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Gravina M, Casavecchia G, Mangini F, Mautone F, Ruggeri D, Guglielmi G, Macarini L, Brunetti ND. Magnetic resonance mapping for the assessment of cardiomyopathies and myocardial disease. Int J Cardiol 2024; 415:132440. [PMID: 39153509 DOI: 10.1016/j.ijcard.2024.132440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
In recent years, the use of cardiac magnetic resonance (CMR) has grown exponentially in clinical practice. The keys for this success are represented by the possibility of tissue characterization, cardiac volumes and myocardial perfusion assessment, biventricular function evaluation, with no use of ionizing radiations and with an extremely interesting profile of reproducibility. The use of late gadolinium enhancement (LGE) nearly compares a non-invasive biopsy for cardiac fibrosis quantification. LGE, however, is partly unable to detect diffuse myocardial disease. These limits are overcome by new acquisition techniques, mainly T1 and T2 mapping, which allow the diagnosis and characterization of various cardiomyopathies, both ischemic and non-ischemic, such as amyloidosis (high T1), Fabry's disease (low T1), hemochromatosis (low T1), dilated and hypertrophic cardiomyopathy and myocarditis. In this review we detail and summarize principal evidence on the use of T1 and T2 mapping for the study and clinical management of cardiomyopathies.
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Affiliation(s)
- Matteo Gravina
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Francesco Mangini
- Cardiac Magnetic Resonance Unit, "Di Summa-Perrino" Hospital, Brindisi, Italy
| | - Francesco Mautone
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Debora Ruggeri
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| | - Luca Macarini
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy.
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Prameswari HS, Kamarullah W, Pranata R, Putra ICS, Undarsa AC, Iqbal M, Dewi TI, Kusumawardhani NY, Akbar MR, Astuti A. Meta-analysis of cardiac magnetic resonance in prognosticating left ventricular function in peripartum cardiomyopathy. ESC Heart Fail 2024. [PMID: 39295149 DOI: 10.1002/ehf2.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/25/2024] [Accepted: 07/31/2024] [Indexed: 09/21/2024] Open
Abstract
AIMS Peripartum cardiomyopathy (PPCM) may result in a number of detrimental adverse cardiovascular events, notably persistent left ventricular ejection fraction (LVEF) reduction or even mortality. Imaging parameters on cardiac magnetic resonance (CMR) and their prognostic implications have rarely been perused in PPCM. We aimed to describe CMR's prognostic value in predicting poor left ventricular (LV) function recovery using late gadolinium enhancement (LGE) and T2-weighted or T2 mapping. METHODS AND RESULTS PubMed, Europe PMC, and ScienceDirect were screened for studies on late gadolinium enhancement (LGE) and myocardial oedema using CMR and PPCM. The outcome of interest was poor LV function recovery, with a follow-up period of at least 6 months. Comparisons between groups with the presence of LGE, myocardial oedema, and recovered against non-recovered patients were pooled. A random-effects model was employed to calculate the effect size. All pooled results were expressed as risk ratios (RRs) and 95% confidence intervals (CI). The area under the curve (AUC) was generated to test overall prognostic accuracy. Six cohort studies with 162 patients were included. The mean age of participants in this study was 30.6 years, and the majority of patients were diagnosed with PPCM after delivery. LGE was associated with a higher risk of poor LV function recovery, particularly when conducted at a later stage of disease (≥2.8 months) [RR = 2.83 (95% CI = 1.25-6.40); P = 0.001]. On the contrary, CMR conducted early (<2.8 months) exhibited a greater predictive value for myocardial oedema perceived by T2 mapping [RR = 3.44 (95% CI = 1.04-11.34); P = 0.043]. Diagnostic-test accuracy meta-analysis revealed that LGE had a sensitivity of 73% (95% CI, 56-85%), specificity of 79% (95% CI, 45-95%), and AUC of 0.78 (95% CI, 0.75-0.82) in predicting poor LV recovery when performed in the later phase, whereas significant myocardial oedema in those with non-recovered LV function had a sensitivity of 12% (95% CI, 2-52%), specificity of 68% (95% CI, 39-88%), and AUC of 0.40 (95% CI, 0.36-0.44) while undertaken in the latter phase. Our findings support the notion that inflammation plays a significant role in PPCM and that alterations to tissue composition occur in a time-dependent manner. CONCLUSIONS Contrast-enhanced CMR can be utilized as an adjunct examination in post-partum PPCM patients to stratify the risk of poor LV function recovery while conducted at a suitable point in time.
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Affiliation(s)
- Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - William Kamarullah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Alberta Claudia Undarsa
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Triwedya Indra Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Nuraini Yasmin Kusumawardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Astri Astuti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
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Sohn SH, Kang Y, Kim JS, Park EA, Lee W, Hwang HY. Impact of Myocardial Viability on Long-term Outcomes after Surgical Revascularization. Thorac Cardiovasc Surg 2024; 72:441-448. [PMID: 38092064 DOI: 10.1055/a-2228-7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). METHODS Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades-0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5-95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure. RESULTS Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10-1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II. CONCLUSION The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Rademaker R, Kimura Y, de Riva Silva M, Beukers HC, Piers SRD, Wijnmaalen AP, Dekkers OM, Zeppenfeld K. Area-weighted unipolar voltage to predict heart failure outcomes in patients with ischaemic cardiomyopathy and ventricular tachycardia. Europace 2024; 26:euad346. [PMID: 38308809 PMCID: PMC10838146 DOI: 10.1093/europace/euad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/15/2023] [Indexed: 02/05/2024] Open
Abstract
AIMS Patients with ischaemic cardiomyopathy (ICM) referred for catheter ablation of ventricular tachycardia (VT) are at risk for end-stage heart failure (HF) due to adverse remodelling. Local unipolar voltages (UV) decrease with loss of viable myocardium. A UV parameter reflecting global viable myocardium may predict prognosis. We evaluate if a newly proposed parameter, area-weighted unipolar voltage (awUV), can predict HF-related outcomes [HFO; HF death/left ventricular (LV) assist device/heart transplant] in ICM. METHODS AND RESULTS From endocardial voltage maps of consecutive patients with ICM referred for VT ablation, awUV was calculated by weighted interpolation of local UV. Associations between clinical and mapping parameters and HFO were evaluated and validated in a second cohort. The derivation cohort consisted of 90 patients [age 68 ±8 years; LV ejection fraction (LVEF) 35% interquartile range (IQR) (24-40)] and validation cohort of 60 patients [age 67 ± 9, LVEF 39% IQR (29-45)]. In the derivation cohort, during a median follow-up of 45 months [IQR (34-83)], 36 (43%) patients died and 23 (26%) had HFO. Patients with HFO had lower awUV [4.51 IQR (3.69-5.31) vs. 7.03 IQR (6.08-9.2), P < 0.001]. A reduction in awUV [optimal awUV (5.58) cut-off determined by receiver operating characteristics analysis] was a strong predictor of HFO (3-year HFO survival 97% vs. 57%). The cut-off value was confirmed in the validation cohort (2-year HFO-free survival 96% vs. 60%). CONCLUSION The newly proposed parameter awUV, easily available from routine voltage mapping, may be useful at identifying ICM patients at high risk for HFO.
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Affiliation(s)
- Robert Rademaker
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
| | - Yoshi Kimura
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
| | - Marta de Riva Silva
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
| | - Hans C Beukers
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Sebastiaan R D Piers
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology (C-05-P), Leiden University Medical Center, P.O. Box 9600, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Willem Einthoven Center of Arrhythmia Research and Management, Leiden, The Netherlands
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Cho Y, Ueda T, Kotani S, Okada K, Ozawa K, Shimura S, Shimizu H. AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure. Int J Cardiol 2023; 391:131277. [PMID: 37598910 DOI: 10.1016/j.ijcard.2023.131277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.
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Affiliation(s)
- Yasunori Cho
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Thoshihiko Ueda
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sohsyu Kotani
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Kimiaki Okada
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Keisuke Ozawa
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichiro Shimura
- Department of Cardiovascular Surgery, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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Ponnusamy SS, Ganesan V, Anand V, Vadivelu R, Kumar M, Mariappan S, Murugan S, Vijayaraman P. Observations of interventricular septal behavior during left bundle branch pacing. J Cardiovasc Electrophysiol 2023; 34:2246-2254. [PMID: 37694670 DOI: 10.1111/jce.16057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Left bundle branch pacing (LBBP) involves the deployment of the lead deep inside the septum. Penetration of the septum by the lead depends on the texture of the septum, rapidity of rotations, operator experience, and implantation tools. OBJECTIVES The aim of our study was to assess the behavior of the lumenless lead during rapid rotations and the physiological property of the interventricular septum(IVS) during LBBP. METHODS Patients undergoing LBBP between January 2021 and December 2022 were retrospectively included in the study. RESULTS Among 255 attempted patients, 20 (7.9%) had procedural failure(no LBB capture-four, inability to penetrate septum-seven, and dislodgements after sheath removal-nine). Septal penetration achieved in 248/255 patients (97.2%). Lead movement inside the IVS was assessed by lead traverse time. Based on the behavior of the IVS (n = 255), three different responses were noted. Type-I response(normal/firm septum) in 93.7% (n = 239) characterized by constant and progressive movement of lead. Neither perforation nor further change in premature-ventricular-complex morphology beyond M-beat were observed despite additional few unintentional rotations indicating the protective mechanism of LV-endocardium. Type-II response(soft/cheesy septum) in 3.5% (n = 9) characterized by hyper-movement of lead without resistance due to altered texture of septum and poor LV subendocardial barrier resulting in perforation. No patients in this group had LV dysfunction or associated coronary artery disease. In type-III response, seen in 2.8% (n = 7), lead could not be penetrated due to scar in IVS. CONCLUSION Three different patterns of responses were observed during LBBP. The most distinct type-ll response was associated with soft/cheesy septum with hyper-movement of the lead predisposing for future dislodgments in patients without structural heart disease.
