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Kiss A, Szucs A, Gregor ZS, Toth A, Furak A, Horvath M, Czimbalmos CS, Dohy ZS, Szabo L, Suhai FI, Merkely B, Vago H. P1824 Feature tracking strain values of noncompaction cardiomyopathy patients: differences in the light of ejection fraction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Feature tracking (FT) is a new cardiac magnetic resonance (CMR) technique for strain measurement which may give additional information about the progression of noncompaction cardiomyopathy (NCMP).
First in the literature, we compared the strain and functional parameters of NCMP patients with reduced (R) and good (G) ejection fraction (EF) using CMR-FT.
From the total of 164 CMR proven R NCMP patients, who were examined between 2009 and 2018 at the Heart and Vascular Center of Semmelweis University, we selected 26 non-ischaemic, contrast agent-free examinations (age: 56 ± 10.6 years; EF: 32.7 ± 10.0%; male = 19). According to their EF they were divided into medium (M; EF: 35-50%; n = 10) and significantly reduced EF (SR; EF <35%; n = 16) subgroups. We searched 25 NCMP patients with good EF (age: 37 ± 14.4 years; EF: 65.9 ± 5.3%; male = 16) and 26 control persons (age: 52 ± 10.7 years; EF: 70.8 ± 5.1%; male = 16) to the above mentioned groups.
The Medis Suite program was used for analysis and the MedCalc software for statistics, (p < 0.05).
Significant differences were found between the functional parameters of R and G patients. The global longitudinal strain (GLS) and global circumferential strain (GCS) values of the R group were decreased significantly compared to G and C groups. (R vs G; GLS: -9.5 ± 4.3 vs -20.9 + 3.2%; GCS: -12.5 ± 6.1 vs -30.5 ± 5.0%, p < 0.0001; R vs C; GLS: -9.5 ± 4.3 vs -23.3 ± 4.4%; GCS: -12.5 ± 6.1 vs -35.6 ± 5.1%, p < 0.0001).
All the segmental strain values of R group were decreased compared to G and C groups, moreover this significancy was observed between the M and SR subgroups as well.
The strain values of the R group in all the basal, mid and apical part of the left ventricle (LV) were reduced equally.
The average longitudinal strain values of the apical part of the LV in the SR subgroup were significantly reduced compared to the average strains of the basal part (apical vs basal: -8.9 ± 3.0 vs -11.9 ± 4.4 %, p < 0.05). In addition, we found positive correlation in the R subgroup between the GCS and the mass of trabeculated muscle (r = 0.58, p = 0.002) .
Our study shows that the global and segmental strain values decreased significantly in proportion to the reduction of the EF which describes well the progression of heart failure in NCMP. However, the decreased strain values of the hypertrabeculated apical part might be specific to NCMP.
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Czimbalmos C, Csecs I, Dohy Z, Toth A, Suhai F, Szabo L, Horvath V, Sydo N, Kiss O, Becker D, Merkely B, Vago H. P4429Cardiac magnetic resonance characteristics of professional athletes and hypertrophic cardiomyopathy patients in the grey zone of hypertrophy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Differentiation between athlete's heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy.
We aimed to determine conventional cardiac magnetic resonance (CMR) parameters such as left ventricular (LV) ejection fraction (EF), BSA-corrected end-diastolic (EDVi), end-systolic and stroke volume (SVi), mass (Mi), derived CMR parameters such as maximal end-diastolic wall thickness to LVEDVi ratio (EDWT/LVEDVi), LVM to LVEDV ratio (LVM/LVEDV), and CMR based strain values (global longitudinal (GLS), radial (GRS) and circumferential strain (GCS)) in male HCM patients and athletes.
We consecutively enrolled male HCM patients with only slightly elevated EDWT (13–18 mm) and highly trained healthy athletes (n=30, 18.7±1.2 training hrs/week) with marked LV hypertrophy. HCM patient group was divided into sedentary (n=30, <7 training hrs/week) and athletic HCM group (n=10; >7 h/week, 12.7±7.3 h training hrs/week).
