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Heidecker B, Dagan N, Balicer R, Eriksson U, Rosano G, Coats A, Tschöpe C, Kelle S, Poland GA, Frustaci A, Klingel K, Martin P, Hare JM, Cooper LT, Pantazis A, Imazio M, Prasad S, Lüscher TF. Myocarditis following COVID-19 vaccine: incidence, presentation, diagnosis, pathophysiology, therapy, and outcomes put into perspective. A clinical consensus document supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases. Eur J Heart Fail 2022; 24:2000-2018. [PMID: 36065751 PMCID: PMC9538893 DOI: 10.1002/ejhf.2669] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 01/18/2023] Open
Abstract
Over 10 million doses of COVID-19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post-vaccine myocarditis can result from adaptive humoral and cellular, cardiac-specific inflammation within days and weeks of vaccination. Rates of vaccine-associated myocarditis vary by age and sex with the highest rates in males between 12 and 39 years. The clinical course is generally mild with rare cases of left ventricular dysfunction, heart failure and arrhythmias. Mild cases are likely underdiagnosed as cardiac magnetic resonance imaging (CMR) is not commonly performed even in suspected cases and not at all in asymptomatic and mildly symptomatic patients. Hospitalization of symptomatic patients with electrocardiographic changes and increased plasma troponin levels is considered necessary in the acute phase to monitor for arrhythmias and potential decline in left ventricular function. In addition to evaluation for symptoms, electrocardiographic changes and elevated troponin levels, CMR is the best non-invasive diagnostic tool with endomyocardial biopsy being restricted to severe cases with heart failure and/or arrhythmias. The management beyond guideline-directed treatment of heart failure and arrhythmias includes non-specific measures to control pain. Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs, and corticosteroids have been used in more severe cases, with only anecdotal evidence for their effectiveness. In all age groups studied, the overall risks of SARS-CoV-2 infection-related hospitalization and death are hugely greater than the risks from post-vaccine myocarditis. This consensus statement serves as a practical resource for physicians in their clinical practice, to understand, diagnose, and manage affected patients. Furthermore, it is intended to stimulate research in this area.
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Affiliation(s)
- Bettina Heidecker
- Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt, Universität zu Berlin, Berlin, Germany
| | - Noa Dagan
- Clalit Health Services, Clalit Research Institute, Ramat Gan, Israel
| | - Ran Balicer
- Clalit Health Services, Clalit Research Institute, Ramat Gan, Israel
| | - Urs Eriksson
- Department of Internal Medicine, Division of Cardiology, GZO - Zurich Regional Health Center, Wetzikon & University of Zurich, Zurich, Switzerland
| | | | - Andrew Coats
- Monash University, Melbourne, Victoria, Australia.,University of Warwick, Warwick, UK
| | - Carsten Tschöpe
- Cardiology, German Heart Center, Charité - University Medicine, Berlin, Germany
| | - Sebastian Kelle
- Cardiology, German Heart Center, Charité - University Medicine, Berlin, Germany
| | | | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy.,IRCCS L. Spallanzani, Rome, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Pilar Martin
- Cientro Nacional de Investigationes Cardiovasculares, Madrid, Spain
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, USA
| | - Leslie T Cooper
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA, and Cardiology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - Antonis Pantazis
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, Udine University Health Integrated Agency, Udine, Italy
| | - Sanjay Prasad
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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252
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Lustermans DRPRM, Amirrajab S, Veta M, Breeuwer M, Scannell CM. Optimized automated cardiac MR scar quantification with GAN-based data augmentation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107116. [PMID: 36148718 DOI: 10.1016/j.cmpb.2022.107116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The clinical utility of late gadolinium enhancement (LGE) cardiac MRI is limited by the lack of standardization, and time-consuming postprocessing. In this work, we tested the hypothesis that a cascaded deep learning pipeline trained with augmentation by synthetically generated data would improve model accuracy and robustness for automated scar quantification. METHODS A cascaded pipeline consisting of three consecutive neural networks is proposed, starting with a bounding box regression network to identify a region of interest around the left ventricular (LV) myocardium. Two further nnU-Net models are then used to segment the myocardium and, if present, scar. The models were trained on the data from the EMIDEC challenge, supplemented with an extensive synthetic dataset generated with a conditional GAN. RESULTS The cascaded pipeline significantly outperformed a single nnU-Net directly segmenting both the myocardium (mean Dice similarity coefficient (DSC) (standard deviation (SD)): 0.84 (0.09) vs 0.63 (0.20), p < 0.01) and scar (DSC: 0.72 (0.34) vs 0.46 (0.39), p < 0.01) on a per-slice level. The inclusion of the synthetic data as data augmentation during training improved the scar segmentation DSC by 0.06 (p < 0.01). The mean DSC per-subject on the challenge test set, for the cascaded pipeline augmented by synthetic generated data, was 0.86 (0.03) and 0.67 (0.29) for myocardium and scar, respectively. CONCLUSION A cascaded deep learning-based pipeline trained with augmentation by synthetically generated data leads to myocardium and scar segmentations that are similar to the manual operator, and outperforms direct segmentation without the synthetic images.
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Affiliation(s)
- Didier R P R M Lustermans
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Sina Amirrajab
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Mitko Veta
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Marcel Breeuwer
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of MR R&D - Clinical Science, Philips Healthcare, Best, the Netherlands
| | - Cian M Scannell
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
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253
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Left Ventricular Function and Iron Loading Status in a Tertiary Center Hemochromatosis Cohort-A Cardiac Magnetic Resonance Study. Diagnostics (Basel) 2022; 12:diagnostics12112620. [PMID: 36359463 PMCID: PMC9689750 DOI: 10.3390/diagnostics12112620] [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: 09/29/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Haemochromatosis (HCH), a common genetic disorder with variable penetrance, results in progressive but understudied iron overload. We prospectively evaluated organ iron loading and cardiac function in a tertiary center HCH cohort. Methods: 42 HCH patients (47 ± 14 years) and 36 controls underwent laboratory workup and cardiac magnetic resonance (CMR), including T1 and T2* mapping. Results: Myocardial T2* (myoT2*), myocardial T1 (myoT1) and liver T2* (livT2*) were lower in patients compared to controls (33 ± 4 ms vs. 36 ± 3 ms [p = 0.004], 964 ± 33 ms vs. 979 ± 25 ms [p = 0.028] and 21 ± 10 ms vs. 30 ± 5 ms [p < 0.001], respectively). MyoT2* did not reach the threshold of clinically significant iron overload (<20 ms), in any of the patients. In 22 (52.4%) patients, at least one of the tissue parameters was reduced. Reduced myocardial T2* and/or T1 were found in 10 (23.8%) patients, including 4 pts with normal livT2*. LivT2* was reduced in 18 (42.9%) patients. MyoT1 and livT2* inversely correlated with ferritin (rs = −0.351 [p = 0.028] and rs = −0.602 [p < 0.001], respectively). LivT2* by a dedicated sequence and livT2* by cardiac T2* mapping showed good agreement (ICC = 0.876 p < 0.001). Conclusions: In contemporary hemochromatosis, significant myocardial iron overload is rare. Low myocardial T2* and/or T1 values may warrant closer follow-up for accelerated myocardial iron overload even in patients without overt liver overload. Cardiac T2* mapping sequence allows for liver screening at the time of CMR.
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254
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Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes. J Cardiovasc Dev Dis 2022; 9:jcdd9100361. [PMID: 36286312 PMCID: PMC9604894 DOI: 10.3390/jcdd9100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.
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255
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Yue X, Yang L, Wang R, Chan Q, Yang Y, Wu X, Ruan X, Zhang Z, Wei Y, Wang F. The diagnostic value of multiparameter cardiovascular magnetic resonance for early detection of light-chain amyloidosis from hypertrophic cardiomyopathy patients. Front Cardiovasc Med 2022; 9:1017097. [PMID: 36330005 PMCID: PMC9623184 DOI: 10.3389/fcvm.2022.1017097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Early-stage amyloidosis of the heart is prone to be underdiagnosed or misdiagnosed, increasing the risk of early heart failure and even death of the patient. To ensure timely intervention for cardiac light-chain amyloidosis (AL CA), it is vital to develop an effective tool for early identification of the disease. Recently, multiparameter cardiovascular magnetic resonance (CMR) has been used as a comprehensive tool to assess myocardial tissue characterization. We aimed to investigate the difference in left ventricular (LV) strain, native T1, extracellular volume (ECV), and late gadolinium enhancement (LGE) between AL CA patients, hypertrophic cardiomyopathy patients (HCM), and healthy control subjects (HA). Moreover, we explored the value of multiparameter CMR for differential diagnosis of the early-stage AL CA patients from HCM patients, who shared similar imaging characteristics under LGE imaging. Methods A total of 38 AL CA patients, 16 HCM patients, and 17 HA people were prospectively recruited. All subjects underwent LGE imaging, Cine images, and T1 mapping on a 3T scanner. The LV LGE pattern was recorded as none, patchy or global. LV strain, native T1, and ECV were measured semi-automatically using dedicated CMR software. According to clinical and biochemical markers, all patients were classified as Mayo stage I/II and Mayo stage IIIa/IIIb. Univariable and multivariable logistic regression models were utilized to identify independent predictors of early-stage AL CA from HCM patients. Receiver operator characteristic (ROC) curve analysis and Youden’s test were done to determine the accuracy of multiparameter CMR in diagnosing Mayo stage I/II AL CA and establish a cut-off value. Results For Mayo stage I/II AL CA patients, the global longitudinal strain (GLS) absolute value (11.9 ± 3.0 vs. 9.5 ± 1.8, P < 0.001) and the global circumferential strain (GCS) absolute value (19.0 ± 3.6 vs. 9.5 ± 1.8, P < 0.001) were significantly higher than in HCM patients. The native T1 (1334.9 ± 49.9 vs. 1318.2 ± 32.4 ms, P < 0.0001) and ECV values (37.8 ± 5.7 vs. 31.3 ± 2.5%, P < 0.0001) were higher than that of HCM patients. In multiparameter CMR models, GCS (2.097, 95% CI: 1.292–3.403, P = 0.003), GLS (1.468, 95% CI: 1.078–1.998, P = 0.015), and ECV (0.727, 95% CI: 0.569–0.929, P = 0.011) were the significant variables for the discrimination of the early-stage AL CA patients from HCM patients. ROC curve analysis and Youden’s test were used on GCS, GLS, ECV, and pairwise parameters for differentiating between Mayo stage I/II AL CA and HCM patients, respectively. The combination of GLS, GCS, and ECV mapping could distinguish Mayo stage I/II AL amyloidosis patients from hypertrophic cardiomyopathy with excellent performance (AUC = 0.969, Youden index = 0.813). Conclusion In early-stage AL CA patients with atypical LGE, who had similar imaging features as HCM patients, ECV mapping, GCS, and GLS were correlated with the clinical classification of the patients. The combination of GCS, GLS, and ECV could differentiate early-stage AL CA from HCM patients. Multiparameter CMR has the potential to provide an effective and quantitative tool for the early diagnosis of myocardial amyloidosis.
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Affiliation(s)
| | - Lili Yang
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Rui Wang
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Queenie Chan
- Philips Healthcare, Hong Kong, Hong Kong SAR, China
| | - Yanbing Yang
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Xiaohong Wu
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Xiaowei Ruan
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Zhen Zhang
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Yuping Wei
- Department of Hematology, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
| | - Fang Wang
- Medical Imaging Center, People’s Hospital of Ningxia Hui Autonomous Region (The North University of Nationalities Teaching Hospital), Yinchuan, China
- *Correspondence: Fang Wang,
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256
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Baldassarre LA, Ganatra S, Lopez-Mattei J, Yang EH, Zaha VG, Wong TC, Ayoub C, DeCara JM, Dent S, Deswal A, Ghosh AK, Henry M, Khemka A, Leja M, Rudski L, Villarraga HR, Liu JE, Barac A, Scherrer-Crosbie M. Advances in Multimodality Imaging in Cardio-Oncology: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:1560-1578. [PMID: 36229093 DOI: 10.1016/j.jacc.2022.08.743] [Citation(s) in RCA: 24] [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: 05/20/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
The population of patients with cancer is rapidly expanding, and the diagnosis and monitoring of cardiovascular complications greatly rely on imaging. Numerous advances in the field of cardio-oncology and imaging have occurred in recent years. This review presents updated and practical approaches for multimodality cardiovascular imaging in the cardio-oncology patient and provides recommendations for imaging to detect the myriad of adverse cardiovascular effects associated with antineoplastic therapy, such as cardiomyopathy, atherosclerosis, vascular toxicity, myocarditis, valve disease, and cardiac masses. Uniquely, we address the role of cardiovascular imaging in patients with pre-existing cardiomyopathy, pregnant patients, long-term survivors, and populations with limited resources. We also address future avenues of investigation and opportunities for artificial intelligence applications in cardio-oncology imaging. This review provides a uniform practical approach to cardiovascular imaging for patients with cancer.
