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Chen Z, Wang Z, Li Y, Chen X, He S. Relation between lymphocyte to monocyte ratio and survival in patients with hypertrophic cardiomyopathy: a retrospective cohort study. PeerJ 2022; 10:e13212. [PMID: 35368342 PMCID: PMC8973459 DOI: 10.7717/peerj.13212] [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: 10/20/2021] [Accepted: 03/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background The lymphocyte-to-monocyte ratio (LMR) has been proposed as a novel prognostic factor in malignancies and cardiovascular diseases. Our study aimed to ascertain whether LMR is a useful biomarker in discriminating the hypertrophic cardiomyopathy (HCM) patients at higher risk of all-cause mortality. Methods This retrospective study consisted of 354 adult HCM patients. Cox's proportional hazards regression models were used to analyze the association between LMR and all-cause mortality. Smooth curve fitting was conducted to explore the linear relationship between LMR and all-cause mortality. Results During the follow-up, 44 patients reached the study endpoint. The all-cause mortality rate was 7.3 per 100 person-years in the first tertile and decreased across the three tertiles of LMR. With the first tertile as reference, adjusted hazard ratios (HR) for all-cause mortality were 0.43 for the second tertile (95% CI [0.20-0.91], p = 0.027) and 0.39 for the third tertile (95% CI [0.17-0.90], p = 0.028), respectively. Smooth curve fitting exhibited a nonlinear relationship between LMR values and all-cause mortality. For LMR < 6.5, per SD increase resulted in a significantly decreased risk of all-cause mortality by 62% (HR: 0.38, 95% CI [0.21-0.68]). For LMR ≥ 6.5, the all-cause mortality risk did not progressively increase. Stratified and subgroup analyses revealed similar results to the main analyses,andE-value analysis suggested robustness to unmeasured confounding. Conclusions The study demonstrated that LMR was an independent predictor of all-cause mortality in HCM patients, and LMR may be useful for identifying HCM patients at high mortality risk.
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Affiliation(s)
- Zhonglan Chen
- West China Hospital Cardiology department/West China School of Nursing, Chinese Evidence-Based Medicine Centre, Cochrane China Center, Chengdu, China
| | - Ziqiong Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Youping Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Center, West China Hospital Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
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Lee LE, Chandrasekar B, Yu P, Ma L. Quantification of myocardial fibrosis using noninvasive T2-mapping magnetic resonance imaging: Preclinical models of aging and pressure overload. NMR IN BIOMEDICINE 2022; 35:e4641. [PMID: 34729828 DOI: 10.1002/nbm.4641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 05/02/2023]
Abstract
Noninvasive imaging of cardiac fibrosis is important for early diagnosis and intervention in chronic heart diseases. Here, we investigated whether noninvasive, contrast agent-free MRI T2 -mapping can quantify myocardial fibrosis in preclinical models of aging and pressure overload. Myocardial fibrosis and remodeling were analyzed in two animal models: (i) aging (15-month-old male CF-1 mice vs. young 6- to 8-week-old mice), and (ii) pressure overload (PO; by transverse aortic constriction in 4- to 5-month-old male C57BL/6 mice vs. sham-operated for 14 days). In vivo T2 -mapping was performed by acquiring data during the isovolumic and early diastolic phases, with a modified respiratory and ECG-triggered multiecho TurboRARE sequence on a 7-T MRI. Cine MRI provided cardiac morphology and function. A quantitative segmentation method was developed to analyze the in vivo T2 -maps of hearts at midventricle, apex, and basal regions. The cardiac fibrosis area was analyzed ex vivo by picro sirius red (PSR) staining. Both aged and pressure-overloaded hearts developed significant myocardial contractile dysfunction, cardiac hypertrophy, and interstitial fibrosis. The aged mice had two phenotypes, fibrotic and mild-fibrotic. Notably, the aged fibrotic subgroup and the PO mice showed a marked decrease in T2 relaxation times (25.3 ± 0.6 in aged vs. 29.9 ± 0.7 ms in young mice, p = 0.002; and 24.3 ± 1.7 in PO vs. 28.7 ± 0.7 ms in shams, p = 0.05). However, no significant difference in T2 was detected between the aged mild-fibrotic subgroup and the young mice. Accordingly, an inverse correlation between myocardial fibrosis percentage (FP) and T2 relaxation time was derived (R2 = 0.98): T2 (ms) = 30.45 - 1.05 × FP. Thus, these results demonstrate a statistical agreement between T2 -map-quantified fibrosis and PSR staining in two different clinically relevant animal models. In conclusion, T2 -mapping MRI is a promising noninvasive contrast agent-free quantitative technique to characterize myocardial fibrosis.
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Affiliation(s)
- Li E Lee
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
| | - Bysani Chandrasekar
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Ping Yu
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
| | - Lixin Ma
- Research Division/Biomolecular Imaging Center, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Department of Physics and Astronomy, University of Missouri, Columbia, Missouri, USA
- Department of Radiology, University of Missouri, Columbia, Missouri, USA
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Hwang JW, Lee SC, Kim D, Kim J, Kim EK, Chang SA, Park SJ, Kim SM, Choe YH, Ahn JH, Park SW. Determinants of Exercise Capacity in Patients With Hypertrophic Cardiomyopathy. J Korean Med Sci 2022; 37:e62. [PMID: 35226420 PMCID: PMC8885453 DOI: 10.3346/jkms.2022.37.e62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Reduced exercise capacity reflects symptom severity and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to identify factors that may affect exercise capacity in patients with HCM. METHODS In 294 patients with HCM and preserved left ventricular (LV) ejection fraction, we compared peak oxygen consumption (peak VO2) evaluated by cardiopulmonary exercise testing as a representative parameter of exercise tolerance with clinical and laboratory data, including N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP), diastolic parameters on echocardiography, and the grade of myocardial fibrosis on cardiac magnetic resonance imaging (CMR). RESULTS Median peak VO2, was 29.0 mL/kg/min (interquartile range [IQR], 25.0-34.0). Age (estimated β = -0.140, P < 0.001), female sex (β = -5.362, P < 0.001), NT-proBNP (β = -1.256, P < 0.001), and E/e' ratio on echocardiography (β = -0.209, P = 0.019) were significantly associated with exercise capacity. Peak VO2 was not associated with the amount of myocardial fibrosis on CMR (mean of late gadolinium enhancement 12.25 ± 9.67%LV). CONCLUSION Decreased exercise capacity was associated with age, female sex, increased NT-proBNP level, and E/e' ratio on echocardiography. Hemodynamic changes and increased filling pressure on echocardiography should be monitored in this population for improved outcomes.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics Team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Karabinowska-Małocha A, Dziewięcka E, Banyś P, Urbańczyk-Zawadzka M, Krupiński M, Mielnik M, Łach J, Budkiewicz A, Podolec P, Żydzik Ł, Wiśniowska-Śmiałek S, Holcman K, Kostkiewicz M, Rubiś P. The Relationship between Cardiac Magnetic Resonance-Assessed Replacement and Interstitial Fibrosis and Ventricular Arrhythmias in Hypertrophic Cardiomyopathy. J Pers Med 2022; 12:jpm12020294. [PMID: 35207782 PMCID: PMC8876292 DOI: 10.3390/jpm12020294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Non-sustained ventricular tachycardia (nsVT) creates the electrical basis for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the relationship between interstitial fibrosis on cardiac magnetic resonance (CMR) and nsVT in HCM. A total of 50 HCM patients underwent CMR with a 3 T scanner to determine the presence of replacement fibrosis expressed by late gadolinium enhancement (LGE), and interstitial fibrosis expressed by native T₁, post-contrast T₁, and extracellular volume (ECV). The incidence of nsVT was assessed by Holter monitoring. We detected nsVT in 14 (28%) out of 50 HCM patients. Replacement fibrosis expressed by LGE was present in 37 (74%) patients and only showed a trend towards a differentiation between the groups with and without nsVT (p = 0.07). However, the extent of LGE was clearly higher in the nsVT group (3.8 ± 4.9% vs. 7.94 ± 4.5%, p = 0.002) and was an independent predictor of nsVT in a multivariable regression analysis (OR 1.2; 95%CI 1.02–1.4; p = 0.02). No relationship was observed between interstitial fibrosis and nsVT. To conclude, it was found that it is not the mere presence but the actual extent of LGE that determines the occurrence of nsVT in HCM patients; the role of interstitial fibrosis remains unclear.
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Affiliation(s)
- Aleksandra Karabinowska-Małocha
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
- Correspondence: ; Tel.: +48-12-614-22-87
| | - Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Paweł Banyś
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Małgorzata Urbańczyk-Zawadzka
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Maciej Krupiński
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Małgorzata Mielnik
- Department of Radiology, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (P.B.); (M.U.-Z.); (M.K.); (M.M.)
| | - Jacek Łach
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Aleksandra Budkiewicz
- Students’ Scientific Group on Heart Failure, at the Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (A.B.); (Ł.Ż.)
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Łukasz Żydzik
- Students’ Scientific Group on Heart Failure, at the Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (A.B.); (Ł.Ż.)
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka Street 80, 31-202 Krakow, Poland; (E.D.); (J.Ł.); (P.P.); (S.W.-Ś.); (K.H.); (M.K.); (P.R.)
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Monda E, Palmiero G, Lioncino M, Rubino M, Cirillo A, Fusco A, Caiazza M, Verrillo F, Diana G, Mauriello A, Iavarone M, Losi MA, De Rimini ML, Dellegrottaglie S, D’Andrea A, Bossone E, Pacileo G, Limongelli G. Multimodality Imaging in Cardiomyopathies with Hypertrophic Phenotypes. J Clin Med 2022; 11:jcm11030868. [PMID: 35160323 PMCID: PMC8836956 DOI: 10.3390/jcm11030868] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 12/16/2022] Open
Abstract
Multimodality imaging is a comprehensive strategy to investigate left ventricular hypertrophy (LVH), providing morphologic, functional, and often clinical information to clinicians. Hypertrophic cardiomyopathy (HCM) is defined by an increased LV wall thickness not only explainable by abnormal loading conditions. In the context of HCM, multimodality imaging, by different imaging techniques, such as echocardiography, cardiac magnetic resonance, cardiac computer tomography, and cardiac nuclear imaging, provides essential information for diagnosis, sudden cardiac death stratification, and management. Furthermore, it is essential to uncover the specific cause of HCM, such as Fabry disease and cardiac amyloidosis, which can benefit of specific treatments. This review aims to elucidate the current role of multimodality imaging in adult patients with HCM.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Michele Iavarone
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Maria Luisa De Rimini
- Department of Nuclear Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy;
| | - Santo Dellegrottaglie
- Cardiovascular MRI Laboratory, Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Antonello D’Andrea
- Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Eduardo Bossone
- Department of Cardiology, Cardarelli Hospital, 80131 Naples, Italy;
| | - Giuseppe Pacileo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.P.); (M.L.); (M.R.); (A.C.); (A.F.); (M.C.); (F.V.); (G.D.); (A.M.); (M.I.); (G.P.)
- Correspondence:
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Nuclear Molecular Imaging of Cardiac Remodeling after Myocardial Infarction. Pharmaceuticals (Basel) 2022; 15:ph15020183. [PMID: 35215296 PMCID: PMC8875369 DOI: 10.3390/ph15020183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
The role of molecular imaging technologies in detecting, evaluating, and monitoring cardiovascular disease and their treatment is expanding rapidly. Gradually replacing the conventional anatomical or physiological approaches, molecular imaging strategies using biologically targeted markers provide unique insight into pathobiological processes at molecular and cellular levels and allow for cardiovascular disease evaluation and individualized therapy. This review paper will discuss currently available and developing molecular-based single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging strategies to evaluate post-infarction cardiac remodeling. These approaches include potential targeted methods of evaluating critical biological processes, such as inflammation, angiogenesis, and scar formation.