Both sedentary and athletic HCM patients showed higher LVEF, lower LVEDVi and LVESVi and higher EDWT compared to the healthy athletes. LVMi of both healthy athletes and athletic HCM patients was significantly higher than in sedentary HCM patients, respectively (98.9±11.4; 94.5±7.8 vs 78.1±14.4 /m2). EDWT/LVEDVi ratio was higher in both sedentary and athletic HCM patients compared to healthy athletes, respectively (0.19±0.04; 0.17±0.04 vs 0.11±0.02). LVM/LVEDV also showed significant difference between HCM patients and healthy athletes. GLS and GRS showed no significant difference between the three groups, GCS was higher in athletic HCM compared to healthy athletes (−20.7±2.2 vs −17.8±2.3%).
Figure 1. Feature tracking analysis of a healthy athlete and a patient with HCM.
CMR characteristics of athletic and sedentary HCM may fundamentally alter. Our preliminary data suggest that besides conventional CMR parameters, derived parameters such as EDWT/LVEDVi and LVM/LVEDV ratios and deformation imaging may also help the differentiation between pathological and physiological hypertrophy.
Acknowledgement/Funding
National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277). Project no. NVKP_16-1-2016-0017
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Vago H, Szabo L, Horvath V, Dohy Z, Czimbalmos C, Toth A, Suhai F, Barczi GY, Becker D, Merkely B. 2388Differential diagnosis of MINOCA patients: the contribution of early cardiac magnetic resonance imaging to the final diagnosis in patients with normal coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The diagnostic value of cardiac magnetic resonance (CMR) imaging has been suggested in determination of the cause behind Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). According to the current STEMI Guideline CMR is considered to have the best diagnostic performance, when CMR timing is within its optimal ≤2 weeks.
Purpose
The aim of our study was to establish the prevalence of the underlying pathologies using early (1–7 days) CMR examination in patients with signs of troponin positive acute coronary syndrome (ACS) but normal coronary angiography (NCA). We also aimed to investigate how early CMR changes the provisional diagnosis, and to provide detailed information of CMR characteristics of our pts and to compare laboratory parameters and risk factors of each group.
Methods
Between 2010–2018 (n=234) consecutive pts (40.2±12.1y, 159 male) with troponin positive ACS underwent CMR examination following NCA (≤20% stenosis), in a mean length of time of 2.5 days. Cine movie, T2-weighted and late gadolinium enhanced images (LGE) were performed. Left ventricular end-diastolic and end-systolic volumes (LVESVi), ejection fraction (LVEF), mass (LVM) and myocardial necrosis were evaluated. We analysed the risk factors and laboratory values of our patients.
Results
CMR proved acute myocardial infarction (MI) in 42 pts (52% male), acute myocarditis in 138 pts (89% male), Tako-Tsubo cardiomyopathy (TTC) in 25 woman, myocardial contusion in one case, in three cases CMR raised the suspicion of sarcoidosis and in 25 pts (56% male) there was no CMR abnormality. LVEF was lower, LVESVi was elevated in TTC patients compared to MI and myocarditis (LVEF: 44±9.1 vs 56.5±7 vs 55±6.6%; LVESVi: 52.5±12.9 vs 41±16.8 vs 42.1±8.9 ml/m2 p<0.001). The most frequently affected areas of the myocardium by LGE were the basal and mid inferolateral segments in case of myocarditis (69% of pts). In MI pts the anterior wall was affected only in 16%, while the involvement of inferior wall was visible in 57% of the pts. Early CMR examination established a definitive diagnosis in 88% of the cases, in 11% there was no CMR abnormality and it remained inconclusive in only 1% of the cases. CMR changed the provisional diagnosis in 47% of the pts.
