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Pei Z, Qiu J, Zhao Y, Song S, Wang R, Luo W, Cai X, Liu B, Chen H, Yin J, Weng X, Wu Y, Li C, Shen L, Ge J. A novel intracoronary hypothermia device reduces myocardial reperfusion injury in pigs. Chin Med J (Engl) 2024:00029330-990000000-00988. [PMID: 38445387 DOI: 10.1097/cm9.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury. METHODS This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (5 and 42 days post-MI) and a series of biomarkers/histological studies were performed. RESULTS The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH. CONCLUSIONS The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.
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Affiliation(s)
- Zhiqiang Pei
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Jin Qiu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Shuai Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Rui Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Wei Luo
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xingxing Cai
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201322, China
| | - Bin Liu
- Department of Cardiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi 030009, China
| | - Han Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Xinyu Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Li Shen
- National Clinical Research for Interventional Medicine, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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Wen J, Qiao J, Tang Y, Zhao Y, Yang Z, Wang L, Tao X, Zhou X, Xia L, Tang D, Huang L. Cardiac magnetic resonance imaging detection of intramyocardial hemorrhage in patients with ST-elevated myocardial infarction: comparison between susceptibility-weighted imaging and T1/T2 mapping techniques. Quant Imaging Med Surg 2024; 14:476-488. [PMID: 38223054 PMCID: PMC10784041 DOI: 10.21037/qims-23-591] [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: 04/28/2023] [Accepted: 11/02/2023] [Indexed: 01/16/2024]
Abstract
Background Susceptibility-weighted imaging (SWI) and T1/T2 mapping can be used to detect reperfusion intramyocardial hemorrhage (IMH) in ST-segment elevation myocardial infarction (STEMI) patients. However, the sensitivity and accuracy of the SWI and T1/T2 mapping sequences were not systematically compared. The study aimed to evaluate image quality and diagnostic performance of SWI in patients with IMH, compared with T1/T2 mapping. Methods A prospective study was conducted on consecutive acute STEMI patients who were recruited from January to July 2022. Within 2-6 days after reperfusion treatment, all patients underwent a 3T cardiac magnetic resonance (CMR) examination, including T2-weighted short-tau inversion recovery (T2W-STIR), T1/T2 mapping, and SWI. A total of 36 patients [age, 56.50±17.25 years; males, 83.33% (30/36)] were enrolled. The relative infarct-remote myocardium signal intensity ratio (SIinfarct-remote) and contrast-to-noise ratio (CNR) were calculated for each patient on T1/T2 mapping and SWI, and the difference between relative signal intensity-to-noise ratio (rSNR) in the IMH (rSNRIMH) was measured for IMH patients on T1/T2 mapping and SWI. SIinfarct-remote, CNR, and rSNRIMH were compared among the three sequences. Receiver operating characteristic (ROC) analyses were used to evaluate the diagnostic performance of three sequences by SIinfarct-remote and visual assessment. Results A total of 26 (72.22%) patients had IMH. Quantitatively, the SIinfarct-remote of three sequences had excellent diagnostic performance for detecting IMH [SWI area under the curve (AUC) =1.000, 95% confidence interval (CI): 1.000-1.000 vs. T1 mapping AUC =0.954, 95% CI: 0.885-1.000 vs. T2 mapping AUC =0.985, 95% CI: 0.955-1.000; SWI vs. T1 mapping, P=0.300; SWI vs. T2 mapping, P=0.188; T1 mapping vs. T2 mapping, P=0.302). Qualitatively, three sequences had similar performance on detecting IMH (SWI AUC =0.895, 95% CI: 0.784-1.000; T1 mapping AUC =0.835, 95% CI: 0.711-0.958; and T2 mapping AUC =0.855, 95% CI: 0.735-0.974; SWI vs. T1 mapping, P=0.172; SWI vs. T2 mapping, P=0.317; T1 mapping vs. T2 mapping, P=0.710). The rSNRIMH was highest in T1 mapping, followed by T2 mapping and SWI, but SWI had the highest CNR. Conclusions SWI, as well as T1/T2 mapping, is a feasible and accurate approach for clinical diagnosis of IMH with excellent performance.
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Affiliation(s)
- Jinyang Wen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoxia Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Luyun Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mei Y, Yang G, Guo Y, Zhao K, Wu S, Xu Z, Zhou S, Yan C, Seeliger E, Niendorf T, Xu Y, Feng Y. Parametric MRI Detects Aristolochic Acid Induced Acute Kidney Injury. Tomography 2022; 8:2902-2914. [PMID: 36548535 PMCID: PMC9786286 DOI: 10.3390/tomography8060243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Exposure to aristolochic acid (AA) is of increased concern due to carcinogenic and nephrotoxic effects, and incidence of aristolochic acid nephropathy (AAN) is increasing. This study characterizes renal alterations during the acute phase of AAN using parametric magnetic resonance imaging (MRI). An AAN and a control group of male Wistar rats received administration of aristolochic acid I (AAI) and polyethylene glycol (PEG), respectively, for six days. Both groups underwent MRI before and 2, 4 and 6 days after AAI or PEG administration. T2 relaxation times and apparent diffusion coefficients (ADCs) were determined for four renal layers. Serum creatinine levels (sCr) and blood urea nitrogen (BUN) were measured. Tubular injury scores (TIS) were evaluated based on histologic findings. Increased T2 values were detected since day 2 in the AAN group, but decreased ADCs and increased sCr levels and BUN were not detected until day 4. Significant linear correlations were observed between T2 of the cortex and the outer stripe of outer medulla and TIS. Our results demonstrate that parametric MRI facilitates early detection of renal injury induced by AAI in a rat model. T2 mapping may be a valuable tool for assessing kidney injury during the acute phase of AAN.