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57
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Finocchiaro G, Magavern EF, Georgioupoulos G, Maurizi N, Sinagra G, Carr-White G, Pantazis A, Olivotto I. Sudden cardiac death in cardiomyopathies: acting upon "acceptable" risk in the personalized medicine era. Heart Fail Rev 2022; 27:1749-1759. [PMID: 35083629 DOI: 10.1007/s10741-021-10198-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Patients with cardiomyopathies are confronted with the risk of sudden cardiac death (SCD) throughout their lifetime. Despite the fact that SCD is relatively rare, prognostic stratification is an integral part of physician-patient discussion, with the goal of risk modification and prevention. The current approach is based on a concept of "acceptable risk." However, there are intrinsic problems with an algorithm-based approach to risk management, magnified by the absence of robust evidence underlying clinical decision support tools, which can make high- versus low-risk classifications arbitrary. Strategies aimed at risk reduction range from selecting patients for an implantable cardioverter defibrillator (ICD) to disqualification from competitive sports. These clinical options, especially when implying the use of finite financial resources, are often delivered from the physician's perspective citing decision-making algorithms. When the burden of intervention-related risks or financial costs is deemed higher than an "acceptable risk" of SCD, the patient's perspective may not be appropriately considered. Designating a numeric threshold of "acceptable risk" has ethical implications. One could reasonably ask "acceptable to whom?" In an era when individual choice and autonomy are pillars of the physician-patient relationship, the subjective aspects of perceived risk should be acknowledged and be part of shared decision-making. This is particularly true when the lack of a strong scientific evidence base makes a dichotomous algorithm-driven approach suboptimal for unmitigated translation to clinical practice.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK. .,King's College London, London, UK. .,Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK. .,Cardiovascular Clinical Academic Group, St George's, University of London, London, UK.
| | - Emma F Magavern
- The London School of Medicine and Dentistry, William Harvey Research Institute, Barts, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | | | - Niccolo' Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gerald Carr-White
- Cardiothoracic Centre, Guy's and St Thomas' Hospital, London, UK.,King's College London, London, UK
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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Sivalokanathan S. The Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Hypertrophic Cardiomyopathy. Diagnostics (Basel) 2022; 12:diagnostics12020314. [PMID: 35204405 PMCID: PMC8871211 DOI: 10.3390/diagnostics12020314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/08/2022] [Accepted: 01/25/2022] [Indexed: 01/19/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder, affecting 1 out of 500 adults globally. It is a widely heterogeneous disorder characterized by a range of phenotypic expressions, and is most often identified by non-invasive imaging that includes echocardiography and cardiovascular magnetic resonance imaging (CMR). Within the last two decades, cardiac magnetic resonance imaging (MRI) has emerged as the defining tool for the characterization and prognostication of cardiomyopathies. With a higher image quality, spatial resolution, and the identification of morphological variants of HCM, CMR has become the gold standard imaging modality in the assessment of HCM. Moreover, it has been crucial in its management, as well as adding prognostic information that clinical history nor other imaging modalities may not provide. This literature review addresses the role and current applications of CMR, its capacity in evaluating HCM, and its limitations.
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Affiliation(s)
- Sanjay Sivalokanathan
- Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA 19107, USA;
- Cardiovascular Clinical Academic Group, St. George’s University of London and St George’s University Hospitals NHS Foundation Trust, London SW17 0RE, UK
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59
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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60
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Rao S, Tseng SY, Pednekar A, Siddiqui S, Kocaoglu M, Fares M, Lang SM, Kutty S, Christopher AB, Olivieri LJ, Taylor MD, Alsaied T. Myocardial Parametric Mapping by Cardiac Magnetic Resonance Imaging in Pediatric Cardiology and Congenital Heart Disease. Circ Cardiovasc Imaging 2022; 15:e012242. [PMID: 34983186 DOI: 10.1161/circimaging.120.012242] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Parametric mapping, that is, a pixel-wise map of magnetic relaxation parameters, expands the diagnostic potential of cardiac magnetic resonance by enabling quantification of myocardial tissue-specific magnetic relaxation on an absolute scale. Parametric mapping includes T1 mapping (native and postcontrast), T2 and T2* mapping, and extracellular volume measurements. The myocardial composition is altered in various disease states affecting its inherent magnetic properties and thus the myocardial relaxation times that can be directly quantified using parametric mapping. Parametric mapping helps in the diagnosis of nonfocal disease states and allows for longitudinal disease monitoring, evaluating therapeutic response (as in Thalassemia patients with iron overload undergoing chelation), and risk-stratification of certain diseases. In this review article, we describe various mapping techniques and their clinical utility in congenital heart disease. We will also review the available literature on normative values in children, the strengths, and weaknesses of these techniques. This review provides a starting point for pediatric cardiologists to understand and implement parametric mapping in their practice.
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Affiliation(s)
- Sruti Rao
- Division of Pediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, India (S.R.)
| | - Stephanie Y Tseng
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, OH (A.P., M.K.)
| | - Saira Siddiqui
- Department of Pediatrics, Morristown Medical Center, NJ (S.S.)
| | - Murat Kocaoglu
- Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, OH (A.P., M.K.)
| | - Munes Fares
- Pediatric Cardiology Division, UT Southwestern Medical Center, Dallas, TX (M.F.)
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Shelby Kutty
- Taussig Heart Center, The Johns Hopkins Hospital Baltimore, MD (S.K.)
| | - Adam B Christopher
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA (A.B.C., T.A.)
| | - Laura J Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC (L.J.O.)
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital, OH (S.Y.T., S.M.L., M.D.T.).,Department of Pediatrics, University of Cincinnati, OH (S.Y.T., S.M.L., M.D.T.)
| | - Tarek Alsaied
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA (A.B.C., T.A.)
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61
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Ye Y, Ji Z, Zhou W, Pu C, Li Y, Zhou C, Hu X, Chen C, Sun Y, Huang Q, Zhang W, Qian Y, Ren H, Yu F, Jiang C, Mao Y, Wang B, Augusto JB, Lai D, Hu H, Fu GS. Mean Scar Entropy by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Associated With Ventricular Arrhythmias Events in Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:758635. [PMID: 34869672 PMCID: PMC8635716 DOI: 10.3389/fcvm.2021.758635] [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: 08/14/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Ventricular arrhythmias are associated with sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Previous studies have found the late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was independently associated with ventricular arrhythmia (VA) in HCM. The risk stratification of VA remains complex and LGE is present in the majority of HCM patients. This study was conducted to determine whether the scar heterogeneity from LGE-derived entropy is associated with the VAs in HCM patients. Materials and Methods: Sixty-eight HCM patients with scarring were retrospectively enrolled and divided into VA (31 patients) and non-VA (37 patients) groups. The left ventricular ejection fraction (LVEF) and percentage of the LGE (% LGE) were evaluated. The scar heterogeneity was quantified by the entropy within the scar and left ventricular (LV) myocardium. Results: Multivariate analyses showed that a higher scar [hazard ratio (HR) 2.682; 95% CI: 1.022–7.037; p = 0.039] was independently associated with VA, after the adjustment for the LVEF, %LGE, LV maximal wall thickness (MWT), and left atrium (LA) diameter. Conclusion: Scar entropy and %LGE are both independent risk indicators of VA. A high scar entropy may indicate an arrhythmogenic scar, an identification of which may have value for the clinical status assessment of VAs in HCM patients.
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Affiliation(s)
- Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - ZhongPing Ji
- Institute of Graphics and Image, School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Wenli Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya Li
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Chengqin Zhou
- Institute of Graphics and Image, School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Xiuhua Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaxun Sun
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Qi Huang
- Department of Cardiovascular, Zhejiang Integrated Traditional and Western Medicine Hospital (HangZhou Red Cross Hospital), Hangzhou, China
| | - Wenjuan Zhang
- Department of Information Technology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu'e Qian
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Ren
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feidan Yu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Yankai Mao
- Department of Cardiac Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bei Wang
- Department of Cardiac Echocardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - João B Augusto
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.,Institute of Cardiovascular Science, University College London, London, United Kingdom.,Cardiac Imaging Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Dongwu Lai
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Hongjie Hu
- Institute of Graphics and Image, School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Guo-Sheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
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62
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Yan C, Li R, Guo X, Yu H, Li W, Li W, Ren M, Yang M, Li H. Cardiac Involvement in Human Immunodeficiency Virus Infected Patients: An Observational Cardiac Magnetic Resonance Study. Front Cardiovasc Med 2021; 8:756162. [PMID: 34869667 PMCID: PMC8634394 DOI: 10.3389/fcvm.2021.756162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the subclinical imaging changes in terms of myocardial inflammation and fibrosis and to explore the risk factors associated with myocardial fibrosis by cardiac magnetic resonance (CMR) approach in a Chinese HIV/AIDS cohort. Methods: We evaluated myocardial function (cine), myocardial inflammation (T1, T2), and myocardial fibrosis (through extracellular volume fraction [ECV] and late gadolinium enhancement [LGE]) by a multiparametric CMR scan protocol in a total of 68 participants, including 47 HIV-infected individuals, who were divided into two groups: asymptomatic HIV (HIV+) (n = 30), and acquired immunodeficiency syndrome (AIDS) (n = 17), and 21 healthy controls. Results: HIV-infected patients had lower left (55.3 ± 6.5 vs. 63.0 ± 7.9%, P < 0.001) and right ventricular systolic function (35.9 ± 15.7 vs. 50.8 ± 9.3%, P < 0.001). Radial systolic strain (30.7 ± 9.3 vs. 39.3 ± 9.4%, P = 0.001), circumferential systolic strain (−17.5 ± 2.6 vs. −19.4 ± 2.7%, P = 0.008), and longitudinal systolic strain (−9.4 ± 5.7 vs. −12.8 ± 3.1%, P = 0.012) were also decreased in HIV. Native T1 relaxation time (1,337.2 ± 70.2 vs. 1,249.5 ± 47.0 ms, P < 0.001), ECV value (33.5 ± 6.2 vs. 28.5 ± 2.9 ms, P = 0.026), and T2 relaxation time (45.2 ± 3.5 vs. 42.0 ± 2.6 ms, P = 0.001) were higher in HIV-infected patients compared with controls. Myocardial fibrosis, predominantly in the mid-inferior wall, was detected in 24.4% of the HIV-infected patients. HIV+ had a significantly lower value of ECV [29.1 (26.1, 31.8) vs. 35.2 (31.8, 41.9) %, P < 0.001] and frequency of LGE [3/25 (8%) vs. 7/16 (43.8%), P = 0.014)] compared with AIDS. AIDS was associated with myocardial fibrosis. Conclusions: HIV-infected patients were associated with changes in myocardial function and higher rates of subclinical myocardial inflammation and fibrosis, which were more abnormal with greater severity of the disease. AIDS was associated with myocardial fibrosis, where the observations supported earlier initiation of antiretroviral therapy in the Chinese HIV/AIDS cohort.
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Affiliation(s)
- Chengxi Yan
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruili Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huan Yu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenhuan Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenqiao Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Meiji Ren
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Minglei Yang
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Shenyang, China
| | - Hongjun Li
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Elsafty HG, El Shafey M, El Arabawy R, Mahrous MR, Dawoud TM. Could native T1 mapping replace late gadolinium enhancement in the assessment of myocardial fibrosis in patients with cardiomyopathy? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cardiomyopathy is a myocardial disease, which usually demonstrates improper ventricular morphology, function, or both. It is classified into two classes based on the organ involved. Primary cardiomyopathy is confined mainly to the myocardium and can be genetic, non-genetic, or acquired. Secondary cardiomyopathy is caused by generalized systemic disorder. Myocardial fibrosis produces abnormal myocardial stiffness and increases arrhythmias risk. Native T1-mapping is an innovative technique that provides quantitative assessment of edema, diffuse myocardial fibrosis, and inflammation in a number of disease states. Furthermore native T1 mapping provides a future method for quantifying myocardial fibrosis in advanced chronic kidney disease and dialysis patients without the use of gadolinium-based contrast agents. So our aim is to assess the potential value of segmental quantification of myocardial fibrosis using native T1 mapping in different types of cardiomyopathy in comparison to late gadolinium enhancement (LGE) imaging.