Myocarditis pts were younger (myocarditis: 32.5±10.8 vs MI 47.6±15.5 vs TTC 65.5±9.6 y; p<0.001) and lower percentage had hypercholesterinaemia (myocarditis: 18.8 vs MI: 40 vs TTC: 54.5%, p<0.01) or hypertension (myocarditis: 14.3 vs MI: 38.7 vs TTC: 55.6%, p<0.001). Laboratory values showed significant elevation of hsTroponin and CKMB of MI and myocarditis pts compared to other groups (p<0.05), but there was no difference between these two groups.
Underlying pathologies in MINOCA
Conclusion
In patients with the working diagnosis of MINOCA and normal coronary angiography early CMR established a definitive diagnosis in 88% of our patients and changed the provisional diagnosis in 47% of the pts.
Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary
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Szabo L, Horvath V, Dohy Z, Czimbalmos C, Toth A, Suhai F, Barczi G, Becker D, Merkely B, Vago H. P876Cardiac magnetic resonance based feature-tracking myocardial strain analysis in MINOCA patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The diagnostic performance of cardiac magnetic resonance (CMR) based deformation imaging (feature tracking - FT) has been demonstrated in various groups of patients including acute myocardial infarction and acute myocarditis. However, the capability of this method to distinguish between patients with the working diagnosis of MINOCA is yet to be tested.
We aimed to compare standard CMR parameters and investigate the differential diagnostic value of CMR-FT myocardial strain in pts with the working diagnosis of MINOCA.
From our consecutive register of pts with troponin positive acute coronary syndrome (n=234 pts) we enrolled 100 pts (47.7±14 y; 51 male) in this study.Twenty-five pts were selected randomly from each group of acute myocardial infarction (MI), acute myocarditis, Tako-Tsubo cardiomyopathy (TTC) and pts without structural alteration on CMR, and an additional group of healthy control (n=20, 46±8.2 y; 12 male). Standard CMR parameters such as left ventricular ejection fraction (LVEF), end-diastolic (LVEDVi) and end-systolic (LVESVi) volumes, myocardial mass were assessed and compared between the groups. We performed CMR-FT analysis of the left ventricle, including: global longitudinal (GLS), circumferential (GCS), standard deviation (SD) of the peak circumferential (CS) strain furthermore mechanical dispersion (MD), defined as the SD of the time-to-peak circumferential (MDC) strain of the LV segments expressed as percent of the cardiac cycle.
LVEF was lower (44±9.1%) and LVESVi (52.5±12.9ml/m2) was higher in TTC pts compared to all other groups (p<0.001). The LVEF, LVEDVi and LVESVi parameters did not show significant difference between MI and myocarditis pts (LVEF 56.5±7% vs 55±6.6%; LVEDVi 85.4±14.8 vs 92.7±10.7ml/m2; LVESVi 37.7±11.4 vs 41.5±9.1ml/m2). GLS and GRS were significantly reduced in TTC pts (−11.4±4.8%; 43.09±12.5%) compared to all other groups (p<0.001). GCS was impaired in pts with TTC, acute myocarditis and MI compared to healthy controls (−14±3.7 vs −18.7±3.7 vs −19.1±3.8 vs −23.2±3.1%, p<0.001), however there was no significant difference between myocarditis and MI pts. SD of the peak CS was lower in myocarditis compared to other groups (p<0.001). MDC was elevated in TTC and MI compared to myocarditis and healthy controls (16.3±5 vs 13.3±3.4 vs 8.1±3.3 vs 9.46±3.5% p<0.05). There was no significant difference between healthy controls and patients without structural alterations in any strain parameter.
Strain analysis of a TTC patient
Feature tracking analysis may enable differentiation between patients with MINOCA. TTC reduces global myocardial strain of the left ventricle and causes regional heterogeneity of the left ventricular contraction. Although standard volumetric CMR parameters and CMR based global strain values have limited capability to distinguish between MI and myocarditis with preserved ejection fraction, regional heterogeneity, expressible in MDC is significantly elevated in MI compared to myocarditis and healthy controls.
Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary
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Szabo L, Czimbalmos CS, Dohy Z, Csecs I, Toth A, Suhai F, Becker D, Geller L, Merkely B, Vago H. P1528The added value of cardiac magnetic resonance to the diagnosis of patients after aborted sudden cardiac death. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
An estimated 25% of all cardiovascular deaths are due to sudden cardiac death (SCD). The primary cause of SCD is coronary artery disease, however cardiac diseases accounted for SCD differ in young vs. older individuals. In patients with normal coronary angiography (NCA) the differential diagnosis is still challenging, due to the broad spectrum of underlying cardiovascular abnormalities. Cardiac magnetic resonance (CMR) provides accurate tissue specific and functional information of the heart.
Purpose
We aimed to investigate patients after aborted sudden cardiac death but NCA using cardiac magnetic resonance imaging (CMR). Our goal was to evaluate left and right ventricular parameters, presence of late gadolinium enhancement (LGE) and to assess the diagnostic value of CMR.
Methods
We enrolled 84 consecutive patients (39±13 y; 51% male) after aborted SCD with NCA and without CMR contraindication. CMR examination including long- and short-axis cine, T2-weighted and LGE images were performed. Left and right ventricular parameters were evaluated. Presence and pattern of the oedema and LGE were also assessed.
Results
Structural myocardial abnormality was present in 57% of pts: dilated (n=13), arrhythmogenic right ventricular (n=6) and hypertrophic (n=4) cardiomyopathy (CMP), moreover acute (n=2) and chronic (n=3) myocardial infarction, acute (n=2) and chronic (n=2) myocarditis, Tako-Tsubo CMP (n=1), noncompaction CMP (n=1), endomyocardial fibrosis (n=1). In 13 cases aspecific structural alterations were detected with (n=7) and without (n=6) LGE. Only 13% of the patients showed ejection fraction lower than 35% (LVEF=52±9%), 54% showed LV dilation (LVEDVi>100 ml/m2 in males and >90 ml/m2 in females; LVEDVi=104±22 ml/m2). LGE was present in 36%, showing ischemic pattern in five cases and nonischaemic pattern in 25 cases. Eleven patients were elite athletes (28±10y, 91% male, training hours: >10 hours/week). Three of them showed ARVC based on the current Task Force criteria, another three athletes showed aspecific structural alteration with nonischaemic LGE.
The CMR examination confirmed the referral diagnosis in 22%, excluded the presence of structural myocardial alteration in 43% and changed the clinical diagnosis in 35% of the patients.
Conclusion
CMR has an important diagnostic value in patients after reanimation but NCA. More than half of these patients showed structural alteration and CMR provided a diagnosis in 42%.
Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary
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Vago H, Szabo L, Czimbalmos CS, Dohy ZS, Csecs I, Toth A, Suhai I, Simor T, Becker D, Merkely B. 4251Results from the Hungarian Cardiac Magnetic Resonance Registry of Structural Heart Disease and Aborted Sudden Cardiac Death in Athletes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sudden cardiac death (SCD) is the most common cause of death in athletes occurring usually during intensive training. Cardiac magnetic resonance (CMR) has a crucial role in the detection of structural myocardial abnormalities.
Aims
Our aim was to investigate the etiology of SCD and to estimate the prevalence of myocardial structural heart diseases among Hungarian athletes using CMR.
Methods
Between January 2011 and January 2019 we performed CMR scans on 228 athletes (199 males, age: 29.1±13.2) with suspected structural myocardial disease. Twelve athletes were investigated after aborted sudden cardiac death and normal coronary angiography.
