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Alajmi F, Kang M, Dundas J, Haenel A, Parker J, Blanke P, Coghlan F, Khoo JK, Bin Zaid AA, Singh A, Heydari B, Yeung D, Roston TM, Ong K, Leipsic J, Laksman Z. Novel Magnetic Resonance Imaging Tools for Hypertrophic Cardiomyopathy Risk Stratification. Life (Basel) 2024; 14:200. [PMID: 38398708 PMCID: PMC10889913 DOI: 10.3390/life14020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common genetic disorder with a well described risk of sudden cardiac death; however, risk stratification has remained a challenge. Recently, novel parameters in cardiac magnetic resonance imaging (CMR) have shown promise in helping to improve upon current risk stratification paradigms. In this manuscript, we have reviewed novel CMR risk markers and their utility in HCM. The results of the review showed that T1, extracellular volume, CMR feature tracking, and other miscellaneous novel CMR variables have the potential to improve sudden death risk stratification and may have additional roles in diagnosis and prognosis. The strengths and weaknesses of these imaging techniques, and their potential utility and implementation in HCM risk stratification are discussed.
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Affiliation(s)
- Fahad Alajmi
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Mehima Kang
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - James Dundas
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, Hardwick Rd, Hardwick, Stockton-on-Tees TS19 8PE, UK
| | - Alexander Haenel
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Jeremy Parker
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Philipp Blanke
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
| | - Fionn Coghlan
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - John King Khoo
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Abdulaziz A. Bin Zaid
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Amrit Singh
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Medical Sciences, 2176 Health Sciences Mall Block C217, Vancouver, BC V6T 2A1, Canada;
| | - Bobby Heydari
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Darwin Yeung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Thomas M. Roston
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Kevin Ong
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada; (J.D.); (J.L.)
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, 2775 Laurel St, 9th Floor, Vancouver, BC V5Z 1M9, Canada; (M.K.); (A.H.); (J.P.); (P.B.); (F.C.); (J.K.K.); (A.A.B.Z.); (B.H.); (D.Y.); (T.M.R.); (K.O.)
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Bustin A, Witschey WRT, van Heeswijk RB, Cochet H, Stuber M. Magnetic resonance myocardial T1ρ mapping : Technical overview, challenges, emerging developments, and clinical applications. J Cardiovasc Magn Reson 2023; 25:34. [PMID: 37331930 DOI: 10.1186/s12968-023-00940-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
The potential of cardiac magnetic resonance to improve cardiovascular care and patient management is considerable. Myocardial T1-rho (T1ρ) mapping, in particular, has emerged as a promising biomarker for quantifying myocardial injuries without exogenous contrast agents. Its potential as a contrast-agent-free ("needle-free") and cost-effective diagnostic marker promises high impact both in terms of clinical outcomes and patient comfort. However, myocardial T1ρ mapping is still at a nascent stage of development and the evidence supporting its diagnostic performance and clinical effectiveness is scant, though likely to change with technological improvements. The present review aims at providing a primer on the essentials of myocardial T1ρ mapping, and to describe the current range of clinical applications of the technique to detect and quantify myocardial injuries. We also delineate the important limitations and challenges for clinical deployment, including the urgent need for standardization, the evaluation of bias, and the critical importance of clinical testing. We conclude by outlining technical developments to be expected in the future. If needle-free myocardial T1ρ mapping is shown to improve patient diagnosis and prognosis, and can be effectively integrated in cardiovascular practice, it will fulfill its potential as an essential component of a cardiac magnetic resonance examination.
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Affiliation(s)
- Aurelien Bustin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France.
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France.
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | | | - Ruud B van Heeswijk
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Avenue du Haut Lévêque, 33604, Pessac, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
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Sebastian SA, Panthangi V, Singh K, Rayaroth S, Gupta A, Shantharam D, Rasool BQ, Padda I, Co EL, Johal G. Hypertrophic Cardiomyopathy: Current Treatment and Future Options. Curr Probl Cardiol 2023; 48:101552. [PMID: 36529236 DOI: 10.1016/j.cpcardiol.2022.101552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a disease involving the cardiac sarcomere. It is associated with various disease-causing gene mutations and phenotypic expressions, managed with different therapies with variable prognoses. The heterogeneity of the disease is evident in the fact that it burdens patients of all ages. HCM is the most prevalent cause of sudden death in athletes. However, several technological advancements and therapeutic options have reduced mortality in patients with HCM to 0.5% per year. In addition, rapid advances in our knowledge of the molecular defects accountable for HCM have strengthened our awareness of the disorder and recommended new approaches to the assessment of prognosis. Despite all these evolutions, a small subgroup of patients with HCM will experience sudden cardiac death, and risk stratification remains a critical challenge. This review provides a practical guide to the updated recommendations for patients with HCM, including clinical updates for diagnosis, family screening, clinical imaging, risk stratification, and management.