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Affiliation(s)
| | - Vidhya Ganesan
- Department of Microbiology, Velammal Medical College, Madurai, India
| | - Vijesh Anand
- Department of Cardiology, Velammal Medical College, Madurai, India
| | | | - Mahesh Kumar
- Department of Cardiology, Velammal Medical College, Madurai, India
| | | | - Senthil Murugan
- Department of Cardiology, Velammal Medical College, Madurai, India
| | - Pugazhendhi Vijayaraman
- Department of Cardiology, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania, USA
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Pan J, Ng SM, Neubauer S, Rider OJ. Phenotyping heart failure by cardiac magnetic resonance imaging of cardiac macro- and microscopic structure: state of the art review. Eur Heart J Cardiovasc Imaging 2023; 24:1302-1317. [PMID: 37267310 PMCID: PMC10531211 DOI: 10.1093/ehjci/jead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Heart failure demographics have evolved in past decades with the development of improved diagnostics, therapies, and prevention. Cardiac magnetic resonance (CMR) has developed in a similar timeframe to become the gold-standard non-invasive imaging modality for characterizing diseases causing heart failure. CMR techniques to assess cardiac morphology and function have progressed since their first use in the 1980s. Increasingly efficient acquisition protocols generate high spatial and temporal resolution images in less time. This has enabled new methods of characterizing cardiac systolic and diastolic function such as strain analysis, exercise real-time cine imaging and four-dimensional flow. A key strength of CMR is its ability to non-invasively interrogate the myocardial tissue composition. Gadolinium contrast agents revolutionized non-invasive cardiac imaging with the late gadolinium enhancement technique. Further advances enabled quantitative parametric mapping to increase sensitivity at detecting diffuse pathology. Novel methods such as diffusion tensor imaging and artificial intelligence-enhanced image generation are on the horizon. Magnetic resonance spectroscopy (MRS) provides a window into the molecular environment of the myocardium. Phosphorus (31P) spectroscopy can inform the status of cardiac energetics in health and disease. Proton (1H) spectroscopy complements this by measuring creatine and intramyocardial lipids. Hyperpolarized carbon (13C) spectroscopy is a novel method that could further our understanding of dynamic cardiac metabolism. CMR of other organs such as the lungs may add further depth into phenotypes of heart failure. The vast capabilities of CMR should be deployed and interpreted in context of current heart failure challenges.
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Affiliation(s)
- Jiliu Pan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Sher May Ng
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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Chrispin J. Takeoff Is Optional… Landing Is Mandatory: Insights Into Hemodynamic Decompensation Following Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2023; 9:1694-1696. [PMID: 37498241 DOI: 10.1016/j.jacep.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Jonathan Chrispin
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Nabeta T, Meucci MC, Westenberg JJM, Reiber JH, Knuuti J, van der Bijl P, Marsan NA, Bax JJ. Prognostic implications of left ventricular inward displacement assessed by cardiac magnetic resonance imaging in patients with myocardial infarction. Int J Cardiovasc Imaging 2023; 39:1525-1533. [PMID: 37249652 PMCID: PMC10427538 DOI: 10.1007/s10554-023-02861-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 05/31/2023]
Abstract
Risk stratification of patients with ischemic heart disease (IHD) still depends mainly on the left ventricular ejection fraction (LVEF). LV inward displacement (InD) is a novel parameter of LV systolic function, derived from feature tracking cardiac magnetic resonance (CMR) imaging. We aimed to investigate the prognostic impact of InD in patients with IHD and prior myocardial infarction. A total of 111 patients (mean age 57 ± 10, 86% male) with a history of myocardial infarction who underwent CMR were included. LV InD was quantified by measuring the displacement of endocardially tracked points towards the centreline of the LV during systole with feature tracking CMR. The endpoint was a composite of all-cause mortality, heart failure hospitalization and arrhythmic events. During a median follow-up of 142 (IQR 107-159) months, 31 (27.9%) combined events occurred. Kaplan-Meier analysis demonstrated that patients with LV InD below the study population median value (23.0%) had a significantly lower event-free survival (P < 0.001). LV InD remained independently associated with outcomes (HR 0.90, 95% CI 0.84-0.98, P = 0.010) on multivariate Cox regression analysis. InD also provided incremental prognostic value to LVEF, LV global radial strain and CMR scar burden. LV InD, measured with feature tracking CMR, was independently associated with outcomes in patients with IHD and prior myocardial infarction. LV InD also provided incremental prognostic value, in addition to LVEF and LV global radial strain. LV InD holds promise as a pragmatic imaging biomarker for post-infarct risk stratification.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands.
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Johan Hc Reiber
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Medis Medical Imaging Systems, Schuttersveld 9, Leiden, 2316 XG, The Netherlands
| | - Juhani Knuuti
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
| | - Pieter van der Bijl
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2300 RC, The Netherlands
- Heart Centre, University of Turku, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20520, Finland
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Park H, Kang DY, Ahn JM, Yang DH, Koo HJ, Kang JW, Lee PH, Lee SE, Kim MS, Kang SJ, Park DW, Lee SW, Kim YH, Lee CW, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JJ, Park SW, Park SJ. Myocardial Scar and Revascularization on Mortality in Ischemic Cardiomyopathy (from the Late Gadolinium Enhancement Cardiac Magnetic Resonance Study). Am J Cardiol 2023; 192:212-220. [PMID: 36848690 DOI: 10.1016/j.amjcard.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023]
Abstract
Myocardial viability test to guide revascularization remains uncertain in patients with ischemic cardiomyopathy. We evaluated the different impacts of revascularization on cardiac mortality according to the extent of myocardial scar assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients with ischemic cardiomyopathy. A total of 404 consecutive patients with significant coronary artery disease and an ejection fraction ≤35% were assessed by LGE-CMR before revascularization. Of them, 306 patients underwent revascularization and 98 patients received medical treatment alone. The primary outcome was cardiac death. During a median follow-up of 6.3 years, cardiac death occurred in 158 patients (39.1%). Revascularization was associated with a significantly lower risk of cardiac death than medical treatment alone in the overall population (adjusted hazard ratio [aHR] 0.29, 95% confidence interval (CI) 0.19 to 0.45, p <0.001). There was a significant interaction between the number of segments with >75% transmural LGE and revascularization on the risk of cardiac death (p = 0.037 for interaction). In patients with limited myocardial scar (<6 segments with >75% transmural LGE, n = 354), revascularization had a significantly lower risk of cardiac death than medical treatment alone (aHR 0.24, 95% CI 0.15 to 0.37, p <0.001); in patients with extensive myocardial scar (≥6 segments with >75% transmural LGE, n = 50), there was no significant difference between revascularization and medical treatment alone regarding the risk of cardiac death (aHR 1.33, 95% CI 0.46 to 3.80, p = 0.60). In conclusion, the assessment of myocardial scar by LGE-CMR may be helpful in the decision-making process for revascularization in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Hanbit Park
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea
| | - Do-Yoon Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Jung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk Jung Choo
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol-Hyun Chung
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Lee
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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A X, Li K, Yan LL, Chandramouli C, Hu R, Jin X, Li P, Chen M, Qian G, Chen Y. Machine learning-based prediction of infarct size in patients with ST-segment elevation myocardial infarction: A multi-center study. Int J Cardiol 2023; 375:131-141. [PMID: 36565958 DOI: 10.1016/j.ijcard.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/19/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (CMR) is the gold standard for measuring infarct size (IS). However, this method is expensive and requires a specially trained technologist to administer. We therefore sought to quantify the IS using machine learning (ML) based analysis on clinical features, which is a convenient and cost-effective alternative to CMR. METHODS AND RESULTS We included 315 STEMI patients with CMR examined one week after morbidity in final analysis. After feature selection by XGBoost on fifty-six clinical features, we used five ML algorithms (random forest (RF), light gradient boosting decision machine, deep forest, deep neural network, and stacking) to predict IS with 26 (selected by XGBoost with information gain greater than average level of 56 features) and the top 10 features, during which 5-fold cross-validation were used to train and optimize models. We then evaluated the value of actual and ML-IS for the prediction of adverse remodeling. Our finding indicates that MLs outperform the linear regression in predicting IS. Specifically, the RF with five predictors identified by the exhaustive method performed better than linear regression (LR) with 10 indicators (R2 of RF: 0.8; LR: 0). The finding also shows that both actual and ML-IS were independently associated with adverse remodeling. ML-IS ≥ 21% was associated with a twofold increase in the risk of LV remodeling (P < 0.01) compared with patients with reference IS (1st tertile). CONCLUSION ML-based methods can predict IS with widely available clinical features, which provide a proof-of-concept tool to quantitatively assess acute phase IS.
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Affiliation(s)
- Xin A
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Kangshuo Li
- Department of Statistics, Columbia University, New York, NY, United States of America
| | - Lijing L Yan
- Global Heath Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu Province 215347, China; Wuhan University School of Health Sciences, Wuhan, Hubei Province, China
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore; Duke-National University Medical School, Singapore
| | - Rundong Hu
- Global Heath Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu Province 215347, China
| | | | - Ping Li
- Department of Cardiology, The first people's hospital of Yulin, Guangxi, China
| | - Mulei Chen
- Department of Cardiology, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Geng Qian
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
| | - Yundai Chen
- Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
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12
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Borzillo I, De Filippo O, Manai R, Bruno F, Ravetti E, Galanti AA, Vergallo R, Porto I, De Ferrari GM, D'Ascenzo F. Role of Intracoronary Imaging in Myocardial Infarction with Non-Obstructive Coronary Disease (MINOCA): A Review. J Clin Med 2023; 12:jcm12062129. [PMID: 36983131 PMCID: PMC10051698 DOI: 10.3390/jcm12062129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease occurs in 6% to 15% of all presentation of myocardial infarctions. The pathophysiologic mechanisms of MINOCA include epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, and coronary thrombus/embolism. The diagnosis is challenging, supported by intracoronary imaging with intravascular ultrasound (IVUS) and optical coherent tomography (OCT), coronary physiology testing, and cardiac magnetic resonance imaging (CMR). OCT is able to identify atherosclerotic causes of MINOCA (plaque erosion, plaque rupture, and calcified nodule) and nonatherosclerotic causes (spontaneous artery dissection, and spasm). In this review, we summarize the performance of the two intracoronary imaging modalities (IVUS and OCT) in MINOCA and discuss the importance of supplementing these modalities with CMR in order to drive target therapy.
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Affiliation(s)
- Irene Borzillo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
| | - Rossella Manai
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Alma Andrea Galanti
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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13
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Ródenas-Alesina E, Romero-Farina G, Herrador L, Jordán P, Espinet-Coll C, Pizzi MN, Ribera A, Ferreira-González I, Aguadé-Bruix S. Development of a risk score for patients with ischaemic cardiomyopathy. Arch Cardiovasc Dis 2023; 116:145-150. [PMID: 36759315 DOI: 10.1016/j.acvd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis. AIM To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease. METHODS All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retrospectively (n=747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model. RESULTS After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomerular filtration rate ≤60mL/min/1.73 m2, age>73 years, diabetes, atrial fibrillation, end-diastolic volume index>83mL/m2 and>12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660-0.740) and calibration was adequate (Hosmer-Lemeshow test P=0.28) for MACE. CONCLUSIONS In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.