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Affiliation(s)
- Yingjie Mei
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Guixiang Yang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Shuyu Wu
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Zhongbiao Xu
- Radiotherapy Center, Guangdong General Hospital, Guangzhou 510080, China
| | - Shan Zhou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Yikai Xu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence & Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou 510515, China
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan 528399, China
- Correspondence:
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Xia R, Zhu T, Zhang Y, He B, Chen Y, Wang L, Zhou Y, Liao J, Zheng J, Li Y, Lv F, Gao F. Myocardial infarction size as an independent predictor of intramyocardial haemorrhage in acute reperfused myocardial ischaemic rats. Eur J Med Res 2022; 27:220. [PMID: 36307869 PMCID: PMC9617410 DOI: 10.1186/s40001-022-00834-5] [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: 10/24/2021] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background In previous studies, haemorrhage occurred only with large infarct sizes, and studies found a moderate correlation between the extent of necrosis and haemorrhage, but the extent of infarction size in these studies was limited. This study aimed to find the correlations between intramyocardial haemorrhage (IMH), myocardial infarction (MI), and myocardial oedema (ME) from small to large sizes of MI in a 7.0-T MR scanner. Methods Different sizes of myocardial infarction were induced by occluding different sections of the proximal left anterior descending coronary artery (1–3 mm under the left auricle). T2*-mapping, T2-mapping and late gadolinium enhancement (LGE) sequences were performed on a 7.0 T MR system at Days 2 and 7. T2*- and T2-maps were calculated using custom-made software. All areas were expressed as a percentage of the entire myocardial tissue of the left ventricle. The rats were divided into two groups based on the T2* results and pathological findings; MI with IMH was referred to as the + IMH group, while MI without IMH was referred to as the –IMH group. Results The final experimental sample consisted of 25 rats in the + IMH group and 10 rats in the –IMH group. For the + IMH group on Day 2, there was a significant positive correlation between IMH size and MI size (r = 0.677, P < 0.01) and a positive correlation between IMH size and ME size (r = 0.552, P < 0.01). On Day 7, there was a significant positive correlation between IMH size and MI size (r = 0.711, P < 0.01), while no correlation was found between IMH size and ME size (r = 0.429, P = 0.097). The MI sizes of the + IMH group were larger than those of the –IMH group (P < 0.01). Conclusions Infarction size prior to reperfusion is a critical factor in determining IMH size in rats.
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Francis R, Chong J, Ramlall M, Bucciarelli-Ducci C, Clayton T, Dodd M, Engstrøm T, Evans R, Ferreira VM, Fontana M, Greenwood JP, Kharbanda RK, Kim WY, Kotecha T, Lønborg JT, Mathur A, Møller UK, Moon J, Perkins A, Rakhit RD, Yellon DM, Bøtker HE, Bulluck H, Hausenloy DJ. Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy. Basic Res Cardiol 2021; 116:59. [PMID: 34648075 PMCID: PMC8516772 DOI: 10.1007/s00395-021-00896-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1-17.1)% of LV mass; control: 11.1 (7.0-17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.
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Affiliation(s)
- Rohin Francis
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Jun Chong
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Manish Ramlall
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Chiara Bucciarelli-Ducci
- Biomedical Research Centre, Bristol Heart Institute, National Institute of Health Research (NIHR), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Upper Maudlin St, Bristol, BS2 8HW, UK
| | - Tim Clayton
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Matthew Dodd
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Thomas Engstrøm
- Rigshospitalet, Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Richard Evans
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- National Institute of Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
- British Heart Foundation Centre of Research Excellence, Oxford, UK
| | - Marianna Fontana
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rajesh K Kharbanda
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Tushar Kotecha
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - Jacob T Lønborg
- Rigshospitalet, Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Ulla Kristine Møller
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - James Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Alexander Perkins
- London School of Hygiene and Tropical Medicine Clinical Trials Unit, London, UK
| | - Roby D Rakhit
- Royal Free Hospital London and Institute of Cardiovascular Science, University College London, London, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Heerajnarain Bulluck
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK.
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
- Department of Cardiology, National Heart Centre, Singapore, Singapore.