Results
CMR confirmed the diagnosis of structural myocardial disease in 62 athletes (26.2%) (28.8±9.1 years, 59 male): hypertrophic cardiomyopathy (HCM) in 14 cases (22.6%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 9 cases (14.5%), noncompaction (NCCMP) in 6 cases (9.7%) and dilated cardiomyopathy (DCM) in 5 cases (8.1%). Subendocardial late gadolinium enhancement (LGE), reflecting myocardial scar, was typical of previous myocardial infarction (post MI) in 3 cases (5.5%). Acute myocarditis was found in 2 cases (3.6%). Nonischaemic LGE pattern was found in 20 cases (32.2%): patchy subepi-midmyocardial LGE suggesting previous myocarditis in 8 athletes, and with aspecific pattern in 12 athletes. Athletes with nonischaemic LGE had normal clinical and laboratory parameters without wall motion abnormalities, in their cases further investigations ruled out systemic disease. One athlete was diagnosed with Fabry-disease, one with coronary artery abnormality (anomalous origin of the left main coronary artery from the right sinus of Valsalva), one athlete showed pheochromocytoma-related Tako-Tsubo cardiomyopathy (each 1.6%). Five athletes with confirmed structural heart disease were investigated after sustained ventricular tachycardia, seven athletes after aborted SCD: ARVC (n=6), aspecific LGE pattern (n=4), HCM (n=1) and pheochromocytoma-related Tako-Tsubo cardiomyopathy (n=1) were diagnosed.
RVOT movie of an ARVC pts
Conclusion
In our national CMR registry the most common structural alteration was nonischaemic fibrosis, the most common cardiomyopathy was HCM, and the leading cause of SCD in Hungarian competitive athletes was ARVC. The national registers are highly important for a better understanding the etiology and the geographical differences of SCD in athletes.
Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary
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Vago H, Dohy Z, Czimbalmos C, Szabo L, Horvath V, Tarjanyi Z, Szakal-Toth Z, Parazs N, Toth A, Suhai F, Edes I, Becker D, Sax B, Merkely B. P3558Cardiac magnetic resonance characteristics of the transplanted heart: first results of the prospective Heart-TIming CMR substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In case of heart transplantation (HTX) the heart is affected by several factors e.g. ischaemia/reperfusion, denervation, immunosuppression. During the adaptation, the heart may show marked temporal changes in terms of myocardial mechanics, function and tissue characteristics. To better understand temporal characteristics after orthotopic bicaval HTX we started the prospective Heart-TIming (Transplantation Imaging) trial in January 2018 including standard 12-lead ECG, 24-hour Holter monitor, endomyocardial biopsy, transthoracic echocardiography, invasive coronary angiography with intravascular ultrasound and optical coherence tomography and cardiac magnetic resonance (CMR).
Aim
In our CMR substudy we aimed to evaluate the physiological structural and functional left and right ventricular characteristics and their temporal changes after HTX using CMR.
Methods
As part of the study HTX patients underwent CMR at 1, 3 and 6 months after HTX (n=31; 52±10.5y, 25 male). Cine images, T2-weighted, late gadolinium enhancement (LGE) and adenosine stress perfusion (at 1 month) images were acquired. In order to describe physiological characteristics of the transplanted heart we excluded pts with significant coronary artery disease, ischaemic scar, ≥Grade II allograft rejection from this present study (n=6). We assessed the left (LV) and right ventricular (RV) ejection fractions, volumes, masses (M) and LV strain. We assessed the global strain values: longitudinal, circumferential (GCS) strain and the standard deviation (SD) of the peak longitudinal strain (LS) and the left ventricular mechanical dispersion. We compared baseline volumetric and strain parameters to age matched healthy controls (n=20; 47±11.4y, 15 male), and the temporal changes between one, three and 6 months.