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Affiliation(s)
| | | | - Karanbir Singh
- Department of Internal Medicine, Government Medical College, Amritsar, Punjab, India
| | - Swetha Rayaroth
- Department of Internal Medicine, JSS Medical College, Mysuru, Karnataka, India
| | - Aditi Gupta
- Department of Internal Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Darshan Shantharam
- Department of Internal Medicine, Yenepoya Medical college, Mangalore, India
| | | | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, New York
| | - Edzel Lorraine Co
- Department of Internal Medicine, University of Santo Tomas, Manila, Philippines
| | - Gurpreet Johal
- Department of Cardiology, Valley Medical Center, University of Washington, Seattle, Washington
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Bazoukis G, Garcia-Zamora S, Çinier G, Lee S, Elvin Gul E, Álvarez-García J, Miana G, Hayıroğlu Mİ, Tse G, Liu T, Baranchuk A. Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings. World J Cardiol 2022; 14:483-495. [PMID: 36187429 PMCID: PMC9523270 DOI: 10.4330/wjc.v14.i9.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis.
AIM To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE).
METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com).
RESULTS A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis.
CONCLUSION Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus
| | | | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China
| | - Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
| | - Jesús Álvarez-García
- Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Gabi Miana
- Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin, Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada
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Dorfman AL, Geva T, Samyn MM, Greil G, Krishnamurthy R, Messroghli D, Festa P, Secinaro A, Soriano B, Taylor A, Taylor MD, Botnar RM, Lai WW. SCMR expert consensus statement for cardiovascular magnetic resonance of acquired and non-structural pediatric heart disease. J Cardiovasc Magn Reson 2022; 24:44. [PMID: 35864534 PMCID: PMC9302232 DOI: 10.1186/s12968-022-00873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is widely used for diagnostic imaging in the pediatric population. In addition to structural congenital heart disease (CHD), for which published guidelines are available, CMR is also performed for non-structural pediatric heart disease, for which guidelines are not available. This article provides guidelines for the performance and reporting of CMR in the pediatric population for non-structural ("non-congenital") heart disease, including cardiomyopathies, myocarditis, Kawasaki disease and systemic vasculitides, cardiac tumors, pericardial disease, pulmonary hypertension, heart transplant, and aortopathies. Given important differences in disease pathophysiology and clinical manifestations as well as unique technical challenges related to body size, heart rate, and sedation needs, these guidelines focus on optimization of the CMR examination in infants and children compared to adults. Disease states are discussed, including the goals of CMR examination, disease-specific protocols, and limitations and pitfalls, as well as newer techniques that remain under development.
