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Ghekiere O, Herbots L, Peters B, Berg BV, Dresselaers T, Franssen W, Padovani B, Ducreux D, Ferrari E, Nchimi A, Demanez S, De Bosscher R, Willems R, Heidbuchel H, La Gerche A, Claessen G, Bogaert J, Eijnde BO. Exercise-induced myocardial T1 increase and right ventricular dysfunction in recreational cyclists: a CMR study. Eur J Appl Physiol 2023; 123:2107-2117. [PMID: 37480391 PMCID: PMC10492712 DOI: 10.1007/s00421-023-05259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac magnetic resonance (CMR) native T1/T2 mapping is sensitive to the pathological increase of myocardial water content. Therefore, we evaluated exercise-induced acute myocardial changes in recreational cyclists by incorporating biomarkers, echocardiography and CMR. METHODS Nineteen male recreational participants (age: 48 ± 5 years) cycled the 'L'étape du tour de France" (EDT) 2021' (175 km, 3600 altimeters). One week before the race, a maximal graded cycling test was conducted to determine individual heart rate (HR) training zones. One day before and 3-6 h post-exercise 3 T CMR and echocardiography were performed to assess myocardial native T1/T2 relaxation times and cardiac function, and blood samples were collected. All participants were asked to cycle 2 h around their anaerobic gas exchange threshold (HR zone 4). RESULTS Eighteen participants completed the EDT stage in 537 ± 58 min, including 154 ± 61 min of cycling time in HR zone 4. Post-race right ventricular (RV) dysfunction with reduced strain and increased volumes (p < 0.05) and borderline significant left ventricular global longitudinal strain reduction (p = 0.05) were observed. Post-exercise cTnI (0.75 ± 5.1 ng/l to 69.9 ± 41.6 ng/l; p < 0.001) and T1 relaxation times (1133 ± 48 ms to 1182 ± 46 ms, p < 0.001) increased significantly with no significant change in T2 (p = 0.474). cTnI release correlated with increase in T1 relaxation time (p = 0.002; r = 0.703), post-race RV dysfunction (p < 0.05; r = 0.562) and longer cycling in HR zone 4 (p < 0.05; r = 0.607). CONCLUSION Strenuous exercise causes early post-race cTnI increase, increased T1 relaxation time and RV dysfunction in recreational cyclists, which showed interdependent correlation. The long-term clinical significance of these changes needs further investigation. TRIAL REGISTRATION NUMBERS AND DATE NCT04940650 06/18/2021. NCT05138003 06/18/2021.
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Affiliation(s)
- Olivier Ghekiere
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Benjamin Peters
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Department of Radiology and Department of Jessa & Science, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | | | - Tom Dresselaers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Franssen
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Nutrition and Movement Sciences; NUTRIM, School for Nutrition and Translation Research Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | - Emile Ferrari
- Department of Cardiology, University Hospital Nice, Nice, France
| | - Alain Nchimi
- Department of Radiology, Centre Hospitalier Universitaire Luxembourg, Luxembourg, Luxembourg
| | - Sophie Demanez
- Department of Cardiology, Centre Cardiologique Orban, Liège, Belgium
| | - Ruben De Bosscher
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Andre La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Guido Claessen
- Faculty of Medicine and Life Sciences/LCRC (-MHU), Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
- Heart Centre, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Bert O Eijnde
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Lisi C, Catapano F, Rondi P, Figliozzi S, Lo Monaco M, Brilli F, Monti L, Francone M. Multimodality imaging in cardio-oncology: the added value of CMR and CCTA. Br J Radiol 2023; 96:20220999. [PMID: 37493228 PMCID: PMC10546447 DOI: 10.1259/bjr.20220999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
During the last 30 years, we have assisted to a great implementation in anticancer treatment with a subsequent increase of cancer survivors and decreased mortality. This has led to an ongoing interest about the possible therapy-related side-effects and their management to better guide patients therapy and surveillance in the chronic and long-term setting. As a consequence cardio-oncology was born, involving several different specialties, among which radiology plays a relevant role. Till the end of August 2022, when European Society of Cardiology (ESC) developed the first guidelines on cardio-oncology, no general indications existed to guide diagnosis and treatment of cancer therapy-related cardiovascular toxicity (CTR-CVT). They defined multimodality imaging role in primary and secondary prevention strategies, cancer treatment surveillance and early CTR-CVT identification and management. Cardiac computed tomography angiography (CCTA) has acquired a central role in coronary assessment, as far as coronary artery disease (CAD) exclusion is concerned; but on the side of this well-known application, it also started to be considered in left ventricular function evaluation, interstitial fibrosis quantification and cardiac perfusion studies. Cardiac magnetic resonance (CMR), instead, has been acknowledged as the gold standard alternative to trans-thoracic echocardiography (TTE) poor acoustic window in quantification of heart function and strain modifications, as well as pre- and post-contrast tissue characterization by means of T1-T2 mapping, early Gadolinium enhancement (EGE), late Gadolinium enhancement (LGE) and extracellular volume (ECV) evaluation. Our review is intended to provide a focus on the actual role of CMR and CCTA in the setting of a better understanding of cardiotoxicity and to draw some possible future directions of cardiac imaging in this field, starting from the recently published ESC guidelines.
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Affiliation(s)
- Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
| | | | - Paolo Rondi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Maria Lo Monaco
- Cardiology Clinical Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Federica Brilli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
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153
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Gatterer C, Wollenweber T, Pichler V, Vraka C, Sunder-Plassmann G, Lenz M, Hengstenberg C, Hacker M, Loewe C, Graf S, Beitzke D. Detection of sympathetic denervation defects in Fabry disease by hybrid [ 11C]meta-hydroxyephedrine positron emission tomography and cardiac magnetic resonance. J Nucl Cardiol 2023; 30:1810-1821. [PMID: 36855009 PMCID: PMC10558396 DOI: 10.1007/s12350-023-03205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Myocardial glycosphingolipid accumulation in patients with Fabry disease (FD) causes biochemical and structural changes. This study aimed to investigate sympathetic innervation in FD using hybrid cardiac positron emission tomography (PET)/magnetic resonance imaging (MRI). METHODS AND RESULTS Patients with different stages of Fabry disease were prospectively enrolled to undergo routine CMR at 1.5T, followed by 3T hybrid cardiac PET/MRI with [11C]meta-hydroxyephedrine ([11C]mHED). Fourteen patients with either no evidence of cardiac involvement (n = 5), evidence of left ventricular hypertrophy (LVH) (n = 3), or evidence of LVH and fibrosis via late gadolinium enhancement (LGE) (n = 6) were analyzed. Compared to patients without LVH, patients with LVH or LVH and LGE had lower median T1 relaxation times (ms) at 1.5 T (1007 vs. 889 vs. 941 ms, p = 0.003) and 3T (1290 vs. 1172 vs. 1184 p = .014). Myocardial denervation ([11C]mHED retention < 7%·min) was prevalent only in patients with fibrosis, where a total of 16 denervated segments was found in two patients. The respective area of denervation exceeded the area of LGE in both patients (24% vs. 36% and 4% vs. 32%). However, sympathetic innervation defects ([11C]mHED retention ≤ 9%·min) occurred in all study groups. Furthermore, a reduced sympathetic innervation correlated with an increased left ventricular mass (p = .034, rs = - 0.57) and a reduced global longitudinal strain (GLS) (p = 0.023, rs = - 0.6). CONCLUSION Hybrid cardiac PET/MR with [11C]mHED revealed sympathetic innervation defects, accompanied by impaired GLS, in early stages of Fabry disease. However, denervation is only present in patients with advanced stages of FD showing fibrosis on CMR.
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Affiliation(s)
- Constantin Gatterer
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Tim Wollenweber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Verena Pichler
- Division of Pharmaceutical Chemistry, Department of Pharmaceutical Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Max Lenz
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Senta Graf
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Gerganov G, Georgiev T, Dimova M, Shivacheva T. Vascular effects of biologic and targeted synthetic antirheumatic drugs approved for rheumatoid arthritis: a systematic review. Clin Rheumatol 2023; 42:2651-2676. [PMID: 36991244 DOI: 10.1007/s10067-023-06587-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD), with inflammation playing a key role. Biologic and targeted synthetic drugs used to treat RA can induce systemic immunomodulation and may have pleiotropic effects on vascular function, making it crucial to investigate their impact on CVD risk in RA patients. METHODS A systematic review of the literature was conducted to investigate the impact of biologic and targeted synthetic treatments approved for RA on various cardiovascular markers, including endothelial function, arterial stiffness, and subclinical atherosclerosis. Our analysis included a search of the MedLine (via PubMed) and Web of Science databases using a pre-determined search strategy. We conducted a narrative synthesis of the included studies due to heterogeneity in study design and outcome measures. RESULTS From an initial pool of 647 records, we excluded 327 studies based on their titles and abstracts, and we selected 182 studies for final examination. Ultimately, 58 articles met our inclusion criteria and were included in our systematic review. Our analysis of these studies revealed a positive effect of biologic and targeted synthetic therapies on vascular dysfunction associated with RA. However, the impact of these treatments on subclinical atherosclerosis was inconsistent. CONCLUSION Overall, our systematic review provides important insights into the potential cardiovascular benefits of biologic and targeted synthetic treatments for RA by a still unknown mechanism. These findings can inform clinical practice and contribute to our understanding of their possible effects on early vascular pathology. Key Points • Great heterogeneity of methods are used to evaluate the endothelial function and arterial stiffness in patients with RA on biologic and targeted synthetic antirheumatic drugs. • Most studies have shown a considerable improvement in endothelial function and arterial stiffness with TNFi, despite some studies reporting only transient or no improvement. • Anakinra and tocilizumab may have a beneficial effect on vascular function and endothelial injury, as indicated by increased FMD, coronary flow reserve, and reduced levels of biomarkers of endothelial function, while the overall impact of JAKi and rituximab remains inconclusive based on the reviewed studies. • To fully comprehend the distinctions between biologic therapies, more long-term, well-designed clinical trials are necessary using a homogeneous methodology.
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Affiliation(s)
- Georgi Gerganov
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria.
- First Department of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria.
| | - Maria Dimova
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
- Clinic of Internal Medicine, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
| | - Tanya Shivacheva
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
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Williams JL, Hung F, Jenista E, Barker P, Chakraborty H, Kim R, McCrary AW, Shah SH, Thielman N, Bloomfield GS. Diffuse Myocardial Fibrosis is Uncommon in People with Perinatally Acquired Human Immunodeficiency Virus Infection. RESEARCH SQUARE 2023:rs.3.rs-3370759. [PMID: 37841862 PMCID: PMC10571634 DOI: 10.21203/rs.3.rs-3370759/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background Cardiovascular disease (CVD) remains a leading cause of death in people living with HIV. Myocardial fibrosis is well-described in HIV infection acquired in adulthood. We evaluate the burden of fibrosis by cardiac magnetic resonance in people with perinatal HIV infection. Methods Individuals with perinatally acquired HIV (pnHIV) diagnosed before 10 years-old and on antiretroviral treatment for ≥ 6 months were matched with uninfected controls. Patients with significant cardiometabolic co-morbidities and pregnancy were excluded. Diffuse fibrosis was assessed by cardiac magnetic resonance (CMR). with native T1 mapping for calculation of extracellular volume fraction (ECV). Viability was assessed with late gadolinium enhancement. The normality of fibrosis was assessed using the Komogrov-Smirnov test. Fibrosis between the groups was analyzed using a Mann-Whitney U test, as the data was not normally distributed. Statistical significance was defined as a p-valve < 0.05. Results Fourteen adults with pnHIV group and 26 controls (71% female and 86% Black race) were assessed. The average (± standard deviation) age in the study group was 29 (± 4.3) years-old. All pnHIV had been on ART for decades. Demographic data, CMR functional/volumetric data, and pre-contrast T1 mapping values were similar between groups. Diastolic function was normal in 50% of pnHIV patients and indeterminate in most of the remainder (42%). There was no statistically significant difference in ECV between groups; p = 0.24. Conclusion Perinatally-acquired HIV was not associated with diffuse myocardial fibrosis. Early exposure to ART may be cardioprotective against development of myocardial fibrosis in patients with perinatal HIV.
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Affiliation(s)
| | | | | | | | | | | | | | - Svati H Shah
- Duke Clinic Research Institute and Duke University School of Medicine
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Pan J, Ng SM, Neubauer S, Rider OJ. Phenotyping heart failure by cardiac magnetic resonance imaging of cardiac macro- and microscopic structure: state of the art review. Eur Heart J Cardiovasc Imaging 2023; 24:1302-1317. [PMID: 37267310 PMCID: PMC10531211 DOI: 10.1093/ehjci/jead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023] Open
Abstract
Heart failure demographics have evolved in past decades with the development of improved diagnostics, therapies, and prevention. Cardiac magnetic resonance (CMR) has developed in a similar timeframe to become the gold-standard non-invasive imaging modality for characterizing diseases causing heart failure. CMR techniques to assess cardiac morphology and function have progressed since their first use in the 1980s. Increasingly efficient acquisition protocols generate high spatial and temporal resolution images in less time. This has enabled new methods of characterizing cardiac systolic and diastolic function such as strain analysis, exercise real-time cine imaging and four-dimensional flow. A key strength of CMR is its ability to non-invasively interrogate the myocardial tissue composition. Gadolinium contrast agents revolutionized non-invasive cardiac imaging with the late gadolinium enhancement technique. Further advances enabled quantitative parametric mapping to increase sensitivity at detecting diffuse pathology. Novel methods such as diffusion tensor imaging and artificial intelligence-enhanced image generation are on the horizon. Magnetic resonance spectroscopy (MRS) provides a window into the molecular environment of the myocardium. Phosphorus (31P) spectroscopy can inform the status of cardiac energetics in health and disease. Proton (1H) spectroscopy complements this by measuring creatine and intramyocardial lipids. Hyperpolarized carbon (13C) spectroscopy is a novel method that could further our understanding of dynamic cardiac metabolism. CMR of other organs such as the lungs may add further depth into phenotypes of heart failure. The vast capabilities of CMR should be deployed and interpreted in context of current heart failure challenges.