Results
The native T1 values of a total 1152 segments (16 segments in 72 patients of cardiomyopathy), 192 segments in 12 patients with hypertrophic cardiomyopathy (HCM), 800 segments in 50 patients with dilated cardiomyopathy (DCM), 80 segments in 5 patients with infiltrative cardiomyopathy, and 80 segments in 5 patients with non-compaction were assessed. These were compared with 160 segments of 10 healthy volunteers. Native T1 values were significantly higher in most of myocardial segments with LGE than in those without including the control group; non-contrast T1 values in mid LV septal segments were found the most significant (1130.85 ± 79.79 ms vs 1047.74 ± 42.74 ms; P = 0.001). Also the current study showed T1 values were significantly higher than normal even in segments unaffected by LGE (P<0.01) in both HCM and DCM groups. A receiver operating characteristic (ROC) analysis revealed the required cutoff value of 1070 ms for detecting myocardial fibrosis with a sensitivity 66% and specificity of 68%.
Conclusion
Contrast-free T1-mapping is a new technique for detecting myocardial fibrosis objectively with a high diagnostic performance especially in patients who cannot afford gadolinium contrast agents as patients with end-stage renal disease.
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Lota AS, Tsao A, Owen R, Halliday BP, Auger D, Vassiliou VS, Tayal U, Almogheer B, Vilches S, Al-Balah A, Patel A, Mouy F, Buchan R, Newsome S, Gregson J, Ware JS, Cook SA, Cleland JGF, Pennell DJ, Prasad SK. Prognostic Significance of Nonischemic Myocardial Fibrosis in Patients With Normal LV Volumes and Ejection-Fraction. JACC Cardiovasc Imaging 2021; 14:2353-2365. [PMID: 34274268 PMCID: PMC8648892 DOI: 10.1016/j.jcmg.2021.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/20/2021] [Accepted: 05/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aims to investigate the prognostic significance of late gadolinium enhancement (LGE) in patients without coronary artery disease and with normal range left ventricular (LV) volumes and ejection fraction. BACKGROUND Nonischemic patterns of LGE with normal LV volumes and ejection fraction are increasingly detected on cardiovascular magnetic resonance, but their prognostic significance, and consequently management, is uncertain. METHODS Patients with midwall/subepicardial LGE and normal LV volumes, wall thickness, and ejection fraction on cardiovascular magnetic resonance were enrolled and compared to a control group without LGE. The primary outcome was actual or aborted sudden cardiac death (SCD). RESULTS Of 748 patients enrolled, 401 had LGE and 347 did not. The median age was 50 years (interquartile range: 38-61 years), LV ejection fraction 66% (interquartile range: 62%-70%), and 287 (38%) were women. Scan indications included chest pain (40%), palpitation (33%) and breathlessness (13%). No patient experienced SCD and only 1 LGE+ patient (0.13%) had an aborted SCD in the 11th follow-up year. Over a median of 4.3 years, 30 patients (4.0%) died. All-cause mortality was similar for LGE+/- patients (3.7% vs 4.3%; P = 0.71) and was associated with age (HR: 2.04 per 10 years; 95% CI: 1.46-2.79; P < 0.001). Twenty-one LGE+ and 4 LGE- patients had an unplanned cardiovascular hospital admission (HR: 7.22; 95% CI: 4.26-21.17; P < 0.0001). CONCLUSIONS There was a low SCD risk during long-term follow-up in patients with LGE but otherwise normal LV volumes and ejection fraction. Mortality was driven by age and not LGE presence, location, or extent, although the latter was associated with greater cardiovascular hospitalization for suspected myocarditis and symptomatic ventricular tachycardia.
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Affiliation(s)
- Amrit S Lota
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Adam Tsao
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brian P Halliday
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Dominique Auger
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vassilios S Vassiliou
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Upasana Tayal
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Batool Almogheer
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Silvia Vilches
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
| | - Amer Al-Balah
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Akhil Patel
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Imperial College London Medical School, London, United Kingdom
| | - Florence Mouy
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Rachel Buchan
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Simon Newsome
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James S Ware
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; MRC London Institute of Medical Sciences, London, United Kingdom
| | - Stuart A Cook
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; National Heart Centre Singapore, Singapore
| | - John G F Cleland
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Dudley J Pennell
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom.
| | - Sanjay K Prasad
- Cardiovascular Research Centre & Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom; National Heart & Lung Institute, Imperial College London, London, United Kingdom
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65
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Francis W, Alkuwari ME, Mohiaddin R, Carr CS. Hypertrophic Cardiomyopathy with a Twist. Indian J Radiol Imaging 2021; 31:751-753. [PMID: 34790330 PMCID: PMC8590540 DOI: 10.1055/s-0041-1735925] [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] [Indexed: 11/15/2022] Open
Abstract
Hypertrophic cardiomyopathy is a relatively common inherited cardiac disorder, with echocardiography still being the initial imaging method for its diagnosis. Cardiac fibroma is a primary neoplasm that most commonly presents in childhood. We present a patient who was investigated for typical cardiac symptoms who went on to have cardiac magnetic resonance imaging and was found to have both of these conditions.
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Affiliation(s)
- W Francis
- Department of Radiology, Heart Hospital, Doha, Qatar
| | - M E Alkuwari
- Department of Radiology, Heart Hospital, Doha, Qatar
| | - R Mohiaddin
- Department of Cardiovascular Imaging, Royal Brompton and Harefield Hospital, England, United Kingdom
| | - C S Carr
- Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
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Liu J, Zhao S, Yu S, Wu G, Wang D, Liu L, Song J, Zhu Y, Kang L, Wang J, Song L. Patterns of Replacement Fibrosis in Hypertrophic Cardiomyopathy. Radiology 2021; 302:298-306. [PMID: 34726536 DOI: 10.1148/radiol.2021210914] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Myocardial replacement fibrosis is one of the major histologic features of hypertrophic cardiomyopathy (HCM), but its characteristics have not been well delineated. Purpose To clarify the characteristics of replacement fibrosis in HCM and to evaluate the prognostic value of the regional extent of fibrosis. Materials and Methods This prospective study evaluated participants with HCM who underwent contrast-enhanced cardiac MRI from March 2011 to April 2019. For each participant, global and 16-segment extent of late gadolinium enhancement (LGE) in the left ventricle (LV) at cardiac MRI was analyzed. The primary end point was all-cause death. Results Among the 798 study participants enrolled (median age, 49 years [interquartile range {IQR}: 38-59 years]; 508 men), 588 (74%) underwent whole-exome sequencing. Thirty-five participants (4%) experienced death from any cause during a median follow-up of 2.9 years (IQR: 1.5-4.7 years). Spearman analysis showed weak correlations between the extent of LGE and wall thickness (LGE of global LV and maximal LV wall thickness, r = 0.35 [P < .001]; LGE and thickness of septum, r = 0.30 [P < .001]). In the 16-segment model, the distribution of LGE was visually inhomogeneous and higher in the basal anterior, basal septal, midanterior, and midseptal regions (P < .001). This similar distribution of LGE was observed in participants with asymmetric septal hypertrophy, those with apical HCM, participants positive for mutation and those negative for mutation, and participants with MYH7 and MYBPC3 mutations. Cox analysis indicated that both the global extent of LGE (adjusted hazard ratio = 1.68 per 10% increase in LGE; P < .001) and the regional extent of LGE (ie, basal, midventricular, and apical regions of LV when on the short-axis view; septum, anterior free wall, inferior free wall, and lateral free wall when on the long-axis view) were associated with adverse outcomes. Conclusion In hypertrophic cardiomyopathy, myocardial replacement fibrosis weakly correlated with hypertrophy, was inhomogeneous and asymmetric, and was predominantly distributed in the interventricular septal wall and anterior free wall at the basal and mid levels. Greater extent of fibrosis was associated with poor prognosis, regardless of its location in the left ventricle. © RSNA, 2021 See also the editorial by Hanneman in this issue.
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Affiliation(s)
- Jie Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shihua Zhao
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Shiqin Yu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Guixin Wu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Dong Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lele Liu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jialin Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Yuming Zhu
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lianming Kang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Jizheng Wang
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
| | - Lei Song
- From the State Key Laboratory of Cardiovascular Disease (J.L., Y.Z., J.W.), MR Center (S.Z., S.Y., L.L., J.S.), Cardiomyopathy Ward (G.W., D.W., L.K., L.S.), and National Clinical Research Center for Cardiovascular Diseases (L.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, Beilishilu, Xicheng District, 100037 Beijing, China
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Kozor R, Cole B, Ugander M, Moon JC. Looking for the Right Diagnosis? Cardiovascular Magnetic Resonance Imaging Can Help Differentiate Cardiomyopathies. Heart Lung Circ 2021; 31:7-16. [PMID: 34483049 DOI: 10.1016/j.hlc.2021.07.020] [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: 04/12/2021] [Revised: 06/08/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Differentiating cardiomyopathies is a common clinical quandary in cardiology. Getting the right diagnosis is important for guiding patient management and providing prognosis. Incorrect or uncertain diagnoses can lead to further unnecessary investigations and/or treatment decisions applied inappropriately, which can have consequences for both the patient and health care costs. Cardiovascular magnetic resonance (CMR) imaging offers strength here due to its precision and breadth in assessing cardiac function and tissue characterisation. This review aims to raise awareness among cardiologists and physicians of the important insights provided by CMR-insights that can improve diagnosis and guide management, as well as aid in risk stratification, in different cardiomyopathies.
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Affiliation(s)
- Rebecca Kozor
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; Kolling Institute and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Ben Cole
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Martin Ugander
- Kolling Institute and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - James C Moon
- Barts Heart Centre, London, UK; Institute of Cardiovascular Science, University College London, London, UK
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CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter-Defibrillator in Non-Ischemic Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22137115. [PMID: 34281168 PMCID: PMC8268120 DOI: 10.3390/ijms22137115] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.
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Langer LB, Hess A, Korkmaz Z, Tillmanns J, Reffert LM, Bankstahl JP, Bengel FM, Thackeray JT, Ross TL. Molecular imaging of fibroblast activation protein after myocardial infarction using the novel radiotracer [ 68Ga]MHLL1. Am J Cancer Res 2021; 11:7755-7766. [PMID: 34335962 PMCID: PMC8315078 DOI: 10.7150/thno.51419] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Myocardial infarction (MI) evokes an organized remodeling process characterized by the activation and transdifferentiation of quiescent cardiac fibroblasts to generate a stable collagen rich scar. Early fibroblast activation may be amenable to targeted therapy, but is challenging to identify in vivo. We aimed to non-invasively image active fibrosis by targeting the fibroblast activation protein (FAP) expressed by activated (myo)fibroblasts, using a novel positron emission tomography (PET) radioligand [68Ga]MHLL1 after acute MI. Methods: One-step chemical synthesis and manual as well as module-based radiolabeling yielded [68Ga]MHLL1. Binding characteristics were evaluated in murine and human FAP-transfected cells, and stability tested in human serum. Biodistribution in healthy animals was interrogated by dynamic PET imaging, and metabolites were measured in blood and urine. The temporal pattern of FAP expression was determined by serial PET imaging at 7 d and 21 d after coronary artery ligation in mice as percent injected dose per gram (%ID/g). PET measurements were validated by ex vivo autoradiography and immunostaining for FAP and inflammatory macrophages. Results: [68Ga]MHLL1 displayed specific uptake in murine and human FAP-positive cells (p = 0.0208). In healthy mice the tracer exhibited favorable imaging characteristics, with low blood pool retention and dominantly renal clearance. At 7 d after coronary artery ligation, [68Ga]MHLL1 uptake was elevated in the infarct relative to the non-infarcted remote myocardium (1.3 ± 0.3 vs. 1.0 ± 0.2 %ID/g, p < 0.001) which persisted to 21 d after MI (1.3 ± 0.4 vs. 1.1 ± 0.4 %ID/g, p = 0.013). Excess unlabeled compound blocked tracer accumulation in both infarct and non-infarct remote myocardium regions (p < 0.001). Autoradiography and histology confirmed the regional uptake of [68Ga]MHLL1 in the infarct and especially border zone regions, as identified by Masson trichrome collagen staining. Immunostaining further delineated persistent FAP expression at 7 d and 21 d post-MI in the border zone, consistent with tracer distribution in vivo. Conclusion: The simplified synthesis of [68Ga]MHLL1 bears promise for non-invasive characterization of fibroblast activation protein early in remodeling after MI.