Results
Comparing the HTX patients' CMR parameters at one month with normal controls, HTX patients had lower LV and RV end-diastolic volumes (LVEDVi: 76.6±15.9 vs 90.6±11.6ml/m2; RVEDVi 74.5±17.5 vs 90.3±12.1ml/m2, p<0.05),stroke volumes (p<0.05) and higher LVMi (67.6±14.4 vs 57.2±11g/m2, p<0.05). CMR based strain analysis of the HTX pts showed hyperkinetic GCS (−40,5±6.3% vs −35.2±4.8%, p<0.05), increased SD of peak LS and more pronounced mechanical dispersion (p<0.001) compared to the controls. Examining temporal changes in HTX pts we found a decrease in LVMi (69.57±16.4 vs 61.7±9.8g/m2, p<0.05) already at three months, normalization of GCS (−37.7±5.5% vs −32.6±4.9%, p<0.05) and decrease in SD of peak LS (13.5±2.3 vs 11.4±2.4, p<0.05) at 6 months. Oedema was present in all pts at one month after HTX, and disappeared after three months. LGE with aspecific pattern was present in 42%.
LGE with aspecific pattern in HTX pts
Conclusions
Understanding the temporal changes of LV mechanics, function and tissue characteristics, furthermore the establishment of physiological values may help in the early, noninvasive identification of pathological changes in HTX pts.
NCT number: NCT03499197
Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary
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Czimbalmos C, Csecs I, Dohy Z, Toth A, Suhai FI, Szabo L, Kiss O, Sydo N, Kovacs A, Lakatos B, Merkely B, Vago H. P310Differentiation between arrhythmogenic right ventricular cardiomyopathy and athlete's heart using cardiac magnetic resonance based derived parameters and strain analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a major cause of sudden cardiac death in young athletes. However diagnosing ARVC in highly trained athletes may be complicated because of overlapping features such as elevated right ventricular (RV) end-diastolic volume index or T-wave inversion in precordial leads. The revised Task Force criteria contain no specific cut-off value for professional athletes. Additional CMR parameters and CMR deformation imaging may have an added diagnostic value in this special patient population.
Our goal was to determine novel CMR parameters which can help to distinguish between ARVC and athlete's heart. CMR examination of ARVC patients with definite diagnosis based on the revised Task Force criteria (n=34; 41±13 y, 22 male) and healthy professional athletes (members of the Hungarian national water polo, canoing or rowing team performing minimum of 15 hours of training per week, n=34, 32±6 y, 22 male) was performed. We evaluated left and right ventricular end-systolic, end-diastolic (EDVi) and stroke volume index, ejection fraction (EF) and mass. We established derived parameters such as ejection fraction ratio (LVEF/RVEF) and end-diastolic volume ratio (LVEDV/RVEDV). Global and regional strain analysis for the right ventricle was performed using feature tracking technique. Area under the ROC curves (AUC) of conventional and derived CMR parameters and CMR based strain values were analysed.
There was no significant difference between RVEDVi of ARVC patients and athletes (124±17 vs 142±47), RVEF was lower in ARVC patients compared to athletes (56±5 vs 41±14%; p<0.001). Significant differences were found between athletes and ARVC patients in LVEDV/RVEDV (0.96±0.08 vs 0.82±0.23), LVEF/RVEF (1.04±0.06 vs 1.41±0.56), global circumferential strain (−34.8±5.9 vs −25.2±12.2) and regional strain values such as midventricular RV strain (−31.5±10.2 vs −20.0±13.4) or midventricular RV strain rate (−1.37±0.56 vs −1.04±0.68), respectively.
RVEF and LVEF/RVEF showed excellent (AUC of 0.9–1.0), RV global strain and RV midventricular strain values showed good diagnostic accuracy (AUC of 0.8–0.9), while RVEDVi showed poor diagnostic accuracy (AUC of 0.59).
Consequently, in highly trained healthy athletes RVEDVi is in the range of major Task Force criteria, while CMR based derived parameters such as LVEDV/RVEDV or LVEF/RVEF and both global and regional RV strain parameters can be useful parameters in the differential diagnosis.