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Affiliation(s)
- Jiliu Pan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Sher May Ng
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Oliver J Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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Magodoro IM, Guerrero-Chalela CE, Claggett B, Jermy S, Samuels P, Zar H, Myer L, Danaei G, Jao J, Ntusi NAB, Siedner MJ, Ntsekhe M. Left ventricular remodeling and its correlates among adolescents with perinatally acquired HIV in South Africa. Int J Cardiol 2023; 387:131121. [PMID: 37336247 PMCID: PMC10529415 DOI: 10.1016/j.ijcard.2023.131121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Left ventricular (LV) remodeling and its transitions from compensatory adaptations to LV dysfunction have not been examined in adolescents with perinatally acquired HIV infection (PHIV). We used cardiovascular magnetic resonance (CMR) in a cross-sectional study to characterize PHIV-related progressive LV remodeling in adolescents in South Africa. METHODS Adolescents with PHIV on antiretroviral treatment and their HIV uninfected peers completed 3 T CMR examination. We defined LV remodeling by LV mass/volume (M/V) ratio, modelling progressive LV remodeling as increasing M/V ratio. Linear regression models were applied to estimate the correlates of progressive LV remodeling. RESULTS Overall, 71 adolescents with PHIV [mean age: 15.2 years; 54% male] and 36 HIV uninfected [15.1 years; 42% male] peers were enrolled. Adolescents with PHIV had lower mean LV M/V ratio (0.68 vs. 0.75 g/mL; p = 0.004) than HIV uninfected peers, without LV hypertrophy in either group. Among adolescents with PHIV, increasing M/V ratio was accompanied by increasing interstitial volume [adjusted mean change (AMC) per 0.1 g/mL M/V ratio: 1.75 mL, p < 0.001] with no change in global circumferential strain (GCS) [AMC per 0.1 g/mL M/V ratio: -0.21%, p = 0.48]. However, in HIV uninfected individuals, increasing M/V ratio was accompanied by increasing peak GCS [AMC per 0.1 g/mL M/V ratio: -1.25%, p = 0.039] with no change in interstitial volume (AMC per 0.1 g/mL M/V ratio: 1.16 mL, p = 0.32]. CONCLUSIONS Successfully treated PHIV is associated with less severe LV remodeling in adolescence when compared to HIV uninfected controls. LV remodeling in PHIV is associated with disproportionate expansion of the non-contractile interstitium not accompanied by improved GCS.
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Affiliation(s)
- Itai M Magodoro
- Division of Cardiology, University of Cape Town, Cape Town, South Africa; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Brian Claggett
- Cardiology Division, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Heather Zar
- Department of Pediatrics and Child Health, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jennifer Jao
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Internal Medicine, Division of Adult Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ntobeko A B Ntusi
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa; Cape Heart Institute, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Noncommunicable and Infectious Diseases, Cape Town, South Africa
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Cape Town, South Africa
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158
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Talle MA, Doubell AF, Robbertse PPS, Lahri S, Herbst PG. Myocardial Tissue Characterization in Patients with Hypertensive Crisis, Positive Troponin, and Unobstructed Coronary Arteries: A Cardiovascular Magnetic Resonance-Based Study. Diagnostics (Basel) 2023; 13:2943. [PMID: 37761309 PMCID: PMC10527803 DOI: 10.3390/diagnostics13182943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Hypertensive crisis can present with cardiac troponin elevation and unobstructed coronary arteries. We used cardiac magnetic resonance (CMR) imaging to characterize the myocardial tissue in patients with hypertensive crisis, elevated cardiac troponin, and unobstructed coronary arteries. Patients with hypertensive crisis and elevated cardiac troponin with coronary artery stenosis <50% were enrolled. Patients with troponin-negative hypertensive crisis served as controls. All participants underwent CMR imaging at 1.5 Tesla. Imaging biomarkers and tissue characteristics were compared between the groups. There were 19 patients (63% male) with elevated troponin and 24 (33% male) troponin-negative controls. The troponin-positive group was older (57 ± 11 years vs. 47 ± 14 years, p = 0.015). The groups had similar T2-weighted signal intensity ratios and native T1 times. T2 relaxation times were longer in the troponin-positive group, and the difference remained significant after excluding infarct-pattern late gadolinium enhancement (LGE) from the analysis. Extracellular volume (ECV) was higher in the troponin-positive group (25 ± 4 ms vs. 22 ± 3 ms, p = 0.008) and correlated strongly with T2 relaxation time (rs = 0.701, p = 0.022). Late gadolinium enhancement was 32% more prevalent in the troponin-positive group (82% vs. 50%, p = 0.050), with 29% having infarct-pattern LGE. T2 relaxation time was independently associated with troponin positivity (OR 2.1, p = 0.043), and both T2 relaxation time and ECV predicted troponin positivity (C-statistics: 0.71, p = 0.009; and 0.77, p = 0.006). Left ventricular end-diastolic and left atrial volumes were the strongest predictors of troponin positivity (C-statistics: 0.80, p = 0.001; and 0.82, p < 0.001). The increased T2 relaxation time and ECV and their significant correlation in the troponin-positive group suggest myocardial injury with oedema, while the non-ischaemic LGE could be due to myocardial fibrosis or acute necrosis. These CMR imaging biomarkers provide important clinical indices for risk stratification and prognostication in patients with hypertensive crisis.
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Affiliation(s)
- Mohammed A. Talle
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri and University of Maiduguri Teaching Hospital, Maiduguri 600004, Nigeria
| | - Anton F. Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Pieter-Paul S. Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Sa’ad Lahri
- Division of Emergency Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Philip G. Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
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Sheagren CD, Cao T, Patel JH, Chen Z, Lee HL, Wang N, Christodoulou AG, Wright GA. Motion-compensated T 1 mapping in cardiovascular magnetic resonance imaging: a technical review. Front Cardiovasc Med 2023; 10:1160183. [PMID: 37790594 PMCID: PMC10542904 DOI: 10.3389/fcvm.2023.1160183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023] Open
Abstract
T 1 mapping is becoming a staple magnetic resonance imaging method for diagnosing myocardial diseases such as ischemic cardiomyopathy, hypertrophic cardiomyopathy, myocarditis, and more. Clinically, most T 1 mapping sequences acquire a single slice at a single cardiac phase across a 10 to 15-heartbeat breath-hold, with one to three slices acquired in total. This leaves opportunities for improving patient comfort and information density by acquiring data across multiple cardiac phases in free-running acquisitions and across multiple respiratory phases in free-breathing acquisitions. Scanning in the presence of cardiac and respiratory motion requires more complex motion characterization and compensation. Most clinical mapping sequences use 2D single-slice acquisitions; however newer techniques allow for motion-compensated reconstructions in three dimensions and beyond. To further address confounding factors and improve measurement accuracy, T 1 maps can be acquired jointly with other quantitative parameters such as T 2 , T 2 ∗ , fat fraction, and more. These multiparametric acquisitions allow for constrained reconstruction approaches that isolate contributions to T 1 from other motion and relaxation mechanisms. In this review, we examine the state of the literature in motion-corrected and motion-resolved T 1 mapping, with potential future directions for further technical development and clinical translation.
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Affiliation(s)
- Calder D. Sheagren
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tianle Cao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, CA, United States
| | - Jaykumar H. Patel
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Zihao Chen
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, CA, United States
| | - Hsu-Lei Lee
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Nan Wang
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, CA, United States
| | - Graham A. Wright
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Joy G, Kelly CI, Webber M, Pierce I, Teh I, McGrath L, Velazquez P, Hughes RK, Kotwal H, Das A, Chan F, Bakalakos A, Lorenzini M, Savvatis K, Mohiddin SA, Macfarlane PW, Orini M, Manisty C, Kellman P, Davies RH, Lambiase PD, Nguyen C, Schneider JE, Tome M, Captur G, Dall’Armellina E, Moon JC, Lopes LR. Microstructural and Microvascular Phenotype of Sarcomere Mutation Carriers and Overt Hypertrophic Cardiomyopathy. Circulation 2023; 148:808-818. [PMID: 37463608 PMCID: PMC10473031 DOI: 10.1161/circulationaha.123.063835] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND In hypertrophic cardiomyopathy (HCM), myocyte disarray and microvascular disease (MVD) have been implicated in adverse events, and recent evidence suggests that these may occur early. As novel therapy provides promise for disease modification, detection of phenotype development is an emerging priority. To evaluate their utility as early and disease-specific biomarkers, we measured myocardial microstructure and MVD in 3 HCM groups-overt, either genotype-positive (G+LVH+) or genotype-negative (G-LVH+), and subclinical (G+LVH-) HCM-exploring relationships with electrical changes and genetic substrate. METHODS This was a multicenter collaboration to study 206 subjects: 101 patients with overt HCM (51 G+LVH+ and 50 G-LVH+), 77 patients with G+LVH-, and 28 matched healthy volunteers. All underwent 12-lead ECG, quantitative perfusion cardiac magnetic resonance imaging (measuring myocardial blood flow, myocardial perfusion reserve, and perfusion defects), and cardiac diffusion tensor imaging measuring fractional anisotropy (lower values expected with more disarray), mean diffusivity (reflecting myocyte packing/interstitial expansion), and second eigenvector angle (measuring sheetlet orientation). RESULTS Compared with healthy volunteers, patients with overt HCM had evidence of altered microstructure (lower fractional anisotropy, higher mean diffusivity, and higher second eigenvector angle; all P<0.001) and MVD (lower stress myocardial blood flow and myocardial perfusion reserve; both P<0.001). Patients with G-LVH+ were similar to those with G+LVH+ but had elevated second eigenvector angle (P<0.001 after adjustment for left ventricular hypertrophy and fibrosis). In overt disease, perfusion defects were found in all G+ but not all G- patients (100% [51/51] versus 82% [41/50]; P=0.001). Patients with G+LVH- compared with healthy volunteers similarly had altered microstructure, although to a lesser extent (all diffusion tensor imaging parameters; P<0.001), and MVD (reduced stress myocardial blood flow [P=0.015] with perfusion defects in 28% versus 0 healthy volunteers [P=0.002]). Disarray and MVD were independently associated with pathological electrocardiographic abnormalities in both overt and subclinical disease after adjustment for fibrosis and left ventricular hypertrophy (overt: fractional anisotropy: odds ratio for an abnormal ECG, 3.3, P=0.01; stress myocardial blood flow: odds ratio, 2.8, P=0.015; subclinical: fractional anisotropy odds ratio, 4.0, P=0.001; myocardial perfusion reserve odds ratio, 2.2, P=0.049). CONCLUSIONS Microstructural alteration and MVD occur in overt HCM and are different in G+ and G- patients. Both also occur in the absence of hypertrophy in sarcomeric mutation carriers, in whom changes are associated with electrocardiographic abnormalities. Measurable changes in myocardial microstructure and microvascular function are early-phenotype biomarkers in the emerging era of disease-modifying therapy.
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Affiliation(s)
- George Joy
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Christopher I. Kelly
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (C.I.L., I.T., A.D., J.E.S., E.D.)
| | - Matthew Webber
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- Medical Research Council Unit for Lifelong Health and Ageing (M.W., I.P., F.C., R.H.D., G.C.), University College London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, UK (M.W., F.C., G.C.)
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- Medical Research Council Unit for Lifelong Health and Ageing (M.W., I.P., F.C., R.H.D., G.C.), University College London, UK
| | - Irvin Teh
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (C.I.L., I.T., A.D., J.E.S., E.D.)
| | - Louise McGrath
- Imaging Department, Royal Brompton & Harefield Hospitals, London, UK (L.M.)
| | - Paula Velazquez
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Cardiology Clinical and Academic Group, St. Georges University of London and St. Georges University Hospitals NHS Foundation Trust, UK (P.V., M.T.)
| | - Rebecca K. Hughes
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Huafrin Kotwal
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
| | - Arka Das
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (C.I.L., I.T., A.D., J.E.S., E.D.)
| | - Fiona Chan
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- Medical Research Council Unit for Lifelong Health and Ageing (M.W., I.P., F.C., R.H.D., G.C.), University College London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, UK (M.W., F.C., G.C.)
| | - Athanasios Bakalakos
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Massimiliano Lorenzini
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Konstantinos Savvatis
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- William Harvey Research Institute, Queen Mary University London, UK (K.S., S.A.M.)
| | - Saidi A. Mohiddin
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- William Harvey Research Institute, Queen Mary University London, UK (K.S., S.A.M.)
| | - Peter W. Macfarlane
- Electrocardiology Section, School of Health and Wellbeing, University of Glasgow, UK (P.W.M.)
| | - Michele Orini
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Charlotte Manisty
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD (P.K.)
| | - Rhodri H. Davies
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- Medical Research Council Unit for Lifelong Health and Ageing (M.W., I.P., F.C., R.H.D., G.C.), University College London, UK
| | - Pier D. Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Christopher Nguyen
- Cardiovascular Innovation Research Centre, HVTI, Cleveland Clinic, OH (C.N.)
| | - Jurgen E. Schneider
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (C.I.L., I.T., A.D., J.E.S., E.D.)
| | - Maite Tome
- Cardiology Clinical and Academic Group, St. Georges University of London and St. Georges University Hospitals NHS Foundation Trust, UK (P.V., M.T.)
| | - Gabriella Captur
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
- Medical Research Council Unit for Lifelong Health and Ageing (M.W., I.P., F.C., R.H.D., G.C.), University College London, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, UK (M.W., F.C., G.C.)
| | - Erica Dall’Armellina
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK (C.I.L., I.T., A.D., J.E.S., E.D.)
| | - James C. Moon
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
| | - Luis R. Lopes
- Barts Heart Centre, Barts Health NHS Trust, London, UK (G.J., I.P., P.V., R.K.H., H.K., A.B., M.L., K.S., S.A.M., M.O., C.M., R.H.D., P.D.L., J.C.M., L.R.L.)