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Affiliation(s)
- Lauren A Baldassarre
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarju Ganatra
- Cardio-Oncology and Cardiac MRI Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Juan Lopez-Mattei
- Cardiovascular Imaging Program, Department of Cardiovascular Medicine, Lee Health, Fort Myers, Florida, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Vlad G Zaha
- Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Timothy C Wong
- UPMC Cardiovascular Magnetic Resonance Center, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chadi Ayoub
- Division of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeanne M DeCara
- Cardio-Oncology Program, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, University College London Hospital and Hatter Cardiovascular Institute, London, United Kingdom
| | - Mariana Henry
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abhishek Khemka
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lawrence Rudski
- Azrieli Heart Center, Department of Medicine, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jennifer E Liu
- Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ana Barac
- Medstar Heart and Vascular Institute, Georgetown University, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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257
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Lindholm A, Kjellström B, Seemann F, Carlsson M, Hesselstrand R, Rådegran G, Arheden H, Ostenfeld E. Atrioventricular plane displacement and regional function to predict outcome in pulmonary arterial hypertension. Int J Cardiovasc Imaging 2022; 38:2235-2248. [PMID: 37726454 PMCID: PMC10509124 DOI: 10.1007/s10554-022-02616-w] [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: 12/30/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
To investigate if left and right atrioventricular plane displacement (AVPD) or regional contributions to SV are prognostic for outcome in patients with pulmonary arterial hypertension (PAH). Seventy-one patients with PAH and 20 sex- and age-matched healthy controls underwent CMR. Myocardial borders and RV insertion points were defined at end diastole and end systole in cine short-axis stacks to compute biventricular volumes, lateral (SVlat%) and septal (SVsept%) contribution to stroke volume. Eight atrioventricular points were defined at end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views for computation of AVPD and longitudinal contribution to stroke volume (SVlong%). Cut-off values for survival analysis were defined as two standard deviations above or below the mean of the controls. Outcome was defined as death or lung transplantation. Median follow-up time was 3.6 [IQR 3.7] years. Patients were 57 ± 19 years (65% women) and controls 58 ± 15 years (70% women). Biventricular AVPD, SVlong% and ejection fraction (EF) were lower and SVlat% was higher, while SVsept% was lower in PAH compared with controls. In PAH, transplantation-free survival was lower below cut-off for LV-AVPD (hazard ratio [HR] = 2.1, 95%CI 1.2-3.9, p = 0.02) and RV-AVPD (HR = 9.8, 95%CI 4.6-21.1, p = 0.005). In Cox regression analysis, lower LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR = 1.16, p = 0.007; RV: HR = 1.11, p = 0.01; per mm decrease). LV-SVlong%, RV-SVlong%, LV-SVlat%, RV-SVlat%, SVsept% and LV- and RVEF did not affect outcome. Low left and right AVPD were associated with outcome in PAH, but regional contributions to stroke volume and EF were not.
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Affiliation(s)
- Anthony Lindholm
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Barbro Kjellström
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Felicia Seemann
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, and the Clinic for Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, and the Section for Heart Failure and Valvular Disease, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, 221 85 Lund, Sweden
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258
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Pons-Lladó G, Kellman P. State-of-the-Art of Myocardial Perfusion by CMR: A Practical View. Rev Cardiovasc Med 2022; 23:325. [PMID: 39077124 PMCID: PMC11267340 DOI: 10.31083/j.rcm2310325] [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: 06/11/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 07/31/2024] Open
Abstract
Ischemic heart disease (IHD) outstands among diseases threatening public health. Essential for its management are the continuous advances in medical and interventional therapies, although a prompt and accurate diagnosis and prognostic stratification are equally important. Besides information on the anatomy of coronary arteries, well covered nowadays by invasive and non-invasive angiographic techniques, there are also other components of the disease with clinical impact, as the presence of myocardial necrosis, the extent of pump function impairment, and the presence and extent of inducible myocardial ischemia, that must be considered in every patient. Cardiovascular Magnetic Resonance (CMR) is a multiparametric diagnostic imaging technique that provides reliable information on these issues. Regarding the detection and grading of inducible ischemia in particular, the technique has been widely adopted in the form of myocardial perfusion sequences under vasodilator stress, which is the subject of this review. While the analysis of images is conventionally performed by visual inspection of dynamic first-pass studies, with the inherent dependency on the operator capability, the recent introduction of a reliable application of quantitative perfusion (QP) represents a significant advance in the field. QP is based on a dual-sequence strategy for conversion of signal intensities into contrast agent concentration units and includes a full automatization of processes such as myocardial blood flow (MBF) calculation (in mL/min/g), generation of a pixel-wise flow mapping, myocardial segmentation, based on machine learning, and allocation of MBF values to myocardial segments. The acquisition of this protocol during induced vasodilation and at rest gives values of stress/rest MBF (in mL/min/g) and myocardial perfusion reserve (MPR), both global and per segment. Dual-sequence QP has been successfully validated against different reference methods, and its prognostic value has been shown in large longitudinal studies. The fact of the whole process being automated, without operator interaction, permits to conceive new interesting scenarios of integration of CMR into systems of entirely automated diagnostic workflow in patients with IHD.
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Affiliation(s)
- Guillem Pons-Lladó
- Head (Emeritus), Cardiac Imaging Unit, Cardiology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Clínica Creu Banca, 08034 Barcelona, Spain
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA
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259
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Mengel A, Nenova L, Müller KAL, Poli S, Kowarik MC, Feil K, Mizera L, Geisler T, Kübler J, Mahrholdt H, Ernemann U, Hennersdorf F, Ziemann U, Nikolaou K, Gawaz M, Krumm P, Greulich S. TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study. Front Cardiovasc Med 2022; 9:989376. [PMID: 36247463 PMCID: PMC9561415 DOI: 10.3389/fcvm.2022.989376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 01/01/2023] Open
Abstract
AimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadolinium Enhancement (LGE)-cardiac magnetic resonance (CMR) with mapping techniques [T1, T2, extracellular volume (ECV)] allow the detection of both focal and diffuse myocardial abnormalities. We investigated the prevalence of culprit lesions by coronary angiography and myocardial tissue abnormalities by a comprehensive CMR protocol in troponin-positive stroke patients.Methods and resultsPatients with troponin-positive acute ischemic stroke and no history of coronary artery disease were prospectively enrolled. Coronary angiography and CMR (LGE, T1 + T2 mapping, ECV) were performed within the first days of the acute stroke. Twenty-five troponin-positive patients (mean age 62 years, 44% females) were included. 2 patients (8%) had culprit lesions on coronary angiography and underwent percutaneous coronary intervention. 13 patients (52%) demonstrated LGE: (i) n = 4 ischemic, (ii) n = 4 non-ischemic, and (iii) n = 5 ischemic AND non-ischemic. In the 12 LGE-negative patients, mapping revealed diffuse myocardial damage in additional 9 (75%) patients, with a high prevalence of increased T2 values.ConclusionsOur data show a low prevalence of culprit lesions in troponin-positive stroke patients. However, > 50% of the patients demonstrated myocardial scars (ischemic + non-ischemic) by LGE-CMR. Mapping revealed additional myocardial abnormalities (mostly inflammatory) in the majority of LGE-negative patients. Therefore, a comprehensive CMR protocol gives important insights in the etiology of troponin which might have implications for the further work-up of troponin-positive stroke patients.
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Affiliation(s)
- Annerose Mengel
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lilyana Nenova
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Karin A. L. Müller
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus C. Kowarik
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Katharina Feil
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lars Mizera
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
- *Correspondence: Simon Greulich,
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Abdulmonem L Hashem D, Chan VSH, Hanneman K, Wald RM, Thavendiranathan P, Ouzounian M, Oechslin E, Karur GR. Association of Pectus Excavatum With Ventricular Remodelling and Mitral Valve Abnormalities in Marfan Syndrome. Can Assoc Radiol J 2022; 74:446-454. [PMID: 36164999 DOI: 10.1177/08465371221127236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Marfan syndrome (MFS) is an inherited connective tissue disorder. Pectus excavatum (PEX) is common in MFS. The purpose was to evaluate the association of PEX with cardiovascular manifestations of MFS, biventricular size and function. Methods: MFS adults undergoing cardiac MRI were retrospectively evaluated. Exclusion criteria were incomplete cardiac MRI, significant artifacts, co-existent ischaemic or congenital heart disease. Haller Index (HI) ≥3.25 classified patients as PEX positive (PEX+) and PEX negative (PEX-). Cardiac MRI analysis included assessment of mitral valve prolapse (MVP), mitral annular disjunction (MAD), biventricular volumetry and aortic dimensions. Results: 212 MFS patients were included, 76 PEX+ and 136 PEX- (HI 8.3 ± 15.2 vs 2.3 ± 0.5, P < .001). PEX+ were younger (33.4 ± 12.0 vs 38.1 ± 14.3 years, P = .02) and similar in sex distribution (55% vs 63% male, P = .26) compared to PEX-. MVP and MAD were more frequent in PEX+ vs PEX- (43/76 [57%] vs 37/136 [27%], P < .001; 44/76 [58%] vs 50/136[37%], P = .003, respectively). PEX+ had higher right ventricular end-diastolic and end-systolic volumes (RVEDVi 92 ± 17mL/m2 vs 84 ± 22mL/m2, P = .04; RVESVi 44 ± 10 mL/m2 vs 39 ± 14 mL/m2, P = .02), lower RV ejection fraction (RVEF 52 ± 5% vs 55 ± 6%, P = .01) compared to PEX-. Left ventricular (LV) volumes, LVEF and aortic dimensions were similar. Conclusion: MFS adults with PEX have higher frequency of cardiac manifestations including MV abnormalities, increased RV volumes and lower RVEF compared to those without PEX. Awareness of this association is important for all radiologists who interpret aortic CT or MRI, where HI can be easily measured. PEX in MFS may suggest more severe disease expression necessitating careful screening for MV abnormalities and outcomes surveillance.
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Affiliation(s)
- Dalia Abdulmonem L Hashem
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Victor Siang Hua Chan
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Kate Hanneman
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Rachel M Wald
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paaladinesh Thavendiranathan
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada,Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Erwin Oechslin
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gauri R Karur
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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261
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Maharlou M, Kaviani R, Rezaeian N, Amin A, Omidvar R, Farrashi M. Right ventricular peak systolic free wall longitudinal strain as a practical tool to detect right ventricular dysfunction in acute myocarditis. Echocardiography 2022; 39:1291-1298. [PMID: 36126335 DOI: 10.1111/echo.15449] [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: 04/18/2022] [Revised: 07/21/2022] [Accepted: 08/20/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Acute myocarditis is one of the etiologies of acute heart failure, chronic dilated cardiomyopathy, and cardiac mortality. The extent of right ventricular (RV) involvement and its impact on the course of the disease have been scarcely studied. This study aimed to evaluate both the prevalence of RV dysfunction in acute myocarditis and echocardiographic measures as a diagnostic tool for RV dysfunction compared with cardiac magnetic resonance imaging (CMR) findings. METHODS This retrospective study enrolled patients with a definite or probable acute myocarditis diagnosis based on the Lake Louise criteria in CMR and evaluated the diagnostic accuracy of echocardiographic measures in predicting RV dysfunction in CMR. RESULTS The study population consisted of 71 patients, including 54 men (76%), at a median (Q1-Q3) age of 33 (26-46) years. CMR detected RV dysfunction in 53.5% of the patients. The RV free wall peak systolic longitudinal strain showed the highest correlation (r = -.786, p < .001) and area under the curve (.919) with the RV ejection fraction in CMR, followed by the RV global peak systolic longitudinal strain and the RV fractional area change. The RV-free wall peak systolic longitudinal strain had a sensitivity of 92% and a specificity of 73% for the diagnosis of RV dysfunction in myocarditis. A cutoff value of -17.9% was 100% specific for RV systolic dysfunction. CONCLUSIONS Echocardiography, as a readily available tool, was predictive of and had acceptable accuracy for RV dysfunction in acute myocarditis compared with CMR.
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Affiliation(s)
- Maryam Maharlou
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raheleh Kaviani
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Rezaeian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Omidvar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Melody Farrashi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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262
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Adeliño R, Martínez-Falguera D, Curiel C, Teis A, Marsal R, Rodríguez-Leor O, Prat-Vidal C, Fadeuilhe E, Aranyó J, Revuelta-López E, Sarrias A, Bazan V, Andrés-Cordón JF, Roura S, Villuendas R, Lupón J, Bayes-Genis A, Gálvez-Montón C, Bisbal F. Electrophysiological effects of adipose graft transposition procedure (AGTP) on the post-myocardial infarction scar: A multimodal characterization of arrhythmogenic substrate. Front Cardiovasc Med 2022; 9:983001. [PMID: 36204562 PMCID: PMC9530287 DOI: 10.3389/fcvm.2022.983001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the arrhythmic safety profile of the adipose graft transposition procedure (AGTP) and its electrophysiological effects on post-myocardial infarction (MI) scar. Background Myocardial repair is a promising treatment for patients with MI. The AGTP is a cardiac reparative therapy that reduces infarct size and improves cardiac function. The impact of AGTP on arrhythmogenesis has not been addressed. Methods MI was induced in 20 swine. Contrast-enhanced magnetic resonance (ce-MRI), electrophysiological study (EPS), and left-ventricular endocardial high-density mapping were performed 15 days post-MI. Animals were randomized 1:1 to AGTP or sham-surgery group and monitored with ECG-Holter. Repeat EPS, endocardial mapping, and ce-MRI were performed 30 days post-intervention. Myocardial SERCA2, Connexin-43 (Cx43), Ryanodine receptor-2 (RyR2), and cardiac troponin-I (cTnI) gene and protein expression were evaluated. Results The AGTP group showed a significant reduction of the total infarct scar, border zone and dense scar mass by ce-MRI (p = 0.04), and a decreased total scar and border zone area in bipolar voltage mapping (p < 0.001). AGTP treatment significantly reduced the area of very-slow conduction velocity (<0.2 m/s) (p = 0.002), the number of deceleration zones (p = 0.029), and the area of fractionated electrograms (p = 0.005). No differences were detected in number of induced or spontaneous ventricular arrhythmias at EPS and Holter-monitoring. SERCA2, Cx43, and RyR2 gene expression were decreased in the infarct core of AGTP-treated animals (p = 0.021, p = 0.018, p = 0.051, respectively). Conclusion AGTP is a safe reparative therapy in terms of arrhythmic risk and provides additional protective effect against adverse electrophysiological remodeling in ischemic heart disease.