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
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Terenicheva MA, Stukalova OV, Shakhnovich RM, Ternovoy SK. The role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in defining the prognosis of patients with acute ST-segment elevation myocardial infarction. Part 1. Indications and contraindications to cardiovascular magnetic resonance. TERAPEVT ARKH 2021; 93:497-501. [DOI: 10.26442/00403660.2021.04.200687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Recently, the role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in the diagnosis of coronary artery disease and acute myocardial infarction has increased significantly. This method is defined as the gold standard for differentiation between ischemic vs non-ischemic and acute vs chronic myocardial injury. This part of the review summarizes the main methods of cardiovascular magnetic resonance, its safety, indications and contraindications.
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Emrich T, Halfmann M, Schoepf UJ, Kreitner KF. CMR for myocardial characterization in ischemic heart disease: state-of-the-art and future developments. Eur Radiol Exp 2021; 5:14. [PMID: 33763757 PMCID: PMC7990980 DOI: 10.1186/s41747-021-00208-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 01/25/2023] Open
Abstract
Ischemic heart disease and its sequelae are one of the major contributors to morbidity and mortality worldwide. Over the last decades, technological developments have strengthened the role of noninvasive imaging for detection, risk stratification, and management of patients with ischemic heart disease. Cardiac magnetic resonance (CMR) imaging incorporates both functional and morphological characterization of the heart to determine presence, acuteness, and severity of ischemic heart disease by evaluating myocardial wall motion and function, the presence and extent of myocardial edema, ischemia, and scarring. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Nevertheless, there are emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents. The aim of this review is to summarize the current state of the art of CMR imaging for ischemic heart disease and to provide insights into promising future developments.
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Affiliation(s)
- Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
| | - Moritz Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz; Langenbeckstraße 1, 55131, Mainz, Germany
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Abstract
Purpose of Review The purpose of this review is to summarize the application of cardiac magnetic resonance (CMR) in the diagnostic and prognostic evaluation of patients with heart failure (HF). Recent Findings CMR is an important non-invasive imaging modality in the assessment of ventricular volumes and function and in the analysis of myocardial tissue characteristics. The information derived from CMR provides a comprehensive evaluation of HF. Its unique ability of tissue characterization not only helps to reveal the underlying etiologies of HF but also offers incremental prognostic information. Summary CMR is a useful non-invasive tool for the diagnosis and assessment of prognosis in patients suffering from heart failure.
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Affiliation(s)
- Chuanfen Liu
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Victor A. Ferrari
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA USA
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Ma Q, Ma Y, Yu T, Sun Z, Hou Y. Radiomics of Non-Contrast-Enhanced T1 Mapping: Diagnostic and Predictive Performance for Myocardial Injury in Acute ST-Segment-Elevation Myocardial Infarction. Korean J Radiol 2020; 22:535-546. [PMID: 33289360 DOI: 10.3348/kjr.2019.0969] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/15/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of texture analysis on non-contrast-enhanced T1 maps of cardiac magnetic resonance (CMR) imaging for the diagnosis of myocardial injury in acute myocardial infarction (MI). MATERIALS AND METHODS This study included 68 patients (57 males and 11 females; mean age, 55.7 ± 10.5 years) with acute ST-segment-elevation MI who had undergone 3T CMR after a percutaneous coronary intervention. Forty patients of them also underwent a 6-month follow-up CMR. The CMR protocol included T2-weighted imaging, T1 mapping, rest first-pass perfusion, and late gadolinium enhancement. Radiomics features were extracted from the T1 maps using open-source software. Radiomics signatures were constructed with the selected strongest features to evaluate the myocardial injury severity and predict the recovery of left ventricular (LV) longitudinal systolic myocardial contractility. RESULTS A total of 1088 segments of the acute CMR images were analyzed; 103 (9.5%) segments showed microvascular obstruction (MVO), and 557 (51.2%) segments showed MI. A total of 640 segments were included in the 6-month follow-up analysis, of which 160 (25.0%) segments showed favorable recovery of LV longitudinal systolic myocardial contractility. Combined radiomics signature and T1 values resulted in a higher diagnostic performance for MVO compared to T1 values alone (area under the curve [AUC] in the training set; 0.88, 0.72, p = 0.031: AUC in the test set; 0.86, 0.71, p002). Combined radiomics signature and T1 values also provided a higher predictive value for LV longitudinal systolic myocardial contractility recovery compared to T1 values (AUC in the training set; 0.76, 0.55, p < 0.001: AUC in the test set; 0.77, 0.60, p < 0.001). CONCLUSION The combination of radiomics of non-contrast-enhanced T1 mapping and T1 values could provide higher diagnostic accuracy for MVO. Radiomics also provides incremental value in the prediction of LV longitudinal systolic myocardial contractility at six months.