- Institute of Cardiovascular Science (G.J.. M.W., I.P., R.K.H., F.C., A.B., M.L., K.S., M.O., C.M., R.H.D., P.D.L., G.C., J.C.M., L.R.L.), University College London, UK
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Kato M, Ninagawa K, Atsumi T. Comment on: Beneficial effects of nintedanib on cardiomyopathy in patients with systemic sclerosis: a pilot study: reply. Rheumatology (Oxford) 2023; 62:e278-e279. [PMID: 36707999 DOI: 10.1093/rheumatology/kead037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Affiliation(s)
- Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keita Ninagawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Thalén S, Ramos JG, Engblom H, Sigfridsson A, Sörensson P, Ugander M. Normal values for native T 1 at 1.5 T in the pericardial fluid of healthy volunteers. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad028. [PMID: 39045066 PMCID: PMC11195767 DOI: 10.1093/ehjimp/qyad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 07/25/2024]
Abstract
Aims T1 mapping cardiovascular magnetic resonance (CMR) imaging has been used to characterize pericardial effusions. The aim of this study was to measure pericardial fluid native T1 values in healthy volunteers to establish normal values. Methods and results Prospectively recruited volunteers (n = 30) underwent CMR at 1.5 T, and native T1 maps were acquired using a modified look-locker inversion recovery 5s(3s)3s acquisition scheme. A volume of pericardial fluid was imaged in a short-axis slice and in a slice perpendicular to the short-axis orientation. A reliable measurement had a region of interest (ROI) size > 10 mm2, coefficient of variation < 10%, and a relative difference < 5% between the two slice orientations. In 26/30 (87%) of volunteers, there was a sufficient amount of pericardial fluid to enable reliable measurement. Native T1 of pericardial fluid was 3262 ± 163 (95% normal limits 2943-3581 ms) and did not differ in the perpendicular slice orientation (3267 ± 173 ms, P = 0.75), due to sex (female 3311 ± 177 vs. male 3220 ± 142 ms, P = 0.17), age (R 2 = 0.03, P = 0.44), heart rate (R 2 = 0.005, P = 0.7), or size of the ROI (0.06, P = 0.23). Conclusion This study shows that T1 values can be reliably measured in the pericardial fluid of healthy volunteers. It is the first to report normal reference ranges for T1 values at 1.5 T in the pericardial fluid of healthy volunteers.
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Affiliation(s)
- Simon Thalén
- Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Joao G Ramos
- Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Peder Sörensson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
- Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, University of Sydney, St Leonards, Sydney, NSW 2065, Australia
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Yu T, Cai Z, Yang Z, Lin W, Su Y, Li J, Xie S, Shen J. The Value of Myocardial Fibrosis Parameters Derived from Cardiac Magnetic Resonance Imaging in Risk Stratification for Patients with Hypertrophic Cardiomyopathy. Acad Radiol 2023; 30:1962-1978. [PMID: 36604228 DOI: 10.1016/j.acra.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of the study was to determine whether myocardial fibrosis parameters of cardiac magnetic resonance imaging (MRI) has added value in the risk stratification of hypertrophic cardiomyopathy (HCM) patients. MATERIALS AND METHODS In this retrospective study, 108 patients with HCM (mean age ± standard deviation, 55.5 ± 13.4 years) were included from January 2019 to April 2022, and were followed up for 2 years to record sudden cardiac death (SCD) adverse events. All HCM patients underwent cardiac MRI and were divided into a training cohort (n = 81; mean age, 56.1 ± 13.0 years) and a validation cohort (n = 27; mean age, 57.8 ± 13.9 years). According to the presence of SCD risk factors defined by the 2020 AHA/ACC guidelines, HCM patients were classified into low-risk and high-risk groups. Cardiac MRI features, including late gadolinium enhancement (LGE), T1 mapping, and extracellular volume fraction (ECV), were assessed and compared between the two groups. Logistic regression analysis was used to select the optimal predictors of SCD from cardiac MRI features and HCM Risk-SCD score to construct prediction models. Receiver operating curve (ROC) analysis was used to assess the predictive performance of the constructed prediction model. Cox regression analysis was also used to determine the optimal predictors of SCD adverse events. RESULTS Multivariate logistic analysis showed that the global ECV was the single myocardial fibrosis parameter predictive of the risk of SCD (p < 0.001). The areas under the ROC curves (AUC) of global ECV were higher than those of LGE, global native T1, global postcontrast T1, and HCM Risk-SCD (AUC = 0.85 vs. 0.74, 0.77, 0.63, 0.78). An integrative risk stratification model combining global ECV (odds ratio, 1.36 [95% CI: 1.16-1.60]; p < 0.001) and HCM Risk-SCD score (odds ratio, 1.63 [95% CI: 1.08-2.47]; p < 0.001) achieved an AUC of 0.89 (95% CI: 0.81-0.96) in the training cohort, which was significantly higher than that of HCM Risk-SCD score alone (p = 0.03). The AUC of the integrative model was 0.93 (95% CI: 0.84-1.00) in the validation cohort. Multivariate Cox regression analysis also showed that the global ECV was an independent predictor of SCD adverse events (hazard ratio, 1.27 [95% CI: 1.10-1.47]). CONCLUSION The ECV derived from cardiac MRI is comparable to the HCM Risk-SCD scale in predicting the SCD risk stratification in patients with HCM.
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Affiliation(s)
- Taihui Yu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhaoxi Cai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenhao Lin
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yun Su
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jixin Li
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shuanglun Xie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jun Shen
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Camporeale A, Bandera F, Pieroni M, Pieruzzi F, Spada M, Bersano A, Econimo L, Lanzillo C, Rubino M, Mignani R, Motta I, Olivotto I, Tanini I, Valaperta R, Chow K, Baroni I, Boveri S, Graziani F, Pica S, Tondi L, Guazzi M, Lombardi M. Effect of Migalastat on cArdiac InvOlvement in FabRry DiseAse: MAIORA study. J Med Genet 2023; 60:850-858. [PMID: 36669872 DOI: 10.1136/jmg-2022-108768] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND A small but significant reduction in left ventricular (LV) mass after 18 months of migalastat treatment has been reported in Fabry disease (FD). This study aimed to assess the effect of migalastat on FD cardiac involvement, combining LV morphology and tissue characterisation by cardiac magnetic resonance (CMR) with cardiopulmonary exercise testing (CPET). METHODS Sixteen treatment-naïve patients with FD (4 women, 46.4±16.2 years) with cardiac involvement (reduced T1 values on CMR and/or LV hypertrophy) underwent ECG, echocardiogram, troponin T and NT-proBNP (N-Terminal prohormone of Brain Natriuretic Peptide) assay, CMR with T1 mapping, and CPET before and after 18 months of migalastat. RESULTS No change in LV mass was detected at 18 months compared to baseline (95.2 g/m2 (66.0-184.0) vs 99.0 g/m2 (69.0-121.0), p=0.55). Overall, there was an increase in septal T1 of borderline significance (870.0 ms (848-882) vs 860.0 ms (833.0-875.0), p=0.056). Functional capacity showed an increase in oxygen consumption (VO2) at anaerobic threshold (15.50 mL/kg/min (13.70-21.50) vs 14.50 mL/kg/min (11.70-18.95), p=0.02), and a trend towards an increase in percent predicted peak VO2 (72.0 (63.0-80.0) vs 69.0 (53.0-77.0), p=0.056) was observed. The subset of patients who showed an increase in T1 value and a reduction in LV mass (n=7, 1 female, age 40.5 (28.6-76.0)) was younger and at an earlier disease stage compared to the others, and also exhibited greater improvement in exercise tolerance. CONCLUSION In treatment-naïve FD patients with cardiac involvement, 18-month treatment with migalastat stabilised LV mass and was associated with a trend towards an improvement in exercise tolerance. A tendency to T1 increase was detected by CMR. The subset of patients who had significant benefits from the treatment showed an earlier cardiac disease compared to the others. TRIAL REGISTRATION NUMBER NCT03838237.
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Affiliation(s)
- Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
- University Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Federico Pieruzzi
- Nephrology and Dialysis Unit, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Marco Spada
- Department of Pediatrics, University of Turin, Torino, Italy
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Laura Econimo
- Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Marta Rubino
- Inherited and Rare Cardiovascular Disease, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Renzo Mignani
- Nephrology and Dialysis Department, Infermi Hospital, Rimini, Italy
| | - Irene Motta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, University Hospital Careggi, Firenze, Italy
| | - Ilaria Tanini
- Cardiomyopathy Unit, University Hospital Careggi, Firenze, Italy
| | - Rea Valaperta
- Operative Unit of Laboratory Medicine 1 - Clinical Pathology, Department of Pathology and Laboratory Medicine, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Kelvin Chow
- Siemens Medical Solutions USA, Malvern, Pennsylvania, USA
| | - Irene Baroni
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
- Cardiology Division, San Paolo Hospital, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Yazaki M, Nabeta T, Takigami Y, Eda Y, Maemura K, Oki T, Fujita T, Iida Y, Ikeda Y, Ishii S, Inoue Y, Ako J. Native T1 high region and left ventricular ejection fraction recovery in patients with dilated cardiomyopathy. Int J Cardiovasc Imaging 2023; 39:1785-1793. [PMID: 37291379 PMCID: PMC10520178 DOI: 10.1007/s10554-023-02888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of < 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of > 5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of ≥ 45% and an LVEF increase of ≥ 10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P = 0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P = 0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM.
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Affiliation(s)
- Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan.
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yu Takigami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuko Eda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Kenji Maemura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Takumi Oki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0329, Japan
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Chen W, Faragli A, Goetze C, Zieschang V, Weiss KJ, Hashemi D, Beyer R, Hafermann L, Stawowy P, Kelle S, Doeblin P. Quantification of myocardial extracellular volume without blood sampling. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad022. [PMID: 39045067 PMCID: PMC11195702 DOI: 10.1093/ehjimp/qyad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 07/25/2024]
Abstract
Aims Cardiac magnetic resonance (CMR) T1 relaxation time mapping is an established technique primarily used to identify diffuse interstitial fibrosis and oedema. The myocardial extracellular volume (ECV) can be calculated from pre- and post-contrast T1 relaxation times and is a reproducible parametric index of the proportion of volume occupied by non-cardiomyocyte components in myocardial tissue. The conventional calculation of the ECV requires blood sampling to measure the haematocrit (HCT). Given the high variability of the HCT, the blood collection is recommended within 24 h of the CMR scan, limiting its applicability and posing a barrier to the clinical routine use of ECV measurements. In recent years, several research groups have proposed a method to determine the ECV by CMR without blood sampling. This is based on the inverse relationship between the T1 relaxation rate (R1) of blood and the HCT. Consequently, a 'synthetic' HCT could be estimated from the native blood R1, avoiding blood sampling. Methods and results We performed a review and meta-analysis of published studies on synthetic ECV, as well as a secondary analysis of previously published data to examine the effect of the chosen regression modell on bias. While, overall, a good correlation and little bias between synthetic and conventional ECV were found in these studies, questions regarding its accuracy remain. Conclusion Synthetic HCT and ECV can provide a 'non-invasive' quantitative measurement of the myocardium's extracellular space when timely HCT measurements are not available and large alterations in ECV are expected, such as in cardiac amyloidosis. Due to the dependency of T1 relaxation times on the local setup, calculation of local formulas using linear regression is recommended, which can be easily performed using available data.
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Affiliation(s)
- Wensu Chen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Alessandro Faragli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Collin Goetze
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Victoria Zieschang
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Karl Jakob Weiss
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Rebecca Beyer
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Philipp Stawowy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
| | - Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, Berlin 13353, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Potsdamer Str. 58, Berlin 10785, Germany
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Jahnke C, Sinn M, Hot A, Cavus E, Erley J, Schneider J, Chevalier C, Bohnen S, Radunski U, Meyer M, Lund G, Adam G, Kirchhof P, Blankenberg S, Muellerleile K, Tahir E. Differentiation of acute non-ST elevation myocardial infarction and acute infarct-like myocarditis by visual pattern analysis: a head-to-head comparison of different cardiac MR techniques. Eur Radiol 2023; 33:6258-6266. [PMID: 37438640 PMCID: PMC10415415 DOI: 10.1007/s00330-023-09905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Parametric cardiac magnetic resonance (CMR) techniques have improved the diagnosis of pathologies. However, the primary tool for differentiating non-ST elevation myocardial infarction (NSTEMI) from myocarditis is still a visual assessment of conventional signal-intensity-based images. This study aimed at analyzing the ability of parametric compared to conventional techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns. METHODS Twenty NSTEMI patients, twenty infarct-like myocarditis patients, and twenty controls were examined using cine, T2-weighted CMR (T2w) and late gadolinium enhancement (LGE) imaging and T1/T2 mapping on a 1.5 T scanner. CMR images were presented in random order to two experienced fully blinded observers, who had to assign them to three categories by a visual analysis: NSTEMI, myocarditis, or healthy. RESULTS The conventional approach (cine, T2w and LGE combined) had the best diagnostic accuracy with 92% (95%CI: 81-97) for NSTEMI and 86% (95%CI: 71-94) for myocarditis. The diagnostic accuracies using T1 maps were 88% (95%CI: 74-95) and 80% (95%CI: 62-91), 84% (95%CI: 67-93) and 74% (95%CI: 54-87) for LGE, and 83% (95%CI: 66-92) and 73% (95%CI: 53-87) for T2w. The accuracies for cine (72% (95%CI: 52-86) and 60% (95%CI: 38-78)) and T2 maps (62% (95%CI: 40-79) and 47% (95%CI: 28-68)) were significantly lower compared to the conventional approach (p < 0.001 and p < 0.0001). CONCLUSIONS The conventional approach provided a reliable visual discrimination between NSTEMI, myocarditis, and controls. The diagnostic accuracy of a visual pattern analysis of T1 maps was not significantly inferior, whereas the diagnostic accuracy of T2 maps was not sufficient in this context. CLINICAL RELEVANCE STATEMENT The ability of parametric compared to conventional CMR techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns can avoid potentially unnecessary invasive coronary angiography and help to shorten CMR protocols and to reduce the need of gadolinium contrast agents. KEY POINTS • A visual differentiation of ischemic from non-ischemic patterns of myocardial injury is reliably achieved by a combination of conventional CMR techniques (cine, T2-weighted and LGE imaging). • There is no significant difference in accuracies between visual pattern analysis on native T1 maps without providing quantitative values and a conventional combined approach for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls. • T2 maps do not provide a sufficient diagnostic accuracy for visual pattern analysis for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls.