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Affiliation(s)
- Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Guillermo Romero-Farina
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Lorena Herrador
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pablo Jordán
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carina Espinet-Coll
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - María Nazarena Pizzi
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Aida Ribera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Santiago Aguadé-Bruix
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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14
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Ponnusamy SS, Murugan M, Ganesan V, Vijayaraman P. Predictors of procedural failure of left bundle branch pacing in scarred left ventricle. J Cardiovasc Electrophysiol 2023; 34:760-764. [PMID: 36738155 DOI: 10.1111/jce.15853] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Presence of scar at the implantation-site is considered as a major factor in determining the success of left bundle branch pacing (LBBP). We aimed at analyzing the predictors of procedural failure in patients with scarred-left ventricle (LV) as demonstrated by cardiac-magnetic resonance-imaging (CMR). METHODS This was a retrospective, observational single-center-study that included consecutive cardiomyopathy patients with LV-scar as demonstrated by late-gadolinium-enhancement (LGE) in CMR requiring LBBP. Procedural-failure was defined as the inability to penetrate the septum to reach the LV subendocardium RESULTS: A total of 25 cardiomyopathy patients demonstrated LGE in CMR and were included in the study. LBBP was successful in 16 patients (group-I; 64% acute-procedural-success). In the remaining 9 patients (group-II) lead could not be penetrated and hence biventricular-pacing was done. LBBP resulted in reduction in QRS-duration and improvement in LV ejection fraction in group-I patients during a mean follow-up of 11.2 ± 3.7 months. Computed-tomography-angiography after LBBP showed the successful lead deployment site (LBBP-Zone) as the overlapping areas of inferior aspect of antero-septum and superior aspect of infero-septum (segment 2/3; AHA-model) in short-axis view(figure-1C). CMR showed LGE in significantly more number of LV-segments and high scar-burden in group-II as compared to group-I (figure-1). A total scar score value of >1.0 predicted failure with 100%-sensitivity and 75%-specificity. CMR revealed transmural-scar in the LBBP-Zone in all patients in group-II (n = 9; 100%). Transmural scar in LBBP-Zone by CMR had 100%-sensitivity and 100%-specificity for predicting the procedural-failure. CONCLUSION CMR helps in predicting the procedural failure of LBBP in patients with scarred LV. Presence of transmural-LGE in the LBBP-Zone predicts failure with high sensitivity and specificity.
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Affiliation(s)
| | - Mariappan Murugan
- Department of Radiodiagnosis, Velammal Medical College, Madurai, India
| | - Vithiya Ganesan
- Department of Microbiology, Velammal Medical College, Madurai, India
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania, USA
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15
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Calvieri C, Riva A, Sturla F, Dominici L, Conia L, Gaudio C, Miraldi F, Secchi F, Galea N. Left Ventricular Adverse Remodeling in Ischemic Heart Disease: Emerging Cardiac Magnetic Resonance Imaging Biomarkers. J Clin Med 2023; 12:jcm12010334. [PMID: 36615133 PMCID: PMC9820966 DOI: 10.3390/jcm12010334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/10/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Post-ischemic left ventricular (LV) remodeling is a biologically complex process involving myocardial structure, LV shape, and function, beginning early after myocardial infarction (MI) and lasting until 1 year. Adverse remodeling is a post-MI maladaptive process that has been associated with long-term poor clinical outcomes. Cardiac Magnetic Resonance (CMR) is the best tool to define adverse remodeling because of its ability to accurately measure LV end-diastolic and end-systolic volumes and their variation over time and to characterize the underlying myocardial changes. Therefore, CMR is the gold standard method to assess in vivo myocardial infarction extension and to detect the presence of microvascular obstruction and intramyocardial hemorrhage, both associated with adverse remodeling. In recent times, new CMR quantitative biomarkers emerged as predictive of post-ischemic adverse remodeling, such as T1 mapping, myocardial strain, and 4D flow. Additionally, CMR T1 mapping imaging may depict infarcted tissue and assess diffuse myocardial fibrosis by using surrogate markers such as extracellular volume fraction, which may predict functional recovery or risk stratification of remodeling. Finally, there is emerging evidence supporting the utility of intracavitary blood flow kinetic energy and hemodynamic features assessed by the 4D flow CMR technique as early predictors of remodeling.
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Affiliation(s)
- Camilla Calvieri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
- Correspondence:
| | - Alessandra Riva
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20129 Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Lorenzo Dominici
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Carlo Gaudio
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00100 Rome, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20129 Milan, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00100 Rome, Italy
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16
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Shaw M, Ojha V, Ganga KP, Malhi AS, Chandrashekhara SH, Kumar S, Khan MA, Jagia P, Sharma S. Reference values of myocardial native T1 and T2 mapping values in normal Indian population at 1.5 Tesla scanner. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2403-2411. [PMID: 36434341 DOI: 10.1007/s10554-022-02648-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
T1 and T2 mapping techniques on cardiovascular magnetic resonance (CMR) provide insights into the myocardial tissue characterisation. We sought to establish the normal reference values of native T1 and T2 mapping in Indian population which can be used subsequently in clinical practice for addressing various cardiac pathologies. This prospective study included consecutive healthy volunteers (18-60 years) who underwent CMR on a 1.5 Tesla scanner using standard protocol. T1 mapping sequence was performed using MOLLI sequence with two different flip angles (FA) (35° and 50°). T2 mapping was performed using a hybrid gradient and spin-echo sequence sequence with two different FA (70° and 12°). Images were analysed with ROIs drawn in all the 16 AHA myocardial segments. 50 volunteers (average age-34 years, males-72%) were included. All the scans were normal. The mean T1 value at 35-degree FA was 946.86 + 14.16 ms and at 50-degree FA was 941.60 + 11.89 ms. The mean T2 mapping value at 70-degree FA was 45.67 + 1.39 ms and at 12-degree FA was 45.61 + 1.47 ms. The mapping values were not statistically different between males and females (all p > 0.2). The T1 and T2 mapping values did not show any significant correlation with LVEF, age, BMI or heart rate (all r < 0.33). The T1 mapping values significantly differ at 35- and 50-degree FAs (p = 0.002). The results establish the normal reference T1 and T2 mapping value for Indian population in institutes using the same protocol and parameters at 1.5 Tesla and may guide future research.
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Affiliation(s)
- Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - Amarindar Singh Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India.
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, Room 10A, New Delhi, 110029, India
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17
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Nies HMJM, Gommers S, Bijvoet GP, Heckman LIB, Prinzen FW, Vogel G, Van De Heyning CM, Chiribiri A, Wildberger JE, Mihl C, Holtackers RJ. Histopathological validation of semi-automated myocardial scar quantification techniques for dark-blood late gadolinium enhancement magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022; 24:364-372. [PMID: 35723673 PMCID: PMC9936958 DOI: 10.1093/ehjci/jeac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the performance of various semi-automated techniques for quantification of myocardial infarct size on both conventional bright-blood and novel dark-blood late gadolinium enhancement (LGE) images using histopathology as reference standard. METHODS AND RESULTS In 13 Yorkshire pigs, reperfused myocardial infarction was experimentally induced. At 7 weeks post-infarction, both bright-blood and dark-blood LGE imaging were performed on a 1.5 T magnetic resonance scanner. Following magnetic resonance imaging (MRI), the animals were sacrificed, and histopathology was obtained. The percentage of infarcted myocardium was assessed per slice using various semi-automated scar quantification techniques, including the signal threshold vs. reference mean (STRM, using 3 to 8 SDs as threshold) and full-width at half-maximum (FWHM) methods, as well as manual contouring, for both LGE methods. Infarct size obtained by histopathology was used as reference. In total, 24 paired LGE MRI slices and histopathology samples were available for analysis. For both bright-blood and dark-blood LGE, the STRM method with a threshold of 5 SDs led to the best agreement to histopathology without significant bias (-0.23%, 95% CI [-2.99, 2.52%], P = 0.862 and -0.20%, 95% CI [-2.12, 1.72%], P = 0.831, respectively). Manual contouring significantly underestimated infarct size on bright-blood LGE (-1.57%, 95% CI [-2.96, -0.18%], P = 0.029), while manual contouring on dark-blood LGE outperformed semi-automated quantification and demonstrated the most accurate quantification in this study (-0.03%, 95% CI [-0.22, 0.16%], P = 0.760). CONCLUSION The signal threshold vs. reference mean method with a threshold of 5 SDs demonstrated the most accurate semi-automated quantification of infarcted myocardium, without significant bias compared to histopathology, for both conventional bright-blood and novel dark-blood LGE.
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Affiliation(s)
| | - Suzanne Gommers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Frits W Prinzen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Gaston Vogel
- Pie Medical Imaging, Maastricht, The Netherlands
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital and GENCOR, University of Antwerp, Antwerp, Belgium
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, UK
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands,Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, AZ 6202, Maastricht, The Netherlands
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Ishidoya Y, Ranjan R. Using MRI to predict ventricular tachycardia recurrence and provide guidance for ablation? Heart Rhythm 2022; 19:1611-1612. [PMID: 35690251 DOI: 10.1016/j.hrthm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Yuki Ishidoya
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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20
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Kim C, Park CH, Kim DY, Cha J, Lee BY, Park CH, Kang EJ, Koo HJ, Kitagawa K, Cha MJ, Krittayaphong R, Choi SI, Viswamitra S, Ko SM, Kim SM, Hwang SH, Trang NN, Lee W, Kim YJ, Lee J, Yang DH. Semi-Quantitative Scoring of Late Gadolinium Enhancement of the Left Ventricle in Patients with Ischemic Cardiomyopathy: Improving Interobserver Reliability and Agreement Using Consensus Guidance from the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) 2020. Korean J Radiol 2022; 23:298-307. [PMID: 35213094 PMCID: PMC8876655 DOI: 10.3348/kjr.2021.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. MATERIALS AND METHODS A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50-61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via web-based review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss' kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). RESULTS Interobserver reliability (Fleiss' kappa) in each segment ranged 0.242-0.662 before the consensus and increased to 0.301-0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728-0.805 and 0.849-0.884; vascular territory, 0.756-0.902 and 0.852-0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. CONCLUSION The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
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Affiliation(s)
- Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yeon Kim
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Jaehyung Cha
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Bae Young Lee
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sang Il Choi
- Department of Radiology, Seoul University Bundang Hospital, Seongnam, Korea
| | - Sanjaya Viswamitra
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Karnataka, India
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul, Korea
| | | | - Whal Lee
- Department of Radiology, Seoul University Hospital, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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21
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de Koning MSLY, van Dorp P, Assa S, Hartman MHT, Voskuil M, Anthonio RL, Veen D, Pundziute-Do Prado G, Leiner T, van Goor H, van der Meer P, van Veldhuisen DJ, Nijveldt R, Lipsic E, van der Harst P. Rationale and Design of the Groningen Intervention Study for the Preservation of Cardiac Function with Sodium Thiosulfate after St-segment Elevation Myocardial Infarction (GIPS-IV) trial. Am Heart J 2022; 243:167-176. [PMID: 34534493 DOI: 10.1016/j.ahj.2021.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/18/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Ischemia and subsequent reperfusion cause myocardial injury in patients presenting with ST-segment elevation myocardial infarction (STEMI). Hydrogen sulfide (H2S) reduces "ischemia-reperfusion injury" in various experimental animal models, but has not been evaluated in humans. This trial will examine the efficacy and safety of the H2S-donor sodium thiosulfate (STS) in patients presenting with a STEMI. STUDY DESIGN The Groningen Intervention study for the Preservation of cardiac function with STS after STEMI (GIPS-IV) trial (NCT02899364) is a double-blind, randomized, placebo-controlled, multicenter trial, which will enroll 380 patients with a first STEMI. Patients receive STS 12.5 grams intravenously or matching placebo in addition to standard care immediately at arrival at the catheterization laboratory after providing consent. A second dose is administered 6 hours later at the coronary care unit. The primary endpoint is myocardial infarct size as quantified by cardiac magnetic resonance imaging 4 months after randomization. Secondary endpoints include the effect of STS on peak CK-MB during admission and left ventricular ejection fraction and NT-proBNP levels at 4 months follow-up. Patients will be followed-up for 2 years to assess clinical endpoints. CONCLUSIONS The GIPS-IV trial is the first study to determine the effect of a H2S-donor on myocardial infarct size in patients presenting with STEMI.