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Affiliation(s)
- Adam L. Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan C.S. Mott Children’s Hospital, 1540 E. Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Margaret M. Samyn
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin/Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226 USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235 USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr. E4A, Columbus, OH 43205 USA
| | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-University Medicine Berlin, Berlin, Germany
| | - Pierluigi Festa
- Department of Cardiology, Fondazione Toscana G. Monasterio, Massa, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Brian Soriano
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Andrew Taylor
- Department of Cardiovascular Imaging, Great Ormond Street Hospital for Sick Children, University College London, London, UK
| | - Michael D. Taylor
- Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children’s Hospital, 3333 Burnet Ave #2129, Cincinnati, OH 45229 USA
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Wyman W. Lai
- CHOC Children’s, 1201 W. La Veta Avenue, Orange, CA 92868 USA
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Souza-Neto FV, Islas F, Jiménez-González S, Luaces M, Ramchandani B, Romero-Miranda A, Delgado-Valero B, Roldan-Molina E, Saiz-Pardo M, Cerón-Nieto MÁ, Ortega-Medina L, Martínez-Martínez E, Cachofeiro V. Mitochondrial Oxidative Stress Promotes Cardiac Remodeling in Myocardial Infarction through the Activation of Endoplasmic Reticulum Stress. Antioxidants (Basel) 2022; 11:antiox11071232. [PMID: 35883722 PMCID: PMC9311874 DOI: 10.3390/antiox11071232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
We have evaluated cardiac function and fibrosis in infarcted male Wistar rats treated with MitoQ (50 mg/kg/day) or vehicle for 4 weeks. A cohort of patients admitted with a first episode of acute MI were also analyzed with cardiac magnetic resonance and T1 mapping during admission and at a 12-month follow-up. Infarcted animals presented cardiac hypertrophy and a reduction in the left ventricular ejection fraction (LVEF) and E- and A-waves (E/A) ratio when compared to controls. Myocardial infarction (MI) rats also showed cardiac fibrosis and endoplasmic reticulum (ER) stress activation. Binding immunoglobulin protein (BiP) levels, a marker of ER stress, were correlated with collagen I levels. MitoQ reduced oxidative stress and prevented all these changes without affecting the infarct size. The LVEF and E/A ratio in patients with MI were 57.6 ± 7.9% and 0.96 ± 0.34, respectively. No major changes in cardiac function, extracellular volume fraction (ECV), or LV mass were observed at follow-up. Interestingly, the myeloperoxidase (MPO) levels were associated with the ECV in basal conditions. BiP staining and collagen content were also higher in cardiac samples from autopsies of patients who had suffered an MI than in those who had died from other causes. These results show the interactions between mitochondrial oxidative stress and ER stress, which can result in the development of diffuse fibrosis in the context of MI.
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Affiliation(s)
- Francisco V. Souza-Neto
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Fabian Islas
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (F.I.); (M.L.)
| | - Sara Jiménez-González
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - María Luaces
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (F.I.); (M.L.)
| | - Bunty Ramchandani
- Servicio de Cirugía Cardiaca Infantil, Hospital La Paz, 28046 Madrid, Spain;
| | - Ana Romero-Miranda
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Beatriz Delgado-Valero
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Elena Roldan-Molina
- Biobanco del Hospital Clínico San Carlos, Instituto de Investigación de Salud del Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.R.-M.); (L.O.-M.)
| | - Melchor Saiz-Pardo
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Mª Ángeles Cerón-Nieto
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
| | - Luis Ortega-Medina
- Biobanco del Hospital Clínico San Carlos, Instituto de Investigación de Salud del Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.R.-M.); (L.O.-M.)
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ernesto Martínez-Martínez
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28222 Majadahonda, Spain
- Correspondence: (E.M.-M.); (V.C.); Tel.: +34-91-3941483 (E.M.-M.); +34-91-3941489 (V.C.)
| | - Victoria Cachofeiro
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28222 Majadahonda, Spain
- Correspondence: (E.M.-M.); (V.C.); Tel.: +34-91-3941483 (E.M.-M.); +34-91-3941489 (V.C.)
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Importance of Newer Cardiac Magnetic Resonance-Based Risk Markers for Sudden Death Prevention in Hypertrophic Cardiomyopathy:An International Multicenter Study. Heart Rhythm 2021; 19:782-789. [PMID: 34933112 DOI: 10.1016/j.hrthm.2021.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The sudden death (SD) risk stratification algorithm in hypertrophic cardiomyopathy (HCM) has evolved, underscored recently by novel cardiac magnetic resonance (CMR)-based risk markers: LV apical aneurysm, extensive late gadolinium enhancement and end-stage with systolic dysfunction, incorporated into 2020 AHA/ACC HCM Guidelines. OBJECTIVE Assess the specific impact of newer predominantly CMR-based risk markers in a large multicenter HCM population that underwent primary prevention ICD implants METHODS: Longitudinal study of 1149 consecutive HCM patients from 6 North American and European HCM centers prospectively judged to be at high SD risk based on ≥ 1 AHA/ACC individual risk markers and prophylactically implanted with ICDs. ESC risk score was retrospectively analyzed with respect to the known clinical outcome. RESULTS Of 1149 patients with ICDs, 162 (14%) experienced device therapy terminating VT/VF 4.6 ± 4.2 years after implant. CMR-based markers solely or in combination led to ICD implantation in 49 of the 162 patients (30%) experiencing device-therapy. Particularly low ESC scores (<4%/5-years) would have excluded an ESC-ICD recommendation for 67 patients who nevertheless experienced appropriate ICD therapy included 26 with the CMR-based risk markers not part of the ESC formula. CONCLUSION The identification and incorporation of novel guideline-supported CMR-based risk markers enhances selection of HCM patients for SD prevention with ICDs. Absence of CMR-based markers from the ESC risk score in part accounts for it not identifying many HCM patients with SD events. These data support inclusion of CMR as a routine part of HCM patient evaluation and risk stratification.