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Affiliation(s)
- Raquel Adeliño
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Daina Martínez-Falguera
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Carolina Curiel
- Boston Scientific Department, Barcelona Delegation, Barcelona, Spain
| | - Albert Teis
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Roger Marsal
- Boston Scientific Department, Barcelona Delegation, Barcelona, Spain
| | - Oriol Rodríguez-Leor
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Prat-Vidal
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Edgar Fadeuilhe
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Júlia Aranyó
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Elena Revuelta-López
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Axel Sarrias
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Víctor Bazan
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - Santiago Roura
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Roger Villuendas
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Can Ruti Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Can Ruti Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina Gálvez-Montón
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Carolina Gálvez-Montón,
| | - Felipe Bisbal
- ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Barcelona, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Carolina Gálvez-Montón,
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263
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Vago H, Szabo L, Szabo Z, Ulakcsai Z, Szogi E, Budai G, Toth A, Juhasz V, Dohy Z, Hoffer K, Becker D, Kiss RG, Nagy GG, Nagy G, Merkely B. Immunological response and temporal associations in myocarditis after COVID-19 vaccination using cardiac magnetic resonance imaging: An amplified T-cell response at the heart of it? Front Cardiovasc Med 2022; 9:961031. [PMID: 36186968 PMCID: PMC9520979 DOI: 10.3389/fcvm.2022.961031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Although myocarditis after anti-SARS-CoV-2 vaccination is increasingly recognized, we have little data regarding the course of the disease and, consequently, the imaging findings, including the tissue-specific features. The purpose of this study is to describe the clinical, immunological, and cardiac magnetic resonance (CMR) features of myocarditis after COVID-19 immunization in the acute phase and during follow-up. We aimed to compare the trajectory of the disease to myocarditis cases unrelated to COVID-19. Methods We assembled a CMR-based registry of potentially COVID-19 vaccination-related myocarditis cases. All patients who experienced new-onset chest pain and troponin elevation after COVID-19 vaccination and imaging confirming the clinical suspicion of acute myocarditis were enrolled in our study. Participants underwent routine laboratory testing and testing of their humoral and cellular immune response to COVID-19 vaccination. Clinical and CMR follow-up was performed after 3–6 months. We included two separate, sex- and age-matched control groups: (1) individuals with myocarditis unrelated to COVID-19 infection or vaccination confirmed by CMR and (2) volunteers with similar immunological exposure to SARS-CoV-2 compared to our group of interest (no difference in the number of doses, types and the time since anti-SARS-CoV-2 vaccination and no difference in anti-nucleocapsid levels). Results We report 16 CMR-confirmed cases of myocarditis presenting (mean ± SD) 4 ± 2 days after administration of the anti-SARS-CoV-2 vaccine (male patients, 22 ± 7 years), frequently with predisposing factors such as immune-mediated disease and previous myocarditis. We found that 75% received mRNA vaccines, and 25% received vector vaccines. During follow-up, CMR metrics depicting myocardial injury, including oedema and necrosis, decreased or completely disappeared. There was no difference regarding the CMR metrics between myocarditis after immunization and myocarditis unrelated to COVID-19. We found an increased T-cell response among myocarditis patients compared to matched controls (p < 0.01), while there was no difference in the humoral immune response. Conclusion In our cohort, myocarditis occurred after both mRNA and vector anti-SARS-CoV-2 vaccination, frequently in individuals with predisposing factors. Upon follow-up, the myocardial injury had healed. Notably, an amplified cellular immune response was found in acute myocarditis cases occurring 4 days after COVID-19 vaccination.
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Affiliation(s)
- Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
- *Correspondence: Hajnalka Vago
| | - Liliana Szabo
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Queen Mary University of London, London, United Kingdom
| | - Zsofia Szabo
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Ulakcsai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | | | - Gizella Budai
- Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, University of Debrecen, Debrecen, Hungary
| | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vencel Juhasz
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsofia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Krisztina Hoffer
- Department of Radiology, Erzsébet Teaching Hospital and Rehabilitation Institute of Sopron, Sopron, Hungary
| | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Gergely Gyorgy Nagy
- Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, University of Debrecen, Debrecen, Hungary
| | - Gyorgy Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
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Wenzel JP, Nikorowitsch J, Bei der Kellen R, Dohm L, Girdauskas E, Lund G, Bannas P, Blankenberg S, Kölbel T, Cavus E, Müllerleile K, Kaul MG, Adam G, Weinrich JM. Comparison of cine cardiac magnetic resonance and echocardiography derived diameters of the aortic root in a large population-based cohort. Sci Rep 2022; 12:15307. [PMID: 36096919 PMCID: PMC9468025 DOI: 10.1038/s41598-022-19461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Transthoracic echocardiography (TTE) and cine cardiac magnetic resonance imaging (CMR) are established imaging methods of the aortic root. We aimed to evaluate the comparability of measurements in TTE and standard cine CMR sequences of the aortic root. Our study included 741 subjects (mean age 63.5 ± 8 years, 43.7% female) from the Hamburg City Health Study (HCHS). Subjects underwent CMR and TTE. Aortic root measurements were performed at the level of the aortic annulus (AoAn), sinus of Valsalva (SoV), and sinotubular junction (STJ) by standard cine CMR in left ventricular long axis and left ventricular outflow tract view. Measurements were performed applying the leading-edge to leading-edge (LL) convention and inner-edge to inner-edge (II) convention in TTE and the II convention in CMR. Inter correlation coefficients (ICCs) demonstrated high inter- and intraobserver reproducibility for CMR and TTE measurements of SoV and STJ (ICCs 0.9–0.98) and moderate reproducibility for AoAn (ICCs 0.68–0.91). CMR measurements of SoV and STJ showed strong agreement with TTE: while correlations were comparable (r = 0.75–0.85) bias was lower with TTE II (bias − 0.1 to − 0.74) versus TTE LL measurements (mean bias − 1.49 to − 2.58 mm). The agreement for AoAn was fair (r = 0.51–0.57) with variable bias (mean bias 0.39–3.9). Standard cine CMR and TTE derived aortic root measurements are reproducible and comparable with higher agreement for TTE II instead of LL measurements. These results support an interchangeable application of TTE and standard CMR for screening of aortic root diseases thereby possibly reducing redundant multimodality imaging.
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Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany. .,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ramona Bei der Kellen
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Luisa Dohm
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Michael Gerhard Kaul
- 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
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Orsborne C, Bradley J, Bonnett LJ, Pleva LA, Naish JH, Clark DG, Abidin N, Woolfson P, Nucifora G, Schmitt M, Jovanovic A, Miller CA, Reid AB. Validated Model for Prediction of Adverse Cardiac Outcome in Patients With Fabry Disease. J Am Coll Cardiol 2022; 80:982-994. [PMID: 36049806 DOI: 10.1016/j.jacc.2022.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/10/2022] [Accepted: 06/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The cardiac manifestations of Fabry disease are the leading cause of death, but risk stratification remains inadequate. Identifying patients who are at risk of adverse cardiac outcome may facilitate more evidence-based treatment guidance. Contemporary cardiovascular cardiac magnetic resonance biomarkers have become widely adopted, but their prognostic value remains unclear. OBJECTIVES The objective of this study was to develop, internally validate, and evaluate the performance of, a prognostic model, including contemporary deep phenotyping, which can be used to generate individual risk estimates for adverse cardiac outcome in patients with Fabry disease. METHODS This longitudinal prospective cohort study consisted of 200 consecutive patients with Fabry disease undergoing clinical cardiac magnetic resonance. Median follow-up was 4.5 years (IQR: 2.7-6.3 years). Prognostic models were developed using Cox proportional hazards modeling. Outcome was a composite of adverse cardiac events. Model performance was evaluated. A risk calculator, which provides 5-year estimated risk of adverse cardiac outcome for individual patients, including men and women, was generated. RESULTS The highest performing, internally validated, parsimonious multivariable model included age, native myocardial T1 dispersion (SD of per voxel myocardial T1 relaxation times), and indexed left ventricular mass. Median optimism-adjusted c-statistic across 5 imputed model development data sets was 0.77 (95% CI: 0.70-0.84). Model calibration was excellent across the full risk profile. CONCLUSIONS This study developed and internally validated a risk prediction model that accurately predicts 5-year risk of adverse cardiac outcome for individual patients with Fabry disease, including men and women, which could easily be integrated into clinical care. External validation is warranted.
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Affiliation(s)
- Christopher Orsborne
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Joshua Bradley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, a Member of Liverpool Health Partners, Liverpool, United Kingdom
| | - Luke A Pleva
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Josephine H Naish
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - David G Clark
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Nik Abidin
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Peter Woolfson
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Gaetano Nucifora
- Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
| | - Ana Jovanovic
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
| | - Anna B Reid
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom
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Puntmann VO, Martin S, Shchendrygina A, Hoffmann J, Ka MM, Giokoglu E, Vanchin B, Holm N, Karyou A, Laux GS, Arendt C, De Leuw P, Zacharowski K, Khodamoradi Y, Vehreschild MJGT, Rohde G, Zeiher AM, Vogl TJ, Schwenke C, Nagel E. Long-term cardiac pathology in individuals with mild initial COVID-19 illness. Nat Med 2022; 28:2117-2123. [PMID: 36064600 PMCID: PMC9556300 DOI: 10.1038/s41591-022-02000-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/08/2022] [Indexed: 01/03/2023]
Abstract
Cardiac symptoms are increasingly recognized as late complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in previously well individuals with mild initial illness, but the underlying pathophysiology leading to long-term cardiac symptoms remains unclear. In this study, we conducted serial cardiac assessments in a selected population of individuals with Coronavirus Disease 2019 (COVID-19) with no previous cardiac disease or notable comorbidities by measuring blood biomarkers of heart injury or dysfunction and by performing magnetic resonance imaging. Baseline measurements from 346 individuals with COVID-19 (52% females) were obtained at a median of 109 days (interquartile range (IQR), 77-177 days) after infection, when 73% of participants reported cardiac symptoms, such as exertional dyspnea (62%), palpitations (28%), atypical chest pain (27%) and syncope (3%). Symptomatic individuals had higher heart rates and higher imaging values or contrast agent accumulation, denoting inflammatory cardiac involvement, compared to asymptomatic individuals. Structural heart disease or high levels of biomarkers of cardiac injury or dysfunction were rare in symptomatic individuals. At follow-up (329 days (IQR, 274-383 days) after infection), 57% of participants had persistent cardiac symptoms. Diffuse myocardial edema was more pronounced in participants who remained symptomatic at follow-up as compared to those who improved. Female gender and diffuse myocardial involvement on baseline imaging independently predicted the presence of cardiac symptoms at follow-up. Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness.
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Affiliation(s)
- Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Simon Martin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anastasia Shchendrygina
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jedrzej Hoffmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eleni Giokoglu
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Byambasuren Vanchin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Niels Holm
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Argyro Karyou
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gerald S Laux
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christophe Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine & Pain Therapy; Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- Department of Internal Medicine, Respiratory Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Institute of Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany
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Krumm P, Greulich S, la Fougère C, Nikolaou K. Hybrid-PET/MRT bei inflammatorischer Kardiomyopathie. DIE RADIOLOGIE 2022; 62:954-959. [PMID: 36056155 PMCID: PMC9613732 DOI: 10.1007/s00117-022-01064-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
Die Myokarditis und die inflammatorische Kardiomyopathie sind aufgrund ihrer unterschiedlichen Auslöser, Phänotypen und Stadien diagnostisch häufig schwer zu diagnostizieren.
Methodische Innovationen und Probleme
Die kardiale Positronen-Emissions-Tomographie/Magnetresonanztomographie (PET/MRT) zeichnet sich neben der myokardialen Gewebecharakterisierung mittels MRT durch den möglichen Nachweis einer aktiven myokardialen Entzündung (Inflammation) mittels PET aus. Die Kombination von MRT und PET ist somit eher synergistisch als rein summativ: Die möglicherweise in der MRT vorhandenen kardialen Veränderungen lassen sich durch die PET in aktive inflammatorische (und somit noch potenziell reversible) Prozesse oder ältere chronische (irreversible) Narben unterscheiden. Die kardiale Sarkoidose mit einem potenziellen Nebeneinander von aktiven und chronischen Veränderungen bietet sich an, um die Stärken einer hybriden PET/MRT zur Geltung bringen zu lassen. Wichtig für eine aussagekräftige kardiale PET ist eine gute Vorbereitung mit Low-Carb-Diät, um eine suffiziente Suppression der myokardialen Glukoseaufnahme zu gewährleisten.