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Pu C, Fei J, Lv S, Wu Y, He C, Guo D, Mabombo PU, Chooah O, Hu H. Global Circumferential Strain by Cardiac Magnetic Resonance Tissue Tracking Associated With Ventricular Arrhythmias in Hypertrophic Cardiomyopathy Patients. Front Cardiovasc Med 2021; 8:670361. [PMID: 34124201 PMCID: PMC8193949 DOI: 10.3389/fcvm.2021.670361] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is prone to myocardial heterogeneity and fibrosis, which are the substrates of ventricular arrhythmias (VAs). Cardiac magnetic resonance tissue tracking (CMR-TT) can quantitatively reflect global and regional left ventricular strain from different directions. It is uncertain whether the change of myocardial strain detected by CMR-TT is associated with VAs. The aim of the study is to explore the differential diagnostic value of VAs in HCM by CMR-TT. Materials and Methods: We retrospectively included 93 HCM patients (38 with VAs and 55 without VAs) and 30 healthy cases. Left ventricular function, myocardial strain parameters and percentage of late gadolinium enhancement (%LGE) were evaluated. Results: Global circumferential strain (GCS) and %LGE correlated moderately (r = 0.51, P < 0.001). HCM patients with VAs had lower left ventricular ejection fraction (LVEF), global radial strain (GRS), GCS, and global longitudinal strain (GLS), but increased %LGE compared with those without VAs (P < 0.01 for all). %LGE and GCS were indicators of VAs in HCM patients by multivariate logistic regression analysis. HCM patients with %LGE >5.35% (AUC 0.81, 95% CI 0.70–0.91, P < 0.001) or GCS >-14.73% (AUC 0.79, 95% CI 0.70–0.89, P < 0.001) on CMR more frequently had VAs. %LGE + GCS were able to better identify HCM patients with VAs (AUC 0.87, 95% CI 0.79–0.95, P < 0.001). Conclusion: GCS and %LGE were independent risk indicators of VAs in HCM. GCS is expected to be a good potential predictor in identifying HCM patients with VAs, which may provide important values to improve risk stratification in HCM in clinical practice.
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Affiliation(s)
- Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingle Fei
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sangying Lv
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengbin He
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danling Guo
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Pierre Umba Mabombo
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Outesh Chooah
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Vullaganti S, Levine J, Raiker N, Syed AA, Collins JD, Carr JC, Bonow RO, Choudhury L. Fibrosis in Hypertrophic Cardiomyopathy Patients With and Without Sarcomere Gene Mutations. Heart Lung Circ 2021; 30:1496-1501. [PMID: 34023176 DOI: 10.1016/j.hlc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) and an identified sarcomere mutation have worse outcomes than those without though the underlying mechanism is incompletely understood. The presence of replacement fibrosis measured by late gadolinium enhancement (LGE) and diffuse fibrosis measured by extracellular volume (ECV) using cardiac magnetic resonance imaging (CMR) are associated with ventricular arrhythmias and cardiac mortality. We aimed to associate these two forms of fibrosis with identified sarcomere mutations. METHODS AND RESULTS Three hundred and thirty-six (336) patients with HCM underwent CMR at a single quaternary referral centre between January 2012 and February 2017. Genetic testing was performed in 73 of these patients, yielding an identified sarcomeric mutation in 29 (G+), no mutation in 39 (G-), and a variant of unknown significance (VUS) in five. LGE was more prevalent in G+ compared to G- patients (86 vs. 56%, OR 4.3, p=0.01) and was more extensive (7.5±5.5% of left ventricular [LV] mass vs. 3.0±3.0%, p<0.001). Global ECV from myocardial segments excluding LGE was similar among both groups (26.9±2.9 vs. 25.6±2.8%, p=0.46). However, in G+ patients ECV was greater in the hypertrophied regions of the basal anteroseptum (30.2±7.0 vs. 26.8±3.6%, p=0.004) and basal inferoseptum (28.1±4.3 vs. 26.2±2.9%, p=0.005). CONCLUSIONS Genotyped HCM patients with an identified sarcomere mutation have greater LGE and greater regional, but not global, ECV than HCM patients without an identified mutation. This difference in fibrosis may contribute to worse outcomes in patients with an identified HCM mutation.
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Affiliation(s)
- Sirish Vullaganti
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jonathan Levine
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nisha Raiker
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amer Ahmed Syed
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert O Bonow
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lubna Choudhury
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Fibrosis in hypertrophic cardiomyopathy: role of novel echo techniques and multi-modality imaging assessment. Heart Fail Rev 2021; 26:1297-1310. [PMID: 33990907 DOI: 10.1007/s10741-020-10058-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/17/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) represents one of the primary cardiomyopathies and may lead to heart failure and sudden cardiac death. Among various histologic features of the disease examined, assessment of myocardial fibrosis may offer valuable information, since it may be considered the common nominator for all HCM connected complications. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) has emerged as the reference noninvasive method for visualizing and quantifying myocardial fibrosis in patients with HCM. T1 mapping, a promising new CMR technique, may provide an advantage over conventional LGE-CMR, by permitting a more valid quantification of diffuse fibrosis. On the other hand, echocardiography offers a significantly more portable, affordable, and easily accessible solution for the study of fibrosis. Various echocardiographic techniques ranging from integrated backscatter and contrast-enhanced ultrasound to two- (2D) or three-dimensional (3D) deformation and shear wave imaging may offer new insights into substrate characterization in HCM. The aim of this review is to describe thoroughly all different modalities that may be used in everyday clinical practice for HCM fibrosis evaluation (with special focus on echocardiographic techniques), to concisely present available evidence and to argue in favor of multi-modality imaging application. It is essential to understand that the role of various imaging modalities is not competitive but complementary, since the information provided by each one is necessary to illuminate the complex pathophysiologic pathways of HCM, offering a personalized approach and treatment in every patient.
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Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease of the myocardium characterized by a hypertrophic left ventricle with a preserved or increased ejection fraction. Cardiac hypertrophy is often asymmetrical, which is associated with left ventricular outflow tract obstruction. Myocyte hypertrophy, disarray, and myocardial fibrosis constitute the histological features of HCM. HCM is a relatively benign disease but an important cause of sudden cardiac death in the young and heart failure in the elderly. Pathogenic variants (PVs) in genes encoding protein constituents of the sarcomeres are the main causes of HCM. PVs exhibit a gradient of effect sizes, as reflected in their penetrance and variable phenotypic expression of HCM. MYH7 and MYBPC3, encoding β-myosin heavy chain and myosin binding protein C, respectively, are the two most common causal genes and responsible for ≈40% of all HCM cases but a higher percentage of HCM in large families. PVs in genes encoding protein components of the thin filaments are responsible for ≈5% of the HCM cases. Whereas pathogenicity of the genetic variants in large families has been firmly established, ascertainment causality of the PVs in small families and sporadic cases is challenging. In the latter category, PVs are best considered as probabilistic determinants of HCM. Deciphering the genetic basis of HCM has enabled routine genetic testing and has partially elucidated the underpinning mechanism of HCM as increased number of the myosin molecules that are strongly bound to actin. The discoveries have led to the development of mavacamten that targets binding of the myosin molecule to actin filaments and imparts beneficial clinical effects. In the coming years, the yield of the genetic testing is expected to be improved and the so-called missing causal gene be identified. The advances are also expected to enable development of additional specific therapies and editing of the mutations in HCM.
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Affiliation(s)
- A J Marian
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston
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Abstract
PURPOSE OF REVIEW The present article serves to review current risk assessment guidelines for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) and to discuss how these guidelines can be applied to patients with childhood HCM. New diagnostic techniques that could lead to more accurate risk assessment tools are also discussed. RECENT FINDINGS Current guidelines for risk assessment in childhood HCM are extrapolated from adult guidelines and lack background research to validate their use. Continuous variables, such as wall thickness, are converted to binary variables, which is particularly concerning in pediatric patients' where weight gain and linear growth is likely to lead to more significant hemodynamic changes in shorter periods of time. Some studies have even shown that risk factors concerning in adults may actually be protective in pediatric patients. Additionally, large gaps still remain between genotype and phenotype expression in HCM. SUMMARY A better understanding of the relationship between cause, phenotype, and outcomes is needed to truly be able to determine risk for SCD in childhood HCM. Larger studies, including newer technologies and quantitative models, similar to the European HCM Risk-SCD model, which allows for a quantitative risk diagnosis, are needed as well.
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Abstract
Heart failure affects 1-2% of the adult population and one of the main contributors to its development is cardiomyopathy. Assessing a patient's risk for adverse events in heart failure is challenging and made more difficult by the heterogenous phenotypic expression of the disease. Cardiac MRI has long been a gold standard measure of myocardial function and anatomy due to its high spatial and temporal resolution. More recently, it has been posited to play a more critical role in the diagnosis and prognosis of cardiomyopathy-related heart failure. Given the limitations of more commonly used imaging modalities, increasing the clinical use of cardiac magnetic resonance imaging could potentially improve the prognosis of specific subgroups of patients at risk of adverse cardiac events.
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Affiliation(s)
- Nishant Lahoti
- Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Richard J Jabbour
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Ben Ariff
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.,Imperial College Healthcare Trust, Hammersmith Hospital, London, UK
| | - Brian Xiangzhi Wang
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
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Mahal S, Tarun T, Datta S, Aggarwal K. A Case Report on Diagnostic Approach of a Complex Clinical Scenario: Differentiation Between Coronary Artery Disease and Apical Hypertrophic Cardiomyopathy as a Cause of Recurrent Debilitating Angina. Cureus 2021; 13:e14496. [PMID: 34007749 PMCID: PMC8121130 DOI: 10.7759/cureus.14496] [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] [Indexed: 12/03/2022] Open
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) is a clinical challenge when presenting with symptoms of angina plus shortness of breath. An appropriate diagnosis of concurrent coronary artery disease (CAD) is needed for proper diagnosis, risk stratification, and management. We present a case of a 64-year-old gentleman with a history of ApHCM and CAD with previous percutaneous intervention presenting with recurrent angina. A repeat coronary angiography showed no new obstructive lesions. A stress cardiac magnetic resonance imaging was performed, which showed perfusion defect in the apex with apical scarring likely secondary to microvascular disease. The patient was managed medically with the improvement of symptoms. Diagnosis and management of CAD in patients with ApHCM are challenging. Multiple diagnostic modalities may be required for delineating the underlying pathology. Patients should be managed initially with medications. If symptoms are not controlled with medical management, a heart team approach with referral to an advanced center experienced in apical myectomy should be considered.