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Affiliation(s)
- Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amra Hot
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Ulf Radunski
- Department of Cardiology, Regio Clinics, Pinneberg, Germany
| | - Mathias Meyer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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168
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Dove ML, Slesnick TC, Oster ME, Hashemi S, Patel T, Wilson HC. Cardiac Magnetic Resonance Findings of Coronavirus Disease 2019 (COVID-19) Vaccine-Associated Myopericarditis at Intermediate Follow-Up: A Comparison with Classic Myocarditis. J Pediatr 2023; 260:113462. [PMID: 37172812 PMCID: PMC10171891 DOI: 10.1016/j.jpeds.2023.113462] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To report intermediate cardiac magnetic resonance (CMR) findings of coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis (C-VAM) and compare with classic myocarditis. STUDY DESIGN Retrospective cohort study including children diagnosed with C-VAM from May 2021 through December 2021 with early and intermediate CMR. Patients with classic myocarditis from January 2015 through December 2021 and intermediate CMR were included for comparison. RESULTS There were 8 patients with C-VAM and 20 with classic myocarditis. Among those with C-VAM, CMR performed at a median 3 days (IQR 3, 7) revealed 2 of 8 patients with left ventricular ejection fraction <55%, 7 of 7 patients receiving contrast with late gadolinium enhancement (LGE), and 5 of 8 patients with elevated native T1 values. Borderline T2 values suggestive of myocardial edema were present in 6 of 8 patients. Follow-up CMRs performed at a median 107 days (IQR 97, 177) showed normal ventricular systolic function, T1, and T2 values; 3 of 7 patients had LGE. At intermediate follow-up, patients with C-VAM had fewer myocardial segments with LGE than patients with classic myocarditis (4/119 vs 42/340, P = .004). Patients with C-VAM also had a lower frequency of LGE (42.9 vs 75.0%) and lower percentage of left ventricular ejection fraction <55% compared with classic myocarditis (0.0 vs 30.0%), although these differences were not statistically significant. Five patients with classic myocarditis did not receive an early CMR, leading to some selection bias in study design. CONCLUSIONS Patients with C-VAM had no evidence of active inflammation or ventricular dysfunction on intermediate CMR, although a minority had persistent LGE. Intermediate findings in C-VAM revealed less LGE burden compared with classic myocarditis.
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Affiliation(s)
- Matthew L Dove
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Timothy C Slesnick
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Matthew E Oster
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sassan Hashemi
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Trisha Patel
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Hunter C Wilson
- Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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169
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Doi S, Yanagawa M, Matsui T, Hata A, Kikuchi N, Yoshida Y, Yamagata K, Ninomiya K, Kido S, Tomiyama N. Usefulness of Three-Dimensional Iodine Mapping Quantified by Dual-Energy CT for Differentiating Thymic Epithelial Tumors. J Clin Med 2023; 12:5610. [PMID: 37685677 PMCID: PMC10488564 DOI: 10.3390/jcm12175610] [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: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Dual-energy CT has been reported to be useful for differentiating thymic epithelial tumors. The purpose is to evaluate thymic epithelial tumors by using three-dimensional (3D) iodine density histogram texture analysis on dual-energy CT and to investigate the association of extracellular volume fraction (ECV) with the fibrosis of thymic carcinoma. Methods: 42 patients with low-risk thymoma (n = 20), high-risk thymoma (n = 16), and thymic carcinoma (n = 6) were scanned by dual-energy CT. 3D iodine density histogram texture analysis was performed for each nodule on iodine density mapping: Seven texture features (max, min, median, average, standard deviation [SD], skewness, and kurtosis) were obtained. The iodine effect (average on DECT180s-average on unenhanced DECT) and ECV on DECT180s were measured. Tissue fibrosis was subjectively rated by one pathologist on a three-point grade. These quantitative data obtained by examining associations with thymic carcinoma and high-risk thymoma were analyzed with univariate and multivariate logistic regression models (LRMs). The area under the curve (AUC) was calculated by the receiver operating characteristic curves. p values < 0.05 were significant. Results: The multivariate LRM showed that ECV > 21.47% in DECT180s could predict thymic carcinoma (odds ratio [OR], 11.4; 95% confidence interval [CI], 1.18-109; p = 0.035). Diagnostic performance was as follows: Sensitivity, 83.3%; specificity, 69.4%; AUC, 0.76. In high-risk thymoma vs. low-risk thymoma, the multivariate LRM showed that the iodine effect ≤1.31 mg/cc could predict high-risk thymoma (OR, 7; 95% CI, 1.02-39.1; p = 0.027). Diagnostic performance was as follows: Sensitivity, 87.5%; specificity, 50%; AUC, 0.69. Tissue fibrosis significantly correlated with thymic carcinoma (p = 0.026). Conclusions: ECV on DECT180s related to fibrosis may predict thymic carcinoma from thymic epithelial tumors, and the iodine effect on DECT180s may predict high-risk thymoma from thymoma.
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Affiliation(s)
- Shuhei Doi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriko Kikuchi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Yuriko Yoshida
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Kazuki Yamagata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Keisuke Ninomiya
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
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Balčiūnaitė G, Rudinskaitė I, Palionis D, Besusparis J, Žurauskas E, Janušauskas V, Zorinas A, Valevičienė N, Ručinskas K, Sogaard P, Glaveckaitė S. Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis. J Clin Med 2023; 12:5588. [PMID: 37685655 PMCID: PMC10488170 DOI: 10.3390/jcm12175588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain in relation to LV remodeling and myocardial fibrosis. 83 severe AS patients underwent surgical AVR, with preoperative 12-lead ECG, cardiovascular magnetic resonance with T1 mapping and echocardiography with global longitudinal strain analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies sampled during AVR. Patients with ECG strain had more severe AS, more advanced LV remodeling and evidence of heart failure. Patients with ECG strain had more diffuse fibrosis, as evident by higher mean native T1 values (974.8 ± 34 ms vs. 946.5 ± 28 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46-34.48, p = 0.02). Patients with persistent ECG strain at 1 year following AVR had more advanced LV remodeling and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Therefore, ECG strain is a marker of adverse LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.
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Affiliation(s)
- Giedrė Balčiūnaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Ieva Rudinskaitė
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Darius Palionis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (D.P.); (N.V.)
| | - Justinas Besusparis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08406 Vilnius, Lithuania; (J.B.)
| | - Edvardas Žurauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08406 Vilnius, Lithuania; (J.B.)
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Nomeda Valevičienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (D.P.); (N.V.)
| | - Kęstutis Ručinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Peter Sogaard
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
- Clinical Institute of Aalborg University, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Sigita Glaveckaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
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171
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Gröschel J, Trauzeddel RF, Müller M, von Knobelsdorff-Brenkenhoff F, Viezzer D, Hadler T, Blaszczyk E, Daud E, Schulz-Menger J. Multi-site comparison of parametric T1 and T2 mapping: healthy travelling volunteers in the Berlin research network for cardiovascular magnetic resonance (BER-CMR). J Cardiovasc Magn Reson 2023; 25:47. [PMID: 37574535 PMCID: PMC10424349 DOI: 10.1186/s12968-023-00954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Parametric mapping sequences in cardiovascular magnetic resonance (CMR) allow for non-invasive myocardial tissue characterization. However quantitative myocardial mapping is still limited by the need for local reference values. Confounders, such as field strength, vendors and sequences, make intersite comparisons challenging. This exploratory study aims to assess whether multi-site studies that control confounding factors provide first insights whether parametric mapping values are within pre-defined tolerance ranges across scanners and sites. METHODS A cohort of 20 healthy travelling volunteers was prospectively scanned at three sites with a 3 T scanner from the same vendor using the same scanning protocol and acquisition scheme. A Modified Look-Locker inversion recovery sequence (MOLLI) for T1 and a fast low-angle shot sequence (FLASH) for T2 were used. At one site a scan-rescan was performed to assess the intra-scanner reproducibility. All acquired T1- and T2-mappings were analyzed in a core laboratory using the same post-processing approach and software. RESULTS After exclusion of one volunteer due to an accidentally diagnosed cardiac disease, T1- and T2-maps of 19 volunteers showed no significant differences between the 3 T sites (mean ± SD [95% confidence interval] for global T1 in ms: site I: 1207 ± 32 [1192-1222]; site II: 1207 ± 40 [1184-1225]; site III: 1219 ± 26 [1207-1232]; p = 0.067; for global T2 in ms: site I: 40 ± 2 [39-41]; site II: 40 ± 1 [39-41]; site III 39 ± 2 [39-41]; p = 0.543). CONCLUSION Parametric mapping results displayed initial hints at a sufficient similarity between sites when confounders, such as field strength, vendor diversity, acquisition schemes and post-processing analysis are harmonized. This finding needs to be confirmed in a powered clinical trial. Trial registration ISRCTN14627679 (retrospectively registered).
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Affiliation(s)
- Jan Gröschel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ralf-Felix Trauzeddel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Maximilian Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- KIZ, Kardiologie im Zentrum, Eisenmannstr. 4, 80331, Munich, Deutschland
| | - Darian Viezzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Hadler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elias Daud
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- The Cardiology Department, Galilee Medical Center, Azrieli Faculty of Medicine Bar-Ilan University, Nahariya, Safed, Israel
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany.
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
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172
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Schönbauer R, Hana F, Duca F, Koschutnik M, Donà C, Nitsche C, Sponder M, Lenz M, Lee J, Loewe C, Hengstenberg C, Mascherbauer J, Kammerlander A. Right Atrial Phasic Function in Heart Failure with Preserved Ejection Fraction: Cardiac Magnetic Resonance Feature Tracking and Outcomes. J Clin Med 2023; 12:5179. [PMID: 37629221 PMCID: PMC10455785 DOI: 10.3390/jcm12165179] [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: 06/24/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study sought to investigate the prognostic impact of right atrial (RA) size and function in patients with heart failure with preserved ejection fraction (HFpEF) in sinus rhythm (SR) and atrial fibrillation (AF). METHODS Consecutive HFpEF patients were enrolled and indexed RA volumes and emptying fractions (RA-EF) were assessed by cardiac magnetic resonance imaging (CMR). For patients in SR, feature tracking of the RA wall was performed during CMR. In addition, all patients underwent right and left heart catheterization and 6 min walk distance (6MWD) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) evaluations. We prospectively followed patients and used Cox regression models to determine the association of RA size and function with a composite endpoint of heart failure hospitalization and cardiovascular death. RESULTS A total of 188 patients (71% female patients, 70 ± 8 years old) were included. Ninety-two patients (49%) were in persistent AF. Eighty-five patients reached the combined endpoint during a follow-up of 69 (42-97) months. After a multivariate cox regression analysis, the impaired RA reservoir strain (HR 0.949; 95% CI [0.909-0.990], p = 0.016), the RA reservoir strain rate (HR 0.991; 95% CI [0.983-0.999], p = 0.028), the RA conduit strain (HR 0.932; 95% CI [0.879-0.988], p = 0.019), and the RA conduit strain rate (HR 0.989; 95% CI [0.881-0.997], p = 0.011) were significantly associated with a worse outcome for patients in SR. In persistent AF, no RA imaging parameter was related to outcome after a multivariate regression analysis. CONCLUSIONS In HFpEF patients in SR, CMR parameters of impaired RA conduit and reservoir function are associated with dismal cardiovascular outcomes. In persistent AF, RA parameters lose their prognostic ability.
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Affiliation(s)
- Robert Schönbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Fiona Hana
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Michael Sponder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Max Lenz
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Jonghui Lee
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Christian Loewe
- Department of Bioimiging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
| | - Andreas Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (R.S.); (F.H.); (F.D.); (M.K.); (C.D.); (C.N.); (M.S.); (M.L.); (J.L.); (C.H.)
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173
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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174
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Wolf P, Bouazizi K, Kachenoura N, Piedvache C, Gallo A, Salenave S, Maione L, Young J, Prigent M, Lecoq AL, Kuhn E, Agostini H, Trabado S, Redheuil A, Chanson P, Kamenický P. Increase in intracellular and extracellular myocardial mass in patients with acromegaly: a cardiac magnetic resonance imaging study. Eur J Endocrinol 2023; 189:199-207. [PMID: 37549351 DOI: 10.1093/ejendo/lvad105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Acromegaly is associated with an increased left ventricular (LV) mass, as reported in echo-based and, more recently, in a few cardiac magnetic resonance imaging (MRI) studies. One possible explanation for this increased LV mass could be water retention and subsequent myocardial edema. METHODS In this prospective cross-sectional study, 26 patients with active acromegaly before and after treatment and 31 controls of comparable age and sex were investigated using cardiac MRI. Cardiac morphology, function, and myocardial tissue characteristics were evaluated. Myocardial T2 relaxation time was used as the main outcome measure of myocardial edema. The study was registered with clinicaltrials.gov (NCT02948322). RESULTS Patients compared to controls had greater LV mass indexes (58.1 [54.7-68.6] vs 46.0 [41.3-49.8] g/m2; P < .001) and end-diastolic volume (EDV) indexes (97.3 [88-101.2] vs 81.6 [78.1-96.2] mL/m2; P = .0069) and had comparable global contractile function. T2 values were not different between patients and controls. Both intracellular (43.83 [41.0-50.0] vs 34.32 [28.9-38.7] g/m2; P < .001) and extracellular (15.06 [13.5-17.1] vs 11.6 [10.8-12.7] g/m2; P < .001) LV mass indexes were higher in patients compared to controls. Log growth hormone correlated with myocardial mass (r = 0.75; P < .001). Sex, systolic blood pressure (BP), and the presence of acromegaly were predictors of the LV mass index. The extracellular LV mass index was associated with sex and the presence of acromegaly, whereas the intracellular LV mass index was associated with sex, systolic BP, and high-density lipoprotein (HDL) cholesterol. Acromegaly treatment reduced EDV and total and intracellular LV mass indexes without significantly affecting extracellular mass. CONCLUSION Acromegaly results in a disease-specific form of LV hypertrophic remodeling, characterized by an increase in both intra- and extracellular mass. The LV mass index and intracellular mass were decreased by treatment.