Empfehlungen
Die Diagnostik einer inflammatorischen Herzerkrankung sowie deren Charakterisierung in akut vs. chronische Prozesse gelingt mit der kardialen Hybrid-PET/MRT, wie am Beispiel der kardialen Sarkoidose gezeigt werden konnte.
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Affiliation(s)
- Patrick Krumm
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - Simon Greulich
- Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Christian la Fougère
- Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Konstantin Nikolaou
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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268
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Cavus E, Schneider JN, Bei der Kellen R, di Carluccio E, Ziegler A, Tahir E, Bohnen S, Avanesov M, Radunski UK, Chevalier C, Jahnke C, Ojeda F, Kirchhof P, Blankenberg S, Adam G, Lund GK, Muellerleile K. Impact of Sex and Cardiovascular Risk Factors on Myocardial T1, Extracellular Volume Fraction, and T2 at 3 Tesla: Results From the Population-Based, Hamburg City Health Study. Circ Cardiovasc Imaging 2022; 15:e014158. [PMID: 36126126 DOI: 10.1161/circimaging.122.014158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Reliable reference intervals are crucial for clinical application of myocardial T1 and T2 mapping cardiovascular magnetic resonance imaging. This study evaluated the impact of sex and cardiovascular risk factors on myocardial T1, extracellular volume fraction (ECV), and T2 at 3T in the population-based HCHS (Hamburg City Health Study). METHODS The final study sample consisted of 1576 consecutive HCHS participants between 46 and 78 years without prevalent heart disease, including 1020 (67.3%) participants with hypertension and 110 (7.5%) with diabetes. T1 and T2 mapping were performed on a 3T scanner using 5b(3b)3b modified Look-Locker inversion recovery and T2 prepared, fast-low-angle shot sequence, respectively. Stepwise regression analyses were performed to identify variables with an independent impact on T1, ECV, and T2. Reference intervals were defined as the interval between the 2.5% and 97.5% quantiles. RESULTS Sex was the major independent influencing factor of myocardial native T1, ECV, and T2. Female patients had significantly higher upper limits of reference intervals for native T1 (1112-1261 versus 1079-1241 ms), ECV (23%-33% versus 22%-32%), and T2 (36-46 versus 35-45 ms) compared with male patients (all P<0.001). Cardiovascular risk factors, such as diabetes and hypertension, did not systematically affect native T1. There was an independent association of T2 by hypertension and, to a lesser degree, by left ventricular mass, heart rate (all P<0.001), and body mass index (P=0.001). CONCLUSIONS Sex needs to be considered as the major, independent influencing factor for clinical application of myocardial T1, ECV, and T2 measurements. Consequently, sex-specific reference intervals should be used in clinical routine. Our findings suggest that there is no need for specific reference intervals for myocardial T1 and ECV measurements in individuals with cardiovascular risk factors. However, hypertension should be considered as an additional factor for clinical application of T2 measurements. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03934957.
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Affiliation(s)
- Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany (E.C., P.K., S. Blankenberg, K.M.)
| | - Jan N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Ramona Bei der Kellen
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Eleonora di Carluccio
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Cardio-Care, Medizincampus Davos, Switzerland (E.d.C., A.Z.)
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Cardio-Care, Medizincampus Davos, Switzerland (E.d.C., A.Z.).,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa (A.Z.)
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Germany (E.T., M.A., G.A., G.K.L.)
| | - Sebastian Bohnen
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Germany (E.T., M.A., G.A., G.K.L.)
| | - Ulf K Radunski
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.)
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany (E.C., P.K., S. Blankenberg, K.M.)
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany (E.C., P.K., S. Blankenberg, K.M.)
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Germany (E.T., M.A., G.A., G.K.L.)
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Germany (E.T., M.A., G.A., G.K.L.)
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Germany (E.C., J.N.S., R.B.d.K., E.d.C., A.Z., S. Bohnen, U.K.R., C.C., C.J., F.O., P.K., S. Blankenberg, K.M.).,Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany (E.C., P.K., S. Blankenberg, K.M.)
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269
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Patel SG, Husain N, Rigsby CK, Robinson JD. Safety and Efficacy of Regadenoson for Pediatric Stress Perfusion Cardiac MRI with Quantification of Myocardial Blood Flow. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091332. [PMID: 36138640 PMCID: PMC9497237 DOI: 10.3390/children9091332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
Myocardial stress perfusion magnetic resonance imaging is a non-invasive tool to assess for myocardial ischemia and viability. Pediatric myocardial stress perfusion MRI can be challenging due to multiple intravenous lines, sedation, inadequate breath holding, fast heart rates, and complex anatomy. We performed a retrospective analysis in 39 children to evaluate safety and efficacy of regadenoson, a coronary vasodilator administered via a single intravenous line (6−10 mcg/kg), with respiratory motion correction (MOCO) and semi-quantitative blood flow analysis. Stress response data and adverse events were recorded, and image quality compared between native and MOCO reconstructions, assessing for perfusion deficits. Semi-quantitative analysis compared myocardial perfusion reserve index (MPRI) between patients who had a focal perfusion defect, patients who had undergone an orthotopic heart transplant, and non-transplant patients with no focal defects. Stress perfusion was completed in 38/39 patients (median age 15 years with a 41 ± 27% rise in heart rate (p < 0.005). Fifteen out of thirty-eight had transient minor side effects with no major adverse events. MOCO image quality was better than non-MOCO (4.63 vs. 4.01 at rest, p < 0.005: 4.41 vs. 3.84 at stress, p < 0.005). Reversible perfusion defects were seen in 4/38 patients with lower segmental mean MPRI in the area of the perfusion defect, nearing statistical significance when compared to non-transplant patients with no defects (0.78 ± 0.22 vs. 0.99 ± 0.36, p = 0.07). The global MPRI of the 16 patients who had undergone orthotopic heart transplant was significantly lower than the non-transplant patients (0.75 ± 0.22 vs. 0.92 ± 0.23, p = 0.03). Regadenoson is a safe and effective coronary vasodilator for pediatric stress perfusion MRI with MOCO producing better image quality and allowing for semi-quantitative assessment of perfusion deficits that correlate with qualitative assessment.
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Affiliation(s)
- Shivani G. Patel
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Correspondence:
| | - Nazia Husain
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Cynthia K. Rigsby
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Joshua D. Robinson
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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270
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Doeblin P, Jahnke C, Schneider M, Al-Tabatabaee S, Goetze C, Weiss KJ, Tanacli R, Faragli A, Witt U, Stehning C, Seidel F, Elsanhoury A, Kühne T, Tschöpe C, Pieske B, Kelle S. CMR findings after COVID-19 and after COVID-19-vaccination-same but different? Int J Cardiovasc Imaging 2022; 38:2057-2071. [PMID: 37726611 PMCID: PMC9097142 DOI: 10.1007/s10554-022-02623-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
Cardiac involvement has been described in varying proportions of patients recovered from COVID-19 and proposed as a potential cause of prolonged symptoms, often described as post-COVID or long COVID syndrome. Recently, cardiac complications have been reported from COVID-19 vaccines as well. We aimed to compare CMR-findings in patients with clinical cardiac symptoms after COVID-19 and after vaccination. From May 2020 to May 2021, we included 104 patients with suspected cardiac involvement after COVID-19 who received a clinically indicated cardiac magnetic resonance (CMR) examination at a high-volume center. The mean time from first positive PCR to CMR was 112 ± 76 days. During their COVID-19 disease, 21% of patients required hospitalization, 17% supplemental oxygen and 7% mechanical ventilation. In 34 (32.7%) of patients, CMR provided a clinically relevant diagnosis: Isolated pericarditis in 10 (9.6%), %), acute myocarditis (both LLC) in 7 (6.7%), possible myocarditis (one LLC) in 5 (4.8%), ischemia in 4 (3.8%), recent infarction in 2 (1.9%), old infarction in 4 (3.8%), dilated cardiomyopathy in 3 (2.9%), hypertrophic cardiomyopathy in 2 (1.9%), aortic stenosis, pleural tumor and mitral valve prolapse each in 1 (1.0%). Between May 2021 and August 2021, we examined an additional 27 patients with suspected cardiac disease after COVID-19 vaccination. Of these, CMR provided at least one diagnosis in 22 (81.5%): Isolated pericarditis in 4 (14.8%), acute myocarditis in 9 (33.3%), possible myocarditis (acute or subsided) in 6 (22.2%), ischemia in 3 (37.5% out of 8 patients with stress test), isolated pericardial effusion (> 10 mm) and non-compaction-cardiomyopathy each in 1 (3.7%). The number of myocarditis diagnoses after COVID-19 was highly dependent on the stringency of the myocarditis criteria applied. When including only cases of matching edema and LGE and excluding findings in the right ventricular insertion site, the number of cases dropped from 7 to 2 while the number of cases after COVID-19 vaccination remained unchanged at 9. While myocarditis is an overall rare side effect after COVID-19 vaccination, it is currently the leading cause of myocarditis in our institution due to the large number of vaccinations applied over the last months. Contrary to myocarditis after vaccination, LGE and edema in myocarditis after COVID-19 often did not match or were confined to the RV-insertion site. Whether these cases truly represent myocarditis or a different pathological entity is to be determined in further studies.
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Constantin Jahnke
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Collin Goetze
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Karl J Weiss
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Undine Witt
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Franziska Seidel
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Ahmed Elsanhoury
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Carsten Tschöpe
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Lim RP, Kachel S, Villa ADM, Kearney L, Bettencourt N, Young AA, Chiribiri A, Scannell CM. CardiSort: a convolutional neural network for cross vendor automated sorting of cardiac MR images. Eur Radiol 2022; 32:5907-5920. [PMID: 35368227 PMCID: PMC9381634 DOI: 10.1007/s00330-022-08724-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 01/22/2022] [Accepted: 03/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an image-based automatic deep learning method to classify cardiac MR images by sequence type and imaging plane for improved clinical post-processing efficiency. METHODS Multivendor cardiac MRI studies were retrospectively collected from 4 centres and 3 vendors. A two-head convolutional neural network ('CardiSort') was trained to classify 35 sequences by imaging sequence (n = 17) and plane (n = 10). Single vendor training (SVT) on single-centre images (n = 234 patients) and multivendor training (MVT) with multicentre images (n = 434 patients, 3 centres) were performed. Model accuracy and F1 scores on a hold-out test set were calculated, with ground truth labels by an expert radiologist. External validation of MVT (MVTexternal) was performed on data from 3 previously unseen magnet systems from 2 vendors (n = 80 patients). RESULTS Model sequence/plane/overall accuracy and F1-scores were 85.2%/93.2%/81.8% and 0.82 for SVT and 96.1%/97.9%/94.3% and 0.94 MVT on the hold-out test set. MVTexternal yielded sequence/plane/combined accuracy and F1-scores of 92.7%/93.0%/86.6% and 0.86. There was high accuracy for common sequences and conventional cardiac planes. Poor accuracy was observed for underrepresented classes and sequences where there was greater variability in acquisition parameters across centres, such as perfusion imaging. CONCLUSIONS A deep learning network was developed on multivendor data to classify MRI studies into component sequences and planes, with external validation. With refinement, it has potential to improve workflow by enabling automated sequence selection, an important first step in completely automated post-processing pipelines. KEY POINTS • Deep learning can be applied for consistent and efficient classification of cardiac MR image types. • A multicentre, multivendor study using a deep learning algorithm (CardiSort) showed high classification accuracy on a hold-out test set with good generalisation to images from previously unseen magnet systems. • CardiSort has potential to improve clinical workflows, as a vital first step in developing fully automated post-processing pipelines.
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Affiliation(s)
- Ruth P Lim
- Austin Health, Melbourne, Australia.
- Departments of Radiology, The University of Melbourne, Melbourne, Australia.