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Affiliation(s)
- Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
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10
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Shin JM, Choi EY, Park CH, Han K, Kim TH. Quantitative T1 Mapping for Detecting Microvascular Obstruction in Reperfused Acute Myocardial Infarction: Comparison with Late Gadolinium Enhancement Imaging. Korean J Radiol 2020; 21:978-986. [PMID: 32677382 PMCID: PMC7369203 DOI: 10.3348/kjr.2019.0736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To compare native and post-contrast T1 mapping with late gadolinium enhancement (LGE) imaging for detecting and measuring the microvascular obstruction (MVO) area in reperfused acute myocardial infarction (MI). Materials and Methods This study included 20 patients with acute MI who had undergone 1.5T cardiovascular magnetic resonance imaging (CMR) after reperfusion therapy. CMR included cine imaging, LGE, and T1 mapping (modified look-locker inversion recovery). MI size was calculated from LGE by full-width at half-maximum technique. MVO was defined as an area with low signal intensity (LGE) or as a region of visually distinguishable T1 values (T1 maps) within infarcted myocardium. Regional T1 values were measured in MVO, infarcted, and remote myocardium on T1 maps. MVO area was measured on and compared among LGE, native, and post-contrast T1 maps. Results The mean MI size was 27.1 ± 9.7% of the left ventricular mass. Of the 20 identified MVOs, 18 (90%) were detected on native T1 maps, while 10 (50%) were recognized on post-contrast T1 maps. The mean native T1 values of MVO, infarcted, and remote myocardium were 1013.5 ± 58.5, 1240.9 ± 55.8 (p < 0.001), and 1062.2 ± 55.8 ms (p = 0.169), respectively, while the mean post-contrast T1 values were 466.7 ± 26.8, 399.1 ± 21.3, and 585.2 ± 21.3 ms, respectively (p < 0.001). The mean MVO areas on LGE, native, and post-contrast T1 maps were 134.1 ± 81.2, 133.7 ± 80.4, and 117.1 ± 53.3 mm2, respectively. The median (interquartile range) MVO areas on LGE, native, and post-contrast T1 maps were 128.0 (58.1–215.4), 110.5 (67.7–227.9), and 143.0 (76.7–155.3) mm2, respectively (p = 0.002). Concordance correlation coefficients for the MVO area between LGE and native T1 maps, LGE and post-contrast T1 maps, and native and post-contrast T1 maps were 0.770, 0.375, and 0.565, respectively. Conclusion MVO areas were accurately delineated on native T1 maps and showed high concordance with the areas measured on LGE. However, post-contrast T1 maps had low detection rates and underestimated MVO areas. Collectively, native T1 mapping is a useful tool for detecting MVO within the infarcted myocardium.
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Affiliation(s)
- Jae Min Shin
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology and the Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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11
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Demirkiran A, Everaars H, Amier RP, Beijnink C, Bom MJ, Götte MJW, van Loon RB, Selder JL, van Rossum AC, Nijveldt R. Cardiovascular magnetic resonance techniques for tissue characterization after acute myocardial injury. Eur Heart J Cardiovasc Imaging 2020; 20:723-734. [PMID: 31131401 DOI: 10.1093/ehjci/jez094] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/19/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
The annual incidence of hospital admission for acute myocardial infarction lies between 90 and 312 per 100 000 inhabitants in Europe. Despite advances in patient care 1 year mortality after ST-segment elevation myocardial infarction (STEMI) remains around 10%. Cardiovascular magnetic resonance imaging (CMR) has emerged as a robust imaging modality for assessing patients after acute myocardial injury. In addition to accurate assessment of left ventricular ejection fraction and volumes, CMR offers the unique ability of visualization of myocardial injury through a variety of imaging techniques such as late gadolinium enhancement and T2-weighted imaging. Furthermore, new parametric mapping techniques allow accurate quantification of myocardial injury and are currently being exploited in large trials aiming to augment risk management and treatment of STEMI patients. Of interest, CMR enables the detection of microvascular injury (MVI) which occurs in approximately 40% of STEMI patients and is a major independent predictor of mortality and heart failure. In this article, we review traditional and novel CMR techniques used for myocardial tissue characterization after acute myocardial injury, including the detection and quantification of MVI. Moreover, we discuss clinical scenarios of acute myocardial injury in which the tissue characterization techniques can be applied and we provide proposed imaging protocols tailored to each scenario.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Casper Beijnink
- Department of Cardiology, Radboudumc, Geert Grooteplein Zuid 10, GA, Nijmegen, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Jasper L Selder
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, HV, Amsterdam, the Netherlands.,Department of Cardiology, Radboudumc, Geert Grooteplein Zuid 10, GA, Nijmegen, the Netherlands
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12
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Pavon AG, Georgiopoulos G, Vincenti G, Muller O, Monney P, Berchier G, Cirillo C, Eeckhout E, Schwitter J, Masci PG. Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of intramyocardial haemorrhage in patients with ST-elevation myocardial infarction. Eur Radiol 2020; 31:1245-1256. [PMID: 32929640 PMCID: PMC7880961 DOI: 10.1007/s00330-020-07254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
Objectives T2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated. Methods and results Between April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent head-to-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2w-STIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixed-effects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p < 0.05 for both scores). For IMH quantification, hypocore on T2 map and T1 map strongly correlated (Spearman’s r > 0.7, p < 0.001 for both) with IMH extent on T2*w and presented an overall excellent agreement on Bland-Altman analysis. By linear mixed model analysis, absolute hypocore size did not differ among T1-, T2 map, and T2*w. T2/T1 maps had the best intra- and inter-observer reproducibility among CMR techniques. Conclusion Hypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in post-STEMI patients. Key Point • Mapping techniques are the best alternatives for diagnosing post-infarction intramyocardial haemorrhage. • Mapping techniques are valuable tools for imaging intramyocardial haemorrhage. Electronic supplementary material The online version of this article (10.1007/s00330-020-07254-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Gabriella Vincenti
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Faculty Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Gregoire Berchier
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Chiara Cirillo
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Eric Eeckhout
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- Faculty Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Pier Giorgio Masci
- Centre of Cardiac Magnetic Resonance - Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital, Lausanne, Switzerland
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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13
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Snel GJH, van den Boomen M, Hernandez LM, Nguyen CT, Sosnovik DE, Velthuis BK, Slart RHJA, Borra RJH, Prakken NHJ. Cardiovascular magnetic resonance native T 2 and T 2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2020; 22:34. [PMID: 32393281 PMCID: PMC7212597 DOI: 10.1186/s12968-020-00627-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.