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Affiliation(s)
- Shanan Mahal
- Department of Internal Medicine, Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, USA
| | - Tushar Tarun
- Division of Cardiovascular Medicine, University of Missouri, Columbia, USA
| | - Sorabh Datta
- Department of Internal Medicine, Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, USA
| | - Kul Aggarwal
- Division of Cardiovascular Medicine, University of Missouri, Columbia, USA
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Papanastasiou CA, Zegkos T, Karamitsos TD, Rowin EJ, Maron MS, Parcharidou D, Kokkinidis DG, Karvounis H, Rimoldi O, Maron BJ, Efthimiadis GK. Prognostic role of left ventricular apical aneurysm in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol 2021; 332:127-132. [PMID: 33794232 DOI: 10.1016/j.ijcard.2021.03.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to systematically review and quantitatively synthesize existing evidence about the prognostic value of LV apical aneurysm in patients with HCM. BACKGROUND Hypertrophic cardiomyopathy (HCM) represents a common inherited heart disease associated with enormous diversity in morphologic expression and clinical course. With the increasing penetration of advanced high resolution cardiovascular imaging into routine HCM practice, a subset of HCM patients with left ventricular (LV) apical aneurysm have become more widely recognized. METHODS Medline was searched for studies describing the prognostic implication of LV apical aneurysm in patients with HCM. In the main analysis the combined endpoint of major HCM-related outcomes was assessed. Separate analyses for sudden cardiac death (SCD) events and thromboembolic events were also performed. RESULTS Six studies comprising of 2382 patients met the inclusion criteria. In the pooled analysis, the presence of LV apical aneurysm was significantly associated with major adverse outcomes (pooled OR: 5.13, 95 CI: 2.85 to 9.23, I2:31%), increased risk of SCD arrhythmic events (pooled OR: 4.67, 95% CI: 2.30 to 9.48, I2: 38%) and thromboembolic events (pooled OR: 6.30, 95% CI: 1.52 to 26.19, I2: 66%). CONCLUSIONS These data demonstrate that LV apical aneurysm in HCM patients is associated with an increased risk for SCD events and thromboembolism. This finding might encourage the inclusion of LV apical aneurysm into the HCM SCD risk stratification algorithm as a novel risk marker that supports consideration for primary prevention implantable cardioverter defibrillator and anticoagulation for stroke prophylaxis.
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Affiliation(s)
- Christos A Papanastasiou
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Zegkos
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
| | - Theodoros D Karamitsos
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Despoina Parcharidou
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Department of Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, United States of America
| | - Haralambos Karvounis
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Ornella Rimoldi
- CNR IBFM, Segrate, Italy; Ospedale San Raffaele, Milano, Italy
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Georgios K Efthimiadis
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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Mawad W, Mertens L, Pagano JJ, Riesenkampff E, Reichert MJE, Mital S, Kantor PF, Greenberg M, Liu P, Nathan PC, Grosse-Wortmann L. Effect of anthracycline therapy on myocardial function and markers of fibrotic remodelling in childhood cancer survivors. Eur Heart J Cardiovasc Imaging 2021; 22:435-442. [PMID: 32535624 PMCID: PMC7984732 DOI: 10.1093/ehjci/jeaa093] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/01/2019] [Accepted: 05/07/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Anthracyclines are a cornerstone of paediatric cancer treatment. We aimed to quantify myocardial cardiac magnetic resonance (CMR) native T1 (NT1) and extracellular volume fraction (ECV) as markers of fibrosis in a cohort of childhood cancer survivors (CCS). METHODS AND RESULTS A cohort of CCS in remission underwent CMR T1 mapping. Diastolic function was assessed by echocardiography. Results were compared to a cohort of normal controls of similar age and gender. Fifty-five CCS and 46 controls were included. Both groups had similar mean left ventricular (LV) NT1 values (999 ± 36 vs. 1007 ± 32 ms, P = 0.27); ECV was higher (25.6 ± 6.9 vs. 20.7 ± 2.4%, P = 0.003) and intracellular mass was lower (37.5 ± 8.4 vs. 43.3 ± 9.9g/m2, P = 0.02) in CCS. The CCS group had lower LV ejection fraction (EF) and LV mass index with otherwise normal diastolic function in all but one patient. The proportion of subjects with elevated ECV compared to controls did not differ between subgroups with normal or reduced LV EF (22% vs. 28%; P = 0.13) and no correlations were found between LVEF and ECV. While average values remained within normal range, mitral E/E' (6.6 ± 1.6 vs. 5.9 ± 0.9, P = 0.02) was higher in CCS. Neither NT1 nor ECV correlated with diastolic function indices or cumulative anthracycline dose. CONCLUSIONS There is evidence for mild diffuse extracellular volume expansion in some asymptomatic CCS; myocyte loss could be part of the mechanism, accompanied by subtle changes in systolic and diastolic function. These findings suggest mild myocardial damage and remodelling after anthracycline treatment in some CCS which requires continued monitoring.
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Affiliation(s)
- Wadi Mawad
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, 1001 Decarie Blvd,Montreal, QC, H4A 3J1, Canada
| | - Luc Mertens
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Joseph J Pagano
- Department of Paedatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, T6G 2B7, AB, Canada
| | - Eugenie Riesenkampff
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Marjolein J E Reichert
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Seema Mital
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital Los Angeles, Keck's School of Medicine of University of South California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Mark Greenberg
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Peter Liu
- Department of Paedatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 01 Smyth Rd, Ottawa, K1H 8L1, ON, Canada
| | - Paul C Nathan
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
| | - Lars Grosse-Wortmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, M5G 1X8, ON, Canada
- Department of Pediatrics Doernbecher Children’s Hospital, Oregon Health and Science University, 700 SW Campus Drive, Portland, OR 97239, USA
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Raphael CE, Mitchell F, Kanaganayagam GS, Liew AC, Di Pietro E, Vieira MS, Kanapeckaite L, Newsome S, Gregson J, Owen R, Hsu LY, Vassiliou V, Cooper R, Mrcp AA, Ismail TF, Wong B, Sun K, Gatehouse P, Firmin D, Cook S, Frenneaux M, Arai A, O'Hanlon R, Pennell DJ, Prasad SK. Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation. J Cardiovasc Magn Reson 2021; 23:26. [PMID: 33685501 PMCID: PMC7941878 DOI: 10.1186/s12968-021-00720-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/10/2020] [Accepted: 01/31/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. METHODS Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. RESULTS A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6-2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16-1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14-1.82, p = 0.002) age (HR 1.37, 95% CI 1.06-1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). DISCUSSION The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.
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Affiliation(s)
- Claire E Raphael
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
- Department of CMR, Royal Brompton Hospital, Sydney Street, Sydney, SW3 6NP, UK.
| | - Frances Mitchell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - Alphonsus C Liew
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Elisa Di Pietro
- Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Miguel Silva Vieira
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Lina Kanapeckaite
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Simon Newsome
- London School of Hygiene & Tropical Medicine, London, UK
| | - John Gregson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Li-Yueh Hsu
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vassilis Vassiliou
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Robert Cooper
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Aamir Ali Mrcp
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Tevfik F Ismail
- King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Brandon Wong
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Kristi Sun
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Peter Gatehouse
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - David Firmin
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Stuart Cook
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
- National Heart Center, Singapore, Singapore
| | | | - Andrew Arai
- Advanced Cardiovascular Imaging Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sanjay K Prasad
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
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80
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Sultan FAT, Saadia S. Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement on Cardiac MRI in Patients with Hypertrophic Cardiomyopathy and their Prognostic Significance - An Experience from a South Asian Country. J Clin Imaging Sci 2021; 11:14. [PMID: 33767906 PMCID: PMC7981941 DOI: 10.25259/jcis_235_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/17/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives Cardiac magnetic resonance (CMR) imaging is very pertinent in the diagnosis and risk stratification of patients with hypertrophic cardiomyopathy (HCM). We aimed to assess the patterns of left ventricular (LV) hypertrophy, late gadolinium enhancement (LGE), and their prognostic significance in HCM patients in Pakistani population, as no such data are available from Pakistan. Material and Methods This was a retrospective, single center study. All patients who had confirmed diagnosis of HCM on CMR at Aga Khan University Hospital during the period of 2011-2019 were identified and included in the study. Results A total of 74 patients were included with the mean age of 45.6 ± 15 years and the majority 71.6 % (n = 53) being male. Maximal LV wall thickness was 21.1 ± 5 mm, asymmetrical septal hypertrophy being the most common pattern (62.2%, n = 46). LGE was present in 75.7% (n = 56) with most common site being septum plus LV free wall (24.3%, n =18). Mean ejection fraction% was found to be lower in patients with LGE (P < 0.001). Major adverse cardiac events (MACE) were observed in 40.5% (n = 30). Presence of LGE and right ventricular involvement was found to have a statistically significant association with MACE (P value 0.018 and 0.046, respectively). In multivariable analysis, only LGE was significantly associated with MACE (odd ratio: 4.65; 95% CI: 1.21-17.88). Conclusion Asymmetrical septal hypertrophy was the most common pattern of hypertrophy. LGE was present in three fourth of the study population and it was significantly associated with MACE.
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Affiliation(s)
| | - Sheema Saadia
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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81
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Österberg AW, Östman-Smith I, Jablonowski R, Carlsson M, Green H, Gunnarsson C, Liuba P, Fernlund E. High ECG Risk-Scores Predict Late Gadolinium Enhancement on Magnetic Resonance Imaging in HCM in the Young. Pediatr Cardiol 2021; 42:492-500. [PMID: 33515326 DOI: 10.1007/s00246-020-02506-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/17/2020] [Indexed: 01/14/2023]
Abstract
An ECG risk-score has been described that predicts high risk of subsequent cardiac arrest in young patients with hypertrophic cardiomyopathy (HCM). Myocardial fibrosis measured by cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) also affects prognosis. We assessed whether an ECG risk-score could be used as an indicator of myocardial fibrosis or perfusion deficit on CMR in HCM. In total 42 individuals (7-31 years); 26 HCM patients, seven genotype-positive, phenotype-negative individuals at risk of HCM (first-degree relatives) and nine healthy volunteers, underwent CMR to identify, and grade extent of, myocardial fibrosis and perfusion defect. 12-lead ECG was used for calculating the ECG risk-score (grading 0-14p). High-risk ECG (risk-score > 5p) occurred only in the HCM group (9/26), and the proportion was significantly higher vs mutation carriers combined with healthy volunteers (0/16, p = 0.008). Extent of LGE correlated to the ECG-score (R2 = 0.47, p = 0.001) in sarcomeric mutations. In low-risk ECG-score patients (0-2p), median percent of myocardium showing LGE (LGE%LVM) were: 0% [interquartile range, IQR, 0-0%], in intermediate-risk (3-5p): 5.4% [IQR 0-13.5%] and in high-risk (6-14p): 10.9% [IQR 4.2-12.3%]. ECG-score > 2p had a sensitivity and specificity of 79% and 84% to detect positive LGE on CMR and 77% vs. 75% to detect perfusion defects in sarcomeric mutations carriers. In patients with myocardial fibrosis as identified by LGE, median ECG risk-score was 8p [range 3-10p]. In conclusions, ECG risk-score > 2 p could be used as a cut-off for screening of myocardial fibrosis. Thus ECG risk-score is an inexpensive complementary tool in risk stratification of HCM in the young.
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Affiliation(s)
- Anna Wålinder Österberg
- Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Department of Pediatrics, Linköping University, 581 85, Linköping, Sweden
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert Jablonowski
- Clinical Physiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Green
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.,Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Gunnarsson
- Department of Clinical Genetics, Department of Biomedical and Clinical Sciences, Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden
| | - Petru Liuba
- Pediatric Heart Centre, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Eva Fernlund
- Crown Princess Victoria Children's Hospital, Department of Biomedical and Clinical Sciences, Department of Pediatrics, Linköping University, 581 85, Linköping, Sweden. .,Pediatric Heart Centre, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden.