- Department of Surgery (Austin), The University of Melbourne, Melbourne, Australia.
| | - Stefan Kachel
- Austin Health, Melbourne, Australia
- Departments of Radiology, The University of Melbourne, Melbourne, Australia
- Department of Radiology, Columbia University, New York, USA
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Leighton Kearney
- Austin Health, Melbourne, Australia
- I-MED Radiology, Melbourne, Australia
| | | | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Cian M Scannell
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
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272
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Soulat G, Scott MB, Pathrose A, Jarvis K, Berhane H, Allen B, Avery R, Alsate AR, Rigsby CK, Markl M. 4D flow MRI derived aortic hemodynamics multi-year follow-up in repaired coarctation with bicuspid aortic valve. Diagn Interv Imaging 2022; 103:418-426. [PMID: 35523699 PMCID: PMC11041270 DOI: 10.1016/j.diii.2022.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the relationships between hemodynamic parameters and longitudinal changes in aortic dimensions on four-dimensional (4D) flow magnetic resonance imaging (MRI) in patients with bicuspid aortic valve (BAV) and repaired coarctation. MATERIALS AND METHODS The study retrospectively included patients with BAV and childhood coarctation repair who had at least two cardiothoracic MRI examinations including 4D flow MRI at baseline and follow-up. Analysis included the calculation of aortic peak velocities, wall shear stress (WSS), pulse wave velocity (PWV), aortic dimensions and annual growth rates. Differences between examinations were assessed using paired t-test or Wilcoxon signed rank test. Relationships between growth rate and 4D flow metrics were assessed using Pearson or Spearman correlation tests. RESULTS The cohort included 15 patients (mean age 35 ± 8 [SD] years, 9 men) with a median follow-up time of 3.98 years (Q1: 2.10; Q3: 4.96). There were no significant differences in aortic mean WSS, peak velocities, and PWV between baseline and follow-up values. Greater baseline peak velocities at the site of the coarctation were strongly associated with aortic narrowing (follow-up vs. baseline diameter) at coarctation zone (r = -0.64; P = 0.010) and moderately in descending aorta (r = -0.53; P = 0.042). In addition, increased baseline WSS in the aortic arch was strongly related with narrowing of the coarctation zone at follow-up (r = -0.64, P = 0.011). CONCLUSION Measures of aortic hemodynamics and aortic WSS are stable over time in patients with BAV with coarctation repair. Increased peak velocity was associated with a progressive narrowing at the site of the coarctation repair.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Université Paris Centre, PARCC INSERM, 75015 Paris, France.
| | - Michael B Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Haben Berhane
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
| | - Bradley Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Ryan Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA
| | - Alejandro Roldan Alsate
- Department of Mechanical Engineering, University of Wisconsin Madison, Madison 53706, WI, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago 60611, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago 60611, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston 60208, IL, USA
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273
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Cardiac Magnetic Resonance Features Associated with the Risk of Cardiac Arrest in Patients with Acute Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
Background: Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). Besides the location and severity of coronary occlusion, different factors may have significant role in the pathogenesis of AMI-related cardiac arrest (CA), but their contribution is still under investigation. The aim of the study was to investigate the cardiac magnetic resonance (CMR) features of myocardial injury associated with a higher risk of CA accompanying an AMI.
Methods: In total, 918 myocardial segments from 54 post-AMI patients undergoing CMR imaging with delayed gadolinium enhancement were enrolled in the study, of which 18.54% presented CA during the acute phase of AMI. In all patients, infarct mass, the proportion of high transmurality extent, and scar mass at different myocardial segments were calculated using QMap software (Medis BV).
Results: Compared to patients without CA, those with CA had a significantly higher infarct size (p = 0.03) and a higher degree of transmurality (29.28% vs. 14.1%, p = 0.01). The risk of CA during the acute phase was significantly higher in patients in whom the location of myocardial injury was at the level of latero-apical, antero-lateral, and basal anterior segments. Group 1 presented a larger infarct size at the level of the latero-apical (33.9 ± 30.6 g vs. 13.6 ± 17.3 g, p = 0.02), anterolateral (26.5 ± 29.0 g vs. 8.9 ± 12.8 g, p = 0.02), and anterobasal segment (20.1 ± 21.5 g vs. 7.8 ± 14.7 g, p = 0.02).
Conclusions: CMR imaging identified infarct mass, high transmurality degree, and large myocardial injury as features associated with an increased risk of CA in the acute phase of AMI, especially at the level of anterolateral segments.
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274
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Brendel JM, Klingel K, Kübler J, Müller KAL, Hagen F, Gawaz M, Nikolaou K, Greulich S, Krumm P. Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis. J Clin Med 2022; 11:jcm11175113. [PMID: 36079039 PMCID: PMC9457022 DOI: 10.3390/jcm11175113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Accepted: 08/28/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. (3) Methods: 48 patients (age 37 (IQR 28−55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (n = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (n = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T1, ECV, T2). (4) Results: Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T1 mapping (applying a segmental or global increase of native T1 > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T2 (AUC 0.66). (5) Conclusions: A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T1 mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings.
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Affiliation(s)
- Jan M. Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin A. L. Müller
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
- Correspondence:
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
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275
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Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy. J Clin Med 2022; 11:jcm11175047. [PMID: 36078976 PMCID: PMC9457265 DOI: 10.3390/jcm11175047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/17/2022] Open
Abstract
(1) Objectives: To discriminate biopsy-proven myocarditis (chronic vs. healed myocarditis) and to differentiate from dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR). (2) Methods: A total of 259 consecutive patients (age 51 ± 15 years; 28% female) who underwent both endomyocardial biopsy (EMB) and CMR in the years 2008−2021 were evaluated. According to right-ventricular EMB results, patients were divided into either chronic (n = 130, 50%) or healed lymphocytic myocarditis (n = 60, 23%) or DCM (n = 69, 27%). The CMR protocol included functional, strain, and late gadolinium enhancement (LGE) imaging, T2w imaging, and T2 mapping. (3) Results: Left-ventricular ejection fraction (LV-EF) was higher, and the indexed end-diastolic volume (EDV) was lower in myocarditis patients (chronic: 42%, median 96 mL/m²; healed: 49%, 86 mL/m²) compared to the DCM patients (31%, 120 mL/m²), p < 0.0001. Strain analysis demonstrated lower contractility in DCM patients vs. myocarditis patients, p < 0.0001. Myocarditis patients demonstrated a higher LGE prevalence (68% chronic; 59% healed) than the DCM patients (45%), p = 0.01. Chronic myocarditis patients showed a higher myocardial edema prevalence and ratio (59%, median 1.3) than healed myocarditis (23%, 1.3) and DCM patients (13%, 1.0), p < 0.0001. T2 mapping revealed elevated values more frequently in chronic (90%) than in healed (21%) myocarditis and DCM (23%), p < 0.0001. T2 mapping yielded an AUC of 0.89 (sensitivity 90%, specificity 76%) in the discrimination of chronic from healed myocarditis and an AUC of 0.92 (sensitivity 86%, specificity 91%) in the discrimination of chronic myocarditis from DCM, both p < 0.0001. (4) Conclusions: Multiparametric CMR imaging, including functional parameters, LGE and T2 mapping, may allow differentiation of chronic from healed myocarditis and DCM and therefore help to optimize patient management in this clinical setting.
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Contento J, Mass P, Cleveland V, Aslan S, Matsushita H, Hayashi H, Nguyen V, Kawaji K, Loke YH, Nelson K, Johnson J, Krieger A, Olivieri L, Hibino N. Location matters: Offset in tissue-engineered vascular graft implantation location affects wall shear stress in porcine models. JTCVS OPEN 2022; 12:355-363. [PMID: 36590712 PMCID: PMC9801286 DOI: 10.1016/j.xjon.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 01/04/2023]
Abstract
Objective Although surgical simulation using computational fluid dynamics has advanced, little is known about the accuracy of cardiac surgical procedures after patient-specific design. We evaluated the effects of discrepancies in location for patient-specific simulation and actual implantation on hemodynamic performance of patient-specific tissue-engineered vascular grafts (TEVGs) in porcine models. Methods Magnetic resonance angiography and 4-dimensional (4D) flow data were acquired in porcine models (n = 11) to create individualized TEVGs. Graft shapes were optimized and manufactured by electrospinning bioresorbable material onto a metal mandrel. TEVGs were implanted 1 or 3 months postimaging, and postoperative magnetic resonance angiography and 4D flow data were obtained and segmented. Displacement between intended and observed TEVG position was determined through center of mass analysis. Hemodynamic data were obtained from 4D flow analysis. Displacement and hemodynamic data were compared using linear regression. Results Patient-specific TEVGs were displaced between 1 and 8 mm during implantation compared with their surgically simulated, intended locations. Greater offset between intended and observed position correlated with greater wall shear stress (WSS) in postoperative vasculature (P < .01). Grafts that were implanted closer to their intended locations showed decreased WSS. Conclusions Patient-specific TEVGs are designed for precise locations to help optimize hemodynamic performance. However, if TEVGs were implanted far from their intended location, worse WSS was observed. This underscores the importance of not only patient-specific design but also precision-guided implantation to optimize hemodynamics in cardiac surgery and increase reproducibility of surgical simulation.
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Key Words
- 4D, four-dimensional
- AR, augmented reality
- CFD, computational fluid dynamics
- CHD, congenital heart disease
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- MRA, magnetic resonance angiography
- MRI, magnetic resonance imaging
- PA, pulmonary artery
- RPA, right pulmonary artery
- SCA, subclavian artery
- STL, stereolithography
- TEVG, tissue-engineered vascular graft
- WSS, wall shear stress
- center of gravity
- computational fluid dynamics
- displacement
- hemodynamics
- surgical planning
- tissue-engineered vascular grafts
- wall shear stress
- αSMA, α-smooth muscle actin
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Affiliation(s)
| | - Paige Mass
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Vincent Cleveland
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Seda Aslan
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
| | - Hiroshi Matsushita
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Hidenori Hayashi
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Vivian Nguyen
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
| | - Keigo Kawaji
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Ill
| | - Yue-Hin Loke
- Department of Cardiology, Children's National Hospital, Washington, DC
| | | | | | - Axel Krieger
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Md
| | - Laura Olivieri
- Department of Cardiology, Children's National Hospital, Washington, DC
| | - Narutoshi Hibino
- Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill,Department of Cardiovascular Surgery, Advocate Children's Hospital, Oak Lawn, Ill,Address for reprints: Narutoshi Hibino, MD, PhD, Section of Cardiac Surgery, Department of Surgery, The University of Chicago, Advocate Children's Hospital, 5841 S Maryland Ave, Room E500B, MC5040, Chicago, IL 60637.
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277
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Evertz R, Schulz A, Lange T, Backhaus SJ, Vollmann D, Kowallick JT, von Haehling S, Hasenfuß G, Schuster A. Cardiovascular magnetic resonance imaging patterns of acute COVID-19 mRNA vaccine-associated myocarditis in young male patients: A first single-center experience. Front Cardiovasc Med 2022; 9:965512. [PMID: 36082124 PMCID: PMC9445185 DOI: 10.3389/fcvm.2022.965512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background The risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation. Methods and results In total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients (n = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; p = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; p = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; p = 0.79 and p = 0.80). Conclusion This study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Dirk Vollmann
- Herz- and Gefäßzentrum Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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278
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Chen X, Pan J, Hu Y, Hu H, Pan Y. Feasibility of one breath-hold cardiovascular magnetic resonance compressed sensing cine for left ventricular strain analysis. Front Cardiovasc Med 2022; 9:903203. [PMID: 36035944 PMCID: PMC9411808 DOI: 10.3389/fcvm.2022.903203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the feasibility of 3D left ventricular global and regional strain by using one breath-hold (BH) compressed sensing cine (CSC) protocol and determine the agreement between CSC and conventional cine (CC) protocols.MethodsA total of 30 volunteers were enrolled in this study. Cardiovascular magnetic resonance (CMR) images were acquired using a 1.436 T magnetic resonance imaging (MRI) system. The CSC protocols included one BH CSC and the shortest BH CSC protocols with different parameters and were only performed in short-axis (SA) view following CC protocols. Left ventricular (LV) end-diastole volume (EDV), end-systole volume (ESV), stroke volume (SV), and ejection fraction (EF) global and regional strain were calculated by CC, one BH CSC, and shortest BH CSC protocols. The intraclass correlation coefficient (ICC) and coefficient of variance (CV) of these parameters were used to determine the agreement between different acquisitions.ResultsThe agreement of all volumetric variables and EF between the CC protocol and one BH CSC protocol was excellent (ICC > 0.9). EDV, ESV, and SV between CC and shortest BH CSC protocols also had a remarkable coherence (ICC > 0.9). The agreement of 3D LV global strain assessment between CC protocol and one BH CSC protocol was good (ICC > 0.8). Most CVs of variables were also good (CV < 15%). ICCs of all variables were lower than 0.8. CVs of all parameters were higher than 15% except global longitudinal strain (GLS) between CC and shortest BH CSC protocols. The agreement of regional strain between CC and BH CSC protocols was heterogeneous (-0.2 < ICC < 0.7). Many variables of CVs were poor.ConclusionNotably, one BH CSC protocol can be used for 3D global strain analysis, along with a good correlation with the CC protocol. The regional strain should continue to be computed by the CC protocol due to poor agreement and a remarkable variation between the protocols. The shortest BH CSC protocol was insufficient to replace the CC protocol for 3D global and regional strain.
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Affiliation(s)
- Xiaorong Chen
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- *Correspondence: Xiaorong Chen,
| | - Jiangfeng Pan
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- Jiangfeng Pan,
| | - Yi Hu
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yonghao Pan
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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279
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Groeneveld SA, Kirkels FP, Cramer MJ, Evertz R, Haugaa KH, Postema PG, Prakken NHJ, Teske AJ, Wilde AAM, Velthuis BK, Nijveldt R, Hassink RJ. Prevalence of Mitral Annulus Disjunction and Mitral Valve Prolapse in Patients With Idiopathic Ventricular Fibrillation. J Am Heart Assoc 2022; 11:e025364. [PMID: 35929463 PMCID: PMC9496286 DOI: 10.1161/jaha.121.025364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls. Methods and Results In this retrospective, multicenter cohort study, cardiac magnetic resonance images from patients with IVF (ie, negative for ischemia, cardiomyopathy, and channelopathies) and age‐ and sex‐matched control subjects were analyzed for the presence of MAD (≥2 mm) and MVP (>2 mm). In total, 72 patients (mean age 39±14 years, 42% women) and 72 control subjects (mean age 41±11 years, 42% women) were included. MAD in the inferolateral wall was more prevalent in patients with IVF versus healthy controls (7 [11%] versus 1 [1%], P=0.024). MVP was only seen in patients with IVF and not in controls (5 [7%] versus 0 [0%], P=0.016). MAD was observed in both patients with (n=4) and without (n=3) MVP. Conclusions Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Feddo P Kirkels
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Maarten J Cramer
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Kristina H Haugaa
- ProCardio Center for Innovation Department of Cardiology Oslo University Hospital Rikshospitalet Oslo Norway.,University of Oslo Oslo Norway
| | - Pieter G Postema
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Niek H J Prakken
- Department of Radiology University Medical Center Groningen Groningen the Netherlands
| | - Arco J Teske
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam UMC, Location AMC University of Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
| | - Birgitta K Velthuis
- Department of Radiology University Medical Center Utrecht Utrecht the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc Nijmegen the Netherlands
| | - Rutger J Hassink
- Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART) http://guardheart.ern-net.eu
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280
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Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting. Curr Cardiol Rep 2022; 24:1309-1325. [PMID: 35925511 PMCID: PMC9556385 DOI: 10.1007/s11886-022-01746-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/04/2022]
Abstract
Purpose of Review This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population. Recent Findings Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Summary Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.