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Thompson EW, Kamesh Iyer S, Solomon MP, Li Z, Zhang Q, Piechnik S, Werys K, Swago S, Moon BF, Rodgers ZB, Hall A, Kumar R, Reza N, Kim J, Jamil A, Desjardins B, Litt H, Owens A, Witschey WRT, Han Y. Endogenous T1ρ cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2021; 23:120. [PMID: 34689798 PMCID: PMC8543937 DOI: 10.1186/s12968-021-00813-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular wall thickness, cardiomyocyte hypertrophy, and fibrosis. Adverse cardiac risk characterization has been performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV). Relaxation time constants are affected by background field inhomogeneity. T1ρ utilizes a spin-lock pulse to decrease the effect of unwanted relaxation. The objective of this study was to study T1ρ as compared to T1, ECV, and LGE in HCM patients. METHODS HCM patients were recruited as part of the Novel Markers of Prognosis in Hypertrophic Cardiomyopathy study, and healthy controls were matched for comparison. In addition to cardiac functional imaging, subjects underwent T1 and T1ρ cardiovascular magnetic resonance imaging at short-axis positions at 1.5T. Subjects received gadolinium and underwent LGE imaging 15-20 min after injection covering the entire heart. Corresponding basal and mid short axis LGE slices were selected for comparison with T1 and T1ρ. Full-width half-maximum thresholding was used to determine the percent enhancement area in each LGE-positive slice by LGE, T1, and T1ρ. Two clinicians independently reviewed LGE images for presence or absence of enhancement. If in agreement, the image was labeled positive (LGE + +) or negative (LGE --); otherwise, the image was labeled equivocal (LGE + -). RESULTS In 40 HCM patients and 10 controls, T1 percent enhancement area (Spearman's rho = 0.61, p < 1e-5) and T1ρ percent enhancement area (Spearman's rho = 0.48, p < 0.001e-3) correlated with LGE percent enhancement area. T1 and T1ρ percent enhancement areas were also correlated (Spearman's rho = 0.28, p = 0.047). For both T1 and T1ρ, HCM patients demonstrated significantly longer relaxation times compared to controls in each LGE category (p < 0.001 for all). HCM patients also showed significantly higher ECV compared to controls in each LGE category (p < 0.01 for all), and LGE -- slices had lower ECV than LGE + + (p = 0.01). CONCLUSIONS Hyperenhancement areas as measured by T1ρ and LGE are moderately correlated. T1, T1ρ, and ECV were elevated in HCM patients compared to controls, irrespective of the presence of LGE. These findings warrant additional studies to investigate the prognostic utility of T1ρ imaging in the evaluation of HCM patients.
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Affiliation(s)
- Elizabeth W Thompson
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Michael P Solomon
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhaohuan Li
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Affiliated Hospital of University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Qiang Zhang
- Oxford Center for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stefan Piechnik
- Oxford Center for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Konrad Werys
- Circle Cardiovascular Imaging Inc., Calgary, AB, Canada
| | - Sophia Swago
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Brianna F Moon
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary B Rodgers
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anya Hall
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Rishabh Kumar
- Department of Biophysics, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Kim
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alisha Jamil
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benoit Desjardins
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anjali Owens
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Yuchi Han
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, 11-135, South Pavilion, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Abstract
This review describes the current role and potential future applications of cardiac magnetic resonance (CMR) for the management of heart failure (HF). CMR allows noninvasive morphologic and functional assessment, tissue characterization, blood flow, and perfusion evaluation. CMR overcomes echocardiography limitations (geometric assumptions, interobserver variability and poor acoustic window) and provides incremental information in relation to cause, prognosis, and treatment monitoring of patients with HF.
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