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82
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The Clinical Prognosis of Presence and Location of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy: a Single-Center Cohort Study. J Cardiovasc Transl Res 2021; 14:1001-1016. [PMID: 33629154 DOI: 10.1007/s12265-021-10107-x] [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: 09/10/2020] [Accepted: 02/15/2021] [Indexed: 01/07/2023]
Abstract
Increasing data have indicated that late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) images is associated with the clinical prognosis of hypertrophic cardiomyopathy (HCM). Recently, pioneer studies indicated that the location of LGE in CMR images also had potential predictive value for HCM prognosis. The aim of the present study was to investigate the prognostic value of the location of LGE for HCM. This present cohort study included 557 HCM patients who underwent LGE-CMR imaging, and the LGE location was classified as LGE in interventricular septum only (IVS-LGE) and LGE outside the IVS with or without IVS involvement (other than IVS-LGE). All-cause mortality, cardiovascular mortality/cardiac transplantation, and sudden cardiac death (SCD) were evaluated. During a mean follow-up time of 83.0±37.8 months, there was a significantly higher all-cause mortality, cardiovascular mortality/cardiac transplantation, and SCD in patients with other than IVS-LGE than in those with IVS-LGE. Multivariate Cox regression suggested that other than IVS-LGE were one of independent prognostic predictors. Risk reclassification for prognosis showed that there were no differences between the prediction values of the presence of LGE and the location of LGE. The presence and location of LGE in CMR images are equally independent prognostic predictors of HCM, and other than IVS-LGE location is associated with an adverse clinical prognosis. Prognosis Trial Registration: ChiCTR-ONRC-11001902.
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83
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Gonçalves AV, Rosa SA, Branco L, Galrinho A, Fiarresga A, Lopes LR, Thomas B, Baquero L, Carmo MM, Ferreira RC. Myocardial work is associated with significant left ventricular myocardial fibrosis in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2237-2244. [PMID: 33598850 DOI: 10.1007/s10554-021-02186-3] [Citation(s) in RCA: 4] [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: 10/31/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022]
Abstract
Late gadolinium enhancement on cardiac magnetic resonance adds prognostic information in patients with hypertrophic cardiomyopathy. Whether Myocardial work, a new parameter on transthoracic echocardiographic, can be associated with significant fibrosis in hypertrophic cardiomyopathy patients is unknown. In a single-centre prospective evaluation of hypertrophic cardiomyopathy patients in whom transthoracic echocardiographic and cardiac magnetic resonance were performed, Myocardial work and related indices were calculated from global longitudinal strain and from estimated left ventricular pressure curves. The extent of late gadolinium enhancement was quantitatively assessed. Late gadolinium enhancement ≥ 15% was chosen to define significant fibrosis. Logistic regression analysis was used to find the variables associated with late gadolinium enhancement ≥ 15% and cut-off values were determined. Among the forty-six patients analysed mean age was 56 ± 15 years, 28 (61%) were male patients and the mean left ventricular ejection fraction by transthoracic echocardiographic was 67 ± 8%. Global constructive work and global work index were significantly related to late gadolinium enhancement ≥ 15%, while global longitudinal strain nearly reached statistical significance. A cut-off ≤ 1550 mmHg% of global constructive work was associated with significant fibrosis with a sensitivity of 91% and a specificity of 84%, while the best cut-off for global longitudinal strain (> - 15%) had a sensitivity of 67% and a specificity of 76%. In our study cohort, global constructive work was associated with significant left ventricular myocardial fibrosis in cardiac magnetic resonance, suggesting its utility in patients who may not be able to have a cardiac magnetic resonance study.
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Affiliation(s)
- António Valentim Gonçalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal.
| | - Sílvia Aguiar Rosa
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal
| | - Luísa Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal
| | - António Fiarresga
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal
| | - Luís Rocha Lopes
- St. Bartholomew's Hospital-Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College of London, London, UK
- Centro Cardiovascular da Universidade Lisboa, Lisboa, Portugal
| | - Boban Thomas
- Department of Cardiology, Hospital da Cruz Vermelha, Lisbon, Portugal
| | - Luís Baquero
- Department of Cardiology, Hospital da Cruz Vermelha, Lisbon, Portugal
| | | | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no 50, 1169-024, Lisbon, Portugal
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84
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Xu S, Tao H, Cao W, Cao L, Lin Y, Zhao SM, Xu W, Cao J, Zhao JY. Ketogenic diets inhibit mitochondrial biogenesis and induce cardiac fibrosis. Signal Transduct Target Ther 2021; 6:54. [PMID: 33558457 PMCID: PMC7870678 DOI: 10.1038/s41392-020-00411-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/31/2020] [Accepted: 11/03/2020] [Indexed: 02/05/2023] Open
Abstract
In addition to their use in relieving the symptoms of various diseases, ketogenic diets (KDs) have also been adopted by healthy individuals to prevent being overweight. Herein, we reported that prolonged KD exposure induced cardiac fibrosis. In rats, KD or frequent deep fasting decreased mitochondrial biogenesis, reduced cell respiration, and increased cardiomyocyte apoptosis and cardiac fibrosis. Mechanistically, increased levels of the ketone body β-hydroxybutyrate (β-OHB), an HDAC2 inhibitor, promoted histone acetylation of the Sirt7 promoter and activated Sirt7 transcription. This in turn inhibited the transcription of mitochondrial ribosome-encoding genes and mitochondrial biogenesis, leading to cardiomyocyte apoptosis and cardiac fibrosis. Exogenous β-OHB administration mimicked the effects of a KD in rats. Notably, increased β-OHB levels and SIRT7 expression, decreased mitochondrial biogenesis, and increased cardiac fibrosis were detected in human atrial fibrillation heart tissues. Our results highlighted the unknown detrimental effects of KDs and provided insights into strategies for preventing cardiac fibrosis in patients for whom KDs are medically necessary.
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Affiliation(s)
- Sha Xu
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China.,Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Hui Tao
- Department of Cardiothoracic Surgery, Second Hospital of Anhui Medical University, and Cardiovascular Research Center, Anhui Medical University, 230601, Hefei, China
| | - Wei Cao
- Department of Cardiothoracic Surgery, Second Hospital of Anhui Medical University, and Cardiovascular Research Center, Anhui Medical University, 230601, Hefei, China
| | - Li Cao
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China
| | - Yan Lin
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China
| | - Shi-Min Zhao
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China.,Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Wei Xu
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China.,Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jing Cao
- Department of Anatomy and Neuroscience Research Institute, School of Basic Medical Sciences, Zhengzhou University, 450001, Zhengzhou, China
| | - Jian-Yuan Zhao
- Zhongshan Hospital of Fudan University, Obstetrics & Gynecology Hospital of Fudan University, State Key Lab of Genetic Engineering, School of Life Sciences, Key Laboratory of Reproduction Regulation of NPFPC, and Institutes of Biomedical Sciences, Fudan University, 200438, Shanghai, China. .,Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Department of Anatomy and Neuroscience Research Institute, School of Basic Medical Sciences, Zhengzhou University, 450001, Zhengzhou, China.
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85
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Pieles GE, Alkon J, Manlhiot C, Fan CPS, Kinnear C, Benson LN, Mital S, Friedberg MK. Association between genetic variants in the HIF1A-VEGF pathway and left ventricular regional myocardial deformation in patients with hypertrophic cardiomyopathy. Pediatr Res 2021; 89:628-635. [PMID: 32375165 DOI: 10.1038/s41390-020-0929-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 02/02/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Information on genetic etiology of pediatric hypertrophic cardiomyopathy (HCM) rarely aids in risk stratification and prediction of disease onset. Little data exist on the association between genetic modifiers and phenotypic expression of myocardial performance, hampering an individual precision medicine approach. METHODS Single-nucleotide polymorphism genotyping for six previously established disease risk alleles in the hypoxia-inducible factor-1α-vascular endothelial growth factor pathway was performed in a pediatric cohort with HCM. Findings were correlated with echocardiographic parameters of systolic and diastolic myocardial deformation measured by two-dimensional (2-D) speckle-tracking strain. RESULTS Twenty-five children (6.1 ± 4.5 years; 69% male) with phenotypic and genotypic (60%) HCM were included. Out of six risk alleles tested, one, VEGF1 963GG, showed an association with reduced regional systolic and diastolic left ventricular (LV) myocardial deformation. Moreover, LV average and segmental systolic and diastolic strain and strain rate were significantly reduced, as assessed by the standardized difference, in patients harboring the risk allele. CONCLUSIONS This is the first study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial function, with the VEGF1 963GG allele associated with reduced LV systolic and diastolic myocardial performance. While studies are needed to link this information to adverse clinical outcomes, this knowledge may help in risk stratification and patient management in HCM. IMPACT Risk allele in the VEGF gene impacts on LV myocardial deformation phenotype in children with HCM. LV 2-D strain is significantly reduced in patients with risk allele compared to non-risk allele patients within HCM patient groups. Describes that deficiencies in LV myocardial performance in children with HCM are associated with a previously identified risk allele in the angiogenic transcription factor VEGF. First study to identify an association between a risk allele in the VEGF pathway and regional LV myocardial deformation measured by 2-D strain in children with HCM.
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Affiliation(s)
- Guido E Pieles
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,NIHR Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK.
| | - Jaime Alkon
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Chun-Po Steve Fan
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Caroline Kinnear
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Leland N Benson
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark K Friedberg
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Wang S, Song C, Cui H, Zhu C, Wu R, Huang X, Lai Y, Wang S. Red blood cell distribution width is associated with adverse cardiovascular events after septal myectomy. J Thorac Dis 2021; 13:582-591. [PMID: 33717531 PMCID: PMC7947493 DOI: 10.21037/jtd-20-2528] [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] [Indexed: 11/09/2022]
Abstract
Background Red blood cell distribution width (RDW) is associated with increased morbidity and mortality in several cardiovascular diseases. However, the prognostic significance of RDW in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remains unclear as no studies have been conducted on this topic. This study aimed to assess the prognostic significance of RDW in these patients. Methods A total of 867 adults with HOCM who underwent septal myectomy at Fuwai Hospital from 2011 to 2017 were retrospectively studied. All patients were assessed comprehensively, including their medical history, echocardiograms, and blood test results. Results The median age of patients was 47.9 [interquartile range (IQR), 37.0–56.0] years and 61.5% of patients were men. During a median follow-up period of 32 (IQR, 17–53) months, 26 patients died and 23 had a cardiovascular death during follow-up. Compared to patients in the lowest RDW quartile, those in the highest quartile had a significantly lower 5-year survival free from all-cause and cardiovascular death (95.9% vs. 87.6%, P<0.001; 95.9% vs. 89.9%, P<0.001). Compared with lower RDW, higher RDW was significantly associated with all-cause and cardiovascular death after adjustment for age, sex, body mass index, and relevant clinical risk factors [per RDW standard deviation (SD) hazard ratio (HR) increase =1.76, 95% confidence interval (CI): 1.54–2.05, P<0.001; per RDW SD HR =1.91, 95% CI: 1.63–2.22, P for trend <0.001]. Conclusions Higher RDW is independently associated with all-cause and cardiovascular death in patients with HOCM after septal myectomy. Therefore, this readily available biomarker could be considered as an additive biomarker for risk stratification in these patients.
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Affiliation(s)
- Shengwei Wang
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Changpeng Song
- Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rong Wu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Huang
- Department of Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongqiang Lai
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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87
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Prognostic value of myocardial extracellular volume fraction evaluation based on cardiac magnetic resonance T1 mapping with T1 long and short in hypertrophic cardiomyopathy. Eur Radiol 2021; 31:4557-4567. [PMID: 33449190 DOI: 10.1007/s00330-020-07650-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/14/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the prognostic significance of T1 mapping using T1 long and short in hypertrophic cardiomyopathy (HCM) patients. METHODS A total of 263 consecutive patients with HCM referred for cardiovascular magnetic resonance (CMR) imaging were enrolled in this study. The imaging protocol consisted of cine, late gadolinium enhancement (LGE), and T1 mapping with T1 long and short. All patients were followed up prospectively. Outcome events were divided into the primary and secondary endpoint events. Primary endpoint events included cardiac death, heart transplant, aborted sudden death, and cardiopulmonary resuscitation after syncope. The secondary endpoint event was defined as unplanned rehospitalization for heart failure. RESULT The average follow-up duration was 28.3 ± 12.1 (range: 1-78) months. In all, 17 patients (7.0%) experienced a primary endpoint including 13 cardiovascular deaths, three aborted sudden deaths, and one resuscitation after syncope, and 34 patients experienced a secondary endpoint. Patients with primary endpoints showed a trend towards more extensive LGE (p < 0.001), significantly higher ECV (p < 0.001), and native T1 (p = 0.028) than those without events. In multivariate Cox regression analysis, ECV was independently associated with primary and secondary endpoints (p < 0.001 and p = 0.047, respectively). For every 3% increase, ECV portended a 1.374-fold increase risk of a primary endpoint occurring (p < 0.001). In the Kaplan-Meier survival analysis, the incidence of primary and secondary endpoint events was significantly higher in HCM with increased ECV (p < 0.001 and p = 0.009, respectively). CONCLUSION In patients with HCM, ECV is a strong imaging marker for predicting adverse outcome. KEY POINTS • ECV is a potent imaging index which has a strong correlation with LVEF and LVEDVI and can evaluate myocardial tissue structure and function. • ECV and LGE can provide a prognostic value in patients with hypertrophic cardiomyopathy. • ECV has stronger predictive effectiveness than LGE; even in the subgroup with LGE, ECV shows independent predictive significance for adverse events.