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Affiliation(s)
- G J H Snel
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - M van den Boomen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - L M Hernandez
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C T Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - D E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Division of Health Sciences and Technology, Harvard-MIT, 7 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Dienstweg 1, 7522 ND, Enschede, The Netherlands
| | - R J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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14
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Hausenloy DJ, Lim MX, Chan MHH, Paradies V, Francis R, Kotecha T, Knight DS, Fontana M, Kellman P, Moon JC, Bulluck H. Interrogation of the infarcted and salvaged myocardium using multi-parametric mapping cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction patients. Sci Rep 2019; 9:9056. [PMID: 31227761 PMCID: PMC6588689 DOI: 10.1038/s41598-019-45449-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/03/2019] [Indexed: 01/06/2023] Open
Abstract
We used multi-parametric cardiovascular magnetic resonance (CMR) mapping to interrogate the myocardium following ST-segment elevation myocardial infarction (STEMI). Forty-eight STEMI patients underwent CMR at 4 ± 2 days. One matching short-axis slice of native T1 map, T2 map, late gadolinium enhancement (LGE), and automated extracellular volume fraction (ECV) maps per patient were analyzed. Manual regions-of-interest were drawn within the infarcted, the salvaged and the remote myocardium. A subgroup analysis was performed in those without MVO and with ≤75% transmural extent of infarct. For the whole cohort, T1, T2 and ECV in both the infarcted and the salvaged myocardium were significantly higher than in the remote myocardium. T1 and T2 could not differentiate between the salvaged and the infarcted myocardium, but ECV was significantly higher in the latter. In the subgroup analysis of 15 patients, similar findings were observed for T1 and T2. However, there was only a trend towards ECVsalvage being higher than ECVremote. In the clinical setting, current native T1 and T2 methods with the specific voxel sizes at 1.5 T could not differentiate between the infarcted and salvaged myocardium, whereas ECV could differentiate between the two. ECV was also higher in the salvaged myocardium when compared to the remote myocardium.
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Affiliation(s)
- Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom.,Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Mei Xing Lim
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
| | - Mervyn H H Chan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
| | - Valeria Paradies
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Rohin Francis
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom.,National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Tushar Kotecha
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Daniel S Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - James C Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom.,Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom. .,Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.
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15
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Hausenloy DJ, Chilian W, Crea F, Davidson SM, Ferdinandy P, Garcia-Dorado D, van Royen N, Schulz R, Heusch G. The coronary circulation in acute myocardial ischaemia/reperfusion injury: a target for cardioprotection. Cardiovasc Res 2019; 115:1143-1155. [PMID: 30428011 PMCID: PMC6529918 DOI: 10.1093/cvr/cvy286] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/11/2022] Open
Abstract
The coronary circulation is both culprit and victim of acute myocardial infarction. The rupture of an epicardial atherosclerotic plaque with superimposed thrombosis causes coronary occlusion, and this occlusion must be removed to induce reperfusion. However, ischaemia and reperfusion cause damage not only in cardiomyocytes but also in the coronary circulation, including microembolization of debris and release of soluble factors from the culprit lesion, impairment of endothelial integrity with subsequently increased permeability and oedema formation, platelet activation and leucocyte adherence, erythrocyte stasis, a shift from vasodilation to vasoconstriction, and ultimately structural damage to the capillaries with eventual no-reflow, microvascular obstruction (MVO), and intramyocardial haemorrhage (IMH). Therefore, the coronary circulation is a valid target for cardioprotection, beyond protection of the cardiomyocyte. Virtually all of the above deleterious endpoints have been demonstrated to be favourably influenced by one or the other mechanical or pharmacological cardioprotective intervention. However, no-reflow is still a serious complication of reperfused myocardial infarction and carries, independently from infarct size, an unfavourable prognosis. MVO and IMH can be diagnosed by modern imaging technologies, but still await an effective therapy. The current review provides an overview of strategies to protect the coronary circulation from acute myocardial ischaemia/reperfusion injury. This article is part of a Cardiovascular Research Spotlight Issue entitled 'Cardioprotection Beyond the Cardiomyocyte', and emerged as part of the discussions of the European Union (EU)-CARDIOPROTECTION Cooperation in Science and Technology (COST) Action, CA16225.