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22
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Peng F, Zheng T, Tang X, Liu Q, Sun Z, Feng Z, Zhao H, Gong L. Magnetic Resonance Texture Analysis in Myocardial Infarction. Front Cardiovasc Med 2021; 8:724271. [PMID: 34778395 PMCID: PMC8581163 DOI: 10.3389/fcvm.2021.724271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Texture analysis (TA) is a newly arisen field that can detect the invisible MRI signal changes among image pixels. Myocardial infarction (MI) is cardiomyocyte necrosis caused by myocardial ischemia and hypoxia, becoming the primary cause of death and disability worldwide. In recent years, various TA studies have been performed in patients with MI and show a good clinical application prospect. This review briefly presents the main pathogenesis and pathophysiology of MI, introduces the overview and workflow of TA, and summarizes multiple magnetic resonance TA (MRTA) clinical applications in MI. We also discuss the facing challenges currently for clinical utilization and propose the prospect.
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Affiliation(s)
- Fei Peng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tian Zheng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoping Tang
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiao Liu
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zijing Sun
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhaofeng Feng
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Heng Zhao
- Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Lianggeng Gong
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang, China
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Image Quality and Reliability of a Novel Dark-Blood Late Gadolinium Enhancement Sequence in Ischemic Cardiomyopathy. J Thorac Imaging 2021; 35:326-333. [PMID: 32845112 DOI: 10.1097/rti.0000000000000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to assess the reliability of a 2D dark-blood phase-sensitive late gadolinium enhancement sequence (2D-DBPSLGE) compared with 2D phase-sensitive inversion recovery late gadolinium enhancement sequence (2D-BBPSLGE) in patients with ischemic cardiomyopathy (ICM). MATERIALS AND METHODS A total of 73 patients with a clinical history of ICM were prospectively enrolled. The following endpoints were evaluated: (a) comparison of image quality between 2D-BBPSLGE and 2D-DBPSLGE for differentiation between blood pool-late gadolinium enhancement (LGE), remote myocardium-LGE, and blood pool-remote myocardium; (b) diagnostic accuracy of 2D-DBPSLGE compared with gold standard 2D-BBPSLGE for the evaluation of infarcted segments; (c) diagnostic accuracy of 2D-DBPSLGE for the evaluation of microvascular obstruction (MVO); (d) comparison of transmurality index between 2D-BBPSLGE and 2D-DBPSLGE; (e) comparison of papillary muscle hyperenhancement between 2D-BBPSLGE and 2D-DBPSLGE; inter-reader agreement for depiction of hyperenhanced segments in both LGE sequences. Data were analyzed using paired t test, Wilcoxon test, and McNemar test, and η coefficient and intercorrelation coefficient (ICC). RESULTS Image quality was superior for 2D-DBPSLGE for differentiation of blood pool-LGE (P<0.001). 2D-DBPSLGE, compared with 2D-BBPSLGE, showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 96.93%, 99.89%, 99.71%, 98.78, and 99.04%, respectively. Concerning MVO detection, 2D-DBPSLGE showed a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 66.67%, 100.00%, 100.00%, 80.95%, and 86.21%, respectively. 2D-DBPSLGE underestimated the transmurality (P=0.007) and identified papillary muscle hyperenhancement (P<0.001). Both LGE sequences showed comparable interobserver agreement for the evaluation of infarcted areas (2D-BBPSLGE: ICC 0.99;2D-DBPSLGE: ICC 0.99). CONCLUSIONS Compared with 2D-BBPSLGE, 2D-DBPSLGE sequences provide better differentiation between LGE and blood-pool, while underestimating LGE trasmurality and the presence of MVO.
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Abou R, Prihadi EA, Goedemans L, van der Geest R, El Mahdiui M, Schalij MJ, Ajmone Marsan N, Bax JJ, Delgado V. Left ventricular mechanical dispersion in ischaemic cardiomyopathy: association with myocardial scar burden and prognostic implications. Eur Heart J Cardiovasc Imaging 2021; 21:1227-1234. [PMID: 32734280 DOI: 10.1093/ehjci/jeaa187] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/12/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Left ventricular (LV) mechanical dispersion (MD) may result from heterogeneous electrical conduction and is associated with adverse events. The present study investigated (i) the association between LV MD and the extent of LV scar as assessed with contrast-enhanced cardiac magnetic resonance (CMR) and (ii) the prognostic implications of LV MD in patients after ST-segment elevation myocardial infarction. METHODS AND RESULTS LV MD was calculated by echocardiography and myocardial scar was analysed on CMR data retrospectively. Infarct core and border zone were defined as ≥50% and 35-50% of maximal signal intensity, respectively. Patients were followed for the occurrence of the combined endpoint (all-cause mortality and appropriate implantable cardioverter-defibrillator therapy). In total, 96 patients (87% male, 57 ± 10 years) were included. Median LV MD was 53.5 ms [interquartile range (IQR) 43.4-62.8]. On CMR, total scar burden was 11.4% (IQR 3.8-17.1%), infarct core tissue 6.2% (IQR 2.0-12.7%), and border zone was 3.5% (IQR 1.5-5.7%). Correlations were observed between LV MD and infarct core (r = 0.517, P < 0.001), total scar burden (r = 0.497, P < 0.001), and border zone (r = 0.298, P = 0.003). In total, 14 patients (15%) reached the combined endpoint. Patients with LV MD >53.5 ms showed higher event rates as compared to their counterparts. Finally, LV MD showed the highest area under the curve for the prediction of the combined endpoint. CONCLUSION LV MD is correlated with LV scar burden. In addition, patients with prolonged LV MD showed higher event rates. Finally, LV MD provided the highest predictive value for the combined endpoint when compared with other parameters.
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Affiliation(s)
- Rachid Abou
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Laurien Goedemans
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Rob van der Geest
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300RC Leiden, The Netherlands
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25
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Milotta G, Munoz C, Kunze KP, Neji R, Figliozzi S, Chiribiri A, Hajhosseiny R, Masci PG, Prieto C, Botnar RM. 3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2021; 23:62. [PMID: 34024276 PMCID: PMC8142497 DOI: 10.1186/s12968-021-00751-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop a free-breathing whole-heart isotropic-resolution 3D late gadolinium enhancement (LGE) sequence with Dixon-encoding, which provides co-registered 3D grey-blood phase-sensitive inversion-recovery (PSIR) and complementary 3D fat volumes in a single scan of < 7 min. METHODS A free-breathing 3D PSIR LGE sequence with dual-echo Dixon readout with a variable density Cartesian trajectory with acceleration factor of 3 is proposed. Image navigators are acquired to correct both inversion recovery (IR)-prepared and reference volumes for 2D translational respiratory motion, enabling motion compensated PSIR reconstruction with 100% respiratory scan efficiency. An intermediate PSIR reconstruction is performed between the in-phase echoes to estimate the signal polarity which is subsequently applied to the IR-prepared water volume to generate a water grey-blood PSIR image. The IR-prepared water volume is obtained using a water/fat separation algorithm from the corresponding dual-echo readout. The complementary fat-volume is obtained after water/fat separation of the reference volume. Ten patients (6 with myocardial scar) were scanned with the proposed water/fat grey-blood 3D PSIR LGE sequence at 1.5 T and compared to breath-held grey-blood 2D LGE sequence in terms of contrast ratio (CR), contrast-to-noise ratio (CNR), scar depiction, scar transmurality, scar mass and image quality. RESULTS Comparable CRs (p = 0.98, 0.40 and 0.83) and CNRs (p = 0.29, 0.40 and 0.26) for blood-myocardium, scar-myocardium and scar-blood respectively were obtained with the proposed free-breathing 3D water/fat LGE and 2D clinical LGE scan. Excellent agreement for scar detection, scar transmurality, scar mass (bias = 0.29%) and image quality scores (from 1: non-diagnostic to 4: excellent) of 3.8 ± 0.42 and 3.6 ± 0.69 (p > 0.99) were obtained with the 2D and 3D PSIR LGE approaches with comparable total acquisition time (p = 0.29). Similar agreement in intra and inter-observer variability were obtained for the 2D and 3D acquisition respectively. CONCLUSION The proposed approach enabled the acquisition of free-breathing motion-compensated isotropic-resolution 3D grey-blood PSIR LGE and fat volumes. The proposed approach showed good agreement with conventional 2D LGE in terms of CR, scar depiction and scan time, while enabling free-breathing acquisition, whole-heart coverage, reformatting in arbitrary views and visualization of both water and fat information.