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281
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Fenski M, Grandy TH, Viezzer D, Kertusha S, Schmidt M, Forman C, Schulz-Menger J. Isotropic 3D compressed sensing (CS) based sequence is comparable to 2D-LGE in left ventricular scar quantification in different disease entities. Int J Cardiovasc Imaging 2022; 38:1837-1850. [PMID: 35243574 PMCID: PMC10509092 DOI: 10.1007/s10554-022-02571-6] [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: 10/26/2021] [Accepted: 02/14/2022] [Indexed: 11/27/2022]
Abstract
The goal of this study was to evaluate a three-dimensional compressed sensing (3D-CS) LGE prototype sequence for the detection and quantification of myocardial fibrosis in patients with chronic myocardial infarction (CMI) and myocarditis (MYC) compared with a 2D-LGE standard. Patients with left-ventricular LGE due to CMI (n = 33) or MYC (n = 20) were prospectively recruited. 2D-LGE and 3D-CS images were acquired in random order at 1.5 Tesla. 3D-CS short axis (SAX) images were reconstructed corresponding to 2D SAX images. LGE was quantitatively assessed on patient and segment level using semi-automated threshold methods. Image quality (4-point scoring system), Contrast-ratio (CR) and acquisition times were compared. There was no significant difference between 2D and 3D sequences regarding global LGE (%) (CMI [2D-LGE: 11.4 ± 7.5; 3D-LGE: 11.5 ± 8.5; p = 0.99]; MYC [2D-LGE: 27.0 ± 15.7; 3D-LGE: 26.2 ± 13.1; p = 0.70]) and segmental LGE-extent (p = 0.63). 3D-CS identified papillary infarction in 5 cases which was not present in 2D images. 2D-LGE acquisition time was shorter (2D: median: 06:59 min [IQR: 05:51-08:18]; 3D: 14:48 min [12:45-16:57]). 3D-CS obtained better quality scores (2D: 2.06 ± 0.56 vs. 3D: 2.29 ± 0.61). CR did not differ (p = 0.63) between basal and apical regions in 3D-CS images but decreased significantly in 2D apical images (CR basal: 2D: 0.77 ± 0.11, 3D: 0.59 ± 0.10; CR apical: 2D: 0.64 ± 0.17, 3D: 0.53 ± 0.11). 3D-LGE shows high congruency with standard LGE and allows better identification of small lesions. However, the current 3D-CS LGE sequence did not provide PSIR reconstruction and acquisition time was longer.
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Affiliation(s)
- Maximilian Fenski
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Thomas Hiroshi Grandy
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Darian Viezzer
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Stela Kertusha
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany
| | | | | | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Charité Medical Faculty, Max-Delbrück Center for Molecular Medicine, Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Charité - Universitätsmedizin Berlin, Kardiologie - ECRC, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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282
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Tijmes FS, Karur GR. Imaging of Heritable Thoracic Aortic Disease. Semin Roentgenol 2022; 57:364-379. [DOI: 10.1053/j.ro.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022]
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283
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Characteristics and Prognostic Relevance of Ventricular Arrhythmia in Patients with Myocarditis. J Cardiovasc Dev Dis 2022; 9:jcdd9080243. [PMID: 36005407 PMCID: PMC9409489 DOI: 10.3390/jcdd9080243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Myocarditis is characterized by various clinical manifestations, with ventricular arrhythmia (VA) as a frequent symptom at initial presentation. Here, we investigated characteristics and prognostic relevance of VA in patients with myocarditis. The study population consisted of 76 patients with myocarditis, verified by biopsy and/or cardiac magnetic resonance (CMR) imaging, including 38 consecutive patients with VA (45 ± 3 years, 68% male) vs. 38 patients without VA (NVA) (38 ± 2 years, 84% male) serving as a control group. VA was monomorphic ventricular tachycardia in 55% of patients, premature ventricular complexes in 50% and ventricular fibrillation in 29%. The left ventricular ejection fraction at baseline was 47 ± 2% vs. 40 ± 3% in VA vs. NVA patients (p = 0.069). CMR showed late gadolinium enhancement more often in VA patients (94% vs. 69%; p = 0.016), incorporating 17.6 ± 1.8% vs. 8.2 ± 1.3% of myocardial mass (p < 0.001). Radiofrequency catheter ablation for VA was initially performed in nine (24%) patients, of whom five remained free from any recurrence over 24 ± 3 months. Taken together, in patients with myocarditis, reduced left ventricular ejection fraction does not predict VA occurrence but CMR shows late gadolinium enhancement more frequently and to a larger extent in VA than in NVA patients, potentially guiding catheter ablation as a reasonable treatment of VA in this population.
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284
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Yakimenka A, Labib D, Dykstra S, Mikami Y, Satriano A, Flewitt J, Feuchter P, Rivest S, Howarth AG, Lydell CP, Quinn FR, Wilton SB, White JA. Influence of Sex-Based Differences in Cardiac Phenotype on Atrial Fibrillation Recurrence in Patients Undergoing Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:894592. [PMID: 35966521 PMCID: PMC9366168 DOI: 10.3389/fcvm.2022.894592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPulmonary vein isolation (PVI) is a commonly engaged therapy for symptomatic atrial fibrillation (AF). Prior studies have documented elevated AF recurrence rates among females vs. males. Sex-specific mechanisms underlying this phenomenon are poorly understood. This prospective cohort study aimed to evaluate the sex-based differences in cardiac phenotype and their influence on (AF) recurrence following first-time PVI.MethodsA total of 204 consecutive patients referred for first-time PVI and 101 healthy subjects were prospectively studied by cardiovascular magnetic resonance (CMR) imaging. Multi-chamber volumetric and functional measures were assessed by sex-corrected Z-score analyses vs. healthy subjects. Patients were followed for a median of 2.6 years for the primary outcome of clinical AF recurrence. Multivariable analyses adjusting for age and comorbidities were performed to identify independent predictors of AF recurrence.ResultsAF recurrence following first PVI occurred in 41% of males and 59% of females (p = 0.03). Females were older with higher prevalence of hypertension and thyroid disorders. Z-score-based analyses revealed significantly reduced ventricular volumes, greater left atrial (LA) volumes, and reduced LA contractility in females vs. males. Multivariable analysis revealed each of LA minimum and pre-systolic volumes and booster EF Z-scores to be independently associated with AF recurrence, providing respective hazard ratios of 1.10, 1.19, and 0.89 (p = 0.001, 0.03, and 0.01).ConclusionAmong patients referred for first time PVI, females were older and demonstrated significantly poorer LA contractile health vs. males, the latter independently associated with AF recurrence. Assessment of LA contractile health may therefore be of value to identify female patients at elevated risk of AF recurrence. Factors influencing female patient referral for PVI at more advanced stages of atrial disease warrant focused investigation.
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Affiliation(s)
- Alena Yakimenka
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - F. Russell Quinn
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B. Wilton
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- *Correspondence: James A. White,
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285
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Zegard A, Okafor O, Moody W, Marshall H, Qiu T, Stegemann B, Beadle R, Leyva F. Right ventricular function and long-term clinical outcomes after cardiac resynchronization therapy: A cardiovascular magnetic resonance study. Pacing Clin Electrophysiol 2022; 45:1075-1084. [PMID: 35899803 DOI: 10.1111/pace.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction has been linked to a poor response to cardiac resynchronization therapy (CRT). We sought to determine whether cardiovascular magnetic resonance (CMR)-derived measures of RV function influence clinical outcomes after CRT. METHODS In this retrospective study, we used cardiovascular magnetic resonance (CMR) to assess pre-implant RV volumes and RV ejection fraction (RVEF) in relation to clinical outcomes after CRT implantation. RESULTS Among 243 patients (age: 70.3 ± 10.8 years [mean ±. SD]; 68.7% male; 121 [49.8%]) with ischemic cardiomyopathy and 122 (50.2%) with non-ischemic cardiomyopathy, 141 (58%) after CRT-defibrillation and 102 (42%) after CRT-pacing, 101 (41.6.0%) patients died, 61 (25.1%) from cardiac causes and 24 (9.88%) from non-cardiac causes, over 5.87 years (median; interquartile range: 4.35-7.73). Two (0.82%) patients underwent cardiac transplantation and 4 (1.64%) had a left ventricular assist device. A total of 41 (16.9%) met the composite endpoint of sudden cardiac death, ventricular tachycardia or ventricular fibrillation. In univariate analyses, no measure of RV function was associated with total mortality or the arrhythmic endpoint. RVEF was associated with cardiac mortality on univariate analyses (HR per 10%: 0.82, 95% CI 0.70-0.96), but not on multivariate analyses that included left ventricular ejection fraction. CONCLUSIONS There is no relationship between measures of RV function, such as RV volumes and RVEF, and the long-term clinical outcome of CRT. These findings indicate that such measures should not be considered in patient selection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Osita Okafor
- Aston Medical School, Aston University, Birmingham, UK
| | | | | | - Tian Qiu
- University Hospitals Birmingham, Birmingham, UK
| | | | - Roger Beadle
- South Warwickshire NHS Foundation Trust, Warwick, UK
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286
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Filomena D, Dresselaers T, Bogaert J. Role of Cardiovascular Magnetic Resonance to Assess Cardiovascular Inflammation. Front Cardiovasc Med 2022; 9:877364. [PMID: 35872907 PMCID: PMC9299360 DOI: 10.3389/fcvm.2022.877364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular inflammatory diseases still represent a challenge for physicians. Inflammatory cardiomyopathy, pericarditis, and large vessels vasculitis can clinically mimic a wide spectrum of diseases. While the underlying etiologies are varied, the common physio-pathological process is characterized by vasodilation, exudation, leukocytes infiltration, cell damage, and fibrosis. Cardiovascular magnetic resonance (CMR) allows the visualization of some of these diagnostic targets. CMR provides not only morphological and functional assessment but also tissue catheterization revealing edema, hyperemia, tissue injury, and reparative fibrosis through T2 weighted images, early and late gadolinium enhancement, and parametric mapping techniques. Recent developments showed the role of CMR in the identification of ongoing inflammation also in other CV diseases like myocardial infarction, atherosclerosis, arrhythmogenic and hypertrophic cardiomyopathy. Future developments of CMR, aiming at the specific assessment of immune cell infiltration, will give deeper insight into cardiovascular inflammatory diseases.
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Affiliation(s)
- Domenico Filomena
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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287
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Prospective evaluation of cardiac effects of first-time marathon training, running, and recovery in middle-aged men: cohort study rationale and design. Neth Heart J 2022; 31:21-28. [PMID: 35834104 PMCID: PMC9281212 DOI: 10.1007/s12471-022-01708-5] [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] [Accepted: 05/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several phenomena may point to potentially detrimental cardiac effects of endurance exercise, such as elevated circulating cardiac troponin levels and reductions in systolic and diastolic function directly after marathon completion. Furthermore, while myocardial abnormalities have been reported in patients who recovered from COVID-19, the cardiac impact of extensive endurance exercise in individuals who recovered from COVID-19 remains unknown. We therefore aim to investigate (potentially detrimental) cardiac effects of first-time marathon training and participation, including a subset of participants who recovered from COVID-19, in apparently healthy middle-aged men. STUDY DESIGN This exploratory prospective cohort study investigates cardiac effects of first-time marathon running in 24 middle-aged (35-50 years) healthy men. Primary outcomes are cardiac morphological changes from pre-training up to 1 month after marathon completion, measured with magnetic resonance imaging (MRI) at 4 time points: 1) baseline (4 months before the marathon), 2) pre-marathon (2 weeks before the marathon), 3) post-marathon (< 24 h post-marathon), and 4) recovery (4 weeks after the marathon). Secondary parameters include other cardiac or non-cardiac changes: 1) quantitative MRI myocardial mapping, including mean diffusivity and extracellular volume fraction, 2) echocardiographic morphology and function changes, 3) VO2max, 4) electrocardiogram changes, and 5) levels of cardiac biomarkers. DISCUSSION This study will contribute to our understanding of cardiac adaptations and maladaptations to first-time marathon running in middle-aged men, and the interaction between extreme endurance exercise and potential detrimental cardiac effects, also in the context of COVID-19. Results will inform on future research directions while providing new clinical insights for health professionals involved in athlete care.