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Affiliation(s)
- Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- The National Institute of Health Research, University College London Hospitals Biomedical Research Centre, Research & Development, London, UK
- Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - William Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, USA
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, F. Policlinico Gemelli—IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - David Garcia-Dorado
- Department of Cardiology, Vascular Biology and Metabolism Area, Vall d’Hebron University Hospital and Research Institute (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
- Instituto CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
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16
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Bulluck H, Dharmakumar R, Arai AE, Berry C, Hausenloy DJ. Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction: Recent Advances, Controversies, and Future Directions. Circulation 2019; 137:1949-1964. [PMID: 29712696 DOI: 10.1161/circulationaha.117.030693] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although mortality after ST-segment elevation myocardial infarction (MI) is on the decline, the number of patients developing heart failure as a result of MI is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention, there is currently no established therapy for reducing MI size. Thus, new cardioprotective therapies are required to improve clinical outcomes after ST-segment-elevation MI. Cardiovascular magnetic resonance has emerged as an important imaging modality for assessing the efficacy of novel therapies for reducing MI size and preventing subsequent adverse left ventricular remodeling. The recent availability of multiparametric mapping cardiovascular magnetic resonance imaging has provided new insights into the pathophysiology underlying myocardial edema, microvascular obstruction, intramyocardial hemorrhage, and changes in the remote myocardial interstitial space after ST-segment-elevation MI. In this article, we provide an overview of the recent advances in cardiovascular magnetic resonance imaging in reperfused patients with ST-segment-elevation MI, discuss the controversies surrounding its use, and explore future applications of cardiovascular magnetic resonance in this setting.
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Affiliation(s)
- Heerajnarain Bulluck
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.).,Royal Papworth Hospital, Cambridge, United Kingdom (H.B.)
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute and Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (R.D.).,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (R.D.)
| | - Andrew E Arai
- Laboratory for Advanced Cardiovascular Imaging, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD (A.E.A.)
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.B.)
| | - Derek J Hausenloy
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.). .,National Institute of Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (D.J.H.).,Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom (D.J.H.).,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (D.J.H.).,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore (D.J.H.).,Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.)
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Bulluck H, Chowdhury N, Lim MX, Allen JC, Bryant JA, Chan MY, Chan MHH, Chin CWL, Ho HH, Lim ST, Tan RS, Tan JW, Wong PE, Yeo KK, Cook SA, Hausenloy DJ. Feasibility to Perform T 2 * Mapping Postcontrast Administration in Reperfused STEMI Patients for the Detection of Intramyocardial Hemorrhage. J Magn Reson Imaging 2019; 51:644-645. [PMID: 31087614 DOI: 10.1002/jmri.26779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heerajnarain Bulluck
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Nazia Chowdhury
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University Singapore Medical School, Singapore, Singapore
| | - Mei Xing Lim
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University Singapore Medical School, Singapore, Singapore
| | - John C Allen
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore, Singapore
| | - Jennifer A Bryant
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mervyn H H Chan
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University Singapore Medical School, Singapore, Singapore
| | - Calvin W L Chin
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Hee Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Soo T Lim
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Jack W Tan
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Philip E Wong
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Khung K Yeo
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart A Cook
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Derek J Hausenloy
- Department of Cardiology, National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-National University Singapore Medical School, Singapore, Singapore.,The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK.,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK.,Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Dastidar AG, Harries I, Pontecorboli G, Bruno VD, De Garate E, Moret C, Baritussio A, Johnson TW, McAlindon E, Bucciarelli-Ducci C. Native T1 mapping to detect extent of acute and chronic myocardial infarction: comparison with late gadolinium enhancement technique. Int J Cardiovasc Imaging 2018; 35:517-527. [DOI: 10.1007/s10554-018-1467-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/10/2018] [Indexed: 12/28/2022]
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Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, Masci PG. Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006428. [PMID: 29146587 DOI: 10.1161/circimaging.117.006428] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. METHODS AND RESULTS Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. CONCLUSIONS CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiography-LVEF and may impact the management of patients with ST-segment-elevation myocardial infarction.