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88
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Fonseca AC, Almeida AG, Santos MO, Ferro JM. Neurological complications of cardiomyopathies. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:91-109. [PMID: 33632460 DOI: 10.1016/b978-0-12-819814-8.00001-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
There is a multifaceted relationship between the cardiomyopathies and a wide spectrum of neurological disorders. Severe acute neurological events, such as a status epilepticus and aneurysmal subarachnoid hemorrhage, may result in an acute cardiomyopathy the likes of Takotsubo cardiomyopathy. Conversely, the cardiomyopathies may result in a wide array of neurological disorders. Diagnosis of a cardiomyopathy may have already been established at the time of the index neurological event, or the neurological event may have prompted subsequent cardiac investigations, which ultimately lead to the diagnosis of a cardiomyopathy. The cardiomyopathies belong to one of the many phenotypes of complex genetic diseases or syndromes, which may also involve the central or peripheral nervous systems. A number of exogenous agents or risk factors such as diphtheria, alcohol, and several viruses may result in secondary cardiomyopathies accompanied by several neurological manifestations. A variety of neuromuscular disorders, such as myotonic dystrophy or amyloidosis, may demonstrate cardiac involvement during their clinical course. Furthermore, a number of genetic cardiomyopathies phenotypically incorporate during their clinical evolution, a gamut of neurological manifestations, usually neuromuscular in nature. Likewise, neurological complications may be the result of diagnostic procedures or medications for the cardiomyopathies and vice versa. Neurological manifestations of the cardiomyopathies are broad and include, among others, transient ischemic attacks, ischemic strokes, intracranial hemorrhages, syncope, muscle weakness and atrophy, myotonia, cramps, ataxia, seizures, intellectual developmental disorder, cognitive impairment, dementia, oculomotor palsies, deafness, retinal involvement, and headaches.
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Affiliation(s)
- Ana Catarina Fonseca
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Miguel Oliveira Santos
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José M Ferro
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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89
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Jensen CJ, Lambers M, Zadeh B, Wambach JM, Nassenstein K, Bruder O. QRS-T angle in patients with Hypertrophic Cardiomyopathy - A comparison with Cardiac Magnetic Resonance Imaging. Int J Med Sci 2021; 18:821-825. [PMID: 33437218 PMCID: PMC7797532 DOI: 10.7150/ijms.52415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: We sought to investigate the possible association of a wide QRS-T angle on the surface EKG and myocardial fibrosis on contrast-enhanced cardiovascular magnetic (CMR) imaging in patients with hypertrophic cardiomyopathy (HCM). Background: Risk stratification in HCM patients is challenging. Late gadolinium enhancement (LGE) visualizes myocardial fibrosis with unique spatial resolution and is a strong and independent prognosticator in these patients. The QRS-T angle from the surface EKG is a promising prognostic marker in various cardiac pathologies. Methods: 70 patients with HCM obtained a standardized digital 12-lead EKG for the calculation of the QRS-T angle and underwent comprehensive CMR imaging for visualization of fibrosis by LGE. Patients were divided into groups according to the absence or presence of fibrosis on CMR. Results: 43 of 70 patients with HCM showed LGE on CMR following contrast administration. HCM patients with LGE (fibrosis) had wider QRS-T angles as compared to the patient group without LGE (100±54 vs. 46±31; <0.001). A QRS-T angle of 90 degrees or more was a strong predictor (OR 32.84, CI 4.08-264.47; p <0.001) of HCM with LGE. Conclusion: There is a strong association of a wide QRS-T angle and myocardial fibrosis in patients with HCM.
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Affiliation(s)
- Christoph Julian Jensen
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.,Ruhr University Bochum, Bochum, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.,Ruhr University Bochum, Bochum, Germany
| | - Behnam Zadeh
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.,Ruhr University Bochum, Bochum, Germany
| | - Jan Martin Wambach
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.,Ruhr University Bochum, Bochum, Germany
| | - Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus Essen, Essen, Germany.,Ruhr University Bochum, Bochum, Germany
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90
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Wang S, Cui H, Ji K, Zhu C, Huang X, Lai Y, Wang S. Relationship Between Obstructive Sleep Apnea and Late Gadolinium Enhancement and Their Effect on Cardiac Arrhythmias in Patients with Hypertrophic Obstructive Cardiomyopathy. Nat Sci Sleep 2021; 13:447-456. [PMID: 33790677 PMCID: PMC8006971 DOI: 10.2147/nss.s270684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) and myocardial fibrosis are associated with cardiac arrhythmia. The purpose of this study was to explore the relationship between OSA and myocardial fibrosis, as well as their impact on cardiac arrhythmia in hypertrophic obstructive cardiomyopathy (HOCM) patients. METHODS We prospectively studied 151 consecutive patients with a confirmed diagnosis of HOCM at the Fuwai Hospital between September 2017 and 2018. Polysomnography, Holter electrocardiography, and cardiac magnetic resonance imaging were performed on all patients. Myocardial fibrosis was reflected by late gadolinium enhancement (LGE), detected using cardiac magnetic resonance imaging. RESULTS Myocardial fibrosis, measured using LGE%, was found to increase with increasing OSA severity [6.8% (3.6-12.9%), 6.1% (3.4-10.0%), 9.6% (5.5-14.5%), and 15.5% (9.3-20.0%) for no-OSA, mild OSA, moderate OSA, and severe OSA, respectively; p=0.003]. LGE% correlated with the New York Heart Association functional classifications (p=0.018), septal thickness (p=0.026), and apnea-hypopnea index (AHI) (p<0.001). The prevalence of isolated premature ventricular contraction (PVC) (p=0.028), paired PVC (p=0.036), ventricular bigeminy (p=0.005)/trigeminy (p<0.001), non-sustained ventricular tachycardia (NSVT) (p=0.001), isolated premature atrial contraction (PAC) (p=0.032), and supraventricular tachycardia (p=0.029) was significantly higher in patients with OSA. Additionally, LGE% and AHI were independent risk factors for isolated PVC (OR: 1.04, p=0.001 and OR: 1.07, p=0.039, respectively), ventricular bigeminy (OR: 1.04, p=0.003 and OR: 1.26, p=0.002, respectively)/trigeminy (OR: 1.07, p=0.040 and OR: 1.06, p=0.001, respectively), and NSVT (OR: 1.17, p<0.001 and OR: 1.08, p<0.001, respectively) after adjustment for age, sex, and other parameters. CONCLUSION Both OSA and LGE% were associated with a greater likelihood and increased frequency of ventricular arrhythmias (including NSVT) in patients with HOCM. Thus, the severity of OSA was independently associated with more severe myocardial fibrosis in patients with HOCM.
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Affiliation(s)
- Shengwei Wang
- Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, People's Republic of China
| | - Hao Cui
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Keshan Ji
- Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaohong Huang
- Special Medical Treatment Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yongqiang Lai
- Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, People's Republic of China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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91
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Bachman NP, Terwoord JD, Richards JC, Braun B, Green CP, Luckasen GJ, Dinenno FA. Comprehensive assessment of cardiovascular structure and function and disease risk in middle-aged ultra-endurance athletes. Atherosclerosis 2020; 320:105-111. [PMID: 33334550 DOI: 10.1016/j.atherosclerosis.2020.11.030] [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: 07/01/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Recent studies suggest that long-term endurance training may be damaging to the heart, thus increasing cardiovascular disease (CVD) risk. However, studies utilizing cardiac imaging are conflicting and lack measures of central and peripheral vascular structure and function, which are also independently predictive of CVD events. METHODS We performed a comprehensive assessment of cardiovascular structure and function in long-term (≥ 10 years) ultra-endurance athletes (ATH, 14 M/11 F, 50 ± 1 y) and physically active controls (CON, 9 M/9 F, 49 ± 2 y). RESULTS As expected, left ventricular mass and end-diastolic volume (echocardiography) were greater in ATH vs CON, whereas there was no difference in cardiac function at rest. Coronary artery calcium scores (computed tomography) were not statistically different between groups. There was no evidence of myocardial fibrosis (contrast magnetic resonance imaging) in any subject. Aortic stiffness (carotid-femoral pulse wave velocity) was lower in ATH vs CON (6.2 ± 0.2 vs 6.9 ± 0.2 m/s, p < 0.05), whereas carotid intima-media thickness (ultrasound) was not different between groups. Peripheral vascular endothelial function (flow-mediated vasodilation of the brachial artery) and microvascular function (peak blood velocity) in response to 5 min of forearm ischemia were not different between groups. Furthermore, there was no difference in 10-year coronary heart disease risk (ATH; 2.3 ± 0.5 vs CON; 1.6 ± 0.2%, p > 0.05). CONCLUSIONS Our data indicate that middle-aged ultra-endurance ATH do not have marked signs of widespread cardiovascular dysfunction or elevated CHD risk compared to CON meeting physical activity guidelines.
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Affiliation(s)
- Nate P Bachman
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Janée D Terwoord
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Jennifer C Richards
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523, USA
| | - Barry Braun
- Human Performance Clinical Research Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523, USA
| | - C Patrick Green
- Medical Center of the Rockies Foundation, University of Colorado Health, 2500 Rocky Mountain Ave, Loveland, CO, 80538, USA
| | - Gary J Luckasen
- Medical Center of the Rockies Foundation, University of Colorado Health, 2500 Rocky Mountain Ave, Loveland, CO, 80538, USA
| | - Frank A Dinenno
- Human Cardiovascular Physiology Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523, USA.
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Progression of Myocardial Fibrosis in Hypertrophic Cardiomyopathy: A Cardiac Magnetic Resonance Study. JACC Cardiovasc Imaging 2020; 14:947-958. [PMID: 33248971 DOI: 10.1016/j.jcmg.2020.09.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study examined fibrosis progression in hypertrophic cardiomyopathy (HCM) patients, as well as its relationship to patient characteristics, clinical outcomes, and its effect on clinical decision making. BACKGROUND Myocardial fibrosis, as quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), provides valuable prognostic information in patients with HCM. METHODS A total of 157 patients with HCM were enrolled in this study, with 2 sequential CMR scans separated by an interval of 4.7 ± 1.9 years. RESULTS At the first CMR session (CMR-1), 70% of patients had LGE compared with 85% at CMR-2 (p = 0.001). The extent of LGE extent increased between the 2 CMR procedures, from 4.0 ± 5.6% to 6.3 ± 7.4% (p < 0.0001), with an average LGE progression rate of 0.5 ± 1.0%/year. LGE mass progression was correlated with higher LGE mass and extent on CMR-1 (p = 0.0017 and p = 0.007, respectively), greater indexed left ventricular (LV) mass (p < 0.0001), greater LV maximal wall thickness (p < 0.0001), apical aneurysm at CMR-1 (p < 0.0001), and lower LV ejection fraction (EF) (p = 0.029). Patients who were more likely to have a higher rate of LGE progression presented with more severe disease at baseline, characterized by LGE extent >8% of LV mass, indexed LV mass >100 g/m2, maximal wall thickness ≥20 mm, LVEF ≤60%, and apical aneurysm. There was a significant correlation between the magnitude of LGE progression and future implantation of insertable cardioverter-defibrillators (p = 0.004), EF deterioration to ≤50% (p < 0.0001), and admission for heart failure (p = 0.0006). CONCLUSIONS Myocardial fibrosis in patients with HCM is a slowly progressive process. Progression of LGE is significantly correlated with a number of clinical outcomes such as progression to EF ≤50% and heart failure admission. Judicious use of serial CMR with LGE can provide valuable information to help patient management.