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Affiliation(s)
- Giorgia Milotta
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK.
| | - Camila Munoz
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Karl P Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, UK
| | - Stefano Figliozzi
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - René M Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital (3rd Floor - Lambeth Wing), Westminster Bridge Road, London, SE1 7EH, UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
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Handa BS, Li X, Baxan N, Roney CH, Shchendrygina A, Mansfield CA, Jabbour RJ, Pitcher DS, Chowdhury RA, Peters NS, Ng FS. Ventricular fibrillation mechanism and global fibrillatory organization are determined by gap junction coupling and fibrosis pattern. Cardiovasc Res 2021; 117:1078-1090. [PMID: 32402067 PMCID: PMC7983010 DOI: 10.1093/cvr/cvaa141] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/25/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Conflicting data exist supporting differing mechanisms for sustaining ventricular fibrillation (VF), ranging from disorganized multiple-wavelet activation to organized rotational activities (RAs). Abnormal gap junction (GJ) coupling and fibrosis are important in initiation and maintenance of VF. We investigated whether differing ventricular fibrosis patterns and the degree of GJ coupling affected the underlying VF mechanism. METHODS AND RESULTS Optical mapping of 65 Langendorff-perfused rat hearts was performed to study VF mechanisms in control hearts with acute GJ modulation, and separately in three differing chronic ventricular fibrosis models; compact fibrosis (CF), diffuse fibrosis (DiF), and patchy fibrosis (PF). VF dynamics were quantified with phase mapping and frequency dominance index (FDI) analysis, a power ratio of the highest amplitude dominant frequency in the cardiac frequency spectrum. Enhanced GJ coupling with rotigaptide (n = 10) progressively organized fibrillation in a concentration-dependent manner; increasing FDI (0 nM: 0.53 ± 0.04, 80 nM: 0.78 ± 0.03, P < 0.001), increasing RA-sustained VF time (0 nM: 44 ± 6%, 80 nM: 94 ± 2%, P < 0.001), and stabilized RAs (maximum rotations for an RA; 0 nM: 5.4 ± 0.5, 80 nM: 48.2 ± 12.3, P < 0.001). GJ uncoupling with carbenoxolone progressively disorganized VF; the FDI decreased (0 µM: 0.60 ± 0.05, 50 µM: 0.17 ± 0.03, P < 0.001) and RA-sustained VF time decreased (0 µM: 61 ± 9%, 50 µM: 3 ± 2%, P < 0.001). In CF, VF activity was disorganized and the RA-sustained VF time was the lowest (CF: 27 ± 7% vs. PF: 75 ± 5%, P < 0.001). Global fibrillatory organization measured by FDI was highest in PF (PF: 0.67 ± 0.05 vs. CF: 0.33 ± 0.03, P < 0.001). PF harboured the longest duration and most spatially stable RAs (patchy: 1411 ± 266 ms vs. compact: 354 ± 38 ms, P < 0.001). DiF (n = 11) exhibited an intermediately organized VF pattern, sustained by a combination of multiple-wavelets and short-lived RAs. CONCLUSION The degree of GJ coupling and pattern of fibrosis influences the mechanism sustaining VF. There is a continuous spectrum of organization in VF, ranging between globally organized fibrillation sustained by stable RAs and disorganized, possibly multiple-wavelet driven fibrillation with no RAs.
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Affiliation(s)
- Balvinder S Handa
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Xinyang Li
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London, UK
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King’s College London, London, UK
| | - Anastasia Shchendrygina
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Catherine A Mansfield
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Richard J Jabbour
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - David S Pitcher
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Rasheda A Chowdhury
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Nicholas S Peters
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
| | - Fu Siong Ng
- National Heart & Lung Institute, Imperial College London, 4th Floor, ICTEM Building, 72 Du Cane Road, London W12 0NN, UK
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Abstract
Purpose of Review The purpose of this review is to summarize the application of cardiac magnetic resonance (CMR) in the diagnostic and prognostic evaluation of patients with heart failure (HF). Recent Findings CMR is an important non-invasive imaging modality in the assessment of ventricular volumes and function and in the analysis of myocardial tissue characteristics. The information derived from CMR provides a comprehensive evaluation of HF. Its unique ability of tissue characterization not only helps to reveal the underlying etiologies of HF but also offers incremental prognostic information. Summary CMR is a useful non-invasive tool for the diagnosis and assessment of prognosis in patients suffering from heart failure.
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Affiliation(s)
- Chuanfen Liu
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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Ishidoya Y, Ranjan R. Novel Approaches to Risk Assessment for Ventricular Tachycardia Induction and Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-020-00666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Markousis-Mavrogenis G, Bacopoulou F, Vlachakis D, Mavrogeni S. Tissue Characterization in Cardiology: Moving Beyond Function. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:89-97. [DOI: 10.1007/978-3-030-78771-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Emrich T, Kros M, Schoepf UJ, Geyer M, Mildenberger P, Kloeckner R, Wenzel P, Varga-Szemes A, Düber C, Münzel T, Kreitner KF. Cardiac magnetic resonance imaging features prognostic information in patients with suspected myocardial infarction with non-obstructed coronary arteries. Int J Cardiol 2020; 327:223-230. [PMID: 33309758 DOI: 10.1016/j.ijcard.2020.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND To assess the prognostic implications of cardiac magnetic resonance imaging (CMR) in patients with clinical suspicion of myocardial infarction with non-obstructed coronary arteries (MINOCA). METHODS A total of 145 patients (58 ± 15 years, 97 men) were retrospectively enrolled in this single-center, longitudinal observational study. All patients underwent CMR including cine, edema-sensitive, and late gadolinium enhancement acquisitions, within a median of 3 days after cardiac catheterization. Follow-up was performed by medical records chart review and phone interviews; the median follow-up time was 4.2 years. The primary endpoint was defined as a combination of death, stroke, new onset of congestive heart failure, recurrent hospitalization, or the need for an invasive cardiac procedure. RESULTS In 143 (98.6%) cases, CMR revealed the following cardiac pathologies: myocarditis (n = 48, 33.1%), structural cardiomyopathies (n = 40, 27.6%), "true" myocardial infarction (n = 22, 15.1%), hypertensive heart disease (n = 19, 13.1%), and Tako-Tsubo cardiomyopathy (n = 14, 9.7%). Only two patients (1.4%) had a normal CMR examination. There were significant prognostic differences between different etiologies, e.g. myocarditis and Tako-Tsubo cardiomyopathy had a more favorable prognosis then structural cardiomyopathies. Age, end-diastolic volume index and time-to-CMR showed significant association with the primary endpoint in multi-variate Cox regression. CONCLUSIONS CMR performed early after the onset of clinical symptoms allows discrimination between acute myocardial injury from "true" MINOCA in patients presenting with chest pain and elevated cardiac biomarkers, thereby helping to identify the underlying pathology in suspected MINOCA and allowing risk stratification based on the established diagnosis. Furthermore, CMR parameters allow for improved prediction of adverse events compared to clinical and laboratory parameters.
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckst. 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckst. 1, 55131 Mainz, Germany; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, 29425, SC, USA
| | - Max Kros
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckst. 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, 29425, SC, USA.
| | - Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Philipp Mildenberger
- Department of Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckst. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckst. 1, 55131 Mainz, Germany; Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, 29425, SC, USA
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckst. 1, 55131 Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckst. 1, 55131 Mainz, Germany; Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckst. 1, 55131 Mainz, Germany
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Yang T, Lu M, Ouyang W, Li B, Yang Y, Zhao S, Sun H. Prognostic value of myocardial scar by magnetic resonance imaging in patients undergoing coronary artery bypass graft. Int J Cardiol 2020; 326:49-54. [PMID: 33296720 DOI: 10.1016/j.ijcard.2020.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/01/2020] [Accepted: 10/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies demonstrated that scar tissue assessed by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) is associated with recovery of cardiac function after coronary artery bypass graft (CABG) in patients with a history of myocardial infarction (MI). However, information on the association between myocardial scar at baseline and long-term survival after CABG in these patients is lacking. METHODS From April 2010 to May 2013, consecutive patients with multivessel coronary artery disease (CAD, > 70% stenosis in ≥2 vessels) and MI (> 3 months) who underwent LGE-CMR within 1 month prior to isolated CABG were enrolled. Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before surgery. A standard 17-segment model was used for scar quantification. Predictors for cardiovascular events (CVEs) were analyzed. RESULTS Of 148 patients who met the study inclusion/exclusion criteria, 140 cases had follow-up data and were included in final analysis. Of the latter, 27 (19.3%) patients suffered CVEs perioperatively or during mean 89.6 ± 12.0 months follow-up. In Cox proportional hazard regression model, the most significant predictor for CVEs after CABG was the number of scar segments on LGE-CMR (Hazard ratio 2.078, 95% Confidence Interval 1.133-3.814, P= 0.018). In Receiver-Operator-Characteristic (ROC) analysis, number of scar segments ≥6 predicted CVEs (sensitivity, 74.1%; specificity, 95.6%; area under the curve [AUC] = 0.934, P < 0.001). CONCLUSIONS Scar tissue identified by LGE-CMR appears to be an independent predictor of CVEs after CABG in patients with a history of MI, which might allow preoperative risk stratification.
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Affiliation(s)
- Tao Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Minjie Lu
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Wenbin Ouyang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Baotong Li
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Yan Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shihua Zhao
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing 100037, China
| | - Hansong Sun
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China..
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Ahmed SW, Sultan FAT, Awan S, Ahmed I. Prognostic Significance of CMR Findings in Patients with Known Coronary Artery Disease - Experience from a South Asian Country. J Clin Imaging Sci 2020; 10:75. [PMID: 33274119 PMCID: PMC7708965 DOI: 10.25259/jcis_153_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives: South Asians (SA) have a higher burden of coronary artery disease (CAD) and are known to have a worse prognosis compared to other ethnicities. Therefore, it is imperative to improve the risk stratification of SA patient with CAD and to seek out newer prognostic markers beyond the conventional echocardiography.The aim of this study was to investigate whether variables obtained by cardiac magnetic resonance (CMR) improve risk stratification of South Asian patients with known CAD. Material and Methods: We retrospectively analyzed 147 patients with evidence of CAD that had a CMR at our center between January 2011 and January 2019. LV volumes and regional wall motions were acquired by cine images, while infarct size (IS) was measured by late gadolinium enhancement. At a mean follow-up of 3.36 ± 2.22 years, cardiac events (non-fatal myocardial infarction, hospitalization due to heart failure, life-threatening arrhythmia, or cardiac death) occurred in 49 patients. An IS ≥35%, left ventricular ejection fraction (LVEF) ≤31%, and a wall motion score index (WMSI) ≥1.9 were strongly associated with follow-up cardiac events (P < 0.001). Patients that had none or less than 3 of these factors, showed a lower risk of cardiac events (HR 0.22 CI [0.11–0.44] P < 0.001 and HR 0.12 CI [0.04–0.32] P < 0.001, respectively) compared to those with all three factors. Conclusion: Integration of CMR derived factors such as IS and WMSI with LVEF can improve the prognostication of the SA population with CAD. Better risk stratification of patients can lead to improved and cost-effective therapeutic strategies to ameliorate the prognosis of these patients.