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288
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Gröschel J, Bhoyroo Y, Blaszczyk E, Trauzeddel RF, Viezzer D, Saad H, Fenski M, Schulz-Menger J. Different Impacts on the Heart After COVID-19 Infection and Vaccination: Insights From Cardiovascular Magnetic Resonance. Front Cardiovasc Med 2022; 9:916922. [PMID: 35911510 PMCID: PMC9329612 DOI: 10.3389/fcvm.2022.916922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Myocarditis-like findings after COVID-19 (coronavirus disease 2019) infection and vaccination were reported by applying cardiovascular magnetic resonance (CMR). These results are very heterogenous and dependent on several factors such as hospital admission or outpatient treatment, timing of CMR, and symptomatic load. This retrospective study aimed to identify differences in myocardial damage in patients with persistent symptoms both after COVID-19 infection and vaccine by applying CMR. Materials and Methods This study entails a retrospective analysis of consecutive patients referred for CMR between August 2020 and November 2021 with persistent symptoms after COVID-19 infection or vaccination. Patients were compared to healthy controls (HC). All patients underwent a CMR examination in a 1.5-T scanner with a scan protocol including: cine imaging for biventricular function and strain assessment using feature tracking, T2 mapping for the quantification of edema, and T1 mapping for diffuse fibrosis and late gadolinium enhancement (LGE) for the detection and quantification of focal fibrosis. Patients were divided into a subacute COVID-19 (sCov) group with symptoms lasting < 12 weeks, post-COVID-19 (pCov) group with symptoms > 12 weeks, and patients after COVID-19 vaccination (CovVac). Results A total of 162 patients were recruited of whom 141 were included for analysis. The median age in years (interquartile range (IQR)) of the entire cohort was 45 (37–56) which included 83 women and 58 men. Subgroups were as follows (total patients per subgroup, median age in years (IQR), main gender): 34 sCov, 43 (37–52), 19 women; 63 pCov, 52 (39–58), 43 women; 44 CovVac, 43 (32–56), 23 men; 44 HC (41 (28–52), 24 women). The biventricular function was preserved and revealed no differences between the groups. No active inflammation was detected by T2 mapping. Global T1 values were higher in pCov in comparison with HC (median (IQR) in ms: pCov 1002ms (981–1023) vs. HC 987ms (963–1009; p = 0.005) with other parings revealing no differences. In 49/141 (34.6%) of patients, focal fibrosis was detectable with the majority having a non-ischemic pattern (43/141; 30.4%; patients) with the subgroups after infection having more often a subepicardial pattern compared with CovVac (total (% of group): sCov: 7/34(21%); pCov 13/63(21%); CovVac 2/44(5%); p = 0.04). Conclusion Patients after COVID-19 infection showed more focal fibrosis in comparison with patients after COVID-19 vaccination without alterations in the biventricular function.
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Affiliation(s)
- Jan Gröschel
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Yashraj Bhoyroo
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Edyta Blaszczyk
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ralf Felix Trauzeddel
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Germany
| | - Darian Viezzer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Hadil Saad
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Maximilian Fenski
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- *Correspondence: Jeanette Schulz-Menger,
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289
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Sierra-Galan LM, Bhatia M, Alberto-Delgado AL, Madrazo-Shiordia J, Salcido C, Santoyo B, Martinez E, Soto ME. Cardiac Magnetic Resonance in Rheumatology to Detect Cardiac Involvement Since Early and Pre-clinical Stages of the Autoimmune Diseases: A Narrative Review. Front Cardiovasc Med 2022; 9:870200. [PMID: 35911548 PMCID: PMC9326004 DOI: 10.3389/fcvm.2022.870200] [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: 02/06/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune diseases (ADs) encompass multisystem disorders, and cardiovascular involvement is a well-known feature of autoimmune and inflammatory rheumatic conditions. Unfortunately, subclinical and early cardiovascular involvement remains clinically silent and often undetected, despite its well-documented impact on patient management and prognostication with an even more significant effect on severe and future MACE events as the disease progresses. Cardiac magnetic resonance imaging (MRI), today, commands a unique position of supremacy versus its competition in cardiac assessment and is the gold standard for the non-invasive evaluation of cardiac function, structure, morphology, tissue characterization, and flow with the capability of evaluating biventricular function; myocardium for edema, ischemia, fibrosis, infarction; valves for thickening, large masses; pericardial inflammation, pericardial effusions, and tamponade; cardiac cavities for thrombosis; conduction related abnormalities and features of microvascular and large vessel involvement. As precise and early detection of cardiovascular involvement plays a critical role in improving the outcome of rheumatic and autoimmune conditions, our review aims to highlight the evolving role of CMR in systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), systemic sclerosis (SSc), limited sclerosis (LSc), adult-onset Still's disease (AOSD), polymyositis (PM), dermatomyositis (DM), eosinophilic granulomatosis with polyangiitis (EGPA) (formerly Churg-Strauss syndrome), and DRESS syndrome (DS). It draws attention to the need for concerted, systematic global interdisciplinary research to improve future outcomes in autoimmune-related rheumatic conditions with multiorgan, multisystem, and cardiovascular involvement.
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Affiliation(s)
- Lilia M. Sierra-Galan
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Mona Bhatia
- Department of Imaging, Fortis Escorts Heart Institute, New Delhi, India
| | | | - Javier Madrazo-Shiordia
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Carlos Salcido
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Bernardo Santoyo
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Eduardo Martinez
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
| | - Maria Elena Soto
- Cardiology Department of the Cardiovascular Division of the American British Cowdray Medical Center, Mexico City, Mexico
- Immunology Department of the National Institute of Cardiology, “Ignacio Chavez”, Mexico City, Mexico
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290
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Kang Y, Yang ZX, Liu LL, Kong H, Wang H, Dong W, Bai L, Wang J, Sun ZJ, Zhang J, Li J, Guo YQ, Zhang Q. ARNI or ARB Treats Residual Left Ventricular Remodelling after Surgery for Valvular Regurgitation: ReReRe study protocol. ESC Heart Fail 2022; 9:3585-3592. [PMID: 35822565 DOI: 10.1002/ehf2.14058] [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: 08/03/2021] [Revised: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS Patients with persistent or de novo left ventricular (LV) dilation and/or reduced ejection fraction (EF) after correction for primary aortic (AR) or mitral (MR) regurgitation (i.e. residual LV remodelling) have not been well studied with regard to guideline-directed medical therapy after successful aetiology-reversing surgery. We aim to (i) compare the effectiveness of sacubitril/valsartan vs. valsartan in promoting LV reverse remodelling and (ii) explore the safety of medication withdrawal after LV recovery. METHODS AND RESULTS The ReReRe study is a multicentre, randomized, open-label, parallel trial that consists of two consecutive parts. A total of 371 patients with an LV end-diastolic diameter (LVEDD) > 60 mm or LVEF < 50%, assessed by transthoracic echocardiography (TTE) 7-14 days after valve surgery for significant AR or primary MR will be enrolled. The 1st randomization into the sacubitril/valsartan or valsartan groups and structured follow-up (1, 3, 6, 9, and 12 months after randomization) will be conducted to observe the primary objective as the rate of complete recovery of LV remodelling (i.e. LVEDD < 55 mm and LVEF ≥ 60% by TTE at two consecutive visits). Those who have complete recovery of LV remodelling will be enrolled in Study Part 2; consequently, they will receive the 2nd randomization into the medication withdrawal or maintenance group and 6-monthly visits for the observation of the primary objective as the rate of LV remodelling relapse (LVEDD > 60 mm or LVEF < 50%). The secondary objectives include the rate of composite clinical outcomes and the degree of change in 6-min walk distance and Kansas City Cardiomyopathy Questionnaire scores. CONCLUSIONS The ReReRe study will provide new evidence for the treatment of patients with residual LV remodelling after curable unloaded surgery, as well as the duration of treatment. The study results will fill the gap in identifying an appropriate medical therapy regimen for this group of patients and perhaps for those with reversible aetiologies of heart failure.
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Affiliation(s)
- Yu Kang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Xuan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu-Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Kong
- The Heart Failure Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Dong
- Department of Cardiology, The Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Ling Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Cardiology, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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291
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Baritussio A, Muthurangu V. Cardiovascular magnetic resonance for the assessment of left ventricular filling pressure in heart failure. Eur Heart J 2022; 43:2523-2525. [PMID: 35574820 DOI: 10.1093/eurheartj/ehac247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
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292
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Warnica W, Al-Arnawoot A, Stanimirovic A, Thavendiranathan P, Wald RM, Pakkal M, Karur GR, Wintersperger BJ, Rac V, Hanneman K. Clinical Impact of Cardiac MRI T1 and T2 Parametric Mapping in Patients with Suspected Cardiomyopathy. Radiology 2022; 305:319-326. [PMID: 35787201 DOI: 10.1148/radiol.220067] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There are limited data on the incremental value of parametric mapping compared with core cardiac MRI protocols for suspected cardiomyopathy in routine clinical practice. Purpose To evaluate the impact of cardiac MRI T1 and T2 mapping in routine clinical practice with respect to diagnostic accuracy, reader diagnostic confidence, and downstream cardiac imaging utilization. Materials and Methods In this retrospective single-center study, consecutive clinical cardiac MRI scans obtained with and without T1 and T2 mapping for evaluation of suspected cardiomyopathy between January 2017 and October 2019 were evaluated. Diagnostic accuracy and reader diagnostic confidence were evaluated in a random subset. Downstream cardiac imaging utilization was analyzed in patients with a minimum of 1 year of clinical follow-up ending before January 2020. Results A total of 1876 patients (mean age, 51 years ± 17 [SD]; 1113 men) were evaluated. Of these, 751 (40%) underwent cardiac MRI with the core protocol and 1125 (60%) with the core protocol plus T1 and T2 mapping. In the mapping group, T1 and T2 were high in 280 (25%) and 47 patients (4%), respectively. In the subset evaluated for diagnostic utility (n = 450), the addition of T1 and T2 maps to the core protocol resulted in an improvement in reader diagnostic confidence in 174 patients (39%). Diagnostic sensitivity was higher with the core protocol plus mapping compared with the core protocol alone for myocarditis (89% [31 of 35 patients] vs 69% [24 of 35]; P = .008), Fabry disease (93% [13 of 14 patients] vs 50% [seven of 14]; P = .01), and amyloidosis (100% [16 of 16 patients] vs 63% [10 of 16]; P = .01). In the subset evaluated for downstream imaging utilization (n = 903), 47% of patients with mapping had at least one subsequent cardiac imaging test compared with 55% of patients without mapping (P = .01). Conclusion In patients with suspected cardiomyopathy, cardiac MRI with T1 and T2 mapping had high diagnostic utility and was associated with lower downstream cardiac imaging utilization. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Jerosch-Herold and Coelho-Filho in this issue.
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Affiliation(s)
- William Warnica
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Amna Al-Arnawoot
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Aleksandra Stanimirovic
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Rachel M Wald
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Mini Pakkal
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Gauri Rani Karur
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Bernd J Wintersperger
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Valeria Rac
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
| | - Kate Hanneman
- From the Department of Medical Imaging (W.W., A.A., P.T., R.M.W., M.P., G.R.K., B.J.W., K.H.) and Division of Cardiology (P.T., R.M.W.), Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, UHN, Toronto, Canada (A.S., V.R.); and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (V.R.)
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293
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Kaolawanich Y, Boonyasirinant T. Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance Imaging in Older Adults with Known or Suspected Coronary Artery Disease. Arq Bras Cardiol 2022; 119:97-106. [PMID: 35830106 PMCID: PMC9352122 DOI: 10.36660/abc.20210530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
Fundamento: Há dados limitados sobre o valor prognóstico da ressonância magnética cardíaca (RMC) em estresse em pacientes idosos. Objetivo: Determinar o valor prognóstico da RMC em estresse com adenosina em idosos com doença arterial coronariana (DAC) conhecida ou suspeita. Métodos: Entre 2010 e 2015, pacientes consecutivos com 65 anos ou mais encaminhados para RMC em estresse com adenosina foram acompanhados para a ocorrência de eventos cardíacos graves (morte cardíaca e infarto do miocárdio não-fatal) e eventos cardiovasculares adversos maiores (ECAM) que também incluíram hospitalização por insuficiência cardíaca e acidente vascular cerebral isquêmico. As análises univariadas e multivariadas foram realizadas para determinar o valor prognóstico da isquemia miocárdica, com valor de p <0,05 considerado estatisticamente significante. Resultados: Após um período médio de seguimento de 50,4 meses em 324 pacientes (48% do sexo masculino, 73±7 anos), ocorreram 21 eventos cardíacos graves e 52 ECAM. Pacientes com isquemia miocárdica (n=99) apresentaram taxas significantemente maiores de eventos cardíacos graves (HR 5,25 [IC 95% 2,11-13,04], p<0,001) e ECAM (HR 3,01 [IC 95% 1,75-5,20], p<0,001) do que aqueles sem isquemia. A análise multivariada determinou a isquemia como preditor independente de eventos cardíacos graves (HR 3,14 [IC 95% 1,22-8,07], p=0,02) e ECAM (HR 1,91 [IC 95% 1,02-3,59], p=0,04). A isquemia forneceu um valor prognóstico incremental sobre fatores clínicos e fração de ejeção do ventrículo esquerdo para predizer eventos cardíacos graves e ECAM (p<0,01 para ambos). Nenhum evento adverso grave ocorreu durante ou imediatamente após os exames de RMC. Conclusão: A RMC em estresse com adenosina é segura e demonstra valor prognóstico em idosos com DAC conhecida ou suspeita.