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Affiliation(s)
- Gianluca Pontone
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.).
| | - Andrea I Guaricci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Daniele Andreini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giovanni Ferro
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Marco Guglielmo
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Andrea Baggiano
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Laura Fusini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giuseppe Muscogiuri
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Valentina Lorenzoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Saima Mushtaq
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Edoardo Conte
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Andrea Annoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Alberto Formenti
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Maria Elisabetta Mancini
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Patrizia Carità
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Massimo Verdecchia
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Silvia Pica
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Fabio Fazzari
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Nicola Cosentino
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Giancarlo Marenzi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Mark G Rabbat
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Piergiuseppe Agostoni
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Antonio L Bartorelli
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Mauro Pepi
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
| | - Pier Giorgio Masci
- From the Centro Cardiologico Monzino, IRCCS, Milan, Italy (G.P., D.A., M.G., A.B., L.F., S.M., E.C., A.A., A.F., M.E.M., M.V., N.C., G.M., P.A., A.L.B., M.P.); Yonsei University Health System, Seoul, South Korea (G.P.); Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital Policlinico Consorziale of Bari, Italy (A.I.G.); Department of Medical and Surgical Sciences, University of Foggia, Italy (A.I.G.); Dipartimento di Cardiologia, Policlinico Universitario Paolo Giaccone, Palermo, Italy (G.F., P.C., F.F.); Centro Medico Polispecialistico, Torre Annunziata (Naples), Italy (G.M.); Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy (V.L.); Multimodality Cardiac Imaging Section, IRCCS, Policlinico San Donato, Milan, Italy (S.P.); Loyola University of Chicago, IL (M.G.R.); Edward Hines Jr. Veterans Administration Hospital, IL (M.G.R.); Luigi Sacco Department of Biomedical and Clinical Sciences (A.L.B.) and Department of Cardiovascular Sciences and Community Health (D.A., P.A.), University of Milan, Italy; and Division of Cardiology, Centre of Cardiac Magnetic Resonance, University Hospital Lausanne, Switzerland (P.G.M.)
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Redefining viability by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction. Sci Rep 2017; 7:14676. [PMID: 29116176 PMCID: PMC5676975 DOI: 10.1038/s41598-017-15353-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/24/2017] [Indexed: 01/05/2023] Open
Abstract
In chronic myocardial infarction (MI), segments with a transmural extent of infarct (TEI) of ≤50% are defined as being viable. However, in the acute phase of an ST-segment elevation myocardial infarction (STEMI), late gadolinium enhancement (LGE) has been demonstrated to overestimate MI size and TEI. We aimed to identify the optimal cut-off of TEI by cardiovascular magnetic resonance (CMR) for defining viability during the acute phase of an MI, using ≤50% TEI at follow-up as the reference standard. 40 STEMI patients reperfused by primary percutaneous coronary intervention (PPCI) underwent a CMR at 4 ± 2 days and 5 ± 2 months. The large majority of segments with 1–25%TEI and 26–50%TEI that were viable acutely were also viable at follow-up (59/59, 100% and 75/82, 96% viable respectively). 56/84(67%) segments with 51–75%TEI but only 4/63(6%) segments with 76–100%TEI were reclassified as viable at follow-up. TEI on the acute CMR scan had an area-under-the-curve of 0.87 (95% confidence interval of 0.82 to 0.91) and ≤75%TEI had a sensitivity of 98% but a specificity of 66% to predict viability at follow-up. Therefore, the optimal cut-off by CMR during the acute phase of an MI to predict viability was ≤75% TEI and this would have important implications for patients undergoing viability testing prior to revascularization during the acute phase.
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Abstract
PURPOSE OF REVIEW The purpose of the present paper is to analytically review the diagnostic and prognostic role of CMR in ST-segment elevation myocardial infarction (STEMI) survivors. Percutaneous coronary intervention (PCI) is the treatment of choice in patients STEMI. However, risk of future events remains substantial. Assessment of the extent of myocardial infarction (MI), cardiac function and ventricular remodelling has become the focus of recent studies. Electrocardiography, angiography and echocardiography parameters, as well as risk scores, lack sensitivity and reproducibility in predicting future cardiovascular events. A major advantage of cardiac magnetic resonance imaging (CMR) is that it provides myocardial tissue characterization. RECENT FINDINGS CMR is able to quantify both reversible and irreversible myocardial injury and correlates with future events. This review will illustrate how microvascular function indices (myocardial salvage index, presence and amount of microvascular obstruction and intramyocardial haemorrhage) detectable by CMR add prognostic information and could impact on future strategies to improve outcomes in revascularized patients.