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Affiliation(s)
- Syed Waqar Ahmed
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Imran Ahmed
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Prognostic value of myocardial fibrosis on cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy: A systematic review. Am Heart J 2020; 229:52-60. [PMID: 32916608 PMCID: PMC7417269 DOI: 10.1016/j.ahj.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 08/03/2020] [Indexed: 01/15/2023]
Abstract
The use of cardiac magnetic resonance imaging (c-MRI) in risk stratification for clinical outcomes of patients with ischemic cardiomyopathy (ICM) remains low. This systematic review investigated the prognostic value of myocardial fibrosis as assessed by late gadolinium enhancement (LGE) on c-MRI in patients with ICM for ventricular tachyarrhythmia, sudden cardiac death (SCD), or all-cause mortality. Methods We conducted a systematic review of the electronic databases Pubmed and Embase for relevant prospective English-language studies published between January 1990 and February 2019. All included articles were prospective studies that comprised of human participants older than 18 years with ICM and a primary or secondary prevention implantable cardioverter/defibrillator (ICD); had a sample size >30 participants; had at least 6 months of follow-up; and reported on ventricular tachyarrhythmia, SCD, and all-cause mortality. A total of 90 articles related to ICM were identified and were subsequently screened independently by 2 authors. Pooled sensitivity and specificity of LGE were calculated using random-effects model. Results Eight studies with 1,085 participants were included in the final analysis. The mean age of patients varied from 43 to 83 years, with most patients being men. The most common comorbidities reported included history of diabetes mellitus (22%-62%), hyperlipidemia (40%-86%), and hypertension (35%-88%). The ejection fraction of each study was reported as mean or median and varied from 22% to 35%. During a follow-up that ranged from 8.5 to 65 months, there were 110 ventricular arrhythmic events reported. The pooled sensitivity and specificity of LGE for ICD therapy delivered for ventricular arrhythmias were 0.79 (95% CI: 0.66-0.87) and 0.28 (95% CI: 0.14-0.46), respectively. For all-cause mortality, the pooled sensitivity and specificity of LGE were 0.76 (95% CI: 0.40-0.93) and 0.41 (95% CI: 0.14-0.75), respectively. Although SCD was of significant interest to our review, only 1 of the studies reported on the association between LGE and SCD, leading to the subsequent exclusion of SCD from the end point analysis. Conclusions LGE has high prognostic value in predicting adverse outcomes in patients with ICM and may provide helpful information for clinical decision making related to SCD prevention. Our findings illustrate how LGE may improve current risk stratification, prognostication, and selection of patients with ICM for ICD therapy.
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Clinical characteristics and outcomes of patients with severe left ventricular dysfunction undergoing cardiac MRI viability assessment prior to revascularization. Int J Cardiovasc Imaging 2020; 37:675-684. [PMID: 33034865 DOI: 10.1007/s10554-020-02042-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Coronary artery bypass grafting improves survival in patients with ischemic cardiomyopathy, however, these patients are at high risk for morbidity and mortality. The role of viability testing to guide revascularization in these patients is unclear. Cardiac magnetic resonance imaging (CMR) has not been studied adequately in this population despite being considered a reference standard for infarct imaging. We performed a multicenter retrospective analysis of patients (n = 154) with severe left ventricular systolic dysfunction [ejection fraction (EF) < 35%] on CMR who underwent CMR viability assessment prior to consideration for revascularization. Using the AHA16-segment model, percent total myocardial viability was determined depending on the degree of transmural scar thickness. Patients with or without revascularization had similar clinical characteristics and were prescribed similar medical therapy. Overall, 43% of patients (n = 66) experienced an adverse event during the median 3 years follow up. For the composite outcome (death, myocardial infarction, heart failure hospitalization, stroke, ventricular tachycardia) patients receiving revascularization were less likely to experience an adverse event compared to those without revascularization (HR 0.53, 95% CI 0.33-0.86, p = 0.01). Patients with > 50% viability on CMR had a 47% reduction in composite events when undergoing revascularization opposed to medical therapy alone (HR 0.53, p = 0.02) whereas patients with a viability < 50% were 2.7 times more likely to experience an adverse event (p = 0.01). CMR viability assessment may be an important tool in the shared decision-making process when considering revascularization options in patients with severe ischemic cardiomyopathy.
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Vazir A, Fox K, Westaby J, Evans MJ, Westaby S. Can we remove scar and fibrosis from adult human myocardium? Eur Heart J 2020; 40:960-966. [PMID: 30203057 DOI: 10.1093/eurheartj/ehy503] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/09/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022] Open
Abstract
The pathological processes leading to heart failure are characterized by the formation of fibrosis and scar, yet the dynamics of scar production and removal are incompletely understood. Spontaneous disappearance of myocardial collagen is reported in infancy but doubted in adulthood where scar volume constitutes a better prognostic indicator than the conventional parameters of ventricular function. Whilst certain drugs are known to attenuate myocardial fibrosis evidence is emerging that stem cell therapy also has the potential to reduce scar size and improve myocardial viability. Both animal studies and clinical trials support the concept that, as in infancy, cellular processes can be triggered to remove collagen and regenerate injured myocardium. The molecular mechanisms likely involve anti-fibrotic cytokines growth factors and matrix-metalloproteinases. Autologous cardiac, bone-marrow and adipose tissue derived stem cells have each shown efficacy. Specific immune privileged mesenchymal stem cells and genetically modified immunomodulatory progenitor cells may in turn provide an allogenic source for the paracrine effects. Thus autologous and allogenic cells both have the potential through paracrine action to reduce scar volume, boost angiogenesis and improve ventricular morphology. The potential benefit of myocardial cell therapy for routine treatment of heart failure is an area that requires further study.
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Affiliation(s)
- Ali Vazir
- National Heart and Lung Institute, Imperial College London and ICMS, Royal Brompton Hospital, Dovehouse Street, London, UK
| | - Kim Fox
- National Heart and Lung Institute, Imperial College London and ICMS, Royal Brompton Hospital, Dovehouse Street, London, UK
| | - Joseph Westaby
- Department of Pathology, St George's University Hospital NHS Foundation Trust, Blackshaw Road, Tooting, London, UK
| | - Martin J Evans
- School of Biosciences, Cardiff University, The Sir Martin Evans Building, Museum Avenue, Cardiff, Wales, UK
| | - Stephen Westaby
- National Heart and Lung Institute, Imperial College London and ICMS, Royal Brompton Hospital, Dovehouse Street, London, UK.,Institute of Life Science, Swansea University, Singleton Park, Swansea, Wales, UK
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Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle. Heart Fail Rev 2020; 27:49-69. [PMID: 32564329 DOI: 10.1007/s10741-020-09986-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratification.
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New Imaging Parameters to Predict Sudden Cardiac Death in Chagas Disease. Trop Med Infect Dis 2020; 5:tropicalmed5020074. [PMID: 32397217 PMCID: PMC7345269 DOI: 10.3390/tropicalmed5020074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Chronic Chagas' cardiomyopathy is the most severe and frequent manifestation of Chagas disease, and has a high social and economic burden. New imaging modalities, such as strain echocardiography, nuclear medicine, computed tomography and cardiac magnetic resonance imaging, may detect the presence of myocardial fibrosis, inflammation or sympathetic denervation, three conditions associated with risk of sudden death, providing additional diagnostic and/or prognostic information. Unfortunately, despite its high mortality, there is no clear recommendation for early cardioverter-defibrillator implantation in patients with Chagas heart disease in the current guidelines. Ideally, the risk of sudden cardiac death may be evaluated in earlier stages of the disease using new image methods to allow the implementation of primary preventive strategies.
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Malaczynska-Rajpold K, Blaszyk K, Kociemba A, Pyda M, Posadzy-Malaczynska A, Grajek S. Islets of heterogeneous myocardium within the scar in cardiac magnetic resonance predict ventricular tachycardia after myocardial infarction. J Cardiovasc Electrophysiol 2020; 31:1452-1461. [PMID: 32227520 DOI: 10.1111/jce.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/06/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We assessed findings in cardiac magnetic resonance (CMR) as predictors of ventricular tachycardia (VT) after myocardial infarction (MI), which could allow for more precise identification of patients at risk of sudden cardiac death. METHODS Forty-eight patients after prior MI were enrolled and divided into two groups: with (n = 24) and without (n = 24) VT. VT was confirmed by electrophysiological study and exit site was estimated based on 12-lead electrocardiogram. All patients underwent CMR with late gadolinium enhancement. RESULTS The examined groups did not differ significantly in clinical and demographical parameters (including LV ejection fraction). There was a significant difference in the infarct age between the VT and non-VT group (15.8 ± 8.4 vs 7.1 ± 6.7 years, respectively; P = .002), with the cut-off point at the level of 12 years. In the scar core, islets of heterogeneous myocardium were revealed. They were defined as areas of potentially viable myocardium within or adjacent to the core scar. The number of islets was the strongest independent predictor of VT (odds ratio [OR], 1.42; confidence interval [CI], 1.17-1.73), but total islet size and the largest islet area were also significantly higher in the VT group (OR, 1.04; CI, 1.02-1.07 and OR, 1.16; CI, 1.01-1.27, respectively). Myocardial segments with fibrosis forming 25%-75% of the ventricular wall were associated with a higher incidence of VT (7.5 ± 2.1 vs 5.7 ± 2.6; P = .014). Three-dimension CMR reconstruction confirmed good correlation of the location of the islets/channels with VT exit site during electroanatomical mapping in five cases. CONCLUSIONS The identification and quantification of islets of heterogeneous myocardium within the scar might be useful for predicting VT in patients after MI.
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Affiliation(s)
- Katarzyna Malaczynska-Rajpold
- Heart Division, Royal Brompton & Harefield NHS Foundation Trust, London, UK.,1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Blaszyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Kociemba
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.,Heart Division, Affidea International Oncology Centre, Poznan, Poland
| | - Malgorzata Pyda
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Stefan Grajek
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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Van Kirk J, Fudim M, Green CL, Karra R. Heterogeneous Outcomes of Heart Failure with Better Ejection Fraction. J Cardiovasc Transl Res 2020; 13:142-150. [PMID: 31721131 PMCID: PMC7170767 DOI: 10.1007/s12265-019-09919-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
We evaluated the heterogeneity of outcomes among heart failure patients with ventricular recovery. The BEST trial studied patients with left ventricular ejection fraction (LVEF) ≤ 35%. Serial LVEF assessment was performed at baseline, 3 months, and 12 months. Heart failure with better ejection fraction (HFbEF) was defined as an LVEF > 40% at any point. Of the patients who survived to 1 year, 399 (21.3%) had HFbEF. Among subjects with HFbEF, 173 (43.4%) had "extended" recovery, 161 (40.4%) had "late" recovery, and 65 (16.3%) patients had "transient" recovery. Subjects with HFbEF had an improved event-free survival from death or first HF hospitalization compared to subjects without recovery (HR 0.50, 95% CI, 0.39-0.64, p < 0.001). Compared to "transient" recovery, "late" and "extended" recovery were associated with an improved event-free survival from all-cause death and HF hospitalization (HR 0.55, 95% CI, 0.34-0.90, p = 0.016). Our study shows patients with HFbEF to be a heterogeneous population with differing prognoses.