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Affiliation(s)
- Peter Wolf
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria
| | - Khaoula Bouazizi
- CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, 75006 Paris, France
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
| | - Nadjia Kachenoura
- CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, 75006 Paris, France
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
| | - Céline Piedvache
- AP-HP, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Antonio Gallo
- Sorbonne Université, Inserm, Unité de recherche sur les maladies cardiovasculaires et métaboliques, AP-HP, Hôpital Pitié-Salpètriêre, Service de Nutrition, 75013 Paris, France
| | - Sylvie Salenave
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Luigi Maione
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Jacques Young
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Mikaël Prigent
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
| | - Anne-Lise Lecoq
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Emmanuelle Kuhn
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Helene Agostini
- AP-HP, Hôpital Bicêtre, Unité de Recherche Clinique, 94275 Le Kremlin-Bicêtre, France
| | - Severine Trabado
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, 94275 Le Kremlin-Bicêtre, France
| | - Alban Redheuil
- CNRS, Inserm, Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, 75006 Paris, France
- Institut de Cardiométabolisme et Nutrition (ICAN), 75013 Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique, 75013 Paris, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
| | - Peter Kamenický
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, AP-HP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, 94275 Le Kremlin-Bicêtre, France
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175
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Quennelle S, Bonnet D. Pediatric heart failure with preserved ejection fraction, a review. Front Pediatr 2023; 11:1137853. [PMID: 37601131 PMCID: PMC10433757 DOI: 10.3389/fped.2023.1137853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Diastolic dysfunction refers to a structural or functional abnormality of the left ventricle, resulting in impaired filling of the heart. Severe diastolic dysfunction can lead to congestive heart failure even when the left ventricle systolic function is normal. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of the hospitalizations for acute heart failure in the adult population but the clinical recognition and understanding of HFpEF in children is poor. The condition is certainly much less frequent than in the adult population but the confirmatory diagnosis of diastolic dysfunction in children is also challenging. The underlying causes of HFpEF in children are diverse and differ from the main cause in adults. This review addresses the underlying causes and prognostic factors of HFpEF in children. We describe the pulmonary hypertension profiles associated with this cardiac condition. We discuss diagnosis difficulties in clinical practice, and we provide a simplified diagnostic algorithm for HFpEF in children.
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Affiliation(s)
- Sophie Quennelle
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Equipe Projet HeKA, Paris, France
- Université Paris Cité, Paris, France
| | - Damien Bonnet
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
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176
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Solomon C, Shmueli O, Shrot S, Blumenfeld-Katzir T, Radunsky D, Omer N, Stern N, Reichman DBA, Hoffmann C, Salti M, Greenspan H, Ben-Eliezer N. Psychophysical Evaluation of Visual vs. Computer-Aided Detection of Brain Lesions on Magnetic Resonance Images. J Magn Reson Imaging 2023; 58:642-649. [PMID: 36495014 DOI: 10.1002/jmri.28559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) diagnosis is usually performed by analyzing contrast-weighted images, where pathology is detected once it reached a certain visual threshold. Computer-aided diagnosis (CAD) has been proposed as a way for achieving higher sensitivity to early pathology. PURPOSE To compare conventional (i.e., visual) MRI assessment of artificially generated multiple sclerosis (MS) lesions in the brain's white matter to CAD based on a deep neural network. STUDY TYPE Prospective. POPULATION A total of 25 neuroradiologists (15 males, age 39 ± 9, 9 ± 9.8 years of experience) independently assessed all synthetic lesions. FIELD STRENGTH/SEQUENCE A 3.0 T, T2 -weighted multi-echo spin-echo (MESE) sequence. ASSESSMENT MS lesions of varying severity levels were artificially generated in healthy volunteer MRI scans by manipulating T2 values. Radiologists and a neural network were tasked with detecting these lesions in a series of 48 MR images. Sixteen images presented healthy anatomy and the rest contained a single lesion at eight increasing severity levels (6%, 9%, 12%, 15%, 18%, 21%, 25%, and 30% elevation in T2 ). True positive (TP) rates, false positive (FP) rates, and odds ratios (ORs) were compared between radiological diagnosis and CAD across the range lesion severity levels. STATISTICAL TESTS Diagnostic performance of the two approaches was compared using z-tests on TP rates, FP rates, and the logarithm of ORs across severity levels. A P-value <0.05 was considered statistically significant. RESULTS ORs of identifying pathology were significantly higher for CAD vis-à-vis visual inspection for all lesions' severity levels. For a 6% change in T2 value (lowest severity), radiologists' TP and FP rates were not significantly different (P = 0.12), while the corresponding CAD results remained statistically significant. DATA CONCLUSION CAD is capable of detecting the presence or absence of more subtle lesions with greater precision than the representative group of 25 radiologists chosen in this study. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Chen Solomon
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Shmueli
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Shai Shrot
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Dvir Radunsky
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Omer
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Neta Stern
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Chen Hoffmann
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
| | - Moti Salti
- Brain Imaging Research Center (BIRC), Ben-Gurion University, Beer-Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hayit Greenspan
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Ben-Eliezer
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University, New York, New York, USA
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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177
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Wei CG, Zeng Y, Zhang R, Zhu Y, Tu J, Pan P, Ma Q, Wei LY, Zhao WL, Shen JK. Native T 1 mapping for non-invasive quantitative evaluation of renal function and renal fibrosis in patients with chronic kidney disease. Quant Imaging Med Surg 2023; 13:5058-5071. [PMID: 37581045 PMCID: PMC10423339 DOI: 10.21037/qims-22-1304] [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: 11/27/2022] [Accepted: 05/12/2023] [Indexed: 08/16/2023]
Abstract
Background To investigate the role of native T1 mapping in the non-invasive quantitative assessment of renal function and renal fibrosis (RF) in chronic kidney disease (CKD) patients. Methods A prospective analysis of 71 consecutive patients [no RF (0%): 9 cases; mild RF (<25%): 36 cases; moderate RF (25-50%): 17 cases; severe RF (>50%): 9 cases] who were clinically diagnosed with CKD that was pathologically confirmed and who underwent magnetic resonance imaging (MRI) examination between October 2021 and September 2022 was performed. T1-C (mean cortical T1 value), T1-M (mean medullary T1 value), ΔT1 (mean corticomedullary difference) and T1% (mean corticomedullary ratio) values were compared. Correlations between T1 parameters and clinical and histopathological values were analyzed. Regression analysis was performed to determine independent predictors of RF. The areas under the receiver operating characteristic curve (AUC) were calculated to assess the diagnostic value of RF. Results The T1-C, ΔT1 and T1% values (P<0.05) were significantly different in the CKD group, but T1-M was not (P>0.05). The ΔT1 and T1% values showed significant differences in pairwise comparisons among CKD subgroups (P<0.05) except for CKD 2 and 3. ΔT1 and T1% were moderately correlated with the estimated glomerular filtration rate (ΔT1: rs=-0.561; T1%: r=-0.602), serum creatinine (ΔT1: rs=0.591; T1%: rs=0.563), blood urea nitrogen (ΔT1: rs=0.433; T1%: rs=0.435) and histopathological score (ΔT1: rs=0.630; T1%: rs=0.658). ΔT1 and T1%, but not T1-C, were independent predictors of RF (P<0.05). ΔT1 and T1% were set as -410.07 ms and 0.8222 with great specificity [ΔT1: 91.7% (77.5-98.2%); T1%: 97.2% (85.5-99.9%)] to identify mild RF and moderate-severe RF. The optimal cutoff values for differentiating severe RF from mild-moderate RF were -343.81 ms (ΔT1) and 0.8359 (T1%) with high sensitivity [both 100% (66.4-100%)] and specificity [ΔT1: 90.6% (79.3-96.9%); T1%: 94.3% (84.3-98.8%)]. Conclusions ΔT1 and T1% overwhelm T1-C for assessment of renal function and RF in CKD patients. ΔT1 and T1% identify patients with <25% and >50% fibrosis, which can guide clinical decision-making and help to avoid biopsy-related bleeding.
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Affiliation(s)
- Chao-Gang Wei
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Zeng
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ye Zhu
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Tu
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Pan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Ma
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lan-Yi Wei
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen-Lu Zhao
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun-Kang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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178
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Miller MA, Devesa A, Robson PM, Liao SL, Pyzik R, El-Eshmawi A, Boateng P, Pandis D, Dukkipati SR, Reddy VY, Adams DH, Fayad ZA, Trivieri MG. Arrhythmic Mitral Valve Prolapse With Only Mild or Moderate Mitral Regurgitation: Characterization of Myocardial Substrate. JACC Clin Electrophysiol 2023; 9:1709-1716. [PMID: 37227360 DOI: 10.1016/j.jacep.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sustained ventricular tachycardia and sudden cardiac death due to degenerative mitral valve prolapse (MVP) can occur in the absence of severe mitral regurgitation (MR). A significant percentage of patients with MVP-related sudden death do not have any evidence of replacement fibrosis, suggesting other unrecognized proarrhythmic factors may place these patients at risk. OBJECTIVES This study aims to characterize myocardial fibrosis/inflammation and ventricular arrhythmia complexity in patients with MVP and only mild or moderate MR. METHODS Prospective observational study of patients with MVP and only mild or moderate MR underwent ventricular arrhythmia characterization and hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI). Coregistered hybrid 18F-fluorodeoxyglucose (18F-FDG)-PET and MRI late gadolinium enhancement images were assessed and categorized. Recruitment occurred in the cardiac electrophysiology clinic. RESULTS In 12 patients with degenerative MVP with only mild or moderate MR, of which a majority had complex ventricular ectopy (n = 10, 83%), focal (or focal-on-diffuse) uptake of 18F-FDG (PET-positive) was detected in 83% (n = 10) of patients. Three-quarters of the patients (n = 9, 75%) had FDG uptake that coexisted with areas of late gadolinium enhancement (PET/MRI-positive). Abnormal T1, T2 and extracellular volume (ECV) values were observed in 58% (n = 7), 25% (n = 3), and 16% (n = 2), respectively. CONCLUSIONS Most patients with degenerative MVP, ventricular ectopy, and mild or moderate MR show myocardial inflammation that is concordant with myocardial scar. Further study is needed to determine whether these findings contribute to the observation that most MVP-related sudden deaths occur in patients with less than severe MR.
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Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ana Devesa
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philip M Robson
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steve L Liao
- Division of Non-invasive Cardiovascular, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Renata Pyzik
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zahi A Fayad
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria G Trivieri
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
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179
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Purevsuren M, Uehara M, Ishizuka M, Suzuki Y, Shimbo M, Kakuda N, Ishii S, Sumida H, Miyazaki M, Yamashita T, Yoshizaki A, Asano Y, Sato S, Hatano M, Komuro I. Native T1 mapping in early diffuse and limited systemic sclerosis, and its association with diastolic function. J Cardiol 2023; 82:100-107. [PMID: 36921691 DOI: 10.1016/j.jjcc.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is divided into diffuse and limited cutaneous SSc (dcSSc and lcSSc). The dcSSc subtype has more severe internal organ damage. This study aimed to assess whether cardiovascular magnetic resonance (CMR) parametric mapping could detect early cardiac involvement and evaluate differences between these two subtypes. METHODS Eighty SSc patients (37 dcSSc and 43 lcSSc) underwent CMR at 3.0 T (Philips Healthcare, Best, The Netherlands) in our hospital between July 2018 and July 2021. We analyzed myocardial damage by CMR parametric mapping and compared it with clinical data. RESULTS The median duration of the disease was 10.2 months. The left ventricular ejection fraction was preserved in both groups. DcSSc had significantly higher native T1 (1333.4 ± 71.2 ms vs. 1295.0 ± 42.7 ms, p = 0.006) and extracellular volume fraction (32.6 ± 4.1 % vs. 30.3 ± 4.0 %, p = 0.018) in the mid-ventricular septum as compared to lcSSc, although there were no differences in T2 values. Native T1 values were positively correlated with the E/e' ratio and left atrial volume indices evaluated by transthoracic echocardiography in overall SSc and dcSSc, but not in lcSSc. Logistic regression analysis revealed that native T1 was an independent predictor of left ventricular diastolic dysfunction in SSc patients (odds ratio, 1.194; 95 % confidence interval, 1.021-1.396; p = 0.026). Native T1 was higher in SSc patients with progressive skin lesions. Additionally, there were positive correlations between brain natriuretic peptide, New York Heart Association functional classification, and native T1. CONCLUSIONS CMR parametric mapping is a useful tool for detecting myocardial changes. Native T1 was the most sensitive parameter for identifying diffuse myocardial changes in the early stages of SSc and was associated with left ventricular diastolic function. DcSSc had more severe myocardial involvement than lcSSc; therefore, the use of CMR parametric mapping may aid in its prediction.
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Affiliation(s)
- Munkhtuul Purevsuren
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masato Ishizuka
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuichi Suzuki
- Radiology Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Mai Shimbo
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobutaka Kakuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ishii
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayakazu Sumida
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miki Miyazaki
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamashita
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Sato
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Advanced Medical Center for Heart Failure, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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180
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Yurista SR, Eder RA, Welsh A, Jiang W, Chen S, Foster AN, Mauskapf A, Tang WHW, Hucker WJ, Coll-Font J, Rosenzweig A, Nguyen CT. Ketone ester supplementation suppresses cardiac inflammation and improves cardiac energetics in a swine model of acute myocardial infarction. Metabolism 2023; 145:155608. [PMID: 37268056 PMCID: PMC10330653 DOI: 10.1016/j.metabol.2023.155608] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Myocardial infarction (MI) is a major risk factor for the development of heart failure with reduce ejection fraction (HFrEF). While previous studies have focused on HFrEF, the cardiovascular effects of ketone bodies in acute MI are unclear. We examined the effects of oral ketone supplementation as a potential treatment strategy in a swine acute MI model. METHODS Farm pigs underwent percutaneous balloon occlusion of the LAD for 80 min followed by 72 h reperfusion period. Oral ketone ester or vehicle was administered during reperfusion and continued during the follow-up period. RESULTS Oral KE supplementation induced ketonemia 2-3 mmol/l within 30 min after ingestion. KE increased ketone (βHB) extraction in healthy hearts without affecting glucose and fatty acid (FA) consumption. During reperfusion, the MI hearts consumed less FA with no change in glucose consumption, whereas hearts from MI-KE-fed animals consumed more βHB and FA, as well as improved myocardial ATP production. A significant elevation of infarct T2 values indicative of inflammation was found only in untreated MI group compared to sham. Concordantly, cardiac expression of inflammatory markers, oxidative stress, and apoptosis were reduced by KE. RNA-seq analysis identified differentially expressed genes related to mitochondrial energy metabolism and inflammation. CONCLUSIONS Oral KE supplementation induced ketosis and enhanced myocardial βHB extraction in both healthy and infarcted hearts. Acute oral supplementation with KE favorably altered cardiac substrate uptake and utilization, improved cardiac ATP levels, and reduced cardiac inflammation following MI.
