Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging. Frontiers in Cardiovascular Medicine, 9, 977414.

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Cardiac Strain Analysis Protocol

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The strain values were calculated utilizing the cvi42 (Circle Cardiovascular Imaging, Calgary, Alberta, Canada) version 5.6.2 (634). The endocardial and epicardial borders of both ventricles were delineated manually at the end-diastolic frame in 2-, 3-, 4-chamber views and all short-axis stacks for the left ventricle (LV) as well as 4-chamber and short-axis images for the right ventricle (RV). Three-dimensional LV and 2D RV strain values were extracted after the propagation of the contours during the entire cardiac cycle. For both ventricles, the absolute values of the global longitudinal strain (GLS), the global circumferential strain (GCS), and the global radial strain (GRS) were assessed. Furthermore, in CA patients, GLS was evaluated in the LV basal, mid, and apical levels (Figure 3). All the patients were stable hemodynamically with euvolemic status during the CMR examination.

Asadian S., Farzin M., Tabesh F., Rezaeian N., Bakhshandeh H., Hosseini L., Toloueitabar Y, & Hemmati Komasi M.M. (2021). The Auxiliary Role of Cardiac Magnetic Resonance Feature-Tracking Parameters in the Differentiation between Cardiac Amyloidosis and Constrictive Pericarditis. Cardiology Research and Practice, 2021, 2045493.

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