Acknowledgement/Funding
National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277), ÚNKP-18-3-IV New National Excellence Program of Human Capacities.
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Adams J, Toth A, Law S, Ganeshananthan M. 132TRANSFORMING ACUTE FRAILTY SERVICES THROUGH QUALITY IMPROVEMENT. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Toth A, Lux S, Siebenhofer M. Utilization of Biorefinery Side Products by Reactive Separation. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Toth A, Erdei J, Balogh E, Nyakundi B, Bányai E, Ryffel B, Paragh G, Cordero M, Jeney V. Induction of NLRP3 inflammasome activation by heme in human endothelial cells. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Czimbalmos C, Csecs I, Toth A, Kiss O, Dohy Z, Juhasz V, Szabo L, Suhai FI, Merkely B, Vago H. P659Athlete's heart or structural heart disease: data of the hungarian magnetic resonance registry of structural heart disease and aborted sudden cardiac death in athletes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dohy Z, Czimbalmos C, Csecs I, Suhai FI, Toth A, Juhasz V, Szabo L, Pozsonyi Z, Vereckei A, Merkely B, Vago H. P4457Fragmented QRS relates to myocardial fibrosis and syncopal episodes in hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vago H, Dohy Z, Czimbalmos C, Csecs I, Szabo L, Suhai FI, Toth A, Barczi G, Becker D, Merkely B. 3336How could cardiac magnetic resonance imaging help the differential diagnosis in MINOCA patients? Single center data of a 10-year period. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Horvath B, Szentandrassy N, Veress R, Baranyai D, Kistamas K, Almassy J, Toth A, Magyar J, Banyasz T, Nanasi PP. Effect of the intracellular calcium concentration chelator BAPTA acetoxy-methylester on action potential duration in canine ventricular myocytes. JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2018; 69:99-107. [PMID: 29769426 DOI: 10.26402/jpp.2018.1.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/26/2018] [Indexed: 11/03/2022]
Abstract
Intracellular calcium concentration ([Ca2+]i) is often buffered by using the cell-permeant acetoxy-methylester form of the Ca2+ chelator BAPTA (BAPTA-AM) under experimental conditions. This study was designed to investigate the time-dependent actions of extracellularly applied BAPTA-AM on action potential duration (APD) in cardiac cells. Action potentials were recorded from enzymatically isolated canine ventricular myocytes with conventional sharp microelectrodes. The effect of BAPTA-AM on the rapid delayed rectifier K+ current (IKr) was studied using conventional voltage clamp and action potential voltage clamp techniques. APD was lengthened by 5 μM BAPTA-AM - but not by BAPTA - and shortened by the Ca2+ ionophore A23187 in a time-dependent manner. The APD-lengthening effect of BAPTA-AM was strongly suppressed in the presence of nisoldipine, and enhanced in the presence of BAY K8644, suggesting that a shift in the [Ca2+]i-dependent inactivation of L-type Ca2+ current may be an important underlying mechanism. However, in the presence of the IKr-blocker dofetilide or E-4031 APD was shortened rather than lengthened by BAPTA-AM. Similarly, the APD-lengthening effect of 100 nM dofetilide was halved by the pretreatment with BAPTA-AM. In line with these results, IKr was significantly reduced by extracellularly applied BAPTA-AM under both conventional voltage clamp and action potential voltage clamp conditions. This inhibition of IKr was partially reversible and was not related to the Ca2+ chelator effect BAPTA-AM. The possible mechanisms involved in the APD-modifying effects of BAPTA-AM are discussed. It is concluded that BAPTA-AM has to be applied carefully to control [Ca2+]i in whole cell systems because of its direct inhibitory action on IKr.