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Affiliation(s)
- Salva R Yurista
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert A Eder
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Aidan Welsh
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - William Jiang
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Shi Chen
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anna N Foster
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Adam Mauskapf
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - William J Hucker
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaume Coll-Font
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Anthony Rosenzweig
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher T Nguyen
- Corrigan Minehan Heart Center, Division of Cardiology, Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Health Science Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA, USA; Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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181
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Isaak A, Bratz J, Kravchenko D, Mesropyan N, Eckardt I, Bischoff LM, Weinhold L, Kuetting D, Pieper CC, Attenberger U, Zimmer S, Luetkens JA. A novel and simple cardiac magnetic resonance score (PE 2RT) predicts outcome in takotsubo syndrome. Eur Radiol 2023; 33:5498-5508. [PMID: 36949253 PMCID: PMC10326093 DOI: 10.1007/s00330-023-09543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS). METHODS Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE2RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE2RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator. RESULTS Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE2RT score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PE2RT score was associated with MACE on Cox regression analysis (hazard ratio per PE2RT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PE2RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001). CONCLUSIONS The introduced PE2RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR. KEY POINTS • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE2RT features) are relatively common in takotsubo syndrome. • The proposed PE2RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
| | - Johanna Bratz
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Irina Eckardt
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Institute of Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany
| | - Claus Christian Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
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Gaur S, Panda A, Fajardo JE, Hamilton J, Jiang Y, Gulani V. Magnetic Resonance Fingerprinting: A Review of Clinical Applications. Invest Radiol 2023; 58:561-577. [PMID: 37026802 PMCID: PMC10330487 DOI: 10.1097/rli.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
ABSTRACT Magnetic resonance fingerprinting (MRF) is an approach to quantitative magnetic resonance imaging that allows for efficient simultaneous measurements of multiple tissue properties, which are then used to create accurate and reproducible quantitative maps of these properties. As the technique has gained popularity, the extent of preclinical and clinical applications has vastly increased. The goal of this review is to provide an overview of currently investigated preclinical and clinical applications of MRF, as well as future directions. Topics covered include MRF in neuroimaging, neurovascular, prostate, liver, kidney, breast, abdominal quantitative imaging, cardiac, and musculoskeletal applications.
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Affiliation(s)
- Sonia Gaur
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Ananya Panda
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Jesse Hamilton
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Yun Jiang
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | - Vikas Gulani
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
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183
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Sunthankar SD, George-Durrett K, Crum K, Slaughter JC, Kasten J, Raucci FJ, Markham LW, Soslow JH. Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:44. [PMID: 37517994 PMCID: PMC10388519 DOI: 10.1186/s12968-023-00951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Cardiomyopathy is the leading cause of death in Duchenne muscular dystrophy (DMD). Cardiac magnetic resonance (CMR) parametric mapping sequences offer insights into disease pathophysiology. We propose a novel approach by leveraging T2 mapping in conjunction with T1 and extracellular volume (ECV) mapping to perform a virtual myocardial biopsy. While previous work has attempted to describe myocardial changes in DMD, our inclusion of T2 mapping enables comprehensive categorization of myocardial tissue characteristics of fibrosis, edema, and fat to better understand the pathological composition of the myocardium with disease progression. METHODS DMD patients (n = 49; median: 12 years-old) underwent CMR, including T1, T2, and ECV. Categories were defined as normal, isolated high T1 (normal ECV, high T1, normal T2), fibrosis (high ECV, normal or high T1, normal T2), edema (normal or high ECV, normal or high T1, high T2), fat (normal ECV, low T1, high T2) or fibrofatty (high ECV, low T1, high T2). RESULTS Median left ventricular ejection fraction (LVEF) was 59% with 27% having LVEF < 55%. Those with normal LVEF and no late gadolinium enhancement (37%) were younger in age (10.5 ± 2.6 vs. 15.0 ± 4.3 years-old, p < 0.001). Native T1 was elevated in at least one slice in 82% of patients. Those with high T2 at any slice (27%) were older (p = 0.005) and had lower LVEF (p = 0.005) compared with subjects with normal T2 (73%). The most common myocardial characterization was fibrosis (43%) followed by isolated high T1 (24%). Of the 13 with high T2, ten were categorized as edema, two as fibrofatty, and one as fat. CONCLUSION CMR parametric mapping sequences offer insights into Duchenne cardiomyopathy pathophysiology, which should drive development of therapeutic interventions aimed at these targets. Myocardial fibrosis is common in DMD. Patients with elevated T2 were older and had lower LVEF. Though fat infiltration was present, the majority of subjects with elevated T2 met criteria for myocardial edema.
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Affiliation(s)
- Sudeep D Sunthankar
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital at Vanderbilt, 2220 Children's Way, Suite 5230, TN, 37232, Nashville, USA.
| | - Kristen George-Durrett
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital at Vanderbilt, 2220 Children's Way, Suite 5230, TN, 37232, Nashville, USA
| | - Kimberly Crum
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital at Vanderbilt, 2220 Children's Way, Suite 5230, TN, 37232, Nashville, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Kasten
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Frank J Raucci
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, VA, 23219, USA
| | - Larry W Markham
- Division of Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, 46202, USA
| | - Jonathan H Soslow
- Thomas P. Graham Jr Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital at Vanderbilt, 2220 Children's Way, Suite 5230, TN, 37232, Nashville, USA
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Doeblin P, Steinbeis F, Witzenrath M, Hashemi D, Chen W, Weiss KJ, Stawowy P, Kelle S. Half-Dose versus Single-Dose Gadobutrol for Extracellular Volume Measurements in Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:316. [PMID: 37623329 PMCID: PMC10455162 DOI: 10.3390/jcdd10080316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents offers unique non-invasive insights into cardiac tissue composition. Myocardial extracellular volume (ECV) has evolved as an objective and robust parameter with broad diagnostic and prognostic implications. For the gadolinium compound gadobutrol, the recommended dose for cardiac imaging, including ECV measurements, is 0.1 mmol/kg (single dose). This dose was optimized for late enhancement imaging, a measure of focal fibrosis. Whether a lower dose is sufficient for ECV measurements is unknown. We aim to evaluate the accuracy of ECV measurements using a half dose of 0.05 mmol/kg gadobutrol compared to the standard single dose of 0.1 mmol/kg. METHODS AND RESULTS From a contemporary trial (NCT04747366, registered 10 February 2021), a total of 25 examinations with available T1 mapping before and after 0.05 and 0.1 mmol/kg gadobutrol were analyzed. ECV values were calculated automatically from pre- and post-contrast T1 relaxation times. T1 and ECV Measurements were performed in the midventricular septum. ECV values after 0.05 and 0.1 mmol/kg gadobutrol were correlated (R2 = 0.920, p < 0.001). ECV values after 0.05 mmol/kg had a bias of +0.9% (95%-CI [0.4; 1.4], p = 0.002) compared to 0.1 mmol/kg gadobutrol, with limits of agreement from -1.5 to 3.3%. CONCLUSIONS CMR with a half dose of 0.05 mmol/kg gadobutrol overestimated ECV by 0.9% compared with a full dose of 0.1 mmol/kg, necessitating adjustment of normal values when using half-dose ECV imaging.
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Affiliation(s)
- Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Lung Research (DZL), 10117 Berlin, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wensu Chen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Karl Jakob Weiss
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Stawowy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Moscatelli S, Leo I, Bianco F, Borrelli N, Beltrami M, Garofalo M, Milano EG, Bisaccia G, Iellamo F, Bassareo PP, Pradhan A, Cimini A, Perrone MA. The Role of Multimodality Imaging in Pediatric Cardiomyopathies. J Clin Med 2023; 12:4866. [PMID: 37510983 PMCID: PMC10381492 DOI: 10.3390/jcm12144866] [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: 06/16/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of myocardial diseases representing the first cause of heart transplantation in children. Diagnosing and classifying the different phenotypes can be challenging, particularly in this age group, where cardiomyopathies are often overlooked until the onset of severe symptoms. Cardiovascular imaging is crucial in the diagnostic pathway, from screening to classification and follow-up assessment. Several imaging modalities have been proven to be helpful in this field, with echocardiography undoubtedly representing the first imaging approach due to its low cost, lack of radiation, and wide availability. However, particularly in this clinical context, echocardiography may not be able to differentiate from cardiomyopathies with similar phenotypes and is often complemented with cardiovascular magnetic resonance. The latter allows a radiation-free differentiation between different phenotypes with unique myocardial tissue characterization, thus identifying the presence and extent of myocardial fibrosis. Nuclear imaging and computed tomography have a complementary role, although they are less used in daily clinical practice due to the concern related to the use of radiation in pediatric patients. However, these modalities may have some advantages in evaluating children with cardiomyopathies. This paper aims to review the strengths and limitations of each imaging modality in evaluating pediatric patients with suspected or known cardiomyopathies.
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Affiliation(s)
- Sara Moscatelli
- Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Paediatric Cardiology Department, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London SW3 5NP, UK
| | - Isabella Leo
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
- Cardiology Department, CMR Unit, Royal Brompton and Harefield Hospitals, Guys' and St. Thomas' NHS Trust, London SW3 5NP, UK
| | - Francesco Bianco
- Cardiovascular Sciences Department-AOU "Ospedali Riuniti", 60126 Ancona, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, A.O. dei Colli, Monaldi Hospital, 80131 Naples, Italy
| | | | - Manuel Garofalo
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy
| | - Elena Giulia Milano
- Centre for Cardiovascular Imaging, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ferdinando Iellamo
- Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Mater Misericordiae University Hospital and Children's Health Ireland Crumlin, D07 R2WY Dublin, Ireland
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, India
| | - Andrea Cimini
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L'Aquila, Italy
| | - Marco Alfonso Perrone
- Division of Cardiology and Cardio Lab, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
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Aquaro GD, Monastero S, Todiere G, Barison A, De Gori C, Grigoratos C, Parisella ML, Faggioni L, Cioni D, Lencioni R, Neri E. Diagnostic Role of Native T1 Mapping Compared to Conventional Magnetic Resonance Techniques in Cardiac Disease in a Real-Life Cohort. Diagnostics (Basel) 2023; 13:2461. [PMID: 37510205 PMCID: PMC10377876 DOI: 10.3390/diagnostics13142461] [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: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023] Open
Abstract
We sought to compare native T1 mapping to conventional late gadolinium enhancement (LGE) and T2-STIR techniques in a cohort of consecutive patients undergoing cardiac MRI (CMR). CMR was performed in 323 patients, 206 males (64%), mean age 54 ± 8 years, and in 27 age- and sex- matched healthy controls. In T2-STIR images, myocardial hyperintensity suggesting edema was found in 41 patients (27%). LGE images were positive in 206 patients (64%). T1 mapping was abnormal in 171 (49%). In 206 patients (64%), a matching between LGE and native T1 was found. T1 was abnormal in 32 out of 41 (78%) with edema in T2-STIR images. Overall, LGE and/or T2-STIR were abnormal in 209 patients, whereas native T1 was abnormal in 154 (52%). Conventional techniques and T1 mapping were concordant in 208 patients (64%). In 39 patients, T1 mapping was positive despite negative conventional techniques (12%). T1 mapping was able in conditions with diffuse myocardial damage such as cardiac amyloidosis, scleroderma, and Fabry disease (additive role in 42%). In contrast, T1 mapping was less effective in cardiac disease with regional distribution of myocardial damage such as myocardial infarction, HCM, and myocarditis. In conclusion, conventional LGE/T2-STIR and T1 mapping are complementary techniques and should be used together in every CMR examination.
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Affiliation(s)
- Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | | | - Giancarlo Todiere
- Academic Radiology Unit, Department of Translational Research and of New Technology in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Andrea Barison
- Academic Radiology Unit, Department of Translational Research and of New Technology in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Carmelo De Gori
- Academic Radiology Unit, Department of Translational Research and of New Technology in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Crysanthos Grigoratos
- Academic Radiology Unit, Department of Translational Research and of New Technology in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | | | - Dania Cioni
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Lencioni
- Academic Radiology Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Gabriele Monasterio CNR-Tuscany Foundation, 56127 Pisa, Italy
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Pepe A, Crimì F, Vernuccio F, Cabrelle G, Lupi A, Zanon C, Gambato S, Perazzolo A, Quaia E. Medical Radiology: Current Progress. Diagnostics (Basel) 2023; 13:2439. [PMID: 37510183 PMCID: PMC10378672 DOI: 10.3390/diagnostics13142439] [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: 06/12/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Recently, medical radiology has undergone significant improvements in patient management due to advancements in image acquisition by the last generation of machines, data processing, and the integration of artificial intelligence. In this way, cardiovascular imaging is one of the fastest-growing radiological subspecialties. In this study, a compressive review was focused on addressing how and why CT and MR have gained a I class indication in most cardiovascular diseases, and the potential impact of tissue and functional characterization by CT photon counting, quantitative MR mapping, and 4-D flow. Regarding rectal imaging, advances in cancer imaging using diffusion-weighted MRI sequences for identifying residual disease after neoadjuvant chemoradiotherapy and [18F] FDG PET/MRI were provided for high-resolution anatomical and functional data in oncological patients. The results present a large overview of the approach to the imaging of diffuse and focal liver diseases by US elastography, contrast-enhanced US, quantitative MRI, and CT for patient risk stratification. Italy is currently riding the wave of these improvements. The development of large networks will be crucial to create high-quality databases for patient-centered precision medicine using artificial intelligence. Dedicated radiologists with specific training and a close relationship with the referring clinicians will be essential human factors.