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Affiliation(s)
- Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok - Tailândia
| | - Thananya Boonyasirinant
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok - Tailândia
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294
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Martínez-Vives P, Cecconi A, Vera A, Fernández C, López-Melgar B, Sanz-García A, Rojas-González A, Nogales-Romo MT, Hernandez Muñiz S, Olivera MJ, Caballero P, Jiménez-Borreguero LJ, Alfonso F. Usefulness of Tissue Tracking by Cardiac Magnetic Resonance to Predict Events in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 174:126-135. [PMID: 35525624 DOI: 10.1016/j.amjcard.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/01/2022]
Abstract
Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ -1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.
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295
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Tan Z, Yang Y, Wu X, Li S, Li L, Zhong L, Lin Q, Fei H, Liao P, Wang W, Liu H. Left atrial remodeling and the prognostic value of feature tracking derived left atrial strain in patients with light-chain amyloidosis: a cardiovascular magnetic resonance study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1519-1532. [PMID: 35113283 DOI: 10.1007/s10554-022-02534-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Systemic light-chain (AL) amyloidosis is characterized by the aggregation of misfolded immunoglobulin light chain, predominantly infiltrating in the heart, including left atrium (LA). LA remodeling, such as increased interatrial septal thickness and enlarged size, has been observed. However, LA strain assessed by cardiac magnetic resonance feature tracking (CMR-FT) and its prognostic role remains to be further determined. Using CMR, the current study sought to investigate the characteristic of LA remodeling and the prognostic value of LA strain in patients with AL. Eighty-seven consecutive patients who underwent CMR with histologically confirmed systemic light-chain amyloidosis were retrospectively enrolled. LA strain parameters were analyzed based on CMR-FT algorithm. Amyloid infiltration and burden loads were assessed with CMR late gadolinium enhancement (LGE) and extracellular volume (ECV). Patients were categorized according to the extent of amyloid infiltration in cardiac myocardium. The primary endpoint was defined as all-cause mortality. The prognosis value of LA strain indices was evaluated using Cox proportional hazards regression and Kaplan-Meier curves. Interatrial septal thickness (3 [2-5] vs. 4 [3-5] mm, p = 0.007) and indexed LA volume (34.6 [26.9-44.6] vs. 50.5 [36.1-58.5] ml/m2, p = 0.001) were significantly higher in patients with atrial involvement (LA-LGE). Compared with patients with low amyloid burden loads (ECV group I), those at moderate and high (ECV group II and III) show progressive impairment in LA reservoir, conduit, and booster strains and strain rates. A total of 44 patients died during a median follow-up of 12 months. In multivariate analysis, LA reservoir strain, New York Heart Association (NYHA), and ECV remained independently associated with survival. On Kaplan-Meier analyses, low LA reservoir strain (< 8.6%) increased the risk of mortality. In moderate amyloid burden loads patients, low LA reservoir strain provides additive prognosis value. Progress left atrial remodeling and dysfunction are common findings in AL cardiac amyloidosis. The CMR-FT-derived LA reservoir strain provides independent and additive prognostic value for all-cause mortality in patients with AL cardiac amyloidosis.
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Affiliation(s)
- Zekun Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yuelong Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xinyi Wu
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Sheng Li
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Liwen Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Liye Zhong
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qiongwen Lin
- Department of Adult Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medicine Sciences, Guangzhou, Guangdong, China
| | - Hongwen Fei
- Department of Adult Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medicine Sciences, Guangzhou, Guangdong, China
| | - Pengjun Liao
- Department of Hematology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenjian Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
| | - Hui Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
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Wang S, Patel H, Miller T, Ameyaw K, Miller P, Narang A, Kawaji K, Singh A, Landeras L, Liu XP, Mor-Avi V, Patel AR. Relation of Myocardial Perfusion Reserve and Left Ventricular Ejection Fraction in Ischemic and Nonischemic Cardiomyopathy. Am J Cardiol 2022; 174:143-150. [PMID: 35487776 PMCID: PMC9886436 DOI: 10.1016/j.amjcard.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 02/02/2023]
Abstract
Quantification of myocardial perfusion reserve (MPR) using vasodilator stress cardiac magnetic resonance is increasingly used to detect coronary artery disease. However, MPR can also be altered because of changes in microvascular function. We aimed to determine whether MPR can distinguish between ischemic cardiomyopathy (IC) secondary to coronary artery disease and non-IC (NIC) with microvascular dysfunction and no underlying epicardial coronary disease. A total of 60 patients (mean age 65 ± 14 years, 30% women), including 31 with IC and 29 with NIC, were identified from a pre-existing vasodilator stress cardiac magnetic resonance registry. Short-axis cine slices were used to measure left ventricular ejection fraction (LVEF) using the Simpson method of disks. MPR index (MPRi) was determined from first-pass myocardial perfusion images during stress and rest using the upslope ratio, normalized for the arterial input and corrected for rate pressure product. Patients in both groups were divided into subgroups of LVEF ≤35% and LVEF >35%. Differences in MPRi between the subgroups were examined. MPRi was moderately correlated with LVEF in patients with NIC (r = 0.53, p = 0.03), whereas the correlation in patients with IC was lower (r = 0.32, p = 0.22). Average LVEF in NIC and IC was 34% ± 8% and 35% ± 8%, respectively (p = 0.63). MPRi was not significantly different in IC compared with NIC (1.17 [0.88 to 1.61] vs 1.23 [1.07 to 1.66], p = 0.41), including the subgroups of LVEF (IC: 1.20 ± 0.56 vs NIC: 1.15 ± 0.24, p = 0.75 for LVEF ≤35% and IC: 1.35 ± 0.44 vs NIC: 1.58 ± 0.50, p = 0.19 for LVEF >35%). However, MPRi was significantly lower in patients with LVEF ≤35% compared with those with LVEF>35% (1.17 ± 0.40 vs 1.47 ± 0.47, p = 0.01). Similar difference between LVEF groups was noted in the patients with NIC (1.15 ± 0.24 vs 1.58 ± 0.50, p = 0.006) but not in the patients with IC (1.20 ± 0.56 vs 1.35 ± 0.44, p = 0.42). MPRi can be abnormal in the presence of left ventricular dysfunction with nonischemic etiology. This is a potential pitfall to consider when using this approach to detect ischemia because of epicardial coronary disease using myocardial perfusion imaging.
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Affiliation(s)
- Shuo Wang
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Department of Medicine, University of Chicago, Chicago, Illinois
| | - Hena Patel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Tamari Miller
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Keith Ameyaw
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Patrick Miller
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Keigo Kawaji
- Illinois Institute of Technology, Chicago, Illinois
| | - Amita Singh
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Luis Landeras
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Xing-Peng Liu
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Radiology, University of Chicago, Chicago, Illinois
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Wang J, Gao Y, Yang ZG, Guo YK, Jiang L, Shi R, Xu HY, Huang S, Li Y. Quantitative assessment of left ventricular myocardial involvement in patients with connective tissue disease: a 3.0T contrast-enhanced cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2022; 38:1545-1554. [PMID: 35284973 PMCID: PMC11143006 DOI: 10.1007/s10554-022-02539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate left ventricular (LV) myocardial involvement in connective tissue disease (CTD) patients using multiparemetric imaging derived from cardiovascular magnetic resonance (CMR). CMR was performed on 146 CTD patients (comprising of 74 with idiopathic inflammatory myopathy (IIM) and 72 with non-IIM) and 72 healthy controls and included measures of LV global strains [including peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR)], myocardial perfusion [including upslope, max signal intensity (MaxSI), and time to maximum signal intensity (TTM)], and late gadolinium enhancement (LGE) parameters. Univariable and multivariable linear regression analyses were performed to determine the association between LV deformation and microvascular perfusion, as well as LGE. Our results indicated that CTD patients had decreased global longitudinal PS (GLPS), PSSR, PDSR, and myocardial perfusion (all p < 0.017) compared with normal controls. Non-IIM patients exhibited lower LV global strain and longer TTM than IIM patients. The presence of LGE was independently associated with global radial PS (GRPS: β = - 0.165, p = 0.011) and global circumferential PS (GCPS: β = - 0.122, p = 0.022). TTM was independently correlated with GLPS (β = - 0.156, p = 0.027). GLPS was the best indicator for differentiating CTD patients from normal controls (area under curve of 0.78). This study indicated that CTD patients showed impaired LV global myocardial deformation and microvascular perfusion, and presence of LGE. Cardiac involvement might be more severe in non-IIM patients than in IIM patients. Impaired microvascular perfusion and the presence of LGE were independently associated with LV global deformation.
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Affiliation(s)
- Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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298
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Wang Y, Wang Z, Tian J, Lu M. Editorial: Multimodality Imaging in Acute Coronary Syndrome. Front Cardiovasc Med 2022; 9:939428. [PMID: 35711376 PMCID: PMC9197208 DOI: 10.3389/fcvm.2022.939428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yining Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhao Wang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Jinwei Tian
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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299
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Mizrak I, Asserhøj LL, Lund MAV, Greisen GO, Clausen TD, Main KM, Vejlstrup NG, Jensen RB, Pinborg A, Madsen PL. Aortic distensibility is equal in prepubertal girls and boys and increases with puberty in girls. Am J Physiol Heart Circ Physiol 2022; 323:H312-H321. [PMID: 35687504 DOI: 10.1152/ajpheart.00097.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Windkessel function is governed by conductance artery compliance that is associated with cardiovascular disease in adults independently of other risk factors. Sex-related differences in conductance artery compliance partly explain the sex-related differences in risk of cardiovascular disease. Studies on sex-related differences in conductance artery function in prepubertal children are few and inconclusive. This study determined conductance artery compliance and cardiac function by magnetic resonance imaging in 150 healthy children (75 girls) aged 7-10 years. Any sex-related difference in conductance artery function was determined with correction for other potential predictors in multivariable linear regression models. Our data showed that ascending (crude mean difference 1.11 95% CI (0.22; 2.01)) and descending (crude mean difference 1.10 95% CI (0.09; 1.91)) aortic distensibility were higher in girls, but differences disappeared after adjustment for pubertal status and other identified potential predictors. Systolic and diastolic blood pressure, cardiac output, left ventricle (LV) systolic function, and total peripheral resistance did not differ between the sexes. In girls, heart rate was 7 bpm higher, whereas pulse pressure (by 2 mmHg), and LV end-diastolic volume index (by 7 mL) and stroke volume (by 5 mL) were lower. LV peak filling rate indexed to LV end-diastolic volume was 0.5 s-1 higher in girls. In conclusion, prepubertal girls and boys have equal conductance artery function. Thus, the well-known sex difference in adult conductance artery function seems to develop after the onset of puberty with girls initially increasing aortic distensibility.
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Affiliation(s)
- Ikram Mizrak
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise L Asserhøj
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten A V Lund
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm O Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynecology and Obstetrics, North Zealand Hospital, Copenhagen University Hospital, Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels G Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke B Jensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,International Center for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Fertility Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Per L Madsen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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300
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Zhang Y, Li XM, Shen MT, Huang S, Li Y, Yang ZG. Atrioventricular coupling and left atrial abnormality in type 2 diabetes mellitus with functional mitral regurgitation patients verified by cardiac magnetic resonance imaging. Cardiovasc Diabetol 2022; 21:100. [PMID: 35681217 PMCID: PMC9185866 DOI: 10.1186/s12933-022-01536-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Functional mitral regurgitation (FMR) in type 2 diabetes mellitus (T2DM) patients induced by left ventricular (LV) enlargement and mitral valve abnormality may aggravated the impairment in left atrial (LA) compliance. Thus, this study aimed to depict how FMR and LV dysfunction affect LA compliance in T2DM patients with FMR. MATERIALS AND METHODS A total of 148 patients with T2DM and 49 age- and sex-matched normal controls underwent cardiac magnetic resonance examination. LA longitudinal strain and LA and LV functional indices were compared among controls and different T2DM patients. The multivariate analysis was used to identify the independent indicators of LA longitudinal strain. RESULTS T2DM Patients without FMR had a lower total LA empty fraction (LAEF) compared with the controls (all P < 0.05). T2DM patients with mild and moderate FMR showed increased LA volume (LAV) and LV volume while decreased LAEF, LA strain, and LV ejection fraction (P < 0.05). T2DM patients with severe FMR showed markedly increased LAV and LV volume while decreased LAEF, LA strain, and LVEF (P < 0.05). In T2DM patients with FMR, reservoir strain (εs) was independently correlated with LV end-diastolic volume (LVEDV) (β = - 0.334) and regurgitation degree (β = - 0.256). The passive strain (εe) was independently correlated with regurgitation degree (β = - 0.297), whereas the active strain (εa) was independently correlated with LVESV (β = - 0.352) and glycated haemoglobin (β = - 0.279). CONCLUSION FMR may aggravate LA and LV dysfunction in T2DM patients. Regurgitation degree was an independent determinant of the εs and the εe, LVEDV was an independent determinant of the εs, and LVESV was an independent determinant of the εa in T2DM patients with FMR.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Radiology, School of Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, China
| | - Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Department of Radiology, School of Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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