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Temur HO, Alkan A, Yozgat CY, Cakir E, Yazan H, Yabul FC, Cesme DH, Yozgat Y. MRI evaluation of right heart functions in children with mild cystic fibrosis. Cardiol Young 2023; 33:1828-1833. [PMID: 36226672 DOI: 10.1017/s1047951122003249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to assess the ventricular anatomy, function of the right ventricle, and the haemodynamic findings of pulmonary artery in children with cystic fibrosis using cardiac MRI. PATIENTS This prospective study consisted of 32 children with mild cystic fibrosis and 30 age-matched healthy control participants. METHODS Cardiac MRI was used to assess right ventricular volumes, anatomy, and function and to assessment of haemodynamic findings of pulmonary artery in the control and study groups. Haemodynamic findings of pulmonary arteries were determined using pulmonary arteries peak velocity (cm/s), and pulmonary arteries time-to-peak velocity (ms) and pulmonary artery systolic pressure. All data of children with mild cystic fibrosis were compared with those of 30 age-matched healthy control group participants. RESULTS Our patients and their age-matched controls were aged from 6 to 17 years and from 7 to 15 years, respectively. We found that ejection fraction (%), cardiac output (L/ml), cardiac output (L/ml/m2), and systolic volume (ml/m2) were significantly lower in children with cystic fibrosis (p < 0.01). Right ventricular anterior wall thickness (mm) was significantly higher in children with cystic fibrosis (p = 0.01). No significant difference was observed between the haemodynamic parameters of pulmonary artery in the patient group. CONCLUSION In our study, cardiac MRI was used to investigate whether the right ventricle was affected functionally and anatomically in children with mild cystic fibrosis. We detected a significant decrease in right ventricular systolic functions and notable alterations in the right ventricular geometry of children with mild cystic fibrosis. These alterations usually manifest themselves as hypertrophy of the right ventricle. Our study's results demonstrate no relationship between the development of pulmonary hypertension in mild cystic fibrosis children.
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Affiliation(s)
- Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Celik Yabul
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Dilek Hacer Cesme
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
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Lagan J, Naish JH, Fortune C, Campbell C, Chow S, Pillai M, Bradley J, Francis L, Clark D, Macnab A, Nucifora G, Dobson R, Schelbert EB, Schmitt M, Hawkins R, Miller CA. Acute and Chronic Cardiopulmonary Effects of High Dose Interleukin-2 Therapy: An Observational Magnetic Resonance Imaging Study. Diagnostics (Basel) 2022; 12:diagnostics12061352. [PMID: 35741162 PMCID: PMC9221588 DOI: 10.3390/diagnostics12061352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022] Open
Abstract
High dose interleukin-2 (IL-2) is known to be associated with cardiopulmonary toxicity. The goal of this study was to evaluate the effects of high dose IL-2 therapy on cardiopulmonary structure and function. Combined cardiopulmonary magnetic resonance imaging (MRI) was performed in 7 patients in the acute period following IL-2 therapy and repeated in 4 patients in the chronic period. Comparison was made to 10 healthy volunteers. IL-2 therapy was associated with myocardial and pulmonary capillary leak, tissue oedema and cardiomyocyte injury, which resulted in acute significant left ventricular (LV) dilatation, a reduction in LV ejection fraction (EF), an increase in LV mass and a prolongation of QT interval. The acute effects occurred irrespective of symptoms. In the chronic period many of the effects resolved, but LV hypertrophy ensued, driven by focal replacement and diffuse interstitial myocardial fibrosis and increased cardiomyocyte mass. In conclusion, IL-2 therapy is ubiquitously associated with acute cardiopulmonary inflammation, irrespective of symptoms, which leads to acute LV dilatation and dysfunction, increased LV mass and QT interval prolongation. Most of these effects are reversible but IL-2 therapy is associated with chronic LV hypertrophy, driven by interstitial myocardial fibrosis and increased cardiomyocyte mass. The findings have important implications for the monitoring and long term impact of newer immunotherapies. Future studies are needed to improve risk stratification and develop cardiopulmonary-protective strategies.
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Affiliation(s)
- Jakub Lagan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Josephine H. Naish
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Christien Fortune
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Christopher Campbell
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (C.C.); (S.C.); (M.P.); (R.H.)
| | - Shien Chow
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (C.C.); (S.C.); (M.P.); (R.H.)
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, Bebingtonm CH63 4JY, UK
| | - Manon Pillai
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (C.C.); (S.C.); (M.P.); (R.H.)
| | - Joshua Bradley
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Lenin Francis
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
| | - David Clark
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
| | - Anita Macnab
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
| | - Gaetano Nucifora
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
| | - Rebecca Dobson
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK;
| | - Erik B. Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA 15213, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Matthias Schmitt
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Robert Hawkins
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK; (C.C.); (S.C.); (M.P.); (R.H.)
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Christopher A. Miller
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK; (J.L.); (C.F.); (J.B.); (L.F.); (D.C.); (A.M.); (G.N.); (M.S.)
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK;
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PT, UK
- Correspondence: ; Tel.: +44-161-291-2034; Fax: +44-161-291-2389
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