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93
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Wabich E, Dorniak K, Zienciuk-Krajka A, Nowak R, Raczak G, Daniłowicz-Szymanowicz L. Segmental longitudinal strain as the most accurate predictor of the patchy pattern late gadolinium enhancement in hypertrophic cardiomyopathy. J Cardiol 2020; 77:475-481. [PMID: 33246844 DOI: 10.1016/j.jjcc.2020.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prognostic value of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) has been well-established. Although cardiac magnetic resonance (CMR) is the method of choice in its revealing as the presence of late gadolinium enhancement (LGE), this technique still has limited availability in daily clinical practice. Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful in verification which HCM patient has the highest probability of LGE presence and hence needs to be qualified to CMR. While the majority of HCM patients have a patchy pattern of myocardial fibrosis, the aim of this study was to evaluate whether segmental rather than global longitudinal strain is more accurate in the identification of the presence of LGE. METHODS Forty-six HCM patients had transthoracic echocardiography and CMR imaging performed. Each patient had global longitudinal strain and rotation parameters calculated, as well as segmental analyses for wall thickness, longitudinal strain, and LGE presence based on 736 segments of the left ventricle (LV). The presence of LGE in CMR was confirmed on a per-segment basis, which was similar to LV segments in the echocardiographic examination. All patients were divided into two groups according to the CMR result: LGE (+) and LGE (-). RESULTS Receiver-operating characteristic analyses identified peak global longitudinal strain and peak twisting velocity with the cut-off values -14.4% and 116°/s respectively as the accurate predictors of LGE presence in CMR, whereas segmental longitudinal strain of -12.5% cut-off value had the highest area under the curve value (87.4%, confidence interval 84.5-90.3%), with 93.7% sensitivity, 86.5% negative predictive value, and 55% specificity. CONCLUSIONS Segmental longitudinal strain with the cut-off value of -12.5% has the highest discriminatory power for LGE presence and seems to be more adequate than global speckle tracking parameters in identification of HCM patients with strong indications for CMR for more accurate risk stratification.
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Affiliation(s)
- Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Zienciuk-Krajka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Radosław Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Dębinki 7 St., 80-211 Gdansk, Poland
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Ren C, Wang S, Yu J, Guo H, Ma H, Wei Z, Liu K, Lai Y. Surgical outcome for hypertrophic cardiomyopathy patients with extreme interventricular septal thickness: a propensity score matched study. J Thorac Dis 2020; 12:5460-5467. [PMID: 33209379 PMCID: PMC7656406 DOI: 10.21037/jtd-20-1705] [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] [Indexed: 11/29/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) is associated with a higher incidence of adverse cardiovascular events. However, the results of these patients who underwent septal myectomy are unclear. Methods We studied 47 HCM patients with IVST ≥30 mm who underwent septal myectomy between 2011 and 2018 in Anzhen Hospital. After a 2:1 propensity score matching, the study cohort included 141 patients and 94 patients with IVST <30 mm. Results Patients with IVST ≥30 mm had a longer clinical course of disease, high incidence of syncope, palpitation, and moderate or severe mitral regurgitation. After a mean follow-up of 34.0±21.3 months, 6 patients died, including 5 with IVST ≥30 mm and 1 with IVST <30 mm. The 5-year survival free of all-cause mortality was significantly higher in patients with IVST ≥30 mm than in those with IVST <30 mm (98.9% vs. 85.7%, P=0.03). Multivariable Cox analysis revealed that IVST ≥30 mm (HR: 1.12, 95% CI: 1.01–1.25, P=0.028) was an independent risk factor for all-cause mortality. Meanwhile, left ventricular end diastole diameter (HR: 0.72, 95% CI: 0.54–0.97, P=0.031) and age (HR: 0.91, 95% CI: 0.83–0.99, P=0.025) were also independent risk factors for all-cause mortality in this special cohort. Furthermore, the incidence of NYHA class III or IV was significantly higher in patients with IVST ≥30 mm. Conclusions The surgical outcome was poor in a matched cohort of HCM patients with IVST ≥30 mm, which was mainly reflected by mortality and the incidence of NYHA class III or IV.
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Affiliation(s)
- Changwei Ren
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Shengwei Wang
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Jianbo Yu
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Hongchang Guo
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Hehe Ma
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Zhipeng Wei
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Kemin Liu
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
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Ghannam M, Siontis KC, Kim HM, Cochet H, Jais P, Eng MJ, Attili A, Sharaf-Dabbagh G, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes. Heart Rhythm O2 2020; 2:64-72. [PMID: 34113906 PMCID: PMC8183950 DOI: 10.1016/j.hroo.2020.11.004] [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] [Indexed: 01/13/2023] Open
Abstract
Background Patients undergoing ablation of premature ventricular complexes (PVCs) can have cardiac scar. Risk factors for the presence of scar are not well defined. Objectives To determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance imaging (DE-CMR) in patients undergoing ablation of PVCs, to create a risk score predictive of scar, and to explore correlations between the scoring system and long-term outcomes. Methods DE-CMR imaging was performed in consecutive patients with frequent PVCs referred for ablation. The full sample was used to develop a prediction model for cardiac scar based on demographic and clinical characteristics, and internal validation of the prediction model was done using bootstrap samples. Results The study consisted of 333 patients (52% male, aged 53.2 ± 14.5 years, preablation ejection fraction 50.9% ± 12.2%, PVC burden 20.7 ± 13.14), of whom 112 (34%) had DE-CMR scarring. Multiple logistic regression analysis showed age (odds ratio [OR] 1.02 [1.01–1.04]/year, P = .019) and preablation ejection fraction (OR 0.92 [0.89–0.94]/%, P < .001) to be predictive of scar. A weighted risk score incorporating age and ejection fraction was used to stratify patients into low-, medium-, and high-risk groups. Scar prevalence was around 86% in the high-risk group and 12% in the low-risk group; high-risk patients had worse survival free of arrhythmia. Conclusions Cardiac scar was present in one-third of patients referred for PVC ablation. A weighted risk score based simply on patient age and preprocedural ejection fraction can help discriminate between patients at high and low risk for the presence of cardiac scar and worse arrhythmia outcomes.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | | | - Hyungjin Myra Kim
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Hubert Cochet
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Mehdi Juhoor Eng
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Anil Attili
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ghaith Sharaf-Dabbagh
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
- Address reprint requests and correspondence: Dr Frank Bogun, Cardiovascular Center, SPC 5853, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5853.
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96
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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97
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Kamp NJ, Chery G, Kosinski AS, Desai MY, Wazni O, Schmidler GS, Patel M, Lopes RD, Morin DP, Al-Khatib SM. Risk stratification using late gadolinium enhancement on cardiac magnetic resonance imaging in patients with hypertrophic cardiomyopathy: A systematic review and meta-analysis. Prog Cardiovasc Dis 2020; 66:10-16. [PMID: 33171204 DOI: 10.1016/j.pcad.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022]
Abstract
Background The role of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (c-MRI) for predicting outcomes of patients with hypertrophic cardiomyopathy (HCM) has been debated. Methods We searched PubMed and Embase and various published bibliographies for prospective studies published in English between January 1990 and February 2019. Two investigators screened 2646 abstracts and full-text articles for inclusion and relevant outcomes. We then performed a systematic review and meta-analysis to calculate pooled odds ratios for LGE on c-MRI and a pooled sensitivity and specificity analysis. Results Our systematic review included 8 prospective studies and 3808 patients. LGE positivity was associated with higher odds of the endpoint of sudden cardiac death (SCD;OR 1.69, 95%CI 1.03-2.78), aborted SCD or appropriate implantable cardioverter- defibrillator (ICD) discharge (OR 3.27 [1.75-6.10]), SCD or aborted SCD or appropriate ICD discharge (OR 2.32 [1.56-3.43]), and all-cause mortality (OR 2.10 [CI 1.00-4.41]). The pooled sensitivity and specificity of positive LGE on c-MRI for SCD were 65% and 42%, respectively; for aborted SCD or appropriate ICD discharge, 79% and 39%; for SCD or aborted SCD or appropriate ICD discharge, 74% and 39%; and for all-cause mortality, 78% and 39%. Conclusion In patients with HCM, LGE on c-MRI is a strong predictor of arrhythmic outcomes including SCD, aborted SCD, and appropriate ICD therapy. These data support the routine use of LGE on c-MRI as a marker of SCD risk in this population.
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MESH Headings
- Adult
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/prevention & control
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/therapy
- Contrast Media
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Gadolinium
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Risk Assessment
- Risk Factors
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Affiliation(s)
| | | | - Andrzej S Kosinski
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | | | | | | | - Manesh Patel
- Duke Clinical Research Institute, Durham, NC, USA
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98
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Grajewski KG, Stojanovska J, Ibrahim ESH, Sayyouh M, Attili A. Left Ventricular Hypertrophy: Evaluation With Cardiac MRI. Curr Probl Diagn Radiol 2020; 49:460-475. [DOI: 10.1067/j.cpradiol.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 01/20/2023]
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99
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Ciabatti M, Fumagalli C, Beltrami M, Vignini E, Martinese L, Tomberli A, Zampieri M, Bertini A, Carrassa G, Marchi A, Berteotti M, Cappelli F, Bolognese L, Pieroni M, Olivotto I. Prevalence, causes and predictors of cardiovascular hospitalization in patients with hypertrophic cardiomyopathy. Int J Cardiol 2020; 318:94-100. [DOI: 10.1016/j.ijcard.2020.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/24/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022]
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100
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Bordonaro V, Bivort D, Dresselaers T, De Langhe E, Bogaert J, Symons R. Myocardial T1 mapping and extracellular volume quantification as novel biomarkers in risk stratification of patients with systemic sclerosis. Clin Radiol 2020; 76:162.e1-162.e8. [PMID: 33109349 DOI: 10.1016/j.crad.2020.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
AIM To study the prognostic value of myocardial native T1 and extracellular volume (ECV), measured by cardiovascular magnetic resonance (CMR), in patients with systemic sclerosis (SSc). MATERIALS AND METHODS Thirty-three SSc patients (16/33 male, 48.5%) were studied using multiparametric CMR including native T1 mapping with ECV calculation, T2 mapping, and late gadolinium enhancement (LGE). Patients were followed-up for cardiac death, haemodynamically significant arrhythmia, or heart failure. Results were compared with 33 age- and gender-matched healthy controls. RESULTS When compared with controls, SSc patients had higher myocardial native T1 (1,058.9±71 versus 989.4±21.4 ms, p<0.001), higher T2 (54.9±5.7 versus 50±2.5 ms, p<0.001), and ECV values (27.9±5.4% versus 24.8±2%, p<0.004). LGE was present in eight patients (24%), two subendocardial, five midwall, and four subepicardial. LGE, native T1, and ECV were significantly associated with adverse events during follow-up in multivariate Cox regression analysis. Kaplan-Meier analysis demonstrated significant divergence of the survival curves based on the presence of elevated native T1 (≥1,069 ms) or ECV (≥31.4%) values. CONCLUSION Cardiac involvement is frequent in SSc. Both native T1 mapping and ECV represent novel non-invasive markers of myocardial fibrosis and could be used in the risk stratification of patients with SSc. CMR mapping may provide a novel biomarker for disease monitoring and study of therapies aiming to reduce myocardial fibrosis in SSc.
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Affiliation(s)
- V Bordonaro
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - D Bivort
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - T Dresselaers
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - E De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - J Bogaert
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - R Symons
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium.
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