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Bulluck H, Hammond-Haley M, Fontana M, Knight DS, Sirker A, Herrey AS, Manisty C, Kellman P, Moon JC, Hausenloy DJ. Quantification of both the area-at-risk and acute myocardial infarct size in ST-segment elevation myocardial infarction using T1-mapping. J Cardiovasc Magn Reson 2017; 19:57. [PMID: 28764773 PMCID: PMC5539889 DOI: 10.1186/s12968-017-0370-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A comprehensive cardiovascular magnetic resonance (CMR) in reperfused ST-segment myocardial infarction (STEMI) patients can be challenging to perform and can be time-consuming. We aimed to investigate whether native T1-mapping can accurately delineate the edema-based area-at-risk (AAR) and post-contrast T1-mapping and synthetic late gadolinium (LGE) images can quantify MI size at 1.5 T. Conventional LGE imaging and T2-mapping could then be omitted, thereby shortening the scan duration. METHODS Twenty-eight STEMI patients underwent a CMR scan at 1.5 T, 3 ± 1 days following primary percutaneous coronary intervention. The AAR was quantified using both native T1 and T2-mapping. MI size was quantified using conventional LGE, post-contrast T1-mapping and synthetic magnitude-reconstructed inversion recovery (MagIR) LGE and synthetic phase-sensitive inversion recovery (PSIR) LGE, derived from the post-contrast T1 maps. RESULTS Native T1-mapping performed as well as T2-mapping in delineating the AAR (41.6 ± 11.9% of the left ventricle [% LV] versus 41.7 ± 12.2% LV, P = 0.72; R2 0.97; ICC 0.986 (0.969-0.993); bias -0.1 ± 4.2% LV). There were excellent correlation and inter-method agreement with no bias, between MI size by conventional LGE, synthetic MagIR LGE (bias 0.2 ± 2.2%LV, P = 0.35), synthetic PSIR LGE (bias 0.4 ± 2.2% LV, P = 0.060) and post-contrast T1-mapping (bias 0.3 ± 1.8% LV, P = 0.10). The mean scan duration was 58 ± 4 min. Not performing T2 mapping (6 ± 1 min) and conventional LGE (10 ± 1 min) would shorten the CMR study by 15-20 min. CONCLUSIONS T1-mapping can accurately quantify both the edema-based AAR (using native T1 maps) and acute MI size (using post-contrast T1 maps) in STEMI patients without major cardiovascular risk factors. This approach would shorten the duration of a comprehensive CMR study without significantly compromising on data acquisition and would obviate the need to perform T2 maps and LGE imaging.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Matthew Hammond-Haley
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Daniel S. Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Alex Sirker
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - James C. Moon
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Full left ventricular coverage is essential for the accurate quantification of the area-at-risk by T1 and T2 mapping. Sci Rep 2017; 7:4871. [PMID: 28687810 PMCID: PMC5501789 DOI: 10.1038/s41598-017-05127-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/24/2017] [Indexed: 01/04/2023] Open
Abstract
T2-weighted cardiovascular magnetic resonance (CMR) using a 3-slice approach has been shown to accurately quantify the edema-based area-at-risk (AAR) in ST-segment elevation myocardial infarction (STEMI). We aimed to compare the performance of a 3-slice approach to full left ventricular (LV) coverage for the AAR by T1 and T2 mapping and MI size. Forty-eight STEMI patients were prospectively recruited and underwent a CMR at 4 ± 2 days. There was no difference between the AARfull LV and AAR3-slices by T1 (P = 0.054) and T2-mapping (P = 0.092), with good correlations but small biases and wide limits of agreements (T1-mapping: N = 30, R2 = 0.85, bias = 1.7 ± 9.4% LV; T2-mapping: N = 48, R2 = 0.75, bias = 1.7 ± 12.9% LV). There was also no significant difference between MI size3-slices and MI sizefull LV (P = 0.93) with an excellent correlation between the two (R2 0.92) but a small bias of 0.5% and a wide limit of agreement of ±7.7%. Although MSI was similar between the 2 approaches, MSI3-slices performed poorly when MSI was <0.50. Furthermore, using AAR3-slices and MI sizefull LV resulted in ‘negative’ MSI in 7/48 patients. Full LV coverage T1 and T2 mapping are more accurate than a 3-slice approach for delineating the AAR, especially in those with MSI < 0.50 and we would advocate full LV coverage in future studies.
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Towards accurate and precise T 1 and extracellular volume mapping in the myocardium: a guide to current pitfalls and their solutions. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:143-163. [PMID: 28608328 PMCID: PMC5813078 DOI: 10.1007/s10334-017-0631-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 01/27/2023]
Abstract
Mapping of the longitudinal relaxation time (T1) and extracellular volume (ECV) offers a means of identifying pathological changes in myocardial tissue, including diffuse changes that may be invisible to existing T1-weighted methods. This technique has recently shown strong clinical utility for pathologies such as Anderson-Fabry disease and amyloidosis and has generated clinical interest as a possible means of detecting small changes in diffuse fibrosis; however, scatter in T1 and ECV estimates offers challenges for detecting these changes, and bias limits comparisons between sites and vendors. There are several technical and physiological pitfalls that influence the accuracy (bias) and precision (repeatability) of T1 and ECV mapping methods. The goal of this review is to describe the most significant of these, and detail current solutions, in order to aid scientists and clinicians to maximise the utility of T1 mapping in their clinical or research setting. A detailed summary of technical and physiological factors, issues relating to contrast agents, and specific disease-related issues is provided, along with some considerations on the future directions of the field.
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