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Banhegyi V, Fagyas M, Manyine Siket I, Enyedi A, Bottyan K, Edes I, Papp Z, Toth A. P568Old dogma, new aspects - Role of angiotensin converting enzymes in the cardiovascular continuum. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Csongradi A, Siket IM, Csipo T, Toth A, Szerafin T, Csanadi Z, Edes I, Papp Z, Fagyas M. P333Cell free hemoglobin inhibits ACE-activity which may be associated with hypotension after coronary artery bybass grafting. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bodi B, Csongradi A, Tamas J, Matyas CS, Toth A, Merkely B, Radovits T, Papp Z. P528Vardenafil prevents the diastolic dysfunction. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rafiroiu S, Ahmad U, Koval C, Hassouna H, Toth A, McCurry K, Johnston D, Ibrahim M, Budev M, Blackstone E, Pettersson G, Tong M. Consequences of Delayed Chest Closure During Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Czimbalmos C, Csecs I, Szabo L, Toth A, Suhai FI, Zima E, Heltai K, Becker D, Geller L, Merkely B, Vago H. P882Structural heart disease in athletes and nonathletes after aborted sudden cardiac death - the added value of CMR. Europace 2018. [DOI: 10.1093/europace/euy015.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kovács N, Juhasz A, Zsuzsanna A, Janszky J, Kovacs M, Harmat M, Karadi K, Makkos A, Takats A, Toth A, Nagy H, Klivenyi P, Dibo G, Dezsi L, Zadori D, Annus A, Vecsei L, Varannai L, Komoly S. Levodopa/carbidopa intestinal gel can improve both motor and non-motor experiences of daily living in advanced Parkinson's disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pilissy T, Toth A, Fazekas G, Sobjak A, Rosenthal R, Luftenegger T, Panek P, Mayer P. Towards a situation-and-user-aware multi-modal motorized toilet system to assist older adults with disabilities: A user requirements study. IEEE Int Conf Rehabil Robot 2017; 2017:959-964. [PMID: 28813945 DOI: 10.1109/icorr.2017.8009373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the recent decades state of the art technologies appeared in many areas to assist older adults with disabilities. However, one very essential activity of daily life, the toileting remained without any relevant development. The iToilet project of the European Union focuses on the development of an intelligent and motorized toilet system to enable independent toilet use for older adults with disabilities. To begin the development, the user requirements of end-users were assessed by means of focus group interviews and questionnaires. The survey was conducted in Austria and Hungary with the participation of 74 persons in total (41 subjects with movement disorders, 21 caregivers and 12 healthcare managers). From the interviews, the ranking of functions and features based on the number of their mentions was derived. The raw ranking was modulated by the average ratings from the questionnaires that resulted in the final list of priorities. Our results suggest that a safe and intelligent motorized toilet system should have foldable handrails on both sides (especially for wheelchair users), motorized height and tilt adjusting mechanism for the toilet bowl, fixed toilet paper holder on both sides and emergency recognition with call function. Simple operation, storage and retrieval of user specific settings including bowl height, and user identification were also deemed as very important features, while the possibility to control functions with gestures was valued rather low.
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Czimbalmos C, Csecs I, Toth A, Suhai F, Horvath B, Dohy Z, Szabo L, Kiss O, Sydo N, Simor T, Merkely B, Vago H. P1532Overlapping features - Differentiation of arrhythmogenic right ventricular cardiomyopathy and athlete's heart using cardiac magnetic resonance imaging. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Csecs I, Czimbalmos C, Toth A, Suhai F, Dohy Z, Toth M, Pozsonyi Z, Vereczkei A, Merkely B, Vago H. P6303Cardiac fingerprints of histiocytic infiltration - Common cardiac characteristics in a diverse, multisystemic histiocytic disease - Single center data over a 12-year period. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vago H, Csecs I, Czimbalmos C, Toth A, Kiss O, Komka Z, Barczi G, Kovats T, Suhai F, Sydo N, Simor T, Geller L, Becker D, Merkely B. P4444Athlete's heart or structural heart disease? - First Hungarian Structural Heart Disease and Aborted Sudden Cardiac Death Magnetic Resonance Registry in Athletes. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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