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Affiliation(s)
- Alessia Pepe
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Filippo Crimì
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Giulio Cabrelle
- Department of Radiology, University Hospital of Padua, 35128 Padua, Italy
| | - Amalia Lupi
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Chiara Zanon
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Sebastiano Gambato
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
| | - Anna Perazzolo
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
- Institute of Radiology, Department of Medicine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, University of Udine, 33100 Udine, Italy
| | - Emilio Quaia
- Institute of Radiology, University Hospital of Padua-DIMED, Padua University Hospital, University of Padua, 35122 Padua, Italy
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Kalapos A, Szabó L, Dohy Z, Kiss M, Merkely B, Gyires-Tóth B, Vágó H. Automated T1 and T2 mapping segmentation on cardiovascular magnetic resonance imaging using deep learning. Front Cardiovasc Med 2023; 10:1147581. [PMID: 37522085 PMCID: PMC10374405 DOI: 10.3389/fcvm.2023.1147581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Structural and functional heart abnormalities can be examined non-invasively with cardiac magnetic resonance imaging (CMR). Thanks to the development of MR devices, diagnostic scans can capture more and more relevant information about possible heart diseases. T1 and T2 mapping are such novel technology, providing tissue specific information even without the administration of contrast material. Artificial intelligence solutions based on deep learning have demonstrated state-of-the-art results in many application areas, including medical imaging. More specifically, automated tools applied at cine sequences have revolutionized volumetric CMR reporting in the past five years. Applying deep learning models to T1 and T2 mapping images can similarly improve the efficiency of post-processing pipelines and consequently facilitate diagnostic processes. Methods In this paper, we introduce a deep learning model for myocardium segmentation trained on over 7,000 raw CMR images from 262 subjects of heterogeneous disease etiology. The data were labeled by three experts. As part of the evaluation, Dice score and Hausdorff distance among experts is calculated, and the expert consensus is compared with the model's predictions. Results Our deep learning method achieves 86% mean Dice score, while contours provided by three experts on the same data show 90% mean Dice score. The method's accuracy is consistent across epicardial and endocardial contours, and on basal, midventricular slices, with only 5% lower results on apical slices, which are often challenging even for experts. Conclusions We trained and evaluated a deep learning based segmentation model on 262 heterogeneous CMR cases. Applying deep neural networks to T1 and T2 mapping could similarly improve diagnostic practices. Using the fine details of T1 and T2 mapping images and high-quality labels, the objective of this research is to approach human segmentation accuracy with deep learning.
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Affiliation(s)
- András Kalapos
- Department of Telecommunications and Media Informatics, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Liliána Szabó
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Zsófia Dohy
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Máté Kiss
- Siemens Healthcare, Budapest, Hungary
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Bálint Gyires-Tóth
- Department of Telecommunications and Media Informatics, Faculty of Electrical Engineering and Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Hajnalka Vágó
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
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189
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Ninagawa K, Kato M, Tsuneta S, Ishizaka S, Ujiie H, Hisada R, Kono M, Fujieda Y, Ito YM, Atsumi T. Beneficial effects of nintedanib on cardiomyopathy in patients with systemic sclerosis: a pilot study. Rheumatology (Oxford) 2023; 62:2550-2555. [PMID: 36458921 DOI: 10.1093/rheumatology/keac674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/29/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Nintedanib is an inhibitor of tyrosine kinases that has been shown to slow the progression of interstitial lung disease (ILD), including ILD associated with SSc. The aim of this study was to explore the effect of nintedanib on cardiomyopathy associated with systemic sclerosis (SSc). METHODS Twenty consecutively hospitalized patients with SSc-ILD were enrolled and prospectively followed. The rate of change at 6 months in cardiac magnetic resonance (CMR) parametric mapping, including myocardial extracellular volume, was primarily evaluated. Other endpoints included changes in CMR functional parameters, echocardiographic parameters, modified Rodnan skin score, serum biomarkers and pulmonary function test. RESULTS Nintedanib was administered in 10 patients, whereas the other 10 were treated without nintedanib or watched, according to ILD severity and progression. Baseline values of CMR parametric mapping were not different between the two groups. The rate of change at 6 months in myocardial extracellular volume was highly different, almost divergent, between the nintedanib group and the control group (-1.62% vs +2.00%, P = 0.0001). Among other endpoints, the change in right ventricular ejection fraction was significantly different between the two groups (P = 0.02), with a preferential change in the nintedanib group. CONCLUSION Our data indicate beneficial signals of nintedanib on cardiomyopathy associated with SSc. The anti-fibrotic effect of nintedanib might not be limited to the lung.
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Affiliation(s)
- Keita Ninagawa
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satonori Tsuneta
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Hisada
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michihito Kono
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Cannata F, Stefanini G, Carlo-Stella C, Chiarito M, Figliozzi S, Novelli L, Lisi C, Bombace S, Panico C, Cosco F, Corrado F, Masci G, Mazza R, Ricci F, Monti L, Ferrante G, Santoro A, Francone M, da Costa BR, Jüni P, Condorelli G. Nebivolol versus placebo in patients undergoing anthracyclines (CONTROL Trial): rationale and study design. J Cardiovasc Med (Hagerstown) 2023; 24:469-474. [PMID: 37285278 DOI: 10.2459/jcm.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS Anthracyclines are the chemotherapeutic agents most frequently associated with cardiotoxicity, while remaining widely used. Different neurohormonal blockers have been tested as a primary prevention strategy to prevent or attenuate the onset of cardiotoxicity, with mixed results. However, prior studies were often limited by a nonblinded design and an assessment of cardiac function based only on echocardiographic imaging. Moreover, on the basis of an improved mechanistic understanding of anthracycline cardiotoxicity mechanisms, new therapeutic strategies have been proposed. Among cardioprotective drugs, nebivolol might be able to prevent the cardiotoxic effects of anthracyclines, through its protective properties towards the myocardium, endothelium, and cardiac mitochondria. This study aims to evaluate the cardioprotective effects of the beta blocker nebivolol in a prospective, placebo-controlled, superiority randomized trial in patients with breast cancer or diffuse large B cell lymphoma (DLBCL) who have a normal cardiac function and will receive anthracyclines as part of their first-line chemotherapy programme. METHODS The CONTROL trial is a randomized, placebo-controlled, double-blinded, superiority trial. Patients with breast cancer or a DLBCL, with a normal cardiac function as assessed by echocardiography, scheduled for treatment with anthracyclines as part of their first-line chemotherapy programme will be randomized 1 : 1 to nebivolol 5 mg once daily (o.d.) or placebo. Patients will be examined with cardiological assessment, echocardiography and cardiac biomarkers at baseline, 1 month, 6 months and 12 months. A cardiac magnetic resonance (CMR) assessment will be performed at baseline and at 12 months. The primary end point is defined as left ventricular ejection fraction reduction assessed by CMR at 12 months of follow-up. CONCLUSION The CONTROL trial is designed to provide evidence to assess the cardioprotective role of nebivolol in patients undergoing chemotherapy with anthracyclines. CLINICAL TRIAL REGISTRATION The study is registered in the EudraCT registry (number: 2017-004618-24) and in the ClinicalTrials.gov registry (identifier: NCT05728632).
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Stefano Figliozzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Novelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Sara Bombace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Cristina Panico
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesca Cosco
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesco Corrado
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giovanna Masci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Rita Mazza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesca Ricci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Giuseppe Ferrante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Bruno R da Costa
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Jüni
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
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Ragab H, Lund GK, Breitsprecher L, Sinn MR, Muellerleile K, Cavus E, Stehning C, Tahir E, Blankenberg S, Patten M, Pressler A, Adam G, Avanesov M. Prevalence and pattern of focal and potential diffuse myocardial fibrosis in male and female marathon runners using contrast-enhanced cardiac magnetic resonance. Eur Radiol 2023; 33:4648-4656. [PMID: 36683089 PMCID: PMC10289973 DOI: 10.1007/s00330-023-09416-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/24/2022] [Accepted: 01/01/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES This study analyzed the prevalence and pattern of focal and potential diffuse myocardial fibrosis detected by late gadolinium enhancement (LGE) and extracellular volume (ECV) imaging in male and female marathon runners using cardiac magnetic resonance (CMR). METHODS Seventy-four marathon runners were studied including 55 males (44 ± 8 years) and 19 females (36 ± 7 years) and compared to 36 controls with similar age and sex using contrast-enhanced CMR, exercise testing, and blood samples. RESULTS Contrast-enhanced CMR revealed focal myocardial fibrosis in 8 of 74 runners (11%). The majority of runners were male (7 of 8, 88%). LGE was typically non-ischemic in 7 of 8 runners (88%) and ischemic in one runner. ECV was higher in remote myocardium without LGE in male runners (25.5 ± 2.3%) compared to male controls (24.0 ± 3.0%, p < 0.05), indicating the potential presence of diffuse myocardial fibrosis. LV mass was higher in LGE + males (86 ± 18 g/m2) compared to LGE- males (73 ± 14 g/m2, p < 0.05). Furthermore, LGE + males had lower weight (69 ± 9 vs 77 ± 9 kg, p < 0.05) and shorter best marathon finishing times (3.2 ± 0.3 h) compared to LGE- males (3.6 ± 0.4 h, p < 0.05) suggesting higher training load in these runners to accomplish the marathon in a short time. CONCLUSION The high frequency of non-ischemic myocardial fibrosis in LGE + male runners can be related to increased LV mass in these runners. Furthermore, a higher training load could explain the higher LV mass and could be one additional cofactor in the genesis of myocardial fibrosis in marathon runners. KEY POINTS • A high frequency of myocardial fibrosis was found in marathon runners. • Myocardial fibrosis occurred typically in male runners and was typically non-ischemic. • Higher training load could be one cofactor in the genesis of myocardial fibrosis in marathon runners.
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Affiliation(s)
- Haissam Ragab
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lynn Breitsprecher
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin R Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | | | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Axel Pressler
- Private Center for Sports and Exercise Cardiology, Munich, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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192
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Endo Y, Kobayashi K, Shibo H, Amanuma M, Kuhara S. Using Dictionary Matching to Improve the Accuracy of MOLLI Myocardial T1 Analysis and Measurements of Heart Rate Variability. Magn Reson Med Sci 2023; 22:389-399. [PMID: 35732413 PMCID: PMC10449558 DOI: 10.2463/mrms.tn.2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 11/09/2022] Open
Abstract
We analyzed modified Look-Locker inversion recovery (MOLLI) T1 measurements by applying a dictionary matching strategy and aimed to acquire T1 measurements more accurately than those acquired by the conventional three-parameter matching analysis. We particularly clarified the robustness of this method for measuring heart rate (HR) variability. A phantom experiment using a 3T MRI system was performed for various HRs. The ideal MOLLI signal corresponding to the scan parameter in the MRI experiment was simulated over a wide range of T1 values according to the dictionary. The unknown T1 values were determined by finding the simulated signals in the dictionary corresponding to the measured signals using pattern matching. The measured T1 values showed that the proposed analysis improved the accuracy of T1 measurements compared to those acquired by traditional analysis by up to 10%. In addition, the variability of measurements at several HRs was reduced by up to 100 ms.
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Affiliation(s)
- Yuta Endo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Kuninori Kobayashi
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Haruna Shibo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Makoto Amanuma
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
| | - Shigehide Kuhara
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Mitaka, Tokyo, Japan
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193
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Fijalkowska J, Glinska A, Fijalkowski M, Sienkiewicz K, Kulawiak-Galaska D, Szurowska E, Pienkowska J, Dorniak K. Cardiac Magnetic Resonance Relaxometry Parameters, Late Gadolinium Enhancement, and Feature-Tracking Myocardial Longitudinal Strain in Patients Recovered from COVID-19. J Cardiovasc Dev Dis 2023; 10:278. [PMID: 37504534 PMCID: PMC10380498 DOI: 10.3390/jcdd10070278] [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: 05/26/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
COVID-19 infection is associated with myocarditis, and cardiovascular magnetic resonance (CMR) is the reference non-invasive imaging modality for myocardial tissue characterization. Quantitative CMR techniques, such as feature tracking (FT) and left ventricular global longitudinal strain (GLS) analysis, have been introduced as promising diagnostic tools to improve the diagnostic accuracy of suspected myocarditis. The aim of this study was to analyze the left ventricular global longitudinal strain (GLS) and the influence of T1 and T2 relaxation times, ECV, and LGE appearance on GLS parameters in a multiparametric imaging protocol in patients who recovered from COVID-19. The 86 consecutive patients enrolled in the study had all recovered from mild or moderate COVID-19 infections; none required hospitalization. Their persistent symptoms and suspected myocarditis led to cardiac magnetic resonance imaging within 3 months of the diagnosis of the SARS-CoV-2 infection. Results: Patients with GLS less negative than -15% had significantly lower LVEF (53.6% ± 8.9 vs. 61.6% ± 4.8; <0.001) and were significantly more likely to have prolonged T1 (28.6% vs. 7.5%; p = 0.019). Left ventricular GLS correlated significantly with T1 (r = 0.303; p = 0.006) and LVEF (r = -0.732; p < 0.001). Left ventricular GLS less negative than -15% was 7.5 times more likely in patients with prolonged T1 (HR 7.62; 95% CI 1.25-46.64). The reduced basal inferolateral longitudinal strain had a significant impact on the global left ventricular longitudinal strain. ROC results suggested that a GLS of 14.5% predicted prolonged T1 relaxation time with the best sensitivity and specificity. Conclusions: CMR abnormalities, including a myocarditis pattern, are common in patients who have recovered from COVID-19. The CMR feature-tracking left ventricular GLS is related to T1 relaxation time and may serve as a novel parameter to detect global and regional myocardial injury and dysfunction in patients with suspected myocardial involvement after recovery from COVID-19.
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Affiliation(s)
- Jadwiga Fijalkowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Anna Glinska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Fijalkowski
- First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | | | | | - Edyta Szurowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Joanna Pienkowska
- Second Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Karolina Dorniak
- Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland
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194
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Halfmann MC, Luetkens JA, Langenbach IL, Kravchenko D, Wenzel P, Emrich T, Isaak A. Cardiac MRI Findings in Patients Clinically Referred for Evaluation of Post-Acute Sequelae of SARS-CoV-2 Infection. Diagnostics (Basel) 2023; 13:2172. [PMID: 37443565 DOI: 10.3390/diagnostics13132172] [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: 06/12/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Persistent or recurrent cardiovascular symptoms have been identified as one of the hallmarks of long-COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). The purpose of this study was to determine the prevalence and extent of cardiac abnormalities in patients referred for cardiac MRI due to clinical evidence of PASC. To investigate this, two tertiary care hospitals identified all patients who were referred for cardiac MRI under the suspicion of PASC in a 2-year period and retrospectively included them in this study. Patients with previously known cardiac diseases were excluded. This resulted in a total cohort of 129 patients (63, 51% female; age 41 ± 16 years). The majority of patients (57%) showed normal cardiac results. No patient had active myocarditis or an acute myocardial infarction. However, 30% of patients had evidence of non-ischemic myocardial fibrosis, which exceeds the prevalence in the normal adult population and suggests that a possible history of myocarditis might explain persistent symptoms in the PASC setting.