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Affiliation(s)
- Jenny Van Kirk
- Department of Medicine, Duke University Medical Center, Box 3126, Durham, NC, 27710, USA
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Box 3126, Durham, NC, 27710, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Ravi Karra
- Department of Medicine, Duke University Medical Center, Box 3126, Durham, NC, 27710, USA.
- Regeneration Next, Duke University, Durham, NC, USA.
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Kolentinis M, Le M, Nagel E, Puntmann VO. Contemporary Cardiac MRI in Chronic Coronary Artery Disease. Eur Cardiol 2020; 15:e50. [PMID: 32612708 PMCID: PMC7312615 DOI: 10.15420/ecr.2019.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic coronary artery disease remains an unconquered clinical problem, affecting an increasing number of people worldwide. Despite the improved understanding of the disease development, the implementation of the many advances in diagnosis and therapy is lacking. Many clinicians continue to rely on patient's symptoms and diagnostic methods, which do not enable optimal clinical decisions. For example, echocardiography and invasive coronary catheterisation remain the mainstay investigations for stable angina patients in many places, despite the evidence on their limitations and availability of better diagnostic options. Cardiac MRI is a powerful diagnostic method, supporting robust measurements of crucial markers of cardiac structure and function, myocardial perfusion and scar, as well as providing detailed insight into myocardial tissue. Accurate and informative diagnostic readouts can help with guiding therapy, monitoring disease progress and tailoring the response to treatment. In this article, the authors outline the evidence supporting the state-of-art applications based on cardiovascular magnetic resonance, allowing the clinician optimal use of this insightful diagnostic method in everyday clinical practice.
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Affiliation(s)
- Michalis Kolentinis
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Melanie Le
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
| | - Valentina O Puntmann
- Institute of Experimental and Translational Cardiovascular Imaging, German Centre for Cardiovascular Research (DZHK) Centre for Cardiovascular Imaging, Partner Site Rhein-Main, University Hospital Frankfurt Frankfurt, Germany
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41
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Lee DC, Albert CM, Narula D, Kadish AH, Panicker GK, Wu E, Schaechter A, Pester J, Chatterjee NA, Cook NR, Goldberger JJ. Estimating Myocardial Infarction Size With a Simple Electrocardiographic Marker Score. J Am Heart Assoc 2020; 9:e014205. [PMID: 31973600 PMCID: PMC7033860 DOI: 10.1161/jaha.119.014205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Myocardial infarction (MI) size is a key predictor of prognosis in post‐MI patients. Cardiovascular magnetic resonance (CMR) is the gold standard test for MI quantification, but the ECG is less expensive and more widely available. We sought to quantify the relationship between ECG markers and cardiovascular magnetic resonance infarct size. Methods and Results Patients with prior MI enrolled in the DETERMINE (Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation) and PRE‐DETERMINE Trial and Registry were included. ECG leads were analyzed for markers of MI: Q waves, fragmented QRS, and T wave inversion. DETERMINE Score=number of leads with [Q waves×2]+[fragmented QRS]+[T wave inversion]. Left ventricular ejection fraction (LVEF) and infarct size as a percentage of left ventricular mass (MI%) were quantified by cardiovascular magnetic resonance. The Modified Selvester Score estimates MI size from 37 ECG criteria. In 551 patients (aged 62.1±10.9 years, 79% men, and LVEF=40.3±11.0%), MI% increased as the number of ECG markers increased (P<0.001). By univariable linear regression, the DETERMINE Score (range 0–26) estimated MI% (R2=0.18, P<0.001) with an accuracy approaching that of LVEF (R2=0.22, P<0.001) and higher than the Modified Selvester Score (R2=0.09, P<0.001). By multivariable linear regression, addition of the DETERMINE Score improved estimation of MI% over LVEF alone (P<0.001) and over Modified Selvester Score alone (P<0.001). Conclusions In patients with prior MI, a simple ECG score estimates infarct size and improves infarct size estimation over LVEF alone. Because infarct size is a powerful prognostic indicator, the DETERMINE Score holds promise as a simple and inexpensive risk assessment tool.
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Affiliation(s)
- Daniel C Lee
- Northwestern University Feinberg School of Medicine Chicago IL
| | | | | | | | | | - Edwin Wu
- Northwestern University Feinberg School of Medicine Chicago IL
| | - Andi Schaechter
- Northwestern University Feinberg School of Medicine Chicago IL
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Kwon DH, Obuchowski NA, Marwick TH, Menon V, Griffin B, Flamm SD, Hachamovitch R. Jeopardized Myocardium Defined by Late Gadolinium Enhancement Magnetic Resonance Imaging Predicts Survival in Patients With Ischemic Cardiomyopathy: Impact of Revascularization. J Am Heart Assoc 2019; 7:e009394. [PMID: 30571486 PMCID: PMC6404459 DOI: 10.1161/jaha.118.009394] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prognostic impact of jeopardized myocardium ( JM ) in patients with advanced ischemic cardiomyopathy ( ICM ) is unclear. We hypothesized that JM is an independent predictor of mortality in patients with advanced ICM . Methods and Results Patients with ICM who underwent cardiac magnetic resonance imaging between January 2002 and January 2013 were included in our study. JM was identified as a vascular territory with <50% myocardial scarring on cardiac magnetic resonance imaging and with >70% stenosis in a major coronary vessel that was not subsequently revascularized. A propensity score was developed for revascularization. A multivariable Cox proportional hazards model was used to evaluate the association of JM with all-cause mortality. We evaluated 631 patients over a mean follow-up of 5.1 years. Overall, 336 patients underwent subsequent revascularization during the follow-up period, among whom 23% had remaining JM , while 295 patients were medically treated (57% with JM ). There were 204 deaths (32%). On multivariable analysis, JM (hazard ratio, 1.88; 95% confidence interval, 1.38-2.55 [ P<0.001]) was independently associated with all-cause mortality after adjusting for multiple other factors. The risk associated with the presence of JM increased by 5% for every 10-unit increase in left ventricular end-systolic volume index. Conclusions JM is an independent and incremental predictor of mortality in patients with advanced ICM . Patients undergoing revascularization with residual JM had similar risk of mortality compared with medically treated patients with JM . The risk associated with JM significantly increased in the presence of worsening adverse left ventricular remodeling. Cardiac magnetic resonance viability assessment may provide important risk stratification in patients with ICM .
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Affiliation(s)
- Deborah H Kwon
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH.,2 Imaging Institute Cleveland Clinic Cleveland OH
| | - Nancy A Obuchowski
- 2 Imaging Institute Cleveland Clinic Cleveland OH.,3 Quantitative Health Sciences Cleveland Clinic Cleveland OH
| | - Thomas H Marwick
- 4 Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Venu Menon
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Brian Griffin
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Scott D Flamm
- 1 Heart and Vascular Institute Cleveland Clinic Cleveland OH.,2 Imaging Institute Cleveland Clinic Cleveland OH
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Alkindi F, El-Menyar A, Rafie I, Arabi A, Al Suwaidi J, Singh R, Albinali H, Gehani AA. Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block. Angiology 2019; 71:256-262. [DOI: 10.1177/0003319719892159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( P = .001), more likely to present with breathlessness rather than chest pain ( P = .001), and had more diabetes mellitus ( P = .001). Patients with RBBB had significantly higher cardiac enzymes ( P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.
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Affiliation(s)
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ihsan Rafie
- Cardiology Department, Heart Hospital, Doha, Qatar
| | | | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Vajapey R, Eck B, Tang W, Kwon DH. Advances in MRI Applications to Diagnose and Manage Cardiomyopathies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:74. [PMID: 31773390 DOI: 10.1007/s11936-019-0762-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The prevalence of heart failure continues to rise, and imaging characterization of the cardiomyopathic process is important for identifying myocardial disease, initiating appropriate treatment, and improving outcomes. We aimed to summarize recent advances in cardiac magnetic resonance imaging (CMR) applications for the diagnosis, characterization, and implications on management of various cardiomyopathies. RECENT FINDINGS Parametric mapping by CMR has emerged as an important advancement in quantification of myocardial fibrosis, increased extracellular space, and myocardial edema. In addition, improved assessment of myocardial function with myocardial strain assessment may provide early identification of patients at risk and determining responsiveness to therapeutic interventions. Novel MRI techniques and the advent of artificial intelligence may help to uncover important mechanistic insights into the cardiomyopathic process. Innovative CMR techniques continue to evolve, and it will be of interest to determine how these advances can be incorporated into clinical practice to improve diagnosis, treatment, and management of patients with cardiomyopathies.
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Affiliation(s)
- Ramya Vajapey
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Brendan Eck
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Wilson Tang
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Deborah H Kwon
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA. .,Department of Cardiovascular Medicine, Cleveland Clinic, Imaging Institute, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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45
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Puntmann VO, Carr-White G, Jabbour A, Yu CY, Gebker R, Kelle S, Rolf A, Zitzmann S, Peker E, D'Angelo T, Pathan F, Elen, Valbuena S, Hinojar R, Arendt C, Narula J, Herrmann E, Zeiher AM, Nagel E. Native T1 and ECV of Noninfarcted Myocardium and Outcome in Patients With Coronary Artery Disease. J Am Coll Cardiol 2019; 71:766-778. [PMID: 29447739 DOI: 10.1016/j.jacc.2017.12.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the major cause of cardiac morbidity and mortality worldwide, despite the advances in treatment with coronary revascularization and modern antiremodeling therapy. Risk stratification in CAD patients is primarily based on left ventricular volumes, ejection fraction (LVEF), risk scores, and the presence and extent of late gadolinium enhancement (LGE). The prognostic role of T1 mapping in noninfarcted myocardium in CAD patients has not yet been determined. OBJECTIVES This study sought to examine prognostic significance of native T1 mapping of noninfarcted myocardium in patients with CAD. METHODS A prospective, observational, multicenter longitudinal study of consecutive patients undergoing routine cardiac magnetic resonance imaging with T1 mapping and LGE. The primary endpoint was all-cause mortality. Major adverse cardiocerebrovascular events (MACCE) (cardiac mortality, nonfatal acute coronary syndrome, stroke, and appropriate device discharge) are also reported. RESULTS A total of 34 deaths and 71 MACCE (n = 665, males n = 424, median age [interquartile range] 57 [22] years; 64%; median follow-up period of 17 [11] months) were observed. Native T1 and extracellular volume were univariate predictors of outcome. Native T1 and LGE were stronger predictors of survival and MACCE compared with extracellular volume, LVEF, cardiac volumes, and clinical scores (p < 0.001). Native T1 of noninfarcted myocardium was the sole independent predictor of all-cause mortality (chi-square = 21.7; p < 0.001), which was accentuated in the absence of LGE or LVEF ≤35%. For MACCE, native T1 and LGE extent were joint independent predictors (chi-square = 25.6; p < 0.001). CONCLUSIONS Characterization of noninfarcted myocardium by native T1 is an important predictor of outcome in CAD patients, over and above the traditional risk stratifiers. The current study's results provide a basis for a novel risk stratification model in CAD based on a complementary assessment of noninfarcted myocardium and post-infarction scar, by native T1 mapping and LGE, respectively.