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Affiliation(s)
- Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55116 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
| | - Julian A Luetkens
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Isabel L Langenbach
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | | | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, 55116 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55116 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55116 Mainz, Germany
| | - Alexander Isaak
- Researchers for the Future (Forschende für die Zukunft), German Society of Radiology (DRG), 10587 Berlin, Germany
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany
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195
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Sinn M, Petersen J, Lenz A, von Stumm M, Sequeira Groß TM, Huber L, Reichenspurner H, Adam G, Lund G, Bannas P, Girdauskas E. Cardiac T1 mapping enables risk prediction of LV dysfunction after surgery for aortic regurgitation. Front Cardiovasc Med 2023; 10:1155787. [PMID: 37424901 PMCID: PMC10328445 DOI: 10.3389/fcvm.2023.1155787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background To assess whether cardiac T1 mapping for detecting myocardial fibrosis enables preoperative identification of patients at risk for early left ventricular dysfunction after surgery of aortic regurgitation. Methods 1.5 Tesla cardiac magnetic resonance imaging was performed in 40 consecutive aortic regurgitation patients before aortic valve surgery. Native and post-contrast T1 mapping was performed using a modified Look-Locker inversion-recovery sequence. Serial echocardiography was performed at baseline and 8 ± 5 days after aortic valve surgery to quantify LV dysfunction. Receiver operating characteristic analysis was performed to determine the diagnostic accuracy of native T1 mapping and extracellular volume for predicting postoperative LV ejection fraction decrease >-10% after aortic valve surgery. Results Native T1 was significantly increased in patients with a postoperatively decreased LVEF (n = 15) vs. patients with a preserved postoperative LV ejection fraction (n = 25) (i.e., 1,071 ± 67 ms vs. 1,019 ± 33 ms, p = .001). Extracellular volume was not significantly different between patients with preserved vs. decreased postoperative LV ejection fraction. With a cutoff-of value of 1,053 ms, native T1 yielded an area under the curve (AUC) of .820 (95% CI: .683-.958) for differentiating between patients with preserved vs. reduced LV ejection fraction with 70% sensitivity and 84% specificity. Conclusion Increased preoperative native T1 is associated with a significantly higher risk of systolic LV dysfunction early after aortic valve surgery in aortic regurgitation patients. Native T1 could be a promising tool to optimize the timing of aortic valve surgery in patients with aortic regurgitation to prevent early postoperative LV dysfunction.
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Affiliation(s)
- Martin Sinn
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | - Maria von Stumm
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | | | - Lukas Huber
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | | | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
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196
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Yue P, Xu Z, Wan K, Tan Y, Xu Y, Xie X, Mui D, Yi C, Han Y, Chen Y. Multiparametric mapping by cardiovascular magnetic resonance imaging in cardiac tumors. J Cardiovasc Magn Reson 2023; 25:37. [PMID: 37349765 PMCID: PMC10286406 DOI: 10.1186/s12968-023-00938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND There is a paucity of quantitative measurements of cardiac tumors and myocardium using parametric mapping techniques. This study aims to explore quantitative characteristics and diagnostic performance of native T1, T2, and extracellular volume (ECV) values of cardiac tumors and left ventricular (LV) myocardium. METHODS Patients with suspected cardiac tumors who underwent cardiovascular magnetic resonance (CMR) between November 2013 and March 2021 were prospectively enrolled. The diagnoses of primary benign or malignant tumors were based on pathologic findings if available, comprehensive medical history evaluations, imaging, and long-term follow-up data. Patients with pseudo-tumors, cardiac metastasis, primary cardiac diseases, and prior radiotherapy or chemotherapy were excluded. Multiparametric mapping values were measured on both cardiac tumors and the LV myocardium. Statistical analyses were performed using independent-samples t-test, receiver operating characteristic, and Bland-Altman analyses. RESULTS A total of 80 patients diagnosed with benign (n = 54), or primary malignant cardiac tumors (n = 26), and 50 age and sex-matched healthy volunteers were included. Intergroup differences in the T1 and T2 values of cardiac tumors were not significant, however, patients with primary malignant cardiac tumors showed significantly higher mean myocardial T1 values (1360 ± 61.4 ms) compared with patients with benign tumors (1259.7 ± 46.2 ms), and normal controls (1206 ± 44.0 ms, all P < 0.05) at 3 T. Patients with primary malignant cardiac tumors also showed significantly higher mean ECV (34.6 ± 5.2%) compared with patients with benign (30.0 ± 2.5%) tumors, and normal controls (27.3 ± 3.0%, all P < 0.05). For the differentiation between primary malignant and benign cardiac tumors, the mean myocardial native T1 value showed the highest efficacy (AUC: 0.919, cutoff value: 1300 ms) compared with mean ECV (AUC: 0.817) and T2 (AUC: 0.619) values. CONCLUSION Native T1 and T2 of cardiac tumors showed high heterogeneity, while myocardial native T1 values in primary malignant cardiac tumors were elevated compared to patients with benign cardiac tumors, which may serve as a new imaging marker for primary malignant cardiac tumors.
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Affiliation(s)
- Pengfei Yue
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ziqian Xu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yinxi Tan
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Xiaotong Xie
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - David Mui
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Cheng Yi
- Division of Abdominal Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, OH USA
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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197
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Szabo L, McCracken C, Cooper J, Rider OJ, Vago H, Merkely B, Harvey NC, Neubauer S, Petersen SE, Raisi-Estabragh Z. The role of obesity-related cardiovascular remodelling in mediating incident cardiovascular outcomes: a population-based observational study. Eur Heart J Cardiovasc Imaging 2023; 24:921-929. [PMID: 36660920 PMCID: PMC10284050 DOI: 10.1093/ehjci/jeac270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS We examined associations of obesity with incident cardiovascular outcomes and cardiovascular magnetic resonance (CMR) phenotypes, integrating information from body mass index (BMI) and waist-to-hip ratio (WHR). Then, we used multiple mediation to define the role of obesity-related cardiac remodelling in driving obesity-outcome associations, independent of cardiometabolic diseases. METHODS AND RESULTS In 491 606 UK Biobank participants, using Cox proportional hazard models, greater obesity (higher WHR, higher BMI) was linked to significantly greater risk of incident ischaemic heart disease, atrial fibrillation (AF), heart failure (HF), all-cause mortality, and cardiovascular disease (CVD) mortality. In combined stratification by BMI and WHR thresholds, elevated WHR was associated with greater risk of adverse outcomes at any BMI level. Individuals with overweight BMI but normal WHR had weaker disease associations. In the subset of participants with CMR (n = 31 107), using linear regression, greater obesity was associated with higher left ventricular (LV) mass, greater LV concentricity, poorer LV systolic function, lower myocardial native T1, larger left atrial (LA) volumes, poorer LA function, and lower aortic distensibility. Of note, higher BMI was linked to higher, whilst greater WHR was linked to lower LV end-diastolic volume (LVEDV). In Cox models, greater LVEDV and LV mass (LVM) were linked to increased risk of CVD, most importantly HF and an increased LA maximal volume was the key predictive measure of new-onset AF. In multiple mediation analyses, hypertension and adverse LV remodelling (higher LVM, greater concentricity) were major independent mediators of the obesity-outcome associations. Atrial remodelling and native T1 were additional mediators in the associations of obesity with AF and HF, respectively. CONCLUSIONS We demonstrate associations of obesity with adverse cardiovascular phenotypes and their significant independent role in mediating obesity-outcome relationships. In addition, our findings support the integrated use of BMI and WHR to evaluate obesity-related cardiovascular risk.
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Affiliation(s)
- Liliana Szabo
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Jackie Cooper
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Oliver J Rider
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 1122, Budapest, Varosmajor utca 68, Hungary
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, Gibbs Building, 215 Euston Rd, London NW1 2BE, UK
- Alan Turing Institute, British Library, 96 Euston Rd, London NW1 2DB, UK
| | - Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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198
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Halfmann MC, Müller L, von Henning U, Kloeckner R, Schöler T, Kreitner KF, Düber C, Wenzel P, Varga-Szemes A, Göbel S, Emrich T. Cardiac MRI-based right-to-left ventricular blood pool T2 relaxation times ratio correlates with exercise capacity in patients with chronic heart failure. J Cardiovasc Magn Reson 2023; 25:33. [PMID: 37331991 PMCID: PMC10278263 DOI: 10.1186/s12968-023-00943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND MRI T2 mapping has been proven to be sensitive to the level of blood oxygenation. We hypothesized that impaired exercise capacity in chronic heart failure is associated with a greater difference between right (RV) to left ventricular (LV) blood pool T2 relaxation times due to a higher level of peripheral blood desaturation, compared to patients with preserved exercise capacity and to healthy controls. METHODS Patients with chronic heart failure (n = 70) who had undergone both cardiac MRI (CMR) and a 6-min walk test (6MWT) were retrospectively identified. Propensity score matched healthy individuals (n = 35) served as control group. CMR analyses included cine acquisitions and T2 mapping to obtain blood pool T2 relaxation times of the RV and LV. Following common practice, age- and gender-adjusted nominal distances and respective percentiles were calculated for the 6MWT. The relationship between the RV/LV T2 blood pool ratio and the results from 6MWT were evaluated by Spearman's correlation coefficients and regression analyses. Inter-group differences were assessed by independent t-tests and univariate analysis of variance. RESULTS The RV/LV T2 ratio moderately correlated with the percentiles of nominal distances in the 6MWT (r = 0.66) while ejection fraction, end-diastolic and end-systolic volumes showed no correlation (r = 0.09, 0.07 and - 0.01, respectively). In addition, there were significant differences in the RV/LV T2 ratio between patients with and without significant post-exercise dyspnea (p = 0.001). Regression analyses showed that RV/LV T2 ratio was an independent predictor of the distance walked and the presence of post-exercise dyspnea (p < 0.001). CONCLUSION The proposed RV/LV T2 ratio, obtained by two simple measurements on a routinely acquired four-chamber T2 map, was superior to established parameters of cardiac function to predict exercise capacity and the presence of post-exercise dyspnea in patients with chronic heart failure.
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Affiliation(s)
- Moritz C. Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Urs von Henning
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Theresia Schöler
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, 5 Courtenay Drive, Charleston, SC 29425-2260 USA
| | - Sebastian Göbel
- Department of Cardiology, University Medical Center Mainz-Center of Cardiology, Johannes Gutenberg University, Langenbeckst.1, 55131 Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckst. 1, 55131 Mainz, Germany
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199
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Tessari FC, Lopes MAAADM, Campos CM, Rosa VEE, Sampaio RO, Soares FJMM, Lopes RRS, Nazzetta DC, de Brito Jr FS, Ribeiro HB, Vieira MLC, Mathias W, Fernandes JRC, Lopes MP, Rochitte CE, Pomerantzeff PMA, Abizaid A, Tarasoutchi F. Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention. Front Cardiovasc Med 2023; 10:1197408. [PMID: 37378406 PMCID: PMC10291604 DOI: 10.3389/fcvm.2023.1197408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Classical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR. Methods This is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups according to the median value of the mean transaortic gradient (≤25 and >25 mmHg). All-cause, intraprocedural, 30-day, and 1-year mortality rates were evaluated. Results All of the patients had degenerative aortic stenosis, with a median age of 66 (60-73) years; most of the patients were men (83%). The median EuroSCORE II was 2.19% (1.5%-4.78%), and the median STS was 2.19% (1.6%-3.99%). On DSE, 73.2% had flow reserve (FR), i.e., an increase in stroke volume ≥20% during DSE, with no significant differences between groups. On CMR, late gadolinium enhancement mass was lower in the group with mean transaortic gradient >25 mmHg [2.0 (0.0-8.9) g vs. 8.5 (2.3-15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3-5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864-0.986, p = 0.019). A mean transaortic gradient ≤25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114). Conclusions In patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if ≤25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.
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Affiliation(s)
- Fernanda Castiglioni Tessari
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Antonieta Albanez A. de M. Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Hemodynamic, Real Hospital Português, Recife, Brazil
| | - Carlos M. Campos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Hemodynamic, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Vitor Emer Egypto Rosa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roney Orismar Sampaio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Rener Romulo Souza Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniella Cian Nazzetta
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Sândoli de Brito Jr
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Henrique Barbosa Ribeiro
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo L. C. Vieira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Mathias
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Joao Ricardo Cordeiro Fernandes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Pezzute Lopes
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos E. Rochitte
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pablo M. A. Pomerantzeff
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Abizaid
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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200
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Shin SH, Kim SM, Cho SJ, Choe YH. Longitudinal Changes in the Myocardial T1 Relaxation Time, Extracellular Volume Fraction, and Left Ventricular Function in Asymptomatic Men. J Cardiovasc Dev Dis 2023; 10:252. [PMID: 37367417 DOI: 10.3390/jcdd10060252] [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: 04/16/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
(1) Background: Longitudinal changes in myocardial T1 relaxation time are unknown. We aimed to assess the longitudinal changes in the left ventricular (LV) myocardial T1 relaxation time and LV function. (2) Methods: Fifty asymptomatic men (mean age, 52.0 years) who underwent 1.5 T cardiac magnetic resonance imaging twice at an interval of 54 ± 21 months were included in this study. The LV myocardial T1 times and extracellular volume fractions (ECVFs) were calculated using the MOLLI technique (before and 15 min after gadolinium contrast injection). The 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score was calculated. (3) Results: No significant differences in the following parameters were noted between the initial and follow-up assessments: LV ejection fraction (65.0 ± 6.7% vs. 63.6 ± 6.3%, p = 0.12), LV mass/end-diastolic volume ratio (0.82 ± 0.12 vs. 0.80 ± 0.14, p = 0.16), native T1 relaxation time (982 ± 36 vs. 977 ± 37 ms, p = 0.46), and ECVF (24.97 ± 2.38% vs. 25.02 ± 2.41%, p = 0.89). The following parameters decreased significantly from the initial assessment to follow-up: stroke volume (87.2 ± 13.7 mL vs. 82.6 ± 15.3 mL, p = 0.01), cardiac output (5.79 ± 1.17 vs. 5.50 ± 1.04 L/min, p = 0.01), and LV mass index (110.16 ± 22.38 vs. 104.32 ± 18.26 g/m2, p = 0.01). The 10-year ASCVD risk score also remained unchanged between the two timepoints (4.71 ± 0.19% vs. 5.16 ± 0.24%, p = 0.14). (4) Conclusion: Myocardial T1 values and ECVFs were stable over time in the same middle-aged men.
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Affiliation(s)
- Sang Hwa Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Soo-Jin Cho
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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