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Affiliation(s)
- Valentina O Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany.
| | - Gerry Carr-White
- Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; King's College Hospital NHS Trust, Denmark Hill, London, United Kingdom
| | - Andrew Jabbour
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Chung-Yao Yu
- Department of Cardiology, St. Vincent's University, Sydney, New South Wales, Australia
| | - Rolf Gebker
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Sabine Zitzmann
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - Elif Peker
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, Ankara University Hospital, Ankara, Turkey
| | - Tommaso D'Angelo
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital Messina, Messina, Italy
| | - Faraz Pathan
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Imaging, Menzies Institute for Medical Research, Hobart Tasmania, Australia
| | - Elen
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Jakarta, Jakarta, Indonesia
| | - Silvia Valbuena
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Rocio Hinojar
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Christophe Arendt
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Jagat Narula
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York
| | - Eva Herrmann
- DZHK Institute of Biostatistics and Mathematical Modelling at Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Services, Guy's and St. Thomas' NHS Trust, London, United Kingdom; Department of Cardiology, University Hospital Frankfurt, Frankfurt-am Main, Germany; Department of Radiology, University Hospital Frankfurt, Frankfurt-am Main, Germany
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Abstract
PURPOSE OF REVIEW Studies from the 1990s and early 2000s documented the utility of dobutamine echocardiography for the prediction of functional recovery and prognosis with revascularization. The results of The Surgical Treatment of Ischemic Heart Failure (STICH) trial called into question the value of viability assessment using dobutamine echocardiography. The purpose of this review is to re-examine the literature on dobutamine echocardiography, put into context the STICH results, and provide insight into the current role of dobutamine echocardiography viability testing. RECENT FINDINGS In contrast to the results of previous nonrandomized trials, the STICH trial showed that patients with viability defined by nuclear perfusion imaging or dobutamine echocardiography did not have improved survival with CABG compared with optimal medical therapy. Viability by dobutamine echocardiography was defined as the presence of contractile reserve in at least five segments with baseline dysfunction. The results of dobutamine echocardiography studies published before and after initiation of the STICH trial suggest that the definition of viability utilized in that trial may be suboptimal for assessment of improvement in global function and prognosis in patients undergoing revascularization. Assessment of global contractile reserve using wall motion score (WMS) or ejection fraction may be superior to utilization of a binary definition of viability confined to assessment of contractile reserve in a fixed number of segments because these indices provide information on both the magnitude and extent of contractile reserve of the entire left ventricle (LV). SUMMARY Assessment of WMS or ejection fraction with dobutamine echocardiography may be the optimal means of evaluating the impact of viability on prognosis.Video abstract http://links.lww.com/HCO/A56.
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Affiliation(s)
- Abhishek Khemka
- Department of Cardiology, Indiana University School of Medicine/Indiana University Health, Indianapolis, Indiana, USA
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Beiert T, Straesser S, Malotki R, Stöckigt F, Schrickel JW, Andrié RP. Increased mortality and ICD therapies in ischemic versus non-ischemic dilated cardiomyopathy patients with cardiac resynchronization having survived until first device replacement. Arch Med Sci 2019; 15:845-856. [PMID: 31360179 PMCID: PMC6657262 DOI: 10.5114/aoms.2018.75139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/05/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy combined with an implantable cardioverter defibrillator (CRT-D) is widely applied in heart failure patients. Sufficient data on arrhythmia and defibrillator therapies during long-term follow-up of more than 4 years are lacking and data on mortality are conflicting. We aimed to characterize the occurrence of ventricular arrhythmia, respective defibrillator therapies and mortality for several years following CRT-D implantation or upgrade. MATERIAL AND METHODS Eighty-eight patients with ischemic (ICM) or non-ischemic dilated cardiomyopathy (DCM) and at least one CRT-D replacement were included in this study and analyzed for incidence of non-sustained ventricular tachycardia (NSVT), defibrillator shocks, anti-tachycardia pacing (ATP) and mortality. RESULTS ICM was the underlying disease in 59%, DCM in 41% of patients. During a mean follow-up of 76.4 ±24.8 months the incidence of appropriate defibrillator therapies (shock or ATP) was 46.6% and was elevated in ICM compared to DCM patients (57.7% vs. 30.6%, respectively; p = 0.017). Kaplan-Meier analysis revealed significantly higher ICD therapy-free survival rates in DCM patients (p = 0.031). Left ventricular ejection fraction, NSVT per year and ICM (vs. DCM) were independent predictors of device intervention. The ICM patients showed increased mortality compared to DCM patients, with cumulative all-cause mortality at 9 years of follow-up of 45.4% and 10.6%, respectively. Chronic renal failure, peripheral artery disease and chronic obstructive pulmonary disease were independent predictors of mortality. CONCLUSIONS The clinical course of patients with ICM and DCM treated with CRT-D differs significantly during long-term follow-up, with increased mortality and incidence of ICD therapies in ICM patients.
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Affiliation(s)
- Thomas Beiert
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Swanda Straesser
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Robert Malotki
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Florian Stöckigt
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Jan W Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - René P Andrié
- Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany
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Nelson T, Garg P, Clayton RH, Lee J. The Role of Cardiac MRI in the Management of Ventricular Arrhythmias in Ischaemic and Non-ischaemic Dilated Cardiomyopathy. Arrhythm Electrophysiol Rev 2019; 8:191-201. [PMID: 31463057 PMCID: PMC6702467 DOI: 10.15420/aer.2019.5.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Ventricular tachycardia (VT) and VF account for the majority of sudden cardiac deaths worldwide. Treatments for VT/VF include anti-arrhythmic drugs, ICDs and catheter ablation, but these treatments vary in effectiveness and carry substantial risks and/or expense. Current methods of selecting patients for ICD implantation are imprecise and fail to identify some at-risk patients, while leading to others being overtreated. In this article, the authors discuss the current role and future direction of cardiac MRI (CMRI) in refining diagnosis and personalising ventricular arrhythmia management. The capability of CMRI with gadolinium contrast delayed-enhancement patterns and, more recently, T1 mapping to determine the aetiology of patients presenting with heart failure is well established. Although CMRI imaging in patients with ICDs can be challenging, recent technical developments have started to overcome this. CMRI can contribute to risk stratification, with precise and reproducible assessment of ejection fraction, quantification of scar and 'border zone' volumes, and other indices. Detailed tissue characterisation has begun to enable creation of personalised computer models to predict an individual patient's arrhythmia risk. When patients require VT ablation, a substrate-based approach is frequently employed as haemodynamic instability may limit electrophysiological activation mapping. Beyond accurate localisation of substrate, CMRI could be used to predict the location of re-entrant circuits within the scar to guide ablation.
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Affiliation(s)
- Tom Nelson
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Pankaj Garg
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
| | - Richard H Clayton
- INSIGNEO Institute for In-Silico Medicine, University of SheffieldSheffield, UK
- Department of Computer Science, University of SheffieldSheffield, UK
| | - Justin Lee
- Sheffield Teaching Hospitals NHS Foundation TrustSheffield, UK
- Department of Immunity, Infection and Cardiovascular Disease, University of SheffieldSheffield, UK
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Abdul Ghaffar Y, Maskoun W, Mustafa NG, Feigenbaum H, Sawada SG. Low dose wall motion score predicts the short and long-term benefit of surgical revascularization in patients with ischemic left ventricular dysfunction. Int J Cardiovasc Imaging 2019; 35:1651-1659. [PMID: 31053980 DOI: 10.1007/s10554-019-01614-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
We investigated the influence of the extent of viability using low dose dobutamine wall motion score index (WMS) on the survival benefit of surgical revascularization (CABG) versus medical therapy. In the STICH trial, viability assessment was not helpful in determining the benefit of CABG. However, the extent of viable myocardium with contractile function was not assessed in the trial. Dobutamine echocardiography was performed in 250 patients with ischemic left ventricular dysfunction (125-medically treated, 125-CABG). The mean ejection fraction (EF) was 32% in both groups. WMS during low dose dobutamine infusion was used to classify patients into groups with extensive (WMS < 2.00), intermediate (WMS 2.00-2.49), and limited (WMS ≥ 2.50) viability. Survival free of cardiac death was assessed at 2 years and for the complete duration of follow-up. There were 44 (35.2%) and 67 (53.6%) cardiac deaths in the revascularized and medically treated patients respectively (follow-up of 5.7 ± 5.8 years). Revascularized and medically treated patients with extensive viability had similar 2-year survival (p = 0.567) but revascularized patients had improved long-term survival (p = 0.0001). In those with intermediate viability, revascularization improved both 2 year (p = 0.014) and long-term survival (p = 0.0001). In patients with limited viability, 2-year survival was worse in revascularized patients (p = 0.04) and long-term survival was similar (p = 0 .25) in revascularized and medically treated groups. Patients with extensive and intermediate amounts of viability have improved survival with CABG but those with limited viability have poorer short-term outcome and no long-term benefit.
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Affiliation(s)
- Yasir Abdul Ghaffar
- Department of Cardiology, West Virginia University, Morgantown, WV, 26505, USA
| | - Waddah Maskoun
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, 48020, USA
| | | | - Harvey Feigenbaum
- Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN, 46202, USA
| | - Stephen G Sawada
- Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN, 46202, USA. .,Krannert Institute of Cardiology, 1801 N. Senate Blvd, M.P.C. II, Suite D4000, Indianapolis, IN, 46202, USA.
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50
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Long-Term Prognostic Value of Myocardial Fibrosis in Patients With Chagas Cardiomyopathy. J Am Coll Cardiol 2018; 72:2577-2587. [DOI: 10.1016/j.jacc.2018.08.2195] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022]
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